TOI Social Impact Awards: An ambulance in time saves lives

MUMBAI: Its 868 ambulances have helped save almost 20 lakh Indians in five states over the last seven years. But these numbers don't quite capture how a small company started by five friends has brought about big changes in India's healthscape.

Before Ziqitza Health Care started its 'Dial 1298 for an Ambulance' service in Mumbai in 2005, it was difficult to imagine a self-sustaining revenue model in emergency medical services (EMS). As the number of EMS providers multiplied , Ziqitza moved the courts to bring transparency into the sector. When they found a southern state offering its emergency medical services to a firm without calling for tenders, they took the matter to the Supreme Court. "Now every state follows the rules," says Shaffi Mather who, along with Ravi Krishna, Sweta Mangal, Naresh Jain and Manish Sacheti, returned from the US to start the company.

They also changed the peculiar Indian habit of using ambulances as hearse vehicles. "In India, ambulances were used to carry dead bodies . We refused to allow that. Ambulances are meant to help lives," says Krishna. Ziqitza's ambulances have often doubled as labour rooms, given the poor state of healthcare in remote areas. More than 6,000 babies have been delivered in their ambulances."Recently, our paramedics in Rajasthan delivered a breech baby in their ambulance," says Sweta Mangal.

The firm has carved out three business models to meet the growing requirement for ambulances. The first is Dial 1298, Ziqitza's private enterprise that charges people for the ambulance (BPL card holders can pay 50% of the fee). The second is Dial 108 in states where the government provides ambulances and money for the service. The third is an outsourcing model for hospitals.

Ziqitza — a combination of jigyasa (quest for knowledge) and chikitsa (medical aid) — was born out of personal crises. Mather didn't know whom to call in Kochi when his mother started choking in her sleep at midnight over seven years back. A few days later, Krishna's mother collapsed in the US but she was taken to hospital within a few minutes. "This contrast made us realize we needed to do something about ambulances back in India," recalls Krishna. Instead of taking the NGO route, they opted for a self-sustaining business model. It has been appreciated, with INSEAD and Harvard Business School writing about them.

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Lilly drug chosen for Alzheimer's prevention study


Researchers have chosen an experimental drug by Eli Lilly & Co. for a large federally funded study testing whether it's possible to prevent Alzheimer's disease in older people at high risk of developing it.


The drug, called solanezumab (sol-ah-NAYZ-uh-mab), is designed to bind to and help clear the sticky deposits that clog patients' brains.


Earlier studies found it did not help people with moderate to severe Alzheimer's but it showed some promise against milder disease. Researchers think it might work better if given before symptoms start.


"The hope is we can catch people before they decline," which can come 10 years or more after plaques first show up in the brain, said Dr. Reisa Sperling, director of the Alzheimer's center at Brigham and Women's Hospital in Boston.


She will help lead the new study, which will involve 1,000 people ages 70 to 85 whose brain scans show plaque buildup but who do not yet have any symptoms of dementia. They will get monthly infusions of solanezumab or a dummy drug for three years. The main goal will be slowing the rate of cognitive decline. The study will be done at 50 sites in the U.S. and possibly more in Canada, Australia and Europe, Sperling said.


In October, researchers said combined results from two studies of solanezumab suggested it might modestly slow mental decline, especially in patients with mild disease. Taken separately, the studies missed their main goals of significantly slowing the mind-robbing disease or improving activities of daily living.


Those results were not considered good enough to win the drug approval. So in December, Lilly said it would start another large study of it this year to try to confirm the hopeful results seen patients with mild disease. That is separate from the federal study Sperling will head.


About 35 million people worldwide have dementia, and Alzheimer's is the most common type. In the U.S., about 5 million have Alzheimer's. Current medicines such as Aricept and Namenda just temporarily ease symptoms. There is no known cure.


___


Online:


Alzheimer's info: http://www.alzheimers.gov


Alzheimer's Association: http://www.alz.org


___


Follow Marilynn Marchione's coverage at http://twitter.com/MMarchioneAP


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Algeria Hostage Crisis Over, One American Dead













After the Algerian military's final assault on terrorists holding hostages at a gas complex, the four-day hostage crisis is over, but apparently with additional loss of life among the foreign hostages.


One American, Fred Buttaccio of Texas, has been confirmed dead by the U.S. State Department. Two more U.S. hostages remain unaccounted for, with growing concern among U.S. officials that they did not survive.


But another American, Mark Cobb of Corpus Christi, Texas is now confirmed as safe. Sources close to his family say Cobb, who is a senior manager of the facility, is safe and reportedly sent a text message " I'm alive."










Inside Algerian Hostage Crisis, One American Dead Watch Video









American Hostages Escape From Algeria Terrorists Watch Video





In a statement, President Obama said, "Today, the thoughts and prayers of the American people are with the families of all those who were killed and injured in the terrorist attack in Algeria. The blame for this tragedy rests with the terrorists who carried it out, and the United States condemns their actions in the strongest possible terms. ... This attack is another reminder of the threat posed by al Qaeda and other violent extremist groups in North Africa."


According to Algerian state media, 32 militants are dead and a total of 23 hostages perished during the four-day siege of the In Amenas facility in the Sahara. The Algerian Interior Ministry also says 107 foreign nationals who worked at the facility for BP and other firms were rescued or escaped from the al Qaeda-linked terrorists who took over the BP joint venture facility on Wednesday.


The Japanese government says it fears "very grave" news, with multiple casualties among the 10 Japanese citizens working at the In Amenas gas plant.


Five British nationals and one U.K. resident are either deceased or unaccounted for in the country, according to British Foreign Minister William Hague. Hague also said that the Algerians have reported that they are still trying to clear boobytraps from the site.




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Foreigners still trapped in Sahara hostage crisis


ALGIERS/IN AMENAS, Algeria (Reuters) - More than 20 foreigners were captive or missing inside a desert gas plant on Saturday, nearly two days after the Algerian army launched an assault to free them that saw many hostages killed.


The standoff between the Algerian army and al Qaeda-linked gunmen - one of the biggest international hostage crises in decades - entered its fourth day, having thrust Saharan militancy to the top of the global agenda.


The number and fate of victims has yet to be confirmed, with the Algerian government keeping officials from Western countries far from the site where their countrymen were in peril.


Reports put the number of hostages killed at between 12 to 30, with possibly dozens of foreigners still unaccounted for - among them Norwegians, Japanese, Britons, Americans and others.


State Department spokeswoman Victoria Nuland confirmed on Friday the death of one American, Frederick Buttaccio, in the hostage situation, but gave no further details.


Two Japanese, two Britons and a French national were among the seven foreigners confirmed dead in the army's storming, the Algerian security source told Reuters. One British citizen was killed when the gunmen seized the hostages on Wednesday.


A U.S. official said on Friday that a U.S. Medevac flight carrying wounded of multiple nationalities had left Algeria.


By nightfall on Friday, the Algerian military was holding the vast residential barracks at the In Amenas gas processing plant, while gunmen were holed up in the industrial plant itself with an undisclosed number of hostages.


Scores of Westerners and hundreds of Algerian workers were inside the heavily fortified compound when it was seized before dawn on Wednesday by Islamist fighters who said they wanted a halt to a French military operation in neighboring Mali.


Hundreds escaped on Thursday when the army launched an operation, but many hostages were killed in the assault. Algerian forces destroyed four trucks holding hostages, according to the family of a Northern Irish engineer who escaped from a fifth truck and survived.


Leaders of Britain, Japan and other countries have expressed frustration that the assault was ordered without consultation and officials have grumbled at the lack of information. Many countries also withheld details about their missing citizens to avoid releasing information that might aid the captors.


An Algerian security source said 30 hostages, including at least seven Westerners, had been killed during Thursday's assault, along with at least 18 of their captors. Eight of the dead hostages were Algerian, with the nationalities of the rest of the dead still unclear, he said.


Algeria's state news agency APS put the total number of dead hostages at 12, including both foreigners and locals.


The base was home to foreign workers from Britain's BP, Norway's Statoil and Japanese engineering firm JGC Corp and others.


Norway says eight Norwegians are still missing. JGC said it was missing 10 staff. Britain and the United States have said they have citizens unaccounted for but have not said how many.


The Algerian security source said 100 foreigners had been freed but 32 were still unaccounted for.


"We must be prepared for bad news this weekend but we still have hope," Norwegian Prime Minister Jens Stoltenberg said.


The attack has plunged international capitals into crisis mode and is a serious escalation of unrest in northwestern Africa, where French forces have been in Mali since last week fighting an Islamist takeover of Timbuktu and other towns.


"We are still dealing with a fluid and dangerous situation where a part of the terrorist threat has been eliminated in one part of the site, but there still remains a threat in another part," British Prime Minister David Cameron told his parliament.


"(The army) is still trying to achieve a ‘peaceful outcome' before neutralizing the terrorist group that is holed up in the (facility) and freeing a group of hostages that is still being held," Algeria's state news agency said on Friday, quoting a security source.


MULTINATIONAL INSURGENCY


Algerian commanders said they moved in on Thursday about 30 hours after the siege began, because the gunmen had demanded to be allowed to take their captives abroad.


A French hostage employed by a French catering company said he had hidden in his room for 40 hours under the bed before he was rescued by Algerian troops, relying on Algerian employees to smuggle him food with a password.


"I put boards up pretty much all round," Alexandre Berceaux told Europe 1 radio. "I didn't know how long I was going to stay there ... I was afraid. I could see myself already ending up in a pine box."


The captors said their attack was a response to the French military offensive in neighboring Mali. However, some U.S. and European officials say the elaborate raid probably required too much planning to have been organized from scratch in the single week since France first launched its strikes.


Paris says the incident proves its decision to fight Islamists in neighboring Mali was necessary.


Security in the half-dozen countries around the Sahara desert has long been a preoccupation of the West. Smugglers and militants have earned millions in ransom from kidnappings.


The most powerful Islamist groups operating in the Sahara were severely weakened by Algeria's secularist military in a civil war in the 1990s. But in the past two years the regional wing of Al Qaeda gained fighters and arms as a result of the civil war in Libya, when arsenals were looted from Muammar Gaddafi's army.


Al Qaeda-linked fighters, many with roots in Algeria and Libya, took control of northern Mali last year, prompting the French intervention in that poor African former colony.


The apparent ease with which the fighters swooped in from the dunes to take control of an important energy facility, which produces some 10 percent of the natural gas on which Algeria depends for its export income, has raised questions over the value of outwardly tough Algerian security measures.


Algerian officials said the attackers may have had inside help from among the hundreds of Algerians employed at the site.


U.S. Defense Secretary Leon Panetta said those responsible would be hunted down: "Terrorists should be on notice that they will find no sanctuary, no refuge, not in Algeria, not in North Africa, not anywhere. ... Those who would wantonly attack our country and our people will have no place to hide."


(Additional reporting by Ali Abdelatti in Cairo, Eamonn Mallie in Belfast, Gwladys Fouche in Oslo, Mohammed Abbas in London, Padraic Halpin and Conor Humphries in Dublin, Andrew Quinn and David Alexander in Washington; Writing by Philippa Fletcher and Peter Graff; Editing by Andrew Roche, Tom Pfeiffer and Jackie Frank)



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Cycling: 'I want to compete again,' Armstrong says

 





LOS ANGELES: Disgraced US cyclist Lance Armstrong said in an interview aired Friday that he wants to take part in competitive sports again, even after being banned for doping and stripped of his honors.

"Hell, yes. I'm a competitor. It's what I've done my whole life. I love to train. I love to race," Armstrong told Oprah Winfrey. "Not the Tour de France, but there's a lot of other things I could do. I deserve to be punished. I'm not sure that I deserve a death penalty."

- AFP




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Indo-Pak LoC tension puts Gujarat farmers in a soup

AHMEDABAD: The heat on the Indo-Pak border has squashed tomato prices in Gujarat. Farmers in Kadi, about 40 km north of here, say if trade with the neighbouring nation does not normalize, they will land up in a... what else, tomato soup!

Prices of tomatoes in the wholesale markets in Ahmedabad have plummeted from around Rs 300/20 kg on Saturday to Rs 80/20 kg on Thursday. The corresponding fall in the retail market is only from Rs 20/kg to Rs 15/kg so far, as traders are holding on to stocks or diverting them elsewhere. During the four winter months, farmers in and around Ahmedabad and Gandhinagar usually produce about 5,000 tonnes of tomatoes. Of this, around 600 tonnes go to Punjab and most of it crosses over to Pakistan. On an average, 40 trucks laden with tomatoes leave Kadi every day for Punjab. The outflow from Kadi, which produces 600 tonnes of tomatoes, has come down to just 10 trucks a day, since the border dispute erupted last week. Asif Darbar, a trader from Kadi, said, "Traders from Punjab come to Kadi frequently to purchase tomatoes due to superior quality, but they have stopped coming." Punjabis have also gone missing from the Jamalpur agri-market in Ahmedabad.

But while tomato farmers are left red-faced with war-mongering on both sides, there is good news for consumers. "Export quality tomatoes are grown over 2,000 hectares in Gujarat and the local variety is popular as it is big in size," said DM Vaghela, deputy director, horticulture, Ahmedabad.

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Lilly drug chosen for Alzheimer's prevention study


Researchers have chosen an experimental drug by Eli Lilly & Co. for a large federally funded study testing whether it's possible to prevent Alzheimer's disease in older people at high risk of developing it.


The drug, called solanezumab (sol-ah-NAYZ-uh-mab), is designed to bind to and help clear the sticky deposits that clog patients' brains.


Earlier studies found it did not help people with moderate to severe Alzheimer's but it showed some promise against milder disease. Researchers think it might work better if given before symptoms start.


"The hope is we can catch people before they decline," which can come 10 years or more after plaques first show up in the brain, said Dr. Reisa Sperling, director of the Alzheimer's center at Brigham and Women's Hospital in Boston.


She will help lead the new study, which will involve 1,000 people ages 70 to 85 whose brain scans show plaque buildup but who do not yet have any symptoms of dementia. They will get monthly infusions of solanezumab or a dummy drug for three years. The main goal will be slowing the rate of cognitive decline. The study will be done at 50 sites in the U.S. and possibly more in Canada, Australia and Europe, Sperling said.


In October, researchers said combined results from two studies of solanezumab suggested it might modestly slow mental decline, especially in patients with mild disease. Taken separately, the studies missed their main goals of significantly slowing the mind-robbing disease or improving activities of daily living.


Those results were not considered good enough to win the drug approval. So in December, Lilly said it would start another large study of it this year to try to confirm the hopeful results seen patients with mild disease. That is separate from the federal study Sperling will head.


About 35 million people worldwide have dementia, and Alzheimer's is the most common type. In the U.S., about 5 million have Alzheimer's. Current medicines such as Aricept and Namenda just temporarily ease symptoms. There is no known cure.


___


Online:


Alzheimer's info: http://www.alzheimers.gov


Alzheimer's Association: http://www.alz.org


___


Follow Marilynn Marchione's coverage at http://twitter.com/MMarchioneAP


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Armstrong's Lowest Point Was Quitting Livestrong













Lance Armstrong, 41, said tonight that the lowest point in his fall from grace and the top of the cycling world came when his cancer charity, Livestrong, asked him to consider stepping down.


After the U.S. Anti-Doping Agency released a report in October 2012 alleging Armstrong doped throughout his reign as Tour de France champion, Armstrong said a second installment of an interview with Oprah Winfrey, his major sponsors -- including Nike, Anheuser Busch and Trek -- called one by one to end their endorsement contracts with him.


"Everybody out," he said. "Still not the most humbling moment."


Then came the call from Livestrong, the charity he founded at age 25 when he was diagnosed with testicular cancer.


"The story was getting out of control, which was my worst nightmare," he said. "I had this place in my mind that they would all leave. The one I didn't think would leave was the foundation.


"That was most humbling moment," he said.


Armstrong first stepped down as chairman of the board for the charity before being asked to end his association with the charity entirely. Livestrong is now run independently of Armstrong.


"I don't think it was 'We need you to step down,' but, 'We need you to consider stepping down for yourself,'" he said, recounting the call. "I had to think about that a lot. None of my kids, none of my friends have said, 'You're out,' and the foundation was like my sixth child. To make that decision, to step aside, that was big."






George Burns/Harpo Studios, Inc.











Lance Armstrong-Winfrey Interview: How Honest Was He? Watch Video









Lance Armstrong-Winfrey Interview: Doping Confession Watch Video







In the first part of the interview, broadcast Thursday, Armstrong admitted for the first time that his decade-long dominance of cycling and seven wins in the Tour de France were owed, in part, to performance-enhancing drugs and oxygen-boosting blood transfusions.


He told Winfrey that he was taking the opportunity to confess to everything he had done wrong, including for years angrily denying claims that he had doped.


READ MORE: Armstrong Admits to Doping


WATCH: Armstrong's Many Denials Caught on Tape


READ MORE: 10 Scandalous Public Confessions


Armstrong said in the interview that he stopped doping following his 2005 Tour de France victory and did not use banned substances when he placed third in 2009 and entered the tour again in 2010.


Investigators familiar with Armstrong's case, however, told ABC News today that Armstrong did not come completely clean to Winfrey, and that they believed he doped in 2009.


They said that Armstrong's blood values at the 2009 race showed clear blood manipulation consistent with two transfusions. Armstrong's red blood cell count suddenly went up at these points, even though the number of baby red blood cells did not.


Investigators said that was proof that he received a transfusion of mature red blood cells.


READ MORE: Lance Armstrong May Have Lied to Winfrey: Investigators


If Armstrong lied about the 2009 race, it could be to protect himself criminally, investigators said.


Federal authorities looking to prosecute criminal cases will look back at the "last overt act" in which the crime was committed, they explained. If Armstrong doped in 2005 but not 2009, the statute of limitations may have expired on potential criminal activity.


The sources noted that there is no evidence right now that a criminal investigation will be reopened. Armstrong is facing at least three civil suits.






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Algeria ends desert siege, but dozens killed


ALGIERS (Reuters) - Algerian forces stormed a desert gas complex to free hundreds of hostages but 30, including several Westerners, were killed in the assault along with at least 11 of their Islamist captors, an Algerian security source told Reuters.


Western leaders whose compatriots were being held did little to disguise their irritation at being kept in the dark by Algeria before the raid - and over its bloody outcome. French, British and Japanese staff were among the dead, the source said.


An Irish engineer who survived said he saw four jeeps full of hostages blown up by Algerian troops whose commanders said they moved in about 30 hours after the siege began because the gunmen had demanded to be allowed to take their captives abroad.


And while a crisis has ended that posed a serious dilemma for Paris and its allies as French troops attacked the hostage-takers' al Qaeda allies in neighboring Mali, it left question marks over the ability of OPEC-member Algeria to protect vital energy resources and strained its relations with Western powers.


Two Japanese, two Britons and a French national were among at least seven foreigners killed, the source told Reuters. Eight dead hostages were Algerian. The nationalities of the rest, as well as of perhaps dozens more who escaped, were unclear. Some 600 local Algerian workers, less well guarded, survived.


Fourteen Japanese were among those still unaccounted for by the early hours of Friday, their Japanese employer said.


Americans, Norwegians, Romanians and an Austrian have also been mentioned by their governments as having been captured by the militants who called themselves the "Battalion of Blood" and had demanded France end its week-old offensive in Mali.


Underlining the view of African and Western leaders that they face a multinational Islamist insurgency across the Sahara - a conflict that prompted France to send hundreds of troops to Mali last week - the official source said only two of the 11 dead militants were Algerian, including the squad's leader.


The bodies of three Egyptians, two Tunisians, two Libyans, a Malian and a Frenchman were found, the security source said.


The group had claimed to have dozens of guerrillas on site and it was unclear whether any militants had managed to escape.


The overall commander, Algerian officials said, was Mokhtar Belmokhtar, a veteran of Afghanistan in the 1980s and Algeria's bloody civil war of the 1990s. He appears not to have been present and has now risen in stature among a host of Saharan Islamists, flush with arms and fighters from chaotic Libya, whom Western powers fear could spread violence far beyond the desert.


"NO TO BLACKMAIL"


Algeria's government spokesman made clear the leadership in Algiers remains implacably at odds with Islamist guerrillas who remain at large in the south years after the civil war in which some 200,000 people died. Communication Minister Mohamed Said repeated their refusal ever to negotiate with hostage-takers.


"We say that in the face of terrorism, yesterday as today as tomorrow, there will be no negotiation, no blackmail, no respite in the struggle against terrorism," he told APS news agency.


British Prime Minister David Cameron, who warned people to prepare for bad news and who canceled a major policy speech on Friday to deal with the situation, said through a spokesman that he would have liked Algeria to have consulted before the raid.


A Briton and an Algerian had also been killed on Wednesday.


The prime minister of Norway, whose state energy company Statoil runs the Tigantourine gas field with Britain's BP and Algeria's national oil company, said he too was not informed.


U.S. officials had no clear information on the fate of Americans, though a U.S. military drone had flown over the area. Washington, like its European allies, has endorsed France's move to protect the Malian capital by mounting air strikes last week and now sending 1,400 ground troops to attack Islamist rebels.


A U.S. official said on Thursday it would provide transport aircraft to help France with a mission whose vital importance, President Francois Hollande said, was demonstrated by the attack in Algeria. Some fear, however, that going on the offensive in the remote region could provoke more bloodshed closer to home.


The apparent ease with which the fighters swooped in from the dunes to take control of an important energy facility, which produces some 10 percent of the natural gas on which Algeria depends for its export income, has raised questions, over the value of security measures that are outwardly draconian.


Foreign firms were pulling non-essential staff out of the country, which has recovered stability only in recent years and whose ruling establishment, heirs to fighters who ended French rule 50 years ago, has resisted demands for reform and political freedoms of the kind that swept North Africa in the Arab Spring.


"The embarrassment for the government is great," said Azzedine Layachi, an Algerian political scientist at New York's St John's University. "The heart of Algeria's economy is in the south. where the oil and gas fields are. For this group to have attacked there, in spite of tremendous security, is remarkable."


"KILL INFIDELS"


A local man who had escaped from the facility told Reuters the militants appeared to have inside knowledge of the layout of the complex, supporting the view of security experts that their raid was long-planned, even if the Mali war provided a motive.


"The terrorists told us at the very start that they would not hurt Muslims but were only interested in the Christians and infidels," Abdelkader, 53, said by telephone from his home in the nearby town of In Amenas. "'We will kill them,' they said."


Algiers, whose leaders have long had frosty relations with the former colonial power France and other Western countries, may have some explaining to do over its tactics in putting an end to a hostage crisis whose scale was comparable to few in recent decades bar those involving Chechen militants in Russia.


Government spokesman Said sounded unapologetic, however: "When the terrorist group insisted on leaving the facility, taking the foreign hostages with them to neighboring states, the order was issued to special units to attack the position where the terrorists were entrenched," he told state news agency APS, which said some 600 local workers were freed.


The militants said earlier they had 41 foreign hostages.


"ARMY BLASTED HOSTAGES"


Stephen McFaul, an electrical engineer, told his family in Northern Ireland after the operation that he narrowly escaped death, first when bound and gagged by the gunmen who fastened explosives around the hostages' necks and then on Thursday when he was in a convoy of five vehicles driving across the complex.


"(The gunmen) were moving five jeeploads of hostages from one part of the compound," his brother Brian McFaul said. "At that stage, they were intercepted by the Algerian army.


"The army bombed four out of five of the trucks and four of them were destroyed ... He presumed everyone else in the other trucks was killed ... The truck my brother was in crashed and at that stage Stephen was able to make a break for his freedom."


McFaul said it was unclear whether the vehicles had been struck by missiles fired from helicopters or by ground forces.


The attack in Algeria did not stop France from pressing on with its campaign in Mali. It said on Thursday it now had 1,400 troops on the ground there, and combat was under way against the rebels that it first began targeting from the air last week.


"What is happening in Algeria justifies all the more the decision I made in the name of France to intervene in Mali in line with the U.N. charter," Hollande said on Thursday.


The French action last week came as a surprise but received widespread public international support. Neighboring African countries planning to provide ground troops for a U.N. force by September have said they will move faster to deploy them.


(Additional reporting by Ali Abdelatti in Cairo, Eamonn Mallie in Belfast, Gwladys Fouche in Oslo, Mohammed Abbas in London and Padraic Halpin and Conor Humprhies in Dublin; Writing by Alastair Macdonald; Editing by Peter Millership)



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Cycling: "One big lie" Armstrong says of 7 drug-fuelled Tours






LOS ANGELES: Lance Armstrong admitted his seven Tour de France titles were fuelled by an array of drugs, reversing years of denials in a televised interview with Oprah Winfrey broadcast Thursday.

Attempting to explain his drug-tainted past, Armstrong sat down with Winfrey for his first interview since being stripped last year of his record seven Tour titles and banned from sport for life.

It was recorded on Monday in Austin, Texas, and was to be aired in two segments on Thursday and Friday on Winfrey's OWN television channel.

"I know the truth. The truth isn't what was out there, the truth isn't what I said... This story was so perfect for so long... you overcome the disease, you win the Tour de France seven times, you have a happy marriage, you have children. I mean, it's just this mythic, perfect story," Armstrong said.

"And it wasn't true."

In an opening series of "yes" or "no" questions, Armstrong admitted using blood-boosting EPO, blood doping transfusions and testosterone or human growth hormone.

Armstrong told Winfrey he didn't believe it was possible to win the Tour in the years he raced without doping, and challenged the characterisation of the doping program on his US Postal Service team as the most sophisticated ever.

Hours before the kickoff, Armstrong saw another accolade withdrawn as the International Olympic Committee said it had asked him to return the cycling time-trial bronze medal he won in 2000.

The International Cycling Union last year upheld the US Anti-Doping Agency's ban of Armstrong, and the revocation of his cycling results from August 1998, but the IOC waited for three weeks to see if Armstrong planned an appeal.

While Winfrey confirmed on Tuesday reports that Armstrong had admitted using banned performance enhancers in their talk, little else was known of what he would reveal.

Speculation swirled as to whether he had implicated others -- notably members of the sport's world governing body -- amid allegations of complicity and cover-up.

The difficulty of untangling the doping web in cycling was again clear when the IOC's move recalled the 2000 Olympic time-trial medallists.

Abraham Olano of Spain, who was fourth, could inherit the bronze after finishing fourth in a race won by Armstrong's ex-US Post Service team-mate Viasheslav Ekimov, with Germany's Jan Ullrich taking silver.

Ekimov is now general manager of the Katusha cycling team that were dropped from the elite ProTeam list for this season because of their ambivalent stance on doping, and Ullrich eventually served a two-year ban for doping.

Some have speculated that Armstrong might attempt to rationalize doping as standard procedure in the years of his cycling career.

Certainly his admission, and his choice of the famously sympathetic Winfrey as confessor, are an about face after years of aggressive denials and often vitriolic attacks on those who doubted him.

"No one could have imagined only a few weeks ago that Lance Armstrong would make his confession publicly, that he would confess in public to having been doped," Tour de France director Christian Prudhomme told reporters in Paris.

"It's obviously something very important but I can't say more than that ... For us, Lance Armstrong is already in the past."

This week's exercise, however, is about the future, with Armstrong reportedly seeking a way back into sports and those in cycling wondering just who will be implicated in his revelations.

-AFP/fl



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