Should breast cancer patients skip the pre-op MRI?

NEW YORK (Reuters Health) – A new review of existing evidence suggests that using magnetic resonance imaging to “stage” a woman’s breast cancer before surgery might do more harm than good.

MRI produces a much clearer image than X-rays and ultrasound, and is recommended for detecting early tumors in women at increased risk for breast cancer. But routinely using the technology once any woman is diagnosed with a tumor may lead to more radical surgery without any benefits, says a team of Australian and U.S. researchers.

They found that about 26 percent of women who had a pre-operative MRI to help determine the extent and severity of their tumor ended up having their entire breast removed, compared to about 18 percent of those whose surgeons only used traditional methods of characterizing the cancer.

“I wasn’t surprised by the results at all. What I am surprised by was the strength of the data,” said Dr. Monica Morrow, the study’s senior author and the chief of breast service at Memorial Sloan-Kettering Cancer Center in New York.

Because MRIs are more sensitive than mammograms, some doctors think they are a good tool for identifying the precise outlines of cancerous tissue. Others, however, have begun to question whether the imaging led surgeons to remove more breast tissue than necessary.

Moreover, women who have MRIs before breast surgery seem to be no less likely to need a second surgery to remove additional cancerous tissue.

A study published in September, for instance, found that among more than 300 women who underwent breast cancer surgery, just as many of those who had an MRI before the first surgery ended up having a repeat operation. (see Reuters Health article of September 25, 2012 here: http://reut.rs/Oogm3c)

An MRI can also add more than $ 1,000 to a patient’s bill.

“I think more surgeons are starting to question this because they’re seeing the outcomes,” Morrow said.

For the new study, she and her colleagues pulled together data from nine previous studies to see if MRIs influenced the number of women who had their breast removed or who had a second surgery to remove additional cancer.

From the nine studies, the researchers had information on 3,112 women who had breast cancer surgery.

Overall, the team found that about 16 percent of the women who had an MRI ended up having the entire cancerous breast removed, known as a mastectomy, during their first surgery. That’s compared to about 8 percent of women who did not have an MRI.

They also found that having an MRI before surgery did not influence whether women would need additional surgery to remove more tissue. In each group, between 11 percent and 12 percent had to go back under the knife.

After taking into account the women’s initial surgery and the second operations, the researchers calculated that about 26 percent of those who had an MRI ended up having their entire breast removed, compared to 18 percent in the no-MRI group.

“It causes more mastectomies to start with, but it doesn’t decrease the number of women who started out wanting a lumpectomy and needing a mastectomy,” said Morrow of preoperative MRIs.

The study did not look at long term outcomes, including how many women survived beyond five years. Nor did it examine the use of MRI to screen the opposite breast for signs that cancer had spread, the researchers note in their report, which is published in the Annals of Surgery.

These results do not apply to certain subgroups of patients, they add, including women with genetic mutations that predispose them to cancer and those whose other diagnostic tests produced conflicting results.

But based on the short term measures of how many surgeries women got and how much tissue surgeons removed from them, Morrow told Reuters Health that MRIs do not seem to have a place in breast cancer surgery.

“There may be select circumstances where we’d use it to solve a problem, but for most women with breast cancer they don’t need an MRI for their evaluation,” she said.

SOURCE: http://bit.ly/RdZNIw Annals of Surgery, online November 26, 2012.

(This story was refiles to change “woman” to “women” in second paragraph.)

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The Era of Twitter Without Instagram Has Now Begun

We know everyone is a little bummed about all those filtered photos disappearing from your Twitter streams this weekend, but let’s not get all worked up about it: They are disappearing, and there is no scandal.

RELATED: Why You Can’t See Instagram Photos on Twitter Anymore

TechCrunch’s  Drew Olanoff got a little too excited on Friday and thought a single in-stream photo meant that Instagram was allowing its Twitter cards back on Twitter and thought the two services were planning a sudden reunion. You may have seen some, too, but a Facebook spokesperson assured users these Instagram photos on Twitter were the last holdouts in the switchover. ”What you are seeing now may be some sort of regression depending on the mobile client, but we’re checking in with the engineers,” read Facebook’s statement, via Talking Points Memo’s Carl Franzen.

RELATED: How to Get Over the Twitter-Instagram War on Photos

Which means the end of this particular social-media marriage is upon us. Despite the immediate user backlash, Instagram CEO Kevin Systrom has made it pretty clear that the photo-sharing app doesn’t plan on making nice with Twitter. In case you hadn’t accepted the reality of Silicon Valley competition the first time around, this photo-friendly weekend might be the time to check out our handy three-step guide to getting over it. 

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High court to hear key gay-marriage cases

A same sex marriage supporter waves a gay pride flag outside the Supreme Court (Chip Somodevilla/Getty Images)

The Supreme Court announced on Friday that it will decide two major gay marriage cases next year that could have a sweeping effect on the rights of same-sex couples to wed. The cases, which likely won't be decided until June, mark the first time the justices will consider arguments for and against same-sex marriage.

The court will review California's gay marriage ban, which passed in a 2008 ballot initiative months after California's high court had legalized same-sex unions and thousands of gay Californians had already tied the knot. Two federal courts have struck down Proposition 8 as discriminatory, leaving the Supreme Court to render a final judgment.

The justices will also hear a challenge to the federal Defense of Marriage Act, a law passed under President Bill Clinton that prevents the federal government from recognizing gay marriages. Windsor v. United States was brought by Edith Windsor, a resident of New York who paid $363,000 in estate taxes after her wife died because the federal government did not recognize their marriage. New York is one of nine states (and the District of Columbia) where gay marriage is legal, so Windsor argues that the federal government is discriminating against her by not recognizing her state-sanctioned marriage.

The Obama administration decided last year to no longer defend DOMA, so Congress has hired outside counsel to argue on behalf of the law. Recently, two federal appeals courts had struck down the law as unconstitutional, virtually requiring the Supreme Court to take the case to settle the dispute between the courts and Congress.

Legal experts are skeptical that the court would deliver a sweeping ruling deciding whether all Americans, regardless of sexual orientation, have a fundamental right to marry in the DOMA case. It's more likely they will narrowly decide whether the federal government has a legitimate interest in refusing to recognize same-sex couples who wed in states where gay marriage is legal. (Marriage has traditionally been regulated by the states.)

In the Proposition 8 case, justices may decide whether a ban on gay marriage is legal in the specific case of California, where gay couples were allowed to marry for several months before the ban passed. Such a narrow decision would not necessarily affect gay marriage bans that have passed in dozens of other states where same-sex marriage was never legal in the first place.

But it's possible the justices could make a broader ruling on Prop 8. Ted Olson, a former U.S. solicitor general under President George W. Bush  and one of the lead attorneys in the battle against Proposition 8, told reporters on Friday that he planned to argue that there's a "fundamental constitutional right to marry for all citizens." His co-counsel, David Boies, called same-sex marriage the civil rights issue of this era. If the justices accept this argument, states could no longer ban gay marriage, dealing the anti-gay marriage movement a fatal blow. If they reject the argument, it would shut down legal challenges to state marriage bans and significantly set back the movement to expand same-sex marriage rights.

John Eastman, the chair for the anti-gay marriage National Organization for Marriage, said in a statement that he thinks the Supreme Court will uphold Proposition 8 and DOMA. "We believe the U.S. Supreme Court will overturn this exercise in judicial activism and stop federal judges from legislating from the bench on the definition of marriage," Eastman said.

For both cases, court-watchers will have their eyes trained firmly on swing Justice Anthony Kennedy, who has a record of ruling in favor of gay rights. In 2003, Kennedy wrote the court's opinion in Lawrence v. Texas, a landmark decision that said the government cannot outlaw anal sex between consenting adults, whatever their sexual orientation. ("The liberty protected by the Constitution allows homosexual persons the right to choose to enter upon relationships in the confines of their homes and their own private lives and still retain their dignity as free persons," he wrote.) Kennedy also cast the deciding vote striking down a Colorado law that would have prevented local governments from passing laws specifically protecting gay civil rights.

Because of Kennedy's history on the issue, many legal experts think there's a good chance the court will strike down DOMA, with Kennedy joining the court's four liberals for the decision. But the workings of the Supreme Court are notoriously hard to predict, and it's still a complete mystery what the nine justices will decide in June.

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Toronto mayor to stay in power pending appeal of ouster

TORONTO (Reuters) – Toronto Mayor Rob Ford can stay in power pending an appeal of a conflict of interest ruling that ordered him out of his job as leader of Canada’s biggest city, a court ruled on Wednesday.

Madam Justice Gladys Pardu of the Ontario Divisional Court suspended a previous court ruling that said Ford should be ousted. Ford’s appeal of that ruling is set to be heard on January 7, but a decision on the appeal could take months.

Justice Pardu stressed that if she had not suspended the ruling, Ford would have been out of office by next week. “Significant uncertainty would result and needless expenses may be incurred if a by-election is called,” she said.

If Ford wins his appeal, he will get to keep his job until his term ends at the end of 2014. If he loses, the city council will either appoint a successor or call a special election, in which Ford is likely to run again.

“I can’t wait for the appeal, and I’m going to carry on doing what the people elected me to do,” Ford told reporters at City Hall following the decision.

Ford, a larger-than-life character who took power on a promise to “stop the gravy train” at City Hall, has argued that he did nothing wrong when he voted to overturn an order that he repay money that lobbyists had given to a charity he runs.

Superior Court Justice Charles Hackland disagreed, ruling last week that Ford acted with “willful blindness” in the case, and must leave office by December 10.

Ford was elected mayor in a landslide in 2010, but slashing costs without cutting services proved harder than he expected, and his popularity has fallen steeply.

He grabbed unwelcome headlines for reading while driving on a city expressway, for calling the police when a comedian tried to film part of a popular TV show outside his home, and after reports that city resources were used to help administer the high-school football team he coaches.

The conflict-of-interest drama began in 2010 when Ford, then a city councillor, used government letterhead to solicit donations for the football charity created in his name for underprivileged children.

Toronto’s integrity commissioner ordered Ford to repay the C$ 3,150 ($ 3,173) the charity received from lobbyists and companies that do business with the city.

Ford refused to repay the money, and in February 2012 he took part in a city council debate on the matter and then voted to remove the sanctions against him – despite being warned by the council speaker that voting would break the rules.

He pleaded not guilty in September, stating that he believed there was no conflict of interest as there was no financial benefit for the city. The judge dismissed that argument.

In a rare apology after last week’s court ruling, he said the matter began “because I love to help kids play football”.

Ford faces separate charges in a C$ 6 million libel case about remarks he made about corruption at City Hall, and is being audited for his campaign finances. The penalty in the audit case could also include removal from office.

(Reporting by Claire Sibonney; Editing by Janet Guttsman, Russ Blinch, Nick Zieminski; and Peter Galloway)

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“Breaking Bad,” dominates Writers Guild TV nominations

LOS ANGELES (Reuters) – Dark drug drama “Breaking Bad” dominated television nominations for the annual Writers Guild Awards on Thursday, with “Modern Family” leading the way in the comedy category.

A trio of HBO newcomers – Lena Dunham‘s “Girls,” Aaron Sorkin‘s “The Newsroom,” and political satire “Veep” – will compete in the new series category, along with network comedy “The Mindy Project” and country music drama “Nashville,” the Writers Guild of America (WGA) announced.

“Girls,” the story of three 20-somethings navigating life and love in New York City, also won a nomination in the best comedy series slot, along with established shows “30 Rock,” “Parks and Recreation,” “Louie” and Emmy darling “Modern Family.”

The Writers Guild recognizes achievements in the writing of U.S. television, radio, news and animation, rather than actors or directors. The Guild will announce its nominations in the movie field in January.

“Breaking Bad,” starring Bryan Cranston as a teacher turned drug kingpin and now in its fifth and final season, picked up five nods on Wednesday, including best drama series and four for individual episodes.

The show is likely to face stiff competition from psychological thriller “Homeland,” which won the WGA’s award for best new drama last year and has since bagged an Emmy and Golden Globe.

“Mad Men,” lavish Prohibition-era show “Boardwalk Empire,” and fantasy series “Game of Thrones,” round out the competition for best drama series.

In longer form television, miniseries “Hatfields and McCoys” – about a 100 year-old family feud – was nominated along with TV film “Hemingway and Gelhorn” and “Political Animals.”

The WGA will hand out its awards in all categories on February 17 at simultaneous ceremonies in both New York and Los Angeles.

(Reporting By Jill Serjeant; editing by Andrew Hay)

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Amarin raises $100 million to help launch heart drug

(Reuters) – Biopharmaceutical company Amarin Corp Plc said it raised $ 100 million in non-equity financing that will help it form a sales force to launch its heart drug Vascepa.

Amarin shares, however, fell 22 percent after the bell as the company did not announce a sale or a partnership to market the drug, as some investors had expected.

“This transaction provides Amarin with non-dilutive capital that will ensure our ability to fully execute on the Vascepa product launch while continuing our strategic partnership discussions,” CEO Joseph Zakrzewski said in a statement.

The company said it will hire 250 to 300 sales professional to launch Vascepa in the first quarter of 2013.

(Reporting By Vrinda Manocha in Bangalore; Editing by Don Sebastian)

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Zynga moves to enter US gambling market

NEW YORK (AP) — Online games company Zynga said it has asked Nevada gambling regulators for a decision that could pave the way for it to enter the U.S. gambling market.

This follows Zynga’s October disclosure that it has signed a deal to offer online poker and casino games, played with real money, in the U.K. It plans to launch those games in the first half of 2013.

Zynga Inc. said in an email late Wednesday that it is seeking an “application for a preliminary finding of suitability” from the Nevada Gaming Control Board. This, the company says, is part of its plan to enter regulated “real-money gaming,” that is, gambling markets.

Zynga has not said what it plans to do with a gaming license. But the company, whose games are played primarily on Facebook, has faltered in recent months and is looking for additional revenue sources beyond online games such as “FarmVille 2″ and “Words With Friends.”

The San Francisco-based company says the process with Nevada regulators should take 12 to 18 months. If Zynga passes the first regulatory hurdle, it can then apply for a gaming license in the state. That, the company said, takes two to three months.

Zynga’s stock rose 17 cents, or 7.1 percent, to close Thursday at $ 2.49. The company went public about a year ago, when its stock priced at $ 10 per share.

Gaming News Headlines – Yahoo! News

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Pelosi slams House GOP for taking break amid debt talks

House Minority Leader Nancy Pelosi today ripped House Republicans for scheduling a five-day break amid the " fiscal cliff" debate, asking why the chamber is not in session "trying to build confidence" and "find common ground" with only 26 days left until a mix of steep tax hikes and spending cuts take effect.

"Here we are, Thursday in December. The talk around here is what's going on at the negotiating table. Is anything going on at the negotiating table?" Pelosi, D-Calif., wondered at her weekly news conference. "I can't even explain to my constituents why Congress isn't in session now trying to at least build bridges of understanding and representing."

The GOP-controlled House concluded legislative business Wednesday afternoon after a light floor schedule this week. House Majority Leader Eric Cantor cancelled one day of legislative business previously scheduled for today, and also cut next Friday from the calendar. Cantor, however, announced Wednesday that he has added an unspecified number of days to the legislative calendar the week of Dec. 17.

"I'm really surprised that the Republicans would leave," Pelosi said. "With all that needs to be done, [are House Republicans] avoiding the conversation? Sounds like people don't want to be in town for some reason."

At least one top House Republican, however, stayed at the Capitol: House Speaker John Boehner.

President Obama and Boehner spoke on the phone Wednesday afternoon, but no details were released about the conversation. An aide to the speaker said that "the lines of communication are open" today.

Pelosi, who said she remains in close contact with the president, has repeatedly described a Republican counter-proposal this week as "an assault" on the middle class, seniors and the country's future. She also criticized the proposal for failing to detail how Republicans would specifically achieve savings if they refused to raise tax rates on the wealthiest taxpayers.

"Why are we not here getting information?" Pelosi said. "What are we talking about here? What are we talking about when we say restructure entitlements? What does restructure mean? Destroy? Wither on the vine? Voucherize? Or does it mean let's work together to make these stronger and improve benefits for the beneficiaries?"

But with a stalemate on tax rates, even negotiations between White House and congressional staffs seem to have ground to a halt.

"It's hard to explain to anyone why there's even a mystery in the conversation that we shouldn't be having the upper 2 percent of our population paying its fair share," she said. "How do you start by saying we want to know what you're going to do to seniors before we will do what we know we have to do, which is make the wealthy pay their fair share?"

Pelosi also doubted whether the GOP proposal, which called for $600 billion in health-care savings through changes such as increasing the eligibility age for Medicare, would create adequate savings.

"Show me the money. I don't even know why that is something that people think is going to produce money. What are we going to do with people between 65 and 67?" she said. "It's not even the right thing to do, first and foremost, but is it a trophy that the Republicans want … to raise the rates for the wealthiest people in our country?"

Lawmakers return to the House for legislative business Tuesday, three weeks before the "fiscal cliff" kicks in.

The Senate is in session today.

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Death toll from Philippine typhoon nears 300

NEW BATAAN, Philippines (AP) — Stunned parents searching for missing children examined a row of mud-stained bodies covered with banana leaves while survivors dried their soaked belongings on roadsides Wednesday, a day after a powerful typhoon killed nearly 300 people in the southern Philippines.

Officials fear more bodies may be found as rescuers reach hard-hit areas that were isolated by landslides, floods and downed communications.

At least 151 people died in the worst-hit province of Compostela Valley when Typhoon Bopha lashed the region Tuesday, including 78 villagers and soldiers who perished in a flash flood that swamped two emergency shelters and a military camp, provincial spokeswoman Fe Maestre said.

Disaster-response agencies reported 284 dead in the region and 14 fatalities elsewhere from the typhoon, one of the strongest to hit the country this year.

About 80 people survived the deluge in New Bataan with injuries, and Interior Secretary Mar Roxas, who visited the town, said 319 others remained missing.

“These were whole families among the registered missing,” Roxas told the ABS-CBN TV network. “Entire families may have been washed away.”

The farming town of 45,000 people was a muddy wasteland of collapsed houses and coconut and banana trees felled by Bopha’s ferocious winds.

Bodies of victims were laid on the ground for viewing by people searching for missing relatives. Some were badly mangled after being dragged by raging flood waters over rocks and other debris. A man sprayed insecticide on the remains to keep away swarms of flies.

A father wept when he found the body of his child after lifting a plastic cover. A mother, meanwhile, went away in tears, unable to find her missing children. “I have three children,” she said repeatedly, flashing three fingers before a TV cameraman.

Two men carried the mud-caked body of an unidentified girl that was covered with coconut leaves on a makeshift stretcher made from a blanket and wooden poles.

Dionisia Requinto, 43, felt lucky to have survived with her husband and their eight children after swirling flood waters surrounded their home. She said they escaped and made their way up a hill to safety, bracing themselves against boulders and fallen trees as they climbed.

“The water rose so fast,” she told AP. “It was horrible. I thought it was going to be our end.”

In nearby Davao Oriental, the coastal province first struck by the typhoon as it blew from the Pacific Ocean, at least 115 people perished, mostly in three towns that were so battered that it was hard to find any buildings with roofs remaining, provincial officer Freddie Bendulo and other officials said.

“We had a problem where to take the evacuees. All the evacuation centers have lost their roofs,” Davao Oriental Gov. Corazon Malanyaon said.

The International Federation of Red Cross and Red Crescent Societies issued an urgent appeal for $ 4.8 million to help people directly affected by the typhoon.

The sun was shining brightly for most of the day Wednesday, prompting residents to lay their soaked clothes, books and other belongings out on roadsides to dry and revealing the extent of the damage to farmland. Thousands of banana trees in one Compostela Valley plantation were toppled by the wind, the young bananas still wrapped in blue plastic covers.

But as night fell, however, rain started pouring again over New Bataan, triggering panic among some residents who feared a repeat of the previous day’s flash floods. Some carried whatever belongings they could as they hurried to nearby towns or higher ground.

After slamming into Davao Oriental and Compostela Valley, Bopha roared quickly across the southern Mindanao and central regions, knocking out power in two entire provinces, triggering landslides and leaving houses and plantations damaged. More than 170,000 fled to evacuation centers.

As of Wednesday evening, the typhoon was over the South China Sea west of Palawan province. It was blowing northwestward and could be headed to Vietnam or southern China, according to government forecasters.

The deaths came despite efforts by President Benigno Aquino III’s government to force residents out of high-risk communities as the typhoon approached.

Some 20 typhoons and storms lash the northern and central Philippines each year, but they rarely hit the vast southern Mindanao region where sprawling export banana plantations have been planted over the decades because it seldom experiences strong winds that could blow down the trees.

A rare storm in the south last December killed more than 1,200 people and left many more homeless.

The United States extended its condolences and offered to help its Asian ally deal with the typhoon’s devastation. It praised government efforts to minimize the deaths and damage.

___

Associated Press writers Jim Gomez, Teresa Cerojano and Oliver Teves in Manila contributed to this report.

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A Minute With: Scottish DJ Calvin Harris hits big time in U.S

LOS ANGELES (Reuters) – Scottish DJ Calvin Harris may not be the most recognizable face in the U.S. music scene, but after writing Rihanna‘s biggest chart hit and with two other top 20 singles, Harris is fast becoming a chart staple.

Harris, 28, found success in the UK over the last five years before storming the Billboard Hot 100 earlier this year with “We Found Love,” a dance-infused dark love song featuring Rihanna’s vocals that became one of 2012′s biggest hits.

The DJ, who released album “18 Months” in November featuring other hits “Feels So Close” and “Let’s Go,” sat down with Reuters to talk about his U.S. breakthrough.

Q: Did you ever think “We Found Love” was going to be one of the biggest hits in the U.S. this year, and what do you think of the growing British presence in the U.S. music charts?

A: “I hoped that it would do really well, but you can’t predict writing Rihanna’s biggest-ever record, else you’re an egomaniac. Couldn’t have predicted that – that was a surprise. It’s nice that British music is getting played over here, it seems like everyone has a more even playing field than before.”

Q: Why do you think dance music is becoming such a big part of the U.S. scene?

A: “The people to thank are probably the Black Eyed Peas and Lady Gaga. They were the first two American mainstream acts to have that house beat in their songs, whereas before, it was all hip hop. I remember Ne-Yo, when ‘Closer’ came out … and it bombed here but in the UK it was number 1, it was massive … Black Eyed Peas’ ‘I Got a Feeling’ and (Lady Gaga’s) ‘Poker Face’ that was pushed really hard, and once they were huge, huge hits … radio stations wanted more and there was plenty of it because it’s been going on for years.”

Q: There are a lot of DJs coming into the mainstream scene now. How do you make yourself stand out in a saturated market?

A: “I like making dance records with lyrical depth. I also like the music to sound rich and full and have real instruments, and not be that kind of synthetic sound, combined with lyrics about popping bottles, being in the club … I like them to be the sort of lyrics you can find in another genre because I think dance music historically, the lyrics have been banal and I’m not into that. I like making actual songs but also something that still works on the dance floor.”

Q: Your new album “18 Months” has songs that span different sounds within the dance-pop genre. Were any tracks challenging?

A: “The two most challenging mixes were the tracks with Example and Florence (Welch), because I think the key is to make it sound like there isn’t that much going on when actually there is … it was a more difficult mix because it was more dynamic.”

Q: Some critics say that you use well-known artists like Rihanna or Florence just so you can get hits. What do you say to people who think you’ve sold out?

A: “Critics don’t buy albums, they’re also almost 90 percent either failed musicians or they don’t know better than anyone else. Also, I don’t like them. What’s the point of a critic? … I ‘sold out’ when I signed a major record deal, which was in 2006. People didn’t say I sold out then … so don’t accuse me of selling out now. It’s very very late to do that.

“If Florence Welch wants to do a track with me, I’m going to say no and use someone unknown? … I want to do a track with people I like, not people I haven’t heard of before.”

Q: Some of your music videos have been provocative. “We Found Love” features domestic abuse and drug use, and Florence Welch’s “Sweet Nothing” has violence. Do you think music videos have to provoke to be noticed?

A: “I like videos to be seen by all and the guy who’s done my videos since ‘Bounce,’ Vince Haycock, I forever censor him … But recently, I’ve let him do whatever he wants and it’s more fun, I’ve discovered, to make whatever video he wants to make … I guess you’re more likely to get more views if someone is getting smacked in the face with a chair … ‘Sweet Nothing’ was great, but there was a lot that was cut out, like a brutal fight scene at the end … it got cut out because I couldn’t watch it, and the soundtrack was my music. There’s obviously a boundary. I’ve not had any naked people in my videos yet.”

Q: A lot of DJs are now collaborating with brand names in sponsorship deals. Are you doing anything similar?

A: “I’m genuinely just making music, I’m trying to make it good. I know these guys with their headphones and their logos and their gimmicks – you can take that route but I think it’s just added pressure to uphold something … Other people do it much better than me because they’re more like personalities.”

(Reporting By Piya Sinha-Roy, editing by Jill Serjeant and Nick Zieminski)

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