Why Obama is pushing for stimulus in 'fiscal cliff' deal

How about a little government economic stimulus?


That may sound incongruous considering the budget deficit and the push from Republicans to cut government spending.


But President Obama’s first offer to avoid going over the "fiscal cliff" holds out the hope of at least some stimulus. This would include extending the 2 percentage point Social Security payroll tax cut, boosting a tax incentive to businesses, establishing a $50 billion bank for long-term infrastructure projects, and extending unemployment benefits.


RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered


The total bill: about $255 billion out of the federal government's pocket – an amount the GOP would likely say needs to be offset by spending cuts elsewhere.


The argument in favor of such stimulus? The tax measures, at least, could minimize the drag on the economy from Mr. Obama's proposed tax increases on the wealthy.


“The increases in the top two income tax brackets would put a drag on consumption, so I think, from the Obama point of view, the spending or tax cuts are designed to offset that drag to consumption,” says Michael Brown, an economist at Wells Fargo Securities in Charlotte, N.C.


But to some budget experts, Obama’s list seems more like an opening round of negotiations, where he has asked for a lot more than he will get.


“It looks to me like these are bargaining chips,” says Pete Davis of Davis Capital Ideas, which advises Wall Street firms. “Even most Democrats had given up on the prospect of getting the payroll tax cut extended.”


Mr. Davis considers the odds of most of the stimulus proposals passing Congress “very low.”


What's needed most, say others, is just buckling down and negotiating an end to the fiscal cliff. “Cancelling the fiscal cliff is economic stimulus,” says Stan Collender, a budget expert and partner at Qorvis Communications in Washington.


If Obama's stimulus were passed, however, here is a look at the impact the four elements might have.


SOCIAL SECURITY PAYROLL TAX CUT


The largest chunk of the Obama plan is the extension of the payroll tax cut. This is the money that comes out of an individual’s paycheck as a contribution to Social Security. Two years ago, in an effort to stimulate the economy, Congress decreased the individual contribution from 6.2 percent to 4.2 percent. The employer’s contribution of 6.2 percent remained unchanged.


The Obama administration estimates extending the cuts would cost the government as much as $115 billion in revenue.


The argument for extending the tax cut is that it helps lower-income workers who live paycheck to paycheck. “The difference in the paycheck might be the ability to pay the electric bill for someone or the chance to go to a sit-down restaurant once a month,” says Chris Christopher, an economist at IHS in Lexington, Mass.


The argument against continuing the cut is that it is weakening the Social Security Trust Fund. In order to make up for the loss of contributions, the government taps the general tax revenues, says Pamela Tainter-Causey, a spokeswoman for the National Committee to Preserve Social Security and Medicare.


“It sets up Social Security to compete for funding from the general fund,” she says. “It’s a perfect set up for people who are gunning for the program and claim we can’t afford it now.”


BUSINESS TAX INCENTIVE


The second largest program proposed by Obama would be the extension of accelerated depreciation for business, which would cost the US Treasury about $65 billion in fiscal year 2013, according to the Congressional Budget Office.


Two years ago, business was allowed to accelerate the write-off of 100 percent of its spending on certain capital equipment. Capital spending on equipment and computer software soared by 18.3 percent in 2011.


Then, this year, the benefit to business was cut in half to 50 percent. Capital spending sank in the third quarter by 2.7 percent compared with the same quarter the prior year. With business interest in using the tax break diminishing, economist Gregory Daco of IHS says “it’s a goner.”


INFRASTRUCTURE BANK


Obama has also proposed a $50 billion infrastructure bank. The idea is to fund roads, bridges, tunnels and other large projects that last for a long period of time. “At the moment the funding is done on a cash basis – you have to pay for it as you build it,” says Mr. Collender.


Democrats have been trying to get Congress to fund the bank for the past 10 years, he says. “It does not have a chance of getting through the House," which is controlled by the Republicans, says Mr. Collender.


UNEMPLOYMENT BENEFITS


And, finally, Obama wants to extend unemployment benefits, which would cost about $30 billion.


Under current law, if Congress does nothing, the maximum number of weeks in which an individual could receive jobless will drop to 26 from the current 73 weeks for states with unemployment over 9 percent and 63 weeks for states with unemployment over 7 percent.


If Congress does nothing about the program during the lame-duck session, some 2.1 million jobless will lose their benefits in the first week of January, says Judy Conti, a federal advocacy coordinator at the National Employment Law Project (NELP) in Washington. By the end of the March, she says, another 900,000 people will lose their benefits.


“Forty percent of the unemployed are long term unemployed,” she says. “They have been out of the workforce for over six months.”


RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered



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Oliver Stone, Benicio del Toro visit Puerto Rico












SAN JUAN, Puerto Rico (AP) — Benicio Del Toro didn’t wait long to collect on a favor that Oliver Stone owed him for working extra hours on the set of his most recent movie, “Savages”, released this year.


The favor? A trip to Del Toro‘s native Puerto Rico, which Stone hadn’t visited since the early 1960s.












“I told him, you owe me one,” Del Toro said with a smile as he recalled the conversation during a press conference Friday in the U.S. territory, where he and Stone are helping raise money for one of the island’s largest art museums.


Del Toro, wearing jeans, a black jacket and a black T-shirt emblazoned with the name of local reggaeton singer Tego Calderon, waved to the press as he was introduced.


“Hello, greetings. Is this a press conference?” he quipped as he and Stone awaited questions.


Both men praised each other’s work, saying they would like to work with each other again.


“I deeply admire him as an actor, the way he thinks, the way he expresses himself,” Stone said. “Of all the actors I’ve worked with, he’s the most interesting.”


Stone said Del Toro always delivers surprises while acting, even when it’s as something as subtle as certain gestures between dialogue.


“I think Benicio is the master of keeping you watching,” he said.


Stone said he enjoys meeting up with Del Toro off-set because he’s one of the few actors in Hollywood who can talk about something other than movies.


“He is very interested in the world around him,” Stone said, adding that the conversations sometimes center around politics and other topics.


Del Toro declined to answer when asked what he thought about Puerto Rico’s referendum earlier this month, which aimed to determine the future of the island’s political status. He said the results did not seem to point to a clear-cut outcome.


Del Toro then said he would like the island’s movie business to grow, especially in a way that would encourage learning.


“I’m talking about movies in an educational sense, as a way to discover other parts of the world,” he said. “Create a film class. You’ll see, kids won’t skip it.”


Del Toro also shared his thoughts on being a father after having a daughter with Kimberly Stewart in August 2011.


He said the girl is learning how to swim and is discovering the world around her.


“She has her own personality,” Del Toro said. “She’s not her mother. She’s not me.”


Both Del Toro and Stone are expected to remain in Puerto Rico through the weekend to raise money for the Art Museum of Puerto Rico, which is hosting its annual movie festival and will honor Stone’s movies.


Museum curator Juan Carlos Lopez Quintero said the money raised will be used to enhance the museum’s permanent collection, especially with Puerto Rican paintings from the 19th century and early 20th century.


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Average wireless bill increased 7% in 2012 , 70% of subscribers now own smartphones












We all love our smartphones, but they are a costly addiction to support. According to Consumer Reports, American wireless subscribers saw their wireless bills increase by 7% between 2011 and 2012, and the big culprit is the continued proliferation of smartphones. Overall, 70% of wireless subscribers who took part in Consumer Reports’ survey owned smartphones this year, up from 50% in 2011. As the publication notes, “upgrading from a plain cell phone at a major carrier isn’t cheap” since “you have to buy the smart phone itself (usually $ 100 to $ 400 when signing a two-year contract) and fork over $ 70 to $ 110 a month for a plan with data service… a lot more than a basic phone plan, which generally costs $ 40 to $ 70 a month.”


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The Economy of Surgery












When I was twelve, my sister and I accompanied my grandparents to their annual yoga retreat in the hilly ranges of southern India. We had never been before, but the summer heat was particularly blistering that year, so we persuaded our grandparents to take us along. I envisioned a blissful two-week vacation in a photogenic little hamlet, nestled among tea plantations, in temperatures that were thirty degrees cooler than on the mainland. It was just that, and yet, it was even less complicated than that.The mean age of folk at the retreat was 67. Bells sounded every morning at 3:30am, and everyone filed out of their cabins and to a little gymnasium in the center of the dwelling, where we all meditated for two hours to the sounds of sitar music and transcendental humming. Meals were served at strict hours three times a day, and consisted of boiled vegetables and grains, with not a lick of salt or spice. The library in the middle of this utopian dwelling held only spiritual and philosophical texts, not the Nancy Drew or Hardy Boys I hoped for. In the afternoons, there were a variety of classes offered – cooking lessons, devotional classes, music and instrumental classes, and yoga. My sister and I stopped by the latter occasionally, and were always put to shame by octogenarians holding themselves up in impossible poses, such as balancing their entire habitus on the tips of their fingers. I journaled in the evenings, writing each day about a new facet of human life that I’d observed. In the absence of stimulus, my dreams grew vivid and exceedingly detailed.Over the course of the two weeks, my sister and I grew quiet and reflective. It was then that we began an important switch in our minds, something that has lasted to this day. We began to see value in living leanly, economically, functionally. We began to separate needs from wants, and to discard the ornamentation.*Third year of medical school has finally brought me around to my surgery rotation: three months of waking up at 4am, stuffing my white coat pockets to the brim with gauze and tape, retracting skin and fat during long abdominal surgeries, and practicing suturing techniques on pig’s feet procured at the local Stop&Shop grocery market. It’s fast and exhilarating, and deeply satisfying. I was skeptical when I first heard that my preceptor’s favorite procedure of all time was draining a deep-seated abscess. But when I saw it being done in clinic, how a single stab of the thing blade led to the gushing of what felt like liters of pus, I couldn’t help but agree. What a joy to just go in and fix a problem so dramatically, reconstruct a failing human body in a matter of hours!During orientation on the first day of the rotation, two residents sat down and gave my classmates and me some hard advice. Surgery is a demanding rotation, they said, and it reflects the demanding residency ahead that awaits the select few. We could expect to go in while it is still dark out, and leave after the sun had set, almost every day. Residents and attendings can be rough around the edges, and may be gruff with you, even kick you out of their operating room if they feel like it, but it’s not personal. Or even if it is, we’ve got to shrug it off and keep it moving. Gone are the days of noon conferences and luxurious afternoon didactics, with their promise of free lunches and coffee. We were to eat when we can, sit when we can, sleep when we can.After an hour of such grim prognostications, my classmates and I took a break and debriefed our feelings with each other outside the bathrooms. Some were giggling nervously with panicked eyes, but most looked inspired. I too felt like I had voluntarily signed up for a warrior training program, and was feeling pretty zen about it. I saw it as a character-building experience: surgery was the time to cut out the silly frills, and embrace a leaner, meaner way of living. It was time to lose the pretty business casual outfits and fancy footwear of internal medicine, and trade them in for utilitarian scrubs and clogs. It promised to be a time of talking less and getting things done.*During a recent health management class, my classmates and I discussed the case of a medical center based in Seattle that benefited from industry principles gleaned from, of all places, the Toyota car manufacturing company. Toyota’s revolution as a manufacturing miracle began in the supply-scarce post-WWII Japan, when management was confronted with the challenge of meeting customer needs in the face of little spare capital to hold inventory as a buffer to fluctuating demand. The company then developed a set of principles focused on cutting muda or waste, while pursuing kaizen, or continuous self -improvement by way of complete intolerance for redundancy. Toyota integrated these principles into every step of production and management.For instance, Toyota emphasizes innovation on the shop floor by frontline workers to solve problems in production in real time. If a problem is discovered that cannot be fixed within the production cycle time, workers pull a cord that halts the entire assembly line and brings a senior supervisor to the scene. The management aggressively seeks ideas for improvement from employees, resulting in an average yield of close to a million ideas annually, 90% of which go on to be implemented.Analysts attribute Toyota’s success to its emphatic optimization of flow – information flow, physical flow of parts, and overall production flow, via standardized processes and continuous improvement. Standardized processes are ones that are streamlined to eliminate aberrations and unplanned redundancies. Waste, measured even in the seconds, is simply not tolerated, forcing a redesign of processes, again and again, which any employee can take on.In 2004, Toyota surpassed Ford Motors to become the world’s second-largest manufacturer of cars and trucks, surpassing the latter consistently in quality, dependability and value assessments. In turn, Ford began to take cues from Toyota, transforming its assembly-line system to similarly cut out waste.*There are two kinds of people in the world: surgeons, and everyone else.Really, what does it mean to live leanly? I rediscovered it in this rotation. A life in surgery isn’t for everyone, but such an experience is something I truly feel everyone should have. These past 6 weeks have been teaching me to think fast, move fast. They’ve been teaching me to suffice with less, be it food, sleep, or words of appreciation. They’ve been teaching me to appreciate the vulnerabilities of the human body – for no matter how exhausted or sleep-deprived I may feel, actually laying hands on the more tangible deficits of another’s is always startling and humbling. The end result is a beautiful dance, for surgeons and their assistants, working with their hands, rediscovering the grace of human movement, bring art back into medicine.I never leave the OR thinking that more is better. I watch instruments fly, I watch the players push and pull, cut and stitch, wash and dry, and I think about things like symmetry, precision, and above all, the beauty of economy.


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Stephen King and Steven Spielberg’s “Under the Dome” gets series order from CBS












LOS ANGELES (TheWrap.com) – “Under the Dome” has landed under the wing of CBS.


The network has given a 13-episode, straight-to-series order for the project, an adaptation of the Stephen King novel of the same name.












The series will premiere in summer 2013.


King will executive-produce, along with Steven Spielberg, whose Amblin Television will produce the series in association with CBS Television Studios. Neal Baer, Justin Falvey, Darryl Frank, Stacey Snider and Brian K. Vaughan are also executive-producing. Niels Arden Oplev (“The Girl With the Dragon Tattoo”) will direct the first episode.


The series will revolve around a small New England town that is suddenly and inexplicably sealed off from the rest of the world by an enormous transparent dome. The town’s inhabitants must deal with surviving the post-apocalyptic conditions while searching for answers to what this barrier is, where it came from and if and when it will go away.


“This is a great novel coming to the television screen with outstanding auspices and in-season production values to create a summer programming event,” CBS Entertainment president Nina Tassler said. “We’re excited to transport audiences ‘Under the Dome’ and into the extraordinary world that Stephen King has imagined.”


Showtime, which is owned by CBS, had previously been developing the project.


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U.N. vote recognizes state of Palestine

UNITED NATIONS (Reuters) - The 193-nation U.N. General Assembly on Thursday overwhelmingly approved the de facto recognition of the sovereign state of Palestine after Palestinian President Mahmoud Abbas called on the world body to issue its long overdue "birth certificate."


The U.N. victory for the Palestinians was a diplomatic setback for the United States and Israel, which were joined by only a handful of countries in voting against the move to upgrade the Palestinian Authority's observer status at the United Nations to "non-member state" from "entity," like the Vatican.


Britain called on the United States to use its influence to help break the long impasse in Israeli-Palestinian peace talks. Washington also called for a revival of direct negotiations.


There were 138 votes in favor, nine against and 41 abstentions. Three countries did not take part in the vote, held on the 65th anniversary of the adoption of U.N. resolution 181 that partitioned Palestine into separate Jewish and Arab states.


Thousands of flag-waving Palestinians in the West Bank and the Gaza Strip set off fireworks and danced in the streets to celebrate the vote.


The assembly approved the upgrade despite threats by the United States and Israel to punish the Palestinians by withholding funds for the West Bank government. U.N. envoys said Israel might not retaliate harshly against the Palestinians over the vote as long as they do not seek to join the International Criminal Court.


If the Palestinians were to join the ICC, they could file complaints with the court accusing Israel of war crimes, crimes against humanity and other serious crimes.


U.S. Secretary of State Hillary Clinton called the vote "unfortunate and counterproductive," while the Vatican praised the move and called for an internationally guaranteed special status for Jerusalem, something bound to irritate Israel.


The much-anticipated vote came after Abbas denounced Israel from the U.N. podium for its "aggressive policies and the perpetration of war crimes," remarks that elicited a furious response from the Jewish state.


"Sixty-five years ago on this day, the United Nations General Assembly adopted resolution 181, which partitioned the land of historic Palestine into two states and became the birth certificate for Israel," Abbas told the assembly after receiving a standing ovation.


"The General Assembly is called upon today to issue a birth certificate of the reality of the State of Palestine," he said.


Israeli Prime Minister Benjamin Netanyahu responded quickly, condemning Abbas' critique of Israel as "hostile and poisonous," and full of "false propaganda.


"These are not the words of a man who wants peace," Netanyahu said in a statement released by his office. He reiterated Israeli calls for direct talks with the Palestinians, dismissing Thursday's resolution as "meaningless."


ICC THREAT


A number of Western delegations noted that Thursday's vote should not be interpreted as formal legal recognition of a Palestinian state. Formal recognition of statehood is something that is done bilaterally, not by the United Nations.


Granting Palestinians the title of "non-member observer state" falls short of full U.N. membership - something the Palestinians failed to achieve last year. But it does have important legal implications - it would allow them access to the ICC and other international bodies, should they choose to join.


Abbas did not mention the ICC in his speech. But Palestinian Foreign Minister Riyad al-Maliki told reporters after the vote that if Israel continued to build illegal settlements, the Palestinians might pursue the ICC route.


"As long as the Israelis are not committing atrocities, are not building settlements, are not violating international law, then we don't see any reason to go anywhere," he said.


"If the Israelis continue with such policy - aggression, settlements, assassinations, attacks, confiscations, building walls - violating international law, then we have no other remedy but really to knock those to other places," Maliki said.


In Washington, a group of four Republican and Democratic senators announced legislation that would close the Palestinian office in Washington unless the Palestinians enter "meaningful negotiations" with Israel, and eliminate all U.S. assistance to the Palestinian Authority if it turns to the ICC.


"I fear the Palestinian Authority will now be able to use the United Nations as a political club against Israel," said Republican Senator Lindsey Graham, one of the sponsors.


Abbas led the campaign to win support for the resolution, which followed an eight-day conflict this month between Israel and Islamists in the Gaza Strip, who are pledged to Israel's destruction and oppose a negotiated peace.


The vote highlighted how deeply divided Europe is on the Israeli-Palestinian conflict.


At least 17 European nations voted in favor of the Palestinian resolution, including Austria, France, Italy, Norway and Spain. Abbas had focused his lobbying efforts on Europe, which supplies much of the aid the Palestinian Authority relies on. Britain, Germany and many others chose to abstain.


The traditionally pro-Israel Czech Republic was unique in Europe, joining the United States, Israel, Canada, Panama and the tiny Pacific Island states Nauru, Palau, Marshall Islands and Micronesia in voting against the move.


'HOPE SOME REASON WILL PREVAIL'


Peace talks have been stalled for two years, mainly over Israeli settlements in the West Bank, which have expanded despite being deemed illegal by most of the world. There are 4.3 million Palestinians in the West Bank and Gaza.


After the vote, U.S. Ambassador to the United Nations Susan Rice called for the immediate resumption of peace talks.


"The Palestinian people will wake up tomorrow and find that little about their lives has changed save that the prospects of a durable peace have only receded," she said.


She added that both parties should "avoid any further provocative actions in the region, in New York or elsewhere."


Palestinian Prime Minister Salam Fayyad said he hoped all sides would use the vote to push for new breakthroughs in the peace process.


"I hope there will be no punitive measures," Fayyad told Reuters in Washington, where he was attending a conference.


"I hope that some reason will prevail and the opportunity will be taken to take advantage of what happened today in favor of getting a political process moving," he said.


Britain's U.N. ambassador, Mark Lyall Grant, told reporters it was time for recently re-elected U.S. President Barack Obama to make a new push for peace.


"We believe the window for the two-state solution is closing," he said. "That is why we are encouraging the United States and other key international actors to grasp this opportunity and use the next 12 months as a way to really break through this impasse."


(Additional reporting by Andrew Quinn in Washington, Noah Browning in Ramallah, Jeffrey Heller in Jerusalem, Robert Mueller in Prague, Gabriela Baczynska and Reuters bureaux in Europe and elsewhere; Editing by Eric Beech and Peter Cooney)


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Noisy city: Cacophony in Caracas sparks complaints












CARACAS, Venezuela (AP) — This metropolis of 6 million people may be one of the world’s most intense, overwhelming cities, with tremendous levels of crime, traffic and social strife. The sounds of Caracas‘ streets live up to its reputation.


Stand on any downtown corner, and the cacophony can be overpowering: Deafening horns blast from oncoming buses, traffic police shrilly blow their whistles and sirens shriek atop ambulances stuck in bumper-to-bumper traffic.












Air horns routinely used by bus drivers are so powerful they make pedestrians on crosswalks recoil, and can even leave their ears ringing. Loud salsa music blares from the windows of buses, trucks with old mufflers rumble past belching exhaust, and “moto-taxis” weave through traffic beeping high-pitched horns.


Growing numbers of Venezuelans are saying they’re fed up with the noise that they say is getting worse, and the numbers of complaints to the authorities have risen in recent years.


One affluent district, Chacao, put up signs along a main avenue reading: “A honk won’t make the traffic light change.”


“The noise is terrible. Sometimes it seems like it’s never going to end,” said Jose Santander, a street vendor who stands in the middle of a highway selling fried pork rinds and potato chips to commuters in traffic.


Prosecutor General Luisa Ortega recently told a news conference that officials have started “putting an increased emphasis on promoting peaceful coexistence” by punishing misdemeanors such as violations of anti-noise regulations and other minor crimes. That effort has translated into hundreds of noise-related cases in recent years.


Some violators are ordered to perform community service. For instance, two young musicians who were recently caught playing loud music near a subway station were sentenced to 120 hours of community service giving music lessons to students in public schools.


Others caught playing loud music on the street have been charged with disturbing the peace after complaints from neighbors. Fines can run as high as 9,000 bolivars, or $ 2,093.


On the streets of their capital, however, Venezuelans have grown used to living loudly. The noisescape adds to a general sense of anarchy, with many drivers ignoring red lights and blocking intersections along potholed streets strewn with trash.


“This is something that everybody does. Nobody should be complaining,” said Gregorio Hernandez, a 23-year-old college student, as he listened to Latin rock songs booming from his car stereo on a Saturday night in downtown Caracas. “We’re just having fun. We’re not hurting anybody.”


Adding to the mess is the country’s notoriously divisive politics, which regularly fill the streets with marches and demonstrations.


On many days, the shouts of protesters streaming through downtown can be heard from blocks away, demanding pay hikes or unpaid benefits.


And the sporadic crackling of gunfire in the slums can be confused for firecrackers tossed by boisterous partygoers.


It’s difficult to rank the world’s noisiest cities because many, including Venezuela’s capital, don’t take measurements of sound pollution, said Victor Rastelli, a mechanical engineering professor and sound pollution expert at Simon Bolivar University in Caracas. But Rastelli said he suspects Caracas is right up there among the noisiest, along with Sao Paulo, Mexico City and Mumbai.


Excessive noise can be more than simply an annoyance, Rastelli said. “This is a public health problem.”


Dr. Carmen Mijares, an audiologist at a private Caracas hospital, said she treats at least a dozen patients every month for hearing damage caused by prolonged exposure to loud noises.


“Many of them work in bars or night clubs, and their maladies usually include temporary hearing loss and headaches,” Mijares said. For others, she said, the day-to-day noise of traffic, car horns and loud music can exacerbate stress and sleeping disorders.


Several cities have successfully reduced noise pollution, said Stephen Stansfeld, a London psychiatry professor and coordinator of the European Network on Noise and Health.


One of the most noteworthy initiatives, Stansfeld said, was in Copenhagen, Denmark, where officials used sound walls, noise-reducing asphalt and other infrastructure as well as public awareness campaigns to fight noise pollution.


But such high-tech solutions seem like a remote possibility in Caracas, where streets are literally falling apart and aging overpasses regularly lack portions of their guard rails. Prosecutors, angry neighbors and others hoping to fight the noise will have to persuade Venezuelans to do nothing less than change their loud behavior.


For Carlos Pinto, however, making noise is practically a political right.


The 26-year-old law student and his friends danced at a recent street party to house music booming from woofers in his car’s open trunk, with neon lights on the speakers that pulsed to the beat.


When asked about the noise, he answered: “We will be heard.”


___


AP freelance video journalist Ricardo Nunes contributed to this report.


___


Christopher Toothaker on Twitter: http://twitter.com/ctoothaker


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Apple overcomes last hurdle, iPhone 5 cleared for sale in China as Android continues to dominate












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Human stool treatment upends race to treat colon germ












(Reuters) – Drugmakers racing to develop medicines and vaccines to combat a germ that ravages the gut and kills thousands have a new challenger: the human stool.


For patients hit hardest by the bacterium Clostridium difficile, getting a “stool transplant” could become a standard treatment within just a few years. Just as blood banks and sperm banks are now commonplace, stool banks may soon dot the landscape.












About 3 million Americans are infected annually with the bacterium – also known as C. diff – which spreads mainly through hospitals, nursing homes and doctors’ offices.


Most people have no symptoms, but 500,000 – more than half of them 65 and older – develop abdominal cramps, fever, diarrhea and inflamed colons. As many as 30,000 Americans die each year from the bacterium, usually after recurrences of infection.


The infections are typically the result of taking antibiotics, which wipe out friendly bacteria in the colon that normally keep C. diff under control. Transplants of stool from screened donors – given by enema, colonoscopy or a tube down the throat – restore these bacteria.


Although the vast majority of C. diff infections occur in healthcare settings, more and more cases are occurring in younger adults and children who have not recently taken antibiotics or been hospitalized. They include people who take proton pump inhibitors – a leading class of heartburn drugs.


Costly treatments from Merck & Co and other drugmakers, and a vaccine from Sanofi, are on the horizon. But growing numbers of gastroenterologists are more excited about the use of human stool transplants, which in experimental settings have consistently cured 85 percent to 90 percent of patients who have had multiple episodes of C. diff.


“Until recently, fecal transplants have been on the fringes of mainstream medicine,” said Dr. Cliff McDonald, an epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC). “It could become the primary mode of therapy within a year or two for patients with multiple recurrences.”


Francie Williamson, a 32-year-old editor for the Cedar Rapids Gazette in Iowa, has been battling C. diff since giving birth in May and considers herself a prime candidate.


After several recurrences, she still suffers from cramping and diarrhea and is making another appointment with her doctor to see if she still has the germ.


“He’s done fecal transplants, like 10 of them. So I definitely want to have (that option) in my back pocket.”


WHEEL OF MISFORTUNE


The first recorded stool transplants were given in 1958 to four patients with inflamed colons. The procedures won more attention in the mid-1980s, when Australian gastroenterologist Thomas Borody began using them to treat his C. diff. patients.


Dr. Moshe Rubin, head of gastroenterology at New York Hospital Queens, said most patients prefer the simplicity of a pill or injection, but for those with multiple bouts the fecal transplants could become a mainstay treatment.


“This has to be tested in large numbers of people before you unleash it for such a widespread disease,” Rubin said.


C. diff medicines and vaccines could eventually claim total annual sales of $ 2 billion, according to Morningstar analyst David Krempa, or 10 times current sales.


Fecal transplants might initially be appropriate for patients who have had a third recurrence – or about 25,000 Americans each year, according to Dr. Sahil Khanna, a Mayo Clinic gastroenterologist. That number could rise as the procedure becomes more widely accepted, and pose perhaps the biggest threat to sales of Merck’s experimental drug, which is expected to target a similar patient group.


About 90 percent of C. diff patients initially treated with vancomycin, and 60 percent of those treated with another standard oral drug called metronidazole, recover within weeks. But 20 percent suffer recurrences, as surviving bacteria spores become activated or as patients become re-infected with spores that cling to clothing and furniture and can survive for months.


With each recurrence, risk of another rises, with more weight loss, diarrhea and fatigue. After a third recurrence, the risk of suffering a fourth is 60 percent to 70 percent.


“It’s a constant wheel of misfortune,” said Eric Kimble, a senior executive for Cubist Pharmaceuticals Inc, which is developing a C. diff treatment called CB-315.


GETTING OVER THE ‘ICK’ FACTOR


Fecal transplants have proved a godsend to such patients. They are given to those who have not benefited from metronidazole or vancomycin – or who have suffered repeat recurrences of C. Diff after being temporarily helped by the treatments.


In more than 100 of the experimental procedures performed by Dr. Christine Lee, the transplants cured the infections and prevented recurrences in 90 percent of patients, said the infectious disease physician at St. Joseph’s Healthcare (hospital) at McMaster University in Hamilton, Ontario.


“Their energy level and appetite bounce back within a week, sometimes within 48 hours,” Lee said. “They can’t believe how simple and effective the procedure is.”


In a five-minute bedside procedure, Lee introduces about 50 grams (1.75 ounces) of donated fecal matter into the rectum, using an inexpensive plastic plunger. A single procedure re-establishes the balance of bacteria.


Friends and family of patients, as well as doctors and nurses, provide without pay the stool used in Lee’s procedures. They are screened to ensure they do not have viruses, such as HIV or hepatitis C, or other pathogens that can be transmitted to patients. She said some donate stool on a regular basis, which can be used for a great number of patients.


Once transplants are approved by health regulators, Lee predicted, enema procedures will be less costly than two other delivery methods now used for stool transplants. They include colonoscopy, in which doctors sedate the patient and insert stool into the colon, or through a different procedure in which a plastic feeding tube is passed through the nose, down the throat and into the stomach.


In the meantime, gastroenterologists say doctors and hospitals can help prevent C. diff by being more restrained in the use of antibiotics and ensuring that hospital rooms are diligently cleaned with bleach wipes to kill C. diff spores.


MERCK, SANOFI TAKE AIM AT TOXINS


One of the best hopes for stopping C. diff, aside from fecal transplants, could be Merck’s injectable monoclonal antibody. In a mid-stage trial, 7 percent of patients had recurrences when taking the Merck product in combination with metronidazole or vancomycin. That compared with 25 percent of those receiving only standard therapy.


Merck’s drug works by disabling two toxins released by C. difficile that wreak havoc in the colon, and is meant to be taken alongside the standard treatments.


“Other drugs go after the bacteria, but there is nothing out there now that targets the toxins directly,” said Dalya Guris, Merck’s project leader for the medicine.


French drugmaker Sanofi is working on a vaccine that is not expected to become available for at least five years. It will be tested among high-risk individuals who expect to be hospitalized for elective surgeries or who plan to enter nursing homes.


“The intent of the vaccination is to prevent the first occurrence of symptoms of the disease” among those at highest risk, said Patricia Pietrobon, Sanofi’s project leader.


Merck and Sanofi declined to say how much they will spend to test their products, but costs of developing antibodies and vaccines can top $ 1 billion and $ 500 million, respectively, according to drugmakers.


The most effective approved drug against the first recurrence of C. diff is Dificid, from Optimer Pharmaceuticals Inc, introduced in May 2011. It is as effective as vancomycin in curing initial C. diff infections, and almost 50 percent better at preventing a first recurrence.


But Dificid has had modest sales because it costs about $ 3,000 for a 10-day course of treatment. That’s twice the cost of vancomycin and 300 times the cost of metronidazole.


Dificid could peak in 2016 with annual sales of $ 210 million, according to Cowen and Co.


Cubist, which co-markets Dificid in the United States, is testing its own drug CB-315 and expects it to be approved in 2016. Like Dificid, it is a narrow-spectrum antibiotic meant to attack C. difficile while sparing normal bowel bacteria.


Dr. Mark Pochapin, director of gastroenterology at NYU Langone Medical Center, said Merck’s anti-toxin approach might eliminate symptoms the same day of treatment. But he said fecal transplants have more appeal.


“They appear effective, balance the normal intestinal flora, are inexpensive and are safe when done with appropriate testing,” he said. “They will far and away revolutionize how we treat this disease.”


Many patients might benefit most from transplantation of their own stool, rather than relying on donors. They would include those undergoing chemotherapy or hip or knee replacements, all of which involve use of antibiotics, said the CDC’s McDonald.


People, he said, would set aside stools for processing into capsules that would be frozen and stored until needed.


Such “bacterial treatment” after antibiotics might eventually also lower the risk of developing asthma, allergy, obesity or other conditions that may be partly linked to loss of helpful bacteria, McDonald said.


“Look at it as a way to put people’s bacterial population back together again after antibiotics, like restoring Humpty Dumpty,” said McDonald.


(Reporting By Ransdell Pierson; Editing by Jilian Mincer, Edward Tobin, Martin Howell and Steve Orlofsky)


Medications/Drugs News Headlines – Yahoo! News


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‘The Inbetweeners’ Canceled by MTV












LOS ANGELES (TheWrap.com) – “The Inbetweeners” now falls solidly in the “canceled” camp.


MTV has decided not to go forward with a second season of the scripted series, which premiered in August and was an adaptation of a British sitcom of the same name.












“While we won’t be moving forward with another season of ‘The Inbetweeners,’ we enjoyed working with the show’s creators and such a talented, funny cast,” an MTV spokesperson told TheWrap in a statement.


The series starred Joey Pollari, Bubba Lewis, Zack Pearlman, Mark L. Young and Alex Frnka as a group of “inbetweeners” – that is, kids who fall somewhere between nerds and jocks on the spectrum of teenage cliques.


The “Inbetweeners” cancelation follows the dropping of the MTV scripted effort “I Just Want My Pants Back” in May after one season.


TV News Headlines – Yahoo! News


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