AIDS fight enters new phase with prevention pill

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CHICAGO (AP) — Condoms and other safe-sex practices have accomplished only so much. Now the 30-year battle against AIDS is on the verge of a radical new phase, with the government expected to endorse a once-a-day pill to prevent infection with the virus.

Some doctors are already giving patients the drug, Truvada, to ward off infection. But Food and Drug Administration approval would expand that practice and could make the highly expensive medicine more affordable. Truvada costs around $11,000 to $14,000 a year.

Approval seems likely after an FDA advisory panel Thursday endorsed the use of Truvada for prevention.

In the generation-long fight against AIDS, "it's the first time we have talked about a medication for prevention of HIV," said Dr. Lisa Sterman of Francisco, who treats HIV-positive patients.

"With this recommendation, we're nearing a watershed moment in our fight against HIV," said James Loduca, a spokesman for the San Francisco AIDS Foundation. "We know this isn't a magic bullet, and it's not going to be the right prevention strategy for everyone, but it could save thousands of lives in the United States and potentially millions around the world."

Truvada has been FDA-approved since 2004 for treating people infected with the AIDS virus. Once a drug is on the market, doctors are free to prescribe it for off-label, or unapproved, uses, and that's what some have been doing in giving Truvada to patients who are healthy but in danger of getting the virus from their partners or through risky sex.

Official FDA backing of the practice would allow Truvada's maker, Gilead Sciences Inc. of Foster City, Calif., to market it for prevention. Approval would also probably lead many more insurance companies to pay for the drug. And by widening the market for Truvada, it could prompt Gilead to lower the price.

An FDA decision is expected by June 15.

The FDA is also considering approving the first over-the-counter HIV test for use at home. Experts said it could help slow the spread of HIV.

An estimated 1.2 million Americans and millions more around the world have HIV. Unless the virus is treated with antiviral drugs, it can turn into full-blown AIDS. Antivirals have made the disease more manageable and allowed patients to live much longer than when the epidemic began in the early 1980s.

Nevertheless, about 50,000 new infections are diagnosed in the U.S. each year, a number that has held steady for about 15 years.

Truvada represents "a pretty radical step, but I think it's a necessary step," said Sterman, who prescribes it to infected patients and those who are healthy but at risk. "We've come as far as we can with condom use and safe-sex strategies."

The drug would be recommended for people at high risk of getting the virus, such as gay men with multiple sex partners, prostitutes and people whose partners are infected.

In one U.S. government study of more than 1,200 men and women in Botswana, Truvada lowered the HIV infection risk by about 78 percent. Another larger study in Africa found a slightly lower rate of effectiveness, but researchers say that if used as directed, the pill can be 90 percent effective or higher.

It is available as an HIV treatment in Africa and other poor regions, but Gilead is seeking approval for prevention in the U.S. only, a company spokeswoman said. Some experts have expressed concern that the use of Truvada for prevention could cause shortages in poor countries that desperately need the drug to treat infected people.

Not everyone in the HIV community is gung-ho about the drug.

Michael Weinstein, president of the AIDS Healthcare Foundation, a Los Angeles-based group that calls itself the nation's largest provider of medical care for HIV, said his main concern is that patients won't take the drug as directed — once a day, while also using condoms. Misuse could create drug-resistant HIV strains and lead to more infections.

The FDA panelists acknowledged that concern and said people should be tested to make sure they don't have HIV before starting Truvada. Patients who already have the virus could develop resistance to the drug.

As for the drug's high cost, generic Truvada for HIV treatment is available in poor countries for as little as $9 per month, a Gilead spokeswoman said. But generic versions are not available in the United States and won't be until after Truvada's U.S. patent expires in 2021. Sterman said she hopes FDA approval leads Gilead to lower the price.

The lifetime cost of treating one person diagnosed with the AIDS virus has been estimated at more than $600,000.

"It's much more cost-effective to prevent a new infection than it is to treat someone for their lifetime," Loduca said. "Of course, the ultimate goal is a vaccine and a cure, but we're many years away from that."

Some of the more serious complications linked to Truvada include kidney and liver problems. But for some people, the risk of kidney problems "10 years down the line may be less than the risk for acquiring HIV, which is significantly more problematic and can be fatal," said Jim Pickett, director of prevention advocacy at the AIDS Foundation of Chicago.

Nick Literski, a government employee in Seattle, has been taking Truvada for HIV prevention for more than a year because his partner is infected. He said the drug has helped prevent the breakup of relationships like his.

"Many HIV-positive men end up ending their relationships with HIV-negative men out of fear of infecting their partner," Literski said.

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AP Health Writer Matthew Perrone contributed to this story from Washington.

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Online:

FDA: http://www.fda.gov

AIDS: http://www.aids.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Exclusive: China amends patent law in fight for cheaper drugs

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HONG KONG (Reuters) - China has overhauled parts of its intellectual property laws to allow its drugmakers to make cheap copies of medicines still under patent protection in a move likely to unnerve foreign pharmaceutical companies.

The Chinese move comes within months of a similar move by India to effectively end the monopoly on an expensive cancer drug made by Bayer AG by issuing its first so-called "compulsory license".

Similar action by China will ring alarm bells in Big Pharma, since the country is a vital growth market at a time when sales in Western countries are flagging.

The amended Chinese patent law allows Beijing to issue compulsory licenses to eligible companies to produce generic versions of patented drugs during state emergencies, or unusual circumstances, or in the interests of the public.

For "reasons of public health", eligible drugmakers can also ask to export these medicines to other countries, including members of the World Trade Organisation.

Compulsory licenses are available to nations to issue under WTO rules in certain cases where life-saving treatments are unaffordable.

"The revised version of Measures for the Compulsory Licensing for Patent Implementation came into effect from May 1, 2012," China's State Intellectual Property Office said in a faxed statement to Reuters.

The changes can be found on the website of China's State Intellectual Property Office at http://www.sipo.gov.cn/.

China is known to be looking at Gilead Sciences Inc's tenofovir, which is recommended by the World Health Organisation as part of a first-line cocktail treatment for AIDS patients, two sources with direct knowledge of the matter said.

China's generic drugmakers were getting ready to produce tenofovir, they added.

At a drug access workshop hosted by the United Nations and health activists in Bangkok in early June, Chinese officials spoke of the changes to its patent law. Officials from Cambodia, India, Indonesia, Malaysia, Myanmar, the Philippines, Thailand and Vietnam also participated in the meeting.

"In May 2012, China created a change in their IPR (intellectual property rights) legislation to be able to issue compulsory licenses. China is considering further strengthening its legal framework, so as to make use of legal space to produce generic drugs," said Bob Verbruggen, senior adviser for the UNAIDS Asia Pacific office, who was present at the workshop.

"China's action plan at the workshop seemed to confirm that it intends to become a generic producer for the domestic and international market," he told Reuters by telephone.

CHINA PREPARED LONG AND HARD FOR THIS

China's move follows India's granting of a compulsory license in March to local generic drugs firm Natco Pharma to manufacture Bayer's cancer drug Nexavar, used for treating kidney and liver cancer.

However, China had signaled interest in the idea from at least 2008-2009, when its State Intellectual Property Office invited foreign experts to Beijing to show Chinese officials how to prepare the legal grounds for issuing compulsory licenses.

"They wanted to know the legal perspective ... They wanted to know about Thailand's IP Act that allowed us to make a CL (compulsory license) under the law for public interests, in an emergency," said Vithaya Kulsomboon, associate professor at Thailand's Chulalongkorn University, who was invited to Beijing at the time.

Kajal Bhardwaj, a legal expert from India who is working on health, HIV and human rights trade laws, said China's move was well within the limits of international trade agreements.

"CLs have previously been issued in the region by Malaysia, Indonesia, Thailand and India. CLs have also been issued on multiple occasions by developed countries including the U.S. and EU member countries," Bhardwaj said.

"It is very encouraging that China is seeking to ensure that this right ... is reflected in its legal regime on intellectual property," she added.

SABRE-RATTLING

China's stable of generic drugmakers has been producing the key ingredients - or active pharmaceutical ingredients (APIs) - in medicines for years, exporting them to foreign drugmakers, which then sell the patented finished products back to China at prices which the average Chinese citizen often cannot afford.

In particular, the government is struggling to provide newer HIV drugs, such as Gilead's tenofovir, known by its brand Viread and which had worldwide sales last year of $737.9 million.

China's government, initially slow to acknowledge the problem of HIV/AIDS in the 1990s, now admits to having a ballooning number of HIV/AIDS cases.

Although Gilead moved to share its intellectual property rights on its medicines in a patent pool with generic drugmakers from many countries last July in return for a small royalty, China was excluded, which meant it had to continue paying high prices for tenofovir.

Since the change in China's patent law, Gilead has offered certain concessions, including giving China a substantial donation of tenofovir if it continues to buy the same amount, said Paul Cawthorne, coordinator for Medecins Sans Frontieres' Access Campaign in Asia.

"This is all a negotiation game; this offer from Gilead came about once the news that the Chinese was considering issuing a CL came out. The end game is okay, you get a better deal or you use the CL, it's a strategy that many countries use," he said.

Gilead in Hong Kong declined to comment. No one was immediately available to comment at its head office in California.

All eyes are now trained on how China battles it out with big foreign drug exporters, especially from 2013 when the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria will no longer give grants to China to fight HIV.

(Reporting by Tan Ee Lyn in Hong Kong and Beijing newsroom; Additional reporting by Ben Hirschler in London; Editing by Anne Marie Roantree and David Cowell)

Centene sees second quarter loss, cuts 2012 view, shares plunge

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(Reuters) - Health insurer Centene Corp said it will post a loss in the second quarter and slashed its earnings forecast for 2012, citing higher costs and claims in Texas and Kentucky, and its Celtic individual health business.

The company's shares plunged 21 percent to $28.00 in premarket trade on Monday.

The health insurer also said it was evaluating the goodwill and intangible assets of its Celtic business and the review may result in a non-cash charge of about $28.0 million. The charge has not been accounted for in the current outlook, it added.

Centene now expects 2012 earnings of $1.45 to $1.65 per share, down sharply from its previous outlook of $2.64 to $2.84 a share.

The company said it expects to return to profitability in the third quarter, even as rising costs at its Texas, Kentucky and Celtic businesses impact results for the rest of the year.

The news comes less than a week after rival Molina Healthcare Inc withdrew its 2012 earnings forecast, claiming it was facing margin pressure in a Texas Medicaid plan.

Molina's Medicaid plans servicing the El Paso and Hidalgo counties in Texas saw high medical costs that outstripped the company's premium revenue from the region.

The El Paso and Hildago service areas experienced significantly higher-than-expected utilization in a contract that became active in March, Jefferies & Co analyst David Windley said in a note on Molina last week.

Centene too said on Monday it saw a significant rise in certain non-inpatient claims in its Hidalgo service area.

Other health insurers, such as Amerigroup Corp and Cigna Corp, which have plans for the El Paso and Hidalgo counties, may also be affected.

Shares of Molina had crashed early last week after it withdrew its full-year outlook, dragging down Centene shares with them. However, both stocks recovered much of the lost value later in the week as Molina and Centene won back a Medicaid contract in Ohio.

Centene shares, which have lost 5 percent of their value since Molina announced its margin issues in Texas, closed at $35.47 on Friday on the New York Stock Exchange.

(Reporting by Esha Dey in Bangalore; Editing by Sreejiraj Eluvangal)

Dieting May Lower Hormone Levels Tied to Breast Cancer

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MONDAY, May 21 (HealthDay News) -- New research suggests that weight loss through exercise and dieting helps overweight women lower the levels of certain hormones in their blood, potentially raising the odds that they'll avoid developing breast cancer.

The findings don't prove that losing weight this way will prevent breast cancer. Still, women who take medications to prevent the disease "need long-term solutions for managing their risk," study co-author Dr. Anne McTiernan, director of the Prevention Center at the Fred Hutchinson Cancer Research Center, said in a news release from the center.

"Weight loss represents an additional option for long-term breast cancer risk reduction without significant or bothersome side effects," McTiernan added.

The study is published in the May 21 online issue of the Journal of Clinical Oncology.

Previous research at the center has suggested that "losing just 5 percent or more of one's weight could cut by a quarter to a half the risk for the most common, estrogen-sensitive breast cancers," McTiernan said.

In the new study, researchers wanted to understand how weight loss through exercise, diet or both would affect potentially dangerous levels of hormones in the body.

The investigators randomly assigned 439 overweight-to-obese women to one of four groups. One group exercised (mainly through walking), one group dieted, one group did both and the remaining group did neither. The women were aged 50 to 75 with an average age of 58.

Those who dieted or dieted and exercised lost an average of about 10 percent of their weight. In addition, they lowered the levels of several hormones.

"The amount of weight lost was key to changes in hormone levels," McTiernan said. "The biggest effect was through diet plus exercise; exercise by itself didn't produce much of a change in weight or estrogen."

Dr. Robert Hiatt, professor and chair of the department of epidemiology and biostatistics at the University of California, San Francisco, cautioned that weight loss has been connected to breast cancer risk after menopause only. "In this stage of a woman's life, most of the circulating estrogens are no longer coming from the ovaries, which cease to function, but from fat tissue that is capable of producing the same types of estrogens," said Hiatt, who's familiar with the study findings.

He cautioned that "the study does not say that losing weight lowers the risk of breast cancer. It would take a larger and longer study to prove that. It does, however, suggest than weight loss has the right kind of effect on circulating estrogens, and it would be reasonable to expect that breast cancer rates would subsequently fall in such women."

More information

For more on breast cancer, visit the U.S. National Library of Medicine.

Copyright c 2012?HealthDay. All rights reserved.

Docs win most malpractice suits, but road is long

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NEW YORK (Reuters Health) - Malpractice claims against U.S. doctors are often dismissed, and when they go to trial, the verdict is usually in the doctor's favor, according to a new study.

But even when a case is dismissed, the road is typically long for both doctors and the patients suing, researchers said.

"Most claims go in favor of the physician, and they take a long time to resolve," said lead researcher Dr. Anupam B. Jena, of Massachusetts General Hospital and Harvard Medical School in Boston.

Medical malpractice claims have become a hot-button issue in the U.S., coming up repeatedly in debates about healthcare reform. Some specialists must pay a couple hundred thousand dollars a year in premiums for insurance against malpractice claims -- though rates vary by state.

But not much has been known about how long malpractice claims take to resolve, or what proportion of them actually end in a payment to patients, according to Jena.

For their study, he and his colleagues looked at more than 10,000 malpractice claims against U.S. doctors closed between 2002 and 2005.

They found that of all claims, about 55 percent resulted in an actual lawsuit.

Of those litigated claims, more than half were dismissed by the court. And out of the rest, most were resolved before a verdict; less than five percent ended up being decided by a trial verdict.

When there was a verdict, it went in favor of the doctor 80 percent of the time, Jena's team reported in the Archives of Internal Medicine.

What stands out in the findings, Jena said, was the length of time cases took to resolve -- even when they were dismissed.

On average, lawsuits dismissed in court took more than 20 months, and those resolved before a verdict took over 28 months.

Cases that went all the way to a trial verdict typically lasted a few years: 39 months, on average, when it went in favor of the doctor, and close to 44 months when the patient won.

"It is hard on everyone," Jena told Reuters Health.

For doctors, the outcomes of claims varied by specialty -- which is not surprising, Jena noted.

For example, internists were among the most likely to have cases against them dismissed in court. Pathologists and pediatricians were least likely: about 36 percent of cases against pathologists, and a little over 40 percent against pediatricians, were dismissed.

That makes sense, according to Jena. Pathologists study lab test samples and are key in diagnosing diseases. If they seem to have missed something, there is going to be more scrutiny. The same may be true in cases against pediatricians because a child is involved.

DEALING WITH ERRORS

"Medical malpractice is necessary," Jena said, "because there are clearly cases where patients are harmed by negligent care."

But, he added, the lengthy legal process, even in cases that are dismissed before trial, is an issue.

For doctors, Jena said, "there's anxiety, and the potential for damage to their reputation."

And for patients, those that have suffered real harm often end up in a long battle. "We need better ways of identifying those patients and making sure they are compensated more quickly," Jena said.

He pointed to some measures that already exist. Some hospitals and healthcare systems have started "early disclosure" programs, where they try to spot medical errors and proactively tell patients about them and offer compensation.

And a majority of U.S. states now have so-called "apology" laws. Under those, doctors who have made an error can own up to it, without having that apology used as evidence against them if there is a lawsuit.

The goal of those laws has been to curb malpractice claims, because litigants often cite anger over a doctor's perceived lack of remorse as a reason for suing.

And a recent study hinted that apology laws may be working as intended. Researchers estimated that in states with apology laws, cases involving the most severe injuries settled about 20 percent faster, and payments in those cases were lower.

SOURCE: http://bit.ly/JxuSmP Archives of Internal Medicine, online May 14, 2012.

Chicago protests on eve of NATO summit raucous, peaceful

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CHICAGO (Reuters) - Hundreds of demonstrators staged raucous protests against Chicago Mayor Rahm Emanuel's budget cuts and other economic issues on the eve of the NATO summit, but police said there were few arrests and only minor clashes.

The crowds were in the hundreds on Saturday, down from an estimated 2,500 people on Friday at Daley Plaza, named for longtime Mayor Richard J. Daley, who headed the city during bloody clashes between police and anti-Vietnam War protesters at the 1968 Democratic convention.

The violence that was anticipated before the NATO summit never materialized, although the biggest rally was expected on Sunday. Chicago police Superintendent Garry McCarthy said late on Saturday there had been 18 arrests during the week.

One protester was taken to a hospital after a group of people swarmed on a police vehicle and slashed a tire, McCarthy said. Local media showed video of the man in front of the vehicle trying to stop it but it was unclear if he was run over.

Another protester spray-painted an "A" for anarchy on the door of a Verizon Wireless store.

Saturday's marches began early, with an estimated 500 people protesting outside Emanuel's home to criticize cuts in city mental health services.

McCarthy said protesters were "making noise and disrupting some people's lives," but that overall, events were going well.

While the city of Chicago had not granted a permit for Saturday's protests, police allowed several groups of protesters to wander around the city guided by officers mostly on bicycles. There was some pushing and shoving between police and protesters but no major clashes.

Saturday's protests followed the announcement that three men arrested earlier in the week had been charged with conspiracy to commit terrorism. Prosecutors said the three self-described anarchists were planning to attack President Barack Obama's Chicago campaign headquarters and Emanuel's home.

'SHAME ON YOU'

Again on Saturday, the protests stressed economic and social policy issues rather than international questions, such as the war in Afghanistan, expected to be discussed by world leaders at the NATO summit on Sunday and Monday.

Three protest leaders said they met with NATO Ambassador Kolinda Grabar of the military alliance's public diplomacy unit.

"My message to Ambassador Grabar was that we are very aware of the immense violence and oppression that the U.S. in its NATO guise does to the world, and that no amount of words from her or pronouncements from the summit itself will obscure that," said Andy Thayer, one of the protest leaders.

Many of the protesters were from the Occupy Wall Street movement that began in New York last autumn to protest policies that lead to income inequality. The group says 1 percent of the U.S. population holds too much of the nation's wealth.

The protest included some former patients of six city-run mental health clinics that shut at the end of April to save $2.3 million to help close the city's $650 million budget deficit.

"He (Emanuel) hasn't talked to us once, not once, since he's been in office," said Marti Luckett, 60, a patient at one of the shuttered clinics. "We want him to show up.

"I think President Obama should be calling Rahm Emanuel and say, 'Shame on you.'" Emanuel is Obama's former White House chief of staff.

The city says patients should be able to receive care at the six remaining clinics or some run by outside groups.

Small groups of protesters, some carrying signs that read: "Food not bombs" and "seize the peace," accompanied former patients of the clinics dressed in green hospital smocks going door to door to talk to residents in Emanuel's neighborhood. The former patients wore signs saying: "Welfare not warfare."

(Writing By Nick Carey; Additional reporting by James Kelleher; Editing by Peter Cooney and Doina Chiacu)

California voters split on $1 per pack tobacco tax

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LOS ANGELES (AP) — A California ballot initiative to raise the tax on cigarettes that pitted big-spending tobacco companies against cycling legend Lance Armstrong and the New York City Mayor was too close to call Tuesday night.

A blizzard of industry-financed radio and television advertisements over the last two months closed the gap on an effort to impose an additional $1-per-pack tax on cigarettes to fund cancer research.

In March, a statewide poll suggested the measure would pass with two-thirds approval. But support slipped just below percent of the vote with more than 3 million ballots cast.

With millions of votes still to be counted, it could be days or longer before a winner is declared.

The attempt to hike taxes on cigarettes and other tobacco products became a national fight with tobacco companies pouring in millions to quash the effort and celebrities urging voters to support it.

Tobacco taxes have been proven to reduce smoking. But opponents said the initiative would create an unaccountable bureaucracy and hurt the economy by sending tax money raised in California to other states.

An extra tax in the nation's most populous state also could mean major losses for tobacco companies.

Both camps said Tuesday night that they had anticipated a close race and remained confident.

"It's going to be a long night, and that's what we expected," said Beth Miller, spokeswoman for the no on 29 campaign. "It's been a question of the voters taking a look and deciding that they really didn't want to support this measure, but it's also coupled with the fact that people generally do support cancer research."

Supporters promised the tax revenue would stay in California and said tobacco companies were inventing arguments to obscure their true motive — safeguarding profits.

"We've been ahead all night and we expect to stay ahead," Jim Knox of the American Cancer Society said Tuesday. "I think the public health message has gotten through the smoke screen of the tobacco companies' nearly $50 million misinformation campaign."

Armstrong and a coalition of anti-smoking groups raised about $18 million to bolster the measure. New York City Mayor Michael Bloomberg gave $500,000 to the campaign to help offset the industry donations.

The tax would generate about $735 million a year, according to the independent legislative analyst's office.

Voters on both sides of the issue expressed strong convictions Tuesday.

"I think that we should aggressively discourage smoking — make it less convenient, make it more expensive," said Susan Hyman, a Democrat who cast her ballot at a Long Beach polling station.

In nearby Glendale, Craig Jerpseth, a 43 year-old nurse, was equally certain about voting the measure down, along with anything or anyone who might mean more taxes.

"I hope we don't get any more taxes. That's pretty much it," he said.

A slew of newspapers, including the Los Angeles Times, have opposed the measure while proclaiming their reluctance to side with tobacco companies. They argue that the revenue should go to the state, which Gov. Jerry Brown announced last month now faces a deficit of $16 billion.

With a smoking rate of 12.1 percent, California has not raised these taxes since 2000. If the measure passes, California would still have only the 16th highest tax rate in the nation.

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Associated Press writers Raquel Maria Dillon in Los Angeles and Amy Taxin in Long Beach and contributed to this report.

After abuse investigation, kids often remain at risk

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NEW YORK (Reuters Health) - Children who remain at home after an abuse investigation are often still facing risk factors for maltreatment a few years later, a new study finds.

In the U.S., states' Child Protective Services (CPS) investigate more than three million new cases of possible child abuse each year. In a small percentage of cases -- less than 10 percent -- the child will be placed into foster care.

A number of studies have looked into how children fare in the foster-care system. But a lot less has been known about that vast majority of kids who remain at home.

"CPS involvement in homes is actually really common in this country," said Dr. Kristine A. Campbell, a pediatrician at the University of Utah in Salt Lake City who led the new study.

It may be easy to make the assumption that those parents are "bad," she noted in an interview.

"But most of them are struggling with risk factors like poverty and poor social support, and may actually be trying to do well," Campbell said.

In her study, it did turn out that many families investigated by CPS were poor, or headed by a mother with depression or suffering abuse from her partner, for example. And at least some of those risk factors were still apparent three years after CPS came to the home for the first time.

The findings, which appear in the Journal of Pediatrics, are based on a national sample of 5,500 children who were followed after a first-time CPS investigation.

At the first CPS visit, 44 percent of families were below the poverty line. Just over 36 percent of moms or other caregivers said they lacked supportive people in their lives, and one-quarter of them had depression symptoms.

On top of that, 22 percent of women were suffering physical abuse from their partner.

All of those issues are also risk factors for child abuse. And Campbell's team found that for the most part, the prevalence of those risk factors did not change much over three years.

There were, however, some bright spots: Fewer women were being abused three years later -- down to just under 14 percent, from 22 percent.

And when CPS gave women a referral to domestic-abuse services, it seemed to make a huge difference, Campbell said. Among those women, the prevalence of partner abuse went from 54 percent to six percent.

"When they get some services, intimate-partner violence does go down dramatically," Campbell said.

And that's important not only for mothers themselves, she pointed out. Children often have to witness the abuse, or become victims themselves.

"We think the intimate-partner violence often precedes the abuse," Campbell said.

Research has also found that partner abuse often goes hand-in-hand with maternal depression, another risk factor for child abuse.

Of course, not all families investigated by CPS end up in any kind of program or service.

Of the families in this study, child abuse or neglect was substantiated in 28 percent of cases. And CPS gave service referrals to two-thirds of those families.

That meant one-third received no apparent help. "It's disappointing, but not surprising," Campbell said.

The reasons for the finding are not clear. But Campbell pointed out that CPS workers typically have "huge" caseloads and deal with situations where families may be less-than-welcoming.

"They have a very difficult job," she told Reuters Health.

That's where pediatricians can step in to help, according to Campbell. If they know a family has been investigated by CPS, they can follow up with the parents to see if they used referrals to any services.

"We can't make assumptions that everything's been taken care of," Campbell said.

The American Academy of Pediatrics now recommends that pediatricians screen mothers for postpartum depression.

Pediatricians do not routinely screen for domestic violence, but some will ask about it if they have reason to be concerned. There's no widespread routine screening because no one knows yet whether it's actually effective, Campbell explained.

What's "encouraging" in the current findings, she said, is that domestic-violence services did appear to help when they were offered.

Certain risk factors for child abuse, such as poverty, may be difficult to change, at least in the shorter term. "The system may not be able to fix everything that's wrong," Campbell noted.

But, she said, it's important to find out which risk factors can be changed, and then get those services to the families that need them.

SOURCE: http://bit.ly/KZmL1d Journal of Pediatrics, online April 4, 2012.

Autism brain samples damaged after freezer problem

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BELMONT, Mass. (AP) — Scientists say a freezer malfunction at a Boston-area hospital has damaged one-third of the world's largest collection of autism brain samples.

The Boston Globe (http://bo.st/NsoCwH) reports that an official at Harvard-affiliated McLean Hospital in Belmont discovered the freezer had failed in late May without triggering alarms. Inside, 150 thawed brains had turned dark from decay. About a third were part of a collection of autism brains.

Dr. Francine Benes, director of the Harvard Brain Tissue Resource Center, says it was "a priceless collection."

The collection is owned by the advocacy and research organization Autism Speaks. The group says the loss's impact on future research is unclear. A spokeswoman says the brains had been split in half and the halves that were stored elsewhere weren't damaged. Some of the damaged brain tissue had already been used in studies.

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Information from: The Boston Globe, http://www.boston.com/globe

Auction claims it's selling vial with Reagan blood

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LONDON (AP) — A Channel Islands auction house says it's selling a vial that allegedly contains blood residue from Ronald Reagan — a move denounced Tuesday by the late U.S. president's family and his foundation.

The vial being auctioned online was used by the laboratory that tested Reagan's blood when he was treated at George Washington University hospital after a 1981 assassination attempt in Washington, the PFCAuctions house said.

Reagan's son Michael condemned the auction but said he was confident it was not his father's blood.

"Whatever's in the vial — could be mouse blood — it's certainly not Reagan blood," Reagan said in a telephone call from Los Angeles. "And what an outrageous thing to do to (Reagan's widow) Nancy and the family. I hope the world calls on this organization to cease and desist because it's so bogus."

"Even if it were true, how dare they, how dare they do such a thing?"

John Heubusch, executive director of the Ronald Reagan Presidential Foundation in California, condemned the auction and vowed to try to halt it. Bidding for the vial had passed the 7,000-pound ($11,000) mark Tuesday, the house said, and the auction ends Thursday.

"If indeed this story is true, it's a craven act and we will use every legal means to stop its sale or purchase," Heubusch said in a statement. "We've spoken to GW (George Washington) Hospital and are assured an investigation as to how something like this could possibly happen is under way.

"Any individual, including a president of the United States, should feel confident that once they enter into the care of a medical system their privacy and rights are held inviolable," he said.

The auction house on the Channels Islands between England and France said on its website that the blood vial did not come from the Washington hospital that treated Reagan but from the Bio Science Laboratory in Columbia, Maryland.

No listing could be found for Bio Science Laboratory in Columbia. The lab company appeared to have changed hands a number of times since 1981.

A spokesman for George Washington University hospital , Steven Taubenkibel, declined to comment.

The item is a five-inch (12.5-centimeter) glass vial that is one half-inch in diameter and has a green rubber stopper. The auction house says it clearly contains traces of dried blood.

The vial is being sold by a man whose late mother took it from the laboratory with permission weeks after the tests were made, auction house spokeswoman Kylie Whitehead told The Associated Press.

"No one from the foundation or from the family has complained to us," she said Tuesday.

In a statement on the auction house's website, the seller said he tried to interest the Reagan library in purchasing the vial from him but did not succeed. He said the lab director told his mother she could take it.

The auction house website says the seller claimed he was a supporter of Reagan's conservative economic policies and believes the late president would have wanted him to sell the vial rather than donate it.

Reagan required emergency surgery after he was shot by John Hinckley Jr. outside the Washington Hilton Hotel shortly after speaking to labor union officials on March 30, 1981. Hinckley fired six shots at the president from close range. All six missed, but one bullet ricocheted and hit Reagan.

The president was wounded barely two months after taking office. He suffered a punctured lung and severe internal bleeding that required life-saving surgery.

His popular press secretary, James Brady, was left paralyzed after being shot. Two people protecting Reagan were also wounded.

Hinckley was found not guilty by reason of insanity. He remains in a psychiatric facility in the Washington area but has been allowed to spend some time with his family.

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Jablon reported from Los Angeles. Associated Press writer Jessica Gresko in Washington contributed to this report.