Fatal Bomb in Morocco Shows Signs of Al Qaeda

The bomb appeared to have all the hallmarks of Al Qaeda in the Islamic Maghreb, Interior Minister Taieb Cherkaoui said, briefing the government in Rabat. “The manner reminds us of the style used generally by Al Qaeda,” he said. “And this leads us to think that there is a possibility of more dangers to come.”

But there was no claim of responsibility on Friday by Al Qaeda or any other group.

“This was not a suicide attack,” Mr. Cherkaoui said, adding that “it appears the bomb was set off remotely,” in remarks carried by the official news agency, MAP. He said the bomb contained ammonium nitrate. A Moroccan security official, asking for anonymity, said the bomb also contained triacetone triperoxide, or TATP, an explosive easily made and popular among bombers in the Middle East, including those from Al Qaeda.

The bombing is a serious blow to Morocco’s tourism industry, already hurt by the economic crisis and anxieties about popular protests that are stirring much of the Arab world. The site — a popular cafe facing the historic Djemma el Fna square — is a regular tourist stop, and the bombing appeared aimed at foreigners.

Fourteen of the 16 dead were foreigners, mostly French citizens, as well as two Canadians, a Briton and a Dutch tourist, officials said. There were 25 people wounded, 14 of whom remained in hospitals, Mr. Cherkaoui said.

Morocco’s king, Mohammed VI, has tried to respond to popular demands for more democracy by beginning constitutional reforms and releasing or commuting the sentences of 190 radical Islamic prisoners arrested after the last big terrorist bombing, in Casablanca in 2003, when 45 people died, including 12 suicide bombers.

On May 1, protesters plan another rally in Moroccan cities to demand a faster transition to a constitutional monarchy, the third such protest since Feb. 20.

Mohamed Darif, a political scientist at King Hassan University in Casablanca, said, “The finger is pointed at Al Qaeda,” and suggested that Al Qaeda in the Islamic Mahgreb had singled out a cafe popular with French tourists. The same group holds four French hostages and demands that for their return, France pull its troops out of Afghanistan.

“They would find no better spot than Marrakesh, which has become a French village, with a strong French presence,” Mr. Darif said.

But he suggested other possible culprits, including radical Islamists who want all their colleagues released from prison — nearly 2,000 or so are detained — and those who do not favor the king’s recent movement toward democratic reform.

Jean-Yves Moisseron, editor in chief of the France-based magazine Maghreb-Machrek, said the way the bombing was carried out pointed to Al Qaeda in the Islamic Maghreb, “since Marrakesh is a very touristy place with a bad reputation, a spot for prostitution and sexual tourism, with international jet-setters” who own houses in the old city.

“There is a very clear will to target tourists; otherwise they would have bombed 50 meters away,” he said, adding that the bombers had to get through significant police controls to hit the square, which is well protected. “They were surely well organized and significantly trained.”

Two of the dead were Michal Zekry, 29, an Israeli-Canadian who was pregnant, and her husband, Messod Wizman, 30, a Moroccan-Canadian. They had come from Shanghai to visit Mr. Wizman’s parents, who live in Casablanca, for Passover, and then took a trip to see Marrakesh.

“They were lovely together, married for three years and have a boy, 2,” said Mr. Wizman’s aunt. “She was pregnant. What happened was that they went to the hotel in Marrakesh, but their room was not ready, so they thought, ‘Why not have a coffee?’ and went to the Argana.” She paused, then said: “There are no words for that.” The couple had left their son with his grandparents.

Mr. Wizman, she said, grew up in Casablanca, studied in Paris and then went to Montreal, where he met his wife.

On Friday evening, the square was packed with people, but the coffee shops and restaurants normally filled with tourists were nearly empty.

Around the corner, the Mabrouka cinema was open, showing “Femmes en Miroirs,” about a young Moroccan photographer living in Paris who returns home to see her sick mother. Rashiq Moulay Alarbi, a literature student, said: “We are not afraid, we are going out. I want these people who did this to us to know that they have not succeeded.”

His friend Abdellah al-Khalaoui, a driver, expressed sorrow for the deaths and concern for the city. “We fear that the tourism will drop; it has already started,” he said. “Already the coffee shops in which people used to sit are empty.”

Nearby, a Spanish couple ate with friends at a small restaurant, undeterred. They were near the square on Thursday but did not hear the explosion. “We’re very sad for the people, but something like this could have happened in Barcelona or Paris as well,” said Manuel Sanroma, a mathematics professor at the University of Barcelona who was making his second visit to Marrakesh.

“We love the Arab world,” he said. “Terrorists can attack you anywhere.”

Souad Mekhennet reported from Marrakesh, and Steven Erlanger from Washington. Ma?a de la Baume contributed reporting from Paris.

 

Drug That Stops Bleeding Shows Off-Label Dangers

 

The studies present a cautionary tale, researchers say, that makes clear the pitfalls of a common medical practice — using new drugs in situations in which they have never been rigorously tested. The drug, sold as NovoSeven, was approved for people who lack a gene to make a particular blood-clotting protein called Factor VIIa and for certain people with hemophilia who can’t tolerate another drug that can stop bleeding.

The drug, which is Factor VIIa, is made by baby hamster kidney cells that have the gene for Factor VIIa added to them. The baby hamster cells secrete the protein into a solution containing newborn calf serum, and the protein is then extracted from that solution and purified. It takes a year to produce — most of that time, nine to 10 months, is devoted to testing the drug for purity and safety. The drug costs $10,000 a dose, but can be a lifesaver for these patients.

It is also used for other patients, according to the new studies, in The Annals of Internal Medicine. In fact, the small group for whom it was approved accounts for only 3 percent of the 18,000 times a year the drug is used in hospitals. Ninety-seven percent of the time when it is used in hospitals, it is given to patients with other reasons for bleeding, including having heart surgery or a hemorrhagic stroke, in which bleeding in the brain causes damage.

For such patients, one of the papers concluded, the drug not only fails to improve survival, it increases the likelihood of a blood clot in the heart or brain, resulting in a heart attack or the kind of stroke in which blood flow to a part of the brain is blocked. The drug is also used in trauma surgery, and in that use as well it fails to show improved survival. In trauma patients who receive the drug, however, there do not appear to be more clots than would otherwise occur.

“It’s scary,” said Dr. Jerry Avorn, a professor of medicine at Brigham and Women’s Hospital in Boston who wrote an editorial commenting on the studies. “This is a powerful drug, and we don’t fully understand it,” said Dr. Veronica Yank of Stanford, an author on both papers.

In heart surgery, the researchers report, one out of every 20 people given Factor VIIa would be expected to have a serious clot in the heart or brain. When the drug is used to control bleeding in or around the brain, as in patients suffering from hemorrhagic stroke, one out of 17 patients would get a dangerous clot at the higher dose that is often used and one out of 33 would get a clot in situations where doctors used a lower dose.

The clots, said Dr. Yank, can occur anywhere in the body, obstructing blood vessels. “Some patients got more than one clot,” she added.

Doctors say they give the drug because they can see an immediate effect: The bleeding stops. “It’s very dramatic,” said Dr. Mark Gladwin, chief of pulmonary and critical care medicine at the University of Pittsburgh Medical Center. And so, he added, “there is a very compelling motivation to use it.”

And the doctors who use the drug during surgery may not see a longer-term effect — clotting — which can occur days later. And they would have no way of knowing if the drug saves lives in the long run. Dr. Gladwin pointed out that doctors routinely administer drugs for unapproved uses.

Companies cannot promote drugs for such uses, but doctors are free to prescribe them. Novo Nordisk, the maker of the Factor VIIa drug, says that it does not promote unapproved uses and that it worked with the Food and Drug Administration to include warnings against such uses on the drug’s label.

As for the high cost, insurers pay for Factor VIIa as part of the general cost of treating hospitalized patients, so the drug may not be specifically identified. “Typically, the health plan would not know that it was used,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group. Payment for Factor VIIa “would be part of a global payment,” she said.

Trauma surgeons were among the most enthusiastic early adopters of Factor VIIa, but they were also among the first to curtail use.

“I have used it, and virtually every trauma surgeon in the world who has access to it has used it,” said Dr. Ernest Moore, chief of surgery at Denver Health, an affiliate of the University of Colorado.

Many doctors got interested when they saw a paper, about a decade ago, describing an Israeli soldier who had a gunshot wound to the abdomen, got Factor VIIa, and was saved from what it seemed would have been certain death. In addition, research studies indicated that Factor VIIa was important in initiating clotting, giving credibility to the report.

As trauma surgeons began using the drug, Dr. Moore said, they had “the unforgettable experience of seeing people who were bleeding to death suddenly stop bleeding.” And, he added, “there is no question that in the right circumstances it can be a miracle treatment.”

But trauma surgeons’ unbridled enthusiasm for Factor VIIa was tempered recently when studies began to show no survival benefit.

He is using it less often now, as are many other trauma surgeons, Dr. Moore said. It is not clear that other medical specialties had a similar awakening, but some institutions, like the University of Pittsburgh Medical Center, have taken steps to control the drug’s use. The Pittsburgh hospital began requiring that doctors who wanted to use Factor VIIa get permission from a hematology consultant.

The one exception was patients who were bleeding into the brain, taking a blood thinner and about to have emergency neurosurgery. The consultants often refuse permission, said Dr. Franklin Bontempo, director of the coagulation laboratory at the University of Pittsburgh Medical Center.

Some doctors want to use it for routine bleeding in trauma patients or in patients having liver transplants. That is unnecessary, they often are told. Others call because a patient is bleeding into the lungs, coughing up blood, and the doctor is, quite understandably, worried, wanting to give Factor VIIa to make the bleeding stop. In that situation, Dr. Bontempo said, the hematologist will suggest other methods. “Often that takes care of the problem,” he said.

The lesson in the story of Factor VIIa, Dr. Yank said, is that anecdotal reports, even ones citing results as powerful as bleeding cessation, can be misleading. Using a drug for an unapproved use can be risky. A single measurement of outcomes can miss the big picture of risks and benefits. And the risk-benefit picture for the approved use may be quite different from what occurs when the drug is used in other situations

“You may be correct in assuming the drug has the same benefits,” Dr. Yank said, “but then again, you may not.”

 

Poll shows Scots' top priorities

 10 April 2011 Last updated at 19:12 ET About 1,000 people in Scotland were asked what policies should be prioritised Cutting cancer treatment waiting times and maintaining the number of police on the streets are the top two priorities for Scotland in the Holyrood elections, according to a poll for BBC Scotland.

The ICM survey also suggested strong backing for free university education.

The BBC poll asked people to rate 25 issues taken from manifestos and party policy statements.

The lowest ranked went to the Tory policy of letting 14-year-olds leave school to train for a trade.

Second lowest priority was given to the plan to build a new bridge across the River Forth.

The idea of combining Scotland's eight police forces into a single national force was also in the bottom three, despite the plan being suggested to save money for frontline policing.

For the poll, ICM Research interviewed a random sample of 1,004 adults by telephone between 5 and 8 April.

Interviews were conducted across Scotland and the results were weighted to the profile of all Scottish adults.

So far, the Scottish Liberal Democrats, the Scottish Tories and Scottish Labour have published their manifestos.

Continue reading the main story Brian Taylor Political editor, BBC Scotland

To start, a few words of caution. This is an opinion poll - it offers a wide-angle snapshot, not the precision of a microscope.

Further, we reminded those taking part that Holyrood may not have the time or the money to do everything at once.

We asked, therefore, for priorities.

But some people, perhaps many people, might still be inclined, in effect, to tick "all of the above" when asked to rank priorities.

Certainly, it would appear that the focus is still upon the services which can be funded by public spending.

For example, two policies ostensibly designed to help business - regional development banks and reduced taxation - were way down the poll.

The SNP is due to make its manifesto public later this week.

However, all the main parties, plus the Scottish Greens, have made their general pledges known in BBC Scotland's issues grid guide.

In terms of parties, the top-ranked policy was in the Labour manifesto; to cut the waiting time for suspected cancer cases to see a specialist from four weeks to two.

Other parties also had policies which were designed to cut health waiting lists or shorten waiting times.

The issue of keeping up the number of police on the streets follows an initiative by the SNP government, backed by the Conservatives, to increase the strength of Scotland's forces by 1,000 officers.

The third ranked policy, that of retaining free university education, was supported by the Liberal Democrats as well as the SNP and Labour. Only the Tories proposed a graduate charge.

More than one party will claim ownership of the policy which is ranked fourth - that of spending more money on apprenticeships for unemployed young people.

Below that, the next focus is upon the council tax - a hugely contentious issue in these elections.

Placed fifth in the poll was a Conservative policy of cutting the council tax for all households where all the adults are pensioners.

Continue reading the main story Cut waiting times to see a cancer specialistKeep up the number of police on the streetsRetain free university education for all Scottish studentsSpend more money on apprenticeships for unemployed young people Reduce the council tax for households where all the adults are pensioners Continue reading the main story Allow 14-year-olds to leave school to train for a tradeBuild a new road bridge across the River Forth Combine the eight separate police forces in Scotland into a single national force Hold a referendum on whether Scotland should become an independent country Raise the money local councils need through a local income tax rather than the council tax In sixth place comes a policy now effectively backed by all the major parties: a council tax freeze for the next two years.

Below that, in seventh place, lies the Lib Dem policy of scrapping the council tax for the poorest pensioners.

Turning to the bottom of the poll, it seems voters do not accord high priority to the idea of replacing the council tax with a local income tax. That comes in at number 21.

That has been contentious in these elections although the parties advocating it, the SNP and the Lib Dems, now say that it would have to await the further devolution of income tax powers which means effectively deferring it for a further Holyrood election.

Ranked at number 22 is the SNP idea of holding a referendum on whether Scotland should become an independent country.

That relatively low ranking may be partly explained by the present focus on immediate economic concerns.

In practice, the SNP have tended to major on other issues while stressing their determination to bring forward a referendum bill if they are re-elected.