Cargo plane crashes in Brazzaville, 3 dead












BRAZZAVILLE, Republic of Congo (AP) — A cargo plane owned by a private company crashed Friday near the airport in Brazzaville, the capital of the Republic of Congo, killing at least three people, officials said.


The Soviet-made Ilyushin-76 belonged to Trans Air Congo and appeared to be transporting merchandise, not people, said an aviation official who requested anonymity because he was not authorized to speak to the media.












The plane was coming from Congo‘s second-largest city, Pointe Noire, and tried to land during heavy rain, he said.


Ambulances rushed to the scene in the Makazou neighborhood, located near the airport, but emergency workers were hampered by the lack of light in this capital, which like so many in Africa has a chronic shortage of electricity.


“At the moment, my team is having a hard time searching for survivors in order to find the victims of the crash because there is no light and also because of the rain,” Congolese Red Cross head Albert Mberi said.


He said that realistically, they will only be able to launch a proper search Saturday, when the sun comes up.


Reporters at the scene fought through a wall of smoke. Despite the darkness, they could make out the smoldering remains of the plane, including what looked like the left wing of the aircraft. A little bit further on, emergency workers identified the body of the plane’s Ukrainian pilot, and covered the corpse in a blanket.


Firefighters were trying to extinguish the blaze of a part of the plane that had fallen into a ravine. They were using their truck lights to try to illuminate the scene of the crash. Although the plane was carrying merchandise, emergency workers fear that there could be more people on board.


Because of the state of the road connecting Pointe Noire to Brazzaville, many traders prefer to fly the roughly 400 kilometers (250 miles).


Africa has some of the worst air safety records in the world. In June, a commercial jetliner crashed in Lagos, Nigeria, killing 153 people, just a few days after a cargo plane clipped a bus in neighboring Ghana, killing 10.


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EBay’s double tax base prompts calls for investigation












LONDON (Reuters) – Britain and Germany may have missed out on a combined $ 1 billion in sales tax since online marketplace eBay picked a tiny Luxembourg office as its base for EU sales, a shift that lawmakers say should now be investigated.


EBay’s nomination of Luxembourg unit eBay Europe Sarl – with a staff of nine – as its provider of services to EU clients allows it to charge customers in Europe a low rate of sales tax, often known as Value Added Tax, helping it to compete against rivals.












However, the unit doesn’t actually receive the money from sales. Instead, eBay said it continues to channel revenues through a Berne-based unit, allowing the company also to benefit from what Swiss tax lawyers say is the most competitive corporate income tax regime in Europe.


EU rules allow companies to establish subsidiaries in Luxembourg and levy VAT at Luxembourg’s low VAT rate on sales to customers across the bloc.


However, the rules also allow individual EU taxmen to challenge any claim to Luxembourg residence, and the right to charge Luxembourg VAT, in their domestic courts, if the taxman feels a Luxembourg-based subsidiary does not have sufficient staff or assets to support its claim to be the true supplier of goods or services.


Tax experts say eBay’s arrangement, which appears to give eBay the best of both income and sales tax worlds, could be open to challenge, and lawmakers in the UK and Germany want their taxmen to investigate.


“I hope that HMRC (UK tax authority Her Majesty’s Revenue and Customs) takes note … and takes prompt action,” said Margaret Hodge, member of parliament and chairman of the Public Accounts Committee (PAC), which monitors government finances.


“I will be seeking assurance that they are, next time we take evidence from HMRC,” she added. Officials from HMRC are due to testify to the PAC in early December as part of the committee’s investigation into tax matters.


Sven Giegold, member of the European Parliament for Germany’s Green Party, said he wanted the German tax authorities to “have a very critical look at this”.


It is common for companies to seek to reduce their tax bills, and a number of multinationals have established bases in Luxembourg so they can charge customers lower levels of VAT.


EBay said HMRC was aware of all its tax arrangements and that it was confident it met all its tax liabilities in the UK and elsewhere.


“In all countries and at all times, eBay is fully compliant with national, EU and international tax rules (including the OECD) including the remittance of VAT to the appropriate authorities,” an eBay spokesman said in an emailed statement.


The UK, German, French and Luxembourg tax authorities declined to comment on eBay, citing rules on taxpayer confidentiality.


LOWER THRESHOLD


Big companies’ tax practices have risen to the top of the political agenda in Europe in the past year, with lawmakers growing increasingly frustrated with the way in which companies such as search engine company Google pay almost no income tax in countries where they have billions of dollars in sales.


The companies escape liability for income taxes in countries like the UK by arguing the value created by their business, and therefore the location where the profit should be realized, is not the place where the customer resides, but rather in the location where the intellectual property underpinning the product or service is based.


Chas Roy-Chowdhury, head of taxation at the Association of Chartered Certified Accountants, said this was a valid economic argument and that if, for example, HMRC wants to claim more income tax from Google, it has to prove the company is generating more value in the UK than it is declaring.


This would require a thorough deconstruction of its business model and supply chain.


However, it is easier to establish liability to VAT, since this tax hinges simply on the location of the buyer and seller.


“The threshold is lower,” said Simon Newark, head of VAT at accountants UHY Hacker.


“There are a lot more aspects for HMRC to challenge in VAT than in direct (income) tax.”


For tax purposes, the EU deems eBay’s online platform an “electronically supplied service”, a category that also covers e-Books and music downloads.


Under EU rules, suppliers of such services based within the bloc are supposed to charge EU customers VAT at the rate prevailing in the country where the supplier is based.


A number of suppliers of electronic services, including Amazon.Com Inc and Apple Inc’s iTunes have established European headquarters in Luxembourg to enable them to charge customers lower VAT rates than prevail in their customers’ countries.


Luxembourg has traditionally charged the lowest standard VAT rates in the European Union. Its 15 percent rate compares with rates of 19-25 percent in most other EU members.


By charging customers VAT at Luxembourg’s rate eBay is better able to compete with rivals based elsewhere in the EU, such as Britain’s eBid, which must charge customers VAT at the standard UK rate of 20 percent.


However, to be entitled to charge Luxembourg rates, a company has to be able to prove in British, German or EU courts that it is genuinely based in the Grand Duchy.


Companies selling to EU customers from outside the EU – as eBay was until the 2007 nomination of eBay Europe Sarl as supplier to EU clients – must charge European customers VAT at the rate prevailing in the country where the customer resides, and to pay that VAT to the taxman in the customer’s country.


There is no definitive checklist that determines the true base of a company and any decision by a national court can be challenged in the European Court of Justice. In the UK, HMRC said it approached the matter on a case-by-case basis, and disputes are often resolved in court.


“HMRC will challenge any arrangements where it is claimed that supplies are made from a particular country but the business does not have the necessary resources to make those supplies,” a spokesman said.


EUROPE EXPANSION


EBay, which is headquartered in San Jose, California, moved into Europe in 1999 when it established eBay International in Berne. Switzerland’s low income tax regime for foreign companies was highly beneficial for the auction site. “We do have a very favorable international tax structure,” then-Chief Financial Officer Rajiv Dutta told analysts in 2002 when asked how the company managed to pay such low taxes on its non-U.S. income.


The Swiss base also meant, initially, that the company didn’t have to charge EU customers VAT. But in 2003, Brussels changed the rules, which forced eBay to charge EU sellers on its platform VAT based on their residence. The VAT gathered was remitted to the tax authority in the customer’s country.


Not all customers are charged VAT. Most medium-sized and big businesses are legitimately exempted from paying VAT on some purchases, such as eBay seller fees.


EBay’s Swiss-based European public relations head declined to say what portion of its EU customers were liable to be charged VAT. James Cordwell, equities analyst at Atlantic Equities, estimated that such customers accounted for 40-50 percent of sales in Europe.


Since the 2007 creation of its Luxembourg operation, eBay has had German fee revenues of $ 6.1 billion and UK revenues of $ 5 billion, its annual accounts show.


If the services were supplied from Switzerland or another non-EU country, and assuming only half of customers should have been charged VAT, EU rules would have obliged eBay to collect $ 580 million in VAT for the German taxman and $ 500 million in VAT for HMRC since 2007.


EBay’s entitlement to charge Luxembourg VAT on sales and to pay this to the Luxembourg taxman rests on being able to prove in court that eBay Europe Sarl is the provider of services to EU clients.


But despite German and UK fee income of $ 3.1 billion last year, eBay Europe Sarl recorded turnover of only 5 million euros in 2011.


John Hemming, an MP with the Liberal Democrats, the junior partner in the British coalition government, said the fact eBay’s sales revenues did not go through the Luxembourg unit undermined the claim that it was the true provider of services to EU clients.


“If it’s a real transaction, you would expect the money to pass with it, and not pass someplace else,” he said.


Rather than going to Luxembourg, the money generated from customers continues to go to Berne-based eBay International AG, a spokeswoman said.


When Reuters visited in mid November, staff at the Luxembourg office, just opposite the central post office, declined to discuss what operations the unit conducted for eBay.


A spokesman later said the office conducted activities including billing, data privacy, contracting, regulatory, management and some customer services operations.


By contrast, Amazon and iTunes do report their sales of ebooks and music downloads to EU customers through their Luxembourg units.


Prem Sikka, professor of accounting at Essex University, along with Newark and Roy-Chowdhury said a cash trail through a unit was one of the key factors used as evidence that the unit was the true supplier of a service.


UK and German tax authorities could argue that the shift in eBay’s supply base to Luxembourg from Berne was therefore not genuine. If successful, they could claim back the VAT lost.


EBay declined to say why it channeled sales through Switzerland. Tax advisors say the country can still offer some companies lower tax rates than other European low-tax jurisdictions such as Ireland and Luxembourg.


Indeed, EBay’s closest rival Amazon, which channels about half its non-U.S. earnings through Luxembourg, reported average income tax on overseas earnings of 6 percent in the past four years. EBay paid just 3 percent over the same period.


(Additional reporting by Brenda Goh; Editing by Will Waterman)


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Producer sues Pythons over ‘Spamalot’ royalties












LONDON (AP) — It’s no joking matter.


A producer of the film “Monty Python and the Holy Grail” is suing the British comedy troupe over royalties from the hit stage musical “Spamalot.”












Producer Mark Forstater wants a bigger share of proceeds from the show, which is based on the Pythons’ 1975 movie spoof of the legend of King Arthur.


Lawyers for Monty Python are contesting Forstater’s claim and will present their arguments later. Python members Eric Idle, Michael Palin and Terry Jones will give evidence during a five-day hearing that began Friday at London’s High Court.


Forstater is suing the trio and the two other surviving Python members, John Cleese and Terry Gilliam. The sixth member of the troupe, Graham Chapman, died in 1989.


Forstater’s lawyer, Tom Weisselberg, said that under an agreement made when the film was produced, “for financial purposes Mr. Forstater was to be treated as the seventh Python” and entitled to the same share of “Holy Grail” merchandising and spin-off income as the other members.


But the lawyer said Forstater had not received his fair share of royalties from the stage show, which has been a hit around the world. It ran on Broadway for almost four years to 2009 and is still playing in London’s West End.


Weisselberg said Forstater, who was declared bankrupt earlier this year, had been forced to go to court because of his “difficult financial circumstances.”


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Ukraine fights spreading HIV epidemic












BUCHA, Ukraine (AP) — Andrei Mandrykin, an inmate at Prison No. 85 outside Kiev, has HIV. He looks ghostly and much older than his 35 years. But Mandrykin is better off than tens of thousands of his countrymen, because is he receiving treatment amid what the World Health Organization says is the worst AIDS epidemic in Europe.


Ahead of World AIDS Day on Saturday, international organizations have urged the Ukrainian government to increase funding for treatment and do more to prevent HIV from spreading from high-risk groups into the mainstream population, where it is even harder to manage and control.












An estimated 230,000 Ukrainians, or about 0.8 percent of people aged 15 to 49, are living with HIV, the virus that causes AIDS. Some 120,000 are in urgent need of anti-retroviral therapy, which can greatly prolong and improve the quality of their lives. But due to a lack of funds, fewer than a quarter are receiving the drugs — one of the lowest levels in the world.


Ukraine’s AIDS epidemic is still concentrated among high-risk groups such as intravenous drug users, sex workers, homosexuals and prisoners. But nearly half of new cases registered last year were traced to unprotected heterosexual contact.


“Slowly but surely the epidemic is moving from the most-at-risk, vulnerable population to the general population,” said Nicolas Cantau of The Global Fund to Fight AIDS, Tuberculosis and Malaria, who manages work in Eastern Europe and Central Asia. “For the moment there is not enough treatment in Ukraine.”


Stigma is also a big problem for those with HIV in Ukraine. Liliya, a 65-year-old woman who would give only her first name, recently attended a class on how to tell her 9-year-old great-granddaughter that she has HIV. The girl, who contacted HIV at birth from her drug-abusing mother, has been denied a place in preschool because of her diagnosis.


“People are like wolves, they don’t understand,” said Liliya. “If any of the parents found out, they would eat the child alive.”


While the AIDS epidemic has plateaued elsewhere in the world, it is still progressing in Eastern Europe and Central Asia, according to Cantau. Nearly 21,200 new cases were reported in Ukraine in 2011, the highest number since the former Soviet republic registered its first case in 1987, and a 3 percent increase over 2010. As a result of limited and often delayed treatment, the number of AIDS-related deaths grew 17 percent last year to about 3,800.


Two years ago, Mandrykin, the prisoner, was on the verge of becoming part of that statistic, with his level of crucial CD4 immune cells — a way to measure the strength of the immune system — dropping to 11. In a healthy person, the CD4 count is usually over 600.


“I was lying in the hospital, I was dying,” said Mandrykin, who is serving seven years for robbery, his fourth stint in jail. “It’s a scary disease.”


After two years of treatment in a small prison clinic, his CD4 count has risen to 159 and he feels much better, although he looks exhausted and is still too weak to work in the workshop of the medium-security prison.


The Ukrainian government currently focuses on testing and treating standard cases among the general population. The anti-retroviral treatment of more than 1,000 inmates, as well as some 10,000 HIV patients across Ukraine who also require treatment for tuberculosis and other complications and all prevention and support activities, are paid for by foreign donors, mainly the Global Fund.


The Global Fund is committed to spending $ 640 million through 2016 to fight AIDS and tuberculosis in Ukraine and then hopes to hand over most of its programs to the Ukrainian government.


Advocacy groups charge that corruption and indifference by government officials help fuel the epidemic.


During the past two years, Ukrainian authorities have seized vital AIDS drugs at the border due to technicalities, sent prosecutors to investigate AIDS support groups sponsored by the Global Fund and harassed patients on methadone substitution therapy, prompting the Global Fund to threaten to freeze its prevention grant.


Most recently, Ukraine’s parliament gave initial approval to a bill that would impose jail terms of up to five years for any positive public depiction of homosexuality. Western organizations say it would make the work of AIDS prevention organizations that distribute condoms and teach safe homosexual sex illegal and further fuel the epidemic. It is unclear when the bill will come up for a final vote.


AIDS drug procurement is another headache, with Ukrainian health authorities greatly overpaying for AIDS drugs. Advocacy groups accuse health officials of embezzling funds by purchasing drugs at inflated prices and then pocketing kickbacks.


Officials deny those allegations, saying their tender procedures are transparent.


Much also remains to be done in Ukraine to educate people about AIDS.


Oksana Golubova, a 40-year-old former drug user, infected her daughter, now 8, with HIV and lost her first husband to AIDS. But she still has unprotected sex with her new husband, saying his health is in God’s hands.


“Those who are afraid get infected,” Golubova said.


Medications/Drugs News Headlines – Yahoo! News


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Amazon’s Robotic Future: A Work in Progress












If you were watching Bloomberg TV recently, you may have seen our correspondent, Cory Johnson, standing in the middle of Amazon’s (AMZN) newest distribution center in Arizona. It’s an impressive facility, brand-new and owned by one of the hardest-charging, most-innovative companies to come onto the retail scene since Sam Walton opened a five-and-dime.


So where are the robots?












After all, aren’t robots supposed to be the future of such places as distribution centers and warehouses? Didn’t Amazon buy a robot manufacturer, Kiva, in March? The online retailer announced in October that it was taking on 50,000 additional part-time workers for the holiday season. Shouldn’t some of those spots be taken up by mechanical arms and wheels?


Maybe not. For all the anxiety over robots coming to take jobs, there are still limitations to what they can do—or what they can do well. Bruce Welty is chief executive officer of Quiet Logistics, an order-fulfillment company that manages the online inventory and distribution for retailers like Gilt, Zara, and Bonobos. He uses robots made by Kiva, the company Amazon purchased, but his warehouse in Massachusetts is not bereft of humans. “Robots aren’t very good at picking up things,” he says. “They aren’t very good at looking at a bin of different things and distinguishing one item from another.”


Welty’s robots do one task and one task only: They move racks of merchandise to workers, who then remove the products from the racks and pack them up for shipping. Saving workers the time and effort to retrieve products offers considerable benefit. “In a typical warehouse, that’s about 60 to 70 percent of the labor,” Welty says.


In addition to what the current state of robotic arts does well, there are further reasons for the continued presence of human beings in warehouses. Labor flexibility is one of the larger ones. “Automation won’t help Amazon in periods of peak demand,” says Stephen Graves, a professor of management science at the Massachusetts Institute of Technology. “People are far more flexible.”


The capital expense to add robots means they need to make sense 12 months out of the year, not two. “The only way to handle spikes in demand is by adding temporary workers,” says Jim Tompkins, CEO of supply-chain consultancy Tompkins International. “If you bought a whole bunch of robots to handle the holiday shopping season, you’d have a whole bunch of robots looking at you, come January.”


So if Amazon just spent nearly a billion dollars buying Kiva, but the robots they produce can’t make a huge difference in how the company operates, what are Amazon’s intentions?


For starters, it’s still early. An acquisition like that of Kiva will take a while to digest, during which time new applications for the robots will surely be devised. “They’re really in a test mode,” says Welty. “They’re going to work on getting it right before any major rollout.”


The Kiva acquisition may have had as much to do with software as it does with hardware, adds Tompkins. “Mechanically, there’s nothing that special about Kiva,” he says. “But what they do have is software that makes sure the robots are in the right place at the right time. This was a software play.”


That’s not exactly how most people would view the deal. But it may be just the head-fake that Amazon CEO Jeff Bezos intended. “I bet Jeff Bezos loves that people are running around trying to put more robots in their distribution centers,” Tompkins says.


Businessweek.com — Top News


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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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RIM stock rises after Goldman Sachs upgrade












TORONTO (AP) — Research In Motion rose Thursday after Goldman Sachs upgraded the phone maker’s shares, saying there’s a “30 percent chance” RIM‘s much-delayed BlackBerry 10 smartphones will be a success.


THE SPARK: Goldman Sachs analyst Simona Jankowski lifted RIM to “Buy” from “Neutral,” the latest analyst to voice a slightly more optimistic view for the troubled company. Goldman lifted its 12-month price target to $ 16 from $ 9.












THE BIG PICTURE: RIM was once Canada’s most valuable company, with a market value of more than $ 80 billion in 2008, but shares have sunk due to ground lost to Apple Inc.‘s iPhone and phones running Google Inc.‘s Android system.


Now the company’s new BlackBerrys, expected sometime after Jan. 30, are considered critical to its survival. The new system includes a touch screen and the apps experience that customers now expect.


THE ANALYSIS: Jankowski noted positive early reviews for the new operating system and broad-based support by carriers who are looking to sell a third operating system beyond Google’s Android and Apple’s iOS.


She predicted that RIM will become profitable in the year ending in February 2014. Analysts polled by FactSet expect a loss. Still, she expects RIM to revert to a loss the next year.


Last week, National Bank Financial Kris Thompson increased his price target to $ 15 from $ 12, while Jefferies analyst Peter Misek doubled his price target from $ 5 to $ 10, saying the BlackBerry 10 operating system has a 20 to 30 percent chance of succeeding.


SHARE ACTION: Shares of Research In Motion added 67 cents, or 6.4 percent, to $ 11.77 in midday trading on the Nasdaq. The stock is up 78 percent since late September — but it’s down 23 percent this year through Wednesday’s close, and has lost more than 90 percent from its 2008 high.


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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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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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Stock futures gain ahead of data on fiscal hopes












NEW YORK (Reuters) – Stock futures rose on Thursday, building on the previous session’s steep gains, on expectations of progress toward a fiscal agreement in Washington that would avert an economic meltdown.


Market participants will continue to focus on discussions in Congress to avoid big spending cuts and tax hikes – dubbed the “fiscal cliff” – and equities may retreat, as they did Tuesday, if the upbeat negotiation environment in Washington shifts.












“There will be a deal before December 31 to avert the economy facing disaster,” said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.


“We’re back on track for a year-end rally to continue,” he said, highlighting the continued support the Federal Reserve has given to equity markets.


Investors await data, including the second estimate of third-quarter gross domestic product, due at 8:30 a.m. ET (1330 GMT). Economists in a Reuters survey forecast a 2.8 percent annualized pace of growth, compared with a 2.0 percent rate in the first estimate.


The Commerce Department will issue preliminary corporate profits for the third quarter at 8:30 a.m. (1330 GMT). At the same time, the Labor Department will release first-time claims for jobless benefits; 390,000 new filings are forecast, compared with 410,000 in the prior week.


The yield on Italy’s 10-year bonds fell to the lowest in two years at an auction, amid relief that immediate risks over Greece had diminished.


“The fact that the bond sales in Europe went well suggest confidence is beginning to reenter some of the peripheral nations and that is a good sign,” Cardillo said.


The euro flirted with the $ 1.30 level and boosted commodity prices, which could lift the basic materials and energy stock sectors.


S&P 500 futures rose 9 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures rose 78 points, and Nasdaq 100 futures added 17.5 points.


Also due for release Thursday are pending home sales for October at 10:00 a.m. (1500 GMT) and the Federal Reserve Bank of Kansas City November manufacturing survey at 11:00 a.m.


Tiffany shares fell 9 percent to $ 58.02 in premarket trading after the upscale jeweler reported quarterly results and lowered its full-year sales and profit forecasts.


U.S.-listed shares of BlackBerry maker Research In Motion soared 11.7 percent to $ 12.40 in premarket trading after Goldman Sachs upgraded the stock to “buy” from “neutral.”


Kroger , the biggest U.S. supermarket operator, is due to report third-quarter earnings.


On Wednesday, the Dow Jones industrial average <.DJI> rose 106.98 points, or 0.83 percent, to 12,985.11. The S&P 500 <.SPX> gained 10.99 points, or 0.79 percent, to 1,409.93. The Nasdaq Composite <.IXIC> added 23.99 points, or 0.81 percent, to close at 2,991.78.


(Editing by Bernadette Baum)


Economy News Headlines – Yahoo! News


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