Nifty has resisted a breakdown and may rally tomorrow
Nervousness ahead of the release of the key economic indicators and the RBI monetary policy kept the market subdued till noon. While gains in Europe perked up the indices in the second half, the news of a massive earthquake off the Indonesian coast resulted in a flat close.
The Nifty broke yesterday’s range to close in the negative. The index still carries a negative bias. If the index closes below 5,205, we may see it going down to the level of 5,165 and then further to 5,100. However, to see some gains the index must close above 5,295. The National Stock Exchange (NSE) saw a volume of 68.38 crore shares.
The market opened in the negative on global cues as Asian markets were trading lower on fresh European debt concerns. Nervousness ahead of the Reserve Bank of India’s (RBI) monetary policy, due next week, also weighed on the sentiments. The Nifty opened 35 points lower at 5,209 and the Sensex resumed trade at 17,126, down 118 points from its previous close.
The early slide saw all sectoral indices on the BSE trading lower. The market fell to its intraday low in the first half-hour itself with the Nifty touching 5,191 and the Sensex dropping to 17,076.
A gradual upmove was noticed as investors resorted to bargain hunting at lower levels. The market ventured into the green in noon trade on positive signals from the European markets. The benchmarks hit their day’s high around 2.00pm with the Nifty rising to 5,264 and the Sensex going up to 17,319.
However, as news of an 8.7 magnitude striking off the coast of Indonesia was known, the markets once again slipped into the red in the last hour. But a firm trend in the European indices ensured a flat ending. The Nifty closed 17 points down at 5,227 and the Sensex finished 44 points lower at 17,199.
The advance-decline ratio on the NSE was 659:977.
Among the broader indices, the BSE Mid-cap index declined 0.63% and the BSE Small-cap index fell by 0.27%.
BSE Healthcare (up 0.58%); BSE Bankex, BSE IT (up .019% each) and BSE Fast Moving Consumer Goods (up 0.10%) settled higher while BSE Metal (down 1.34%); BSE Capital Goods (down 1.05%); BSE Oil & Gas (down 0.86%); BSE Capital Goods (down 0.83%) and BSE Realty (down 0.77%) were the top sectoral losers.
The top Sensex gainers were Sun Pharma (up 2.08%); NTPC (up 1.79%); Infosys (up 0.92%); State Bank of India (up 0.43%) and HDFC Bank (up 0.33%). The losers were led by Jindal Steel (down 2.92%); Bharti Airtel (down 2.27%); Sterlite Industries (down 1.97%); BHEL (down 1.92%) and Tata Power (down 1.87%).
The key performers on the Nifty were Kotak Mahindra Bank (up 2.55%); Sun Pharma (up 2.01%); Infosys (up 1.86%); NTPC (up 1.85%) and Power Grid Corporation (up1.27%). The main losers on the index were ACC (down 4.31%); Ambuja Cement (down 4.05%); Reliance Infrastructure (down 3.71%); Jaiprakash Associates (down 3.30%) and Reliance Power (down 2.35%).
Markets in Asia settled lower as fresh debt concerns in Europe weighed on the sentiments. A spike in the yields of 10-year Spanish bonds, touching the highest level this year, had investors worried.
The Hang Seng declined 1.06% the Jakarta Composite lost 0.48%; the Nikkei 225 dropped 0.83%; and the Straits Times closed 1.21% lower. Bucking the trend, the Shanghai Composite rose 0.13% and the Taiwan Weighted advanced 0.21%. Markets in South Korea and Malaysia were closed for trade today. At the time of writing, the key indices in Europe were in the positive and US stock futures were in the green.
Back home, institutional investors—both foreign and domestic—were net sellers in the equities segment on Tuesday. While foreign institutional investors pulled out funds worth Rs328.67 crore, domestic institutional investors sold stocks amounting to Rs190.18 crore.
Piramal Healthcare today said it has received approval from European regulator to market its bio-orthopaedic product BST- CarGel used for cartilage repair in the European Union. The approval provides access to a $200 million-market in Europe with a potential for a larger market with greater penetration of treatment in Europe. The stock declined 1.24% to close at Rs450.30 on the NSE.
Unity Infraprojects is looking to generate up to 25% of its targeted Rs5,000-crore revenue by 2014-15 from overseas markets in a bid to ensure a better rate of return and higher margins. The stock settled 0.10% lower at Rs50.55 on the NSE.
Engineering, procurement and construction company, Tecpro Systems, has secured orders totalling Rs297 crore from Abhijeet Projects and NTPC. The APL order is worth Rs 155 crore while the NTPC order is valued at Rs 141.9 crore. The stock closed at Rs188.55 on the NSE, up 2.88% over its previous close.
Patients seem relieved and comforted that they needn’t go through repeated tests and torture as supported by our obsession with evidence-based medicine. They can enjoy their lives that have been prolonged by simple things like exercise, reasonable diet, and patient-centered goals
We proclaim from house-tops that modern medicine is evidence-based and all other systems are not. What is this evidence base that we talk about; that too in a “risk factor arena”? Let us examine one such commonly talked about evidence base for hypertension treatment. Elevated blood pressure, which is at best, a risk factor for heart disease, stroke, etc, has now been elevated to a full blown “silent killer” disease status, thanks to the pharmaceutical lobby. Let us analyse its “so called” evidence base very calmly from the beginning.
The largest and possibly the longest follow up study, MRFIT (Multiple Risk Factor Intervention Trial), has just given us the following data, if one were to go by the data alone. The conclusions of MRFIT analysis by Dr Roger W Sherwin is quite shocking: “The original goal of the MRFIT was to determine whether reduction of the risk factors like smoking, cholesterol and elevated blood pressure in high-risk but otherwise healthy men would reduce CHD (coronary heart disease) mortality, non-fatal MI (myocardial infarction) or CHD, cardiovascular mortality and mortality from all causes. (1) Their paper answers these questions thus:
“In conclusion we have shown that it is possible to apply an intensive long-term intervention program against three coronary risk factors with considerable success in terms of risk factor changes. The overall results do not show a beneficial effect on CHD or total mortality.”
In other words, they found that changing the “risk factors” does not apparently change the risks. This necessarily means that the “risk factors” are not as important as they are thought to be. Indeed, it should be concluded that the “risk factors” were no such thing; at least as far as MRFIT trial is concerned.
Uffe Ravnskov’s analysis of survival benefit, Relative Risk Reduction, and absolute risk reduction (ARR) shows our evidence base in very poor light! (5)
Relative Risk Reduction% -20 -21
Absolute risk reduction % -0.8 -3.3 Survival chance without drugs % 96 88.5
Survival chance with drugs % 96.8 91.8
If we look carefully modern medicine deep down is very, very shallow. (6, 7, 8, 9, 10, 11, 12)
Diabetes—the story is no different!
“But recently part of a large clinical diabetes study was halted after researchers found an increased death rate among those taking higher doses of blood sugar-lowering medication. The ACCORD trial, as it is called, is funded by several US government agencies and the finding surprised many doctors. The New York Times of 27 May 2009 had this to say: “For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels with drugs, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older patients with Type II diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported. The study also stressed that intensive blood pressure and combination lipid therapies do not reduce combined cardiovascular events in adults with diabetes.13
Pregnant fat mothers are now the target for drug companies! They are now pushing to give a dangerous drug, Metformin, which has long list of dangerous side effects like muscle pain and weakness, cardiac arrhythmias like slow or uneven heart rate, nausea and vomiting, difficulty breathing, reduced sex hormone levels, limb numbness, pain abdomen, and even lactic acidosis, a dangerous side effect, to babies to prevent them from becoming diabetics in life even when they are in their mother’s womb. They propose to give Metformin to every obese pregnant lady! I think it is pure insanity. See this report in The Daily Mail: "If the strategy is a success, the treatment could be in widespread use in as little as five years, with tens of thousands of overweight but, otherwise healthy mothers-to-be drugged each year." 14
Routine screening patients with diabetes for occult coronary disease, a bad practice in my opinion, has been shown not to reduce cardiovascular mortality according to the results of large American study.15 We need not scare the common man by saying that he is more prone to heart disease and death if he suffers from diabetes. “Current best evidence requires a change in emphasis in our care for patients with Type 2 diabetes. Clinicians should prioritize supporting well-being and healthy lifestyles, preventive care, and cardiovascular risk reduction for these patients. The randomized trial evidence that we reviewed does not strongly support tight glycaemic control as more beneficial than harmful in reducing the risk for diabetes complications,” 16
I can not sum up this note in a better way than what one of the doctors, Mark Mc Connell, did in the US after all these evidences erupted: “So much theory, so much data, and so little time. Is the care of patients so complicated? It actually seems fairly straightforward unless we have a hard time giving up our past biases that "lower is always better". The patients I meet generally are overwhelmed with testing, clinic visits, finger pricks, and fat bills.”
Patients are happy to be given the good news that they are doing well clinically. They seem relieved and comforted that they needn’t go through repeated tests and torture as supported by our obsession with evidence based medicine—a real boondoggle. Patients can enjoy their lives that have been prolonged by fairly simple things like exercise (daily walk has been shown to produce 80% reduction in premature deaths due to risk factors!), reasonable diet, and patient-centred goals. Unfortunately, we have ‘wise’ doctors who think that BM Hegde is being less compassionate towards modern medicine. They have a right to their opinion, of course. Some might even say that these references are selective, but that is what is being done daily in all science papers, anyway. I will have to pay them in their own coin. Uncertainty is the only certainty in this world. The world is simply a Wirklichkeit (changing drama, reality).
I do not believe in the caste system in healing. For me healing a patient can be achieved by any means which are scientifically authenticated, as long as my interventions do not become worse than his/her original disease. Primum non-nocere! After all, patient care is just CARING for the patient.
“Intellectual integrity made it quite impossible for me to accept the myths and dogmas of even very great scientists, more particularly of the belligerent and so-called advanced nations. Indeed, those intellectuals who accepted them were abdicating their functions for the joy of feeling themselves at one with the herd”—Bertrand Russell (1872-1969)
1) Zukel WJ, Paul O, Schnaper HW. The multiple risk factor intervention trial (MRFIT). I. Historical perspective. Prev. Med. 1981 Jul; 10(4):387-401.
2) Hot Study Group. www.thelancet.com/journals/lancet/.../PIIS0140-6736(98)04311-6
3) Rawlins M. The Harveian Oration of 2008. De Testimonio. On the evidence for decisions about the use of therapeutic interventions. Royal College of Physicians, 2008.
4) Hegde BM. Where is the reality?
5) Ravnskov U. Chance of surviving with and without treatment. 18 June 2002 ...
6) Marcia Angell. Patient Preferences in RCTs. NEJM 1984; 310:1385-87.
7) Clarke CJ. Rapid determination of number of patients required for RCT. Lancet 1966; 11: 1357.
8) Cromie BW. Feet of clay of RCTs. 1963; 11; 994-997.
9) Freidman, Howard S. RCTS and common sense. Am. J. Med. 1986; 81: 1047.
10) MRC streptomycin trials BMJ 1948; 11: 769-782.
11) Harris L Coulter. The Controlled Clinical Trials by Centre for Empirical Medicine and Project Cure Washington DC 1991. ISBN 0-916386
12) Sherwin RB. MRFIT study.
13) ACCORD study.
14) Babies treated in the womb for obesity
15) Young LH, Wackers FJ, Chyun DA, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes. JAMA 2009; 301: 1547-1555.
16) Montori VM and Balsells MF. Glycaemic control in Type II diabetes Time for an evidence based-about face? Ann. Intern. Med. 2009; 150: 803-808.
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also Editor-in-Chief of the Journal of the Science of Healing Outcomes, Chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former Vice Chancellor of Manipal University at Mangalore and former professor for Cardiology of the Middlesex Hospital Medical School, University of London. Prof Dr Hegde can be contacted at [email protected])
Reliance Capital Trustee Company bought 8.1 lakh shares of Titagarh Wagons, a supplier of wagons and freight cars, for Rs330.01 a piece, valuing the transaction at Rs26.72 crore
Reliance Capital Trustee Company, a subsidiary of Anil Ambani Group's Reliance Capital, purchased 8.1 lakh shares of Titagarh Wagons for Rs27 crore through open market transactions, reports PTI.
Reliance Capital Trustee Company bought 8.1 lakh shares of Titagarh Wagons, a supplier of wagons and freight cars, for Rs330.01 per share, valuing the transaction at Rs26.72 crore, according to bulk deal data available on the stock exchanges.
Meanwhile, India Capital Fund, a shareholder of Titagarh Wagons, sold 6.86 lakh shares of the company for Rs330 a piece for Rs22.65 crore.
Besides, another entity India Capital Opportunities offloaded 1.22 lakh equities of Titagarh Wagons for Rs330.01 a piece, valuing the deal worth Rs4.04 crore.
As of December quarter, India Capital Fund held 715,188 equities or 3.8% stake in Titagarh Wagons.
Reliance Capital shares ended Wednesday 5.48% down at Rs360.55 while Titagarh Wagon’s shares closed 1% higher at Rs338.25 per share on the Bombay Stock Exchange.