Cold wave grips north India

NEW DELHI: Cold wave conditions gripped north India as mercury dipped in most parts of the region on Saturday, with Kashmir Valley shivering under sub-zero temperature.


In Delhi, the minimum temperature settled two notches below normal at 6.2 degrees Celsius, Met office said, predicting a foggy morning for tomorrow.


In Jammu and Kashmir, temperature remained below freezing point in most parts of the state, with the mercury in capital Srinagar recording minus 3.4 degrees Celsius.


Kargil also witnessed a dip in the night temperature, which settled at minus 14.4 degrees Celsius.


Pahalgam, which serves as the base camp for the annual Amarnath yatra, was freezing at minus 8.0 degrees Celsius.


The famous ski resort of Gulmarg was the coldest place in the Valley yesterday with a minimum of minus 10.8 degrees Celsius, Met officials said.


In Punjab and Haryana, night temperatures continued to drop, with Narnaul in Haryana being the coldest place in the region at 3.5 degrees.


While Ludhiana with 5.8 degrees Celsius was coldest place in Punjab, Chandigarh recorded a night temperature of 6.9 degrees.


In Uttar Pradesh, biting cold, coupled with dense fog, threw life out of gear and claimed life of one person in Hamirpur district.


The mercury nose-dived by several notches to settle below normal in most places, with the Bareilly and Meerut divisions recording the sharpest decline.


While Najibabad remained the coldest place in the state with 3.4 degrees Celsius, temperature fell in other places of the state including capital Lucknow, Kanpur, Allahabad, Agra and Mathura districts.

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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.


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Online:


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


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


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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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ASEAN will continue to push for open skies agreement with India: PM Lee






SINGAPORE: Prime Minister Lee Hsien Loong said the issue of an open skies agreement between ASEAN and India is something which Singapore will continue to push for.

Speaking to the Singapore media at the end of his visit to New Delhi for the ASEAN-India commemorative summit, Mr Lee said passenger traffic keeps on growing, and hence the need for more capacity.

"I keep on making the point to them that if you want to engage Asia, if you want to engage ASEAN, this is really one of the easiest ways you can help to make it happen because if you open up the links, then the businessmen will travel, the tourists will travel, the business opportunities will be identified, more investments will come.

"I think the business people are quite persuaded but I think it's a subject we need to keep on pushing because some of the incumbent players, they prefer a slower pace. I hope there will be progress. The Singapore-India path we are discussing how to improve the air services agreement. The ASEAN-India air services agreement is something they have not started talking about, but we hope that they will begin soon," he shared.

Mr Lee concluded his trip to New Delhi with a visit to the Red Fort and he had the opportunity to meet the Singaporean team which took part in the ASEAN-India Car Rally.

The Prime Minister was encouraged by their participation, and it was also an opportunity for him to hear first-hand their experiences in driving 8,000 kilometres and through several states in ASEAN, before reaching New Delhi.

- CNA/ck



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Rail attendant lodges FIR against UP minister Azam Khan

LUCKNOW: Dirty linen in air-conditioned coaches of Indian Railways is something which many passengers have experienced and complained about. But, senior Samajwadi Party leader and cabinet minister Mohd Azam Khan could be an exception. Khan allegedly slapped and pinched the coach attendant for not making a 'perfect' bedding for him. And, later the minister denied the allegation.

As per records, Khan boarded the Amritsar Howrah Express (train number 13005) on Tuesday afternoon from Charbagh Railway station to reach his native place Rampur. He reportedly found that the linen provided to him in his first class AC cabin was not made neatly. Though he didn't react initially, he called the attendant about five minutes before the train was to stop at Rampur. "He told me that I do not know how to set a bedding properly. And before I could say anything, he started uttering foul words. I tried to defend myself, he slapped me and pinched me while locking into the coupe. He told me that he would let me go only if I would hold my ears and do sit-ups 50 times. I was following the order helplessly when the train reached Rampur. The minister got down, leaving me absolutely numb," said the victim, Nirmal Murmu - a technical III staff with the Eastern Railway.

TOI spoke to the attendant when the train was on its way back to Howrah (train number 13006) on Thursday morning. The train stopped at Charbagh at around 10.35 am and departed for the next station at 10.50 am. Nirmal stated that before he could think of reporting the matter to the authorities on Tuesday, the train departed. "I decided to not to let the matter go like this. At around 2.30 pm on December 19, I lodged an FIR with the government railway police at Amritsar station," he said adding that he has seen people complaining about lack of facilities but the way in which the minister behaved with him was uncalled for.

Nirmal is working with the Eastern Railway since 2001 and presently holds the designation of technical-III staff. He belongs to Hooghly district of West Bengal and says that he has never faced such a 'torture'. "In 12 years of my service, I have seen many passengers getting annoyed over lack of facilities. But not even once, I have seen anyone getting down to this level. I feel that I was tortured for no reason," he told TOI.

When asked to comment, Mohd Azam Khan said, "Mujhe nahi yaad ki aisa kuch hua tha." (I do not remember if something of this sort happened). TOI informed the minister that the attendant has named him in his complaint, which has been duly received by the police officials, he said, "Koi aur hoga mere naam ka." (It could be someone else with my name). Victim Murmu continued to plead his case. "It is not for the first time that the minister was travelling. I recognise him and people who travel with him. He is usually accompanied by a gunner. The person was surely Mohd Azam Khan," asserted Murmu.

It may be noted that the seat allotted against the PNR number (660-9767668) mentioned in Murmu's complaint was in the name of Azam Khan. The seats were allotted against VIP quota. Incidentally, this is not for the first time that the SP leader has sparked off a controversy. "Stories of his argument with the railway staff are not new," said KP Singh, coach mechanic who has been witness to the incident.

However, some railway officials believe that the quota for public representatives is often misused. "We have seen that the same MP or MLA travels to different destinations on the same day, which is practically impossible," said an officer, requesting anonymity. Meanwhile, the incident has shattered Murmu's self-respect and he has decided to raise the matter with his employees' union in Kolkata.

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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.


___


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.


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NRA to Speak on Stopping Newtown Repeat













For the past week, leadership at the National Rifle Association has largely stayed away from the media, but this morning the group may weigh in on how to keep a deadly shooting massacre like last week's at a Newtown, Conn., elementary school from happening again.


The NRA will hold a news conference in Washington, D.C., just before 11 a.m.


Its leadership has held off on interviews this week after refusing to appear on Sunday morning public affairs shows this past weekend.


The group came under pressure after Adam Lanza, 20, killed 20 children and six adults before shooting himself at Sandy Hook Elementary School in Newtown last Friday.


"Out of respect for the families, and as a matter of common decency, we have given time for mourning, prayer and a full investigation of the facts before commenting," the group said in a press release Tuesday. "The NRA is prepared to offer meaningful contributions to help make sure this never happens again."


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."






Christian Gooden/St. Louis Post-Dispatch/AP Photo











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





The guns used in the attack were legally purchased and owned by the shooter's mother, Nancy Lanza, who 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.


President Obama announced Wednesday that Vice President Joe Biden will head a task force of leaders from across the country that will evaluate the best solutions to reduce gun violence in the United States.


Obama said he will "use all the powers of this office to help advance efforts aimed at preventing more tragedies like this."


Mayors Against Illegal Guns, of which Mayor Bloomberg is co-chair, released a letter to President Obama signed by more than 750 mayors calling on him to produce a plan to "make it harder for dangerous people to possess guns."


The letter asked for mandatory background checks for gun buyers, a ban on high-capacity rifles and ammunition magazines, and a designation of gun trafficking as a federal crime.


ABC News' George Stephanopoulos looked at whether strict gun control laws like those that have worked for the United Kingdom and Japan could work for the U.S. on "Good Morning America" Thursday.


Others have argued that, rather than banning guns, the government should be arming teachers and administrators in schools so that they can defend students in the event of another school shooting.


While Michigan Gov. Rick Snyder vetoed a measure that would have let guns into schools on Tuesday, Texas Gov. Rick Perry and Virginia Gov. Bob McDonnell praised the idea.


Speaking on the NRA's daily news program Tuesday, Dave Koppel of the Independence Institute said the teachers at Sandy Hook should have had weapons.


"We'd certainly be talking about fewer innocent people and children dead," Koppel said.


While a national debate over the necessary solutions to prevent a tragedy of this nature from ever happening again wages on, Connecticut residents will have to wait "several months" before the final Connecticut State Police report on the Newtown shootings is complete.



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Egypt opposition vows to fight on against Islamist charter


CAIRO (Reuters) - Egypt's opposition, facing defeat over a new constitution in a referendum this weekend, urged its supporters to reject the Islamist-backed charter and pledged to fight on to amend it during elections expected next year.


Forty-eight hours before the second round of the plebiscite, the main opposition coalition of liberals, leftist, Christians and secular Muslims called for a "no" vote against a document it views as leaning too far towards Islamism.


The first day of voting last weekend resulted in a 57 percent majority in favor of the constitution, promoted by President Mohamed Mursi as a vital step in Egypt's transition to democracy almost two years after the fall of Hosni Mubarak.


The second stage on Saturday is expected to produce another "yes" vote as it covers areas of the country that are seen as more conservative and likely to back Mursi.


The National Salvation Front, the main opposition coalition, said a "no" vote meant taking a stand against attempts by the Muslim Brotherhood, Mursi's political backers, to dominate Egypt.


"For the sake of the future, the masses of our people should strongly and firmly say 'no' to injustice and 'no' to the Brotherhood's dominance," the Front said in a statement.


A senior Front member, Abdel Ghaffar Shokr, head of the Popular Socialist Coalition Party, said that if the constitution was approved, the opposition would go on fighting to change it.


"That's why we will participate in the legislative election because it is the only way to amend the constitution," he said.


The constitution must be in place before elections can be held. If it passes, the poll should be held within two months.


In an attempt to mobilize voters, the opposition said it planned to hold public meetings, distribute flyers and send cars equipped with loudspeakers through the streets.


A street protest against the constitution in Cairo this week attracted only a few hundred people, well down on the numbers drawn to previous such events.


ISLAMIST GROUPS


Islamist groups are planning a mass protest in Alexandria on Friday, a move likely to raise tensions a day before the vote.


The rally by the Muslim Brotherhood was called after a violent confrontation between Islamists and the opposition in Egypt's second city last week that ended with a Muslim preacher besieged inside his mosque for 14 hours.


The run-up to the referendum has been marked by often violent protests in which at least eight people have died.


U.N. Secretary-General Ban Ki-moon called for the final stage of the referendum to pass off peacefully so the country can focus on building "a pyramid of democracy in the heart of the Arab world".


"I sincerely hope there should be no further violence and the protest must be carried out in a peaceful manner so people will be free to express their views," Ban told reporters in New York on Wednesday.


Mursi and his backers say the constitution is needed to advance Egypt's transition from decades of military-backed autocratic rule. Opponents say it is too Islamist and ignores the rights of women and of minorities, including 10 percent of Egyptians who are Christian.


Demonstrations erupted when Mursi awarded himself extraordinary powers on November 22 and then fast-tracked the constitution through a drafting assembly dominated by his Islamist allies and boycotted by many liberals.


The referendum is being held over two days because many of the judges needed to oversee polling stayed away in protest.


Judicial authorities on Thursday named the judges who will supervise polling stations on Saturday. The opposition cited a lack of judges at some polling stations in a list of alleged irregularities in the first round.


In order to pass, the constitution must be approved by more than 50 percent of those voting.


(Writing by Giles Elgood; Editing by Alistair Lyon)



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SGX consults markets on proposed rule changes






SINGAPORE: The Singapore Exchange (SGX) is consulting the securities and derivatives markets on proposed rule changes to provide market participants with more clarity of their rights and responsibilities.

The proposed rule changes are meant to clarify when settlement and other payments between the clearing house and clearing members become final.

SGX is proposing rule refinements to remove rules related to the trading, clearing or settlement of physical scrip in the securities market.

It is also seeking to formalise the practice of SGX members maintaining separate accounts for each customer.

This will help monitor risks associated with customers of SGX members.

The rule amendments are set out in two consultation papers and are available from Thursday at www.sgx.com

The SGX invites comments on the papers till 3 January 2013.

- CNA/xq



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CWG case: Order on framing of charges against Kalmadi tomorrow

NEW DELHI: A Delhi court will pronounce tomorrow its order on framing of charges against former Commonwealth Games Organising Committee (OC) Chairman Suresh Kalmadi and 10 others in a games-related graft case.

Special CBI Judge Talwant Singh had on November 21 slated for tomorrow the pronouncement of order on charges in the case also involving former CWG OC Secretary General Lalit Bhanot as an accused in the case.

Besides Kalmadi and Bhanot, nine others have been charge-sheeted by the CBI for allegedly "illegally" awarding a contract to install Timing, Scoring and Results system for the 2010 CWG to Swiss Timing at an inflated rates causing a loss of over Rs 90 crore to the public exchequer.

They have been charge-sheeted under various provisions of the IPC, including those of criminal conspiracy under section 120(B), cheating (section 420), forgery (section 468 & 471) of the Indian Penal Code and the Prevention of Corruption Act.

The CBI had alleged Kalmadi and others had rejected Spanish firm MSL's much lower bid of Rs 62 crore and awarded the contract to Swiss Timing Omega, causing a loss of over Rs 90 crore to the exchequer.

The other nine accused in the case are OC's Director General V K Verma, Director General (Procurement) Surjit Lal, Joint Director General (Sports) A S V Prasad and Treasurer M Jayachandran. They are no more associated with the sporting body.

Promoters of two construction companies - P D Arya and A K Madan of Faridabad-based Gem International and A K Reddy of Hyderabad-based AKR Constructions are also accused in the case.

Besides the two firms, Swiss Timing Omega, the Swiss firm which was awarded the contract allegedly at exorbitant rates, is also an accused in the case.

During the arguments on charges, CBI counsel V K Sharma had argued that Kalmadi and others had decided to award the contract for installing the TSR system for the CWG to Swiss Timing even before the firm had bid for it.

Sharma had also said that for TSR installation, two bids had been received - one from Swiss Timing and other from MSL Spain, and the same were opened on November 4, 2009 but Kalmadi and Verma had announced in a meeting on October 12, 2009 itself that the contract would be given to Swiss Timing.

He had also said Kalmadi had made up his mind in advance to award the contract to the Swiss firm.

Kalmadi's counsel, however, had argued that the facts given in the CBI's charge sheet were contrary to the documents which the agency had filed in the court.

Kalmadi had told the court that he was only doing the work assigned to him as the OC chairman and nothing wrong was done by him in the entire process.

The counsel appearing for other accused had also opposed the allegations levelled against them by the CBI.

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