Pfizer has started selling Viagra online.

Why Chinese Couples Are Divorcing Before Buying a Home.

Long queues of happy couples waiting to get married might be a common sight in Las Vegas. But lines of happily married couples waiting to get divorced? Only in China.

In major cities across the country last month, thousands of couples rushed to their local divorce registry office to dissolve their marriages in order to benefit from fast-expiring tax breaks on property investments for unmarried individuals. Local media reported long waits at registries in Beijing, Shanghai, Guangzhou and elsewhere as savvy investors sought to buy or sell a second home before the government introduced strict new regulations that would force married homeowners to pay hefty taxes on the sale of second properties.

The new regulations are designed to cool speculation in China’s feverish property market and are part of a package of measures that would require couples to pay up to 20% capital gains tax on the sale of second homes. But for determined investors, nothing gets in the way of a good bargain, and some quickly noticed that the 20% impost didn’t apply if the second home was bought before the couple were married — or after they got divorced.

China’s marriage law allows for divorce if couples simply sign an agreement to divorce, present themselves at the registry office and pay a fee of just $1.50. Weighed against the prospect of tens or even hundreds of thousands of dollars of profit from property investments, many couples are deciding the $1.50 charge is worth it.

According to media reports, in March the number of couples getting divorced in Tianjin, a large city on the eastern seaboard, soared to 300 per day — more than triple the normal amount. In Beijing, too, realtors reported a boom in divorcing couples seeking out new houses. “Half of the deals I made last month were cases where the couples were getting divorced,” a Mr. Jin, who works as an agent at one of the biggest realtors in Beijing, tells TIME. “These were all young couples between 25 and 35 years old, and all of them were looking to buy another house as an investment.”

As an emerging middle class accumulates wealth, more and more young families are finding that they have limited options to make good use of their money. With overseas investment options closed off by complex regulatory barriers, banks offering measly interest-rate returns on deposits and the stock markets on a never ending losing streak, there aren’t many attractive investment choices.

Some choose to invest in gold and other precious metals. Indeed, when gold prices fell sharply last week, shops in mainland China and Hong Kong quickly reported stock shortages and empty shelves. But China’s savvy purchasers have long had an affinity for putting their money into bricks and mortar, not least because property prices in most cities have soared over the past decade and continue to rise sharply.

With a seemingly endless supply of money flowing into the country’s property sector, and prices on a constant upward trajectory, regulators have long been worried about the frothy market giving rise to major property bubbles, especially in the most populous cities like Beijing and Shanghai. But it seems that canny investors are quick to spot ways around the cooling measures, hence the new vogue for divorce.

It’s not only profiteers who are choosing the divorce route. Many couples who simply want to trade up from their current home have realized that they can save tens of thousands of dollars by splitting up before making their next purchase. According to media reports, one couple in the southern city of Guangzhou, who already owned two apartments, saved $32,000 by getting divorced and selling one of their houses before buying another.

The divorce solution is extreme but it’s the kind of solution to which China’s put-upon middle classes have become accustomed. Civil-servant couples, for example, are subject to a particularly strict version of the one-child policy that would require them to give up their jobs if they had a second child. Some have decided to circumvent those rules by getting divorced and having a second child out of wedlock, registered under either parent’s name as a “first” child.

Of course, the country’s regulators have also taken notice of the long queues outside divorce registries and have acted to put a stop to the practice. In recent weeks, the government revised its regulations to increase the taxes payable by unmarried individuals selling a secondhand property, effectively cutting the most speculative investors out of the market.

Others, though, are still happy to break the knot, if only because they need not stay divorced for long. Realtor Jin advises his clients who are considering the process that they can be back in happy matrimonial bliss within as little as three weeks. “If you pay the full price in cash up front, the whole transaction can be completed in as little as 10 days — and even if you’re taking out a mortgage, it only takes about six weeks,” Jin says. “Once that’s done, you can go and get remarried right away.”



Case report links artificial sweeteners, Hashimoto’s thyroiditis.

Recent literature suggest sugar-sweetened beverages increase the likelihood of incident obesity and diabetes. However, data from a case report presented here suggest that patients who consume a large amount of artificial sweeteners, such as Splenda, are also more likely to develop Hashimoto’s thyroiditis.

“We know that in the 20th and 21st century there is an increasing consumption of sugar substitutes. If you look at the literature in animal studies, it suggests it may cause obesity and some tumors. I found that this sugar substitute increases insulin levels in consumers and high insulin levels may be associated with obesity,” Issac Sachmechi, MD, FACE, FACP, clinical associate professor of medicine at Icahn School of Medicine at Mount Sinai; and chief of endocrinology at Queens Hospital Center, said during a press conference.

According to abstract data, Sachmechi treated a woman aged 52 years with a history of high intake of artificial sweeteners and a diagnosis of Hashimoto’s hypothyroidism in 2008. The patient’s TSH measured 12.2 mIU/L, free T4was 0.5 ng/dL and antithyroid peroxidase antibodies (TPOAb) were 196 IU/mL.

Sachmechi treated the patient with levothyroxine 0.75 mg per day and normalized her TSH (between 1.23 mIU/L and 2.16 mIU/L) over 3 years of treatment. Subsequently, the patient stopped ingesting the sweeteners in February 2012 due to weight gain.

This resulted in a TSH level of 0.005 mIU/L, where it remained low despite a decrease of levothyroxine dose to 0.05 mg per day. Furthermore, a complete discontinuation of the drug was followed with normal TSH and anti-TPOAb <20 IU/mL, TSI of 113% and TBII <6%.

Sachmechi reported that the patient continued to be clinically euthyroid without further treatment during subsequent follow-up visits.

“We know there is an increased prevalence of Hashimoto’s hypothyroidism and differentiated thyroid cancer without currently known etiologies. “It is possible that the artificial sweetness may have a roll in this,” Sachmechi said.

“We plan to do a study looking at the use of artificial sweetness in large number patients with diagnosis of Hashimoto’s hypothyroidism and patients with well differentiated thyroid cancer to see if we find any coloration consumption of artificial sweetness and those thyroid diseases.”

These data indicate eliminating artificial sweeteners from the diet can benefit patients with thyroid disease. Sachmechi told Endocrine Today that a study is underway to confirm these findings in a larger cohort. – by Samantha Costa

Source: Endocrine Today


Radiofrequency superior to laser ablation in large thyroid nodules.

When compared with laser ablation, radiofrequency ablation yielded greater reductions in volume in large, benign thyroid nodules and allowed more rapid decompression in a single session, according to data presented during a late-breaking session here.

“The bottom line is we want to treat large, benign nodules,” Roberto Valcavi, MD, FACE, of the endocrinology division and thyroid disease center at Arcispedale Santa Maria Nuova in Reggio, Emilia, Italy, said during his presentation. “There have been many papers on reducing nodules with radiofrequency or laser ablation, but so far, there has been no comparison between the two techniques in large nodules.”

To study to the effects of laser vs. radiofrequency ablation in nodules >35 mL, Valcavi and colleagues randomly assigned 108 patients with benign nodules to laser ablation (n=54; mean age, 51 years) or radiofrequency (n=54; mean age, 47 years). Mean nodule volume was approximately 40 mL in both groups.

Results revealed clear differences between the two treatment groups at 1, 3 and 6 months. At 1 month post-procedure, nodule volume was 31.9 mL in patients who underwent laser ablation vs. 28.9 mL in those who underwent radiofrequency ablation (P<.03). At 3 months, compared with the laser ablation group, reductions in nodule volume remained greater in the radiofrequency ablation group (27.8 mL vs. 26.6 mL; P<.04). At 6 months, the difference in nodule reduction became even more apparent (22.6 mL vs. 16.9 mL; P<.01), according to Valcavi.

“We have a faster and greater effect in the radiofrequency group, with a 70% reduction in nodule volume at 6 months vs. a 50% reduction, which is also a lot, with laser ablation,” he said.

A greater decrease in compressive symptoms was also noted in the radiofrequency ablation group, according to the study abstract. Symptoms declined from 5.1 at baseline to 2.5 at 6 months post-procedure in patients who underwent laser vs. from 5.3 to 0.8 in those who underwent radiofrequency ablation (P<.01).

Additionally, the researchers observed tissue carbonization in patients treated with laser ablation, but they found none in patients treated with a cool-tip radiofrequency ablation device.

“This is extremely important because we think the absence of carbonization may speed up nodule reabsorption, which is, on the other hand, ‘foxilized’ by the extremely high temperatures achieved by laser ablation,” Valcavi said.

He also noted that radiofrequency ablation is less expensive than laser ablation in which you need the proper equipment.

“We demonstrated that, in a single, well-done session, we can shrink the nodule and potentially cure the patient,” Valcavi said. “My final message is that, if you are confident enough with finding aspirates on ultrasound, you may have a new, very effective instrument to cure your patients.”

Source: Endocrine Today


Phase 3 study: Canagliflozin improved beta cell function.

An SGLT2 inhibitor recently approved by the FDA may improve measures of beta cell function in addition to glycemic control in patients already taking metformin plus sulfonylurea, according to phase 3 study results presented here at the AACE Annual Scientific and Clinical Congress.

“Despite the fact it doesn’t act directly on the beta cells, there is a lot of evidence from previous studies that SGLT2 inhibitors can improve beta-cell function,” David Polidori, PhD, of Janssen Research & Development, LLC, said here during a presentation.

Polidori and colleagues conducted a 26-week, randomized, double blind, placebo controlled study to evaluate canagliflozin (Invokana, Janssen) 100-mg and 300-mg compared with placebo as an add on to metformin plus sulfonylurea in patients with type 2 diabetes (n=469; mean age, 57 years). The mean baseline HbA1c level was 8.1%, BMI was 33 kg/m2, and duration of diabetes was 9.6 years, according to data.

Of the 469 patients, 168 were administered a meal tolerance test at baseline and week 26. Their plasma glucose and serum C-peptide levels were measured seven times over a 3-hour period.

Polidori reported that at week 26, canagliflozin 100 mg significantly reduced HbA1c by –0.71% and 300 mg  by –0.92% compared with placebo (P<.001).

Further data indicate that the insulin secretion rates (ISR) vs. glucose relationship did not change with placebo. However, the relationship shifted upwards in both canagliflozin doses, Polidori said. This indicated an increase in ISR at each plasma glucose concentration, according to data.

Measures of beta cell function, including the ratio of C-peptide to glucose, were approximately 20% higher than baseline levels in both canagliflozin groups (P=.051 for 100 mg and P=.056 for 300 mg) but remained relatively unchanged in the placebo group. Mean beta cell glucose sensitivity was also increased by about 20% in both canagliflozin groups (P=.14 for 100 mg andP=.22 for 300 mg).

Additionally, mean ISR at 9 mM of glucose increased by about 50% to 60% in both canagliflozin groups (P=.02 for 100 mg and P=.007 for 300 mg), but remained relatively unchanged in the placebo group.

“Consistent with what we’ve seen in patients at earlier stages of diabetes and in some of the animal studies, both doses of canagliflozin improved the measures of beta cell function that we looked at in the meal tolerance test in these more advanced patients who were already inadequately controlled on dual therapy. This is promising,” Polidori said. “This is 26-week data and we’re certainly interested to see longer term data to see if this type of treatment can better prolong beta cell function and hopefully slow the rate of progression of type 2 diabetes.” – by Samantha Costa

Source: Endocrine Today



PreDx finger stick comparable to venous blood assay in detecting diabetes risk.

Clinicians may be able to accurately detect a patient’s likelihood of developing type 2 diabetes with the use of a finger stick capillary blood collection test, according to data presented here at the AACE Annual Scientific and Clinical Congress.

“We’ve developed what we call the PreDx score (Tethys Bioscience). It’s a multimarker algorithm-based diagnostic. It combines the results from seven different blood-based biomarkers along with the patient’s age and gender to produce a single score between 1 and 10,” researcher Theodore Tarasow, PhD, senior vice president of research and development at Tethys Biosciences, said during a late-breaking abstract presentation here. “We’ve done clinical studies to show that that score is directly tied to a person’s 5-year risk for developing diabetes.”

Tarasow said the accuracy of the finger stick blood assays yielded promising results that were comparable to venous blood assays. Data presented indicate that the coefficient of variation ranged from 2.4% for HbA1c to 11.3% for adiponectin. Upon calibration, results showed impressive agreement between PreDx values and matched samples. Overall slope was 0.997 (95% CI, 0.916-1.078) and intercept was –0.048 (95% CI, –0.206 to 0.110) by Deming regression, according to data.

Further, data from the Inter99 study indicated no significant differences in area under the curve (AUC), positive predictive value or sensitivity when comparing simulated finger stick scores with venous scores. Both PreDx venous and PreDx finger stick were also superior to fasting glucose by AUC and other measures in predicting development of diabetes.

“What we really need is the ability to find those at the highest risk and apply additional resources to try and prevent or delay that conversion to diabetes,” Tarasow said.

Tarasow said the PreDx is no more expensive than current tests available for its diagnostic purpose.

“From a clinical perspective what this is really going to allow us to do is have greater access to patients where there is not access to onsite phlebotomy,” Tarasow said. – by Samantha Costa



  • Using a litmus paper — a simple technique to do this test — allows greater adoption of this predictive tool for how to aggressively treat diabetes or not. If you have a patient at high risk for diabetes in the prediabetes population, you then may use pharmaceutical agents (i.e., metformin), but if you’re treating a low-risk patient, you probably don’t need to do so. Or, you may put them into a supervised exercise program or some type of diet or bariatric surgery. Your intervention will be much stronger.
  • Bruce W. Bode, MD
  • o    Atlanta Diabetes Associates
    Endocrine Specialty Group

Source: Endocrine Today



FDA Approves New Cholesterol-Cutting Combination Drug .

The FDA has approved a new ezetimibe-atorvastatin tablet (brand name, Liptruzet) for lowering cholesterol in patients with primary or mixed hyperlipidemia, and in those with homozygous familial hypercholesterolemia.

In a trial of some 620 patients, the once-daily tablet reduced LDL cholesterol by 53% at the lowest dose (10/10 mg) and 61% at the highest dose (10/80 mg). Common side effects include changes in liver function tests, muscle pain, memory loss, and tendon problems.

The combination treatment has not been shown to improve cardiovascular outcomes better than atorvastatin, which has some cardiologists questioning the FDA’s decision. Steven Nissen, chairman of cardiology at the Cleveland Clinic, says in Forbes that the agency seems to be “tone deaf” to concerns “about approving drugs with surrogate endpoints like cholesterol without evidence of a benefit for the disease [cardiologists] are truly trying to treat — cardiovascular disease.”

Source: Forbes 




Lower Oxygen Saturation Levels in Preemies Associated with Higher Mortality by Discharge .

The question of which oxygen-saturation level is best for very premature infants remains open after the publication of two studies over the weekend. Commentators suggest that levels under 90% should be avoided, however.

Researchers in the BOOST II study (published in the New England Journal of Medicine) report outcomes at hospital discharge for some 2400 infants randomized to lower (85 to 89%) or higher (91 to 95%) saturation levels. Interpretation is muddied somewhat by the fact that the oximeters had a measurement flaw that wasn’t discovered until halfway through the study. Among infants measured with corrected oximeters, mortality was higher for those receiving lower oxygen saturation (23% vs. 16%). Retinopathy was lower with lower saturation.

In JAMA, COT study researchers found no significant differences in the rates of mortality or retinopathy by 18 months in some 1200 infants similarly studied.

Commentators say the best interim course would be to target saturation levels between 90% and 95%, realizing the dangers of retinopathy.

Source: NEJM 



Urological Group’s Guidelines Recommend Against PSA Screening in Most Men.

The American Urological Association‘s new guidelines recommend prostate cancer screening only in men aged 55 to 69 and based on shared decision-making and the patient’s preferences. The guidelines put AUA‘s position more in line with other medical organizations.

In the 55-to-69 age group, one prostate-cancer death is prevented for every 1000 men screened over a decade. For men who decide to undergo prostate-specific antigen screening, AUA recommends testing every two years or more, rather than annual testing.

The group now recommends against routine PSA screening for men younger than 55 who are at average risk, those older than 69, and those with less than 10 to 15 years of expected life remaining.

The recommendations come less than a year after the U.S. Preventive Services Task Force recommended against routine PSA screening in all men.

Source:American Urological Association guidelines


Ben Kingsley is a man of the theater and, in turn, a man of the written word. He tells that every movie he’s ever done has been because of the script. That includes this weekend’s Iron Man 3, written and directed by Hollywood legend, Shane Black.

“The dialogue all the way through, the arc, is all on the page,” Kingsley says. “I get everything from the page. Drew Pearce collaborated with Shane and brought that English dry humor to the writing. Honestly, because I spent so many years in the theater, 15 years, I grew to love the written word. I grew to love what’s on the page.”

When it came to playing Marvel’s ultimate terrorist, The Mandarin, Kingsley found every bit of personality, every nuanced gesture, every haunting word in writer/director Black’s script. Black knows a thing or two about writing action movies: he’s the scribe behind Lethal Weapon,Last Action Hero, and the hyper-stylized Kiss Kiss Bang Bang. So Kingsley felt no need — and Black and Marvel head honcho Kevin Feige gave him no pressure — to immerse himself in 50 years of comic book lore.

“They sent me a lovely box of illustrations and graphics. But their approach was so original and contemporary, that that was a wonderful jumping off point. The iconography is very different now. It’s very impactful,” Kingsley says.

The Mandarins is a rare achievement in blockbuster cinema, a layered character that is slowly deconstructed over the course of the film. The top layer is the amplified amalgamation of every terrorist ringleader world audiences have ever seen. Below that is a bumbling idiot: the fame-hungry, actor-wannabe Trevor.

Kingsley was particularly taken by Black’s interpretation of The Mandarin’s diabolical side. Although the persona is instantly recognizable, the actor keenly notes that rarely do we see terrorist types make bombastic threats. “The writing was beautiful to study and bring to life because there never is a mad rant,” he says. “There always is a steady, measured… it’s like torture. The drip. Chinese water torture.”

For a good chunk of the film, The Mandarin is presented through scratchy, lo-fi aesthetic often associated with terrorist broadcasts. He hits on every front: TV takeover broadcasts, YouTube videos, and even graphic propaganda spread across the country. They all depicted Kingsley’s over-the-top look, echoed by a voice he describes as “Presidential.” For Kingsley, it was all about embodying The Mandarin’s righteousness. “He has to convey to the TV audience the absolute belief in his vision of destiny, the future, culture, civilization, where it should go,” says the actor. “He has quite a grip on Western culture, history, iconography, and with almost a homegrown, patriarchal. He’s able to manipulate his knowledge. Turn it on its head. Vilify it. Mock it. Destroy it in front of the eyes of his TV audience during those horrendous political broadcasts that interrupt the airwaves.”

When the first trailers for Iron Man 3 arrived, Kingsley’s unrecognizable accent for The Mandarin was one of the biggest talking points. He explains that was all born a piece of Black’s dialogue. At one point, Tony Stark describes The Mandarin as sounding like “a preacher.”

“From the script also, The Mandarin refers to his lessons and refers to himself as a teacher. If you’re a teacher delivering lessons to the audience, it narrows down the target for the voice. It has to have the authority, the patriarchal tone to it. Almost patronizing and deliberate,” Kingsley says.

To interpret Black’s language, Kingsley turned to documentary footage.“I can watch speeches made in the 1930s and that sense of righteousness and destiny is there in the speech,” he says like a kid in a candy store. “They’re beautifully written, if that’s not too bizarre a phrase to use. They’re written to impact the audience with repetitive speech, certain rhythms, certain cadences, staying inside a word and elongating it.” Watching how influential figures operate while on stage, Kingsley says he “was able to graft them on to what The Mandarin is up to in front of the camera.”

Then came the other side of Mandarin’s duel personalities. Kingsley is no stranger to comedy, having gone toe-to-toe with Sacha Baron Cohen‘s General Aladeen in 2012’s The Dictator. In Iron Man 3, he creates his feeblest character yet, a struggling thespian who can kick back a PBR regardless of the hour. Kingsley says Trevor, much like “The Mandarin,” is another tapestry of memories collected by the actor over his 40-year career in show business.

“It’s like building a mosaic,” Kingsley says. “You take little pieces of your experiences, your memory, and your past. Your acquaintances and those with whom you have worked. Maybe there are 4,000 pieces to that mosaic. I couldn’t count them. There are a lot of pieces that go into my work and it’s never a copy of one person.”

But really, he must have met at least one real-life Trevor in his time as an actor. Right? “Hundreds of them!”