Financial Services Modernization: A Cure for Problem Banks?

On February 5, 1991, after consulting federal financial regulatory agencies and other interested governmental parties, the Department of the Treasury transmitted to Congress its report: Modernizing the Financial System: Recommendations for Safer, More Competitive Banks. The Treasury Report concludes that four major problems confront the U.S. banking system: (1) reduced bank competitiveness and financial strength, caused by outdated legal restrictions that prevent banks from responding to changing financial markets and technology; (2) the overextension of deposit insurance, resulting in excessive exposure for taxpayers and weakened market discipline for banks; (3) a fragmented regulatory system that has created duplicative rules and has often failed to produce decisive remedial action; and (4) an undercapitalized deposit insurance fund. To address these problems, the Treasury Report recommends four fundamental legislative reforms: (1) to increase bank competitiveness, Congress should authorize nation-wide banking, new financial activities for banks, and commercial ownership of banks; (2) to reduce taxpayer exposure and increase market discipline, Congress should reduce the scope of deposit insurance, require a link between regulatory supervision and capital strength, and require risk-based insurance premiums for deposit insurance; (3) to reduce duplicative rules and produce decisive remedial action, Congress should streamline the federal regulatory system; and (4) to recapitalize the Bank Insurance Fund, Congress should adopt a funding plan based on contributions from the banking industry, rather than from the Treasury and the taxpayers. After a very basic historical review of past attempts to reform the banking industry, this Article focuses on the less publicized portions of the Treasury recommendations in an attempt to identify some of the issues that would remain unsettled, even if the proposals are enacted into law

Early Detection of Ovarian Cancer using the Risk of Ovarian Cancer Algorithm with Frequent CA125 Testing in Women at Increased Familial Risk – Combined Results from Two Screening Trials

Purpose: Women at familial/genetic ovarian cancer risk often undergo screening despite unproven efficacy. Research suggests each woman has her own CA125 baseline; significant increases above this level may identify cancers earlier than standard 6- to 12-monthly CA125 > 35 U/mL. Experimental Design: Data from prospective Cancer Genetics Network and Gynecologic Oncology Group trials, which screened 3,692 women (13,080 woman-screening years) with a strong breast/ovarian cancer family history or BRCA1/2 mutations, were combined to assess a novel screening strategy. Specifically, serum CA125 q3 months, evaluated using a risk of ovarian cancer algorithm (ROCA), detected significant increases above each subject's baseline, which triggered transvaginal ultrasound. Specificity and positive predictive value (PPV) were compared with levels derived from general population screening (specificity 90%, PPV 10%), and stage-at-detection was compared with historical high-risk controls. Results: Specificity for ultrasound referral was 92% versus 90% ( P = 0.0001), and PPV was 4.6% versus 10% ( P > 0.10). Eighteen of 19 malignant ovarian neoplasms [prevalent = 4, incident = 6, risk-reducing salpingo-oophorectomy (RRSO) = 9] were detected via screening or RRSO. Among incident cases (which best reflect long-term screening performance), three of six invasive cancers were early-stage (I/II; 50% vs. 10% historical BRCA1 controls; P = 0.016). Six of nine RRSO-related cases were stage I. ROCA flagged three of six (50%) incident cases before CA125 exceeded 35 U/mL. Eight of nine patients with stages 0/I/II ovarian cancer were alive at last follow-up (median 6 years). Conclusions: For screened women at familial/genetic ovarian cancer risk, ROCA q3 months had better early-stage sensitivity at high specificity, and low yet possibly acceptable PPV compared with CA125 > 35 U/mL q6/q12 months, warranting further larger cohort evaluation. Clin Cancer Res; 23(14); 3628-37. ©2017 AACR