Study questions kidney cancer treatment in elderly

In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away.

Even though nearly all of these tumors turned out to be cancer, they rarely proved fatal. And surgery roughly doubled patients' risk of developing heart problems or dying of other causes, doctors found.

After five years, 24 percent of those who had surgery had died, compared to only 13 percent of those who chose monitoring. Just 3 percent of people in each group died of kidney cancer.

The study only involved people 66 and older, but half of all kidney cancers occur in this age group. Younger people with longer life expectancies should still be offered surgery, doctors stressed.

The study also was observational — not an experiment where some people were given surgery and others were monitored, so it cannot prove which approach is best. Yet it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared. Surgery is the standard treatment now.

"I think it should change care" and that older patients should be told "that they don't necessarily need to have the kidney tumor removed," said Dr. William Huang of New York University Langone Medical Center. "If the treatment doesn't improve cancer outcomes, then we should consider leaving them alone."

He led the study and will give results at a medical meeting in Orlando, Fla., later this week. The research was discussed Tuesday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.

In the United States, about 65,000 new cases of kidney cancer and 13,700 deaths from the disease are expected this year. Two-thirds of cases are diagnosed at the local stage, when five-year survival is more than 90 percent.

However, most kidney tumors these days are found not because they cause symptoms, but are spotted by accident when people are having an X-ray or other imaging test for something else, like back trouble or chest pain.

Cancer experts increasingly question the need to treat certain slow-growing cancers that are not causing symptoms — prostate cancer in particular. Researchers wanted to know how life-threatening small kidney tumors were, especially in older people most likely to suffer complications from surgery.

They used federal cancer registries and Medicare records from 2000 to 2007 to find 8,317 people 66 and older with kidney tumors less than 1.5 inches wide.

Cancer was confirmed in 7,148 of them. About three-quarters of them had surgery and the rest chose to be monitored with periodic imaging tests.

After five years, 1,536 had died, including 191 of kidney cancer. For every 100 patients who chose monitoring, 11 more were alive at the five-year mark compared to the surgery group. Only 6 percent of those who chose monitoring eventually had surgery.

Furthermore, 27 percent of the surgery group but only 13 percent of the monitoring group developed a cardiovascular problem such as a heart attack, heart disease or stroke. These problems were more likely if doctors removed the entire kidney instead of just a part of it.

The results may help doctors persuade more patients to give monitoring a chance, said a cancer specialist with no role in the research, Dr. Bruce Roth of Washington University in St. Louis.

Some patients with any abnormality "can't sleep at night until something's done about it," he said. Doctors need to say, "We're not sticking our head in the sand, we're going to follow this" and can operate if it gets worse.

One of Huang's patients — 81-year-old Rhona Landorf, who lives in New York City — needed little persuasion.

"I was very happy not to have to be operated on," she said. "He said it's very slow growing and that having an operation would be worse for me than the cancer."

Landorf said her father had been a doctor, and she trusts her doctors' advice. Does she think about her tumor? "Not at all," she said.

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Online:

Kidney cancer info: http://www.cancer.net/cancer-types/kidney-cancer

and http://www.cancer.gov/cancertopics/types/kidney

Study: http://gucasym.org

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Stock index futures point to slightly higher start

LONDON (Reuters) - Stock index futures pointed to a slightly higher open on Wall Street on Wednesday, with futures for the S&P 500, the Dow Jones and the Nasdaq 100 up 0.1-0.2 percent at 0958 GMT (4.58 a.m EST).

European shares were slightly lower, although they remained near the top of a six-day trading range. French bank Societe Generale sank 3.7 percent after it unveiled a bigger-than-expected quarterly loss.

U.S. President Barack Obama said in his State of the Union speech on Tuesday he backs higher taxes for the wealthy and a $50 billion spending plan to create jobs by rebuilding degraded roads and bridges.

The U.S. Commerce Dept. releases U.S. retail sales data at 1330 GMT. It was expected to show a 0.1 percent rise in January, slowing from a 0.5 percent increase in December as consumers eyed smaller paychecks on the back of a recent tax increase.

Business inventories data for December, due at 1500 GMT, are expected to show a rise of 0.3 percent, a repeat of the November increase.

Comcast Corp clinched full control of NBC Universal for $16.7 billion on Tuesday, the latest in a series of deals that have taken the cable operator from humble roots in Tupelo, Mississippi, to Manhattan's iconic Rockerfeller Center.

The group is due to unveil fourth-quarter results before the market open, with earnings per share seen at $0.53 from $0.47 one year earlier.

Networking equipment maker, Cisco Systems , is expected to report a $0.01 increase in its quarterly earnings per share, with corporate North America and parts of Europe showing signs of improvement. The results are due after the market close.

Chip-maker Nvidia is also among companies due to report quarterly results.

Clearwire Corp , the wireless service provider that both Sprint Nextel S.N and Dish Network DISH.O want to buy, said on Tuesday that it would need Sprint financing to keep afloat up to the end of the year.

Asset manager Legg Mason Inc is preparing to name its interim head, Joseph Sullivan, as its permanent chief executive, two people familiar with the matter said, as the company turns to a sales chief to stop an outflow of funds.

BlackRock Inc named Morgan Stanley MS.N banker and long-time financial advisor Gary Shedlin as its next chief financial officer, to succeed Ann Marie Petach.

Yahoo Inc Chief Executive Marissa Mayer said the company's search partnership with Microsoft Corp was not delivering the market share gains or the revenue boost that it should.

The Dow Jones industrial average <.dji> closed 47.46 points higher, or 0.34 percent, at 14,018.70 on Tuesday. The Standard & Poor's 500 Index <.spx> was up 2.42 points, or 0.16 percent, at 1,519.43. The Nasdaq Composite Index <.ixic> was down 5.51 points, or 0.17 percent, at 3,186.49.

(Reporting by Francesco Canepa; editing by Patrick Graham)

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Mobile phone maker Nokia expands budget Asha line-up

HELSINKI (Reuters) – Mobile phone maker Nokia expanded its line of low-end smartphones on Tuesday with the Asha 310, which comes with dual-SIM and wi-fi access, aiming to bolster its market share in developing markets.

Nokia has been losing market share to Samsung and Apple in the high-end smartphone market and is also struggling at the low end against growing competition from Chinese manufacturers.

The Finnish company said that the new Asha 310 will come with a full-touch 3-inch display and 2 megapixel camera. The phone allows users to switch between SIM cards and wi-fi to keep down costs.

Nokia plans for the phone to be in stores in Asia, the Middle East, Africa and Brazil this quarter at a price of $ 102.

(Reporting by Helsinki Newsroom; Editing by David Goodman)

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India Ink: Lost and Found at the Kumbh Mela

ALLAHABAD, Uttar Pradesh— Most people know the heart-sinking feeling of losing someone in a crowded place. Imagine the feeling of being lost at the largest gathering of humanity in the world, the Kumbh Mela.

It’s a scene so dramatic, and so common, that it’s a theme in many Bollywood movies — families who attend the Kumbh are separated and then reunited decades later.

Pranmati Pandey, a middle-aged woman from Bihar, knows the experience well. The mother of four was separated from her family on Sunday morning in the tide of an estimated 30 million people who gathered for the auspicious bathing day. Late on Sunday night she sat huddled with hundreds of other people, mostly women, who had also been separated from their friends and family.

“I just looked away from my family to give rice to the poor people on the road,” Mrs. Panday said, too exhausted from the day to cry. “When I turned around they were gone.” She wandered around for a few hours before a benevolent stranger took her to the police.

Every 12  years, an enormous pop-up city is erected on a flood plain, where the Ganges, the Yamuna, and the mythical Saraswati rivers merge.  Organizers say up to 80 million people are likely to attend the six-week event.  Though there is not an official estimate of the crowds yet, the police and organizers say that on Feb. 10, the largest bathing day, the number of people separated from their family and friends at the mela rose above 20,000.

To reconnect the huge numbers of missing, scores of police officers, government officials, and nongovernmental workers, like Rajaram Tiwari, are collaborating to assure that the lost will be found. Mr. Tiwari started an organization, Bharat Seva Dal, to find missing people at the Kumbh Mela back in 1947.

Tin Cans to Smartphones

“I came to the Kumbh when I was a teenager,” Mr. Tiwari said. “I saw how many people suffered when they lost their loved ones. So, I decided to start this organization. ”

During the first few Kumbhs he attended, Mr. Tiwari said he walked around with megaphones crafted with tin cans, announcing the names of the missing. Mr. Tiwari, who is in his eighties, said that over the last few decades the government has understood the importance of his service, and eventually gave him more resources.

Now, there are tens of thousands of speakers throughout the gathering, blaring 24-hour announcements with the names and descriptions of the lost. The system is manned by Mr Tiwari’s organization, several other NGOs, and the police.

There is a chaotic order to Mr. Tiwari and his comrades’ lost-and-found command stations, the largest of which is easily identified by a golf cart-sized yellow balloon that floats several hundred feet above it. As people come in, their names and details are written on a slip of paper and broadcast across the Kumbh.

On non-bathing days when the crowds are more manageable, the system works relatively well. But as the masses gathered on Sunday, it teetered on total collapse.

Half naked and soaked pilgrims, who had been separated from their friends and family in the rush to take a dip at the Sangam, swarmed a platform set up by the police on the banks of the river in hopes of finding the missing. Terrified children stood on the platform and screamed for their parents. One little boy, who spotted his father  among the masses, jumped off the stage and crowd-surfed into his arms.

By Sunday night, mountains of paper scraps with names scrawled on them littered the tiny tin-paneled announcement room at Tiwari’s tent. With no system of tracking the missing, many of the names were read once and then discarded.

In hopes of improving the process, police this year tried to utilize mobile internet technology.

“At the last Maha Kumbh in 2001, we were using land line phones and only had one digital camera to take pictures of missing people,” said Alok Sharma, the inspector general of the police in Allahabad.

This Kumbh, Mr. Sharma, 42, said the police are using “WhatsApp,” a smart phone application that sends messages and photos in real time to share information. They’ve also created a digitized photo system of the lost and found people that is available online.

But for Mrs. Panday and the thousands of other frantic people clambering to get the attention of  the police and Mr. Tiwar’s tent for help on Sunday, cell phones mattered little.

No Phone, No Money, No Address

Mrs. Panday is illiterate,  has no money, cell phone or even a phone number to contact her loved ones. So she  relied on her name being called on the loudspeaker. She said she heard it three times but no one had turned up.

The new technologies are supposed to make policing easier and cut back on the time that people are lost from days to hours, Mr. Sharma said. But in many ways, the old-school system of public announcements remains the most effective.

“The crowds are such that they are still not that much into computers and things like that,” said Mr. Sharma, who expected 18,000 police to patrol this year’s festival. “They would just go back to the basics. That is the announcement system.”

 Hundreds of Languages

But, in a country with hundreds of different dialects, making announcements can be difficult.

During one of the bathing days in January, when Mr. Tiwari and his staff did not understand the language of a missing person named Manu, a middle-aged woman from West Bengal, he turned the mic over to her. Scared, Manu only managed to utter a few words in Bengali between sobs.

Luckily for her, a Bengali soldier heard the troubled call and came to the tent to make an announcement on her behalf. Within an hour, a member of her family showed up to claim her.

Overwhelmed with the droves of “lost people” on Sunday, the system of announcements was largely turned over to the missing.  The terrified voices of the old, young children and women reverberated around the Mela, a foreboding warning to stay close to your companions.

Bollywood Reunions

In the early hours of the morning on Monday, Mrs. Panday was still waiting for her family to claim her. A woman sitting nearby let out a shrill shout when she saw her husband. Both in their 70’s, the couple, who had been married for almost six decades, had been separated for hours.

The two made announcements for the other, but in the deafening madness of the Kumbh neither had heard them. As a last resort, the elderly man stopped by Mr. Tiwari’s tent where he reunited with his wife.

Despite the odds, the police and organizers said that in the next few days all of the missing will be reconnected. Well, almost all of them.

Some people who turn up at the tent in the Kumbh are still hoping for the Bollywood story.  A bespectacled man in his forties came to the tent to find his father, whom became a Sadhu 35 years ago.

“I’m not lost,” the man said.  “After attending a Kumbh when I was a child, my father decided to take up the life of a Sadhu and disconnected from the family. I was just hoping this could be the Kumbh I found him.”

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Bethenny Frankel & Daughter's Happy Playtime in Beverly Hills

Caught in the Act

02/12/2013 at 06:00 AM EST

Bethenny Frankel and Bryn

Ramey

Bethenny Frankel and daughter Bryn enjoyed some mommy and me time in Beverly Hills on Saturday.

Frankel looked happy as the duo played at the Beverly Canon Gardens outside the Montage Hotel, an onlooker tells PEOPLE. "Bethenny was all smiles and was hugging and playing with her daughter."

Dressed casually like her mom, Bryn wore a pink sweater and jeans – which she accessorized with sparkly pink glasses.

"Everyone in the park was stopping and saying hi to Bryn," the source adds.


– Raha Lewis

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Yen steady, euro dips after G7 urges against FX war

LONDON (Reuters) - The yen hovered near three-year lows against the dollar and the euro fell on Tuesday after the G7 nations urged countries to refrain from competitive devaluations and a U.S. official backed Japan's new anti-deflation policies.

The Group of Seven industrialized nations published a statement saying it remained committed to "market-determined" exchange rates, reacting to weeks of concern that Japan's monetary easing policy, which has also weakened its currency, could trigger far-reaching currency wars.

"We reaffirm that our fiscal and monetary policies have been and will remain oriented towards meeting our respective domestic objectives using domestic instruments, and that we will not target exchange rates," the group said.

Japan's Finance Minister Taro Aso welcomed the G7 statement, saying it showed the group recognized Japan's new anti-deflation policy was not aimed at affecting foreign exchange markets.

By 5:30 a.m. ET the yen was close to a three-year low of 94.31 to the dollar. The euro was down 0.2 percent versus the dollar and 0.5 percent lower at 125.90 yen after rising over 2 percent on Monday.

Treasury Undersecretary Lael Brainard said on Monday the United States supported Japanese efforts to end deflation, but also noted the G7 has long been committed to exchange rates determined by market forces.

The euro, the main riser among major currencies over the last few months as confidence in the euro zone has rebounded and the yen has slumped, was back at $1.3405 following the G7 statement.

It had risen briefly earlier after ECB Vice President Vitor Constancio said the bank's employment growth and inflation forecasts next month were likely to be close to the December figures.

The comments doused rate cut hopes, only re-kindled last week by the head of the bank, Mario Draghi, who said it was looking to see whether the euro's recent rise risked pushing inflation below its comfort zone.

SPAIN FOCUS

Having started the day down 0.2 percent, European shares were almost level again by 5:30 a.m. ET as London's FTSE 100 <.ftse> and Paris's CAC-40 <.fchi> recovered, though Frankfurt's DAX <.gdaxi> remained down 0.2 percent.

In the bond market, Spanish and Italian bonds inched up as domestic buyers took advantage of a recent sell-off, but the recovery looked fragile given political uncertainty in both countries.

Spain sold 5.6 billion euros ($7.5 billion) of 6- and 12-month Treasury bills, beating the top end of the target amount, but paid a higher yield on the longer-term paper as a political corruption scandal weighed on shaky confidence.

The ECB's Draghi is due to address Spanish lawmakers later on Tuesday to explain and defend the ECB's current monetary policy strategy against a backdrop of heightened concerns about the strong euro.

Draghi is also expected to meet Prime Minister Mariano Rajoy, but the market does not expect them to discuss whether Madrid might need financial aid, which would trigger the ECB's bond purchase scheme.

Financial markets showed a muted reaction, meanwhile, to the news that North Korea has conducted a nuclear test.

The nuclear test monitoring agency said the blast was double the size of its 2009 test. NATO condemned the move, calling it an "irresponsible act" that posed a grave threat to world peace.

"The test was not something that makes your heart pound as much as a pressing situation between Iran and Israel," said Kaname Gokon, research manager at brokerage Okato Shoji, referring to the threat of possible military action to prevent Iran from developing nuclear weapons.

Brent oil dipped to just under $118 a barrel, copper was flat, while spot gold stayed near a one-month low.

(Editing by Will Waterman)

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Tim Cook reportedly opposed suing Samsung but was overruled by Steve Jobs in 2011

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Pope Benedict XVI Says He Will Resign, Cites Ill Health

Samantha Zucchi Insidefoto/European Pressphoto Agency

Pope Benedict XVI blessing members of the Order of the Knights of Malta at the Vatican on Saturday.

ROME — Pope Benedict XVI, the former Cardinal Joseph Ratzinger who took office in 2005 following the death of his predecessor, said on Monday that he will resign on Feb. 28, the first pope to do so in six centuries.

Regarded as a doctrinal conservative, the pope, 85, said that after examining his conscience “before God, I have come to the certainty that my strengths, due to an advanced age, are longer suited to an adequate exercise” of his position as head of the world’s Roman Catholics.

The announcement is certain to plunge the Roman Catholic world into frenzied speculation about his likely successor and to evaluations of a papacy that was seen as both conservative and contentious.

In a statement in several languages, the pope said his “strength of mind and body” had “deteriorated in me to the extent that I have had to recognize my incapacity to adequately fulfill the ministry entrusted to me.”

Elected on April 19, 2005, Pope Benedict said his papacy would end on Feb. 28.

He was a popular choice within the college of 115 cardinals who elected him as a man who shared — and at times went beyond — the conservative theology of his predecessor and mentor, John Paul II, and seemed ready to take over the job after serving beside him for more than two decades.

When he took office, Pope Benedict’s well-known stands included the assertion that Catholicism is “true” and other religions are “deficient;” that the modern, secular world, especially in Europe, is spiritually weak; and that Catholicism is in competition with Islam. He had also strongly opposed homosexuality, the ordination of women priests and stem cell research.

Born on April 16, 1927, in Marktl am Inn, in Bavaria, he was the son of a police officer. He was ordained in 1951, at age 24, and began his career as a liberal academic and theological adviser at the Second Vatican Council, supporting many efforts to make the church more open.

But he moved theologically and politically to the right. Pope Paul VI named him bishop of Munich in 1977 and appointed him a cardinal within three months. Taking the chief doctrinal job at the Vatican in 1981, he moved with vigor to quash liberation theology in Latin America, cracked down on liberal theologians and in 2000 wrote the contentious Vatican document “’Dominus Jesus,” asserting the truth of Catholic belief over others.

The last pope to resign was Gregory XII, who left the papacy in 1415 to end what was known as the Western Schism among several competitors for the papacy.

Benedict’s papacy was caught up in growing sexual abuse scandals in the Roman Catholic Church that crept ever closer to the Vatican itself.

In 2010, as outrage built over clerical abuses, some voices called for his resignation, their demands fueled by reports that laid part of blame at his doorstep, citing his response both as a bishop long ago in Germany and as a cardinal heading the Congregation for the Doctrine of the Faith, which handles such cases.

In one disclosure, news emerged that in 1985, when Benedict was Cardinal Ratzinger, he signed a letter putting off efforts to defrock a convicted child-molesting priest. He cited the priest’s relative youth but also the good of the church.

Vatican officials and experts who follow the papacy closely dismissed the idea of stepping down at the time. “There is no objective motive to think in terms of resignation, absolutely no motive,” said the Rev. Federico Lombardi, the Vatican spokesman. “It’s a completely unfounded idea.”

In the final years of John Paul II’s papacy, which were dogged by illness, Cardinal Ratzinger had spoken in favor of the resignation of incapacitated popes. If John Paul “sees that he absolutely cannot do it anymore, then certainly he will resign,” he said at the time.

In 2006, less than two years into his papacy, Benedict also stirred ire across the Muslim world, referring in a long, scholarly address to a conversation on the truths of Christianity and Islam that took place between a 14th-century Byzantine Christian emperor, Manuel II Paleologus, and a Persian scholar.

“The emperor comes to speak about the issue of jihad, holy war,” the pope said. “He said, I quote, ‘Show me just what Muhammad brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached.’”

While making clear that he was quoting someone else, Benedict did not say whether he agreed or not. He also briefly discussed the Islamic concept of jihad, which he defined as “holy war,” and said that violence in the name of religion is contrary to God’s nature and to reason.

Elisabetta Povoledo reported from Rome, and Alan Cowell from London.

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Anne Hathaway on Winning An Oscar: Whatever Happens, Happens

By Phil Boucher

02/11/2013 at 07:00 AM EST

She's won big at the Golden Globes and now the BAFTAs, but will Anne Hathaway take home an Oscar?

Hathaway – who is nominated for Best Supporting Actress for her role in Les Misérables – isn't spending too much time worrying about it.

"Whatever happens in two weeks, happens. It won't be the worst thing that happens to me if I don't win, and with my husband by my side it won't be the best thing either. So I am feeling very good about whatever," the actress, 30, told reporters backstage after nabbing a best supporting actress statue at Sunday's British Academy of Film and Television Arts Awards in London.

"I really have to say that getting to do the work, getting to play the character with this cast and to have this opportunity, it is the most sublime experience. I don't know how I got so lucky. ... So I don't think ahead – I am just happy to be in the conversation in two weeks' time," she said.

But should she win, Hathaway has been imagining where to keep her statue.

"I kind of have this fantasy – because this year that I have been lucky enough to receive a few pieces of hardware – that I'm going to get a tool shed and keep it in my garage so that it opens to some music. But for now I am just going to keep it in my kitchen," she said.

While she's earned awards and received critical acclaim for her portrayal of Fantine, she says the best thing to come of filming the musical epic was meeting costar Russell Crowe.

"The biggest surprise of the whole experience was what a sweetie pie Russell Crowe was. The whole cast would kind of gather around his place and we would just sing for hours. We all bonded that way. He has become a dear, dear friend," she said, "and I feel very blessed to have him in our life."

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What heals traumatized kids? Answers are lacking

CHICAGO (AP) — Shootings and other traumatic events involving children are not rare events, but there's a startling lack of scientific evidence on the best ways to help young survivors and witnesses heal, a government-funded analysis found.

School-based counseling treatments showed the most promise, but there's no hard proof that anxiety drugs or other medication work and far more research is needed to provide solid answers, say the authors who reviewed 25 studies. Their report was sponsored by the federal Agency for Healthcare Research and Quality.

According to research cited in the report, about two-thirds of U.S. children and teens younger than 18 will experience at least one traumatic event, including shootings and other violence, car crashes and weather disasters. That includes survivors and witnesses of trauma. Most will not suffer any long-term psychological problems, but about 13 percent will develop symptoms of post-traumatic stress, including anxiety, behavior difficulties and other problems related to the event.

The report's conclusions don't mean that no treatment works. It's just that no one knows which treatments are best, or if certain ones work better for some children but not others.

"Our findings serve as a call to action," the researchers wrote in their analysis, published online Monday by the journal Pediatrics.

"This is a very important topic, just in light of recent events," said lead author Valerie Forman-Hoffman, a researcher at the University of North Carolina-Chapel Hill.

She has two young children and said the results suggest that it's likely one of them will experience some kind of trauma before reaching adulthood. "As a parent I want to know what works best," the researcher said.

Besides the December massacre at Sandy Hook Elementary School in Connecticut, other recent tragedies involving young survivors or witnesses include the fatal shooting last month of a 15-year-old Chicago girl gunned down in front of a group of friends; Superstorm Sandy in October; and the 2011 Joplin, Mo., tornado, whose survivors include students whose high school was destroyed.

Some may do fine with no treatment; others will need some sort of counseling to help them cope.

Studying which treatments are most effective is difficult because so many things affect how a child or teen will fare emotionally after a traumatic event, said Dr. Denise Dowd, an emergency physician and research director at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who wrote a Pediatrics editorial.

One of the most important factors is how the child's parents handle the aftermath, Dowd said.

"If the parent is freaking out" and has difficulty controlling emotions, kids will have a tougher time dealing with trauma. Traumatized kids need to feel like they're in a safe and stable environment, and if their parents have trouble coping, "it's going to be very difficult for the kid," she said.

The researchers analyzed 25 studies of treatments that included anti-anxiety and depression drugs, school-based counseling, and various types of psychotherapy. The strongest evidence favored school-based treatments involving cognitive behavior therapy, which helps patients find ways to cope with disturbing thoughts and emotions, sometimes including talking repeatedly about their trauma.

This treatment worked better than nothing, but more research is needed comparing it with alternatives, the report says.

"We really don't have a gold standard treatment right now," said William Copeland, a psychologist and researcher at Duke University Medical Center who was not involved in the report. A lot of doctors and therapists may be "patching together a little bit of this and a little bit of that, and that might not add up to the most effective treatment for any given child," he said.

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Online:

Pediatrics: http://www.pediatrics.org

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