SASSAgate: Anatomy of the Hidden Hand will all be revealed to ConCourt? – Daily Maverick

On Friday afternoon, in response to a PAIA application by DA Shadow Minister of Social Development, Bridget Masango, for information on any new contract between Sassa and CPS, the Department of Social Developments Deputy Information Officer, Michael Machuberg, responded, contract entered into between the department and/or Sassa with Net1/CPS for the distribution of social grants from 01 April 2017 does not exist and therefore not unavailable in our possession.

On March 6, however, Net1 CEO Serge Belamant in an interview with Radio 702 said that the previous week his company had agreed to a set of terms with Sassa on two very, very important issues, one of them were the commercial terms going forward, and the other set of terms is what we were going to do on behalf of Sassa in order for them to take in-house a number of technical processes we currently perform.

So, with only three weeks to go, the entire Sassa social grants crisis still appears to be in legal limbo.

Chief Justice Mogoeng Mogoeng last Wednesday directed Sassa to furnish, by 16:00 on Monday, full details of responsible officials, dates when these officials became aware that the time frames set out by the court could not be met, why the court had not been informed and whether Minister Dlamini had been informed, and if so, when.

Hopefully, whatever it is Sassa and the department and the minister submits to the court will unravel this very thickly woven knot of obfuscation, lies, deceit and delay tactics, and most important, why. Sassa officials and the minister, hopefully, will also answer why they secretly met with President Jacob Zumas lawyer Michael Hulley in December 2016 who then offered legal advice overruling that offered by Advocate Wim Trengove.

One of the officials who is likely to feature in the submission to the ConCourt is Zodwa Mvulane, Sassas Executive Manager, Special Projects. A batch of letters accompanying Belamants affidavit to the ConCourt on March 7 and in response to an application by the Black Sash gives some insight into the anatomy of the train smash.

Timeline and names of officials:

On May 24, 2016, Belamant wrote to Mvulane indicating that he had met with Sassa at your request a few months ago to discuss the implications for Sassa to achieve this objective [of taking the payment in-house]. We discussed both a closed loop system that could permit interoperability with the NPS [National Payments System], as well as an open loop system as is currently provided.

Belamant told Mvulane there is not enough time left between now on March 31, 2017 for the banks to assist in this massive task... As time is running out quite rapidly, it is critical for Sassa to decide on the way forward. In order to prevent disruption in the payment process and to protect beneficiaries, it may be better for Sassa to extend the current CPS contract for at least 12 months, during which Sassa could refine their strategy and implement a phase-out and phase-in plan.

On May 31 Advocate Nazeer Cassim and Mias Mostert advised Sassa that the Constitutional Court would have to be informed of the change in status pertaining to deliverables as well as the possibility of CPS tenure being extended. Meaning that by then Sassa had been aware that it was not going to meet the seven deliverables as set out by the ConCourt.

The court will be especially sensitive in our view to the continued involvement of CPS. Our concern is that the impression might be created that Sassa has all along been pulling the wool over the courts eyes. To prevent this impression from being created, our suggestion is that the change in proposed time frames relating to deliverables be coupled to new information emerging from the meeting with SARB... wrote Cassim and Mostert.

Presenting Sassas annual report to Parliaments portfolio committee on social development on October 13, 2016, where the closing balance of irregular expenditure was revealed as R1-billion and fruitless and wasteful expenditure as R10.9-million, the agency dedicated one paragraph to the institutionalisation of the payment system.

This is planned for implementation in four phases. Phase 0 was the Advisory Committee investigation that took place against the backdrop of the Cash Paymaster Services that ends in March 2017. Phase 1 will be led by Work Stream leaders appointed with the concurrence of the minister to guide the successful implementation of the recommendations of the Advisory Committee for the smooth transition of Sassa towards effectively and efficiently incorporating its payment role to the current in-house functions. Phase 2 and 3 entailing the transition and full roll-out respectively will be implemented during the period April 2017-March 2019.

It was at that presentation, made by then Acting Director-General of the DSD, Dr Wiseman Magasela, that the DAs Bridget Masango first raised the alarm saying that this was a huge project that needed to be undertaken by Sassa and which required a lot of preparation and that involved the lives of 17-million people who were dependent on social grants.

Where is the plan for this project and could the portfolio committee have access to it? Also was Sassa ready to take over the process? asked Masango.

The DAs Lindy Wilson also asked how far the agency was in terms of the seven deliverables as set out by the Constitutional Court.

According to the Parliamentary Monitoring Groups record of the presentation Magasela told the committee that Sassa was ready to give details or reach an agreement of when to come back to the committee to explain progress for the takeover and not withholding any information from the Committee.

Mr Magasela said Sassa was fully aware that the project was a huge one with responsibility in terms of making sure that social grants for 17-million south Africans were fully paid on time as had been the established practice. The Agency was working towards making sure that come March 2017 all south Africans would receive their grants. The Minister was providing political leadership on the issue. There was also a project manager managing this project.

On October 19 the portfolio committee met again to review and adopt the DSD budget and recommendations report. Once again members asked about the progress for Sassas takeover of grant payments.

On November 16 a meeting had been planned for Sassa to brief the portfolio committee but was cancelled at short notice and replaced by a presentation by the National Development Agency.

The minutes read: Members objecting pointed out that the Sassa briefing had been agreed upon as far back as 13 October and had been placed on the agenda following an agreement by the chairperson as far back as June that the plan would be presented to the committee. There was a suggestion that the chairperson had deliberately tried to prevent the presentation, but the chairperson explained that this had in fact happened firstly because the Minister, who wanted to accompany the Sassa delegation, was out of the country, and secondly because Sassa would be meeting with stakeholders prior to coming to brief the committee.

On November 30 Minister Dlamini and Sassa returned to Parliament to brief the committee with regard to Sassas readiness to take over as paymaster for the grants. Present along with Dlamini was the newly-appointed Director-General of the Department of Social Development, Zane Dangor, as well as newly appointed CEO Thokozani Magwaza. At that meeting opposition as well as ANC members complained that the department had not sent the presentation document earlier so that members could read and interrogate it.

At that meeting Magwaza told members that Sassa was ready for the takeover from April 1.

However, SASSA through the minister asked that the committee does not push it to reveal its contingency plans in public as this might jeopardise the work it has done already. What matters is that by 1 April 2017, the grant will be paid. (our italics)

Sassas Executive Manager, Raphaahle Ramokgopa, at that meeting said that Sassa had fulfilled its obligations to the Constitutional Court which had assumed a supervisory role over the agency after the 2012 contract with CPS had been declared irregular. The first report, she said had been about the fresh tender application, the second dealing with progress towards implementation of the tender, the third with the outcome of the tender process and the fourth with the implementation process within Sassa.

Ramokgopa admitted that there are areas where Sassa was not meeting deadlines and that the agency had sought a legal opinion.

With the feedback received from legal counsel and other people, Sassa will go back to explain to the court what had happened, the work in progress and the mechanism in place for implementation, said Ramokgopa.

At this presentation is appears as if Ramokgopa parrots some of the content of Belamants May 24 letter to Mvulane.

Heres Ramokgopa on November 30; There are two options. The first is an open architecture or open loop. This involves operating in the national payment system that is provided for by the Reserve Bank. The second option looks into a combination of both an open and closed loop system. Both options specify the need for Sassa account requirements which Sassa has done an expression of interest for. Sassa is also in discussion with the Reserve Bank, PASA and BASA on a specialised account which has limited facilities... The open loop is a system operating in the national payment system, the accounts are fully accessible and allow direct reconciliation. Biometrics is a key factor in both options. In the current payment, the Reserve Bank has given permission to Sassa to utilise biometrics for older people and disabled persons. Discussions are on the way as to whether this can be extended to all beneficiaries. The reason for the need for biometrics is for fraud and risk management. Option 1 requires a new Sassa card that operates in both a closed and open system. It must be an integrated system flexible enough to operate in both and allow cash disbursement for beneficiaries in remote areas. Generally, for both options Sassa needs to develop an internal ICT system, recruit relevant capacity and use a phase in and phase out approach.

Heres Belamant to Mvulane on May 24; We discussed both a closed loop system that could permit interoperability with the NPS, as well as an open loop system as is currently provided. The reason for the two approaches which are both technologically equivalent in terms of interoperability, is that a closed loop system would allow Sassa to provide a payment solution which would be under its control in totality as Sassa would operate only under the Social Assistance Act of 2004. An open system would require Sassa to obtain or make use of a banking licence, amongst others, or to outsource this function to one or more banks resulting in a solution similar to the current system. The open loop payment solution would be governed by the banking rules, the SARB. PASA Visa and MasterCard, the FSB, etc. and, as such, Sassa would not have actually taken the payment function in house in any way but simply outsourced it to a different bank or/and service provider which would probably require a fresh tender to be issued.

At that meeting the DAs Wilson asked whether Sassa had accomplished the ConCourts seven deliverables as well as Who is the supervisor now? Was the court informed when the deliverables were changed? Have the deliverables been extended especially once the deadline for a deliverable has passed? Was the Constitutional Court informed about it and what was the decision?

To which Dangor replied that the fact that some of the timelines have not been met means that Sassa has to go back to the Constitutional Court to discuss the options. The Constitutional Court is the supervisor.

Zodwa Mvulane replied that when Sassa began to solicit advice from other stakeholders as well as reports from the work streams it became apparent that Sassa had been overly ambitious about some of its timelines.

Hence Sassa took the advice and broke down the deliverables and start working on things that matter.

Minister Dlamini then suggested the committee invite officials from Treasury, the Reserve Bank, the Post Office and Postbank so that members could have a clear understanding of what is going on.

However, added Dlamini, there are challenges Sassa cannot talk about.

Back now to Belamant waiting in the wings.

On December 9, 2016 Belamant wrote to Dlamini expressing that he was becoming increasingly concerned with the lack of communication from Sassa and that CPS would also commence the dismantling of its payment infrastructure on January 1, 2017.

Belamant told Dlamini As you are aware, on November 30, 2016, Sassa reported to Parliament that it would be ready to perform the payment of all social grants by April 1, 2017. The Contract and Service Level Agreement (the contracts) between Sassa and Cash Paymaster Services (Pty) Ltd (CPS) were declared invalid by the Constitutional Court of South Africa. The Constitutional Court, however, suspended the declaration of invalidity until a) Sassa issued and awarded a fresh tender or b) until March 31 , 2017 which ever event occurred first.

He added that over the past six months (so at least from August) the SARB, PASA, Grindrod bank and MasterCard have engaged with us to debate the technological issues related to the longevity of the existing Sassa branded cards and if a solution could be found to prolong their lifespan beyond April 1, 2017. He added that these stakeholders were of the view that finding a solution was primordial as Sassa had not finalised or disclosed their transition plan, but that such plan would undoubtedly require the Sassa branded cards to continue to operate beyond April 1, 2017 to ensure that there would be no disruption to the payment of grants service going forward.

And then As a result, we have developed and tested a plan that will ensure continuity but such plan requires your urgent endorsement and commitment.

On December 18 the Sunday Times reported that Minister Dlamini, Dangor, Magwaza, Mvulane and Ramokgopa had met with President Zumas lawyer, Michael Hulley, at the Intercontinental Hotel at OR International Airport. Dlamini had summoned the officials and Hulley had arrived out of the blue.

Dangor and Magwaza reportedly expressed at the meeting their serious concerns with the meddling of Hulley in the matter and also quizzed his role in the matter.

On December 22 Sassas Mvulane responded to CPS saying that it was willing to engage on probabilities for assistance in the transition of Sassa operations towards a new service model, and suggested a first meeting on January 5, 2017.

On December 30 Dlamini chaired a meeting with Sassa CEO, Magwaza, Mvulane, Dlaminis special adviser, Sipho Shezi, DSD deputy director-general Brenton van Vrede, Sassas legal consultant Tim Sukazi, Ramokgopa as well as head of corporate services, Dumisani Ndlovu, at President Zumas lawyer Michael Hulleys office in Durban. There they discussed the CPS contract.

Dangor reportedly refused to attend this meeting.

On February 1 Sassa was back in Parliament for a briefing with the committee, a meeting Dlamini skipped, opting to attend a Cabinet lekgotla instead. Opposition members refused to accept her apology and also complained once again about the late circulation of material to be presented.

ANC committee member Hope Malgas rebuked opposition members saying the lekgotla was important and warranted the postponement of meetings.

There is nothing wrong in postponing. The ANC being in government has to give guidance, said Malgas.

Ramokgopa set out six options including retaining CPS (only snag being the extension of the illegal contract), procuring the services of banks [Treasurys suggestion] while this option may guarantee service delivery, there is no guarantee that beneficiaries will be paid who are at the cash pay point, procuring the services of banks and the setting up of a special account [a plan that needed six months], option four using banks for some payouts and CPS for cash pay points, using SAPO and the appointment of a service provider for cash distribution and for banked beneficiaries to use existing accounts.

Given the above circumstances, Sassa came to the conclusion that it has failed. Sassa is of the view that Option 1 carries the least risk in terms of service delivery failure and as such should pursue the option while working on Option 6. In order to pursue this option, Sassa will approach Constitutional Court as a matter of urgency, since this is likely to be virtually the only mechanism to regularise such an approach which would otherwise be irregular. Also procurement in relation to Treasury practice Note 3 of 2016/17 will need to be followed.

It was at this meeting that Magwaza let slip with regard to the fact that Sassas selection of option 1, to go with CPS, had not yet approached the Constitutional Court but that the lawyers have assured Sassa that the court will approve since it is a matter of national emergency.

Which lawyers Magwaza did not disclose.

Was this Hulleys advice?

The ConCourt will soon find out.

On February 2 the Minister of Finance wrote to Dlamini informing her that continuing a contract with CPS would expose government to legal challenges. He proposed that a tender be given to banks and the Post Office.

Sassa revealed what everyone keenly watching developments feared, and suspected: that it was nowhere near ready to assume the critical function and had, in fact, not fulfilled even a single one out of the seven deliverables set out by the Constitutional Court.

If you ask me to choose between irregular [processes] and the country going up in flames, I choose irregular, Thokozani Magwaza told the committee to some audible gasps in the room.

9 February Magwaza wrote to Belamant with regard to exploratory discussions.

16 February Belamant replied to Magwaza stating we have... not received any formal notification from Sassa or yourself regarding the dates for such exploratory discussions. I am concerned that any further delay will significantly impact on our ability to conclude an interim arrangement. It is our view that any negotiations in this respect will require adequate time and consultation to address the following aspects of a new contract. including but not limited to duration, price, phase-in or phase-out strategy, BEE.

Belamant added that it is unlikely that the current contract can be extended due to the Constitutional Court judgment as well as the legal constraints of the PFMA. An extension of the contract would, in any case, be unacceptable to the Net1 board of directors due to the ongoing controversy and reputational damage to our company. I have rescheduled my diary as well as my travel arrangements to accommodate the Sassa meetings and will be available to meet with you from 1 March 2017.

On February 22 the portfolio committee met again. This time the panic was even palpable in the minutes published later by PMG. Dlamini, with CEO Magwaza wiping his brow frequently, dominated the meeting, seldom allowing Sassa officials to speak.

It was the IPFs Liezl Van Der Merwe at the meeting who asked, Can you confirm they [CPS] are seeking an extra R1.3-billion from this department to pay out the social grants? I also want to know that you dont want to pass the buck to Treasury but there are allegations that come March 31 and there is a problem of some sorts you will pass the buck and blame Minister Pravin Gordhan which will give the minister and the president more ammunition to fire Pravin Gordhan.

Committee chair Rose Capa accused the media of terrorising the poor.

On February 28 Sassa appeared before Scopa to account for the mess. It was learned that Magwaza had been booked of ill with high blood pressure and that CEO of the National Development Agency, Thamo Mzobe, had been appointed that morning as acting CEO, and who became ill a week later. Dlamini opted to skip this Scopa meeting, which angered members. It was a shambolic presentation. Members called for Dlamini to account to Scopa.

That same day Sassa filed papers with the Constitutional Court asking it to authorise its engagement with CPS for 12 months from April 1, 2017 to March 30, 2018. Twenty-four hours later Sassa withdrew the application on orders from the minister. Mzobe, who was still on the job at that point, said that Sassa had not been consulted by Magwaza and were now merely sending a follow-up report to the court.

On the same day, the Black Sash filed with the Constitutional Court asking it to act in a supervisory role with regard to the new CPS contract. In court papers the Sash says Sassa breached its constitutional obligations of transparency and accountability to the public to Parliament and to the court.

March 2, 2017 Dlamini and Sassa filed the follow-up report with the ConCourt accepting responsibility for the fiasco.

The minister and Sassa accept responsibility for Sassas inability to deliver the system deliverables set out in the progress report, reads their submission.

Sassa also claimed it only became aware in August and October 2016 after advice from technical advisers that it would be unable to take the payment of social grants in house after March 31. Sassa added it was not ready to move forward due to budget constraints, insufficient internal capacity and a lack of skilled personnel to implement the plan in the time frame it had contemplated.

March 3, 2017 DSD DG Zane Dangor resigned citing a breakdown in the relationship with the minister.

March 5, President Zuma met with Dlamini and Gordhan and said the Sassa crisis is solvable.

March 5 Dlamini and her spokesperson Lumka Oliphant called a last-minute press conference which ended up with Dlamini refusing to answer questions from journalists. Dlamini blamed the media for creating panic with regard to the payment of grants on April 1. Dlamini confirmed, however, that no deal with CPS had been signed, contradicting an earlier statement that a deal had in fact been concluded.

March 7 Minister Dlamini appeared before Scopa and received a grilling of note. She told committee members that Scopa had underestimated the amount of work.

March 8 The Chief Justice Mogoeng Mogoeng directed Sassa to reply in detail questions relating to responsible officials, a time line for the fiasco as well as when it was the minister was informed.

March 14 4pm Will all be revealed? DM

Photo: Minister of Social Development Bathabile Dlamini closes the National Youth Camp at 3 South African Infantry Battalion near Kimberley, Northern Cape, 12 December 2016. (Photo: GCIS)

The rest is here:
SASSAgate: Anatomy of the Hidden Hand will all be revealed to ConCourt? - Daily Maverick

‘Grey’s Anatomy’ recap: ‘Civil War’ – EW.com

Meredith whos baaack opens the episode talking about a father who sent both of his sons to fight on either side of the Civil War, an apt story considering almost everyone in the hospital is in a small, personal war against at least one or two of their colleagues. (Though considering the episode is titled Civil War, Im not sure what else we could expect.)

That said, here is how the battle lines were drawn:

Catherine vs. Richard

The Chief is sleeping in the hospitals on-call rooms, which prompts him to request that Bailey replace all the mattresses with something that provides lumbar support. But the bigger issue, of course, is that he feels that the longer Minnick stays, the more the other members of the hospital staff will grow to love him something Arizona tries to talk him out of.

However, Richard cant keep ignoring Catherine who suggested he can come sleep at home forever, as theyre both operating on the same patient, a man whos been in a deep fryer-related accident courtesy of his friends boyfriend. Of course part of this is Richards annoyance that Catherine would dare to watch Hamilton in Chicago without him.

Later in the night, Richard asks Arizona if he can stay with her, but she mentions her date (not telling him its actually with Minnick), so he decides to pull an all-nighter at the hospital instead. Only the patient gets into trouble and needs to be operated on, but when all the doctors get in, Ben is already operating on him. Catherine tells Richard to step in, but he says that Jacksons got it.

After the surgery, Jackson gets mad at Richard for basically using Minnicks method, but the former Chief points out that he was teaching the way hes always taught; its just that Ben is a very capable second year resident. He also doesnt want to tear mother and son apart, especially seeing the younger Avery rail against Catherine this entire episode. But Jackson just responds that his mother wont stop because she wants things her way.

Later, Richard walks in on Arizona and Minnick as theyre about to kiss, following a long night where they just slept on a hospital couch instead of going back to Arizonas place, where Minnick was going to make her pierogies. As he apologizes and leaves, Richard shoots Arizona a hurt look, and its clear that she too feels awful.

Back in an on-call room, Catherine asks Richard to come home and get a good night of sleep. He tells her he didnt want to come between her and Jackson. He then sleeps in the on-call room. She wishes him a good night and leaves.

Jackson vs. Catherine and April

Jackson blames this whole thing on his mother, and he sees April, who is frustrated by having to give Meredith her job back, as a traitor. First he goes and tells his mom that as the Avery Foundation representative on the hospitals board, hes going over her head, then hes very short with her as they attempt to work on the groups trauma patient.

It doesnt help matters that Catherine, who feels April has earned her position and is proud of her work, is planning to take the trauma surgeon to Chicago with her so the Avery Foundation hospital doctors there can learn from her. (They also plan on seeing Hamiltonand going on a boat tour, which Ben says is lovely. So, you know, theres that.)

NEXT: Jacksons anger continues, And its Alex vs. Riggs

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'Grey's Anatomy' recap: 'Civil War' - EW.com

Employees who decline genetic testing could face penalties under proposed bill – Washington Post

Employers could impose hefty penalties on employees who decline to participate in genetic testing as part of workplace wellness programs if a bill approved by a U.S. House committee this week becomes law.

In general, employersdon't have that power under existing federal laws, which protect genetic privacy and nondiscrimination. But a bill passed Wednesday by theHouse Committee on Education and the Workforce would allow employers to get around thoseobstacles if the information is collected as part of a workplace wellness program.

Suchprograms which offer workers a variety ofcarrots and sticksto monitor and improve their health, such as lowering cholesterol have become increasingly popularwith companies.Some offer discounts on health insurance to employees who complete health-risk assessments. Others might charge people more for smoking.Under the Affordable Care Act, employers are allowed to discount health insurance premiums by up to 30 percent and in some cases 50 percent for employees who voluntarily participate in a wellness program.

[Obamacare revision clears two House committees as Trump, others tried to tamp down backlash]

The bill is under review by other House committees and still must be considered by the Senate. But it has already faced strong criticism from a broad array of groups, as well as House Democrats. In a letter sent to the committee earlier this week, nearly 70 organizations representing consumer, health and medical advocacy groups, including the American Academy of Pediatrics, AARP, March of Dimes and the National Women's Law Center said the legislation, if enacted, would undermine basic privacy provisions of the Americans With Disabilities Act and the 2008 Genetic Information Nondiscrimination Act(GINA).

Congress passed GINA to prohibit discrimination by health insurers and employers based on the information that people carry in their genes. There is an exception that allows for employees to provide that information as part of voluntary wellness programs. But the law states that employee participation must be entirely voluntary, with no incentives for providing the dataor penalties for not providing it.

But theHouse legislation would allow employers to impose penalties of up to 30 percent of the total cost of the employee's health insurance on those who choose to keep such information private.

[Rich Americans seem to have found a way to avoid paying a key Obamacare tax]

It's a terrible Hobson's choice between affordable health insurance and protecting one's genetic privacy, said Derek Scholes, director of science policy at the American Society of Human Genetics, which represents human genetics specialists. The organization sent aletter to the committee opposing the bill.

The average annual premium for employer-sponsored family health coverage in 2016 was $18,142, according to the Kaiser Family Foundation. Under the plan proposed in the bill, a wellness program could charge employees an extra $5,443 in annual premiums if they choose not to share their genetic and health information.

The bill, Preserving Employee Wellness Programs Act, HR 1313, was introduced by Rep. Virginia Foxx, (R-N.C.), who chairs the Committee on Education and the Workforce. A committee statement said the bill provides employers the legal certainty they need to offer employee wellness plans, helping to promote a healthy workforce and lower health care costs.

The bills supporters in the business community have argued that competing regulations in federal laws make it too difficult for companies to offer these wellness programs. In congressional testimony this month, the American Benefits Council, which represents major employers, said the burdensome rules jeopardize wellness programs that improve employee health, can increase productivity and reduce health care spending.

A House committee spokeswoman told CNBC that those opposed to the bill are spreading false informationin a desperate attempt to deny employees the choice to participate in a voluntary program that can reduce health insurance costs and encourage healthy lifestyle choices.

Read more:

Deadly fungal infection that doctors have been fearing now reported in U.S.

Obamacare repeal guts crucial public health spending, including prevention of disease outbreaks

These 12 superbugs pose the greatest threat to human health, WHO says

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Employees who decline genetic testing could face penalties under proposed bill - Washington Post

Better Buy: Myriad Genetics, Inc. vs. Opko Health, Inc. – Motley Fool

It's been a rough 12 months for Myriad Genetics (NASDAQ:MYGN) and Opko Health (NASDAQ:OPK). Myriad lost nearly half of its market cap during the period, while Opko stock is down around 20%.

Could better days be ahead for these two stocks? And which is the better pick for long-term investors? Here's how Myriad Genetics and Opko Health stack up against each other.

Image source: Getty Images.

There are three primary arguments in favor of buying Myriad Genetics stock. The company is a leader in the U.S. hereditary cancer screening market and is poised to expand its lead. Myriad is quickly growing its non-hereditary cancer business. The company also has significant opportunities in international markets.

How does Myriad plan to grow its U.S. hereditary cancer business? The greatest potential lies in expanding testing beyond breast cancer patients. A key to achieving this objective is with Myriad's myRisk, a single comprehensive DNA test that screens for breast cancer, ovarian cancer, colon cancer, uterine cancer, melanoma, pancreatic cancer, prostate cancer, and gastric cancer.

In Myriad Genetics' fiscal year 2013, only 1% of total testing volume stemmed from non-hereditary cancer screening. The company expects to report that figure is roughly 67% for fiscal year 2017. One primary product making this growth possible is GeneSight, a genomic test used to help physicians prescribe the correct psychiatric medications for patients. Myriad picked up GeneSight with its acquisition last year of Assurex Health.

As for international growth, Myriad is looking over the short term to expand primarily in the Canadian and major European markets. Over the longer term, though, the company plans to grow significantly in Japan, China, and Brazil.

Myriad's management team thinks the company can grow revenue at an average annual rate of more than 10% with an operating margin of at least 30%. The stock is up so far in 2017, thanks to a string of good news for the company -- including positive coverage decisions for Myriad's EndoPredict breast cancer test by multiple Blue Cross Blue Shield plans.

There are two key things to look at with Opko Health: the company's current products and services and its pipeline prospects. Opko currently gets over 80% of its revenue from services provided by Bio-Reference Labs, which it acquired in 2015. Bio-Reference generates solid cash flow and helps Opko market its 4Kscore prostate cancer DNA test.

Opko also has two drugs on the market. Varubi, which is used to treat chemotherapy-induced nausea and vomiting (NINV), is licensed to Tesaro. Rayaldee won U.S. regulatory approval in June 2016 for thetreatment of secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD). Although it's still relatively early in the commercial launch of Rayaldee, the potential for the drug appears to be quite promising. CKD is the ninth leading cause of death, with most CKD patients dying from cardiovascular disease precipitated by SHPT. There aren't any great options for treating SHPT other than Rayaldee.

Opko has several pipeline candidates. The most eagerly anticipated product is human growth hormone hGH-CTP that Opko is developing in partnership withPfizer. Opko reported disappointing results from a late-stage study of hGH-CTP.However, the company saw some outliers in the clinical data that gave hope that the hormone could potentially still win regulatory approval. Opko and Pfizer are working to advance to a regulatory filing based on an additional statistical analysis of the data.

Unlike Myriad Genetics, Opko isn't turning a profit right now. The company reported a net loss in 2016 of $25 million. However, its bottom line has improved and should get a big boost if Rayaldee picks up steam.

Quite frankly, both of these stocks are risky. Myriad Genetics faces intense competition in the DNA screening business. It's also at the mercy of payers' reimbursement decisions. Opko Health could be derailed if its hGH-CTP doesn't win approval or if Rayaldee sales don't meet expectations.

Personally, my risk tolerance isn't enough for me to buy either of these stocks. However, I thinkOpko gets the nod as the better choice between the two. The basis of my decision was on the opportunity that Opko has if things go its way. Granted, that might not happen. But if the company enjoys some good luck, the stock could soar.

Keith Speights owns shares of Pfizer. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.

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Better Buy: Myriad Genetics, Inc. vs. Opko Health, Inc. - Motley Fool

Canada’s new genetic privacy law is causing huge headaches for Justin Trudeau – Science Magazine

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By Wayne KondroMar. 10, 2017 , 6:00 PM

A vote in Canadas Parliament to approve a genetic privacy bill is creating a self-inflicted political headache for Prime Minister Justin Trudeaus Liberal governmentand could result in a relatively rare and unusual court case.

The Genetic Non-Discrimination Act, originally introduced in 2013 by now-retired Liberal Senator James Cowan, is aimed at preventing the use of information generated by genetic tests to deny health insurance, employment, and housing, or to influence child custody and adoption decisions. It calls for fines of up to $740,000 and prison terms of up to 5 years for anyone who requires any Canadian to undergo a genetic test, or to disclose test results, in order to obtain insurance or enter into legal or business relationships. The bill bars discrimination on the grounds of genetics, and the sharing of genetic test results without written consent (with exemptions for researchers and doctors).

Supporters said the law is needed to encourage Canadians to make greater use of genetic testing. Currently, they claimed, many Canadians refuse genetic tests in the course of care or clinical trials because they fear insurers or others could use the results against them. But opponents of the bill, including health and life insurers, argued a ban would increase treatment and insurance costs. Instead, insurers support a voluntary code regulating the use of genetic tests in underwriting life insurance policies; it would allow insurers to require tests only for policies worth more than $185,500. Trudeaus Liberal Party cabinet also formally opposed the measure, with Justice Minister Jody Wilson-Raybould arguing that the bill is unconstitutional because it intrudes on powers given to Canadas 13 provincial and territorial governmentsto regulate insurance.

Those arguments, however, failed to sway lawmakers. On 9 March, members of Parliament voted 22260 to approve the measure. More than 100 Liberal members voted for the bill, taking advantage of a so-called free vote, which allows members to vote their conscience rather follow the party line.

The vote was applauded by Bev Heim-Myers, chair of the Canadian Coalition for Genetic Fairness in Kitchener, which represents 18 disease-based organizations. Finally, the voices of Canadians, and the voices of science and medicine, were heard, she says.

The result has prompted Trudeaus government to consider extraordinary measures to block the legislation. Normally, the bill would become law once it is approved by Canadas governor-general (and in this case, after Canadas Senate approves a minor amendment requested by the House of Commons). The governor-general, who represents the queen of England, is a holdover from Canadas past as a British colony, and typically rubber stamps legislation passed by Parliament.

To delay and potentially kill the legislation, Trudeaus government is considering not sending the bill to the governor-general (a tactic that doesnt appear to have been used since the 1920s), and instead asking Canadas Supreme Court to rule on the bills constitutionality. That process could take up to 2 years.

Cowan, the bills original sponsor, says he cant fathom the rationale behind the governments stance. Is it really up to the government of Canada to defend provincial jurisdiction, or the insurance industry? he asks.

Prominent legal scholars are skeptical of the governments claim that the law is unconstitutional. Canadas Supreme Court has previously held that federal criminal law can apply to regulating food, drugs, guns, and other areas in which the goal is to mitigate so-called social evils, they note. And the claim that the bill infringes on provincial power to regulate insurance may not hold up, because the law applies equally to all commercial sectors.

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Canada's new genetic privacy law is causing huge headaches for Justin Trudeau - Science Magazine

Genetics and cancer: why testing can aid prevention – WRVO Public Media

No one wants to talk about cancer. A disease that has taken the lives of so many, even the word itself has an ominous connotation. But as much as we dont want to talk about it, new genetic technology suggests that starting the conversation about your familys cancer history might be in everyones best interest.

In her new book, "A Cancer in the Family: Take Control of your Genetic Inheritance," Dr. Theodora Ross addresses how our familys medical history plays a role in our health. To shed some light on the genetics of cancer, as well as genetic counseling, Ross spoke with Take Care to explain the importance of knowing your family history. Ross, a cancer geneticist, is director of University of Texas Southwestern Medical Centers cancer genetics program.

First and foremost, Ross says that while you may feel theres nothing you can do about an impending cancer diagnosis, knowing is always better than not knowing. Ross herself was hesitant to find out about her own genetics, even though she's a cancer expert and has a family history of the disease, including a sister with breast cancer. But when she developed a melanoma in 2004, she decided it was time to talk to a geneticist and a genetic counselor.

Ross attributes her hesitation to truthiness, which occurs when we want something to be true. Often when it comes to health, we ignore or deny potential problems. We dont go to doctors when were healthy, we dont want to believe there could be a problem, and so we dont look.

But Ross says knowing the family history of a patient is an important step in prevention, and helps not only the patient, but researchers too. Genetic counselors can go to physicians and obtain medical records, which gives researchers more data to work with, and gives patients an accurate understanding of their family history.

According to Ross, the most common genetically inherited cancer syndrome is Lynch syndrome, which occurs when there is a mutation in mismatched repaired genes. This mutation will lead to a predisposition to colon, endometrial, ovarian, pancreatic, and other cancers. The kicker? Only 5 percent of people with this syndrome actually know they have it, and its common. About one in 300 have it, says Ross. And if they knew, they could carry out preventative measures such as frequent colonoscopies and check-ups.

Comprehensive genetic testing is becoming cheap enough, according to Ross, for people to seek out this information at a reasonable cost. Genetic counselors, she says, have an incredible ability to connect with their patients while providing them with the information they need to make the most of their genetic history. Talking about cancer in the family can be a scary conversation, but its crucial, says Ross, to aid in our efforts towards prevention.

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Genetics and cancer: why testing can aid prevention - WRVO Public Media

Tennessee Bird Flu Shares Name, Not Genetics, Of Feared China Strain – Huffington Post

The strain of bird flu that infected a chicken farm in Tennessee in recent days shares the same name as a form of the virus that has killed humans in China, but is genetically distinct from it, U.S. authorities said on Tuesday.

The U.S. Department of Agriculture identified the strain in Tennessee as H7N9, following a full genome sequencing of samples from the farm. It said all eight gene segments of the virus had North American wild bird lineage.

On Sunday, the USDA confirmed the farm in Tennessee was infected with highly pathogenic bird flu, making it the first case in a commercial U.S. operation in more than a year.

In China, at least 112 people have died from H7N9 bird flu this winter, Xinhua news agency said on Friday.

However, that virus has Eurasian lineage, U.S. flu experts said.

Even though the numbers and the letters are the same, if you look at the genetic fingerprint of that virus, it is different, said Dan Jernigan, director of the influenza division at the National Center for Immunization and Respiratory Diseases at U.S. Centers for Disease Control and Prevention.

Jernigan said the risk to humans from the virus found in Tennessee is low. Genome sequencing shows the H7N9 virus did not have genetic features present in the virus in China that make it easier for humans to become infected, he said.

The virus found in Tennessee likely mutated to become highly pathogenic from a less dangerous, low pathogenic form, he said.

Disease experts fear a deadly strain of bird flu could mutate into a form that could be passed easily between people and become a pandemic.

Multiple outbreaks of the virus have been reported in poultry farms and wild flocks across Europe, Africa and Asia in the past six months. Most involved strains that were low risks for human health, but the sheer number of different types, and their simultaneous presence in so many parts of the world, has increased the risk of viruses mixing and mutating - and possibly jumping to people, according to disease experts.

Chinas Center for Disease Control and Prevention has said the majority of people infected by H7N9 in China reported exposure to poultry, especially at live markets.

Identifying the viruses in Tennessee and China both as H7N9 is similar to having two cars from different states with the same license plate number, said Carol Cardona, avian flu expert at the University of Minnesota.

The strain in Tennessee is NOT the same as the China H7N9 virus that has impacted poultry and infected humans in Asia, the USDA emphasized in a statement.

While the subtype is the same as the China H7N9 lineage that emerged in 2013, this is a different virus and is genetically distinct from the China H7N9 lineage, the USDA added.

U.S. officials are working to determine how the Tennessee farm, which was a supplier to Tyson Foods Inc, became infected. All 73,500 birds there were killed by the disease or suffocated with foam to prevent its spread.

Tyson, the worlds biggest chicken company, is hopeful this is an isolated incident, spokesman Worth Sparkman said.

Authorities have not identified the name of the farm or the town in Lincoln County, Tennessee, where it is located.

(Editing by Matthew Lewis and Bernard Orr)

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Tennessee Bird Flu Shares Name, Not Genetics, Of Feared China Strain - Huffington Post

How Global Warming Is Threatening Genetic Diversity | JSTOR Daily – JSTOR Daily

The meltwater stonefly has adapted to a very specific and extreme niche the cold, clear water that pours off of the melting ice and snow from the glaciers in Glacier National Park in Montana. This bug is on the leading edge of climate change because its frigid mountain habitat is rapidly disappearing. Since 1850, 85 percent of the ice in Glacier has disappeared, and all of it is forecast to vanish completely by 2020.

In a study published in 2016, researchers found the cold-loving insect in trouble. Their physiology requires really, really cold water, and they cant survive once the water gets above an average of 9 degrees Centigrade during August, said Joe Giersch, a biologist with the U.S. Geological Survey (USGS), who has studied this and a similar insect, the western glacier stonefly.

Meltwater stoneflies and western glacier stoneflies move upstream to find cold water as things warm, and because of steeper mountain topography, populations become separated. This has interrupted gene flow, causing some genetics to disappear. As genes dwindle, the species is losing genetic variation and likely adaptive capacity the genetics that give species the ability to evolve needed traits as habitat conditions change. Its a big part of why the meltwater stonefly (Lednia tumana) is being considered for listing as threatened under the federal Endangered Species Act.

And many of its fellow high-altitude insects are in trouble too. This stonefly, Giersch and his co-authors wrote, likely represents a guild of species facing similar threats in alpine headwaters worldwide.

There is a huge unknown when it comes to protecting the meltwater stonefly and other species. Biologists are missing a huge piece of the puzzle knowing which genetics will give species the evolutionary lift that allows them to adapt successfully to a warmer world. This hidden DNA and the possibly important traits it represents are known as cryptic diversity, and much of it is being lost, experts say, as the range of species contracts, fragments, and otherwise changes. Yet this DNA is vital because it contains information on different lineages and on species that are emerging, the cutting edge of evolution. Losing it will greatly complicate the task of assessing how climate change will affect biodiversity and what to protect.

Genetic diversity in foundational plant species alpine flowers, cottonwoods, or tall grass prairie drive hundreds if not thousands of other species.

What disappears before we know it could have far-reaching consequences. A long-term research project on the genetic variations in cottonwood trees, called the Cottonwood Ecology Group, found that the genotype of a tree affects the communities of some 700 insect species that depend on it, as well as chemical emissions, microbes, bacteria, lichens, beavers, and birds that feed on the insects. Should important genotypes disappear, whole ecological communities could change in unpredictable ways. Genetic diversity in foundational plant species alpine flowers, cottonwoods, or tall grass prairie drive hundreds if not thousands of other species, said Thomas Whitham who heads the project at Northern Arizona University. Thats why climate change is an evolutionary event.

Often where the climate is changing fastest is where species are affected most. The bull trout, a threatened species that depends on very cold water in the Pacific Northwest, is also being impacted by warming. What we found is that genetic diversity is lowest in those locations that are going to experience the greatest climate change and the most stressful environmental conditions, said Ryan Kovach, a USGS fisheries biologist in Glacier National Park who has published papers on the subject of bull trout and climate. In other words they dont have genetic diversity where they are most likely to need it. Thats because there are fewer fish in these habitats because of already stressful conditions.

These kinds of genetic studies are a race against climate warming that is happening far faster than predicted. Although genetic diversity is literally the fundamental building block for all life, it is almost completely ignored in the context of climate change, said Kovach.

Carsten Nowak, a conservation biologist at the Senckenberg Research Institute and Natural History Museum in Gelnhausen, Germany, has also studied the genetics of climate change response in alpine insects, as well as in wolves and other species.

In 2011 Nowak and his colleagues conducted research in high-country Europe that looked at seven species of caddis fly and one species each of mayfly and stonefly, which like the stoneflies in Glacier National Park are cold-loving bugs. The scientists examined the species genetics and divided them into a finer scale, populations within the species that are genetically distinct from each other, something known as Evolutionary Significant Units (ESUs).

If the climate scenario doesnt change, according to their work, 79 percent of the ESUs will go extinct by 2080, decimating hidden genetic diversity. If greenhouse gas emissions are reduced by the amount needed to cap global warming at 2 degrees Celsius, as the Intergovernmental Panel on Climate Change has urged, then 59 percent of the ESUs are projected to disappear.

Nowaks study predicted that the loss of genetic diversity in Europe would be most marked in the Mediterranean region of southern Europe, which is also the area of the continent with the greatest genetic diversity. Even if populations disappear, no one knows what the loss represents. We need to know if there are ten populations and nine disappear does that matter? Nowak said.

Portuguese researchers forecasted in a paper published in February of 2016 that many lineages of amphibians and reptiles on the Iberian peninsula, which is expected to be hardest hit by warmer and drier weather, could disappear or contract within the next half century, causing a loss of cryptic diversity with implications to evolutionary processes.

These losses are important because a species, for example, that is exposed to a new disease, might not be able to evolve resistance to it because the genetics that govern immune response are gone. Or the genes that allow a fish or stonefly to regulate its temperature in warmer water might disappear.

The good news is that there has been a revolution in the ability to sequence DNA its now much faster and far cheaper than ever. The goal of many conservation scientists is to sequence the genomes of a species and then understand which section is responsible for adaptation, including such traits as migratory abilities, dispersal, and the ability to adapt to warmer temperature. Once thats done, it allows managers to allocate scarce resources to protect the populations most essential for adapting to changing conditions.

Can we use the Indian tiger to repopulate Siberia?

Nowak cited the example of the Siberian tiger, whose population has dwindled to a few hundred. Can we use the Indian tiger to repopulate Siberia? he asked rhetorically. If you have a lot of Evolutionary Significant Units and know what they represent, you might want some that are better at cold adaptation or fish catching, to repopulate Siberia. You cant just protect the species, you have to protect the populations, the small units of a species that might have the genes necessary for adaptation. Knowing what they represent is the hard part.

As ecologically important species come on line with their adaptation capacity mapped, it will give managers a powerful tool to triage species to protect the adaptation genetics. They might even affect gene rescues by focusing on the populations with the most vital genes. One of the options we have for the stonefly is translocation moving one population to a different location, said Giersch. Thats after we investigate the hidden adaptations within the DNA to figure out which ones have the ability to adapt to warmer temperatures. Thats a ways down the road.

Two species of trees have recently had their climate genes mapped and adaptive capacity located. A study published in September of 2016 found that two distantly related trees interior spruce and lodgepole pine use the same set of 47 genes to deal with temperature, precipitation and other climate variables. Knowing about these adaptations trees is important because they migrate slowly, over generations, and assisted migration efforts with trees are already underway. We have to understand climate adaptation in other conifers so we can address trees that are becoming mismatched to their environment, said Sally Aitken, a professor of forest and conservation science at the University of British Columbia. That will inform better management strategies, she said, and enable us to plant trees that are more likely to thrive and adapt more quickly to climate change.

By: C. Thompson, E. David, M. Freestone, and C.T. Robinson

Western North American Naturalist, Vol. 73, No. 2 (July 2013), pp. 137-147

Monte L. Bean Life Science Museum, Brigham Young University

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How Global Warming Is Threatening Genetic Diversity | JSTOR Daily - JSTOR Daily

Style anatomy: Rabbiya Abdullah – The Express Tribune

The owner and designer of Pakistans first loungewear label, Blood Orange, shares her personal style

The owner and designer of Pakistans first loungewear label, Blood Orange, shares her personal style. Find out what caused her style evolution and what she considers the biggest fashion mistake!

Understanding your body is the key to looking good and a trait found amongst all impeccably dressed fashionistas. While people shy away from talking about their bodies, these brave souls explain how they work their anatomies to their advantage

How would you describe your body type?

I would say I have an hourglass figure.

Has your body type changed over the last five years?

I used to be quite lean and thin naturally, but for the last few years its become hard to maintain my weight.

How has your style changed over the years?

My style has definitely become more laidback. It has also quite literally become a reflection of my personality.

In your opinion what is your most troublesome area?

My thighs!

How do you dress your body according to your body type?

I like monochromatic colours and simple cuts as they complement my body and easily hide my problem areas.

In your opinion what is the biggest mistake a person can make while dressing here?

Here people focus more on incorporating labels in their outfits, and dont think about what looks good or fits with their personality. Style isnt original or personal anymore. Also, I dont like cluttered looks. I always notice someone whose style and ensemble is well put together.

Which silhouettes suit your body the most?

I prefer flared cuts to fitted silhouettes.

What is the one piece of clothing that you shy away from wearing and why?

I usually avoid vibrant colours and exaggerated garments. I am a minimalist!

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Style anatomy: Rabbiya Abdullah - The Express Tribune

ACC 2017: CVD Outcomes for Evolocumab, Intermediate-Risk TAVR, Coronary Physiology Tests, and More – TCTMD

Returning to their own backyard again this year, the American College of Cardiology (ACC) 2017 Scientific Sessions kick off next Friday with high hopes of giving the world some headlines to compete with other news coming out of the nations capital. Among the hot-ticket items on this years roster are a large, cardiovascular outcomes trial for a market-approved PCSK9 inhibitor, a randomized comparison of a non-vitamin K antagonist oral anticoagulant (NOAC) against aspirin in acute coronary syndromes, and 2-year outcomes from ABSORB III, the pivotal randomized trial that led to US approval of the first bioresorbable scaffold in 2016.

According to the ACC 2017 program chairs, who spoke with media via a telebriefing last week, this years conference attracted over 2,600 abstracts, of which 114 were late-breaking clinical trial (LBCT) submissions. A full 23 of these were selected as late breakers, and an additional 17 submissions are grouped in the featured clinical research sessions. There are a total of five LBCT sessions and three featured clinical research sessions distributed throughout the 3-day congress, which runs from Friday, March 17, through Sunday, March 19.

Were incredibly excited about this upcoming meeting, Jeffrey Kuvin, MD (Dartmouth-Hitchcock Medical Center, Manchester, NH), enthused during the telebriefing. Were confident there will be numerous practice-changing science presentations.

Chief among those is shaping up to be FOURIER, the 27,500-patient cardiovascular outcomes trial testing the PCSK9 inhibitor evolocumab on top of statin therapy against statins alone for the prevention of cardiovascular death, nonfatal MI, nonfatal stroke, hospitalization for angina, or coronary revascularization. As previously reported by TCTMD, the company announced in February that the trial had met its primary and secondary endpoints, but full details on those will be released in the opening LBCT session at ACC.

This is undoubtedly going to be a widely noted study and has the potential to be truly game changing, Kuvin said

Fleshing out Fridays opening LBCT session are the SPIRE I and II results looking at cardiovascular outcomes with a second PCSK9 inhibitor, bococizumab. These trials were stopped early in late 2016 after trial monitors noticed an unanticipated attenuation of LDL cholesterol lowering over time combined with an increase in immunogenicity and injection-site reactions.

The third trial in what the ACC has dubbed its opening showcase is SURTAVI, the pivotal trial testing the CoreValve transcatheter valve (Medtronic) in intermediate-risk patients with severe symptomatic aortic stenosis. The trial, which was initially launched outside the United States and then extended to include US patients, is anticipated to pave the way for an expanded US Food and Drug Administration (FDA)-approved indication later this year.

Day two of ACC 2017 includes two LBCT sessions, the first of which is jointly hosted by the Journal of the American College of Cardiology and the Journal of the American Medical Association.

During the telebriefing, Kuvin highlighted EBBINGHAUS, a cognitive function substudy from FOURIER, as well as two NOAC studies in that session. The first of these, EINSTEIN CHOICE, is looking at rivaroxaban versus aspirin for extended treatment of venous thromboembolism, while the second, GEMINI-ACS-1, is comparing rivaroxaban and aspirin on top of P2Y12 inhibition for patients post-ACS.

ACC 2017 Vice Chair Andrew Kates, MD (Washington University in St. Louis, MO), also speaking on the media telebriefing, took over from Kuvin to list some of the highlights of the remaining two LBCT sessions. Topping Kates list was ABSORB III. When the primary results of the study were released in 2015, the Absorb BVS (Abbott Vascular) was noninferior to DES at 1 year, Kates noted, adding that severalbut not allstudies have pointed to an increased rate of scaffold thrombosis with the bioresorbable device after 1 year. What were excited about at ACC 17 is well be hearing the interval data between years 1 and 2 [as well as the] the 2-year data in this session, Kates said, adding, Certainly its going to be important data that were looking forward to hearing.

Kates highlighted a number of other key trials throughout the program. These included LEVO-CTS looking at the use of levosimendan in patients with LV systolic dysfunction undergoing cardiovascular surgery with cardiopulmonary bypass, part of Sundays LBCT IV session co-hosted by JACC and the New England Journal of Medicine. Also in LBCT IV, Kates noted, is a trial testing a cerebral protection device during cardiac surgery.

While using embolic protection devices is safe and does capture embolic material, Kates said, its really not clear whether these devices really do anything to prevent strokes, or if they may reduce cognitive decline after surgery. This is certainly a very important topic that we all care about.

Finally, from LBCT V, Kates highlighted two heart rhythm studies, RE-CIRCUIT and ARISTOTLE. The first is looking at a relatively new drug, dabigatran (Pradaxa, Boehringer Ingelheim), used without interruption during ablation for atrial fibrillation. The second is looking at an old drug, digoxin, in A-fib patients with and without heart failure.

For Interventionalists: TAVR and FFR/iFR

Interventionalists attending ACC 2017 will find plenty of other late breakers relevant to their subspecialty. Updates from transcatheter valve studies are dotted throughout the LBCT and featured clinical research sessions, including, in LBCT IV, an MRI analysis of microbleeds during TAVR and two studies looking at subclinical leaflet thrombosis in surgical and transcatheter valve prostheses. Saturdays featured clinical research session is focused on interventions and comparisons of SAVR and TAVR; transcatheter valve replacement for native versus failed surgical bioprostheses; and TAVR for bicuspid versus tricuspid valve disease. The same session also has a presentation addressing 1-year outcomes with the MitraClip (Abbott) in the US following FDA approval.

Coronary disease is also front and center, particularly in LBCT IV. This session includes a trial of culprit lesion versus complete revascularization in STEMI, plus two randomized trials of fractional flow reserve (FFR) versus instantaneous wave-free ratio (iFR): DEFINE-FLAIR and iFR-SWEDEHEART. These two large CV outcomes trials will determine how the physiologic information provided by iFR compares with the usefulness of FFR in guiding treatment.

Research and Practice

Beyond the late breakers and featured research, this years ACC has11 learning pathways including one on special topics spanning everything from malpractice minefields to public reporting. There are also seven keynote lectures, including one by Janet S. Wright, MD, executive director of the joint Centers for Disease Control/Centers for Medicare & Medicaid Services Million Hearts initiative, now perilously close to its deadline of preventing 1 million heart attacks and strokes by the end of 2017. Another keynote will be delivered by NEJM Editor-in-Chief Jeffrey Drazen, MD, speaking on data sharing in clinical trials. Drazen famously penned a controversial editorial in the journal poking holes in the Open Data proposal set forth in draft form by the International Committee of Medical Journal Editors and referring to the risk of research parasites, a position he revised in a second editorial days later.

The entire TCTMD editorial teamCaitlin Cox, Yael Maxwell, Laura McKeown, Todd Neale, Michael ORiordan, and me, Shelley Wood, will be on the ground at ACC 2017. Follow us on Twitter for breaking news and find our in-depth stories on our conference coverage page.

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ACC 2017: CVD Outcomes for Evolocumab, Intermediate-Risk TAVR, Coronary Physiology Tests, and More - TCTMD