Egypt's constitution approved in vote, say rival camps

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

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

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

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

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

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

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

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

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

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

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

PROTESTS

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

"I'm voting 'no' because Egypt can't be ruled by one faction," said Karim Nahas, 35, a stockbroker, heading to a polling station in Giza, in greater Cairo, in the last round.

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

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

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

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

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

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

TURNOUT

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

But the committee overseeing the two-stage vote said its investigations showed no major irregularities in voting on December 15, which covered about half of Egypt's 51 million voters. About 25 million were eligible to vote in the second round.

The Brotherhood said turnout was about a third of voters.

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

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

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

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

At least eight people were killed in protests outside the presidential palace in Cairo this month. Islamists and rivals clashed in Alexandria, the second-biggest city, on the eves of both voting days.

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

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

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

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

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

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Japan Emperor Akihito turns 79, says back to health

TOKYO: Japanese Emperor Akihito turned 79 years old on Sunday and reassured thousands of well-wishers that he has regained his health since his heart bypass surgery in February.

The softly-spoken monarch gave his birthday address to the public from a glass-covered balcony at the Imperial Palace overlooking the East Garden, filled with visitors braving the bitter cold and waving small Japanese flags.

"In February, I had a heart surgery and worried many people. Please remain assured that I am now living normally like before," he said in a brief speech.

Surgeons carried out the operation on February 18 -- the emperor's first since he was treated in 2003 for prostate cancer -- after tests showed a narrowing of two of his coronary arteries.

The four-hour operation went without a hitch.

During his birthday address, Akihito also said his thoughts were with those who have be unable to return to their homes since the devastating earthquake and tsunami that hit northern Japan in March 2011.

"There is only a little time left this year, which once again was a difficult year," he said.

"I plan to spend my time praying for the happiness of all of the Japanese public, particularly those who were affected by the disaster," Akihito said.

The disaster crippled the Fukushima Daiichi nuclear plant, which went through meltdowns and explosions, forcing tens of thousands of residents around the facility to abandon their homes, farmland, fishing boats and livestock.

Before his birthday, Akihito told a ceremonial press conference that his health has recovered to the point where he can play tennis.

He added that he wanted to continue to carry out his public duties at the same level, despite calls from his family and court officials to reduce his workload.

Since his heart surgery, Akihito and his wife Michiko have travelled around Japan and visited Britain in May to celebrate Queen Elizabeth II's diamond jubilee, the royal couple's first overseas trip since 2009, when they visited Canada and Hawaii.

- AFP/ck

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Railways pitches for 5-10 paise fare hike per kilometre

NEW DELHI: Faced with mounting deficit of over Rs 20,000 crore in the passenger segment, Railways is keen on raising passenger fares between 5-10 paise per km in the coming months to generate about Rs 4,000 crore revenue.

The hike could come close on the heels of railways finalising the broader contours of the proposed Rail Tariff Authority (RTA), which would be placed before Cabinet in January.

"The passenger fares should be hiked by 5 paise to 10 paise per km in the Rail Budget (2013-14). The financial condition of Railways is not good. We need funds, otherwise Railways will not survive," Minister of State for Railways KJ Surya Prakash Reddy told PTI.

The other Minister of State Adhir Ranjan Chowdhury also advocated an urgent hike in fare.

"There is an urgent need for passenger hike as railways' financial condition is bad."

Railways has incurred a loss of Rs 22,000 crore in the passenger segment this year, an increase of deficit of Rs 4000 crore from the last year.

However, a senior railway official said, "A decision is yet to be taken whether to increase the passenger fare before the Rail Budget or announce it in the budget."

Asked about the quantum of possible hike, the official said, "It is likely to be between 10 per cent and 15 per cent," something which former Railway Minister Dinesh Trivedi had proposed in the last Rail Budget.

Reviewing the performance of Railways, the PMO's has asked the chairman railway board to finalise and submit its recommendations on the constitution of proposed RTA by December 31.

RTA is expected to suggest the quantum of hike in passenger fare and freight tariff.

"We are working on it (RTA)," said Railway Minister Pawan Kumar Bansal when asked about the progress on RTA.

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

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

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

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

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

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

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

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

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

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

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

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

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

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

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

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

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

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

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

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

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

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

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

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

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Online:

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

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

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Obama, Congress Waving Bye-Bye Lower Taxes?

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

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

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

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

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

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

Fiscal Cliff Negotiations Halted for Christmas Watch Video

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Iran defense minister says NATO missiles harm Turkey security

DUBAI (Reuters) - The installation of Patriot anti-missile batteries sent by NATO members to bolster Turkey's defenses against a possible missile attack from Syria will only harm Turkey's security, Iran's defense minister was quoted as saying on Saturday.

NATO approved Turkey's request for the air defense system earlier this month, in a move meant to calm Ankara's fears of being hit by Syrian missiles.

Iran has strongly supported its Arab ally President Bashar al-Assad of Syria as he attempts to suppress a 21-month-old uprising against his rule. Tehran opposes the installation of NATO missiles as Western interference in the region and has said it could lead to a "world war.

"The installation of Patriot missiles in Turkey plays no role in establishing Turkey's security and this harms the country of Turkey," Iranian Defense Minister Ahmad Vahidi said on Saturday, according to the Iranian Students' News Agency (ISNA). "The West has always pursued its viewpoints and interests and we disagree with the presence of Western countries in regional interactions."

Vahidi also denied that Iran is training Syrian forces to battle the rebels, ISNA reported. Iran considers itself, Syria's rulers and the Lebanese Shi'ite militant group Hezbollah as part of an "axis of resistance" against U.S. and Israeli power in the Middle East, but has denied accusations that it helping Assad militarily.

"Syria has no need for the training of its forces by the Islamic Republic of Iran, because Syria has a powerful military which has prepared itself for involvement with the Zionist regime (Israel)," Vahidi said.

(Reporting by Yeganeh Torbati; Editing by Lisa Shumaker)

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US gun lobby urges armed police in every school

WASHINGTON: The US' most powerful pro-gun lobbying group is suggesting that armed police be deployed to every school in the country following a mass shooting that left 20 young children dead.

The National Rifle Association, which supports a broad interpretation of US citizens' constitutional right to bear arms, had been under pressure to respond in the wake of last week's massacre in a Connecticut elementary school.

Even as the NRA leaders made their combative and determined appearance, another four people died in Pennsylvania in America's latest shooting spree, including the alleged shooter.

And a string of celebrities including Jeremy Renner, Gwyneth Paltrow and Beyonce launched a video to back a campaign to clamp down on gun sales following the Newtown school massacre.

But the pro-gun lobbyists ceded no ground to those calling for tougher gun laws.

"The only thing that stops a bad guy with a gun is a good guy with a gun," declared NRA vice-president Wayne LaPierre Friday, in his first public comments since the shooting at the Sandy Hook Elementary School in Newtown, Connecticut.

"I call on Congress today to act immediately to appropriate whatever is necessary to put armed police officers in every single school in this nation," he said, in a lengthy statement. He took no questions from reporters.

LaPierre said the NRA was ready to help train security teams for schools and work with teachers and parents to improve security measures, and accused the media and the political class of demonising gun owners.

Last Friday, a troubled 20-year-old man burst into the Sandy Hook school and gunned down 20 six- and seven-year-old children and six staff members trying to protect them, before taking his own life. He also fatally shot his mother.

As LaPierre and his allies were on stage in Washington on Feiday, police in Pennsylvania shot dead a man who had killed three people and wounded "several" others, state troopers.

These deaths were the latest in a series of mass shootings in the United States this year, and prompted President Barack Obama to throw his weight behind plans to revive a ban on assault weapons.

America has suffered an epidemic of gun violence over the last three decades including 62 mass shooting incidents since 1982. The vast majority of weapons used have been semi-automatic weapons obtained legally by the killers.

There were an estimated 310 million non-military firearms in the United States in 2009, roughly one per citizen, and people in America are 20 times more likely to be killed by a gun than someone in another developed country.

But LaPierre insisted gun ownership is not the problem.

"You know, five years ago after the Virginia Tech tragedy when I said we should put armed security in every school, the media called me crazy," he said, referring to a 2007 campus shooting that left 32 people dead.

"But what if, what if when Adam Lanza started shooting his way into Sandy Hook Elementary School last Friday, he'd been confronted by qualified armed security?" he demanded.

"Will you at least admit it's possible... that 26 innocent lives might have been spared that day? Is it so abhorrent to you that you'd rather continue to risk the alternative?"

The statement immediately drew criticism from supporters of tougher gun control, who are pushing to ban semi-automatic assault weapons like the .223 Bushmaster rifle that Lanza used in Friday's shooting.

"The NRA leadership's drive to fill our schools with more deadly guns and ammo is wildly out of touch with responsible gun owners and the American public," New Jersey Senator Frank Lautenberg said.

The New York Times, in an editorial Saturday, did not mince words, calling LaPierre's remarks a "mendacious, delusional, almost deranged rant".

One of the protesters, who attempted to drown out LaPierre's statement, bore a banner reading "NRA kills our kids" the other "NRA has blood on its hands". They were led away by security.

Hollywood stars including Julianne Moore, Jamie Foxx and Jon Hamm meanwhile recorded a video backing a campaign calling notably for a ban on assault weapons, as well as criminal background checks for every gun sold.

"Columbine. Virginia Tech. Tucson. Aurora. Fort Hood. Oak Creek. Newtown. Newtown. Newtown," they intoned in the black-and-white video, taking turns to list the names of America's worst gun massacres of recent years.

"How many more? How many more colleges? How many more classes? How many more movie theatres? How many more houses of faith? How many more shopping malls?" they added in the video on the "Demand a Plan" campaign website.

- AFP/al

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Fog blinds UP, disrupts railway traffic

LUCKNOW: More than 84 trains were delayed due to the thick fog that enveloped the Uttar Pradesh capital and most parts of the state early Saturday, officials here said.

A railway spokesperson said the thick fog, which started on Friday and became denser on Saturday, threw the train schedule haywire and more than 84 trains were running late by several hours.

The long-distance trains were most effected due to the thick fog cover in Uttar Pradesh and parts of Bihar, he added.

Major trains running late by five-six hours included Triveni Express, Garib Rath, Purabia Express, Avadh Assam, Ganga Sutlej, Gareeb Nawaz and Shaheed Express.

Chilly weather conditions prevailed in the state with the mercury dipping to about five degrees Celsius in Lucknow, Kanpur and Allahabad on Saturday. The weather office here has forecast sub-zero temperatures in some regions by the year end.

Saturday's minimum temperature in Lucknow was five degrees Celsius, while it was 5.4 and 5.2 degrees Celsius in Allahabad and Kanpur, respectively, a weather official said.

Muzaffarnagar was the coldest in Uttar Pradesh at 2.7 degrees Celsius, followed by Najibabad (3.5 degrees Celsius) and Agra (4.2 degrees Celsius).

The average maximum temperature in the state on Saturday was 17 degrees celsius, which was six notches below the normal for this time of the season.

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AP IMPACT: Big Pharma cashes in on HGH abuse

A federal crackdown on illicit foreign supplies of human growth hormone has failed to stop rampant misuse, and instead has driven record sales of the drug by some of the world's biggest pharmaceutical companies, an Associated Press investigation shows.

The crackdown, which began in 2006, reduced the illegal flow of unregulated supplies from China, India and Mexico.

But since then, Big Pharma has been satisfying the steady desires of U.S. users and abusers, including many who take the drug in the false hope of delaying the effects of aging.

From 2005 to 2011, inflation-adjusted sales of HGH were up 69 percent, according to an AP analysis of pharmaceutical company data collected by the research firm IMS Health. Sales of the average prescription drug rose just 12 percent in that same period.

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

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Unlike other prescription drugs, HGH may be prescribed only for specific uses. U.S. sales are limited by law to treat a rare growth defect in children and a handful of uncommon conditions like short bowel syndrome or Prader-Willi syndrome, a congenital disease that causes reduced muscle tone and a lack of hormones in sex glands.

The AP analysis, supplemented by interviews with experts, shows too many sales and too many prescriptions for the number of people known to be suffering from those ailments. At least half of last year's sales likely went to patients not legally allowed to get the drug. And U.S. pharmacies processed nearly double the expected number of prescriptions.

Peddled as an elixir of life capable of turning middle-aged bodies into lean machines, HGH — a synthesized form of the growth hormone made naturally by the human pituitary gland — winds up in the eager hands of affluent, aging users who hope to slow or even reverse the aging process.

Experts say these folks don't need the drug, and may be harmed by it. The supposed fountain-of-youth medicine can cause enlargement of breast tissue, carpal tunnel syndrome and swelling of hands and feet. Ironically, it also can contribute to aging ailments like heart disease and Type 2 diabetes.

Others in the medical establishment also are taking a fat piece of the profits — doctors who fudge prescriptions, as well as pharmacists and distributors who are content to look the other way. HGH also is sold directly without prescriptions, as new-age snake oil, to patients at anti-aging clinics that operate more like automated drug mills.

Years of raids, sports scandals and media attention haven't stopped major drugmakers from selling a whopping $1.4 billion worth of HGH in the U.S. last year. That's more than industry-wide annual gross sales for penicillin or prescription allergy medicine. Anti-aging HGH regimens vary greatly, with a yearly cost typically ranging from $6,000 to $12,000 for three to six self-injections per week.

Across the U.S., the medication is often dispensed through prescriptions based on improper diagnoses, carefully crafted to exploit wiggle room in the law restricting use of HGH, the AP found.

HGH is often promoted on the Internet with the same kind of before-and-after photos found in miracle diet ads, along with wildly hyped claims of rapid muscle growth, loss of fat, greater vigor, and other exaggerated benefits to adults far beyond their physical prime. Sales also are driven by the personal endorsement of celebrities such as actress Suzanne Somers.

Pharmacies that once risked prosecution for using unauthorized, foreign HGH — improperly labeled as raw pharmaceutical ingredients and smuggled across the border — now simply dispense name brands, often for the same banned uses. And usually with impunity.

Eight companies have been granted permission to market HGH by the U.S. Food and Drug Administration, which reviews the benefits and risks of new drug products. By contrast, three companies are approved for the diabetes drug insulin.

The No. 1 maker, Roche subsidiary Genentech, had nearly $400 million in HGH sales in the U.S. last year, up an inflation-adjusted two-thirds from 2005. Pfizer and Eli Lilly were second and third with $300 million and $220 million in sales, respectively, according to IMS Health. Pfizer now gets more revenue from its HGH brand, Genotropin, than from Zoloft, its well-known depression medicine that lost patent protection.

On their face, the numbers make no sense to the recognized hormone doctors known as endocrinologists who provide legitimate HGH treatment to a small number of patients.

Endocrinologists estimate there are fewer than 45,000 U.S. patients who might legitimately take HGH. They would be expected to use roughly 180,000 prescriptions or refills each year, given that typical patients get three months' worth of HGH at a time, according to doctors and distributors.

Yet U.S. pharmacies last year supplied almost twice that much HGH — 340,000 orders — according to AP's analysis of IMS Health data.

While doctors say more than 90 percent of legitimate patients are children with stunted growth, 40 percent of 442 U.S. side-effect cases tied to HGH over the last year involved people age 18 or older, according to an AP analysis of FDA data. The average adult's age in those cases was 53, far beyond the prime age for sports. The oldest patients were in their 80s.

Some of these medical records even give explicit hints of use to combat aging, justifying treatment with reasons like fatigue, bone thinning and "off-label," which means treatment of an unapproved condition

Even Medicare, the government health program for older Americans, allowed 22,169 HGH prescriptions in 2010, a five-year increase of 78 percent, according to data released by the Centers for Medicare and Medicaid Services in response to an AP public records request.

"There's no question: a lot gets out," said hormone specialist Dr. Mark Molitch of Northwestern University, who helped write medical standards meant to limit HGH treatment to legitimate patients.

And those figures don't include HGH sold directly by doctors without prescriptions at scores of anti-aging medical practices and clinics around the country. Those numbers could only be tallied by drug makers, who have declined to say how many patients they supply and for what conditions.

First marketed in 1985 for children with stunted growth, HGH was soon misappropriated by adults intent on exploiting its modest muscle- and bone-building qualities. Congress limited HGH distribution to the handful of rare conditions in an extraordinary 1990 law, overriding the generally unrestricted right of doctors to prescribe medicines as they see fit.

Despite the law, illicit HGH spread around the sports world in the 1990s, making deep inroads into bodybuilding, college athletics, and professional leagues from baseball to cycling. The even larger banned market among older adults has flourished more recently.

FDA regulations ban the sale of HGH as an anti-aging drug. In fact, since 1990, prescribing it for things like weight loss and strength conditioning has been punishable by 5 to 10 years in prison.

Steve Kleppe, of Scottsdale, Ariz., a restaurant entrepreneur who has taken HGH for almost 15 years to keep feeling young, said he noticed a price jump of about 25 percent after the block on imports. He now buys HGH directly from a doctor at an annual cost of about $8,000 for himself and the same amount for his wife.

Many older patients go for HGH treatment to scores of anti-aging practices and clinics heavily concentrated in retirement states like Florida, Nevada, Arizona and California.

These sites are affiliated with hundreds of doctors who are rarely endocrinologists. Instead, many tout certification by the American Board of Anti-Aging and Regenerative Medicine, though the medical establishment does not recognize the group's bona fides.

The clinics offer personalized programs of "age management" to business executives, affluent retirees, and other patients of means, sometimes coupled with the amenities of a vacation resort. The operations insist there are few, if any, side effects from HGH. Mainstream medical authorities say otherwise.

A 2007 review of 31 medical studies showed swelling in half of HGH patients, with joint pain or diabetes in more than a fifth. A French study of about 7,000 people who took HGH as children found a 30 percent higher risk of death from causes like bone tumors and stroke, stirring a health advisory from U.S. authorities.

For proof that the drug works, marketers turn to images like the memorable one of pot-bellied septuagenarian Dr. Jeffry Life, supposedly transformed into a ripped hulk of himself by his own program available at the upscale Las Vegas-based Cenegenics Elite Health. (He declined to be interviewed.)

These promoters of HGH say there is a connection between the drop-off in growth hormone levels through adulthood and the physical decline that begins in late middle age. Replace the hormone, they say, and the aging process slows.

"It's an easy ruse. People equate hormones with youth," said Dr. Tom Perls, a leading industry critic who does aging research at Boston University. "It's a marketing dream come true."

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

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

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

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

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Obama Still an 'Optimist' on Cliff Deal

Mandel Ngan/AFP/Getty Images

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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