American Airlines pilots ratify union contract

Pilots at American Airlines on Friday ratified a new union labor contract in a move that may help the airline emerge from bankruptcy protection and pave the way for a merger with US Airways, which reportedly has made a formal bid to combine two of the nation's largest carriers.

The new pilot contract, among other terms, includes pay raises and a 13.5 percent stake in the company in exchange for allowing the airline to outsource more of its flying to regional jets and airline partners.

Friday's ratification removes uncertainty created by the unresolved pilot contract, so creditors in the bankruptcy "can focus without distraction on the underlying strategic and financial merit of an AMR/US Airways merger," the pilots union said recently in a missive to members.

And the pilots' 13.5 percent stake in the company, which besides being worth at least $100,000 per pilot on average, gives the union "important influence over the restructuring process, including input in the selection of a new AMR leadership and the optimal strategic alternative," said Dennis Tajer, spokesman for the Allied Pilots Association.

Jamie Baker, a stock analyst with JPMorgan Securities, agreed in a research note to clients, writing "ratification helps ease the way towards a potential merger. ... A failure to ratify would have essentially stopped the clock, in our view, further dragging out an already complex process."

US Airways' merger proposal could value the combined airline at around $8.5 billion, and a deal could come as soon as January, Reuters reported Friday, citing two unnamed sources.

The union contract agreement with AMR was approved by 74 percent of Allied Pilots Association members overall and 86 percent of Chicago-based pilots, the union reported. AMR and pilots have been trying to agree on a new collective bargaining agreement since 2006. 

Thousands of American Airlines passengers in late September and early October were affected by the labor dispute between management and pilots when the airline experienced rampant delays and cancellations nationwide, which also involved hundreds of flights at O'Hare International Airport. The airline blamed pilots for the operational failures, although the Allied Pilots Association denied organizing a work slowdown.

Earlier this week, a union message to pilots said the contract is not perfect, but there was a limit to what can be achieved in bankruptcy. "It's not a 'scorched earth' bankruptcy contract," wrote APA Vice President Tony Chapman. "It's a contract that retains much of what constitutes our quality of life and eventually closes the pay gap with our brethren at United and Delta."

Denise Lynn, American Airlines senior vice president of people, said in a statement that the contract "is an important step forward in our restructuring."

"Today's ratification gives us the certainty we need for American to successfully restructure, providing opportunity and growth for all of our people and stakeholders," Lynn said.

Pilots are the last union at American to reach a deal with the airline. But even with ratification of the contract, pilots say they support an AMR merger with US Airways, with whom all AMR unions already struck labor agreements. 

American Airlines officials have said they prefer the airline to emerge from bankruptcy as a stand-alone company. 

"This ratified agreement should not in any way be viewed as support for the American stand-alone plan or for this current management team," Tajer said. "We continue to support an American Airlines-US Airways merger as the best way to strengthen our airline and enhance our pilots' long-term career prospects. ... This contract represents a bridge to a merger with US Airways."

Ray Neidl, aerospace analyst with Maxim Group, sees pros and cons to a combination with US Airways.

"Advantages of a merger would give the enlarged entity the size to compete with Delta Air Lines and United Airlines, both of which overtook American after their own mergers with other carriers in recent years," Neidl wrote in a note to investors Friday. "We believe the disadvantage would be that it would be a difficult merger to engineer and could create major disruptions over at least the next two years."

Tom Horton, AMR's chief executive, said in a letter to employees Friday that management is still evaluating a merger with US Airways. "We expect to have a conclusion on this soon," he wrote.

American Airlines, the No. 2 carrier in the Chicago region, entered bankruptcy protection in an attempt to cut labor costs, as its major competitors already have done.

The largest carrier in the Chicago region, United Continental Holdings, has also experienced contract disputes with pilots this year. But Chicago-based United Continental, parent of United Airlines, also has a tentative agreement with its pilots. Ratification voting on that contract opened Nov. 30 and runs through Dec. 15.

gkarp@tribune.com

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Preckwinkle rips Emanuel, McCarthy's handling of violence

Cook County Board President Toni Preckwinkle today publicly blasted Mayor Rahm Emanuel’s crime-fighting strategy and the quality of the public schools he controls, then quickly walked back the remarks.

The Democratic leader said her criticism was targeted at society as a whole and not the mayor personally, much as she did last summer when she harshly criticized former President Ronald Reagan for his role in the war on drugs.

The comments about Emanuel came during a question-and-answer session during a luncheon at the Union League Club. Preckwinkle was asked how to address Chicago violence.

“Clearly, this mayor and this police chief have decided the way in which they are going to deal with the terrible violence that faces our community is just arrest everybody,” Preckwinkle said. “I don’t think in the long term that’s going to be successful.

“We’re going to have to figure out how to have interventions that are more comprehensive than just police interventions in the communities where we have the highest rates of crime. And they’re almost all in African-American and Latino communities.”

Homicides and shootings in Chicago have attracted national attention this year following a spike in the city’s murder rate and brazen incidents such as the shooting of a young man at a funeral for a gang member.

Preckwinkle said much of the problem results from a school system that has a low high school graduation rate.

“We have contented ourselves with a miserable education system that has failed many of our children,” Preckwinkle said, saying more after-school enrichment and job-training programs are needed. “I’m talking about the kids who don’t graduate, let alone the kids who graduate don’t get a very good education, even with a high school diploma.”

Emanuel aides responded with restraint, saying the mayor is taking many of the actions Preckwinkle said were needed, even as he maintained a tough stance on crime.

“Mayor Emanuel strenuously agrees that a holistic approach is necessary to successfully address crime,” Emanuel spokeswoman Sarah Hamilton said in a statement. “His multi-part strategy ranges from improving early childhood education, providing a longer school day and creating re-engagement centers for youth, to delivering wrap-around services, revitalizing the community policing program and working to prevent retaliatory actions by gangs.

“All of these work in tandem, but let's make no mistake, criminals deserve to be arrested,” the statement read.

At a news conference after her speech and question session, Preckwinkle said her criticism of schools wasn’t aimed at Emanuel, who as mayor appoints the Chicago Public Schools board and picks the system’s CEO.

“This was a critique of all of us, it wasn’t aimed at the mayor,” said Preckwinkle, a former CPS high school history teacher.

Preckwinkle also acknowledged that Emanuel is putting more city money into early childhood education, after-school programs and youth job programs — in part through programs coordinated with the county.

Her point, she said, was that education over the long run will do more to quell violence than arresting people and locking them up.

“You know unfortunately we live in a country in which we are much more willing to spend money on keeping people in prison than we are on educating them in our public schools,” she said. “And that’s disgraceful. It reflects badly on all of us.”

She added, “I don’t think we are going to arrest our way out of our violence problems.”

Mayor Emanuel's aides said they just learned of the remarks and are preparing a response.

Preckwinkle is a liberal who has been consistently critical of a justice system that locks up African-American and Latino men in far greater numbers than their white counterparts, particularly for drug crimes when studies show drugs are used in equal numbers across ethnic and racial boundaries

It wasn’t the first time that, while speaking without a script, she made comments that ruffled some feathers.

In August, she said former President Ronald Reagan deserved “a special place in hell” for his role in the War on Drugs, later saying she regretted the “inflammatory” remark.

hdardick@tribune.com

Twitter @ReporterHal

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George Zimmerman sues NBC and reporters

ORLANDO, Fla. (AP) — George Zimmerman sued NBC on Thursday, claiming he was defamed when the network edited his 911 call to police after the shooting of Trayvon Martin to make it sound like he was racist.

The former neighborhood watch volunteer filed the lawsuit seeking an undisclosed amount of money in Seminole County, outside Orlando. Also named in the complaint were three reporters covering the story for NBC or an NBC-owned television station.

The complaint said the airing of the edited call has inflicted emotional distress on Zimmerman, making him fear for his life and causing him to suffer nausea, insomnia and anxiety.

The lawsuit claims NBC edited his phone call to a dispatcher in February. In the call, Zimmerman describes following Martin in the gated community where he lived, just moments before he fatally shot the 17-year-old teen during a confrontation.

“NBC saw the death of Trayvon Martin not as a tragedy but as an opportunity to increase ratings, and so set about to create a myth that George Zimmerman was a racist and predatory villain,” the lawsuit claims.

NBC spokeswoman Kathy Kelly-Brown said the network strongly disagreed with the accusations made in the complaint.

“There was no intent to portray Mr. Zimmerman unfairly,” she said. “We intend to vigorously defend our position in court.”

Three employees of the network or its Miami affiliate lost their jobs because of the changes.

Zimmerman is charged with second-degree murder but has pleaded not guilty, claiming self-defense under Florida’s “stand your ground law.”

The call viewers heard was trimmed to suggest that Zimmerman volunteered to police, with no prompting, that Martin was black: “This guy looks like he’s up to no good. He looks black.”

But the portion of the tape that was deleted had the 911 dispatcher asking Zimmerman if the person who had raised his suspicion was “black, white or Hispanic,” to which Zimmerman responded, “He looks black.”

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Drug Makers Challenge Pill Disposal Law in California

Brand name drug makers and their generic counterparts rarely find themselves on the same side of an issue, but now they are making an exception. They have teamed up to fight a local law in California, the first in the nation, that makes them responsible for running — and paying for — a program that would allow consumers to turn in unused medicines for proper disposal.

Such so-called drug take-back programs are gaining in popularity because of a growing realization that those leftover pills in your medicine cabinet are a potential threat to public health and the environment.

Small children might accidentally swallow them and teenagers will experiment with them, advocates of the laws say. Prescription drug abusers can, and are, breaking into homes in search of them. Unused pills are sometimes flushed down the toilet, so pharmaceuticals are now polluting waterways and even drinking water. One study found the antidepressant Prozac in the brains of fish.

Most such take-back programs are run by local or other government agencies. But increasingly there are calls to make the pharmaceutical industry pay.

“We feel the industry that profits from the sales of these products should have the financial responsibility for proper management and disposal,” said Miriam Gordon, California director of Clean Water Action, an advocacy group.

In July, Alameda County, Calif., which includes Oakland and Berkeley, became the first locality to enact such a requirement. Drug companies have to submit plans for accomplishing it by July 1, 2013.

But the industry plans to file a lawsuit in United States District Court in Oakland on Friday, hoping to have the law struck down. The suit is being filed by the Pharmaceutical Research and Manufacturers of America, or PhRMA, which represents brand-name drug companies, the Generic Pharmaceutical Association and the Biotechnology Industry Organization.

James M. Spears, general counsel of PhRMA, said the Alameda ordinance violated the Constitution in that a local government was interfering with interstate commerce, a right reserved for Congress.

“They are telling a company in New Jersey that you have to come in and design and implement and pay for a municipal service in California,” he said in an interview.

“This program is one where the cost is shifted to companies and individuals who are not located in Alameda County and who won’t be served by it.”

Mr. Spears, who is known as Mit, said that the program would cost millions of dollars a year to run and that pharmaceutical companies were “not in the waste disposal business.” He said it would be best left to sanitation departments and law enforcement agencies, which must be involved if narcotics, like pain pills, were to be transported.

Nathan A. Miley, the president of the Alameda County Board of Supervisors and the champion of the legislation, said late Thursday, “It’s just unfortunate that PhRMA would fight this because it would be pennies for them.”

“We will win legally and will win in the court of public opinion as well,” Mr. Miley said.

The battle in Alameda could set the direction for other states and localities. Legislators in seven states have introduced bills to require drug companies to pay for take-back programs in the last few years, said Scott Cassel, founder and chief executive of the Product Stewardship Institute, a nonprofit group that advocates such programs. But none of the bills have passed.

Mr. Cassel said about 70 similar “extended producer responsibility” laws have been enacted in 32 states for other products, like electronic devices, mercury-containing thermometers, fluorescent lamps, paint and batteries. He said he was not aware that any had been struck down on constitutional grounds.

The pharmaceutical industry already pays for take-back programs in some other countries. The law in Alameda is modeled partly on the system in British Columbia and two other Canadian provinces. There, the industry formed the Post-Consumer Pharmaceutical Stewardship Association, which runs the programs.

Consumers can take unused drugs back to pharmacies, from which they are periodically collected. Drug companies pay for the program in proportion to their market share, said Ginette Vanasse, executive director of the association. The program for British Columbia, with a population over four million, costs about $500,000 a year, she said.

The extent of the problem of unused pills and how best to handle them are matters of debate.

The United States Geological Survey has found various drugs, including antidepressants, antibiotics, heart medicines and hormones, in waterways it has sampled. Sewage treatment plants and drinking water treatment plants are not meant to remove pharmaceuticals.

Still, it is not known what effect the chemicals might have. “It’s a hard-to-pin-down problem,” said Sonya Lunder, a senior analyst at the Environmental Working Group, an advocacy group. It is thought that trace amounts in drinking water are probably not harmful. But larger amounts found in wastewater could be having an impact on wildlife.

It is also unclear whether take-back programs will help. Experts generally agree that the bigger source of pollution is urine and feces containing the remnants of drugs that are ingested, not the unused pills flushed down the toilet.

PhRMA also argues that take-back programs will not help much with the problem of drug abuse either. Mr. Spears said that it was better to have consumers tie up unused pills in a plastic bag and throw them in the trash. That is more effective, he said, because people would not have to travel to a collection point. Such collection points could become targets for thieves and drug abusers.

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Lurie Children's Hospital sees surge in patients at new Chicago building

Executives at the Ann & Robert H. Lurie Children's Hospital of Chicago expected a "bump" in patients when the $855 million hospital opened in June.

They weren't prepared for a mountain.

Since the former Children's Memorial traded its patchwork of aging buildings in Lincoln Park for a new high-rise in Streeterville on June 9, patient volume has surged, more than doubling hospital projections.

The number of patients is up about 16 percent in the first five months, according to hospital data, an increase driven by an influx of children with more acute health problems, including transplant patients, kids with heart problems and others in need of specialized care.

Revenue over that five-month period increased 12.9 percent to $222 million.

"We expected to have a new-hospital bump in (patients). We had a new-hospital mountain," said Michelle Stephenson, Lurie Children's chief patient care services officer and chief nurse executive. "We've had some months where the (number of inpatients) was 24 percent over what we expected. "

To meet the demand, the hospital hired 151 nurses to ensure full coverage, she said.

Those new hires came on top of about three dozen pediatric specialists and department heads Lurie Children's recruited in the run-up to the hospital opening.

Stephenson said the hospital has yet to determine the specific reasons behind the jump in patients, but said data shows it is drawing more children from the collar counties and downstate.

She also cited the location, adjacent to Northwestern Memorial Hospital, Northwestern University's Feinberg School of Medicine and Prentice Women's Hospital, which is connected to Lurie via an enclosed skyway.

Moving 31/2 miles south next to Prentice, which sends Lurie about a quarter of its patients, is likely a significant factor in the patient boom, said Jay Warden, a senior vice president at The Camden Group, a consulting firm.

"It used to be a challenge for moms to have a baby transferred to Children's while they had to stay at Prentice until they're discharged," Warden said. "Now it's the best of both worlds for both hospitals."

Warden said hospitals typically get a burst of new patients when they open facilities, in part because of the accompanying marketing and publicity blitz. That's not always the case with children's hospitals, which tend to serve the sickest and smallest of patients who have few other options.

He said limitations at the old hospital likely kept some patients away.

Indeed, Children's Memorial had a listed capacity of 247 beds, but with shared rooms and other factors, executives considered the hospital full at 220 patients, Stephenson said. The Lurie hospital has a capacity of 288 beds in all-private rooms, which it has come close to filling on a few occasions.

One ward that's consistently bursting at the seams is the neonatal intensive care unit, which was built to handle 44 patients but is averaging about 50. Some of the children have been bumped into shared space in the hospital's cardiac care unit, Stephenson said.

As for patients, the new facility has been a hit, with satisfaction scores up an average of 10 percent, hospital officials said.

Tina Sneed, whose 18-year-old daughter Whitney Ballard recently underwent a liver transplant at the hospital, said she's happy with the expanded rooms and new areas for parents.

She and her daughter have made several 7-hour trips from Kentucky in the last 18 months to see specialists, including overnight stays at both facilities.

Her only complaint?

"The waiting room was kind of crowded," she said. "It was nothing too bad, they just have so many (surgeries) going on at the same time we barely had room to move in there."

pfrost@tribune.com

Twitter @peterfrost

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Top cop announces shake-up in command structure

As the Chicago Police Department tries to tamp down the city’s rise in homicides and shootings this year, Superintendent Garry McCarthy announced a shake-up in his command structure, moving seven commanders to different assignments.

The changes mean that McCarthy has replaced 19 of the city’s 23 district commanders – some because of retirement -- since he became superintendent in May 2011.

The rise in violent crime in parts of the South and West Sides played a role in the shake-up, Melissa Stratton, McCarthy’s spokeswoman, said Wednesday. She said the changes had been in the planning stages for some time. So far this year, homicides have risen 19 percent through Chicago, while shootings are up more than 11 percent.

Among the changes, Joseph Gorman, the commander of the gang investigations unit, was named commander of the South Side’s Deering police district.

Stratton said McCarthy put Gorman in charge of Deering to quell its gang violence. The department touts him as its foremost gang expert.

Deering, which includes such crime-ridden neighborhoods as Back of the Yards and Fuller Park, led all 23 districts in shootings last month, up 49 percent from a year earlier, as the Tribune reported earlier this week.So far this year in Deering, homicides there have jumped 50 percent and shootings 37 percent, according to department statistics. 

 Gorman succeeds David Jarmusz, who will head the department’s public transportation section, which oversees patrols along CTA lines. Christopher Kennedy, the commander of the Central police district, which includes downtown, succeeds Gorman as the commander the citywide gang investigations unit. John Graeber, the former head of public transportation, takes over as commander of the Central district.

In addition, Melissa Staples was moved from commander of the Northwest Side’s Albany Park District to head the new Near West District, a consolidation of the former Monroe and Wood districts. The district’s station at 1412 S. Blue Island Ave. is slated to open next week.

Lucy Moy-Bartosik will move from acting command of the North Side’s Lincoln District, which covers the Edgewater and Uptown neighborhoods, to police headquarters to become executive officer of the patrol division. Jimmy Jones, the former executive officer of the Far South Side’s Calumet District, will take Moy-Bartosik’s former post.

jgorner@tribune.com

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In brewing rivalry, Instagram trims ties to Twitter

SAN FRANCISCO (Reuters) – Facebook Inc’s recently acquired photo-sharing service Instagram removed a key element of its integration with Twitter, signaling a deepening rift between two of the Web’s dominant social media companies.

Instagram Chief Executive Kevin Systrom said Wednesday his company turned off support for Twitter “cards” in order to drive Twitter users to Instagram’s own website. Twitter “cards” are a feature that allows multimedia content like YouTube videos and Instagram photos to be embedded and viewed directly within a Twitter message.

The move marked the latest clash between Facebook and Twitter since April, when Facebook, the world’s no. 1 social network, outbid Twitter to nab fast-growing Instagram in a cash-and-stock deal valued at the time at $ 1 billion. The acquisition closed in September for roughly $ 715 million, reflecting Facebook’s recent stock drop.

The companies’ ties have been strained since. In July, Twitter blocked Instagram from using its data to help new Instagram users find friends.

Beginning earlier this week, Twitter’s users began to complain in public messages that Instagram photos did not seem to display properly on Twitter’s website.

Systrom confirmed Wednesday that his company had decided its users should view photos on Instagram’s own Web pages and took steps to change its policies.

“We believe the best experience is for us to link back to where the content lives,” Systrom said in a statement, citing recent improvements to Instagram’s website.

“A handful of months ago, we supported Twitter cards because we had a minimal Web presence,” Systrom said, noting that the company has since released new features that allow users to comment about and “like” photos directly on Instagram’s website.

The move escalates a rivalry in the fast-growing social networking sector, where the biggest players have sought to wall off access to content from rival services and to their ranks of users.

“They’re both competing for slices of the same pie, the pie being users’ attention,” said Ray Valdes, an analyst with research firm Gartner.

If Facebook decides to offer advertising on Instagram, it’s important that the users visit Instagram’s own website, said Valdes. “If the eyeballs are elsewhere, you have less to work with in terms of monetization,” he said.

Photos are among the most popular features on both Facebook and Twitter, and Instagram’s meteoric rise in recent years has further proved how picture-sharing has become a key front in the battle for social Internet supremacy.

Instagram, which has 100 million users, allows consumers to tweak the photos they take on their smartphones and share the images with friends, a feature that Twitter has reportedly also begun to develop. Twitter’s executive chairman, Jack Dorsey, was an early investor in Instagram and had hoped to acquire it before Facebook CEO Mark Zuckerberg made a successful bid.

When Zuckerberg announced the acquisition in an April blog post, he highlighted Instagram’s inter-connectivity with other social networks.

“We think the fact that Instagram is connected to other services beyond Facebook is an important part of the experience,” Zuckerberg wrote. “We plan on keeping features like the ability to post to other social networks.”

A Twitter spokesman declined comment Wednesday, but a status message on Twitter’s website confirmed that users are “experiencing issues,” such as “cropped images” when viewing Instagram photos on Twitter.

(Reporting By Alexei Oreskovic and Gerry Shih; Editing by Nick Zieminski and Leslie Adler)

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Obama leads heads of state atop Forbes 2012 power list

NEW YORK (Reuters) – When it comes to power, politics trumps business, according to a new Forbes ranking on Wednesday that found heads of state occupying six of the top 10 spots among the world’s most powerful people, led by President Barack Obama.

The annual list selected what Forbes said were the world’s 71 most-powerful people from among the roughly 7.1 billion global populace, based on factors ranging from wealth to global influence.

Obama was joined in the top 10 by German Chancellor Angela Merkel, Russian President Vladimir Putin, King Abdullah bin Abdulaziz al Saud of Saudi Arabia and British Prime Minister David Cameron.

The list’s highest-ranked businessman was Microsoft co-founder Bill Gates at No. 4. U.S. Federal Reserve Chairman Ben Bernanke and European Central Bank President Mario Draghi, both public officials, also made the top 10.

“This year’s list reflects the changing of the guard in the world’s two most powerful countries: the United States and China,” Michael Noer, Forbes‘ executive editor, told Reuters in an email.

Noer noted that China’s President Hu Jintao, last year’s third most-powerful person, fell off the list as he is leaving power, and his successor, Xi Jinping, ranked ninth instead.

Both U.S. Treasury Secretary Timothy Geithner and Secretary of State Hillary Clinton, who have stated they will not be serving in Obama’s second term, were not in this year’s rankings.

While elected and appointed officials and business people made up the vast majority of Forbes’ most powerful, Pope Benedict XVI placed fifth in the rankings.

Among the oddities was Joaquin Guzman Loera at No. 63.

Loera, far from a household name, is a billionaire nicknamed “El Chapo” who as head of Mexico’s Sinaloa cartel is the world’s most powerful drug trafficker, according to Forbes.

Age was also not a barrier, with two of the youngest and oldest of this year’s most powerful — 28-year-old Facebook CEO Mark Zuckerberg and 81-year-old News Corp CEO Rupert Murdoch — back-to-back at numbers 25 and 26, respectively.

Forbes noted that Zuckerberg fell out of last year’s top 10 after Facebook’s IPO disappointed. A gainer, meanwhile, was Brazilian President Dilma Rousseff, who moved up four spots to No. 18 despite being only halfway into her first term of office.

To create the rankings, which Forbes readily concedes bore a measure of subjectivity, editors graded candidates on four criteria for power and averaged the four grades:

– Power over many people

– Control over financial and other valuable resources

– Power in multiple spheres or arenas

– Active use of power

Some measures, such as power over many people, favored leaders such as the Pope, while the world’s richest man — Mexican telecom magnate Carlos Slim Hula, worth a reported $ 72 billion — placed 11th on the strength of his wealth.

Others, such as New York’s billionaire Mayor Michael Bloomberg, scored high in all areas, placing him at No. 16.

Noer said that Elon Musk, one of the co-founders of Paypal and Tesla Motors, was “one of the more interesting newcomers” on the list due to his SpaceX company, a private space exploration venture.

“With NASA retiring the space shuttle fleet, private companies like SpaceX have been awarded huge contracts to do things like resupply the International Space Station. The commercialization of space is just beginning, but we expect it to be big business,” Noer said.

Former President Bill Clinton placed 50th, with editors noting that by hitting the campaign trail for Obama, Clinton “cemented his status as a kingmaker”, along with his nonpartisan Global Initiative raising more than $ 71 billion in commitments to fund charitable action worldwide.

Other high-ranking heads of state included French President Francois Hollande at No. 14, Indian Prime Minister Manmohan Singh at No. 19 and Iran’s Grand Ayatollah Ali Hoseini-Khamenei at No. 21.

Among businessmen in the top 20 were Berkshire Hathaway CEO Warren Buffett at No. 15, Wal-Mart CEO Michael Duke at No. 17 and Google co-founders Larry Page and Sergey Brin at No. 20.

The entire list can be found at www.forbes.com/power as well as the December 24 issue of the magazine.

(Reporting by Chris Michaud, Editing by Piya Sinha-Roy and Andrew Hay)

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Extended Use of Breast Cancer Drug Suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

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Bill passes to fast-track foreclosure of abandoned properties in Ill.

The Illinois General Assembly passed a bill Wednesday that would fast-track the foreclosure process for abandoned, vacant homes while funding foreclosure prevention efforts throughout the state.

The legislation, which now will be considered by Gov. Pat Quinn, could shrink to 90 to 100 days a residential foreclosure process that can take as long as two years in Illinois. It also would require lenders to pay additional fees to file foreclosure actions, and the estimated $41 million in fees collected annually would be used to fund homeowner foreclosure counseling and prevention efforts.

The measure was passed by the Senate Wednesday and the House Tuesday.

"It empowers communities and municipalities to have the funding necessary to maintain and stabilize communities," said Sen. Jacqueline Collins, D-Chicago, the chief sponsor of the bill in the Senate. "It's the first step to putting some stability in the housing market."

Lenders could ask courts to fast-track foreclosures for abandoned single-family homes and multifamily buildings that have six units or fewer and are not legally occupied by a homeowner or another occupant. The shortened timeline could also apply to homes under construction where no activity has taken place for at least six months and there has been damage to the property. It would not apply to vacant buildings that are secured but are either for sale, part of a probate action or comply with local regulations.
 
"In most neighborhoods, there is still some kind of market," said Adam Gross, director of affordable housing at Business and Professional People for the Public Interest, which helped craft the bill. "It's not a vibrant market, but there's some kind of market. If you have a property that sits vacant for 600 days, whatever neighborhood it is, it's going to be worth a lot less at the end of 600 days than at the beginning of that 600 days. This has the potential to be beneficial in every neighborhood."

In addition to the $50 filing fee charged to lenders in foreclosure actions, the legislation also would require lenders that filed at least 175 foreclosure complaints during the previous calendar year to pay an additional $500 per foreclosure complaint. Those that filed at least 50 to 174 foreclosure actions would pay an extra $250 and those that filed no more than 49 foreclosure actions will be assessed an extra $50 fee.

Seventy percent of the collected fees would be used to help municipalities offset their costs to secure and maintain neglected buildings. Most of the remaining funds would be used to make grants to assist foreclosure prevention programs and housing counseling programs throughout the state.

The bill's proponents estimate that the additional housing counseling funds could benefit 18,000 homeowners annually, while the ability to speed the foreclosure process for abandoned homes by as much as 17 months could save lenders $43,000 to $89,000 per property. Using a conservative estimate of 5,000 foreclosure cases fast-tracked annually, that would generate savings to the financial industry of almost $214 million a year.

Under the bill, Chicago aldermen also would receive notices of foreclosure on properties in their wards.

The bill would take effect June 1.

mepodmolik@tribune.com | Twitter @mepodmolik

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