Brain image study: Fructose may spur overeating

This is your brain on sugar — for real. Scientists have used imaging tests to show for the first time that fructose, a sugar that saturates the American diet, can trigger brain changes that may lead to overeating.

After drinking a fructose beverage, the brain doesn't register the feeling of being full as it does when simple glucose is consumed, researchers found.

It's a small study and does not prove that fructose or its relative, high-fructose corn syrup, can cause obesity, but experts say it adds evidence they may play a role. These sugars often are added to processed foods and beverages, and consumption has risen dramatically since the 1970s along with obesity. A third of U.S. children and teens and more than two-thirds of adults are obese or overweight.

All sugars are not equal — even though they contain the same amount of calories — because they are metabolized differently in the body. Table sugar is sucrose, which is half fructose, half glucose. High-fructose corn syrup is 55 percent fructose and 45 percent glucose. Some nutrition experts say this sweetener may pose special risks, but others and the industry reject that claim. And doctors say we eat too much sugar in all forms.

For the study, scientists used magnetic resonance imaging, or MRI, scans to track blood flow in the brain in 20 young, normal-weight people before and after they had drinks containing glucose or fructose in two sessions several weeks apart.

Scans showed that drinking glucose "turns off or suppresses the activity of areas of the brain that are critical for reward and desire for food," said one study leader, Yale University endocrinologist Dr. Robert Sherwin. With fructose, "we don't see those changes," he said. "As a result, the desire to eat continues — it isn't turned off."

What's convincing, said Dr. Jonathan Purnell, an endocrinologist at Oregon Health & Science University, is that the imaging results mirrored how hungry the people said they felt, as well as what earlier studies found in animals.

"It implies that fructose, at least with regards to promoting food intake and weight gain, is a bad actor compared to glucose," said Purnell. He wrote a commentary that appears with the federally funded study in Wednesday's Journal of the American Medical Association.

Researchers now are testing obese people to see if they react the same way to fructose and glucose as the normal-weight people in this study did.

What to do? Cook more at home and limit processed foods containing fructose and high-fructose corn syrup, Purnell suggested. "Try to avoid the sugar-sweetened beverages. It doesn't mean you can't ever have them," but control their size and how often they are consumed, he said.

A second study in the journal suggests that only severe obesity carries a high death risk — and that a few extra pounds might even provide a survival advantage. However, independent experts say the methods are too flawed to make those claims.

The study comes from a federal researcher who drew controversy in 2005 with a report that found thin and normal-weight people had a slightly higher risk of death than those who were overweight. Many experts criticized that work, saying the researcher — Katherine Flegal of the Centers for Disease Control and Prevention — painted a misleading picture by including smokers and people with health problems ranging from cancer to heart disease. Those people tend to weigh less and therefore make pudgy people look healthy by comparison.

Flegal's new analysis bolsters her original one, by assessing nearly 100 other studies covering almost 2.9 million people around the world. She again concludes that very obese people had the highest risk of death but that overweight people had a 6 percent lower mortality rate than thinner people. She also concludes that mildly obese people had a death risk similar to that of normal-weight people.

Critics again have focused on her methods. This time, she included people too thin to fit what some consider to be normal weight, which could have taken in people emaciated by cancer or other diseases, as well as smokers with elevated risks of heart disease and cancer.

"Some portion of those thin people are actually sick, and sick people tend to die sooner," said Donald Berry, a biostatistician at the University of Texas MD Anderson Cancer Center in Houston.

The problems created by the study's inclusion of smokers and people with pre-existing illness "cannot be ignored," said Susan Gapstur, vice president of epidemiology for the American Cancer Society.

A third critic, Dr. Walter Willett of the Harvard School of Public Health, was blunter: "This is an even greater pile of rubbish" than the 2005 study, he said. Willett and others have done research since the 2005 study that found higher death risks from being overweight or obese.

Flegal defended her work. She noted that she used standard categories for weight classes. She said statistical adjustments were made for smokers, who were included to give a more real-world sample. She also said study participants were not in hospitals or hospices, making it unlikely that large numbers of sick people skewed the results.

"We still have to learn about obesity, including how best to measure it," Flegal's boss, CDC Director Dr. Thomas Frieden, said in a written statement. "However, it's clear that being obese is not healthy - it increases the risk of diabetes, heart disease, cancer, and many other health problems. Small, sustainable increases in physical activity and improvements in nutrition can lead to significant health improvements."

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Online:

Obesity info: http://www.cdc.gov/obesity/data/trends.html

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Mike Stobbe can be followed at http://twitter.com/MikeStobbe

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House faces test on fiscal cliff deal

Vice President Joe Biden gives two thumbs up following a Senate Democratic caucus meeting about the fiscal cliff …

Updated 4:25 pm ET

A hard-fought bipartisan compromise passed in the Senate early Tuesday to spare all but the richest Americans from painful income-tax hikes teetered on the edge of collapse as angry House Republicans denounced its lack of spending cuts.

While House Speaker John Boehner considered whether to bring the Senate-passed measure to the floor for a vote Tuesday, Majority Leader Eric Cantor told fellow Republicans in a closed-door meeting that he opposed the legislation negotiated by Vice President Joe Biden and Republican Senate Minority Leader Mitch McConnell and passed by the Senate 89-8 shortly after 2 a.m.

Cantor told the group he could not back the bill in its current form, according to two officials in the room, which could leave open the possibility of an attempt to modify the package and send it back to the upper chamber. But Democrats there have signaled that changing the compromise risks killing it.

A report released by the Congressional Budget Office Tuesday complicated matters further still. The nonpartisan group "scored" the Biden-McConnell compromise as likely adding nearly $4 trillion to the federal deficit over 10 years, hardening opposition among many Republicans seeking further spending cuts.

The country technically went over the “fiscal cliff” at midnight, triggering across-the-board income-tax increases and deep, automatic cuts to domestic and defense programs. Taken together, those factors could plunge the still-fragile economy into a fresh recession. Financial markets were closed for New Year’s Day, potentially limiting the damage from the partisan impasse in dysfunctional Washington at least until Wednesday.

Time was running short for another reason, however: A new Congress will take office at noon on Thursday, forcing efforts to craft a compromise by the current Congress back to the drawing board.

“The Speaker and Leader laid out options to the members and listened to feedback,” Boehner spokesman Brendan Buck said in a statement emailed to reporters. “The lack of spending cuts in the Senate bill was a universal concern amongst members in today’s meeting.”

“Conversations with members will continue throughout the afternoon on the path forward,” Buck said.

As House Republicans raged at the bill, key House Democrats emerging from a closed-door meeting with Biden expressed support for the compromise and pressed Boehner for a vote on the legislation as currently written.

“Our Speaker has said when the Senate acts, we will have a vote in the House. That is what he said, that is what we expect, that is what the American people deserve…a straight up-or-down vote,” Democratic House Minority Leader Nancy Pelosi told reporters.

Conservative activist organizations like the anti-tax Club for Growth warned lawmakers to oppose the compromise. The Club charged in a message to Congress that “this bill raises taxes immediately with the promise of cutting spending later.”

Under the compromise arrangement, taxes would rise on income above $400,000 for individuals and $450,000 for households, while exemptions and deductions the wealthiest Americans use to reduce their tax bill would face new limits. The accord would also raise the taxes paid on large inheritances from 35% to 40% for estates over $5 million. And it would extend by one year unemployment benefits for some two million Americans. It would also prevent cuts in payments to doctors who treat Medicare patients and spare tens of millions of Americans who otherwise would have been hit with the Alternative Minimum Tax. And it would extend some stimulus-era tax breaks championed by progressives.

The middle class will still see its taxes go up: The final deal did not include an extension of the payroll tax holiday.

Efforts to modify the first installment of $1.2 trillion in cuts to domestic and defense programs over 10 years -- the other portion of the “fiscal cliff,” known as sequestration -- had proved a sticking point late in the game. Democrats had sought a year-long freeze but ultimately caved to Republican pressure and signed on to just a two-month delay while broader deficit-reduction talks continue.

That would put the next major battle over spending cuts right around the time that the White House and its Republican foes are battling it out over whether to raise the country's debt limit. Republicans have vowed to push for more spending cuts, equivalent to the amount of new borrowing. Obama has vowed not to negotiate as he did in 2011, when a bruising fight threatened the first-ever default on America's obligations and resulted in the first-ever downgrade of the country's credit rating. Biden sent that message to Democrats in Congress, two senators said.

“This agreement is the right thing to do for our country and the House should pass it without delay,” President Barack Obama said in a written statement shortly after the Senate vote.

There were signs that the 2016 presidential race shaped the outcome in the Senate. Republican Senator Marco Rubio, widely thought to have his eye on his party’s nomination, voted no. Republican Senator Rand Paul, who could take up the libertarian mantle of his father Ron Paul, did as well.

Biden's visit -- his second to Congressional Democrats in two days -- aimed to soothe concerns about the bill and about the coming battles on deficit reduction.

“This is a simple case of trying to Make sure that the perfect does not become the enemy of the good,” said Democratic Representative Elijah Cummings, one of the chamber’s most steadfast liberals. “Nobody’s going to like everything about it.”

Asked whether House progressives, who had hoped for a lower income threshold, would back the bill, Cummings said he could not predict but stressed: “I am one of the most progressive members, and I will vote for it.”

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World giving enthusiastic welcome to 2013

LONDON (AP) — Lavish fireworks displays ushered in 2013 across the Asia-Pacific region on Tuesday, and Europe was holding scaled-back festivities and street parties in the hope of beginning a new year that will be kinder to its battered economies.

Asian cities kicked off New Year's celebrations in style and an atmosphere of renewed optimism, despite the "fiscal cliff" impasse of spending cuts and tax increases threatening to reverberate globally from the United States.

Huge fireworks lit up skylines in Sydney, Hong Kong and Shanghai, and even the once-isolated country of Myanmar joined the countdown party for the first time in decades.

Celebrations were planned around the world, including the traditional crystal ball drop in New York City's Times Square, where 1 million people were expected to cram into the surrounding streets.

In Russia, Moscow's iconic Red Square was filled with spectators as fireworks exploded near the Kremlin to welcome in the new year. Earlier in the day, about 25 people were reportedly arrested in Moscow for trying to hold an unsanctioned demonstration. But President Vladimir Putin gave an optimistic New Year's Eve address, making no reference to the anti-government protests that have occurred in his country in the past year.

"We believe that we can change the life around us and become better ourselves, that we can become more heedful, compassionate, gracious," Putin said, according to the ITAR-Tass news agency.

In Australia, a balmy summer night was split by 7 tons of fireworks fired from rooftops and barges in Sydney, many cascading from the city's Harbor Bridge, in a $6.9 million pyrotechnic extravaganza billed by organizers as the world's largest.

In Myanmar, after nearly five decades under military regimes that discouraged or banned big public gatherings, about 90,000 people experienced the country's first New Year's Eve countdown in a field in the largest city of Yangon.

"We feel like we are in a different world," said Yu Thawda, a university student who came with three of her friends.

Tens of thousands of people lined Hong Kong's Victoria Harbor to view a $1.6 million fireworks display, said to be the biggest ever in the southern Chinese city.

In North Korea, cannons boomed at midnight in Pyongyang as people crowded the streets of the capital to watch a fireworks show over the Taedong River. After being in mourning a year ago regarding leader Kim Jong Il's death, North Koreans celebrated the end of a big year that included the rise of new leader Kim Jong Un and the recent launch of a satellite into space.

Hotels, clubs and other sites in New Delhi, the Indian capital, canceled festivities after the death Saturday of a young rape victim touched off days of mourning and reflection about women's safety. People were asked to light candles to express their solidarity with the victim.

In Indonesia, Jakarta's street party centered on a 7-kilometer (4-mile) thoroughfare closed to traffic from nightfall until after midnight. Workers erected 16 large stages along the normally clogged, eight-lane highway through the heart of the city. Indonesia's booming economy is a rare bright spot amid global gloom and is bringing prosperity — or the hope of it — to its people.

In the Philippines, where many are recovering from devastation from a recent typhoon, health officials have hit upon a successful way to stop revelers from setting off huge illegal firecrackers that maim and injure hundreds of Filipinos each year.

A health official, Eric Tayag, donned the splashy outfit of South Korean star PSY and danced to his YouTube hit "Gangnam Style" video while preaching against the use of illegal firecrackers on TV, in schools and in public arenas.

"The campaign has become viral," Tayag said.

In austerity-hit Europe, the mood was more restrained — if hopeful. The year 2013 is projected to be a sixth straight one of recession amid Greece's worst economic crisis since World War II. In fact, the new year was starting with a 24-hour strike by subway and train workers in Athens to protest salary cuts that are part of the government's austerity measures.

Still, in his televised New Year's Eve message, Prime Minister Antonis Samaras promised Greeks that the worst of the crisis is past, and declared 2013 a "year of hope" that will see the beginning of the country's rebirth.

Celebrating New Year's Eve with a vespers service in St. Peter's Basilica, Pope Benedict XVI said that despite all the injustice in the world, goodness prevails. In his homily, Benedict said it's tough to remember that goodness can win when bad news — death, violence and injustice — "makes more noise than good." He said taking time to meditate in prolonged reflection and prayer can help "find healing from the inevitable wounds of daily life."

German Chancellor Angela Merkel's New Year's message warned her country to prepare for difficult economic times ahead. Nicosia, the capital of Cyprus, decided to cancel celebrations in light of the economic crisis. Nicosia said 16,000 euros ($21,000) saved from the canceled event will be given to some 320 needy schoolchildren.

In Spain, where a recession has left unemployment at a staggering 25 percent, people are hoping for a better new year.

"It's been tough, but some celebrations are too deeply-ingrained to let go," said Olga Camino, 25. She said she would be celebrating in the streets of Madrid in fancy dress with a large group of friends. Camino said they would all eat 12 grapes as the clock in Madrid's central Puerta del Sol struck midnight, a tradition observed throughout Spain.

Scotland's Edinburgh, which traditionally hosts one of the biggest New Year's Eve parties in Europe, also planned good cheer. Festivities for the three-day Hogmanay —or year-end — celebrations began Sunday with a torchlight procession in the Scottish capital, and organizers said about 75,000 people are expected to line the streets for Tuesday's fireworks.

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McGuirk reported from Sydney. Associated Press writers Aye Aye Win in Yangon, Myanmar; Jean Lee in Pyongyang, North Korea; Chris Brummitt in Jakarta, Indonesia; Kelvin Chan in Hong Kong; Ashok Sharma in New Delhi; Jim Gomez in Manila, Philippines; Nicholas Paphitis in Athens; Raphael Satter in London; Harold Heckle in Madrid, Spain; and Menelaos Hadjicostis in Nicosia, Cyprus, contributed to this report.

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Sony No Longer Shipping PlayStation 2 in Japan

You may have grown up with it. Your children may have, too.

Sony‘s PlayStation 2 home game console, released in 2000, was one of the most popular game consoles of all time, rivaled in sales only by the different kinds of Nintendo DS handheld console. It continued to be sold new on store shelves until just recently, even years after Sony launched its PlayStation 3 successor.

Now, however, Sony’s sent out its last shipment of new “PS2″ consoles for the Japanese market, according to Japanese gaming news site Famitsu (as reported by Polygon’s Emily Gera). Some other regions are continuing to receive shipments for now, but the heart of the PlayStation 2 phenomenon has finally stopped beating.

A gaming legend

Japanese PlayStation fans saw thousands more titles released in their language than English-speaking players. The PlayStation 2 was especially well-known for its role-playing games, such as the MMORPG Final Fantasy XI, which was designed so closely around the PS2′s capabilities that its Windows PC version uses almost entirely the same graphics and controller-based interface.

New PS2 games continue to ship; Final Fantasy XI is even getting a full-fledged, retail-boxed expansion pack this March. It’ll only support the PS2 in Japan, however, where dedicated players continue to use the original “fat” PS2 consoles with the hard drive expansion slot. Internationally, it will only support the PC and Xbox 360.

PS2 games in a post-PS2 world

The first PlayStation 3 consoles — infamous for the silence which ensued at the Sony event where their price at launch was announced to be “599 U.S. dollars” — were backwards-compatible with the vast majority of PlayStation 2 and original PSOne games. Sony achieved PS2 backwards compatibility, however, by including the PS2′s actual “Emotion Engine” and “Graphics Synthesizer” chips inside each PS3, essentially making it two game consoles in one (and helping to drive up that launch price).

A redesign bumped down the price some, but at the cost of removing the Emotion Engine chip, which caused the redesigned PS3 consoles to sometimes have bugs or fail to play certain games. Today’s PS3 consoles lack both chips, which means that while they play PSOne games just fine, they don’t support PS2 game discs at all and can’t be upgraded to do so.

The legend lives on?

Sony has made HD remakes of certain PS2 titles, and republished others for the PS3 under the “PlayStation 2 Classics” brand. Dozens of such titles have been re-released as digital downloads in the PlayStation Network store.

This method of playing a PS2 game on the PS3, however, involves essentially buying the game again (assuming that it’s even in the store), sort of like Sony’s method of playing PlayStation Portable games on the Vita. Even rebuying the games for the PS3 doesn’t ensure continued playability on modern Sony consoles; the upcoming “PlayStation 4″ (not its actual name) reportedly won’t be able to play games made for the PS3.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.
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Armstrong better, Green Day to resume tour in 2013

LOS ANGELES (AP) — Green Day is going back on the road.

The Grammy-winning punk band announced new tour dates Monday.

The band canceled the rest of its 2012 club schedule and postponed the start of a 2013 arena tour after singer-guitarist Billie Joe Armstrong's substance abuse problems emerged publicly in September when he had a profane meltdown on the stage of the iHeartRadio Music Festival in Las Vegas. The band's rep announced later that Armstrong was headed to treatment for substance abuse.

"I just want to thank you all for the love and support you've shown for the past few months," Armstrong told fans in a statement Monday. "Believe me, it hasn't gone unnoticed and I'm eternally grateful to have such an amazing set of friends and family. I'm getting better every day. So now, without further ado, the show must go on."

The tour is scheduled to begin March 28 at the Allstate Arena in the Chicago area. Tickets for postponed shows will be honored on the new dates, and refunds will be available for canceled shows.

"We want to thank everyone for hanging in with us for the last few months," the band said. "We are very excited to hit the road and see all of you again, though we regret having to cancel more shows."

The band released their most recent album, "Tre," on Dec. 11, more than a month ahead of schedule.

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Online:

http://www.greenday.com/

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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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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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