More Americans getting high: cannabis study

Paris (AFP) – The number of adult cannabis users in the United States increased by ten million from 2002 to 2014, said a study Thursday that called for better education on the potential pitfalls.

The increase coincided with a general rise in the potency of the popular recreational drug and a growing belief that it is not harmful, researchers wrote in The Lancet Psychiatry.

The findings, the US-based team wrote, “suggest a potential benefit of education and prevention messages” even as many US states are relaxing cannabis policies.

Based on a survey of over 500,000 US adults between 2002 and 2014, the study found that marijuana use rose from 10.4 percent of the population in 2002 to 13.3 percent in 2014 — from 21.9 million to 31.9 million.

The number of daily or near-daily users was about 8.4 million in 2014, they estimated — up from 3.9 million in 2002.

The proportion of people who said they feared great risk or harm from smoking dope once or twice a week, dropped from 50.4 percent to 33.3 percent over the same period.

The study did not find a rise in so-called marijuana use disorders such as abuse or dependence.

The study did not look at cannabis use among children or teenagers.

Critics of decriminalisation have argued it will cause more people to take up the drug, which is partly what prompted the study.

“These changes in the prevalence of cannabis use occurred during a period when many US states legalised cannabis for medicinal use, but before four states went on to legalise recreational cannabis use,” addiction experts Michael Lynskey and Wayne Hall wrote in a comment also carried by the journal.

“It is probably too soon to draw conclusions about the effects of these legal changes on rates of cannabis use and cannabis-related harms, but it is likely that these policy changes will increase the prevalence and frequency of cannabis use,” they said.

The trend is not a global one — cannabis use in Britain has gone down in the last 10 years, according to Robin Murray of Kings College London, who also commented on the study.

Seriously, don't come to work if you're sick

There’s nothing more selfish you can do than come to work sick. You may get a gold star for showing your sniffling face at the office and soldiering through the workday to prove your value—but everyone around you just gets sick. You’re an inconsiderate work hazard.

When people bring their infectious illness to work, it spreads—and when sick people don’t have a financial incentive to show up to work, fewer people get sick, according to a new working paper by the nonprofit National Bureau of Economic Research.

The researchers studied U.S. cities with paid sick-leave mandates and, using Google Flu Trends data at the city and state level from 2003 to 2015, looked for changes in flu rates after those mandates went into effect.

The cities that adopted paid sick-leave mandates in that time frame saw flu cases drop by about 5 percent after their laws took effect. For a city of 100,000 people, that comes out to 100 fewer infections per week, the researchers estimate.

“You see people who are at the workplace sneezing and potentially infectious. That’s how diseases spread,” said Nicolas R. Ziebarth, an assistant professor at Cornell University and one of the study’s researchers.

For most of us, staring at a computer through the fog of illness is torture, and does nothing to help us recover. Yet 3 million people, or 2 percent of the U.S. population, bring their ailments to work each week—a phenomenon the researchers dubbed “contagious presenteeism.”

Many do so because of financial pressures; nearly a third of workers have no access to paid sick leave, according to the Bureau of Labor Statistics. The other two-thirds, who have the luxury of taking a sick day, need to stop making excuses for showing up at work sick.

Almost half of workers say they worry work will pile up if they stay home sick. People who find their jobs engaging also have a hard time staying home, finding work more fun than submitting to the reality of a sick day.

“Some people want to appear tough and signal that they are hard-working,” said Ziebarth.

But those diligent workers aren’t just showing their commitment, they’re also showering their coworkers with germs; the modern open office plan is a breeding ground for contagious illnesses. Worst of all, people tend to come to the office at the beginning of an illness, when they’re at their most contagious but still feeling well enough to get a little work done.

“You have over-the-counter drugs that suppress your symptoms, but they don’t suppress contagiousness,” Ziebarth pointed out.

Employers, for their part, should encourage ailing workers to stay home. Presenteeism—showing up at work ill, whether they’re contagious or not—costs companies about $150 billion a year, one study estimated. A worker is about a third as productive when he’s slumped in a desk chair working at half-speed as he is when he’s healthy, say researchers. By staying home when he’s sick, he can get better faster. The rest of the workforce can remain in full—and fully productive—health.

And diligent workers who absolutely must meet a deadline or finish a life-or-death project should at least self-quarantine. Telecommuting has become an increasingly acceptable way to work, and 60 percent of employers let employees work from home, according to the Society for Human Resource Management’s annual Employee Benefits Survey.

“It’s good to change the culture of how people see each other,” said Ziebarth. “You can signal hard work in a lot of different ways. It’s not the right way to go into the office and spread diseases.”

In fact, we all need to do our part to stigmatize coming to work sick. If a coworker comes in complaining of a tickle in his throat or clammy hands, say: “Go home! Nobody wants you and your gross germs.”

Or just send him a link to this article.

Philippines' Duterte to workers returning from Saudi: Don't do drugs

By Neil Jerome Morales

MANILA (Reuters) – Philippine President Rodrigo Duterte, heavily criticized for a brutal anti-narcotics drive in which hundreds have been killed, on Wednesday welcomed home more than 100 Filipinos abandoned in desert camps in Saudi Arabia with a warning – don’t do drugs.

The Southeast Asian nation’s war on drugs has gained some popular support but the wave of killings has shocked rights groups and brought expressions of concern from the United States, a close ally of Manila.

Duterte railed against the United Nations this month after it called for an end to the killings.

“Avoid drugs at all cost because it could cost your life too,” Duterte told the workers after an almost 10-hour flight from Dammam.

The number of drug-related killings in the Philippines has reached 2,000 since Duterte became president two months ago on a pledge to wipe out the drug trade.

Migrant oil and construction workers, abandoned in their thousands by Saudi employers during the kingdom’s economic slump, are fighting to claim back wages and benefits.

“I lost my job so my children were forced to drop out of college and they were mad at me but what can I do?” Ronie Surilla, 47, a construction worker living for almost a decade in Saudi Arabia, told Reuters, adding that he had not been paid for eight months.

Filipinos living and working outside the country sent home a record $13.2 billion in remittances, a major driver of the Southeast Asian nation’s household consumption, in the first half of 2016.

For the returning overseas workforce, the president committed to boost the economy and provide jobs.

The Philippines’ economy grew at 7 percent in the second quarter from a year earlier, its highest level in three years. It made the Philippines the fastest growing among all countries that have reported so far for the second quarter.

(Editing by Nick Macfie)

High cost hampers treatment of hepatitis B, C in Vietnam: experts

Photo: Thuy Anh

The high cost of medicines has undermined treatment of hepatitis B and C in Vietnam, where their rates of chronic infection is high, according to a conference in Hanoi Monday.

A course of treatment for the diseases costs up to VND45 million (US$2,016), according to Nguyen Van Kinh, director of the National Hospital for Tropical Diseases.

By using generic drugs, similar treatment costs only $200 in Egypt and $250 in India, he said.

Vietnam has been negotiating prices with drug suppliers, but even if it succeeds in bringing them down, the treatment cost would remain as high as $700-$800 in 2017, he said.

Statistics presented at the conference showed that hepatitis prevalence in Vietnam is among the highest in the Western Pacific region.

 Graphic: World Health Organization 

Some 8.7 million people are chronically infected with hepatitis B virus (HBV) and 1 million with hepatitis C virus (HCV) out of Vietnam’s population of 90 million.

HBV caused more than 23,000 deaths and HCV, about 6,000 deaths in the country last year.

Yet only 5 percent of those chronically infected were aware of their condition, and just less than 1 percent of them actually underwent treatment, the statistics showed.

Kinh said studies by his hospital showed that prohibitively high medicine costs dissuade patients from pursuing treatment even after health insurance covers part of the cost.

About 43 percent of the chronically infected patients surveyed said they could afford only VND3 million for treatment, he said. If the course cost VND10 million, only 10 percent more said they could afford it.

The country is also lagging behind in terms of prevention, experts said at the event.

The World Health Organization advises that routine hepatitis B vaccination should be given to children, the first shot within 24 hours after birth.

In Vietnam, however, just 50-60 percent of newborns get it within 24 hours, according to Duong Thi Hong, deputy director of the National Institute Of Hygiene And Epidemiology.

The rate is particularly low – down to 11-12 percent – in some remote provinces, she said.

Vietnamese doctors successfully remove ‘turtle shell’ on 10-year-old girl’s back

The 10-year-old girl before the surgery. Photo: Nguyen Mi

Doctors at Ho Chi Minh City Children’s Hospital 1 successfully removed a turtle-shell-like mole on the back of a 10-year-old girl after a 3-hour surgery on Monday.

Dao Trung Hieu, the hospital vice director, said Tran Thi Ngoc Tham of Soc Trang Province, who suffers from congenital melanocytic nevus, has recovered several hours after the surgery from 10:20 a.m. – 1:15 p.m.

“The mole weighs 1.05 kg (2.2 lbs) and measures 22 cm (8.7 inches) in diameter,” he said. After it was removed, doctors covered the area with skin grafted from her thigh, he said.

Six doctors and 5 medical workers involved in the surgery, he said.

The hospital is supporting the poor patient with hospital fees and food.

Tham’s mother, Thach Thi Da Ni, 34, said she was born with the birthmark measuring the size of “a mandarin orange”, and it has been growing over the years.

Tham quit school after being repeatedly teased by others as the “turtle-shell girl” but Ni has no money for her treatment, she said.

Tham has a 12-year-old brother who does not have congenital abnormality.

The surgery is conducted by Ho Chi Minh City Children’s Hospital 1 doctors. Photos: Nguyen Mi
 

 The mole weighs more than 1 kg

 Tham is taken care by a nurse

Her mother, Thach Thi Da Ni, smiles happily after the surgery. 

Southeast Asia needs to up its game to combat Zika: experts

An Aedes aegypti mosquito is seen inside a test tube as part of a research on preventing the spread of the Zika virus and other mosquito-borne diseases at a control and prevention center in Guadalupe, neighbouring Monterrey, Mexico, March 8, 2016.

The spread of the Zika virus across tropical Southeast Asia is likely to be significantly under-reported as local health authorities fail to conduct adequate screening, regional experts said on Monday.

International travel hub Singapore confirmed 41 locally-transmitted cases of the mosquito-borne virus on Sunday and said it anticipated more, raising fears about how quickly it could disperse throughout the region.

Other parts of Southeast Asia have reported dozens of cases of Zika, which in Brazil has been linked to thousands of suspected cases of microcephaly, a rare birth defect, but there are fears the true numbers are masked.

“Zika is under-reported and under-diagnosed,” Khin Myint, head of the emerging virus research unit at Indonesia’s government-funded Eijkman Institute, told Reuters. “We find many cases are not presented in hospitals because it’s a relatively mild disease with mild symptoms and people are not going to doctors.”

The World Health Organization (WHO) lists Indonesia, Thailand, the Philippines and Vietnam as countries with “possible endemic transmission or evidence of local mosquito-borne Zika infections in 2016.”

But the Jakarta-based Eijkman Institute, the main body testing for Zika in Indonesia, said it tested only 1,000 people in the past year – a tiny number in Southeast Asia’s most populous country. It found just one positive case, despite reports that Zika is prevalent in the country.

Thailand has recorded the highest number of cases in the region at almost 100 infected people across 10 provinces this year.

“Thailand’s surveys have not been thorough enough,” said Kriengsak Limkittikul, assistant professor at the Department of Tropical Medicine at Mahidol University in Bangkok, noting that people without symptoms are often not tested. “Screening is inadequate in other countries in the region, too, where health authorities are ill-equipped to test,” he said.

Vietnam has recorded three cases of Zika infection, all locally-transmitted, while Cambodia has reported seven cases.

Hong Kong confirmed its first case of Zika on Friday, in a woman who had traveled to the Caribbean.

A major difficulty is that while Zika can cause mild fever, a rash and red eyes, an estimated 80 percent of people infected have no symptoms.

There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and is transmitted by mosquito. There have also been a small number of cases of sexual transmission reported in the United States and elsewhere.

MIXED RESPONSE

Some countries in the region began ramping up protective measures following the outbreak in Singapore.

Muhamad Subuh, a senior Indonesian health ministry official, said authorities are “in the process of stepping up health checks at main airports and ports, including in Batam,” the island closest to Singapore.

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Indonesia introduced thermal scanners at airports targeting arrivals from Singapore over the weekend, and plans to roll them out to ports. Authorities are also handing out printed warnings to all incoming passengers, noting Zika has an incubation period of around 10 days before presenting any symptoms.

Malaysian Health Minister Subramaniam Sathasivam said travelers who enter Johor Bahru, where up to 200,000 people commute daily to and from Singapore, will go through thermal screening at border checkpoints. People crossing in private vehicles will not be scanned but handed a pamphlet detailing the symptoms and asking them to report to authorities if they develop those.

Malaysia is also stepping up vector control mechanisms including fogging and larvicidal spraying in Johor Bharu.

“What we can do as a country comes down to how well we control our vectors, and at this point of time, dengue is still a bigger problem than Zika because people can die from dengue,” Subramaniam said.

Other countries were not responding so quickly.

In Thailand, the Department of Disease Control said it was screening athletes returning from the Olympic Games in Brazil, but otherwise not changing its prevention methods. Vietnam and Cambodia made no immediate changes to their border controls.

“Different countries have different economic and political situations and it’s not that they don’t want to screen the virus, but they don’t have the resources and capacity to do it at this stage,” said Jasper Fuk-Woo Chan, a clinical assistant professor at the Carol Yu Centre for Infection at the University of Hong Kong.

HIV self-testing launched in Vietnam

US Ambassador Ted Osius (center) and his husband Clayton Bond (2nd L) join Vietnamese government officials and celebrities to demonstrate how to do the HIV self-test in Ho Chi Minh City on August 26, 2016. Photo credit: Phuong Nguyen/USAID

Vietnamese health officials and the US Embassy on Friday launched the HIV self-testing service, the first of its kind in Vietnam, in Ho Chi Minh City.

The service helps users know their HIV status 20 minutes after using the test kit to take their sample of saliva or blood.

US Ambassador to Vietnam Ted Osius said: “HIV testing has never been as simple as it is with a self-test. Anyone at risk can learn their HIV status confidentially, privately, and in a safe way.”

Nguyen Hoang Long, director of the Vietnam Administration for HIV/AIDS Control, said the service will increase access to HIV testing and normalize it as other over-the-counter rapid tests such as for diabetes or pregnancy.

The HIV self-testing service is part of the Healthy Markets project, which has been supported by the US President’s Emergency Plan for AIDS Relief through the US Agency for International Development (USAID) and implemented by PATH, a non-profit organization, and Vietnam’s Ministry of Health since October 2015.

Dr. Vu Ngoc Bao, deputy director for the project at PATH, said that initial results from the service have been very promising.

“Since the end of May, over 377 individuals have opted for HIV self-testing.

“Of the seven percent confirmed HIV positive, all (100 percent) were successfully enrolled in HIV treatment services.”

Vietnam has committed to the United Nations 90-90-90 targets toward ending the HIV epidemic. Accordingly, by 2020, 90 percent of people living with HIV will know their HIV status; 90 percent of people who know their status are on HIV treatment; and 90 percent of all people on treatment will have undetectable levels of HIV in their body, known as viral suppression.

There were an estimated 260,000 people living with HIV in Vietnam as of 2016.

Although the country has seen a reduction in new HIV infections over recent years, there is low annual uptake of HIV testing among key populations at high risk of transmission. This includes people who inject drugs, men who have sex with men, transgender women, and female sex workers.

‘Decline in vulture population has given rise to diseases’: Dr Vibhu Prakash

Written by Srishti Choudhary | Published:August 29, 2016 3:48 am

Dr Vibhu Prakash. Express Photo

Enlighten us how decreasing population of vultures is posing a problem?

The situation is very grave. As per estimate, there were 40 million birds in our country and by 2007 we had lost about 99.9 per cent of them. Only a small population of bird species remain. This is the steepest decline of any species anywhere in the world. Vultures are long lived and are slow in breeding. It starts breeding only when it is at least 6-year-old and only 50 per cent of them survive. It can cause extinction and urgent measures are required. Though conservation through breeding is not the best option, but it is an insurance against extinction. At least, the birds we have kept in captivity will not die.

Is the population of vultures decreasing only in India or across the globe?

Unfortunately, the population is decreasing across the globe. In South Asia, it is dying of drug poisoning. In Africa, they are being killed by poachers. Till 1990s, vultures were not critically endangered, except for the Californian Condor. But now, white-backed, slender billed, king vultures are being listed in the critically endangered category.

Has the decreasing vulture population affected other species, especially scavengers?

Certainly. The decline has resulted in steep increase in population of feral dogs, although, it is difficult to quantify, as their population is very high. Earlier, when one visited the carcass dumps, they would see that vultures would descend and take over of the carcass and dogs were forced to stay away. But now, the population of dogs have increased because there is lot of food on the offing.

Has it affected human health?

Yes, it has led to increase in the population of dogs, which carry all kinds of diseases, including rabies. Dead animal or humans promotes breeding of all kinds of pathogens. Before, vultures used to feed on carcasses before bacteria could multiply. Since their decline, there has been a spurt in such diseases. But, as diseases are found in abundance it is difficult to quantify these observations through research.

Do you think depiction of vultures’ in children’s books as predatory, dangerous creatures justified?

The depiction is completely wrong. Right from the beginning, we are known to look down on scavengers. Nobody tells children how important scavenging is for nature. Those who are living will only survive when the dead are properly disposed off. One should enlighten the children that if the body is not disposed off properly it can give birth to diseases. For survival of humans, vultures are important because they feed on the dead.

When did you decide to start working for the conservation of vultures?

I was working on my PhD programme which focused on monitoring the population of raptors. In mid 1990s, I realised that population of vultures was declining and I began investigating the matter. Raptors are bio-indicators. So, if you are studying raptors, you will know, what is happening to the eco-system.

You were part of the Indian team which concluded that the drug Diclofenac was the reason behind declining population of vultures. What led this to this investigation?

It was first discovered by the US scientists in Pakistan. We were working in India and we found that a number of dead birds were suffering from visceral gout. We found vultures sitting with their necks dropped. At first, we thought they were sick and wanted to treat them, but eventually they died. Scientists in Pakistan came out with findings about Diclofenac, after which we tested preserved vulture tissues and found that 76 % vultures died because of visceral gout which contained residues of the drug. It was quite a strong evidence. We looked for Diclofenac in cattle carcass and found 10% of them contained the drug. The evidences were strong enough to conclude that vultures were dying because of it. The research was conducted in 2003 but the paper was published in 2004.

In 2006, the drug was banned for veterinary use. Tell us something about it.

In 2004, we prepared the Vulture Recovery Plan and recommended banning the drug for veterinary use. Secondly, we wanted to find an alternative to the drug and also we wanted to start the conservation breeding programme. We lobbied with the government and they finally banned it in 2006. Initially, they were hesitant because Diclofenac was a useful drug for cattle, which comprises a huge population in the country. We looked for a safe drug through a global search and found a drug called Meloxicam. It’s good for cattle and does not cause any mortality in vultures. We recommended it and the ban was imposed.

How effective has the ban been?

In 2006, prevalence of the drug in cattle carcasses was 10 % and in 2007, it came down to about 8 % and it further reduced to 6 % in 2011. We conducted a search for the availability of the drug in markets and found that there was no veterinary Diclofenac available, but multi dose vial for human was available. These vials were being misused on cattle, which resulted in mortality.

What all needs to be done?

We recommended the government to restrict the use of multi-dose vial of Diclofenac for humans and in July 2015 onwards, human formulation of the drug is being sold only in single vial of 3 ml only. We want prevalence of the drug to come down to less than 1 per cent in cattle carcass to save vultures.

How have the human habits affected the whole eco-system?

We are irresponsible and selfish. Why do we dispose waste, when we can remove it totally? We just cannot be sentimental fools, saying, “I will preserve it, but will not remove stuff”. Nature is ruthless and organised. If you disturb it, you will face the consequences.

What’s the role of society and how can a common man help in this regard?

One should become more responsible. We take shower everyday but take pleasure at making other places dirty. Don’t throw garbage outside. Other species have right to live. There are certain areas that we must keep safe and we should not do interfere. I don’t believe that we can co-exist in all things. Make sure that we do not throw food around. It must be kept in containers. We need to keep our houses sanitised and avoid confrontation and conflict with animals.

Asia’s first Gyps Reintroduction programme was launched on June 4. What support do you seek from the society for its success?

When we release the birds, people should report to us whenever they spot them. If they happen to find them sick, they should bring the matter to our notice. Avoid using Diclofenac in cattles. Whenever they treat cattle, ensure that the drug is not being used. Don’t go to quacks but get the cattle treated from a qualified veterinary doctor.

Singapore confirms 41 cases of locally-transmitted Zika virus

A contractor fogs a condominium garden in Singapore in an effort to kill mosquitoes, September 5, 2013.

Singapore authorities have confirmed 41 cases of locally-transmitted Zika virus, which in Brazil has been linked to a rare birth defect, and said more cases were expected to be identified.

Those infected include 36 foreign construction workers employed at a site near Aljunied in the southeast of the island, the health ministry and the National Environment Agency (NEA) said in a joint statement on Sunday.

On Saturday, authorities had confirmed Singapore’s first case of a local transmission of the virus, to a 47-year-old Malaysian woman, also from the Aljunied area.

“MOH (the ministry of health) cannot rule out further community transmission in Singapore since some of those tested positive also live or work in other parts of Singapore,” the statement said. “We expect to identify more positive cases.”

The authorities said they have tested 124 people, primarily construction workers. Seventy-eight tested negative and five cases were pending. Thirty-four patients have fully recovered. It was not immediately clear where the foreign workers were from, but Singapore hosts a large contingent of workers from the Asian sub-continent.

“All the cases are residents or workers in the Aljunied Crescent/Sims Drive area. They are not known to have traveled to Zika-affected areas recently, and are thus likely to have been infected in Singapore. This confirms that local transmission of Zika virus infection has taken place,” the statement said.

Dozens of NEA staff cleaned drains and sprayed insecticide in the mainly residential area early on Sunday, and volunteers and contractors handed out leaflets and insect repellent. The NEA workers had accessed more than 1,800 premises of a total of 6,000 in the area to check for mosquito breeding.

Local residents welcomed the clean-up.

“I’m very scared of mosquitoes because they always seem to bite me, they never bite my husband,” Janice, 31, who gave only her first name, told Reuters. “This concerns me because maybe in a couple of years I want to have another (child).”

Zika was detected in Brazil last year and has since spread across the Americas. The virus poses a risk to pregnant women because it can cause severe birth defects. It has been linked to more than 1,600 cases of microcephaly in Brazil.

Regional risk

The Singapore government said there were “ongoing local transmission” cases in Indonesia, Thailand and Vietnam. Other countries in the region to have detected the Zika virus since 2013 include Bangladesh, Cambodia, Laos, Malaysia, Maldives and the Philippines, according to the World Health Organization (WHO).

An Aedes aegypti mosquito is seen inside a test tube as part of a research on preventing the spread of the Zika virus and other mosquito-borne diseases at a control and prevention center in Guadalupe, neighbouring Monterrey, Mexico, March 8, 2016.

Malaysia said on Sunday it stepped up surveillance at main transit points with Singapore.

Health director-general Noor Hisham Abdullah said leaflets on Zika prevention were being handed out and paramedics were at entry points to handle visitors with potential symptoms.

As of this month, Malaysia said it has screened more than 2 million visitors at air, sea and land entrances, and found no Zika infections.

In Thailand, where close to 100 cases of Zika have been recorded across 10 provinces this year, the Department of Disease Control (DDC) was screening all athletes returning from the Olympic Games in Brazil, but was not otherwise changing its prevention measures.

“Every country in this region has Zika transmission cases,” said Prasert Thongcharoen, an adviser to the DDC. “Thailand has, however, managed to contain the problem through early detection.”

Indonesian foreign ministry spokesman Armanatha Nasir said the country was “following developments”. Oskar Pribadi, a health ministry official, said there have been no recent Zika cases.

Vietnam has to date reported three cases of locally-transmitted Zika infection.

The current strain of Zika that is sweeping through Latin America and the Caribbean originated in Asia, where people could have built up greater immunity.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems.

The WHO has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults.

10-year-old Vietnamese girl to have giant ‘turtle shell’ mole removed

The congenigal growth on the back of the 10-year-old girl. Photo: Nguyen Mi

Doctors at Ho Chi Minh City Children’s Hospital 1 have decided to perform a surgery to remove a turtle-shell-like mole on the back of a 10-year-old girl as the result of a rare condition.

Dao Trung Hieu, the hospital’s deputy director, said the surgery for Tran Thi Ngoc Tham of Soc Trang Province, who suffers from congenital melanocytic nevus, is scheduled for August 29.

“We can’t wait until it grows larger,” he told the media Friday, adding that the mole is now around 22 cm across.

“Her case is similar to the famous Columbian ‘turtle boy’ Didier Montalvo who was operated on in the UK in 2014.

“Didier’s was considered to be among world’s rarest birthmarks. Tham is probably the world’s second case of this rare condition.”

Tham’s mother, Thach Thi Da Ni, 34, said she was born with the birthmark measuring the size of “a mandarin orange”, and it has been growing over the years.

Tham quit school after being repeatedly teased by others as the “turtle-shell girl.” She also suffers from sleeping difficulties because the mole is itchy.

When she brought her daughter to the hospital Ni had only VND600,000 (US$27).

The poor woman, who also has a 12-year-old son who is being treated in Soc Trang for appendicitis, is seeking donations to fund the surgery, whose cost is not known.

FDA recommends Zika testing for all blood donated in U.S.

By Julie Steenhuysen and Letitia Stein

CHICAGO/TAMPA, Fla. (Reuters) – The U.S. Food and Drug Administration recommended on Friday that all blood donated in the United States and its territories be tested for Zika virus, as it moves to prevent transmission of the virus through the blood supply.

The agency said its decision to expand blood screening in the United States was based on concerns about more cases of local transmission in Florida, the growing number of travel-related infections and concerns that Zika-tainted blood could unwittingly be given to a pregnant woman, putting her unborn baby at risk of severe birth defects.

“The transfusion of a pregnant woman with blood infected with the Zika virus could have terrible consequences,” Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said during a conference call with reporters.

The current Zika outbreak was first detected in Brazil last year and has since spread across the Americas. In Brazil, Zika has been linked to more than 1,800 cases of microcephaly, and U.S. officials expect as many as 270 cases in Puerto Rico, where local transmission of the virus is widespread.

“Over 8,000 travel associated and over 2,000 non-travel associated cases of Zika have been reported in the United States and U.S. territories,” Marks told reporters.

Given frequency of travel of individuals within the United States, he said there was a risk that people without symptoms of Zika could donate blood and transmit the virus.

Testing of donated blood is underway in Florida, Puerto Rico, as well as in other areas of the United States, and has been proven helpful in finding infected donations.

“About 1 percent of donations in Puerto Rico have tested positive for Zika virus,” Marks said.

Such testing also helped spot one unit of Zika-tainted blood in the past few weeks. Marks said testing discovered the infected blood before it reached any patients.

FDA TO ROLL OUT TESTING IN STAGES

The Food and Drug Administration plans to roll out its recommendations in stages. In states and territories with local, mosquito-borne transmission, the recommendations will go into effect immediately. This affects Florida and Puerto Rico.

In 11 states near areas with local transmission or high rates of travel-related infections, the guidelines must be implemented within four weeks. These states include Alabama, Arizona, California, Georgia, Hawaii, Louisiana, Mississippi, New Mexico, New York, South Carolina and Texas.

For the rest of country, the guidelines must be implemented within 12 weeks.

Marks said Hologic Inc and Roche Molecular Systems had been granted special approval for their tests to be used to screen the blood supply.

Marks said the FDA had already reviewed data submitted by the companies and was confident these investigational tests would “perform appropriately” in this setting.

In addition to tests to check whole blood for Zika RNA, the agency said blood collection centers were permitted to use Cerus Corp’s Intercept pathogen inactivation system in certain blood products, such as plasma.

America’s Blood Centers, a network of 63 blood centers with 600 donation sites in 45 U.S. states, is currently testing for Zika primarily in Florida, where local transmission has been reported. It also has centers testing in areas of Texas that are considered at high risk for the spread of the virus, and an affiliate in Arizona testing high-risk donors.

Dr. Louis Katz, chief medical officer for America’s Blood Centers, said it would take a “titanic” effort to implement testing in the first-tier states expected to be online in four weeks, but stressed the organization’s commitment to a safe blood supply.

“Testing labs and the test vendors are working feverishly to allow testing to start on time in the areas subject to the 12-week timeline,” he said in an email. “My conversations with the vendors suggest that if all goes smoothly that goal is feasible. Then, whether things go smoothly in an incredibly complex set of processes becomes critical.”

In March, the FDA granted Roche approval for a clinical trial testing its Zika blood screening test in Puerto Rico, where local blood donations had been halted and blood had to be imported from the continental United States.

The company said its second phase of deployment would be to prepare for blood donations in the southern United States.

OneBlood, a part of America’s Blood Centers network whose coverage area includes most of Florida and smaller parts of Alabama, Georgia and South Carolina, has been testing all collections for close to a month as part of the Roche trial, said Dr. Rita Reik, chief medical officer.

“We aren’t surprised, nor do we disagree, with the FDA guidance that just came out,” Reik said in a telephone interview.

The American Red Cross has been conducting blood tests for Zika as part of a clinical trial of a Zika blood screening test made by Hologic and Grifols the FDA approved in June.

The trial involved five southeastern states believed to be at greatest risk for local Zika transmission. Over the next two weeks, the Red Cross said it will expand this testing to four additional states in the south central and southwestern United States.

Hologic said in an emailed statement that the company has been ramping up for months and is confident it can meet the added demand from the FDA’s guidance.

Shares of Hologic closed up 1 percent at $38.80 on Nasdaq.

BLOOD TRANSFUSION RISK “IS REALLY LOW”

Dr. Alyssa Ziman, medical director of the clinical laboratories and transfusion medicine at the University of California Los Angeles, said the new recommendations for Zika follow the similar steps the FDA took to protect the blood supply from the West Nile virus.

In that case, the FDA also had to rush out an unapproved test to detect the West Nile virus in the blood supply, Ziman said. Such tests are now approved.

“We are gathering data on the performance of the test while the test is in a sense being required by the FDA,” she said.

Because the products are investigational, UCLA will need special permission from an independent ethics committee known as an Institutional Review Board, then each patient will need to sign a special consent form before receiving a transfusion.

Ziman said with the testing on top of the questioning already being done about people’s travel histories to places where Zika is being spread, she believes the risk of getting Zika through a blood transfusion “is really low.”

She said people who need a blood transfusion need to balance the risk of not getting transfused against their perceived risk of contracting Zika.

Vijay Kumar, an analyst for Evercor ISI, estimates that the FDA’s recommendation for Zika universal testing “will add at least $30 million to revenues, which are likely to be split between Roche and Hologic.”

(This version of the story has been refiled to add comments from blood collection companies, background on clinical trials, comment from doctor on potential risk)

(Reporting by Ankur Banerjee in Bengaluru, Julie Steenhuysen in Chicago and Sruthi Shankar in Bangalore; Editing by Saumyadeb Chakrabarty and Bernard Orr)

Four in critical condition after sleeping near charcoal stove in HCMC

Despite the doctors’ efforts, they were still in critical condition at press time.

Four people are in critical condition due to gas poisoning after they slept in a closed room with a charcoal stove which burned all night, doctors at a hospital in Ho Chi Minh City said Friday.

The patients included a 19-year-old man, his 20-year-old wife and her mother and aunt, both 38, according to the doctors at Nguyen Tri Phuong Hospital.

They were all unconscious when being admitted to the hospital on Friday morning. Despite the doctors’ efforts, they were still in critical condition at press time.

According to their relatives, the couple, who live in Binh Chanh Dist., just lost their premature baby on Thursday.

That night they and the wife’s mother and aunt slept in the same air-conditioned room

They burned charcoal in a stove in the room, since it is a tradition belief that doing so during the first postnatal weeks will keep women and newborns strong and healthy.

Their relatives found them lying motionless when they entered the room at 6 a.m. Friday, and rushed them to the hospital.

Doctor Phan Van Nghiem, vice director of Nguyen Tri Phuong Hospital, warned against the practice of using charcoal burners to warm mothers and newborns, saying that it can emit poisonous gases such as SO2, NO2 and CO that can cause respiratory inflammation or deadly suffocation in a closed room.

This is not the first time the practice has resulted in tragic outcomes.

The incident has been reported to local police for further investigation.

Depression in HIV patients increasing risk of heart diseases, reveals study

By: IANS | New York | Published:August 26, 2016 3:45 pm

With antiretroviral therapy and improved survival, people with HIV-infection are living longer, however, they are now at an increased risk of cardiovascular diseases (Source:Pixabay)

Human immuno-deficiency virus (HIV)-infected individuals already suffering from depression are at an increased risk of experiencing a heart attack than those without the mental health condition, finds a study.

The findings showed that HIV-infected patients with major depressive disorder (MDD) — a mood disorder causing a persistent feeling of sadness and loss of interest — had a 30 per cent greater risk of having an acute myocardial infarction (AMI) or heart attack.

With the advent of highly effective antiretroviral therapy and improved survival, people with HIV-infection are living longer. However, they are now at an increased risk of cardiovascular diseases (CVD).

This elevation in heart attack risk decreased by 25 per cent after further adjustment for other variables, such as hepatitis C infection, kidney disease, alcohol or cocaine abuse or dependence and haemoglobin levels, the study said.

“Our findings raise the possibility that similar to the general population, MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population,” said Matthew S. Freiberg of the Vanderbilt University School in the US.

There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV, the researchers concluded in the paper published online by JAMA Cardiology.

For the study, the team included 26,144 HIV-infected veterans without heart disease at baseline (1998-2003) participating in the US Department of Veterans Affairs ‘Veterans Aging Cohort Study’ from April 2003 through December 2009.

Burned firefighter feels normal again after face transplant

NEW YORK (AP) — A Mississippi firefighter who received the world’s most extensive face transplant after a burning building collapsed on him said Wednesday that he feels like “a normal guy” for the first time in 15 years.

Patrick Hardison, 42, said he can now eat, see, hear and breathe normally, thanks to last year’s surgery. He has a full head of hair and hits the gym twice a week.

“Before the transplant, every day I had to wake up and get myself motivated to face the world,” Hardison told reporters at NYU Langone Medical Center. “Now I don’t worry about people pointing and staring or kids running away crying. . I’m happy.”

Hardison was a volunteer firefighter in Senatobia, Mississippi, when a building collapsed on him in 2001. He had 71 reconstructive surgeries before the transplant.

While there have been nearly 40 face transplant surgeries since 2005, Hardison’s was the first to include a scalp and functioning eyelids. Doctors have since fixed up some features and removed his breathing and feeding tubes.

Hardison has no scars on his face, and although he resembles his old self, some of his features are different. His eyes are smaller and his face is rounder, but he still has sandy brown hair.

“I don’t get up and look in the mirror and focus on that,” he said. “I get up and just go along with my day.”

The divorced father of five said one of the best moments of his life was seeing his children for the first time after the August 2015 surgery. Four of his children attended the news conference.

His 21-year-old daughter, Alison, said she cried after seeing him because she was so relieved.

“I walked into the room and I was just speechless,” she said. “He gave me a hug and our cheeks touched, and his cheeks were kind of warm, and that was something I hadn’t felt in 14 years.”

She said her father “wasn’t normal on the inside” before the surgery.

“He was very unhappy,” Alison Hardison said. “Now he’s happy with himself and happy with life.”

Patrick Hardison can finally drive and live independently thanks to his new field of vision. Previously, he could see only through “pinholes” because doctors had sewed his eyelids partially shut to protect his eyes, he said.

Eduardo Rodriguez, chairman of Langone’s plastic surgery department, said Hardison has not had any issues with transplant rejection, which is due to his medications, his children and his strength.

“He’s a remarkable individual,” Rodriguez said.

The surgery is estimated to cost about $1 million, according to NYU, but the hospital covered the cost. Rodriguez was recently awarded $2.5 million from the Defense Department to continue face transplant research.

Hardison said he hopes to meet this fall with the family of his donor, a 26-year-old artist who died in a bike accident in Brooklyn.

“I’d like to say that I’m the same old Pat, but that would not give enough credit to the amazing journey I have gone through this past year,” Hardison said. “The road to recovery has been long and hard, but if I had to do it again, I’d do it in a heartbeat.”

___

This story has been corrected to show Hardison’s daughter’s name is Alison, not Allison.

Parkinson's eye test offers hope

 

A newly developed eye test offers the hope of far earlier diagnosis of Parkinson’s disease, a devastating condition usually discovered too late in patients for effective treatment. The non-invasive, inexpensive, diagnostic test could also be used to monitor how patients respond to treatment.

Quake brings down buildings in central Italy, at least 10 believed killed

By Steve Scherer

ACCUMOLI, Italy (Reuters) – A strong earthquake brought down buildings in mountainous central Italy early on Wednesday, trapping residents and sending others fleeing into the streets, with at least 10 people believed killed.

The quake caused serious damage to a number of towns and villages, but did not seem to have hit heavily populated areas.

The worst affected towns were believed to be Accumoli, Amatrice, Posta and Arquata del Tronto.

“Now that daylight has come, we see that the situation is even more dreadful than we feared with buildings collapsed, people trapped under the rubble and no sound of life,” said Accumoli mayor Stefano Petrucci.

Earlier, Petrucci told RAI state broadcaster that a family of four had been buried when their house collapsed, adding that there was no indication they had survived.

RAI quoted police as saying two people were known to have died in the nearby village of Pescara del Tronto. Two bodies were removed from the debris in the small town of Amatrice.

“Three quarters of the town is not there anymore,” Amatrice mayor Sergio Pirozzi told RAI. “The aim now is to save as many lives as possible. There are voices under the rubble, we have to save the people there.”

A Reuters reporter said the town’s hospital had been badly damaged by the quake, with patients moved into the streets.

The earthquake caused damage to towns in three regions – Umbria, Lazio and Marche. The U.S. Geological Survey, which measured the quake at 6.2 magnitude, said it struck near the Umbrian city of Norcia, which has a picturesque historic centre and is a major tourist site.

Mayor Nicola Alemanno said no deaths had been reported in Norcia. “The anti-seismic structures of the town have held. There is damage to the historic heritage and buildings, but we do not have any serious injuries,” he told RAI.

MULTIPLE AFTERSHOCKS

Residents of Rome, some 170 km (105 miles) from the epicentre, were woken by the quake, which rattled furniture and swayed lights in most of central Italy.

“It was so strong. It seemed the bed was walking across the room by itself with us on it,” Lina Mercantini of Ceselli, Umbria, told Reuters.

Olga Urbani, in the nearby town of Scheggino, said: “Dear God it was awful. The walls creaked and all the books fell off the shelves.”

The Italian earthquake institute (INGV) reported 60 aftershocks in the four hours following the initial quake, the strongest measuring 5.5. It measured the original quake at 6.0.

Italy sits on two fault lines, making it one of the most seismically active countries in Europe.

The last major earthquake to hit the country struck the central city of L’Aquila in 2009, killing more than 300 people.

The most deadly since the start of the 20th century came in 1908, when an earthquake followed by a tsunami killed an estimated 80,000 people in the southern regions of Reggio Calabria and Sicily.

(Reporting by Steve Scherer, Crispian Balmer, Philip Pullella, Stephen Jewkes, Eleanor Biles and Giulia Segreti.; Editing by Nick Macfie, Robert Birsel)

Added sugar may increase heart disease risk in kids: Study

By: PTI | Washington | Published:August 23, 2016 9:17 pm

Children who eat food high in added sugars may develop risk factors for heart disease.

Parents, take note! Children who eat food high in added sugars may develop risk factors for heart disease, such as an increased risk of obesity and
elevated blood pressure, a new study has warned. Children ages 2 to 18 should eat or drink less than six teaspoons – equivalent to about 100 calories or 25 grammes – of added sugars daily, researchers said. “For most children, eating no more than six teaspoons of added sugars per day is a healthy and achievable target,” said Miriam Vos from Emory University in the US.

Eating foods high in added sugars throughout childhood is linked to the development of risk factors for heart disease, such as an increased risk of obesity and elevated blood pressure in children and young adults, researchers said. “Children who eat foods loaded with added sugars tend to eat fewer healthy foods, such as fruits, vegetables, whole grains and low-fat dairy products that are good for their heart health,” said Vos.

The likelihood of children developing these health problems rises with an increase in the amount of added sugars consumed. Overweight children who continue to take in more added sugars are more likely to be insulin resistant, a precursor to type 2 diabetes, researchers said. Added sugars are any sugars – including table sugar, fructose and honey – either used in processing and preparing foods or beverages, added to foods at the table or eaten
separately. According to researchers, added sugars should not be included at all in the diet of children under the age of 2 years.

The calorie needs of children in this age group are lower than older children and adults, so there is little room for food and beverages containing added sugars that do not provide them with good nutrition.

In addition, taste preferences begin early in life, so limiting added sugars may help children develop a life-long preference for healthier foods. “The best way to avoid added sugars in your child’s diet is to serve mostly foods that are high in nutrition, such as fruits, vegetables, whole grains, low-fat dairy products, lean meat, poultry and fish, and to limit foods with little nutritional value,” said Vos.

Estimated calories needed by children range from 1,000 a day for a sedentary 2-year-old to 2,400 for an active 14-18-year-old girl and 3,200 for an active 16-18-year-old boy, researchers said.

“If your child is eating the right amount of calories to achieve or maintain a healthy body weight, there is not much room in their food “budget” for low-value junk foods, which is where most added sugars are found,” said Vos. The findings were published in the journal Circulation.

Playing wind instruments can increase risk of lung diseases

By: IANS | London | Published:August 23, 2016 9:30 pm

The warning comes after a 61-year-old British man died of the chronic inflammatory lung condition called hypersensitivity pneumonitis – thought to have been caused by regularly breathing in mould and fungi. Source: pixabay.com

Love to play wind instruments like trumpets, trombones, saxophones or bagpipes? Be careful, you may be at an increased risk of developing a deadly inflammatory lung disease dubbed as ‘bagpipe lung’, warns a study.

The warning comes after a 61-year-old British man died of the chronic inflammatory lung condition called hypersensitivity pneumonitis – thought to have been caused by regularly breathing in mould and fungi lurking inside the moist interior of a set of bagpipes.

The man had a dry cough and progressive breathlessness for seven years, despite treatment with immunosuppressant drugs. The doctors identified multiple potential precipitating antigens isolated from his bagpipes.

He died as a result of extensive lung damage consistent with acute respiratory distress syndrome and tissue fibrosis (scarring), the study said.

“This is the first case that identified fungal exposure, from a bagpipe player, as a potential trigger for the development of (hypersensitivity pneumonitis),” said Jenny King from University Hospital of South Manchester (UHSM) in Manchester, Britain.

The findings showed that interiors of wind instruments turn moist and may thus foster growth of fungi or moulds that can lead to hypersensitivity pneumonitis, that gets triggered by the immune system’s response to an inhaled environmental antigen.

The condition can eventually progress to disabling or fatal lung disease, the authors noted, adding that any type of wind instrument could be contaminated with yeasts and moulds, making players susceptible to the risk of hypersensitivity pneumonitis. Cleaning instruments immediately after use and allowing them to drip dry could theoretically curb the risk of microbe growth, the researchers suggested, in the paper published in the journal Thorax.

Indian doctors remove 40 knives from man's stomach

 

Surgeons in the northern Indian city of Amritsar say they have successfully removed 40 knives from a man’s stomach.

Philippines drug war deaths double to 1,800, president spars with U.N.

MANILA (Reuters) – The number of drug-related killings since President Rodrigo Duterte took power and declared war on drugs in May has doubled to about 1,800, police said on Monday, a day after Duterte lashed out over United Nations criticism of the wave of deaths.

Duterte said in a bizarre and strongly worded late-night news conference on Sunday the Philippines might leave the United Nations and invite China and others to form a new global forum, accusing it of failing to fulfil its mandate.

However, Duterte’s foreign minister, Perfecto Yasay, said on Monday the Philippines would remain a U.N. member and described the president’s comments as expressions of “profound disappointment and frustration”.

“We are committed to the U.N. despite our numerous frustrations and disappointments with the international agency,” Yasay told a news conference on Monday.

Last week, two U.N. human rights experts urged Manila to stop the extra-judicial executions and killings that have escalated since Duterte won the presidency in May on a promise to wipe out drugs.

As recently as Sunday, the number of suspected drug traffickers killed in Duterte’s seven-week war on drugs had been put at about 900 by Philippine officials.

However on Monday, Philippine National Police Chief Ronald Dela Rosa told a Senate committee investigating extra-judicial killings that 712 drug traffickers and users had been killed during police operations. Police were also investigating 1,067 drug-related killings outside normal police work, Dela Rosa said.

The latest figures had been compiled since July 1, he said.

Yasay said Duterte has promised to uphold human rights in the fight against drugs and has ordered the police to investigate and prosecute offenders. He criticized the U.N. rapporteurs for “jumping to an arbitrary conclusion that we have violated human rights of people”.

“It is highly irresponsible on their part to solely rely on such allegations based on information from unnamed sources without proper substantiation,” he said of the United Nations.

Senator Leila de Lima, a staunch critic of the president, started a two-day congressional inquiry into the killings on Monday, questioning top police and anti-narcotics officials to explain the “unprecedented” rise in killings.

(Reporting by Karen Lema; Editing by Michael Perry and Paul Tait)

HCMC to set up emergency aid stations, train paramedics

An ambulance car is stuck in traffic in Ho Chi Minh City. Photo: An Bang

Ho Chi Minh City plans to set up emergency aid stations in many places to provide first aid more effectively given its heavy traffic.

The health department has proposed cooperation with an Australian university to train paramedics to man the 25 planned stations, or an average of one per district.

Tang Chi Thuong, deputy director of the health department, said setting up such centres is appropriate for a crowded city prone to traffic jams.

The emergency stations, which can use spare ambulances at district hospitals, would make sure patients get first aid promptly before they can reach a hospital, he said.

The city of 12 million, including migrants, has more than 200 ambulances, but they do not always reach patients in time due to the heavy traffic.

Le Truong Giang, chairman of the HCMC Public Health Association, said if the ambulances can be stationed at the proposed centres, the system can serve 30 times more patients than now.

Also, each emergency care station will be staffed and equipped to provide first aid for people of all ages and various conditions from injuries to strokes, something no hospital in the city can currently do.

The estimated cost of the project has not been disclosed.

Repeal or retain? Election opens final act for 'Obamacare'

WASHINGTON (AP) — Election Day 2016 will raise the curtain on the final act in the nation’s long-running political drama over President Barack Obama’s health care overhaul.

If Republican Donald Trump wins, the unraveling begins.

“We have an obligation to the people who voted for us to proceed with ‘repeal and replace,'” said Sen. John Barrasso, a Wyoming Republican.

If Democrat Hillary Clinton goes to the White House, it gets very difficult for Republicans to keep a straight face about repealing “Obamacare.”

“There just won’t be any credible way to keep talking about repealing the Affordable Care Act,” said Ron Pollack, executive director of Families USA and a supporter of the law.

After years of debating health care politics and policies, Americans remain divided over the 2010 law, which was passed without a single Republican vote when Democrats still controlled both houses of Congress. What happens next could affect health insurance for nearly everyone.

It’s not just the millions who have gained coverage through expanded Medicaid in a majority of states and subsidized private health insurance in every part of the country.

It’s also anyone with an existing medical condition who now can apply for health insurance without fear of being turned away. It’s millennials weighing paying monthly premiums against paying a fine for remaining uninsured. It’s women whose birth control is covered free by their employer, and parents who can keep late-blooming kids on their workplace plans until age 26.

Brian Greenberg of Stamford, Connecticut, is in his early 30s, and his insurer has already spent more than $845,000 on medical care for the Crohn’s disease patient. A financial services professional, Greenberg worries about a return to lifetime dollar limits on coverage, a type of cutoff that was previously allowed.

Deborah Paddison, of Phoenix, fears she would become uninsurable. For most her life she has battled rheumatoid arthritis, an autoimmune disease that attacks the joints and tissues. Paddison works as a freelance editor and writer and says her independence is due in part to subsidized coverage under the health care law.

The law’s tangible benefits for Greenberg, Paddison and millions of other Americans present a major challenge for Republicans.

They have honed their legislative strategy for repealing most, if not all, of Obama’s law, but they still have to work out key parts of their plan for replacing it. Among the questions would be what to do with the exchanges that serve as marketplaces for people buying private health insurance policies. Many of the exchanges have come under stress as major insurers have pulled out over rising costs, a factor that has reduced competition and consumer choice.

The framework that GOP congressional leaders have released isn’t detailed enough to allow a full comparison with current law. The Center for American Progress, a think tank aligned with the Clinton campaign, estimates 24 million people will lose coverage by 2021 if the law is repealed and says the Republican replacement will not fill that hole.

But Barrasso, one of his party’s leaders on health policy, said Republicans will provide a path to more affordable coverage with less government regulation.

“I have no desire to protect ‘Obamacare,’ but I want to protect the American people,” he said.