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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Egyptians back new constitution in referendum

CAIRO (Reuters) - An Islamist-backed Egyptian constitution won approval in a referendum, rival camps said on Sunday, after a vote the opposition said would sow deep social divisions in the Arab world's most populous nation.

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

An opposition official also told Reuters their unofficial count showed the result was a "yes" vote, while party spokesmen said there had been a series of abuses during the voting.

The main opposition coalition, the National Salvation Front, responded to the defeat by saying it was moving towards forming a single political party to challenge the Islamists who have dominated the ballot box since strongman Hosni Mubarak was overthrown two years ago.

Members of the opposition, taking heart from a low turnout of about 30 percent of voters, pledged to keep up pressure on Mursi through peaceful protests and other democratic means.

"The referendum is not the end of the road," said Khaled Dawoud, a spokesman for the National Salvation Front. "It is only the beginning of a long struggle for Egypt's future."

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 Mubarak was ousted in a popular uprising. It will provide the stability needed to help a fragile economy, they say.

The constitution was "a historic opportunity to unite all national powers on the basis of mutual respect and honest dialogue for the sake of stabilizing the nation," the Brotherhood said in a statement.

RECIPE FOR UNREST

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.

The opposition said voting in both rounds was marred by abuses. However, an official said the overall vote favored the charter.

"The majority is not big and the minority is not small," liberal politician Amr Hamzawy said, adding that the National Salvation Front would use "all peaceful, democratic means" such as protests to challenge the constitution.

The vote was split over two days as many judges had refused to supervise the ballot, making a single day of voting impossible.

During the build-up to the vote there were deadly protests, sparked by Mursi's decision to award himself extra powers in a November 22 decree and then to fast-track the constitutional vote.

The new basic law sets a limit of two four-year presidential terms. It says the principles of sharia, Islamic 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.

ABUSES

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 opposition Front.

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.

(Writing by Edmund Blair and Giles Elgood; editing by Philippa Fletcher)

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Sydney Harbour floating heliport plan on hold

SYDNEY: A plan for wealthy executives and tourists landing in Sydney to flit directly to the city's famous harbour via a floating heliport has been put on hold after fierce public opposition.

The company that was set up to run the operation, providing for quick transfers to and from Sydney airport and scenic flights over the harbour, said it wanted to further consider the operation's "feasibility".

"It is Newcastle Helicopter's intention to address the relevant concerns and queries with thoroughly considered and accurate information, and is taking the appropriate steps to do so," it said in a statement late Saturday.

It followed rising public anger over the New South Wales state government giving the go-head last month to unlimited flights from a barge anchored on the harbour, which is popular for yachting and close to residential areas.

According to reports, the Roads and Maritime Services (RMS) issued the licence without consulting the community, doing an environmental impact assessment, testing for noise, or putting the project out to tender.

The Sydney Morning Herald also claimed approval was given two weeks before authorities asked about air safety or air traffic control regulations.

New South Wales Deputy Premier Andrew Stoner last week insisted all usual procedures had been followed.

"As required by RMS, the proponent wrote to relevant councils in October outlining the proposal and inviting feedback but received no responses," he said in a statement.

Federal MP Malcolm Turnbull led the campaign against the heliport and said the decision had descended into farce.

"If you put this into an episode of 'Yes, Minister', nobody would believe it," he told reporters, referring to the satirical British comedy show, which revolves around the inner workings of government.

Industry leaders have long called for a heliport based in the city, which last had one in the late 1980s operating from the Darling Harbour tourist precinct.

- 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.

___

Online:

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

___

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

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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

Cliffhanger: Congress Heads Home after 'Plan B' Vote Pulled from House Floor Watch Video

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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Egypt constitution approved in vote, say rival camps

CAIRO (Reuters) - Egypt's new constitution, which was drafted by an Islamist-dominated assembly, was approved by 64 percent of voters in a two-round referendum, an official in the Muslim Brotherhood said on Sunday citing the group's unofficial tally.

An official from Egypt's main opposition group, which campaigned against the constitution saying it would deepen divisions in Egypt, also said that its unofficial count indicated the document was approved.

The first round of voting was held on held on December 15 and a second round was staged on Saturday, with roughly half Egypt's 51 million eligible voters covered in each round.

"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," the Brotherhood official, who was in an operations room monitoring the vote, told Reuters.

Murad Ali, a senior official in the Muslim Brotherhood's Freedom and Justice Party, confirmed the numbers. His group propelled President Mohamed Mursi to office in a June election.

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.

"We can tell from the results so far that it will be a 'yes' vote," an official from the National Salvation Front told Reuters. "They (Islamists) are ruling the country, running the vote and influencing the people, so what else could we expect."

(Reporting by Yasmine Saleh; Writing by Edmund Blair; Editing by Bill Trott)

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Football: Barca battle on without Vilanova for time being

MADRID: Barcelona will have to continue their march at the top of La Liga without Tito Vilanova after it was revealed the coach has suffered a relapse of a tumour on which he was operated just over a year ago.

The 44-year-old who took over from Pep Guardiola at the beginning of the season was thought to have fully recovered from surgery last November to remove the growth on his parotid gland, and he was back at work within 15 days.

However after an operation on Thursday it is thought he will have treatment for at least six weeks and he may or may not be available to return to work at some stage during that time.

Until then, Sporting director Andoni Zubizarreta confirmed on Thursday, the side will be led by Vilanova's assistant Jordi Roura.

"Without going into too much detail about the sporting side today and whether we win or not at Valladolid on Saturday, just to say we'll continue with our coaching staff and our way of working, we'll be in extraordinary hands and Tito I'm sure will be watching us on TV," he said.

Barca president Sandro Rossell added "the most important thing for the club at this moment is the full recovery of Tito".

Vilanova has led Barcelona to the most successful start to a season in La Liga's history, with 15 wins and one draw in 16 matches so far.

With the final round of La Liga games of 2012 brought forward to allow the players an extra day of Christmas holidays, Barca will make it a great finish to the year, on the pitch at least, if they take three points at Valladolid.

Last weekend's win over closest rivals Atletico Madrid increased the Catalan side's lead to nine points and with Real Madrid's surprise draw with Espanyol leaving them 13 points back in third, for some La Liga title is already destined for the Nou Camp in May.

That win was followed with the news on Monday that Carles Puyol and Xavi Hernandez will stay at Barca until at least 2016 and Lionel Messi until 2018, and it was all looking positive until Wednesday's shock news.

Last Sunday's clear dominance over their closest rivals Atletico Madrid, especially in the second-half of the 4-1 win, left most observers concluding that it is the Catalan side's title to lose.

Meanwhile, Real Madrid face a tricky trip to fourth placed Malaga less than a week after manager Jose Mourinho said the title was "almost impossible now".

Defeats at Getafe, Sevilla and Betis, followed by the draw with Espanyol last Sunday, have left Madrid far adrift from table-toppers Barca.

One player the 'Merengues' missed last Sunday was French forward Karim Benzema.

Benzema is closer to a return than colleague Gonzalo Higuain, but could still miss the trip to Malaga with a foot injury. However he has pledged his future to the club this week, despite his name being linked with Paris Saint-Germain.

Malaga come into the game with the best defensive record in the league having conceded only 10 goals in 16 games and full-back Nacho Monreal is confident.

"We're going to be up for the Madrid match, we're doing well, we're at home and we know that Madrid is not going too good, but they're a good team and it will be difficult. I just hope we can take our chances and get the three points," he said.

In this week's matches already played, Rayo Vallecano beat Levante 3-0, Real Sociedad edged Sevilla 2-1 and Espanyol defeated Deportivo La Coruna 2-0, on Thursday.

On Friday, substitute Adrian Lopez hit an important winner as Atletico Madrid beat Celta Vigo 1-0.

Their win, Atletico's ninth straight victory at home this season, moves the club from the capital to within six points of Barca, in second position.

Earlier on Friday, Valencia beat Getafe 4-2 at home to make it two wins out of three for new manager Ernesto Valverde.

Saturday's fixtures:
Betis v Mallorca (1500 GMT), Valladolid v Barcelona (1700 GMT), Osasuna v Granada (1900 GMT), Malaga v Real Madrid (1900 GMT), Athletic Bilbao v Zaragoza (2100 GMT)

- 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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