AP IMPACT: Big Pharma cashes in on HGH abuse

A federal crackdown on illicit foreign supplies of human growth hormone has failed to stop rampant misuse, and instead has driven record sales of the drug by some of the world's biggest pharmaceutical companies, an Associated Press investigation shows.

The crackdown, which began in 2006, reduced the illegal flow of unregulated supplies from China, India and Mexico.

But since then, Big Pharma has been satisfying the steady desires of U.S. users and abusers, including many who take the drug in the false hope of delaying the effects of aging.

From 2005 to 2011, inflation-adjusted sales of HGH were up 69 percent, according to an AP analysis of pharmaceutical company data collected by the research firm IMS Health. Sales of the average prescription drug rose just 12 percent in that same period.

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EDITOR'S NOTE — Whether for athletics or age, Americans from teenagers to baby boomers are trying to get an edge by illegally using anabolic steroids and human growth hormone, despite well-documented risks. This is the second of a two-part series.

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Unlike other prescription drugs, HGH may be prescribed only for specific uses. U.S. sales are limited by law to treat a rare growth defect in children and a handful of uncommon conditions like short bowel syndrome or Prader-Willi syndrome, a congenital disease that causes reduced muscle tone and a lack of hormones in sex glands.

The AP analysis, supplemented by interviews with experts, shows too many sales and too many prescriptions for the number of people known to be suffering from those ailments. At least half of last year's sales likely went to patients not legally allowed to get the drug. And U.S. pharmacies processed nearly double the expected number of prescriptions.

Peddled as an elixir of life capable of turning middle-aged bodies into lean machines, HGH — a synthesized form of the growth hormone made naturally by the human pituitary gland — winds up in the eager hands of affluent, aging users who hope to slow or even reverse the aging process.

Experts say these folks don't need the drug, and may be harmed by it. The supposed fountain-of-youth medicine can cause enlargement of breast tissue, carpal tunnel syndrome and swelling of hands and feet. Ironically, it also can contribute to aging ailments like heart disease and Type 2 diabetes.

Others in the medical establishment also are taking a fat piece of the profits — doctors who fudge prescriptions, as well as pharmacists and distributors who are content to look the other way. HGH also is sold directly without prescriptions, as new-age snake oil, to patients at anti-aging clinics that operate more like automated drug mills.

Years of raids, sports scandals and media attention haven't stopped major drugmakers from selling a whopping $1.4 billion worth of HGH in the U.S. last year. That's more than industry-wide annual gross sales for penicillin or prescription allergy medicine. Anti-aging HGH regimens vary greatly, with a yearly cost typically ranging from $6,000 to $12,000 for three to six self-injections per week.

Across the U.S., the medication is often dispensed through prescriptions based on improper diagnoses, carefully crafted to exploit wiggle room in the law restricting use of HGH, the AP found.

HGH is often promoted on the Internet with the same kind of before-and-after photos found in miracle diet ads, along with wildly hyped claims of rapid muscle growth, loss of fat, greater vigor, and other exaggerated benefits to adults far beyond their physical prime. Sales also are driven by the personal endorsement of celebrities such as actress Suzanne Somers.

Pharmacies that once risked prosecution for using unauthorized, foreign HGH — improperly labeled as raw pharmaceutical ingredients and smuggled across the border — now simply dispense name brands, often for the same banned uses. And usually with impunity.

Eight companies have been granted permission to market HGH by the U.S. Food and Drug Administration, which reviews the benefits and risks of new drug products. By contrast, three companies are approved for the diabetes drug insulin.

The No. 1 maker, Roche subsidiary Genentech, had nearly $400 million in HGH sales in the U.S. last year, up an inflation-adjusted two-thirds from 2005. Pfizer and Eli Lilly were second and third with $300 million and $220 million in sales, respectively, according to IMS Health. Pfizer now gets more revenue from its HGH brand, Genotropin, than from Zoloft, its well-known depression medicine that lost patent protection.

On their face, the numbers make no sense to the recognized hormone doctors known as endocrinologists who provide legitimate HGH treatment to a small number of patients.

Endocrinologists estimate there are fewer than 45,000 U.S. patients who might legitimately take HGH. They would be expected to use roughly 180,000 prescriptions or refills each year, given that typical patients get three months' worth of HGH at a time, according to doctors and distributors.

Yet U.S. pharmacies last year supplied almost twice that much HGH — 340,000 orders — according to AP's analysis of IMS Health data.

While doctors say more than 90 percent of legitimate patients are children with stunted growth, 40 percent of 442 U.S. side-effect cases tied to HGH over the last year involved people age 18 or older, according to an AP analysis of FDA data. The average adult's age in those cases was 53, far beyond the prime age for sports. The oldest patients were in their 80s.

Some of these medical records even give explicit hints of use to combat aging, justifying treatment with reasons like fatigue, bone thinning and "off-label," which means treatment of an unapproved condition. In other cases, the drug was used "for an unknown indication," meaning that the reason for treatment wasn't clear.

Even Medicare, the government health program for older Americans, allowed 22,169 HGH prescriptions in 2010, a five-year increase of 78 percent, according to data released by the Centers for Medicare and Medicaid Services in response to an AP public records request. And nearly half the increase came in one year: 2007.

"There's no question: a lot gets out," said hormone specialist Dr. Mark Molitch of Northwestern University, who helped write medical standards meant to limit HGH treatment to legitimate patients.

And those figures don't include HGH sold directly by doctors without prescriptions at scores of anti-aging medical practices and clinics around the country. Those numbers could only be tallied by drug makers, who have declined to say how many patients they supply and for what conditions.

The AP approached every U.S.-authorized manufacturer to ask what efforts they make to market responsibly and prevent abuse. Only one HGH supplier, Novo Nordisk, agreed to an interview.

"We're doing our level best to make sure that the right patients are getting the right medicine at the right time," said company spokesman Ken Inchausti.

He said the company is aware of the abuse issue. He said if patients apply for assistance from the company's patient-support hub, prescriptions will be flagged for review if they are missing the most rigorous test or an endocrinologist's signature. He said the company won't sell HGH directly to doctors accused of bad practices and does not deal with anti-aging clinics.

Representatives of other FDA-approved HGH makers insist they do not encourage use by bodybuilders or athletes or wealthy baby boomers trying to recapture their youth. But some said they are largely powerless to control who uses their medications or why.

"Lilly cannot restrict the actions of distributors, pharmacies or doctors," Eli Lilly spokeswoman Kelley Murphy said in a written statement.

That argument doesn't fly for critics like Dr. Peter Rost, a retired Pfizer executive who filed a whistleblower lawsuit over the HGH marketing practices of Pharmacia, which later merged with Pfizer. He said drug companies are simply looking the other way and betting that their profits will eclipse the cost of any fines.

They view it as "good business," he said.

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PEDDLED ON INTERNET

Type "human growth hormone" into any Internet search engine, and it will spit back countless websites with overblown promises of smoother skin, better sex, weight loss and even renewed body organs.

Any doctor who actually prescribes the drug for those purposes is taking a legal risk.

FDA regulations ban the sale of HGH as an anti-aging drug. In fact, since 1990, prescribing it for things like weight loss and strength conditioning has been punishable by 5 to 10 years in prison.

Such marketing claims are routinely made at hormone clinics like Palm Beach Life Extension, whose owners are among 13 people now awaiting trial on federal charges in Florida in a steroids and HGH distribution case brought last year.

"Grow YOUNG with Us!" screamed a banner on the company's now-defunct website, which advertised that HGH can reduce body fat, improve vision, strengthen the immune system, aid kidney function, lower blood pressure and enhance memory and mood.

The clinic arranged to have its clients' prescriptions filled at Treasure Coast Pharmacy, in Jensen Beach, Fla.

In 2009, the FBI recorded a phone call between the pharmacy's owner, Peter Del Toro, and a doctor in Elkton, Md., who was cooperating with agents after being implicated in a related steroid-distribution case.

Their talk, documented in a court filing, illustrates how things often work in the networks of pharmacies and clinics that drive HGH sales.

Patients submitted a medical history form by mail and took a blood test. But in most instances, the indictment said, the evaluation was a sham: One doctor was charged with giving a clinic a pad of blank, signed prescriptions to save him the chore of signing off on each diagnosis. He got $50 for every drug order bearing his name, the indictment said.

Dr. Rodney Baltazar, the Maryland physician cooperating with the FBI, sometimes consulted briefly with patients via webcam. But he made it clear in the call that those evaluations were perfunctory at best.

Baltazar was a gynecologist, not an endocrinologist. He said he knew "a little bit" about HGH and testosterone, which are often prescribed in tandem, but he relied largely on clinic salespeople to set doses.

The pharmacist coached the doctor: Keep detailed medical charts documenting that patients are taking the drug for at least some kind of health problem, just in case the U.S. Drug Enforcement Administration ever came calling.

"Because somebody questions you, you want to be able to say, 'Here, look at his chart. You know, he's got fatigue. He's got, you know, a decreased sex drive. He's got increased body fat. He has some -- some slight depression, probably.' Whatever his signs and symptoms are."

None of these conditions is a legal reason to prescribe HGH. But the pharmacist said that most investigators will be satisfied and move on "because there's guys that are just selling stuff basically like a boiler room."

Del Toro was arrested along with 12 other people in September 2011 on charges that they distributed steroids and human growth hormone to people who had no legitimate medical need. He is awaiting trial. His lawyer declined to comment. Baltazar was sentenced to six months in prison for involvement in steroid distribution schemes.

At the height of the crackdown in 2007, the federal government went after Pfizer in a case involving anti-aging clinics. The company paid $34.7 million in fines to settle the case — 11 percent of the company's annual revenue from the drug.

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TROUBLED HISTORY

Blockbuster U.S. sales of HGH represent the latest frustration in 25 years of government efforts to control abuse of the growth drug made infamous by sports scandals.

First marketed in 1985 for children with stunted growth, HGH was soon misappropriated by adults intent on exploiting its modest muscle- and bone-building qualities. Congress limited HGH distribution to the handful of rare conditions in an extraordinary 1990 law, overriding the generally unrestricted right of doctors to prescribe medicines as they see fit.

Despite the law, illicit HGH spread around the sports world in the 1990s, making deep inroads into bodybuilding, college athletics, and professional leagues from baseball to cycling. The even larger banned market among older adults has flourished more recently.

For years, cheaper supplies from unauthorized foreign factories, particularly in China, fed the market via direct and Internet sales that sidestepped the medical establishment.

Though such shipments were banned under other law, the imports initially attracted little attention because they were usually labeled as raw pharmaceutical ingredients, which compounding pharmacies are allowed to bring into the country.

That flow began to be curtailed in 2006, when U.S. drug authorities stepped up efforts to block shipments at the border.

A handful of pharmacies across the country were hit with criminal charges over their handling of HGH. Federal prosecutors charged China's biggest HGH maker, GeneScience Pharmaceutical, with illegally distributing its Jintropin brand in the U.S. The company's CEO pleaded guilty in 2010.

With illicit supplies crimped, many pharmacies stopped selling unauthorized HGH. But tens of thousands of adult abusers began buying pricey U.S.-approved HGH that remained available in abundant supply, the AP found in its analysis of sales data.

Thus, pushed by a powerful demand, sales of U.S.-approved brands have swelled far beyond expected levels for a drug approved in just a handful of rare conditions.

Dr. Robert Marcus, a retired hormone specialist who left HGH manufacturer Eli Lilly and Co. in 2008, said that company was bent on stopping foreign counterfeits, not on cutting off abusers. "That's where their major level of frustration was — pharmaceutical fraud — rather than focusing on people who were using growth hormone illegitimately," he said.

Dr. Jim Meehan, of Tulsa, Okla., who has used HGH to treat aging problems and sports injuries, said the federal clampdown "never seemed to affect my patients and their ability to get Omnitrope, Tev-Tropin" and other government-approved brands.

The big drug companies have applauded the foreign crackdown and urged the government to do even more to combat sales of fake or fraudulently labeled HGH. In 2004, Bruce Kuhlik, speaking for the Pharmaceutical Research and Manufacturers of America, told a federal task force that unauthorized drug importation "is inherently unsafe" and industry representatives used Chinese HGH imports as their poster child.

In 2007, as the HGH embargo gained momentum, authorized makers picked up 41 percent more HGH orders, raising their annual total from 245,000 to 345,000, according to the analysis of the IMS Health data. Similarly, most of the drug's sales boom happened in the first two years of the crackdown, with 46 percent inflation-adjusted growth in yearly sales to $1.1 billion.

Steve Kleppe, of Scottsdale, Ariz., a restaurant entrepreneur who has taken HGH for almost 15 years to keep feeling young, said he noticed a price jump of about 25 percent after the block on imports. He now buys HGH directly from a doctor at an annual cost of about $8,000 for himself and the same amount for his wife.

Despite higher prices, the business has expanded in recent years largely on the strength of sales to healthy adults who can afford to indulge their hope of retaining youthful vigor.

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GROWING OLD

Many older patients go for HGH treatment to scores of anti-aging practices and clinics heavily concentrated in retirement states like Florida, Nevada, Arizona and California.

These sites are affiliated with hundreds of doctors who are rarely endocrinologists. Instead, many tout certification by the American Board of Anti-Aging and Regenerative Medicine, though the medical establishment does not recognize the group's bona fides.

The clinics offer personalized programs of "age management" to business executives, affluent retirees, and other patients of means, sometimes coupled with the amenities of a vacation resort.

The clinics insist there are few, if any, side effects from HGH. Mainstream medical authorities say otherwise.

A 2007 review of 31 medical studies showed swelling in half of HGH patients, with joint pain or diabetes in more than a fifth. A French study of about 7,000 people who took HGH as children found a 30 percent higher risk of death from causes like bone tumors and stroke, stirring a health advisory from U.S. authorities.

For proof that the drug works, marketers turn to images like the memorable one of pot-bellied septuagenarian Dr. Jeffry Life, supposedly transformed into a ripped hulk of himself by his own program available at the upscale Las Vegas-based Cenegenics Elite Health. (He declined to be interviewed.)

These promoters of HGH say there is a connection between the drop-off in growth hormone levels through adulthood and the physical decline that begins in late middle age. Replace the hormone, they say, and the aging process slows.

"It's an easy ruse. People equate hormones with youth," said Dr. Tom Perls, a leading industry critic who does aging research at Boston University. "It's a marketing dream come true."

Some scientific studies of HGH have found modest benefits: some muscle and bone building, as well as limited fat loss, but nothing like the claims of the anti-aging industry. And some of the value credited to HGH may instead come from testosterone, which is routinely provided with HGH by anti-aging doctors and sports suppliers.

Endocrinologists say it's natural for the body to produce less growth hormone as people age beyond their early 20s, because they aren't growing anymore. Only a tiny number of adults with extraordinarily low HGH levels — perhaps several thousand of them — are believed to suffer real deficiencies that can properly be treated with the hormone.

Still, anti-aging doctors routinely diagnose otherwise healthy middle-aged people with an HGH deficiency, simply because their levels are lower than in young adults. "Basically anyone going through midlife," can benefit from the drug, declared one prescriber, Dr. Howard Elkin, of Whittier, Calif., who has himself competed as a bodybuilder.

Dr. Kenneth Knott, of Marietta, Ga., said HGH helps his older patients feel "more vibrant" and look "more alive."

Like many anti-aging doctors, he diagnoses patients by testing for a blood component called insulin growth factor, which is indirectly tied to HGH. Endocrinologists use a more authoritative test that stimulates the pituitary gland to make HGH itself. Nearly all insurers insist on this stimulation testing, and that's why clinic patients almost always pay for HGH out of their own pockets.

Bob Vitols, a 50-year-old lab assistant at a veterinary medicine company in Lincoln, Neb., is a rare exception. His unusually generous health plan isn't allowed to challenge a doctor's prescription.

Four years ago, Vitols began feeling run down. So he Googled his symptoms on the Internet, decided he had a hormone deficiency, and sought out a clinic.

One doctor put him on testosterone replacement therapy. A second clinic added HGH after diagnosing him with osteopenia, a mild bone thinning common in aging adults. It is not, however, a condition that can properly be treated with HGH.

Despite the diagnosis, the treatments — which can cost $10,000 per year — have been covered by his health insurance, he said. He takes Genotropin, the HGH made by Pfizer. His prescriptions are filled via mail order by CVS Caremark Corp., one of the largest dispensers of prescription drugs in the U.S.

Vitols said the drug changed his life: his mood is better, and he isn't burning out every day at 2 p.m. "I feel like I could walk outside and just walk through a fence — and come out fine on the other side," he said.

His experiences with the drug haven't all been positive, though. Vitols said he initially developed elevated liver enzymes and went to a specialist, who told him to stop taking hormones immediately.

Instead, Vitols said, he adjusted his dosage, and the problem disappeared.

He also dumped the specialist:

"I could tell he was against hormones right at the start," Vitols said.

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Associated Press Writer David Caruso reported from New York and AP National Writer Jeff Donn reported from Plymouth, Mass. AP Writer Troy Thibodeaux provided data analysis assistance from New Orleans.

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AP's interactive on the HGH investigation: http://hosted.ap.org/interactives/2012/hgh

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The AP National Investigative Team can be reached at investigate(at)ap.org

EDITOR'S NOTE _ Whether for athletics or age, Americans from teenagers to baby boomers are trying to get an edge by illegally using anabolic steroids and human growth hormone, despite well-documented risks. This is the second of a two-part series.

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Amid Protest, NRA Calls for Armed Guards in Schools

The National Rifle Association stood its ground today in arguing that the answer to gun violence in schools is an armed security force that can protect students, while blaming the media and violent entertainment and video games for recent deadly shootings.

"The only thing that can stop a bad guy with a gun is a good guy with a gun," NRA executive vice president Wayne LaPierre said in presenting the NRA's first comments about the Connecticut school shooting since it occured a week ago today.

LaPierre offered no olive branch to gun-control advocates who have called for tougher laws in the wake of the shooting at Sandy Hook Elementary School. Instead, he called for schools across the country to recruit armed security professionals to protect their students.

"It's not just our duty to protect [our children], it's our right to protect them," LaPierre said at a news conference. "The NRA knows there are millions of qualified active and reserved police, active and reserve military, security professionals, rescue personnel, an extraordinary corps of qualified trained citizens to join with local school officials and police in devising a protection plan for every single school."

He was interrupted twice by protestors who stood in front of LaPierre's podium holding signs and shouting that the NRA "has blood on its hands" and that the NRA is "killing our kids." The protestors were eventually escorted out of the room.

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LaPierre also scoffed at the notion that banning so-called assault weapons or enacting gun control laws would stop school violence. He instead cast blame for gun violence in schools on violent entertainment, including video games, and the media.

"How many more copycats are waiting in the wings for their moment of fame from a national media machine that rewards them with a wall of attention they crave while provoking others to make their mark?" he asked.

LaPierre announced that former U.S. congressman Asa Hutchinson of Arkansas would lead the NRA's effort to advocate for school security forces.

The leadership of the NRA has held off on interviews this week after refusing to appear on Sunday morning public affairs shows this past weekend. They said they would grant interviews beginning next week to discuss their position.

NRA News anchor Ginny Simone said Thursday that in the wake of the Sandy Hook shooting, membership surged "with an average of 8,000 new members a day."

New York City Mayor Michael Bloomberg has said the NRA is partially to blame for the tragedy.

"We're not trying to take away your right to advance the interests of gun owners, hunters, people who want to protect themselves," Bloomberg told "Nightline" anchor Cynthia McFadden in an interview Thursday. "But that's not an absolute right to encourage behavior which causes things like Connecticut. In fact, Connecticut is because of some of their actions."

The guns used in the attack were legally purchased and owned by the shooter's mother, Nancy Lanza, whom Adam Lanza shot to death before his assault on the school.

In the aftermath of the shooting, many, including Bloomberg, have called for stricter regulations on the type of weapons used in this and other instances of mass gun violence this year.

Sen. Dianne Feinstein, D-Calif., has said she intends to introduce a bill banning assault weapons on the first day of next year's Congress -- a step the president said he supports.

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Syrian rebels fight for strategic town in Hama province

BEIRUT (Reuters) - Rebels began to push into a strategic town in Syria's central Hama province on Thursday and laid siege to at least one town dominated by President Bashar al-Assad's minority sect, activists said.

The operation risks inflaming already raw sectarian tensions as the 21-month-old revolt against four decades of Assad family rule - during which the president's Alawite sect has dominated leadership of the Sunni Muslim majority - rumbles on.

Opposition sources said rebels had won some territory in the strategic southern town of Morek and were surrounding the Alawite town of al-Tleisia.

They were also planning to take the town of Maan, arguing that the army was present there and in al-Tleisia and was hindering their advance on nearby Morek, a town on the highway that runs from Damascus north to Aleppo, Syria's largest city and another battleground in the conflict.

"The rockets are being fired from there, they are being fired from Maan and al-Tleisia, we have taken two checkpoints in the southern town of Morek. If we want to control it then we need to take Maan," said a rebel captain in Hama rural area, who asked not to be named.

Activists said heavy army shelling had targeted the town of Halfaya, captured by rebels two days earlier. Seven people were killed, 30 were wounded, and dozens of homes were destroyed, said activist Safi al-Hamawi.

Hama is home to dozens of Alawite and Christian villages among Sunni towns, and activists said it may be necessary to lay siege to many minority areas to seize Morek. Rebels want to capture Morek to cut off army supply lines into northern Idlib, a province on the northern border with Turkey where rebels hold swathes of territory.

From an offshoot of Shi'ite Islam, Alawites have largely stood behind Assad, many out of fear of revenge attacks. Christians and some other minorities have claimed neutrality, with a few joining the rebels and a more sizeable portion of them supporting the government out of fear of hardline Islamism that has taken root in some rebel groups.

Activists in Hama said rebels were also surrounding the Christian town of al-Suqeilabiya and might enter the city to take out army positions as well as those of "shabbiha" - pro-Assad militias, the bulk of whom are usually Alawite but can also include Christians and even Sunnis.

"We have been in touch with Christian opposition activists in al-Suqeilabiya and we have told them to stay downstairs or on the lowest floor of their building as possible, and not to go outside. The rebels have promised not to hurt anyone who stays at home," said activist Mousab al-Hamdee, speaking by Skype.

He said he was optimistic that potential sectarian tensions with Christians could be resolved but that Sunni-Alawite strife may be harder to suppress.

SECTARIAN FEARS

U.N. human rights investigators said on Thursday that Syria's conflict was becoming more "overtly sectarian", with more civilians seeking to arm themselves and foreign fighters - mostly Sunnis - flocking in from 29 countries.

"They come from all over, Europe and America, and especially the neighboring countries," said Karen Abuzayd, one of the U.N. investigators, told a news conference in Brussels.

Deeper sectarian divisions may diminish prospects for post-conflict reconciliation even if Assad is ousted, and the influx of foreigners raises the risk of fighting spilling into neighboring countries riven by similar communal fault lines.

Some activists privately voiced concerns of sectarian violence, but the rebel commander in Hama said fighters had been told "violations" would not be tolerated and argued that the move to attack the towns was purely strategic.

"If we are fired at from a Sunni village that is loyal to the regime we go in and we liberate it and clean it," he said. "So should we not do the same when it comes to an Alawite village just because there is a fear of an all-out sectarian war? We respond to the source of fire."

President Vladimir Putin of Russia, Assad's main ally and arms supplier, warned that any solution to the conflict must ensure government and rebel forces do not merely swap roles and fight on forever. It appeared to be his first direct comment on the possibility of a post-Assad Syria.

The West and some Arab states accuse Russia of shielding Assad after Moscow blocked three U.N. Security Council resolutions intended to increase pressure on Damascus to end the violence, which has killed more than 40,000 people. Putin said the Syrian people would ultimately decide their own fate.

Assad's forces have been hitting back at rebel advances with heavy shelling, particularly along the eastern ring of suburbs outside Damascus, where rebels are dominant.

A Syrian security source said the army was planning heavy offensives in northern and central Syria to stem rebel advances, but there was no clear sign of such operations yet.

Rebels seized the Palestinian refugee district of Yarmouk earlier this week, which put them within 3 km (2 miles) of downtown Damascus. Heavy shelling and fighting forced thousands of Palestinian and Syrian residents to flee the Yarmouk area.

Rebels said on Thursday they had negotiated to put the camp - actually a densely packed urban district - back into the hands of pro-opposition Palestinian fighters. There are some 500,000 Palestinian refugees and their descendants living in Syria, and they have been divided by the uprising.

Palestinian factions, some backed by the government and others by the rebels, had begun fighting last week, a development that allowed Syrian insurgents to take the camp.

A resident in Damascus said dozens of families were returning to the camp but that the army had erected checkpoints. Many families were still hesitant to return.

LEBANON BORDER POST TAKEN

Elsewhere, Syrian insurgents took over an isolated border post on the western frontier with Lebanon earlier this week, local residents told Reuters on Thursday.

The rebels already hold much of the terrain along Syria's northern and eastern borders with Turkey and Iraq respectively.

They said around 20 rebels from the Qadissiyah Brigade overran the post at Rankus, which is linked by road to the remote Lebanese village of Tufail.

Video footage downloaded on the Internet on Thursday, dated December 16, showed a handful of fighters dressed in khaki fatigues and wielding rifles as they kicked down a stone barricade around a small, single-storey army checkpoint.

Syrian Interior Minister Ibrahim al-Shaar arrived in Lebanon on Wednesday for treatment of wounds sustained in a bomb attack on his ministry in Damascus a week ago.

Lebanese medical sources said Shaar had shrapnel wounds in his shoulder, stomach and legs but they were not critical.

The Syrian opposition has tried to peel off defectors from the government as well as from the army, though only a handful of high-ranking officials have abandoned Assad.

The conflict has divided many Syrian families. Security forces on Thursday arrested an opposition activist who is also the relative of Vice President Farouq al-Sharaa, the Syrian Observatory said. The man was arrested along with five other activists who are considered pacifists, it said.

Sharaa, a Sunni Muslim who has few powers in Assad's Alawite-dominated power structure, said earlier this week that neither side could win the war in Syria. He called for the formation of a national unity government.

(Reporting by Erika Solomon; Editing by Andrew Osborn)

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Monti, Berlusconi spar as Italy election campaign looms

ROME: Italian Prime Minister Mario Monti sparred with Silvio Berlusconi on Thursday over the need for austerity, as local media reported the economics professor was preparing to take on the colourful billionaire in a looming election campaign.

"We are really only just beginning," Monti said in a speech at a Fiat car factory in southern Italy in which he defended the "bitter medicine" of the budget discipline he has implemented and warned against any attempt to turn back the clock.

"Italy had a high temperature and we could not cure it with a simple aspirin. We needed a bitter medicine that was not easy to digest but that was absolutely necessary to go in deep and completely cure the illness," said the former EU commissioner.

"I think it would be irresponsible to waste all the sacrifices that Italians made," he said in an apparent reference to recent campaign talk from Berlusconi, who has promised to put an end to austerity and abolish a new property tax.

"This could plunge Italians back into a state of nirvana far from reality," Monti said at the event, which announced the launch of two new Fiat models at a plant that has been hit hard by plunging sales.

"What is happening here is not magic but a symbol of a turnaround that is possible also for Italy. That is what I want for this country!"

"Today in Melfi, we are starting an operation that is not for the weak of heart but we know that an Italy that is strong of heart can emerge," he said.

In a radio interview, his predecessor Berlusconi warned Monti against joining the campaign and condemned his economic policies.

"I do not think that it is in Monti's interests to become a small player in politics along with other small players," he said.

Berlusconi, 76, said Monti's policies should be "completely changed", adding: "The politics of austerity leads to recession."

Meanwhile the Senate voted a budget for next year that will now go before the lower house for final approval expected on Friday at around 1800 GMT.

Monti, 69, has said he will resign and open the election campaign as soon as the vote is passed, although he will stay on in a caretaker capacity until elections.

Monti is then to hold a press conference and declare his intentions on Saturday or Sunday.

The most likely date for the vote is February 24.

Media reports said Monti will take part in the campaign as unofficial leader of a centrist coalition that some observers likened to the Christian-Democrats who dominated Italy for decades.

While Monti's name cannot be on the ballot as he is already a senator-for-life, he can still be appointed to a post in government including prime minister.

The centrist agenda will include "historic reforms" and "far deeper liberalisation than we have witnessed so far", the Corriere della Sera daily reported, citing participants in meetings with Monti in recent days.

The current favourite in the opinion polls is centre-left leader Pier Luigi Bersani, who has promised to continue Monti's reforms adding "jobs and equity".

Berlusconi is preparing for his sixth campaign in two decades in politics despite being convicted of tax fraud this year and being a defendant in a trial for having sex with an underage prostitute that is due to end with a verdict in February.

He is also on trial over the publication in a newspaper owned by his media empire of a wire-tapped conversation between a leftist politician and the head of insurance company Unipol.

The lead prosecutor in the case on Thursday asked for a one-year prison sentence for Berlusconi. That verdict is expected in January.

European Union leaders, Italy's business lobby and the Roman Catholic Church have encouraged Monti to stay in politics, seeing him as the best guarantee of the economic and political stability seen in Italy over the past year.

Monti has launched a far-reaching programme of austerity and reforms that has reassured the financial markets but the cost has been record-high unemployment and an economy still stuck in recession, while the country is laden with over two trillion euros in debt.

Opinion polls indicate Monti's popularity has been falling from a peak of 62 per cent shortly after he came to power down to 33 per cent in a poll by SWG released earlier this month as austerity measures begin to bite.

Monti was installed at the head of a technocratic government by parliament in November 2011 after Berlusconi was forced to step down in a whirl of sex scandals, market panic and infighting among his supporters.

- AFP/fa

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Jaya writes to PM on Cauvery issue

CHENNAI: Tamil Nadu chief minister J Jayalalithaa today requested the Centre to expedite steps for notification of the final award of the Cauvery Water Disputes Tribunal.

In a letter to Prime Minister Manmohan Singh, she said "the Counsels for all states, including Karnataka, brought to the notice of the Supreme Court (on December 5) the fact that the final order of the Cauvery Water Disputes Tribunal is yet to be notified by the Government of India, despite a statutory mandate."

The Supreme Court ordered the Counsel for the Government of India to seek instructions as to when the final order of the Tribunal would be notified, and report to the Court, she said.

"The Cauvery Monitoring Committee, in its 31st meeting on December 7, had categorically stated that the final order of the Tribunal will be notified at the earliest but not later than the end of this month (December 2012). Once the award is notified, the institutions like Cauvery Monitoring Committee and Cauvery River Authority shall cease to exist. New Organisations like the Cauvery Management Board and Cauvery Regulation Committee will be constituted," she said.

Jayalalithaa said the apex court had on December 10 taken on record the proceedings of the 31st meeting of CMC.

"In the circumstances, I request you to expedite the Notification of the final order of the Cauvery Water Disputes Tribunal and also to constitute the Cauvery Management Board forthwith so as to safeguard the livelihood of the farmers of Tamil Nadu," she said.

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AP IMPACT: Steroids loom in major-college football

WASHINGTON (AP) — With steroids easy to buy, testing weak and punishments inconsistent, college football players are packing on significant weight — 30 pounds or more in a single year, sometimes — without drawing much attention from their schools or the NCAA in a sport that earns tens of billions of dollars for teams.

Rules vary so widely that, on any given game day, a team with a strict no-steroid policy can face a team whose players have repeatedly tested positive.

An investigation by The Associated Press — based on dozens of interviews with players, testers, dealers and experts and an analysis of weight records for more than 61,000 players — revealed that while those running the multibillion-dollar sport believe the problem is under control, that is hardly the case.

The sport's near-zero rate of positive steroids tests isn't an accurate gauge among college athletes. Random tests provide weak deterrence and, by design, fail to catch every player using steroids. Colleges also are reluctant to spend money on expensive steroid testing when cheaper ones for drugs like marijuana allow them to say they're doing everything they can to keep drugs out of football.

"It's nothing like what's going on in reality," said Don Catlin, an anti-doping pioneer who spent years conducting the NCAA's laboratory tests at UCLA. He became so frustrated with the college system that it drove him in part to leave the testing industry to focus on anti-doping research.

Catlin said the collegiate system, in which players often are notified days before a test and many schools don't even test for steroids, is designed to not catch dopers. That artificially reduces the numbers of positive tests and keeps schools safe from embarrassing drug scandals.

While other major sports have been beset by revelations of steroid use, college football has operated with barely a whiff of scandal. Between 1996 and 2010 — the era of Barry Bonds, Mark McGwire, Marion Jones and Lance Armstrong — the failure rate for NCAA steroid tests fell even closer to zero from an already low rate of less than 1 percent.

The AP's investigation, drawing upon more than a decade of official rosters from all 120 Football Bowl Subdivision teams, found thousands of players quickly putting on significant weight, even more than their fellow players. The information compiled by the AP included players who appeared for multiple years on the same teams, making it the most comprehensive data available.

For decades, scientific studies have shown that anabolic steroid use leads to an increase in body weight. Weight gain alone doesn't prove steroid use, but very rapid weight gain is one factor that would be deemed suspicious, said Kathy Turpin, senior director of sport drug testing for the National Center for Drug Free Sport, which conducts tests for the NCAA and more than 300 schools.

Yet the NCAA has never studied weight gain or considered it in regard to its steroid testing policies, said Mary Wilfert, the NCAA's associate director of health and safety. She would not speculate on the cause of such rapid weight gain.

The NCAA attributes the decline in positive tests to its year-round drug testing program, combined with anti-drug education and testing conducted by schools.

"The effort has been increasing, and we believe it has driven down use," Wilfert said.

Big gains, data show

The AP's analysis found that, regardless of school, conference and won-loss record, many players gained weight at exceptional rates compared with their fellow athletes and while accounting for their heights. The documented weight gains could not be explained by the amount of money schools spent on weight rooms, trainers and other football expenses.

Adding more than 20 or 25 pounds of lean muscle in a year is nearly impossible through diet and exercise alone, said Dan Benardot, director of the Laboratory for Elite Athlete Performance at Georgia State University.

The AP's analysis corrected for the fact that players in different positions have different body types, so speedy wide receivers weren't compared to bulkier offensive tackles. It could not assess each player's physical makeup, such as how much weight gain was muscle versus fat, one indicator of steroid use. In the most extreme case in the AP analysis, the probability that a player put on so much weight compared with other players was so rare that the odds statistically were roughly the same as an NFL quarterback throwing 12 passing touchdowns or an NFL running back rushing for 600 yards in one game.

In nearly all the rarest cases of weight gain in the AP study, players were offensive or defensive linemen, hulking giants who tower above 6-foot-3 and weigh 300 pounds or more. Four of those players interviewed by the AP said that they never used steroids and gained weight through dramatic increases in eating, up to six meals a day. Two said they were aware of other players using steroids.

"I just ate. I ate 5-6 times a day," said Clint Oldenburg, who played for Colorado State starting in 2002 and for five years in the NFL. Oldenburg's weight increased over four years from 212 to 290, including a one-year gain of 53 pounds, which he attributed to diet and two hours of weight lifting daily. "It wasn't as difficult as you think. I just ate anything."

Oldenburg told the AP he was surprised at the scope of steroid use in college football, even in Colorado State's locker room. "College performance enhancers were more prevalent than I thought," he said. "There were a lot of guys even on my team that were using." He declined to identify any of them.

The AP found more than 4,700 players — or about 7 percent of all players — who gained more than 20 pounds overall in a single year. It was common for the athletes to gain 10, 15 and up to 20 pounds in their first year under a rigorous regimen of weightlifting and diet. Others gained 25, 35 and 40 pounds in a season. In roughly 100 cases, players packed on as much 80 pounds in a single year.

In at least 11 instances, players that AP identified as packing on significant weight in college went on to fail NFL drug tests. But pro football's confidentiality rules make it impossible to know for certain which drugs were used and how many others failed tests that never became public.

What is bubbling under the surface in college football, which helps elite athletes gain unusual amounts of weight? Without access to detailed information about each player's body composition, drug testing and workout regimen, which schools do not release, it's impossible to say with certainty what's behind the trend. But Catlin has little doubt: It is steroids.

"It's not brain surgery to figure out what's going on," he said. "To me, it's very clear."

Football's most infamous steroid user was Lyle Alzado, who became a star NFL defensive end in the 1970s and '80s before he admitted to juicing his entire career. He started in college, where the 190-pound freshman gained 40 pounds in one year. It was a 21 percent jump in body mass, a tremendous gain that far exceeded what researchers have seen in controlled, short-term studies of steroid use by athletes. Alzado died of brain cancer in 1992.

The AP found more than 130 big-time college football players who showed comparable one-year gains in the past decade. Students posted such extraordinary weight gains across the country, in every conference, in nearly every school. Many of them eclipsed Alzado and gained 25, 35, even 40 percent of their body mass.

Even though testers consider rapid weight gain suspicious, in practice it doesn't result in testing. Ben Lamaak, who arrived at Iowa State in 2006, said he weighed 225 pounds in high school and 262 pounds in the summer of his freshman year on the Cyclones football team. A year later, official rosters showed the former basketball player from Cedar Rapids weighed 306, a gain of 81 pounds since high school. He graduated as a 320-pound offensive lineman and said he did it all naturally.

"I was just a young kid at that time, and I was still growing into my body," he said. "It really wasn't that hard for me to gain the weight. I had fun doing it. I love to eat. It wasn't a problem."

In addition to random drug testing, Iowa State is one of many schools that have "reasonable suspicion" testing. That means players can be tested when their behavior or physical symptoms suggest drug use.

Despite gaining 81 pounds in a year, Lamaak said he was never singled out for testing.

The associate athletics director for athletic training at Iowa State, Mark Coberley, said coaches and trainers use body composition, strength data and other factors to spot suspected cheaters. Lamaak, he said, was not suspicious because he gained a lot of "non-lean" weight.

"There are a lot of things that go into trying to identify whether guys are using performance-enhancing drugs," Coberley said. "If anybody had the answer, they'd be spotting people that do it. We keep our radar up and watch for things that are suspicious and try to protect the kids from making stupid decisions."

There's no evidence that Lamaak's weight gain was anything but natural. Gaining fat is much easier than gaining muscle. But colleges don't routinely release information on how much of the weight their players gain is muscle, as opposed to fat. Without knowing more, said Benardot, the expert at Georgia State, it's impossible to say whether large athletes were putting on suspicious amounts of muscle or simply obese, which is defined as a body mass index greater than 30.

Looking solely at the most significant weight gainers also ignores players like Bryan Maneafaiga.

In the summer of 2004, Maneafaiga was an undersized 180-pound running back trying to make the University of Hawaii football team. Twice — once in pre-season and once in the fall — he failed school drug tests, showing up positive for marijuana use. What surprised him was that the same tests turned up negative for steroids.

He'd started injecting stanozolol, a steroid, in the summer to help bulk up to a roster weight of 200 pounds. Once on the team, where he saw only limited playing time, he'd occasionally inject the milky liquid into his buttocks the day before games.

"Food and good training will only get you so far," he told the AP recently.

Maneafaiga's coach, June Jones, meanwhile, said none of his players had tested positive for doping since he took over the team in 1999. He also said publicly that steroids had been eliminated in college football: "I would say 100 percent," he told The Honolulu Advertiser in 2006.

Jones said it was news to him that one of his players had used steroids. Jones, who now coaches at Southern Methodist University, said many of his former players put on bulk working hard in the weight room. For instance, adding 70 pounds over a three- to four-year period isn't unusual, he said.

Jones said a big jump in muscle year-over-year — say 40 pounds — would be a "red light that something is not right."

Jones, a former NFL head coach, said he is unaware of any steroid use at SMU and believes the NCAA is doing a good job testing players. "I just think because the way the NCAA regulates it now that it's very hard to get around those tests," he said.

The cost of testing

While the use of drugs in professional sports is a question of fairness, use among college athletes is also important as a public policy issue. That's because most top-tier football teams are from public schools that benefit from millions of dollars each year in taxpayer subsidies. Their athletes are essentially wards of the state. Coaches and trainers — the ones who tell players how to behave, how to exercise and what to eat — are government employees.

Then there are the health risks, which include heart and liver problems and cancer.

On paper, college football has a strong drug policy. The NCAA conducts random, unannounced drug testing and the penalties for failure are severe. Players lose an entire year of eligibility after a first positive test. A second offense means permanent ineligibility from sports.

In practice, though, the NCAA's roughly 11,000 annual tests amount to just a fraction of all athletes in Division I and II schools. Exactly how many tests are conducted each year on football players is unclear because the NCAA hasn't published its data for two years. And when it did, it periodically changed the formats, making it impossible to compare one year of football to the next.

Even when players are tested by the NCAA, people involved in the process say it's easy enough to anticipate the test and develop a doping routine that results in a clean test by the time it occurs. NCAA rules say players can be notified up to two days in advance of a test, which Catlin says is plenty of time to beat a test if players have designed the right doping regimen. By comparison, Olympic athletes are given no notice.

"Everybody knows when testing is coming. They all know. And they know how to beat the test," Catlin said, adding, "Only the really dumb ones are getting caught."

Players are far more likely to be tested for drugs by their schools than by the NCAA. But while many schools have policies that give them the right to test for steroids, they often opt not to. Schools are much more focused on street drugs like cocaine and marijuana. Depending on how many tests a school orders, each steroid test can cost $100 to $200, while a simple test for street drugs might cost as little as $25.

When schools call and ask about drug testing, the first question is usually, "How much will it cost," Turpin said.

Most schools that use Drug Free Sport do not test for anabolic steroids, Turpin said. Some are worried about the cost. Others don't think they have a problem. And others believe that since the NCAA tests for steroids their money is best spent testing for street drugs, she said.

Wilfert, the NCAA official, said the possibility of steroid testing is still a deterrent, even at schools where it isn't conducted.

"Even though perhaps those institutional programs are not including steroids in all their tests, they could, and they do from time to time," she said. "So, it is a kind of deterrence."

For Catlin, one of the most frustrating things about running the UCLA testing lab was getting urine samples from schools around the country and only being asked to test for cocaine, marijuana and the like.

"Schools are very good at saying, 'Man, we're really strong on drug testing,'" he said. "And that's all they really want to be able to say and to do and to promote."

That helps explain how two school drug tests could miss Maneafaiga's steroid use. It's also possible that the random test came at an ideal time in Maneafaiga's steroid cycle.

Enforcement varies

The top steroid investigator at the U.S. Drug Enforcement Administration, Joe Rannazzisi, said he doesn't understand why schools don't invest in the same kind of testing, with the same penalties, as the NFL. The NFL has a thorough testing program for most drugs, though the league has yet to resolve a long-simmering feud with its players union about how to test for human growth hormone.

"Is it expensive? Of course, but college football makes a lot of money," he said. "Invest in the integrity of your program."

For a school to test all 85 scholarship football players for steroids twice a season would cost up to $34,000, Catlin said, plus the cost of collecting and handling the urine samples. That's about 0.2 percent of the average big-time school football budget of about $14 million. Testing all athletes in all sports would make the school's costs higher.

When schools ask Drug Free Sport for advice on their drug policies, Turpin said she recommends an immediate suspension after the first positive drug test. Otherwise, she said, "student athletes will roll the dice."

But drug use is a bigger deal at some schools than others.

At Notre Dame and Alabama, the teams that will soon compete for the national championship, players don't automatically miss games for testing positive for steroids. At Alabama, coaches have wide discretion. Notre Dame's student-athlete handbook says a player who fails a test can return to the field once the steroids are out of his system.

"If you're a strength-and-conditioning coach, if you see your kids making gains that seem a little out of line, are you going to say, 'I'm going to investigate further? I want to catch someone?'" said Anthony Roberts, an author of a book on steroids who says he has helped college football players design steroid regimens to beat drug tests.

There are schools with tough policies. The University of North Carolina kicks players off the team after a single positive test for steroids. Auburn's student-athlete handbook calls for a half-season suspension for any athlete caught using performance-enhancing drugs.

Wilfert said it's not up to the NCAA to determine whether that's fair.

"Obviously if it was our testing program, we believe that everybody should be under the same protocol and the same sanction," she said.

Fans typically have no idea that such discrepancies exist and players are left to suspect who might be cheating.

"You see a lot of guys and you know they're possibly on something because they just don't gain weight but get stronger real fast," said Orrin Thompson, a former defensive lineman at Duke. "You know they could be doing something but you really don't know for sure."

Thompson gained 85 pounds between 2001 and 2004, according to Duke rosters and Thompson himself. He said he did not use steroids and was subjected to several tests while at Duke, a school where a single positive steroid test results in a yearlong suspension.

Meanwhile at UCLA, home of the laboratory that for years set the standard for cutting-edge steroid testing, athletes can fail three drug tests before being suspended. At Bowling Green, testing is voluntary.

At the University of Maryland, students must get counseling after testing positive, but school officials are prohibited from disciplining first-time steroid users. Athletic department spokesman Matt Taylor denied that was the case and sent the AP a copy of the policy. But the policy Taylor sent included this provision: "The athletic department/coaching staff may not discipline a student-athlete for a first drug offense."

By comparison, in Kentucky and Maryland, racehorses face tougher testing and sanctions than football players at Louisville or the University of Maryland.

"If you're trying to keep a level playing field, that seems nonsensical," said Rannazzisi at the DEA. He said he was surprised to learn that what gets a free pass at one school gets players immediately suspended at another. "What message does that send? It's OK to cheat once or twice?"

Only about half the student athletes in a 2009 NCAA survey said they believed school testing deterred drug use.

As an association of colleges and universities, the NCAA could not unilaterally force schools to institute uniform testing policies and sanctions, Wilfert said.

"We can't tell them what to do, but if went through a membership process where they determined that this is what should be done, then it could happen," she said.

'Everybody around me was doing it'

Steroids are a controlled substance under federal law, but players who use them need not worry too much about prosecution. The DEA focuses on criminal operations, not individual users. When players are caught with steroids, it's often as part of a traffic stop or a local police investigation.

Jared Foster, 24, a quarterback recruited to play at the University of Mississippi, was kicked off the team in 2008 after local authorities arrested him for giving a man nandrolone, an anabolic steroid, according to court documents. Foster pleaded guilty and served jail time.

He told the AP that he doped in high school to impress college recruiters. He said he put on enough lean muscle to go from 185 pounds to 210 in about two months.

"Everybody around me was doing it," he said.

Steroids are not hard to find. A simple Internet search turns up countless online sources for performance-enhancing drugs, mostly from overseas companies.

College athletes freely post messages on steroid websites, seeking advice to beat tests and design the right schedule of administering steroids.

And steroids are still a mainstay in private, local gyms. Before the DEA shut down Alabama-based Applied Pharmacy Services as a major nationwide steroid supplier, sales records obtained by the AP show steroid shipments to bodybuilders, trainers and gym owners around the country.

Because users are rarely prosecuted, the demand is left in place after the distributor is gone.

When Joshua Hodnik was making and wholesaling illegal steroids, he had found a good retail salesman in a college quarterback named Vinnie Miroth. Miroth was playing at Saginaw Valley State, a Division II school in central Michigan, and was buying enough steroids for 25 people each month, Hodnik said.

"That's why I hired him," Hodnik said. "He bought large amounts and knew how to move it."

Miroth, who pleaded no contest in 2007 and admitted selling steroids, helped authorities build their case against Hodnik, according to court records. Now playing football in France, Miroth declined repeated AP requests for an interview.

Hodnik was released from prison this year and says he is out of the steroid business for good. He said there's no doubt that steroid use is widespread in college football.

"These guys don't start using performance-enhancing drugs when they hit the professional level," the Oklahoma City man said. "Obviously it starts well before that. And you can go back to some of the professional players who tested positive and compare their numbers to college and there is virtually no change."

Maneafaiga, the former Hawaii running back, said his steroids came from Mexico. A friend in California, who was a coach at a junior college, sent them through the mail. But Maneafaiga believes the consequences were nagging injuries. He found religion, quit the drugs and became the team's chaplain.

"God gave you everything you need," he said. "It gets in your mind. It will make you grow unnaturally. Eventually, you'll break down. It happened to me every time."

At the DEA, Rannazzisi said he has met with and conducted training for investigators and top officials in every professional sport. He's talked to Major League Baseball about the patterns his agents are seeing. He's discussed warning signs with the NFL.

He said he's offered similar training to the NCAA but never heard back. Wilfert said the NCAA staff has discussed it and hasn't decided what to do.

"We have very little communication with the NCAA or individual schools," Rannazzisi said. "They've got my card. What they've done with it? I don't know."

___

Associated Press writers Ryan Foley in Cedar Rapids, Iowa; David Brandt in Jackson, Miss.; David Skretta in Lawrence, Kan.; Don Thompson in Sacramento, Calif.;and Alexa Olesen in Shanghai, China; and researchers Susan James in New York and Monika Mathur in Washington contributed to this report.

___

Contact the Washington investigative team at DCinvestigations (at) ap.org.

Whether for athletics or age, Americans from teenagers to baby boomers are trying to get an edge by illegally using anabolic steroids and human growth hormone, despite well-documented risks. This is the first of a two-part series.

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Schools Threatened Nationwide After Sandy Hook

Schools across the country, already on edge following last week's massacre of 20 students and six adults at a Newtown, Conn., elementary school have been further unnerved following a series of copycat threats, sometimes yielding arrests and caches of deadly weapons.

From California to Connecticut, police in the past five days have arrested more than a dozen individuals in Indiana, South Carolina, Maryland and elsewhere who were plotting or threatening to attack schools.

"After high-profile incidents like the shootings at Columbine and Sandy Hook, threats go off the wall. Some of those threats turn out to be unfounded, but sometimes those incidents propel people planning legitimate threats," Ken Trump, a national school safety consultant, told ABCNews.com.

CLICK HERE FOR AN INTERACTIVE MAP AND TIMELINE OF THE SANDY HOOK SHOOTING.

Many of these incidents turned out to be little more than young people acting out or seeking attention, but in some cases police found significant stockpiles of firearms and ammunition.

Just a few hours after the world learned what happened inside the halls at the Sandy Hook elementary school, police arrested a 60-year-old Indiana man who had allegedly threatened to "kill as many people as he could before police stopped him," according to the police report, at an elementary school in Cedar Lake, Ind.

Brendan Smialowski/AFP/Getty Images

Indiana School Shooting Threat: Parents Not Notified Watch Video

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Maryland Student Hospitalized for Alleged Threat Watch Video

When Von Meyer was arrested, just 1,000 feet from Jane Ball Elementary School, police confiscated from his home $100,000 worth of guns and ammunition including 47 weapons.

The school was placed on lockdown.

Meyer's case was taken by the Lake County public defender's office, but an attorney has not yet been assigned. He has been charged with seven crimes, including felonious intimidation, and an automatic "not guilty" plea was made on his behalf at a hearing on Tuesday.

Many of the suspects arrested in the wake of the Connecticut shooting were themselves school students – teenagers or young adults.

On Wednesday, in Laurel, Md., an unidentified student at Laurel High School was taken to the hospital and placed under psychiatric evaluation after school security officials found maps of the school and lists of students they believed he planned to kill.

Authorities called the evidence a "credible threat." The student, however, was not arrested or charged with a crime.

In Columbia, Tenn., police arrested Shawn Lenz, 19, who on Saturday posted to Facebook that he felt like "goin on a rampage, kinda like the school shooting were that one guy killed some teachers and a bunch of students."

He later told police that "it was stupid" to have written what he did. Lenz was arraigned Tuesday on terrorism and harassment charges and was appointed a public defender. He did not enter a plea.

A Tampa, Fla., school was put on lockdown two days in a row, Tuesday and Wednesday, after students found bullets on a school bus. Police there have made no arrests.

Despite the rash of recent threats, anecdotal data compiled by Trump's National School Safety and Security Services and analyzed by Scripps Howard found that there were approximately 120 known but thwarted plots against schools between 2000 and 2010. The list is not comprehensive and many incidents likely went unreported.

Fifty-five of those known threats -- all thwarted -- involved guns and 22 of them involved explosive devices, according to the Scripps Howard report.

"We're getting better at preventing these situations," Trump told ABC News.com.

But in that same time there were about 50 lethal school shootings, including the killing of 32 people at Virginia Tech.

"While shootings statistically may be rare, they impact a community and these kids forever," said Trump.

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Syrian rebels fight for strategic town in Hama province

BEIRUT (Reuters) - Rebels thrust into a strategic town in Syria's central Hama province on Thursday, activists said, pursuing a string of territorial gains to help cut army supply lines and cement a foothold in the capital Damascus to the south.

They have made a series of advances across the country, seizing several military installations and more heavy weaponry, hardening the threat to President Bashar al-Assad's power base in Damascus 21 months into an uprising against his rule.

Rebels said a day earlier they had captured at least six towns in Hama province. On Thursday heavy fighting erupted in Morek, a town on the highway that runs from Damascus north to Aleppo, Syria's largest city and another battleground.

The opposition-linked Syrian Observatory for Human Rights said rebels were trying to take checkpoints in Morek, one of which they had already seized, and described the town as a critical position for the Syrian army.

"The town of Morek lies on the Damascus-Aleppo road ... it has eight checkpoints and two security and military headquarters. If the rebels were able to control the town they would completely sever the supply lines between Hama and Damascus to Idlib province," the group said in an email.

Idlib is in the rebel-dominated north bordering on Turkey.

The British-based Observatory has a network of activists across the country. Activist reports are difficult to verify, as the government restricts media access into Syria.

Fighting in Hama could aggravate Syria's sectarian strife as it is home to many rural minority communities of Alawites and Christians. Minorities, and particularly the Alawite sect to which Assad himself belongs, have largely backed the president. Syria's Sunni Muslim majority has been the engine of the revolt.

"Rebels are trying to take Mohardeh and al-Suqaylabiya, which are strongholds of the regime and are strategic. The residents are Christian and the neighboring towns are Alawite. The rebels worry security forces may be arming people there," said activist Safi al-Hamawi, speaking on Skype.

He said the opposition feared skirmishes that had previously been largely Sunni-Alawite could spread into a broader sectarian conflict.

"I think it is still unlikely, because the residents have tried to maintain neutrality, but if the battle became a sectarian clash, it could be a catastrophe. Christians and Muslims could suddenly find themselves enemies."

U.N. human rights investigators said on Thursday that Syria's conflict was becoming more "overtly sectarian", with more civilians seeking to arm themselves and foreign fighters - mostly Sunnis - flocking in from 29 countries.

"They come from all over, Europe and America, and especially the neighboring countries," said Karen Abuzayd, one of U.N. investigators, told a news conference in Brussels.

The deepened sectarian divisions may diminish prospects for post-conflict reconciliation even if Assad is ousted, and the influx of foreigners raises the risk of fighting spilling into neighboring countries riven by similar communal fault lines.

President Vladimir Putin of Russia, Assad's main ally and arms supplier, warned that any solution to the conflict must ensure government and rebel forces do not merely swap roles and fight on forever. It appeared to be his first direct comment on the possibility of a post-Assad Syria.

The West and some Arab states accuse Russia of shielding Assad after Moscow blocked three U.N. Security Council resolutions intended to increase pressure on Damascus to end the violence, which has killed more than 40,000 people. Putin said the Syrian people would ultimately decide their own fate.

FIGHTS FOR DAMASCUS CAMP

Assad's forces have been hitting back at rebel advances with bouts of heavy shelling, particularly along the eastern ring of suburbs outside Damascus, where rebels are dominant.

A Syrian security source said the army was planning heavy offensives in northern and central Syria to stem rebel advances, but there was no clear sign of such operations yet.

Rebels seized the Palestinian refugee district of Yarmouk earlier this week, which put them within 3 km (2 miles) of downtown Damascus. Heavy shelling and fighting forced thousands of Palestinian and Syrian residents to flee the Yarmouk area.

But rebels said on Thursday they were negotiating to put the camp - actually a densely packed urban district - back into the hands of pro-opposition Palestinian fighters. There are some 500,000 Palestinian refugees and their descendants living in Syria, and they have been divided by the uprising.

Palestinian factions, some backed by the government and others by the rebels, had begun fighting last week, a development that allowed Syrian insurgents to take the camp.

Despite warnings of continued violence, a video released by activists on Thursday showed dozens of people returning to Yarmouk. Most of the people in the footage were men, suggesting entire families may not be venturing back yet.

"There are still negotiations going on between the Palestinians and the rebels. The rebels want control of the checkpoints to be sure they can keep supply routes open to central Damascus," said a rebel who asked not to be named.

"Palestinians want their fighters to run the checkpoints so the army will stop attacking and people can go home. But we are worried there are government collaborators among them."

The fighter said rebels were looking to ensure their Palestinian allies could keep open access for rebels in Yarmouk, which they have described as a gateway to central Damascus.

LEBANON BORDER POST TAKEN

Elsewhere, Syrian insurgents took over an isolated border post on the western frontier with Lebanon earlier this week, local residents told Reuters on Thursday.

They said around 20 rebels from the Qadissiyah Brigade overran the post at Rankus, which is linked by road to the remote Lebanese village of Tufail.

Video footage downloaded on the Internet on Thursday, dated December 16, showed a handful of fighters dressed in khaki fatigues and wielding rifles as they kicked down a stone barricade around a small, single-storey army checkpoint.

"This is the end of you, Bashar you dog," one of the fighters said. The remains of two army trucks, which the rebels said had been blown up, stood nearby on a single track dirt road crossing a flat brown plain between snow-capped mountains.

The rebels already hold much of the terrain along Syria's northern and eastern borders with Turkey and Iraq respectively.

Syrian Interior Minister Ibrahim al-Shaar arrived in Lebanon on Wednesday for treatment of wounds sustained in a bomb attack on his ministry in Damascus a week ago.

Lebanese medical sources said Shaar had shrapnel wounds in his shoulder, stomach and legs but they were not critical.

The Syrian opposition has tried to peel off defectors not only from the army but from the government as well, though only a handful of high-ranking officials have abandoned Assad.

But the conflict has divided many Syrian families. Security forces arrested on Thursday an opposition activist who is also the relative of Vice President Farouq al-Sharaa, the Syrian Observatory said. The man was arrested along with five other activists who are considered pacifists, it said.

Sharaa, a Sunni Muslim who has few powers in Assad's Alawite-dominated power structure, said earlier this week that neither side could win the war in Syria. He called for the formation of a national unity government to solve a crisis that has killed more than 40,000 Syrians.

(Reporting by Erika Solomon; Editing by Mark Heinrich)

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Bank of England votes 8-1 to maintain stimulus

LONDON: Bank of England policymakers voted 8-1 to maintain their quantitative easing stimulus programme at their December meeting, repeating the voting pattern from the previous month, minutes showed on Wednesday.

The BoE's nine-member monetary policy committee (MPC) had voted earlier this month to keep the QE stimulus amount at 375 billion pounds ($611 billion, 460 billion euros).

Polcymakers were also unanimous in keeping the bank's key interest rate at 0.50 percent, according the minutes from the December 5-6 gathering. British borrowing costs have stood at this record low level since March 2009.

Lone policymaker David Miles voted again this month for an extra £25 billion for the asset purchasing programme in order to lift economic growth, repeating his call from November.

Under quantitative easing, the Bank of England creates cash that is used to purchase assets such as government and corporate bonds with the aim of boosting lending and in turn economic activity.

- AFP/de

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Experts: Kids are resilient in coping with trauma

WASHINGTON (AP) — They might not want to talk about the gunshots or the screams. But their toys might start getting into imaginary shootouts.

Last week's school shooting in Connecticut raises the question: What will be the psychological fallout for the children who survived?

For people of any age, regaining a sense of security after surviving violence can take a long time. They're at risk for lingering anxiety, depression, post-traumatic stress disorder.

But after the grief and fear fades, psychiatrists say most of Newtown's young survivors probably will cope without long-term emotional problems.

"Kids do tend to be highly resilient," said Dr. Matthew Biel, chief of child and adolescent psychiatry at MedStar Georgetown University Hospital.

And one way that younger children try to make sense of trauma is through play. Youngsters may pull out action figures or stuffed animals and re-enact what they witnessed, perhaps multiple times.

"That's the way they gain mastery over a situation that's overwhelming," Biel explained, saying it becomes a concern only if the child is clearly distressed while playing.

Nor is it unusual for children to chase each other playing cops-and-robbers, but now parents might see some also pretending they're dead, added Dr. Melissa Brymer of the UCLA-Duke National Center for Child Traumatic Stress.

Among the challenges will be spotting which children are struggling enough that they may need professional help.

Newtown's tragedy is particularly heart-wrenching because of what such young children grappled with — like the six first-graders who apparently had to run past their teacher's body to escape to safety.

There's little scientific research specifically on PTSD, post-traumatic stress disorder, in children exposed to a burst of violence, and even less to tell if a younger child will have a harder time healing than an older one.

Overall, scientists say studies of natural disasters and wars suggest most children eventually recover from traumatic experiences while a smaller proportion develop long-term disorders such as PTSD. Brymer says in her studies of school shootings, that fraction can range from 10 percent to a quarter of survivors, depending on what they actually experienced. A broader 2007 study found 13 percent of U.S. children exposed to different types of trauma reported some symptoms of PTSD, although less than 1 percent had enough for an official diagnosis.

Violence isn't all that rare in childhood. In many parts of the world — and in inner-city neighborhoods in the U.S., too — children witness it repeatedly. They don't become inured to it, Biel said, and more exposure means a greater chance of lasting psychological harm.

In Newtown, most at risk for longer-term problems are those who saw someone killed, said Dr. Carol North of the University of Texas Southwestern Medical Center, who has researched survivors of mass shootings.

Friday's shootings were mostly in two classrooms of Sandy Hook Elementary School, which has about 450 students through fourth-grade.

But those who weren't as close to the danger may be at extra risk, too, if this wasn't their first trauma or they already had problems such as anxiety disorders that increase their vulnerability, she said.

Right after a traumatic event, it's normal to have nightmares or trouble sleeping, to stick close to loved ones, and to be nervous or moody, Biel said.

To help, parents will have to follow their child's lead. Grilling a child about a traumatic experience isn't good, he stressed. Some children will ask a lot of questions, seeking reassurance, he said. Others will be quiet, thinking about the experience and maybe drawing or writing about it, or acting it out at playtime. Younger children may regress, becoming clingy or having tantrums.

Before second grade, their brains also are at a developmental stage some refer to as magical thinking, when it's difficult to distinguish reality and fantasy. Parents may have to help them understand that a friend who died isn't in pain or lonely but also isn't coming back, Brymer said.

When problem behaviors or signs of distress continue for several weeks, Brymer says it's time for an evaluation by a counselor or pediatrician.

Besides a supportive family, what helps? North advises getting children back into routines, together with their friends, and easing them back into a school setting. Studies of survivors of the Sept. 11 terrorist attacks found "the power of the support of the people who went through it with you is huge," she said.

Children as young as first-graders can benefit from cognitive-behavioral therapy, Georgetown's Biel said. They can calm themselves with breathing techniques. They also can learn to identify and label their feelings — anger, frustration, worry — and how to balance, say, a worried thought with a brave one.

Finally, avoid watching TV coverage of the shooting, as children may think it's happening all over again, Biel added. He found that children who watched the 9/11 clips of planes hitting the World Trade Center thought they were seeing dozens of separate attacks.

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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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