Venezuela’s opposition demands “whole truth” about Chavez health

CARACAS (Reuters) – Venezuela‘s opposition on Wednesday demanded the government tell “the whole truth” about the health of cancer-stricken President Hugo Chavez, who has not been heard from in three weeks after undergoing a grueling operation in Cuba.

Officials have acknowledged the usually garrulous former soldier’s health is delicate after his fourth cancer surgery in 18 months, but they have offered scant details on his condition.

He has not spoken in public in more than three weeks.

Ramon Aveledo, head of the opposition Democratic Unity coalition, slammed the government for not keeping its word about keeping Venezuelans informed.

“The official version (of Chavez’s health) hides more information than it gives,” Aveledo said at a press conference.

“The vice president himself has promised to tell the truth, whatever it is. Fine, he should tell it. He should tell the whole truth,” said Aveledo.

Vice President Nicolas Maduro, whom Chavez last month designated as his heir apparent, on Tuesday said in an interview from Havana that Chavez had recognized the complexity of his post-operative condition.

Maduro said he was returning to Venezuela after several days visiting with Chavez and his relatives, which may quell rumors his trip to Cuba signaled the president was in his final days.

The president’s son-in-law and Science Minister Jorge Arreaza, who is in Havana, said via his Twitter account on Wednesday that the medical team told him Chavez’s condition “remains stable” but that his health is still delicate.

“Commander Chavez is fighting hard and he sends his love to the people. Dedication and patience!!!” he tweeted.

Chavez’s abrupt exit from the political scene would be a shock for Venezuela, where his oil-financed socialism has made him a hero to the poor majority but a nemesis to critics who call him a dictator.

He is still set to be sworn in on January 10, as laid out in the constitution. If he dies or steps aside, new elections would be held within 30 days, with Maduro running as the Socialist Party candidate.

DELICATE HEALTH

Chavez suffered unexpected bleeding and a respiratory infection after a six-hour operation on December 11. Terse official statements have said nothing about when he might be expected back or whether his life is in danger.

The government has provided none of the signature videos or pictures released after Chavez was diagnosed with cancer in June 2011 and his relapse in 2012. And allies have refused to discuss the possibility that he could hand over power or resign.

Chavez last year staged what appeared to be remarkable comeback from the disease to win reelection to a third six-year term in October despite being weakened by radiation therapy. He returned to Cuba for new treatment within weeks of his win.

Officials from the ruling Socialist Party are now suggesting his inauguration could be postponed indefinitely to accommodate his health.

Aveledo insisted the government should stick to the January 10 timeline called for in the constitution.

“Trying to make the country believe that the president is governing is absurd to the point of being irresponsible,” he said. “January 10 marks the end of one presidential term and the start of another. As such, there is no continuation of the current government.”

Aveledo said if Chavez cannot make it back in time, he should hand power over to the president of Congress – who would temporarily run the country while elections are called.

Congress, controlled by Chavez allies, on Saturday elects a new president. Current Congress chief Diosdado Cabello, a close Chavez ally who could be reelected to head the legislature, has at times been considered a rival of Maduro. The two have taken great pains in recent weeks to publicly deny this.

While the constitution cites January 10 as the start of the new term, it does not explicitly state what happens if the president does not take office on that date.

Chavez’s condition is being watched closely by Latin American countries that have benefited from his generous assistance, as well as Wall Street investors who are drawn to Venezuela’s lucrative and heavily traded bonds.

(Editing by Cynthia Osterman)

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Gambian leader says to build herbal AIDS-cure hospital

BANJUL (Reuters) – AIDS patients would be offered an herbal cure at a 1,111-bed hospital in Gambia that the president said on Tuesday he plans to build despite medical concerns the treatment is dangerous.

President Yahya Jammeh said in 2007 he had found a remedy of boiled herbs to cure AIDS, stirring anger among Western medical experts who claimed he was giving false hope to the sick.

“With this project coming to fruition, we intend to treat 10,000 HIV/AIDS patients every six months through natural medicine,” Jammeh said in his New Year’s address, adding that he expected the 1,111-bed hospital to open in 2015.

The World Health Organisation and the United Nations have said Jammeh’s HIV/AIDS treatment is alarming mainly because patients are required to cease their anti-retroviral drugs, making them more prone to infection.

Jammeh said in October that 68 HIV/AIDS patients undergoing his herbal remedy had been cured and discharged, the seventh batch since the treatments began five years ago.

Other African leaders have drawn criticism for extolling the power of natural remedies to combat AIDS.

The administration of former South African President Thabo Mbeki was ridiculed for denying there was a link between HIV and AIDS while prescribing meaningless treatments such as beet root instead of internationally proven medicines.

The HIV rate in Gambia is relatively low compared to other African states, with 2 percent of the country’s roughly 1.8 million people infected, according to the United Nations.

Jammeh came to power in Gambia, a sliver of land on Africa’s west coast that is popular with sun-seeking European tourists, in a bloodless military coup in 1994.

He is accused by activists of human rights abuses during his rule, and most recently drew international criticism for executing nine death-row inmates by firing squad.

(Reporting by Pap Saine; Writing by Richard Valdmanis; Editing by Michael Roddy)

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New Year’s Resolutions For Better Health

New Year’s resolutions are typically so singular, self-focused and private. How about making a resolution or two this year that has benefits beyond yourself? Here are some suggestions with lots of links to get you started.

You can help stop the spread of disease. Resolve to get up-to-date on your vaccines. While children have a full slate of vaccines, many adults don’t realize they have regular immunization obligations, too. Getting flu, pertussis, human papillomavirus and other vaccines can protect you and help stop the spread of diseases that harm others. Here’s a great guide to adult immunizations from the federal government. If the cost of vaccines is an issue, check into free or low-cost immunizations through your county’s public health department. Here’s a guide to finding your local office. Volunteer with an organization that needs your help. A group called Catchafire matches professionals who wish to volunteer their skills to organizations that need the help — including many important health organizations. The idea is to give great organizations access to top talent while respecting the professionals’ schedules and making their volunteer work meaningful. Here’s the link. Influence a healthier food climate. Americans spend about half of their food budgets eating out. So we had better demand thorough nutritional information about what we’re getting. Under healthcare reform, many restaurant chains will soon carry nutritional information. But the law has loopholes. If you don’t see the information you’re looking for on salt, fat, calories or other nutrients, ask the restaurant’s manager where you can find it. Nutritional information should be easy to access. Until it is, speak up and ask for it. Do your part to keep down healthcare costs. The Affordable Care Act will bring many consumers into the insurance healthcare system for the first time. But that doesn’t mean we can ignore the cost of care. Rising healthcare costs remain a huge issue that could drag down the economy and bedevil some reform efforts. You can help by being a wise healthcare consumer. Read your insurance policy and know what it does and doesn’t cover. Take advantage of free preventive care services and screening tests under the ACA. Shop around for prescriptions to find the cheapest prices. Ask your doctor for generic equivalents. Finally, use your health savings account if your employer offers one. These accounts provide incentives for using your money wisely, shopping around to find the best healthcare prices and weighing the costs and benefits of certain drugs, tests or procedures.  Here’s a guide to understanding how HSAs work. Be responsible about the prescription drugs you store at home. You can reduce your own risk of addiction and lower the risk for others, too, if you are careful about medications kept in your home. This year marked a turning point in the nation’s epidemic of prescription-drug abuse and addiction.  Admissions to addiction treatment centers for use of narcotic painkillers rose 569 percent in the past decade, according to the federal government. More people now die from drug overdoses than from traffic accidents. More than six million Americans abuse prescription drugs, and more than 70 percent of addicts get their drugs through family or friends or by raiding a home medicine cabinet. Dispose of unused medications. The Drug Enforcement Agency operates a National Prescription Drug Take-Back Day a few times a year (the next one is in April), that makes it easy to dispose of dangerous substance.  Go through your home today and collect unused medications. You can take them to a pharmacy for disposal or even flush them down the toilet. Some drugs carry disposal instructions on the label. Here’s information on how to dispose of prescription medications. Be a safe driver. One of the biggest safety issues on the nation’s roads these days is driver distraction. A large share of the distractions come from talking on a hand-held cell phone or text messaging while driving. You’re 23 times more likely to crash if you text while driving. Most states now prohibit texting while driving, but there are still many people who do it while knowing it’s unsafe. Break yourself of this terrible habit. The federal government has a website that provides people with information and tools to discourage distracted driving. Included in this package is a simple pledge sheet you can print out, sign and post on your refrigerator door or bathroom to help you make the commitment. There are a couple of other things you can do, too. Speak out if the driver you’re riding with is distracted. Encourage family and friends to drive phone-free. Run a race for the greater good. Who doesn’t love a good 5K walk or run? You benefit from the exercise and, if you choose a charity race, others reap rewards, too. There are thousands of charity races each year. Pick one and invite your friends to participate with you. Here’s a website to help you find a race.  Apply for a grant. There’s money out there for doing good. Saucony’s Run for Good Foundation aims at preventing child obesity by promoting running as part of a healthy lifestyle for kids. The foundation issues grant money to organizations that want to organize a kids’ running group. You can find information on how to apply at the foundation website. Sign a petition. Concerned about flame retardants in consumer products? Gun safety? Funding for research to fight a particular disease? There’s probably a petition for that. It’s an easy way to make your voice heard. Both change.org and thepetitionsite.com are good places to look to find a petition close to your heart.

Question: What resolutions can you make to help others? Tell us what you think in the comments.

---

Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.

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State’s first flu death is Tulsa County resident

A Tulsa County resident between the ages of 19 and 64 is the first person in Oklahoma to die from the flu this season.

Since Sept. 30 there have been 24 hospitalizations due to flu reported in Tulsa County, the most for any county in the state.

Oklahoma County has reported 10, according to the Oklahoma State Department of Health.

There have been 75 flu hospitalizations throughout the state. Twenty-one of those were reported last week. The age range with the most hospitalizations was 65 and older with 28. Children under 4 accounted for 20 cases, according to the department.

Nationally 1,013 people have been hospitalized and eight children have died, according to the Centers for Disease Control and Prevention.

Flu activity has been increasing, particularly in the south central and southeastern regions of the county. Oklahoma reported regional flu activity last week while 29 states had widespread activity, according to the CDC.

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Ex-U.S. President George H.W. Bush in intensive care

AUSTIN, Texas (Reuters) – Former President George H.W. Bush is in the intensive care unit of a Houston hospital and is in “guarded condition,” family spokesman Jim McGrath said Wednesday.

“The president is alert and conversing with medical staff, and is surrounded by family,” McGrath said in a statement.

“Following a series of setbacks including a persistent fever, President Bush was admitted to the intensive care unit at Methodist Hospital on Sunday where he remains in guarded condition,” McGrath said.

Doctors at Methodist Hospital “continue to be cautiously optimistic about the current course of treatment,” McGrath said.

The 88-year-old was admitted to the hospital November 23 for bronchitis.

Bush, the 41st U.S. president and a Republican, took office in 1989 and served one term in the White House. The father of former President George W. Bush, he also served as a congressman, ambassador to the United Nations, envoy to China, CIA director and vice president for two terms under Ronald Reagan.

(Reporting by Corrie MacLaggan; Editing by Paul Thomasch and Phil Berlowitz)

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Catholic Church urges Irish to oppose abortion law

DUBLIN (Reuters) – The head of Ireland‘s Catholic Church urged followers in his Christmas Day message to lobby against government plans to legalize abortion.

Ireland, the only EU member state that currently outlaws the procedure, is preparing legislation that would allow limited access to abortion after the European Court of Human Rights criticized the current regime.

The death last month of an Indian woman who was denied an abortion of her dying foetus and later died of blood poisoning has intensified the debate around abortion, which remains a hugely divisive subject in the predominantly Catholic country.

“I hope that everyone who believes that the right to life is fundamental will make their voice heard in a reasonable, but forthright, way to their representatives,” Cardinal Sean Brady said in a Christmas message on Tuesday.

“No government has the right to remove that right from an innocent person.”

Irish Prime Minister Enda Kenny, a regular Mass goer, is bringing in legislation that would allow a woman to have an abortion if her life was at risk from pregnancy.

The country’s Supreme Court ruled in 1992 that abortion was permitted when a woman’s life was at risk but successive governments have avoided legislating for it because it is so divisive.

The death of Savita Halappanavar, who repeatedly asked for an abortion while she was miscarrying in an Irish hospital, highlighted the lack of clarity in Irish law that leaves doctors in a legally risky position.

Halappanavar’s death re-ignited the abortion debate and prompted large protests by groups both in favor of and against abortion.

Kenny and his conservative Fine Gael party have been criticized for tackling the abortion issue and some party members have indicated that they may not be able to back the law.

Relations between the Irish government and the once dominant Catholic Church are at an all-time low in the wake of years of clerical sex abuse scandals.

Kenny told parliament last year that the Vatican’s handling of the scandals had been dominated by “elitism and narcissism” and accused it of trying to cover up the abuse. The speech prompted the Vatican to recall its ambassador, or nuncio, to Ireland.

Brady, who has faced calls this year to resign over accusations he failed to warn parents their children were being sexually abused, said in his Christmas message that he wanted relations with government to improve.

“My hope is that the year ahead will see the relationship between faith and public life in our country move beyond the sometimes negative, exaggerated caricatures of the past.”

(Reporting by Carmel Crimmins; Editing by Sandra Maler)

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Few tests done at toxic sites after superstorm

OLD BRIDGE, N.J. (AP) — For more than a month, the U.S. Environmental Protection Agency has said that the recent superstorm didn’t cause significant problems at any of the 247 Superfund toxic waste sites it’s monitoring in New York and New Jersey.

But in many cases, no actual tests of soil or water are being conducted, just visual inspections.

The EPA conducted a handful of tests right after the storm, but couldn’t provide details or locations of any recent testing when asked last week. New Jersey officials point out that federally designated Superfund sites are EPA’s responsibility.

The 1980 Superfund law gave EPA the power to order cleanups of abandoned, spilled and illegally dumped hazardous wastes that threaten human health or the environment. The sites can involve long-term or short-term cleanups.

Jeff Tittel, executive director of the Sierra Club in New Jersey, says officials haven’t done enough to ensure there is no contamination from Superfund sites. He’s worried toxins could leach into groundwater and the ocean.

“It’s really serious and I think the EPA and the state of New Jersey have not done due diligence to make sure these sites have not created problems,” Tittel said.

The EPA said last month that none of the Superfund sites it monitors in New York or New Jersey sustained significant damage, but that it has done follow-up sampling at the Gowanus Canal site in Brooklyn, the Newtown Creek site on the border of Queens and Brooklyn, and the Raritan Bay Slag site, all of which flooded during the storm.

But last week, EPA spokeswoman Stacy Kika didn’t respond to questions about whether any soil or water tests have been done at the other 243 Superfund sites. The agency hasn’t said exactly how many of the sites flooded.

“Currently, we do not believe that any sites were impacted in ways that would pose a threat to nearby communities,” EPA said in a statement.

Politicians have been asking similar questions, too. On Nov. 29, U.S. Sen. Frank Lautenberg, D-N.J., wrote to the EPA to ask for “an additional assessment” of Sandy’s impact on Superfund sites in the state.

Elevated levels of lead, antimony, arsenic and copper have been found at the Raritan Bay Slag site, a Superfund site since 2009. Blast furnaces dumped lead at the site in the late 1960s and early 1970s, and lead slag was also used there to construct a seawall and jetty.

The EPA found lead levels as high as 142,000 parts per million were found at Raritan Bay in 2007. Natural soil levels for lead range from 50 to 400 parts per million.

The EPA took four samples from the site after Superstorm Sandy: two from a fenced-off beach area and two from a nearby public playground. One of the beach samples tested above the recreational limit for lead. In early November, the EPA said it was taking additional samples “to get a more detailed picture of how the material might have shifted” and will “take appropriate steps to prevent public exposure” at the site, according to a bulletin posted on its website. But six weeks later, the agency couldn’t provide more details of what has been found.

The Newtown Creek site, with pesticides, metals, PCBs and volatile organic compounds, and the Gowanus Canal site, heavily contaminated with PCBs, heavy metals, volatile organics and coal tar wastes, were added to the Superfund list in 2010.

Some say the lead at the Raritan Bay site can disperse easily.

Gabriel Fillippeli, director of the Center for Urban Health at Indiana University-Purdue University Indianapolis, said lead tends to stay in the soil once it is deposited but can be moved around by stormwaters or winds. Arsenic, which has been found in the surface water at the site, can leach into the water table, Fillippeli said.

“My concern is twofold. One is, a storm like that surely moved some of that material physically to other places, I would think,” Fillippeli said. “If they don’t cap that or seal it or clean it up, arsenic will continue to make its way slowly into groundwater and lead will be distributed around the neighborhood.”

The lack of testing has left some residents with lingering worries.

The Raritan Bay Slag site sits on the beach overlooking a placid harbor with a view of Staten Island. On a recent foggy morning, workers were hauling out debris, and some nearby residents wondered whether the superstorm increased or spread the amount of pollution at the site.

“I think it brought a lot of crud in from what’s out there,” said Elise Pelletier, whose small bungalow sits on a hill overlooking the Raritan Bay Slag site. “You don’t know what came in from the water.” Her street did not flood because it is up high, but she worries about a park below where people go fishing and walk their dogs. She would like to see more testing done.

Thomas Burke, an associate dean at the Johns Hopkins School of Public Health, says both federal and state officials generally have a good handle on the major Superfund sites, which often use caps and walls to contain pollution.

“They are designed to hold up,” Burke said of such structures, but added that “you always have to be concerned that an unusual event can spread things around in the environment.” Burke noted that the storm brought in a “tremendous amount” of water, raising the possibility that groundwater plumes could have changed.

“There really have to be evaluations” of communities near the Superfund sites, he said. “It’s important to take a look.”

Officials in both New York and New Jersey note they’ve also been monitoring less toxic sites known as brownfields and haven’t found major problems. The New York DEC said in a statement that brownfields in that state “were not significantly impacted” and that they don’t plan further tests for storm impacts.

Larry Ragonese, a spokesman for the New Jersey Department of Environmental Protection, said the agency has done visual inspections of major brownfield sites and also alerted towns and cities to be on the lookout for problems. Ragonese said they just aren’t getting calls voicing such concerns.

Back at the Raritan Bay slag site, some residents want more information. And they want the toxic soil, which has sat here for years, out.

Pat Churchill, who was walking her dog in the park along the water, said she’s still worried.

“There are unanswered questions. You can’t tell me this is all contained. It has to move around,” Churchill said.

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Colorado Woman Billed Medicaid for Dead Father

A Colorado woman was convicted this week for felony forgery for submitting fraudulent documents to Medicaid regarding personal health care services provided to her father after he died. It was the second announcement of Medicaid fraud-related convictions made by the Colorado Attorney General’s office in less than a week. Here are the details.

* According to the office of Colorado Attorney General John Suthers, 52-year-old Viola Kwong pleaded guilty to felony forgery in Denver District Court on Tuesday. She was sentenced to pay $ 16,000 in criminal restitution and perform 50 hours of public service. The restitution reflects all of the money illegally received by Kwong.

* Kwong will also be placed on supervised probation for four years, is responsible for all court costs and probation supervision fees associated with her case, and will pay a civil penalty of more than $ 37,000 to the Colorado Medicaid program, the Attorney General’s Office stated.

* The Attorney General’s Office stated that Kwong had requested services for her elderly father through a Medicaid program that allows the Medicaid client to direct his or her own home-based medical care.

* Because Kwong’s father was too ill to manage his care, Kwong was authorized by the program as his personal representative, in charge of obtaining those services for her father.

* Kwong’s father died on July 23, 2010, but Kwong continued to submit documents about personal health care services that were being provided to her father until Nov. 8, 2010.

* Suthers stated that the restitution ordered was “another significant recovery for Colorado’s Medicaid program.”

* Colorado Department of Health Care Policy and Financing initially referred the case to the Attorney General’s Medicaid Fraud Control Unit.

* Last week, the Attorney General’s Office announced the conviction of occupational therapist Cheryl Moss, 47, for felony theft and felony forgery. Moss pleaded guilty to forging treatment records and fraudulently billing the Colorado Medicaid program for services she did not perform.

* Moss agreed to repay the program $ 54,332, serve 60 days home detention and perform 300 hours of community service. She was also ordered to pay an additional $ 46,000 to resolve any potential civil issues and to report her conviction to the agency charged with licensing occupational therapists in Colorado.

* According to the Attorney General, Medicaid is health insurance for qualifying low-income, disabled individuals, and children and families. Covered services include hospital care, skilled nursing home care, residential adult family care services, hospice, mental health, dental and eyeglass services. Each state administers its own Medicaid program.

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Lauded cancer researcher, Springfield native, dies

A Springfield High School and Wittenberg University graduate whose research transformed the treatment of breast cancer and saved and prolonged the lives of women afflicted by it died Sunday in Cincinnati.

Elwood Jensen was 92.

Known as the “Father of the Nuclear Receptor Field,” Jensen was one of three researchers to share the 2004 Lasker Award for Basic Medical Research, what some call the American Nobel Prize.

The University of Cincinnati, where Jensen was a distinguished professor of cancer biology, noted that just one other of its graduates had won the honor, Albert Sabin, who developed a vaccine for polio.

“Some have estimated that his work annually saves or prolongs the lives of more than 100,000 women,” the university said in announcing his death.

A 1936 graduate of Springfield High School, Jensen was honored in 2008 as one of the Springfield City Schools Alumni of Distinction and he made periodic visits and lectures at Wittenberg University, one of five institutions to award him an honorary doctorate.

A 1940 graduate of Wittenberg, he went on to earn a Ph.D in organic chemistry from the University of Chicago, where he enjoyed a long career as a teacher and researcher. His interest in studying hormones began during 1946, when he spent a year as a Guggenheim Fellow at the Federal Institute of Technology at Zurich.

After his 1990 retirement from the University of Chicago, Jens also taught at Cornell, the University of Hamburg and the Karolinksa Institute in Stockholm and did research at the National Institutes of Health.

In 2003, the University of Cincinnati honored him by organizing the Jensen Symposium on Nuclear Receptors and Endocrine Disorders, which drew more than 300 top researchers from around the world.

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New Laser Treatment at Cosmedics Skin Clinics Offers Fast, Efficient Results for Facial Thread Veins

Although thread veins are relatively common and medically harmless, they can look unpleasant and people can go to great lengths to hide them. Now laser technology is set to offer a fast, effective treatment on the high street and now Medical Director Dr Ross Perry of Cosmedics Skin Clinics offers laser thread vein removal in London and Bristol.

London (PRWEB UK) 19 December 2012

Thread veins are quite common and the good news is that they are medically harmless. However, they are rarely considered attractive; so for those patients struggling to hide the appearance of red spider veins on the face or bluish broken veins on the legs, they can become quite a prominent feature which they would rather not have.

Facial thread veins are the most obvious as they are so visible year round. They can appear as one or just a few quite distinct veins with a bluish tinge; or where there are a lot, look more like a red patch of tiny capillaries, interwoven at the skin’s surface and lending a “ruddy” appearance. They are especially noticeable where the skin is thin, for example, on the nose, chin or cheeks.

Now the latest advanced laser technology offers thread vein sufferers hope of a fast, efficient and permanent solution in private clinics.

Dr Ross Perry, Medical Director at Cosmedics Skin Clinics, explains:

“For the broken, red spider veins on the face and particularly the nose we use a safe cautery laser to seal off the unsightly blemishes, removing the redness. The laser works efficiently to target the vein or veins while leaving the surrounding skin untouched so that it can heal quickly with a minimum of scarring and sometimes none at all.”

“Treatment is surprisingly effective and for many patients, the problem can be solved in just treatment, though in some cases 2-3 sessions may be advisable to get the optimum finished result.”

“Once treated with laser, the thread veins should not return; although continued over-exposure to the sun, smoking or hormonal changes such as menopause may cause new thread veins to appear.”

For treating larger veins which can appear on the body, tiny sclerotherapy injections are more suitable. These work to effectively block the offending veins at the skin’s surface, causing them to dissolve over the following weeks. In some cases, laser and injection treatments may be combined for best results.

Laser thread vein treatment is available in all of Cosmedics’ 6 Skin Clinics based in London (Putney, City, Harley Street, Canary Wharf, Knightsbridge) and Bristol. All treatments are carried out by skilled and experienced doctors who are registered with the GMC.

Cosmedics Skin Clinics was established by Dr Perry in 2003 and remains a doctor owned and managed company. The company is renowned for high standards of professionalism and discretion throughout.

Cosmedics’ doctors offer a full range of private medical skin treatments including mole removal, skin tag, cyst, verruca and wart removal, hyperpigmentation, thread vein treatment and excessive sweating injections; as well as popular cosmetic anti-ageing injections including dermal fillers. In addition, Cosmedics Beauty therapists offer a variety of treatments including laser hair removal and CACI.

Call 020 7386 0464 or email info(at)cosmedics(dot)co(dot)uk to book an appointment. http://www.cosmedics.co.uk for further information.

Patient Liaison
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NICE may reject Roche’s Avastin for advanced ovarian cancer

LONDON (Reuters) – Britain’s healthcare cost-effectiveness watchdog said it may reject Roche Holding AG‘s drug Avastin for treating advanced ovarian cancer in combination with two standard chemotherapy drugs.

In the latest of a series of setbacks for the medicine, the National Institute for Health and Clinical Excellence (NICE) said Avastin used with chemotherapy drugs paclitaxel and carboplatin is not a cost-effective treatment for the government-funded National Health Service (NHS).

NICE said the drug costs around 2,500 pounds a month per patient.

Ovarian cancer is the fifth most common cancer in women in the UK and in 2009, the latest year for which data are available, there were nearly 7,000 new cases diagnosed in the country.

NICE rejected Avastin as a first-line treatment for advanced breast cancer in July. This was after drug regulators in the United States came to the same conclusion in 2011.

The watchdog will make a final decision on treating ovarian cancer with the drug, also known as bevacizumab, next year. Its latest guidance could change after feedback from a public consultation that runs to January 22, during which Roche could appeal.

In the meantime, NICE chief executive Andrew Dillon said that although the combination did appear to delay the spread of ovarian cancer in some patients, it was unclear whether it helped patients live longer overall.

“There was no evidence to show that the clinical benefit of the treatment justifies its cost, when compared to existing treatments – an important factor to consider, especially as the NHS has finite resources,” Dillon said in a statement.

Roche said it was disappointed but would work with NICE to win the regulator’s backing.

“Avastin is the first drug for 15 years that has been shown to improve outcomes for women with advanced ovarian cancer, and can halt the progression of the disease for up to six months compared to chemotherapy alone,” the company said.

Roche noted the drug was approved by the European Medicines Agency for treating advanced ovarian cancer in combination with standard chemotherapy in December 2011.

Until the final decision, NICE said the NHS should make decisions locally on funding the treatment but if the final decision goes against Roche, hospitals will not be able to use core NHS funds for the treatment.

(Reporting by Chris Wickham; Editing by Mark Potter)

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Daylight savings tied to bump in heart attack rates

(Reuters) – Setting the clock ahead for daylight savings time may set the scene for a small increase in heart attacks the next day, according to a U.S. study – which suggests that sleep deprivation may be to blame.

Researchers at two hospitals in the U.S. state of Michigan, whose findings appeared in the American Journal of Cardiology, reviewed six years of records and found that they treated an average of 23 heart attacks on the Sunday when the United States switched to daylight savings time. That compared to 13 on a typical Sunday.

“Nowadays, people are looking for how they can reduce their risk of heart disease and other ailments,” said Monica Jiddou, the study’s lead author and a cardiologist at William Beaumont Hospital in Royal Oak.

“Sleep is something we can potentially control. There are plenty of studies that show sleep can affect a person’s health.”

A 2008 Swedish report, for instance, found that the chance of a heart attack increased in the first three weekdays after the switch to daylight savings time, and decreased the Monday after the clocks returned to standard time in the autumn.

Jiddou told Reuters Health that her team wanted to see if their respective hospitals experienced the same increase and decrease in heart attacks seen in the Swedish study.

For the new study, she and her colleagues reviewed records for the 328 patients who were diagnosed with a heart attack during the week after a time change between 2006 and 2012, and for the 607 heart attack patients who were treated two weeks before and after the time shifts.

They found that except for the small increase on the Sunday that daylight savings time kicked in, there were no significant differences in heart attack rates in the first week after the spring clock change or in the fall, when people set clocks back.

The authors note, however, that the small trends they observed suggest shifts to and from daylight savings time may be linked with small increases in heart attacks in the spring, and small decreases in the fall.

They speculate that sleep deprivation resulting from the time changes could raise levels of stress hormones and inflammatory chemicals just enough to trigger a heart attack, especially in those already at high risk.

Though the slight increase in heart attacks in the days following time shifts were so small they could have been due to chance, Jiddou told Reuters Health that she believes the problem was the size of the study population.

“The numbers weren’t necessarily striking, but the trends make you stop and think,” she said.

But Steven Nissen, a cardiologist who is chair of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic, said that people should be carefully interpreting the findings.

“We haven’t generally thought that missing an hour of sleep causes heart attacks. This may or may not hold up,” Nissen said.

He added that while the study looks at a good question and he applauds the researchers’ efforts, but stressed the limitations of the results and noted that the size of the effect is not huge. SOURCE: http://bit.ly/W391bW

(Reporting from New York by Andrew Seaman; editing by Elaine Lies)

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California home for developmentally disabled faces abuse inquiry

SAN FRANCISCO (Reuters) – California health officials have threatened to shut down part of the state’s oldest home for developmentally disabled adults due to evidence of physical abuse and neglect, in a move that could displace nearly 300 of its residents.

The state-run Sonoma Developmental Center could lose its license to run one unit if it does not fix the problems, according to a letter the state health department sent this week to the director of the sprawling facility in Eldridge.

Monitors this month and last “documented incidents of abuse constituting immediate jeopardy, as well as actual serious threats to the physical safety of female clients in certain units,” the California Department of Public Health letter said.

Among the incidents were physical abuse, a staff member exposing himself to a female client and inadequate monitoring of a patient who had propensity to swallow inedible items, leading to surgery, said Pam Dickfoss, assistant deputy director of the California Center for Health Care Quality.

The threat of sanctions against the board-and-care center in the heart of wine country represents a significant blow to a historic facility that opened at its current site in 1891 next to the bucolic town of Sonoma.

The center is northern California‘s only state-run residential facility for developmentally disabled adults and sits on 1,000 acres of land, including a petting zoo and sports fields.

Closure of the unit under scrutiny, the Intermediate Care Facility, could require moving 290 of the center’s more than 500 residents, officials said. It is unclear where they would be sent and officials say they hope that will not be necessary.

Administrators have vowed to correct deficiencies and said they plan to appeal the move to potentially strip them of federal funding and a state license for the unit under scrutiny.

“We are moving quickly to fix this center and protect our residents,” said Terri Delgadillo, director of the state Department of Developmental Services, which oversees the center.

She said the problems forced the removal of the center’s executive and clinical directors as well as other staff changes.

State monitors identified 57 deficiencies during a July visit, including four that posed an immediate danger to residents, and dozens of other threats to residents in more recent visits, the letter said.

The facility gets $ 117,000 a day in federal funding, said Nancy Lungren, a spokeswoman for the California Department of Developmental Services.

Most of the center’s residents suffer from cerebral palsy, epilepsy, autism, or a combination of those conditions. Many have lived their entire adult lives at the center.

Leslie Morrison, director of the investigations unit of Disability Rights California, a watchdog group, said she was troubled by reports from the facility over the past year.

“This has been developing for a long period,” Morrison said. “They have been trying to correct things, but it’s going to take a long time.”

(Editing by Alex Dobuzinskis and Eric Walsh)

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Vision insurance tied to better eye health

NEW YORK (Reuters Health) – Older adults’ eyesight may suffer irreversibly if they don’t have vision insurance, suggests a new study that argues eye health should be a mandatory part of regular health insurance policies.

Researchers found that people between 40 and 65 years old with vision insurance were twice as likely to see an eye doctor in the past year, compared to those without coverage.

And people who saw an eye doctor were more likely to be able to read printed material and to recognize someone from across the street.

“The study finds that having vision insurance increases the likelihood of an eye care visit, and that a prior-year eye care visit is associated with better vision status,” the researchers write in the Archives of Ophthalmology.

Led by Yi-Jhen Li at the University of South Carolina in Columbia, the team notes that by 2020 it’s estimated that over 5.6 million Americans will have an age-related eye disease that may lead to vision loss.

But the researchers add that permanent vision loss from some of those eye diseases – including glaucoma and cataracts – can be staved off with early detection and treatment.

“We want to get them in the door. If they get in the door, they’re likely get what they need,” said John Crews, a health scientist at the U.S. Centers for Disease Control and Prevention in Atlanta, who was not involved in the research.

“The problem from a public health point of view is, ‘what is impeding people from getting access to care?’” Crews said.

For the new study, Li and colleagues wanted to see if lack of vision insurance might stand in the way of working-age adults’ ability to go to an eye doctor and whether that would affect their vision.

They used a 2008 survey of 27,152 people from across eight U.S. states. Of those, 11,541, or 43 percent, did not have vision insurance.

Of the 15,611 people who did have vision insurance, about 64 percent had seen an eye doctor in the previous year, compared to about 45 percent of people without coverage.

After taking certain traits – such as age, sex and race – into account, the researchers also found that generally healthy people with vision insurance were 24 percent more likely to report that they had no trouble recognizing friends from across the street and 34 percent more likely to say they could read printed material without problems, compared to those without the insurance.

The difference was even greater among a subsample of people who had common eye ailments like glaucoma, cataracts or age-related macular degeneration – those with vision insurance were 37 percent more likely to say they could read and 45 percent were more likely to recognize a friend from afar.

In both the general population and those with eye diseases, people who saw a doctor within the past year were also more likely to report better vision.

Li and colleagues, who were not available for comment, note in their paper that the age group they focused on, between 40 and 64, are too young to be covered by Medicare but are “at high risk for eye diseases that cause gradual vision loss that is preventable.”

Theirs is the first study, they add, to examine how having vision insurance, versus general health insurance, influences how often people in this working-age segment of the population get regular eye care.

While 85 percent of the people in their sample had health insurance, the researchers write, just about 68 percent of those with health insurance had vision coverage. And, they say, their study indicates that it is vision insurance, but not health insurance, that determines not only whether people go to the eye doctor, but also the quality of their reported vision.

Making vision coverage a mandatory part of standard insurance policies would raise costs by about three percent, they conclude, calling that a “good value” compared to the costs of the vision loss that could be prevented.

The American Academy of Ophthalmology says older adults should have regular eye checkups every two to four years. The group recommends that people 65 years old and up see an eye doctor every one or two years.

SOURCE: http://bit.ly/UiObja Archives of Ophthalmology, online December 10, 2012.

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Mandela’s Infection May Be Pneumonia

Nelson Mandela is being treated for a lung infection, a term often used synonymously with pneumonia.

Elderly people are at an increased risk for infections in general – more so if the person has many chronic medical problems, but as people age their immune systems are less capable of fighting off infections.

South African officials say Mandela’s lung infection is “recurring.” The former president is 94 years old.

As elderly people become more and more infirm, they have a decreased cough response and may aspirate oral secretions into their lungs, raising the risk of infections. And if someone is bedridden, their breaths become more shallow, raising the risk even more.

It may seem surprising that it took so long for Mandela’s diagnosis to be made public. However, it’s possible that it took this long to make a diagnosis.

Elderly people respond differently to pneumonia, meaning they might lack common symptoms like fever and cough, and instead show signs of confusion. The evaluation of change in physical or mental condition in someone of Mandela’s age is broad with much testing needed to make a diagnosis.

There are different types of pneumonia including viral (caused by influenza), bacterial (caused by pneumococcus or tuberculosis), fungal and parasitic. I suspect Mr. Mandela most likely has a viral or bacterial pneumonia. If he does, they are likely treating him with antibiotics and providing respiratory support.

Pneumonia is a leading infectious cause of death in the elderly. But with proper treatment, many do recover.

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More “fiscal cliff” talks but neither side giving ground

WASHINGTON (Reuters) – The White House and House of Representatives Speaker John Boehner’s office held more negotiations on Monday on ways to break the “fiscal cliff” stalemate, although neither side showed any public signs that they were ready to give ground.

The talks gained urgency after Republican Boehner met at the White House with President Barack Obama on Sunday, raising hopes of progress in averting the onset of tax increases and spending cuts that kicks in on January 1 unless Congress intervenes.

But while striking a more conciliatory tone, both sides kept to a familiar script in the weeks-long standoff. Obama renewed his call for higher tax rates for the richest Americans, which most Republicans oppose, while Republican leaders urged Obama to submit a new offer with specific spending cuts he would back.

Economists say going over the fiscal cliff could throw the U.S. economy back into a recession.

On a road trip to Michigan to drum up support for his stance, Obama said he was willing to compromise on some things but not on his demand that Republicans support an increase in tax rates for the wealthiest 2 percent of Americans.

“What you need is a package that keeps taxes where they are for middle-class families, we make some tough spending cuts on things that we don’t need, and then we ask the wealthiest Americans to pay a slightly higher tax rate, and that’s a principle I won’t compromise on,” Obama said during a visit to an auto plant in Redford, Michigan.

Boehner spokesman Michael Steel said Republicans were still waiting for the president to make a new offer that identifies the spending cuts he will make in the deficit-reduction negotiations.

“The Republican offer made last week remains the Republican offer,” Steel said, adding the two sides were holding staff-level talks on Monday.

Boehner and the House Republican leadership submitted their terms for a deal to the White House last week, after Obama presented his opening proposal. Both sides seek to cut budget deficits by more than $ 4 trillion over the next 10 years but differ drastically on how to get there.

Boehner and Republicans oppose letting any tax rates increase and prefer to find new revenues by closing loopholes and limiting deductions. Republicans also want deeper spending cuts than Obama has offered in entitlements like the Medicare and Medicaid healthcare programs.

Democrats have insisted that tax rates for the richest must be nailed down before negotiating further on how to proceed with tax reform efforts or new spending cuts in entitlement programs.

‘A DEAL IS POSSIBLE’

“I can only say that the president believes that a deal is possible,” White House spokesman Jay Carney told reporters on the flight to Michigan. “But it requires acceptance and acknowledgement in a concrete way by Republicans that the top 2 percent will see an increase in their rates.”

Financial markets have calmed recently after a series of wild swings, when nearly every utterance from a politician about the looming budget crisis caused volatility in stock prices.

Polling shows most Americans would blame Republicans if the country goes over the cliff, and pressure has been building from some Republicans for Boehner to get an agreement quickly, even if it means tax hikes on the wealthiest.

Republican Senator Bob Corker of Tennessee called for a quick deal with the White House to allow an extension of the lower tax rates that have been in place for about a decade, except for the top two rates that Obama wants to raise.

“Right now there is no question in my mind the president has the slight upper hand in the negotiations,” Corker said on CNBC on Monday.

He said there was support among Senate Republicans for taking that step so the fiscal cliff negotiations could then shift to focusing on how to restrain the growing costs of Medicare and other entitlement programs.

“If you did it this week (agree to raising tax rates on the richest) you’d have the rest of this month to have the focus totally on entitlements,” said Corker, who has a record of reaching out to Democrats on major bills.

More conservative Senate Republicans, most notably Senator Tom Coburn of Oklahoma, also have signaled a willingness to let tax rates rise on higher-income groups.

Erskine Bowles, co-chairman of the so-called Bowles-Simpson deficit reduction commission, said he thought chances were improving for a deal.

“I think the atmospherics are getting so much better. We have kind of gotten out of Kabuki theater and gone to dancing the tango,” Bowles told CNBC on Monday. “Any time you start to tango you’ve got a chance.”

Bowles said he did not expect the president to give in on his demand that taxes rise for the top 2 percent of earners.

“I would almost guarantee that rates are going to go up for people in the top 2 percent,” he said.

U.S. stocks edged higher on Monday but moves remained muted as investors looked for any signs of movement on the fiscal cliff front.

The S&P 500 index has nearly retraced the 5.3 percent slide it suffered in the first seven sessions after the November 6 presidential election.

“The sentiment has definitely changed,” said Andrew Wilkinson, chief economic strategist at Miller Tabak & Co in New York. “The market has become somewhat desensitized to headlines out of Washington because the fear of the economy hitting a wall in 2013 if we don’t get a deal done has diminished.”

(Additional reporting by Steve Holland, Jeff Mason, Thomas Ferraro, Susan Heavey and Franklin Paul; Writing by John Whitesides; Editing by Alistair Bell and Eric Beech)

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Health workers march in Spain’s capital against cuts, reforms

MADRID (Reuters) – Thousands of health workers, on strike since last month, marched on Sunday in Madrid to protest against budget cuts and plans from the Spanish capital’s regional government to privatize the management of public hospitals and medical centers.

It was the third time doctors, nurses and health workers have rallied since the local authorities put forward a plan in October to place six hospitals and dozens of medical practices under private management. The plan also calls for patients to be charged a fee of 1 euro for prescriptions.

Workers launched an indefinite strike last month against the plan, which has not been endorsed by the centre-right government of Prime Minister Mariano Rajoy. Health workers in the capital are striking Monday-Thursday each week and seeing patients only on Fridays, while also responding to emergencies.

Spain’s 17 autonomous regions control health and education policies and spending. They have all had to implement steep cuts this year as the country struggles to meet tough European Union-agreed deficit targets.

Dressed in white scrubs, the protesters shouted slogans such as “Health is not for sale” and “Health 100 percent public, no to privatizations”.

“Of course, privatization can be reversed. Actually the question is not if it can be reversed, because privatization should never have a future,” said Luis Alvarez, an unemployed man from Madrid attending the demonstration.

Belen Padilla, a doctor at Madrid’s hospital Gregorio Maranon, said one million citizens had already signed a petition rejecting the plan.

(Reporting by Reuters Television; Writing by Julien Toyer; Editing by Peter Graff)

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Former South Africa president Mandela admitted to the hospital

JOHANNESBURG (Reuters) – Former South African president Nelson Mandela was admitted to hospital on Saturday for medical tests, although the government said there was no cause for alarm.

A statement from President Jacob Zuma‘s office gave no details of the condition of the 94-year-old anti-apartheid leader.

“Former President Mandela will receive medical attention from time to time which is consistent with his age,” the statement said.

“President Zuma assures all that Madiba is doing well and there is no cause for alarm,” it added, referring to Mandela by his clan name.

Mandela, who became South Africa‘s first black president after the country’s first all-race elections in 1994, was admitted to hospital in February because of abdominal pain but released the following day after a keyhole examination showed there was nothing seriously wrong with him.

He has since spent most of his time in his ancestral home in Qunu, a village in the impoverished Eastern Cape province.

His frail health prevents him from making any public appearances in South Africa, although in the last few months he has continued to receive high-profile visitors, including former U.S. President Bill Clinton.

(Reporting by Ed Cropley; Editing by Andrew Heavens)

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When drugs for depression fail, talking therapies help

LONDON (Reuters) – Patients with depression who fail to benefit from antidepressant drugs may do better if they are also treated with a type of “talking” psychotherapy called CBT, according to new research published on Friday.

In the first large-scale trial to test the effectiveness of cognitive behavioral therapy, or CBT, alongside medication for depression, scientists said they found that the combination works where drug treatment alone fails.

Nicola Wiles of Bristol University‘s school of social and community medicine, who led the study, said the findings underline the need to increase the availability of therapy for depressed patients.

“While there have been initiatives to increase access to CBT in both the UK and Australia, worldwide initiatives are rare,” she said in a statement.

Wiles and colleagues recruited 469 adults from across Britain who had not responded to at least 6 weeks of treatment with an antidepressant. For the study, 235 patients continued with their usual antidepressant medication, while 234 patients got their usual care plus CBT and were followed up for 12 months.

The results, published in The Lancet medical journal, showed that after 6 months, 46 percent of those who got CBT as well as their usual care had improved – reporting at least a 50 percent reduction in their depressive symptoms. This compared to 22 percent of those who did not get CBT.

Patients treated with CBT, which involves talking through behaviors and ways of thinking with a trained psychotherapist or psychologist, were also more likely to go into remission and have fewer symptoms of anxiety, the researchers said. Similar effects were reported at 12 months.

Major depression affects around 20 percent of people at some point in their lives. The World Health Organization (WHO)predicts that by 2020, depression will rival heart disease as the health disorder with the highest global disease burden.

While there are many antidepressants on the market, including top sellers such as Prozac and Seroxat, it is widely accepted that many antidepressants work in only half of patients half of the time, and drugmakers are struggling to come up with a new generation of drugs in this field.

Willem Kuyken, a clinical psychology professor at Exeter University who also worked on the study, said its results showed that doctors and patients should be looking beyond drugs.

“This trial provides further evidence that psychological treatments like cognitive therapy can provide substantive and lasting help to people who suffer depression,” he said.

Wiles added, however, that even in wealthy countries such as Britain, where there has been a recent push to invest more into psychological therapies, many people who have not responded to antidepressants still don’t get the chance of trying intensive CBT that take between 12 and 18 sessions.

In the United States, only about a quarter of people with depression have received any form of psychological therapy in the last 12 months, she said.

(Editing by Sonya Hepinstall)

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Fossil fuel subsidies in focus at climate talks

DOHA, Qatar (AP) — Hassan al-Kubaisi considers it a gift from above that drivers in oil- and gas-rich Qatar only have to pay $ 1 per gallon at the pump.

“Thank God that our country is an oil producer and the price of gasoline is one of the lowest,” al-Kubaisi said, filling up his Toyota Land Cruiser at a gas station in Doha. “God has given us a blessing.”

To those looking for a global response to climate change, it’s more like a curse.

Qatar — the host of U.N. climate talks that entered their final week Monday — is among dozens of countries that keep gas prices artificially low through subsidies that exceeded $ 500 billion globally last year. Renewable energy worldwide received six times less support — an imbalance that is just starting to earn attention in the divisive negotiations on curbing the carbon emissions blamed for heating the planet.

“We need to stop funding the problem, and start funding the solution,” said Steve Kretzmann, of Oil Change International, an advocacy group for clean energy.

His group presented research Monday showing that in addition to the fuel subsidies in developing countries, rich nations in 2011 gave more than $ 58 billion in tax breaks and other production subsidies to the fossil fuel industry. The U.S. figure was $ 13 billion.

The Paris-based Organization for Economic Cooperation and Development has calculated that removing fossil fuel subsidies could reduce carbon emissions by more than 10 percent by 2050.

Yet the argument is just recently gaining traction in climate negotiations, which in two decades have failed to halt the rising temperatures that are melting Arctic ice, raising sea levels and shifting weather patterns with impacts on droughts and floods.

In Doha, the talks have been slowed by wrangling over financial aid to help poor countries cope with global warming and how to divide carbon emissions rights until 2020 when a new planned climate treaty is supposed to enter force. Calls are now intensifying to include fossil fuel subsidies as a key part of the discussion.

“I think it is manifestly clear … that this is a massive missing piece of the climate change jigsaw puzzle,” said Tim Groser, New Zealand’s minister for climate change.

He is spearheading an initiative backed by Scandinavian countries and some developing countries to put fuel subsidies on the agenda in various forums, citing the U.N. talks as a “natural home” for the debate.

The G-20 called for their elimination in 2009, and the issue also came up at the U.N. earth summit in Rio de Janeiro earlier this year. Frustrated that not much has happened since, European Union climate commissioner Connie Hedegaard said Monday she planned to raise the issue with environment ministers on the sidelines of the talks in Doha.

Many developing countries are positive toward phasing out fossil fuel subsidies, not just to protect the climate but to balance budgets. Subsidies introduced as a form of welfare benefit decades ago have become an increasing burden to many countries as oil prices soar.

“We are reviewing the subsidy periodically in the context of the total economy for Qatar,” the tiny Persian gulf country’s energy minister, Mohammed bin Saleh al-Sada, told reporters Monday.

Qatar’s National Development Strategy 2011-2016 states it more bluntly, saying fuel subsides are “at odds with the aspirations” and sustainability objectives of the wealthy emirate.

The problem is that getting rid of them comes with a heavy political price.

When Jordan raised fuel prices last month, angry crowds poured into the streets, torching police cars, government offices and private banks in the most sustained protests to hit the country since the start of the Arab unrest. One person was killed and 75 others were injured in the violence.

Nigeria, Indonesia, India and Sudan have also seen violent protests this year as governments tried to bring fuel prices closer to market rates.

Iran has used a phased approach to lift fuel subsidies over the past several years, but its pump prices remain among the cheapest in the world.

“People perceive it as something that the government is taking away from them,” said Kretzmann. “The trick is we need to do it in a way that doesn’t harm the poor.”

The International Energy Agency found in 2010 that fuel subsidies are not an effective measure against poverty because only 8 percent of such subsidies reached the bottom 20 percent of income earners.

The IEA, which only looked at consumption subsidies, this year said they “remain most prevalent in the Middle East and North Africa, where momentum toward their reform appears to have been lost.”

In the U.S., environmental groups say fossil fuel subsidies include tax breaks, the foreign tax credit and the credit for production of nonconventional fuels.

Industry groups, like the Independent Petroleum Association of America, are against removing such support, saying that would harm smaller companies, rather than the big oil giants.

In Doha, Mohammed Adow, a climate activist with Christian Aid, called all fuel subsidies “reckless and dangerous,” but described removing subsidies on the production side as “low-hanging fruit” for governments if they are serious about dealing with climate change.

“It’s going to oil and coal companies that don’t need it in the first place,” he said.

___

Associated Press writers Abdullah Rebhy in Doha, Qatar, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report

____

Karl Ritter can be reached at www.twitter.com/karl_ritter

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