Next great medical innovations that could save children

What medical advancements could save the lives of our children in the future? That’s the question members of the American Academy of Pediatrics asked themselves. Their answers were published last week in the journal Pediatrics.

“We thought about the next 40 years and what fields of study might lead to great medical achievements,” said co-author Dr. Tina Cheng, Director of the Department of Pediatrics at John Hopkins Hospital.

“We wanted to identify areas that could have the greatest impact on improving children’s lives,” added co-author Dr. Clifford Bogue, a critical care pediatrician at Yale University School of Medicine. “Because we believe child research is a great investment, we thought it would be helpful for advocating for funding in the future.”

What has pediatric research accomplished?

Studies say research into diseases that disable and kill children falls far behind those done on adults in both scope and quality.

“The amount of research being done with children and infants has been declining,” said Cheng, “and funding for pediatric research has been flat or declining as well.”

To draw attention to the disparity, the American Academy of Pediatrics created a campaign: the “7 Great Achievements in Pediatric Research.” By canvassing board members and asking them to rank key advances in childhood health, the AAP created a list of seven of the greatest pediatric research achievements of the last 40 years.

Published in 2015, the historical advances included the famous “Back to Sleep” campaign to prevent sudden infant death syndrome, or SIDS; the all-out push for laws requiring car seats and seat belts for children of all ages; preventing disease with life-saving immunizations and finding a successful treatment for the most common childhood cancer, acute lymphocytic leukemia.

Other great achievements they highlighted were helping premature babies breathe with a surfactant therapy, reducing HIV transmission from mother to baby and increasing the life expectancy for children with sickle cell anemia and cystic fibrosis.

“We wanted to highlight to the public and to legislators just what the value was for the research dollars that were spent, most of which were funded by the National Institutes of Health,” said Bogue, “to show the huge impact the research had on saving and improving the lives of children and their families.”

What could the future hold?

Drawing on that same survey, here are the advancements the AAP’s Committee on Pediatric Research predicts could occur over the next 40 years.

More childhood immunizations

The AAP strongly advocates for routine vaccinations as one of the best ways to protect children from dangerous diseases. Two examples in the survey are rotavirus, a severe gastroenteritis, and Haemophilus influenzae type b (Hib), a leading cause of bacterial meningitis.

Before vaccines were developed, rotavirus killed about 450,000 children worldwide each year. In the United States Haemophilus influenzae type b took the lives of 1,200 children annually.

“We’d had incredible success,” said Cheng. “A lot of residents-in-training have never seen tetanus, influenza or polio. But there are always new and emerging diseases, and even some of the vaccines we have need to be better.”

Some of the vaccines the survey participants hope to see in the future include Zika, Ebola, certain cancers, and the flu.

“As we see from history, there are regular pandemics in our world and we are due for one,” said Cheng. “Many point to the flu as most likely culprit. It’s especially hard on the young and elderly and those with chronic illness.”

Cancer immunotherapy ‘moonshot’

“We need to find an innovation that can really make a difference with childhood cancer, and immunotherapy may be the next great thing, the sort of ‘moonshot’ we need,” said Cheng.

Using one’s own immune system to target cancer cells is cutting-edge research that is showing enormous potential. While most current research focuses on adults, it’s also expected to reap huge dividends in childhood cancer treatment, especially for cancers notoriously difficult to treat.

“Immunotherapy is booming right now and that’s why we picked it,” agreed Bogue. “But children are often left out of that research. One reason is safety issues, but they are also a very small market for pharmaceutical companies.

“Yet it’s very important to do the research in children,” added Bogue. “Because if you can cure a cancer with immunotherapy at age 10 or 15 instead of 65 you have greatly magnified the impact of that therapy.”

Genomic testing

As understanding of our human genome continues to grow, so will the ability of science to discover genetic mutations and test for them “prenatally, at birth, and throughout the life course”, says the committee, which will allow us to better predict, diagnose and prevent disease.

“Right now when you have a baby, she gets a heel stick for a few drops of blood and they test for a host of genetic conditions that if found early, can be much more treatable,” said Cheng.

“30% of disease in young infants and children is due to a genetic disorder and that’s just based on the small number of genes we have identified and confirmed to date,” added Bogue.

He points out that as science works on the human genome, it’s getting cheaper and easier to gather information, take it to the lab and do the work to figure out why a mutation causes a disease, the pathways involved and how science might intervene.

“That’s the big promise in genomic information,” Bogue said. “We can not only tell parents what their child has, but also why and even come up with new treatments.”

Early interventions

Wouldn’t you like to know as a child if you might get type 2 diabetes, heart disease or cancer later in life?

“Many adult diseases are present in childhood,” said Bogue, “and follow a pathway that may take years to develop.”

As research on the human genome progresses, it is beginning to pinpoint the environmental, behavioral and genetic triggers that might flip a disease switch into action.

“For example, science is beginning to show that young adults who develop schizophrenia may have had brain abnormalities as infants,” explained Bogue. “So we can now begin to predict and intervene before the disease becomes severe.

“In the future, if we knew someone was going to become a diabetic at 25, we could start intervening at age 5. Just think of the impact on that child’s life, as well as society.”

Impact of social, behavior and environmental factors

Exposure to toxic chemicals in our environment has long been known to impact a child’s development. For example, a mother or father’s exposure to heavy metals, such as arsenic, mercury and lead, can lead to lower IQ and other neurologic and psychological disorders in their children.

But according to the AAP committee, there are social and behavioral ways that can limit a child’s potential. They point to maternal malnutrition and other stresses, as well as childhood exposure to violence as stress factors that can “clearly re-program a variety of gene interactions.”

“Even interactions that parents have with their child, such as reading to them versus propping them in front of a TV,” said Bogue,” can have a huge impact on their child’s development. We need to focus on those factors as well.”

Improving our systems of care

What’s the third most common cause of death in the United States? It’s not a disease. According to researchers at Johns Hopkins, medical errors by health care providers lead to approximately 251,000 deaths each year. The AAP committee sees advances in service among health care providers to be a key area of growth that will have an impact on children’s health in the future.

“We’re not talking on the individual level, but improving health care itself,” explained Cheng. “If we decrease medical errors and provide the same highest quality of care every time we see a patient, we will save lives.”

“It’s about systems of care,” agreed Bogue. “How do we engineer the care we deliver so that it gives us better outcomes? And oddly it often ends up being cheaper.”

Increasing global access to care

Today, many children around the world are without access to even the basics of proper health care, such as sanitary water, medical supplies, and food. Nearly one in five children have not received routine immunizations, much less the many advances that have occurred in the last 40 years.

Knowing that intervention A reduces disease B by 90% is great medicine, said Bogue, but how do you actually implement that science so providers and even whole countries are doing it?

“It can take years for those breakthroughs to become standard practice,” he explained. “We need to markedly shorten time frame from knowing when it works to putting it into practice so that people can benefit from it.”

Are these seven medical advancements a definite for the future? No, and they aren’t meant to be, said the authors.

“It’s true we can’t really predict what comes next, but we need to be thinking about it and where are we going,” said Cheng. “The take home message here is that pediatric research has led to improved life expectancy and there are emerging diseases and issues we need to combat. We just want to start the conversation.”

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Sessions won’t say if Assange charges could lead to prosecution of journalists

Attorney General Jeff Sessions on Friday declined to say whether the Justice Department’s decision to prepare charges against Julian Assange of WikiLeaks would open the door to such action against U.S. news organizations like The New York Times and CNN.

“That’s speculative, and I’m not able to comment on that,” Sessions said in an interview on CNN.

“I think I understood your question,” he added, before telling anchor Kate Bolduan that he was having “a little difficulty hearing” her.

But Sessions gave the same non-answer when he was asked a similar question during an interview on MSNBC later in the morning.

“That’s, you know, a hypothetical and facts are so important in those cases,” he said. “I’d want to consult with my good lawyers before I gave you an opinion anyway, so I’m just not able to comment on that.”

In each interview, Sessions appeared alongside Homeland Security Secretary John Kelly. The two were scheduled to tour the United States-Mexico border during a visit to San Diego on Friday.

Sessions said at a news conference Thursday that arresting Assange is a “priority” — remarks that had advocates of press freedom concerned.

“Once you start criminalizing publication of secret docs,” The Intercept’s Glenn Greenwald said on Twitter, “all media outlets are endangered.”

It isn’t the first time President Trump’s attorney general has set off alarm bells in newsrooms. During his confirmation hearing in January, Sessions was asked by Sen. Amy Klobuchar (D-MN) whether he would commit to not “put reporters in jail for doing their jobs.”

“I’m not sure,” Sessions responded, saying he hadn’t studied rules put in place in 2015 by former Attorney General Eric Holder that required extra layers of review before the Justice Department could subpoena a journalist.

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Should you take statins? Two guidelines offer different answers

When it comes to using statins to prevent a first heart attack or stroke, one leading US guideline recommends the drugs to 9 million more people than the other, according to a study published today in the Journal of the American Medical Association.

This leaves experts debating over who should get these cholesterol-lowering drugs when it comes to 40- to 75-year-olds with no history of cardiovascular problems.

“There’s generally confusion on who should be getting statins,” said Michael Pencina, one of the study’s authors and a professor of biostatistics and bioinformatics at the Duke Clinical Research Institute. “I don’t think we have the perfect guideline yet.”

The first recommendation — put out in 2013 by the American College of Cardiology and the American Heart Association — covers 26.4 million Americans, the study estimated. This recommendation is based partly on a 10-year risk of stroke or heart disease, which can be plugged into a risk calculator. People over 40 with at least a 7.5% risk of these conditions are included in the guidelines.

The US Preventive Services Task Force (USPSTF), however, released its own recommendation last year. Those who stand to benefit most from preventive statins, they said, have at least one other risk factor — such as hypertension, diabetes or smoking — in addition to a 10% risk on the same calculator. These guidelines cover a more conservative 17.1 million Americans.

“That’s a major change,” said Pencina.

Over one in five Americans between the ages of 40 and 75 already take a statin to prevent an initial heart attack or stroke, the study estimated. Following either of the guidelines consistently would add millions to that list, and the ACC/AHA recommendation in particular would more than double it.

Pencina said that much of the difference — 9.3 million people — includes those under 60 and those with diabetes. Some of these people may have a low 10-year risk, he said, but a relatively high 30-year risk.

The guidelines “highlight many, many important similarities much more than it highlights some small differences,” said Dr. Don Lloyd-Jones, a spokesperson for the AHA and a professor of preventive medicine at Northwestern University Feinberg School of Medicine.

“Both guidelines start with the same concepts,” he said. “The difference is how they look at the evidence.”

USPSTF chair Dr. Kirsten Bibbins-Domingo agrees.

“While there are some variations among the major guidelines on when to use statins, all of the guidelines recognize the important role that these medications can play in preventing heart attacks and strokes,” she said.

Pencina’s study was funded by the Duke Clinical Research Institute. However, several of the study’s authors reported receiving separate grants and fees from the ACC, the AHA and various pharmaceutical companies. A number of these companies manufacture statins and other lipid-lowering drugs.

The study does not estimate what the effects of either recommendation would be — such as how many heart attacks or strokes would be prevented, or what the harms and costs would be.

But some health experts have criticized both recommendations for inflating the benefits, which they say could push doctors to over-prescribe the drugs, leading to minimal rewards, a hefty price tag and potential side effects.

“People have a very exaggerated idea of the benefits,” said Dr. Rita Redberg, a professor of medicine at University of California, San Francisco and the editor-in-chief of the journal JAMA Internal Medicine.

Numbers game

Critics of the guidelines say that most people who take statins for primary prevention — meaning, to prevent a first stroke or heart attack — don’t actually benefit from it, but they could be exposed to side effects such as an increased risk of diabetes, muscle pain, cognitive problems and fatigue.

This is different from secondary prevention — the use of statins to prevent heart attacks and strokes in people who have already had one. Redberg said the evidence for this is much stronger.

Out of 100 people taking primary preventive statins for five years, “the best estimates are that one or two people will avoid a heart attack, and none will live longer, by taking statins,” Redberg said.

To prevent just one death from any cause, 250 people would need to take statins for one to six years, according to the USPSTF’s analysis.

Some studies have found no overall mortality benefit for using statins preventatively in at-risk groups. Other research has taken aim at the risk calculator itself, saying that it overestimates the likelihood of heart disease in real life.

“We’ve seen a number of groups in which (the risk calculator) performs extremely well,” said the Heart Association’s Lloyd-Jones.

Lloyd-Jones said that the current risk estimator was “a huge step forward” in that it accounts for women and African Americans, who have often been overlooked in large-scale health surveys. The 7.5% threshold used by the AHA is based heavily on clinical trial data, he said.

“These risk scores were never intended to be perfect,” Lloyd-Jones said. “They’re there to start a conversation, not to write a prescription.”

Company ties

Beyond the data, some health experts have questioned the industry forces behind these studies.

A number of experts who worked on the ACC/AHA guidelines had financial links to drug companies, which they disclosed publicly. No conflicts of interests were reported by the authors of the USPSTF guidelines, but nearly all of the trials they included in their analysis were sponsored by industry, according to Redberg, who stressed this point in a January editorial in the journal she oversees.

“The ACC did not follow its own conflict of interest guidelines,” she said.

Studies funded by the pharmaceutical industry tend to find drugs to be more effective than independently funded studies, according to a Cochrane review published in February. Redberg also said that some raw data on statins have not been publicly released, and the data on side effects can be scattered and inconsistent.

“If you don’t ask about muscle weakness in a study, you’re not going to report it,” she said.

Pencina said that if all experts with industry ties were ruled out, guideline committees might have a hard time finding the most qualified minds. He added that many studies would be difficult to fund without money from pharmaceutical companies.

“We have the scientific freedom to do whatever we think is necessary,” he said. “I don’t have reasons to doubt the quality of the data that these studies are providing.”

But Redberg said that there are plenty of experts without conflicts of interest, which is important to keep in mind when considering top-selling drugs like statins.

“It’s billions of dollars here,” she said. “You can’t ignore that.”

The market for statins extends far beyond just the United States, experts say, and some countries have their own guidelines, as well.

For example, a leading UK organization, the National Institute for Health and Care Excellence, lowered its 10-year risk threshold from 20% to 10% in 2014, making statins more widely available in an effort to combat heart disease.

The AHA’s Lloyd-Jones agreed that knowing where research and guidelines come from is important. He said that panels like ACC/AHA rigorously vet anyone who serves on the panel.

“The purpose of the ACC/AHA, the purpose of USPSTF is not to create a healthy pharmaceutical industry. It’s to create better care for our patients,” Lloyd-Jones said.

Lloyd-Jones said that for the upcoming 2018 ACC/AHA panel, there would be “no conflicts allowed, period.”

He added, “Having been a member of the guidelines panel in 2013 … the data are so overwhelming that it would’ve been hard for us to come to any other conclusion.”

Starting a conversation

Because Redberg has been outspoken against the wide use of statins for primary prevention, she said she regularly receives emails from people who are “miserable” taking statins. She also recalled a fellow physician who forgot to take his pills on a business trip. The doctor realized he had been developing memory issues, she said, “and suddenly, everything was clear.”

But Redberg, Lloyd-Jones and other health experts do agree on one thing: No pill should replace a healthy diet, exercise and avoiding smoking.

“The sooner you start to try to prevent (heart disease) … the more effective you’ll be at reducing that risk,” Lloyd-Jones said, adding that for some people, safe and effective medications could be part of that plan.

Still, these guidelines are not sweeping rules that patients must follow, he said; they are a way for people to start a conversation with their doctors.

“Since heart attacks and strokes are by far our leading cause of death and disability, I’m not sure there are much more important things you’d want to talk to your primary care doctor about,” Lloyd-Jones said.

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NYC Uber drivers could soon start getting tips

New York City is on its way to mandating that Uber allow tips.

On Monday, the Taxi and Limousine Commission — which regulates yellow cabs and for-hire vehicles — said will propose a rule requiring Uber and similar services to enable tipping in their apps.

That’s according to a letter that was sent from deputy commissioner Christoper Wilson to the Independent Drivers Guild on Monday and viewed by CNNTech.

IDG, which formed last May, is a coalition of 50,000 drivers for companies like Uber, Lyft and Juno. It said tipping is a top concern among its drivers.

Lyft has supported tipping since its early days, but Uber has repeatedly refused to include this option, citing a “hassle-free” experience that’s better for both drivers and riders.

IDG raised the concern with Uber in June. After making no headway, it proposed a petition to the TLC in February to try to force Uber’s hand.

IDG founder Jim Conigliaro Jr. estimates that drivers could make $300 million more a year if tipping practices for yellow cabs in NYC are applied to Uber rides.

“New York City’s professional drivers have traditionally depended on gratuities for a substantial portion of their income. Cuts to driver pay across the ride-hail industry has made tipping income more important than ever,” said Conigliaro in a statement. “The exploitation of ride-hail drivers must end and this is an important first step.”

Conigliaro said that Uber’s “big excuse” has been that tipping complicates the service’s “ease of use.” But he said there are ways to make the process “as seamless as it is right now.”

“People do want to tip,” he said. “They actually feel uncomfortable when they get out of the car and don’t tip the driver.”

In a statement sent to CNNTech, Uber said that it has “not seen the proposal.”

“[We] look forward to reviewing it,” Uber said, adding that it is “always striving to offer the best earning opportunity for drivers and we are constantly working to improve the driver experience.”

Uber said that’s the reason it has partnered with IDG, an affiliate of the International Association of Machinists and Aerospace Workers Union, to make sure its policies support drivers. IDG is the only organized group of drivers that meets regularly with Uber management to advocate for drivers.

It will be some time before drivers start seeing any benefits of Monday’s announcement. The TLC said it will propose the rule by July. It must then be certified by the NYC Law Department and publicly posted for a 30 day comment period. At that point, a final rule is posted and then voted on by the TLC board of commissioners.

“We’ll follow this all the way through to make sure it does become a rule,” said Conigliaro.

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Microsoft says it’s patched flaws exposed in leak of NSA hacks

On Friday, the Shadow Brokers hacking group published a cache of documents revealing Windows hacking tools allegedly belonging to the NSA. But Microsoft said it has already patched the flaws.

Previous updates protect customers from the vulnerabilities listed in the dump, the company said.

“We’ve investigated and confirmed that the exploits disclosed by the Shadow Brokers have already been addressed by previous updates to our supported products,” a Microsoft spokesperson told CNNTech. “Customers with up-to-date software are already protected.”

Microsoft said three exploits don’t reproduce on “supported platforms,” meaning people should upgrade to Windows 7 or a newer version.

The documents published by the hacking group list exploits for Windows servers and Windows computers. Researchers were able to replicate some of the hacks. In a blog post late Friday, Microsoft listed specific updates — including one released as recently as March — that protect users against the vulnerabilities.

Windows users should make sure their software is up-to-date. Microsoft offers Auto Update to tell you when updates are available for your machine. Here’s how to turn it on.

Matthew Hickey, founder of Hacker House whoo reproduced the hacks, said businesses who delay patches for operational purposes should make sure their software is up to date.

“Consumers should ensure auto updates ran on desktops and that the personal firewall is enabled to prevent attacks,” Hickey told CNNTech in an email.

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New report says tech companies spy on students in school

Kids aren’t the only ones learning in the classroom. Turns out, tech companies have access to a lot of student data that makes parents and teachers increasingly uncomfortable.

Tech companies spy on students through data collection, and many educational technology firms don’t have proper protections in place to ensure privacy, according to a new report from the Electronic Frontier Foundation (EFF).

Laptops, tablets and wearable devices collect information on individual students — from birth dates to what they look at online.

The EFF investigated 152 tech services currently used in classrooms and found they “were lacking in encryption, data retention and data sharing policies.”

“We are hoping by documenting these concerns, we can drive home the point that these are concerns to be taken seriously,” EFF researcher Gennie Gebhart told CNNTech.

The organization surveyed over 1,000 people around the country, and while the report is not a comprehensive representation of school systems, it shows that parents, teachers and students are concerned about the state of privacy.

A main concern, the report found, is parents aren’t always aware of what apps their kids are using, or what information they collect.

Internet users are already tracked through the news they read, the stuff they buy and the videos they watch. That data is used to create personalized ads that are targeted at each individual user. Parents are concerned that edtech companies might use their kids’ emails, personal information or interests in similar ways.

For instance, fitness trackers are used in schools to track kids’ PE performance. Educational fitness firm IHT (which isn’t mentioned in the EFF report) partners with Adidas and monitors student activity like heart rate and fitness level. Its privacy policy says it makes some personal information available to third-parties “or that help IHT market to customers.”

Schools rely too much on “privacy by policy” to protect student information, the report found. While many edtech companies have policies in place to say they won’t sell or share data, historically, those policies have failed.

In 2014, 20 million student records from the college and job planning platform ConnectEDU were sold to other companies without first alerting users, violating its own data use policy.

“In security, if you are trusting someone not to break the rules, you’re not really defending or protecting anything,” said Jessy Irwin, a security educator unaffiliated with the report who advocates for more privacy in the classroom.

There are federal privacy laws that regulate student data, but critics say they haven’t evolved with technology. Some states have enacted their own rules about student data. California, Colorado and Connecticut, for instance, prohibit companies from using student data for targeted advertising.

When it comes to using a new website or app, Gebhart said teachers frequently have free rein to use things on the internet. Many parents who responded to the survey said they’re not made aware, or have little say, over what schools are using.

“Education is always 10 to 15 years behind technologically,” Irwin said. “But we’re seeing a lot of businesses get embarrassed by not having solid security practices, and schools are going to have to figure that out, too.”

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