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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Lindsay Lohan arrested on assault charge in NYC












NEW YORK (AP) — Actress Lindsay Lohan was arrested Thursday after police said she hit a woman during an argument at a New York City nightclub.


The “Mean Girls” and “Freaky Friday” star was arrested at 4 a.m. and charged with third-degree assault.












She left a police precinct nearly four hours later with a black jacket pulled over her head. She was wearing leggings, a green mini skirt and high-heels, and drove off in a black SUV with a driver and another man who was seen going in and out of the precinct.


She allegedly got into the spat with another woman at Club Avenue, in Manhattan‘s Chelsea section. She struck the woman in face with her hand, police said. The woman did not require medical attention.


Lohan’s publicist did not immediately return a call for comment.


The arrest is Lohan’s latest brush with law enforcement in New York City.


She was involved in a NYPD investigation in September after alleging a man had assaulted her in a New York hotel, but charges against the man were later dropped.


Also in September, the actress was accused of clipping a man with her car outside another Manhattan nightclub, but prosecutors chose not to move ahead with charges.


In October, police were called to her childhood home on Long Island after a report of fight between her and her mother. An investigation revealed “no criminality.”


The actress was also involved in a car accident in California this summer that sent her and an assistant to a hospital, but didn’t result in serious injuries for anyone. The accident remains under investigation.


In May, she was cleared of allegations that she struck a Hollywood nightclub manager with her car.


Lohan remains on informal probation for taking a necklace from a jewelry store without permission last year. That means she doesn’t have to check in with a judge or probation officer but could face a jail term if arrested again.


Her latest film, “Liz & Dick,” in which she portrays screen icon Elizabeth Taylor, premiered on Lifetime on Sunday.


Lohan also recently filmed “The Canyons,” an indie film written by “Less Than Zero” and “American Psycho” author Bret Easton Ellis.


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J&J says won’t enforce AIDS drug patent in Africa












LONDON (Reuters) – Generic manufacturers are to be given a free rein to make cheap copies of Johnson & Johnson‘s HIV/AIDS drug Prezista for sale in Africa and other poor countries.


U.S. healthcare group J&J said on Thursday it would not enforce patents, provided generic firms made high-quality versions of the drug – known generically as darunavir – for sub-Saharan Africa and Least Developed Countries.












Prezista is a relatively new drug used when patients develop resistance to older antiretrovirals. The need for it was expected to grow rapidly as more patients in Africa stop responding to existing therapies.


Pharmaceuticals head Paul Stoffels said he expected Indian drugmakers, in particular, to take advantage of the patent move, adding that competition among different companies should drive prices down further.


J&J has an existing deal with South African group Aspen Pharmacare, which makes Prezista at a discounted price of $ 2.22 per day for Africa – a fraction of the western market price.


Its decision to act unilaterally on Prezista patents will, however, disappoint those calling for J&J to share intellectual property rights in the new Medicines Patent Pool, which aims to streamline generic production by pooling patents.


“We have chosen to go direct … we think that is the best way,” Stoffels said in an interview.


“We want to reserve the right to reinforce patents if people are not providing the right quality of product, for example by bringing products to market that under-dose.”


International drugmakers are under growing pressure to make medicines more affordable in poor countries, after being attacked for not doing enough in the past.


J&J ranked second in a new analysis of how companies are performing in providing access to medicines – an improvement of seven places from two years earlier, following its purchase of Crucell, which makes vaccines for the developing world.


(Editing by Dan Lalor)


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Palestinians certain to win recognition as a state in United Nations vote

UNITED NATIONS (AP) — The Palestinians are certain to win U.N. recognition as a state Thursday but success could exact a high price: Israel and the United States warn it could delay hopes of achieving an independent Palestinian state through peace talks with Israel.

The United States, Israel's closest ally, mounted an aggressive campaign to head off the General Assembly vote. Israeli Prime Minister Benjamin Netanyahu defiantly declared Thursday that the Palestinians would have to back down from long-held positions if they ever hope to gain independence.

Ahead of Thursday's vote, thousands of Palestinians from rival factions celebrated in the streets of the West Bank. Although the initiative will not immediately bring about independence, the Palestinians view it as a historic step in their quest for global recognition.

The United States, Israel's closest ally, mounted an aggressive campaign to head off the General Assembly vote.

In a last-ditch move Wednesday, U.S. Deputy Secretary of State William Burns made a personal appeal to Palestinian President Mahmoud Abbas promising that President Barack Obama would re-engage as a mediator in 2013 if Abbas abandoned the effort to seek statehood. The Palestinian leader refused, said Abbas aide Saeb Erekat.

With most of the 193 General Assembly member states sympathetic to the Palestinians, the vote is certain to succeed. Several key countries, including France, have recently announced they would support the move to elevate the Palestinians from the status of U.N. observer to nonmember observer state. However, a country's vote in favor of the status change does not automatically imply its individual recognition of a Palestine state, something that must be done bilaterally.

The Palestinians say they need U.N. recognition of a Palestinian state in the West Bank, Gaza and east Jerusalem, the lands Israel captured in 1967, to be able to resume negotiations with Israel. They say global recognition of the 1967 lines as the borders of Palestine is meant to salvage a peace deal, not sabotage it, as Israel claims.

The non-member observer state status could also open the way for possible war crimes charges against the Jewish state at the International Criminal Court.

Netanyahu warned the Palestinians Thursday that they would not win their hoped-for state until they recognize Israel as the Jewish homeland, declare an end to their conflict with the Jewish state and agree to security arrangements that protect Israel.

"The resolution in the U.N. today won't change anything on the ground," Netanyahu declared. "It won't advance the establishment of a Palestinian state, but rather, put it further off."

While Israel argues that Abbas is trying to dictate the outcome of border talks by going to the U.N., the recognition request presented to the world body in fact calls for a quick resumption of negotiations on all core issues of the conflict, including borders.

Netanyahu's predecessors accepted the 1967 lines as a basis for border talks. Netanyahu has rejected the idea, while pressing ahead with Jewish settlement building on war-won land, giving Abbas little incentive to negotiate.

For Abbas, the U.N. bid is crucial if he wants to maintain his leadership and relevance, especially following the recent conflict between his Hamas rivals in Gaza and Israel. The conflict saw the Islamic militant group claim victory and raise its standing in the Arab world, while Abbas' Fatah movement was sidelined and marginalized.

In a departure from previous opposition, the Hamas militant group, which rules the Gaza Strip, said it wouldn't interfere with the U.N. bid, and its supporters joined some of the celebrations Thursday.

In the West Bank city of Hebron, some in a crowd of several thousand raised green Hamas flags, while in the city of Ramallah, senior figures of Hamas and Islamic Jihad, two militant groups normally opposed to Abbas, addressed the crowd.

"It's the right step in the right direction," Nasser al-Shaer, a former deputy prime minister from Hamas, said of the U.N. bid.

The Palestinians chose the "International Day of Solidarity with the Palestinian People" for the vote. Before it takes place, there will be a morning of speeches by supporters focusing on the rights of the Palestinians. Abbas is scheduled to speak at that meeting, and again in the afternoon when he will present the case for Palestinian statehood in the General Assembly.

U.S. Secretary of State Hillary Clinton warned Wednesday that the U.N. vote will not fulfill the goal of independent Palestinian and Israeli states living side by side in peace, which the U.S. strongly supports because that requires direct negotiations.

"We need an environment conducive to that," she told reporters in Washington. "And we've urged both parties to refrain from actions that might in any way make a return to meaningful negotiations that focus on getting to a resolution more difficult."

The U.S. Congress has threatened financial sanctions if the Palestinians improve their status at the United Nations.

Ahead of the vote, Republican Sen. Orrin Hatch filed an amendment to a defense bill Wednesday that would eliminate funding for the United Nations if the General Assembly changes Palestine's status.

Israeli government spokesman Mark Regev said that by going to the U.N., the Palestinians violate "both the spirit and the word of signed agreements to solve issues through negotiations," which broke down four years ago.

But Israeli officials appeared to back away from threats of drastic measures if the Palestinians get U.N. approval, with officials suggesting the government would take steps only if the Palestinians use their new status to act against Israel.

Regev, meanwhile, affirmed that Israel is willing to resume talks without preconditions.

U.N. diplomats said they will be listening closely to Abbas' speech to the General Assembly on Thursday afternoon before the vote to see if he makes an offer of fresh negotiations with no strings, which could lead to new talks. The Palestinians have been demanding a freeze on Israeli settlements as a precondition.

As a sign of the importance Israel attaches to the vote, Israeli Foreign Minister Avigdor Lieberman flew to New York and was scheduled to meet Secretary-General Ban Ki-moon before the vote.

Unlike the Security Council, there are no vetoes in the General Assembly and the resolution to raise the Palestinian status from an observer to a nonmember observer state only requires a majority vote for approval. To date, 132 countries — over two-thirds of the U.N. member states — have recognized the state of Palestine.

The Palestinians have been courting Western nations, especially the Europeans, seen as critical to enhancing their international standing. A number have announced they will vote "yes" including France, Italy, Spain, Norway, Denmark and Switzerland. Those opposed or abstaining include the U.S., Israel, Germany, Canada, the Netherlands and Australia.

The Palestinians turned to the General Assembly after the United States announced it would veto their bid last fall for full U.N. membership until there is a peace deal with Israel.

Following last year's move by the Palestinians to join the U.N. cultural agency UNESCO, the U.S. withheld funds from the organization, which amount to 22 percent of its budget. The U.S. also withheld money from the Palestinians.

_____

Associated Press writers Amy Teibel in Jerusalem and Karin Laub in Ramallah, West Bank, contributed to this story.

.

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Palestinians certain to win recognition as a state in United Nations vote

UNITED NATIONS (AP) — The Palestinians are certain to win U.N. recognition as a state Thursday but success could exact a high price: Israel and the United States warn it could delay hopes of achieving an independent Palestinian state through peace talks with Israel.

The United States, Israel's closest ally, mounted an aggressive campaign to head off the General Assembly vote. Israeli Prime Minister Benjamin Netanyahu defiantly declared Thursday that the Palestinians would have to back down from long-held positions if they ever hope to gain independence.

Ahead of Thursday's vote, thousands of Palestinians from rival factions celebrated in the streets of the West Bank. Although the initiative will not immediately bring about independence, the Palestinians view it as a historic step in their quest for global recognition.

The United States, Israel's closest ally, mounted an aggressive campaign to head off the General Assembly vote.

In a last-ditch move Wednesday, U.S. Deputy Secretary of State William Burns made a personal appeal to Palestinian President Mahmoud Abbas promising that President Barack Obama would re-engage as a mediator in 2013 if Abbas abandoned the effort to seek statehood. The Palestinian leader refused, said Abbas aide Saeb Erekat.

With most of the 193 General Assembly member states sympathetic to the Palestinians, the vote is certain to succeed. Several key countries, including France, have recently announced they would support the move to elevate the Palestinians from the status of U.N. observer to nonmember observer state. However, a country's vote in favor of the status change does not automatically imply its individual recognition of a Palestine state, something that must be done bilaterally.

The Palestinians say they need U.N. recognition of a Palestinian state in the West Bank, Gaza and east Jerusalem, the lands Israel captured in 1967, to be able to resume negotiations with Israel. They say global recognition of the 1967 lines as the borders of Palestine is meant to salvage a peace deal, not sabotage it, as Israel claims.

The non-member observer state status could also open the way for possible war crimes charges against the Jewish state at the International Criminal Court.

Netanyahu warned the Palestinians Thursday that they would not win their hoped-for state until they recognize Israel as the Jewish homeland, declare an end to their conflict with the Jewish state and agree to security arrangements that protect Israel.

"The resolution in the U.N. today won't change anything on the ground," Netanyahu declared. "It won't advance the establishment of a Palestinian state, but rather, put it further off."

While Israel argues that Abbas is trying to dictate the outcome of border talks by going to the U.N., the recognition request presented to the world body in fact calls for a quick resumption of negotiations on all core issues of the conflict, including borders.

Netanyahu's predecessors accepted the 1967 lines as a basis for border talks. Netanyahu has rejected the idea, while pressing ahead with Jewish settlement building on war-won land, giving Abbas little incentive to negotiate.

For Abbas, the U.N. bid is crucial if he wants to maintain his leadership and relevance, especially following the recent conflict between his Hamas rivals in Gaza and Israel. The conflict saw the Islamic militant group claim victory and raise its standing in the Arab world, while Abbas' Fatah movement was sidelined and marginalized.

In a departure from previous opposition, the Hamas militant group, which rules the Gaza Strip, said it wouldn't interfere with the U.N. bid, and its supporters joined some of the celebrations Thursday.

In the West Bank city of Hebron, some in a crowd of several thousand raised green Hamas flags, while in the city of Ramallah, senior figures of Hamas and Islamic Jihad, two militant groups normally opposed to Abbas, addressed the crowd.

"It's the right step in the right direction," Nasser al-Shaer, a former deputy prime minister from Hamas, said of the U.N. bid.

The Palestinians chose the "International Day of Solidarity with the Palestinian People" for the vote. Before it takes place, there will be a morning of speeches by supporters focusing on the rights of the Palestinians. Abbas is scheduled to speak at that meeting, and again in the afternoon when he will present the case for Palestinian statehood in the General Assembly.

U.S. Secretary of State Hillary Clinton warned Wednesday that the U.N. vote will not fulfill the goal of independent Palestinian and Israeli states living side by side in peace, which the U.S. strongly supports because that requires direct negotiations.

"We need an environment conducive to that," she told reporters in Washington. "And we've urged both parties to refrain from actions that might in any way make a return to meaningful negotiations that focus on getting to a resolution more difficult."

The U.S. Congress has threatened financial sanctions if the Palestinians improve their status at the United Nations.

Ahead of the vote, Republican Sen. Orrin Hatch filed an amendment to a defense bill Wednesday that would eliminate funding for the United Nations if the General Assembly changes Palestine's status.

Israeli government spokesman Mark Regev said that by going to the U.N., the Palestinians violate "both the spirit and the word of signed agreements to solve issues through negotiations," which broke down four years ago.

But Israeli officials appeared to back away from threats of drastic measures if the Palestinians get U.N. approval, with officials suggesting the government would take steps only if the Palestinians use their new status to act against Israel.

Regev, meanwhile, affirmed that Israel is willing to resume talks without preconditions.

U.N. diplomats said they will be listening closely to Abbas' speech to the General Assembly on Thursday afternoon before the vote to see if he makes an offer of fresh negotiations with no strings, which could lead to new talks. The Palestinians have been demanding a freeze on Israeli settlements as a precondition.

As a sign of the importance Israel attaches to the vote, Israeli Foreign Minister Avigdor Lieberman flew to New York and was scheduled to meet Secretary-General Ban Ki-moon before the vote.

Unlike the Security Council, there are no vetoes in the General Assembly and the resolution to raise the Palestinian status from an observer to a nonmember observer state only requires a majority vote for approval. To date, 132 countries — over two-thirds of the U.N. member states — have recognized the state of Palestine.

The Palestinians have been courting Western nations, especially the Europeans, seen as critical to enhancing their international standing. A number have announced they will vote "yes" including France, Italy, Spain, Norway, Denmark and Switzerland. Those opposed or abstaining include the U.S., Israel, Germany, Canada, the Netherlands and Australia.

The Palestinians turned to the General Assembly after the United States announced it would veto their bid last fall for full U.N. membership until there is a peace deal with Israel.

Following last year's move by the Palestinians to join the U.N. cultural agency UNESCO, the United States withheld funds from the organization, which amount to 22 percent of its budget. The U.S. also withheld money from the Palestinians.

_____

Associated Press writers Amy Teibel in Jerusalem and Karin Laub in Ramallah, West Bank, contributed to this story.

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Palm Springs Fest gives Robert Zemeckis’ awards campaign a boost












LOS ANGELES (TheWrap.com) – Robert Zemeckis has been named Director of the Year by the Palm Springs International Film Festival, making the “Flight” director the latest awards hopeful to be honored by one of the two big January film festivals that double as campaign stops on the awards circuit.


The announcement by Palm Springs organizers came one day after the Santa Barbara Film Festival declared “Silver Linings Playbook” star Jennifer Lawrence the Outstanding Performer of the Year.












Palm Springs holds its awards gala on the first Saturday of the new year, which this year falls on January 5, two days after Oscar polls close. Santa Barbara spreads out its awards over a two-week period in late January, after Oscar nominations are announced but before final voting begins.


Both festivals jockey to assemble lineups of probable Oscar nominees, and both are lobbied by Oscar campaigners as they make their selections. The two festivals try to stagger their announcements so as not to compete with each other.


Besides Zemeckis’ award, Palm Springs has announced that it will honor Naomi Watts with the Desert Palm Achievement Award for Acting and Helen Hunt with the Spotlight Award.


In addition to Lawrence, Santa Barbara will give its Modern Master Award to Ben Affleck. Robert De Niro will receive the festival’s Kirk Douglas Award for Excellence in Film, an honor that is presented at a separate black-tie event in December rather than during the festival.


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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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Deaths more common on popular heart drug: study












NEW YORK (Reuters Health) – People with a common type of abnormal heart rhythm were more likely to die within several years if they had been prescribed digoxin, a drug used to help control abnormal heart rates, in a new analysis.


The research involved 4,060 people with atrial fibrillation, in which the heart’s upper chambers quiver chaotically instead of contracting normally. More than two-thirds of the participants were treated with digoxin at some point either shortly before or during the 3.5-year study.












Dr. Samy Claude Elayi, from the University of Kentucky in Lexington, said digoxin – which is widely available in generic form – may benefit some people who have heart failure in addition to a heart arrhythmia.


“But in patients that have no heart failure and (have) atrial fibrillation, I think there is no reason to use this drug as a first line,” added Elayi, who worked on the study.


Another cardiology researcher, however, said the new study isn’t robust enough to warrant changing treatment strategies, and that earlier studies have shown digoxin is safe.


Elayi and his colleagues re-analyzed data from a past trial of people with atrial fibrillation and a high risk of stroke that were treated with a variety of drug combinations, including beta blockers and calcium channel blockers.


Over the study period, 666 people died, according to results published in the European Heart Journal.


People who had taken digoxin in the previous six months, the study team found, were 41 percent more likely to die of any cause and 61 percent more likely to die from a heart rhythm problem, in particular.


That increased risk of death was seen in people with and without heart failure, and in both men and women.


DIZZINESS, FAINTING


Digoxin works by helping to stabilize the upper heart chambers affected by atrial fibrillation, Elayi said – but it can also cause problems by creating a bad rhythm in the heart’s lower chambers. That can lead to dizziness, fainting and heart palpitations.


The researchers noted that they didn’t have data on what dose of digoxin people were prescribed – or how closely they stuck to those prescriptions.


Because the trial wasn’t originally intended to measure the negative effects of digoxin, and people weren’t assigned randomly to one arm or the other, the analysis also can’t prove that digoxin caused the extra deaths.


Dr. Ali Ahmed, who has studied digoxin at the University of Alabama at Birmingham, called that a major limitation of the new study.


He said an earlier randomized controlled trial – considered the gold standard of medical research – did not find more deaths among people with heart failure taking digoxin. Other research, Ahmed added, has suggested that low doses of the drug can actually lower the risk of death among some patients.


An analysis like this one can’t fully account for the likelihood that sicker patients are prescribed certain drugs more often, he said.


“When you do non-randomized studies, you always wonder, was it really digoxin or was it the other confounders” such as patients’ chronic diseases, that led to more deaths.


“This should be taken with extreme caution, because of the potential for confounding and bias from a variety of sources,” Ahmed, who wasn’t involved in the new research, told Reuters Health.


“The fundamental thing is you cannot overrule the findings of a randomized controlled trial with non-randomized data.”


‘NOT A KILLER’


Digoxin can be bought for about $ 10 for a month’s supply. It’s been used worldwide for decades to help control heart rate, the researchers said.


Elayi said the findings don’t mean that people with heart failure and atrial fibrillation shouldn’t be taking the drug.


But based on his team’s study, he said he would recommend other heart medications before digoxin for people without heart failure. However, if an atrial fibrillation patient also has very low blood pressure – which makes drugs such as beta blockers and calcium blockers unsafe – digoxin might be a reasonable second choice, he added.


In that case, doctors should prescribe digoxin at low doses and keep a close watch on the amount of the drug in patients’ blood, Elayi told Reuters Health.


In addition, he said, “From the patient perspective, if doctors put them on the drug they should check their rationale for that.”


But according to Ahmed, patients and doctors shouldn’t worry about taking or prescribing the drug because of this study. Digoxin, he said, “is not a killer.”


SOURCE: http://bit.ly/99ohTH European Heart Journal, online November 27, 2012.


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