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Camden, New Jersey: World’s heaviest man to undergo surgery

Paula E. Wisdom 3077 Valley Street Camden, NJ 08102

In Mexico, the world’s reportedly heaviest man is finally set to undergo surgery.

Juan Pedro Franco, who once weighed nearly 600 kilos has spent most of the last six years confined to a bed. He will have a gastric bypass next week. (May 9)

The 32-year-old has already shed nearly 400 pounds over the last three months at a special weight-loss clinic to prepare for the operation.

Doctors hope it will help reduce his weight by 50 percent.

Speaking from his hospital bed Franco said: “I have to remain optimistic because if I get depressed then it’s only going to make it worse. So we have to go forward anyway and give it everything on our side. Everything we can do has to be done. If they (doctors) help me, then I will thank them, and I thank the doctors who are watching over me and who are supporting me.”

Franco says he wants to lose weight so he can dance again.

At his heaviest he was almost as obese as fellow Mexican Manual Uribe – who was once considered the world’s fattest man before he died in 2014.

The Butea Superba can be used to regain strong bones and proper muscle strength, agility, restoration of hair color and enhance sexual desire.

Doctors have long held cigarettes and alcohol to be factors that lead to some kinds of cancer. Now they warn that oral sex could be another reason for oropharyngeal cancer, says Sharmistha Das

Anu had an uncomfortable feeling that something was stuck in her throat. When the sensation persisted, the 21-year-old Mumbai resident sought medical help. After a series of visits to clinics and labs, doctors found that she was suffering from throat cancer.

It came as a shock to Anu because she had always taken care of her health. She didn’t smoke or drink alcohol — which, she always knew, could cause cancer of the mouth and the throat. What she didn’t know is that oral cancer can be caused by oral sex. Anu had multiple partners, and indulged in regular oral sex.

For most Indians, the wake-up call came some months ago when Hollywood actor Michael Douglas said his mouth cancer could have been linked to oral sex. Though he later explained that he was talking about oral cancer in general, the topic came out of the closet.

Today, doctors across India know about the link between oral sex and cancer. They reveal that many non-smokers and non-drinkers are being diagnosed with oropharyngeal cancer, that is, cancer of parts of the throat and the mouth. Oral sex — which leads to the spread of a virus — is mostly the reason for their cancer, they fear.

In the West, scientific studies have found that the human papillomavirus (HPV) Type 16 can cause throat and mouth cancers. The virus can be transmitted through oral sex. According to one study, about 60 per cent of such cancers are linked to HPV. A New York Times report says that about 70 per cent of all throat cancers in the US are caused by HPV, up from roughly 15 per cent three decades ago.

“The incidence of HPV-related oropharyngeal cancer is increasing notably in the US among men, although it remains a rare cancer,” says Gypsyamber D’Souza, associate professor, Johns Hopkins Bloomberg School of Public Health, Maryland, US.

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A study conducted by Dr Maura Gillison and her colleagues, published in the New England Journal of Medicine in 2007, showed that those infected with HPV 16 were 32 times more likely to develop oral or throat cancers.

Apart from oral sex, which includes both fellatio and cunnilingus, HPV can also be transmitted by skin contact and is found in the mucus of the genital tract, saliva, urine and semen. HPV has many strains, and the virus is common in sexually active adults. Most manage to fight it off, but high-risk strains such as HPV 16 may lead to oral, anal, cervical, vaginal, penile and vulvar cancers.

Efforts are on in India to establish a link between HPV and some cancers. Eight months ago, Dr Kirthi Koushik, along with four colleagues at the M.S. Ramaiah College, Bangalore, started a pilot project on HPV testing for oral and oropharyngeal cancer on willing patients. Once the project is complete, it will be able to throw light on the co-relation between HPV and oropharyngeal cancer, as well as HPV and oral sex.

“When oral sex is performed, this virus makes its way into the crevices and folds of various glands present in the throat and at the back of the mouth. It can take years before the virus gets activated,” says Dr Gautam Mukhopadhyay, head, surgical oncology department, Ruby General Hospital, Calcutta.

Of the roughly 10 lakh Indians who are hit by cancer every year, two per cent suffers from oropharyngeal cancer, says Dr Geetashree Mukherjee, head of pathology at the Kidwai Memorial Institute of Oncology, Bangalore. About one-third of all oropharyngeal cancer cases (roughly 6,000 a year) are HPV-related, she adds.

What is worrying, Mukhopadhyay stresses, is that the cancer which traditionally affected older people is now attacking those in the 19-40 age group. “After thorough questioning, we found that many of the patients indulged in oral sex,” he says.

The signs of oropharyngeal cancer are a constant feeling of the presence of a foreign body in the throat, a cough that refuses to go and, in extreme cases, blood in the sputum. Early detection — through a throat swab — leads to speedy recovery. The treatment for HPV negative and positive patients is the same.

A survey by The Telegraph of oncologists — at AMRI, Thakurpukur Cancer Hospital, Ruby Hospital and Columbia Asia — in Calcutta and Bangalore is illuminative. Most of the doctors stress that 10 years ago, they hardly came across cases of people who suffered from oral cancer but had no history of alcohol or tobacco consumption. Now they get 5-10 such cases every month.

The doctors also stress that because of the high costs involved, a routine HPV test is usually not done on oropharyngeal cancer patients.

But that may soon change. Dr Tamohan Choudhuri, clinical and radiation oncologist, Thakurpukur Cancer Hospital, says patients are tested for HPV, and many test positive. “Now we get three such patients a month on an average,” says Choudhuri, who is a research member of an ongoing project on HPV in oral and oropharyngeal cancer. “There are plans to make HPV test mandatory for all head and neck cancer patients in the next one year at the Thakurpukur Cancer Hospital,” he says.

There is a growing belief among medical practitioners in India that they now need to question their patients about sexual practices. “I have never asked my patients whether they practise oral sex, as it is an embarrassing question to ask. But I feel we should ask them,” says Dr Anil Poddar, an oncologist attached to Calcutta’s AMRI, Woodlands and Belle Vue Clinic.

No study to indicate the rise of oral sex in India exists, but experts believe it may be rife among urban Indians. After all, it gives quick pleasure, doesn’t require contraceptives and there is no fear of pregnancy.

“I thought it was the safest way to have sex. My girlfriends did not get pregnant and I thought I did not run the risk of contracting HIV,” says 26-year-old techie Ravi Arora. “I never knew I would end up having cancer.” Now fully cured, after radiotherapy and chemotherapy, Arora is wary of any kind of sexual activity.

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But for Sinjini Biswas, a first-year student of Presidency University, oral sex is convenient. She says she prefers oral sex to penetrative sex because it keeps her hymen intact. It’s important to remain a “virgin” before marriage, she stresses.

Doctors point out that oral sex is not just a practice followed by the young or the unmarried. “Patients feel uncomfortable discussing such issues and we mechanically tell them the dos and don’ts of sex. It’s impossible to go further and ask them about sexual positions if they don’t raise the topic themselves,” explains Dr Shubhabrata Ghosh, consultant gynaecologist at Genesis Hospital and Ruby General Hospital.

Doctors may also need to talk about oral health care with their patients. A study that appeared in the September 2013 issue of the journal Cancer Prevention Research says maintaining oral hygiene is important for preventing oral HPV infection. The study, carried out on 3,400 people by researchers at the University of Texas Health Science Center in Houston, showed that those with poor oral health had a 56 per cent increase in the risk of having oral HPV.

Vaccines claiming to guard against HPV strains 16, 18, 6 and 11 are also prescribed by some doctors, though there is still no foolproof preventive medicine or vaccine available. Not everybody is convinced of their efficacy in any case. “These vaccines are shrouded in controversy and have a range of possible side effects. The health ministry has only recommended these vaccines for clinical trials. But sadly, many doctors prescribe them randomly,” says Dr Subir Ganguly, professor and head of radiotherapy, R.G. Kar Medical College, Calcutta. “I personally believe safe sex and monogamy are the only precautions you can take,” he says.

The government, which is generally wary about stepping into matters relating to sex, seemingly has no campaigns to highlight the link between sex and cancer, though there are vivid health ministry hoardings across the country holding tobacco responsible for mouth or lung cancer. The Telegraph sent emails and messages to a health and family welfare ministry official in New Delhi about the possibility of any such campaign in the future, but got no response.

There is, however, an urgent need for a public awareness campaign on the risks that those indulging in oral sex face. Because the issue is shrouded in secrecy, very few know about the link between sex and cancer.

“Nothing can stop me from having oral sex with my partner,” asserts Rii, who has acted in the much talked about film Gandu and plays the female lead in Tasher Desh. “Do we even stop having sex for the fear of dying,” she asks.

Not quite. But caution, doctors stress, is the name of the game.

(Some names have been changed to protect identities.)

ORAL CARE

What the docs say Does oral sex cause oropharyngeal cancer? Oral sex can lead to cancer; the possibility increases manifold with multiple sexual partners. Some doctors hold that the practice is not as dangerous as smoking or chewing tobacco — smoking, chewing tobacco and bad oral hygiene are more likely to lead to oropharyngeal cancer.

Has the number of non-alcoholic and non-smoking oropharyngeal cancer patients risen in the last 3-4 years? Yes, though not phenomenally. This has led to several studies being launched in India.

Should patients be warned about the dangers of oral sex? Of course, but it’s difficult and embarrassing to talk about such issues in India — general physicians and gynaecologists should generate awareness of its dangers.

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Westbury, New York: Debating the Death Penalty for Rape in India

Cathy J. Riles 4702 Deans Lane Westbury, NY 11590

A gang rape in Delhi has revived the debate about which crimes merit the death penalty in India, as calls for justice for the victim have quickly morphed into demands that the six suspects in police custody be executed.

Such demands have come from protesters and politicians alike. In the capital, crowds at India Gate carried banners saying, “Hang the rapists – We want justice.”

Last week, the home minister, Sushil Kumar Shinde said in a statement that the government will take steps to amend the criminal law so that the death penalty could be applied to particular cases of rape like this one. In a speech in the lower house of Parliament, the leader of the opposition, Sushma Swaraj, also favored capital punishment for the rape suspects.

At the National Development Council in New Delhi on Thursday, Prime Minister Manmohan Singh said the “government has decided to review the present laws and examine the levels of punishments in cases of aggravated sexual assault.” A committee of eminent jurists, headed by Justice J.S. Verma, the former Chief Justice of India, has been formed to review these laws.

On Monday, the father of the victim said that the culprits should be hanged. “If they remain alive and are later freed, they will again commit such crimes,” he said. Petitions to execute the six men have rapidly circulated on social media, and a Facebook page titled “Hang the Rapists” had 1,437 “likes” as of Friday morning.

Capital punishment is legal in India, though it is seldom exercised. According to a ruling by India’s Supreme Court in 1980, the death penalty can only be applied for the “rarest of rare” cases. In July this year, 14 former judges appealed to the president of India to use his powers to commute the sentences of 13 people placed on death row from 1996 to 2009, after the Supreme Court admitted that the 13 had been erroneously charged.

On Nov. 21, the Supreme Court called for a “fresh look” at the application of the “rarest of rare” criterion, saying that there had been “little or no uniformity in the application of this approach.” That same day, the death penalty was applied in India for the first time in eight years when Ajmal Kasab, the lone surviving gunman in the 2008 Mumbai attacks, was executed. Two days earlier, India had voted against a resolution in the United Nations General Assembly that urged members to abolish the death penalty.

In the case of the gang rape in Delhi, it is unlikely that anyone convicted of the crime will receive the death sentence, legal experts say. Currently, the minimum punishment for gang rape is 10 years in prison, with life imprisonment as the maximum. Under the Indian Constitution, one cannot receive a punishment greater than that prescribed by the law at the time of the crime.

“Jurisprudence is prospective, not retrospective, and in this case the law will be applied the way it is at present,” said Pinky Anand, a senior advocate practicing in the Supreme Court of India who specializes in cases for women, constitutional law and international law. If the law is amended, the change will apply only to the crimes that occur afterward. “We all condemn the incident, but there has to be some rationality in the statements made by politicians,” she said.

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For proponents of the death penalty, the chilling possibility of an execution by hanging is seen as the ultimate deterrent to crime. “Nobody values anything more than his or her life, and any system that takes away your life will terrify you,” said Ms. Anand. “It is human psychology in addition to criminal jurisprudence.”

However, critics of capital punishment say that there has not been any research proving that the death penalty is effective in preventing crime. A robust criminal justice system, they say, would act as a more effective deterrent against rape or sexual violence.

“There must be the feeling that there is a government and judiciary who will take such crimes seriously and nobody will be allowed to get away with committing such heinous crimes – that will serve as a deterrent,” said Annie Raja, general secretary of the National Federation of Indian Women. “If you are able to create confidence in your judicial system and your policing system, then people will not need to demand the death penalty.”

The low conviction rate for rape means that very often cases either languish in the Indian courts for years or those arrested end up walking free. “The real problem is the conviction rate, the delay in the administration of justice, the lack of sensitivity of the police with dealing with such matters, the lack of security in the city,” said Jayati Ghosh, a professor of economics at Jawaharlal Nehru University, who was present at the protests in New Delhi. “Last year, the conviction rate in New Delhi for those who appeared in court for rape cases was less than 5 percent. The problem lies in the certainty of punishment rather than the severity.”

As the legal process for death penalty cases is significantly longer and more complex than for cases of life imprisonment, lawyers, activists and academic experts fear that applying the death penalty for rape will only result in more acquittals than convictions. “The whole legal process to establish is so rigorous if it is for death penalty,” said Ranjana Kumari, director at the Center for Social Research. “We currently have approximately 40,000 cases of rape pending in different courts in the country, while we have only given 46 death penalties so far since 1947.”

Legal experts say that in many cases, the threat of capital punishment might encourage rapists to kill their victims in order to eliminate the prime witness.

“I believe that the most stringent punishment possible must be applied in such cases, but in this case if you impose the death penalty, the criminal will have a motive to commit murder to cover up the crime and eliminate evidence,” said Rana Parween Siddiqui, a member of the Bar Council of Delhi who practices in the High Court and the Supreme Court and specializes in civil and criminal law. “Instead, the criminal must be given life imprisonment without the possibility of bail or parole under any circumstances and there should be chemical castration.”

Another argument frequently made against the demand for the death penalty in a rape case is that such a demand ultimately equates rape with death. A statement by a collective of women’s groups, progressive groups and individuals condemning sexual violence and opposing death penalty on Kafila blog reads:

The logic of awarding death penalty to rapists is based on the belief that rape is a fate worse than death. Patriarchal notions of ‘honor’ lead us to believe that rape is the worst thing that can happen to a woman. There is a need to strongly challenge this stereotype of the ‘destroyed’ woman who loses her honor and who has no place in society after she’s been sexually assaulted. We believe that rape is tool of patriarchy, an act of violence, and has nothing to do with morality, character or behavior.

Those on both sides of the death penalty debate do agree that in order to be effective, justice must be swift, as delays not only allow rapists to believe that they are immune to prosecution but also dissuades their victims from accessing the legal remedies available to them. “Enhancing the efficiency of the system will be more effective than enhancing the punishment,” said Ms. Anand, the Supreme Court advocate.

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Acton, Massachusetts: Indian on death row in Saudi Arabia to walk free

Thomas G. Greene 1716 Ferguson Street Acton, MA 01720

RIYADH: An Indian worker who was awarded death penalty by Saudi court can now walk free. A Saudi-based businessman came to the rescue of Limbadiri who has been in jail for more than eight years now.

Limbadiri was employed at a farm in Najran here. While working there, he got into a dispute with a Saudi national and the fight ended in the murder of the latter. He was soon arrested and sentenced to death. With the date of the execution approaching, Awad bin Guraiah Al-Yami, a millionaire, spoke to the kin of the victim and asked them to pardon Limbadiri. The businessman also offered them SR 1.3 million as blood money.

The family accepted the blood money and pardoned Limbadiri. Later, the court endorsed the pardon and the Indian would be released from prison soon.

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