Predicting who's at risk for violence isn't easy


CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.


Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.


But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.


"They're yellow flags. They only become red flags once the blood is spilled," he said.


Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.


Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)


Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.


Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.


"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."


The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."


In a guidelines for families, the academy lists several risk factors for violence, including:


—Previous violent or aggressive behavior


—Being a victim of physical or sexual abuse


—Guns in the home


—Use of drugs or alcohol


—Brain damage from a head injury


Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.


Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.


Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.


According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.


Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.


Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.


And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.


All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.


Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.


Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.


Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.


___


Online:


American Academy of Child & Adolescent Psychiatry: http://www.aacap.org


___


AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner


Read More..

'Fiscal Cliff' Leaves Boehner a Wounded Speaker












John Boehner is a bloodied House speaker following the startling setback that his own fractious Republican troops dealt him in their "fiscal cliff" struggle against President Barack Obama.



There's plenty of internal grumbling about the Ohio Republican, especially among conservatives, and lots of buzzing about whether his leadership post is in jeopardy. But it's uncertain whether any other House Republican has the broad appeal to seize the job from Boehner or whether his embarrassing inability to pass his own bill preventing tax increases on everyone but millionaires is enough to topple him.



"No one will be challenging John Boehner as speaker," predicted John Feehery, a consultant and former aide to House GOP leaders. "No one else can right now do the job of bringing everyone together" and unifying House Republicans.



The morning after he yanked the tax-cutting bill from the House floor to prevent certain defeat, Boehner told reporters he wasn't worried about losing his job when the new Congress convenes Jan. 3.



"They weren't taking that out on me," he said Friday of rank-and-file GOP lawmakers, who despite pleading from Boehner and his lieutenants were shy of providing the 217 votes needed for passage. "They were dealing with the perception that somebody might accuse them of raising taxes."






Jacquelyn Martin/AP Photo








That "somebody" was a number of outside conservative groups such as the Club for Growth and Heritage Action for America, which openly pressured lawmakers to reject Boehner's bill. Such organizations often oppose GOP lawmakers they consider too moderate and have been headaches for Boehner in the past.



This time, his retreat on the tax measure was an unmistakable blow to the clout of the 22-year House veteran known for an amiable style, a willingness to make deals and a perpetual tan.



Congressional leaders amass power partly by their ability to command votes, especially in showdowns. His failure to do so Thursday stands to weaken his muscle with Obama and among House Republicans.



"It's very hard for him to negotiate now," said Sarah Binder, a George Washington University political scientist, adding that it's premature to judge if Boehner's hold on the speakership is in peril. "No one can trust him because it's very hard for him to produce votes."



She said the loss weakens his ability to summon support in the future because "you know the last time he came to you like this, others didn't step in line."



Boehner, 63, faces unvarnished hostility from some conservatives.



"We clearly can't have a speaker operate well outside" what Republicans want to do, said freshman Rep. Tim Huelskamp, R-Kan.



Huelskamp is one of four GOP lawmakers who lost prized committee assignments following previous clashes with party leaders. That punishment was an anomaly for Boehner, who is known more for friendly persuasion than arm-twisting.



He said Boehner's job would depend on whether the speaker is "willing to sit and listen to Republicans first, or march off" and negotiate with Obama.



Conservative Rep. Steve King, R-Iowa, said one of the tea party's lasting impacts would be if Boehner struggled to retain his speakership due to the fight over the fiscal cliff, which is the combination of deep tax increases and spending cuts that start in early January without a bipartisan deal to avert them.



"If there's a major defeat delivered here, it could make it tough on him," King said. "He's in a tough spot."





Read More..

Egypt extends voting on Islamist-drafted charter


CAIRO (Reuters) - Egypt extended voting by four hours on Saturday in the second and decisive round of a referendum that was expected to approve the country's new Islamist-drafted constitution after weeks of protests and violence.


Islamist supporters of President Mohamed Mursi, who was elected in June, say the charter is vital to move Egypt towards democracy, nearly two years after an Arab Spring revolution overthrew authoritarian ruler Hosni Mubarak.


It will help restore the stability needed to fix an economy that is on the ropes, they say.


But the opposition says the document is divisive and has accused Mursi of pushing through a text that favors his Islamist allies while ignoring the rights of Christians, who make up about 10 percent of the population, as well as women.


"I'm voting 'no' because Egypt can't be ruled by one faction," said Karim Nahas, 35, a stockbroker, heading to a polling station in Giza, a province included in this round of voting which covers parts of greater Cairo.


At another polling station, some voters said they were more interested in ending Egypt's long period of political instability than in the Islamist aspects of the charter.


"We have to extend our hands to Mursi to help fix the country," said Hisham Kamal, an accountant.


Queues formed at some polling stations around the country and voting was extended by four hours to 11 p.m. (2100 GMT).


Unofficial tallies are likely to emerge within hours of the close, but the referendum committee may not declare an official result for the two rounds until Monday, after hearing appeals.


CHEATING ALLEGED


As polling opened on Saturday, a coalition of Egyptian rights groups reported a number of alleged irregularities.


They said some polling stations had opened late, that Islamists urging a "yes" vote had illegally campaigned at some stations, and complained of irregularities in voter registration irregularities, including the listing of one dead person.


The first round of voting last week resulted in a 57 percent vote in favor of the constitution, according to unofficial figures.


Analysts expect another "yes" on Saturday because the vote covers rural and other areas seen as having more Islamist sympathizers. Islamists may also be able to count on many Egyptians who are simply exhausted by two years of upheaval.


Among the provisions of the new basic law are a limit of two four-year presidential terms. It says the principles of sharia law remain the main source of legislation but adds an article to explain this further. It also says Islamic authorities will be consulted on sharia - a source of concern to Christians and other non-Muslims.


If the constitution is passed, a parliamentary election will be held in about two months. If not, an assembly will have to be set up to draft a new one.


After the first round of voting, the opposition said a litany of alleged abuses meant the first stage of the referendum should be re-run.


But the committee overseeing the two-stage vote said its investigations showed no major irregularities in voting on December 15, which covered about half of Egypt's 51 million voters.


There was no indication on Saturday that the alleged abuses were any worse than those claimed during the first round.


MORE UNREST


Even if the charter is approved, the opposition say it is a recipe for trouble since it has not received broad consensus backing from the population. They say the result may go in Mursi's favor but it will not be the result of a fair vote.


"I see more unrest," said Ahmed Said, head of the liberal Free Egyptians Party and a member of the National Salvation Front, an opposition coalition formed after Mursi expanded his powers on November 22 and then pushed the constitution to a vote.


Protesters accused the president of acting like a pharaoh, and he was forced to issue a second decree two weeks ago that amended a provision putting all his decisions above legal challenge.


Said cited "serious violations" on the first day of voting, and said anger against Mursi and his Islamist allies was growing. "People are not going to accept the way they are dealing with the situation."


At least eight people were killed in protests outside the presidential palace in Cairo this month. Islamists and rivals clashed on Friday in the second biggest city of Alexandria, hurling stones at each other. Two buses were torched.


The head of the Muslim Brotherhood, an Islamist group that represents Mursi's power base, said the vote was an opportunity for Egypt to move on.


"After the constitution is settled by the people, the wheels in all areas will turn, even if there are differences here and there," the Brotherhood's supreme guide, Mohamed Badie, said as he went to vote in Beni Suef, south of Cairo.


"After choosing a constitution, all Egyptians will be moving in the same direction," he said.


The vote was staggered after many judges refused to supervise the ballot, meaning there were not enough to hold the referendum on a single day nationwide.


The first round was won by a slim enough margin to buttress opposition arguments that the text was divisive. Opponents who include liberals, leftists, Christians and more moderate-minded Muslims accuse Islamists of using religion to sway voters.


Islamists, who have won successive ballots since Mubarak's overthrow, albeit by narrowing margins, dismiss charges that they are exploiting religion and say the document reflects the will of a majority in the country where most people are Muslim.


(Additional reporting by Tamim Elyan; Writing by Edmund Blair and Giles Elgood; Editing by Mark Trevelyan)



Read More..

N. Korea confirms arrest of US citizen






SEOUL: North Korea confirmed Friday that it had arrested a US citizen in November, saying legal action would be taken against him but giving no details of the charges.

The man, identified as Pae Jun-Ho, entered North Korea on November 3 as a tourist, and "committed a crime" against the country, the official Korean Central News Agency (KCNA) said.

"He was put into custody by a relevant institution," it added.

The United States has no diplomatic ties with North Korea and KCNA said consular officials from the Swedish embassy, which acts on behalf of the US, had visited Pae on Friday.

"Legal actions are being taken against Pae in line with the criminal procedure law" of North Korea, the agency said without elaborating.

The arrest was first reported earlier this month by a South Korean newspaper which had identified the detainee as a a 44-year-old Korean-American tour operator.

KCNA said Pae was detained as he entered the north-eastern port city of Rason which lies inside a special economic zone near North Korea's border with Russia and China.

Several Americans have been held in North Korea in recent years.

In 2010 former US president Jimmy Carter won plaudits when he negotiated the release of American national, Aijalon Mahli Gomes, sentenced to eight years of hard labour for illegally crossing into the North from China.

On another mercy mission a year earlier in 2009, former president Bill Clinton won the release of US television journalists Laura Ling and Euna Lee, jailed after wandering across the North Korean border with China.

- AFP/jc



Read More..

Rape victim taken off ventilator, all 6 accused arrested

NEW DELHI: All the six accused in the Delhi gang rape case have been arrested with the two men on the run being caught today, five days after the assault on the 23-year-old paramedical student who was taken off ventilator but showed early signs of infection in a "mixed response".

As protests continued for the fifth day here including at India Gate and outside Congress president Sonia Gandhi's 10 Janpath residence over the dastardly crime in a moving bus on Sunday night, government vowed that the chargesheet in the case will be filed by Delhi Police "quickly" seeking maximum punishment of life term for the accused.

Akshay Thakur, the sixth and final accused who was one of the helpers in the bus, was arrested from his house in Bihar's Aurangabad district this evening.

"A joint team of Bihar police and Delhi police caught the accused Akshay Thakur from his home in Lahankarma village in Tandwa police station of Aurangabad district," In-Charge Superintendent of Police, Aurangabad, Pranav Kumar told PTI. Delhi Police Commissioner Neeraj Kumar confirmed the arrest.

The other accused on the run was apprehended from Uttar Pradesh's Badaun and he has claimed to be a minor.

"The fifth accused has been arrested in the rape case. His age is being verified before giving details," Kumar told a press conference in the presence of home secretary R K Singh. Four accused have been already arrested.

Singh complimented Delhi Police for cracking the "blind case" within a very short span of time.

But the heat was on the Police when the Delhi High Court slammed it for being "evasive" in its probe status report in providing details of its officers on patrol duty in the area covered by the bus in which the girl was gang-raped for about 40 minutes.

"She has shown some mixed response. She has shown some signs of improvement and there are some signs of deterioration. She is off the ventilator at the moment. She is no more on ventilator. She is breathing spontaneously on her own," Dr B D Athani, Medical Superintendent of the Hospital, told a press conference. She was on ventilator in the ICU ever since she was admitted on Sunday night.

On the deterioration in the girl's health, Athani said the level of Bilirubin, the yellow breakdown product of normal heme catabolism, has increased to five which is a cause of concern as it would affect liver.

"There are early signs of setting up of infection. Infection seems to be setting in. These are early signs of sepsis. That is a part of the blood culture and several other. We have sent blood for test," he said.

Read More..

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.


___


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.


___


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.


___


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.


___


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.


___


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.


___


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.


___


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


___


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.


Read More..

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.








President Obama Launches Gun-Violence Task Force Watch Video









President Obama on Gun Control: Ready to Act? Watch Video









Joe Biden to Lead Task Force to Prevent Gun Violence Watch Video





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.






Read More..

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)



Read More..

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



Read More..

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.

Read More..