Egypt's constitution approved in vote, say rival camps

CAIRO (Reuters) - A constitution drafted by an Islamist-dominated assembly was approved by a majority of Egyptians in a referendum, rival camps said on Sunday, after a vote the opposition said drove a wedge through the Arab world's most populous nation.

The Muslim Brotherhood, which propelled President Mohamed Mursi to power in a June election, said 64 percent of voters backed the charter after two rounds of voting that ended with a final ballot on Saturday. It cited an unofficial tally.

An opposition official also told Reuters their unofficial count showed the result was a "yes" vote.

The referendum committee may not declare official results for the two rounds until Monday, after hearing appeals. If the outcome is confirmed, a parliamentary election will follow in about two months.

Mursi's Islamist backers say the constitution is vital for the transition to democracy, nearly two years after the overthrow of autocrat Hosni Mubarak in an uprising. It will provide stability needed to help a fragile economy, they say.

But the opposition accuses Mursi of pushing through a text that favors Islamists and ignores the rights of Christians, who make up about 10 percent of the population, as well as women. They say it is a recipe for further unrest.

"According to our calculations, the final result of the second round is 71 percent voting 'yes' and the overall result (of the two rounds) is 63.8 percent," a Brotherhood official, who was in an operations room monitoring the vote, told Reuters.

His figures were confirmed by a statement issued shortly afterwards by the group and broadcast on its television channel.

The Brotherhood and its party, as well as members of the opposition, had representatives monitoring polling stations and the vote count across the country.

The opposition said voting in both rounds was marred by abuses and had called for a re-run after the first stage. However, an official said the overall vote favored the charter.

"They (Islamists) are ruling the country, running the vote and influencing the people, so what else could we expect," the senior official from the main opposition coalition, the National Salvation Front, told Reuters.

PROTESTS

The vote was split over two days as many judges had refused to supervise the ballot.

"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, in greater Cairo, in the last round.

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.

The build-up to the vote witnessed deadly protests, sparked by Mursi's decision to award himself extra powers in a decree on November 22 and then to fast-track the constitution to a vote.

Hours before polls closed, Vice President Mahmoud Mekky announced his resignation. He said he wanted to quit last month but stayed on to help Mursi tackle the crisis that blew up when the Islamist leader assumed wide powers.

Mekky, a prominent judge who said he was uncomfortable in politics, disclosed earlier he had not been informed of Mursi's power grab. The timing of his resignation appeared linked to the lack of a vice-presidential post under the draft constitution.

The new basic law sets a limit of two four-year presidential terms. It says the principles of Islamist sharia law remain the main source of legislation but adds an article to explain this. It also says Islamic authorities will be consulted on sharia - a source of concern to Christians and others.

TURNOUT

Rights groups reported what they said were illegalities in voting procedures. They said some polling stations opened late, that Islamists illegally campaigned at some polling places and complained of irregularities in voter registration.

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. About 25 million were eligible to vote in the second round.

The Brotherhood said turnout was about a third of voters.

The opposition says the constitution will stir up more trouble on the streets since it has not received sufficiently broad backing for a document that should be agreed by consensus, and raised questions about the fairness of the vote.

In the first round, the district covering most of Cairo voted "no," which opponents said showed the depth of division.

"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.

He cited "serious violations" on the first day of voting, and said anger against Mursi 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 in Alexandria, the second-biggest city, on the eves of both voting days.

Late on Saturday, Mursi announced the names of 90 new members he had appointed to the upper house of parliament, state media reported, and a presidential official said the list was mainly liberals and other non-Islamists.

A spokesman for the National Salvation Front, which groups opponents who include liberals, socialists and other parties and politicians, said the Front's members had refused to take part.

Legislative powers, now held by Mursi because the lower house of parliament was dissolved earlier this year, will pass to the upper house under the new constitution.

Two-thirds of the 270-member upper house was elected in a vote this year, with one third appointed by the president. Mursi, elected in June, had not named them until now. Mursi's Islamist party and its allies dominate the assembly.

(Writing by Edmund Blair and Giles Elgood; Editing by Mark Trevelyan and Todd Eastham)

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Euro survives 2012, further tests in store

BRUSSELS: The battered euro, written off as a dud many times during a crisis-wracked year, appears to have survived 2012, but 2013 could prove just as difficult if the economy continues to struggle.

It finished the year strongly after the 17 eurozone nations earlier this month nailed down a deal to supply long-delayed bailout funds to Greece to keep the country afloat, and the bloc intact.

Athens in turn delivered on its part of the bargain -- more stinging austerity, economic reforms and a tight budget -- all with the aim of cutting its massive debt burden to a more sustainable 124 percent of GDP by 2020.

Then progress towards tighter economic and fiscal coordination in the eurozone, and a key first step towards a shared bank supervision regime, rounded out the gains, leaving the Europe in much better shape than seemed likely at the beginning of the year.

"Many observers felt it was all over for Greece (and its) ... remaining in the eurozone. As year-end approaches, we know that these Casandras were wrong," EU Economics Commissioner Olli Rehn said.

For many months, all analysts could talk about was Greece's likely exit from the eurozone and what it would mean for the bloc's future.

Now, "the likelihood of a member state leaving the eurozone is gone," said Janis Emmanouilidis of the European Policy Centre (EPC) think-tank.

Reflecting the change, Standard and Poor's raised Greece's sovereign debt rating by a massive six notches because of what it termed the "strong determination of ... (eurozone) member states to preserve Greek membership."

Greek Finance Minister Yannis Stournaras said the decision "was a very important one that created a climate of optimism. But we know that the road is still long and hard, the hour is not one for easing up."

Analysts also highlighted agreement on the eurozone's Single Supervisory Mechanism (SSM) to regulate its banks, a first step in ring-fencing lenders who get into trouble and threaten financial disaster.

Perhaps the key breakthrough, giving purpose and backing to the other reforms, was a commitment by European Central Bank head Mario Draghi over the summer months to do anything necessary to save the euro.

In September, Draghi said the ECB would buy up the sovereign debt of any eurozone member state without limit, if that is what it took to keep the financial markets in check.

This pledge of 'Outright Monetary Transactions' meant markets' could no longer enjoy a one-way bet against a member state as the ECB could step in on its side.

The immediate result was a sharp easing in borrowing costs, especially for Spain and Italy which had been tipped to follow Greece, Ireland and Portugal in needing a bailout.

That change, backed up a 100 billion euros eurozone lifeline for its banks, allowed the Spanish government to hold the line.

By year-end, few were talking of Madrid as the next debt crisis casualty, with its banks also being stabilised at a much lower-than-expected cost of some 40 billion euros.

Some analysts said it was important not to get too carried away, however.

The outlook for the next two years "looks less unsettled and will be concerned above all with implementing the new supervisory regime and winding up mechanism for the banks," CM-CIC Securities analysts said in a note.

For Barclays, talks on closer integration in the eurozone could prove heated and even chaotic, with the emergence of deep differences running the risk of stoking fresh tensions on the markets.

Above all, the uncertainties for the coming year are political, with elections due in Italy and then Germany, while the situation in "Greece is still on a knife-edge," said Emmanouilidis at the EPC.

The economic outlook is also clouded, with the eurozone in recession and expected to slow further while unemployment runs at a record 11.7 percent, rising to unprecedented levels around 25 percent in Spain and Greece.

Against that background, German Chancellor Merkel's guarded words on the outlook seem appropriate.

"We have already achieved a lot but I think we still have a very difficult time ahead," Merkel said after the last EU leaders summit of the year earlier this month.

- AFP/ck

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Two more toy trains running on Kalka-Shimla route to meet tourist rush

CHANDIGARH: Tourists who are looking forward to celebrating Christmas and New Year in Shimla have a better option to reach the hill station with two more toy trains running on the Kalka-Shimla route from Friday. Seeing the rush from West Bengal and Delhi in particular, Northern Railways started the two toy trains from Kalka to Shimla. The departure timings of these trains from Kalka have been fixed in such a manner that it gets connected with other trains' arrival at Kalka.

The first toy train with a capacity of about 100 passengers leaves at 6.30am. All coaches are first class. The timings of this train are such that those arriving on board Howrah-Kalka mail at 4.30am can board it. The second toy train departs at 12.45pm and is connected with the Himalayan Queen and Shatabdi from Delhi arriving at Kalka at 11.20 am and 11.40am, respectively. This toy train has first and second class bogies with a total capacity of about 150 people.

"We have started two toy trains and timings have been fixed in such a manner that it gets connected with the other trains arriving at Kalka. These two trains will continue its services till the first week of January, but seeing the rush it can be extended also," said P K Sanghi, DRM, Ambala division.

Apart from these two toy trains, Northern Railways is already running five toy trains from Kalka to Shimla.

The 97-km track, figuring in UNESCO world heritage list, has over 900 sharp curves besides 102 tunnels and 988 bridges. It is the sharp curves which have made the proposal of increasing speed of the trains not feasible as it could result in accidents on the curves, sources said.

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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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Obama, Congress Waving Bye-Bye Lower Taxes?

The first family arrived in the president's idyllic home state of Hawaii early today to celebrate the holidays, but President Obama, who along with Michelle will pay tribute Sunday to the late Sen. Daniel Inouye at the National Memorial Cemetery of the Pacific, could be returning home to Washington sooner than he expected.

That's because the President didn't get his Christmas wish: a deal with Congress on the looming fiscal cliff.

Members of Congress streamed out of the Capitol Friday night with no agreement to avert the fiscal cliff -- a massive package of mandatory tax increases and federal spending cuts triggered if no deal is worked out to cut the deficit. Congress is expected to be back in session by Thursday.

It's unclear when President Obama may return from Hawaii. His limited vacation time will not be without updates on continuing talks. Staff members for both sides are expected to exchange emails and phone calls over the next couple of days.

Meanwhile, Speaker of the House John Boehner is home in Ohio. He recorded the weekly GOP address before leaving Washington, stressing the president's role in the failure to reach an agreement on the cliff.

"What the president has offered so far simply won't do anything to solve our spending problem and begin to address our nation's crippling debt," he said in the recorded address, "The House has done its part to avert this entire fiscal cliff. ... The events of the past week make it clearer than ever that these measures reflect the will of the House."

Fiscal Cliff Negotiations Halted for Christmas Watch Video

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Fiscal Cliff: Boehner Doesn't Have Votes for Plan B Watch Video

Senate Minority Leader Mitch McConnell echoed the sentiment while lamenting the failure to reach a compromise.

"I'm stuck here in Washington trying to prevent my fellow Kentuckians having to shell out more money to Uncle Sam next year," he said.

McConnell is also traveling to Hawaii to attend the Inouye service Sunday.

If the White House and Congress cannot reach a deficit-cutting budget agreement by year's end, by law the across-the-board tax hikes and spending cuts -- the so called fiscal cliff -- will go into effect. Many economists say that will likely send the economy into a new recession.

Reports today shed light on how negotiations fell apart behind closed doors. The Wall Street Journal, citing unnamed sources, reported that when Boehner expressed his opposition to tax rate increases, the president allegedly responded, "You are asking me to accept Mitt Romney's tax plan. Why would I do that?"

The icy exchange continued when, in reference to Boehner's offer to secure $800 billion in revenue by limiting deductions, the speaker reportedly implored the president, "What do I get?"

The president's alleged response: "You get nothing. I get that for free."

The account is perhaps the most thorough and hostile released about the series of unsuccessful talks Obama and Boehner have had in an effort to reach an agreement about the cliff.

Unable to agree to a "big deal" on taxes and entitlements, the president is now reportedly hoping to reach a "small deal" with Republicans to avoid the fiscal cliff.

Such a deal would extend unemployment benefits and set the tone for a bigger deal with Republicans down the line.

In his own weekly address, Obama called this smaller deal "an achievable goal ... that can get done in 10 days."

But though there is no definitive way to say one way or the other whether it really is an achievable goal, one thing is for certain: Republican leadership does not agree with the president on this question.

Of reaching an agreement on the fiscal cliff by the deadline, Boehner said, "How we get there, God only knows."

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Venezuela's VP Maduro a "poor copy" of Chavez: opposition

CARACAS (Reuters) - Venezuela's opposition mocked President Hugo Chavez's chosen successor Nicolas Maduro on Friday as a "poor copy" of his boss who should be promoting national unity rather than insulting opponents during a delicate time for the South American nation.

In power since 1999, Chavez named vice president and foreign minister Maduro as his preferred replacement should he be incapacitated by the cancer he is battling in Cuba.

Since the December 11 operation, Maduro, 50, a former bus driver and union leader who shares Chavez's socialist politics, has been fronting day-to-day government in Venezuela while the president has been neither seen nor heard from in public.

Though lacking Chavez's booming charisma, Maduro has borrowed elements of his style - speaking regularly and lengthily on live TV, inaugurating public works, rallying supporters and attacking "bourgeois" opponents at every turn.

He even used one of Chavez's old catch phrases to gloat that Sunday's regional vote, where Chavez allies won 20 of 23 governorships, smashed the opposition into "cosmic dust."

The opposition Democratic Unity coalition reacted angrily.

"Vice President Nicolas Maduro has begun his temporary rule badly," it said in a withering statement, accusing him of ignoring Venezuela's pressing social, economic and political problems while falling back on antagonistic speeches.

"Mr. Maduro, the country expects better from you than a bad imitation of your boss. ... In his rhetoric, Maduro hides the leadership crisis in government given President Chavez's absence. He hides his weakness with shouts and threats."

"Don't waste the opportunity to create a wide national consensus," the statement said.

After an extraordinary year - in which Chavez proclaimed himself cured from the cancer that has dogged him since mid-2011, won a presidential election, then disappeared for new surgery - Venezuelans are heading into an uncertain 2013.

Government officials say Chavez, 58, is lucid and recovering in a hospital, but have acknowledged he is still suffering a respiratory infection after his operation and needs total rest.

Speculation is rife that his condition is life-threatening, and there is uncertainty over whether Chavez will be able to return to start his new term on January 10.

IN-FIGHTING?

The stakes are huge in Venezuela's political drama.

Beyond its borders, Venezuela helps sustain an alliance of left-wing Latin American governments from Cuba to Bolivia via oil subsidies and other economic aid.

Should Chavez be forced to vacate power, a new election would be held within 30 days, with the probable scenario a straight competition between Maduro and opposition leader Henrique Capriles, who lost to Chavez in the October vote.

There are rumors of in-fighting within "Chavismo" - the wide movement of military men and hard-left ideologues that has ruled for the last 14 years. Yet in public, the senior figures have repeatedly vowed unity and loyalty to Chavez.

Apart from Maduro, the two most powerful men are Congress head Diosdado Cabello and Energy Minister Rafael Ramirez.

"You know, there is a campaign from abroad and by the national right wing to try and divide us," Maduro said in one of a string of speeches on Friday at ceremonies to celebrate the pro-Chavez governors' election wins.

"Every day, they say we're fighting, that Diosdado is Joseph Stalin and I am Leon Trotsky. Ridiculous, ridiculous and more ridiculous! ... We've never been more united."

Cabello, a former military comrade of Chavez viewed by Venezuelans as the hard man in government with possible presidential ambitions of his own, stirred controversy this week by suggesting that the January 10 inauguration date could be delayed to accommodate Chavez's recovery.

Confusion over that and any tensions within the ruling Socialist Party threaten to create a difficult transition to any post-Chavez government in the OPEC nation with the world's largest crude oil reserves.

Former soldier Chavez has vastly expanded presidential powers and built a near-cult following among millions of poor Venezuelans, who love his feisty language and pouring of funds into welfare projects in the nation's slums.

Smarting from defeats in the presidential and state polls in quick succession, the opposition coalition is trying to keep Venezuelans' attention on a raft of unresolved problems, from a soaring black market in currency to rampant crime.

"The economy is in dust. Citizens' security is in dust. Public services are in dust. The only thing that isn't is corruption in government," the coalition statement said.

(Additional reporting by Daniela Desantis in Asuncion; editing by Todd Eastham)

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Squash: World No. 1 Nicol David extends haul of World Open titles

GRAND CAYMAN, Cayman Islands: Nicol David extended her record of World Open titles to seven from eight finals on Friday with a balanced performance and great patience to beat English third seed Laura Massaro.

The Malaysian heroine's 11-6 11-8 11-6 victory silenced critics who had suggested younger rivals were closing the gap on the 29-year-old champion.

Massaro forced many long rallies and even led 7-5 in the second game, but David responded well to the important moments which followed.

She mixed containment with well-timed drops and lightning-quick changes of direction that prevented her opponent from getting a crucial foothold in the match.

The outcome was that David only dropped one game throughout the entire tournament, but she had to focus harder and for longer in the final than in any of her four other encounters.

Her relief and joy at surviving the perpetual pressure of expectations yet again was smilingly obvious.

She held her head in both hands, then placed her hands high on the court, and finally caressed the ball affectionately against a wall before allowing herself to accept that no more was required of her racket.

Then her words reflected the frequent struggle between doubt and self-confidence.

"I can't believe it," she said. "I just can't believe it.

"I am just so pleased with my match. Laura pushed me every point. There was no point where I could let up because she was just on it every point. She played a very good match."

David knew the danger well as Massaro is one of the few players to have beaten her twice. However, she did so last year and, although the challenger has improved further since then, the champion at her best has too, perhaps just as much.

Two of the most crucial moments came when David got back to 7-7 in the pivotal middle game and then nosed ahead to 8-7 with a disputed point.

The levelling rally saw brilliantly nimble retrieves from David, plus some patient backhand wall straight driving with a tight little backhand drop to finish it.

That was followed in the next rally by a marginally mistimed backhand drive by Massaro, which caused the ball to come away from the wall and resulted in her slightly impeding David.

A penalty stroke was awarded, Massaro's video review appeal failing to get the decision overturned.

David pushed hard to capitalise, offered a rare fist pump when she broke through to a two-game lead, and was quickly five points up in the third and motoring away.

"I am a little bit disappointed with that," said Massaro, who had saved a match point in a long and hard semi-final with Raneem El Weleily, the second-seeded Egyptian, and may have paid a price in the third game of the final.

"It was just a few points here and there and that's all the difference," she said. "The middle of the games were so crucial and that's what I have to work on.

"It's still pretty rare that she is beaten. We are still training hard and improving and she's rising to the challenge."

To do that well as she moves through her 30th year, David may need to select peaks more carefully for the tournaments she really wants to win.

But at her best, she is still too fine an athlete and too steady a rallyer for everyone, even during her moments of doubt. Her high profile among the all-time greats is likely to rise yet further.

- AFP/al

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HC vacates stay on results for 14,000 new PGT posts

CHANDIGARH: While vacating the stay on the announcement of results for around 14,000 new posts of Post Graduate Teachers (PGTs), the Punjab and Haryana high court on Friday held that only those who clear the Haryana Teachers Eligibility Test (HTET) would be eligible for teaching posts in Haryana.

With these orders, candidates having qualified the eligibility test of state, other than Haryana or Central Teachers Eligibility Test (CTET), will not be eligible for these teaching posts in the state.

A division bench headed by chief justice A K Sikri also upheld the condition of Haryana School Teachers Selection Board (HSTSB) that all candidates with four years of teaching experience are eligible for appointments if they qualify HTET before 2015.

The bench passed these orders while dismissing a petition filed by some HTET qualified candidates, who had sought directions to quash the selection criteria which allowed candidates, who have not qualified HTET but are working in any recognized school for the last four years, to become eligible for these posts.

In June this year, Haryana had advertised around 14,000 posts of PGTs in which the government had given relaxation to those candidates from qualifying HTET having teaching experience of four years.

The petitioners had contended that the government was exempting the candidates from HTET just to accommodate the guest teachers working in various schools of the state for last so many years.

Acting on their petition, the HC had restrained HSTSB from declaring the final result of selection in August this year.

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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

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.

"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.

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.

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.

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.

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 operations 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."

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

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

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

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

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Obama Still an 'Optimist' on Cliff Deal

Mandel Ngan/AFP/Getty Images

WASHINGTON D.C. – Ten days remain before the mandatory spending cuts and tax increases known as the “fiscal cliff” take effect, but President Obama said he is still a “hopeless optimist” that a federal budget deal can be reached before the year-end deadline that economists agree might plunge the country back into recession.

“Even though Democrats and Republicans are arguing about whether those rates should go up for the wealthiest individuals, all of us – every single one of us -agrees that tax rates shouldn’t go up for the other 98 percent of Americans, which includes 97 percent of small businesses,” he said.

He added that there was “no reason” not to move forward on that aspect, and that it was “within our capacity” to resolve.

The question of whether to raise taxes on incomes over $250,000 remains at an impasse, but is only one element of nuanced legislative wrangling that has left the parties at odds.

For ABC News’ breakdown of the rhetoric versus the reality, click here.

At the White House news conference this evening, the president confirmed he had spoken today to Senate Majority Leader Harry Reid, D-Nev., and House Speaker John Boehner, R-Ohio, although no details of the conversations were disclosed.

The talks came the same day Speaker Boehner admitted “God only knows” the solution to the gridlock, and a day after mounting pressure from within his own Republican Party forced him to pull his alternative proposal from a prospective House vote. That proposal, ”Plan B,” called for extending current tax rates for Americans making up to $1 million a year, a far wealthier threshold than Democrats have advocated.

Boehner acknowledged that even the conservative-leaning “Plan B” did not have the support necessary to pass in the Republican-dominated House, leaving a resolution to the fiscal cliff in doubt.

“In the next few days, I’ve asked leaders of Congress to work towards a package that prevents a tax hike on middle-class Americans, protects unemployment insurance for 2 million Americans, and lays the groundwork for further work on both growth and deficit reduction,” Obama said. ”That’s an achievable goal.  That can get done in 10 days.”

Complicating matters: The halls of Congress are silent tonight. The House of Representatives began its holiday recess Thursday and Senate followed this evening.

Meanwhile, the president has his own vacation to contend with. Tonight, he was embarking for Hawaii and what is typically several weeks of Christmas vacation.

However, during the press conference the president said he would see his congressional colleagues “next week” to continue negotiations, leaving uncertain how long Obama plans to remain in the Aloha State.

The president said he hoped the time off would give leaders “some perspective.”

“Everybody can cool off; everybody can drink some eggnog, have some Christmas cookies, sing some Christmas carols, enjoy the company of loved ones,” he said. “And then I’d ask every member of Congress, while they’re back home, to think about that.  Think about the obligations we have to the people who sent us here.

“This is not simply a contest between parties in terms of who looks good and who doesn’t,” he added later. “There are real-world consequences to what we do here.”

Obama concluded by reiterating that neither side could walk away with “100 percent” of its demands, and that it negotiations couldn’t remain “a contest between parties in terms of who looks good and who doesn’t.”

Boehner’s office reacted quickly to the remarks, continuing recent Republican statements that presidential leadership was at fault for the ongoing gridlock.

“Though the president has failed to offer any solution that passes the test of balance, we remain hopeful he is finally ready to get serious about averting the fiscal cliff,” Boehner said. “The House has already acted to stop all of the looming tax hikes and replace the automatic defense cuts. It is time for the Democratic-run Senate to act, and that is what the speaker told the president tonight.”

The speaker’s office said Boehner “will return to Washington following the holiday, ready to find a solution that can pass both houses of Congress.”

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