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Malpractice Suits, Other Factors Contribute To Rise In Caesarean Births, Experts Say
Many doctors believe that the increase in caesarean section births in the U.S. over the last decade has been fueled by three main factors -- fear of malpractice lawsuits, a decrease in vaginal births after c-sections and rising rates of obesity -- the St. Petersburg Times reports. According to the Times, 31.8% of U.S. births were c-sections in 2007, compared with 21% a decade earlier, making c-sections the most commonly performed procedure in the nation"s hospitals.A few decades ago, c-section births were relatively rare, representing only 4% of U.S. births in 1965. According to the Times, c-section rates began to increase when it was believed that many cerebral palsy cases were the result of infants being deprived of oxygen during traumatic vaginal deliveries, which led to malpractice suits against doctors. At the same time, advancements in neonatal care and electronic fetal monitoring in recent decades have helped make the procedure safer and therefore more common. Robert Yelverton, a physician and board member of the Florida Obstetric and Gynecologic Society, said that doctors "tend to opt for the method of childbirth most likely to withstand a legal challenge." Whereas doctors in the past were more likely to use techniques such as vacuum extraction or manually turning an infant during a difficult birth, doctors today automatically opt for a c-section, according to Yelverton. According to the Times, one study found that 76% of U.S. obstetricians reported at least one litigation event, with an average award of $2.3 million for negligence in childbirth.An increase in obesity and a decline in VBACs also have driven the rise in c-section births, the Times reports. VBACs have declined from nearly 30% in the 1990s to 7.9% in 2005, which some doctors say is a result of fear of litigation because of the chance for rare but serious complications during birth. Similarly, obesity puts women at an increased risk for gestational diabetes, delivering prematurely or having larger infants, which can make birth more risky, the Times reports. More than one-third of U.S. women of childbearing age are overweight or obese (Martin, St. Petersburg Times, 6/17).

Doctors And Hospitals Look For Ways To Cut Costs, Improve Quality
The "patient-centered" practices movement is growing in popularity, the New York Times reports. Primary care physicians in the practices "spend more time with patients, emphasize prevention and education" to keep patients healthy and "can handle many medical problems without referrals to specialists." Often, "this kind of care can reduce a patient"s medical bills." Dr. Jose Batlle, a doctor in the Bronx, for example, gives patients his cell phone number and helps his patients cut down on the number of prescription drugs that have him prescribed to them by multiple specialists. "I prefer to keep them healthy than treat them when they are sick," Batlle says.
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Eisai And Pfizer Decide Not To Appeal NICE Decision And Call For An Expedited Review Of Guidance For Alzheimer's Disease
On June 11, the National Institute for Health and Clinical Excellence
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Carbohydrate Acts As Tumor Suppressor

Scientists at Burnham Institute for Medical Research (Burnham) have discovered that specialized complex sugar molecules (glycans) that anchor cells into place act as tumor suppressors in breast and prostate cancers. These glycans play a critical role in cell adhesion in normal cells, and their decrease or loss leads to increased cell migration by invasive cancer cells and metastasis. An increase in expression of the enzyme that produces these glycans, í²3GnT1, resulted in a significant reduction in tumor activity. The research was published in the journal Proceedings of the National Academy of Sciences. The specialized glycans are capable of binding to laminin and are attached to the í±-DG cell surface protein. This binding facilitates adhesion between epithelial and basement membrane cells and prevents cells from migrating. The team of scientists, led by Professor Minoru Fukuda, Ph.D., demonstrated that í²3GnT1 controls the synthesis of laminin-binding glycans in concert with the genes LARGE/LARGE2. Down-regulation of í²3GnT1 reduces the number of glycans, leading to greater movement by invasive cancer cells. However, when the researchers forced aggressive cancer cells to express í²3GnT1, the laminin-binding glycans were restored and tumor formation decreased. "These results indicate that certain carbohydrates on normal cells and enzymes that synthesize those glycans, such as í²3GnT1, function as tumor suppressors," said Dr. Fukuda." Upregulation of í²3GnT1 may become a novel way to treat cancer." Using antibodies, the team investigated the expression of both í±-DG and its associated glycans in both normal and cancerous cells. They found that the quantity of í±-DG was similar in both cell types, but the level of attached glycans was reduced in the cancer cells. Further study showed that prostate cancer cells that highly expressed the í±-DG glycans produced smaller tumors. The team also found that when they knocked down í²3GnT1 expression by RNA interference, which reduces protein expression, the amount of glycans decreased even when LARGE was overexpressed. The scientists demonstrated that í²3GnT1 plays a key role in forming laminin-binding glycans attached to í±-DG, which in turn reduces cancer cell movement. The study provides a new understanding of the role that complex carbohydrates play in cancer and could lead to new directions in the development of therapeutics. About Burnham Institute for Medical Research Burnham Institute for Medical Research is dedicated to revealing the fundamental molecular causes of disease and devising the innovative therapies of tomorrow. Burnham, with operations in California and Florida, is one of the fastest-growing research institutes in the country. The Institute ranks among the top-four institutions nationally for NIH grant funding and among the top-25 organizations worldwide for its research impact. Burnham utilizes a unique, collaborative approach to medical research and has established major research programs in cancer, neurodegeneration, diabetes, infectious and inflammatory and childhood diseases. The Institute is known for its world-class capabilities in stem cell research and drug discovery technologies. Burnham is a nonprofit, public benefit corporation. Burnham Institute for Medical Research


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