Hydroxychloroquine: a drug dividing the world

PARIS - Banned in some countries, promoted in others -- the drug hydroxychloroquine as a potential treatment for the new coronavirus is dividing opinion worldwide.

Scientists looking to find licensed medicines that could be repurposed as a treatment for COVID-19 had started tests of hydroxychloroquine, normally used to treat arthritis, and chloroquine, an anti-malarial. 

Both drugs can produce potentially serious side effects, particularly heart arrhythmia, leading many experts to warn against their use outside of clinical trials.

But that has not stopped prominent figures like US President Donald Trump endorsing hydroxychloroquine despite a lack of evidence of its efficacy.

Escalating the debate, The Lancet on May 22 published a study of nearly 100,000 coronavirus patients that showed no benefit in treating them with the two drugs - and even increased the likelihood of them dying in hospital.

This led the World Health Organization to suspend clinical trials of hydroxychloroquine, but dozens of scientists have since raised concerns over the study's methodology.

The Lancet corrected part of the data, but researchers have stood by their conclusions.

Countries worldwide vary on their own policies.

BANNED

The study prompts several countries to halt the use of hydroxychloroquine.

France does so on May 27, days after controversial French doctor Didier Raoult - whose own methodology has been questioned - rejected the study and stood by his belief the drug can help patients recover from the virus. 


Other countries including Italy, Egypt, Tunisia, Colombia, Chile, El Salvador, Cape Verde, Albania, and Bosnia and Herzegovina also ban the use of the drug for COVID-19 patients, though in Italy it remains possible in clinical trials.

Hungary meanwhile does not use the drug "for newly diagnosed patients" but continues to do so "for patients who already started taking it", according to a government spokesperson.

Even before the study some countries had stopped using hydroxychloroquine for COVID-19 patients. 

Sweden had used the drug in the early phases of the pandemic to treat patients with severe symptoms, but halted its use in April after the European Medicines Agency recommended it only be used in clinical trials.

Germany too had judged that the current studies did not allow for the drug to be used on individual COVID-19 patients and it could only be used in clinical trials.

PROMOTED

Several countries continue to promote the use hydroxychloroquine in the fight against the virus.

These include Brazil, Algeria, Morocco, Turkey, Jordan, Romania, Portugal, Kenya, Senegal, Chad and the Republic of Congo.

Russia, Bahrain, Oman and the United Arab Emirates have not yet suspended the use of the drug either, and in Iran recent social media posts of prescriptions show virus patients are still receiving it there.

Thailand is also still using hydroxychloroquine in its treatment of COVID-19 patients, and India and Venezuela continue to use the drug as a preventative measure. 

Cuba too is using the drug but will revise its protocols to introduce further precautions.

In the US hydroxychloroquine can only in principle be given to COVID-19 patients in hospital, but the Food and Drug Administration (FDA) warned in April that the drug could have potential harmful impact on the heart.

Trump had promoted the use of the drug and even said he was taking hydroxychloroquine as a precaution, before saying shortly after the publication of the study that he had stopped.

CLINICAL TRIALS SUSPENDED

The study has led to the suspension of the use of the drug in several clinical trials including the WHO's Solidarity Trial and Europe's Discovery program coordinated by France's Inserm research institute.

The international trial Copcov also suspended its use of doses on medical personnel in contact with the virus. 

Two trials led by the University of Tuebingen clinic in Germany and five trials in Denmark have also been suspended and Mali says it is ready to suspend its clinical trials too.

STILL TESTING

But other clinical trials are continuing, such as the Recovery trial in Britain, the one by McGill University in Canada and ones taking place in Nigeria and Mexico.

In China the drug is only used in clinical trials but its potential as a treatment, considered promising by the University of Wuhan in February, has since been called into question by a respected hospital in Shanghai.

Agence France-Presse

100-fold reduction of virus: S. Korea pharma company reports progress in experimental COVID-19 drug

SEOUL (Reuters) - South Korea's Celltrion Inc said on Monday its experimental treatment of COVID-19 demonstrated a 100-fold reduction in viral load of the disease in animal testing.

Drugmakers worldwide are rushing to develop treatments and vaccines for the illness that has caused more than 371,000 deaths globally.

The pre-clinical study of the drug showed improved recovery in runny nose, cough and body aches after the first day of treatment, and clearing of lung inflammation within six days, the company said in a statement.

Celltrion has research experience with other types of coronavirus conditions such as Middle East Respiratory Syndrome (MERS). It hopes to commence first in-human clinical trials for the COVID-19 treatment in July, said Kwon Ki-Sung, head of the firm's research and development unit.

"(Celltrion) has the capability to roll out mass production of the therapeutic antibody treatment once it is ready," Kwon said.

Shares in Celltrion traded up 4.2% on Monday morning in Seoul compared to the benchmark KOSPI's 1.4% climb.

(Reporting by Joyce Lee; Editing by Himani Sarkar and Christopher Cushing)

-reuters-

Fujifilm expands production for COVID-19 treatment Avigan

TOKYO - Japan's Fujifilm Holdings Corp said it has expanded manufacturing capacity to "significantly increase" production of its anti-flu drug Avigan that is being tested as a treatment for COVID-19.

Fujifilm expects to increase the production of Avigan up to 100,000 treatment courses by July 2020, about 2.5 times more compared to the beginning of March when the company first began its current production run, and then to 300,000 by September, it said in a statement on Wednesday.

Fujifilm is allocating additional capacity at its Fujifilm Wako Pure Chemical Co. facility in Japan to produce the ingredients used to make Avigan. The company has also made partnerships with domestic and overseas companies for manufacturing processes and the production of raw ingredients.

Fujifilm is conducting clinical trials of Avigan on patients of COVID-19, the disease caused by the novel coronavirus, in Japan and the United States.

-reuters-

How iPhone, Apple Watch can help reshape health research

In 1976, the Harvard School of Public Health and two other major medical institutions started a study on nurses that has become one of the largest and longest research efforts ever conducted on women’s health. They have so far enrolled more than 275,000 participants.

On Thursday, the Harvard school announced an even more ambitious women’s health study, one that aims to enroll 1 million women over a decade.

The new ingredients allowing the huge scale: Apple’s iPhones, apps and money.

Harvard’s new study is just one of three new large research efforts that Apple is working on with leading academic research centers and health organizations. Together, the studies, which Apple is paying for, show how the Silicon Valley giant and its popular products are reshaping medical research.

To enroll in clinical trials, patients have often had to travel to medical centers to be briefed by researchers and fill out the study paperwork in person. Many studies also follow patients only intermittently, in periodic surveys and visits to hospitals.

But Apple tools are enabling large-scale virtual studies that can follow people as they go about their daily lives. The company has developed a research app for iPhones — which participants can download from its app store — that is helping researchers quickly and easily recruit hundreds of thousands of study volunteers.

Researchers at Stanford Medicine, who studied whether an app on the Apple Watch could detect an irregular heartbeat condition, were able to enroll more than 400,000 participants in just 8 months. Apple helped recruit volunteers by promoting the study, which was published Wednesday, in its app store and emailing customers who had bought Apple Watches.

Dr. Ethan Weiss, an associate professor of medicine at the University of California, San Francisco, said he thought there would be many more of these so-called virtual studies, partly because they reduce the burden and costs compared with in-person studies.

He noted, however, that doctors did not yet know whether monitoring people en masse through smartphones and consumer-wearable devices would significantly improve health outcomes. “This is the big question. Is this ‘so what’? Or are we going to learn something meaningful we don’t know yet?”

Michelle A. Williams, dean of Harvard’s T.H. Chan School of Public Health, said she hoped the new study of women, called the Apple Women’s Health Study, would enable researchers to learn much more about how women’s bodies and reproductive health change over time.

Through surveys, she said, women participating in the study may choose to provide qualitative information about their menstrual cycles, pregnancies, menopause and other health issues. Through the study’s app, they may also choose to automatically share fitness, heart rate and other quantitative data gathered by their iPhones or Apple Watches.

“I’m most excited about the fact that we’ll be able to collect women’s menstrual cycle information in ways that we’ve not really done before,” Williams said. “Having this data on a large modern cohort is so relevant to clinical women’s health today because a lot of the decision-making and diagnostic protocols that we’re currently using are from data from 50 years ago, when the social environment was different.”

Apple’s involvement in the research studies is the latest example of how the biggest tech companies are edging their way into the country’s $3.5 trillion health care market. The companies are making inroads in medicine in part by exploiting their scale, along with the technologies that have helped them dominate markets like cloud computing, search, productivity tools and consumer apps.

Microsoft recently began testing an artificial intelligence system for hospitals that records, transcribes and analyzes doctor-patient conversations. Google is working with hospitals to analyze millions of patients’ medical records in the hopes of identifying patterns to improve diagnosis and treatment.

Apple is striking out in a different direction. The company has acquired health and wellness startups and hired prominent medical researchers. It has made health a marketing point of its devices. Last year, it introduced an electrocardiogram app on the Apple Watch Series 4. This year it introduced menstrual cycle tracking and hearing health services for the iPhone and the watch.

In addition to the women’s health study, Apple is sponsoring a study, led by researchers at Brigham and Women’s Hospital in Boston, that will examine physical activity and heart data from the Apple Watch to try to identify early warning signs of declining heart health. Another study, by researchers at the University of Michigan, will collect noise level data from headphones and an iPhone app to examine how long-term sound exposure can affect hearing.

The names of the studies also provide a marketing opportunity: They’re called the Apple Hearing Study, the Apple Women’s Health Study, and the Apple Heart and Movement Study.

Jeff Williams, chief operating officer of Apple, said the company hoped the studies would bolster the understanding of women’s, heart and hearing health. Apple also hopes to use the study data to improve its products or create new ones.

“We have a noise meter on people’s Apple Watches,” Williams said. “If we can help them understand the sound exposure in their environment and help them avoid the problem, or at least mitigate the problem, with hearing loss, that’s a huge contribution to society.”

The Apple studies could also influence how research studies treat health privacy. Apple’s research app allows study participants to granularly choose which types of information — such as heart or physical activity data — they share with researchers. Participants also have the ability to stop sharing their data or change their data-sharing category selections at any time. They can also choose to delete the current day’s data before it is shared with the study.

Apple has long marketed privacy as a feature that distinguishes its products from those of its rivals like Google. Apple has said that it does not have access to consumer data collected by the iPhone Health app, for instance, because the information is stored locally on users’ devices.

For the research studies, Apple said the technology was designed to meet federal standards for safeguarding health information. The company also said its researchers would have access to study participants’ data under pseudonymous ID codes — not their names.

But the studies reliant on Apple devices have inherent limitations because owners of the company’s products are not representative of the general US population. People who use iPhones have a median income of about $89,000 compared with $64,510 for Android users, according to recent data from Comscore. Among the Apple Watch users in the Apple Heart Study, there was a lower percentage of women, African Americans, Latinos and people ages 65 or older than in census data for the general population.

Michelle Williams of Harvard said that the women’s health study would ask participants for demographic information and adapt its methodology to account for any underrepresented groups.

There are also some concerns that Apple, which has already reshaped how people live, communicate and entertain themselves, is pursuing yet another way to influence society, this time through health.

“The broader point here is the fact that Apple has control over the app store, that Apple has connections with all of the people that have Apple iPhones, and that Apple gets to make a lot of decisions about how you collect the data, about how to notify people to be a part of the study,” said Matt Stoller, author of a new book, “Goliath: The 100-Year War Between Monopoly Power and Democracy.”

Whatever the potential health benefits, he said, “it’s still an extraordinary concentration of power in Apple’s hands.”


2019 The New York Times Company

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GSK recalls popular heartburn drug Zantac globally after cancer scare

GlaxoSmithKline on Tuesday said it was recalling the popular heartburn medicine Zantac in all markets as a "precaution", days after the US Food and Drug Administration found "unacceptable" levels of probable cancer-causing impurity in the drug.

Zantac, also sold generically as ranitidine, is the latest drug in which cancer-causing impurities have been found. Regulators have been recalling some blood pressure and heart failure medicines since last year.

Britain's medicines watchdog said GlaxoSmithKline (GSK) was recalling four prescription-only Zantac medicines: a syrup, an injection and tablets of 150 and 300 milligram (mg) dosages.

Over-the-counter 75 mg dosage Zantac products are produced by a different company and are not affected by the recall, it added.

"GSK informed the MHRA of our decision to suspend the release, distribution and supply of all dose forms of Zantac products," a company spokesman confirmed to Reuters.

"GSK is continuing with investigations into the potential source of the NDMA," he said, adding that the investigations include continued engagement with its suppliers and with external laboratories to conduct tests on finished product batches of Zantac.

The Medicines and Healthcare products Regulatory Agency (MHRA) said healthcare professionals were told on Monday to "stop supplying the products immediately, quarantine all remaining stock and return it to their supplier".

"We are advising that patients should not to stop taking their medication, and do not need to see their doctor until their next routine appointment but should seek their doctor's advice if they have any concerns," the MHRA said.

GLOBAL STOPPAGE

US and European health regulators said last month they were reviewing the safety of ranitidine, after online pharmacy Valisure flagged the impurities.

The FDA said Valisure's higher-temperature testing method generated very high levels of NDMA from the ranitidine drugs.

NDMA had previously been found in some blood pressure medicines from a class of drugs known as angiotensin II receptor blockers, or ARBs.

After checking the over-the-counter drugs using a low-heat method of testing, the FDA said it found much lower levels of NDMA than was discovered with a higher temperature test employed by Valisure.

The US regulator has asked ranitidine makers to conduct their own testing to assess levels of the impurity and to send samples of their products for testing by the agency.

Swiss drugmaker Novartis halted global distribution of its ranitidine drugs last month.

Last week, Walmart Inc joined pharmacy chains CVS Health Corp, Walgreens Boots Alliance Inc and Rite Aid Corp in suspending the sale of over-the-counter heartburn drugs containing ranitidine.

Canada's health authorities have asked makers of the drugs to halt distribution as they gather more information. Last month, regulators in Hong Kong pulled four products, while in Ireland 13 products containing ranitidine were recalled.

The impurity was believed to have been introduced by changes in the manufacturing process.

source: news.abs-cbn.com

J&J verdict sends opioid makers a billion-dollar warning

WASHINGTON -- The US pharmaceutical industry faces tens of billions of dollars in potential damage payments for fueling the opioid addiction crisis after Oklahoma won a $572 million judgment against drugmaker Johnson & Johnson.

One day after the healthcare giant was found guilty of flooding the market with highly addictive painkillers, another top opioid producer, Purdue Pharma, was reported to have offered $10-12 billion to settle more lawsuits before they come to trial.

Dozens more companies in the US prescription drugs chain -- giants like Teva Pharmaceuticals, Allergan, Mallinckrodt, Walmart, CVS and Walgreens Boots -- could face similarly large payouts as the next major opioids case gears up in Ohio.

Nearly 2,300 lawsuits similar to Oklahoma's have been rolled into one trial to begin in October.

The states, cities, towns and Native American tribes who filed the suits are demanding huge sums to pay for the fallout of the crisis -- overwhelmed health and social systems, families unable to care for themselves, and babies born addicted to the drugs.

$454 BILLION DAMAGE ESTIMATE

The case has drawn comparison to the $206 billion the tobacco industry agreed to pay 46 states in 1998 for the consequences of decades of nicotine addiction.

In the consolidated Ohio case, one estimate submitted to the court puts the total costs that communities face due to the epidemic at $453 billion over the coming decade.

In the Oklahoma case, Judge Thad Balkman said the $572 million would cover estimates of just one year of "abatement," or mitigation efforts related to the rash of addiction and overdose deaths the state has experienced.

Balkman said J&J's aggressive promotion of prescription painkillers, downplaying and hiding the high addiction risks, "compromised the health and safety of thousands of Oklahomans."

That was a clear message for the companies accused of doing the same in the Ohio case.

Purdue, which settled out of court early on in the Oklahoma case for $270 million, confirmed Tuesday it was in talks to avoid going to trial in Ohio as well.

"While Purdue Pharma is prepared to defend itself vigorously in the opioid litigation, the company has made clear that it sees little good coming from years of wasteful litigation and appeals," the company said in a statement.

The company, whose Oxycontin painkiller became an emblem of the addiction epidemic, and whose wealthy owners the Sackler family have come under international scorn, would not confirm or deny the media reports that it had offered up to $12 billion to resolve its liability.

However, it said, "The people and communities affected by the opioid crisis need help now."

"Purdue believes a constructive global resolution is the best path forward, and the company is actively working with the state attorneys general and other plaintiffs to achieve this outcome."

MILLIONS ADDICTED

The cases seek to address the costs of millions of Americans sinking into addiction after using potent opioid painkillers that the companies churned out and doctors freely, and often criminally, prescribed over the past two decades.

Well over 400,000 people died of opioid overdoses in that period, while the companies involved raked in billions of dollars in profits.

And while the flood of prescription opioids into the black market has now been curtailed, addicts are turning to heroin and highly potent fentanyl, where the risk of overdose and death is even higher.

Even so, the lawsuits are complex and legally challenging. 

The producers, wholesale distributors and pharmacies that liberally distributed the prescription painkillers argue they acted legally in a highly regulated industry, and say the fault lies mainly in doctors over-prescribing the drugs.

The Oklahoma and Ohio suits depend on evidence showing the drug industry knew the risks and covered them up, encouraging overprescription to make more money.

Both suits rely on "public nuisance" laws that are rarely used in such a case, and J&J says it will appeal Monday's judgment based in part on the over-expansive use of the statute.

But University of Georgia law professor Elizabeth Burch said the Oklahoma case brought out evidence about the drug companies' behavior that had not been seen before -- evidence that could hurt the defendants in the Ohio trial.

"Some of Judge Balkman's key findings will certainly play a role in future cases, but it's the evidence itself, not his ruling that will be on display," she said.

"I think it will have an effect on all the district litigations in Ohio because defendants will see they could be held liable," said University of Richmond law professor Carl Tobias.

"I think some defendants are going to have to think twice about going to trial," he said.

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Half of statins patients don't hit 'healthy' cholesterol levels

PARIS, France - Millions of patients around the world taking statins to lower the risk of heart disease fail to achieve the recommended levels of cholesterol reduction after two years of treatment, new research said Monday.

Statins -- a class of medicines designed to reduce cholesterol linked to heart disease and strokes -- are among the most commonly prescribed drugs in the United States and Britain.

The cholesterol-lowering industry is worth billions of dollars, but guidelines over who should take statins are often unclear.

A team of researchers in Britain reviewed public health records of 165,000 patients taking the medicine and found that fewer than one in two reached the recommended "healthy" 40 percent cholesterol reduction within two years.

"Statins do work and are effective, but some trials have highlighted there have been variations in responses among some patients," said Ralph Kwame Akyea, research associate at the University of Nottingham's Faculty of Medicine and Health Sciences.

"But we've shown there are some people not reaching this (safe cholesterol level) and the reducing of their risk is lower," he told AFP.

Akyea's study, published in the journal Heart, found that people on average started taking statins aged 62. It found nearly 23,000 cases of cardiovascular disease within six years of statin treatment among patients. 

In total, 51 percent of patients had an insufficient drop in cholesterol even while taking the drugs. 

Akyea stressed that the study -- the largest of its kind to date -- could not establish why some patients responded positively to statins while others didn't.

"Probably some people would have stopped taking their medication, maybe they had side effects," he said. 

"There might also be a role played by genetic variation. Not everyone responds to the medication and there are currently studies looking at the genetics of drug response."

MILLIONS MORE PATIENTS EXPECTED

Recent changes to prescription guidelines are set to see statins given to more than 55 million people in the US and 12 million people in Britain in the next few years.

Akyea and his team suggested that better guidance and monitoring was needed to ensure those given statins were taking the correct doses for the prescribed amount of time. 

Writing in a linked editorial, Marcio Bittencourt, from Sao Paulo's University Hospital, said the study's results were "clearly alarming". 

He stressed, however, that statins had been shown to significantly reduce the likelihood of heart attacks and strokes in a large percentage of at-risk patients. 

"Patients and society should be educated on the scientific evidence documenting the benefits of lipid lowering therapy," said Bittencourt. 

"Anti-statin propaganda based on pseudoscience should be strongly disavowed."

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Scientists behind cancer immunotherapies win Nobel medicine prize

STOCKHOLM/LONDON - American James Allison and Japanese Tasuku Honjo won the 2018 Nobel Prize for Physiology or Medicine on Monday for game-changing discoveries about how to harness and manipulate the immune system to fight cancer.

The scientists' work in the 1990s has since swiftly led to new and dramatically improved therapies for cancers such as melanoma and lung cancer, which had previously been extremely difficult to treat.

"The seminal discoveries by the two Laureates constitute a landmark in our fight against cancer," the Nobel Assembly at Sweden's Karolinska Institute said as it awarded the prize of nine million Swedish crowns ($1 million).

Allison and Honjo "showed how different strategies for inhibiting the brakes on the immune system can be used in the treatment of cancer," it said, adding that resulting treatments, known as immune checkpoint blockade, have "fundamentally changed the outcome" for some advanced cancer patients.

Medicine is the first of the Nobel Prizes awarded each year. The prizes for achievements in science, literature and peace were created in accordance with the will of dynamite inventor and businessman Alfred Nobel and have been awarded since 1901.

The literature prize will not be handed out this year after the awarding body was hit by a sexual misconduct scandal. A Swedish court on Monday found a man at the center of the scandal guilty of rape and sentenced him to two years in jail.

"LIVING PROOF"

Allison's and Honjo's work focused on proteins that act as brakes on the immune system - preventing the body's main immune cells, known as T-cells, from attacking tumors effectively.

Allison, professor at the University of Texas MD Anderson Cancer Center, worked on a protein known as CTLA-4 and realized that if this could be blocked, a brake would be released, unleashing immune cells to attack tumors.

Honjo, professor at Kyoto University since 1984, separately discovered a second protein called PD-1 and found that it too acted as an immune system brake, but with a different mechanism.

The discoveries led to the creation of a multibillion-dollar market for new cancer medicines. In particular, drugs targeting PD-1 blockade have proved a big commercial hit, offering new options for patients with melanoma, lung and bladder cancers.

U.S. drugmakers Merck & Co and Bristol-Myers Squibb currently lead the field after winning drug approvals in 2014, but Roche, AstraZeneca, Pfizer and Sanofi are also fielding rivals.

Sales of such medicines, which are given as infusions, are expected to reach some $15 billion this year, according to Thomson Reuters' consensus forecasts. Some analysts see eventual revenues of $50 billion.

Honjo, who is now 76, told a news conference in Tokyo he was honored to get the Nobel, but that his work was not yet done. "I would like to keep on doing my research ...so that this immune treatment could save more cancer patients," he said.

Allison also said he was "honored and humbled" by the award.

"I never dreamed my research would take the direction it has," he said in a statement on his university's website.

"It's a great, emotional privilege to meet cancer patients who've been successfully treated with immune checkpoint blockade. They are living proof of the power of basic science."

Commenting on Monday's award, Dan Davis, an immunologist at Britain's University of Manchester, said "this game-changing cancer therapy" has "sparked a revolution in thinking about the many other ways in which the immune system can be harnessed or unleashed to fight cancer and other illnesses."

Charles Swanton, chief clinician at the charity Cancer Research UK, said the scientists' work had revolutionized cancer and immunotherapy.

"The booming field of immunotherapy that these discoveries have precipitated is still relatively in its infancy, so it's exciting to consider how this research will progress in the future and what new opportunities will arise," he said.

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Amazon takes on pharmacy sector with new acquisition

WASHINGTON -- Amazon set its sights on the pharmacy market Thursday with the acquisition of tech-focused retailer PillPack, sending shock waves through the sector over prospects of disruption by the US online colossus.

Amazon has long been rumored to be interested in the pharmacy business, and the entry by a powerful new player could unsettle a business dominated by large American chains including CVS and Walgreens.

Terms were not disclosed on the deal for PillPack, an online pharmacy which operates in all 50 US states and offers pre-sorted dose packaging and home delivery. Some media reports said Amazon paid $1 billion and outbid rival retail giant Walmart.

"PillPack's visionary team has a combination of deep pharmacy experience and a focus on technology," said Jeff Wilke, head of Amazon Worldwide Consumer, in a statement.

"We want to help them continue making it easy for people to save time, simplify their lives, and feel healthier."

CVS shares slid 6.1 percent in closing trading on the news, while Walgreens Boots Alliance slumped 9.9 percent.

Neil Saunders of the research firm GlobalData Retail called the Amazon acquisition "a warning shot" for the pharmacy sector.

"Not only has Amazon finally made a solid move into pharmacy, it has done so via an innovative supplier which helps patients manage and organize their prescription drugs," Saunders said in a research note.

He added this "is only the first play in an increasingly aggressive strategy" by Amazon in the sector.

"This is incredibly bad news for traditional players, like Walgreens and CVS, who stand to lose the most from Amazon's determination to grow its share," Saunders said.

Saunders added that "Amazon's entry into any market will put downward pressure on prices and upward pressure on costs as others try to match its service," and that CVS and Walgreens could be vulnerable.

Walgreens CEO Stefano Pessina told a conference call on its quarterly results Thursday that "we are not particularly worried" about Amazon but added that "we know that we have to change the level of our services to the customers and we are working quite hard on that."

HACKING MEDICINE

PillPack was launched by two members of the "hacking medicine" initiative at the Massachusetts Institute of Technology, and helps people manage multiple medications with a software platform that offers reminders, dose-specific packaging and delivery.

The Boston-based company said it raised $118 million from investors and venture funds since its launch in 2013.

"Together with Amazon, we are eager to continue working with partners across the healthcare industry to help people throughout the US who can benefit from a better pharmacy experience," PillPack co-founder and CEO TJ Parker said in a statement.

Amazon and PillPack said they expected to close the deal by the end of the year, subject to regulatory approval.

Seattle-based Amazon, which began two decades ago as an online bookseller, has mushroomed into one of the world's largest companies.

It has retail operations across the globe, a large cloud computing business, a video service that competes with Netflix and a hardware division that makes devices powered by its digital assistant Alexa, which is available to makers of appliances, cars and other products.

Last year, Amazon closed a deal to acquire the Whole Foods grocery chain and has begun offering discounts to consumers who are members of its Prime subscription service.

Separately Thursday, Amazon announced plans to expand its own delivery fleet to reduce its dependence on services like Fedex and the US Postal Service.

Amazon said it committed $1 million to a fund to help individuals and entrepreneurs set up a contractual delivery service with Amazon.

"Individual owners can build their business knowing they will have delivery volume from Amazon, access to the company's sophisticated delivery technology, hands-on training, and discounts on a suite of assets and services, including vehicle leases and comprehensive insurance," an Amazon statement said.

"Over time, Amazon will empower hundreds of new, small business owners to hire tens of thousands of delivery drivers across the US."

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Sanofi may seek U.S. approval for Dengvaxia

PARIS - Sanofi will decide shortly whether to seek regulatory approval for its dengue vaccine Dengvaxia in the United States and remains committed to the medicine despite a health scare in the Philippines, a senior executive said on Wednesday.

David Loew, head of Sanofi Pasteur, the French drugmaker's vaccines division, said his teams had complied with all regulations regarding Dengvaxia and had no regrets about the way the product had been developed.

The Philippines, where more than 800,000 school-age children were vaccinated in 2016, suspended a vast public immunisation programme last year because of safety concerns.

Sanofi warned in November that the use of Dengvaxia was to be limited due to evidence it can worsen the disease in people who have not previously been exposed to the infection.

In February, a Philippine government agency filed a lawsuit against Sanofi, demanding compensation for the parents of a 10-year-old girl who the agency said had died as a result of receiving Dengvaxia.

Sanofi has repeatedly said it knew of no deaths resulting from the vaccine. While some experts have said the company and regulators might have ignored warnings about how the vaccine was developed, executives at Sanofi deny any wrongdoing.

"On the whole path of development, we always worked with the World Health Organisation (WHO) and experts in the dengue community. We were always transparent," Loew told Reuters in an interview, referring to the WHO and other regulators.

"You need to ask yourself: what was done with the information that was available at the time? Looking back, I would say no, we would not have done anything differently."

Mosquito-borne dengue is the world's fastest-growing infectious disease, afflicting up to 100 million people worldwide. It causes half a million life-threatening infections and kills about 20,000 people, mostly children, each year.

Loew said the company would decide within two months whether to make a regulatory filing for Dengvaxia with the U.S. Food and Drug Administration.

He also said Sanofi was holding discussions with external partners and universities to come up with a test which would be applicable before vaccination. Such a test would take at least two years to bring to the market.

"We operate in environments where the temperature is 30-40 degrees Celsius so you want to be sure that the tests resist (...) If you have a vaccination campaign taking place in a school for example, you want to make sure it is 'implementable,'" he said.

Dengvaxia has been approved and registered in 19 countries so far, mostly in the developing world. It is currently under review by the European Medicines Agency.

Sanofi booked an impairment charge of 87 million euros ($108 million) related to Dengvaxia in its fourth-quarter results.

Loew said the prospect of another financial charge this year was "extremely low."

source: news.abs-cbn.com

'Pharma bro' Martin Shkreli's notoriety slows New York jury selection

NEW YORK - Jury selection in the New York trial of former drug company executive Martin Shkreli will enter its third day Wednesday, after some potential jurors said they could not be fair to a man who gained notoriety by raising the price of a life-saving drug more than 5,000 percent.

 U.S. prosecutors have accused Shkreli, dubbed the "pharma bro," of running a Ponzi-like scheme at his former hedge fund and a drug company he once ran. Shkreli has pleaded not guilty to charges of securities and wire fraud.

The difficulty of finding a jury became apparent on Monday, with potential jurors variously describing Shkreli as "evil" and a "snake." More jurors cited the length of the trial, expected to last up to six weeks, as a hardship.

The ensuing headlines prompted Shkreli's lawyer, Benjamin Brafman, to ask U.S. District Judge Kiyo Matsumoto in Brooklyn on Tuesday morning to declare a mistrial. She refused.

The trouble continued Tuesday, as Matsumoto asked potential jurors left over from Monday whether they had been exposed to negative media reports about the previous day. Several who said they had were dismissed.

Shkreli, 34, rose to fame in 2015 by raising the price of anti-parisitic drug Daraprim to $750 a pill, from $13.50, when he was chief executive of Turing Pharmaceuticals. The move sparked outrage among patients and U.S. lawmakers.

Shkreli's upcoming trial is not about Turing but about Shkreli's management at his previous drug company, Retrophin Inc, and the hedge fund MSMB Capital Management between 2009 and 2012.

Prosecutors said Shkreli lied about MSMB's finances to lure investors and concealed devastating trading losses from them. They said he paid the investors back with money stolen from Retrophin, which he founded in 2011.

Tuesday's jury questioning suggested Turing might come up anyway. One juror, a pharmacist, was dismissed after saying he was familiar with the company, and that he would compare any testimony about drug pricing to his own knowledge.

Shkreli himself may have complicated the jury selection. While most criminal defendants lie low, he has sought public attention since his December 2015 arrest, lashing out at critics and boasting of his wealth on social media. He was banned from Twitter in January for harassing a journalist.

One juror was dismissed on Tuesday after saying he was familiar with Shkreli's Twitter account.

"Unfortunately, the Twitter history is just horrific," Brafman said.

source: news.abs-cbn.com

Medical delivery drones take flight over Rwanda

"Three, two, one, launch!" And with that, catapulted from a ramp, the small fixed-wing drone buzzes into the air towards its pre-programmed destination, the Kabgayi hospital two kilometers away.

On Friday Rwanda inaugurated a drone operation that its backers hope will kickstart a revolution in the supply of medical care in rural parts of Africa, in the first instance by delivering batches of blood to 21 clinics in the west of the country.

Maternal mortality rates in Africa are among the highest in the world, according to the World Health Organization (WHO), largely due to postpartum hemorrhage caused by lack of access to simple blood transfusions.

Rwanda is no exception, and the situation here is worsened by the topography of a country dubbed "the land of a thousand hills" as well as intense seasonal rains making the transport of blood by road often long and difficult.

Blood "is a very precious commodity so you cannot just stock a lot of it in every single heath center," said Keller Rinaudo, CEO of Zipline, a California-based robotics company that designed the 15 drones and the base housing them in Muhanga, 50 kilometers (31 miles) west of the capital Kigali.

FASTER, MORE EFFICIENT
Rinaudo hopes his drone delivery system will "allow the Rwandan government to instantly deliver life-saving transfusions to any citizen in the country in 15 to 30 minutes."

US package-delivery giant UPS and global vaccine alliance Gavi have invested $1.1 million (one million euros) in the Zipline project, one of a handful on the continent seeking to harness the potential of delivery drones to overcome poor infrastructure.

For the Rwandan government blood delivery by drone is not cheaper, but it promises to be much faster.

The drones dubbed "Zips" are shaped like a fat-bellied miniature plane with a two-metre (six-foot) wingspan.

They are battery-powered with a range of around 150 kilometers, weigh 13 kilos (29 pounds) and can carry a cargo of about 1.5 kilos, or three bags of blood.

Flying at up to 70 kilometers per hour, it is predicted each drone could make as many as 150 deliveries a day.

At the tent that serves as a launch station, Zipline technicians monitor the drones from laptops while others prepare the payload: small cardboard boxes with paper parachutes that will hold the transfusion blood and be dropped from a height of around 20 meters.

As the test flights were carried out curious residents peered through the fence, watching as the drones were flung into the air, returning after dropping their cargo at the hospital, and landing on an inflatable mattress.

Zipline plans to open a second base in Rwanda next year meaning the whole of the tiny country will be within range.

"These flights will save lives," said Gregg Svingen, head of communications at UPS. "Today it is blood, tomorrow it will be vaccines."

source: www.abs-cbnnews.com

Advocates pitch benefits of medical marijuana

MANILA -- Advocates of medical marijuana on Tuesday attempted to convince lawmakers of the positive use of the illegal plant in the field of medicine.

Various experts attended the hearing of the House Committee on Health to convince lawmakers to pass House Bill 4477, or the "Compassionate Use of Medical Marijuana Act,'' which was filed by Isabela 1st District Representative Rodolfo Albano III and has 69 co-authors.

The advocates, including a foreign doctor who shared his expertise through a video message, explained the medical significance of cannabis or marijuana.

They insisted that cannabis is a unique drug that has vast potential for treatment.

Marijuana is the only known plant that produces large amounts of a class of chemicals known as cannabinoids, which is naturally produced by the human body.

The cannabinoid system, only discovered roughly two decades ago, is responsible for the regulation and protection of the the body. Cannabis has been used to manage pain, fight inflammation, battle depression, and regulate appetite and sleep, among others.

It has been proven as an effective treatment against serious ailments like Post Traumatic Stress Disorder (PTSD), epilepsy, Parkinson's Disease, and Multiple Sclerosis.

Albano clarified that HB 4477 only seeks to legalize marijuana strictly for medical use only. The bill seeks to regulate the use of cannabis for treatment and medication of patients with debilitating medical conditions.

If enacted, a Medical Cannabis Regulatory Authority under the Department of Health will be established to regulate the medical use of marijuana.

Qualified patients will be given identification cards that will protect them from criminal liability for the use of medical cannabis.

source: www.abs-cbnnews.com

Why taking painkillers for gout is dangerous

MANILA -- It is common for people suffering from gout to resort to painkillers to get rid of the excruciating pain caused by inflamed joints.

However, a rheumatologist warned against taking painkillers frequently, as this can lead to more serious problems.

In an interview on DZMM's "Magandang Gabi Dok," Dr. Julie Li-Yu, a rheumatologist, explained that most painkillers, if abused, can lead to complications and other medical conditions not related to gout.

"Kadalasan, dahil sa sobrang kampante ng ilang mga pasyenteng gumagamit ng mga gamot, paulit-ulit nilang ginagamit na walang konsultasyong. Nasisira na ang bato, nabubutas ang sikmura, nagkakaroon ng bleeding, bleeding ulcer, kidney failure, liver problems... depende sa profile ng pasyente," Li-Yu said.

Gout is caused by high levels of uric acid production. The excess uric acid is then deposited in the joints, usually in the feet.

The pain and inflammation is the body's reaction to the excess uric acid in the joints, which it considers as a foreign body.

According to Li-Yu, advised patients to always consult their doctors before taking medicines, since specialists prescribe medicines depending on the patient's profile and medical history.

She also noted that the number of younger people suffering from gout is increasing, which the doctor attributed to poor lifestyle choices.

"What we see nowadays, ang iniisip kasi natin ay contribution ng maraming factors. Pwede 'yang kontribusyon ng lifestyle, pwede 'yan ang No. 1, dahil iba na ang diet ng mga tao ngayon eh, lifestyle tapos walang exercise," Li-Yu explained.

Genetics is also one of the factors being considered, especially if gout runs in the family.

"Lalo na 'pag pabata ng pabata, and it runs strongly in the family, we look also into the genetics," she said.

source: www.abs-cbnnews.com

Older minds need physical and mental activity

Exercising the body and mind may be the best way to keep an older brain sharp, suggests a new study.

“The best medicine is physical activity,” lead researcher Ralph Martins told Reuters Health.

“At the end of the day, the two together – physical activity and cognitive training – gave us an additional benefit,” said Martins, who directs the Center of Excellence for Alzheimer’s Disease Research and Care at Edith Cowan University in Perth, Australia.

Martins and his colleagues studied 172 people from ages 60 to 85 years, assigning them randomly into four groups.

One group walked three days a week for an hour and did 40 minutes of resistance training twice a week for 16 weeks. Another group did hour-long computer brain-training exercises five days a week, also for 16 weeks. A third group did both the physical exercise and the computer activities. A fourth group maintained their regular routines.

The researchers write in Translational Psychiatry that only the group that engaged in both physical activity and computerized brain training showed significantly improved verbal memory, which helps people remember words and language.

The researchers note that the study failed to show benefits for executive functions that control focus, attention to details and goal setting. They also didn’t find benefits for visual memory, processing speed or attention.

Martins said physical exercise had the most profound and constant effect.

Dr. David Merrill also sees physical activity as the most useful aid to maintaining memory and cognitive ability as people age, but the combination of physical and mental exercise may offer “synergistic” benefits.

“What’s good for the muscular-skeletal system is good for the cardiovascular system, and it’s also good for the brain,” said Merrill, who is a geriatric psychiatrist at the David Geffen School of Medicine at the University of California, Los Angeles.

“Physical exercise sets the stage for the brain to be responsive to new information,” said Merrill, who was not involved with the new study. “You’re all ready to build new synapses, new connections.”

Both Martins and Merrill recommend that older people exercise regularly and stay intellectually involved. Both favor real-life challenges over computerized brain exercises.

Martins urges retirees to join service organizations, like the Rotary Club, and to dance for the physical exercise and mental acuity.

"Full retirement doesn’t make sense for graceful aging,” Merrill said. “People should try to keep working not only to maintain their self-identity but to challenge their brain.”

Merrill said the new research is the most recent of a handful of studies showing that a combination of interventions can help seniors remain mentally alert.

He advocates building up to more strenuous exercise than people did in the study.

“There’s lots of data that shows that being physically active is good for the brain,” he said. “It’s almost so intuitive that it defies logic that so few people are active physically.”

The U.S. Centers for Disease Control and Prevention recommends that older adults perform moderate and vigorous aerobic and muscle-strengthening activities at least twice a week.

source: www.abs-cbnnews.com

AIDS campaigners say pandemic has finally reached tipping point

LONDON - The world has finally reached "the beginning of the end" of the AIDS pandemic that has infected and killed millions in the past 30 years, according to a leading campaign group fighting HIV.

The number of people newly infected with HIV over the last year was lower than the number of HIV-positive people who joined those getting access to the medicines they need to take for life to keep AIDS at bay.

But in a report to mark World AIDS Day on Dec. 1, the ONE campaign, an advocacy group working to end poverty and preventable disease in Africa, warned that reaching this milestone did not mean the end of AIDS was around the corner.

"We've passed the tipping point in the AIDS fight at the global level, but not all countries are there yet, and the gains made can easily stall or unravel," said Erin Hohlfelder, ONE's director of global health policy.

The human immunodeficiency virus (HIV) that causes AIDS is spread via blood, semen and breast milk. There is no cure for the infection, but AIDS can be kept at bay for many years with cocktails of antiretroviral drugs.

United Nations data show that in 2013, 35 million people were living with HIV, 2.1 million people were newly infected with the virus and some 1.5 million people died of AIDS. By far the greatest part of the HIV/AIDS burden is in sub-Saharan Africa.

The AIDS pandemic began more than 30 years ago and has killed up to 40 million people worldwide.

The United Nations AIDS agency, UNAIDS, says that, by June 2014, some 13.6 million people globally had access to AIDS drugs, a dramatic improvement on the 5 million who were getting treatment in 2010.

"Despite the good news, we should not take a victory lap yet," said Hohlfelder.

She highlighted several threats to current progress, including a $3 billion shortfall in the funds needed each year to control HIV around the world.

"We want to see bold new funding from a more diversified base, including more from African domestic budgets," she said.

ONE also noted that HIV is increasingly concentrated among hard-to-reach populations such as injecting drug users, gay men and sex workers - groups who are often stigmatised and have trouble accessing treatment and prevention services.

source: www.abs-cbnnews.com

Pot tied to fewer brain injury deaths: study

NEW YORK - People who use marijuana may be more likely to survive a serious head injury than people who don't, a new study suggests.

At one hospital, the death rate after traumatic brain injury was lower among people who tested positive for tetrahydrocannabinol (THC, the active ingredient in marijuana) than among people who tested negative for it, researchers found.

“This data fits with previous data showing that (THC) may be neuroprotective,” Dr. David Plurad, one of the study's authors, said in a phone interview.

Experiments in animals have found that THC may protect the brain after injury, Plurad and his colleagues write in The American Surgeon. Little is known about the specific effects of THC on brain injury in humans, however.

For the new study, the researchers reviewed data on 446 adults treated at Harbor-UCLA Medical Center in Torrance, California for traumatic brain injuries. All had been tested for THC.

Overall, approximately one in five patients tested positive for THC and one in 10 patients died after their injury.

About 2.4 percent of people who tested positive for THC died, compared to about 11.5 percent of those with negative THC tests.

People who tested positive for THC were about 80 percent less likely to die, compared to people with negative THC tests, researchers found after they adjusted the numbers to account for age, gender, injury severity and type.

Previous studies have also suggested that alcohol may protect the brain in traumatic brain injuries, Plurad said. Those studies did not account for the presence of THC, however.

“We included the presence of alcohol in our statistical analysis, and it didn't turn out to be as protective as the presence of the marijuana,” he said, adding that future studies examining the effects of alcohol on traumatic brain injury should account for the presence of THC.

One concern with the study, according to Plurad, is that the test for THC could not distinguish occasional from regular users. A person could test positive after having used marijuana days or even weeks before.

Given that marijuana is inexpensive and may have some medical benefits, its therapeutic effects are worth investigating further, he added.

“There's not going to be one answer, is marijuana good for you, is marijuana bad for you,” he added. “Like most things in life, and particularly medicine, it's going to be somewhere in between.”

source: www.abs-cbnnews.com

Woman has baby after womb transplant in world first: Lancet

PARIS - A 36-year-old Swede has become the world's first woman to give birth after receiving a womb transplant, medical journal The Lancet said on Saturday, describing the event as a breakthrough for infertile women.

The healthy baby boy was born last month, it said. Both mother and infant are doing well.

Weighing 1.775 kilos (3.9 pounds), the baby was born by Caesarean section at 31 weeks after the mother developed pre-eclampsia, a pregnancy condition, the journal said.

The woman had a genetic condition called Rokitansky syndrome which meant she was born without a womb, although her ovaries were intact.

The surgeons said the exploit smashes through the last major barrier of female infertility -- the absence of a uterus as a result of heredity or surgical removal for medical reasons.

"Absolute uterine factor infertility is the only major type of female infertility that is still viewed as untreatable," they said in a paper published by the British journal.

The replacement organ came from a 61-year-old woman, a close family friend who had been through menopause seven years earlier. The organ was transplanted in a 10-hour operation last year.

The recipient underwent in-vitro fertilization, in which eggs were harvested from her ovaries and fertilized using sperm from her partner, and then cryogenically preserved.

A year after the transplant, a single early-stage embryo was inserted into the transplanted womb. A pregnancy test three weeks later was positive.

The womb encountered a brief episode of rejection, but this was successfully tackled by increasing a dose of corticosteroid drugs to suppress the immune system.

- A decade of research -

"Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility," the Lancet quoted Professor Matts Braennstroem of the University of Gothenburg, who led the operation, as saying.

"What is more, we have demonstrated the feasibility of live-donor uterus transplantation, even from a post-menopausal donor."

Rokitansky syndrome -- Mayer-Rokitansky-Kuester-Hauser syndrome to give it its full name -- affects approximately one in 4,500 newborn girls, previous research has found.

The options open to women with this disorder, or who have had a hysterectomy, are adoption or having a baby through a surrogate mother.

But surrogacy is not allowed in many countries because of ethical, legal or religious reasons.

The unnamed Swede was one of nine who received a uterus from live donors under Braennstroem's programme.

Two of them had to undergo hysterectomy within a few months, either because the womb became infected or blood flow to it became clotted, the paper said.

The other seven women began menstruation during the first two to three months, and the transplanted organs remained viable during the first year after the operation.

Two other transplant attempts have been reported elsewhere, but neither resulted in a live birth.

The first, carried out in Saudi Arabia in 2000, ended in failure after three months when the uterus became necrotic and had to removed.

The second, carried out in Turkey in 2011, entailed a uterus that was transplanted from a deceased donor, resulting in pregnancies that miscarried within six weeks.

source: www.abs-cbnnews.com

What you need to know about sepsis

MANILA -- Are you worried you or someone you know might have sepsis? Here are ways to identify its symptoms.

Sepsis is a life-threatening complication caused by any kind of infection. Formerly referred to as blood infection, it became known in 2005 as the cause of death of Pope John Paul II.

In an interview on "Magandang Gabi Dok" on Thursday, Dr. Jose Emmanuel Palo of The Medical City explained how common infections can lead to sepsis.

"Ang sepsis ay reaction ng katawan sa isang infection," Palo said. "Hindi siya 'yung infection, separate po siya doon sa infection mismo. Kaya lang, 'yung reaction po na iyon, inherent po, nasa loob ng katawan natin. Minsan nakaka-damage po or nakakasama sa sariling mga organs or tissues po ng katawan natin."

Any kind of infection, whether caused by a virus, bacteria or fungus, may cause sepsis, Palo added.

Sepsis can also lead to death, especially in severe cases.

According to Palo, common symptoms of sepsis include fever, increase in pulse and heart rate, rapid breathing and a feeling of weakness.

Once it becomes severe, sepsis can also cause a person's blood pressure to drop.

"Kapag bumagsak na ang blood pressure ng isang taong may sepsis, tapos hindi na po mahabol using swero o fluids, nangangailangan na po ng special na medicines para mapaakyat ang blood pressure," Palo added.

Palo said it is important for people to immediately consult a doctor once they notice these symptoms.

"Ang importante siguro is kapag nandoon na ang mga symptoms or signs na 'yun at nararamdaman natin, the moment po na feeling natin kakaiba na po ang pakiramdam, nanghihina po, mas importante po siguro na i-check po kung nangyayari na ang sepsis."

Doctors can then check whether a person is suffering from sepsis through blood tests.

Palo also said people with prevailing illnesses like cancer, or those undergoing treatments like dialysis, are at high risk of sepsis.

This is also the reason why doctors and other hospital personnel should practice proper hygiene.

"Halimbawa may cancer. Habang nag-chemotherapy, habang ginagamot, bumabagsak ang immune system. Mas mataas ang chance na magkaroon ng sepsis," he added.

source: www.abs-cbnnews.com

Hayden opens up on getting license back

MANILA – For the first time since the Professional Regulation Commission (PRC) returned his medical license, Hayden Kho finally broke his silence to share his feelings now that he’s allowed to practice medicine again.

In an interview with “The Buzz” on Sunday, Kho admitted there was a point in his life when he already gave up on getting back his license.

“In 2009, when they told me ‘You can no longer practice as a doctor,’ it really broke my heart. I thought that was permanent. I was not really expecting anymore,” he said.

That’s why the PRC’s decision came as a surprise to him, Kho said, especially since he was out of the country when the commission rendered its decision.

Fresh from his trip abroad where he took classes on Apologetics, Kho said he has not even read yet the documents from the PRC reinstating him as a doctor.

“Honestly I don’t know how it works. In fact, I haven’t even seen the papers that were sent to my parents’ house. I just arrived so hindi ko pa nakikita. Pinadala lang ng mom ko 'yung pictures,” he said.

Kho also clarified reports saying that getting back his license was the reason behind his decision to become a Christian.

“I did not do that so that I could gain my medical license back," he said about his faith. "Why did I do what I did? The answer to that is I wanted to seek the Lord and in my experience, when I go to those places, in India, the poorest of the poor, when I helped out, I feel God more in my life. The beautiful thing about this is God does want to let his children know who he is,” he said.

After everything that he has been through, Kho said he is grateful to have his mother beside him.

“I love you mommy. Those seven years were very tough for me. Maraming beses kami nag-away ng mom ko. Ngayon ko lang talaga naiintindihan 'yung heart ng isang mom. She’s been very very patient with me. We fought many times but the love is still there. Ngayon ko lang naiintindihan 'yung love,” he said.

Asked about the most important lesson he learned from this ordeal, Kho said: “We all long for love. Doon sa mga tao na nagkamali before, and everyone abandoned you, I have been through that place. If you need someone to love you, if you need a hand that will hold you and they are not there, always remember tha there’s a heavenly Father who wants to put his arms around you.”

source: www.abs-cbnnews.com