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. 

More children surviving beyond five'

Better maternal care, smaller families, and birth spacing contributed to the decline in early childhood mortality, Nurul Islam Hasib reports as demographic and health survey result released Nurul Islam Hasib 
 Public Health Correspondent 

Dhaka, Apr 17  More children in Bangladesh are surviving beyond their fifth birthday thanks to better maternal health care, smaller families, and birth spacing by using contraceptives, says the demographic and health survey. 

One of the major highlights of the Bangladesh Demographic and Health Survey (BDHS) 2011 released on Tuesday in Dhaka is that the under-5 mortality rate has dropped to 53 from 65 per 1,000 births in four years, which means the country is on track of Millennium Development Goal-4. 

The mortality rate is now 53 per 1,000 births which was 65 in 2007. The MDG-4 targets to cut the deaths to 48 by 2015. 

The mortality rate was more than double (133) in 1993 when the first BDHS, a key source for monitoring, evaluation and preparing strategies for health sector, commenced. 

Under-1 mortality rate has also been reduced from 52 per 1,000 births to 43, while deaths of newborns within first month of birth reduced from 37 per 1,000 births in 2007 to 32 in 2011. 

However, the deaths within one month of birth account for 60 percent of mortality under five. 

Researchers say better maternal health care, smaller families, and birth spacing by using contraceptive methods contributed much to the decline in early childhood mortality. 

Confirming the trends shown in 2010 Bangladesh Maternal Mortality Survey, the BDHS indicates that more women are getting assistance of skilled birth attendants while giving birth. 

Now, almost one in three pregnant women, 32 percent, is assisted by trained health service providers during delivery while it was 21 percent in 2007. 

Paediatricians say more trained birth attendants mean less chance of newborn deaths. 

"One-fifth of the newborn deaths occur due to trouble in breathing (asphyxia) at birth," said Dr Khurshid Talukder, a paediatrician. 

He said it would be a great challenge for the government to keep newborn deaths low. 

"Breastfeeding within one hour of birth can be an option," he said as it gets newborn immune to infections, another major cause of deaths within one month of birth. 

However, Bangabandhu Sheikh Mujib Medical University has recently taken up a three-year programme to train up 20,000 birth-time attendants to help babies breathe using a kit called sucker machine, a bag and musk for artificial breathing. 

Apart from improving child survival, the latest BDHS also found lower fertility, increasing use of family planning methods and better care for expectant mothers. But malnutrition among children still remains high with little progress in the last four years. 

The survey is being carried out every 3 to 4 years since 1993-94. Based on the 2011 findings, the ongoing Health, Population and Nutrition Sector Development Plan (HPNSDP) targets of ministry of health and family welfare will be evaluated.

Acne drug tied to a doubled risk of eye problems

Pills used to treat acne have been linked to a two-fold risk of developing eye problems, such as pink eye, styes and dryness. New York, Apr 19  Prescription pills used to treat severe acne were linked to a two-fold risk of developing eye problems, such as pink eye, styes and dryness, in a large new study from Israel. 

Isotretinoin, which goes by brand names including Roaccutane, Claravis and Amnesteem, is known to have serious side effects, such as bone growth delays in teenagers and miscarriages and birth defects when taken by pregnant women. 

The medications are quite popular, however, for treating severe cases of acne in both teens and adults. 

According to Roche, the maker of Roaccutane, formerly known as Accutane, 16 million people worldwide have used that brand alone since 1982. 

Some eye problems are already more common in people with acne, but in the new study of nearly 15,000 Israeli adolescents and young adults, 14 percent of those taking isotretinoin were treated for eye conditions within a year of starting the drug. 

That compared to seven percent of an acne-free comparison group and 9.6 percent of subjects with acne who had never taken isotretinoin. 

"I would give parents the advice to (have their children) see an ophthalmologist before they take it, and every three months for the first year they take it, because if we catch things early we can fix them and not leave you with permanent side effects," said Dr. Rick Fraunfelder, a professor at Oregon Health and Science University and an expert in eye problems related to medications. 

Although eye problems have been documented among people taking the drugs, Fraunfelder, who was not involved in the new study, said past research has not detailed how common the issues are. 

To get an idea of how often eye problems develop among patients on isotretinoin, researchers at the Tel Aviv Medical Center collected information on users and non-users from the records of a large managed-care organization. 

Gabriel Chodick, a researcher at Tel Aviv University and one of the study authors, said that each year about one percent of adolescents in the Maccabi Healthcare Services system start isotretinoin treatment to clear up their acne. 

In the study group, whose average age was 16, nearly 2,000 people developed inflammatory eye conditions -- 991 who were taking isotretinoin, 446 with acne but not on the medication and 354 in the acne-free group. 

The most common complaint was conjunctivitis, also called pink eye, which is inflammation or infection in the eye.

Four out of every 100 people on isotretinoin were diagnosed with conjunctivitis, while about two out of every 100 people not on any acne medication were treated for conjunctivitis, the researchers reported in Archives of Dermatology. 

Chodick said one likely explanation for the increased risk of eye problems is that isotretinoin can disrupt the function of the meibomian glands on the eyelids. 

These glands produce an oily substance that prevents the eyes from drying, and if the glands don't work properly the eyes can become irritated or inflamed. 

"In addition, the presence of isotretinoin and its metabolites in the tear film may have a direct irritating effect on the (eye's) surface," Chodick told Reuters Health in an email. 

Roche would not comment on the study but a spokesperson pointed to possible side effects already listed in the medication's packaging labels, including eye problems such as conjunctivitis, decreased night vision and visual disturbances. 

Despite its potential hazards, the drug is still worth it for some patients, Chodick said. 

"Several studies have shown that acne can diminish a person's quality of life," he said. "Many of the adverse effects of systemic isotretinoin can be avoided or minimized if proper measures are introduced with, or soon after, introducing the drug." 

He said that doctors who prescribe these acne drugs should do so along with eye lubricants to prevent drying and irritation. 

"The beneficial preventive and therapeutic effects of using artificial tears should be discussed with the patients, especially for contact lens wearers," Chodick said. 

Fraunfelder urged people to seriously consider the side effects before starting isotretinoin treatment. 

"It's a relatively dangerous drug," he said. "The best way to avoid these side effects is if you do not take the drug at all." 

If people do opt for the treatment, he added, they should make sure to talk with their doctor about ways to prevent damage to the eyes. 

Breast cancer clutch of 10 diseases: Study

Scientists who conducted a major international study into the genetics of breast cancer say they can now classify the disease into 10 subtypes - a finding that points to more accurate, tailored treatment for individual patients in future. London, Apr 19  Scientists who conducted a major international study into the genetics of breast cancer say they can now classify the disease into 10 subtypes - a finding that points to more accurate, tailored treatment for individual patients in future. 

In research published in the journal Nature on Wednesday, a team led by scientists at the Cancer Research UK (CRUK) charity also found several completely new genes that drive breast cancer, offering potential targets for new types of drugs. 

Carlos Caldas, who co-led the study at CRUK's Cambridge Research Institute and the University of Cambridge said the findings mean breast cancer should now be seen as an "umbrella term" for a larger number of diseases. 

"Essentially we've moved from knowing what a breast tumour looks like under a microscope to pinpointing its molecular anatomy," he said. 

"This research won't affect women diagnosed with breast cancer today. But in the future, .. patients will receive treatment targeted to the genetic fingerprint of their tumour." 

Breast cancer is the most common cancer among women worldwide, accounting for 16 percent of all female cancer cases, according to the World Health Organisation. 

A study last year by the Institute for Health Metrics and Evaluation in the United States found that global breast cancer cases have more than doubled in just three decades, from 641,000 cases in 1980 to 1.6 million cases in 2010 - a pace that far exceeds global population growth. 

For the genetic study, Caldas's team worked with the BC Cancer Agency, based in Vancouver, Canada, and analysed 2,000 tumor samples taken from women diagnosed with breast cancer between five and 10 years ago. 

To get a detailed picture, they studied both DNA and RNA - which translates DNA into proteins - to find out which genes are switched on or off in each tumour sample. 

MOLECULAR MAP 

In a briefing for reporters, the researchers explained how this combined analysis of DNA and RNA helped reveal the identity of genes known as oncogenes - the drivers of cancer - and of tumour suppressor genes, which protect against cancer. 

This helped them reclassify breast cancer into 10 new categories based on gene activity rather than current tests, which look for the presence of so-called biomarkers such as oestrogen receptors or the cell surface receptor HER2. 

Drugs such as the generic tamoxifen, and aromatase inhibitors like AstraZeneca's Arimidex or Novartis's Femara, which block oestrogen activity, are already used in targeted treatment for breast cancer patients whose tumors produce large amounts of oestrogen receptor (ER). 

Roche's Herceptin is another targeted breast cancer drug which is given to patients whose tumours depend on HER2. 

Harpal Kumar, CRUK's chief executive, said the new findings would help oncologists make far more precise diagnoses for each breast cancer patient - "and that will enable us to make sure that we really target the right treatment to the right woman." 

The study "changes the way we think about breast cancer - no longer as one disease, but actually as 10 quite distinct diseases depending on which genes are really switched on and which ones aren't," he said. 

Samuel Aparicio, who co-led the study with the team in Vancouver, described the reclassification into 10 subtypes as a new "molecular map" of breast cancer which he said pointed to the potential development of new medicines. 

The scientists said the next step would be to find out how specific molecular patterns make tumours grow, and to seek out the faults that might respond to new drugs in the future. 

They said the information from this study would be made available to scientists worldwide in an effort to boost drug discovery and development.

Govt moves to seal Destiny fate

The government is considering steps against Destiny-2000 Ltd 'to protect people from deception', finance minister A M A Muhith said on Saturday. 

"A commission like the one on Jubok will be formed to bar asset transfer by such firms," Muhith told reporters at his office. 

Muhith's remarks followed recent newspaper reports on 'illegal banking' by Destiny Group. 

"Media reports on Destiny in the past few days have created an emergency-like situation," he said. "The government can't sit idle without taking action in this situation." 

"Jubok couldn't transfer all assets as its properties were confiscated. In that way, the clients can be compensated to some extent. A commission will be formed in the same manner," he said. 

He also said the finance and commerce ministries and relevant departments have already started working to form the commission. 

Jubo Karmasangsthan Society, better known as Jubok, was found guilty of illegal banking by a central bank investigation in July 2006. It was asked to repay Tk 1 billion it owed its depositors. 

Jubok was enlisted as a 'society' under the government's Registrar of Joint Stock Companies. 

Earlier, the parliamentary standing committee on commerce ministry decided to request the finance minister and the central bank governor for action against Destiny-2000 Ltd-like MLM companies. 

Following the parliamentary watchdog's move, the Bangladesh Bank on Apr 1 issued a circular warning people against investing in unapproved banking institutions. 

"It is to notify all that some institutions under different names are operating like banks in various districts across the country. They are collecting money from people by promising an abnormally higher rate of interest and profit," read the central bank statement. 

62 registered MLM Cos 

On mar 6 last year, then commerce minister Muhammad Faruk Khan had said there are 62 registered MLM companies operating in Bangladesh. 

He told parliament that only Destiny has 4.5 million clients. He had said other MLM companies had fewer clients than Destiny. Another prominent MLM company is Unipay-2 U. 

Asked about actions against Destiny, Muhith said, "I couldn't see the reports on Destiny by Bangladesh Bank and other organisations as I was abroad. I've seen them today (Saturday). It seems to me that Jubok-like actions are needed in this regard. We'll take those steps." 

He said the government is 'disturbed' by the media reports on Destiny. 

Two weeks ago, the central bank sent a report on Destiny to the finance ministry. The report alleged that Destiny-2000 was conducting illegal banking. 

Law on MLM Cos 

Finance minister on Saturday said the government has taken steps to formulate a law to bring MLM business under legal framework. 

The government took steps to formulate law after clients of another prominent MLM company Unipay-2 U took to the streets in 2010 following allegations of deception by the company. 

A commerce ministry official, requesting anonymity, told bdnews24.com that they have already finalised a draft of the law but could not present it to the cabinet due to objection by the public administration ministry. 

"The draft proposed to form a directorate and appoint staff there. But the public administration ministry is not giving its nod about recruiting manpower. So, the draft could not be presented to the cabinet," he said. 

Jubok clients not repaid even after 6 years 

Clients of Jubo Karmasangsthan Society, better known as Jubok, are yet to be repaid though six years have passed the MLM company was shut. 

After an investigation found Jubok guilty of illegal banking the central bank asked it to stop illegal operations and repay Tk 1 billion it owed its depositors by Mar 2006. 

The government shut Jubok as it had failed to repay its clients within the stipulated time. 

After the current government took charge, a commission headed by the former central bank governor Mohammed Farashuddin was formed to make proposals on Jubok and how to repay its clients. 

The commission proposed to sell Jubok's assets to repay the clients and also asked to form a permanent commission to oversee the matter. 

Following the proposal, the government formed a permanent commission headed by former joint secretary Rafikul Islam. But the Jubok clients are yet to be repaid. 

Neutralise finance minister to win tobacco war'

Tobacco control pits health ministers against finance ministers in many countries where the former is 'unlikely' to win, Nurul Islam Hasib hears at a global meet in Sin As tobacco control pits health ministers against finance ministers in many countries where the former is 'unlikely' to win, public health experts at a global conference suggest innovative approaches to unite them to fight against the tobacco industries.

Social movement through strong civil society coalition has been seen instrumental in this regard, they observed on Wednesday, the second day of the 15th World Conference on Tobacco or Health in Singapore.

"It's (tobacco control) a political talk especially when it pits the health minister against the finance minister," said professor K Srinath Reddy, president of Public Health Foundation of India (PHFI).

He said economic arguments were important but again it was part of a political battle.

"But you cannot expect health minister's victory over finance minister. Finance minister is politically stronger and senior in the cabinet. Health minister too needs the goodwill of the finance minister for other health programmes.

"So what we can expect is concord between them to move the finance minister to a neutral position from active opposition," Prof Reddy, the leading public health expert in India, said in a paper presented on Wednesday.

Dr Monika Arora, head of tobacco control of the public-private initiative PHFI, presented the paper on his behalf. Prof Reddy could not come because of his last moment engagement in a state programme.

Earlier, representatives from a number of countries including India, Kenya, Mexico, Russia and Indonesia said tobacco control activities do not progress in their countries due to interference by tobacco companies through the finance ministry.

A bdnews24.com investigation also found the finance ministry had shot down a move (Tougher tobacco law plan botched) by the health ministry to draft a tobacco stricter control act in Bangladesh.

Prof Reddy in his paper said even in India, the finance ministry was presently not favouring strong tobacco control measures, although health ministry wanted it.

"But still then we can win over the finance minister if the economic argument, development, disease burden, vulnerability and right to life argument of non-smokers and children are made.

"And if we counter tobacco industry's misleading arguments convincingly. Tobacco control will not lead to unemployment, need not hurt farmers, will not result in revenue loss, will not discourage foreign investment. [We need to] mobilise civil society to vigorously campaign against tobacco industry's fear and smear tactics."

He said while the finance minister was the main decision maker on taxation, others will exert influence on the overall tobacco control policy.

"We have to remember that donations to political parties also influence government attitudes. Policies are not made in pure isolation in closed cabinet rooms.

"Economists are also divided. So to whom finance minister will listen to?" He added the civil society coalition needed to be expanded taking all relevant stakeholders on board.

Prof Reddy said in short terms raised taxes will raise revenues. "As consumption goes down, non or ex-smokers will spend their disposable incomes on other goods which are also taxable.

"Total economic tally of tobacco related health, environmental and social costs will amount to an economic and developmental cost that exceeds any loss of tobacco revenues," he argued

Bangladesh data shows that tobacco-related healthcare costs alone exceed tobacco revenues.

Even then, he said, if the finance minister listened to the industry, 'get the non-tobacco segments of the industry to understand why tobacco control was important for them too'.

"Tobacco related disease leads to productivity losses among their employees and workforce in general; tobacco related expenditure drains disposable incomes which can be used for buying other products which they make.

"Show that tobacco industry is a law breaker. It evades excise tax and encourages illicit trade.

"And finally give the argument that tobacco control is the integral part of sustainable development."

John R Seffrin, chief executive officer of American Cancer Society, appreciated the idea and said tobacco taxation was the 'best buy' for the economy and for saving lives.

He said tax can be a major threat of tobacco companies' existence in a country.

"Because of increased tobacco taxes, cancer survival rate has increased in US, decreasing mortality rate."

"Raising tobacco taxes saves lives by encouraging smokers to quit, reduce the number of cigarettes smoked and prevent potential users from ever starting," he said.

According to American Cancer Society, 10 percent increase in cigarette prices reduces demand by 2 to 6 percent in high-income countries and by 2 to 8 percent in low and middle-income countries.

Youth, minorities, and low-income smokers are two to three times more likely than other smokers to quit or go smokeless in response to price increases, it said.gapore. 

Mourinho can succeed Ferguson: Robson

 Manchester United legend Bryan Robson believes Jose Mourinho has the right credentials for the 'near impossible' task of succeeding manager Sir AlexManchester United legend Bryan Robson believes Jose Mourinho has the right credentials for the "near impossible" task of succeeding manager Sir Alex Ferguson.

Ferguson has celebrated his 70th birthday and the 25th anniversary of his appointment at Old Trafford this season and is showing little sign of slowing down, reports ESPNstar.

Because of that, Robson, Ferguson's former captain, does not think the club have even thought about the identity of their next manager.

But Robson knows the time will come when the issue has to be dealt with and he feels Real Madrid's former Chelsea boss would be a good fit.

The former England captain, speaking at the Soccerex forum in Manchester, said: "As far as I am concerned, and from what I know about Manchester United, they are not considering that at the moment.

"How do you replace Sir Alex Ferguson? It is near enough impossible.

"But they are going to have to do that and Mourinho is definitely one who would be up at the top of the list. His record speaks for itself."

Aside from the suitability of Mourinho, who has won the Champions League with Porto and Inter Milan, Robson feels United might have other candidates closer to home.

Robson has been impressed with the work of Ferguson's assistants Mike Phelan and Rene Meulensteen and would consider them as good options.

Robson said: "Whoever goes in there they will have their opinions and ideas, but because of the success United have had over the last 20 years, you can't go in and rip everything apart and try to rebuild the way you think it should be.

"How can you do that after so much success?

"Why not Mike Phelan and Rene take over from Sir Alex Ferguson when he does decide to pack in.

"That never gets mentioned but they know how it works. It has always has to be someone who is really well known with a track record." Ferguson

Maradona confronts 'coward' fans following match

Diego Maradona has called opposition fans 'cowards' after alleg Diego Maradona has called opposition fans 'cowards' after allegedly being involved in a confrontation following a match in the United Arab Emirates.

The trouble started during his club Al Wasl's 2-0 UAE Pro League defeat at Al Shabab, whose fans allegedly started abusing players' wives and girlfriends, reports BBC sport website.

Maradona is understood to have climbed up into the stands to protect his wife.

"Some people are cowards," Maradona told Gulf News.

"They only attack women and have no courage to confront men."

He added: "This is the first time I am upset with the fans. If they are angry with me they should know that I [climbed the stands] for my wife because someone was calling her names.

"They shouldn't be angry with me, they should be angry with the people who did this. They are cowards, not real fans.

"I accept defeat but I am not happy with what happened against the fans tonight."

Security, players and Maradona helped wives and girlfriends to exit Al Wasl's stadium, based in the United Arab Emirates. Local media reported that no one was hurt.

It was also reported that Al Wasl player Juan Ignacio Mercier's girlfriend tripped and fell down the stairs as she left the venue, with Mercier then helping her to safety.

Al Shabab coach Paulo Bonamigo told Gulf News that he had not seen the incident.

"By the time that was happening we were already down the tunnel," he said.

"I don't think it had anything to do with our players. So it wasn't a problem with us. I have no comment."

Maradona, who led Argentina to the quarter-finals of the 2010 World Cup, signed a two-year contract with the club in May.

Al Wasl are currently fifth in the UAE equivalent of the Premier League - the UAE Pro League - 15 points behind leaders Al Ain.edly being involved in a confrontation following a match in the United Arab Emirates

Sharapova sinks Wozniacki to reach Miami final

Maria Sharapova advanced to the Sony Ericsson Key Biscayne, Mar 30 - Maria Sharapova advanced to the Sony Ericsson Open final by beating Caroline Wozniacki 4-6, 6-2, 6-4 on Thursday in a two-and-a-half hour battle.

The Russian will play Agnieszka Radwanska in Saturday's final after the Pole beat France's Marion Bartoli 6-4, 6-2 to reach the biggest final of her career.

Second seed Sharapova, who has lost in all three of her previous finals in Miami, will start as clear favourite after another solid showing against Wozniacki.

The Russian was ahead early but lost the first set after her serve disappeared, allowing Wozniacki to win five consecutive games and take command of the match.

But the Russian recovered in the second set, striking the ball with impressive power.

"I could have easily, after losing a few straight games, let concentration down, I could have easily just gone down in the second set," said Sharapova.

"But I really stepped it up again. I went out there and started being aggressive. I didn't stop after I put myself in a good position. I'm extremely pleased that I pulled it out today."

Wozniacki stuck at her task however and with Sharapova serving for the match at 5-3 she broke, forcing two errors out of the Russian after winning a rally with a magnificent backhand cross-court winner.

The Dane held serve and then faced Sharapova serving for the match again.

There was a controversial finish when Sharapova's serve at 40-15 was initially ruled out but the call was overruled by the chair umpire, who ordered the point to be replayed.

Wozniacki, whose return had found the net, protested the decision but with no challenges remaining she was stuck with the verdict and Sharapova subsequently wrapped up the win with a smart volley.

"Overall I'm pretty happy with my game," said Wozniacki, who beat Serena Williams in the quarter-finals. "This week I have been playing some really good tennis. And obviously you love to win and I didn't do that today."

Radwanska dominated from the outset against a determined Bartoli and took advantage of the 35 unforced errors from her French opponent.

The Pole was well set at 4-2 in the second set when the lights went out on stadium court and there was a 20-minute delay before play resumed and Radwanksa booked her place in the final.

Sharapova has won seven of the eight previous meetings with Radwanska.Open final by beating Caroline Wozniacki after a two-and-a-half hour battle

Jayawardene cherishes victory over England

Sri Lanka captain Mahela Jayawardene celebrates with his players after the win over England
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Features : Herath joins small group
Report : Herath takes 12 in Sri Lanka's victory
News : Lack of runs 'frustrating' - Strauss
Features : Trott ton trumped by Herath's ten
Players/Officials: Rangana Herath | Mahela Jayawardene
Matches: Sri Lanka v England at Galle
Series/Tournaments: England tour of Sri Lanka
Teams: England | Sri Lanka
Mahela Jayawardene's manner was as unassuming as ever, but he knew the importance of Sri Lanka's Test victory against England in Galle. "This was a big win," he said. "It's been a tough period for us."

Twenty months earlier, on the same ground, the ancient walls of the Dutch Fort were lit up by fireworks as Muttiah Muralitharan ended his Test career in momentous fashion, the first man to 800 Test wickets, achieved in Bollywood style: India's last pair at the crease, Sri Lanka's president on hand to bestow congratulations, and finally a catch at slip by Jayawardene himself to ensure a perfect finale.

At last, after this victory, their first on home soil since Murali's perfect send off, Jayawardene dared to imagine a bright future for Sri Lanka without the bowler who sustained them for a decade. "Any Test win is important, but to do it against the best side in the world is a moment to cherish," he said. "It's been tough for us to get things right but the boys worked really hard to improve as a team and today we showed a lot of character."

Jayawardene is a reluctant Sri Lanka captain, a respected performer who had contentedly handed the leadership over to his close friend, Kumar Sangakkara, only for Sangakkara to resign after Sri Lanka lost the World Cup final a year ago. The uncertain reign of Tillakaratne Dilshan was aggravated by Sri Lanka cricket's financial meltdown because of overspending on their World Cup. Not only was there no Murali, there was no money. After receiving requests from high places to come to the country's aid, Jayawardene realised that his leadership days were far from spent.

Sri Lankan cricket needed something in which people could show faith and that something was Jayawardene. Such faith was needed when England were 233 for 4, 108 short of victory. The new ball was six overs old and Sri Lanka's desperate need for their first home victory since the retirement of Murali was by no means certain to be answered. This time nobody had planned any fireworks.

"The England line-up is top class so we had to just wait patiently," Jayawardene said." After 60 overs the ball got really soft, there wasn't much for the bowlers with the slowness of the wicket so we had to wait for the second new ball. We tried to not give too many runs away so we had a comfort zone. We knew we'd be able to create more opportunities and that's what happened. There were a couple of really good catches to turn things around for us and then the bowlers took over."

Jayawardene's praise of Rangana Herath, his stock left-arm spinner, after he took six wickets in the first innings had been interpreted by some as a depiction of Herath as "the new Murali". Anybody who knows Jayawardene would recognise that was not his intention. The aim has been to give Herath a stable environment in which he can forget comparisons with Muralitharan and concentrate on reawakening his own more modest potential. Match figures of 12 for 171 suggested that mission has been accomplished and made him only the fifth Sri Lanka bowler to take 10 wickets in a Test: they have achieved it 27 times, but 22 of those were down to Murali.

"Herath has been around a long time and is a class act," Jayawardene said. "He's the most experienced bowler I have right now and he's taken responsibility not just here but away from home when he bowled us to victory in Durban. He's showing a lot of class and showed a lot of patience. We knew had to be patient and Rangana kept it going. It was a long spell for him but he kept on going and took crucial wickets for us. I'm very happy with the performance.

"We know England are very good opposition so we will cherish this one. It was a good challenge for us to go against the No. 1 team. We knew we had to work really hard to get a result from them so I'm quite happy with that. It gives us an idea of where we are right now and where we need to improve. Now need to maintain consistency.

"We can still improve overall. As a batting group we need to be more consistent and as bowlers all four guys need to chip in to get 20 wickets. We will never be the team where everything works. We have some youngsters in the side and they need to have time to develop. There is a lot of hard work to do over the next 6-12 months. We did not have a complete game, but very close to that."