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Within a year of initiation, a multidisciplinary project to improve screening and treatment for iron deficiency in pregnancy resulted in a sixfold rise in screening rates for iron deficiency in pregnant patients, a 20-fold rise in the number of intravenous (IV) iron infusions, and a significant improvement in median hemoglobin levels.

Screening rates went from 10% to over 60% within a year. Two-thirds of pregnant patients screened were found to be iron deficient, indicating that this is a very common, but readily fixable problem.”

Richard Godby, MD, lead author, hematologist at the Mayo Clinic in Rochester, Minnesota

Women of child-bearing age are at high risk for iron deficiency. Menstruation and low intake of iron-rich foods are some of the most common causes of iron deficiency among women in this age group, Dr. Godby said. In addition, some commonly used medications, such as proton pump inhibitors, can inhibit the body’s ability to absorb iron.

The body needs more iron during pregnancy. Iron deficiency and anemia during pregnancy have been associated with adverse outcomes such as fetal growth restriction, premature birth, low birth weight, and compromised development of the fetus’s brain and nervous system. 

Iron deficiency can be diagnosed with a blood test for ferritin, a protein that enables the body to store iron. However, guidelines from the American College of Obstetrics and Gynecology – the professional society that represents most U.S. doctors in this specialty – currently recommend iron deficiency screening only for pregnant women with anemia, which they define as a hemoglobin level below 11 g/dL in the first or third trimester.

Dr. Godby and his colleagues worked with a multidisciplinary team at the Mayo Clinic to develop and implement a quality improvement project aimed at standardizing the screening and treatment of iron deficiency in pregnancy. They added ferritin testing to the list of recommended lab tests that patients typically undergo at eight to 12 weeks of pregnancy and again at 24 to 28 weeks. If patients had low ferritin levels at eight to 12 weeks, their teams offered to prescribe oral iron supplements. If patients’ ferritin was low at 24 to 28 weeks, the teams offered them an IV infusion of iron dextran.

To measure the project’s results, the research team compared changes after project implementation between the two cohorts of patients – one treated before implementation (2,097 pregnancies; the Before cohort) and one treated a year later, after implementation (2,429 pregnancies; the After cohort).

Results showed that, in the Before cohort, just 10% of patients underwent ferritin testing, compared with 63% in the After cohort. Among those tested, 66% in the Before cohort and 69% in the After cohort were iron deficient. Just 0.9% of patients in the Before cohort received IV iron dextran infusions, compared with 21% in the After cohort.

Among patients who received IV iron infusions, the median hemoglobin level improved from 10.7 to 11.8 g/dL. Patients whose hemoglobin level was 12 g/dL at study entry (above the cutoff of 11 g/dL to be considered anemic according to current guidelines from the American College of Obstetricians and Gynecologists) saw an increase to 12.8 g/dL. “These findings suggest reassessing the threshold for diagnosing anemia and screening for iron deficiency in pregnancy,” Dr. Godby said. 

Before the project, 3.1% of pregnancies required a blood transfusion during hospitalization for delivery, compared with 2.7% after the project’s implementation. Most patients who needed blood transfusions had not been tested for iron deficiency. While this difference was not statistically significant, Dr. Godby said, it suggests that a reduction in the need for post-partum blood transfusions could be an additional benefit of treating iron deficiency during pregnancy.

Dr. Godby noted that nearly all of the patients in both the Before and After cohorts took prenatal vitamins, which are recommended during pregnancy and supposed to contain iron. However, these supplements were usually purchased over the counter rather than prescribed by the health care team. Over-the-counter dietary supplements are not regulated to ensure they contain the ingredients and amounts of ingredients claimed by the manufacturers, he said.

As a next step, the team hopes to analyze whether treating iron deficiency in pregnancy improves patients’ quality of life by enabling them to feel better, experience less post-partum depression, return to work sooner, and more.

Richard Godby, MD, of the Mayo Clinic, will present this study on Sunday, December 7, 2025, at 12:00 noon Eastern time in W304A-D of the Orange County Convention Center.

Nikhil Rathi, chief executive of the Financial Conduct Authority, made a pilgrimage on Friday from its glass and steel HQ in east London to the Pioneers Museum in Rochdale – the spiritual home of the co-operative movement.

His unlikely day trip aimed to highlight the City watchdog’s role in opening the way to a doubling of the size of the mutuals sector – a Labour manifesto pledge.

Among these customer- or worker-owned organisations, including huge companies such as John Lewis and Nationwide building society, are the 350 credit unions.

These are locally based lenders whose interest rates are capped by law and whose clients tend to include the low-income consumers left behind by major banks. Holding assets of £4.9bn between them, the UK’s credit unions serve about 2 million members. Their US counterparts have more than 143 million.

The FCA’s new report, which Rathi was in Rochdale to launch, included a series of recommendations aimed at encouraging credit unions to expand, and to offer more services.

The Treasury has already promised to review the “common bond” – the legal promise that governs each credit union, for example specifying the area it serves – to allow these to adapt more easily to changing circumstances. Ministers have also set aside £30m to fund modernisation – updating credit unions’ IT systems, for example.

Yet campaigners for fairer lending fret that cash-strapped customers will continue to be left at the mercy of loan sharks unless mainstream banks are forced to do more.

The need is certainly there. Visiting an employability project on a housing estate in Stockton this week, it was depressing to hear about residents resorting to loan sharks, often unaware of the cheaper and less unpleasant alternative of a local credit union.

That chimed with evidence from a recent roundtable discussion organised in Glasgow by campaign group the Finance Innovation Lab, where low-income borrowers recounted their experiences to local MPs.

“When there’s an unexpected cost like that you just need to get it sorted, but you’re left with no good options,” one woman said, citing a broken bed as an example of the kind of expense that can drive consumers into paying extortionate interest rates to unscrupulous lenders.

Recent research by Fair4All Finance, the government-backed not-for-profit that promotes financial inclusion, found that 1.9 million adults in Britain had turned to unlicensed money lenders or loan sharks in the past year.

Dr Paul A Jones of Liverpool John Moores University is an expert on the credit union movement. He is optimistic about its future, and argues that some of the impetus for growth must come from within the sector itself.

“We need more credit unions of a significant size. We need more credit unions to get in the fast lane,” he says. “If you don’t want to, and you want to carry on in your village hall with 1,000 members, no problem, but that’s not where growth is going to come from.”

He welcomes some of the changes promised by the government – but warns that the constraint on many credit unions is lack of capital. “External investment is going to be important,” he says.

That’s where the Finance Innovation Lab and a coalition of other charities and lenders argue that legislation is needed, to force the powerful high street banks to play their part.

The government published its financial inclusion strategy last month, aimed at easing the struggle of consumers to secure affordable banking, insurance and other crucial services. But it included no specific targets, and made few firm demands of the finance sector.

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There was backing for a “small sum lending pilot”, led by Fair4All Finance, “to help expand access to affordable credit in England”. But the scale of the pilot was not specified – and it was unclear how it would differ from existing mutual lenders that already make small loans.

Campaigners including the actor Michael Sheen, who made a TV documentary on the exorbitant cost of debt for low-paid consumers in his home town of Port Talbot, argue for the much more muscular approach of a “Fair Banking Act”.

This would be a new law, modelled on the US Community Reinvestment Act, which has been in force for almost 50 years. Under the US version, banks are ranked by regulators according to how well their services reach underserved communities – and obliged to publish strategies to show how they will improve.

In many cases this then involves working with credit unions, or community development financial institutions (CDFIs) – another form of non-profit lender – hugely expanding the amount of capital these institutions have available to back new lending.

The coalition promoting the idea, which includes the Finance Innovation Lab alongside a string of mutual lenders and other campaign groups, argues that if such an act were implemented in the UK, it could lead to lending by credit unions and CDFIs to jump from £250m today to up to £3bn a year.

The proposal is backed among others by the Co-operative party, whose members include 41 Labour MPs, including the Treasury minister James Murray and the Treasury select committee chair, Meg Hillier.

It is a stretch to imagine the government slapping a Fair Banking Act on an industry that Rachel Reeves has called the “crown jewel in our economy”, but with the sector’s power should come responsibility.

The banks escaped the windfall tax that many on the left had hoped to see in the budget, and which the Institute for Public Policy Research (IPPR) argued could raise £8bn a year. It does not seem too much to ask that, in return, they put a fraction of that sum behind supporting the local, mutual lenders that help to keep the loan sharks at bay.

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Entering Printemps in downtown New York City feels like an escape. A slight smell of musk hangs in the air as shoppers weave carefully around racks of coats and shelves of handbags and shoes. For the holidays, the store set up a small ice rink on its second floor where skaters perform on weekends.

The French luxury retail emporium opened its first New York outlet earlier this year and has said it wants shoppers to feel so comfortable that it feels like their own chic “French apartment”. The store has a bar upstairs, along with a roving champagne cart, and encourages shoppers to sip on their drinks while they browse. Plush carpeting in the dressing room, full of orange and reds, is reminiscent of a Wes Anderson movie set.

Across the street at Trinity Church, hundreds of people line up for free food and other necessities. Dodge your way past the steaming potholes and snarling traffic and a doorman welcomes you to another world. The atmosphere is so heady that suddenly, when browsing through its racks, a $600 black fur coat seems entirely inexpensive, and the $1,450 leather tabi boots upstairs are an investment.

On a recent weekday afternoon, fashionably dressed shoppers milled slowly around the store. Some took pictures of the skating rink or of displays of housewares that instructed: “Please ask for assistance – do not touch.”

Julien, who declined to give his last name, was visiting the store to pick up a gift for a Secret Santa exchange and said he wasn’t surprised by the prices. “For the brands they have, it’s normal,” he said.

Kathy, another shopper, said that she offered to take her friend out to lunch at the restaurant located inside the store and see if she could find a certain brand of ballet flats. “This is the only place that carries them,” she said, holding two bright green Printemps bags.

For a small fraction of Americans, the Printemps fantasy of comfortable luxury is just a way of life. An $890 chapka hat is a sweet gift for a friend, dropping $200 on perfume that smells like freshly cut grass is normal.

Around the corner from Printemps is the headquarters of the New York Stock Exchange, the ultimate symbol of American wealth and one of the main drivers of all this luxury spending.

Over the last few years, many Americans have reported they’re struggling with higher grocery prices, rising healthcare costs and other bills, and have given up on dreams of buying homes. And yet the stock market has only gone up and up.

The S&P 500 has shot up nearly 86% over the last five years, hitting record highs, especially with the recent AI boom. A ballooning stock market has meant a small percentage of Americans have been striking gold. According to data from the Federal Reserve, Americans in the top 1% of wealth own nearly 50% of the stock market. The top 10% own 87.2% of the market. The bottom 50% of all Americans own just 1.1% of stocks.

Area chart showing corporate equities and mutual fund shares held, in millions of dollars, by wealth percentile

Meanwhile, inflation has gone up from a recent low of 2.3% in April to 3% in September, while the unemployment rate has risen slightly, from 4% in January to 4.4% in September. The Yale Budget Lab has estimated that price increases from Donald Trump’s tariffs will cause a 1.2% price rise in the short run, costing the average household $1,700.

The split between rich and poor has handed Trump the biggest dilemma of his presidency. While the president promised to fix prices, and continues to blame Joe Biden’s presidency for today’s prices, his recent approval ratings show Americans are unhappy about the economy. In the YouGov/Economist poll of Trump’s approval ratings around specific economic issues, he had +5% approval on inflation after his inauguration in January. By 2 November, his ratings dropped to -35%.

With Republicans facing a tough fight to maintain control of Congress in next year’s midterm elections, Axios reported that Trump is set to embark on a US-wide tour to stare down “criticism that he’s prioritized global issues over pocketbook worries”.

It may prove to be a tough sell. In April 2020, at the very start of the pandemic, economist Peter Atwater came up with an easy way to describe what this divide feels like to Americans: a K-shaped economy. A small few are on the upper part of the “K”, while most Americans feel as if they’re sliding down on the bottom side of the letter.

To Atwater, the “K” described a time when “those at the bottom experience price inflation at a time when those at the top are experiencing asset inflation”.

Higher prices affect everyone, no matter a person’s financial status. But inflation doesn’t affect everyone equally.

A line chart showing that the wage growth for lower-income households dropped to just 1%, while it rose to 3.7% for higher-income households, compared with same time last year 

“Those at the top appear to have everything – not only everything, but have it in oversupply,” Atwater said. “Meanwhile, those at the bottom feel like they’re experiencing scarcity in everything that matters – affordability of food, healthcare, education, job opportunity.”

“If you’re at the bottom, the difference between 2% to 3% inflation over time is significant.”

Atwater said the phenomenon of the K-shaped economy didn’t start with the pandemic, but with the recovery from the 2008 financial crisis. Many Americans were upset to see the federal government focus stimulus efforts from the top down.

“What we saw is that it took until about 2018 before those at the bottom began to see any real wage growth,” Atwater said. “But Covid just poured gasoline on that fire.”

While inflation skyrocketed in 2022 after the Covid pandemic, prices started to cool in the years following. The annualized inflation rate went from 9.1% in June 2022 to 2.3% in April 2025 – the lowest it had been since March 2021. But since the spring, inflation has started climbing again.

And just as prices have been getting higher, key anti-poverty programs have been cut under the Trump administration, which advocates say has led to more Americans coming under the poverty threshold. Over the last year, the White House tightened enrollment into the national food stamp program and cut funding for housing assistance.

Research from the Robin Hood Foundation, an anti-poverty non-profit based in New York, found that the city’s poverty rate hit 25% this year – almost double the national poverty rate of 13%.

“The combination of rising costs, stagnation at the lower-end of the wage scale and reduction in support for helping people meet their basic necessities, these are all driving the poverty rate increase,” said Matthew Klein, chief program officer at Robin Hood.

Recent data has shown the outsized spending higher-income Americans have been doing compared with those in the bottom tiers of wealth. Bank of America found that low-income household spending has grown 0.7% over the last year, compared with a 2.7% growth for high-income earners.

A line chart showing that spending growth rose to 0.7% for lower-income households and to 2.7% for higher-income groups, compared with same time last year 

The trend has been showing up slowly in people’s credit scores. The number of people with super-prime credit scores has climbed simultaneously to the number of people with sub-prime credit scores also rising, according to credit agency TransUnion.

Chief executives of companies such as Delta, Coca-Cola and McDonald’s have pointed out the K-shaped gap they’re seeing in consumer behavior.

Delta’s CEO, Ed Bastian, said the company is seeing a lot of growth from its premium customers, who buy business- and first-class tickets. Henrique Braun, the chief operating officer of the Coca-Cola Company, said on an earnings call that the company’s revenue growth is being led by higher sales of its premium products, such as Topo Chico sparkling water and Fairlife protein shakes.

Meanwhile, McDonald’s CEO, Chris Kempczinski, said that the chain’s middle- and low-income consumers are “feeling under a lot of pressure right now”.

“It’s a really kind of two-tier economy,” he said. “People are actually skipping breakfast – or they are choosing to just eat at home.”

Julien, the Printemps Christmas shopper, said he’s seen his business as a custom stylist grow over the last year.

“Our company is growing, it’s better than last year,” he said. “No complaints there. Rich people are still rich.”

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Start the music. Players walk clockwise in a circle. When the music stops, everyone sits in a chair. Big Tech is setting in motion its plans for the next gen of lead designers, engineers, AI chiefs, and even CEOs.

In Cupertino, Apple execs with familiar faces are retiring or reducing responsibilities. Who’s in and who’s out? Well, chief operating officer Jeff Williams retired in November, and the speculation is that CEO Tim Cook could follow in the near term. Lisa Jackson, who has led Apple’s sustainability efforts since 2013, is now set to retire in January too.

There’s also the squad of Apple staffers who have been lured away to work with OpenAI, notably Apple’s former chief design officer Jony Ive after his independent stint at LoveFrom. In 2024, Molly Anderson was named industrial design leader, heading up a team of mostly fresh faces. Others have gone to Meta, such as Apple’s VP of human interface design, Alan Dye, who just this week was poached to head up a new Reality Labs design studio. At Apple, he’s been replaced by long-time UI designer Stephen Lemay. Phew.

In this swirl of shifting talent, John Ternus, who has worked for Apple since 2001, and served as SVP of hardware engineering for the last four years, reporting directly to Tim Cook, is emerging as the frontrunner to succeed Cook as Apple CEO, reportedly as soon as next year. WIRED asked Apple for comment but didn’t hear back before publication.

Alongside a steady drip of “leaks” on succession planning and Ternus’ position at the front of the pack, since 2023, Ternus has been given more prominence at product launch events. He announced the iPhone Air onstage this past September, and has appeared alongside other senior Apple leaders in press interviews and in-store Apple events.

“I think they’re testing to see what sentiment is like. Apple likes to control the narrative. So these ‘leaks,’ they’re not happening unintentionally,” suggests Anshel Sag, principal analyst at Moor Insights & Strategy. “Apple’s lost a lot of people. I think it might actually be a net positive because it will create a fresh crop of people that have more power now than they did before.”

New Names to Know

It’s always tricky to pick up an individual’s contributions at Apple, beyond the odd detail, such as John Ternus himself reportedly being behind the MacBook’s TouchBar. Bertrand Nepveu worked in the Apple Vision Pro team from 2017 to 2021, after Apple acquired his VR headset startup Vrvana, and now runs Montreal-based VC firm Triptyq Capital. During his three and a half years, mostly working on the Vision Pro’s pass-through capabilities, the team ballooned from 300 to around 1,200. “John Ternus, even though I never worked with him, the feedback I got is that he’s a great product person,” he says, “and I think that’s what is needed for the next phase of Apple, especially with AI and with XR.”

With this future in mind, Nepveu sees the combination of Ternus-as-CEO working well with other personnel moves at Apple, including the news in March that Rockwell was taking over development of Siri from the head of AI, John Giannandrea. In another major future-facing reshuffle, Giannandrea was replaced this week by Amar Subramanya, who spent 16 years at Google, including work on Gemini and DeepMind, before a six-month stint at Microsoft.

“Mike Rockwell, I worked with him in the Vision Pro group, I think he’s the right person for that because they [XR and AI] work in tandem,” says Nepveu. “He used to joke that Siri was crap. I liked him because he didn’t drink the Kool-Aid. I was happy when I saw that he got promoted. I think in tandem with someone who is more product-focused [Ternus], it’s the way to go for Apple.”

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Bladder cancer is one of the most frequently diagnosed cancers worldwide, affecting nearly 600,000 people each year (Sung et al., 2021). While survival statistics are often discussed, many patients ask a different question: “What is Bladder Cancer Remission Rate?”

Remission refers to the absence of detectable cancer after treatment. Depending on the stage and type of bladder cancer, remission may be long-lasting, temporary, or—especially for early non–muscle-invasive disease—followed by recurrence. Understanding these patterns helps patients know what to expect and prepare for follow-up care.

Read About Bladder Cancer on OncoDaily 

What Does Remission Mean in Bladder Cancer?

In oncology, remission is typically classified as:

• Complete remission (CR): No evidence of cancer on cystoscopy, imaging, or cytology.
• Partial remission: Significant tumor shrinkage but not complete disappearance.

Bladder cancer is unique because the bladder lining is prone to repeated tumor formation. Even after complete remission, recurrence rates can be high, especially in NMIBC. Because of this, remission is often discussed alongside recurrence-free survival and progression-free survival (Babjuk et al., 2022).

Remission Rates by Bladder Cancer Stage

Bladder cancer is broadly categorized as:

• Non–muscle-invasive bladder cancer (NMIBC) – Ta, T1, and CIS
• Muscle-invasive bladder cancer (MIBC) – T2–T4
• Metastatic bladder cancer

Each category has different treatment goals and remission expectations.

Remission Rates in Non–Muscle-Invasive Bladder Cancer (NMIBC)

Most bladder cancers—about 70%—are diagnosed at an early stage, when the tumor is confined to the inner layers of the bladder wall. These cancers have high remission rates, especially when treated promptly and followed by preventive therapy.

For low-grade tumors, remission is extremely common after surgery (TURBT). Many patients achieve complete remission, but recurrence may occur over time, which is why continued monitoring is essential.

For high-grade tumors, intravesical therapy such as BCG is usually recommended. Studies show that:

• Complete remission is achieved in about 70%–80% of patients after BCG treatment.
• The highest remission rates occur within the first 6 months of therapy.
• Even among patients who achieve remission, up to half may have a recurrence at some point, but many recurrences are still treatable.

Overall, NMIBC has an excellent chance of entering remission, especially when treated early and monitored regularly (Babjuk et al., 2022).

Remission Rates in Muscle-Invasive Bladder Cancer (MIBC)

Muscle-invasive bladder cancer is more aggressive and requires stronger treatments, such as surgery or chemoradiation. Despite being more advanced, remission is still possible, and modern treatments continue to improve outcomes.

When patients receive chemotherapy before surgery (called neoadjuvant chemotherapy), research shows that:

• About 30%–40% achieve a pathologic complete remission, meaning no cancer is found at the time of surgery.
• Patients who achieve complete remission often have significantly improved long-term survival.

For patients choosing bladder-preserving chemoradiation:

• Durable complete remission occurs in about 50%–70% of patients.
• Those who achieve remission often maintain a functioning bladder and good quality of life.

In both treatment pathways, the chance of remission depends on tumor biology, overall health, and response to therapy.

Remission in Metastatic or Advanced Bladder Cancer

Remission becomes more complex in metastatic disease, but modern therapies have transformed expectations.

Chemotherapy

Platinum-based chemotherapy produces response (partial + complete) in 40–60% of patients (von der Maase et al., 2000). Complete remission occurs in ~5–15%.

Immunotherapy (Pembrolizumab, Nivolumab, Atezolizumab)

Complete remission in 5–10%, with durable responses in some patients (Bellmunt et al., 2017).

Read About Immunotherapy for Bladder Cancer on OncoDaily 

Antibody–Drug Conjugates (Enfortumab Vedotin)

• Response rates ~40–45%
• Complete remission in 4–6% (Rosenberg et al., 2019)

EV + Pembrolizumab (EV-302 Trial)

One of the most promising regimens: 67.7% response rate, with CR rates up to 29% (Powles et al., 2024). This represents a major breakthrough for previously untreatable metastatic disease.

Why Bladder Cancer Can Come Back Even After Remission

Bladder cancer has one of the highest recurrence rates of all cancers. This does not mean treatment failed—it is simply a characteristic of the disease. Even after a successful remission, small tumor cells may remain or may return over time. Because of this, bladder cancer requires ongoing cystoscopy, imaging, and urine tests. Early detection of recurrence allows for early treatment, which improves outcomes.

What Affects a Patient’s Chance of Remission?

Factors include:

• Stage and grade of the tumor
• Whether cancer has invaded muscle
• Presence of carcinoma in situ (CIS)
• Whether chemotherapy, immunotherapy, or BCG is used
• Lifestyle factors such as smoking
• Tumor mutations and response to therapy

Patients who stop smoking after diagnosis have better remission and survival outcomes.

How Long Does Remission Last?

This depends heavily on stage:

• Low-risk NMIBC: Many remain cancer-free long-term.
• Intermediate/high-risk NMIBC: Half recur within 5 years.
• MIBC (after cystectomy or trimodality therapy): Long-term remission possible in ~40%.

Metastatic disease: Remission is often temporary, but immunotherapy and ADCs have created long-lasting responses in a meaningful subset.

Can Bladder Cancer Be Cured?

Yes — but cure depends on stage.

• Early-stage (NMIBC): Many patients are effectively cured, though recurrence is common.
• MIBC: Cure is possible with surgery or chemoradiation.
• Metastatic disease: Rarely curable, but long-term remission is increasingly reported with modern immunotherapy and combination regimens.

Read About Bladder Cancer Cure Rate on OncoDaily 

Follow-Up After Remission

Because recurrence risk remains lifelong, guidelines recommend:

• Cystoscopy every 3–6 months for NMIBC depending on risk
• Imaging every 6–12 months for MIBC
• Ongoing monitoring for metastatic disease using scans and biomarkers

Adhering to follow-up is one of the most important factors for maintaining remission.

The Outlook for Bladder Cancer Remission

Although recurrence is common, bladder cancer remains highly treatable, especially when detected early. Many patients live long, healthy lives after treatment, even with recurrences. New therapies—including immunotherapy, targeted treatments, and antibody-drug conjugates—continue to improve remission rates and long-term survival across all stages.

Remission is not always a one-time event in bladder cancer; rather, it is a process of treatment, surveillance, and ongoing care. With regular follow-up and modern therapies, patients have more options than ever before to achieve remission and maintain quality of life

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Written by Armen Gevorgyan, MD