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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Wall Street Week Ahead: A lump of coal for "Fiscal Cliff-mas"

NEW YORK (Reuters) - Wall Street traders are going to have to pack their tablets and work computers in their holiday luggage after all.


A traditionally quiet week could become hellish for traders as politicians in Washington are likely to fall short of an agreement to deal with $600 billion in tax hikes and spending cuts due to kick in early next year. Many economists forecast that this "fiscal cliff" will push the economy into recession.


Thursday's debacle in the U.S. House of Representatives, where Speaker John Boehner failed to secure passage of his own bill that was meant to pressure President Obama and Senate Democrats, only added to worry that the protracted budget talks will stretch into 2013.


Still, the market remains resilient. Friday's decline on Wall Street, triggered by Boehner's fiasco, was not enough to prevent the S&P 500 from posting its best week in four.


"The markets have been sort of taking this in stride," said Sandy Lincoln, chief market strategist at BMO Asset Management U.S. in Chicago, which has about $38 billion in assets under management.


"The markets still basically believe that something will be done," he said.


If something happens next week, it will come in a short time frame. Markets will be open for a half-day on Christmas Eve, when Congress will not be in session, and will close on Tuesday for Christmas. Wall Street will resume regular stock trading on Wednesday, but volume is expected to be light throughout the rest of the week with scores of market participants away on a holiday break.


For the week, the three major U.S. stock indexes posted gains, with the Dow Jones industrial average <.dji> up 0.4 percent, the S&P 500 <.spx> up 1.2 percent and the Nasdaq Composite Index <.ixic> up 1.7 percent.


Stocks also have booked solid gains for the year so far, with just five trading sessions left in 2012: The Dow has advanced 8 percent, while the S&P 500 has climbed 13.7 percent and the Nasdaq has jumped 16 percent.


IT COULD GET A LITTLE CRAZY


Equity volumes are expected to fall sharply next week. Last year, daily volume on each of the last five trading days dropped on average by about 49 percent, compared with the rest of 2011 - to just over 4 billion shares a day exchanging hands on the New York Stock Exchange, the Nasdaq and NYSE MKT in the final five sessions of the year from a 2011 daily average of 7.9 billion.


If the trend repeats, low volumes could generate a spike in volatility as traders keep track of any advance in the cliff talks in Washington.


"I'm guessing it's going to be a low volume week. There's not a whole lot other than the fiscal cliff that is going to continue to take the headlines," said Joe Bell, senior equity analyst at Schaeffer's Investment Research, in Cincinnati.


"A lot of people already have a foot out the door, and with the possibility of some market-moving news, you get the possibility of increased volatility."


Economic data would have to be way off the mark to move markets next week. But if the recent trend of better-than-expected economic data holds, stocks will have strong fundamental support that could prevent selling from getting overextended even as the fiscal cliff negotiations grind along.


Small and mid-cap stocks have outperformed their larger peers in the last couple of months, indicating a shift in investor sentiment toward the U.S. economy. The S&P MidCap 400 Index <.mid> overcame a technical level by confirming its close above 1,000 for a second week.


"We view the outperformance of the mid-caps and the break of that level as a strong sign for the overall market," Schaeffer's Bell said.


"Whenever you have flight to risk, it shows investors are beginning to have more of a risk appetite."


Evidence of that shift could be a spike in shares in the defense sector, expected to take a hit as defense spending is a key component of the budget talks.


The PHLX defense sector index <.dfx> hit a historic high on Thursday, and far outperformed the market on Friday with a dip of just 0.26 percent, while the three major U.S. stock indexes finished the day down about 1 percent.


Following a half-day on Wall Street on Monday ahead of the Christmas holiday, Wednesday will bring the S&P/Case-Shiller Home Price Index. It is expected to show a ninth-straight month of gains.


U.S. jobless claims on Thursday are seen roughly in line with the previous week's level, with the forecast at 360,000 new filings for unemployment insurance, compared with the previous week's 361,000.


(Wall St Week Ahead runs every Friday. Questions or comments on this column can be emailed to: rodrigo.campos(at)thomsonreuters.com)


(Reporting by Rodrigo Campos; Additional reporting by Chuck Mikolajczak; Editing by Jan Paschal)



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North Korea Says It Has Detained an American Citizen





SEOUL, South Korea — North Korea said on Friday that it had detained an American citizen on charges of committing “hostile acts against the republic,” a crime punishable by years in prison in the isolated country.




The North’s state-run Korean Central News Agency said the American, Bae Jun-ho, had entered the country on Nov. 3 through a port city near the Russian border. Human rights activists in South Korea said they believed Mr. Bae to be Kenneth Bae, 44, who they said earlier this month had been detained in the North.


The North Korean report said, without elaborating, that an investigation had established Mr. Bae’s guilt and that he had confessed. It said he had been allowed to meet with officials from the Swedish Embassy in the North Korean capital, Pyongyang. The Swidish Embassy intervenes on Washington’s behalf on issues involving American citizens in North Korea. Washington has no diplomatic relations with the North.


The charge comes at a sensitive time for Washington, which is trying to rally support for a new round of penalties against North Korea over its launch of a long-range rocket earlier this month. In recent years, North Korea has detained several Americans, in some cases agreeing to let them go only after high-profile American figures visited Pyongyang to seek their release. Analysts have suspected North Korea of trying to use such arrests to counter Washington’s diplomatic pressure over its nuclear and missile programs and force it to engage with the regime.


The human rights activists in South Korea said Mr. Bae ran a travel company that specialized in taking tourists and prospective investors to North Korea. Mr. Bae, a naturalized American citizen born in South Korea, was detained after escorting five European tourists into the North, said Do Hee-youn, who heads the Citizens’ Coalition for the Human Rights of North Korean Refugees, based in Seoul. The Europeans were allowed to leave the country, Mr. Do said.


The South Korean daily newspaper Kookmin Ilbo earlier cited an unnamed source as saying that Mr. Bae was detained after North Korean security officials found a computer hard disk in his possession that they believed contained sensitive information about the country. Mr. Do said that Mr. Bae may have taken pictures of North Korean orphans he wanted to help and that the authorities may have considered that an act of anti-North Korean propaganda.


In 2009, North Korea arrested two American journalists, Laura Ling and Euna Lee, and sentenced them to 12 years of hard labor for illegally entering the North and committing “hostile acts against the Korean nation.” But the women were pardoned and released five months later, after former President Clinton visited Pyongyang and met with Kim Jong-il, North Korea’s leader at the time.


In 2010, North Korea released Robert Park, a Korean-American Christian activist who entered the country in December 2009 to draw international attention to the North’s poor human rights record. Another American, named Aijalon Mahli Gomes, was arrested the same year in North Korea and was sentenced to eight years of hard labor for illegal entry and “hostile acts.” He was freed after former President Carter visited Pyongyang and, according to North Korea, “apologized” for the man’s crime.


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Kristen Stewart, Amy Adams a 'Dream' to Dress in On the Road




Style News Now





12/20/2012 at 09:00 AM ET



Kristen Stewart On the RoadMichele K. Short


Sure, one of the more notable scenes in the new movie On the Road actually features an actress without clothes, but costume designer Danny Glicker promises that audiences will be blown away by the film’s clothes. And with all of the work he put into these looks, they’d better be.


“It was a hugely immersive research period,” Glicker (who was nominated for an Oscar for his work on Milk) tells PEOPLE. “We obviously started with the script, but then I really had to reconstruct Jack Kerouac’s entire journey, so that we’d have a reference point for every place that the characters go.”


The film takes viewers on a trip that extends throughout the U.S. and Mexico of the 1950s, so Glicker says he “had to look with a fresh set of eyes at what the countries really did look like back then, in post-war America.”


However, a perk of the job was dressing the film’s leads: Kristen Stewart, Amy Adams and Kirsten Dunst. “It was a dream,” Glicker says. “They were amazing. I had so much fun with all of them.”


Glicker says each woman “had a very specific piece of the puzzle. Kristen and I worked super closely together — she was so committed to the role,” he shares. “And to see her intelligence and awareness of how clothing can inform every aspect of her understanding of a character … that was pure pleasure.”



Working with Adams was also “a dream,” because Glicker considers himself “such a huge fan. I got to make her look quite awful, actually — she’s playing a woman who’s incredibly strung-out on drugs — but thankfully she’s a brilliant actress. We had a ball.”


Dunst had one of the more fun characters to dress, Glicker says, because “she had an elegance about her,” he explains. “It was fun to show that elegance through her clothing, and that then impacted everything, like her posture, and how she appeared against the other characters in the larger picture.”


On the RoadMichele K. Short


Dressing the men of the cast was interesting, too, and of course lots of thought went into the actor’s outfits. “Sam Riley, who is our Kerouac, was a nice partner in crime,” Glicker says. And one of his pieces was the most important in the film.


“Something you may not notice when you see the movie, is that he has this incredibly iconic red-and-black plaid jacket — it was designed specially for the movie.”


Glicker sourced five of the pieces for filming, since Riley wears the coat throughout the movie, but as time goes on, “it gets more destroyed,” the designer says. “It’s not at all a gag, but wouldn’t you notice if it was clean over the course of a four-year roadtrip? So it was really fun to explore clothing in that way.”


Since Glicker had to create so many costumes — seriously, the cast list is long! — was he able to pick just one favorite? Not a chance. As he says, “There were thousands of standouts.” On the Road opens in New York and Los Angeles on Friday, and throughout the rest of the country soon. Tell us: Do you plan to see the film? 


–Kate Hogan


PHOTOS: SEE MORE STARS ALL DRESSED UP ON SET IN ‘LIGHTS! CAMERA! FASHION!’



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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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Stock futures sink, bill failure may make fiscal deal unlikely


NEW YORK (Reuters) - Stock futures were sharply lower on Friday, dropping more than 1 percent, after a Republican proposal for averting the "fiscal cliff" failed to pass, further eroding hopes that a deal would be reached quickly.


Trading is expected to be volatile as investors view a fiscal agreement between the White House and Republicans before the year-end as increasingly unlikely. With trading thin ahead of the holidays, market swings will probably be amplified. CBOE VIX front-month futures, a measure of volatility, rose 5.7 percent.


Late on Thursday, Republican House Speaker John Boehner conceded there were insufficient votes from his party to pass a tax bill, dubbed "Plan B," to help avert the cliff, a combination of tax hikes and spending cuts that could tip the economy into recession if they take effect next year.


Boehner said he would hold a press conference at 10:00 a.m. ET (1500 GMT), during which he is expected to discuss the vote.


Plan B had called for tax increases on those who earn $1 million a more a year, a far smaller slice of taxpayers than President Barack Obama had asked for.


The bill's failure suggested it would be difficult to get Republican support for the more expansive tax increases Obama has urged, making it less likely an agreement will be reached before the end of the year.


"This calls Boehner's leadership into question as well as the government's ability to compromise on a deal. There's now little chance anything will happen before the end of the year," said Robert Pavlik, chief market strategist at Banyan Partners LLC in New York.


"This will lead to weakness throughout the day, and things could get very bad with so many people out for the holidays."


Investors had previously considered such an outcome unlikely. The decline implied by futures on Friday would wipe out most of the week's equity gains, which buoyed the S&P 500 close to two-month highs.


Banking and energy shares, which outperform in times of economic expansion and have led the market on signs of progress with the fiscal impasse, could be the most vulnerable to any setback. February crude futures dropped 1.3 percent in early trading on Friday.


S&P 500 futures sank 19 points, or 1.3 percent, and were below fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures lost 184 points and Nasdaq 100 futures slid 36.5 points.


The S&P 500 is up about 1.8 percent this week, boosted by signs of progress in the fiscal negotiations between Obama and Boehner earlier in the week.


So far in 2012, the index has gained 14.8 percent, though uncertainty over the cliff may prompt many traders to lock in gains as the year draws to a close.


November durable goods data is scheduled for release at 8:30 a.m. ET (1330 GMT), along with personal income and spending data. The Thomson Reuters/University of Michigan's final December consumer sentiment survey is due at 9:55 a.m.


Durable goods are seen rising 0.2 percent while the main index in the consumer sentiment survey is seen at 74.7, compared with a prior read of 74.5. Both income and spending are seen rising 0.3 percent.


With budget worries at the forefront, investors are likely to shrug off Friday's data, as they did on Thursday, when strong economic growth and home sales figures failed to excite them.


"All other news will take a third-row seat to the negotiations as investors deal with the game of 'chicken' being played in Washington," Pavlik said.


Nike Inc rose 3.5 percent to $102.50 in premarket trading, after reporting second-quarter earnings that handily beat expectations Thursday on strong demand in North America. Software distributor Red Hat Inc posted third-quarter revenue that beat expectations.


U.S.-listed shares of Research in Motion slumped 14 percent to $12.20 in premarket trading. The company reported its first-ever decline in its subscriber numbers Thursday and outlined plans to transform the way it charges for its BlackBerry services.


(Editing by Bernadette Baum)



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IHT Rendezvous: In London for the Holidays? Theatrical Gifts for Everyone on Your List

So who needs more possessions? The holidays afford the chance to give the gift of theatergoing, the kind of present that will be remembered (one hopes) throughout the year. With that in mind, what follows is a handful of London theater suggestions for the festive season.
Enjoy, and curtain up!

For parents (or grandparents)

“Singin’ in the Rain” at the Palace Theater should fit the bill, whether or not your grandparents (or parents, even) first saw the 1952 MGM film musical at the time of its release. Set against the backdrop of the uneasy transition in moviedom from silent pictures to the talkies, the Gene Kelly film has spawned multiple stage versions on both sides of the Atlantic, of which the director Jonathan Church’s current incarnation is by some measure the best of the three that I have seen.

Inheriting Kelly’s role as silent film star Don Lockwood, onetime Tony nominee Adam Cooper (“Swan Lake”) makes as charming and insouciant a leading man as you could wish for, and his own family must thrill at the larger-than-life facsimile of Mr. Cooper (sporting an umbrella, ‘natch) on view to passers-by in front of the playhouse. The production has time-honored songs (“Good Morning,” “Moses Supposes,” and the title number among them), nifty choreography from Andrew Wright and lashings of real rain. Go and get soaked! And I don’t just mean over that extra intermission gin and tonic.

Is that just too familiar a title, or you would you rather give the family a taste of next year’s likely Broadway biggie? In that case, the Royal Shakespeare Company’s buoyant and witty “Matilda” is a good bet, continuing strong in London at the Cambridge Theater even as its New York bow gets nearer. A child-oriented piece that possibly means even more to adults, Matthew Warchus’s production also offers a prime man-as-woman star turn, more on which below.

For lovers

“The Effect,” running in repertory at the National Theater’s Cottesloe auditorium through Feb. 23, represents an intriguing date-night theatrical prospect largely because it places the speedy bloom of passion at its feverishly pulsating heart. One frequently hears the term “meet cute” to describe (often sniffily) an adorable if unlikely impromptu meeting.

But initial concerns that this play’s Connie and Tristan might not rise above the shopworn clichĂ© inherent in the above phrase are soon dispelled by the unexpected path forged by Lucy Prebble’s play, which lands its newfound couple in the world of pharmaceutical research where desire is not to be trusted. Is romance actually having its day, the play asks, or are such reactions merely drug-induced? Ms. Prebble seems to come down on something resembling the primacy of truly authentic feeling, but not before taking her audience on a wild emotional ride. What more could you ask from the theater – well, that and Billie Piper’s gorgeous portrayal of Connie, which ranks among the year’s best performances.

For students

You don’t have to be engaged in academia, of course, to enjoy the current Royal Court mainstage entry, “In the Republic of Happiness,” but it helps to be alive and alert to theatrical form when taking in the playwright Martin Crimp’s latest. And if students don’t fit that bill, who does? And as London’s – some would say the English-speaking theater’s – premier playhouse for new writing, the Court has the added appeal of the “cool” factor, and the further attractions of the downstairs cafĂ©/bar don’t hurt, either.

Told across three scenes, the shifts between visual environments managed with characteristically easeful dazzle by the designer Miriam Buether, Mr. Crimp here anatomizes a world given over to self-obsession and self-improvement whereby our constant quest for happiness has resulted only in hollowing us out. Brainiacs in the house will enjoy making clear the connections that are implicit in writing that asks the audience to do some work and then pays off with an ending that recalls (in tone if not content) the finale to Robert Altman’s seminal film, “Nashville,” as a requiem for a benumbed society. Dominic Cooke, artistic director of the Court, has done a tricky piece proud, and those who don’t walk out – as quite a few did at the performance I caught – will stay to cheer and possibly even book to see the show again.

For gender-benders

You thought cross-dressing was confined to the British tradition of the seasonal pantomime, which demands that a leggy young woman play the principal boy and usually casts a man of some seniority as the principal dame? (Ian McKellen, of all distinguished folk, filled that latter bill for two consecutive seasonal runs of “Aladdin” at the Old Vic.)

Pantos continue to proliferate on cue across the capital, but the so-called “legit” theater, too, seems to have gone cross-dressing mad. Consider for starters Miss Trunchbull that armor-plated harridan of a headmistress in “Matilda.” David Leonard is doing the honors now, while original leading man (um, woman?) Bertie Carvel readies for his New York debut. Not to be outdone are Mark Rylance and the cast of the all-male productions of “Twelfth Night” and “Richard III,” now at the Apollo Theater following sellout engagements at Shakespeare’s Globe last summer, and Simon Russell Beale in “Privates On Parade” at the Noel Coward Theater sporting baubles, bangles and sometimes not much at all as Terri Dennis, the campest – and most irresistible – of military captains.

Too many men, what about the women? Get in line for return tickets for Phyllida Lloyd’s all-female “Julius Caesar” at the Donmar: the London play that boasts by some measure the most swagger in town.

For someone you hope never to see again

“Viva Forever!”, at the Piccadilly Theater: Gift this one, scored to the back catalog of the Spice Girls, to someone from whom you hope to part company: trust me, they’ll never speak to you again.

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Best Practice Institute Introduces New Social Network that Promises ‘Future of 360′






A new social network, skillrater.com launched today, makes it easy for members to request work performance ratings from overseers, co-workers and direct reports across a domestic and global workforce.


West Palm Beach, Fla. (PRWEB) December 20, 2012






Skillrater.com, an online social network that launched today, makes it easy for members to request work performance ratings from overseers, co-workers and direct reports across a domestic and global workforce.


“This is the future of 360-degree assessment and social learning,” said the network’s creator, Louis Carter, CEO of Best Practice Institute.


“Get rated. Get better. Get noticed,” says Skillrater.com’s website, which describes the new social network as “the world’s first rating, networking and feedback tool on a social platform.”


Executives, employees and entrepreneurs who have already been friended, linked and tweeted can now get feedback and rating on their skill sets and work at Skillrater.com. Individuals may join the Skillrater social network at no cost; corporations may purchase a premium or enterprise membership to use Skillrater as an in-house platform for feedback, talent management and social networking.


The Next Thing in 360 Assessment and Corporate Social Networking


“I want to bring a revolution to 360 so that organizations become more open and transparent, and driven by the desire for employees to request feedback on their competencies/skills and activities they execute on a daily basis” said Carter, BPI’s founder and a social-organizational psychologist.


The world of work is becoming more open and transparent. “A new IBM study of 1709 Chief Executive Officers from 64 countries and 18 industries worldwide reveals that CEOs are changing the nature of work by adding a powerful dose of openness, transparency and employee empowerment to the command-and-control ethos that has characterized the modern corporation for more than a century.”


Employees using skillrater engage in conversations and threaded discussions around improving their activities at work. Instead of hiding feedback from employees, employees may receive immediate correction of negatively reinforcing workplace habits directly from their bosses, peers, and customers. Employees may continue the feedback process in a threaded discussion to receive deeper advice and help from executive coaches or other members of the team. Repeating this process will show measurable changes in behavior and actions over time for your organization, as well as show patterns for the changes that need to me made on an individual, team, and organization level. The employee requests feedback of others directly, so that a culture of accountability and feedback is encouraged. Instead of “big brother/sister” HR forcing feedback of competencies and workplace performance, employees take ownership for creating their own culture of transparency so they may show their progress toward growth.


One study found that as many as 90 percent of all Fortune 500 companies use 360-degree feedback with their employees. In a 360 assessment, feedback is sought from all directions of an employee’s circle: overseers, peers, direct reports, and sometimes even external sources, such as customers and suppliers.


Skillrater brings several innovations to the 360-degree process to make the technique easier to use and to increase the tool’s beneficial results. Features include:


“Skillrater is a great tool. Leaders and managers are going to fall in love with it,” said the world’s leading executive coach and bestselling author Marshall Goldsmith. “There is no better way for organizational leaders to track talent data. Skillrater gives you a simple way to request receive feedback on what you are doing, while building an in-house social network to discuss the feedback. The ability to customize Skillrater around the desired competencies of your organization is brilliant.”"


Focus on Leadership Development in Globally Dispersed Workforces


Most importantly, Carter said, Skillrater provides a social network through which members can springboard from quantitative ratings to qualitative discussions that make the feedback truly transformative. This is especially beneficial for dispersed workforces where consistent face-to-face communication is costly to accomplish.”


“Our goal is to create a social network within an organization that is focused on helping employees improve their skills and improve performance,” Carter said. “Skillrater is not primarily about promotion and pay decisions, it’s about leadership development and positive behavioral change throughout a national or global workforce.”


Studies have shown 360-degree feedback is an effective way to help workers identify their strengths and weaknesses, including blind spots in which they need further development. Skillrater’s convenient online platform, along with the addition of a social networking dimension, makes Skillrater a powerful leadership development for dispersed or collective learning environments.


After corporate clients learn their way around all the bells and whistles of Skillrater’s multi-rater feedback tool, Carter said, they will move on to appreciate the richness of the in-house social network, creating a dispersed learning environment in which ongoing leadership development and action learning is cultivated within domestic or global workforces.


Skillrater Benefits for Individual Users


Individuals may join Skillrater.com for free and choose up to five skills upon which to be rated. Top executives, mid-level rising stars and lower-level workers with an eye on advancement may all use Skillrater to request feedback and map their own course of development. Requesting a Skillrater rating is an excellent way for an individual to confirm satisfaction with a completed project or identify additional steps needed to achieve satisfaction. Using Skillrater, a worker can demonstrate to higher-ups one’s desire to perform well and also document tangible improvement.


An individual who has acquired several ratings on one’s Skillrater profile and has made those ratings public may catch the attention of employers on the search for talent. Skillrater will become a go-to destination for talent recruitment. Other social networks provide an individual’s name, personal background and employment history, but Skillrater provides rubber-meets-the-road details of how an individual has been evaluated by co-workers, clients and customers on actual projects.


Skillrater Benefits for Corporate Users


Companies may purchase an enterprise membership, giving executives an unparalleled tool for talent management and leadership development. Enterprise membership enables companies to enroll 1,000 users and place them in 20 groups or divisions.


For senior talent management executives, Skillrater provides a remarkable way to track the job performance, skill sets and leadership development of dozens, hundreds or even thousands of employees spread out across a national or global workforce. For years, connecting the right employees with the right tasks has been the elusive aim of talent management. With Skillrater, when a particular skill set is needed for a particular task, a manager can search on those specific skills, and then read fresh feedback on recent projects, including not only numerical ratings but subsequent comments and discussion. That is rich, valuable talent data, which Skillrater puts at executives’ fingertips.


Managers from different divisions may customize their own groups to have specific skills or competencies that are important for success on-the-job. Users can select these group skills when requesting ratings to get targeted feedback that meets the need of the department head or head of leadership development. The ability to customize skills is critical to an organization’s success, making this a key feature of Skillrater’s enterprise membership level.


VPs of leadership development have the ability to set up action learning groups with specific action items. Group members work together online to achieve goals and get ratings on the skills that will make them most successful on the action learning project. Changes in behavior and actual project results may be tracked over time, proving the ROI of the leadership development program.


How Does Skillrater Work?


Joining Skillrater is easy and painless. An individual can create a Skillrater profile in a few moments or import one’s profile and skill set from LinkedIn.


A Skillrater member may request a rating from anybody on anything. It really is that simple. The user simply clicks the “Request Rating” button, specifies the task or activity for which one seeks a rating and the specific skills on which feedback is desired.


Then the member sends off the rating requests. If the desired rater is already a Skillrater.com member, requesting a rating is just one additional click. If not, the user enters the desired rater’s email address, and a message is sent requesting the rating and providing the necessary link.


After feedback has been received, Skillrater notifies the user. Results include a spider chart, an easy-to-understand graphical interpretation of how the feedback lines up with one’s self-assessment. Users continue to share advice and further clarification via a discussion thread to continue the social learning and coaching experience online.


ABOUT BEST PRACTICE INSTITUTE


Best Practice Institute is an award-winning leadership development center, think tank, peer network, research institute and online learning portal with more than 10,000 corporate and individual members around the world. Corporate members include Walmart, Bank of America, Pfizer, Hilton Hotels Worldwide, Scripps and many more of the world’s top corporations. BPI is based in West Palm Beach, FL, and is on the web at http://www.bestpracticeinstitute.org. BPI is ranked as one of the top ten “Best in Leadership Development” by Leadership Excellence Magazine.


Louis Carter is the founder and CEO of Best Practice Institute. Carter is a social-organizational psychologist, concept innovator, entrepreneur and a highly regarded authority on learning, talent, leadership development and change. He is the author or co-author of 11 books and a regular contributor to Fast Company, Chief Learning Officer, Talent Management, and Training Magazine.


For More Information or to schedule an interview, please contact Louis Carter: 800-718-4274; lou(at)bestpracticeinstitute.org


Louis Carter
Best Practice Institute
800-718-4274
Email Information


Internet News Headlines – Yahoo! News





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Miss USA Olivia Culpo Wins Miss Universe















12/20/2012 at 08:35 AM EST







Miss Universe Olivia Culpo


Julie Jacobson/AP


USA! USA!

Olivia Culpo, the 20-year-old Miss USA and former Miss Rhode Island, won the Miss Universe pageant on Wednesday night in Las Vegas, becoming the first American to do so since 1997.

The Boston University sophomore outlasted 88 other competitors. Miss Philippines, Janine Tugonon, came in second, and Miss Venezuela, Irene Sofia Esser Quintero, finished third.

"What an honor! This night was a dream come true. Thank you everyone for your support tonight!! USA finally did it!" Culpo wrote on Twitter after the competition ended.

The U.S. drought in the competition had gone back 15 years. The last American to win was Hawaii's Brook Lee.

With Culpo earning her new title, Miss Maryland, Nana Meriwether, now becomes the new Miss USA.

Culpo had told the Boston Herald this week, before she won, that the Miss Universe competition was a whole different challenge than Miss USA. "For Miss USA, I felt more pressure to be lean," she said. "Here, they're bigger and taller. The look of Miss Universe is more voluptuous."

On Thursday, Culpo was ready to embrace everything that comes with the Miss Universe title. "Rise and shine!!" she wrote on Twitter. "Makeup time with @Yukyan51 for a long day of media. Ready for day one of #MissUniverse life :)"

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AP IMPACT: Steroids loom in major-college football


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


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


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


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


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


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


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


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


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


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


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


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


Big gains, data show


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


The cost of testing


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Enforcement varies


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


'Everybody around me was doing it'


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


___


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


___


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


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


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