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SAN FRANCISCO — With Apple set to unveil its newest iPhones, a key question for the California tech giant is whether it can recapture the magic from its first release a decade ago.

The keenly anticipated media event  on Tuesday will be the first in the Steve Jobs Theatre at Apple’s new “spaceship” campus in Silicon Valley, evoking the memory of the company’s late co-founder and iconic pitchman.

Jobs introduced the first iPhone on January 9, 2007 and set the stage for mobile computing — and an entire industry revolving around it. The first devices became an instant hit as they went on sale on June 29 of that year.

Apple as usual has revealed little about the September 12 event in Cupertino. Invitations provided the date, time, location and a message that read: “Let’s meet at our place.”

The timing, however, is in sync with Apple’s annual unveiling of new iPhone models and comes as rivals field fresh champions powered by Google-backed Android software.

Eyes are on Apple to dazzle as the culture-changing firm seeks to retain its image as an innovation leader in a global smartphone market, showing signs of slowing and as Chinese rivals close ground.

Chinese smartphone colossus Huawei passed Apple in global smartphone sales for the first time in June and July, taking second place behind South Korean giant Samsung, according to market tracker Counterpoint Research.

Samsung last month unveiled a new model of its Galaxy Note, as it seeks to move past the debacle over exploding batteries in the previous generation of the device, and mount a renewed challenge to Apple’s flagship devices.

Other makers are also scrambling for market share, including Google, which is expected to soon unveil a second-generation of its flagship Pixel smartphone.

iPhone X?

Some reports say Apple will introduce three new iPhone models, with unconfirmed talk that a special premium iPhone will be priced as high as $1,400.

“It will have to be magical,” analyst Rob Enderle of Enderle Group said of a new iPhone with that kind of price tag.

“Even if you can’t afford it, this has to be the one you lust after.”

The new iPhone would also need to “set the bar” in a market with premium Android-powered handsets priced much lower, according to the analyst.

Two new iPhone models are expected to be improved versions of the prior generation, with most of the dramatic changes built into a premium handset unofficially referred to by some as “X” but pronounced “ten” in honour of the anniversary.

Loup Ventures partner Gene Munster said in a research note that the new premier iPhone “will be the biggest step forward in iPhone technology that we’ve seen since the original device launched 10 years ago”.

Some reports say the new iPhone will include a high-quality, edge-to-edge screen with a notch in the top for an extra camera supporting 3D facial recognition.

Others speculate that the back of the new handset will be glass and will offer wireless charging.

The most dramatic changes were expected in the premium model, which could go so far as to get rid of a home button that has been a main control feature since the iPhone debut.

Flicking or swiping gestures could replace the home button function, enabling the handset face to appear almost all-screen.

RBC Capital Markets said that a recent survey of iPhone 8 users in the US indicated “sizable pent-up demand and excitement around the upcoming iPhone launch” with wireless charging generating the most interest.

Augmenting reality

In 2007, Jobs billed his smartphone approach as blending liberal arts, design and technology. Today Apple is seen as needing a fresh spark, whether from the phone itself or from services or other devices like the Apple Watch.

Apple’s new iOS 11 operating system unveiled earlier this year boasts new camera features, the Siri digital assistant made smarter, and the potential for augmented reality applications.

Apple made an AR kit available to developers to create apps with the technology.

Adding 3D and computer vision hardware to an iPhone would “be a big step toward putting AR in the hands of everyday users”, Munster said.

Apple has taken to spotlighting the growing stream of revenue from selling content and services to the hundreds of millions of people using its devices.

“We believe Apple’s true differentiation is its unique computing ecosystem: iOS,” RBC Capital Markets said, referring to the mobile software powering the company’s creations.

“Simplistically, the scale of users attracts application developers, which in turn bolsters the number of users.”

LONDON — When Ingrid Caldironi decided to start living a more eco-friendly lifestyle, she made a few changes to her routine.

Caldironi bought a reusable coffee cup, started making her own beauty products and tried to stop buying packaged products.

But she soon hit a wall.

Most British supermarkets sell few unpackaged products, and she was spending most of her weekends roaming London in search of loose vegetables and bulk coffee.

So she decided to open her own shop: the only “zero-waste” store in London, which sells foods in bulk, products made out of waste and durable alternatives to typical throwaway products such as plastic cutlery, razors and sponges.

“I want to help people understand that it’s not difficult to be sustainable,” Caldironi told the Thomson Reuters Foundation at her store, Bulk Market, in east London.

“When people change their behaviours, and they start demanding something different, then companies will need to change,” she added.

Bulk Market opened last week and sells everything from rice to dog food to cakes, catering for customers who want to leave no trace with their consumption. 

It currently serves about 50 people a day, from young families to older customers, in a small, white-walled store lined with glass bins, wooden tables and wicker baskets.

As Caldironi talked, she sipped sparkling water infused with wonky cucumbers — destined for landfill due to their shape — in a can made of aluminium, a widely recycled material.

Dozens of similar, package-free shops have opened across the world, from Copenhagen to Montreal, as a response to mounting concerns about plastic pollution and food waste.

Plastic planet

According to researchers, humans have produced more than 8 billion tons of plastic since the 1950s, with most of it discarded in landfills or the wider environment, hurting ecosystems and human health. 

Most of the plastics that do get recycled — less than 10 per cent of the total — can only be recycled once before they too end up in landfills, while other materials, such as the aluminium, used in drink cans, can be recycled indefinitely. 

Packaging is the largest market for plastic and the petroleum-based product accelerated a global shift from reusable to single-use containers, researchers said. 

Fed up with how government and business are responding to the climate change emergency, a fast-growing group of individuals is taking matters into its own hands.

Enter Bea Johnson, a California-based French blogger who rose to fame after she cut the yearly waste produced by her family of four to a single jar and published a guide to living waste-free.

“Recycling is not the solution to our environmental problems, Johnson told the Thomson Reuters Foundation in a phone interview. “It depends on way too many factors to be efficient.”

Instead, Johnson focuses her efforts on waste prevention, using five rules: refuse what you do not need, reduce what you own, reuse items instead of buying disposables, recycle only what you cannot refuse, reduce or reuse, and compost the rest.

Some of the main staples of the zero-waste lifestyle include bamboo toothbrushes, which can be composted, and stainless steel straws, paper towels and reusable sanitary products which do not need to be replaced as often as their throwaway counterparts.

Banana bread

A plethora of zero waste bloggers also provide recipes explaining how to use commonly thrown-away foods, such as bananas, broccoli stalks or stale bread.

The bulk containers provided in zero-waste stores such as Bulk Market allow customers to refill their own jars with the exact quantity of beans, spice or oil they need, cutting waste.

In Britain, an estimated 7 million tonnes of food and drink are thrown from homes each year, costing an average household about £470 ($604.89) a year, according to the Food Standards Agency, a government body.

Some EU countries, including France and Italy, have already adopted national measures to fight food waste. 

Britain still has among the lowest levels of food redistribution, whereby out-of-date but edible food is redistributed to people in need via charities and food banks.

Caldironi, a former marketing executive, also hopes to support local social enterprises such as Toast Ale, which makes beer out of surplus bread and Luminary Bakery, which employs female former inmates. 

“My place is going to be a place to show people you can have a different way of shopping — you can have a normal life, you don’t need to change so much,” Caldironi said.

But although the emphasis is on the impact small changes can have on the environment, many zero-waste advocates say the shift to a “circular economy” — which means reusing products and materials, producing no waste and pollution, and using fewer new resources and energy — can only be achieved with the help of businesses and governments.

“Citizens are making a big difference but it can’t all be on the shoulders of citizens,” Ariadna Rodrigo, product policy campaigner at Brussels-based advocacy group Zero Waste Europe, told the Thomson Reuters Foundation.

“You need a change across the whole idea of how business is done.”

After years of growing doubt about the value of screening men for prostate cancer, a new analysis of existing clinical trial evidence has found that when men between 55 and 70 get the prostate-specific antigen, or PSA, test, the result is lives saved.

In 2009, a New England Journal of Medicine editorialist famously called the debate over PSA testing for prostate cancer “the controversy that refuses to die”. That comment came with the publication of two clinical trials — one conducted in the United States, the second in Europe — that drew two contradictory conclusions on prostate cancer testing.

The US undertaking, called the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, found that screening men for prostate cancer does not save lives. The European Randomised Study of Screening for Prostate Cancer suggested that screening drove down the rate of deaths from prostate cancer by 20 per cent.

In 2012, a federally funded panel of experts on preventive care concluded there are more risks than benefits to screening American men for prostate cancer with the PSA test. And in April 2017, the US Preventive Services Task Force dumped the decision squarely into the laps of patients and their doctors. Some men between 55 and 69 years of age might well decide to get their PSA checked, the task force said. After hearing the ledger of pros and cons, however, others in that age bracket might just as reasonably skip the screening test, the panel concluded.

The new research, published this week in the Annals of Internal Medicine, now calls those recommendations into question. The authors of the study, led by biostatistician Ruth Etzioni of Fred Hutchinson Cancer Research Centre in Seattle, concluded that screening men over age 55 “can significantly reduce the risk for prostate cancer death”.

When men who fit the criteria for screening get the PSA test, the reduction in deaths due to prostate cancer was between 25 per cent and 32 per cent, the new study found.

But the newly published analysis also underscores that the value of prostate cancer screening rests heavily on which men you screen, where and for how long you conduct the clinical trial and how you crunch the numbers.

In the end, said Vanderbilt University urological surgeon Dr Sam Chang, the new analysis “reinforces what urological surgeons and treating physicians have thought all along: that PSA screening is helpful”.

But it is helpful, said Chang, only when it focuses on the right men — those between 55 and 70 — and when it is tempered by an understanding that not all worrisome findings are evidence of disease that should be treated aggressively.

Sometimes, said Chang, who was not involved in the newly published article, a man will get a problematic PSA test reading and decide not to act on it immediately or aggressively. But knowing there is a decision to be made is probably a better basis for planning than not knowing, he added.

“Over the past five to 10 years, there has been a better understanding by everyone about the harms of over-treatment,” Chang said. “You want to avoid over-diagnosis and over-treatment.”

Chang underscored that for two groups in particular — African American men and those with a first-degree relative who died of prostate cancer — knowing is especially important, because the risks of aggressive disease in such populations is much higher than for others. Neither group was the subject of special attention in the newly published analysis.

In an editorial published Monday alongside the new analysis, Andrew Vickers of Memorial Sloan Kettering Cancer Centre also made clear that it’s what patients and their physicians do after the PSA test that matters most.

“Unfortunately, the way screening has been implemented in the United States leaves much to be desired,” Vickers wrote. “The controversy about PSA-based screening should no longer be whether it can do good but whether we can change our behaviour so that it does more good than harm,” he added.

Prostate cancer is the most common non-skin cancer found in men, affecting 101.6 of 100,000 American men, according to the Centres for Disease Control & Prevention. In 2013, the latest year for which figures are available, 176,000 got a diagnosis of prostate cancer and 28,000 died of it.

But a change in a man’s reading on the PSA test is a highly imperfect gauge of trouble: approximately 80 per cent of positive PSA test results are thought to produce false-positives, creating scares that prompt men to get biopsies. And treatment, which carries with it a high risk of subsequent difficulties with sexual function, urination and bowel movements, is often unnecessary because prostate cancers are often so slow-growing they will never make a man sick.

Not getting enough sleep? It could be adding to your waistline.

A United Kingdom study has found that people who sleep about six hours a night had a waist 3.05 centimetres larger than those getting nine hours of sleep a night.

The research, which was led by Laura Hardie of the University of Leeds, looked at 1,615 adults who reported how long they slept and kept records of food intake. Participants had blood samples taken and their weight, waist measurement and blood pressure recorded. The researchers also took into account age, ethnicity, sex, smoking and socioeconomic status. The findings were published in the journal PLOS One.

“Because we found that adults who reported sleeping less than their peers were more likely to be overweight or obese, our findings highlight the importance of getting enough sleep,” Hardie told the ScienceDaily.com website.

“How much sleep we need differs between people,” she added, “but the current consensus is that seven to nine hours is best for most adults.”

Lack of sleep was also linked to reduced levels of HDL cholesterol — the “good” cholesterol — a factor that can increase the risk of heart disease.

However, according to ScienceDaily, the study did not find any relationship between shortened sleep and a less healthy diet, a fact that surprised the researchers. Other studies have suggested that shortened sleep can lead to poor dietary choices.

As to why lack of shut-eye can increase weight, another study, which took place at the University of Chicago in 2012, found that signals from the brain that control appetite are affected by lack of sleep, the website reported. In particular, the hormones ghrelin, which increases appetite, and leptin, which indicates when the body is satiated, are impacted.

Another of the Leeds researchers, Greg Potter, said the number of people with obesity worldwide has more than doubled since 1980.

“Obesity contributes to the development of many diseases, most notably type 2 diabetes,” he told the website. “Understanding why people gain weight has crucial implications for public health.”

The chief reason why some people — a minority, certainly — still fight the trend to go full steam ahead in the IT cloud is the fear to see their data stolen, lost, hacked or misused. And yet, there are other reasons that make working online a nuisance. I am thinking of one of them more particularly: the way they handle online subscriptions, and the associated renewal and payment processes. From unfair practice, to downright deception, unethical attitude and time-consuming processes, it is not always a pleasant ride.

Whether it is a one-time purchase or a yearly subscription, most if not all online services want you to create an account, enter a lot of data and provide credit card details. Some will offer a free trial period, but will still ask you for your credit card details from the onset, “just in case” you decide to extend the trial period to a fully paid subscription. And you only find out after you spend long minutes painstakingly entering personal data!

Most of the antivirus software and e-mail hosting companies will automatically put you on “auto-renewal” mode. This means that after the first subscription period is over, they will automatically debit your credit card. You may notice the auto-renewal feature or you may not. If you do notice, some of the services will give you the option to go and untick the box so as to disable the auto-renewal; whereas one would expect such option to be turned off by default, and not the other way round.

The worst case of auto-renewal I have encountered, yet, is with the antivirus subscription by a well-known company, which name I will avoid mentioning here. There was no way for me to turn off the auto-renewal on the account by browsing the account on the website, and I had to call the company’s customer service on the phone. I was told that disabling this feature was not possible online but that they can do it for me, since I cared enough to call. When I confirmed that this is what I wanted they did not do it immediately, not before asking the usual annoying question: “Why? Wouldn’t you reconsider?”

There is worse. Some will ask you for your credit card details on the phone, which of course is against all known and accepted practices in terms of security. They do not necessarily mean or plan to misuse the info, but…

If what you are buying is software, you may want to deselect all automatic payments, if given the possibility to do so. Except in cases where you fully trust the seller, and automatic payment for updates of the software is really more convenient for you. Just remember that updates are frequent.

Among the online services that I found to behave very ethically when it comes to payments and renewals, and as examples only, I can mention Amazon, GoDaddy, Microsoft, Google, PayPal, Netflix and beIN Sports. To be fair I must say that almost all the big players in the cloud behave ethically. After all their reputation, and therefore their business, is at stake. They are too smart not to behave!

Perhaps a last, small advice from someone who handles countless online accounts and subscriptions of all kinds. Remember that it is a real market out there, just like the real-life physical market you may go to in downtown Amman for instance. Yes, bargaining is the word. With some online services, you can call them on the phone, tell them that you are considering renewing or buying more options, and that a nice discount would really be welcome. You would be surprised to see how many would respond positively, even if such discount usually remains within the limited 10 per cent to 20 per cent range. Unfortunately, not all such services provide customer support over the phone.

SHANGHAI — Li Minsheng is one of the junior members of the “Old Jazz Band” at Shanghai’s ornate Fairmont Peace Hotel. He’s 76.

Frequently described as the oldest jazz band on the planet and once recognised as such by Guinness World Records, its six wizened members range from a relatively youthful 63 to a scarcely believable 97-year-old trumpeter.

They are an institution in Shanghai and a rare constant in a city and country that are modernising at breakneck speed.

“I have been performing jazz for at least 40 years,” Li, an alto saxophonist with a soft face and gentle air, told AFP.

“I got this saxophone in the 1960s and have played it ever since.”

Born during the tumult and war following Japan’s late-1930s invasion, Li — like other Chinese his age — has witnessed remarkable change.

“I started playing jazz and performing after the opening-up,” said Li, referring to the economic reforms launched in the late 1970s by Deng Xiaoping that propelled China from a basket case to the world’s second-largest economy today.

“We were not able to play before the opening-up due to the political situation then,” Li said, moments before going on stage once more in a red bow tie, crisp white shirt, pristine white blazer and black trousers.

That meant practising at home in secret.

“Back then I would play at home a little bit and enjoy it by myself. I didn’t play outside.” 

Jazz is more readily associated with New Orleans or New York than Shanghai, but the Chinese city has its own proud heritage in that regard that flickers on.

And the Peace Hotel, completed in 1929 and a prime example of Art Deco architecture on Shanghai’s historic riverside Bund area, is in many ways central to it.

The bar where the “Old Jazz Band” now plays 365 nights of the year was originally an English-style pub and it retains that flavour with its bar stools, dark-wooden fittings and slightly musty feel.

During Shanghai’s hard-partying 1930s heyday the bar became so well known for its jazz — which arrived in the city around that time with American musicians hired to play at nightclubs — that it became simply known as “The Jazz Bar”.

Then came war, the 1949 Communist takeover and the political turmoil of the 1966-76 Cultural Revolution, when virulent campaigns against anything foreign made playing or even listening to jazz a dangerous hobby.

‘Long way to go’

Emerging from all that, the “Old Jazz Band”, which attempts to revive the bar’s 1930s air, has been a fixture at the hotel since 1980.

Former US presidents Bill Clinton and Ronald Reagan are among the dignitaries who have dropped in for an evening of jazz — Clinton, who plays the sax, even joined in.

The band, which has an average age of 82, plays what it calls “soft jazz” and with a Shanghainese flavour.

“Jazz has come to China bit by bit,” said Li, who has been in the band for more than 30 years and was put forward by his fellow members to speak for them.

“After China’s opening-up, the influx of Western jazz had a huge impact on the jazz scene here. By watching their performances, we were able to learn from them and improve our music.

“But of course, compared to the top jazz scenes in the world, we still have a long way to go.”

And the million-dollar question: when does Li plan to close the lid on his saxophone case for the last time?

“Generally speaking, playing the sax has an age limit,” he said, smiling.

But as long as he remains enthusiastic and people keep filling the bar to listen, he plans to carry on.

“Interacting with the audience is the greatest thing for me. Without anyone to listen, we’d have no reason to perform.”

People with higher incomes tend to be “weekend warriors”, who are sedentary much of the time but exercise a lot on their days off, a recent US study suggests. 

Plenty of previous research has linked affluence to a higher likelihood of intense physical activity and more time devoted to exercise compared to people with lower incomes. But these findings have typically relied on individuals to report on their own workout habits, a notoriously unreliable measure of physical activity, researchers note in the journal Preventive Medicine. 

For the current study, researchers examined income and activity data for 5,206 adults who were asked to wear accelerometers to track their movements during waking hours for one week. 

Compared to people making less than $20,000 a year, individuals earning at least $75,000 annually were 1.6 times more likely to meet physical activity guidelines of 150 minutes of moderate exercise or 75 minutes of vigorous workout during a two-day period. Over the entire week, the more-affluent people were 1.9 times as likely to meet the guidelines. 

“Meeting physical activity guidelines is important for longevity, improved quality of life, mental and cognitive health and chronic disease prevention including type 2 diabetes and some cancers,” said lead study author Kerem Shuval, director of physical activity and nutrition research at the American Cancer Society in Atlanta. 

In one respect, lower-income individuals in the study came out ahead. They tended to spend less time overall sitting or standing still than their more affluent counterparts. 

“Although lower income individuals are less likely to meet physical activity guidelines, they are less sedentary and engage in more light activity,” Shuval said by e-mail. “To improve our health, we should strive to sit less, move more and attempt to incorporate exercise into our weekly routines.” 

High-income individuals engaged in 9.3 fewer minutes of light intensity activity during a typical day and spent 11.8 more minutes sedentary, the study found. 

The more-affluent study participants also spent 4.6 more minutes a day on average doing moderate or vigorous exercise. 

This adds up to more than 30 minutes more exercise in a week, enough to make a meaningful difference in health, Shuval said. 

While the study focused on a large, nationally representative sample of adults, it was not designed to prove whether or how activity levels and sedentary time influence health. 

It’s possible that income levels contributed to different patterns in activity levels and sedentary time because of the types of jobs people had, with more-affluent individuals more tethered to desks, the researchers note. 

Lower-income people might have gotten more light activity during the week because they did more housework or were on their feet more at their jobs. It is also possible that richer people worked out more outside of their jobs because they could afford gym memberships. 

Wearing the accelerometers might also have changed participants’ exercise habits, producing results that do not reflect what people really do in a typical week, the authors note. 

Regardless of what job people have or how much they earn, there may still be ways to get more exercise and reduce sedentary time, said Hannah Arem, a researcher at the Milken Institute for Public Health at George Washington University in Washington, DC, who was not involved in the study. 

“Strategies to increase physical activity outside of the gym include taking the stairs instead of an elevator and parking farther away or getting off a bus a stop early and walking in cities, through bike share programs and increasing walking and biking infrastructure,” Arem said by e-mail. 

“Some studies have shown that active commuting is associated with a lower risk of cardiovascular disease.” 

Depression is a mental illness that is not taken as seriously as it should be, at least in my home country, India. When one of our highest paid Bollywood actresses confessed to suffering from this ailment, she was ridiculed by all and sundry. It was almost as if, with a successful career like hers, in addition to the enormous wealth and fan-following that she enjoyed, she had no right to feel melancholic. Thankfully, she took the help of medical practitioners and managed to overcome the disorder but there are millions of others, who continue to get neglected. 

We all have mood swings and every female of the species is familiar with it. But feeling irritable, sad or angry occasionally is very different from being in a continuous state of anxiety, unhappiness or emptiness that may lead to attempting or actually committing suicide.

Taking one’s own life or self-annihilation is what the latest Blue Whale Internet game is all about. It exist in several countries and allegedly consists of a series of tasks assigned to players by administrators during a fifty day period, with the final challenge requiring the player to kill oneself. These daily tasks start off easy, such as listening to certain genres of music, waking up at odd hours, watching a horror movie, among others and then slowly escalate to carving out shapes on one’s skin, self-mutilation and eventually suicide.

It is still not clear how a participant plays the game. While some say the user has to install a particular application on their smart phone, others say it is via social media platforms such as Instagram and Facebook that the administrators get in touch with the participant. 

Named after the whales that occasionally beach en masse and die, it originated in Russia in 2013 and supposedly was the cause of a suicide in 2015. Philipp Budeikin, a former psychology student who was expelled from his university, claimed that he invented the game. Budeikin stated that his purpose was to “clean” the society by pushing to suicide those he deemed as having no value.

Right! So why my friends and family should be worried is because the rate of undetected depression, especially among teenagers, is high in our country and mental health is usually disregarded for years. Therefore India ranks among the top ten nations with a high, basal suicide rate and we have to be more vigilant than we normally are, especially when our children are between the gullible ages of ten and nineteen. 

What we can do to prevent it from happening is to look for signs and behavioural changes, especially when our progeny are on their smartphone, tablet or computer. Communication channels between them and us should always be kept open and their time online must be monitored. 

Keeping that in mind, I tried to question my nine-year-old nephew recently. I asked him to name the different kind of fish. 

“Shark, tuna, goldfish, salmon, mackerel, tilapia, trout,” he rattled off. 

“A group of them together is called a school of fish,” he informed me. 

“Have you heard of whales,” I queried. 

“They are huge marine mammals with a blubber of fat,” my nephew said. 

“What is the difference between veil and wail?” I changed the subject. 

“Sounds the same,” he responded. 

“One is a head covering,” I prompted him.

“The other means to cry aloud,” he cut in. 

“You know what the Blue Whale Challenge is?” he asked suddenly. 

“Tell me,” I invited. 

In a step that heralds a new era in cancer treatment, the US Food and Drug Administration (FDA) said on Wednesday it had approved a form of gene therapy that is highly effective at fighting an aggressive form of leukaemia in young patients with no other options.

The treatment, to be marketed under the name Kymriah, is neither a pill nor an injection, but a personalised medicine service that functions as a “living drug”. Patients would have their body’s own disease-fighting T cells fortified and multiplied in a lab, then get the cells back to help them fight their cancer.

In clinical trials of 88 patients with a relapsing or treatment-resistant form of acute lymphoblastic leukaemia, 73 went into remission after receiving the experimental treatment.

FDA Commissioner Scott Gottlieb, himself a survivor of blood cancer, predicted that this new approach to cancer treatment would “change the face of modern medicine”.

Cancer researchers and physicians outside the agency shared Gottlieb’s enthusiasm.

Dr Crystal L. Mackall, associate director of Stanford University’s Cancer Institute, called Kymriah “a transformative therapy. … It represents an entirely new class of cancer therapies that holds promise for all cancer patients”.

Acute lymphoblastic leukaemia is the most common form of paediatric cancer, affecting some 3,000 children and young adults yearly in the United States. Though it is considered highly curable in most patients, about 600 each year either do not respond to chemotherapy or see their leukaemia return after an initial round of successful treatment.

“Those patients don’t make it — none of them do,” said Dr Stephan A. Grupp, director of the cancer immunotherapy programme at Children’s Hospital of Philadelphia, who administered the first course of Kymriah five years ago when it was an experimental treatment called CTL019.

That initial patient, 7-year-old Emily Whitehead of Philipsburg, Pa., saw her leukaemia remit completely within three weeks of getting the treatment. Now 12, she was among those calling on the FDA to approve Kymriah for other patients like her.

“Certainly for blood cancers, this is a game-changer,” Grupp said. Adapting this therapy for patients with solid tumours, he said, will be “the work of the next five years”.

The new approach was designed to fight some of the most stubborn cancers by giving the body’s immune system a very specific assist.

It starts by harvesting a cancer patient’s T cells, the warriors of the immune system. The cells are delivered to a specialised lab where scientists alter their DNA, essentially reprogramming them to target cancer cells. These re-engineered cells are called chimeric antigen receptor T cells, or CAR-T cells.

The new and improved cells are copied millions of times before they’re sent back to the patient. Once infused into the bloodstream, the CAR-T cells are much better equipped to hunt down and kill cancer cells, wherever they may hide.

Novartis, the company that developed Kymriah, intends to have 32 certified treatment centres up and running by the end of 2018. Patients up to the age of 25 would go to one of these centres to have their T cells harvested and later reintroduced in their modified form.

The cells themselves will be genetically engineered at a Novartis manufacturing facility in Morris Plains, New Jersey.

Kymriah is the first CAR-T treatment to come before the FDA, but it won’t be the last. No fewer than 76 CAR-T treatments are currently under review at the FDA, and Gottlieb predicted other approvals would follow.

Therapies that would operate in similar ways — engineering T cells to fight disease more effectively — are under investigation for a host of other conditions, including HIV/AIDS, genetic and autoimmune disorders and other forms of cancer.

“Today’s FDA ruling is a milestone,” said Dr David Maloney, medical director of cellular immunotherapy at Fred Hutchinson Cancer Research Centre in Seattle. “This is just the first of what will soon be many new immunotherapy-based treatments for a variety of cancers.”

Novartis, the Swiss pharmaceutical company that is gearing up to provide Kymriah to as many as 600 patients a year, said it would charge $475,000 for the treatment.

Novartis representatives said they calculated a “cost-effective price” for the therapy that fell between $600,000 and $750,000. But the company chose instead to charge a price that it said would “cover costs”, and to introduce a novel approach to billing. Chief Executive Joseph Jimenez said the company would not charge hospitals for the therapy if the patient did not fully respond in a given period of time.

The company also said it would launch a patient assistance program for those who were uninsured or underinsured, and provide some travel assistance for patients and caregivers seeking the treatment.

Novartis’ application for Kymriah came just seven months ago. The agency tagged the application with two designations that ensured its speedy review.

First proposed in 1972, the idea of correcting or enhancing genes to treat disease has a history buoyed by promise but also buffeted by failures.

In approving Kymriah, the FDA warned it had the potential to cause severe side effects, including cytokine release syndrome, an overreaction to the activation and proliferation of immune cells that causes fever and flu-like symptoms, and neurological events. Both can be life-threatening.

The FDA called for continuing safety studies of the new therapy.

Replacing the outgoing Viano nameplate and re-adopting the V-Class moniker as of 2014, Mercedes-Benz presents the latest generation of highly practical large people carrier that is better than ever, and makes a compelling argument as an alternative to a saloon or SUV. 

With more emphasis on design, luxury and technology, the new V-Class is an evolutionary improvement with noticeably better ride and cabin refinement, and handling ability and agility that was unexpected for a large van-based vehicle. Offered with a single smaller petrol engine in Jordan, the 2-litre turbocharged V250 offers better efficiency than its 3.5-litre V6 Viano predecessor.

A decidedly more charismatic and muscularly assertive design than its predecessor, the V-Class features an interplay between convex and concave shapes and surfaces at the sides and fascia, including more emphasised upper and lower creases along its flanks and smoother, better integrated bumper surfacing. Bearing strong familial resemblance to Mercedes’ passenger car model lines, the V-Class’ large upright grille features a three-dimensional tri-star badge flanked by twin chrome-like louvers and rising, stretched around headlights with a moodier aesthetic and LED elements that seem to frame the grille. A bulging bonnet and single louvre lower side intakes also lend more presence and elegance. 

Cavernous and quick

Driven in the longest Extra Long version of three available lengths, with extended 3200mm wheelbase and longer rear overhang, the V-Class’s features a very subtly descending roofline and low CD0.31 aerodynamics for efficiency and low wind noise. It’s long, tall and wide rear loading bay and body allow for hugely cavernous cargo and passenger space, among the best in the MPV and van segments, and simply unmatched by SUVs or estate cars. At the rear, the new model features smaller, better integrated rear lights than the Viano, a low loading lip, electric tailgate and smaller glass hatch opening for more convenience for loading smaller items.

Offered in most markets with a 2.15-litre turbodiesel engine, the sole petrol V250 variant, available in Jordan, is powered by Mercedes’ now familiar and effective 2-litre turbocharged direct injection four-cylinder. Replacing its Viano predecessor’s 3.5-litre naturally-aspirated V6, the V250 develops 208BHP at 5500rpm and 258lb/ft torque throughout 1200-4000rpm, and is approximately capable of 0-100km/h in 9.4-seconds and a 210km/h top speed. At a 20BHP disadvantage to the Viano yet gaining 4lb/ft, the V250 nevertheless feels the more responsive, suitable engine and certainly more efficient engine, and benefits from a well-sorted and brilliantly geared version of Mercedes’ also familiar 7-speed automatic gearbox, in place of the Viano’s 5-speed.

Lively and
surprisingly agile

With quick-spooling turbo and responsive aggressively geared first and second ratios, the V250 feels sprightly and responsive from standstill, with turbo lag all but seemingly absent when driven in Comfort or Sport gearbox response mode. In Economy mode, revs are kept lower and gears higher, so naturally lag becomes slightly more apparent, but efficiency improves, and also benefits from taller top gears. Brawny, lively and versatile with muscular mid-range pull for inclines, overtaking and hauling, the V250’s engine belies a hefty 2055kg estimated weight, and is smooth, refined and willing to be revved hard to its redline, where engine roar is slightly more evident.

Another significant benefit courtesy of the V250’s downsized engine is that its front end feels noticeably lighter than its predecessor, with a crisper and more eager turn-in than expected from a large MPV, let alone one that is van-based. Tidy into corners with good front grip and little understeer when pushed too aggressively, the V250 Extra long is surprisingly agile through switchbacks, with its front engine and rear drive balance working in its favour. Meanwhile its long wheelbase provides good rear grip, and predictably telegraphed oversteer if provoked by a pivot to tighten a cornering line, or with too much throttle coming out of a corner.

Balance and comfort

Similar to other Mercedes passenger cars, the V250’s electric-assisted rack and pinion steering is positive, precise and eager to self-centre. And with better feel and feedback than some cars and many MPVs, vans and SUVs, the V250’s steering, upright driving position and balanced chassis, one feels involved and in the middle of the action. With a tauter and more rigid and refined feel to its construction and driving dynamic than the Viano, the V250 rides on independent rear suspension with variable dampers that soften to allow for supple ride comfort and tighten for comparably good body lean control through corners and to press wheels tautly into the tarmac.

Stable and refined at speed for its segment, the V250 is, however, in its comfort zone when cruising, while its optional Avantgarde trim 245/45R19 tyres provide a good compromise between control and comfort, and braking is reassuring. Riding well and smooth, the V250 can wallow very slightly over particularly choppy road surfacing, and on heavy braking, there is slight brake dive — both of which were less than expected. With a tight 12.5-metre turning circle, the V250 Extra Long is more manoeuvrable than its size suggests, but given its length and forward driving position, one often needs to turn-in later than intuitive when driving a car.

Manoeuvrable
and configurable

Enormous at 5370mm long, 1928mm wide and 1880mm tall, the V-Class Extra Long is, however, relatively easily manoeuvrable, especially when moving forward. To help with rear visibility, which can be tricky owing to size and height, the V250 Avantgarde version driven featured a 360° and reversing camera parking package. Meanwhile for overtaking and lane-changing manoeuvres, in which lower cars aren’t completely visible in big blind spots and, optional blind spot and lane assistance systems were invaluable. Over shoulder visibility is better when second row seats are configured to be front-facing, while bigger van-like side mirrors would be a welcome addition, even if at the expense of aerodynamics and aesthetics.

Refined, luxurious and superbly comfortable inside, the V250 Avantgarde has a classy and modern ambiance, with a contemporary dashboard, leather upholstery and steering, user-friendly infotainment and convenience features, soft textures, good fit and finish, tinted rear windows, and contemporary car-like dashboard and steering. In terms of practicality, the luxurious Avantgarde version features plenty of storage spaces and two — rather than one — huge electric and remote operable sliding doors to easily access the rear two seat rows. Accommodating 8-passengers with two rear bench seats, the 7-seat Avantgarde, however, featured twin middle row captain’s seats and a table unit, all of which are detachable and configurable along twin long flush rails.

TECHNICAL SPECIFICATIONS

Engine: 2-litre, turbocharged, in-line 4-cylinders

Bore x stroke: 83.1 x 91.9mm

Compression ratio: 9.8:1

Valve-train: 16-valve, DOHC, direct injection

Gearbox: 7-speed automatic, rear-wheel-drive

Power, BHP (PS) [kW]: 208 (211) [155] @5500rpm

Specific power: 104.5BHP/litre

Torque, lb/ft (Nm): 258 (350) @ 1200-4000rpm

Specific torque: 175.8Nm/litre

0-100km/h: 9.4-seconds

Maximum speed: 210km/h

Fuel tank: 70-litres

Length: 5370mm

Width: 1928mm

Height: 1880mm

Wheelbase: 3200mm

Track, F/R: 1666/1646mm

Overhang, F/R: 895/1045mm

Aerodynamic drag co-efficiency: 0.31

Unladen weight: 2055kg (estimate)

Steering: Electric-assisted, rack and pinion

Turning circle: 12.5-metres

Suspension F/R: MacPherson struts/semi-trailing arms, coil springs, anti-roll bars, variable damping

Brakes: Ventilated discs

Tyres: 245/45R19