Avramovic: It's not about me

SINGAPORE: In his near decade-long spell as Singapore's national coach, Radojko Avramovic has always cut an intriguing figure - a fuss-free man of few words, gruff at times, but always charming with the occasional dose of deadpan humour.

And in typical understated fashion, he played down his role in masterminding the Lions' path to victory in the 2012 ASEAN Football Federation (AFF) Suzuki Cup after a 3-2 aggregate win over Thailand despite losing the second-leg 1-0 at Bangkok's Supachalasai Stadium on Saturday.

It was Singapore's fourth AFF Championship title - a record - three of which were under Avramovic.

Even though he is bowing out as the Lions' head coach, the 63-year-old Serb preferred that the talk centred on his 22-man squad.

"There was no loser in this final," said Avramovic after Saturday's tempestuous encounter.

"We won in Singapore and Thailand won in Bangkok. We gave our best and Thailand gave their best too. But in the end, luck favoured us a little and that's why we won the Cup."

In his nine-and-a-half years as Lions coach, the former Notts County and Coventry City goalkeeper sealed his reputation as a tough taskmaster who usually said what he needed to say in a short and sharp manner.

Like most in his trade, he faced calls for his head on several occasions when results did not go his way, including the group stage exit from the 2010 AFF Suzuki Cup.

But throughout the years, Avramovic, who succeeded Dane Jan Poulsen as Singapore's head coach in July 2003 after spells with Oman and Kuwait, stuck with the likes of veterans Daniel Benett, Baihakki Khaizan, Shahril Ishak and Khairul Amri, all of whom were part of his three AFF Championship winning squads of 2004, 2007 and now 2012.

And that solidity and familiarity showed on Saturday night, as they withstood a Thai onslaught that started almost from the first whistle.

In a rare public show of emotion, Avramovic paid tribute to them, as well as all involved with the squad.

"I say a big thank you to my players. They won the cup for Singapore and I only played a small part," he said. "But we trusted each other and we use the trust to build a winning team.

"Maybe I have been lucky in the sense that I managed to win three AFF titles with Singapore. But there was the unwavering support from everybody connected with the team which helped a lot. I alone cannot do such a job."

Although Kirati Keawsombut's 45th minute header giving Thailand the eventual 1-0 win in Saturday's second-leg, Singapore prevailed thanks to their 3-1 win in Wednesday's first-leg at the Jalan Besar Stadium through goals from Fahrudin Mustafic, Amri and an injury-time strike from Baihakki which proved decisive.

Thailand were also looking to become the first side to lift the AFF Championship trophy four times, having done so in 1996, 2000 and 2002, and they needed at least a 2-0 victory to draw 3-3 and win on the away goals rule to do so.

But the likes of Datsakorn Thonglao and Teerasil Dangda, the tournament's leading scorer with five goals, failed to find a way past a resolute Lions more than once despite vociferous support from the 20,000 crowd inside the Supachalasai Stadium.

Nonetheless, Thailand coach Winfried Schafer felt his team had done their best.

"We gave 100 per cent but it was not enough," said the German.

"We were very tired in the last ten minutes but overall I am proud my team. At least we scored a victory over Singapore but one goal was not enough. I don't like being in second place but what to do? I accept the result."

Apart from Avramovic, it is also the last for 42-year-old forward Aleksandar Duric in Singapore colours. But midfielder Isa Halim is sure to feature in the tournament's next edition in 2014, which is set to be co-hosted by Singapore and Vietnam.

"It's my first AFF tournament and I am a winner of a championship medal," said the 26-year-old who came in after Hariss Harun suffered a fractured shin in Singapore's second Group B match against Indonesia.

"Words just cannot describe my feelings right now. Hopefully I can use this experience to help me become a better player in the international arena.

"It was a tough 90 minutes for me as a defensive midfielder. But I will learn from it."

Isa's midfield partner Fahrudin Mustafic also played in a vital role over the two-legged final, including converting a twice-taken penalty to give the Lions the lead in the first-leg.

Despite suffering a groin injury which threatened his chances of appearing in the final, the 31-year-old Tampines Rovers star soldiered on and kept the Thai midfield of Datsakorn Thonglao, Pichitphong Choeichiu and Adul Lahsoh at bay.

"It was sheer hard work for us tonight. The Thais were the better team I have to admit," he said.

"But now with the medal around my neck I can look forward to a well-earned rest. It has been a long two months for me. Right after the S-League season is over I reported for training with the National team and I have been on my toes since then.

"I am not complaining. The medal means so much to me and to the team and to coach Raddy. He had faith in us and we had faith in him." -- ADDITIONAL REPORTING FROM DAN GUEN CHIN IN BANGKOK

- TODAY/jc

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Punjab’s toxic water kills in womb: Study

CHANDIGARH: The toxic groundwater in Punjab villages along five major waste drains ——Buddha, Hudiara, Kala Singha East Bein and Tung Dhab —is having dangerous fallout. It is resulting in rise in stillbirths and spontaneous abortions as well as delayed language learning and mental growth in children under the age of 12. These startling facts have come out in a study recently published in an international journal, which examines the impact of the deadly cocktail of heavy metals present in groundwater on women and children.

This is the first bit of evidence from North India that shows a link between heavy metal and pesticide pollution of water and reproductive and child health morbidity. Leave aside the toxicity in cattle milk, even mother's milk has been found to have high levels of metals.

The study published in Journal Epidemiol Community health covers 35 villages in Amritsar, Ludhiana and Jalandhar districts of Punjab, where toxicity has been ascertained. The study's main investigator, Dr J S Thakur, from PGI's school of public health had been the first to establish the toxicity in Punjab's groundwater.

In a cross-sectional community-based survey, 1904 women in reproductive age group and 1762 children below 12 from 35 villages were interviewed for general health morbidity. Doctors also conducted their clinical examination. Out of 35 villages, 25 served as target (exposed) and 10 as non-target (less exposed).

Spontaneous abortion (20.6 per 1000 live births) and premature births (6.7 per 1000 live births) were significantly higher in the area affected by heavy metal and pesticide pollution. Stillbirths were about five times more as compared to a meta-analysis for South Asian countries. A large proportion of children in target area was reported to have delayed language learning, blue line in the gums, mottling of teeth and gastrointestinal problems. Mercury was found in more than permissible limits in 84.4% samples from the target area.

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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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Urban Advocates Say New Gun Control Talk Overdue

For years, voices have cried in the urban wilderness: We need to talk about gun control.

Yet the guns blazed on.

It took a small-town slaughter for gun control to become a political priority. Now, decades' worth of big-city arguments against easy access to guns are finally being heard, because an unstable young man invaded an elementary school in Newtown, Conn., with a military-style assault rifle and 30-bullet magazines. Twenty young children and six adults were slain.

President Barack Obama called the tragedy a "wake-up call." Vice President Joe Biden met Thursday with Obama's cabinet and law-enforcement officers from around the country to launch a task force on reducing gun violence. Lawmakers who have long resisted gun control are saying something must be done.

Such action is energizing those who have sought to reduce urban gun violence. Donations are up in some places; other leaders have been working overtime due to this unprecedented moment.

The moment also is causing some to reflect on the sudden change of heart. Why now? Why weren't we moved to act by the killing of so many other children, albeit one by one, in urban areas?

Certainly, Newtown is a special case, 6- and 7-year-olds riddled with bullets inside the sanctuary of a classroom. Even in a nation rife with violence, where there have been three other mass slayings since July and millions enjoy virtual killing via video games, the nature of this tragedy is shocking.

Critics Slam NRA for Proposing Armed School Guards Watch Video

Gun Violence Victims, Survivors Share Thoughts After Newtown Massacre Watch Video

But still: "There's a lot of talk now about we have to protect our children. We have to protect all of our children, not just the ones living in the suburbs," said Tammerlin Drummond, a columnist for the Oakland Tribune.

In her column Monday, Drummond wrote about 7-year-old Heaven Sutton of Chicago, who was standing next to her mother selling candy when she was killed in the crossfire of a gang shootout. Also in Chicago, which has been plagued by a recent spike in gun violence: 6-year-old Aaliyah Shell was caught in a drive-by while standing on her front porch; and 13-year-old Tyquan Tyler was killed when a someone in a car shot into a group of youths outside a party.

Wrote Drummond: "It has taken the murders of 20 babies and six adults in an upper-middle class neighborhood in Connecticut to achieve what thousands of gun fatalities in urban communities all over this country could not."

So again: What took so long? The answers are complicated by many factors: resignation to urban violence, even among some of those who live there; the assumption that cities are dangerous and small towns safe; the idea that some urban victims place themselves in harm's way.

In March, the Children's Defense Fund issued a report titled "Protect Children, Not Guns 2012." It analyzed the latest federal data and counted 299 children under age 10 killed by guns in 2008 and 2009. That figure included 173 preschool-age children.

Black children and teens accounted for 45 percent of all child and teen gun deaths, even though they were only 15 percent of the child/teen population.

"Every child's life is sacred and it is long past time that we protect it," said CDF president Marian Wright Edelman in the report.

It got almost no press coverage — until nine months later, when Newtown happened.

Tim Stevens, founder and chairman of the Black Political Empowerment Project in Pittsburgh, has been focusing on urban gun violence since 2007, when he said Pennsylvania was declared the worst state for black-on-black violence.

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Italy PM Monti resigns, elections likely in February

ROME (Reuters) - Italian Prime Minister Mario Monti tendered his resignation to the president on Friday after 13 months in office, opening the way to a highly uncertain national election in February.

The former European commissioner, appointed to lead an unelected government to save Italy from financial crisis a year ago, has kept his own political plans a closely guarded secret but he has faced growing pressure to seek a second term.

President Giorgio Napolitano is expected to dissolve parliament in the next few days and has already indicated that the most likely date for the election is February 24.

In an unexpected move, Napolitano said he would hold consultations with political leaders from all the main parties on Saturday to discuss the next steps. In the meantime Monti will continue in a caretaker capacity.

European leaders including German Chancellor Angela Merkel and European Commission President Jose Manuel Barroso have called for Monti's economic reform agenda to continue but Italy's two main parties have said he should stay out of the race.

Monti, who handed in his resignation during a brief meeting at the presidential palace shortly after parliament approved his government's 2013 budget, will hold a news conference on Sunday at which he is expected clarify his intentions.

Ordinary Italians are weary of repeated tax hikes and spending cuts and opinion polls offer little evidence that they are ready to give Monti a second term. A survey this week showed 61 percent saying he should not stand.

Whether he runs or not, his legacy will loom over an election which will be fought out over the painful measures he has introduced to try to rein in Italy's huge public debt and revive its stagnant economy.

His resignation came a couple of months before the end of his term, after his technocrat government lost the support of Silvio Berlusconi's centre-right People of Freedom (PDL) party in parliament earlier this month.

Speculation is swirling over Monti's next moves. These could include outlining policy recommendations, endorsing a centrist alliance committed to his reform agenda or even standing as a candidate in the election himself.

The centre-left Democratic Party (PD) has held a strong lead in the polls for months but a centrist alliance led by Monti could gain enough support in the Senate to force the PD to seek a coalition deal which could help shape the economic agenda.

BERLUSCONI IN WINGS

Senior figures from the alliance, including both the UDC party, which is close to the Roman Catholic Church, and a new group founded by Ferrari sports car chairman Luca di Montezemolo, have been hoping to gain Monti's backing.

He has not said clearly whether he intends to run, but he has dropped heavy hints he will continue to push a reform agenda that has the backing of both Italy's business community and its European partners.

The PD has promised to stick to the deficit reduction targets Monti has agreed with the European Union and says it will maintain the broad course he has set while putting more emphasis on reviving growth.

Berlusconi's return to the political arena has added to the already considerable uncertainty about the centre-right's intentions and increased the likelihood of a messy and potentially bitter election campaign.

The billionaire media tycoon has fluctuated between attacking the government's "Germano-centric" austerity policies and promising to stand aside if Monti agrees to lead the centre right, but now appears to have settled on an anti-Monti line.

He has pledged to cut taxes and scrap a hated housing tax which Monti imposed. He has also sounded a stridently anti-German line which has at times echoed the tone of the populist 5-Star Movement headed by maverick comic Beppe Grillo.

The PD and the PDL, both of which supported Monti's technocrat government in parliament, have made it clear they would not be happy if he ran against them and there have been foretastes of the kind of attacks he can expect.

Former centre-left prime minister Massimo D'Alema said in an interview last week that it would be "morally questionable" for Monti to run against the PD, which backed all of his reforms and which has pledged to maintain his pledges to European partners.

Berlusconi who has mounted an intensive media campaign in the past few days, echoed that criticism this week, saying Monti risked losing the credibility he has won over the past year and becoming a "little political figure".

(Additional reporting by Gavin Jones, Massimiliano Di Giorgio and Paolo Biondi; Writing by Gavin Jones and James Mackenzie; Editing by Michael Roddy)

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Judge halts Argentine woman's wedding to sister's killer

BUENOS AIRES: An Argentine judge has blocked planned nuptials between a 22-year-old woman and her twin sister's convicted killer after a formal complaint by her mother.

Edith Casas insists that Victor Cingolani did not murder her sister Johana Casas, a fashion model. He is serving a 13-year prison sentence in southern Santa Cruz province for her murder in 2010.

The twins' mother Marcelina Orellana says Edith is mentally ill and "does not know what she is doing." She filed a request in court to suspend the marriage.

Casas "does not have full use of her faculties, is deprived of reason, and her physical and mental well-being are at risk," said the mother's lawyer Fabian Farias.

The Argentine Civil Code says that any permanent or temporary loss of mental capacities is reason enough to prevent a marriage.

Farias said Casas made the surprise decision to marry the convicted killer just 10 days ago. The couple had planned to marry in jail to avoid a media circus over the highly publicized wedding.

"She used to live with her parents and nobody expected such a sudden change in behavior," he said.

But Casas has insisted that Cingolani was unjustly convicted, saying he "is a guy who would not hurt a fly. He did not kill her."

She also accused her mother of abandoning her and her sister, adding: "she cannot say I need a psychiatrist because I am fully aware of what I am doing."

Another man, Marcos Diaz, who had also gone out with Johana, is also doing time for the killing.

Cingolani's lawyer has filed a brief appealing the judge's decision.

- AFP/al

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

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

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

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

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

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

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

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

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AP IMPACT: Big Pharma cashes in on HGH abuse

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Obama Still an 'Optimist' on Cliff Deal

Mandel Ngan/AFP/Getty Images

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Syrian rebels fight for strategic town in Hama province

BEIRUT (Reuters) - Rebels began to push into a strategic town in Syria's central Hama province on Thursday and laid siege to at least one town dominated by President Bashar al-Assad's minority sect, activists said.

The operation risks inflaming already raw sectarian tensions as the 21-month-old revolt against four decades of Assad family rule - during which the president's Alawite sect has dominated leadership of the Sunni Muslim majority - rumbles on.

Opposition sources said rebels had won some territory in the strategic southern town of Morek and were surrounding the Alawite town of al-Tleisia.

They were also planning to take the town of Maan, arguing that the army was present there and in al-Tleisia and was hindering their advance on nearby Morek, a town on the highway that runs from Damascus north to Aleppo, Syria's largest city and another battleground in the conflict.

"The rockets are being fired from there, they are being fired from Maan and al-Tleisia, we have taken two checkpoints in the southern town of Morek. If we want to control it then we need to take Maan," said a rebel captain in Hama rural area, who asked not to be named.

Activists said heavy army shelling had targeted the town of Halfaya, captured by rebels two days earlier. Seven people were killed, 30 were wounded, and dozens of homes were destroyed, said activist Safi al-Hamawi.

Hama is home to dozens of Alawite and Christian villages among Sunni towns, and activists said it may be necessary to lay siege to many minority areas to seize Morek. Rebels want to capture Morek to cut off army supply lines into northern Idlib, a province on the northern border with Turkey where rebels hold swathes of territory.

From an offshoot of Shi'ite Islam, Alawites have largely stood behind Assad, many out of fear of revenge attacks. Christians and some other minorities have claimed neutrality, with a few joining the rebels and a more sizeable portion of them supporting the government out of fear of hardline Islamism that has taken root in some rebel groups.

Activists in Hama said rebels were also surrounding the Christian town of al-Suqeilabiya and might enter the city to take out army positions as well as those of "shabbiha" - pro-Assad militias, the bulk of whom are usually Alawite but can also include Christians and even Sunnis.

"We have been in touch with Christian opposition activists in al-Suqeilabiya and we have told them to stay downstairs or on the lowest floor of their building as possible, and not to go outside. The rebels have promised not to hurt anyone who stays at home," said activist Mousab al-Hamdee, speaking by Skype.

He said he was optimistic that potential sectarian tensions with Christians could be resolved but that Sunni-Alawite strife may be harder to suppress.

SECTARIAN FEARS

U.N. human rights investigators said on Thursday that Syria's conflict was becoming more "overtly sectarian", with more civilians seeking to arm themselves and foreign fighters - mostly Sunnis - flocking in from 29 countries.

"They come from all over, Europe and America, and especially the neighboring countries," said Karen Abuzayd, one of the U.N. investigators, told a news conference in Brussels.

Deeper sectarian divisions may diminish prospects for post-conflict reconciliation even if Assad is ousted, and the influx of foreigners raises the risk of fighting spilling into neighboring countries riven by similar communal fault lines.

Some activists privately voiced concerns of sectarian violence, but the rebel commander in Hama said fighters had been told "violations" would not be tolerated and argued that the move to attack the towns was purely strategic.

"If we are fired at from a Sunni village that is loyal to the regime we go in and we liberate it and clean it," he said. "So should we not do the same when it comes to an Alawite village just because there is a fear of an all-out sectarian war? We respond to the source of fire."

President Vladimir Putin of Russia, Assad's main ally and arms supplier, warned that any solution to the conflict must ensure government and rebel forces do not merely swap roles and fight on forever. It appeared to be his first direct comment on the possibility of a post-Assad Syria.

The West and some Arab states accuse Russia of shielding Assad after Moscow blocked three U.N. Security Council resolutions intended to increase pressure on Damascus to end the violence, which has killed more than 40,000 people. Putin said the Syrian people would ultimately decide their own fate.

Assad's forces have been hitting back at rebel advances with heavy shelling, particularly along the eastern ring of suburbs outside Damascus, where rebels are dominant.

A Syrian security source said the army was planning heavy offensives in northern and central Syria to stem rebel advances, but there was no clear sign of such operations yet.

Rebels seized the Palestinian refugee district of Yarmouk earlier this week, which put them within 3 km (2 miles) of downtown Damascus. Heavy shelling and fighting forced thousands of Palestinian and Syrian residents to flee the Yarmouk area.

Rebels said on Thursday they had negotiated to put the camp - actually a densely packed urban district - back into the hands of pro-opposition Palestinian fighters. There are some 500,000 Palestinian refugees and their descendants living in Syria, and they have been divided by the uprising.

Palestinian factions, some backed by the government and others by the rebels, had begun fighting last week, a development that allowed Syrian insurgents to take the camp.

A resident in Damascus said dozens of families were returning to the camp but that the army had erected checkpoints. Many families were still hesitant to return.

LEBANON BORDER POST TAKEN

Elsewhere, Syrian insurgents took over an isolated border post on the western frontier with Lebanon earlier this week, local residents told Reuters on Thursday.

The rebels already hold much of the terrain along Syria's northern and eastern borders with Turkey and Iraq respectively.

They said around 20 rebels from the Qadissiyah Brigade overran the post at Rankus, which is linked by road to the remote Lebanese village of Tufail.

Video footage downloaded on the Internet on Thursday, dated December 16, showed a handful of fighters dressed in khaki fatigues and wielding rifles as they kicked down a stone barricade around a small, single-storey army checkpoint.

Syrian Interior Minister Ibrahim al-Shaar arrived in Lebanon on Wednesday for treatment of wounds sustained in a bomb attack on his ministry in Damascus a week ago.

Lebanese medical sources said Shaar had shrapnel wounds in his shoulder, stomach and legs but they were not critical.

The Syrian opposition has tried to peel off defectors from the government as well as from the army, though only a handful of high-ranking officials have abandoned Assad.

The conflict has divided many Syrian families. Security forces on Thursday arrested an opposition activist who is also the relative of Vice President Farouq al-Sharaa, the Syrian Observatory said. The man was arrested along with five other activists who are considered pacifists, it said.

Sharaa, a Sunni Muslim who has few powers in Assad's Alawite-dominated power structure, said earlier this week that neither side could win the war in Syria. He called for the formation of a national unity government.

(Reporting by Erika Solomon; Editing by Andrew Osborn)

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