The Economy of Surgery

When I was twelve, my sister and I accompanied my grandparents to their annual yoga retreat in the hilly ranges of southern India. We had never been before, but the summer heat was particularly blistering that year, so we persuaded our grandparents to take us along. I envisioned a blissful two-week vacation in a photogenic little hamlet, nestled among tea plantations, in temperatures that were thirty degrees cooler than on the mainland. It was just that, and yet, it was even less complicated than that.The mean age of folk at the retreat was 67. Bells sounded every morning at 3:30am, and everyone filed out of their cabins and to a little gymnasium in the center of the dwelling, where we all meditated for two hours to the sounds of sitar music and transcendental humming. Meals were served at strict hours three times a day, and consisted of boiled vegetables and grains, with not a lick of salt or spice. The library in the middle of this utopian dwelling held only spiritual and philosophical texts, not the Nancy Drew or Hardy Boys I hoped for. In the afternoons, there were a variety of classes offered – cooking lessons, devotional classes, music and instrumental classes, and yoga. My sister and I stopped by the latter occasionally, and were always put to shame by octogenarians holding themselves up in impossible poses, such as balancing their entire habitus on the tips of their fingers. I journaled in the evenings, writing each day about a new facet of human life that I’d observed. In the absence of stimulus, my dreams grew vivid and exceedingly detailed.Over the course of the two weeks, my sister and I grew quiet and reflective. It was then that we began an important switch in our minds, something that has lasted to this day. We began to see value in living leanly, economically, functionally. We began to separate needs from wants, and to discard the ornamentation.*Third year of medical school has finally brought me around to my surgery rotation: three months of waking up at 4am, stuffing my white coat pockets to the brim with gauze and tape, retracting skin and fat during long abdominal surgeries, and practicing suturing techniques on pig’s feet procured at the local Stop&Shop grocery market. It’s fast and exhilarating, and deeply satisfying. I was skeptical when I first heard that my preceptor’s favorite procedure of all time was draining a deep-seated abscess. But when I saw it being done in clinic, how a single stab of the thing blade led to the gushing of what felt like liters of pus, I couldn’t help but agree. What a joy to just go in and fix a problem so dramatically, reconstruct a failing human body in a matter of hours!During orientation on the first day of the rotation, two residents sat down and gave my classmates and me some hard advice. Surgery is a demanding rotation, they said, and it reflects the demanding residency ahead that awaits the select few. We could expect to go in while it is still dark out, and leave after the sun had set, almost every day. Residents and attendings can be rough around the edges, and may be gruff with you, even kick you out of their operating room if they feel like it, but it’s not personal. Or even if it is, we’ve got to shrug it off and keep it moving. Gone are the days of noon conferences and luxurious afternoon didactics, with their promise of free lunches and coffee. We were to eat when we can, sit when we can, sleep when we can.After an hour of such grim prognostications, my classmates and I took a break and debriefed our feelings with each other outside the bathrooms. Some were giggling nervously with panicked eyes, but most looked inspired. I too felt like I had voluntarily signed up for a warrior training program, and was feeling pretty zen about it. I saw it as a character-building experience: surgery was the time to cut out the silly frills, and embrace a leaner, meaner way of living. It was time to lose the pretty business casual outfits and fancy footwear of internal medicine, and trade them in for utilitarian scrubs and clogs. It promised to be a time of talking less and getting things done.*During a recent health management class, my classmates and I discussed the case of a medical center based in Seattle that benefited from industry principles gleaned from, of all places, the Toyota car manufacturing company. Toyota’s revolution as a manufacturing miracle began in the supply-scarce post-WWII Japan, when management was confronted with the challenge of meeting customer needs in the face of little spare capital to hold inventory as a buffer to fluctuating demand. The company then developed a set of principles focused on cutting muda or waste, while pursuing kaizen, or continuous self -improvement by way of complete intolerance for redundancy. Toyota integrated these principles into every step of production and management.For instance, Toyota emphasizes innovation on the shop floor by frontline workers to solve problems in production in real time. If a problem is discovered that cannot be fixed within the production cycle time, workers pull a cord that halts the entire assembly line and brings a senior supervisor to the scene. The management aggressively seeks ideas for improvement from employees, resulting in an average yield of close to a million ideas annually, 90% of which go on to be implemented.Analysts attribute Toyota’s success to its emphatic optimization of flow – information flow, physical flow of parts, and overall production flow, via standardized processes and continuous improvement. Standardized processes are ones that are streamlined to eliminate aberrations and unplanned redundancies. Waste, measured even in the seconds, is simply not tolerated, forcing a redesign of processes, again and again, which any employee can take on.In 2004, Toyota surpassed Ford Motors to become the world’s second-largest manufacturer of cars and trucks, surpassing the latter consistently in quality, dependability and value assessments. In turn, Ford began to take cues from Toyota, transforming its assembly-line system to similarly cut out waste.*There are two kinds of people in the world: surgeons, and everyone else.Really, what does it mean to live leanly? I rediscovered it in this rotation. A life in surgery isn’t for everyone, but such an experience is something I truly feel everyone should have. These past 6 weeks have been teaching me to think fast, move fast. They’ve been teaching me to suffice with less, be it food, sleep, or words of appreciation. They’ve been teaching me to appreciate the vulnerabilities of the human body – for no matter how exhausted or sleep-deprived I may feel, actually laying hands on the more tangible deficits of another’s is always startling and humbling. The end result is a beautiful dance, for surgeons and their assistants, working with their hands, rediscovering the grace of human movement, bring art back into medicine.I never leave the OR thinking that more is better. I watch instruments fly, I watch the players push and pull, cut and stitch, wash and dry, and I think about things like symmetry, precision, and above all, the beauty of economy.

Follow Scientific American on Twitter @SciAm and @SciamBlogs.Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.
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Putin aide denies Russian president has health problems

TOKYO/MOSCOW (Reuters) – Vladimir Putin is in good health, his chief of staff said on Friday after Japanese media said Prime Minister Yoshihiko Noda had postponed a visit to Moscow next month because the Russian president had a health problem.

A former KGB officer who enjoys vast authority in Russia, Putin has long cultivated a tough-guy image, and health issues could damage that. His condition though has been questioned in some media since he was seen limping at a summit in September.

Three Russian government sources told Reuters late in October that Putin, who began a six-year term in May and turned 60 last month, was suffering from back trouble, but the Kremlin has dismissed talk that he had a serious back problem.

Putin’s health troubles stem from a recent judo bout, Belarussian President Alexander Lukashenko said this week.

Then on Friday Japanese news agencies Kyodo and Jiji reported that Prime Minister Noda talked about the delay of a visit planned for December in a meeting with municipal officials on the northern island of Hokkaido.

“It’s about (President Putin’s) health problem. This is not something that can easily be made public,” Jiji cited one of the officials as quoting Noda as saying.

But Putin’s chief of staff Sergei Ivanov denied there was any problem.

“Please don’t worry, don’t be concerned. Everything is in order with his health,” Putin’s said in Vienna, according to state-run Russian news agency RIA.

In an interview published on Friday in the popular Russian tabloid Komsomolskaya Pravda, Putin’s spokesman Dmitry Peskov said rumors about a spine problem were “strongly exaggerated”.

“He is working as he has before and intends to continue working at the same pace,” Peskov said.

“He also does not plan to give up his sports activities and for this reason, like any athlete, his back, his arm, his leg might sometimes hurt a little – this has never gotten in the way of his ability to work.”

Putin had been expected to make several foreign trips in late October or November, but they did not take place.

Putin is however due to visit Turkey on Monday and Turkmenistan on Wednesday.

Putin’s foreign policy adviser, Yuri Ushakov, made amply clear the Kremlin was displeased by the public discussion of scheduling by Japanese officials and denied that Noda’s visit had been postponed, saying no date had been set.

“It is just unethical to name the dates that were discussed. There were several: at first it was October, November, December, January … then we even shifted to February,” Ushakov said, adding that the sides eventually agreed tentatively on January.

He said the diplomatic process of agreeing dates for the visit should have been “hermetically sealed”.

Putin’s image as a fit, healthy man helped bring him popularity when he rose to power 13 years ago because of the stark contrast with his predecessor Boris Yeltsin, who was sometimes drunk in public and had heart surgery when president.

He has used activities like scuba diving and horseback riding to maintain that image.

On Friday, Putin met leaders of parliamentary factions in his Novo-Ogaryovo residence outside Moscow. He appeared in good health and was walking without any sign of a limp.

Likely to be on the agenda in talks between Russian and Japanese officials are energy cooperation and a decades-old dispute over islands north of Hokkaido known as the Southern Kurils in Russia and the Northern Territories in Japan.

(Additional reporting by Darya Korsunskaya; Writing by Tomasz Janowski and Steve Gutterman; Editing by Nick Macfie and Jon Hemming)

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African Union asks UN for immediate action on Mali

DAKAR, Senegal (AP) — In an open letter Thursday to U.N. Secretary-General Ban Ki-moon, the president of the African Union urged the U.N. to take immediate military action in northern Mali, which was seized by al-Qaida-linked rebels earlier this year.

Yayi Boni, the president of Benin who is also head of the African Union, said any reticence on the part of the U.N. will be interpreted as a sign of weakness by the terrorists now operating in Mali. The AU is waiting for the U.N. to sign off on a military plan to take back the occupied territory, and the Security Council is expected to discuss it in coming days.

In a report to the Security Council late Wednesday, Ban said the AU plan “needs to be developed further” because fundamental questions on how the force will be led, trained and equipped. Ban acknowledged that with each day, al-Qaida-linked fighters were becoming further entrenched in northern Mali, but he cautioned that a botched military operation could result in human rights abuses.

The sprawling African nation of Mali, once an example of a stable democracy, fell apart in March following a coup by junior officers. In the uncertainty that ensued, rebels including at least three groups with ties to al-Qaida, grabbed control of the nation’s distant north. The Islamists now control an area the size of France or Texas, an enormous triangle of land that includes borders with Mauritania, Algeria and Niger.

Two weeks ago, the African Union asked the U.N. to endorse a military intervention to free northern Mali, calling for 3,300 African soldiers to be deployed for one year. A U.S.-based counterterrorism official who saw the military plan said it was “amateurish” and had “huge, gaping holes.” The official insisted on anonymity because he was not authorized to speak on the matter.

Boni, in his letter, said Africa was counting on the U.N. to take decisive action.

“I need to tell you with how much impatience the African continent is awaiting a strong message from the international community regarding the resolution of the crisis in Mali. … What we need to avoid is the impression that we are lacking in resolve in the face of these determined terrorists,” he said.

The most feared group in northern Mali is al-Qaida in the Islamic Maghreb, or AQIM, al-Qaida’s North African branch, which is holding at least seven French hostages, including a 61-year-old man kidnapped last week.

On Thursday, SITE Intelligence published a transcript of a recently released interview with AQIM leader, Abu Musab Abdul Wadud, in which he urges Malians to reject any foreign intervention in their country. He warned French President Francois Hollande that he was “digging the graves” of the French hostages by pushing for an intervention.

Also on Thursday, Islamists meted out the latest Shariah punishment in northern city of Timbuktu. Six young men and women were each given 100 lashes for having talked to each other on city streets, witnesses said.

___

Associated Press writer Virgile Ahissou in Cotonou, Benin and Baba Ahmed in Bamako, Mali contributed to this report.

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Apple overcomes last hurdle, iPhone 5 cleared for sale in China as Android continues to dominate

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Human stool treatment upends race to treat colon germ

(Reuters) – Drugmakers racing to develop medicines and vaccines to combat a germ that ravages the gut and kills thousands have a new challenger: the human stool.

For patients hit hardest by the bacterium Clostridium difficile, getting a “stool transplant” could become a standard treatment within just a few years. Just as blood banks and sperm banks are now commonplace, stool banks may soon dot the landscape.

About 3 million Americans are infected annually with the bacterium – also known as C. diff – which spreads mainly through hospitals, nursing homes and doctors’ offices.

Most people have no symptoms, but 500,000 – more than half of them 65 and older – develop abdominal cramps, fever, diarrhea and inflamed colons. As many as 30,000 Americans die each year from the bacterium, usually after recurrences of infection.

The infections are typically the result of taking antibiotics, which wipe out friendly bacteria in the colon that normally keep C. diff under control. Transplants of stool from screened donors – given by enema, colonoscopy or a tube down the throat – restore these bacteria.

Although the vast majority of C. diff infections occur in healthcare settings, more and more cases are occurring in younger adults and children who have not recently taken antibiotics or been hospitalized. They include people who take proton pump inhibitors – a leading class of heartburn drugs.

Costly treatments from Merck & Co and other drugmakers, and a vaccine from Sanofi, are on the horizon. But growing numbers of gastroenterologists are more excited about the use of human stool transplants, which in experimental settings have consistently cured 85 percent to 90 percent of patients who have had multiple episodes of C. diff.

“Until recently, fecal transplants have been on the fringes of mainstream medicine,” said Dr. Cliff McDonald, an epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC). “It could become the primary mode of therapy within a year or two for patients with multiple recurrences.”

Francie Williamson, a 32-year-old editor for the Cedar Rapids Gazette in Iowa, has been battling C. diff since giving birth in May and considers herself a prime candidate.

After several recurrences, she still suffers from cramping and diarrhea and is making another appointment with her doctor to see if she still has the germ.

“He’s done fecal transplants, like 10 of them. So I definitely want to have (that option) in my back pocket.”

WHEEL OF MISFORTUNE

The first recorded stool transplants were given in 1958 to four patients with inflamed colons. The procedures won more attention in the mid-1980s, when Australian gastroenterologist Thomas Borody began using them to treat his C. diff. patients.

Dr. Moshe Rubin, head of gastroenterology at New York Hospital Queens, said most patients prefer the simplicity of a pill or injection, but for those with multiple bouts the fecal transplants could become a mainstay treatment.

“This has to be tested in large numbers of people before you unleash it for such a widespread disease,” Rubin said.

C. diff medicines and vaccines could eventually claim total annual sales of $ 2 billion, according to Morningstar analyst David Krempa, or 10 times current sales.

Fecal transplants might initially be appropriate for patients who have had a third recurrence – or about 25,000 Americans each year, according to Dr. Sahil Khanna, a Mayo Clinic gastroenterologist. That number could rise as the procedure becomes more widely accepted, and pose perhaps the biggest threat to sales of Merck’s experimental drug, which is expected to target a similar patient group.

About 90 percent of C. diff patients initially treated with vancomycin, and 60 percent of those treated with another standard oral drug called metronidazole, recover within weeks. But 20 percent suffer recurrences, as surviving bacteria spores become activated or as patients become re-infected with spores that cling to clothing and furniture and can survive for months.

With each recurrence, risk of another rises, with more weight loss, diarrhea and fatigue. After a third recurrence, the risk of suffering a fourth is 60 percent to 70 percent.

“It’s a constant wheel of misfortune,” said Eric Kimble, a senior executive for Cubist Pharmaceuticals Inc, which is developing a C. diff treatment called CB-315.

GETTING OVER THE ‘ICK’ FACTOR

Fecal transplants have proved a godsend to such patients. They are given to those who have not benefited from metronidazole or vancomycin – or who have suffered repeat recurrences of C. Diff after being temporarily helped by the treatments.

In more than 100 of the experimental procedures performed by Dr. Christine Lee, the transplants cured the infections and prevented recurrences in 90 percent of patients, said the infectious disease physician at St. Joseph’s Healthcare (hospital) at McMaster University in Hamilton, Ontario.

“Their energy level and appetite bounce back within a week, sometimes within 48 hours,” Lee said. “They can’t believe how simple and effective the procedure is.”

In a five-minute bedside procedure, Lee introduces about 50 grams (1.75 ounces) of donated fecal matter into the rectum, using an inexpensive plastic plunger. A single procedure re-establishes the balance of bacteria.

Friends and family of patients, as well as doctors and nurses, provide without pay the stool used in Lee’s procedures. They are screened to ensure they do not have viruses, such as HIV or hepatitis C, or other pathogens that can be transmitted to patients. She said some donate stool on a regular basis, which can be used for a great number of patients.

Once transplants are approved by health regulators, Lee predicted, enema procedures will be less costly than two other delivery methods now used for stool transplants. They include colonoscopy, in which doctors sedate the patient and insert stool into the colon, or through a different procedure in which a plastic feeding tube is passed through the nose, down the throat and into the stomach.

In the meantime, gastroenterologists say doctors and hospitals can help prevent C. diff by being more restrained in the use of antibiotics and ensuring that hospital rooms are diligently cleaned with bleach wipes to kill C. diff spores.

MERCK, SANOFI TAKE AIM AT TOXINS

One of the best hopes for stopping C. diff, aside from fecal transplants, could be Merck’s injectable monoclonal antibody. In a mid-stage trial, 7 percent of patients had recurrences when taking the Merck product in combination with metronidazole or vancomycin. That compared with 25 percent of those receiving only standard therapy.

Merck’s drug works by disabling two toxins released by C. difficile that wreak havoc in the colon, and is meant to be taken alongside the standard treatments.

“Other drugs go after the bacteria, but there is nothing out there now that targets the toxins directly,” said Dalya Guris, Merck’s project leader for the medicine.

French drugmaker Sanofi is working on a vaccine that is not expected to become available for at least five years. It will be tested among high-risk individuals who expect to be hospitalized for elective surgeries or who plan to enter nursing homes.

“The intent of the vaccination is to prevent the first occurrence of symptoms of the disease” among those at highest risk, said Patricia Pietrobon, Sanofi’s project leader.

Merck and Sanofi declined to say how much they will spend to test their products, but costs of developing antibodies and vaccines can top $ 1 billion and $ 500 million, respectively, according to drugmakers.

The most effective approved drug against the first recurrence of C. diff is Dificid, from Optimer Pharmaceuticals Inc, introduced in May 2011. It is as effective as vancomycin in curing initial C. diff infections, and almost 50 percent better at preventing a first recurrence.

But Dificid has had modest sales because it costs about $ 3,000 for a 10-day course of treatment. That’s twice the cost of vancomycin and 300 times the cost of metronidazole.

Dificid could peak in 2016 with annual sales of $ 210 million, according to Cowen and Co.

Cubist, which co-markets Dificid in the United States, is testing its own drug CB-315 and expects it to be approved in 2016. Like Dificid, it is a narrow-spectrum antibiotic meant to attack C. difficile while sparing normal bowel bacteria.

Dr. Mark Pochapin, director of gastroenterology at NYU Langone Medical Center, said Merck’s anti-toxin approach might eliminate symptoms the same day of treatment. But he said fecal transplants have more appeal.

“They appear effective, balance the normal intestinal flora, are inexpensive and are safe when done with appropriate testing,” he said. “They will far and away revolutionize how we treat this disease.”

Many patients might benefit most from transplantation of their own stool, rather than relying on donors. They would include those undergoing chemotherapy or hip or knee replacements, all of which involve use of antibiotics, said the CDC’s McDonald.

People, he said, would set aside stools for processing into capsules that would be frozen and stored until needed.

Such “bacterial treatment” after antibiotics might eventually also lower the risk of developing asthma, allergy, obesity or other conditions that may be partly linked to loss of helpful bacteria, McDonald said.

“Look at it as a way to put people’s bacterial population back together again after antibiotics, like restoring Humpty Dumpty,” said McDonald.

(Reporting By Ransdell Pierson; Editing by Jilian Mincer, Edward Tobin, Martin Howell and Steve Orlofsky)

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Dollar-Less Iranians Discover Virtual Currency

Under sanctions imposed by the U.S. and its allies, dollars are hard to come by in Iran. The rial fell from 20,160 against the greenback on the street market in August to 36,500 rials to the dollar in October. It’s settled, for now, around 27,000. The central bank’s fixed official rate is 12,260. Yet there’s one currency in Iran that has kept its value and can be used to purchase goods from abroad: bitcoins, the online-only currency.

Created in 2009 by a mysterious programmer named Satoshi Nakamoto, bitcoins behave a lot like any currency. Their value is determined by demand, and they can be used to buy stuff. Bitcoin transactions are encrypted and handled by a decentralized global network of tens of thousands of personal computers. Merchants around the world accept the currency, from a bakery in San Francisco to a dentist in Finland. Individuals who own bitcoins and wish to exchange them for physical currencies like euros or dollars can use exchange sites such as localbitcoins.com, a Finland-based site founded by Jeremias Kangas. “I believe that bitcoin is, or will be in the future, a very effective tool for individuals who want to avoid sanctions, currency restrictions, and high inflation in countries such as Iran,” Kangas wrote in an e-mail.

The advantage for Iranians is that bitcoins can be swapped for dollars that can then be kept outside the country. Another plus: Regulators can’t easily track the transactions, since bitcoins aren’t issued from a central server. Bitcoin users can conduct business on virtual private networks, which hide customers’ identities.

At online store coinDL.com, shoppers can use bitcoins to buy Beyond Matter, the latest album from Iranian artist Mohammad Rafigh. Anyone in the U.S. downloading songs, which fetch .039 bitcoins or 45¢ each, risks violating U.S. sanctions. That doesn’t bother Rafigh, who’s studying computer engineering as well as playing music. “Bitcoin is so interesting for me,” Rafigh wrote in an e-mail. “I wish the culture of using digital money spreads all over the world, because it does not have any dependency on anything like politics.” Rafigh has translated some bitcoin software into Farsi for his friends. “I love Iran, and if bitcoin is good for me, it can be good for more Iranians like me.”

Iranian-American bitcoin consultant Farzhad Hashemi recently traveled to Tehran and talked up bitcoin to his friends. “They are instantly fascinated by it,” he says. “It’s a flash for them when they realize how it can solve their problems.” Iranians working or living abroad can send bitcoins to their families, who can use one of the online currency matchmaking services to find someone willing to exchange bitcoins for euros, rials, or dollars. Bitcoins are useful to Iranians wishing to move their money abroad, either to children studying in Europe or America or simply to stash cash in a safe place.

As the value of the rial plunges, many Iranians are trying to acquire foreign currencies. “We have no idea what will happen,” says Amir-Hossein Madani, who says he’s traded tens of millions of street market dollars in Tehran over the past two years. “These days prices change every 10 minutes.”

The uncertainty has led some Iranian software developers to ask clients to pay them in bitcoins. “Anyone with a computer is able to own, send, and receive them. You can be at an Internet cafe in Iran and managing a bitcoin account,” says Jon Matonis, a founding board member of the Bitcoin Foundation, a Seattle nonprofit that promotes the currency. The exchange rate in Iran is 332,910 rials per bitcoin. It isn’t known how many Iranians use bitcoins to skirt sanctions. According to localbitcoins’ Kangas, 32 people in Iran have contacted each other through his site.

An internal FBI report in April expressed concern over the online currency. The report was leaked to Wired and Betabeat. “Since Bitcoin does not have a centralized authority, law enforcement faces difficulties detecting suspicious activity, identifying users, and obtaining transaction records—problems that might attract malicious actors to Bitcoin,” says the report. For now, Iranians are using bitcoins to maintain a fragile connection to the outside world.

The bottom line: Iranians are resorting to virtual currency to move money into and out of the country in a way that Western authorities find hard to detect.

With Ladane Nasseri, Yeganeh Salehi, and Peter S. Green

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Myanmar cracks down on mine protest; dozens hurt

MONYWA, Myanmar (AP) — Security forces used water cannons and other riot gear Thursday to clear protesters from a copper mine in in northwestern Myanmar, wounding villagers and Buddhist monks just hours before opposition leader Aung San Suu Kyi was to visit the area to hear their grievances.

The crackdown at the Letpadaung mine near the town of Monywa risks becoming a public relations and political fiasco for the reformist government of President Thein Sein, which has been touting its transition to democracy after almost five decades of repressive military rule.

The environmental and social damage allegedly produced by the mine has become a popular cause in activist circles, but was not yet a matter of broad public concern. However, hurting monks — as admired for their social activism as they are revered for their spiritual beliefs — is sure to antagonize many ordinary people, especially as Suu Kyi’s visit highlights the events.

“This is unacceptable,” said Ottama Thara, a 25-year-old monk who was at the protest. “This kind of violence should not happen under a government that says it is committed to democratic reforms.”

According to a nurse at a Monywa hospital, 27 monks and one other person were admitted with burns caused by some sort of projectile that released sparks or embers. Two of the monks with serious injuries were sent for treatment in Mandalay, Myanmar’s second biggest city, a 2 ½ hour drive away. Other evicted protesters gathered at a Buddhist temple about 5 kilometers (3 miles) from the mine’s gates.

Lending further sympathy to the protesters’ cause is whom they are fighting against. The mining operation is a joint venture between a Chinese company and a holding company controlled by Myanmar’s military. Most people remain suspicious of the military, while China is widely seen as having propped up army rule for years, in addition to being an aggressive investor exploiting the country’s many natural resources.

Government officials had publicly stated that the protest risked scaring off foreign investment that is key to building the economy after decades of neglect.

State television had broadcast an announcement Tuesday night that ordered protesters to cease their occupation of the mine by midnight or face legal action. It said operations at the mine had been halted since Nov. 18, after protesters occupied the area.

Some villagers among a claimed 1,000 protesters left the six encampments they had at the mine after the order was issued. But others stayed through Wednesday, including about 100 monks.

Police moved in to disperse them early Thursday.

“Around 2:30 a.m. police announced they would give us five minutes to leave,” said protester Aung Myint Htway, a peanut farmer whose face and body were covered with black patches of burned skin. He said police fired water cannons first and then shot what he and others called flare guns.

“They fired black balls that exploded into fire sparks. They shot about six times. People ran away and they followed us,” he said, still writhing hours later from pain. “It’s very hot.”

Photos of the wounded monks showed they had sustained serious burns on parts of their bodies. It was unclear what sort of weapon caused them.

The protest is the latest major example of increased activism by citizens since the elected government took over last year. Political and economic liberalization under Thein Sein has won praise from Western governments, which have eased sanctions imposed on the previous military government because of its poor record on human and civil rights. However, the military still retains major influence over the government, and some critics fear that democratic gains could easily be rolled back.

In Myanmar’s main city of Yangon, six anti-mine activists who staged a small protest were detained Monday and Tuesday, said one of their colleagues, who asked not to be identified because he did not want to attract attention from the authorities.

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U.S. daily deals website Living Social to cut 400 jobs: WSJ

(Reuters) – U.S. daily deals online firm Living Social Inc is expected to announce on Thursday it is cutting 400 jobs, representing 9 percent of its workforce, as demand for daily deals and emailed daily discounts dries up, the Wall Street Journal reported, citing a source familiar with the plans.

The Washington-based company’s workforce has increased nearly 10-fold since the beginning of 2010 and it currently employs about 4,500 people worldwide, the Journal said. (http://link.reuters.com/rus34t)

Retail website Amazon.Com Inc owns a 30 percent stake in Living Social and booked a third-quarter charge of $ 169 million on the holding.

Living Social declined to comment to Reuters on the Journal report.

(Reporting By Neha Dimri and Alistair Barr; Editing by Muralikumar Anantharaman)

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DEA probes Walgreens pharmacies over drug diversion in Florida

(Reuters) – The U.S. Drug Enforcement Administration is probing three Walgreen Co pharmacies in Florida in connection with a wide-ranging investigation of the diversion of prescription drugs for illicit use.

The Miami Field Division of the DEA issued the pharmacies with orders to show cause – notifications that are given to facilities requiring them to prove why they should be allowed to keep their licenses.

The pharmacies affected are Walgreens #04727 in Fort Pierce; Walgreens #03629 in Hudson; and Walgreens #06997 in Oviedo.

The actions by the DEA do not immediately prevent the pharmacies from handling or distributing potentially addictive controlled substances such as sedatives and narcotic pain-killers.

However, Special Agent in Charge Mark R. Trouville, of the DEA’s Miami Field Division, said the diversion of prescription drugs continues to be a “great concern for the DEA.”

A spokesman for Walgreens, Jim Graham, said the company stopped accepting prescriptions for certain controlled substances at these pharmacies last May in a bid to show its willingness to work with the DEA.

“We have taken a number of steps since mid-2011 to enhance our monitoring and reporting criteria,” he said in an e-mail. “These actions have resulted in a 35 percent drop in the number of tablets dispensed by our pharmacies in Florida for the most commonly abused pain management drug between June 2011 and March 2012.”

The pharmacy’s actions have included enhancing its ordering and inventory reporting requirements to limit quantities of several controlled substances with high risk potential, Graham said.

In April the DEA said it would inspect six Walgreens pharmacies and its Florida distribution center after the agency noticed a jump in purchases of the painkiller oxycodone. On September 14, the distribution center’s registration was suspended. An administrative hearing is scheduled to begin on that matter on January 7, 2013.

The DEA has been ratcheting up its focus on drug wholesalers and pharmacies over the past year as attempts to battle what the Centers for Disease Control and Prevention calls a prescription drug abuse epidemic. Deaths from narcotic pain-killers now exceed those of heroin and cocaine combined.

Florida has long been considered the epicenter of prescription drug abuse and the DEA has dismantled dozens of “pill mills” – sham pain clinics whose doctors write prescriptions for thousands of pain pills to drug dealers and addicts.

The DEA said the pharmacies who received the orders may file a written request with the agency within 30 days for an opportunity to have an administrative hearing to determine whether their right to sell controlled substances should be revoked.

(Reporting by Toni Clarke; Editing by Andrew Hay and Dan Grebler)

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France Veers to Left With Threat to Nationalize a Mill

France’s threat to nationalize a steel mill to prevent job losses is shaping up as a public relations disaster for the government—with potential collateral damage to the European steel industry as well.

President François Hollande’s Socialist government says it may take temporary control of the Hayange-Florange plant in Lorraine to prevent its owner, ArcelorMittal (MT), from eliminating about 630 of 2,700 jobs at the site. Industry Minister Arnaud Montebourg told Parliament on Nov. 28 that the government had already found a potential buyer for the facility, which ArcelorMittal does not want to sell. The transaction would involve “a temporary nationalization” and resale, Montebourg said.

Talks between the government and the steelmaker are continuing after a Nov. 27 tête-à-tête between Hollande and Chief Executive Lakshmi Mittal at the Elysée Palace failed to produce an agreement.

The showdown has sparked an uproar extending well beyond France’s borders. In a Nov. 26 newspaper interview, Montebourg said, “We don’t want Mittal in France,” and accused the company of breaking earlier promises to protect jobs. Lakshmi Mittal’s family told Le Monde it was “extremely shocked” by the comment. London Mayor Boris Johnson, who happened to be visiting Mittal’s native India at the time, told a group of Indian businessmen: “If France doesn’t want you, Britain does.”

Nationalization of private companies was abandoned decades ago by most major economies—including France, where it was last used by Socialist President François Mitterrand in the early 1980s.  Its resurrection, along with the government’s attacks on Mittal, aren’t likely to help French efforts to reverse a slump in foreign investment. According to the United Nations, foreign direct investment in France last year totaled $ 40.9 billion, less than half the figure five years ago. Even the left-leaning Paris newspaper Libération wondered in a Nov. 27 article whether nationalization was “really a good idea, or mission impossible?”

Underlying the Florange dispute is a big problem facing European steelmakers: Too much production capacity is chasing too few customers. Producers such as Luxembourg-based ArcelorMittal and Germany’s ThyssenKrupp (TKA:GR) collectively sell about 150 million tons of steel per year, utilizing only 71 percent of their capacity, says Seth Rosenfeld, an analyst at Jefferies International in London.

The excess capacity “reduces their pricing power” and weighs on profitability, Rosenfeld says. ArcelorMittal on Oct. 31 reported its lowest quarterly profit in almost three years.

With steel demand slumping almost everywhere in the world except China, other producers are struggling to cut capacity. ThyssenKrupp is trying to sell mills in the U.S. and Brazil, and Russia’s Novolipetsk Steel wants to downsize its mill at Louvière, Belgium.

Against that backdrop, transferring ownership of Florange to another company “continues the situation of having excess steelmaking capacity,” Rosenfeld says. “The government has a short-term view toward job preservation, rather than a longer-term view toward allowing the steel industry to remain profitable.”

ArcelorMittal wants to close two blast furnaces at Florange that are already idle, while continuing to operate other factories at the site. Taking those factories away from ArcelorMittal would disrupt its supply chain, jeopardizing “substantially more jobs” among the 20,000 the company employs in France, says Charles Bradford, an independent steel industry analyst in New York. “Arcelor has an integrated setup, some plants feed other plants,” he says. Without supplies from Florange, “other mills would have to close because they wouldn’t have the feedstock.”

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