MEDICAL MARIJUANA INDUSTRY GROWING IN IL

CHICAGO (WLS) --

Two years ago, medical marijuana became legal in Illinois. No patients have received treatments yet, but people are investing millions of dollars in the industry.

North of Rochelle, a big building looms over the fields of corn. Soon, marijuana will be grown inside. One of 18 state-licensed marijuana cultivation centers, the facility is the second one run by Pharmacannis. In Dwight, the growing process has begun.

Cameras are not allowed inside.

Qualified medical marijuana patients will buy their products from a dispensary in an Ottawa strip mall. That dispensary will likely be one of the first to open since the Compassionate Care Act was signed by Gov. Pat Quinn.

"Everybody likes things that move fast, but this is a brand new industry. There's a number of people, a number of groups that all need to converge to get it up and running, and we're growing into it right now," Teddy Scott, Pharmacannis CEO, said.

Scott is a lawyer with a degree in molecular biophysics who, with his partners, saw this initially as a business opportunity, but have become fully invested in the medical need. They're also heavily invested financially to the tune of roughly $10 million. It's a gamble, especially when the number of patients signed up thus far is but a fraction of what was expected.

"It is, this is a long term play," Jim Champion, Medical Marijuana Advisory Board, said. "There are a lot of moving parts. A lot of regulation. We want to do it right."

Champion is a vet who was diagnosed with MS 27 years ago. He was the first to sign up for the program, and sits on its advisory board. He and his wife see it as a Godsend, but they and others who rallied Thursday want the governor to sign an extension to the four year pilot program. Without added time, their concern is that the licensed sellers may not regain their investments.

"They could raise the prices on the patients, and patients are going to wind up back on the streets, and there goes the program," Sandy Champion said.

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Mindfulness meditation may help smokers quit - even those with no willpower

The review of addiction research, published in the journal Trends in Cognitive Sciences, says a smoker's intention to quit smoking is not always needed to reduce cigarette cravings.

A will to stop, however, is often seen as a requirement for enrolling into smoking cessation treatment programs.

"Early evidence suggests that exercises aimed at increasing self-control, such as mindfulness meditation, can decrease the unconscious influences that motivate a person to smoke," say the experts, including senior study author Dr. Nora Volkow, director of the US National Institute on Drug Abuse.

Recent brain scanning studies have shown that smokers have less activity in areas associated with self-control. Could targeting these neurobiological circuits be a way to treat addiction?

"We are interested in trying to probe how repeated use of drugs ultimately influences our ability to control our desires," says Dr. Volkow.

"We are starting to work through how drugs affect areas of the brain that normally enable us to self-regulate," she adds, "to create goals and to be able to achieve them, and how those changes influence the behavior of the person addicted."

Subconscious smoking reduction

In one study cited by the review, an "integrative body-mind training program that included relaxation training techniques" was examined to see how improving self-control could help smokers with their cravings.

Texas Tech University and University of Oregon researchers recruited 60 undergraduate students (27 cigarette smokers and 33 non-smokers) to the training program.

Each of the students came into the program expecting to learn meditation and relaxation techniques for stress reduction and cognitive improvement.

Half of them received mindfulness meditation training (becoming self-aware of one's experience) and half received a relaxation technique.

Over 2 weeks, the participants had a total of 5 hours of 30-minute sessions. Before and at the end, their brains were scanned and self-report questionnaires were completed. Each student also had their smoking objectively measured with carbon monoxide testing.

Even though many of the students said they had smoked the same number of cigarettes before and after the training, for those who had received mindfulness meditation, an objective measure of carbon dioxide percentage in their lungs showed a 60% reduction in smoking in the 2 weeks after the study.

Lead study author Yi-Yuan Tang, a professor of psychological sciences at Texas Tech in Lubbock, explains:

"The students changed their smoking behavior but were not aware of it. When we showed the data to a participant who said they had smoked 20 cigarettes, this person checked their pocket immediately and was shocked to find 10 left."

"We then measured intention to see if it correlated with smoking changes and found there was no correlation," adds Prof. Tang. "But if you improve the self-control network in the brain and moderate stress-reactivity, then it's possible to reduce smoking."

Other studies reviewed by the authors showed how integrative body-mind training such as mindfulness meditation could reduce the levels of the stress hormone cortisol, as well as increase immune reactivity. Specific changes in the brain have also been identified, showing stronger connectivity between regions linked to self-control.

Not all questions are answered, however, and more research is needed.

"Mindfulness meditation, as well as other strategies that are aimed at strengthening self-control, are likely to be useful for the management of addiction, but not necessarily for everybody," Dr. Volkow says, adding:

"However, understanding how our brain works when we do interventions that strengthen self-control can also have multiple implications that relate to behaviors that are necessary for health and wellbeing."

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How do we dream? What are nightmares?

Dreams are stories and images that our minds create while we sleep. They can be entertaining, fun, romantic, disturbing, frightening and sometimes bizarre. This article specifically focuses on how we dream, what nightmares are, lucid dreams and why some dreams are difficult to remember where others are more memorable. It follows on from a previous article: Dreams: why do we dream?

How do we dream?

Until REM sleep is completed, the body is essentially paralyzed. This paralysis is caused by the release of glycine - an amino acid - from the brain stem onto the motor neurons (neurons that conduct impulses outward from the brain or spinal cord). REM sleep is the sleep stage at which most dreaming occurs and this paralysis could be nature's way of making sure we do not act out our dreams.

Each complete sleep cycle takes about 90-110 minutes. The first REM sleep period usually occurs around 70 to 90 minutes after we fall asleep. The first sleep cycles each night contain relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages 1, 2, and REM.¹⁰⁷

The relationship between dreaming and strictly REM sleep has been one of controversy amongst researchers with varying hypotheses. Does REM-sleep physiology explain the dream experience, or is REM sleep neither a necessary nor a sufficient condition for dreaming to occur?¹⁴

One study hypothesized that different physiological processes underlie dreaming during REM and non-REM (NREM) sleep. Researchers concluded that although "dreaming" may occur during both REM and NREM periods, as previous researchers have suggested, the dreams obtained from these periods differ significantly in both quality and quantity and are likely to be produced by different processes.⁸

Visual imagery, in a separate study, was reported more often after awakenings from REM compared with stage 2 sleep. These results are consistent with previous researchers who have described REM sleep as a state of high visual hallucinatory quantity, and quality compared with NREM sleep. 83% of REM awakenings compared with only 34% stage 2 awakenings resulted in imagery reports.¹¹

A study proposed that the hormone cortisol plays an important role in controlling the state of memory systems during sleep. High levels of cortisol, as are observed late at night and in the context of REM sleep, disrupt normal hippocampal to neocortical communication, which interferes with the form of memory consolidation that is dependent upon this communication. At the same time, the content of dreams is also affected.⁸³

In slow-wave sleep, dream content reflects the normal interaction between hippocampal and neocortical circuits, allowing typical episodic memories to emerge. Normal episodic memories are only retrieved during slow-wave sleep when hippocampal to neocortical communication is functional.

In REM sleep, however, dream content reflects only neocortical activation, which we assume accounts for the fragmented, often bizarre, nature of these dreams.

Recent developments on how we dream from MNT news

Computer can "see" our dreams

fMRI scans can reveal the visual images we have in our brains while we are dreaming, researchers from Japan reported in the journal Science. Put simply, they have found a way of seeing our dreams.

What are bad dreams and nightmares?

A nightmare is a distressing dream that usually forces at least partial awakening. The dreamer may feel any number of disturbing emotions in a nightmare, such as anger, guilt, sadness or depression, but the most common feelings are fear andanxiety.

Bad dreams, or nightmares are common in both adults and children. They can be caused by:

• Stress
• Fear
• Trauma
• Emotional issues
• Medication or drug use
• Illness.

How do you decide if a dream is considered to be a "bad dream" or a "nightmare"? The content of 9,796 dream reports was collected, which exposed:^32,75

• 253 nightmares - frequently contained physical aggression, situations that were more bizarre and more emotionally intense, containing more failures and unfortunate endings. 35% of nightmares contained primary emotions other than fear.
• 431 bad dreams - frequently contained interpersonal conflicts. 55% of bad dreams contained primary emotions other than fear.

In a study of 840 German athletes from various sports, discussing distressing dreams on the nights before an important competition or game:⁴⁶

• About 15% of the athletes stated that they experienced at least one distressing dream before an important competition or game during the preceding 12 months
• An almost equal number of athletes reported at least one distressing dream in their sports career
• In about 3% of the events, a distressing dream occurred
• Reported dream content referred mainly to athletic failure.

A survey examining the dreams, nightmares, and sleep patterns of 30 women who were dealing with relationship violence found:⁶⁹

• 50% of the sample experienced nightmares on a weekly basis
• Some of the dream images included drowning, being chased, being killed or killing others
• 56% experienced a recurring dream
• Most women had trouble falling asleep and, on average, slept for 6.1 hours per night.

The threat simulation theory of dreaming (TST) states that dream consciousness is essentially an ancient biological defense mechanism, evolutionarily selected for its capacity to repeatedly simulate threatening events.

Children who live in an environment in which their physical and psychological well-being is constantly threatened should then have a highly activated dream production and threat simulation system, whereas children living in a safe environment that is relatively free of such threat cues should have a weakly activated system.

Results of a study with dream reports from severely traumatized and less traumatized Kurdish children and ordinary, non-traumatized Finnish children showed that severely traumatized children reported a significantly greater number of dreams, with their dreams including a higher number of threatening dream events. The dream threats of traumatized children were also more severe in nature than the threats of less traumatized or non-traumatized children.⁸⁰

A study of 190 normal school children aged 4 to 12 years reported the following forms of anxiety symptoms:

• Fears - 75.8%
• Worries - 67.4%
• Scary dreams - 80.5%.

Fears of scary dreams were common among children aged 4-6 years old, becoming even more prominent in 7- to 9-year-olds and then decreasing in frequency for 10- to 12-year-olds.

Types of fears, worries, and dreams were found to change across age groups, with fears and scary dreams relating to imaginary creatures decreasing with age. In contrast, worries about test performance increased with age.⁹⁵

Findings from dream reports of 610 boys and girls recalling disturbing and normal dreams at both 13 and 16 years of age highlights how a prevalence of disturbing dreams is especially marked for adolescent girls. Frequent recall of disturbing dreams is associated with pathological symptoms of trait anxiety, even in girls as young as 13 years of age.⁹³

Conditions

Certain conditions appear to increase the frequency of nightmares in individuals such as:

• Migraine: recurrent dreams featuring complex visual imagery, often terrifying nightmares, can occur as migraine aura symptoms.⁹⁴ The brain of migraineurs seems to dream with some peculiar features, all with a negative connotation, as fear and anguish.¹⁸
• Sleep apnea: patients with sleep apnea have more emotionally negative dreams than sleepy snorers.⁵⁰
• Depression: frequent nightmares are associated with suicidal tendency in patients with major depression.⁹⁸

What are night terrors/sleep terrors?

Night terrors are very different from nightmares. The behavior of a child experiencing night terrors may feature:

• Screaming
• Shouting
• Thrashing around
• Panic
• Jumping out of bed
• Inability to recognize parents trying to comfort them.

Night terrors occur on waking abruptly from deep NREM sleep, whereas nightmares are thought to occur during REM sleep.

It is estimated that approximately 1-6% of children in the US experience sleep terror at some point in their childhood. It is common in children aged between 3-12 years. Children are not fully awake in these episodes, even if their eyes are open, and usually have no memory of the event the next day.

The episodes usually occur in the early part of the night and can continue for several minutes (up to 15 minutes).

Night terrors are more common in children with a family history of night terrors or sleepwalking behavior.

A night terror attack may be triggered by anything that:

• Increases how much deep sleep the child has, such as tiredness, fever or certain types of medication.
• Makes the child more likely to wake from deep sleep, such as excitement, anxiety or sudden noise.

Most children will eventually grow out of night terrors.

Studies of twin cohorts and families with sleep terror and sleepwalking suggest genetic involvement of parasomnias (a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep).

Restless leg syndrome and sleep-disordered breathing have been shown to have familial recurrence. Restless leg syndrome has been shown to have genetic involvement.¹¹⁷

Night terrors have also been linked to enlarged tonsils and adenoids.

What are recurring dreams?

A recurring dream is a type of dream that occurs on a regular basis when we sleep.

A study of 212 recurrent dreams that were scored using a slightly expanded version of the Dream Threat rating scale showed:⁷⁴

• 66% of the recurrent dream reports contained one or more threats. The threats tended to be dangerous and aimed at the dreamer. When facing a threat, the dreamer tended to take defensive or evasive actions that were possible and reasonable.
• Less than 15% of the recurrent dreams depicted realistic and probable situations that were critical for physical survival or reproductive success. During these dreams, the dreamer rarely succeeded in fleeing the threat despite important and appropriate efforts.

These findings provide mixed support for the threat simulation theory.⁷⁴

Research indicates that recurrent dreams in adults are associated with poor psychological well-being. Authors of a study hypothesized that children reporting recurrent dreams would also show poorer psychosocial adjustment than children without recurrent dreams.

In an examination of dream reports and measures of psychosocial adjustment in 168 children aged 11:⁶¹

• 35% of children reported having experienced a recurrent dream during the past year.
• Boys reporting recurrent dreams reported significantly higher scores for reactive aggression than those who did not.

[Original Article]

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What happens to the body when you drink Coca-Cola?

According to the Centers for Disease Control and Prevention (CDC), around half of the US population drink sugary beverages on any given day, with consumption of these drinks highest among teenagers and young adults.

There are approximately 10 teaspoons of added sugar in a single can of cola. The World Health Organization (WHO) recommend consuming no more than 6 teaspoons of added sugar daily, meaning drinking just one serving of cola a day could take us well above these guidelines.

As such, it is no surprise that sugary drink consumption is associated with an array of health conditions. According to the Harvard School of Public Health, people who drink 1-2 cans of sugary beverages daily are 26% more likely to develop type 2diabetes, and last month, Medical News Today reported on a study claiming 184,000 global deaths each year are down to sugary drink consumption.

Now, an infographic created by British pharmacist Niraj Naik - based on research by health writer Wade Meredith - shows the damage a 330 ml can of Coca-Cola can do to the body within 1 hour of consumption.

Coca-Cola 'comparable to heroin' in how it stimulates the brain's reward and pleasure centers

According to Naik, the intense sweetness of Coca-Cola as a result of its high sugar content should make us vomit as soon as it enters the body. However, the phosphoric acid in the beverage dulls the sweetness, enabling us to keep the drink down.

Blood sugar levels increase dramatically within 20 minutes of drinking the Cola, explains Naik, causing a burst of insulin. The liver then turns the high amounts of sugar circulating our body into fat.

Within 40 minutes, the body has absorbed all of the caffeine from the Cola, causing a dilation of pupils and an increase in blood pressure. By this point, the adenosine receptors in the brain have been blocked, preventing fatigue.

Five minutes later, production of dopamine has increased - a neurotransmitter that helps control the pleasure and reward centers of the brain. According to the infographic, the way Coca-Cola stimulates these centers is comparable to the effects of heroin, making us want another can.

An hour after drinking the beverage, a sugar crash will begin, causing irritability and drowsiness. In addition, the water from the Cola will have been cleared from the body via urination, along with nutrients that are important for our health.

According to Naik, the infographic is not only applicable to Coca-Cola, but to all caffeinated fizzy drinks.

"Coke is not just high in high fructose corn syrup, but it is also packed with refined salts and caffeine," writes Naik on his blog The Renegade Pharmacist. "Regular consumption of these ingredients in the high quantities you find in Coke and other processed foods and drinks, can lead to higher blood pressure, heart disease, diabetes and obesity."

"However a small amount now and then won't do any major harm," he adds. "The key is moderation."

In a press statement, a spokesperson for Coca-Cola says the beverage is "perfectly safe to drink and can be enjoyed as part of a balanced diet and lifestyle."

Our Knowledge Center article - "How much sugar is in your food?" - looks at the sugar content of some of the most popular foods and drinks.

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Potential target for future Huntington's disease treatment discovered

The findings of the study, conducted by scientists from Cardiff University in the UK, are published in the journal Cell.

"Our findings may not be able to help those already affected byHuntington's disease, but this could prove to be a turning point in how we treat the disease in future generations," states study author Lesley Jones, a professor of neurogenetics at the Institute of Psychological Medicine and Clinical Neurosciences.

Huntington's disease is an inherited degenerative brain disorder that affects movement and cognitive function and can also lead to changes in behavior and personality.

People with the condition inherit a single defective gene. The gene in question, HTT, has a mutation involving a DNA segment known as CAG, comprised of the compounds cytosine, adenine and guanine appearing multiple times in a row.

In most people, the CAG segment is repeated around 10-35 times, but in people carrying the defective HTT gene, the segment is repeated over 36 times. While people with 36-39 CAG repeats may or may not develop Huntington's disease, people who have 40 or more CAG segment repeats in the HTT gene almost always develop the condition.

"We have known for over 20 years that the number of times a certain sequence of DNA repeats itself plays a part in the age at which the symptoms of Huntington's disease develop," states Prof. Jones. "This research goes a step further, and tells us that the way that repeated sequences of DNA are handled by brain cells is likely to be critical in Huntington's disease."

The role of DNA repair in Huntington's disease

For the study, Prof. Jones and colleagues set out to compare the age of onset and the DNA of more than 6,000 patients with Huntington's disease. In doing so, they discovered that the mechanism controlling the manufacture and repair of DNA could influence the age at which individuals begin to develop the condition.

Whenever DNA in any cell is repaired, it must be cut so that the incorrect sequence can be removed. The researchers know that the proteins involved with DNA repair lead to CAG segments getting longer in HTT.

Prof. Jones told Medical News Today the team thinks that "DNA repair probably has a role in Huntington's disease through increasing the likelihood of the DNA near the CAG repeat being cut and needing to be repaired. She then explained why the DNA repair mechanism might influence the age of Huntington's disease onset:

"When it is repaired the molecular machinery finds it hard to know the correct repeat length and the CAG repeat gets longer. A longer repeat makes cells more likely to die - so the more this happens, the earlier someone is likely to get the disease."

The researchers believe their findings could lead to further discoveries relating to the development of other diseases inherited through the passing of a single gene, as well as potential ways to treat the currently untreatable Huntington's disease.

"In understanding the mechanisms by which nature influences the age of onset of this devastating condition, we have identified a target for potential treatments," Prof. Jones concludes. "If we can develop a way to interfere with these processes, then we could possibly delay or even prevent the onset of the disease."

Last month, MNT reported on a study that confirmed an activating protein called Rhes plays a pivotal role in Huntington's disease. This protein could become a drug target in future treatments.

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Medical marijuana in Minnesota, how it affects Iowa

DES MOINES, Iowa —Iowa has one of the most restrictive laws in the country concerning medical marijuana.

Without any manufacturing or distribution of medical cannabis in the state, very few, if any, patients have taken advantage of the law.

That is not the case in neighboring Minnesota.

Gov. Mark Dayton, a Democrat, signed Minnesota's Medical Cannabis Therapeutic Use Act last year.

One veteran Minnesota House member says there was a specific amendment added that made the idea of a medical marijuana program palatable to legislators.

This month, the third medical marijuana dispensary in Minnesota opened its doors inside a nondescript storefront in a Rochester strip mall.

Minnesota Medical Solutions is one of two companies in the state growing and distributing medical cannabis.

The company grows its marijuana plants at a giant greenhouse in a small city northwest of Minneapolis.

"I would challenge you to find someone in Iowa who, once they see our system here, see how we run things, would oppose that," said Dr. Kyle Kingsley, the company's chief executive officer.

"Our goal is to build a model accepted by mainstream medicine. That's how most patients are going to get access."

Kingsley says the medical marijuana is distributed to dispensaries in pill, liquid and oil form.

Kim Falk's story

Kim Falk says her son Daniel had up to 24 seizures a day.

The Wisconsin family moved to Colorado where he first started a cannabis oil regiment.

Initially, Daniel got worse, but his mother says the seizures started to disappear.

"They stopped eventually, and his cognition has just gotten better and better," she said.

When Minnesota's new medical marijuana law started this month, the Falk family moved to Minnesota because patients must be residents of the state. Then they found a neurologist to certify Daniel's epilepsy.

"We filled out our paperwork. It took half an hour at the most, and paid our fee, so it was really quite simple," the mother said.

Kim was the first customer at the Rochester dispensary.

She tells KCCI that Daniel's month-long supply costs $200. It's not covered by insurance, but she says it's a small price for access to a product she claims has helped her son where many medications have failed.

Falk says the cannabis oil has the CBD compound, which is believed to relieve pain, nausea and convulsions.

It does not contain the best-known marijuana plant compound, THC, which delivers a "marijuana high."

House action

Rep. Kim Norton, D-Rochester, now in her fifth term in the Minnesota House, was originally against the medical cannabis bill.

"When it started being sold as medical marijuana, that's when it started being taken more seriously," she said.

However, two years ago mothers of epileptic children began swarming the Minnesota Capitol.

"They were organized, particularly the young mothers who were there with their children, and that was very moving," Norton said.

She says another big step was an amendment she helped add to the bill. It created a way to record the effectiveness of medical marijuana as it was being used.

"I wanted data that showed this actually worked. We were hearing anecdotal stories, but there was no data," she said.

In Minnesota, each time patients go to a dispensary to pick up their medical cannabis, they must fill out a questionnaire that will help researchers gauge how the patient is responding to their treatment.

"While it's not a peer-reviewed scientific study, it was the closest we could get, as a state, to really monitor it," Norton said. "When that amendment went on, to me it said, 'We're going to treat this seriously, we are going to treat it like a pharmaceutical and we are going to look for results.'"

Implications for Iowa

In Iowa, some of the most vocal opponents at the Capitol have repeatedly said they are waiting for results from a University of Iowa study into the effectiveness of cannabis oil on pediatric epilepsy.

"No more 'I heard this. It was on the Internet, etc, etc.' I want to see results, and then we can move very, very cautiously on something like this," said state Rep. Clel Baudler, R-Greenfield.

A University of Iowa spokesman tells KCCI the clinical trial has just started, after the head researcher received approval from the federal government. The study involves 80 participants from across the country.

One group of young patients will be treated with medical cannabis. The other will receive a placebo.

The trial will last 24 weeks.

It's a different approach to testing the effectiveness of medical marijuana than the one underway in Minnesota, which is based solely on 'user feedback.

"We didn't want them to have to wait, and in fact, many people felt it would be immoral to have a test where you have a cohort that's not getting any treatment," Norton said. "They didn't want that kind of research being done."

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Special Report: Indian doctor’s legal troubles bedevil World Medical Association

LUCKNOW, India (Reuters) - The former president of the Medical Council of India, which regulates the country’s medical colleges, stood before a judge last week in a dingy courthouse in this northern city.

For several years, Dr. Ketan Desai has been facing allegations that he conspired in 2009 to have the Medical Council recommend that a private medical college be allowed to add more students. The Lucknow case, which is scheduled to resume Aug. 20, isn’t Desai’s only legal problem.

He also faces charges in a separate criminal case in New Delhi. Prosecutors there allege he was involved in a conspiracy in 2010 to obtain a 20 million rupee bribe – about $450,000 at the time – in return for having the Medical Council recommend allowing another school to expand its student body.

Desai, who denies the allegations in both legal cases, no longer heads the Medical Council of India.

But next year, the 58-year-old urologist is scheduled to be inaugurated as president of a much more prestigious organization: the World Medical Association, or WMA, which sets ethical standards for physicians worldwide and represents millions of doctors in more than 100 countries. Known for its pioneering work in ethics, its members include the American Medical Association and the British Medical Association.

Some past and present officials of the France-based WMA express chagrin over Desai’s legal troubles, but the organization continues to back him, as do the American and Indian medical associations.

“It’s terrible in general that this hangs like a great pall over everything,” said Sir Michael Marmot, a British doctor who is slated this fall to become the WMA’s president, to be followed by Desai in 2016. “We need clarity. It’s just not good for anybody.”

"A HANDY SCAPEGOAT"

In a written response to questions from Reuters, Desai denied any wrongdoing. “I am and have been innocent,” he said, adding that “in not a single case any allegation against me has been proved.” Desai said he is a “handy scapegoat” and a victim of retaliation for his attempts to crack down on fraud at private medical schools during his time as Medical Council president.

“As such,” he wrote in the letter, “I have always remained under a continuous malignant and malicious campaign … of absolutely false and concocted allegations.”

How did a doctor facing criminal allegations manage to be selected as the WMA’s future president? And why have the world’s leading national medical associations stood behind him?

In part, Desai has held on because he enjoys the support of stout allies – distinguished physicians, a New Delhi businessman who boasts that he has partied with pop star Rihanna, and a top WMA official who compared him to a World War II resistance fighter against the Nazis.

A Reuters examination shows that the WMA’s due diligence into the criminal allegations relied heavily on information supplied by Desai and the Indian Medical Association – which Desai once headed.

The Indian association repeatedly asserted to the WMA – inaccurately – that all charges against Desai had been withdrawn. Representatives of major doctors organizations, including the U.S. and British medical associations, accepted the information as fact.

On Thursday, shortly after this article was published, the WMA said it will examine “a number of questions” raised by the Reuters investigation of Desai.

"We take this article very seriously,” the WMA said in a statement. “It raises a number of questions we have to discuss with the Indian Medical Association and that is what we shall now do.”

"A COMPROMISED LEADER"

Dr. Ardis Hoven, a former president of the American Medical Association and now chair of the WMA’s Council, which recommends policies, confirmed that the AMA did not oppose inaugurating Desai as president. “The AMA delegation has not had an opportunity or a reason to discuss this issue recently,” she told Reuters in an email. “The facts as we know them still stand absent any other information.”

One prominent ethicist says Desai’s election threatens the credibility of the world body. Arthur Caplan, director of the Division of Medical Ethics at New York University Langone Medical Center, urged the WMA to look for another leader.

“The whole force of the WMA is its moral authority,” Caplan said. “You can’t have a compromised leader, you just can’t.... If you push against torture, if you try to defend doctors in jeopardy from totalitarian regimes, if you try to speak up about getting more care for the poor, people will just point toward your president and say: ‘Why should we care? You have a leader who is morally suspect. You’re not in a position to lecture us about anything.’”

Some allies – including a leader of the Indian Medical Association – say Desai is perfect for the job. “He has a vast knowledge, experience and leadership qualities to become the WMA president,” said K.K. Aggarwal, the Indian association’s honorary secretary general.

Desai’s scheduled inauguration provides another example of how problems in India’s medical regulatory system have spread far beyond the country’s borders.

Last month, Reuters documented how the system for training doctors in India – the world’s largest exporter of physicians - is plagued by fraud and unprofessional teaching practices.

“THE HIGHEST POSSIBLE STANDARDS”

Regulators and prosecutors have accused more than one out of six of the country’s 398 medical schools of cheating. Indian recruiting companies routinely provide schools with doctors to pose as full-time faculty members to pass government inspections. To demonstrate that teaching hospitals have enough patients to provide students with clinical experience, colleges round up healthy people to pretend they are sick.

The WMA works with the World Health Organization and other international bodies on public health issues. It was founded in 1947 as a response to the revelations of ghastly medical experiments, torture and euthanasia practiced in Nazi Germany. “The organization was created to ensure the independence of physicians, and to work for the highest possible standards of ethical behavior and care by physicians, at all times,” the WMA states on its website.

Today, the WMA is best known for creating a global framework for medical ethics. It crafted a modern version of the Hippocratic Oath that is used by many medical schools. Its signature achievement was the Declaration of Helsinki, a statement of ethical principles for medical research involving human subjects.

In India, the body charged with maintaining “excellence in medical education” is the Medical Council, which was established by parliament in 1934. Under India’s regulatory system for medical colleges, the council makes recommendations to the health ministry, which has the final say.

Desai has been one of the Medical Council’s most powerful figures in recent decades, twice serving as president. Former colleagues describe him as a politically connected and determined manager with an encyclopedic knowledge of every Indian medical college. But he also has had repeated brushes with law enforcement.

PAST ALLEGATIONS

In 2001, the Delhi High Court ordered him removed from office at the Medical Council and prosecuted on allegations brought by another doctor. The court ruled that he abused his position as the chief regulator of medical colleges and received unexplained large monetary gifts.

“If those who are entrusted with the task of ensuring proper medical education and medical services in the country are to act in such dishonest manner, it is complete betrayal of the trust reposed,” stated a court judgment. At the time, Desai also was president of the Indian Medical Association, the equivalent of the AMA, which represents tens of thousands of doctors.

A subsequent probe by the Central Bureau of Investigation found no evidence of wrongdoing by Desai. The case eventually closed.

Desai first ran for WMA president in 2007. He lost. He ran again two years later, at a WMA meeting in New Delhi, this time unopposed. By then, cleared of the 2001 corruption allegations, he had been re-elected president of the Medical Council by its members.

Desai was to be inaugurated by the WMA in the fall of 2010 at its meeting in Vancouver, Canada. But in April that year, he was arrested and jailed.

He and several other defendants were accused by the Central Bureau of Investigation of conspiring in early 2010 to extract a 20 million rupee bribe from officials at Gian Sagar Medical College in the northern state of Punjab.

In exchange, India’s Central Bureau of Investigation alleged, Desai helped the college get a recommendation from the Medical Council to allow the school to accept a new class of 100 students, for a total of about 400 overall, even though it lacked such basics as an auditorium.

PARTYING WITH RIHANNA

Court records show the case was based in part on intercepted telephone conversations between Desai and J.P. Singh, a New Delhi businessman. Investigators allege the two men discussed the college and the bribe using coded language. For example, the CBI alleges the men used the surname of a local politician as code for the college. A transcript of the phone calls is included in a New Delhi district court order.

Those and other intercepted conversations between the various defendants led investigators to raid Singh’s home and seize about 20 million rupees in cash.

In his response to Reuters, Desai said he “never discussed Gian Sagar Medical College issue in coded telephone conversations with him in early 2010.”

In an interview, Singh described Desai as “a very dear acquaintance” but denied the bribery allegations against them. He said the seized cash was an advance payment to him for a land deal from a businessman he did not name. “There was no money dealing with Dr. Ketan Desai,” he said.

Singh said a college official had visited his home the morning of the raid and given him a gift of two bottles of whiskey that cost nearly $400 each. The liquor was confiscated, too.

“I am fond of good things,” Singh said in the interview. He later pointed Reuters to a fashion website. The site includes pictures of Singh at a New York event with Rihanna, along with an article that describes Singh as “Delhi’s very own fashion wolf.”

A spokeswoman for Rihanna did not respond to a request for comment. The school in the case, Gian Sagar Medical College, is not a defendant. It declined to comment.

“THE EVIDENCE IS WEAK”

Then, in May 2010, India’s national crime-fighting agency brought a separate case against Desai in Lucknow. The Central Bureau of Investigation alleged he had entered into a criminal conspiracy in 2009 to help another private medical school get a favorable ruling from the Medical Council: Shri Ram Murti Smarak Institute of Medical Sciences, in the state of Uttar Pradesh.

In that case, Desai was accused of conspiring with institute officials to obtain a recommendation from the Medical Council that the school be allowed to expand, despite a shortage of faculty and other deficiencies.

The school ultimately received health ministry approval. Investigators allege that in order to pass inspections, the college paid doctors to pose as full-time faculty and falsified registries to inflate its number of hospital patients.

Dev Murti, the college’s chairman and one of the defendants, denied the allegations. “The evidence is very weak,” he said.

Dr. Suresh C. Shah, a Medical Council inspector, told investigators that Desai had instructed him to be strict during two initial inspections of the college, but later directed him to overlook shortcomings during a third inspection. Shah was accused in the case of conspiracy and corruption. He declined to comment.

A summary of Shah’s testimony is contained in the case’s charge sheet. He is the same inspector who Desai allegedly conspired with in the Gian Sagar Medical College case. Desai called Shah’s allegations about him “false and totally baseless.”

COMPARED TO A TEENAGE HERO

With the two cases hanging over his head in 2010, Desai never made it to the WMA meeting for his inauguration. He had been released from jail on bail by then. But days before the meeting, the Medical Council suspended his medical license “in view of the grave and serious allegations against you,” according to a letter the council sent Desai. The council barred him from representing doctors at any conference.

By then, the central government, in response to Desai’s arrest, was trying to remake the regulatory system. The government had disbanded the Medical Council’s elected board and installed a new board of governors. The plan was to win parliamentary approval to replace the Medical Council with a new regulatory body, according to health ministry officials.

Desai still had influential backers. Ahead of the WMA meeting, Dr. Otmar Kloiber, the WMA’s secretary general, weighed in. He described Desai in an article in the organization’s journal as a “charismatic and powerful leader” who for years had fought attempts by the Indian government to take away the Medical Council’s independence.

Kloiber, who is German, compared Desai to the late André Wynen – a Belgian who as a teenager joined the resistance to the Nazi occupation and ended up in a concentration camp. Wynen survived and later went on to become a surgeon and the WMA’s secretary general.

Asked in an interview with Reuters why he had compared Desai to a concentration camp prisoner, Kloiber responded: “Have you seen any evidence that he has been bribed? Have you seen that?”

WMA officials said in interviews that back in 2010, their organization had no rules defining what to do if a president-elect or other senior official was arrested. The association did, however, have guidelines on how to deal with an ill leader.

A CONVENIENT RULING

So, according to a report in its organ, the World Medical Journal, the WMA decided Desai should “be considered ‘disabled’ and unable to carry out his duties,” and it voted to suspend his inauguration indefinitely.

In 2013, Desai’s luck turned. The central government failed to win parliamentary support for replacing the Medical Council. So, in 2013, the government ordered elections for the council’s board. In one of its first acts, the new board reinstated Desai’s medical license, according to council officials at the time.

That same year, Desai got a hand from another ally: the Indian Medical Association, where he had served as president from 2001 to 2002. The doctors’ lobby asked the WMA to lift the suspension, claiming that the charges against him had been withdrawn.

Dr. Mukesh Haikerwal, an Indian-born Australian physician, was chair of the WMA’s Council at the time. He told Reuters he met with Desai and other members of the Indian Medical Association in New Delhi after learning of the effort to make him president. Based on information given by the association, he said, he came away believing Desai had been cleared.

“The question was, ‘Are there any other pending charges that we should be worried about?’” Haikerwal said. “And the answer was that all the charges had been dropped.”

In his letter to Reuters, Desai said Haikerwal had been provided with all of the court orders pertaining to his cases. He didn’t address whether Haikerwal had been told that the charges had been dropped.

CASES REMAIN ACTIVE

According to the World Medical Journal, Haikerwal provided an update on Desai in October 2013 at the WMA annual meeting, telling members that the charges against him had been withdrawn. “Dr. Haikerwal said Dr. Desai had been badly maligned by the Indian court system,” the journal reported. Haikerwal confirms making those remarks.

Afterward, the assembly voted overwhelmingly to lift the suspension and to decide at a later date when Desai should take office as president.

But a review by Reuters of Indian court records and interviews with people involved in the two cases show that to this day, criminal allegations are still pending against him in both New Delhi and Lucknow.

In New Delhi, the district court charged Desai with corruption and criminal conspiracy over the Gian Sagar Medical College matter. The charges are listed in a court order [PDF] dated June 1, 2012. The case proceedings were stayed - put on hold - by the Supreme Court in 2013 pending the outcome of an appeal by another defendant. But Desai still faces the charges, according to people familiar with the case investigation.

In fact, Desai appeared at a hearing in the case in New Delhi in March. Another is scheduled for August.

“The charges have not been dropped. A stay does not mean that he has been exonerated from the charges,” said a Central Bureau of Investigation official who is close to the probe.

Desai also still faces criminal allegations in Lucknow in the Shri Ram Murti Smarak Institute case. In response to an appeal by Desai, the High Court in Lucknow set aside corruption allegations in February, ruling there was no evidence he had received anything of value. But the court did not dismiss allegations of criminal conspiracy and cheating.

WMA officials said they relied almost entirely on the Indian doctors’ lobby for their inquiries into Desai’s legal situation.

“We’ve gotten all of our information from the Indian Medical Association,” said Kloiber, the secretary general. He said the Indian association told him the Lucknow case “has been closed,” and he didn’t know about the outstanding conspiracy allegations in the case.

THE WMA IN LIMBO

Indian Medical Association officials say they never misled the WMA about Desai. They insist that his legal problems are over.

“We are very clear about it that there are no corruption charges against him as of now,” said Aggarwal, the Indian Medical Association’s honorary secretary general.

Aggarwal cited, among other things, the recent High Court decision to dismiss the corruption allegations in Lucknow. And he said that the conspiracy allegation won’t stand. “If there is not corruption, how can there be a conspiracy? That is my interpretation,” he said.

The Central Bureau of Investigation official said Aggarwal is wrong. Desai still could be prosecuted in both the Lucknow and New Delhi cases.

Desai is scheduled to take over the WMA presidency in a little more than a year. That leaves the association’s succession plan at the mercy of India’s courts - where cases typically drag on for years.

[Original Article]

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