Your medical chart could include exercise minutes

CHICAGO (AP) — Roll up a sleeve for the blood pressure cuff. Stick out a wrist for the pulse-taking. Lift your tongue for the thermometer. Report how many minutes you are active or getting exercise.

Wait, what?

If the last item isn't part of the usual drill at your doctor's office, a movement is afoot to change that. One recent national survey indicated only a third of Americans said their doctors asked about or prescribed physical activity.

Kaiser Permanente, one of the nation's largest nonprofit health insurance plans, made a big push a few years ago to get its southern California doctors to ask patients about exercise. Since then, Kaiser has expanded the program across California and to several other states. Now almost 9 million patients are asked at every visit, and some other medical systems are doing it, too.

Here's how it works: During any routine check of vital signs, a nurse or medical assistant asks how many days a week the patient exercises and for how long. The number of minutes per week is posted along with other vitals at the top the medical chart. So it's among the first things the doctor sees.

"All we ask our physicians to do is to make a comment on it, like, 'Hey, good job,' or 'I noticed today that your blood pressure is too high and you're not doing any exercise. There's a connection there. We really need to start you walking 30 minutes a day,'" said Dr. Robert Sallis, a Kaiser family doctor. He hatched the vital sign idea as part of a larger initiative by doctors groups.

He said Kaiser doctors generally prescribe exercise first, instead of medication, and for many patients who follow through that's often all it takes.

It's a challenge to make progress. A study looking at the first year of Kaiser's effort showed more than a third of patients said they never exercise.

Sallis said some patients may not be aware that research shows physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. As recently as November a government-led study concluded that people who routinely exercise live longer than others, even if they're overweight.

Zendi Solano, who works for Kaiser as a research assistant in Pasadena, Calif., says she always knew exercise was a good thing. But until about a year ago, when her Kaiser doctor started routinely measuring it, she "really didn't take it seriously."

She was obese, and in a family of diabetics, had elevated blood sugar. She sometimes did push-ups and other strength training but not anything very sustained or strenuous.

Solano, 34, decided to take up running and after a couple of months she was doing three miles. Then she began training for a half marathon — and ran that 13-mile race in May in less than three hours. She formed a running club with co-workers and now runs several miles a week. She also started eating smaller portions and buying more fruits and vegetables.

She is still overweight but has lost 30 pounds and her blood sugar is normal.

Her doctor praised the improvement at her last physical in June and Solano says the routine exercise checks are "a great reminder."

Kaiser began the program about three years ago after 2008 government guidelines recommended at least 2 1/2 hours of moderately vigorous exercise each week. That includes brisk walking, cycling, lawn-mowing — anything that gets you breathing a little harder than normal for at least 10 minutes at a time.

A recently published study of nearly 2 million people in Kaiser's southern California network found that less than a third met physical activity guidelines during the program's first year ending in March 2011. That's worse than results from national studies. But promoters of the vital signs effort think Kaiser's numbers are more realistic because people are more likely to tell their own doctors the truth.

Dr. Elizabeth Joy of Salt Lake City has created a nearly identical program and she expects 300 physicians in her Intermountain Healthcare network to be involved early this year.

"There are some real opportunities there to kind of shift patients' expectations about the value of physical activity on health," Joy said.

NorthShore University HealthSystem in Chicago's northern suburbs plans to start an exercise vital sign program this month, eventually involving about 200 primary care doctors.

Dr. Carrie Jaworski, a NorthShore family and sports medicine specialist, already asks patients about exercise. She said some of her diabetic patients have been able to cut back on their medicines after getting active.

Dr. William Dietz, an obesity expert who retired last year from the Centers for Disease Control and Prevention, said measuring a patient's exercise regardless of method is essential, but that "naming it as a vital sign kind of elevates it."

Figuring out how to get people to be more active is the important next step, he said, and could have a big effect in reducing medical costs.

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Online:

Exercise: http://1.usa.gov/b6AkMa

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Diabetes is a stubborn adversary

One by one, the diabetic patients reluctantly stepped on the scale in the basement of a South Los Angeles clinic. Nearby, a nurse scribbled numbers on a chart.

Camara January, 31, her round face framed by a sparkly headband, held her breath. The number stopped at 245 pounds. "That's not good," January said. Tracy Donald, 45, stepped up. Just under 240 pounds. "That is wrong," she said. Ramon Marquez, 62, tall and clean-shaven, methodically took off his watch, his cap and his shoes. 170 pounds. Ramon strips down to almost nothing, the others jokingly complain.

They are among those who come each month to the To Help Everyone (T.H.E.) Clinic, hoping to finally gain the upper hand on their diabetes, a disease wreaking havoc on their bodies — and their community. Several have been hospitalized. Some have seen relatives die from complications. All have struggled to manage blood sugar levels that spike and plummet to ominous extremes.

FULL COVERAGE: T.H.E. Clinic in South L.A.

A chronic illness that can lead to heart attacks, blindness and kidney failure, diabetes is exploding across the United States and raising enormous obstacles to the Obama administration's drive to control costs and reform the healthcare system. In California alone, the disease costs taxpayers and businesses roughly $24 billion annually. One in seven California residents has diabetes — a 32% increase in the last decade.

"This is a train going in the wrong direction," said Dean Schillinger, a UC San Francisco Medical School professor and medical officer at the California Diabetes Program, run by the university and the state public health department.

PHOTOS: T.H.E. Clinic: Battling diabetes

Community health centers like T.H.E. Clinic are a crucial front line in the federal government's war against diabetes. They're charged with slowing the advance of the disease, which disproportionately affects poor patients whose care may be taxpayer-funded.

To do so, clinics must get millions of patients to change deeply ingrained eating habits, embrace regular exercise regimens and better manage their health to avoid unnecessary hospitalizations.

Many low-income, urban patients struggle with the willpower challenges afflicting diabetes sufferers everywhere. But their struggle is often complicated by limited understanding of the links between lifestyle and blood sugar levels, along with fewer safe, affordable and convenient options for healthy activities and fresh food.

"The approach of telling people they need to lose weight and exercise is clearly not working," said Martha Funnell, past chairwoman of the National Diabetes Education Program.

::

Like her mother and grandmother, 17-year-old Charnay Winbush has diabetes. She injects herself with insulin five times a day and wears a bracelet identifying her illness. But Charnay often tells people she isn't diabetic.

Without her injections, she feels weak and tired. When her blood sugar levels climb, she gets extremely thirsty and can't stop sweating. One incident sent her to the emergency room this summer. "I was scared," she said.

Doctors at T.H.E. Clinic tell Charnay she needs to lose weight, but she continues to gain. She keeps small bags of candy in the refrigerator next to her insulin. Counting calories brings unwelcome memories of math class, she says. The only exercise she likes is playing virtual tennis or bowling.

The diabetes battle permeates almost every aspect of T.H.E Clinic's routine. Patients are greeted in the waiting room by television programs about the disease. They are routinely tested for it, counseled about how to prevent it and referred to nutritionists and diabetic education groups to manage it.

Research shows such efforts can produce results. Patients surrounded by support and education programs do better at controlling their blood sugar, eat more healthfully and use their medication as recommended.

At the Saturday session, retired nurse Emily Moore handed out a soul food cookbook with healthy recipes. Patients shared about their favorite types of exercise. One woman said she liked dancing to disco music, another announced she was going to Zumba classes.

The sessions began as a diabetes education class but soon morphed into a less formal support group, said M.D. Donnell, education manager at T.H.E. Clinic. Patients say they come for the snacks, the nutrition advice and the camaraderie. James Hicks, whose leg was amputated after a diabetes-related infection, said he serves as a cautionary tale for others. "You never want to get this far," he said.

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Plane Carrying Vittorio Missoni Lost Near Venezuela

MILAN — Venezuelan emergency services mounted a sea-and-air rescue mission on Saturday after a plane carrying the fashion executive Vittorio Missoni went missing off the coast of Venezuela.

The plane carrying Mr. Missoni, 58; his wife, Maurizia Castiglioni; another couple and two Venezuelan crew members disappeared after taking off from the resort of Los Roques, an archipelago off the coast of Venezuela, Italian media said.

“It disappeared yesterday. They have been looking for it with helicopters and ships, but have not found anything yet. They are still searching for it this morning,” the Italian consul in Venezuela, Giovanni Davoli, said.

Mr. Missoni is the oldest son of the founders of the fashion house famous for its exuberantly colored knits, featuring bold stripes and zigzags. He is co-owner with two siblings, Luca and Angela, who handle the technical and design sides of the firm.

“The Missoni family has been informed by the Venezuelan Consulate that Vittorio Missoni and his wife are missing, but we don’t know any more,” a Missoni spokeswoman, Maddalena Aspes, said.

Other members of the Missoni family are traveling back to Italy from a holiday in France, Ms. Aspes said.

Mr. Missoni and his siblings took over managing the company from their parents Ottavio and Rosita in 1996, aiming to relaunch the brand to a larger, younger market as rivals Gucci and Burberry have done. Under Vittorio’s tenure, Missoni has opened hotels in Scotland and Kuwait and started the Missoni Home collection.

By 2011, the brand’s appeal was wide enough for American mass-market retailer Target to ask it to design a collection.

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A+E Networks and Amazon Prime Reach Licensing Deal

LOS ANGELES (TheWrap.com) – “Pawn Stars” fans, rejoice; you’ll now be able to catch Big Hoss and Chumley on Amazon Prime.

Amazon announced Friday that it has struck a licensing deal with A+E Networks to carry A&E, bio, History and Lifetime programs on its premium Prime Instant Video service. The deal includes prior seasons of programs such as “Pawn Stars,” “Storage Wars” and “Dance Moms.”

Amazon Prime, which allows subscribers to stream videos through a variety of gadgets, costs $ 79 a year.

The pact between Amazon and A+E Networks comes a few months after rival streaming service Netflix decided to drop all but about 300 hours of A+E programming. Netflix, which had been seeking exclusivity from A+E for its content, opted not to renew its agreement with the company.

Brad Beale, Amazon’s director of digital video content acquisition, said that Amazon has more than doubled the amount of content for Amazon Prime customers.

“We remain focused on adding TV episodes and movies to Prime Instant Video that we think our customers will enjoy,” Beale said. “A+E Networks has some of the most popular shows on television and we know our customers will love streaming the A+E content with Prime Instant Video.”

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PHOTO: Check Out Jessica Simpson's Daring Dinner Wear

Mom & Babies
Celebrity Baby Blog

01/04/2013 at 03:00 PM ET

FameFlynet

Blonde bombshell!

An expectant Jessica Simpson shows off her assets as she leaves a restaurant Thursday evening in Oahu, Hawaii, where she’s currently vacationing with her fiancé Eric Johnson and their 8-month-old daughter Maxwell Drew.

“I find myself going for more sophisticated looks, but I do think that’s kind of trendy right now — just a classier-looking woman,” the Fashion Star mentor, 32, tells PEOPLE of her recent style choices.

“I love to show off my curves, but being a mom, I guess I do it in a little bit more classy way, even though for Halloween I was a milkmaid – but there are moments.”

RELATED: Jessica Simpson Reveals Her Baby Bump

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FDA: New rules will make food safer

WASHINGTON (AP) — The Food and Drug Administration says its new guidelines would make the food Americans eat safer and help prevent the kinds of foodborne disease outbreaks that sicken or kill thousands of consumers each year.

The rules, the most sweeping food safety guidelines in decades, would require farmers to take new precautions against contamination, to include making sure workers' hands are washed, irrigation water is clean, and that animals stay out of fields. Food manufacturers will have to submit food safety plans to the government to show they are keeping their operations clean.

The long-overdue regulations could cost businesses close to half a billion dollars a year to implement, but are expected to reduce the estimated 3,000 deaths a year from foodborne illness. The new guidelines were announced Friday.

Just since last summer, outbreaks of listeria in cheese and salmonella in peanut butter, mangoes and cantaloupe have been linked to more than 400 illnesses and as many as seven deaths, according to the federal Centers for Disease Control and Prevention. The actual number of those sickened is likely much higher.

Many responsible food companies and farmers are already following the steps that the FDA would now require them to take. But officials say the requirements could have saved lives and prevented illnesses in several of the large-scale outbreaks that have hit the country in recent years.

In a 2011 outbreak of listeria in cantaloupe that claimed 33 lives, for example, FDA inspectors found pools of dirty water on the floor and old, dirty processing equipment at Jensen Farms in Colorado where the cantaloupes were grown. In a peanut butter outbreak this year linked to 42 salmonella illnesses, inspectors found samples of salmonella throughout Sunland Inc.'s peanut processing plant in New Mexico and multiple obvious safety problems, such as birds flying over uncovered trailers of peanuts and employees not washing their hands.

Under the new rules, companies would have to lay out plans for preventing those sorts of problems, monitor their own progress and explain to the FDA how they would correct them.

"The rules go very directly to preventing the types of outbreaks we have seen," said Michael Taylor, FDA's deputy commissioner for foods.

The FDA estimates the new rules could prevent almost 2 million illnesses annually, but it could be several years before the rules are actually preventing outbreaks. Taylor said it could take the agency another year to craft the rules after a four-month comment period, and farms would have at least two years to comply — meaning the farm rules are at least three years away from taking effect. Smaller farms would have even longer to comply.

The new rules, which come exactly two years to the day President Barack Obama's signed food safety legislation passed by Congress, were already delayed. The 2011 law required the agency to propose a first installment of the rules a year ago, but the Obama administration held them until after the election. Food safety advocates sued the administration to win their release.

The produce rule would mark the first time the FDA has had real authority to regulate food on farms. In an effort to stave off protests from farmers, the farm rules are tailored to apply only to certain fruits and vegetables that pose the greatest risk, like berries, melons, leafy greens and other foods that are usually eaten raw. A farm that produces green beans that will be canned and cooked, for example, would not be regulated.

Such flexibility, along with the growing realization that outbreaks are bad for business, has brought the produce industry and much of the rest of the food industry on board as Congress and FDA has worked to make food safer.

In a statement Friday, Pamela Bailey, president of the Grocery Manufacturers Association, which represents the country's biggest food companies, said the food safety law "can serve as a role model for what can be achieved when the private and public sectors work together to achieve a common goal."

The new rules could cost large farms $30,000 a year, according to the FDA. The agency did not break down the costs for individual processing plants, but said the rules could cost manufacturers up to $475 million annually.

FDA Commissioner Margaret Hamburg said the success of the rules will also depend on how much money Congress gives the chronically underfunded agency to put them in place. "Resources remain an ongoing concern," she said.

The farm and manufacturing rules are only one part of the food safety law. The bill also authorized more surprise inspections by the FDA and gave the agency additional powers to shut down food facilities. In addition, the law required stricter standards on imported foods. The agency said it will soon propose other overdue rules to ensure that importers verify overseas food is safe and to improve food safety audits overseas.

Food safety advocates frustrated over the last year as the rules stalled praised the proposed action.

"The new law should transform the FDA from an agency that tracks down outbreaks after the fact, to an agency focused on preventing food contamination in the first place," said Caroline Smith DeWaal of the Center for Science in the Public Interest.

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Dumped Christmas trees are a gift for Lake Havasu fish

The ghosts of Christmas past can be found in some unusual places. The bottom of Lake Havasu, for instance.

There, thousands of Christmas trees sunk by wildlife biologists have found a second life as fish habitat in an ecosystem damaged by the damming of the Colorado River decades ago.

What nature once provided — a steady source of organic material such as brush and uprooted trees — disappeared when the once wild and muddy river was tamed.

By the late 1980s, Lake Havasu's now crystal clear waters harbored few places where newly spawned fish could find shelter from predators. Fish populations were a fraction of what they had been a generation before.

"There was no place for the young fish to hide until they matured," said Kirk Koch, a fisheries program manager for the U.S. Bureau of Land Management. "Instead, they would be consumed by bigger fish."

The solution was a gift that keeps on giving: Christmas trees.

More than 30 million farm-harvested trees are sold nationwide each year. No matter how pretty they're decorated, they all meet the same ignoble fate: ground up as mulch or buried in landfills.

When it began in 1992, the effort at Lake Havasu was the largest fresh-water habitat recovery program in the nation, Koch said.

Over the next decade, $16 million and countless hours of work by volunteers created 875 acres of artificial reefs.

Structures were formed by sinking PVC pipe, concrete sewer pipe and cinder blocks in 42 coves. Then, discarded Christmas trees were lashed together, weighted down and dumped around the structures. Piles of brush were added.

As the trees and brush decomposed, the pipe and concrete structure grew a biological skin of mosses and algae that was then colonized by insects. In addition to providing shelter, the Christmas tree structures also became a source of fish food.

Scuba divers check sites annually and have found that fish are drawn to Christmas trees as much as Santa is.

"When they started, they could count all of the fish at any spot on their fingers," Koch said. "Progressively, they found more fish — way, way more fish — than they can count."

The project turned Lake Havasu into a popular sport fishing destination.

"Before this, the lake was basically dead," said Arnold Vignoni, president of the local chapter of Anglers United, whose members help maintain the reefs. "The bass tournament guys — and we have lots of bass tournaments here now — say the fishing is just outstanding."

It takes a Christmas tree five to six years to decompose under water. So each year, volunteers toss in as many as 500 additional trees and a thousand brush piles to replenish the reefs.

Part of the benefit of creating habitat with Christmas trees is that it's cheap — trash haulers are happy to unload onto others what they pick up at the curb.

This year, Riverside County supervisors approved a plan to transfer 2 tons of trees collected at county landfills to the California Department of Fish and Wildlife, which will dump them into two lakes that badly need them.

The load will make Quinn Granfors' job much easier.

Granfors, a state fisheries biologist, has been tossing trees into Lake Elsinore and Lake Perris since 2006. Working under budget constraints, he was left to scrounge around on his own after Christmas in search of trees. Now they'll be coming to him.

In the coming weeks, he and volunteers will send hundreds of weighted trees to the bottom of the lakes.

"I kind of joke with the guys that they're now qualified to get a job with the mob," Granfors said. "Because they know how to make organic material disappear."

mike.anton@latimes.com

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Fatah Party Stages First Rally in Gaza Since 2007

Mohammed Salem/Reuters

Palestinians waved a Palestinian flag, left, and a Fatah flag, right, during a rally marking the 48th anniversary of the founding of the Fatah movement, in Gaza City on Friday.

GAZA CITY, Gaza Strip (AP) — Leaders of the Palestinian Fatah party led tens of thousands of supporters Friday in a mass rally in the Gaza Strip, the first such gathering for the largely secular party in the territory since the rival Islamist Hamas seized power there in 2007.

The demonstration, which was condoned by Hamas, showed how the long-bitter relations between the rival Palestinian factions have improved since an Israeli assault on the Gaza Strip in November.

While Friday's rally pointed to the improving ties between Hamas and Fatah, it also served as a reminder of the conflicts within Fatah that continue to dog the movement: Officials cancelled the event halfway through after 20 people were injured due to overcrowding, and shoving matches erupted between separate Fatah factions.

Yahiya Rabah, a top Fatah official in Gaza, said the rally was cancelled "due to the huge number of participants and logistical failures."

But witnesses said one pushing match was between supporters of Palestinian President Mahmoud Abbas and partisans of former Fatah's former Gaza security commander Mohammed Dahlan, who was expelled from the party because of conflicts with Abbas.

Another Fatah official, who spoke anonymously because he did not want to embarrass the party, said the rally was cancelled because hundreds of Dahlan supporters jumped up on the stage and clashed with Abbas supporters.

Fatah spokesman Fayez Abu Etta attributed the injuries to overcrowding and the excitement of the rally.

Overnight, throngs had camped out in a downtown Gaza square to ensure themselves a spot for the anniversary commemoration of Fatah's 1965 founding, and tens of thousands marched early Friday carrying Fatah banners. When the rally began, people stampeded to the stage to try to shake leaders' hands.

Hamas was not directly involved in the event but allowed it to take place. Top Fatah officials arrived in Gaza for the first time since they were ousted from Gaza by Hamas in 2007.

Abbas, who rules in the West Bank, did not attend the event, but spoke to the crowd via a televised address, telling them that "there is no substitute for national unity."

Organizers then ended the rally, cancelling the other planned speeches and musical performances.

Hamas has gained new support among Palestinians following eight days of fighting with Israel in November, during which Israel pounded the seaside strip from the air and sea, while Palestinians militants lobbed rockets toward the Israeli cities of Jerusalem and Tel Aviv for the first time.

Following the fighting, relations have thawed somewhat between Hamas and Fatah. Hamas was allowed to hold its first West Bank rallies since the 2007 split in which Hamas seized Gaza and Fatah was left in control of the West Bank. Hamas returned the favor Friday by allowing the Fatah rally.

Senior Fatah official Nabil Shaath said the party received a congratulatory message from Hamas Prime Minister Ismail Haniyeh, who expressed hope that the two factions could reconcile their differences and work together as joint representatives of the Palestinian people.

"This festival will be like a wedding celebration for Palestine, Jerusalem, the prisoners, the refugees and all the Palestinians," Shaath said.

Reconciliation between the two factions, however, is still far from a done deal. Hamas chief Khaled Mashaal, considered more pragmatic than Hamas' Gaza-based hardline leaders, forged a reconciliation agreement with Abbas in 2011.

But the Gaza-based leadership, unsupportive of the deal, has held up implementing it. Fatah enjoys Western support and has been pressured not to forge a unity agreement with the militant Hamas - facing a potential cutback in foreign aid if it does. Hamas has carried out hundreds of deadly attacks against Israeli citizens and is regarded by the U.S. and Israel as a terrorist organization.

Fadwa Taleb, 46, who worked as a police officer during the previous rule of Fatah, gathered at the rally with her family. "We feel like birds freed from our cage today," Taleb said. "We are happy and feel powerful again."

A Gaza security official said a Fatah-linked former aide to the late Palestinian leader Yasser Arafat died of a heart attack in the square overnight, saying he was shocked by the large crowd that was allowed to gather.

In the West Bank, Palestinian President Abbas signed a presidential decree changing the name of the Palestinian Authority to the "State of Palestine," following the Palestinians' upgraded status at the United Nations as a non-member observer state.

According to the decree, reported by the official Palestinian news agency Wafa Thursday night, all stamps, signs, and official letterhead will be changed to bear the new name.

It is the first concrete, albeit symbolic, step the Palestinians have taken following the November decision by the United Nations. Abbas has hesitated to take more dramatic steps, like filing war crimes indictments against Israel at the International Criminal Court, a tactic that only a recognized state can carry out.

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Princess Diana Photo, Never Seen Before, Hits Auction Block

By Andrea Billups

01/04/2013 at 10:30 AM EST

Diana Spencer and unknown male companion

The Caren Archive

She was one of the world's most photographed women, but now a new and unseen photo of the late Princess Diana is causing a stir nearly 16 years after her death as it goes to public auction.

The black-and-white photo shows a teenage Diana on a Swiss ski holiday lounging on the lap of a young man, who is unidentified. He is reading a book and resting it on her shoulder.

A bottle of liquor rests on a window ledge above her head, creating an image that was certain to be unfit for a future princess, and is one that was marked "not to be published," according to Britain's Daily Mirror, which purchased the picture in Feb. 26 1981 – just two days after the then-Diana Spencer was engaged to Prince Charles.

The photo was kept hidden in the paper's archives until it was purchased seven years ago by the private Caren Archive. It is now set for auction by RR Auctions in New Hampshire, and is being described as a "salacious teenage image of the future princess."

"This would certainly not be in the way the Royal Family would have Diana to have been presented," said Eric Caren, owner of the Caren Archive, to the Daily Mail.

Diana is thought to be 18 or 19 years old when the photo was taken. It is expected to sell for at least $1,200 – though there are reports it could go for several thousands of dollars.

Diana, who rose to become an international fashion icon and human rights activist, and who later split with Prince Charles, died at 36 in 1997 in an infamous Paris car crash. Her tragic death sent Britain and the world in mourning as her two sons, Prince William and Prince Harry, were left without a mother.

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Indian court to rule on generic drug industry

NEW DELHI (AP) — From Africa's crowded AIDS clinics to the malarial jungles of Southeast Asia, the lives of millions of ill people in the developing world are hanging in the balance ahead of a legal ruling that will determine whether India's drug companies can continue to provide cheap versions of many life-saving medicines.

The case — involving Swiss drug maker Novartis AG's cancer drug Glivec — pits aid groups that argue India plays a vital role as the pharmacy to the poor against drug companies that insist they need strong patents to make drug development profitable. A ruling by India's Supreme Court is expected in early 2013.

"The implications of this case reach far beyond India, and far beyond this particular cancer drug," said Leena Menghaney, from the aid group Doctors Without Borders. "Across the world, there is a heavy dependence on India to supply affordable versions of expensive patented medicines."

With no costs for developing new drugs or conducting expensive trials, India's $26 billion generics industry is able to sell medicine for as little as one-tenth the price of the companies that developed them, making India the second-largest source of medicines distributed by UNICEF in its global programs.

Indian pharmaceutical companies such as Cipla, Cadila Laboratories and Lupin have emerged over the past decade as major sources of generic cancer, malaria, tuberculosis and AIDS drugs for poor countries that can't afford to pay Western prices.

The 6-year-old case that just wrapped up in the Supreme Court revolves around a legal provision in India's 2005 patent law that is aimed at preventing companies from getting fresh patents for making only minor changes to existing medicines — a practice known as "evergreening."

Novartis' argued that a new version of Glivec — marketed in the U.S. as Gleevec — was a significant change from the earlier version because it was more easily absorbed by the body.

India's Patent Controller turned down the application, saying the change was an obvious development, and the new medicine was not sufficiently distinct from the earlier version to warrant a patent extension.

Patient advocacy groups hailed the decision as a blow to "evergreening."

But Western companies argued that India's generic manufacturers were cutting the incentive for major drug makers to invest in research and innovation if they were not going to be able to reap the exclusive profits that patents bring.

"This case is about safeguarding incentives for better medicines so that patients' needs will be met in the future," says Eric Althoff, a Novartis spokesman.

International drug companies have accused India of disregarding intellectual property rights, and have pushed for stronger patent protection that would weaken India's generics industry.

Earlier this year, an Indian manufacturer was allowed to produce a far cheaper version of the kidney and liver cancer treatment sorefinib, manufactured by Bayer Corp.

Bayer was selling the drug for about $5,600 a month. Natco, the Indian company, said its generic version would cost $175 a month, less than 1/30th as much. Natco was ordered to pay 6 percent in royalties to Bayer.

Novartis says the outcome of the new case will not affect the availability of generic versions of Glivec because it is covered by a grandfather clause in India's patent law. Only the more easily absorbed drug would be affected, Althoff said, adding that its own generic business, Sandoz, produces cheap versions of its drugs for millions across the globe.

Public health activists say the question goes beyond Glivec to whether drug companies should get special protection for minor tweaks to medicines that others could easily have uncovered.

"We're looking to the Supreme Court to tell Novartis it won't open the floodgates and allow abusive patenting practices," said Eldred Tellis, of the Sankalp Rehabilitation Centre, a private group working with HIV patients.

The court's decision is expected to be a landmark that will influence future drug accessibility and price across the developing world.

"We're already paying very high prices for some of the new drugs that are patented in India," said Petros Isaakidis, an epidemiologist with Doctors Without Borders. "If Novartis' wins, even older medicines could be subject to patenting again, and it will become much more difficult for us in future to provide medicines to our patients being treated for HIV, hepatitis and drug resistant TB."

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