http://ftalphaville.ft.com/thecut/2012/02/01/861911/growth-linked-sweete... Paul Volcker has defended proposed trading rules for US banks that are being criticised by foreign governments as likely to disrupt the operation of their national bond markets. Japanese, UK and Canadian regulators,
http://ftalphaville.ft.com/thecut/2012/02/01/861901/volcker-says-bond-ma... The Chinese manufacturing sector has made a surprisingly strong start to the year, the FT says, with domestic orders cushioning the impact of Europe’s debt woes, according to an official survey. The purchasing managers’ index,
http://ftalphaville.ft.com/thecut/2012/02/01/861981/chinas-official-pmis... France’s Dassault has been awarded frontrunner status in the hotly contested $20bn race to supply 126 fighter jets to India, reports the FT. The Indian government said the French Rafale fighter jet had beaten the four-nation Eurofighter Typhoon to become preferred bidder to equip India with the multi-role fighter jets in one of the world’s largest military contracts.
http://ftalphaville.ft.com/thecut/2012/02/01/861781/india-boost-for-dass... Bloomberg reports on staling housing markets in Asia that have been hit by government efforts to prevent the real estate bubbles that Western economies have seen burst over the last few years. Property prices in Hong Kong have decreased by 6 per cent since June and Barclays analysts estimate a drop of 25 per cent could be seen by 2013.
http://ftalphaville.ft.com/thecut/2012/01/31/861091/hong-kong-faces-prop... US stocks defied European trends for a second day running, falling sharply on poor US economic data, after global indices had rallied on enthusiasm for a eurozone fiscal discipline pact brokered by Germany,
http://ftalphaville.ft.com/thecut/2012/01/31/861061/house-price-fall-tri... Unemployment figures have highlighted the widening gap between Germany and many fellow eurozone members, a day after Angela Merkel secured a new treaty enshrining Berlin’s vision for tough fiscal discipline,
http://ftalphaville.ft.com/thecut/2012/01/31/861041/unemployment-rises-i... Russia’s economy grew by 4.3 per cent last year, benefiting from a surge in agricultural output and robust consumer spending, as well as record-low inflation. Yet the country is seeing signs of a slowdown in manufacturing,
http://ftalphaville.ft.com/thecut/2012/01/31/861011/russian-agriculture-... US economic growth will slow dramatically if tax rises and spending cuts come into effect as planned in 2013, according to new figures from the Congressional Budget Office. The expiry of tax cuts originally passed by president George W. Bush, the end of a 2 per cent payroll tax holiday and automatic spending cuts agreed last August will reduce growth to just 1.1 per cent in 2013 unless changes are made.
http://www.ft.com/intl/cms/s/0/1510a4dc-4c20-11e1-98dd-00144feabdc0.html... Wsj.com Most Asian stock markets were modestly higher Wednesday as encouraging China manufacturing data tempered concerns over a batch of downbeat U.S. economic reports, while earnings disappointments in Japan capped stocks there. Early trade was dominated by interest in China’s official manufacturing Purchasing Managers Index for January, which rose to 50.5 compared with 50.3 in December, and was higher than the median forecast of 49.5 in a Dow Jones Newswires poll of seven economists. The unexpected rise in the index is likely to assuage market concerns about a slowdown in Asia’s largest economy, although the result also meant that any near-term policy easing steps from Beijing may be delayed.
http://online.wsj.com/article/SB1000142405297020474090457719571252951537... Mitt Romney handily won Florida’s Republican primary Tuesday, riding a new, combative campaign style to a victory that returns him to his role as the favorite to win his party’s presidential nomination. Fueled by a nearly 5-to-1 spending advantage over his top rival, Mr. Romney outpaced former House Speaker Newt Gingrich among conservatives and tea-party supporters and drew nearly even with him among evangelical Christians, according to surveys of voters leaving polling sites. Those voters had gravitated to Mr. Romney’s opponents in some prior contests.
http://online.wsj.com/article/SB1000142405297020474090457719504165678824... The dark knight of British banking has been ordered to hand in his sword. In what may be the ultimate clawback for a bank boss in the wake of the financial crisis, a U.K. government panel has stripped the knighthood of former Royal Bank of Scotland Group PLC Chief Executive Fred Goodwin.
http://online.wsj.com/article/SB1000142405297020465290457719503039482281... The European Central Bank, Greece’s biggest creditor, is finding it hard to stay on the sidelines as Greece negotiates a debt-restructuring deal with its private-sector bondholders. The ECB isn’t part of the talks, even though it holds around €50 billion ($66 billion) in Greek government bonds, about one-seventh of Greece’s outstanding debt. Those holdings raise questions about the central bank’s appropriate role in keeping Greece afloat that will linger even if a deal with other investors is completed this week.
http://online.wsj.com/article/SB1000142405297020392020457719499367745249... London looks likely to experience a drought of new housing over the next few years, as construction of homes in the capital slows amid fears of renewed recession and a dearth of mortgage finance, a report from property consultant Drivers Jonas Deloitte suggests. While many Londoners expect this year’s Olympic Games to boost the housing stock and hope that the slowdown in construction due to the recession is over, the new data suggest the housing shortage will persist. Together with international demand for property in the city—prompted by its safe-haven status outside the euro zone and the weakness of sterling—this will stop house prices from falling as they have in much of the rest of England, industry participants say.
http://online.wsj.com/article/SB1000142405297020392020457719496109034348... The average housing price in 100 major Chinese cities fell for a fifth consecutive month in January as China’s property market continued to slow, a survey showed Wednesday. Still, the pace of decline slowed in January, which indicates that property prices are softening at a steady pace, abating some concerns of a sharp plunge in the market for now. The data were released a day after Chinese Premier Wen Jiabao reiterated the government’s stance that it must continue with macroeconomic controls, consolidate its property-tightening campaign and bring about a “reasonable” correction in housing prices.
http://online.wsj.com/article/SB1000142405297020474090457719595170657157... Marketwatch.com South Korea’s January trade data showed the country’s first drop in exports since 2009 and its first trade deficit since January 2010, according to data released Wednesday. Korean exports fell 6.6% in January compared to a year earlier, while imports rose 3.6%, sending the trade account to a deficit of $1.96 billion. In January 2011, South Korea posted a trade surplus of $2.9 billion. HSBC economist Ronald Man said the data, along with soft inflation numbers, meant the central bank would likely cut the policy interest rate by a quarter point by the end of March. “Sure, there may have been distortions from the Lunar New Year. However, this alone is difficult to justify the swing to an outright contraction,” said Man.
http://www.marketwatch.com/story/korea-swings-to-first-trade-deficit-in-... Gold futures inched higher in electronic trading, in a mixed session for metals, with gains limited by a stronger dollar. Gold for April delivery added 80 cents, or 0.1%, $1,741.20 an ounce on the Comex division of the New York Mercantile Exchange during Asian trading hours. The gains tracked mild rises for most Asian markets on Tuesday after data showed a mixed picture of manufacturing activity in China.
http://www.marketwatch.com/story/gold-edges-higher-in-electronic-trading... Hong Kong said Wednesday it’s on track for a budget surplus of 66.7 billion Hong Kong dollars ($8.6 billion) for the fiscal year ending March 31, compared to a HK$75.1 billion surplus in the prior fiscal year. The provisional budget figure was released Wednesday during an address to legislators by Financial Secretary John Tsang
http://www.marketwatch.com/story/hong-kong-budget-surplus-narrowing-tsan... Reuters.com Facebook is expected to submit paperwork to regulators on Wednesday morning for a $5 billion initial public offering and has selected Morgan Stanley and four other bookrunners to handle the mega-IPO, sources close to the deal told IFR. The company founded by Mark Zuckerberg in a Harvard dorm room in 2004 picked Morgan Stanley to take the coveted “lead left” role in what is expected to be the largest IPO ever to emerge from Silicon Valley.
http://www.reuters.com/article/2012/01/31/us-facebook-ipo-idUSTRE80U29V2... The United States is headed for a fourth straight year with a $1 trillion-plus budget deficit, congressional forecasters said on Tuesday, giving Republicans ammunition to hammer President Barack Obama’s spending record in November’s elections. The non-partisan Congressional Budget Office said the fiscal 2012 deficit would rise to $1.079 trillion from its previous estimate of $973 billion made last August. If Congress extends payroll tax cuts through year-end, as expected, the deficit would likely rise by another $100 billion through ecember.
http://www.reuters.com/article/2012/01/31/us-usa-budget-idUSTRE80U288201... Bloomberg.com South Korea’s central bank is considering buying several hundred million dollars worth of Chinese equities and a greater amount of the nation’s bonds to diversify its foreign-exchange reserves. “The Chinese yuan has the potential to become a key reserve currency in the long term and thus we are building a channel to invest there,” Choo Heung Sik, 53, director general at the Bank of Korea’s Reserve Management Group, said in an interview in his office yesterday in Seoul. He said the bank may invest in Chinese shares in the second half of this year, after purchases of debt in the first six months.
http://www.bloomberg.com/news/2012-02-01/south-korea-central-bank-plans-... The Australian dollar is likely to stay “relatively high for years to come,” Prime Minister Julia Gillard said, challenging the nation’s businesses to work harder to overcome the drawbacks of a stronger currency. “Our success is driving the dollar,” she said in the text of a speech to the Australia-Israel Chamber of Commerce in Melbourne. “In turn, the dollar is driving change and in doing so it’s making our economy leaner and stronger, forcing us to move more of our effort — more money, more equipment, more people — into the parts of our economy where we can create the greatest value.”
http://www.bloomberg.com/news/2012-02-01/aussie-to-stay-relatively-high-... Cnbc.com California needs to come up with more than $3 billion to avoid burning through its cash by March, according to the state controller, who urged borrowing and delaying some payments. “Assuming no additional revenue loss, erosion of borrowable internal funds, or significant spikes in spending, $3.3 billion of cash solutions are needed to address California’s liquidity needs during this period,” State Controller John Chiang said in a letter to the chairman and vice chairman of the Joint Legislative Budget Committee released on Tuesday.
http://www.cnbc.com/id/46212105 Amazon.com reported quarterly earnings that beat Wall Street’s expectations, but its revenue fell short of forecasts on Tuesday, sending its shares lower in extended trading. The online retail giant posted fourth-quarter earnings excluding items of 38 cents per share, down from 91 cents in the year-earlier period. Revenue was $17.43 billion, a 35-percent increase from $12.95 billion a year ago. Analysts had expected the Seattle-based company to report earnings excluding items of 17 cents per share on $18.25 billion in revenue.
http://www.cnbc.com/id/46191172 Concerns over the size of United States debt reared their head once again as ratings agency Standard & Poor’s warned that health care costs for a number of highly-rated Group of 20 countries, including the U.S., could hurt growth prospects and harm their sovereign creditworthiness from the middle of this decade. S&P downgraded the United Statescredit rating for the first time ever in August of last year.
http://www.cnbc.com/id/46202656 The European Central Bank won’t solve the euro zone’s debt crisis as long as the European Union behaves like a “dysfunctional” family, Bill Gross, Pimco founder and co-chief investment officer, told CNBC on Tuesday. The main problem is the split between North and South Europe, Gross said: The northern countries have low debt and are export oriented, while the southern economies’ debt ratios are high and their economies are based more on domestic consumption.
http://www.cnbc.com/id/46205597 Nytimes.com The European Central Bank may forgo future profits on its Greek bonds as efforts remain under way to fill a financial hole that has been obstructing a second bailout forGreece. Talks among senior Europe n officials in Brussels ended Tuesday without any commitment from the central bank but with hopes still alive that the bank would agree to the deal. Because the European Central Bank bought Greek bonds, with an estimated face value of 50 billion euros, ($65 billion) at a discount to their market price, it could enter into a deal that would cause it to give up future gains without taking a loss, said a European official, requesting anonymity because of the sensitivity of the issue.
http://www.nytimes.com/2012/02/01/business/global/hopes-now-shift-to-ecb... Foxbusiness.com The Australian Industry Group – PwC Australian performance of manufacturing index rose 1.4 points to 51.6 in January, according to data out Wednesday. The increase was largely due to a rise in the delivery of inputs and a rise in inventories of finished goods, according to the survey. “The growth was underpinned by expansion in key sub-sectors such as food & beverages and transport equipment,” said Australian Industry Group Chief Executive, Heather Ridout. “Respondents cited ongoing global economic uncertainty and strong overseas competition as factors inhibiting growth in January,” she added.
http://www.foxbusiness.com/markets/2012/01/31/australian-january-manufac... USAtoday.com Eager to spend their growing disposable income, travelers from mainland China’s wealthy and rising middle classes are traversing the globe in search of iconic destinations they can cross off their bucket lists. That wanderlust has increasingly brought them to a dream destination, the USA, in recent years as travel restrictions on them eased. Despite occasional economic and political dust-ups between the two nations’ governments, a record number of Chinese visitors came to the U.S. in 2011.
http://www.usatoday.com/money/industries/travel/story/2012-01-31/Chinese... The U.S. Census Bureau reported Tuesday that the nation’s homeownership rate fell to 66% in the fourth quarter, continuing a seven-year drop from a fourth-quarter peak of 69.2% in 2004. At the same time, U.S. home prices fell 1.3% in November from October and were 3.7% below 2010 levels, the Standard & Poor’s/Case-Shiller home price index indicates.
http://www.usatoday.com/money/economy/housing/story/2012-01-31/home-pric... BBC.co.uk Walt Disney’s expansion plans in India have received a big boost as it agreed to acquire a controlling stake in UTV, one of India’s biggest media companies. The move comes after India’s cabinet approved a proposal by Disney last month to buyout shares in UTV that it did not previously own. The companies did not disclose how much Disney was paying to acquire the stake.
http://www.bbc.co.uk/news/business-16828451 Santander has revealed a 35% fall in annual profits after the group took extra provisions for deteriorating real estate assets in Spain. The bank announced a net profit of 5.35bn euros ($7.05bn; ?4.48bn) for 2011, down from 8.18bn euros in 2010. It said it had made a 1.8bn euro provision against property exposure in Spain and had written off 600m euros relating to its businesses in Portugal.
http://www.bbc.co.uk/news/business-16806206 Telegraph.co.uk Germany is enjoying the greatest jobs boom in 20 years even as unemployment rises to post-EMU highs across southern Europe, stretching the euro’s North-South divide ever closer to breaking point. The latest Eurostat data shows that the two halves of the currency bloc have diverged dramatically. Germany’s jobless rate dropped to 5.5pc in December, the lowest since reunification in 1990, with even lower rates of 4.9pc in Holland and 4.2pc in Austria.
http://www.telegraph.co.uk/finance/financialcrisis/9052931/German-jobs-m... Independent.co.uk More quantitative easing likely after fall in money supply. The prospects of fresh action by the Bank of England to boost growth increased on Tuesday after Threadneedle Street released figures showing a contraction in the money supply and weak borrowing by both companies and households. News of a drying up of credit left City analysts confident that a fresh round of quantitative easing would be announced by the Bank’s nine-strong monetary policy committee when it meets next week.
http://www.guardian.co.uk/business/2012/jan/31/more-quantitative-easing-... Smh.com.au Australian house prices plunged by the most on record in 2011 as global economic uncertainty and concerns about its impact at home kept a lid on demand. An index measuring the weighted average of prices for established houses in eight major cities slid 4.8 per cent from a year earlier, according to the Australian B ureau of Statistics, the biggest calendar-year drop since the data began in March 2002. They fell 1 per cent in the three months to December from the previous quarter, when they retreated a revised 1.9 per cent. Economists had predicted a 0.6 per cent quarterly fall.
http://www.smh.com.au/business/property/record-slump-in-house-prices-in-... Crude fluctuated after confidence among US consumers unexpectedly dropped in January and Germany’s unemployment rate fell to a record low. Oil erased a 2.5 per cent gain as the Conference Board’s confidence index decreased to 61.1 from a revised 64.8 reading in December. The Standard & Poor’s 500 Index also reversed an advance. Futures rose earlier as the Nuremberg-based Federal Labor Agency said Germany’s adjusted jobless rate slipped to 6.7 per cent, the lowest level since records began in 1991.
http://www.smh.com.au/business/markets/oil-slides-on-weak-us-data-201202... Xinhuanet.com Tibet Airlines will launch three regular flights linking cities in the plateau region of Tibet with other Chinese cities this week in a move to meet growing market demand, a company spokesman said Tuesday. Of the new air routes, the Chengdu-Nyingchi flight will open Wednesday and be operated every Monday, Wednesday, Friday and Sunday, the Lhasa-Nyingchi flight will open Thursday and be operated every every Monday and Thursday, and the Chongqing-Nyingchi flight will open Thursday and be operated every Tuesday, Thursday and Saturday, the spokesman said.
http://news.xinhuanet.com/english/china/2012-01/31/c_131384610.htm The business outlook for the services and manufacturing sectors of Singapore in the first half remained weak, according to results of surveys released on Tuesday. The results of the latest business expectations survey by the Department of Statistics showed that all industries in the services sector were expecting a negative outlook for the first half of the year, except the recreation, community and personal services. The real estate sector fared the worst, with a net weighted 60 percent surveyed expecting less favourable business prospects.
http://news.xinhuanet.com/english/business/2012-02/01/c_131385208.htm India’s economic growth has been revised down to 8.4 percent for 2010-11 fiscal year from the earlier estimate of 8.5 percent, said official data Tuesday. “The Gross Domestic Product (GDP) at factor cost at constant prices in 2010-11 has registered a growth of 8.4 percent over the previous year,” said provisional data released by the Indian Ministry of Statistics and Program Implementation. GDP at factor cost at constant (2004-05) prices in 2010-11 is estimated at 48.85954 trillion rupees (about 1 trillion U.S. dollars), which is 8.4 percent more than the previous year’s 45. 07637 trillion.
http://news.xinhuanet.com/english/business/2012-01/31/c_131384505.htm Turkey’s exports saw a 18.5-percent year-on-year growth in 2011 to reach 134.9 billion U.S. dollars, Turkey’s statistics authority TurkStat said Tuesday. In an announcement posted on its official website, TurkStat said that Turkey’s imports in 2011 surged 29.8 percent year-on- year to reach 240.8 billion U.S. dollars. In 2010, Turkey’s exports stood at 113.8 billion U.S. dollars and its imports were 185.5 billion U.S. dollars. Moreover, in December 2011, Turkey’s exports were up 5.6 percent year-on-year to 12.4 billion U.S. dollars, while the imports rose 0.2 percent to 10.5 billion U.S. dollars.
http://news.xinhuanet.com/english/business/2012-01/31/c_131384760.htm Cs.com.cn China is mulling a new round of efforts to regulate the sizzling property market after the moves it imposed about a year ago to limit purchases of residential apartments effectively brought down prices, analysts said Tuesday. Minister of Housing and Urban-Rural Development Jiang Weixin revealed that the ministry would complete a project to link databases of personal housing information concerning 40 major cities by the end of June, a measure designed to further curb house speculation, the analysts said. Since 2010, China has imposed a raft of measures to cool the property market — including tighter credit supply, higher down payments and limiting the number of homes that people can own.
http://www.cs.com.cn/english/ei/201202/t20120201_3223813.html The State Council, or China’s Cabinet, announced Tuesday that it will send drafts of the annual government work report to local governments and some central departments in order to solicit opinions and get feedback. The decision was made at a work conference chaired by Premier Wen Jiabao, as representatives gathered to discuss the draft of the government work report which is to be delivered at the opening of the fifth session of the 11th National People’s Congress (NPC), China’s top legislature. Wen said China’s economy is moving toward the direction that has been laid out by the country’s macro-control policies, and the past year has seen relatively fast growth, stabilizing prices and improving livelihood in China.
http://www.cs.com.cn/english/ei/201202/t20120201_3223796.html Chairman of Tehran Chamber of Commerce Yahya Ale-Eshagh on Tuesday dismissed fears of a shortage of foreign exchange reserves in Iran, saying the country has 120 billion U.S. dollars and 907 tons of gold in reserves, the semi- official Mehr news agency reported. Speaking to reporters on Tuesday, Ale-Eshagh said that Iran purchased the gold in recent years at an average price of 600 U.S. dollars per ounce and the current price of gold has almost tripled, said the report. “We don’t have any shortage of foreign currencies or gold in the face of local demand,” he was quoted as saying. The chairman’s remarks came as the recent turmoil in Iran’s gold and currency market led to a sudden increase of over 10 percent in commodity prices and caused panic among the citizens.
http://www.cs.com.cn/english/ei/201202/t20120201_3223657.html The Washington-based World Bank Group cautioned Tuesday that global food prices were high and volatile, and that the world needed to remain vigilant to the trend. Global food prices declined eight percent between September and December of 2011 due to increasing supplies and uncertainty about the global economy, but still remained volatile and high with the 2011 annual index 24 percent higher than its average
http://www.cs.com.cn/english/ei/201202/t20120201_3223655.html Thehindu.com Prime Minister Manmohan Singh on Tuesday announced a massive investment of Rs.1.40-lakh crore by 17 blue chip government undertakings in the forthcoming financial year (2012-13) in a bid to cope with the adverse global economic environment. Giving away the SCOPE Excellence awards for 2009-10 here, Mr. Singh said “public investment was particularly needed at a time when the country was facing a difficult global environment and looking to domestic drivers of growth.” Union Minister of Heavy Industries Praful Patel presided over the function.
http://www.thehindu.com/business/Economy/article2848234.ece The Reserve Bank of India on Tuesday hinted at the possibility of another cut in the CRR (cash reserve ratio) during its mid-quarter monetary policy in March in case pressure on the liquidity situation persists till then. Interacting with the media on the sidelines of a National Housing Board function here, RBI Deputy Governor Subir Gokarn said: “We are watching the liquidity situation … I think that decision [another cut in CRR] will be taken when we do our mid-quarter review … Having done one, I think the possibility of another is always on the table.”
http://www.thehindu.com/business/Economy/article2848235.ece Economictimes.com India’s manufacturing sector grew at its fastest pace in eight months in January as factory output surged the most on record on increased domestic and foreign demand, a business survey showed on Wednesday. The HSBC manufacturing purchasing managers’ index (PMI) , compiled by Markit, jumped to 57.5 from 54.2 in December. “Activity in the manufacturing sector rebounded again in January led by higher demand from both domestic and foreign clients, suggesting some recovery in sentiment in recent months,” said Leif Eskesen, economist at HSBC.
http://economictimes.indiatimes.com/news/economy/indicators/indias-facto... Fin24.com South Africa’s trade account recorded a surplus of R4.7bn in December compared with an R8bn deficit in November, the South African Revenue Service said on Tuesday. Exports fell by 8.0% month-on-month to R63.0bn in December while imports plunged by 23.8% to R58.3bn. Economists surveyed by Reuters expected a shortfall of R3bn for December but the data is volatile and thus hard to forecast.
http://www.fin24.com/Economy/SAs-trade-account-in-surplus-20120131 Tehrantimes.com The Iranian Oil Minister has said that international sanctions have not been effective on investments in Iran’s oil and gas industry, and that Iranian oil can not be excluded from international markets. Rostam Qasemi made the remarks in an interview with IRNA news agency in Tehran, saying that it is self-defeating for countries to impose oil sanctions against the Islamic Republic. A law to be debated in Iran’s parliament on Sunday could halt exports of oil to the European Union as early as next week.
http://www.tehrantimes.com/economy-and-business/94998-minister-sanctions... Thetrader.se This rather extreme prolonged Santa Rally has made people frustrated over the last weeks. The many conflicting themes of the Economy, the Euro mess, the collapse in volatility etc, is contributing to people’s frustration over where the market should be going. Currently we see great accumulation of a bigger move coming up due to “skewed” psychology of the market. Meanwhile some fundamentals from Hussman. Goat Rodeo – Appalachian slang for a chaotic, high-risk, or unmanageable scenario requiring countless things to go right in order to walk away unharmed.
http://www.thetrader.se/2012/01/31/are-we-up-for-a-goat-rodeo/
That's right, you're a 50-year-old, middle-income, single woman with diabetes. And your health has been impacted in dramatic ways by forces beyond your control.
How? Well,
in a new report, the aptly named Institute for Alternative Futures lays out four scenarios that could become realities for primary care by 2025. And for you, Mary, that means the potential for four very different -- but equally plausible -- futures.
The various health policy decisions, technological advances and political outcomes that remain to be seen will determine the fate of your health care -- and health. Here, with the help of the officials behind the report, we launch you into four parallel health care worlds.
Behold, Mary. These are your lives.
SCENARIO 1: "Expectable Future
"
In this scenario, which is a continuation of current trends, policymakers have ramped up access to preventive care, in part through a concept called the "patient-centered medical home." Back in 2014, the Affordable Care Act expanded coverage to most Americans, emphasized coordinated care and greatly boosted the use of electronic medical records. People like Mary have a primary care team that includes a physician, a nurse practitioner (who is actually her main point of contact), social workers and others who take care of the vast majority of her needs. They heavily reference her electronic medical record, which tracks her life history, her lifestyle and all bio-monitoring data that comes from devices she wears on her body -- earrings, a wristwatch, and a sleep pad that gives a pretty comprehensive picture of her health. Mary also has access to a digital health coach -- a virtual personality that helps condense all the medical information available online to advise her on behavior changes that she might want to consider.
SCENARIO 2: "Challenging Future
"
To put it mildly, things don't look so bright in this second outcome. With greater economic difficulties prompting significant cuts in federal health care spending, many doctors grew fed-up with lowered reimbursement rates and retired early. That led to even greater health care shortages and decreased access for many Americans, including Mary. Most blame the hardships on the passage of the Affordable Care Act, which caused many employers to stop providing health insurance. Mary considers herself lucky to still have a low-paying job in the aftermath of the second Great Recession, but she can't really afford any kind of real health insurance on her own. So she relies on the minute clinics, online information and emergency rooms when necessary. But her diabetes is so out-of-control she may lose her eyesight or need a limb amputation.
SCENARIO 3: "Aspiring Future
"
In this scenario, most health care initiatives embrace a triple aim promoted as the key implementation goal of the ACA -- enhancing the patients' experience, reducing per capita health care costs, and improving the overall health of the population. The latter means the "patient-centered medical home" has become a "community-centered health home" that monitors and contributes to the overall health of the general population. Mary works with Eva, a community health worker, to manage her diet and exercise. She has a health team: a doctor, nurse and access to all the health professionals. But Eva's her primary contact and the one who works with her on a daily basis -- the one who visits her three or four times per year and reviews Mary's health data so that she doesn't run the risk of diabetes-related conditions. To top it off, Mary has joined a group of other diabetics who like to walk together in the early evening, and for much of the year she gardens daily in one of the two community gardens started by her community health center.
SCENARIO 4: "Surprisingly Successful Future"
In our fourth scenario, primary care is divided into two major camps. The bulk of the health care system has been transformed into personalized programs supported by technologies that allow people to take over many functions of primary care for themselves. A second branch provides efficient, cost-competitive care for complex health needs -- services that are only necessary when people still need care despite all the new, preventive programs. Mary takes care of herself quite well. Her job doesn't cover her health insurance, but she has a consumer-directed plan through her state's Health Insurance Exchange that gives her what she needs. That includes a very effective digital health coach, which analyzes her personal bio-monitoring and genetic code and recommends steps she should take to improve her health. When she does need a doctor, the digital coach analyzes the quality and the price of the doctors in her neighborhood, relates those to the recommendations of her friends, and tells her the best option based upon her budget and health needs.
So, Mary, which do you prefer, and which do you think is most likely? Participate in the poll below -- which will remain open until Feb. 7 -- and share your thoughts in the comments section. Check back next week for the results, as well as expert analysis on the likelihood of the four scenarios and a look at what will need to happen for each to become reality.
Which Scenario Do You Think Is Most Likely? Click each scenario to rate its likelihood.
Rate SCENARIO 1: "Expectable Future"
Rate SCENARIO 2: "Challenging Future"
Rate SCENARIO 3: "Aspiring Future"
Rate SCENARIO 4: "Surprisingly Successful Future"
here.
The scenarios were developed in consultation with some of the top health care experts in the country, and with the support of The Kresge Foundation, which is also a NewsHour underwriter. Read the full report
here.
Mitt Romney celebrates his win in the Florida primary. Photo by Joe Raedle/Getty Images.
With his decisive victory in the Florida primary Tuesday night, Mitt Romney regained command of the Republican nomination battle, rebounding from a disappointing second-place finish in South Carolina 10 days earlier, and now enters February with a full head of steam.
With all of the Sunshine State's precincts reporting, here is the tally:
- Mitt Romney: 46 percent (771,842 votes)
- Newt Gingrich: 32 percent (531,294 votes)
- Rick Santorum: 13 percent (222,248 votes)
- Ron Paul: 7 percent (116,776 votes)
Check out the
full results here in our map center.
Just how decisive was Romney's victory Tuesday? He beat Gingrich and Santorum combined by 18,300 votes. That margin helped Romney undercut Gingrich's pre-election projection that the "conservative" candidates would "out-poll" Romney.
Addressing supporters at a primary night event in Tampa, a triumphant Romney commented on the negative tone of the Florida campaign, which saw millions of dollars poured into blistering television attack ads as well as repeated sharp exchanges between the two main GOP contenders both in debates and on the stump.
"A competitive primary does not divide us, it prepares us. And we will win," Romney declared. He added that the party will be "united" when it returns to Tampa in August for the convention.
Pivoting to the general election, Romney also took aim at President Obama. "Leadership is about taking responsibility, not making excuses," Romney said. "Mr. President, you were elected to lead, you chose to follow, and now it's time for you to get out of the way."
Gingrich spoke in Orlando and offered no words of congratulation to his rival. Instead, the former House speaker promised an unrelenting campaign.
"We're going to contest everyplace and we are going to win," Gingrich told supporters, many of whom held signs that read: "46 states to go." [It's worth noting that Gingrich
decided to skip Missouri's non-binding primary on Feb. 7 and failed to qualify for the ballot in Virginia, which holds its primary in March.]
"It is now clear that this will be a two-person race between the conservative leader, Newt Gingrich, and the Massachusetts moderate," Gingrich said.
Given the winner-take-all dynamic in Florida, Santorum had moved on to Nevada by Tuesday night, after spending most of the day in Colorado. He disputed Gingrich's statement that the GOP race was now a two-man contest between himself and the former Massachusetts governor.
"In Florida, Newt Gingrich had his opportunity. He came out of the state of South Carolina. He came out with a big win and a lot of money and he said, 'I'm going to be the conservative alternative. I'm going to be the anti-Mitt.' And it didn't work," Santorum charged. "He became the issue. We can't allow our nominee to be the issue in the campaign."
Santorum also lamented the negativity of the Romney-Gingrich feud. "The American public does not want to see two or three candidates get into a mud-wrestling match where everybody walks away dirty and not in a position to be able to represent our party proudly," Santorum said. "What we saw in the last few weeks in Florida is not something that's going to help us win this election."
After largely avoiding Florida, Texas Rep. Ron Paul also spent his primary night in Nevada, which holds its caucuses Saturday. "We will spend our time in the caucus states, because if you have an irate, tireless minority you do very well in the caucus states."
"People are beginning to realize that the problem is too much government," Paul said. "We need liberty."
While the Florida win puts Romney back in the driver's seat, he's still a long way from clinching the 1,144 delegates needed to claim the Republican presidential nomination. [The Washington Post has put together
an incredibly helpful delegate tracker.] With many states having switched to proportional allocation, the other contenders can point to the math as a reason to stay in the race.
In another signal of Romney's strength, he
will soon start receiving Secret Service protection, ABC News reported Tuesday night. In addition, the Boston Globe is reporting that Romney's campaign has been negotiating an endorsement with former candidate and Tea Party darling Rep. Michele Bachmann. Romney is, after all,
headed to her home state of Minnesota on Wednesday afternoon.
Miss any of the fun?
Watch our election special here. All of the candidate speeches
can be found here.
46 STATES TO GO?
Politico's Jonathan Martin writes about the anxiety among Republicans
about the nasty fight between Romney and Gingrich, with several top party members fretting about how it might harm the eventual nominee's general election chances against President Obama.
And the other guys don't seem to be going anywhere, but for now, Santorum is keeping his sights on Gingrich.
Santorum told CNN's Dana Bash on Tuesday night that the more affordable contests ahead in smaller states give his campaign an opportunity to rise. The former Pennsylvania senator said he raised $4.5 million in the month of January alone.
With the gambling mecca of Nevada is next up on the nominating calendar, Santorum is putting playing cards to political use. He released
a harsh new ad, taking 60 seconds to tell caucus-goers that Gingrich is just like President Obama and Democratic House Leader Nancy Pelosi.
Jon Ralston, the dean of Nevada politics, reminds the candidates
how to pronounce the state's name ahead of Saturday's caucuses:
Just because Steve Wynn can't say it right...pronounce the name correctly. Please. It is not, as Wynn says, Ne-vah-duh; it's Ne-vad-a. Practice it in front of the mirror. Put a phonetic pronouncer in the prompter. Or just memorize it. You can be sure we in the media will be listening.
The most recent polling in the Silver State, conducted by the Las Vegas Review-Journal on Dec. 12, found Romney leading Gingrich, 33 percent to 29 percent, with Paul getting 13 percent and Santorum 3 percent.
Polls of Colorado and Minnesota, which hold caucuses Tuesday, show a split result. An early December poll of Colorado voters from the left-leaning Public Policy Polling showed Gingrich at 37 percent to Romney's 18 percent. But a PPP Minnesota poll just a few weeks ago found Romney leading Gingrich, 36 percent to 18 percent.
There are no recent polls from Maine, which begins its week-long caucuses Jan. 4 and received a visit from Paul last weekend.
Arizona and Michigan vote in primaries on Feb. 28, and Romney leads polls conducted in both states.
TEAM OBAMA RESPONDS
Deputy Obama campaign manager Stephanie Cutter wrote a memo Tuesday night arguing that Romney's victory in Florida "came at a very steep price," detailing that he spent five times more than Gingrich. Cutter pointed to polling that found Republicans dissatisfied with their candidates and said he has damaged himself among swing voters:
Team Romney wants voters and the national media to believe its victory reflects its candidate's positions. In reality, it is a product of the fact that Romney and his SuperPAC allies carpet-bombed Gingrich by spending five times as much money on Florida's airwaves, and running more than 60 television ads for every one Gingrich and his allies aired. Nearly all of the $15.3 million Romney's campaign and its allies' spent on advertising in Florida was focused not on their own candidate, but on the rest of a weak field of opponents, contributing to a campaign in which more than nine out of every 10 ads were negative - by far the most negative campaign in Florida's history.
FOLLOW THE MONEY
The campaigns, Super PACs and outside groups were required to file their fourth-quarter reports with the Federal Election Commission by midnight. Here's a look at some of the findings.
Ron Paul
raised $13 million in the fourth quarter.
The Karl Rove-backed Crossroads group hauled in $51 million.
Priorities USA, the pro-Obama Super PAC, raised just $1.24 million.
Politico's Ken Vogel
crunched the numbers on Gingrich and writes that his report "paints a picture of a campaign that is working to professionalize, but continues to be based in part around the candidate himself and the network of companies and non-profits that he built after leaving Congress." For example, the Gingrich campaign paid the candidate $47,000 for a list of supporters and paid one of Gingrich's companies $67,000 for web hosting, Vogel writes.
PayPal co-founders
donated to a pro-Paul Super PAC, Reuters reported.
President Obama's campaign voluntarily released its list of the big donors who bundle multiple donations for the president and called on the other candidates to do the same.
See the list here.
Roll Call's Kate Ackley found three former members of Congress, including one who works at a lobbying and law firm and one who has been plagued by a scandal,
were among the bundlers. Ackley writes:
Ex-New Jersey Gov. Jon Corzine, a former Senator who has been under fire for the collapse of his brokerage and commodities firm MF Global; former Rep. Ron Klein (D-Fla.), who is not a registered lobbyist but is a member of the public policy and regulation group at Holland & Knight; and ex-Rep. Patrick Kennedy(D-R.I.) are listed as top bundlers for the president. The president returned Corzine's personal campaign contributions, according to numerous news reports.
We'll examine the disclosures on Wednesday's NewsHour. Tune in.
2012 LINE ITEMS
- Matt Strawn resigned as chairman of the Iowa Republican Party Tuesday morning, fallout from the messy counting of caucus votes and the party's delay in declaring Santorum the new winner.
From NewsHour politics desk assistant Alex Bruns:
According to the Associated Press, it was only after a late night conference call between 17 members of the Iowa Republican Central Committee weeks after the caucuses that Strawn finally made the decision to release an official statement awarding the victory to Santorum. Strawn will leave office Feb. 10, the day before the next committee meeting, which will be charged with selecting a new chairman.
Even though Strawn is leaving his job, he will have little time to rest. The Iowa Barnstormers, an Arena League Football team he co-owns, kicks off its season March 12 against the Spokane Shock.
Sen. Marco Rubio dodged the veepstakes question in an interview Tuesday night with Judy Woodruff. "I understand people have to speculate about somebody. Now, when they move on to other states, they will probably speculate about other people," he said.
Watch the full segment here.
Bachmann's campaign
was broke when she dropped out, with just $358,724 in cash on hand after the Iowa caucuses. She has more than $1 million in campaign debt, Talking Points Memo reported.
TOP TWEETS
src="//platform.twitter.com/widgets.js" charset="utf-8">Big story in the WSJ about a new Obama push coming today to cure the ailing housing market:
— Gerald F Seib (@GeraldFSeib)
on.wsj.com/yhh6rA via @
WSJ
February 1, 2012
src="//platform.twitter.com/widgets.js" charset="utf-8">A guide to Nevada for presidential candidates
— Jon Ralston (@RalstonFlash)
bit.ly/zL1SxQ
February 1, 2012
src="//platform.twitter.com/widgets.js" charset="utf-8">Off camSen @
— Judy Woodruff (@JudyWoodruff)
MarcoRubio says college class he taught last week included role
#VP Vice President plays in senate
#flaprimary
January 31, 2012
OUTSIDE THE LINES
Democrat Suzanne Bonamici
decisively won a special House election Tuesday to replace Democrat David Wu, who resigned last year amid a sex scandal involving a young woman.
The Democratic Congressional Campaign Committee
spent $1.3 million in independent expenditures, mostly on TV ads that painted GOP candidate Rob Cornilles as a Tea Party-affiliated Republican, not the moderate he portrayed himself to be on the campaign trail, Roll Call's Kyle Trygstad reports.
Nathan Gonzales of the Rothenberg Political Report notes that Democrats took nothing for granted and
"outspent Republicans on television about 4-to-1." Bonamici spent about a half-a-million dollars on television, the Democratic Congressional Committee almost a million, in addition to spending from a few other Democratic groups, Gonzales writes.
Rep. Dan Burton, R-Ind.,
will not seek re-election, reports the Indianapolis Star's Mary Beth Schneider. The 73-year-old Republican lawmaker has served 15 terms.
Democrats think
they can win back the House in November.
First lady Michelle Obama
yukked it up with Jay Leno on Tuesday night, commenting on Romney's singing skills and pushing healthy eating.
The Virginia Supreme Court on Tuesday
allowed a redistricting lawsuit to proceed, prompting Republican Attorney General Ken Cuccinelli to ask that the state delay its congressional primaries by two months, the Washington Post's Ben Pershing reports.
ON THE TRAIL
All events are listed in Eastern Time.
Rick Santorum makes four Colorado campaign stops, addressing the Arapahoe Republican Men's Club breakfast in Denver at 10 a.m., holding a press conference in Lakewood at 12 p.m., delivering remarks on health care in Woodland Park at 3 p.m. and attending a rally in Colorado Springs at 9 p.m.
Ron Paul campaigns in Las Vegas, with events set for for 12 p.m. and 5 p.m., and press availabilities scheduled to follow both.
Mitt Romney holds a rally in Eagan, Minn., at 2:05 p.m. and another rally in Las Vegas at 9:30 p.m.
Newt Gingrich holds a campaign rally in Reno, Nev., at 4 p.m.
All future events can be found on our
Political Calendar:
For more political coverage, visit our
politics page.
Sign up here
to receive the Morning Line in your inbox every morning.
Follow the politics team
on Twitter:
@cbellantoni,
@burlij,
@elizsummers,
@quinnbowman.
“Heartburn pills taken by thousands of women ‘raise risk of hip fractures by up to 50 per cent’,” the Daily Mail reported today. The headline is based on a large new study of drugs called proton pump inhibitors (PPIs), which are commonly used to treat heartburn, acid reflux and ulcers.
The study found that post-menopausal women who regularly took PPIs for at least two years were 35% more likely to suffer hip fracture than non-users, a figure that increases to 50% for women who were current or former smokers. However, although this increase in risk is large, the overall risk of fractures remains small.
This was a large, well conducted study that suggests that long-term use of PPIs is associated with a small increase in risk of hip fracture, although the researchers point out that the risk seems to be confined to women with a history of smoking. Unlike previous research, this study took careful account of other factors that might affect risk such as body weight and calcium intake.
Women who are concerned about their use of PPIs are advised to consult their GP.
Where did the story come from?
The study was carried out by researchers from Massachusetts General Hospital, Boston University and Harvard Medical School and was funded by the US National Institutes of Health. The study was published in the
peer-reviewed British Medical Journal.
Although the Mail’s headline is technically correct, it gives the impression that these drugs carry a very large increase in the risk of hip fracture. In fact, the study found that, in absolute terms, the increase in risk for regular users was small. Researchers found that among the women in the study who regularly used PPIs, about two in every 1,000 fractured a hip each year. In non-users, this figure was about 1.5 in every 1,000. This is a increase of about five fractures a year in every 10,000 women taking PPIs.
The Mail did point out this “absolute difference” towards the end of its story. Both the Mail and the BBC included comments from independent experts.
What kind of research was this?
The researchers point out that PPIs are among the most commonly used drugs worldwide. In the US they are available over the counter, but in the UK are available only on prescription. They are used for symptoms of heartburn, gastro-oesophageal reflux disease (GORD) and stomach ulcers. PPIs are thought to work by reducing acid production in the stomach. Concern has grown over a potential association between long-term use of these drugs and bone fractures, although the researchers say that previous studies have had conflicting results and many did not take other factors (called
confounders) that might affect the risk of fracture into account.
In their
cohort study of nearly 80,000 post-menopausal women, the researchers set out to examine the association between long-term use of PPIs and the risk of hip fracture. Unlike a
randomised controlled trial, a cohort study cannot prove cause and effect. However, cohort studies enable researchers to follow large groups of people for long periods and they are useful for looking at potential long-term risks and benefits of treatments. The study was
prospective, which means it followed participants in time, rather than collecting information retrospectively. This makes it more reliable.
What did the research involve?
This study took its data from a large ongoing US study called the Nurses Health Study, which began in 1976 and which sent health questionnaires every two years to 121,700 female nurses aged 30-55.
From 1982 participants were asked to report all previous hip fractures and in each biennial questionnaire, women were asked if they had sustained a hip fracture over the previous two years. Those who reported a hip fracture were sent a follow-up questionnaire asking for more details. Fractures from bad accidents, such as falling down a flight of stairs, were excluded from the study. A review of medical records for 30 of the women validated all self-reported fractures.
From 2000 to 2006 the women were asked if they had regularly used a PPI in the previous two years. In earlier questionnaires (1994, 1996, 1998 and 2000), the women were also asked if they had regularly used other drugs for acid reflux, called H2 blockers.
The biennial questionnaires also included questions on other factors including menopausal status, body weight, leisure activities, smoking and alcohol use, use of hormone replacement therapy (HRT) and other medicines. Researchers used a validated food frequency questionnaire to calculate the women’s total intake of calcium and vitamin D.
They then analysed the data for any association between regular use of PPIs and hip fracture, adjusting their findings for key confounders such as body weight, physical activity, smoking and alcohol and calcium intake. They also took into account whether the reasons for using a PPI might have affected the results.
Finally, they carried out a systematic review combining their results with 10 previous studies on the risk of hip fracture and the long-term use of PPIs.
What were the basic results?
The researchers documented 893 hip fractures during the period of the study. They also found that, in 2000, 6.7% of women regularly used a PPI – a figure that had risen to 18.9% by 2008.
- Amongst women who had regularly taken a PPI at any time, there were 2.02 hip fractures per 1,000 person years, compared with 1.51 fractures per 1,000 person years among non-users.
- Women who regularly used PPIs for at least two years had a 35% higher risk of hip fracture than non-users (age adjusted hazard ratio (HR) 1.35; 95%
confidence interval (CI) 1.13 to 1.62), with longer use associated with increasing risk. Adjustment for risk factors, including body mass index, physical activity and intake of calcium did not alter this association (HR 1.36; CI 1.13 to 1.63).
The increased risk did not change when researchers also took into account the reasons for PPI use:
- Current and former smokers who regularly used PPIs were 51% more likely to have a hip fracture than non-users (HR 1.51; (CI) 1.20 to 1.91).
- Among women who never smoked there was no association between PPI use and hip fracture (HR 1.06; (CI) 0.77 to 1.46).
- In a meta-analysis of these results with 10 previous studies, the risk of hip fracture in users of PPI was higher compared to non–users of PPIs (pooled odds ratio 1.30; CI 1.25 to 1.36).
The researchers also found that two years after women stopped taking PPIs, their risk of hip fracture returned to a similar level to that in women who had never taken them. Also, women taking H2 blockers had a “modest” increased risk of hip fracture but the risk was higher in women who took PPIs.
How did the researchers interpret the results?
The researchers conclude that their results provide “compelling evidence” of a risk between PPI use and hip fracture. They say the findings suggest that the need for long-term, continuous use of PPIs should be carefully evaluated, particularly among people who have smoked or are still smokers.
They suggest that PPIs may increase the risk of fracture by impairing the absorption of calcium, although in this study the risk of fracture was not affected by dietary calcium intake. The finding that the risk was confined to women with a history of smoking (an established risk factor for fracture) indicates that smoking and PPIs may act together (have a “synergistic effect”) on fracture risk.
Conclusion
This large study had several strengths. Unlike some previous studies, it collected information on and took into account other key risk factors for fracture, including body weight, smoking, alcohol use and physical activity. It also looked at the women’s use of PPIs every two years (rather than just asking them once) and took into account variations in use during this time in their analysis.
However, as the authors note, it also had some limitations:
- It did not ask about the brands of PPI used, nor the doses of PPI the women took, both of which could affect risk of fracture.
- The information about hip fracture was self-reported and not confirmed by medical records (although a smaller study has found self-reporting of hip fracture to be reliable).
- Also, the study did not record the women’s bone mineral density (BMD). Low[?] BMD is an important risk factor for fracture and adding a measure of this could have strengthened the study.
Finally, because this was a cohort study, other factors both measured and unmeasured may have affected the results, even though researchers took many of these into account in their analysis. Socio-economic status and education, for example, were not established. Because this was a study of registered nurses, the applicability of the results to other socio-economic groups might be limited.
This study found that the long-term, regular use of these drugs is associated with a small increased risk in hip fracture among older women, a risk that seems to be confined to past or current smokers. Women who regularly take PPIs and who are concerned about these findings are advised to talk to their GP. Whether any change in use of this commonly prescribed drug is needed requires further study.
Links To The Headlines
Indigestion drugs taken by millions linked to hip fractures. The Daily Telegraph, February 1 2012
Heartburn pills taken by thousands of women 'raise risk of hip fractures by up to 50 per cent'. Daily Mail, February 1 2012
Ulcer drugs 'link to fractures'. BBC News, February 1 2012
Links To Science
Khalili H, Huang ES, Jacobsen BC, et al.
Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. British Medical Journal. Published online January 31 2012
Ritalin and Adderall, a combination of dextroamphetamine and
amphetamine, are stimulants. So why do they appear to calm children down? Some experts argued that because the brains of children with attention problems were different, the drugs had a mysterious paradoxical effect on them.
However, there really was no paradox. Versions of these drugs had been given to World War II radar operators to help them stay awake and focus on boring, repetitive tasks. And when we reviewed the literature on attention-deficit drugs again in 1990 we found that all children, whether they had attention problems or not, responded to stimulant drugs the same way. Moreover, while the drugs helped children settle down in class, they actually increased activity in the playground. Stimulants generally have the same effects for all children and adults. They enhance the ability to concentrate, especially on tasks that are not inherently interesting or when one is fatigued or bored, but they don’t improve broader learning abilities.
And just as in the many dieters who have used and abandoned similar drugs to lose weight, the effects of stimulants on children with attention problems fade after prolonged use. Some experts have argued that children with
A.D.D. wouldn’t develop such tolerance because their brains were somehow different. But in fact, the
loss of appetite and
sleeplessness in children first prescribed attention-deficit drugs do fade, and, as we now know, so do the effects on behavior. They apparently develop a tolerance to the drug, and thus its efficacy disappears. Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children’s bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.
TO date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.
But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.
Men are far more likely to have the sexually transmitted human papillomavirus (HPV) in their mouths than women, the Daily Mail has reported. The Mail has outlined research into the prevalence of HPV, which is a risk factor mouth cancer and other cancers. Researchers found that HPV was more commonly found in people who engaged in all kinds of sexual activity – including vaginal, anal and oral. The Mail reports that the researchers suggest that HPV vaccination for men needs investigating to see whether it could help stop oral HPV and, potentially, oral cancer.
Mouth cancer has risen more than 20% in the past 30 years. Tobacco use and prolonged, heavy alcohol drinking are the biggest risk factors, but the presence of oral HPV is also a clear risk factor for the disease.
The latest research set out to estimate the proportion of people infected with oral HPV in the United States, and any factors associated with infection. It found that approximately 7% of the US population aged 14 to 69 years were infected with this virus, and that men were more likely to be infected than women.
This study shows a marked difference in oral HPV infection between men and women in the US, but does not necessarily reflect how many people in the UK are infected. There are many different types of HPV, and not everyone who is infected will go on to develop cancer.
HPV is known to cause cervical cancer, and a vaccine campaign for girls aims to reduce its prevalence among women, and so reduce the number of cervical cancers. It remains unclear whether vaccinating men would have an effect on the presence of oral HPV or reduce the number of cancers.
Where did the story come from?
The study was carried out by researchers from Ohio State University, the US National Cancer Institute and a US company called Information Management Services. The research was funded by Ohio State University, the US National Cancer Institute, John and Nina Cassils and the pharmaceutical company Merck. Merck is the manufacturer of Gardasil, the cervical cancer jab that targets several strains of HPV, including type 16, which is most commonly associated with oral cancer.
The study was published in the
peer-reviewed Journal of the American Medical Association.
This research was covered appropriately in the media, with the Daily Mail emphasising that the prevalence estimate was drawn from a US population, and pointing out that not all individuals infected with oral HPV will go on to develop oral cancer. The BBC was careful to point out that it is not known if the existing vaccines against HPV used for preventing cervical cancer are effective against oral HPV infection and that vaccination cannot be recommended for the primary prevention of oropharyngeal cancer.
What kind of research was this?
This was a
cross-sectional study that examined the number of people aged 14 to 69 infected with oral HPV in the United States.
Cross-sectional studies are a useful way to generate estimates of the number of cases in a population. However, they only collect information at one point in time, and cannot tell us why things are related, or how things change over time. This study provides a snapshot of the number of infections in one time period (between 2009 and 2010), but it does not attempt to link these numbers to the risk of developing oral cancer.
Background information supplied by the researchers suggests that the number of cases of oral cancer has increased over the past 30 years in several countries, and HPV has been directly implicated as the underlying cause.
What did the research involve?
Researchers recruited a sample of individuals that was intended to be representative of the US population. They conducted interviews and a physical examination. During the interview, participants provided information about:
- sociodemographic factors – such as age, sex, education, socioeconomic status, sexual orientation and marital status
- substance use – including tobacco, alcohol and marijuana
- sexual behaviour – including ever having had sex, ever having performed oral sex, age at first sex, number of sexual partners and history of sexually transmitted infection
During the physical examination samples of cells were taken from the inside of the mouth. These samples were sent to a laboratory where researchers isolated DNA from the cells to determine whether the individual was infected with oral HPV and, if so, to identify the virus type. They tested for 37 HPV types, of which 18 were ‘high-risk’ DNA types.
The researchers then analysed the data, arriving at overall estimates of the number of infections in the US population. They also conducted an analysis that accounted for sociodemographic and behavioural factors.
What were the basic results?
There were 5,579 participants in the beginning of the study. Of these 5,501 (98.6%) were included in the analysis. The researchers found that overall:
- 6.9% of participants were infected with HPV (95%
confidence interval (CI) 5.7% to 8.3%)
- 3.7% of participants were infected with a type of HPV classified as having a high risk of causing cancer (95% CI 3.0% to 4.6%)
- 3.1% of participants were infected with a low-cancer-risk type of HPV (95% CI 2.5% to 3.9%)
- the most prevalent type of virus detected was HPV-16 (1.0%, 95% CI 0.7% to 1.3%)
When the researchers accounted for sociodemographic and behavioural factors in their analysis, they found that the following variables were independently associated with oral HPV infection:
- Age: infections peaked at two distinct age groups - in those aged 30 to 34, and again in those aged 60 to 64. This pattern was stronger for men than women.
- Sex: men had more than twice the number of infections as women (10.1% male versus 3.6% female;
prevalence ratio (PR) 2.33, 95% CI 1.66 to 3.26). When looking at the most common HPV type (HPV-16) this increased to a nearly fivefold difference (1.6% male versus 0.3% female; PR 5.41, 95% CI 2.12 to 13.83).
- Lifetime number of sexual partners: those with two or more partners had significantly more infections than those who had no sexual partners. The prevalence of infection increased with increasing numbers of lifetime partners.
- Current smoking intensity: those who smoked 10 or more cigarettes a day had significantly more infections than those who had never smoked or who no longer smoked. This association was stronger for women than for men.
Ethnicity, marital status and alcohol and marijuana use were not independently associated with oral HPV infection.
How did the researchers interpret the results?
The researchers concluded that approximately 7% of the US population between the ages of 14 and 69 were infected with oral HPV. They say that this is significantly lower than infection with genital HPV.
Conclusion
This was a relatively large cross-sectional study that estimated the number of oral HPV infections in the US among 14 to 69 year olds. These estimates cannot be directly generalised to the UK.
The researchers say that their data provide evidence that oral HPV infection is mainly sexually transmitted. This is because infection was uncommon among participants with no previous sexual partners, but was up to eight times higher among those with previous partners, and increased significantly as the number of partners increased. The researchers do point out, however, that their study did not collect information on possible non-sexual transmission methods.
While policy decisions regarding HPV infection generally focus on genital HPV among females, this research demonstrated that, at least in the US, men are more likely to be infected with oral HPV. As high-risk types of oral HPV have been shown to cause mouth cancer, this research may open up discussions on the need to address these risks. Options for reducing the risk of infection include targeting modifiable behaviours, such as smoking and sexual behaviour. Whether current vaccines against HPV can prevent oral cancer is unknown and this research does not provide any evidence as to how effective any vaccine might be.
All in all, this was a well conducted cross-sectional study that estimated the prevalence of oral HPV infections in the United States. However, it does not provide any information on the number of participants who went on to develop oral cancer. It is important to remember that there are many different types of HPV, and not everyone who is infected will go on to develop cancer. This study cannot tell us the rates of oral HPV infection in the United Kingdom, but may provide information on risk factors for infection that apply to populations outside the US.
Links To The Headlines
More men 'have oral cancer virus'. BBC News, January 27 2012
More than 16 million Americans have oral HPV. Daily Mail, January 26 2012
Links To Science
Gillison ML, Broutian T, Pickard RKL,
et al
.
Prevalence of oral HPV infection in the United States, 2009-2010. Journal of the American Medical Association. Published online January 26 2012
FDA Lawyers Blog is pleased to announce that FLH Partner
Brian J. Malkin was quoted in an
FDAnews article by David Pittman commenting on the FDA e-mail monitoring suit concerning several FDA whistleblowers in the Center for Devices and Radiological Health.
FDAnews
to Access this article and othe content on
FDAnews
:
FDA Email Monitoring Suit May Chill Whistleblowing on Safety Concerns
The FDA's alleged monitoring of the personal emails of employees who voiced product safety concerns to Congress could dissuade other staffers from airing grievances, industry experts tell DID.
Several FDA staffers are suing the agency, claiming it monitored personal email accounts from the government computers of six FDA scientists and doctors. These employees had contacted congressional staff to draft whistleblower complaints about what they believed were unsafe medical devices that gained approval, according to a lawsuit filed last week in Washington, D.C. federal court. The staffers were harassed and eventually fired from their positions in the Center for Devices and Radiological Health, according to the suit.
If the allegations are true, "this is the kind of retaliation that will intimidate other scientists from stepping forward when they are aware of wrongdoing," Joe Newman, spokesman for FDA watchdog Project on Government Oversight, told
DID
. "One has to wonder why the FDA seems more concerned about punishing whistleblowers than it is about getting to the bottom of their grievances."
The HHS Office of Inspector General found no criminal conduct and said the staffers had a right to communicate with Congress and journalists.
The FDA's alleged actions, if true, would place employees in a difficult situation, experts said. They would either need to leave the agency to voice their concerns or risk seeing complaints go unanswered if speaking through authorized channels.
The FDA wants its official communications to Congress to go through the agency's legislative office, rather than individuals.
Brian Malkin, attorney with Frommer Lawrence & Haug and a former FDA staffer, suggests the agency clarify what communications its employees can have with legislative staff and other outsiders.
And it should establish criteria for what information can and can't be shared with outsiders, Richard Samp, chief counsel at the Washington Legal Foundation, told
DID
. Whistleblowers are supposed to expose corruption, not simply publicize the decisions they disagree with, he said.
The FDA does not comment on pending legal actions, an agency spokeswoman told
DID
.
View the lawsuit at
www.fdanews.com/ext/files/CDRH_lawsuit.pdf. -- David Pittman
His attorneys argued in a motion filed last week that the arrangement protects him from criminal prosecution in Maryland because Brigham administered drugs that killed the fetuses while the patients were in New Jersey
Dr. Steven Chase Brigham speaks with one of his attorneys in this 2010 file photo. Brigham of Voorhees, faces charges of performing illegal abortions at an abortion clinic on East High Street in Elkton, Md.
WASHINGTON — Lawyers for an abortion doctor charged with murder in Maryland for the deaths of five fetuses have asked a judge to dismiss the charges, arguing that prosecutors lack jurisdiction because the deaths occurred in New Jersey.
Dr. Steven Brigham, 55, of Voorhees, N.J., lost his New Jersey medical license in 2010 after regulators discovered an arrangement under which he would begin second- and third-trimester abortions in New Jersey, and then have the patients drive themselves to Maryland the next day to complete the procedures.
His attorneys argued in a motion filed last week that the arrangement protects him from criminal prosecution in Maryland because Brigham administered drugs that killed the fetuses while the patients were in New Jersey. He then extracted the fetuses at his clinic in Elkton, Md., a small town in the northeast corner of the state.
Brigham's lawyers also argue that he is immune from prosecution under Maryland's fetal homicide law, which was intended to apply to people who kill or do physical harm to pregnant women, causing fetal death. The law includes exemptions for physicians administering lawful medical care, and Brigham's attorneys say using it against an abortion doctor interferes with a woman's constitutional right to terminate a pregnancy.
"By bringing these charges, the state has placed a chilling effect on doctors who perform abortions and thus will inhibit women from finding doctors who perform abortions even if the procedure is necessary to protect the life or health of the woman," attorneys Nancy Forster and C. Thomas Brown argue in their motion.
Cecil County State's Attorney Ellis Rollins declined to comment Monday.
Prosecutors have made few public statements about their rationale for the charges, although Rollins has acknowledged they are in uncharted territory. Experts on both sides of the abortion debate say it is highly unusual, if not unprecedented, to charge an abortion doctor with murder under a fetal homicide law. Thirty-eight states have such statutes.
At a bail review hearing earlier this month in Cecil County Circuit Court for Brigham's co-defendant, Dr. Nicola Riley, Deputy State's Attorney Kerwin Miller suggested that prosecutors believe any death of a viable fetus to be homicide, regardless of the circumstances.
"The law is clear that it is unlawful, as a matter of fact it is homicide, when you kill a viable fetus," Miller said, according to a transcript of the proceeding. "So an abortion on a viable fetus is not a lawful procedure, is not lawful medical care."
In their motion, Brigham's attorneys also take issue with prosecutors' characterization of the fetuses as viable, arguing that the state has no right to interfere with a doctor's judgment about the need for an abortion.
Maryland's fetal homicide law, the attorneys argue, "leaves the determination of viability to the 'best medical judgment of the attending physician.' If a doctor determines that the fetus is not viable, for whatever reason, and the state disagrees with that determination, under their theory, the doctor can be charged with fetal homicide."
Doctors generally consider fetuses to be viable outside the womb starting around 23 weeks. Prosecutors have not detailed how they determined the viability of the five fetuses Brigham is accused of killing. One of them was known to have been aborted at 21 weeks.
Riley, Brigham's former colleague, also has been charged with murder in the death of that 21-week-old fetus. Her attorneys also have argued that she is immune from prosecution under the fetal homicide law. Both Brigham and Riley, of Salt Lake City, Utah, are free on bond.
In the case that led to charges against both Brigham and Riley, the patient suffered serious injuries, and Riley drove her to a nearby hospital rather than call 911. That case alerted medical regulators to Brigham's unusual arrangement, which authorities described as an effort to take advantage of Maryland's more permissive abortion laws. Brigham was not licensed to perform abortions after the first trimester in New Jersey.
In Maryland, licensed physicians can perform abortions before the fetus is deemed capable of surviving outside the womb, and abortions of viable fetuses are permitted to protect the life or health of the mother or if the fetus has serious genetic abnormalities.
carried out by researchers at the world-renowned Johns Hopkins Bloomberg School of Public Health and Medical Institutions in Baltimore and published online this week in the medical journal Obesity. They found that physicians with a high body mass index (BMI) were almost half as likely to discuss weight-management issues with overweight and obese patients than doctors with normal BMIs (18% versus 30%, respectively). The study’s lead researcher Dr. Sara Bleich says they also found that doctors with normal BMIs felt more confident in their competency to provide weight-loss advice to patients than their overweight colleagues (53% versus 37%, respectively). Because primary care doctors in particular can be highly influential in intervening and counseling patients struggling with their weight, the study’s authors believe that a physician’s BMI may be a critical factor in a patient’s obesity care. Bleich’s team looked at a cross section of 500 general internists, general practitioners and family practice doctors, recruiting physicians from a pool of volunteers through the Epocrates Honors panel which has a membership of some 145,000 AMA-certified doctors. Each participating physician was asked to fill out a questionnaire with questions relating to diagnosing obesity and weight-management strategies. They were also asked to score their own effectiveness in helping patients with weight loss, including initiating counseling and prescribing weight-loss medications. The study also examined the doctors’ perspectives on the importance of modeling healthy behavior and whether they believed that a patient’s trust in the soundness of their doctor’s advice was connected with the doctor’s weight. The results indicated that doctors with normal BMIs were more likely than their overweight counterparts to believe that physicians have a responsibility to serve as role models for their patients in terms of maintaining healthy weight (73% versus 57%, respectively). A similar correlation was also observed regarding how the participants thought their patients perceive the relationship between their doctor’s weight and his competence in advising them. Some 79% of the normal-weight responders believed that patients were more likely to trust the advice of a non-overweight doctor compared with 69% of the overweight or obese doctors. The largest discrepancy came in terms of how the MDs’ perception of their own weight affected their diagnoses and treatment recommendations for overweight patients. Of the surveyed doctors, 93% reported that they were more likely to diagnose a patient as obese if they perceived that patient’s body weight as being greater than their own compared to 7% who said they wouldn’t. Approximately the same ratio held true for whether or not they would start a conversation about weight loss with a patient they thought heavier than themselves. While the study provides researchers with some initial orientation and insight into a largely unexplored field of weight-loss studies, the authors were quick to point out their study has a number of critical weaknesses and cannot yet be treated as medical gospel. For one thing, the study was set-up to show possible correlation only and cannot be held up as an example of causal evidence that skinnier doctors are more effective in helping patients lose weight. Moreover, because a number of the questions relied not on the physicians’ actual BMI but rather on their self-image—the accuracy of which can vary greatly from one responder to the next—exact relationships cannot be objectively determined. Nonetheless, the team stated, some general advice can still be gleaned from the survey. “Physician self-efficacy to care for obese patients—regardless of their BMI—may be improved by targeting physician well being and enhancing the quality of obesity-related training in medical school, residency or continuing medical education,” their report concluded. --- On the Net:
Earlier this month, celebrity chef Paula Deen announced that she has adult-onset or type 2 diabetes, then accepted a multimillion dollar deal to promote Novo Nordisk’s type 2 diabetes drug, Victoza. Before there was Paula Deen, there was figure skater
Dorothy Hamill and actor
Wilford Brimley. Indeed, there has been a long line of celebrity spokespeople for pharmaceutical companies, and their track record thus far has been quite poor in terms of honesty, openness, and promoting the public’s health.
Middle-aged arthritis sufferers flocked to their doctors demanding Vioxx for pain relief after watching Hamill figure skate in TV ads touting the drug shortly into the new millennium. We now have
evidence that Vioxx caused as many as 140,000 extra cases of serious heart disease in the United States during the years that its maker concealed evidence of its risks, and it was withdrawn from the US market in 2004.
All right, you say, Hamill was paid to shill for a dangerous drug. But what could be wrong with Brimley telling diabetics to check their blood sugar?
There is one group of patients with type 2 diabetes, the most common form of the disease, who need to check their sugar levels frequently and who really need those cute little machines. Those are also those (apparently including Brimley) who take insulin shots. But the majority of type 2 diabetes folks take only oral medicines or use diet and exercise to regulate their blood sugar. From those ubiquitous TV ads in the late 1990s and early 2000s, however, you’d guess that scientific studies show great health advantages to religiously using home glucose monitors.
Funny thing, though. The available research shows overwhelmingly that there’s no known health benefit to home glucose monitoring for people not on insulin. A number of
large studies on improving outcomes and death rates in diabetes show consistently that tight blood sugar control is not where the action is. Rather, type 2 diabetes tends to strike through severe complications like heart attacks, strokes, kidney failure, and other diseases that basically are caused by diabetes’ effects on both large and small blood vessels. Doing things to protect yourself from those diseases—diet, exercise, stopping smoking, controlling blood pressure, and so on—improves and lengthens life in diabetics. Lowering blood sugar by itself hardly helps at all.
Don’t hold your breath waiting for highly-paid celebrity spokespersons to tell you these important medical facts on TV. And the reason they won’t is part of why the whole system of celebrities touting drugs and medical devices is unfortunate for public health. These ads don’t just sell us products. They sell us ways to think about disease. And the industry wants to be sure that the way we think about a disease is whatever way is best for pushing their sales and profits.
Physician and historian
Jeremy Greene wrote about this a few years ago. He showed how the pharmaceutical industry jumped onto the preventive medicine bandwagon to convince both doctors and the rest of us to “prescribe by the numbers”—not to ask what drugs actually lengthened life or improved quality, but simply to be happy when a lab test result, such as blood sugar or cholesterol, was high and a drug made it go lower. It turns out that it’s much easier to discover and market a drug that makes your lab values look prettier than it is to find drugs that really save lives and prevent heart attacks. But most of us simply assume that lower lab numbers mean less risk and a healthier future—a connection that medical research informs us is often missing. (A great book on this frequent lack of connection is
Overdiagnosed by W. Gilbert Welch.)
Now, at this point I have to add the usual disclaimer, and then a disclaimer on the disclaimer. The disclaimer is that you should treat your medical condition based on your doctor’s advice and not what you read on a blog or news outlet. If you have diabetes, for instance, find a physician that you trust and follow that physician’s advice, though you should also ask questions and feel free to do your own research.
But here’s disclaimer squared: when a drug or device company markets products to you with a celebrity spokesperson, you can be sure that the same marketing, probably on steroids, is going on behind the scenes in doctors’ offices and hospital corridors. When at least 84 percent of American doctors regularly rely on industry salespeople for critical information about drugs, the “prescribe by the numbers” message is
just as ingrained in their thinking as it is in the general public’s. (The celebrities that drug companies use to brainwash doctors are not the Wilford Brimleys of the world, but rather distinguished medical school faculty physicians who happily take company money to serve on their speakers’ bureaus and to push the company marketing message.)
So, bottom line: is there something especially bad about any single celebrity deciding to shill for a particular drug or medical device, like Paula Deen telling us to eat cheeseburgers and also take good care of our diabetes? Maybe yes, maybe no. Is there a problem with how these products are marketed in the United States today? Absolutely.
Howard Brody is a family physician and medical ethicist and directs the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston. He maintains
a blog on the ethics of the relationship between the medical profession and the pharmaceutical industry.
Nurses, midwives and allied health workers across Australia are wanted to take part in a study exploring the international migration of health and social care workers.
Nurses and allied health professionals who have migrated here along with non-migrant workers are wanted to take part in the Public Services International study.
The New South Wales Nurses’ Association and Queensland Nurses Union are taking part in the research project, surveying nurses and midwives to collate evidence about migration experiences and to find out why people migrate and how the experience of migration can be improved.
With a global shortage of more than four million health care workers and an exodus of workers leaving the sector, with many migrating in search of better pay and conditions in other countries, PSI wants to map migration and forge a global report on the issue, which will be presented at its international conference in South Africa later this year.
NSW Nurses’ Association acting assistant general secretary Lisa Kremmer said the survey hoped to provide a snapshot of health worker migration to Australia.
“There’s been a recent report released of research in South Africa and Australia is one of their more population destinations,” she said.
“Australia is one of the first countries of destination to be participating (in the study) so it’s very exciting.”
Ms Kremmer said the two separate surveys, one for migration and the other for non-migration, would discover migrating nurses and midwives’ country of origin, their job position, reasons for migration, when they migrated, their experiences and whether their experience or skills had been recognised here and what can be done to improve the process.
The non-migration survey explores what value overseas nurses play in Australia, any issues, and what can be done to improve the transition, she said.
“It explores a whole range of things around an overseas nurse working in the Australian context,” she said.
“I think there’s lots of areas that we can learn from with this project to try and improve on in the future.”
Ms Kremmer said while the union was targeting nurses and midwives, the survey was open for all health care workers to complete.
For more information contact Lisa Kremmer on (02) 8595 1234 or lkremmer@nswnurses.asn.au.
Surveys are available electronically and can be returned via email.
For many years, global health has been associated with diseases like HIV/AIDS and malaria. And rightly so. These diseases present significant threats to health around the world. But they aren't the only major killers. In fact, they're not even the leading killers anymore! Today, cancer claims more lives globally than HIV/AIDS, malaria, and tuberculosis combined, and the death toll from cancer is only going to grow.
How can this be? Well, there are two major factors that affect the growing impact of cancer around the world.
First, we've done a much better job of controlling diseases that used to kill people while they were still quite young. Vaccinations, new medications including antibiotics, and prevention programs (like providing bed nets to combat mosquitoes and malaria, and clean drinking water to curb a host of other water-borne illnesses) have led to people living longer. And as people live longer they are faced with the diseases more common to older age, such as cancer.
Second, when people live longer, there is a greater chance that they will be exposed to cancer-causing agents - like tobacco - at some point in their lives. Longer lives plus greater exposure to cancer-causing substances equals more cancer.
'Reduce suffering and death'
For nearly 100 years, the American Cancer Society has been working to save lives and reduce suffering from cancer in the United States. But did you know that for most of our history we've also supported the
fight against cancer globally? That's right, the American Cancer Society is one of a handful of organizations striving to end cancer wherever it occurs.
So why is the global fight against cancer so important? No reason is more important than the commitment "to reduce suffering and death" that appears at the heart of our mission. Cancer doesn't recognize geographic boundaries; it doesn't stop at the border. We live in an interconnected world.
The Society is working throughout the world to make sure that people everywhere know about deadly risk factors that cause cancer, like tobacco and obesity, and we are helping other countries establish policies to make their communities safer. The success in reducing the number of Americans who smoke through education and life-saving polices has had a direct impact on tobacco use in other regions of the world. As Americans quit smoking, the tobacco industry has gone looking for new markets for their products. As a result, some of the highest smoking rates in the world today are in low- and middle-income countries where tobacco controls are weak.
We've also seen the market for fast and convenience foods expand dramatically. Many of the production techniques and marketing tactics that were perfected in the United States are now being used in the developing world. One result of easier access to this type of food, which tends to be less-nutritious, is that obesity rates are exploding everywhere. Worldwide obesity has more than doubled since 1980.
To combat these dangerous trends, we are helping other countries promote smoke-free environments and increases in the price of cigarettes in order to reduce the number of people who smoke and who may eventually get cancer. And we are helping to educate people about the importance of exercise and maintaining a healthy weight in helping to prevent and control cancer.
Sharing advances
Once, not too long ago, cancer was a death sentence. Today, we have more opportunities than ever to save lives. We have vaccines for Hepatitis B, which is associated with liver cancer, and human papillomavirus (HPV), which is responsible for most cases of cervical cancer. We have effective screening tests for breast, colon, and cervical cancers. We have treatments for cancer that are getting better and better.
The tools at our disposal are powerful and effective. Some are ready to be used worldwide right now. For instance, we are teaching and funding patient groups in Brazil to advocate for better breast cancer screening and treatment; we're doing economic research on the impact of tobacco on South African communities and in their general society; in India, we've partnered with an organization to help people quit tobacco, assisting with training, offering culturally-relevant materials, and helping strengthen community involvement and advocacy efforts to change laws regarding tobacco; also in India, we're providing technical support and funding for
patient navigation, particularly important because of their large underserved communities.
Certain issues like tobacco require a global solution. You can't fight a multinational industry in just one country and succeed. The stronger the tobacco industry is abroad, the more resources it has to advance its interests everywhere, including the United States. In addition, as the world becomes more interconnected, our work in other regions of the world becomes more important to us at home. For example, research and interventions conducted in other countries can give us insight into new ways to reach immigrant and underserved communities in the United States.
We have the knowledge to help prevent and effectively treat many cases of cancer around the world; we simply need the will to do so.
Grey is the national vice president of global health for the American Cancer Society.
Johnny Carson once said that if you want to clear your system out, sit on a piece of cheese and swallow a mouse. Many would claim that a homeopath's prescription for colonic purging would be about as helpful. In the UK activists have devised a colourful way to make their point.
The Guardian reports on a series of unusual protests outside pharmacies in the UK. On Saturday, January 30, hundreds of self-proclaimed skeptics gathered to denounce the Boots chain's hawking of homeopathic remedies, treatments that are unregulated and have little or no scientific basis. At precisely 10:23am local time protesters staged a series of mass overdoses in several cities, downing entire bottles of pills and potions to emphasize their worthlessness as medicine.
A promised sympathy demo was to have taken place in Canada, but at least according to
CanadaPharmacyNews, no one seems to have braved the cold to have at it with Canuck homeopathy.
Skeptics argue that theories behind homeopathy – which relies on the extreme dilution of animal, plant, mineral as well as synthetic substances so that remedies do not contain a molecule of the original substance – are utter nonsense. Most scientists agree that the only possible impact of such remedies is as a placebo. The
10:23 Campaign, which organized the demonstrations in Britain, has created an interesting website, with a provocative collection of
videos. Richard Dawkins is entertaining as he demolishes homeopathic theory in less than ten minutes.
As predicted, no ill effects were reported from consuming massive amounts of homeopathic remedies. Anti-homeopathy groups have targeted Boots because they believe its nationwide status as a long-established pharmacy retailer gives the public false confidence in such products. The sale of homeopathic pills and potions in drugstores – along with potato chips, candy and soft drinks – sends a mixed message.
The anti-homeopathy lobby believes that by diverting people with genuine complaints away from conventional medicine homeopaths can put lives at risk. They cite cases of patients who have been been warned away from vaccinations, given homeopathic preparations for serious diseases like malaria, or advised to stop taking medication for cardiac disease.
The Canadian Pharmacists Association (CPhA) has not changed its position on homeopathy since 1998, when it issued a
brief on herbal and homeopathic products, making several recommendations that generally revolved around ensuring that such preparations are regulated, that their claims of efficacy are substantiated by available clinical data, and that the safety of the Canadian public is protected.
The
Natural Health Products Regulations require all homeopathic medicines to have a licence before being sold in Canada. Licence holders are issued a product number which must appear on the label of their product. The Natural Health Products Directorate (NHPD), which is responsible for issuing product licences for all natural health products, uses evidence submitted by applicants to critically assess the safety, efficacy and quality of NHPs before approving them for sale in Canada.
In addition to a product licence, all businesses in Canada which manufacture, package, label and/or import homeopathic medicines for sale must also have a site licence as of January 1, 2006. For more information on
Canadian regulation of natural and homeopathic products, see the Health Canada website. Despite these detailed rules, Canada's pharmacies are full of products of questionable pedigree.
Caveat emptor
.
Photo credits:
flickr photo by
TW Collins
flickr photo by
ten23campaign
Earthquakes are continuing to take a toll on New Zealand’s health facilities.
The Canterbury District Health Board has been forced to suddenly close the 1923-built theatre block at Ashburton Hospital, after engineering assessments raised fears the unreinforced masonry buildings could collapse in the event of a major earthquake.
The hospital’s general operating theatre carries out 1500 procedures each year on a day and short stay basis, made up of mainly general surgery and gynaecology.
CDHB cancelled 13 scheduled surgeries and rescheduled others at Christchurch Hospital as concerns grew that further buildings at Ashburton may be closed due to quake risk.
Meanwhile, Christchurch Hospital, which provides services to over 35,600 inpatients each year, will have its landmark chimney removed amid fears it could crumble in another earthquake.
Since the September 2010 quake, more than 7500 CDHB hospital rooms have been damaged.
The organisation has made urgent major repairs while further inspections are continuing at some of its 200 buildings throughout the Canterbury region.
Up to 14 theatre staff at Ashburton Hospital will be affected and while no job losses are envisaged, some staff could be asked to work in different areas at the hospital or at different locations.
CDHB chief executive David Meates said the building was assessed as part of CDHB’s process of reviewing the seismic capacity of buildings.
“We cannot continue to operate in this theatre given that we are still experiencing quakes and we know parts of the building are earthquake-prone,” he said.
“We are waiting for engineering assessments on other buildings on the Ashburton site.
“However, because of their age it is likely some of these buildings, including wards, may also be earthquake prone.”
Mr Meates said he expected the reports to be completed within weeks.
“At that point we will need to explore a range of options for service delivery in Ashburton.”
CDHB expects the cost of repairs, initially estimated to be $70 million, could rise as a result of further inspections.
Details of a major new collaboration involving many of the world's most recognisable pharmaceutical firms were announced at the end of January 2012.
Working alongside governments and a number of prominent global health agencies, they'll be donating both drugs and insight in a bid to manage or eradicate 10 tropical diseases over the next eight years.
The tie-up represents the largest ever measure taken against the likes of sleeping sickness, Guinea worm disease and leprosy, all of which come under the NTDs (Neglected Tropical Diseases) tag. Sleeping sickness is spread by the tsetse fly while another type of insect causes Chagas disease infections in humans.
Neglected Tropical Disease Drugs
Come 2020, 14 billion individual doses will have been supplied to the Neglected Tropical Disease drugs cause. 13 drugs firm are involved in all, including GlaxoSmithKline and Novartis while, on the political side, the British, US and UAE governments are leading the initiative.
"With the boost to this momentum being made today, I am confident almost all of these diseases can be eliminated or controlled by the end of this decade", Margaret Chan - the Director-General of the World Health Organization - stated.
Neglected Tropical Diseases are rife within the world's poorest nations. According to the best guesses of medical experts, they affect in excess of one billion people, with children making up more than half of affected cases.
NTD Drug Doses
In its first report on the state of these diseases released in 2010, WHO highlighted the draining impact they have on economies but stressed how they tended to be ignored, since there's not too much money to be made from developing and distributing the NTD drugs that would be used to treat them.
"We fully support the WHO's bold vision and we are committed to playing our part in helping to achieve universal coverage of intervention programmes for diseases that can be controlled or eliminated by existing treatments, and to spur R&D into new treatments for diseases where none currently exist", GSK's Chief Executive Officer, Sir Andrew Witty, stated in a company release.
"Through this new partnership, we have both the means and the energy to strike a decisive blow against disease in the world's poorest countries."
Image copyright Geoffrey M. Attardo - Courtesy Wikimedia Commons
It isn't often that a prescription product repurposed on the street then returns to the clinic. But that's just what's happening with ketamine, sold as a generic and by Pfizer (
$PFE) under the brand names Ketalar and Ketaject (and illegally as Special K). Studies testing the injectable against depression are yielding some dramatic results, described by patients in language familiar to recreational users.
Researchers from the National Institute for Mental Health and from Houston's Ben Taub General Hospital have administered ketamine to severely depressed patients with almost instantaneous results, NPR reports. Yale scientists have pinpointed a potential explanation: Ketamine appears to affect glutamate in the brain, triggering new connections among brain cells.
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"I feel that something's lifted or feel that I've never been depressed in my life," was how NIMH researcher Carlos Zarate described his ketamine patients' reactions. "And it was a different experience from feeling high. This was feeling that something has been removed." One Ben Taub study patient, who believes she got ketamine, not placebo, said she went home feeling "no more fogginess, no more heaviness." Both of them reactions that
LA Weekly
deemed obvious. "Any raver could have told you this," the paper said.
Ketamine has serious potential side effects, including hallucinations during its infusion--and, not insignificantly, addiction. But unlike drugs already approved as antidepressants, the injectable appears to work quickly, a big advantage for patients in crisis. Further study is on the way; the Ben Taub researchers say that if their trial shows that ketamine outperforms a placebo, they plan to conduct a longer-term study to determine whether its effects could be long-lasting.
- see the blog
post at NPR
- get
more, also from NPR
- see the
LA Weekly
post
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Kader Arif, the lead Acta negotiator in the European Parliament, says Acta potentially cuts access to lifesaving generic drugs and restricts online freedom
The French MEP who resigned his position in charge of negotiating the international Anti-Counterfeiting Trade Agreement (Acta) has said it "goes too far" by potentially cutting access to lifesaving generic drugs and restricting internet freedom.
In an exclusive interview with the Guardian, Kader Arif – a member of the European parliament's international trade group, who was the lead negotiator over Acta – said that despite talks over the agreement having begun in 2007, "the European parliament, which represents the rights of the people, had no access to this mandate, neither had it information of the position defended by the commission or the demands of the other parties to the agreement".
Arif resigned in protest on 26 January as the EU signed the treaty, saying that he wished to "denounce in the strongest manner the process that led to the signing of this agreement: no association of civil society [and] lack of transparency from the beginning".
He said that it now threatens online freedom, access to the use of generic versions of drugs for treating illnesses, and could potentially mean that someone crossing a border who has a single song or film on their computer could face criminal charges.
Asked what he thought European citizens should do, Mr Arif said: "Showing that there is interest and concern about this agreement is the best way of creating a real public debate, which was never possible until now because of the lack of transparency on this dossier. Especially if the timeframe is short, raising awareness of members of parliament will be crucial. And because Acta is a mixed agreement, it will have to be ratified both by the European parliament and by every member state of the union, so there is also an opportunity to organise debates at the national level."
He says that it is now impossible to renegotiate the agreement because the 11 key parties to it concluded their discussions on 1 October 2011: "the European commission negotiated it on behalf of the EU, on the basis of a mandate given by the member states in 2007."
That means, he says, that "at this stage one can only accept or reject the agreement – no change of the text is possible. If the right wing of the European parliament had not imposed such a tight calendar, the members of the European parliament could have drafted an interim report, which would have put conditionalities to the ratification of the agreement, by giving recommendations to the commission and member states on how to implement it. But this is no longer a feasible option."
"The title of this agreement is misleading, because it's not only about counterfeiting, it's about the violation of intellectual property rights," he told the Guardian. "There is a major difference between these two concepts."
Acta
has triggered public protests in a number of European and other countries, as well as online attacks by the hacking collective Anonymous. The US, EU member states, Australia, New Zealand, Canada, Japan and a number of other countries have signed it, although none has yet ratified it in national legislation.
The agreement would create an international framework and set of standards for a voluntary legal regime to enforce intellectual property rights across national boundaries.
Arif said one example illustrates this difference particularly well – the case of generic medicines. "Generic medicines are not counterfeited medicines; they are not the fake version of a drug; they are a generic version of a drug, produced either because the patent on the original drug has expired, or because a country has to put in place public health policies," he said.
A number of countries such as India and African nations have sought to use generic versions of drugs for infections such as HIV, which has often been resisted by pharmaceutical companies. Under Acta, Arif fears such countries would not have the same freedom to determine their own actions.
"There are international agreements,
such as the Trips agreement, which foresees this last possibility," he said. "They're particularly important for developing countries which cannot afford to pay for patented HIV drugs, for example.
"The problem with Acta is that, by focusing on the fight against violation of intellectual property rights in general, it treats a generic drug just as a counterfeited drug. This means the patent holder can stop the shipping of the drugs to a developing country, seize the cargo and even order the destruction of the drugs as a preventive measure."
He thinks that is a key flaw: "Acta also limits the flexibilities listed in the Trips agreements to support developing countries in need of generic drugs. When the question of finding the right equilibrium between protection of intellectual property rights and protection of final users is so crucial, Acta appears to be very unbalanced in favour of patent holders. This is one of the major problems with the agreement."
Internet freedoms could also be under threat if Acta is ratified in its present form, he says. "The chapter on internet is particularly worrying as some experts consider it reintroduces the concept of liability of internet providers, which is clearly excluded in the European legislation." That could make ISPs, who provide internet access, liable for users' illicit file-sharing.
Arif also expressed concern that there could be more intrusive checks at borders to fight counterfeiting.
"I see a great risk concerning checks at borders, and the agreement foresees criminal sanctions against people using counterfeited products as a commercial activity," he said.
"This is relevant for the trade of fake shoes or bags for example, but what about data downloaded from the internet? If a customs officer considers that you may set up a commercial activity just by having one movie or one song on your computer, which is true in theory, you could face criminal sanctions.
"I don't want people to have their laptops or MP3 players searched at borders, there needs to be a clearer distinction between normal citizens and counterfeiters which trade fake products as a commercial activity. Acta goes too far."
The
text of the finalised treaty (PDF) has now been made public, and the European commission has begun to try to explain how Acta would work. It has also published a document called
10 Myths about Acta, asserting that the public was informed "since the launch of the negotiations"; that it is drafted "in very flexible terms" and that "safeguards and exceptions under EU law or under the Trips agreement remain fully preserved".
It also insists that "Acta is about tackling large-scale illegal activity … there is a provision on Acta specifically exempting travellers from checks if the infringing goods are of a non-commercial nature and not part of large-scale trafficking".
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The following post is a midwinter dispatch from Dylan Stableford of Yahoo! News
FAIRFIELD, Conn. — "I never wanted to be the general manager of the New York Yankees," Brian Cashman said. "I still don't."
You would think he was joking, but he said it twice.
Cashman and Theo Epstein, his former Red Sox rival-cum-Cubs president, took part in a wide-ranging, surprisingly candid discussion with ESPN's Steve Berthiaume on the campus of Sacred Heart University in Fairfield, Connecticut on Tuesday.
Theo and Cash, as they call each other now, have not seen Moneyball.
"We live it," Epstein said.
But they have enough stories for a sequel.
Cashman recounted his contentious relationship with George Steinbrenner. "We had some legendary fights," Cashman recalled, calling the late Yankees owner "intense" and "the boss of all bosses."
"Forget the game, every inning was Armageddon," Cashman said. "It was very tough to operate like that in a game of chance like baseball."
The Yankees GMs that had preceded him— including Bob Watson and Bob Quinn — were worried about their health. And he understood why: "The jubilation from the winning was, 'Thank God we didn't lose.'"
The most striking example of that dynamic came during the 2000 Subway Series against the Mets, when Steinbrenner was concerned that the Yankees' television contract with MSG hinged on the outcome. "It felt like if we lost, we'd lose the city," Cashman said. "The entire corporate business plan was on the line."
At one point during a Q+A with the audience, a brash youngster asked Cashman bluntly, "Do you feel comfortable with A.J. Burnett in the starting rotation?"
"You sound like George," Cashman quipped.
Losing was not tolerated off the field, either — especially when it came to free agents coveted by Epstein, like, say, Jose Contreras.
In 2002, Boston's Latin American scout was the first to arrive at a Nicaraguan hotel where Contreras — who had defected from the Cuban national team--was staying, and booked the room next to the right-hander.
"He called me up and said, 'All the other teams are on their way down here, what do you want me to do?' I said, 'Buy all the rooms,'" Epstein recalled. He did, and Yankees executives were forced to stay down the road. "We were smoking cigars and drinking rum [with Contreras] at four in the morning."
"The boss was not happy," Cashman recalled of Epstein's stunt. "He would not be denied."
The next day, Epstein said, the Yankees offered him $10 million more.
"That was it," Epstein said, adding that he confronted Contreras in the tunnel at Yankees Stadium years later. "I said, 'What happened?' He said, 'I don't know.'"
Another pitcher both executives coveted was Curt Schilling. In Nov. 2003, Epstein flew to Arizona to negotiate a contract with Schilling, spending Thanksgiving with the family. Schilling's wife cooked her first Thanksgiving turkey. Jed Hoyer, Epstein's assistant GM, got food poisoning.
"He was vomiting all over the place," Epstein said. "I was throwing $20 bills all over the hotel room for the maid because I felt so bad."
When Epstein finally reached a deal with Schilling, he said he walked into Schilling's home office to type up the contract. Sitting on the desk, a copy of "Negotiating For Dummies."
"He had been using it the whole time," Epstein said.
The new Cubs GM bemoaned the rise of Moneyball-style management, because until the book became a New York Times bestseller, only a handful of teams were able to truly assess the market.
"Owner of baseball teams have a lot of leisure time because they're really rich," Epstein said. "So they're on their yachts, reading 'Moneyball,' saying, 'Hey, why aren't we doing this?'"
The unlikely chummy GMs revealed only once did they even discuss a trade, when Epstein, then in his first year in Boston, offered Shea Hillenbrand for Nick Johnson.
"Cash laughed at me," Epstein said.
Dylan Stableford works for Yahoo! News. Find more of his work
here or follow him on Twitter —
@stableford.
The researchers aren't recommending anyone begin taking inorganic nitrate supplements based on the new findings. Rather, they say that the results may offer one explanation for the well-known health benefits of fruits and vegetables, and leafy green vegetables in particular.
We're talking about an amount of nitrate equivalent to what is found in two or three red beets or a plate of spinach, said Eddie Weitzberg of the Karolinska Institutet in Sweden. We know that diets rich in fruits and vegetables can help prevent cardiovascular disease and diabetes but the active nutrients haven't been clear. This shows inorganic nitrate as a candidate to explain those benefits.
In fact, up until recently nitrate wasn't thought to have any nutritional value at all. It has even been suggested that this component of vegetables might be toxic. But Weitzberg and his colleague Jon Lundberg earlier showed that dietary nitrate feeds into a pathway that produces nitric oxide with the help of friendly bacteria found in our mouths. Nitric oxide has been known for two decades as a physiologically important molecule. It opens up our blood vessels to lower blood pressure, for instance.
The new study offers yet another benefit of nitrate and the nitric oxides that stem from them. It appears that the increased mitochondrial efficiency is owed to lower levels of proteins that normally make the cellular powerhouses leaky. Mitochondria normally aren't fully efficient, Weitzberg explained. No machine is.
Questions do remain. The new results show that increased dietary nitrate can have a rather immediate effect. But it's not yet clear what might happen in people who consume higher levels of inorganic nitrate over longer periods of time. Weitzberg says it will be a natural next step to repeat the experiment in people with conditions linked to mitochondrial dysfunction, including diabetes and cardiovascular disease, to see if they too enjoy the benefits of nitrates.
Among the more consistent findings from nutritional research are the beneficial effects of a high intake of fruit and vegetables in protection against major disorders such as cardiovascular disease and diabetes, the researchers concluded. However, the underlying mechanism(s) responsible for these effects is still unclear, and trials with single nutrients have generally failed. It is tempting to speculate that boosting of the nitrate-nitrite-NO pathway may be one mechanism by which vegetables exert their protective effects.
As an interesting aside, Weitzberg says that the benefits of dietary nitrates suggest that powerful mouthwashes may have a downside. We need oral bacteria for the first step in nitrate reduction, he says. You could block the effects of inorganic nitrate if you use a strong mouthwash or spit [instead of swallowing your saliva]. In our view, strong mouthwashes are not good if you want this system to work.
statement. The Gates Foundation announced a five-year, $363 million commitment to support NTD product and operational research. Gates also announced last Thursday that the foundation would be donating $750 million to help fight AIDS through the Global Fund to Fight Aids program. The World Health Organization (WHO) unveiled a new strategy to fight NTDs, including a roadmap for implementation that sets targets for what can be achieved by the end of the decade. "The efforts of WHO, researchers, partners, and the contributions of industry have changed the face of NTDs. These ancient diseases are now being brought to their knees with stunning speed," Dr. Margaret Chan, Director-General of the WHO, said in a press release. "With the boost to this momentum being made today, I am confident almost all of these diseases can be eliminated or controlled by the end of this decade." In the largest coordinated effort yet to fight diseases like Guinea worm disease, leprosy and sleeping sickness, the group promised to give an average of 1.4 billion treatments each year to those in need. Experts say that a billion people are affected by NTDs around the world, including over 500 million children. The WHO said in a 2010 report on NTDs that while the diseases cost billions of dollars in lost productivity, they are often ignored because they affect mainly poor people and do not offer a profitable market for drug makers. Andrew Witty, CEO of GlaxoSmithKline, said speaking on behalf of the CEOs of the 13 pharmaceutical companies: "Many companies and organizations have worked for decades to fight these horrific diseases. But no one company or organization can do it alone." --- On the Net:
Since the first days of January 2012, Algeria has experienced a wave of protest and contestation in a dozen wilayas (regions) - either strikes, demonstrations or sit-ins in the streets, or in front of the wilaya headquarters, in industrial zones or even in high schools (Constantine) . This storm of protest is mostly led by
Algerian unemployed youth but it has attracted people of all ages.
Let's return briefly to the reforms announced by the president in 2011 to help us understand the current context, poised as we are four months before parliamentary elections scheduled for May 2012 that are pledged to be transparent - and the inspiring case of Laghouat (400 kilometers from Algiers).
In the first half of 2011, several political initiatives such as those taken by Algeria's
Coordination for Democratic Change (CNCD) or the Movement of Independent Youths for Change (MJIC) attempted to bring together different entities in order to organize peaceful demonstrations in Algiers. Many factors contributed to the failure of the movement: deep divisions within the opposition to the authoritarian regime; the regime strategy of isolating and attacking the credibility of the initiative; recurrent repression and violations of liberties that discourage political and citizen engagement; the disproportionate mobilization of security forces and certainly the fear inherited from the traumatic 'dark decade' (
of civil war in the 1990s). On the other side, a parallel dynamic - and maybe less elitist - started in January 2011, simultaneously with the events in Tunisia, and led to clashes between impoverished youngsters with no prospect/hope and the anti-riots special units. In April 2011, two months after the suspension of the state of emergency (that has not changed anything), the president Abdelaziz Bouteflika gave his first televised speech since the beginning of the events, calling for a return to calm, promising socio-economic measures and announcing political reforms.
Exclusive video by Al-Arabiya on the living conditions & protests – Laghouat
A few months later, nothing has changed in Algeria: the atmosphere remains the same. The priority of the so-called reforms was the 'securitarization' of civil society concretized by new laws governing the media, associations and the political parties that have been widely criticized. This series of 'reforms' eventually approved by the Constitutional Council - whose presidential mandate has expired - has marked a dangerous regression in the most fundamental rights and endorses state control in all the sectors that can act as forces of opposition. Amnesty International wrote a letter to the Algerian deputies to denounce the explicit violation of the international conventions signed by Algeria represented by this repressive draft law on associations, in vain. For instance, this law allows the authorities to ban 'foreign subsidies' – in others words, all the local offices or partners of Amnesty International, Transparency & others associations for the defense of human rights are clearly targeted and financially asphyxiated. Moreover, a regulatory agency will be created to control all the aspects of the media. There is considerable disappointment and disillusion with the content of these laws, so clearly designed by the Algerian authorities to defend the regime from any future source of destablisation.
Meanwhile, control of the
hydrocarbon sector and its rent flows remains an efficient tool to purchase social peace (public sector wage increases etc.) even if this strategy is not sustainable in the long-term.
2012: peaceful movements of protest in Laghouat & other oil and gas cities
However, these excessive attempts to protect the authoritarian structures cannot stifle socio-economic protest against unemployment (20-25% of the youth is unemployed, source IMF), the housing crisis (unsanitary housing conditions, overpopulated houses, social housing favoritism), obsolete health infrastructures, the lack of economic dynamism, corrupt local governance, the failures of the school system etc. The protests about unemployment, housing and public services have engendered solidarity between citizens of all ages over the last weeks. The shift from socioeconomic demands toward the politization of the movement (including a call for regional magistrates to step down, denunciation of corrupt and failed local governance etc.) contradicts the postulate that Algerian society is impermeable to universal aspirations of freedom, dignity and better living conditions. Furthermore, the country has known many massive movements of revolt and angry protest over the decades (1963, 1980, 1988, the dark decade). It is not doomed to suffer some kind of permanent fate or perennial status quo.
6th day of peaceful protest in Laghouat (collecting trash after the sit-in)
True, the political and institutional system - in which the military/intelligence services play a key political role - seems to be blocked and cannot be reformed without structural changes, an option that is excluded,
de facto
, by the regime. But there remains one alternative: the potential catalyst of democratic change in Algeria is certainly civil society.
Unfortunately civil society is closely controlled and regulated by these new laws that aim at 'legalizing' the previous abuses committed by the administrative and security authorities (a ban on meetings and demonstrations etc.). The opacity of the Algerian system also makes the situation more complex because of the existence of opposition parties who nevertheless work in cahoots with the authoritarian regime and many regime-affiliated or infiltrated associations, trade unions etc. that soon bring discredit to the rare independent initiative.
Protest in Algeria is often described in terms of recurrent, trivial and non-political local contestations. But the recent events in Laghouat - and other oil and gas cities - have been accompanied by peaceful protest which has lasted over a week. The sit-in and demonstrations in front of the wilaya headquarters have gathered unemployed persons together with the many who protest against the corrupt allocation of social housing (29 beneficiaries from the same family). They are denouncing foreign and Algerian hydrocarbon-extracting companies which do not use local employment agencies and do not offer any jobs to the inhabitants who live close to the giant gas field of Hassi R’mel (25% of the national gas production). The wilaya of Laghouat is criss-crossed by huge gas pipelines running towards Europe (Transmed & Maghreb-Europe) and the national oil company
Sonatrach had to deal with a previous lengthy sit-in in Laghouat as recently as in 2010.
The peaceful dimension of the protest is inspiring – the demonstrators chanting “selmiya” (peaceful) in the videos and even offering flowers to the police. However most Algerian newspapers and the Algerian authorities promptly described the movement in negative terms as 'violent riots', distorting the reality. The demonstrations have been supported by a general strike on January 8 that paralyzed the city (teachers, administrators, bus drivers etc.) and expressed considerable local solidarity for the protest. However, on the sixth day of protest, the governor ordered the police to use tear gas to break up the peaceful demonstration in front of his headquarters and arrested around 30 persons including minors (arrested at home). The day after, the protestors called for the liberation of the persons arrested and the resignation of the governor. He refused to resign in a letter while recognizing the irregularities in the attribution of social housing.
Protesters chanting
However, the Algerian authorities are now deeply perturbed by this new form of solidarity between citizens in peaceful contestation that can no longer justify the use of force by the security forces. Many Algerians have shared the videos of Laghouat (posted by Yacine Zaid, human rights activist) on the social networks and one of them commented on Twitter, “the attitude of the demonstrators in Laghouat is similar to the atmosphere that preceded the massive protests of October 1988”. Even if state television persists in associating every youth initiative with criminal/violent acts; the professionalization of the demonstrations is undeniable (videos, organization, clear and non-negotiable demands, use of social networks) and Laghouat has given the rest of us a great example of peaceful action for democratic change in Algeria.
Nevertheless, it would be utopian to expect that this exemplary action has become the norm. Unfortunately, for many years now, most demonstrations have led to clashes and riots because the authorities refuse pointblank to recognise the innate purpose of civil society - that is to aggregate the claims, defend them, and to be a mediator in an ongoing dialogue with the state. But, the Algerian system does not tolerate an independent civil society and this total denial of rights encourages pathological relationships between state and non-state entities and leads to predictable and recurrent violence. The traditional alternative 'violence or silence' with which we have so often been confronted has become far too frustrating, anti-democratic and impossible to accept in 2012.
To conclude, the fact that these cities in particular - Skikda, Ourgla, Laghouat - are located at the heart of oil and gas fields regions emphasizes the relative inefficiency of the Algerian rentier state. The Algerian economic and bureaucratic model seems unable to offer job opportunities to most young unemployed people, including well-qualified graduate students. It cannot operate without massive corruption on various levels of society and yet does not consider the resolution of our socioeconomic difficulties as a vital priority. Over the last week, anger at housing has unleashed more violent clashes between the population and anti-riot forces in Oran and in the Cite Baraka in Algiers while the number of self-immolations is constantly on the increase. Algeria may celebrate the 50th anniversary of its independence soon, but it is currently going through a pre-electoral turmoil that is particularly explosive and uncertain.
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