Crime Trends Have Been Tough To Track. Breaking Down Biggest Cities

 by Petr Svab via The Epoch Times (emphasis ours),

Is crime rising or falling across the United States? National crime trends have been difficult to track in recent years because of changes in the way that police departments report their statistics to the FBI.

But by examining crime data from large police departments individually, a clearer pattern emerges.

The Epoch Times’ analysis of data going back several years shows that while the major crime spike that plagued the United States’ largest cities has ebbed, crime rates are still exceeding numbers from before the 2020 summer of protests and riots.

Car theft, in particular, has remained high. Robbery, on the other hand, has declined significantly in some large cities.

The analysis has focused on the top 10 most populous cities and the four offenses of murder, robbery, aggravated assault, and car theft, which tend to be the most reliably reported to the police, according to the National Crime Victimization Survey conducted by the Census Bureau.

New York City, Pop. 8.2 Million

The country’s largest city suffered a surge in violence starting in mid-2020 as a wave of protests and riots hit the country following the death of George Floyd in police custody in Minneapolis.

Shootings doubled that year, with more than 1,850 wounded or killed. Car theft, after dwindling for decades, shot up by 66 percent, NYPD data show.

Crime continued to rise in 2021, with 488 people murdered—the most in a decade.

In 2022, murder declined by about 10 percent, but instances of other serious crimes kept increasing. Car theft was up by more than 150 percent from 2019. Major theft (of items worth more than $1,000 in value) and felony assaults reached numbers unseen since the 1990s.

Violent crime subsided a step further in 2023. Murder dropped by another 11 percent but was still more than 20 percent above the pre-2020 numbers. Meanwhile, car thefts and felony assaults went up again.

This year, so far, murder appears to be further receding, though still holding stubbornly 20 percent above 2019 numbers for the same period. Robberies and felony assaults, however, are both up from last year and more than 40 percent above 2019 levels. Car theft has eased up, yet the rate is still double that of 2019.

Los Angeles, Pop. 3.8 Million

Los Angeles is following a similar trajectory to New York City. Crime surged in 2020 and continued to rise until 2022, aside from murder, which peaked in 2021 with 401 fatalities—the worst since 2006.

Based on incomplete data, crime seems to have declined a bit in 2023, although murder is still 30 percent above the 2019 level, felony assault is up by about 17 percent, and car theft is up by more than 70 percent.

Officials stand next to a barrel where a body was discovered in Malibu Lagoon State Beach, Calif., on July 31, 2023. (Robyn Beck/AFP via Getty Images)

This year, it appears that the LAPD hasn’t been releasing its weekly crime reports. A spokesman reached by phone said the department is switching to a new system so the reports aren’t available.

The department provided some figures for this year up to June 22: Violent crime had been up by 3.5 percent from the same period in 2023, and so was murder. Robberies were up by 18.5 percent, and burglaries up by 4.2 percent. Property crime dropped by 3.1 percent.

Chicago, Pop. 2.7 Million

Chicago experienced a giant spike in murder in 2016. But by 2019, it had just about managed to get it under control. Then 2020 hit and, just as with other cities, violence exploded anew and continued upward in 2021, which resulted in 811 murders—the most since 1995.

Since 2022, murders have decreased, but other crime has continued to rise. So far this year, murder is up by 20 percent compared with the same period in 2019, robbery is up by 40 percent, aggravated battery is up by 4 percent, and car theft is up by 150 percent. Last year, nearly 30,000 cars were stolen in Chicago—the most since at least the year 2000.

Houston, Pop. 2.3 Million

Houston was still trying to contain a wave of violence that started in 2015 when another wave hit in 2020. The following year, in 2021, the city recorded 471 murders, making for its highest homicide rate since 1994.

The violence has eased since then, but last year’s murders still outpaced 2019 by more than 20 percent.

In the first four months of this year, murders seem to have further abated, although aggravated assaults are still nearly 20 percent above the same period in 2019 and car theft is almost 50 percent higher.

Robberies, on the other hand, have been on a steady decline since 2019—down by 25 percent in 2023.

Police line up on Vermont Avenue as people protest over the death of George Floyd, in Washington on June 23, 2020. (Brendan Smialowski /AFP via Getty Images)

Phoenix, Pop. 1.6 Million

Phoenix followed much the same trajectory, with a spike in violence in 2016, another increase in 2020, and a peak in 2022 when 217 people were killed, making for the city’s highest murder rate since 2007.

In 2023, violence somewhat declined, but car theft jumped by 22 percent.

In the first quarter of this year, the city managed another reduction in murders because of a particularly calm March, with five murders. Car thefts and aggravated assaults barely budged, though, and robberies are up by 17 percent compared with the first quarter of 2023.

https://www.zerohedge.com/political/crime-trends-have-been-tough-track-breaking-down-10-biggest-cities

How to Help Recovering Progressives

 It was Winston Churchill who once said, “You can always count on America to do the right thing, after it has exhausted all other options.” I don’t know about all the other options, but when it comes to progressive ideology and its various manifestations -- net zero environmentalism, Critical Race Theory, anticolonialism, DEI hiring programs -- the country does seem to be gradually coming to its senses.

Signs of a recovery first showed up during Covid, when parents of school-age children got to see internet broadcasts of their kids’ classes and had to confront the extent to which a combination of woke ideology and low academic standards had come to substitute for a traditional K-12th grade education. It is not a coincidence that over the last two years, twelve states have passed universal school choice laws, which allow families to use tax dollars to educate their children far from the influence of progressive teacher unions. And in a further thirty-six states, homeschool collaboratives and small parent-run schools (so-called “microschools”) are booming.

After parents, the next to pull back from progressive ideology, according to the Wall Street Journal, were the CEOs of major U.S. businesses. Only a year after they had responded to the death of George Floyd and the rise of Black Lives Matter movement with a rush of Diversity, Equity, and Inclusion initiatives, many told their HR departments to play down the use of the term “DEI” while quietly opening such programs to everyone. At the same time, the annual reports from public companies significantly reduced their coverage of how the firms were addressing racial and gender issues.

More recently, it has become clear that a large number of voters have reevaluated just how much they want to sacrifice to end the use of fossil fuels. Not only has President Biden’s misnamed Inflation Reduction Act, passed in 2022 to provide hundreds of billions in electric car subsidies, failed to produce a demand for such vehicles, but is widely viewed as responsible for both the recent bout of inflation and the Federal Reserve’s unwillingness to lower interest rates. Tellingly few constituents complained in early June when Virginia Gov. Glenn Youngkin determined not to abide by California’s Clean Cars II standards, which require 35 percent of new passenger automobiles sold in 2026 to be either electric or hydrogen fueled.

Even some liberal journalists have begun turning against their own colleagues for excessively hyping a woke agenda. On April 9, National Public Radio’s senior business editor Uri Berliner wrote "I’ve Been at NPR for 25 Years. Here’s How We Lost America’s Trust," in which he described NPR’s evolution from an institution founded to provide listeners with multiple viewpoints to an instrument of left-wing propaganda. And in May, former New York Times correspondent Nellie Bowles published Morning After the Revolution, which, among other things, details how young journalists are constantly pressured by their editors to attack conservatives and to treat any criticism of progressivism as “right-wing fascism.”

Yet for all the promising signs of an ideological recovery, the length of time woke thinking has dominated the country’s educational institutions, from K-12 public schools to colleges and universities, means that millions of their graduates are still under its sway. Not that these Americans have actually been converted to a far-left worldview -- only 6 percent of voters consider themselves progressive, according to Pew -- but many still suffer from an academically conditioned fear of appearing too out-of-step with “enlightened” opinion. When intelligent.com conducted a 2021 survey of American college students, it found that 52 percent were already reluctant to express their honest views on political and social issues, not just to professors but to friends and classmates as well.

All of which raises the interesting question as to what conservatives can do to accelerate the country’s rebound from what economic historian Naill Ferguson has called the “bogus ideology that hardly anyone really believes in, but everyone has to parrot unless they want to be labeled dissidents.” In other words, what can be done to help more citizens realize the public courage of their private convictions?

During the late twentieth century a remarkable group of Russian intellectuals -- including novelist Aleksandr Solzhenitsyn, physicist Andrei Sakharov, mathematician Igor Shafarevich, historian Vadim Borisov, and art publisher Evgeny Barabanov -- gave considerable thought to a very similar problem. Writing at a time when the flaws of Soviet Marxism were glaring enough to stir private doubts, but insufficiently debated to discredit the philosophy itself, they searched for a way to give average people greater confidence in their own growing skepticism.

The most effective tactic, they eventually determined, was for those at the forefront of anti-communist thinking to resolve never to allow any objectionable idea to pass freely in everyday conversation. Even at the risk of seeming impolite or disturbing an otherwise congenial mood.

Not that one had to be belligerent or confrontational to have a liberating impact. (Indeed, being too outspoken in the old Soviet Union could lead to arrest, a career demotion, or even a death sentence.) All that was necessary, Solzhenitsyn and his fellow writers believed, was to subtly acknowledge the other person’s own half-conscious doubts with a bemused smile, a blank stare, a cocked eyebrow, or some other gesture of disapproval. In effect, to magnify the authority of the unspoken against what was being said.

As Solzhenitsyn himself put it in “The Smatterers,” defeating a flawed ideology “doesn’t mean going around preaching the truth at the top of your voice.” It “doesn’t even mean muttering what you think in an undertone.” It simply means not allowing one’s passivity to imply consent. In other words, “don’t say or let stand what you don’t really think.”

If this psychological strategy seems a bit too nuanced to be effective in our own time, it is worth considering why today’s far-left intellectuals remain so obsessed with the politically correct micromanagement of everyday language and behavior.  Their stated reason may be to prevent some aggrieved minority from ever feeling judged, unsafe, or -- as they like to say -- “triggered.”

But could it also be the knowledge that hearing one’s private reservations echoed by someone else has the tendency to strengthen their perceived legitimacy? Or as the poet Ralph Waldo Emerson famously argued in his essay on “Self-Reliance,” it is often true that the only thing differentiating a rejected thought from a firm conviction is having had the former confirmed by a thoughtful outsider.

If nothing else, the willingness to visibly recoil from progressive nostrums is a signal to the politically intimidated that not everyone is as fearful of contradicting fashionable opinion as they are. And given enough such signals, who knows what people will dare?

Dr. Lewis M. Andrews is president of the Children’s Educational Opportunity Foundation.

https://www.americanthinker.com/articles/2024/06/how_to_help_recovering_progressives.html

CBS: Biden dispatches immigration officials to foreign nations to assist migrants claiming ‘asylum’

 How soon until the U.S. has an immigration processing station in every third world hellscape? With Democrats running the show, it’s only a matter of time.

“Using State Department funds,” the Joe Biden administration will now assist Panama in building up its “deportation infrastructure.” That’s the story, according to Camilo Montoya-Galvez at CBS News, who reported on a new bilateral agreement signed Monday between the Bidenites and the administration of the new Panamanian president, José Raúl Mulino. From Montoya-Galvez:

Under the joint initiative, U.S. immigration officials will train and provide assistance to Panamanian authorities to help them carry out more deportations of migrants heading north. In recent years, Panama has reported record numbers of crossings along the roadless Darién jungle, including over half a million in 2023 alone.

The Department of Homeland Security will be dispatching officials who have experience screening asylum claims and deporting migrants to Panama so they can assist their Panamanian counterparts on the ground. Using State Department funds, the U.S. will also help Panama build up its deportation infrastructure.

Never mind using State Department funds, aka American taxpayer dollars and debt, to build up the deportation infrastructure here where we need it as our nation crumbles under the disaster brought by Joe Biden’s mass migration scheme, Biden’s staff think the best course of action is, at least ostensibly, to assist Panama in processing all the migrants flowing through the Darien Gap. 

What’s interesting though is that Montoya-Galvez reported that the DHS officials who are being dispatched to Panama aren’t just seasoned deportation officials, but include “asylum officers” who will assist their Panamanian “counterparts” in determining which migrants meet the eligibility criteria.

But...what comes after that? Well, Montoya-Galvez didn’t say, but the obvious implication is that these “asylum-criteria-eligible” migrants will be permitted to continue on their journey north, presumably cruising right on through our ports of entry with their U.S. paperwork in hand. It’s not like these migrants are seeking asylum in Panama, because Panama doesn’t hand out debit cards loaded with thousands of dollars; host them in luxury hotels; provide food, medical care, and “free” school; or give them preferential treatment in the hiring process because they come without the tax burdens of social security and unemployment.

And how do I know that? Well here’s this, from another outlet, reporting on the “agreement” news:

News of the agreement comes after Panama’s new President Jose Raul Mulino vowed on Monday that the Central American nation would no longer be a country of transit for migrants.

‘I will not allow Panama to be a path open to thousands of people who enter our country illegally supported by an entire international organization related to drug and human trafficking,’ Mulino said at his swearing-in ceremony.

‘Panama will no longer be a transit country for illegals,’ he said amid cheers from those present.

‘The numbers of illegal immigrants passing through the Darién are shocking,’ Mulino said, adding that he intends to ‘appeal to international solidarity regarding the cause that generates the problem and will seek solutions with the countries involved, especially with the United States, which is the final destination of such immigrants.’

Like Mulino said, the United States is the “final destination” for these migrants; Panama is just a thoroughfare. Offended that Biden is using your money to pay for flights to ship them straight in so that they don’t have to deal with the hassle of walking, swimming, or wading across the southern border? Well, now he’s using your dollars to set up de facto processing centers around the world, expediting our collapse.

https://www.americanthinker.com/blog/2024/07/cbs_news_joe_biden_dispatches_immigration_officials_to_foreign_nations_to_assist_migrants_claiming_asylum.html

Feds Aim To End Hospital System's 'Unfair' Noncompete For Part-Time Docs

 Mount Sinai Health System in New York City is forcing part-time physicians to sign employment contracts that violate their labor rights, according to a June 2024 complaint by the National Labor Relations Board (NLRB). 

The complaint stems from no-poaching and confidentiality clauses in the agreements required as a condition of employment, NLRB officials alleged.

The contracts state that for 1 year following termination, part-time physicians may not recruit, solicit, or induce to terminate the employment of any hospital system employee or independent contractor, according to a copy of the terms included in NLRB's June 18 complaint. 

By requiring the agreements, NLRB officials claimed, Mount Sinai is "interfering with, restraining, and coercing employees" in violation of the National Labor Relations Act. The health system's "unfair labor practices" affects commerce as outlined under the law, according to the NLRB. The Act bans employers from burdening or obstructing commerce or the free flow of commerce.

Mount Sinai did not respond to requests for comment.  

The NLRB's complaint follows a landmark decision by the Federal Trade Commission (FTC) to ban noncompete agreements nationwide. In April 2024, the FTC voted to prohibit noncompetes indefinitely in an effort to protect workers.

"Noncompete clauses keep wages low, suppress new ideas, and rob the American economy of dynamism, including from the more than 8500 new startups that would be created a year once noncompetes are banned," FTC Chair Lina M. Khan said in a statement. "The FTC's final rule to ban noncompetes will ensure Americans have the freedom to pursue a new job, start a new business, or bring a new idea to market."

Business groups and agencies have since sued to challenge against the ban, including the US Chamber of Commerce. The Chamber and other business groups argue that noncompete agreements are important for companies to protect trade secrets, shield recruiting investments, and hide confidential information. The lawsuits are ongoing. 

A Physician Blows the Whistle

An anonymous physician first alerted the NLRB to the contract language in November 2023. The doctor was required the sign the hospital system's agreement for part-time physicians. The complaint does not say if the employee is still employed by the hospital system. 

To remedy the unfair labor practices alleged, the NLRB seeks an order requiring the health system to rescind the contract language, stop any actions against current or former employees to enforce the provisions, and make whole any employees who suffered financial losses related to the contract terms. 

The allegation against Mount Sinai is among a rising number of grievances filed with the NLRB that claim unfair labor practices. During the first 6 months of fiscal year 2024, unfair labor practice charges filed across the NLRB's field offices increased 7% — from 9612 in 2023 to 10,278 in 2024, according to a news release. 

NLRB, meanwhile has been cracking down on anticompetitive labor practices and confidentiality provisions that prevent employees from speaking out. 

In a February 2023 decision for instance, NLRB ruled that an employer violates the National Labor Relations Act by offering severance agreements to workers that include restrictive confidentiality and non-disparagement terms. In 2022, the NLRB and the Federal Trade Commission forged a partnership to more widely combat unfair, anticompetitive, and deceptive business practices. 

"Noncompete provisions reasonably tend to chill employees in the exercise of Section 7 rights when the provisions could reasonably be construed by employees to deny them the ability to quit or change jobs by cutting off their access to other employment opportunities that they are qualified for," NLRB General Counsel Jennifer Abruzzo said in a 2023 release. 

Abruzzo stressed in a memo that NLR Act is committed to an interagency approach to restrictions on the exercise of employee rights, "including limits to workers' job mobility, information sharing, and referrals to other agencies." 

Mount Sinai Health System must respond to the NLRB's complaint by July 16, and an administrative law judge is scheduled to hear the case on September 24. 

https://www.medscape.com/viewarticle/feds-aim-end-hospital-systems-unfair-noncompete-part-time-2024a1000cay

Hypoglycemia Risk Limits Use of Once-Weekly Insulin in T1D

 The US Food and Drug Administration Endocrine Advisory Committee voted against recommending approval of once-weekly insulin icodec for treatment in people with type 1 diabetes. The vote was 7 to 4. The reason people voted against it was because there was an increased risk for hypoglycemia with the once-weekly icodec compared with standard therapy. 

The data for this come from the ONWARDS 6 trial, in which they took 582 people with type 1 diabetes and randomized them to one of two regimens. One regimen was icodec plus premeal insulin aspart and one was insulin degludec plus premeal insulin aspart. They followed the patients for a year and found that, overall, in terms of glucose control, there was no difference between the two groups except that patients on icodec had a higher rate of hypoglycemia, both mild and severe. 

The increased risk for hypoglycemia seems to have happened because once-weekly icodec has something of a peak. It has a peak glucose-lowering effect that is seen 2-4 days after injection. This is even once people are at steady state. During that period of time, there is an increased risk for hypoglycemia. During that period of time, theoretically, patients would have to give less rapid-acting insulin to account for the fact that there was more of an effect of the long-acting insulin. This is somewhat hard for people to do; at least, I think it is hard for people to do who aren't in the clinical trial. 

In overall safety, there was no imbalance in terms of death or other serious adverse events, excluding hypoglycemia or discontinuations. At week 57, insulin icodec had a 50% higher incidence rate and an 80% higher event rate of hypoglycemia. 

These higher rates were observed regardless of whether the hypoglycemia was captured vs fingerstick glucose monitoring or continuous glucose monitoring. The risk was greater 2-4 days following each weekly injection, and the time below range throughout — meaning below 54 — was higher in the insulin icodec arm. The episodes of hypoglycemia were similar in duration, management, and recovery. They just were more frequent in the patients on the icodec. 

There are some proposals to try to figure out how to mitigate the hypoglycemia risk. I think they're a bit complicated, if you ask me, but they make some sense. The patients with the highest coefficient of variation did the worst. One way to mitigate some of the risk is to choose only patients who have a lower coefficient of variation, meaning a coefficient of variation of ≤ 36%. 

All people on this insulin would need to be on a continuous glucose monitor so they could deal with this increased risk for hypoglycemia. People who have a history of hypoglycemia unawareness or episodes of severe hypoglycemia shouldn't take it. I think that, obviously, if people are having hypoglycemic events that can't be mitigated, it should be stopped. I think education would be vital here because people would need to give somewhat less insulin on days 2-4 after the weekly injection. 

These are recommendations that the company had. I think it might work if this was given more often, like twice a week, although that's hard to do. I want to point out that I'm talking about people with type 1 diabetes. I think this actually would work better in people with type 2 diabetes. Clinical trials have shown that there isn't an increased risk for hypoglycemia in people with type 2 diabetes. I like the idea for people on basal insulin on a once-weekly form of incretin therapy to give them both together. That makes sense to me. 

In these patients with type 1 diabetes, there was this problem. I've long been hoping that once-weekly insulin could help my patients at risk for diabetic ketoacidosis and other complications just to have some sort of basal insulin in their system. I'd have to see how this worked, and I'd have to see how we really dealt with this risk for hypoglycemia, because hypoglycemia is the thing that most limits my patients' use of insulin. 

Dr Anne Peters for Medscape

https://www.medscape.com/viewarticle/hypoglycemia-risk-limits-use-once-weekly-insulin-t1d-2024a1000c95

How Facial Temperature Reveals Age and Disease

 Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson of the Yale School of Medicine.

My oldest daughter is at sleepaway camp for a couple of weeks, and the camp has a photographer who goes around all day taking pictures of the kids, which get uploaded to a private Facebook group. In the past, I would go online every day (or, okay, several times a day) and scroll through all those pictures looking for one that features my kid. 

I don't have to do that anymore. This year, I simply uploaded a picture of my daughter to an app and artificial intelligence (AI) takes care of the rest, recognizing her face amidst the sea of smiling children, and flagging just those photos for me to peruse. It's amazing, really. And a bit scary.

The fact that facial recognition has penetrated the summer camp market should tell you that the tech is truly ubiquitous. But today we're going to think a bit more about what AI can do with a picture of your face, because the power of facial recognition is not just skin deep.

What's got me hot and bothered about facial images is this paper, appearing in Cell Metabolism, which adds a new layer to the standard facial-analysis playbook: facial temperature.

To understand this paper, you need to understand a whole field of research that is developing various different "clocks" for age. 

It turns out that age really is just a number. Our cells, our proteins, our biochemistry can be analyzed to give different numbers. These "clocks," as distinct from the calendar we usually use to measure our age, might have more predictive power than the number itself. 

There are numerous molecular clocks, such as telomere length, that not only correlate with calendar age but are superior to calendar age in predicting age-related complications. Testing telomere length typically requires a blood sample — and remains costly. But we can use other sources to estimate age; how about a photo?

I mean, we do this all the time when we meet someone new or, as a physician, when we meet a new patient. I have often written that a patient "appears younger than their stated age," and we've all had the experience of hearing how old someone is and being shocked. I mean, have you seen Sharon Stone recently? She's 66 years old. Okay — to be fair, there might be some outside help there. But you get the point.

Back to the Cell Metabolism paper. Researchers report on multiple algorithms to obtain an "age" from a picture of an individual's face. 

The first algorithm is pretty straightforward. Researchers collected 2811 images, all of Han Chinese individuals ranging in age from 20 to 90 years, and reconstructed a 3D facial map from those. 

They then trained a convolutional neural network to predict the individuals' ages from the pictures. It was quite accurate, as you can see here.

In the AI age, this may not seem that impressive. A brief search online turned up dozens of apps that promised to guess my age from a photo.

I sent this rather unflattering picture of myself to ChatGPT which, after initially demurring and saying it was not designed to guess ages, pegged me at somewhere between 35 and 45, which I am taking as a major victory.

But the Cell Metabolism paper goes deeper. Literally. They added a new dimension to facial image analysis by taking an individual's temperature using a thermal scanning camera that provided temperatures at 54 different landmarks across the face

And this is where things start to get interesting. Because sure, the visible part of your face can change depending on makeup, expression, plastic surgery, and the like. But the temperature? That's harder to fake.

It turns out that the temperature distribution in your face changes as you get older. There is a cooling of the nose and the cheeks, for example.

And the researchers could combine all this temperature data to guess someone's calendar age fairly accurately, though notably not as accurately as the model that just looks at the pictures.

But guessing your age is not really the interesting part of thermal imaging of the face. It's guessing — or, rather, predicting — the state of your metabolism. All these study participants had extensive metabolic testing performed, as well as detailed analysis of their lifestyle behaviors. And facial images could be used to predict those factors.

For example, the 3D reconstruction of the faces could predict who ate seafood (they tend to look younger than their actual age) compared with who ate poultry and meat (they tend to look older). The thermal imaging could predict who got more sleep (they look younger from a temperature perspective) and who ate more yogurt (also younger-appearing, temperature-wise). Facial temperature patterns could identify those with higher BMI, higher blood pressure, higher fasting glucose. 

The researchers used the difference between actual and predicted age as a metric to measure illness as well. You can see here how, on average, individuals with hypertension, diabetes, and even liver cysts are "older," at least by face temperature.

It may even be possible to use facial temperature as biofeedback. In a small study, the researchers measured the difference between facial temperature age and real age before and after 2 weeks of jump-roping. It turns out that 2 weeks of jump-roping can make you look about 5 years younger, at least as judged by a thermal camera. Or like the Predator.

Okay, this is all very cool, but I'm not saying we'll all be doing facial temperature tests in the near future. No; what this study highlights for me is how much information about ourselves is available to those who know how to decode it. Maybe those data come from the wrinkles in our faces, or the angles of our smiles, or the speed with which we type, or the temperature of our elbows. The data have always been there, actually, but we've never had the tools powerful enough to analyze them until now.

When I was a kid, I was obsessed with Star Trek — I know, you're shocked — and, of course, the famous tricorder, a scanner that could tell everything about someone's state of health in 5 seconds from 3 feet away. That's how I thought medicine really would be in the future. Once I got to medical school, I was disabused of that notion. But the age of data, the age of AI, may mean the tricorder age is not actually that far away.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and public health and director of Yale's Clinical and Translational Research Accelerator. 

https://www.medscape.com/viewarticle/how-facial-temperature-reveals-age-and-disease-2024a1000c73

Standard Dose or Baby TAM for Breast Cancer Prevention?

 Should 5 mg of tamoxifen — known as "baby TAM" — or the usual 20 mg dose be standard of care for breast cancer prevention in high-risk women?

Research to date clearly shows that tamoxifen can reduce the risk for breast cancer in high-risk individuals by 30%-50%. Recent evidence also indicates that this chemoprevention approach can reduce the risk of dying from breast cancer by as much as 57%.

In 2019, the US Preventive Services Task Force issued updated recommendations that clinicians offer risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women at an increased risk for breast cancer and a low risk for adverse medication effects.

However, this prophylactic strategy remains underused.

A major roadblock: The drug's side effects, which include venous thromboembolic events, endometrial cancer, as well as symptoms of menopause, such as hot flashes and sexual issues, have made uptake and adherence a challenge.

Offering women a lower dose of tamoxifen could allay fears about toxicities and improve uptake as well as reduce side effects and boost long-term adherence among those receiving baby TAM.

However, experts remain uncertain about whether patients need the standard dose to experience the full prevention benefit.

The Debate

Years ago, Andrea De Censi, MD, a breast cancer researcher at the Galliera Hospital in Genova, Italy, and his colleagues reasoned that, because tamoxifen is a competitive estrogen receptor inhibitor, it may indeed have a minimal effective dose below 20 mg/d.

The fruits of that line of thought were presented to the world in the TAM-01 trial, first published in 2019, which pitted tamoxifen 5 mg/d for 3 years against placebo in 500 women with high-risk lesions, including lobular and ductal carcinoma in situ.

De Censi and colleagues found that baby TAM reduced the risk for invasive breast cancer by 52% and the risk for contralateral breast cancer by 75%.

Treatment adherence was slightly higher in the baby TAM group at 65% vs 61% in the placebo group.

A recent 10-year follow-up showed ongoing benefits associated with baby TAM vs placebo — a 42% reduction in breast cancer and a 64% drop in contralateral lesions.

The baby TAM group vs placebo experienced a slight increase in hot flashes but no significant increase in other common side effects.

Regarding serious adverse events, the baby TAM arm had one case of stage I endometrial cancer (0.4% of patients) and 20 cases of endometrial polyps (5%) vs 13 cases of endometrial polyps in the placebo arm. But there were no significant differences in thrombosis, cataracts, bone fractures, and other serious events.

De Censi said he's surprised the baby TAM vs tamoxifen topic is still being debated. "Baby TAM, in my opinion, is a new standard of care for endocrine prevention of breast cancer in high-risk [women]," and baby TAM over 3 years is enough, said De Censi during a debate on the topic at the 2024 European Society for Medical Oncology Breast Cancer Congress in Berlin.

Gareth Evans, MD, a cancer genetics and prevention specialist at the University of Manchester, Manchester, England, however, isn't convinced.

During the debate, Evans explained that  his main concern was that the baby TAM trial was limited to women with high-risk lesions, not other common reasons for tamoxifen prophylaxis, such as a positive family history or BRCA mutations.

"In Manchester, we have put over a thousand women on tamoxifen who have a family history or other risk factors, not high-risk lesions," and there simply isn't definitive evidence for baby TAM in these women, Evans said.

The vast weight of evidence for tamoxifen prophylaxis, he added, is in trials involving tens of thousands of women, followed in some cases for 20 years, who received the 20 mg dose for 5 years.

As a result, women in Manchester are started on 20 mg and dropped down to 5 mg only for side effects. That way, Evans explained, we are not taking away the benefit among women who can tolerate 20 mg.

Meanwhile, there's no evidence that baby TAM improves medication adherence, he noted. Trials have reported similar adherence rates to baby TAM and standard dose tamoxifen as well as no definitive evidence that the risk for cancer and thrombosis is less with baby TAM, he said.

In fact, Evans noted, "many women take tamoxifen 20 mg for 5 years with no side effects."

Overall, "I don't think we've got the evidence yet to drop" dosages, particularly in women without high-risk lesions, Evans said. A real concern, he added, is poor metabolizers for whom 5 mg won't be enough to have a preventive effect.

De Censi noted, however, that there will likely never be a definitive answer to the question of baby TAM vs standard dosing because industry has no financial incentive to do a head-to-head trial because tamoxifen went off patent over 30 years ago.

Still, a poll of the audience favored Evans' approach — 80% said they would start high-risk women on 20 mg for breast cancer prophylaxis and reduce for side effects as needed.

De Censi didn't have any disclosures. Evans is a consultant/advisor for AstraZeneca, SpringWorks, Recursion, Everything Genetic, and Syantra.

https://www.medscape.com/viewarticle/clinical-controversy-standard-dose-or-baby-tam-breast-cancer-2024a1000cc0