Tobacco victims shown to sway govt

Dhaka, May 27 Sofura Begum came to know about the harmful effect of chewing tobacco only when doctors detected cancer in her mouth. 

The 60-year old from southeastern Comilla chewed tobacco, a common habit among rural Bangladeshi women, for long. 

Doctors removed part of her jaw. "It's difficult to take food now," she gags as the cancer prevents her from opening the mouth and maneuvering the tongue properly. 

A farmer in his 60s, Sheikh Nazrul Islam is also battling against laryngeal (voice box) cancer. The poor farmer said he used to take hand-roll bidis and zarda for over 40 years. 

United Forum Against Tobacco (UFAT), a common platform of doctors' professional bodies, brought them to a discussion to show tobacco harms to policy makers on Sunday when the 2012-13 budget session begins. 

UFAT demands an increase in taxes on all tobacco products as there is an inverse relationship between tobacco product prices and consumption; falling prices lead to increases in consumption while rising prices will reduce the habit. 

Cancer specialist of Dhaka Medical College Hospital Dr Golam Mohiuddin Faruk said in 2011 alone they got at least 6,000 cancer patients, of whom 30 percent had oral cavity cancer. 

He termed it 'alarming' as they believed 90 percent of the cases had to with consuming tobacco. 

Ranked 20th among the tobacco-producing nations in the world, the prices of tobacco in Bangladesh are said to be the cheapest. 

The supplementary duties on cigarettes vary from 36 percent to 60 in four tiers. It is only 20 percent for bidis while 30 percent for smokeless tobacco like zarda and gul. 

Economists say if specific tax of Tk 34 per 10 cigarettes, Tk 4.95 per pack of 25 bidis were levied ending existing price slabs, the government would earn Tk 22.2 billion more in revenue from those products even though 10.4 million people will have quit the habit. 

Thousands of lives would be saved in Bangladesh where more than 150 people are estimated to be dying every day due to tobacco-related illness. 

As industry proponents argue generating millions employment in tobacco factories, a recent study showed only around 65,000, far below the claim of 'millions of workers', work in 117 bidi factories in Bangladesh where the real prices of tobacco have fallen, shooting the number of consumers. 

"We have placed the demand of increasing taxes and amending the 2005 Tobacco Control Act at the soonest to the President and Health Minister," UFAT Organising Secretary Dr Sohel Reza Chowdhury said. President Mohammed Zillur Rahman is the chief patron of the platform. 

National Professor Abdul Malik said the government believed it earned huge revenue from tobacco industries, but in reality, it had to spend more on the tobacco-induced incurable diseases. 

"We have to stop tobacco cultivation. Its inhumane if we even think of exporting tobacco (products) for revenue generation." 

The draft tobacco control law has incorporated smokeless tobacco such as zarda, sada pata and gul as tobacco products and suggested pictorial health warnings covering 50 percent of a tobacco packet to discourage smokers. 

Common painkillers tied to lower skin cancer risk: study

Denmark, May 30  People who had taken aspirin, ibuprofen and related painkillers - especially at high doses and for years at a time - were less likely to get skin cancer compared to those who rarely used those medications, according to a study from Denmark. 

The findings, which looked at records from more than 18,000 people from Denmark and were published in the peer-reviewed journal Cancer, add to growing evidence that long-term use of the medications, known as nonsteroidal anti-inflammatory drugs (NSAIDS), may help protect people against skin cancer, including melanoma, the deadliest. 

"NSAIDS work by inhibiting specific enzymes involved in inflammation," said lead author Sigrun Alba Johannesdottir, from Aarhus University hospital, in an email to Reuters Health. 

"Previous studies show that elevated levels of these enzymes are found in skin cancer and that they are involved in important steps of cancer development." 

Not all research as been unanimous about the impact of the drugs. One large 2008 report found no link between NSAIDS and melanoma. 

The drugs have also been linked to an increased risk of kidney cancer and come with known bleeding risks, so more research is necessary to weigh the possible harms and benefits of the drugs outside of pain relief, researchers said. 

And they conceded that there were some limitations to their study, including that they didn't have information on other possible risks for skin cancer, such as exposure to ultraviolet light. In addition, not all Danish cancer cases were included in their registries. 

"More work needs to be done to examine this association," said Maryam Asgari, a research scientist at Kaiser Permanente in Oakland, California, who was not involved in the study. 

"I don't think I'd recommend to people, 'Hey, take an aspirin a day to prevent skin cancer.' I don't think we have enough data to say that. I think we do have enough data to say, certain NSAIDS appear to be promising." 

Johannesdottir and her team looked at records from more than 18,000 people in northern Denmark with skin cancer, both melanoma and less risky forms, between 1991 and 2009. 

They matched each of those cancer cases with another ten people of the same age and gender without cancer, and compared their prescription drug records for the years before the cancer patients were diagnosed. 

Thirty-eight percent of people without cancer had filled more than two prescriptions for an NSAID. 

People with a history of using aspirin and other NSAIDS had a 13 percent lower risk of melanoma compared to non-NSAID users, and a 15 percent lower risk of squamous cell carcinoma, a less-deadly form of skin cancer. 

There was no difference in the risk of basal cell carcinoma, another type of skin cancer. 

When researchers looked specifically at people who had filled prescriptions for the drugs over at least seven years, and used them twice a week or more, they found a stronger link. 

Long-term, high-intensity NSAID users had a 46 percent lower risk of melanoma, a 35 percent lower risk of squamous cell carcinoma, and a 17 percent lower chance of basal cell carcinoma. 

Google gets first license for self-driven cars

Google's self-driven cars will soon be appearing on Nevada roads after the state's Department of Motor Vehicles approved on Monday the nation's first autonomous vehicle license. Nevada, May 9 Google's self-driven cars will soon be appearing on Nevada roads after the state's Department of Motor Vehicles approved on Monday the nation's first autonomous vehicle license. 

The move came after officials rode along on drives on highways, in Carson City neighborhoods and along the famous Las Vegas Strip, the Nevada DMV said in a statement. 

The Nevada legislature last year authorized self-driven cars for the state's roads, the first such law in the United States. That law went into effect on March 1, 2012. 

Google's self-driven cars rely on video cameras, radar sensors, lasers, and a database of information collected from manually driven cars to help navigate, according to the company. 

The DMV licensed a Toyota Prius that Google modified with its experimental driver-less technology, developed by Stanford professor and Google Vice President Sebastian Thrun. 

Google's self-driving cars have crossed the Golden Gate Bridge and driven along the picturesque Pacific Coast Highway, according to the company. 

Autonomous vehicles are the "car of the future," Nevada DMV director Bruce Breslow said in a statement. The state also has plans to eventually license autonomous vehicles owned by the members of the public, the DMV said. 

Legislation to regulate autonomous cars is being considered in other states, including Google's home state of California. 

"The vast majority of vehicle accidents are due to human error. Through the use of computers, sensors and other systems, an autonomous vehicle is capable of analyzing the driving environment more quickly and operating the vehicle more safely," California state Senator Alex Padilla said in March when he introduced that state's autonomous car legislation. 

Other car companies are also seeking self-driven car licenses in Nevada, the DMV said. 

Want to quit smoking ? Try acupuncture or hypnosis

WASHINGTON, May 7  Acupuncture and hypnosis have been promoted as drug-free ways to help smokers kick the habit, and there is some evidence that they work, according to a research review that looked at 14 international studies. 

Researchers, whose findings appeared in the American Journal of Medicine, said that there are still plenty of questions, including exactly how effective alternative therapies might be and how they measure up against conventional methods to quit smoking. 
 
But the alternatives should still stand as options for smokers determined to break the habit, said researchers led by Mehdi Tahiri of McGill University in Montreal, Canada. 

In general, smokers who want to quit should first try the standard approaches, which include nicotine-replacement therapy, medications and behavioral counseling, Tahiri said. 

"But some people are not interested in medication," he said, adding that in many cases the standard therapies had not worked. "Then I think we should definitely recommend (acupuncture and hypnosis) as choices." 

Researchers found that some studies showed that smokers subjected to acupuncture were more than three times as likely to be tobacco-free six months to a year later. 

Similarly, across four trials of hypnosis, smokers had a higher success rate with the therapy compared to people who had minimal help. 

But there were some caveats, researchers said. The success rate was not consistent in all the tests conducted, although the broad trends pointed to the benefits of alternate treatment. 

A 2008 study that ran a few sessions of laser acupuncture on 258 smokers found that 55 percent who'd received the treatment quit the habit in six months, compared with four percent who were not given the treatment. 

But a 2007 study from Taiwan that looked at needle acupuncture around the ear, the area typically targeted for smoking cessation, reported a lower success rate. 

Only nine percent of those who were given acupuncture had quit after six months compared with six percent who stopped smoking without the treatment. 

The situation was similar across the hypnosis trials. Two studies showed a significant impact : 20 to 45 percent of hypnosis patients were smoke-free six months to a year later. The other two trials showed smaller effects. 

Nonetheless, Tahiri said, there was a "trend" toward a benefit across all of the studies of acupuncture and hypnosis. 

There are still definitely questions, he added, about how many sessions of acupuncture or hypnosis might be necessary, or which specific techniques are best. 

Other research reviews, though, have concluded that the jury is still out on alternative therapies for quitting smoking. 

'We hate Khichuri, Tehari, Shemai…'

Barely a week into its campaign, BRAC Chicken had to pull down its billboards. Nurul Islam Hasib explains why.Dhaka, May 2  Barely a week after unveiling a new range of food items, BRAC Chicken pulled down its billboards faced with sharp criticism of its slogan. 

The tagline with pictures of disgruntled looking children read, "We hate Khichuri, Tehari, Shemai, Cake, Pauruti…" 

Khichuri, traditional dish made with essentially rice, lentils, vegetables and meat, is generally considered to be rather nutritious and in fact recommended by child experts and nutritionists. 

'Shemai' or vermicelli is a traditional sweet dish in Bangladesh, and 'Pauruti' means bread. 

The other side of the billboards, with the same children looking rather happy, read "We love BRAC Chicken, healthy choice." 

Child experts and nutritionists condemned the campaign slogan on the billboards across Dhaka and in the advertisements in several leading newspapers as it despised the very food 'Khichuri' recommended to prevent malnutrition in Bangladesh. 

"[The campaign] is a threat to local food," president of Bangladesh Paediatric Association Prof Dr Md Hanif told bdnews24.com. 

He said that 'Khichuri' was a balanced food. "Chicken fry is not (that balanced). It is very much linked to obesity," he said referring to the advertisement, showing happy children biting into a chicken drumstick. 

BRAC Chicken launched an entire range of frozen food items on Apr 25 including what they called, masala nuggets, kids nuggets, regular nuggets, drumsticks, wings, burger patties, sausage, kebab, cutlet and chicken tandoori. 

President of the paediatric association said they had brought the 'objectionable' advertisement to the notice of the BRAC Health staff. 

"They assured us they would withdraw those adverts," Dr Hanif said on Wednesday. "But if they don't, we will protest formally." 

BRAC media manager, Zia Hashan told bdnews24.com the same evening that the billboards had already been taken out because they were being taken 'the wrong way'. 

"As soon as we realised that the message was being misinterpreted, we decided to pull down the billboards." 

Prof Hanif was disappointed with the campaign though. "We never expected this type of a campaign from an organisation like BRAC." 

Established in 1972 as the Bangladesh Rural Advancement Committee and said to be the largest NGO in the world, BRAC has operations ranging from Haiti to Afghanistan to South Sudan. 

Prof Hanif said this type of chicken generally had high salt, high fat content leading to obesity, high blood pressure and other chronic diseases. 

"Khichuri is a balanced, time-tested diet and we recommend it for six-month old children." 

BRAC media manager Hashan also pointed out that BRAC had published the advertisement in newspapers only once. "We did not go for any repeats." 

He said that it had not been possible to bring down the hoardings across Dhaka because of the general strike but confirmed that the last remaining few must have been taken out by Tuesday after the BNP shutdown ended. 

Prof Md Ekhlasur Rahman, Line Director of National Nutrition Services who was not aware of the campaign, reacted sharply after hearing the tagline. 

"I did not notice it," he said. "But if so, it would be very bad," he told bdnews24.com, adding that it was evident that Khichuri contained everything a child needed. 

"We also treat severe acute malnutrition cases with a special type of Khichuri," he said. 

"It's an anti-nutrition campaign that we cannot expect from BRAC," he said. 

Renowned paediatrician, Prof M Q K Talukder said, "It indicates total ignorance. This is very dangerous." 

He said BRAC's own health workers recommended Khichuri in their nutrition campaign, "then how come their advert said 'hate Khichuri'!" 

"[Khichuri] is an excellent food. It transformed the health of the children of the country." 

"There is nothing like it," he continued, citing Kichuri's ingredients – dal, rice, vegetables and chicken. 

'Law needed' 

In the absence of appropriate laws and monitoring, ad campaigns and slogans sometimes violate certain standards and norms. 

bdnews24.com reported in Oct 2008 on a Horlicks campaign — carried by major television stations and newspapers — with false nutritional claims for which it was banned in Britain. 

Britain's advertisement watchdog found the maker GlaxoSmithKline's claim that Horlicks makes babies "taller, stronger and sharper" false and banned the commercial made for Bangladesh but mistakenly aired in the UK. 

A former Dhaka University journalism teacher Dr Sakhawat Ali Khan had told bdnews24.com then: "Anyone being affected by the wrong advertisement can go to the Press Council for redress." 

"If proved right in the court, the media outlet concerned will have to pay compensation to the victims as per a previous verdict of the Press Council," the professor said. 

Prof Hanif, however, suggested a strong law to check those adverts for the sake of children. 

He said the government could not take action against the advertiser in the absence of a law against such practices. 

Experts earlier warned of a 'new threat' to infant feeding and nutrition in Bangladesh when the country is gearing up to launch a strong fight against malnutrition with natural and locally available solutions. 

They said various international agencies and global manufacturers were out to promote this new — ready-to-use-therapeutic-food (RUTF) — in Bangladesh after being rejected outright in Malaysia, India and even Pakistan. 

Value of screening for kidney disease unclear

A new review unveiled that there is no research to prove tNew York, Apr 19  Screening people to catch early kidney disease may sound like a good idea, but there is no research to prove that it's worthwhile, according to a new review. 

In the US, about 11 percent of adults have chronic kidney disease, the vast majority of whom have early-stage disease. 

The disease is very common among older adults - more than 44 percent of Americans older than 70 have it - and high blood pressure and diabetes are the main risk factors. 

In its early stages, chronic kidney disease usually has no symptoms. But there are blood and urine tests that can catch signs of trouble, so it may sound logical to use them to screen everyone for early kidney dysfunction. 

The problem is, no clinical trials have tested the effectiveness of widespread screening, according to the new review published in the Annals of Internal Medicine. 

Nor have there been clinical trials to see whether routine monitoring of people with early kidney disease improves their long-term outlook. 

Controlled clinical trials - in which people are randomly assigned to have a particular intervention or not - are considered the "gold standard" of medical research. 

"This doesn't mean (screening and monitoring) are not beneficial," said Dr Howard Fink, a staff physician at the Veterans Affairs Medical Center in Minneapolis, who led the study. "The bottom line is that it's uncertain." 

Fink and his colleagues conducted the review of existing research on this subject for the US Preventive Services Task Force (USPSTF), a government-backed advisory group. The panel is currently revisiting its recommendations on kidney cancer screening; right now, there is no recommendation for or against it. 

And that's "unlikely to change," given the lack of clinical trials, according to Drs. Katrin Uhlig and Andrew Levey of Tufts Medical Center in Boston, who wrote an editorial published with the review. 

Before experts recommend widespread screening for a disease - which, by definition, means testing symptom-free people - they want evidence that the benefits outweigh the risks. 

"On its surface, it seems like screening for a disease would be beneficial," Fink said in an interview. 

But, he said, with any screening test, some people will get "false positive" results. And that will often lead to unnecessary (and possibly invasive) follow-up tests, extra costs and anxiety. 

With chronic kidney disease, there have been no studies on the benefits or harms of widespread screening. "Right now, all the screening-related harms are theoretical," Fink said. And so, too, are the benefits. 

It's also unclear whether it would be wise to routinely test all people with early-stage kidney disease to see if the problem is worsening over time. 

Fink noted that only a small percentage of people with early disease will actually progress to end-stage kidney failure - at which point dialysis or a kidney transplant are needed. 

The review did, however, find evidence that certain kidney disease treatments can slow the progression of the disease. 

Fink's team found 110 clinical trial reports on treatments. Overall, two types of blood pressure drugs - ACE inhibitors and angiotensin II-receptor blockers (ARBs) - lowered people's risk of developing end-stage kidney disease by about one-quarter to one-third. 

But that benefit was largely limited, Fink said, to people with diabetes and high blood pressure, plus large amounts of protein in the urine (known as macroalbuminuria). 

Based mainly on one trial, ACE inhibitors seemed to lower death risk in people with diabetes or cardiovascular disease. 

According to Fink, if screening is going to work, the "best chance" would come from targeting it to those people who are at increased risk and most likely to benefit from early treatment. 

Of course, many people with high blood pressure or diabetes will already be on an ACE inhibitor or ARB, Fink pointed out. So the added value of screening them for kidney disease is still not clear. 

On top of that, those same patients will usually automatically have their glomerular filtration rate (GFR), an important measure of how well the kidneys are working, reported after routine blood work at their doctor's office, said Uhlig. 

"This diminishes the benefit from screening," she told Reuters Health in an email. 

For patients, the main thing is to get their risk factors for kidney disease under better control, according to Uhlig. 

"Even without strong evidence on the benefits of screening for chronic kidney disease," she said, "risk factors like hypertension (high blood pressure) and diabetes require treatment to avoid kidney disease, as well as cardiovascular disease." 

As for people who already have early-stage kidney disease, some type of monitoring is needed, according to Uhlig. 

"However," she said, "how often and how depends on many factors: the type of disease, the speed with which the disease progresses, treatments, other healthcare problems." hat screening people to catch early kidney disease is worthwhile. 

Cancer patients rarely speak up about care problems

Many people who had problems with their cancer treatment never said anything to the doctor and almost none reported the problems to the hospitals New York, Apr 19  In a new survey of cancer patients, many people who'd had problems with their treatment never said anything to the doctor they thought was responsible - and almost none formally reported the problems to the hospital. 

Patients cited delays in treatment, surgical complications and other issues related to medical care, in addition to communication barriers or breakdowns between them and their doctors, as the most common potentially harmful problems. 

There could be many reasons why cancer patients don't always bring up concerns about those issues during treatment, according to the study's lead author. 

"Sometimes there's a situation where they're really still thankful for the care that they got, and so they don't want to hurt anybody by saying, 'Everything was great, except...' Or they don't want to do harm to their relationship (with their doctor)," said Kathleen Mazor, from Meyers Primary Care Institute and the University of Massachusetts Medical School in Worcester. 

Patients may also not want to dwell on some aspect of care that's in the past, she added. 

"When people are undergoing something like cancer, they really feel they need to put all their energy on looking forward," Mazor said. 

"They're thinking about getting better, moving forward, dealing with cancer and coming out the other end." 

In interviews with about 400 breast and colon cancer patients, more than one in five said something "went wrong" during their cancer care that could have been prevented - and caused or could have caused them physical or psychological harm. 

Seventy-eight patients, almost all women who'd been treated for breast cancer, completed interviews with Mazor and her colleagues about those treatment-related problems. 

About three-quarters of them cited communication problems with their doctor, such as not getting enough information or getting inaccurate information about their cancer. Specific examples include not being told about treatment options or being told their cancer would lead to death, only to have test results reveal it was treatable. 

Half said something went wrong during their medical care itself, such as surgical problems requiring additional surgery, infections, or perceived delays in treatment or diagnosis. 

Almost all cancer patients said that the problems with their doctor, whether communication-related or medical, had resulted in psychological harms, such as anger, fear and distress. The majority also cited physical harms like pain and the need for additional treatment. 

Study participants also mentioned financial costs, life disruptions such as missed work and a negative impact on their family stemming from the perceived treatment problems. 

Despite those consequences, just one-third of people the researchers interviewed said they'd discussed the harmful event with the doctor or nurse they believed was responsible. 

Ten of them reported the problem to the hospital administration, Mazor's team wrote in the Journal of Clinical Oncology. 

The message to patients is, "speak up," according to Mazor. 

"Sometimes patients think that something has gone wrong and it hasn't. But if you never tell anybody… they never have a chance to say, 'This is how it always goes,' or, 'We couldn't prevent that,'" she said. 

"If they can't say something to the person that they feel let them down or did something wrong, hopefully there's someone else like a nurse or their primary care physician or another physician that they can talk to and make their concerns known," she told Reuters Health. 

Dr Jeffrey Peppercorn, a breast cancer doctor from Duke University Medical Center in Durham, N.C., wrote in a commentary published with the study that addressing some of these problems may simply come down to doctors talking more with their patients and asking them to be open about concerns. 

"We need to more generally improve communication with patients about their experience over the course of care," he wrote. 

Mazor said hospitals can do their part by making it clear who people can go to if they feel something went wrong during their care, such as a patient advocate.