Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing ten years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

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ICC lets ComEd delay smart meters until 2015

The Illinois Commerce Commission on Wednesday approved ComEd's request to delay the installation of smart meters until 2015 but said it will revisit the issue in April when the utility is scheduled to file a progress report on the program.

Under massive grid modernization legislation, ComEd was supposed to begin installing smart meters this year, but the ICC cut the funds ComEd was expecting to receive under the program and the utility said it could no longer afford to install the meters that quickly. The two sides are battling in court in a process that could take years.

An administrative law judge, as well as several consumer advocacy groups, had recommended the commission not accept the delay.

Jim Chilsen, spokesman for Citizens Utility Board, said a delay is not in the best interest of consumers. According to a ComEd commissioned analysis, the delay means consumers will miss out on approximately $187 million in savings that could come from the program over 20 years and will pay $5 million more for the smart meters. Chilsen said that CUB, which had urged the commission not to delay the program, will review the order once it becomes available and that it could seek to appeal the decision before the Illinois Appeals Court.

Other aspects of smart grid installation are under way, including "smart switches" used to automatically isolate outages and reroute power to customers. However, smart meters are the most consumer facing aspect smart grid and let the utility track on a computer what customers lack power and those who have had power restored.

Without the smart meters, customers must alert ComEd to an outage. Other parts of smart grid allow ComEd to see where the power is out in general.

The smart meters were a major component in ComEd's pitch to the state legislature for massive regulatory overhaul legislation that streamlines the rate-making processto give ComEd faster and more frequent rate hikes as it undertakes the multibillion-dollar grid modernization.

jwernau@tribune.com | Twitter @littlewern

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Judge: Mooseheart players from Sudan can suit up for now

A west suburban high school accepted four students from Sudan about one year ago. (WGN - Chicago)

By Ted Gregory




Tribune reporter

4:25 p.m. CST, December 4, 2012

A Kane County judge this afternoon kept alive the hoop dreams of three Sudanese basketball players at tiny Mooseheart in Batavia.

Judge David R. Akemann said that the full board of the state athletic association must hear arguments on both sides of the players’ eligibility issue before preventing them from continuing to compete for the Red Ramblers.

A hearing before the Illinois High School Association is scheduled for Monday in Bloomington.

The three Sudanese, meanwhile, will suit up tonight against Westminster Christian.

The Red Ramblers will also play Wednesday against rival Hinckley-Big Rock, which started the eligibility investigation by filing a complaint with the IHSA in March, 2012.

The IHSA contends the child residential school in Batavia recruited the boys for their athletic prowess, a violation of IHSA bylaws.

Mooseheart rejects that allegation, noting that the school specifically told the agency placing the teens that the Batavia institution would take Sudanese children regardless of whether they are athletes.

In arguments Tuesday morning, Mooseheart attorney Peter Rush said preventing the players -- gifted athletes who stand 6 feet 7 inches and above -- from participating in games before the IHSA has a full hearing on the issues is akin to executing a defendant before trial.

IHSA attorney David Bressler said the agency provided Mooseheart "rudimentary due process" by teleconferences and a meeting with IHSA director Marty Hickman before issuing the ineligibility decision.

He also noted that the agency through which Mooseheart brought the teens to campus specifically handles the placement of athletes.

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Google updates Gmail for iOS to support multiple accounts, deliver autocomplete suggestions

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Disney, Netflix sign exclusive TV distribution deal

(Reuters) – Walt Disney Co agreed to give Netflix exclusive TV distribution rights to its movies, becoming the first major studio to stream its movies to TV viewers via Netflix instead of distributing them to HBO, Showtime or other premium TV channels.

The agreement begins in 2016, after Disney‘s current deal with Liberty Media’s pay-TV channel Starz expires.

The deal gives Netflix streaming rights to movies from Disney‘s live action and animation studios, including those from Pixar, Marvel, and the recently acquired Lucasfilms. Disney bought the famed studio founded by George Lucas and responsible for the “Star Wars” franchise for $ 4 billion on October 30.

Movies from Steven Spielberg’s DreamWorks studios are not included in the deal, as that studio distributes its movies through CBS’s Showtime on TV. Disney recently signed a deal to distribute DreamWorks’ films theatrically after the studio’s deal with Viacom’s Paramount Pictures expired.

Under the deal’s terms, Netflix can stream Disney movies beginning seven to nine months after they appear in theaters, as Starz had done in Disney’s prior agreement. The deal does not cover DVD rentals of Disney movies.

The agreement follows similar deals Netflix has inked with smaller studios, including Relativity Media, The Weinstein company and DreamWorks Animation.

Netflix shares were up 12.9 percent to $ 85.83 in afternoon trading following news of the agreement.

(Reporting By Ronald Grover; Editing by Peter Lauria and Tim Dobbyn)

TV News Headlines – Yahoo! News

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Software Programs Help Doctors Diagnose, but Can’t Replace Them

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

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United Dreamliner makes emergency landing in New Orleans

A brand-new United Airlines "Dreamliner" airplane bound for Newark was diverted Tuesday morning, making an emergency landing in New Orleans because of an undisclosed mechanical problem.

The highly acclaimed Boeing 787 Dreamliner recently began service in North America in a debut last month with United Airlines. United and Boeing are both based in Chicago.

On Tuesday, the 7:30 a.m. United flight 1146 from Houston to Newark was diverted to Louis Armstrong New Orleans International Airport and landed safely there at 9:25 a.m., the airline said. The plane, the third delivered to United recently, carried 174 customers and 10 crew members. Neither United nor Boeing would describe the problem except to say it was a "mechanical issue."

"We are reaccommodating the customers on a different aircraft to Newark," United said in a statement. "United will work with Boeing to review the diversion and determine the cause."

The Federal Aviation Administration "is looking into it," an FAA spokesman said.

Flights can be diverted for many reasons, from serious problems to a simple malfunction of a cockpit warning light. And flight diversions are not exceptionally uncommon. There were 816 diversions among large U.S. carriers in September alone and double that number in July, for example, according to federal statistics.

The 787 Dreamliner, a new-model aircraft that features greater passenger comforts and fuel efficiency compared with similar planes, is a big deal for both United and Boeing and has been highly touted by both the airline and the aircraft-maker.

However, any hint of a problem with a 787 is noticed. The plane has gotten mostly rave reviews, but is being delivered more than three years late because of design and production problems. The Dreamliner is different because instead of being made mostly of metal, half the plane, including the fuselage and wings, is made of strong, light composite materials.

gkarp@tribune.com

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Daley nephew indicted in '04 death of David Koschman

A special Cook County grand jury indicted former Mayor Richard Daley's nephew on a charge of involuntary manslaughter in the death of David Koschman in a drunken confrontation on the city’s Near North Side, the special prosecutor said today.

The grand jury found that Richard J. Vanecko "recklessly performed acts which were likely to cause death or great bodily harm to another" in Koschman’s death in 2004, according to the indictment.

Koschman, 21, had been drinking in the Rush Street nightlife district early on April 25 2004 when he and friends quarreled with a group that included Vanecko. During the altercation, Koschman was knocked to the street, hitting the back of his head. He died 11 days later.

Former U.S. Attorney Dan Webb, appointed special prosecutor in the case last spring, noted that at 6-foot-3 and 230 pounds, Vanecko towered over Koschman, who was 5-foot-5 and 125 pounds. There is no statute of limitations on a charge of involuntary manslaughter.

Koschman’s mother, Nanci Koschman, told a news conference that she planned to visit her son's grave and "I'm going to tell David tomorrow that he can finally have peace."

She said she refused to believe, over the years, that the fight was her son's fault, as detectives had told her. "You have to find the strength to go on," Koschman said. "I wanted his name cleared."

Koschman said she never sought vengeance, but accountability. "I want to thank the grand jury," she said. But she added, "It doesn't bring David back. And that's all I wanted."

Vanecko’s attorneys issued a statement saying they were disappointed by the indictment. According to the lawyers, Koschman’s blood-alcohol content was nearly three times the .08 legal limit for motorists – though he was on foot at the time of the confrontation.

Koschman “was clearly acting in an unprovoked, physically aggressive manner,” Vaneckos’ legal team said. “We are confident that when all the facts are aired in a court of law, the trier of fact will find Mr. Vanecko not guilty.”

Vanecko’s lawyers defended the work of police and prosecutors, saying “these agencies professionally investigate these types of incidents on a daily basis.”

“These decisions were not because of favoritism but because the facts did not warrant felony charges,” the lawyers said.

Vanecko, who currently lives in California, is expected to appear for arraignment at 9:30 a.m. Monday at the Leighton Criminal Court Building at 26th Street and California Avenue. Plans call for him to post $10,000 cash bond and be released pending trial. He faces 2 to 5 years in prison, or probation, if convicted of involuntary manslaughter.

Lawyers for Koschman’s mother sought a special prosecutor last year after an investigative series by the Chicago Sun-Times raised questions about whether police and prosecutors intentionally concealed evidence for political reasons.

In a statement released this afternoon, Webb said the grand jury continues “at a vigorous pace” to look into how authorities handled their investigation of Koschman’s death.

Locke Bowman, an attorney with Northwestern University's MacArthur Justice Center who represents Nanci Koschman, said he was encouraged that the investigation was continuing.

"Why has this taken so long?" he asked, wondering if the the clout of the powerful Daley family was at work. "Clearly, we need to have answers."

Webb said thousands of documents have been reviewed and more than 50 witnesses interviewed so far in the seven-month investigation.

Among the  issues Webb was tasked to sort out were whether clout tainted the original investigation in addition to whether Vanecko, now 38, should be charged criminally in connection with the death.

Judge Michael Toomin took the rare step of appointing Webb as a special prosecutor in April after concluding that Chicago police and county prosecutors mishandled the investigation.

The charges mark a dramatic twist in a case that seemed to fizzle out in 2004 as the investigation went nowhere.

Police initially said that witnesses gave conflicting accounts of what occurred and some claimed Koschman was the aggressor in the confrontation.

Almost two weeks after Koschman died of his injuries, a top prosecutor in the Cook County state’s attorney’s office was called to the Belmont Area headquarters on the day detectives put Vanecko in several lineups, all of which police said ended with witnesses failing to identify him as the assailant.

Vanecko had come to the station with his attorney, Terence Gillespie, who told police his client would not answer questions.

Dan Kirk, chief of staff for current State’s Attorney Anita Alvarez told the Tribune in an interview earlier this year that there was no admissible evidence that could have been used to file charges at the time.

Kirk said police had no positive identification from any of the lineups they conducted, no statements from the main suspect, no statement from the victim and no physical evidence.

jmeisner@tribune.com

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Turkey fines TV channel for “The Simpsons” blasphemy

ISTANBUL (Reuters) – Turkey‘s broadcasting regulator is fining a television channel for insulting religious values after it aired an episode of “The Simpsons” which shows God taking orders from the devil.

Radio and television watchdog RTUK said it was fining private broadcaster CNBC-e 52,951 lira ($ 30,000) over the episode of the hit U.S. animated TV series, whose scenes include the devil asking God to make him a coffee.

“The board has decided to fine the channel over these matters,” an RTUK spokeswoman said but declined further comment, saying full details would probably be announced next week.

CNBC-e said it would comment once the fine was officially announced.

Turkey is a secular republic but most of its 75 million people are Muslim. Religious conservatives and secular opponents vie for public influence and critics of the government say it is trying to impose Islamic values by stealth.

Elected a decade ago with the strongest majority seen in years, Prime Minister Tayyip Erdogan and his Islamist-rooted AK Party have overseen a period of unprecedented prosperity in Turkey. But concerns are growing about authoritarianism.

Erdogan last week tore into a chart-topping soap opera about the Ottoman Empire’s longest-reigning Sultan and the broadcasting regulator has warned the show’s makers about insulting a historical figure.

“The Simpsons” first aired in 1989 and is the longest-running U.S. sitcom. It is broadcast in more than 100 countries and CNBC-e has been airing it in Turkey for almost a decade.

“I wonder what the script writers will do when they hear that the jokes on their show are taken seriously and trigger fines in a country called Turkey,” wrote Mehmet Yilmaz, a columnist for the Hurriyet newspaper.

“Maybe they will add an almond-moustached RTUK expert to the series,” he said, evoking a popular Turkish stereotype of a pious government supporter.

($ 1 = 1.7873 Turkish liras)

(Reporting by Ece Toksabay; Editing by Nick Tattersall and Paul Casciato)

TV News Headlines – Yahoo! News

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Well: A Royal Spotlight on a Rare Condition

News that the Duchess of Cambridge, the former Kate Middleton, is pregnant spurred headlines and excitement around the world on Monday, but the exuberance was tempered by word that the mother-to-be has been hospitalized with a rare form of severe morning sickness.

Most people have never heard of the condition, called hyperemesis gravidarum or H.G., now getting worldwide attention. To learn more, we spoke with Dr. Marlena Fejzo, an obstetrics researcher at the University of California, Los Angeles. Dr. Fejzo twice experienced H.G. during her own pregnancies and is an adviser and board member for the Hyperemesis Education and Research Foundation. We talked about the risks of H.G., why it happens and whether its occurrence can predict the sex of the baby.

Q.

What is hyperemesis gravidarum?

A.

It’s severe, debilitating nausea and vomiting in pregnancy that generally leads to more than 5 percent weight loss and requires fluid treatment. Sometimes, in more extreme cases, it requires nutritional supplements.

Q.

Are there treatments?

A.

Doctors try to give IV and anti-nausea medication at first. About 20 percent of the women who contact the Hyperemesis Education and Research Foundation require tube feeding. It’s very serious. They have to have a tube inserted above their heart. Blood tests have to be done every day, or every other day, and the bag of nutrients has to be monitored to make sure it’s personalized for the woman’s needs. But I don’t think Kate Middleton (based on news reports) has it that bad. She’s just gone in for the IV fluids.

Q.

How common is H.G.?

A.

It probably depends on how you define it. It’s generally defined in populations as 0.2 percent. A study from Shanghai, China, said that 10 percent of women get it or are hospitalized for it. Obviously anyone can get it, even a duchess.

Q.

What are the main symptoms and how is it different from regular morning sickness?

A.

The main signs are rapid weight loss and rapid dehydration, the inability to tolerate fluids, feeling lightheaded and weak, and persistent nausea and vomiting. It just doesn’t go away.

Q.

Are there risks or complications associated with H.G.?

A.

It used to be a major cause of death in women until the 1950s when they introduced IV fluids. There is a serious complication called Wernicke encephalopathy. It’s a serious neurological disorder that happens when you are not able to get enough thiamine (vitamin B-1), a vitamin that is needed for proper brain functioning. When it’s depleted you can get this serious neurological problem.

Wernicke encephalopathy is rare, but it would be preventable with a thiamine shot. If women come in with H.G., they shouldn’t just be treated with fluids, they need to have that thiamine shot. This complication typically leads to fetal death, and it’s serious for the mother too.

Q.

Are there long-term risks to the baby or the mother from H.G.?

A.

There is very little research on H.G. One paper that looked at extreme nausea and vomiting found that children had more attention problems and difficulty in task persistence at ages 5 and 12. We found an increased risk of preterm labor and preterm birth due to H.G.

We need to do more studies, and we are following up on these women. We’re running a huge study to identify the genes and risk factors involved. About 30 percent of women had a mother who had it, and 20 percent had a sister who had it. We’re looking for the genes, and hopefully from that we can find the cause. Now it’s treated with medications that are developed to treat the symptoms but not to treat the cause.

Two major studies just came out the past couple years that showed an increased risk of preterm birth in H.G. But the majority of babies are fine.

Q.

Does the onset of H.G. predict whether a woman is carrying a boy or girl?

A.

It occurs for both male and female fetuses, but is more common in women carrying female fetuses.

Q.

Is a woman at risk for it in a second pregnancy if she gets it in the first?

A.

Yes, the recurrence risk is upwards of 80 percent. There is a study that says it’s more common in first pregnancies, but I think a lot of women don’t have a second pregnancy after having it. It’s bad enough that women decide not to have another baby, or to adopt or find another way.

Q.

Why is raising awareness so important given that this is a temporary condition?

A.

It’s not necessarily a temporary condition. There are long-term effects to the fetus possibly, and there are long-term effects to the women. We also have an article on post-traumatic stress following pregnancies. When you’re suffering day after day at a time when you know nutrition is so important for your baby, its very traumatic for women. Even the medicines that help, they don’t cure it.

Also, there are a lot of misconceptions about it. A lot of women are treated really badly. They’re treated like they’re faking it or that they just don’t want their child. We have a lot of women who have lost pregnancy after pregnancy, or who had abortions because they just couldn’t tolerate it. There needs to be more awareness. There needs to be funding for research so women won’t be treated like this is all in their head, and the fact that the duchess has it is going to help.

Q.

What was your own experience with H.G.?

A.

That’s why I’m so motivated. I had H.G. in two pregnancies. In my first pregnancy, I had a healthy baby boy. In the second case I lost the baby at 15 weeks. I don’t have it in my family, but I wanted to see if it was genetic since I’m a geneticist. We started on a genetic and epigenetic study we’re doing now. We’re going to find the cause, we’re getting there, but it’s really good to have awareness like this, although I feel terrible for the duchess.

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