Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts

Deportations of illegal immigrants in 2012 reach new US record

The United States deported more than 400,000 illegal immigrants in 2012, the most of any year in the nation’s history, US Immigration and Customs Enforcement (ICE) reports.
The record number, released Friday, is also important for another reason: It is a stinging reminder to Latinos that President Obama failed during his first term to pursue the comprehensive immigration reform that they seek.
The Obama administration framed its 2012 work in immigration enforcement as focused mainly on criminals – 55 percent of deportations came from convicted criminals, a record high – rather than on indiscriminately rounding up illegal immigrants and sending them home. ICE on Friday also issued new detention guidelines intended to emphasize legal action against those who have committed crimes above and beyond immigration violations.
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“While the [fiscal year] 2012 removals indicate that we continue to make progress in focusing resources on criminal and priority aliens, we are constantly looking for ways to ensure that we are doing everything we can to utilize our resources in a way that maximizes public safety,” ICE Director John Morton said in a statement.
In four years, the Obama administration has deported three-quarters of the number of people that President George W. Bush’s administration did in eight. And unlike Mr. Bush, Obama made no concerted effort to reform the US immigration system – a history that’s not lost on the president’s Latino supporters.
"This is nothing to be proud of,” said Rep. Luis Gutierrez (D) of Illinois, a leading lawmaker on immigration reform for a decade, in a statement on the deportation statistics.
While Representative Gutierrez lauded the crackdown on criminals as necessary, he said some 90,000 undocumented parents of American-born children continue to be deported each year.
“We must also realize that among these hundreds of thousands of deportations are parents and breadwinners and heads of American families that are assets to American communities and have committed no crimes,” the Gutierrez statement said. "Solving this problem in a humane and sensible way requires Congress to act on immigration reform and do what we have been unable to do for 25 or 30 years.”
The closest the Obama administration came to reshaping immigration policy was the summer 2012 implementation of the Deferred Action for Childhood Arrivals (DACA) program, whereby some young unauthorized immigrants could gain a two-year deferral of deportation and access to work permits and driver's licenses.
Some 355,000 people have applied under the program, and just over 100,000 have been approved through mid-December, according to the latest data from US Citizenship and Immigration Services. As many as 1.7 million undocumented immigrants could be eligible for the program over time, experts say.
While immigration advocates cheered the president's DACA order, they also remember his unfulfilled promise at the start of his term in 2009 to take on immigration reform, as well as the record number of deportations under his watch.
“The credibility of the president is on the line,” says Ali Noorani, executive director of the National Immigration Forum. “The president has to lead. The president has to show Republicans and Democrats that he’s serious about this and that he’s not just going to use it as a political lightning rod.”
Obama has promised to tackle immigration reform early in 2013, and congressional discussions about potential legislation are under way between lawmakers from both parties in the House and Senate.
If Obama doesn’t, Republicans will be eager to point out that Democrats once again broke their promises to some of the left’s key voting blocs.
“I just want to remind all of you, though, that the Democrats had two years to do something about immigration reform,” said Rep. Raul Labrador (R) of Idaho after a vote on a GOP-led bill that would have[would have? didnt that pass?] killed the diversity visa lottery in favor of more visas for highly educated immigrants in the STEM (science, technology, engineering and math) fields.
“They had a White House. They had the House. They had the Senate. And they did nothing about immigration reform,” he said.
And that could make Latino and Asian voters, who sided overwhelmingly with Democrats in the 2012 election, susceptible to Republican overtures in the future.
“Everybody talks about the incredible turnout of the new American vote in 2012, but Latinos, Asians, and other voters are not die-hard Democrats,” Mr. Noorani says. “There’s a lot of space there for Republicans to step into.”
Until Obama and reform-minded members of Congress make good on their vows that 2013 will yield a comprehensive fix to America’s immigration system, however, Latino, Asian, and other pro-immigration forces will continue to feel uneasy about the high level of deportations under a Democratic president.
“We are the one country,” Gutierrez told the Monitor in a prior interview, “that orphans children who have parents.
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Republicans Turn to An Unlikely Name for Inspiration: George W. Bush

As Republicans reassess their future in the presidential wilderness, seeking a message and messenger to resonate with a new generation of voters, one unlikely name has popped up as a role model: former President George W. Bush.
Prominent Republicans eager to rebuild the party in the wake of the 2012 election are pointing to Bush’s successful campaigns for Hispanic votes, his efforts to pass immigration reform, and his mantra of “compassionate conservatism.” Bush won 35 percent of the Hispanic vote in 2000 and at least 40 percent in 2004, a high-water mark for a Republican presidential candidate.
In contrast, Romney received only 27 percent of the Latino vote, after taking a hard-line approach to illegal immigration during the Republican presidential primaries, touting “self-deportation” for undocumented workers. In exit polls, a majority of voters said that Romney was out of touch with the American people and that his policies would favor the rich. While Romney beat Obama on questions of leadership, values, and vision, the president trounced him by 63 points when voters were asked which candidate “cares about people like me.”
These signs of wear and tear to the Republican brand are prompting some of Bush’s critics to acknowledge his political foresight and ability to connect with a diverse swath of Americans, although the economic crash and unpopular wars on his watch make it unlikely he will ever be held up as a great president.
“I think I owe an apology to George W. Bush,” wrote Jonah Goldberg, editor-at-large of the conservative National Review Online, after the election. “I still don't like compassionate conservatism or its conception of the role of government. But given the election results, I have to acknowledge that Bush was more prescient than I appreciated at the time.”
The ebb in Bush-bashing could help pave the way for a 2016 presidential bid by his brother, former Gov. Jeb Bush of Florida, another proponent of immigration reform with proven appeal in the Hispanic community. “The Bush family knows how to expand the party and how to win,” said GOP consultant Mark McKinnon, a former George W. Bush political aide, when asked about a possible Jeb Bush campaign. Voter wariness toward a third Bush administration could ease if the former president and his father, who served one term, are remembered less for their failures and more for their advocacy of “compassionate conservatism” and “a kinder, gentler nation.”
“I think all that certainly helps if Jeb decides to do so something down the road, though I think he will eventually be judged on his own,” said Al Cardenas, chairman of the American Conservative Union, who led the Florida Republican Party when Bush was governor.
President Bush’s press secretary, Ari Fleischer, was tapped last week by the Republican National Committee to serve on a five-member committee examining what went wrong in the 2012 election. Two days earlier, a survey released by Resurgent Republic and the Hispanic Leadership Network found that a majority of Hispanic voters in Colorado, Florida, Nevada, and New Mexico  don’t think the GOP “respects” their values and concerns.
“One of the party’s biggest challenges going forward is the perception that Republicans don’t care about people, about minorities, about gays, about poor people,” Fleischer said. “President Bush regularly made a push to send welcoming messages, and one of the lessons of 2012 is that we have to demonstrate that we are an inclusive party.”
President Bush’s success with minority voters stemmed in large part from his two campaigns for governor in Texas. He liked to say, “Family values don’t stop at the Rio Grande.” Unlike Romney, who invested little in Spanish-language advertising until the final two months of his campaign, Bush began reaching out to Hispanics early; he outspent his Democratic opponents in Spanish media in both the 2000 and 2004 campaigns.
“I remember people grumbling about making calls in December 2003, but we kept pushing,” said Jennifer Korn, who led Bush’s Hispanic outreach in his 2004 campaign. The president’s upbeat Spanish-language ads depicted Latino families getting ahead in school and at work. “I’m with Bush because he understands my family,” was the theme of one spot.
Korn, who now serves as executive director of the Hispanic Leadership Network, said Republicans are constantly asking her how the party can win a bigger share of the Latino vote.
“I tell them we already did it,” she said. “President Obama just took Bush’s plan and updated it.”
Republicans are also looking at the groundwork that Bush laid on immigration reform. He has kept a low profile since leaving office, but he waded into the debate in a speech in Dallas last month. The legislation he backed in his second term would have increased border security, created a guest-worker program, and allowed illegal immigrants to earn citizenship after paying penalties and back taxes.
“America can be a lawful society and a welcoming society at the same time,” Bush said in Dallas. “As our nation debates the proper course of action related to immigration I hope we do so with a benevolent spirit and keep in mind the contributions of immigrants.”
Bush is even a presence in the current high-stakes budget negotiations between Capitol Hill and the White House. Although the tax cuts enacted by the Bush administration for the wealthiest Americans have been a major sticking point, the tax policy it put in place for the vast majority of households has bipartisan support.
“When you consider that the Obama administration is talking about not whether to extend the Bush tax cuts but how much of them to extend, you see that Bush is still setting the agenda,” said Republican consultant Alex Castellanos, who worked on Bush’s 2004 campaign.
While a possible presidential bid by Jeb Bush heightens the impact of his brother’s evolving legacy, it’s not unusual for a president’s image to change after leaving office. (Look at former President Clinton, who enjoyed positive ratings during most of his presidency, infuriated Obama supporters during Hillary Rodham Clinton’s presidential campaign in 2008, and emerged after the election as a better Democratic spokesman than Obama.)  Gallup pegged Bush’s presidential approval at 25 percent at the end of his second term, the lowest ranking since Richard Nixon. But after President Obama spearheaded unpopular spending packages and health care reforms, Bush’s popularity began to tick up.
A Bloomberg News survey in late September showed Bush’s favorability at 46 percent, 3 points higher than Romney’s rating. Still, with a majority of voters viewing the former president unfavorably, Romney rarely, if ever, mentioned his name during the campaign. Asked to address the differences between him and the former president in one of the debates, Romney said, “I’m going to get us to a balanced budget. President Bush didn’t.” Obama seized on the comparison, taking the unusual tack of praising the Republican successor he had vilified in his first campaign to portray Romney as an extremist.
“George Bush didn’t propose turning Medicare into a voucher,” Obama said. “George Bush embraced comprehensive immigration reform. He didn’t call for self-deportation. George Bush never suggested that we eliminate funding for Planned Parenthood.”
Democrats and moderate Republicans found themselves cheering for Bush, if only for a moment. A majority of voters said that Bush is more to blame for the current economic problems than Obama, according to exit polling. If Bush wasn’t the bigger scapegoat, Obama may not have won a second term.
Veterans of Bush’s campaigns and administrations say that while learning from his mistakes, Republicans should also take note of the political risks he took by proposing reforms to immigration and education laws and boosting funding for community health centers and AIDS outreach in Africa.
“One of the issues we ran into in the 2012 campaign is that there weren’t a lot of differences between Mitt Romney and Republican orthodoxy,” said Terry Nelson, Bush’s political director in the 2004 campaign. “I think that’s something Republican candidates in the future have to consider.  The public respects it when you can show you can stand up to your party on certain issues. Bush did that.
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The Tea Party's War on Itself Now Includes a Literal Armed Rebellion

It's been more than a month since the 2012 election was decided, but the postmortems continue, particularly for the Tea Party, which continues to have its relevance questioned after a tumultuous year. Both The Washington Post and The New York Times published Christmas Day stories about competing factions within the movement — gun-toting infights and all — and how they will fight to control its mission looking forward to 2014.
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The Post story in particular underscores how deep and bitter the division can run, even among the most devoted activists. In the middle of this year's election season, former House majority leader Dick Armey found himself at odds with fellow executives at FreedomWorks, the libertarian-leaning group they helped build and run together. Armey was the chairman, while author and activist Matt Kibbe is the president.
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For years, the two men had created an effective partnership. But on September 10, according to the Post, Armey showed up at the FreedomWorks offices with his wife, and aide, and a unidentified man wearing a gun on his hip. The armed man escorted Kibbe and his top deputy out of the building, while Armey began suspending other staffers.
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However, two weeks later, it was Armey who found himself forced out. A member of the board of director threw his support behind Kibbe, pledging $8 million in new donations to FreedomWorks, which expanded into a super-PAC this election cycle, if Armey resigned and the suspended workers returned to their jobs. That's a lot more money than what Politico originally reported as a spat over a book deal.
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In addition to just being plain scary — the incident happened just two weeks after a man had been shot trying to break into the Family Research Council, another conservative lobbying group — the tale of Armey and the gun-wielding suspensions also raises questions about just who is really running the Tea Party movement. FreedomWorks has long portrayed itself as a grassroots organization, yet the donation shows how it's really become a handful of wealthy individuals who are calling the shots for these groups. The man behind the pledge, Illinois millionaire Richard Stephenson, gave more than $12 million to FreedomWorks donations before this election cycle, funneling the money through two dummy corporations set up just one day apart in Tennessee.
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The Times story, meanwhile, examines how much of the Tea Party's efforts are being redirected from major nationwide issues like taxes and Obamacare, to smaller pet causes on the state or local level. Some are pushing states to nullify health care law, while others are pursuing voter fraud cases. Meanwhile, others are focusing on individual races, which can make the Tea Party a greater election headache for moderate Republicans than Democratic opponents.
The strength of the Tea Party has always worked better when directed at smaller campaigns than through national causes. And those smaller campaign are often the pet causes of the millionaires who fund their activities. Stephenson founded Cancer Treatment Centers of America, a for-profit health care company. (Kibbe and Stephenson became close after Kibbe was treated at his centers.) One of biggest issues for FreedomWorks has been the repeal of Obamacare. That's not happening any time soon, but Stephenson, FreedomWorks, and the other Tea Party activists aren't giving up; they're just trying a different path.
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Why the Election Polls Missed the Mark

In the days following an election in which his organization's polls proved to be inaccurate, Gallup Editor in Chief Frank Newport published a blog post warning of "a collective mess."
The results of the election--President Obama's 4-point victory--was not the only indication that Gallup's polls were biased in favor of Republican Mitt Romney. Websites that average and aggregate polls showed, on balance, that Obama was in a stronger position than Gallup's polls did, which allowed some observers to paint the longtime pollster as an outlier, both before and after the votes were tallied.
Newport, in his blog post three days after the election, saw these aggregators as a threat--not only to the Gallup Organization but to the entire for-profit (and nonprofit) public-opinion industry. "It's not easy nor cheap to conduct traditional random sample polls," Newport wrote. "It's much easier, cheaper, and mostly less risky to focus on aggregating and analyzing others' polls. Organizations that traditionally go to the expense and effort to conduct individual polls could, in theory, decide to put their efforts into aggregation and statistical analyses of other people's polls in the next election cycle and cut out their own polling. If many organizations make this seemingly rational decision, we could quickly be in a situation in which there are fewer and fewer polls left to aggregate and put into statistical models."
Newport's hypothetical--that because aggregators that averaged polls or used polls to model the election results more accurately predicted the results than his traditional, phone polling--sounds a little paranoid on its face. But it underscores the effects that increasing costs and decreasing budgets are having on media organizations that cover politics and typically pay for this kind of survey work.
It also reopens a long-standing debate over poll aggregation. Some pollsters and media organizations think the practice of averaging polls that survey different universes or are conducted using different methodologies is bunk. They warn that considering cheaper, less rigorous polling on the same plane as live-caller polls that randomly contact landline and cell-phone respondents allows the averages to be improperly influenced by less accurate surveys. And, ultimately, while the poll averages and poll-based forecasts accurately picked the winner, they underestimated the margin of Obama's victory by a significant magnitude.
But others, including the poll aggregators themselves, maintain that averaging polls, or using poll results as part of a predictive model, produces a more accurate forecast than considering any one individual poll. Before an election, it's difficult to predict which polls will be more accurate and which polls will miss the mark. Averaging results together also provides important context to media and consumers of political information when every new poll is released, proponents argue.
Ultimately, this is a debate that also goes beyond the statistical questions about averaging polls. It touches on the nature of horse-race journalism and the way in which we cover campaigns.
The First Number Crunchers
Real Clear Politics began the practice of averaging polls before the 2002 midterm elections. RCP was joined by Pollster.com--which is now part of The Huffington Post--four years later. "Pollster started in 2006, and we were really building on what Real Clear Politics did," founding Coeditor Mark Blumenthal said. The statistician Nate Silver began a similar practice in 2008, and his site, FiveThirtyEight, was acquired by The New York Times shortly thereafter. More recently, the left-leaning website Talking Points Memo started its PollTracker website before the 2012 election.
Each of these organizations differ in their approaches. Real Clear Politics does a more straightforward averaging of the most recent polls. TPM's PollTracker is an aggregation involving regression analysis that uses the most recent polls to project a trajectory for the race. FiveThirtyEight and HuffPost Pollster use polls, adjusting them for house effects--the degree to which a survey house's polls lean consistently in one direction or another. FiveThirtyEight also uses non-survey data to project the election results.
All four of these outlets underestimated Obama's margin of victory. Both Real Clear Politics and PollTracker had Obama ahead by only 0.7 percentage points in their final measurements. HuffPost Pollster had Obama leading by 1.5 points, while FiveThirtyEight was closest, showing Obama 2.5 points ahead of Romney in the last estimate. The aggregators that came closest to Obama's overall winning margin were the ones that attempted to account for pollsters' house effects.
"The polls, on balance, understated President Obama's support," said John McIntryre, cofounder of Real Clear Politics. "Our product is only as good as the quality and the quantity of the polls that we use."
These sorts of house effects were why HuffPost Pollster moved to a model that attempted to control for them, but their average still underestimated Obama's margin of victory by a sizable magnitude. "One of the main reasons why we moved to using a more complex model that controlled for house effects was precisely to prevent that phenomenon from happening," Blumenthal said. "Our goal is to minimize that to next to zero."
Pros and Cons
John Sides, a political-science professor at George Washington University and the coauthor of the blog The Monkey Cage, is one of the more prominent proponents of using polling averages--and a critic of press coverage that doesn't. "You're better off looking at averages, because any individual poll may be different from the truth because of sampling error and any idiosyncratic decisions that pollsters make," he said.
Sides believes that news coverage of campaigns tends to overemphasize some polls at the expense of others. In some cases, a poll is considered newsier because it shows something different than the balance of other polling in the race. In other words, polls that are outliers are given more attention than polls that hew more closely to the average, and those outlier polls are more likely to be inaccurate, Sides argues.
"I'm not overly optimistic that the averages are going to become a more important factor in news coverage. I think there are still strong incentives to seek drama where you can find it. And that may mean chasing an outlier," Sides said. "I would like to think that it would start to creep in at the margins. So instead of saying, 'Some polls say ___,' it may say, 'A new poll showed ___, but other polls haven't showed that yet.' "
But, as this year's results show, the averages aren't perfect, and they all showed a closer race than the actual outcome. Comparing polls that accurately predicted the election--the final poll from the Pew Research Center, for example--to the poll averages at the time would have made those more accurate polls appear to be outliers.
Part of that problem, at least when it comes to the national presidential race, were the daily tracking polls from Gallup and automated pollster Rasmussen Reports. Both firms reported results that were biased in favor of Romney this cycle, but by publishing a new result every day, their polls could be overrepresented in the averages. "The one sort of Achilles' heel of the regression trend line that we've done classically on our charts, there are two pollsters that contribute most of the data points," said Pollster's Blumenthal. "Not only does that make the overall aggregate off, it can also create apparent turns in the trend line that are [because] we've had nothing but Gallup and Rasmussen polls for the last 10 days."
In addition to the ubiquitousness of surveys from some firms, poll aggregators also worry that partisans may try to game the system by releasing polls with greater frequency, or by skewing or fabricating results. A prominent Democratic strategist told National Journal last month that some outside groups conducted polls in presidential swing states and released them to the public as a means of countering polls from Rasmussen Reports that were less favorable to President Obama. Blumenthal told National Journal that his biggest fear was not the increase in partisan polls but the possibility that groups would release rigged or fabricated results, as outfits like Strategic Vision and Research 2000 apparently have over the past handful of years, to influence the averages. "My biggest concern over the last two or three years has been the potential for the repeat of something like that," Blumenthal said.
"Champagne" of Polls
The blog post written by Gallup's Newport after the election demonstrates another source of opposition to poll averages: the pollsters themselves. Pollsters all make choices about how best to sample the probable or likely electorate, and those choices vary. Additionally, more expensive live-caller polls compete in the averages with cheaper automated-phone and Internet polls that may not make the same efforts to obtain random samples of voters; merits aside, those live-caller pollsters surely want to protect their businesses from less expensive competitors. Moreover, news organizations that spend tens of thousands of dollars to conduct a poll are likely to report and trumpet their poll's results over other surveys.
"If you're merely an information aggregator, it's very hard for me to see how you're adding value to the proposition," Gary Langer, whose firm Langer Research Associates produces polls for ABC News, told National Journal in a phone interview last month. "Averaging polls is like averaging champagne, Coca-Cola, and turpentine," Langer added.
Overall, 2012 brought more attention than ever to poll aggregators, with their methods becoming more sophisticated. But where do they go from here?
"I don't think there are great advances in averaging or modeling horse-race polling data," Blumenthal said. "We are ultimately reliant on the quality of the data that's collected."
There is evidence that data are becoming less reliable, but supporters of using polling averages argue the underlying changes that are leading to more variable polls bolster their case for using averages instead of individual poll results. "It's a powerful piece of information, and it's a very good piece of information, and I think it's better than any one single poll in terms of using it as a data point to analyze a race," said RCP's McIntyre.
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How Dark Money Helped Democrats Hold a Key Senate Seat

In the waning days of Montana's hotly contested Senate race, a small outfit called Montana Hunters and Anglers, launched by liberal activists, tried something drastic.
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It didn't buy ads supporting the incumbent Democrat, Sen. Jon Tester. Instead, it put up radio and TV commercials that urged voters to choose the third-party candidate, libertarian Dan Cox, describing Cox as the "real conservative" or the "true conservative."
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Where did the group's money come from? Nobody knows.
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The pro-Cox ads were part of a national pattern in which groups that did not disclose their donors, including social welfare nonprofits and trade associations, played a larger role than ever before in trying to sway U.S. elections. Throughout the 2012 election, ProPublica has focused on the growing importance of this so-called dark money in national and local races.
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Such spending played a greater role in the Montana Senate race than almost any other. With control of the U.S. Senate potentially at stake, candidates, parties and independent groups spent more than $51 million on this contest, all to win over fewer than 500,000 voters. That's twice as much as was spent when Tester was elected in 2006.
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Almost one quarter of that was dark money, donated secretly to nonprofits.
"It just seems so out of place here," said Democrat Brian Schweitzer, the governor of Montana who leaves office at the end of this year. "About one hundred dollars spent for every person who cast a vote. Pretty spectacular, huh? And most of it, we don't have any idea where it came from. Day after the election, they closed up shop and disappeared into the dark."
Political insiders say the Montana Senate race provided a particularly telling glimpse at how campaigns are run in the no-holds-barred climate created by the Supreme Court's 2010 Citizens United decision, giving a real-world counterpoint to the court's assertion that voters could learn all they needed to know about campaign funding from disclosure.
In many ways, Montana was a microcosm of how outside spending worked nationally, but it also points to the future. Candidates will be forced to start raising money earlier to compete in an arms race with outside groups. Voters will be bombarded with TV ads, mailers and phone calls. And then on Election Day, they will be largely left in the dark, unable to determine who's behind which message.
All told, 64 outside groups poured $21 million into the Montana Senate election, almost as much as the candidates. Party committees spent another $8.9 million on the race.
The groups started spending money a year before either candidate put up a TV ad, defining the issues and marginalizing the role of political parties. In a state where ads were cheap, they took to the airwaves. More TV commercials ran in the Montana race between June and the election than in any other Senate contest nationwide.
The Montana Senate race also shows how liberal groups have learned to play the outside money game — despite griping by Democratic officials about the influence of such organizations.
Liberal outside groups spent $10.2 million on the race, almost as much as conservatives. Conservatives spent almost twice as much from anonymous donors, but the $4.2 million in dark money that liberal groups pumped into Montana significantly outstripped the left's spending in many other races nationwide.
As in other key states, conservative groups devoted the bulk of their money in Montana to TV and radio ads. But sometimes the ads came across as generic and missed their mark.
Liberal groups set up field offices, knocked on doors, featured "Montana" in their names or put horses in their TV ads. Many of them, including Montana Hunters and Anglers, were tied to a consultancy firm where a good friend of Jim Messina, President Barack Obama's campaign manager, is a partner.
The end result? Tester beat Republican Rep. Denny Rehberg by a narrow margin. And the libertarian Cox, who had so little money he didn't even have to report to federal election authorities, picked up more votes than any other libertarian on the Montana ballot.
Montana Republicans blamed Montana Hunters and Anglers, made up of a super PAC and a sister dark money nonprofit, for tipping the race. Even though super PACs have to report their donors, the Montana Hunters and Anglers super PAC functioned almost like a dark money group. Records show its major donors included an environmentalist group that didn't report its donors and two super PACs that in turn raised the bulk of their money from the environmentalist group, other dark money groups and unions.
"Part of what's frustrating to me is I look at Montana Hunters and Anglers and say, 'That is not fair,'" said Bowen Greenwood, executive director for the Montana Republican Party. "I am a hunter. I know plenty of hunters. And Montana hunters don't have their positions. It would be fairer if it was called Montana Environmental Activists. That would change the effect of their ads."
Cox and Tester deny the group's efforts swung the race. No one from Montana Hunters and Anglers returned calls for comment.
Tester, who's argued that all groups spending on elections should disclose their donors and also pushed against super PACs, said he wasn't familiar with any of the outside groups running ads. By law, candidates are not allowed to coordinate with outside spending groups, which are supposed to be independent.
Despite his ambivalence, he said he was glad the outside groups jumped in.
"If we wouldn't have had folks come in on our side, it would have been much tougher to keep a message out there," Tester said. "We had no control over what they were saying. But by the same token, I think probably in the end if you look at it, they were helpful."
* * *
Montana has long prided itself on a refusal to be pigeonholed. It's the kind of place that votes Republican for president but elects Democrats to state office. Politicians wear bolo ties, tout their Montana credentials and use words like "hell" and "crap." People introduce themselves by saying what generation Montanan they are.
Consistently, the state fights against any mandate that smacks of Washington meddling, from the federal speed limit to the Citizens United ruling in early 2010, which opened the door to corporations and unions spending unlimited money on independent ads, echoing an earlier court ruling that equated money with free speech.
Before that, Montana had one of the country's toughest campaign finance laws, dating back 100 years, to the time of the copper kings. After one of those kings bribed state lawmakers to back him as senator, the state banned corporate political spending.
Even after Citizens United, the Montana Supreme Court insisted that Montana's legacy of corruption justified keeping the ban. In June, the U.S. Supreme Court squashed that move, saying the Citizens United decision applied to every state in the nation.
By then, dark money groups were already weighing in on Montana's Senate race.
The TV ads started in March 2011, the month after Rehberg announced. The Environmental Defense Action Fund attacked Rehberg for his stance on mercury emissions. The Electronic Payments Coalition praised Tester for his push to delay implementing new debit-card swipe fees.
"The thing that surprised me a little bit was how early they got involved," said David Parker, an associate professor of political science at Montana State University who tracked all 160 TV commercials as part of a book he is writing on the race. "And I think that was critical, because very early on, they were able to establish the contours of this race. The candidates were just busy putting their organizations together and raising money."
Most of the money spent in 2011 on TV ads came from groups that didn't have to report their donors. They also didn't have to report their ads to the Federal Election Commission, because they didn't specifically tell voters to vote for or against a candidate. Instead of saying "Vote for Rehberg," they said things like "Call Jon Tester. Tell him to stop supporting President Barack Obama." Ads like that only have to be reported to the FEC if they air during the two months before an election.
The only way to compile data on such ad spending is by visiting TV stations, which Parker did. ProPublica helped him collect information on the last round of ads.
Parker's data shows that several heavyweight conservative groups entered the fray in mid-2011 to try to cast Tester, whom they saw as vulnerable, as a big spender.
Crossroads GPS, the dark money group launched by GOP strategist Karl Rove, ran two ads in July 2011 similar to those attacking Democrats in other states for supporting excessive spending.
Also that month, a conservative group called Concerned Women for America Legislative Action Committee ran a sarcastic ad about a new miracle drug called "Spenditol," Washington's answer to America's problems. "Call Sen. Jon Tester," the ad said. "Tell him, stop spending it all." Similar ads ran against Democratic senators up for election in tight races in Florida, Nebraska and Ohio.
Several ads run by conservative groups backfired, messing up in ways that irked Montanans.
The National Republican Senatorial Committee — a party committee that reports its donors — ran an ad that appeared to show Tester with all five digits on his left hand. (Tester is well known for having lost three fingers in a childhood accident involving a meat grinder.) The U.S. Chamber of Commerce misspelled Tester's first name. A Montana cable operator yanked a Crossroads ad for claims the operator deemed false.
"The first one that burned me really bad was from the U.S. Chamber," said Verner Bertelsen, a former Republican state legislator and Montana secretary of state. "I thought — you buggers! We don't need you to come in here and tell us who to vote for."
Starting in July 2011, three new liberal dark money groups ran ads. Patriot Majority USA criticized Republicans for allegedly planning to cut Medicare and help to seniors. The Partnership to Protect Medicare praised Tester for opposing Medicare cuts.
And in October, weeks after forming, the dark money side of Montana Hunters and Anglers, Montana Hunters and Anglers Action!, launched its first TV ad, starring Land Tawney, the group's gap-toothed and camouflage-sporting president, who also served on the Sportsmen's Advisory Panel for Tester. At the time, the super PAC side of the group was basically dormant.
The new Hunters ad accused Rehberg of pushing a bill — House bill 1505 — that supposedly would give Washington politicians control of access to public lands in Montana. Rehberg, one of 60 cosponsors, argued the legislation was necessary to help the Department of Homeland Security protect the state from illegal immigrants, drug smugglers and terrorists.
"Nobody in Montana was talking about that bill," Greenwood said. "I've only heard it talked about in campaign ads. And it played a role throughout the election."
* * *
The gusher of outside money into Montana's Senate race was part of a larger pattern. Nationally, in addition to the $5.1 billion spent by candidates and parties, almost 700 outside spending groups dumped more than $1 billion into federal elections in the 2012 cycle, FEC filings show.
Of that, about $322 million was dark money, most of it from 153 social welfare nonprofits, groups that could spend money on politics as long as social welfare — not politics — was their primary purpose.
Relating those numbers to previous elections is a largely pointless exercise, akin to comparing statistics from baseball and lacrosse. The Citizens United ruling changed the game, opening the door to unlimited corporate donations to super PACs and to a new breed of more politically active nonprofits.
"Instead of being in a boxing match in a ring, you're in a dark alley being hit by four or five people, and you don't know who they are," said Michael Sargeant, the executive director of the Democratic Legislative Campaign Committee, which helps Democrats run for state offices.
Some of the players in the 2012 cycle were longtime activist organizations such as the liberal Sierra Club and the conservative National Right to Life Committee, with clear social welfare missions and only a limited amount of political spending. Other dark money groups were juggernauts like Crossroads GPS and Americans for Prosperity, founded years ago by conservative billionaire brothers Charles and David Koch, which crank up their fundraising during election years and devote more money to election ads than other nonprofits.
Finding out about some of the less prominent nonprofits was no easy feat. Many were formed out of post-office boxes or law firms. On their applications to the Internal Revenue Service, they minimized or even denied any political activity.
Documents for pop-up nonprofits like the conservative America Is Not Stupid and A Better America Now, both of which formed in 2011, led back to a Florida law firm that offered no explanations. The Citizens for Strength and Security Action Fund, a liberal pop-up group that spent millions on elections in 2010, closed down in 2011. In its place came a new group: the Citizens for Strength and Security Fund, which earlier this year bought almost $900,000 in ads attacking Rehberg and the Republican Senate candidate in New Mexico.
Groups picked names that seemed designed to confuse: Patriot Majority USA is liberal. Patriotic Veterans is conservative. Common Sense Issues backed conservatives. Common Sense Movement backed a Democrat.
As in the 2010 midterms, the dark money spent in 2012 had a partisan tilt. Conservative groups accounted for about 84 percent of the spending reported to the FEC — mainly through Crossroads GPS, Americans for Prosperity and the U.S. Chamber of Commerce. Liberal groups spent 12 percent of the dark money. Nonpartisan groups made up the rest.
Despite shelling out hundreds of millions of dollars, conservatives lost big. Only about 14 percent of conservative dark money went to support winners.
Still, campaign-finance reformers say it's a mistake to minimize the influence of this money.
"What these donors were buying was access and influence, not only to the candidates but to the party machine," said Paul S. Ryan, senior counsel for the Campaign Legal Center. "And they will get that access. On the Republican side, you have people lining up to kiss the ring of (billionaire donor) Sheldon Adelson. And on the Democratic side, you have even people critical of these groups meeting with the funders of these groups. This money is not going away."
Even though liberal groups spent far less than conservative ones, they had a higher success rate. About 70 percent backed winning candidates.
Some Democrats have shown distaste for the dark-money arts, pushing for more transparency. But liberal strategists are preparing to ramp up their efforts before the next election, unless the IRS, Congress or the courts change the rules.
"We probably have a lot less comfort with some of the existing rules that allow for the Koch brothers to write unlimited checks to these groups," said Navin Nayak, the senior vice president for campaigns at the League of Conservation Voters, a liberal social welfare nonprofit for more than 40 years. "But as long as these are the rules, we're certainly going do our best to make sure we're competitive and that our candidates have a shot at winning. We're certainly not going to cede the playing field to the Koch brothers."
* * *
By the time Tester and Rehberg started buying TV ads, outside groups had been defining the race for a year.
Rehberg, 57, a six-term congressman and rancher often pictured wearing a cowboy hat and a plaid shirt, was portrayed as voting five times to increase his pay and charging an SUV to taxpayers. Tester, 56, a farmer with a flat top, was dinged for voting with Obama 95 percent of the time.
Tester's campaign went up with ads in March, mainly to counter the outside messages.
"The original plans were going up 60 or 90 days later than that," Tester said. "But it was important...We had to remind people of who I am."
His early ads highlighted his Montana roots, depicting him riding a combine on his farm and packing up Montana beef to carry back to Washington.
Rehberg had less money, so his earliest TV ads, which mainly attacked Tester, went up in May.
Neither Rehberg nor anyone from his media staff responded to requests for an interview on his views on campaign finance. In the past, he has said he supports the Citizens United ruling.
Meanwhile, conservative groups bought TV ads that hit at Tester but stopped just short of telling people how to vote. For instance, the conservative 60 Plus Association spent almost $500,000 buying TV ads featuring crooner Pat Boone criticizing Tester over the health care law. None of that was reported to the FEC.
Over the summer, the Concerned Women for America's legislative committee, Crossroads GPS and the U.S. Chamber of Commerce all weighed in. The TV spots were overwhelmingly negative, and many of them were cookie-cutter ads, similar to those that ran in other states against Democrats.
Liberal groups bought TV ads, too, but that was only part of their game plan. They spent their dark money on retail politics, hitting the streets and knocking on doors.
In January, the League of Conservation Voters set up two offices in Montana — one in Missoula and one in Billings. It canvassed voters and hired a full-time organizer, reaching out to 28,000 sporadic voters to urge them to vote early by mail.
Lindsay Love, the spokeswoman at Planned Parenthood Advocates of Montana, another nonprofit that doesn't report its donors for election spending, said the group targeted 41,000 female voters. More than 1,500 people ended up knocking on 28,500 doors and making 162,000 phone calls, she said. The group sent out about 470,000 pieces of mail.
"It's hard to unpack this," Parker said. "But it's fascinating to look at groups like the League, unions and Planned Parenthood. By and large, they did phones, canvassing, mail, very little TV. One of the best ways to get out the vote is personalized contact."
Many liberal groups active in Montana, including Montana Hunters and Anglers, were connected through Hilltop Public Solutions, a Beltway consulting firm.
Barrett Kaiser, a former aide to Montana's other Democratic senator, Max Baucus, is a partner at Hilltop and runs its office in Billings. The Hilltop website notes that Kaiser helped with Tester's upset Senate win in 2006. Kaiser is also a good friend of Messina, the manager of Obama's 2012 campaign, who also once worked for Baucus.
Kaiser was on the board of the Montana Hunters and Anglers dark money group. Another Hilltop employee in Billings served as the treasurer for the Montana Hunters and Anglers super PAC.
Hilltop partners in Washington also helped run two other dark money groups that spent money on the Montana race: the Citizens for Strength and Security Fund and the Partnership to Protect Medicare.
The League of Conservation Voters and Planned Parenthood Advocates of Montana paid management fees to Hilltop.
No one from Hilltop returned calls, but Nayak and Love said they worked with Hilltop independently of other groups.
Outside groups are allowed to coordinate with each other or use the same consultants — they're just not allowed to coordinate with a candidate. By working together, groups can disguise who is actually behind an ad.
In early July, for instance, the League of Conservation Voters gave $410,000 to the Montana Hunters and Anglers super PAC — almost all the money the group raised as of that date.
When the super PAC spent the money on TV ads against Rehberg later that month, the spots were paid for by what appeared to be an organization of Montana hunters, not some Washington-based conservationist group. Nayak said that was not a coincidence.
"We figured having a local brand like that and partnering with them on local issues made more sense than having a D.C. brand," he said.
Nayak said the League did not donate money for the later ads pushing Cox, the libertarian.
It's not clear where that money came from. The dark money side of Montana Hunters and Anglers paid for the radio ads. The super PAC bought the TV ads and had to disclose its donors, but FEC filings show its money came mainly from two other super PACs, which in turn reported getting most of their money from unions and dark money groups, including the League.
* * *
As the Montana Senate race approached its climax, as many as five fliers landed in voters' mailboxes daily. Robocalls, supposedly illegal in Montana, interrupted meals. Strangers knocked on doors, promising free pizza for voting. People turned off their TVs, dumped their mail without looking at it and stopped answering the phone.
"My ex and I moved in together, because he had cancer and I took care of him," said Louise McMillin, 51, who lives in the university district in Missoula. "He kept getting polling calls as he was dying. After he died, I kept saying, 'He's dead, could you take his name off the list?' And they said, 'Sure, sure.' And they kept calling."
The race stayed tight. Demand for TV ad slots spiked, so the TV stations started raising their prices. The law required them to charge candidates their lowest rate. But outside groups? They could be hit up for whatever the market would bear.
Rehberg's campaign paid $400 to run a 30-second ad during the show Blue Bloods on Oct. 19 on the CBS affiliate in Great Falls. A week later, Crossroads GPS paid $2,000 for a slot during the same show.
Anything was fair game for the ads. One, from the super PAC Now Or Never, made fun of Tester's buzz cut, then showed his hair growing down to his shoulders, a bizarre sequence apparently designed to signal his ties to Obama. Another ad, from the dark money group America Is Not Stupid, featured a baby with a gravelly voice saying he didn't know what smelled worse, his diaper or Tester.
"By the middle of October, people were just so tuned out and quite frankly disgusted by all these third-party ads," said Ted Dick, the executive director of the Montana Democratic Party. "We found that face-to-face conversations toward the end were most persuasive and effective. That's the lesson we're taking forward."
There are other lessons. Tester said the Montana race made clear that candidates will have to raise money sooner, and go up with TV ads faster. Although uncomfortable with outside money, Tester also said it's just the way things are now, even on the liberal side.
"I mean, look, they did it," he said. "And with as many ads that were against me, I was glad they did. But it needs to be transparent. I mean, everybody's needs to be transparent... It's important to know who's spending money on who so you know why they're doing it. And the way the system is set up right now, there is no transparency. Very little."
Campaign finance reformers agree that knowing who is behind a message helps people assess it.
One example: Two postcards sent to thousands of Montanans just before the election didn't include the required notice saying who paid for them. One said Rehberg had wasted "hundreds of millions of our tax dollars on pork barrel projects," and urged people to vote for Cox, "a champion for fiscal responsibility." The other called Rehberg "the king of pork" and told people to vote for Cox.
Cox said he didn't send them. The bulk-mail permit on the postcards came back to a Las Vegas company called PDQ Printing, according to the U.S. Postal Service. In an online manual, PDQ describes itself as "Nevada's preeminent Union printer." No one there returned phone calls.
Greenwood, the head of the Montana Republican Party, filed a complaint with the FEC over the mailers. The complaint blames liberal groups and says they "engaged in a duplicitous strategy of supporting the libertarian candidate, Dan Cox, in a desperate attempt" to siphon votes from Rehberg.
More than likely, that complaint won't be resolved for years.
Greenwood said he didn't think disclosure was a cure-all. But he also said the current system marginalized political parties.
"Whether it's Montana Hunters and Anglers or (the conservative super PAC) American Crossroads, they are not responsive to the grassroots," Greenwood said. "These are the professionals and the money men who are not responsive at all to people. The system as it is now does not reflect what people want."
Besides picking between Tester and Rehberg, Montanans got a chance in this election to say how they want the system to work. On the ballot was an initiative — largely symbolic in light of recent court decisions — that declared that corporations are not human beings and banned corporate money in politics.
Gov. Schweitzer, a Democrat, and Bertelsen, the former Republican secretary of state, campaigned for the initiative. In a shocker for backers, almost 75 percent of voters supported it.
"I realized it absolutely didn't have any legal basis to do anything dramatic," said Bertelsen, who is 94. "But it's a case of saying, 'We don't like it.' I guess we could just sit down and not say a word. But the Supreme Court — I think they made a mistake. Money isn't speech, anyhow. It's just money.
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FDA approves Roche's Tamiflu for infants with new flu symptoms

The U.S. Food and Drug Administration on Friday expanded the use of Tamiflu, the flu drug from Roche, to children as young as two weeks old who have shown flu symptoms for no more than two days.
The FDA said the drug cannot be used to prevent flu infection in this age group. The drug is currently approved as both a flu treatment and preventative flu drug for children ages 1 and older, and adults. It aims to help lessen the length and severity of the flu.
Tamiflu was approved in 1999 and is distributed in the United States by Genentech, part of Roche. It was co-developed by Gilead Sciences. Its most common side effects include vomiting and diarrhea.
The FDA said its expanded use is based on extrapolating data from previous study results in adults and older children, and supporting studies by the U.S. National Institutes of Health and Roche.
Tamiflu, which had peak sales of $3 billion in 2009 because of the H1N1 swine flu epidemic, is approved by regulators worldwide but some researchers claim there is little evidence it works and have asked Roche to hand over data so they can study its effectiveness.
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Cancer Immunotherapy Where Are We Going?

The compelling concept of utilizing the patient's own immune system for a stronger and more effective way to attack cancer cells is not a new one. William Coley observed in 1891 that infections produced in patients with inoperable cancer following an injection of streptococcal organisms (Gram-positive bacteria) led to tumor shrinkage especially when the patients developed fever and other signs of a full-blown infection.1 Since then, research has embraced approaches to "train" the patient's own immune system to recognize certain biomarkers or proteins that are mainly found on cancer cells and to destroy the cells.
After several setbacks the first cellular immunotherapy, Dendreon's Sipuleucel-T (Provenge(R)), was approved for the treatment of prostate cancer in 2010. Today, new promising cancer immunotherapy approaches are in clinical trials. Most recently, researchers at the 54th American Society of Hematology (ASH) meeting reported early success with a developmental-stage cell-based cancer vaccine for the treatment of leukemia and have shown remission in several patients 2,3, including a 7-year old girl who relapsed twice after chemotherapy.
Cancer immunotherapy can be thought of as either active or passive immunotherapy. The most prominent passive immunotherapies, which have revolutionized cancer therapy, are monoclonal antibodies that either target tumor-specific antigens and receptors or block important pathways central to tumor growth and survival. Therapeutic monoclonal antibodies are the market leader in the targeted cancer therapy space and include blockbusters such as trastuzumab (Herceptin(R)) or rituximab (Rituxan(R)).
In general, antibodies are significant elements of the body's adaptive immune system. They play a dominant role in the recognition of foreign antigens and the stimulation of the immune response. Therapeutic antibodies target and bind to antigens, usually proteins that are mainly expressed on diseased cells such as cancer cells. After binding, cancer cells can be destroyed by different mechanisms such as antibody-dependent cellular cytotoxicity, the activation of the complement system -- an important part of the immune system -- and triggering cell death.
Although very successful, especially in oncology, therapeutic antibodies have a significant limitation: they don't generate a memory response by the immune system, and thus, repeated antibody infusions are required. Further, monoclonal antibodies are only able to recognize specific proteins present of the cell surface. Monoclonal antibodies are mostly produced in cell culture systems which are often costly. Humanization of murine monoclonal antibodies by replacing of certain parts of the antibody with human sequences has improved the tolerability of antibodies and made them less immunogenic, but even fully human sequence-derived antibodies can carry some immunological risk.
Novel approaches in the passive immunization strategy include antibody drug conjugates, a combination of targeting antibody with a very potent drug such as the recently approved brentuximab vedotin (ADCETRIS(TM)) for Hodgkin lymphoma and anaplastic large cell lymphoma (ALCL). ADCETRIS comprises an anti-CD30 monoclonal antibodyanti-CD30 monoclonal antibody and a cytotoxic (cell-killing) agent that is released upon internalization into CD30-expressing tumor cells. Currently, the development of next generations of ADCs is underway.
Alternatively, specific and durable cancer immunotherapies designed to actively "train" or stimulate the patient's intrinsic immune response have been more problematic; however, recent success stories, such as the cell-based immunotherapy Provenge, have revitalized this field. Dendreon's approach modifies the patients' own dendritic cells to present a protein specific to prostate cancer cells.
Dendritic cells are the most potent, "professional" antigen-presenting cells. They process the antigen material and present it on their surface to other cells of the immune system. Once activated, the dendritic cells migrate to the lymphoid tissues where they interact with T-cells and B-cells -- white blood cells and important components of the immune system -- to initiate and shape the adaptive immune response. To develop Provenge, each patient's own dendritic cells are harvested and then loaded ex vivo with the tumor-associated antigen. Now "presenting" the antigen, the dendritic cells are administered back into the patient to induce a potent, cell-mediated anticancer immune response resulting in tumor shrinkage and clinical benefit.
In another experimental approach for the treatment of leukemia, patients' own modified T-cells were infused back into the patients. Prior to this, the T-cells were transduced with a lentivirus to express the CD19-specific chimeric antigen receptor. CD19 is an antigen which is found on B-cell neoplasms, cancerous B-cells, and the lentivirus was the vehicle to transfer the genetic material for CD19 into the cells. A case report published in the New England Journal of Medicine stated that a patient with chronic lymphocytic leukemia (CLL) was in ongoing remission 10 months after treatment.3
These promising results have spurred continued research for new and safe ways to achieve effective tumor vaccination, and drug developers have explored many cancer immunotherapy strategies. To generate an effective antitumor immunity, therapeutic intervention should drive several functions; specifically, it should promote the antigen presentation functions of dendritic cells, promote the production of protective T-cell responses, stimulate B-cells and overcome immunosuppression characteristics that are common to tumor cells.4
Cell-based therapeutic vaccines are most frequently produced outside the patient's body and involve isolation of the specific cells, such as dendritic cells, and the introduction of preselected antigens, often with the use of specific vehicle, into the cells. The antigens can be encoded in viral vectors (frequently DNA) or administered as peptides or proteins in a suitable adjuvant and carrier through a long and cumbersome process.
During my doctoral thesis, I conducted immunization experiments using RNA as a negative control, assuming that the RNA would be degraded during the experiment thus making it impossible to use as a vaccine. The physiological role of messenger (m) RNA is to transfer genetic information from the nucleus to the cytoplasm where this information is translated into the corresponding protein. mRNA is known to be very unstable and has a relatively short half-life. But astonishingly, we were able to measure a solid T-cell immune response. We repeated the experiment and confirmed that the RNA we had produced had the potential to be used as a vaccine. Importantly, we didn't need to isolate the patients' cells: mRNA-based vaccines can be injected directly into the skin (intradermal). The mRNA-based vaccines are then taken up by antigen-presenting cells, such as dendritic cells, and are then able to induce an immune response. Importantly, mRNA-vaccines can also be synthesized quickly for any antigen sequence identified.5
The first mRNA-based vaccines (RNActive(R)) are now in the clinic for the treatment of prostate cancer and lung cancer and have demonstrated that they do what they are supposed to do - induce a balanced humoral, as well as T cell-mediated, immune response that is entirely HLA independent. The HLA (human leukocyte antigen) system is used to differentiate the body's own cells (self) and non-self cells. Additionally, RNA-vaccines do not need a vehicle such as a virus for delivery to the cells, nor do they contain virus-derived elements that are often found in DNA-vaccines. These attributes make RNActive a very safe therapeutic.
The risk of integration of the RNA into the host-genome is minimized (RNA would have been transcribed first to DNA, and then it has to be transported to the nucleus), as is the residual risk of DNA-based vaccines for inactivating or activating genes or affecting cellular regulatory elements, which can induce oncogenesis. Thus, the favorable safety profile of mRNA-based therapies broadens their potential use not only for the treatment of diseases but for use as prophylactic vaccinations. A recent proof-of-concept study using mRNA-based vaccines (RNActive) in animal models for influenza was published in Nature Biotechnology.6
Therapeutic cancer immunotherapies and vaccines have come a long way, and novel, promising approaches give hope for safe and effective treatment options. This may one day lead to the treatment of all cancers as chronic diseases.
Literature
1Kirkwood JM, Butterfield LH, Tarhini AA, Zarour H, Kalinski P, Ferrone S: Immunotherapy of cancer in 2012. CA Cancer J Clin. 2012
2June CH, Blazar BR: T-Cell Infusions: A New Tool for Transfusion Medicine That Has Come of Age. Presentation at 54th ASH Annual Meeting 2013
3Porter DL, Levine BL, Kalos M, Bagg A, and June CH: Chimeric Antigen Receptor-Modified T Cells in Chronic Lymphoid Leukemia. N Engl J Med 2011
4Mellman I, Coukos G, Dranoff G: Cancer immunotherapy comes of age. Nature. 2011
Petsch B, Schnee M, Vogel AB, Lange E, Hoffmann B, Voss D, Schlake T, Thess A, Kallen KJ,
5Hoerr I, Obst R, Rammensee HG, Jung G: In vivo application of RNA leads to induction of specific cytotoxic T lymphocytes and antibodies. Eur J Immunol. 2000
6Petsch B, Schnee M, Vogel AB, Lange E, Hoffmann B, Voss D, Schlake T, Thess A, Kallen KJ, Stitz L, Kramps T: Protective efficacy of in vitro synthesized, specific mRNA vaccines against influenza A virus infection. Nat Biotechnol. 2012
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Allergies, extra weight tied to bullying

 Kids who have food allergies or are overweight may be especially likely to get bullied by their peers, two new studies suggest.
Not surprisingly, researchers also found targets of bullying were more distressed and anxious and had a worse quality of life, in general, than those who weren't picked on.
Bullying has become a concern among parents, doctors and school administrators since research and news stories emerged linking bullying - including online "cyberbullying" - with depression and even suicide.
"There has been a shift and people are more and more recognizing that bullying has real consequences, it's not just something to be making jokes about," said Dr. Mark Schuster, chief of general pediatrics at Boston Children's Hospital and a professor at Harvard Medical School, who wrote a commentary published with the new research.
Studies suggest between one in ten and one in three of all kids and teens are bullied - but those figures may vary by location and demographics, researchers noted.
The new findings come from two studies published Monday in the journal Pediatrics.
In one, Dr. Eyal Shemesh from the Mount Sinai Medical Center in New York and his colleagues surveyed 251 kids who were seen at an allergy clinic and their parents. The children were all between age eight and 17 with a diagnosed food allergy.
Just over 45 percent of them said they'd been bullied or harassed for any reason, and 32 percent reported being bullied because of their allergy in particular.
"Our finding is entirely consistently with what you find with children with a disability," Shemesh told Reuters Health.
A food allergy, he said, "is a vulnerability that can be very easily exploited, so of course it will be exploited."
The kids in the study were mostly white and well-off, the researcher said - a group that you'd expect would be targeted less often. So bullying may be more common in poorer and minority children who also have food allergies.
But allergies aren't the only cause of teasing and harassment by peers.
In another study, researchers from Yale University in New Haven, Connecticut, found that almost two-thirds of 361 teens enrolled in weight-loss camps had been bullied due to their size.
That likelihood increased with weight, so that the heaviest kids had almost a 100 percent chance of being bullied, Rebecca Puhl and her colleagues found. Verbal teasing was the most common form of bullying, but more than half of bullied kids reported getting taunted online or through texts and emails as well.
'START THE CONVERSATION'
Shemesh's team found only about half of parents knew when their food-allergic child was being bullied, and kids tended to be better off when their families were aware of the problem.
He said parents should feel comfortable asking kids if they're being bothered at school or elsewhere - and that even if it only happens once, bullying shouldn't be ignored.
"We want parents to know," he said. "Start the conversation."
"Parents whose kids have a food allergy should really be aware that their kids have the kind of characteristic that often leads to being bullied," Schuster told Reuters Health. "They should be working with the school to handle the food allergy in a way that isn't going to make it more likely that their kids will be bullied - and they need to be attuned to their kids."
That's the same for parents of overweight and obese children, he added.
"Kids need their parents to be their allies in these situations," he said. "Their parents can help them still feel strong.
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12 Weeks is a Long Time to Wait for Breast Cancer Chemotherapy

FIRST PERSON | How long a wait is too long when it comes to treatment of breast cancer? A report published in the Dec. 19 issue of JNCI, Journal of the National Cancer Institute, states that after examining records from 6,622 women, the average time for a woman to wait for adjuvant chemotherapy (chemo given after surgery) for breast cancer is 12 weeks. After my surgery, I waited four weeks before chemotherapy began.
Reconstruction delays
A main cause for delays in starting chemotherapy after surgery was immediate reconstruction. Flap surgeries allow for immediate breast reconstruction. This type of surgery requires a long recuperation period. Chemotherapy impedes healing. All incisions must be healed and all drains removed before chemotherapy can start.
I chose breast implants for reconstruction. This process was partially started during my mastectomy -- consider it partially immediate reconstruction. A tissue expander was put in after they removed my breast. Recovery time is significantly less than with flap surgery. I still had some stitches in when chemo started.
Testing and imaging delays
Testing such as 21-gene reverse-transcription polymerase chain reaction assay testing and MRIs increased the time frame from lumpectomy or mastectomy to the start of chemotherapy. Some doctors use post-surgical MRIs to determine if clear margins were reached. If they are unhappy with the results of the MRI, a second surgery may be required, thus increasing the time before chemo can start.
My oncologist did not feel that any further testing other than a MUGA scan was necessary following my mastectomy. The MUGA scan was performed in order to check heart function before starting on treatment with a monoclonal antibody. Even though I had to go through this imaging, it did not delay the start of chemotherapy.
Other delays
One of the biggest causes of delays in starting chemotherapy treatment in minority women was access to health insurance. Black women who received Medicaid had the longest wait between surgery and the start of chemotherapy when compared to white women with private insurance. This is something that needs to change. When dealing with breast cancer, the faster and more aggressively it is treated, the better the prognosis for survival. There is no reason a woman should have to wait for treatment just because the government is paying for the chemotherapy.
Twelve weeks is too long to wait to start chemotherapy after surgery. Imaging should not have an impact on how long a person waits for chemo. Waiting too long, especially with aggressive forms of breast cancer could be the difference between life and death. I had imaging and started chemo just four weeks after my mastectomy. My outcome might have been very different had I been forced to wait an additional eight weeks before I started chemotherapy.
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New Genetic Tests Determines Breast Cancer and Ovarian Cancer Risks

COMMENTARY | New research has uncovered that mutations in the PPM1D gene is associated with an increased risk of breast cancer and ovarian cancer. Unlike BRCA1 and BRCA2 mutations, the PPM1D mutation is not inherited. Instead, the mutation only shows up in the blood when breast cancer or ovarian cancer is present. Medical News Today quotes professor Nazneen Raham assaying, "This is one of our most interesting and exciting discoveries."
Important discovery
PPM1D mutations are very important. Because of the way they show up in the blood, if you have this mutation you have a 1 in 5 chance of developing breast cancer or ovarian cancer. That is almost twice the average risk for breast cancer and it is 10 times the risk for ovarian cancer. Knowing if you carry this mutation will help women decide on imaging and other preventative treatments. Right now, the only genetic test we have is the BRCA test. As PPM1D shows, BRCA is not the only gene mutation that indicates and increased risk for breast or ovarian cancers.
The study
Unlike many recent studies that have so few participants it makes the data questionable, this study looked at 7,781 women with either breast cancer or ovarian cancer and compared the PPM1D gene to 5,861 women from the general population. This allows the results to be statistically significant because they looked at so many different results. What the study showed is that in the group of women who had  cancer, the researchers found 25 faults in the PPM1D gene. In the group of women without cancer only one fault was found. From a statistical standpoint, those results are quite amazing.
This study proves that newer, more detailed gene sequencing is needed to help determine cancer risks. This is especially true for ovarian cancers, sometimes called the silent killer, because most times this type of cancer is not caught until very late stages. Women with a family history of breast cancer or ovarian cancer need more weapons for detection in their arsenal. BRCA testing alone does not cut it. In my case, I have a family history of cancer but no identified genetic issues, like BRCA. I wonder how many lives testing for PPM1D could save.
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Antibiotics in pregnancy tied to asthma in children: study

(Reuters) - Children whose mothers took antibiotics while they were pregnant were slightly more likely than other children to develop asthma, according to a Danish study.

The results don't prove that antibiotics caused the higher asthma risk, but they support a current theory that the body's own "friendly" bacteria have a role in whether a child develops asthma, and antibiotics can disrupt those beneficial bugs.

"We speculate that mothers' use of antibiotics changes the balance of natural bacteria, which is transmitted to the newborn, and that such unbalance bacteria in early life impact on the immune maturation in the newborn," said Hans Bisgaard, one of the study's authors and a professor at the University of Copenhagen.

Previous research has linked antibiotics taken during infancy to a higher risk of asthma, although some researchers have disputed those findings.

To look for effects starting at an even earlier point, Bisgaard and his colleagues gathered information from a Danish national birth database of more than 30,000 children born between 1997 and 2003, and followed for five years.

They found that about 7,300 of the children, or nearly one quarter, were exposed to antibiotics while their mothers were pregnant. Among them, just over three percent, 238 children, were hospitalized for asthma by age five.

The study, which appeared in The Journal of Pediatrics, found that by contrast, about 2.5 percent, or 581 of some 23,000 children whose mothers didn't take antibiotics, were hospitalized with asthma.

After taking into account other asthma risk factors, Bisgaard's team calculated that the children who had been exposed to antibiotics were 17 percent more likely to be hospitalized for asthma.

Similarly, these children were also 18 percent more likely to have been given a prescription for an asthma medication than children whose mothers did not take antibiotics when they were pregnant.

His team also looked at a smaller group of 411 children who were at higher risk for asthma because their mothers had the condition. They found that these children were twice as likely as their peers to develop asthma too if their mothers took antibiotics during the third trimester of pregnancy.

Others said that it was possible that something besides the antibiotics was responsible, such as the illness the drugs were prescribed for.

"This study, it doesn't tell us whether it's the antibiotic use or whether it's the infection. That's one thing we can't decipher," said Anita Kozryskyj, a professor at the University of Alberta who also studies the antibiotics-asthma link but wasn't involved in the new study.

The results don't suggest that women should avoid antibiotics since some infections can be quite dangerous to a fetus, she said, adding that Bisgaard's study suggests that the development of asthma might start before birth, something researchers hadn't studied very closely.
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Extra prenatal choline doesn't help kids' brains

NEW YORK (Reuters Health) - Taking extra choline during pregnancy does not improve babies' language and memory skills, according to a new study.

"I think eating the recommended amount of choline, which is just about a half of a gram a day for pregnant women, would probably do you well," Dr. Steven Zeisel, the senior author of the study and a professor at the University of North Carolina, Chapel Hill, told Reuters Health. "Going to high levels doesn't always give you improvement."

The results contrast with earlier studies in animals showing that a choline boost in utero improves rodents' performance on memory tasks. Companies claim that choline pills support "brain health," along with the health of other organs, and sell choline supplements over the counter for about $9 for 100 250-milligram capsules.

Choline is an essential nutrient found in meat, eggs and milk, and during pregnancy and breastfeeding, large amounts of choline are delivered to the baby through the mother. Zeisel said it's possible that the women in the study who didn't take a choline pill were getting enough from their diet.

Earlier studies have found that pregnant women with very low levels of choline in their diet have a higher chance of delivering a baby with a birth defect (see Reuters Health report of September 25, 2009). And adults who eat a choline-rich diet perform better on memory tests (see Reuters Health report of November 23, 2011: http://reut.rs/swPWp3).

To see if adding extra choline during pregnancy can offer any benefits to babies, Zeisel and his colleagues asked 99 pregnant women to take six pills every day, beginning when they were 18 weeks pregnant and continuing until three months after the baby was born.

Fifty of the moms received fake pills containing corn oil, while 49 received pills with 833 milligrams (mg) of phosphatidylcholine, a form of choline.

The phosphatidylcholine pills added up to 750 mg of choline each day, the equivalent of 170 percent of the recommended level for pregnant women and 140 percent of the recommended daily amount for breastfeeding moms.

When the children were 10 and 12 months old, Zeisel's team gave them a battery of tests to measure short and long term memory, language skills and general development.

There were no differences between the two groups on any of the tests, the team reports in The American Journal of Clinical Nutrition.

TRACKED LONG ENOUGH?

Marie Caudill, a professor at Cornell University in Ithaca, New York, who was not involved in the current research, said the study was well conducted, but she offered a number of reasons that might explain the discrepancy between the animal studies and the current findings.

One possibility is that the babies were not tracked long enough to see any differences in their abilities.

"The animal studies demonstrated (that) supplementing the maternal diet with extra choline during pregnancy resulted in lasting beneficial effects on cognitive functioning in the adult offspring and prevented age-related cognitive decline," Caudill told Reuters Health by email.

Additionally, the type of choline used - phosphatidylcholine - might be less effective than choline itself. (Zeisel's group chose not to use choline because it can result in a fishy body odor.)

In addition, the tests may not be "sufficiently challenging," Caudill added.

Zeisel agreed that perhaps as children age and start to perform more complex mental processing, it might be easier to measure if a child has a deficit or a strength.

For now, he said, there's no reason to use supplements during pregnancy to get extra choline, and women should refer to the U.S. Department of Agriculture's recommendations for how much choline they should get from their diet.

Zeisel and his colleagues are developing studies in Gambia, where dietary choline levels are known to be low, to see if supplementation there might make a bigger difference than in a region where choline intake appears to be sufficient.
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Europe mulls banning 'boxes' for abandoned babies

BERLIN (AP) — German pastor Gabriele Stangl says she will never forget the harrowing confession she heard in 1999. A woman said she had been brutally raped, got pregnant and had a baby. Then she killed it and buried it in the woods near Berlin.

Stangl wanted to do something to help women in such desperate situations. So the following year, she convinced Berlin's Waldfriede Hospital to create the city's first so-called "baby box." The box is actually a warm incubator that can be opened from an outside wall of a hospital where a desperate parent can anonymously leave an unwanted infant.

A small flap opens into the box, equipped with a motion detector. An alarm goes off in the hospital to alert staff two minutes after a baby is left.

"The mother has enough time to leave without anyone seeing her," Stangl said. "The important thing is that her baby is now in a safe place."

Baby boxes are a revival of the medieval "foundling wheels," where unwanted infants were left in revolving church doors. In recent years, there has been an increase in these contraptions — also called hatches, windows or slots in some countries — and at least 11 European nations now have them, according to United Nations figures. They are technically illegal, but mostly operate in a gray zone as authorities turn a blind eye.

But they have drawn the attention of human rights advocates who think they are bad for the children and merely avoid dealing with the problems that lead to child abandonment. At a meeting last month, the United Nations Committee on the Rights of the Child said baby boxes should be banned and is pushing that agenda to the European Parliament.

There are nearly 100 baby boxes in Germany. Poland and the Czech Republic each have more than 40 while Italy, Lithuania, Russia and Slovakia have about 10 each. There are two in Switzerland, one in Belgium and one being planned in the Netherlands.

In the last decade, hundreds of babies have been abandoned this way; it's estimated one or two infants are typically left at each location every year, though exact figures aren't available.

"They are a bad message for society," said Maria Herczog, a Hungarian child psychologist on the U.N. committee. "These boxes violate children's rights and also the rights of parents to get help from the state to raise their families," she said.

"Instead of providing help and addressing some of the social problems and poverty behind these situations, we're telling people they can just leave their baby and run away."

She said the practice encourages women to have children without getting medical care. "It's paradoxical that it's OK for women to give up their babies by putting them in a box, but if they were to have them in a hospital and walk away, that's a crime," Herczog said. She said the committee is now discussing the issue with the European Parliament and is also asking countries which allow the practice to shut them down.

Herczog also said it's wrong to assume only mothers are abandoning these children and that sometimes they may be forced into giving up children they might otherwise have kept. "We have data to show that in some cases it's pimps, a male relative or someone who's exploiting the woman," she said.

In some countries — Australia, Canada and Britain — it is illegal to abandon an infant anywhere. Yet, in the U.S. there are "safe haven" laws that allow parents to anonymously give up an infant in a secure place like a hospital or police department. A handful of other countries including Japan and Slovakia have similar provisions.

Countries that support this anonymous abandonment method contend they save lives. In a letter responding to U.N. concerns, more than two dozen Czech politicians said they "strongly disagreed" with the proposed ban. "The primary aim of baby hatches, which (have) already saved hundreds of newborns, is to protect their right to life and protect their human rights," the letter said.

However, limited academic surveys suggest this hasn't reduced the murder of infants. There are about 30 to 60 infanticides in Germany every year, a number that has been relatively unchanged for years, even after the arrival of baby boxes. That's similar to the per capita rate in Britain where there is no such option.

Across Germany, there is considerable public support for the boxes, particularly after several high-profile cases of infanticide, including the grisly discovery several years ago of the decomposed remains of nine infants stuffed into flower pots in Brandenburg.

Officials at several facilities with baby boxes say biological parents sometimes name the infant being abandoned. "The girl is called Sarah," read one note left with a baby in Lubeck, Germany in 2003. "I have many problems and a life with Sarah is just not possible," the letter said.

The secretive nature also means few restrictions on who gets dropped off, even though the boxes are intended for newborns. Friederike Garbe, who oversees a baby box in Lubeck, found two young boys crying there last November. "One was about four months old and his brother was already sitting up," she said. The older boy was about 15 months old and could say "Mama."

Still, Germany's health ministry is considering other options. "We want to replace the necessity for the baby boxes by implementing a rule to allow women to give birth anonymously that will allow them to give up the child for adoption," said Christopher Steegmans, a ministry spokesman.

Austria, France, and Italy allow women to give birth anonymously and leave the baby in the hospital to be adopted. Germany and Britain sometimes allow this under certain circumstances even though it is technically illegal. Eleven other nations grant women a "concealed delivery" that hides their identities when they give birth to their babies, who are then given up for adoption. But the women are supposed to leave their name and contact information for official records that may be given one day to the children if they request it after age 18.

For German couple Andy and Astrid, an abandoned infant in a baby box near the city of Fulda ended their two-year wait to adopt a child nearly a decade ago.

"We were told about him on a Sunday and then visited him the next day in the hospital," said Astrid, a 37-year-old teacher, who along with her husband, agreed to talk with The Associated Press if their last names were not used to protect the identity of their child. The couple quietly snapped a few photos of the baby boy they later named Jan. He weighed just over 7 pounds when he was placed in the baby box, wrapped in two small towels.

When Jan started asking questions about where he came from around age 2, his parents explained another woman had given birth to him. They showed him the photos taken at the hospital, introduced him to the nurses there and showed him the baby box where he had been left.

Earlier this year, the couple began the procedure to adopt a second child, a boy whose mother gave birth anonymously so she could give him up for adoption.

Astrid said Jan, now 8, loves football, tractors and anything to do with the farming that he sees daily in their rural community. She said it's not so important for her and her husband to know who his biological parents are.
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Bounce houses a party hit but kids' injuries soar

CHICAGO (AP) — They may be a big hit at kids' birthday parties, but inflatable bounce houses can be dangerous, with the number of injuries soaring in recent years, a nationwide study found.

Kids often crowd into bounce houses, and jumping up and down can send other children flying into the air, too.

The numbers suggest 30 U.S. children a day are treated in emergency rooms for broken bones, sprains, cuts and concussions from bounce house accidents. Most involve children falling inside or out of the inflated playthings, and many children get hurt when they collide with other bouncing kids.

The number of children aged 17 and younger who got emergency-room treatment for bounce house injuries has climbed along with the popularity of bounce houses — from fewer than 1,000 in 1995 to nearly 11,000 in 2010. That's a 15-fold increase, and a doubling just since 2008.

"I was surprised by the number, especially by the rapid increase in the number of injuries," said lead author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio.

Amusement parks and fairs have bounce houses, and the playthings can also be rented or purchased for home use.

Smith and colleagues analyzed national surveillance data on ER treatment for nonfatal injuries linked with bounce houses, maintained by the U.S. Consumer Product Safety Commission. Their study was published online Monday in the journal Pediatrics.

Only about 3 percent of children were hospitalized, mostly for broken bones.

More than one-third of the injuries were in children aged 5 and younger. The safety commission recommends against letting children younger than 6 use full-size trampolines, and Smith said barring kids that young from even smaller, home-use bounce houses would make sense.

"There is no evidence that the size or location of an inflatable bouncer affects the injury risk," he said.

Other recommendations, often listed in manufacturers' instruction pamphlets, include not overloading bounce houses with too many kids and not allowing young children to bounce with much older, heavier kids or adults, said Laura Woodburn, a spokeswoman for the National Association of Amusement Ride Safety Officials.

The study didn't include deaths, but some accidents are fatal. Separate data from the product safety commission show four bounce house deaths from 2003 to 2007, all involving children striking their heads on a hard surface.

Several nonfatal accidents occurred last year when bounce houses collapsed or were lifted by high winds.
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U.S. kids getting recommended amount of sleep: study

NEW YORK (Reuters Health) - Children in the U.S. appear to be getting as much shut-eye as the Centers for Disease Control and Prevention (CDC) recommends, according to a new study.

"We can't say this is the amount that they should be sleeping," said Jessica Williams, the lead author of the study and a graduate student at the University of California, Los Angeles.

"All we could really do is compare our estimated norms with what is recommended, and it seems like it falls pretty well in line with the recommendations," she told Reuters Health.

Williams and her colleagues point out in their study, published in the Archives of Pediatrics and Adolescent Medicine, that there has been concern that U.S. kids are getting too little sleep.

Insufficient sleep has been tied to all sorts of issues in kids and teens, from behavior problems to heart health risks (see Reuters Health reports of October 2, 2012 and October 16, 2012).

But there isn't a lot of hard evidence on how much shut-eye children typically get, Williams said, so the group set out to get an estimate of average sleep duration from birth to age 18.

The researchers gathered data from a nationwide survey that has tracked families for decades.

For this study, they focused on parents' reports of their children's sleep, beginning in 1997.

At the time, 2,832 children were included. In 2002 and 2007 the families were surveyed again and there were 2,520 and 1,424 children included, respectively.

Dr. Maurice Ohayon, director of the Stanford Sleep Epidemiology Research Center in Palo Alto, California, said one of the big strengths of the study is that it tracked changes in sleep among the same children as they aged.

"We have an evolution of the sleep during the childhood," said Ohayon, who was not involved in the study. "That is the unique thing."

Williams's team found that until their second birthday, babies in the study slept an average of 12 to 14 hours during each 24-hour period.

By age four that had dropped to about 11 hours of sleep and by age 10, to 10 hours. By age 16, kids were getting an average of about nine hours of sleep per night.

The findings suggest most kids' sleep habits are in step with government guidelines.

According to the CDC, toddlers should be getting 12 to 14 hours of sleep. Preschoolers should get 11 to 13 hours of sleep, and adolescents age 10 to 17 should get 8.5 to 9.5 hours.

The researchers didn't find any differences in the amount of sleep between boys and girls, and only a slight gap between white and Hispanic kids.

Hispanic children tended to sleep 19 minutes longer than white children after age nine, but Williams said that difference is too small to matter for individual kids.

Parent reports of how much sleep their kids get are not perfectly accurate, and they often can't describe the quality of sleep, such as whether kids wake up in the night. Williams said it's still possible individual children aren't sleeping enough, because the study could only measure reports of sleep duration, and not sleep quality.

Tracking sleep in a laboratory is more precise, but would cost too much for a study this size, said Ohayon.

He told Reuters Health the study still offers a good sense of how much sleep children typically get, which is valuable in helping to gauge whether a child has a sleep disorder.

"What we are hoping to do with these norms is give some sort of reference to be used by clinicians and parents to see if children fall far from average," said Williams.
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