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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Manhunt Heats Up for Two Escaped Bank Robbers

The manhunt for two bank robbers who escaped from a downtown Chicago prison this week intensified overnight, with police chasing multiple leads as new footage shows the men getting into a taxi minutes after their brazen escape.

Investigators say surveillance cameras captured Joseph "Jose" Banks, 37, and Kenneth Conley, 38,
getting into a taxi minutes after their early Tuesday escape. They entered the taxi at the intersection of Michigan Avenue and Congress Street, just blocks away from the jail.

The FBI considers them "armed and dangerous."

The men then showed up five hours later at the home of Sandy Conley, Kenneth Conley's mother, in the Chicago suburb of Tinley Park, Ill.

"He was in the house for two minutes," Sandy Conley said. "I can't tell you if he was armed. I made him get out."

Thomas Trautmann of the Chicago FBI said the clock is ticking on finding the men.

"[As] each hour goes by, our chances get longer and longer," he said. "However, we do have several viable leads that we are running down."

He did not specify the information.

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Prison Break: Convicts Escape from Jail on Bed Sheets Watch Video

Banks and Conley were last seen Monday at 10 p.m. during a prison head count at the Metropolitan Correctional Center in downtown Chicago's Loop district. The two borrowed a move from the film "Escape From Alcatraz" by stuffing their beds with clothes in the shape of bodies.

They men then broke the window of their cell at the federal prison, shimmying out a hole only inches wide, and scaled down the side of the building 17 stories, all the while holding onto a rope of sheets and towels taken from the prison. The rope was strong enough to support the two, one weighing 165 pounds the other 185 pounds.

At 7 a.m. the next morning, as employees arrived at work, they noticed the sheets left dangling from the building and at jailers discovered that Conley and Banks were missing.

While the men have had plenty of time to leave the area, there's no indication that they have, ABC 7 TV's public-safety expert Jody Weis said.

"There's a likelihood that they're going to stay here," Weis, a former Chicago police superintendent, said. "They'll have people they can trust. They can have people they can work with. There are going to be people that might be able to hide them out."

Banks, nicknamed "the second-hand bandit" because of the used clothing disguises he wore in several robberies, was convicted of armed robbery last week. His parting words to his judge, Rebecca Pallmeyer, were, "I'll be seeking retribution as well as damages ... you'll hear from me."

Conley had been in jail for several years.

Pallmeyer and others who presided over the men's cases have reportedly been offered protection.

"If they're willing to go down a sheet 17 floors, they're willing to take a chance," Weis said. "And I think you can draw your own conclusion as to what that might mean."

The FBI and U.S. Marshals are offering a combined reward of $60,000 to find the inmates and bring them back into custody.

Escape Has Similarities to 1985 Prison Break

Banks and Conley's disappearance has some striking similarities to the daring escape made by two convicted murders who also broke out of the downtown jail 27 years ago.

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Syrian rebels fight for strategic town in Hama province

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

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

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

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

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

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

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

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

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

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

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

SECTARIAN FEARS

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

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

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

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

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

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

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

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

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

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

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

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

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

LEBANON BORDER POST TAKEN

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

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

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

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

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

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

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

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

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

(Reporting by Erika Solomon; Editing by Andrew Osborn)

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Narendra Modi addresses nation after winning Gujarat assembly election

AHMEDABAD: Fresh from the hat-trick in the assembly polls, chief minister Narendra Modi gave women and youth voters the credit for the BJP's thumping win. Addressing a 'vijay sabha' outside BJP headquarters in Khanpur on Thursday, he said if he had committed any 'mistake', he seeks forgiveness from the people.

"If there has been a mistake somewhere. If I have erred somewhere, I seek apology from you, the six crore Gujaratis," Modi said in the victory speech in Hindi, aiming to reach out to a wider audience.

Modi, who has always been under attack following the 2002 post-Godhra violence, made no mention of it in his 45-minute speech.

"You have given me power. Now you also give me your blessings so that I do not commit any mistake, no one is hurt, and there is no mistake committed by me even unknowingly. When people, who are in fact God, give their blessings, there is no possibility of a mistake," he said.

Analysts said that by choosing to speak in Hindi when he had stuck to Gujarati during his entire election campaign, Modi may be signalling his national ambitions.

Taking potshots at his detractors, Modi said he did not need a certificate from anyone after people had given him "the biggest medal."

As the cheering crowd shouted "PM-PM," Modi said he would visit Delhi on December 27 for a day. "Gujarat is a role model for the elections," he said. "The entire election was fought here on the plank of development. Gujarat has endorsed the plank of development and has voted accordingly."

He went on to say: "This victory is not the victory of Narendra Modi, but of the six crore Gujaratis and those Indians who aspire to prosperity and development. This is a victory of all those who wish for the country's good."

During his speech, he mostly tried to address the masses outside the state. "People of India want development. Whether it is Assam, Kerala or Jammu and Kashmir or any corner of the country, this victory belongs to all those who want development."

Modi also promised to fulfill the dreams and aspirations of people of Gujarat and work more rigorously over the next five years.

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AP IMPACT: Steroids loom in major-college football

WASHINGTON (AP) — With steroids easy to buy, testing weak and punishments inconsistent, college football players are packing on significant weight — 30 pounds or more in a single year, sometimes — without drawing much attention from their schools or the NCAA in a sport that earns tens of billions of dollars for teams.

Rules vary so widely that, on any given game day, a team with a strict no-steroid policy can face a team whose players have repeatedly tested positive.

An investigation by The Associated Press — based on interviews with players, testers, dealers and experts and an analysis of weight records for more than 61,000 players — revealed that while those running the multibillion-dollar sport say they believe the problem is under control, that control is hardly evident.

The sport's near-zero rate of positive steroids tests isn't an accurate gauge among college athletes. Random tests provide weak deterrence and, by design, fail to catch every player using steroids. Colleges also are reluctant to spend money on expensive steroid testing when cheaper ones for drugs like marijuana allow them to say they're doing everything they can to keep drugs out of football.

"It's nothing like what's going on in reality," said Don Catlin, an anti-doping pioneer who spent years conducting the NCAA's laboratory tests at UCLA. He became so frustrated with the college system that it was part of the reason he left the testing industry to focus on anti-doping research.

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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 first of a two-part series.

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While other major sports have been beset by revelations of steroid use, college football has operated with barely a whiff of scandal. Between 1996 and 2010 — the era of Barry Bonds, Mark McGwire, Marion Jones and Lance Armstrong — the failure rate for NCAA steroid tests fell even closer to zero from an already low rate of less than 1 percent.

The AP's investigation, drawing upon more than a decade of official rosters from all 120 Football Bowl Subdivision teams, found thousands of players quickly putting on significant weight, even more than their fellow players. The information compiled by the AP included players who appeared for multiple years on the same teams.

For decades, scientific studies have shown that anabolic steroid use leads to an increase in body weight. Weight gain alone doesn't prove steroid use, but very rapid weight gain is one factor that would be deemed suspicious, said Kathy Turpin, senior director of sport drug testing for the National Center for Drug Free Sport, which conducts tests for the NCAA and more than 300 schools.

Yet the NCAA has never studied weight gain or considered it in regard to its steroid testing policies, said Mary Wilfert, the NCAA's associate director of health and safety.

The NCAA attributes the decline in positive tests to its year-round drug testing program, combined with anti-drug education and testing conducted by schools.

The AP's analysis found that, regardless of school, conference and won-loss record, many players gained weight at exceptional rates compared with their fellow athletes and while accounting for their heights.

Adding more than 20 or 25 pounds of lean muscle in a year is nearly impossible through diet and exercise alone, said Dan Benardot, director of the Laboratory for Elite Athlete Performance at Georgia State University.

In nearly all the rarest cases of weight gain in the AP study, players were offensive or defensive linemen, hulking giants who tower above 6-foot-3 and weigh 300 pounds or more. Four of those players interviewed by the AP said that they never used steroids and gained weight through dramatic increases in eating, up to six meals a day. Two said they were aware of other players using steroids.

"I ate 5-6 times a day," said Clint Oldenburg, who played for Colorado State starting in 2002 and for five years in the NFL. Oldenburg's weight increased over four years from 212 to 290.

Oldenburg told the AP he was surprised at the scope of steroid use in college football, even in Colorado State's locker room. "There were a lot of guys even on my team that were using." He declined to identify any of them.

The AP found more than 4,700 players — or about 7 percent of all players — who gained more than 20 pounds overall in a single year. It was common for the athletes to gain 10, 15 and up to 20 pounds in their first year under a rigorous regimen of weightlifting and diet. Others gained 25, 35 and 40 pounds in a season. In roughly 100 cases, players packed on as much 80 pounds in a single year.

In at least 11 instances, players that AP identified as packing on significant weight in college went on to fail NFL drug tests. But pro football's confidentiality rules make it impossible to know for certain which drugs were used and how many others failed tests that never became public.

Even though testers consider rapid weight gain suspicious, in practice it doesn't result in testing. Ben Lamaak, who arrived at Iowa State in 2006, said he weighed 225 pounds in high school. He graduated as a 320-pound offensive lineman and said he did it all naturally.

"I was just a young kid at that time, and I was still growing into my body," he said. "It really wasn't that hard for me to gain the weight. I love to eat."

In addition to random drug testing, Iowa State is one of many schools that have "reasonable suspicion" testing. That means players can be tested when their behavior or physical symptoms suggest drug use. Despite gaining 81 pounds in a year, Lamaak said he was never singled out for testing.

The associate athletics director for athletic training at Iowa State, Mark Coberley, said coaches and trainers use body composition, strength data and other factors to spot suspected cheaters. Lamaak, he said, was not suspicious because he gained a lot of "non-lean" weight.

But looking solely at the most significant weight gainers also ignores players like Bryan Maneafaiga.

In the summer of 2004, Bryan Maneafaiga was an undersized 180-pound running back trying to make the University of Hawaii football team. Twice — once in pre-season and once in the fall — he failed school drug tests, showing up positive for marijuana use but not steroids.

He'd started injecting stanozolol, a steroid, in the summer to help bulk up to a roster weight of 200 pounds. Once on the team, he'd occasionally inject the milky liquid into his buttocks the day before games.

"Food and good training will only get you so far," he told the AP recently.

Maneafaiga's former coach, June Jones, said it was news to him that one of his players had used steroids. Jones, who now coaches at Southern Methodist University, believes the NCAA does a good job rooting out steroid use.

On paper, college football has a strong drug policy. The NCAA conducts random, unannounced drug testing and the penalties for failure are severe. Players lose an entire year of eligibility after a first positive test. A second offense means permanent ineligibility for sports.

In practice, though, the NCAA's roughly 11,000 annual tests amount to a fraction of all athletes in Division I and II schools. Exactly how many tests are conducted each year on football players is unclear because the NCAA hasn't published its data for two years. And when it did, it periodically changed the formats, making it impossible to compare one year of football to the next.

Even when players are tested by the NCAA, experts like Catlin say it's easy enough to anticipate the test and develop a doping routine that results in a clean test by the time it occurs. NCAA rules say players can be notified up to two days in advance of a test, which Catlin says is plenty of time to beat a test if players have designed the right doping regimen. By comparison, Olympic athletes are given no notice.

Most schools that use Drug Free Sport do not test for anabolic steroids, Turpin said. Some are worried about the cost. Others don't think they have a problem. And others believe that since the NCAA tests for steroids their money is best spent testing for street drugs, she said.

Doping is a bigger deal at some schools than others.

At Notre Dame and Alabama, the teams that will soon compete for the national championship, players don't automatically miss games for testing positive for steroids. At Alabama, coaches have wide discretion. Notre Dame's student-athlete handbook says a player who fails a test can return to the field once the steroids are out of his system.

The University of North Carolina kicks players off the team after a single positive test for steroids. Auburn's student-athlete handbook calls for a half-season suspension for any athlete caught using performance-enhancing drugs.

At UCLA, home of the laboratory that for years set the standard for cutting-edge steroid testing, athletes can fail three drug tests before being suspended. At Bowling Green, testing is voluntary.

At the University of Maryland, students must get counseling after testing positive, but school officials are prohibited from disciplining first-time steroid users.

Only about half the student athletes in a 2009 NCAA survey said they believed school testing deterred drug use. As an association of colleges and universities, the NCAA could not unilaterally force schools to institute uniform testing policies and sanctions, Wilfert said.

"We can't tell them what to do, but if went through a membership process where they determined that this is what should be done, then it could happen," she said.

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Associated Press writers Ryan Foley in Cedar Rapids, Iowa; David Brandt in Jackson, Miss.; David Skretta in Lawrence, Kan.; Don Thompson in Sacramento, Calif., and Alexa Olesen in Shanghai, China, and researchers Susan James in New York and Monika Mathur in Washington contributed to this report.

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Contact the Washington investigative team at DCinvestigations (at) ap.org.

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 first of a two-part series.

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Inside One School's Extraordinary Security Measures

While schools across America reassess their security measures in the wake of the tragic shooting at Sandy Hook Elementary School in Newtown, Conn., one school outside of Chicago takes safety to a whole new level.

The security measures at Middleton Elementary School start the moment you set foot on campus, with a camera-equipped doorbell. When you ring the doorbell, school employees inside are immediately able to see you, both through a window and on a security camera.

“They can assess your demeanor,” Kate Donegan, the superintendent of Skokie School District 73 ½, said in an interview with ABC News.

Once the employees let you through the first set of doors, you are only able to go as far as a vestibule. There you hand over your ID so the school can run a quick background check using a visitor management system devised by Raptor Technologies. According to the company’s CEO, Jim Vesterman, only 8,000 schools in the country are using that system, while more than 100,000 continue to use the old-fashioned pen-and-paper system, which do not do as much to drive away unwanted intruders.

“Each element that you add is a deterrent,” Vesterman said.

In the wake of the Newtown shooting, Vesterman told ABC News his company has been “flooded” with calls to put in place the new system. Back at Middleton, if you pass the background check, you are given a new photo ID — attached to a bright orange lanyard — to wear the entire time you are inside the school. Even parents who come to the school on a daily basis still have to wear the lanyard.

“The rules apply to everyone,” Donegan said.

The security measures don’t end there. Once you don your lanyard and pass through a second set of locked doors, you enter the school’s main hallway, while security cameras continue to feed live video back into the front office.

It all comes at a cost. Donegan’s school district — with the help of security consultant Paul Timm of RETA Security — has spent more than $175,000 on the system in the last two years. For a district of only three schools and 1100 students, that is a lot of money, but it is all worth it, she said.

“I don’t know that there’s too big a pricetag to put on kids being as safe as they can be,” Donegan said.

“So often we hear we can’t afford it, but what we can’t afford is another terrible incident,” Timm said.

Classroom doors open inward — not outward — and lock from the inside, providing teachers and students security if an intruder is in the hallway. Some employees carry digital two-way radios, enabling them to communicate at all times with the push of a button. Administrators such as Donegan are able to watch the school’s security video on their mobile devices. Barricades line the edge of the school’s parking lot, keeping cars from pulling up close to the entrance.

Teachers say all the security makes them feel safe inside the school.

“I think the most important thing is just keeping the kids safe,” fourth-grade teacher Dara Sacher said.

Parents like Charlene Abraham, whose son Matthew attends Middleton, say they feel better about dropping off their kids knowing the school has such substantial security measures in place.

“We’re sending our kids to school to learn, not to worry about whether they’re going to come home or not,” she said.

In the wake of the horrific shooting at Sandy Hook last Friday, Donegan’s district is now even looking into installing bullet-resistant glass for the school building. While Middleton’s security measures continue to put administrators, teachers, parents and students at ease, Sacher said she thinks that more extreme measures — such as arming teachers, an idea pushed by Oregon state Rep. Dennis Richardson — are a step too far.

“I wouldn’t feel comfortable being armed,” Sacher said. “Even if you trained people, I think it’d be better to keep the guns out of school rather than arm teachers.”

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Clinton not responsible for Benghazi shortcomings: inquiry

WASHINGTON (Reuters) - The leaders of an official inquiry into the fatal attack on a U.S. mission in Benghazi, Libya, did not find Secretary of State Hillary Clinton responsible for security lapses even as they outlined widespread failings within her department.

The unclassified version of the report, released late Tuesday by the State Department, concluded that the mission was completely unprepared to deal with a September 11 attack that killed U.S. Ambassador Chris Stevens and three other Americans.

Responsibility for security shortcomings in Benghazi lay farther down the State Department command chain, said Retired Ambassador Thomas Pickering, who lead the inquiry.

"We fixed (responsibility) at the assistant secretary level, which is, in our view, the appropriate place to look for where the decision-making in fact takes place, where - if you like - the rubber hits the road," Pickering said after closed-door meetings with congressional committees.

A deputy assistant secretary in the Bureau of Near Eastern affairs resigned after the report, a Capitol Hill source said. Media outlets reported other resignations, including Eric Boswell, the assistant secretary of state for diplomatic security, one of his deputies and another official.

State Department officials declined to comment.

The report by the Accountability Review Board probing the attack and comments by its two lead authors suggested that Clinton, who accepted responsibility for the incident, would not be held personally culpable.

"The secretary of state has been very clear about taking responsibility here, it was from my perspective not reasonable in terms of her having a specific level of knowledge," said retired Admiral Michael Mullen, the former chairman of the U.S. Joint Chiefs of Staff and the other inquiry leader.

Pickering and Mullen spoke to the media after briefing members of the House Foreign Affairs Committee and Senate Foreign Relations Committee behind closed doors on classified elements of their report.

Clinton had been expected to appear at an open hearing on Benghazi on Thursday, but is recuperating after suffering a concussion, dehydration and a stomach bug last week and will instead be represented by her top two deputies.

"GROSSLY INADEQUATE"

The unclassified version of the report cited "leadership and management" deficiencies, poor coordination among officials and "real confusion" in Washington and in the field over who had the authority to make decisions on policy and security concerns.

The scathing report could tarnish Clinton's four-year tenure as secretary of state, which has seen her consistently rated as the most popular member of President Barack Obama's Cabinet.

Clinton, who intends to step down in January, said in a letter accompanying the review that she would adopt all of its recommendations, which include stepping up security staffing and requesting more money to fortify U.S. facilities.

The National Defense Authorization Act for 2013, which is expected to go to Congress for final approval this week, includes directing the Pentagon increase the Marine Corps presence at diplomatic facilities by up to 1,000 Marines.

Some Capitol Hill Republicans who had criticized the Obama administration's handling of the Benghazi attacks said they were impressed by the report.

"It was very thorough," said Senator Johnny Isakson. Another Republican, Senator John Barrasso said: "It was very, very critical of major failures at the State Department at very high levels." Both spoke after the closed-door briefing.

But Republicans continued to call for Clinton to testify as soon as she is able.

Senator Bob Corker, who will be the top Republican on the Senate Foreign Relations Committee when the new Congress is seated early next year, said Clinton should testify about Benghazi before her replacement is confirmed by the Senate.

"I do think it's imperative for all concerned that she testify in an open session prior to any changing of the regime," Corker said.

Republicans have focused much of their firepower on U.S. Ambassador to the United Nations Susan Rice, who appeared on television talk shows after the attack and suggested it was the result of a spontaneous protest rather than a premeditated attack.

The report concluded that there was no such protest.

Rice, widely seen as President Barack Obama's top pick for the State job, withdrew her name from consideration last week.

(Additional reporting by Toby Zakaria; Editing by Doina Chiacu)

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Tennis: Levine drops US to represent Canada

MONTREAL: Jesse Levine, ranked 104th on the ATP Tour, will represent his native Canada and no longer compete for the United States, Tennis Canada announced on Wednesday.

The 25-year-old left-hander was born in Ottawa and spent the first 13 years of his life growing up in Canada's capital city before moving with his family to Florida.

Levine reached a career-high of 69th in the rankings last October and has won 25 ATP matches, seven of them in Grand Slam events. His lone ATP final came in doubles with Ryan Sweeting in 2009 on clay at Houston.

"We are pleased that Jesse has decided to play for Canada," Tennis Canada president Michael Downey said. "We believe he can strengthen our Davis Cup team and add depth to our roster when he is eligible to play."

It was not certain whether or not the International Tennis Federation would approve the nationality switch in time for Levine to represent Canada in the first-round Davis Cup tie against Spain in February at Vancouver.

Levine woukld become the No. 2 Canadian in the world rankings behind No. 13 Milos Raonic.

- AFP/de

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Presidential pardon saved rapists the noose

NEW DELHI: The rising chorus to make rape an offence punishable by death penalty could be a fraught proposition. There have been at least four cases in the recent past where rapists awarded death penalty managed to escape the noose after the President commuted their sentence to life imprisonment.

These include a convict who raped and killed a five-year-old and another who tried to rape a teenager and killed her family in revenge when she resisted.

In most cases, courts follow the "rarest of rare" principle of criminal law giving death sentence to convicts who have committed murder. These four convicts were found guilty of not just rape but murder as well.

The most recent case was that of Uttar Pradesh's Bantu who was convicted of raping and killing a five-year-old girl. The trial court awarded him death which was confirmed by the HC and the apex court. On death row since June 2008, his mercy petition was accepted by President Pratibha Patil in June 2012.

Another convict Satish raped and murdered a six-year-old girl, Visakha, in Uttar Pradesh in 2001. His death sentence was commuted to life imprisonment by President Patil in May 2012.

The last accused hanged was Dhananjoy Chatterjee who was found guilty of rape and murder of a 14-year-old.

At present, there is one death row convict whose case has been pending since 1999. Dharam Pal from Haryana murdered five members of the family of a girl he had raped, helped by his brother. The trial court awarded them death and the Punjab and Haryana HC upheld the decision.

However, in March 1999, the apex court, while upholding Dharam Pal's death sentence, converted the sentence of the second accused into a life term. Pal's plea, filed in 1999, was rejected by the home ministry in 2000. The case was resubmitted to the President in 2005. The case came back to the home ministry after Pranab Mukherjee took over as President.

Rapists who escaped the noose:

Bantu raped and killed a five-year-old girl — June 2012

Satish raped and murdered a six-year-old girl — May 2012

Molai Ram & Santosh Yadav gang raped and murdered the 10-year-old daughter of a jailor — February 2011

Dharmender Singh and Narendra Yadav tried to rape a girl, then killed her family — June 2010

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Experts: Kids are resilient in coping with trauma

WASHINGTON (AP) — They might not want to talk about the gunshots or the screams. But their toys might start getting into imaginary shootouts.

Last week's school shooting in Connecticut raises the question: What will be the psychological fallout for the children who survived?

For people of any age, regaining a sense of security after surviving violence can take a long time. They're at risk for lingering anxiety, depression, post-traumatic stress disorder.

But after the grief and fear fades, psychiatrists say most of Newtown's young survivors probably will cope without long-term emotional problems.

"Kids do tend to be highly resilient," said Dr. Matthew Biel, chief of child and adolescent psychiatry at MedStar Georgetown University Hospital.

And one way that younger children try to make sense of trauma is through play. Youngsters may pull out action figures or stuffed animals and re-enact what they witnessed, perhaps multiple times.

"That's the way they gain mastery over a situation that's overwhelming," Biel explained, saying it becomes a concern only if the child is clearly distressed while playing.

Nor is it unusual for children to chase each other playing cops-and-robbers, but now parents might see some also pretending they're dead, added Dr. Melissa Brymer of the UCLA-Duke National Center for Child Traumatic Stress.

Among the challenges will be spotting which children are struggling enough that they may need professional help.

Newtown's tragedy is particularly heart-wrenching because of what such young children grappled with — like the six first-graders who apparently had to run past their teacher's body to escape to safety.

There's little scientific research specifically on PTSD, post-traumatic stress disorder, in children exposed to a burst of violence, and even less to tell if a younger child will have a harder time healing than an older one.

Overall, scientists say studies of natural disasters and wars suggest most children eventually recover from traumatic experiences while a smaller proportion develop long-term disorders such as PTSD. Brymer says in her studies of school shootings, that fraction can range from 10 percent to a quarter of survivors, depending on what they actually experienced. A broader 2007 study found 13 percent of U.S. children exposed to different types of trauma reported some symptoms of PTSD, although less than 1 percent had enough for an official diagnosis.

Violence isn't all that rare in childhood. In many parts of the world — and in inner-city neighborhoods in the U.S., too — children witness it repeatedly. They don't become inured to it, Biel said, and more exposure means a greater chance of lasting psychological harm.

In Newtown, most at risk for longer-term problems are those who saw someone killed, said Dr. Carol North of the University of Texas Southwestern Medical Center, who has researched survivors of mass shootings.

Friday's shootings were mostly in two classrooms of Sandy Hook Elementary School, which has about 450 students through fourth-grade.

But those who weren't as close to the danger may be at extra risk, too, if this wasn't their first trauma or they already had problems such as anxiety disorders that increase their vulnerability, she said.

Right after a traumatic event, it's normal to have nightmares or trouble sleeping, to stick close to loved ones, and to be nervous or moody, Biel said.

To help, parents will have to follow their child's lead. Grilling a child about a traumatic experience isn't good, he stressed. Some children will ask a lot of questions, seeking reassurance, he said. Others will be quiet, thinking about the experience and maybe drawing or writing about it, or acting it out at playtime. Younger children may regress, becoming clingy or having tantrums.

Before second grade, their brains also are at a developmental stage some refer to as magical thinking, when it's difficult to distinguish reality and fantasy. Parents may have to help them understand that a friend who died isn't in pain or lonely but also isn't coming back, Brymer said.

When problem behaviors or signs of distress continue for several weeks, Brymer says it's time for an evaluation by a counselor or pediatrician.

Besides a supportive family, what helps? North advises getting children back into routines, together with their friends, and easing them back into a school setting. Studies of survivors of the Sept. 11 terrorist attacks found "the power of the support of the people who went through it with you is huge," she said.

Children as young as first-graders can benefit from cognitive-behavioral therapy, Georgetown's Biel said. They can calm themselves with breathing techniques. They also can learn to identify and label their feelings — anger, frustration, worry — and how to balance, say, a worried thought with a brave one.

Finally, avoid watching TV coverage of the shooting, as children may think it's happening all over again, Biel added. He found that children who watched the 9/11 clips of planes hitting the World Trade Center thought they were seeing dozens of separate attacks.

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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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