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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Congress to miss midnight cliff deadline

America is going over the “fiscal cliff” – for a few minutes, or hours, at the very least. Don't panic. There's no need to move the family into the Doomsday bunker in the backyard. Yet.

While President Barack Obama and Republican Senate Minority Leader Mitch McConnell have said they are close to a broad agreement that would prevent across-the-board income-tax hikes, lawmakers are unlikely to approve actual legislation before a midnight deadline.

That’s not expected to pose any major logistical problem in the next few days, provided that Democrats and Republicans actually have a deal. Unlike a college student who writes an end-of-semester paper overnight before a morning deadline, then drops the assignment off hours after it was due, Congress can write its own rules to minimize the damage – and Americans whose taxes are staying the same won’t see a change in their bottom line.

“It’s basically a matter of saying it’s effective January 1,” one senior Republican aide shrugged.

The deal – if a final deal is reached – will originate in the Democratic-led Senate (but on a House bill, since legislation affecting revenues technically has to start in the lower chamber). Republican House Speaker John Boehner has said that the House will only act after the Senate does. Obama and McConnell have both said that they expected work to continue on avoiding the first installment in $1.2 trillion in cuts to domestic and defense programs, the other part of the "fiscal cliff." McConnell called earlier in the day for lawmakers to vote on the tax component now, but Democrats demurred.

As of 5 p.m. on Monday, it was not clear whether the Senate would vote before midnight.

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US family pleas for couple missing in Afghanistan

KABUL (AP) — The family of an ailing, pregnant American woman missing in Afghanistan with her Canadian husband has broken months of silence over the mysterious case, making public appeals for the couple's safe return.

James Coleman, the father of 27-year-old Caitlan Coleman, told The Associated Press over the weekend that she was due to deliver in January and needed urgent medical attention for a liver ailment that required regular checkups. He said he and his wife, Lyn, last heard from their son-in-law Josh on Oct. 8 from an Internet cafe in what he described as an "unsafe" part of Afghanistan. The Colemans asked that Josh be identified by his first name only to protect his privacy.

The couple had embarked on a journey last July that took them to Russia, the central Asian countries of Kazakhstan, Tajikistan and Kyrgyzstan, and then finally to Afghanistan.

Neither the Taliban nor any other militant group has claimed it is holding the couple, leading some to believe they were kidnapped. But no ransom demand has been made.

An Afghan official said their trail has gone dead.

"Our goal is to get them back safely and healthy," the father told AP on Friday night by phone. "I don't know what kind of care they're getting or not getting," he added. "We're just an average family and we don't have connections with anybody and we don't have a lot of money."

He made a similar appeal in a video posted on YouTube on Dec. 13.

"We appeal to whoever is caring for her to show compassion and allow Caity, Josh and our unborn grandbaby to come home," he said.

Before the video came out, the family had kept quiet about the case since the couple disappeared in early October. They appear to have broken their silence in hopes it might lead to a breakthrough.

But many questions remain over the disappearances.

It is not known whether the couple is still alive or how or why they entered Afghanistan. And there is no information about what they were doing in the country before they went missing.

James Coleman, of York County, Pennsylvania, said he was not entirely sure what his daughter and her husband were doing in Afghanistan. But he surmised they may have been seeking to help Afghans by joining an aid group after touring the region.

In the AP interview, he described his daughter as "naive" and "adventuresome" with a humanitarian bent.

He said Josh did not disclose their exact location in his last email contact on Oct. 8 from the Internet cafe, only saying they were not in a safe place. James Coleman also said the last withdrawals from the couple's account were made Oct. 8 and 9 in Kabul with no activity on the account and no further communication from them after that date.

"He just said they were heading into the mountains — wherever that was, I don't know," the father said. "I assume they were going to strike out on foot like they were doing" he said. "They're both kind of naive, always have been in my view. I don't really know why they went there," he added. "I assume it was more of the same, getting to know the local people, if they could find an NGO or someone they could work with in a little way."

There was some indication that the couple knew they were in dangerous territory, though they perhaps did not grasp just how dangerous. James Coleman said in general, they preferred small villages and communities because they felt safer there than in big cities, and that is where they wanted to focus their travels.

Both the U.S. State Department and Canadian Foreign Affairs Ministry say they are looking into the disappearance.

"Canada is pursuing all appropriate channels and officials are in close contact with local authorities," Canadian Foreign Affairs Ministry spokeswoman Chrystiane Roy said Friday, calling the incident a "possible kidnap."

It was not known whether the silence over the case by U.S. and Canadian officials and, until now, by the Coleman family was because of ongoing negotiations to seek their release. But information black-outs have kept some similar past cases quiet in an attempt to not further endanger those missing.

According to Hazrat Janan, the head of the provincial council in Afghanistan's Wardak province, the two were abducted in Wardak in an area about 25 miles west of the capital Kabul. They were passing through Wardak while traveling from Ghazni province south of Kabul to the capital.

Wardak province, despite its proximity to Kabul, is a rugged, mountainous haven for the Taliban and travel along its roads is dangerous. Foreigners who do not travel with military escorts take a substantial risk.

He said they were believed to have been taken from one district in Wardak to a second and then into Ghazni.

"After that, the trail went dead," Janan said.

He said it was suspected that the kidnappers were Taliban because criminal gangs would have likely asked for a ransom.

When the AP contacted Taliban spokesman Zabihullah Mujahid about the missing couple two months ago, he said the group had carried out an investigation and found no Taliban members were involved.

"We do not know about these two foreigners," he said in a telephone interview.

Janan's information could not be independently verified, and U.S. and Canadian officials still do not say for certain the couple was abducted.

NATO officials said they had no current information on the case, which was turned over to the U.S. State Department after it was determined the couple were not affiliated with foreign military forces.

Coleman said his daughter and her husband met on the Internet and married in 2011. They had previously travelled through Central America so they had some experience abroad.

During their recent Asian travels, they bought local goods to help vendors, slept in their tent and hostels and interacted with villagers. Despite her travel fever, love of history and a desire to do good, her father said Caitlan "wanted basically to be a housewife and have a bunch of kids."

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Tucker reported from Washington. Associated Press reporter Amir Shah in Kabul contributed to this report.

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'The Hobbit' stays atop box office for third week

LOS ANGELES (AP) — "The Hobbit: An Unexpected Journey" continues to rule them all at the box office, staying on top for a third-straight week and capping a record-setting $10.8 billion year in moviegoing.

The Warner Bros. fantasy epic from director Peter Jackson, based on the beloved J.R.R. Tolkien novel, made nearly $33 million this weekend, according to Sunday studio estimates, despite serious competition from some much-anticipated newcomers. It's now made a whopping $686.7 million worldwide and $222.7 million domestically alone.

Two big holiday movies — and potential Academy Awards contenders — also had strong openings. Quentin Tarantino's spaghetti Western-blaxploitation mash-up "Django Unchained" came in second place for the weekend with $30.7 million. The Weinstein Co. revenge comedy, starring Jamie Foxx as a slave in the Civil War South and Christoph Waltz as the bounty hunter who frees him and then makes him his partner, has earned $64 million since its Christmas Day opening.

And in third place with $28 million was the sweeping, all-singing "Les Miserables," based on the international musical sensation and the Victor Hugo novel of strife and uprising in 19th century France. The Universal Pictures film, with a cast of A-list actors singing live on camera led by Hugh Jackman, Anne Hathaway and Russell Crowe has made $67.5 million domestically and $116.2 worldwide since debuting on Christmas.

Additionally, the smash-hit James Bond adventure "Skyfall" has now made $1 billion internationally to become the most successful film yet in the 50-year franchise, Sony Pictures announced Sunday. The film stars Daniel Craig for the third time as the iconic British superspy.

"This is a great final weekend of the year," said Paul Dergarabedian, an analyst for box-office tracker Hollywood.com. "How perfect to end this year on such a strong note with the top five films performing incredibly well."

The week's other new wide release, the Billy Crystal-Bette Midler comedy "Parental Guidance" from 20th Century Fox, made $14.8 million over the weekend for fourth place and $29.6 million total since opening on Christmas.

Dergarabedian described the holding power of "The Hobbit" in its third week as "just amazing." Jackson shot the film, the first of three prequels to his massively successful "Lord of the Rings" series, in 48 frames per second — double the normal frame rate — for a crisper, more detailed image. It's also available in the usual 24 frames per second and both 2-D and 3-D projections.

"I think people are catching up with the movie. Maybe they're seeing it in multiple formats," he said. "I think it's just a big epic that feels like a great way to end the moviegoing year. There's momentum there with this movie."

"Django Unchained" is just as much of an epic in its own stylishly violent way that's quintessentially Tarantino. Erik Lomis, The Weinstein Co.'s president of theatrical distribution, said the opening exceeded the studio's expectations.

"We're thrilled with it, clearly. We knew it was extremely competitive at Christmas, particularly when you look at the start 'Les Miz' got. We were sort of resigned to being behind them. The fact that we were able to overtake them over the weekend was just great," Lomis said. "Taking nothing away from their number, it's a tribute to the playability of 'Django.'"

"Les Miserables" went into its opening weekend with nearly $40 million in North American grosses, including $18.2 on Christmas Day. That's the second-best opening ever on the holiday following "Sherlock Holmes," which made $24.9 million on Christmas 2009. Tom Hooper, in a follow-up to his Oscar-winner "The King's Speech," directs an enormous, ambitious take on the beloved musical which has earned a CinemaScore of "A'' from audiences and "A-plus" from women.

Nikki Rocco, Universal's head of distribution, said the debut for "Les Miserables" also beat the studio's expectations.

"That $18.2 million Christmas Day opening — people were shocked ... This is a musical!" she said. "Once people see it, they talk about how fabulous it is."

It all adds up to a record-setting year at the movies, beating the previous annual record of $10.6 billion set in 2009. Dergarabedian pointed out that the hits came scattered throughout the year, not just during the summer blockbuster season or prestige-picture time at the end. "Contraband," ''Safe House" and "The Vow" all performed well early on, but then when the big movies came, they were huge. "The Avengers" had the biggest opening ever with $207.4 million in May. The raunchy comedy "Ted" and comic-book behemoth "The Dark Knight Rises" both found enormous audiences. And Paul Thomas Anderson's challenging drama "The Master" shattered records in September when it opened on five screens in New York and Los Angeles with $736,311, for a staggering per-screen average of $147,262.

"We were able to get this record without scratching and clawing to a record," he said.

Estimated ticket sales for Friday through Sunday at U.S. and Canadian theaters, according to Hollywood.com. Where available, latest international numbers are also included. Final domestic figures will be released Monday.

1. "The Hobbit: An Unexpected Journey," $32.9 million ($106.5 million international).

2."Django Unchained," $30.7 million.

3."Les Miserables," $28 million ($38.3 million international).

4."Parental Guidance," $14.8 million ($7 million international).

5."Jack Reacher," $14 million ($18.1 million).

6."This Is 40," $13.2 million.

7."Lincoln," $7.5 million.

8."The Guilt Trip," $6.7 million.

9."Monsters, Inc. 3-D," $6.4 million.

10."Rise of the Guardians," $4.9 million ($11.6 million).

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Estimated weekend ticket sales at international theaters (excluding the U.S. and Canada) for films distributed overseas by Hollywood studios, according to Rentrak:

1."The Hobbit: An Unexpected Journey," $106.5 million.

2."Life of Pi," $39.2 million.

3."Les Miserables," $38.3 million.

4."Wreck-It Ralph," $20.4 million.

5."Jack Reacher," $18.1 million.

6."Rise of the Guardians," $11.6 million.

7."Parental Guidance," $7 million.

8."The Tower," $6.6 million.

9."Pitch Perfect," $6.2 million.

10."De L'autre Cote Du Periph," $4 million.

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Online:

http://www.hollywood.com

http://www.rentrak.com

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Universal and Focus are owned by NBC Universal, a unit of Comcast Corp.; Sony, Columbia, Sony Screen Gems and Sony Pictures Classics are units of Sony Corp.; Paramount is owned by Viacom Inc.; Disney, Pixar and Marvel are owned by The Walt Disney Co.; Miramax is owned by Filmyard Holdings LLC; 20th Century Fox and Fox Searchlight are owned by News Corp.; Warner Bros. and New Line are units of Time Warner Inc.; MGM is owned by a group of former creditors including Highland Capital, Anchorage Advisors and Carl Icahn; Lionsgate is owned by Lions Gate Entertainment Corp.; IFC is owned by AMC Networks Inc.; Rogue is owned by Relativity Media LLC.

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GOP Senate leader urges Biden to break ‘fiscal cliff’ impasse

Senate Minority Leader Mitch McConnell (R-KY) is shown in this C-Span video footage as he addresses the Senate …Republican Senate Minority Leader Mitch McConnell urged Vice President Joe Biden on Sunday to jump into “fiscal cliff” talks in hopes of breaking an impasse that threatens Americans with sharply higher income taxes come January 1.

In a brief speech on the Senate floor, McConnell complained that Democrats had not yet placed a counter-offer to a new Republican proposal, delivered at 7 pm on Saturday, “despite the obvious time crunch.”

“I’m concerned about the lack of urgency here,” the Kentucky lawmaker said. “I think we all know we’re running out of time.”

Besides conferring with his Democratic counterpart, Senate Majority Leader Harry Reid, McConnell said he had reached out to Biden "to see if he could help jump-start the negotiations on his side.”

McConnell added, “The vice president and I have worked together on solutions before, and I believe we can again."

Absent a breakthrough by tomorrow, income tax rates will rise across the board while government spending on domestic and defense programs will be slashed – a combination that some experts warn could plunge the economy into a new recession.

President Barack Obama has pressed for extending Bush-era tax rates on income up to $250,000 but letting them expire above that threshold. Republicans have resisted raising taxes on income at all levels. The two sides have also been at odds on issues like the estate tax and whether to extend unemployment benefits that stand to expire for some two million Americans.

Republican aides said that McConnell and Biden had spoken several times. A Biden aide said the vice president went to the White House after spending Christmas with his family in Delaware.

“We’re willing to work with whoever, whoever can help,” McConnell said. “There’s no single issue that remains an impossible sticking point. The sticking point appears to be a willingness, an interest, or frankly the courage to close the deal.”

“I’m willing to get this done, but I need a dance partner,” he said.

Reid said he had spoken several times on Sunday with Obama but acknowledged that his side had been “unable” to present a counter-offer to the latest Republican proposal.

“He and the vice president, I wish them well. In the meantime I will continue to try to come up something but at this stage I don’t have a counter-offer to make,” Reid said. “We are apart on some pretty big issues.”

Reid said he remained "hopeful but realistic" about the prospects for a breakthrough.

But he also seemed to confirm that one key sticking point was a Republican demand for reducing Social Security payments but adopting a less generous cost-of-living calculation known as “chained CPI” (the CPI being “consumer price index,” a measure of inflation).

“We’re not going to have any Social Security cuts,” Reid declared, saying it would not be “appropriate” in a short-term deal. Democratic leaders have cautiously signaled support for that approach – but only as part of a larger-scale deal that would see the U.S. debt limit raised for a significant stretch of time. Republicans want to use the debt ceiling fight to wrangle deeper government spending cuts.

“We're willing to make difficult concessions as part of a balanced, comprehensive agreement,” Reid said, “but we'll not agree to cut Social Security benefits as part of a small or short-term agreement, especially if that agreement gives more handouts to the rich.”

Republican aides bristled at Reid's characterization, noting that Democrats had not yet returned with a counter-offer. "If they don't like the CPI thing, they can strike it out," one told Yahoo News.

Republican senators, meanwhile, emerged from a closed door party meeting saying that chained CPI was off the table for now. The proposal was "not a winning hand" in the current standoff, John McCain told reporters drily.

Republican House Speaker John Boehner has said that it's up to the Senate to craft a compromise that can clear both chambers of Congress. Boehner suffered an embarrassing setback 10 days ago when conservative opposition forced him to withdraw legislation that would have let taxes rise on income of above $1 million. But a senior Republican aide noted that the exercise allowed the speaker to gauge how many of his rank-and-file would accept any increase in tax rates.

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Indian rape victim dies in hospital

SINGAPORE (AP) — A young Indian woman who was gang-raped and severely beaten on a bus in New Delhi died Saturday at a Singapore hospital, after her horrific ordeal galvanized Indians to demand greater protection from sexual violence that impacts thousands of women every day.

She "passed away peacefully" with her family and officials of the Indian embassy by her side," said Dr. Kevin Loh, the chief executive of Mount Elizabeth hospital where she had been treated since Thursday. "The Mount Elizabeth Hospital team of doctors, nurses and staff join her family in mourning her loss," he said in a statement.

He said the woman had remained in an extremely critical condition since Thursday when she was flown to Singapore from India. "Despite all efforts by a team of eight specialists in Mount Elizabeth Hospital to keep her stable, her condition continued to deteriorate over these two days. She had suffered from severe organ failure following serious injuries to her body and brain. She was courageous in fighting for her life for so long against the odds but the trauma to her body was too severe for her to overcome."

The woman and a male friend, who have not been identified, were traveling in a public bus after watching a film on the evening of Dec. 16 when they were attacked by six men who took turns to rape her. They also beat the couple and inserted an iron rod into her body resulting in severe organ damage. Both of them were then stripped and thrown off the bus, according to police.

Indian police have arrested six people in connection with the attack, which left the victim with severe internal injuries, a lung infection and brain damage. She also suffered from a heart attack while in hospital in India.

Indian High Commissioner, or ambassador, T.C.A. Raghanvan told reporters that the scale of the injuries she suffered was "very grave" and in the end it "proved too much.

He said arrangements are being made to take her body back to India

The frightening nature of the crime shocked Indians, who have come out in their thousands for almost daily demonstrations, demanding stronger protection for women and death penalty for rape, which is now punishable by a maximum life imprisonment. Women face daily harassment across India, ranging from catcalls on the streets, groping and touching in public transport to rape.

But the tragedy has forced India to confront the reality that sexually assaulted women are often blamed for the crime, which forces them to keep quiet and not report it to authorities for fear of exposing their families to ridicule. Also, police often refuse to accept complaints from those who are courageous enough to report the rapes and the rare prosecutions that reach courts drag on for years.

After 10 days at a New Delhi hospital, the victim was brought to the Mount Elizabeth hospital, which specializes in multi-organ transplant. But by late Friday, the young woman's condition had "taken a turn for the worse" and her vital signs had deteriorated. It was clear then that she would not survive long.

Indian attitudes toward rape are so entrenched that even politicians and opinion makers have often suggested that women should not go out at night or wear clothes that might be seen provocative.

Other politicians have come under fire for comments insulting the protesters and diminishing the crime.

On Friday, Abhijit Mukherjee, a national lawmaker and the son of India's president, apologized for calling the protesters "highly dented and painted" women, who go from discos to demonstrations.

"I tender my unconditional apology to all the people whose sentiments got hurt," he told NDTV news.

Separately, authorities in Punjab took action Thursday when an 18-year-old woman killed herself by drinking poison a month after she told police she was gang-raped.

State authorities suspended one police officer and fired two others on accusations they delayed investigating and taking action in the case. The three accused in the rape were only arrested Thursday night, a month after the crime was reported.

"This is a very sensitive crime, I have taken it very seriously," said Paramjit Singh Gill, a top police officer in the city of Patiala.

The Press Trust of India reported that the woman was raped Nov. 13 and reported the attack to police Nov. 27. But police harassed the girl, asked her embarrassing questions and took no action against the accused, PTI reported, citing police sources.

Authorities in the eastern state of Chhattisgarh also suspended a police officer on accusations he refused to register a rape complaint from a woman who said she had been attacked by a driver.

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Associated Press writer Faris Mokhtar contributed to this report.

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FBI removes many redactions in Marilyn Monroe file

LOS ANGELES (AP) — FBI files on Marilyn Monroe that could not be located earlier this year have been found and re-issued, revealing the names of some of the movie star's communist-leaning friends who drew concern from government officials and her own entourage.

But the records, which previously had been heavily redacted, do not contain any new information about Monroe's death 50 years ago. Letters and news clippings included in the files show the bureau was aware of theories the actress had been killed, but they do not show that any effort was undertaken to investigate the claims. Los Angeles authorities concluded Monroe's death was a probable suicide.

Recently obtained by The Associated Press through the Freedom of Information Act, the updated FBI files do show the extent the agency was monitoring Monroe for ties to communism in the years before her death in August 1962.

The records reveal that some in Monroe's inner circle were concerned about her association with Frederick Vanderbilt Field, who was disinherited from his wealthy family over his leftist views.

A trip to Mexico earlier that year to shop for furniture brought Monroe in contact with Field, who was living in the country with his wife in self-imposed exile. Informants reported to the FBI that a "mutual infatuation" had developed between Field and Monroe, which caused concern among some in her inner circle, including her therapist, the files state.

"This situation caused considerable dismay among Miss Monroe's entourage and also among the (American Communist Group in Mexico)," the file states. It includes references to an interior decorator who worked with Monroe's analyst reporting her connection to Field to the doctor.

Field's autobiography devotes an entire chapter to Monroe's Mexico trip, "An Indian Summer Interlude." He mentions that he and his wife accompanied Monroe on shopping trips and meals and he only mentions politics once in a passage on their dinnertime conversations.

"She talked mostly about herself and some of the people who had been or still were important to her," Field wrote in "From Right to Left." ''She told us about her strong feelings for civil rights, for black equality, as well as her admiration for what was being done in China, her anger at red-baiting and McCarthyism and her hatred of (FBI director) J. Edgar Hoover."

Under Hoover's watch, the FBI kept tabs on the political and social lives of many celebrities, including Frank Sinatra, Charlie Chaplin and Monroe's ex-husband Arthur Miller. The bureau has also been involved in numerous investigations about crimes against celebrities, including threats against Elizabeth Taylor, an extortion case involving Clark Gable and more recently, trying to solve who killed rapper Notorious B.I.G.

The AP had sought the removal of redactions from Monroe's FBI files earlier this year as part of a series of stories on the 50th anniversary of Monroe's death. The FBI had reported that it had transferred the files to a National Archives facility in Maryland, but archivists said the documents had not been received. A few months after requesting details on the transfer, the FBI released an updated version of the files that eliminate dozens of redactions.

For years, the files have intrigued investigators, biographers and those who don't believe Monroe's death at her Los Angeles area home was a suicide.

A 1982 investigation by the Los Angeles District Attorney's Office found no evidence of foul play after reviewing all available investigative records, but noted that the FBI files were "heavily censored."

That characterization intrigued the man who performed Monroe's autopsy, Dr. Thomas Noguchi. While the DA investigation concluded he conducted a thorough autopsy, Noguchi has conceded that no one will likely ever know all the details of Monroe's death. The FBI files and confidential interviews conducted with the actress' friends that have never been made public might help, he wrote in his 1983 memoir "Coroner."

"On the basis of my own involvement in the case, beginning with the autopsy, I would call Monroe's suicide 'very probable,'" Noguchi wrote. "But I also believe that until the complete FBI files are made public and the notes and interviews of the suicide panel released, controversy will continue to swirl around her death."

Monroe's file begins in 1955 and mostly focuses on her travels and associations, searching for signs of leftist views and possible ties to communism. One entry, which previously had been almost completely redacted, concerned intelligence that Monroe and other entertainers sought visas to visit Russia that year.

The file continues up until the months before her death, and also includes several news stories and references to Norman Mailer's biography of the actress, which focused on questions about whether Monroe was killed by the government.

For all the focus on Monroe's closeness to suspected communists, the bureau never found any proof she was a member of the party.

"Subject's views are very positively and concisely leftist; however, if she is being actively used by the Communist Party, it is not general knowledge among those working with the movement in Los Angeles," a July 1962 entry in Monroe's file states.

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Anthony McCartney can be reached at http://twitter.com/mccartneyAP

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Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.

Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.

Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.

"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."

"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."

The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.

Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.

"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.

She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.

A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.

"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.

Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.

One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.

Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.

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Associated Press reporter Tom Odula contributed to this report.

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'Clock is ticking': Debt talks underway

WASHINGTON (AP) — The end game at hand, President Barack Obama and congressional leaders made a final stab at compromise Friday to prevent a toxic blend of middle-class tax increases and spending cuts from taking effect at the turn of the new year.

Success was far from guaranteed in an atmosphere of political mistrust — even on a slimmed-down deal that postponed hard decisions about spending cuts into 2013, and pessimism vied with optimism in a Capitol where lawmakers grumbled about the likelihood of spending the new year holiday in the Capitol.

"The clock is ticking," Sen. Max Baucus, chairman of the Senate Finance Committee, said in remarks on the Senate floor as Obama and congressional leaders were meeting several blocks away at the White House. "My message to them is simple. We can do this. We can get this done, and we must," added the Montana Democrat.

Congressional Democrats said Obama was ready with a revised offer to present.

But that drew a denial from a person familiar with the talks, who said the president would review his proposal from a week ago, when he urged lawmakers to preserve tax cuts for most while letting rates rise above incomes of $250,000 a year. At the same time, Obama said lawmakers should extend unemployment benefits for the long-term jobless. The person was unauthorized to discuss the private meeting publicly and spoke on condition of anonymity.

The meeting lasted a little over an hour and neither the president nor the four lawmakers spoke with reporters before or immediately after the session.

The guest list included two Republicans, House Speaker John Boehner, and Senate Republican leader Mitch McConnell; as well as Democrats Harry Reid, the Senate Majority Leader, and Rep. Nancy Pelosi of California, her party's leader in the House.

The same group last met more than a month ago and emerged expressing optimism they could strike a deal that avoided the fiscal cliff. At that point, Boehner had already said he was willing to let tax revenues rise as part of an agreement, and the president and his Democratic allies said they were ready to accept spending cuts.

Since then, though, talks between Obama and Boehner faltered, the speaker struggled to control his rebellious rank and file, and Reid and McConnell sparred almost daily in speeches on the Senate floor. Through it all, Wall Street has paid close attention, and in the moments before the meeting, stocks were trading lower for the fifth day in a row.

The core issue is the same as it has been for more than a year, Obama's demand for tax rates to rise on upper incomes while remaining at current levels for most Americans. He made the proposal central to his successful campaign for re-election, when he said incomes above $200,000 for individuals and $250,000 for couples should rise to 39.6 percent from the current 35 percent.

Boehner refused for weeks to accept any rate increases, and simultaneously accused Obama of skimping on the spending cuts he would support as part of a balanced deal to reduce deficits, remove the threat of spending cuts and prevent the across-the-board tax cuts.

Last week, the Ohio Republican pivoted and presented a Plan B measure that would have let rates rise on million-dollar earners. That was well above Obama's latest offer, which called for a $400,000 threshold, but more than the speaker's rank and file were willing to accept.

Facing defeat, Boehner scrapped plans for a vote, leaving the economy on track for the cliff that political leaders in both parties had said they could avoid. In the aftermath, Democrats said they doubted any compromise was possible until Boehner has been elected to a second term as speaker when the new Congress convenes on Jan. 3.

Apart from income tax rates, congressional officials in both parties said a handful of other issues were the subject of private talks in the Capitol. These included the Alternative Minimum Tax, which would effectively raise taxes on millions of upper-middle-class families unless Congress acts; as well as taxes on capital gains, dividends and estates.

In addition, benefits for the long-term unemployed are due to expire in the next few days, and doctors face the prospect of a deep cut in the fees they receive for treating Medicare patients unless legislation is passed to prevent it.

Further compounding the year-end maneuvering, there are warnings that the price of milk could virtually double beginning next year.

Congressional officials said that under current law, the federal government is obligated to maintain prices so that fluid milk sells for about $20 per hundredweight. If the law lapses, the Department of Agriculture would be required to maintain a price closer to $36 of $38 per hundredweight, they said. It is unclear when price increases might be felt by consumers.

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Associated Press writers Alan Fram and Andrew Taylor contributed to this report.

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China tightening controls on Internet

BEIJING (AP) — China's new communist leaders are increasing already tight controls on Internet use and electronic publishing following a spate of embarrassing online reports about official abuses.

The measures suggest China's new leader, Xi Jinping, and others who took power in November share their predecessors' anxiety about the Internet's potential to spread opposition to one-party rule and their insistence on controlling information despite promises of more economic reforms.

"They are still very paranoid about the potentially destabilizing effect of the Internet," said Willy Lam, a politics specialist at the Chinese University of Hong Kong. "They are on the point of losing a monopoly on information, but they still are very eager to control the dissemination of views."

This week, China's legislature took up a measure to require Internet users to register their real names, a move that would curtail the Web's status as a freewheeling forum to complain, often anonymously, about corruption and official abuses. The legislature scheduled a news conference Friday to discuss the measure, suggesting it was expected to be approved.

That comes amid reports Beijing might be disrupting use of software that allows Web surfers to see sites abroad that are blocked by its extensive Internet filters. At the same time, regulators have proposed rules that would bar foreign companies from distributing books, news, music and other material online in China.

Beijing promotes Internet use for business and education but bans material deemed subversive or obscene and blocks access to foreign websites run by human rights and Tibet activists and some news outlets. Controls were tightened after social media played a role in protests that brought down governments in Egypt and Tunisia.

In a reminder of the Web's role as a political forum, a group of 70 prominent Chinese scholars and lawyers circulated an online petition this week appealing for free speech, independent courts and for the ruling party to encourage private enterprise.

Xi and others on the party's ruling seven-member Standing Committee have tried to promote an image of themselves as men of the people who care about China's poor majority. They have promised to press ahead with market-oriented reforms and to support entrepreneurs but have given no sign of support for political reform.

Communist leaders who see the Internet as a source of economic growth and better-paid jobs were slow to enforce the same level of control they impose on movies, books and other media, apparently for fear of hurting fledgling entertainment, shopping and other online businesses.

Until recently, Web surfers could post comments online or on microblog services without leaving their names.

That gave ordinary Chinese a unique opportunity to express themselves to a public audience in a society where newspapers, television and other media are state-controlled. The most popular microblog services say they have more than 300 million users and some users have millions of followers reading their comments.

The Internet also has given the public an unusual opportunity to publicize accusations of official misconduct.

A local party official in China's southwest was fired in November after scenes from a videotape of him having sex with a young woman spread quickly on the Internet. Screenshots were uploaded by a former journalist in Beijing, Zhu Ruifeng, to his Hong Kong website, an online clearing house for corruption allegations.

Some industry analysts suggest allowing Web surfers in a controlled setting to vent helps communist leaders stay abreast of public sentiment in their fast-changing society. Still, microblog services and online bulletin boards are required to employ censors to enforce content restrictions. Researchers say they delete millions of postings a day.

The government says the latest Internet regulation before the National People's Congress is aimed at protecting Web surfers' personal information and cracking down on abuses such as junk e-mail. It would require users to report their real names to Internet service and telecom providers.

The main ruling party newspaper, People's Daily, has called in recent weeks for tighter Internet controls, saying rumors spread online have harmed the public. In one case, it said stories about a chemical plant explosion resulted in the deaths of four people in a car accident as they fled the area.

Proposed rules released this month by the General Administration of Press and Publications would bar Chinese-foreign joint ventures from publishing books, music, movies and other material online in China. Publishers would be required to locate their servers in China and have a Chinese citizen as their local legal representative.

That is in line with rules that already bar most foreign access to China's media market, but the decision to group the restrictions together and publicize them might indicate official attitudes are hardening.

That comes after the party was rattled by foreign news reports about official wealth and misconduct.

In June, Bloomberg News reported that Xi's extended family has amassed assets totaling $376 million, though it said none was traced to Xi. The government has blocked access to Bloomberg's website since then.

In October, The New York Times reported that Premier Wen Jiabao's relatives had amassed $2.7 billion since he rose to national office in 2002. Access to the Times' Chinese-language site has been blocked since then.

Previous efforts to tighten controls have struggled with technical challenges in a country with more than 500 million Internet users.

Microblog operators such as Sina Corp. and Tencent Ltd. were ordered in late 2011 to confirm users' names but have yet to finish the daunting task.

Web surfers can circumvent government filters by using virtual private networks — software that encrypts Web traffic and is used by companies to transfer financial data and other sensitive information. But VPN users say disruptions that began in 2011 are increasing, suggesting Chinese regulators are trying to block encrypted traffic.

Curbs on access to foreign sites have prompted complaints by companies and Chinese scientists and other researchers.

In July, the American Chamber of Commerce in China said 74 percent of companies that responded to a survey said unstable Internet access "impedes their ability to do business."

Chinese leaders "realize there are detrimental impacts on business, especially foreign business, but they have counted the cost and think it is still worthwhile," said Lam. "There is no compromise about the political imperative of controlling the Internet."

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