New School for Sandy Hook Duplicated to the Crayons













The students and staff of Sandy Hook Elementary School will return to school on Thursday for the first time since the shooting rampage that left 20 young students and six adults dead. The students will be in a new building where their old classrooms have been completely recreated.


Instead of returning to the halls of Sandy Hook Elementary School in Newtown, Conn., they will be going to the building that used to be the Chalk Hill Middle School in Monroe, about six miles away.


Sandy Hook school was shut since Adam Lanza carried out his massacre shortly before Christmas.


Since principal Dawn Hochsprung was one of the victims of the shooting, the school will be led by interim principal Donna Page. Page was the school's prior principal who retired in 2010.


"Please know the inspiration you and your children have been to my staff and me as we connect with you at Chalk Hill," Page wrote in a letter posted on the school's website. "Be assured that the towns of Monroe and Newtown are working night and day to ensure the facility is safe, secure, and fully operational for our return," Page wrote.


The school will host a walk-through for families on Wednesday and "Opening Day" will be Thursday.


"I want to reassure you that we understand many parents may need to be near their children on their first day(s) of school and you will be welcome," Page wrote.






Don Emmert/AFP/Getty Images











Tragedy at Sandy Hook: The Search for Solutions Watch Video











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The school is encouraging students to take the bus in order to help them return to familiar routines and said parents may come to the school's classrooms or auditorium throughout the day after the 9:07 a.m. opening. They are asking that no more than one adult family member accompany each child in order "to ensure a safe and secure environment."


In addition to a parental presence at the school, comfort dogs will be returning to brighten the day. Small armies of golden retrievers spread out all over Newtown in the days following the shooting to comfort mourners young and old.


Chicago's Lutheran Church Charities' K-9 Parish Comfort Dogs were in Newtown after the shooting and are traveling back to Connecticut today. Nine dogs and their handlers gathered at their building at 1 a.m. this morning to board a caravan of one RV and two vans heading to Connecticut.


"The community of Newtown will be going through the healing process for a very long time," the group wrote on their website. "The LCC K-9 Comfort dogs will be returning to Newtown...They will be there to greet children as they return to school."


The rest of the Newtown school district resumes classes on Wednesday.


Furniture and supplies from Sandy Hook were moved to Chalk Hill in order to recreate the classrooms just as they were.


Teachers photographed their classrooms at Sandy Hook in order to replicate everything about them, from the pictures on the walls to the crayons left on the students' desks. This is all part of an effort to make the students feel as comfortable as possible.


Workers completely retrofitted the former middle school to fit the needs of its young students, including tearing out bathrooms that were made for teenagers and rebuilding them for elementary-aged kids.


New security systems are being installed at Chalk Hill school, and Newtown Councilman Steve Vavrek told ABC News that the school will be "the safest school in America."


For a school that has gone through so much, moving forward does not mean forgetting.


"I want parents and families enduring the loss of their precious children to know their loved ones are foremost in our hearts and minds as we move forward," Page wrote. "Your strength and compassion has been, and will continue to be an inspiration to me and countless others as we work to honor the memory of your precious children and our beloved staff."



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At least 61 crushed to death in Ivory Coast stampede


ABIDJAN (Reuters) - At least 61 people were crushed to death in a stampede after a New Year's Eve fireworks display at a stadium in Ivory Coast's main city Abidjan early on Tuesday, officials said.


Witnesses said police had tried to control crowds around the Felix Houphouet-Boigny Stadium following the celebrations, triggering a panic in which scores were trampled.


"The estimate we can give right now is 49 people hospitalized ... and 61 people dead," said the chief of staff of Abidjan's fire department Issa Sacko.


Crying women searched for missing family members outside the stadium on Tuesday morning. The area was covered in patches of dried blood and abandoned shoes.


"My two children came here yesterday. I told them not to come but they didn't listen. They came when I was sleeping. What will I do?" said Assetou Toure, a cleaner.


Sanata Zoure, a market vendor injured in the incident, said New Year's revelers going home after watching the fireworks had been stopped by police near the stadium.


"We were walking with our children and we came upon barricades, and people started falling into each other. We were trampled with our children," she said.


Another witness said police arrived to control the crowd after a mob began chasing a pickpocket.


President Alassane Ouattara called the deaths a national tragedy and said an investigation was under way to find out what happened.


"I hope that we can determine what caused this drama so that we can ensure it never happens again," he said after visiting the injured in hospital.


The country, once a stable economic hub for West Africa, is struggling to recover from a 2011 civil war in which more than 3,000 people were killed.


Ivory Coast's security forces once were among the best trained in the region, but a decade of political turmoil and the 2011 war has left them in disarray.


At least 18 people were killed in another stampede during a football match in an Abidjan stadium in 2009.


(Reporting by Loucoumane Coulibaly and Alain Amontchi; Writing by Richard Valdmanis; Editing by Michael Roddy)



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Football: I'm not retiring any time soon says Fergie






LONDON: Alex Ferguson has quashed retirement talk by revealing he has no plans to step down as Manchester United manager in the near future.

Ferguson, who turned 71 on Monday, has been forced to deal with questions about his retirement plans since the time he reversed his decision to leave the club in 2002.

With Pep Guardiola due to end his post-Barcelona sabbatical in a few months, Jose Mourinho tipped to leave Real Madrid and David Moyes' Everton contract close to expiring, three of the main candidates to replace Ferguson could be available at the end of the season, prompting a new round of speculation about the Scot's future.

But Ferguson, who has been in charge at Old Trafford since 1986, marked the new year by making it clear he won't be leaving United for some while.

"I'm hoping to stay on for a bit of time," he said in an interview with the Abu Dhabi Sports channel.

It is widely accepted few will get to know when Ferguson is ready to call it a day, with chief executive David Gill the man tasked with advising the Glazer family about a replacement.

And, though Guardiola, Mourinho and Moyes are bound to be at the top of the list if they are available, Ferguson knows plenty of other candidates are likely to have emerged by the time he finally quits.

"It's very difficult," Ferguson said. "Over the years, names have been bandied about but football is such a precarious industry.

"But you could be talking about one of the potentially exciting young managers in the game, but is he going to be here in two or three years' time?

"The sack race is horrendous. Sometimes a manager can only survive four games if he doesn't win a match.

"Top managers will always been in demand but nobody knows where they are going to be in two or three years' time."

- AFP/jc



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Draft code for ambulance in the works

NEW DELHI: Transport vehicles converted into ambulances with virtually non-existent emergency care facilities for patients would be phased out over next few years. According to the draft code for ambulance — being prepared by an expert group set up by the road transport and highways ministry — the new norms would be stricter to ensure patients' safety during transit.

The Centre is formulating codes for ambulances for the first time after a working group on emergency care observed the conspicuous absence of the concept in India. Now, ambulances are found to be like any other transport vehicle, and consequently ill-equipped to ferry patients. "These vehicles ferry patients because of deficiencies in our laws. Goods vehicles without necessary safety features have been converted into ambulances and naturally are more prone to accidents," said one of the members of the working group.

Consequently, majority of ambulances have no proper storage facility, non-ambulatory ventilator support system and other necessary features.

Soon the Centre would define an ambulance after the code is finalized. Sources said ambulance in "brilliant white" will be designed and built in a manner so that it doesn't disintegrate even if it turns turtle. Besides, ceiling, interior sidewalls and doors of patient's compartment will be non-permeable and resistant to disinfectant. Moreover, patient cabin will be complete with a digital display panel to show status of oxygen supply.

Highway ministry officials said that there would be four categories of ambulances based on patients' condition. "Medical first responder" will be two/three-wheeler with necessary first-aid, but won't transport patients. "Patient transport vehicle" will be designed to transport stable patients for non-emergency transfers like scheduled visits for treatment, routine physical examinations, x-rays etc.

"Basic life support ambulance" will be designed and equipped with staff for transportation and treatment of patients requiring non-invasive airway management/basic monitoring. And, "advanced life support ambulance" will be designed and equipped for transport and treatment of emergency patients requiring invasive airway management and intensive monitoring.

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Clinton receiving blood thinners to dissolve clot


WASHINGTON (AP) — Secretary of State Hillary Rodham Clinton continues to recover in a New York hospital where she's being treated for a blood clot in her head.


Her doctors say blood thinners are being used to dissolve the clot and they are confident she will make a full recovery. Clinton didn't suffer a stroke or neurological damage from the clot that formed after she suffered a concussion during a fainting spell at her home in early December, doctors said in a statement Monday.


Clinton, 65, was admitted to New York-Presbyterian Hospital on Sunday when the clot turned up on a follow-up exam on the concussion, Clinton spokesman Phillipe Reines said. The clot is located in the vein in the space between the brain and the skull behind the right ear. She will be released once the medication dose for the blood thinners has been established, the doctors said.


In their statement, Dr. Lisa Bardack of the Mount Kisco Medical Group and Dr. Gigi El-Bayoumi of George Washington University said Clinton was making excellent progress and was in good spirits.


Clinton's complication "certainly isn't the most common thing to happen after a concussion" and is one of the few types of blood clots in the skull or head that are treated with blood thinners, said Dr. Larry Goldstein, a neurologist who is director of Duke University's stroke center. He is not involved in Clinton's care.


The area where Clinton's clot developed is "a drainage channel, the equivalent of a big vein inside the skull. It's how the blood gets back to the heart," Goldstein said.


Blood thinners usually are enough to treat the clot and it should have no long-term consequences if her doctors are saying she has suffered no neurological damage from it, Goldstein said.


Clinton returned to the U.S. from a trip to Europe, then fell ill with a stomach virus in early December that left her severely dehydrated and forced her to cancel a trip to North Africa and the Middle East. Until then, she had canceled only two scheduled overseas trips, one to Europe after breaking her elbow in June 2009 and one to Asia after the February 2010 earthquake in Haiti.


Her condition worsened when she fainted, fell and suffered a concussion while at home alone in mid-December as she recovered from the virus.


This isn't the first time Clinton has suffered a blood clot. In 1998, midway through her husband's second term as president, Clinton was in New York fundraising for the midterm elections when a swollen right foot led her doctor to diagnose a clot in her knee requiring immediate treatment.


Clinton had planned to step down as secretary of state at the beginning of President Barack Obama's second term. Whether she will return to work before she resigns remains a question.


Democrats are privately if not publicly speculating: How might her illness affect a decision about running for president in 2016?


After decades in politics, Clinton says she plans to spend the next year resting. She has long insisted she had no intention of mounting a second campaign for the White House four years from now. But the door is not entirely closed, and she would almost certainly emerge as the Democrat to beat if she decided to give in to calls by Democratic fans and run again.


Her age — and thereby health — would probably be a factor under consideration, given that Clinton would be 69 when sworn in, if she were elected in 2016. That might become even more of an issue in the early jockeying for 2016 if what started as a bad stomach bug becomes a prolonged, public bout with more serious infirmity.


Not that Democrats are willing to talk openly about the political implications of a long illness, choosing to keep any discussions about her condition behind closed doors. Publicly, Democrats reject the notion that a blood clot could hinder her political prospects.


"Some of those concerns could be borderline sexist," said Basil Smikle, a Democratic strategist who worked for Clinton when she was a senator. "Dick Cheney had significant heart problems when he was vice president, and people joked about it. He took the time he needed to get better, and it wasn't a problem."


It isn't uncommon for presidential candidates' health — and age — to be an issue. Both in 2000 and 2008, Sen. John McCain, R-Ariz., had to rebut concerns he was too old to be commander in chief or that his skin cancer could resurface.


Beyond talk of future politics, Clinton's three-week absence from the State Department has raised eyebrows among some conservative commentators who questioned the seriousness of her ailment after she canceled planned Dec. 20 testimony before Congress on the deadly attack on the U.S. diplomatic mission in Benghazi, Libya.


Clinton had been due to discuss with lawmakers a scathing report she had commissioned on the attack. It found serious failures of leadership and management in two State Department bureaus were to blame for insufficient security at the facility. Clinton took responsibility for the incident before the report was released, but she was not blamed. Four officials cited in the report have either resigned or been reassigned.


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Fiscal Cliffhanger: Tax Deal 'Within Sight,' Not Done













President Obama said an 11th-hour agreement to avert year-end tax hikes on 98 percent of Americans is "within sight" but not yet complete with just hours to go before the nation reaches the so-called fiscal cliff.


"There are still issues left to resolve but we're hopeful Congress can get it done," Obama said at a midday White House news conference. "But it's not done."


Congressional and White House negotiators have forged the contours of an agreement that would extend current tax rates for households making $450,000 or less; raise the estate tax from 35 to 40 percent for estates larger than $5 million; and prevent the Alternative Minimum Tax from hammering millions of middle-class workers, sources said.


The deal would also extend for one year unemployment insurance benefits set to expire Tuesday, and avert a steep cut to Medicare payments for doctors.


"I can report that we've reached an agreement on the all the tax issues," Senate Minority Leader Mitch McConnell said in an afternoon speech on the Senate floor.


But Sen. John McCain, R-Ariz., was among the less conciliatory Republicans.
Rather than staging a "cheerleading rally," he said, the president should have been negotiating the finishing touches of the deal.






Chip Somodevilla/Getty Images











'Fiscal Cliff': Lawmakers Scramble for Last-Minute Deal Watch Video









"What did the president of the United States just do? Well, he kind of made fun, he made a couple of jokes, laughed about how people are going to be here for New Year's, sent a message of confrontation to the Republicans," McCain said. "I guess I have to wonder, and I think the American people have to wonder whether the president really wants this issue resolved or is it to his short-term political benefit for us to go over the cliff?"


McCain said the president's speech today "clearly will antagonize members of the House," and "that's not the way presidents should lead."


Both sides remained at odds on what to do about the other significant piece of the "fiscal cliff" -- the more than $1 trillion of automatic cuts to defense and domestic programs set to begin tomorrow.


The White House has proposed a three-month delay of the cuts to allow more time to hash out details for deficit reduction, while many Senate Democrats want a flat one-year delay. Republicans insist that some spending cuts should be implemented now as part of any deal.


"In order to get the sequester moved, you're going to have to have real, concrete spending cuts," Rep. Mike Rogers, R-Mich., said. "[Without that], I don't know how it passes the House."


Vice President Joe Biden and McConnell, R-Ky., have been locked in behind-the-scenes negotiations for much of the day, sources said, following several "good" conversations that stretched late into Sunday night.


"We are very, very close," McConnell said today. "We can do this. We must do this."


If a deal is reached between Biden and McConnell, members in both chambers would still need to review it and vote on it later today. Passage is far from guaranteed.


"This is one Democrat that doesn't agree with that at all," Iowa Democratic Sen. Tom Harkin said of the tentative deal. "No deal is better than a bad deal, and this looks like a very bad deal the way this is shaping up."


"I don't see how you get something voted on today," Rogers said. "Even if they get a handshake deal today, you have to put the whole thing together and that's probably not going to happen before midnight. So it would make sense to roll into tomorrow to do that."






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State Department made "grievous mistake" over Benghazi: Senate report


WASHINGTON (Reuters) - The State Department made a "grievous mistake" in keeping the U.S. mission in Benghazi open despite inadequate security and increasingly alarming threat assessments in the weeks before a deadly attack by militants, a Senate committee said on Monday.


A report from the Senate Homeland Security Committee on the September 11 attacks on the U.S. mission and a nearby CIA annex, in which the U.S. ambassador to Libya and three other Americans died, faulted intelligence agencies for not focusing tightly enough on Libyan extremists.


It also faulted the State Department for waiting for specific warnings instead of improving security.


The committee's assessment, "Flashing Red: A Special Report On The Terrorist Attack At Benghazi," follows a scathing report by an independent State Department accountability review board that resulted in a top security official resigning and three others at the department being relieved of their duties.


Joseph Lieberman, an independent senator who chairs the committee, said that in thousands of documents it reviewed, there was no indication that Secretary of State Hillary Clinton had personally denied a request for extra funding or security for the Benghazi mission. He said key decisions were made by "midlevel managers" who have since been held accountable.


Republican Senator Susan Collins said it was likely that others needed to be held accountable, but that decision was best made by the Secretary of State, who has the best understanding "of how far up the chain of command the request for additional security went."


The attacks and the death of U.S. Ambassador Christopher Stevens put diplomatic security practices at posts in risky areas under scrutiny and raised questions about whether intelligence on militant activity in the region was adequate.


The Senate report said the lack of specific intelligence of an imminent threat in Benghazi "may reflect a failure" by intelligence agencies to focus closely enough on militant groups with weak or no operational ties to al Qaeda and its affiliates.


"With Osama bin Laden dead and core al Qaeda weakened, a new collection of violent Islamist extremist organizations and cells have emerged in the last two to three years," the report said. That trend has been seen in the "Arab Spring" countries undergoing political transition or military conflict, it said.


NEED FOR BETTER INTELLIGENCE


The report recommended that U.S. intelligence agencies "broaden and deepen their focus in Libya and beyond, on nascent violent Islamist extremist groups in the region that lack strong operational ties to core al Qaeda or its main affiliate groups."


Neither the Senate report nor the unclassified accountability review board report pinned blame for the Benghazi attack on a specific militant group. The FBI is investigating who was behind the assaults.


President Barack Obama, in an interview on NBC's "Meet the Press" on Sunday, said the United States had "very good leads" about who carried out the attacks. He did not provide details.


The Senate committee said the State Department should not have waited for specific warnings before acting on improving security in Benghazi.


It also said it was widely known that the post-revolution Libyan government was "incapable of performing its duty to protect U.S. diplomatic facilities and personnel," but the State Department failed to fill the security gap.


"Despite the inability of the Libyan government to fulfill its duties to secure the facility, the increasingly dangerous threat assessments, and a particularly vulnerable facility, the Department of State officials did not conclude the facility in Benghazi should be closed or temporarily shut down," the report said. "That was a grievous mistake."


The Senate panel reviewed changing comments made by the Obama administration after the attack, which led to a political firestorm in the run-up to the November presidential election and resulted in U.S. Ambassador to the United Nations Susan Rice withdrawing her name from consideration to replace Clinton, who is stepping down early next year.


Rice had said her initial comments that the attack grew out of a spontaneous protest over an anti-Islam film were based on talking points provided by intelligence agencies.


Lieberman said it was not the job of intelligence agencies to formulate unclassified talking points and they should decline such requests in the future.


The report said the original talking points included a line saying "we know" that individuals associated with al Qaeda or its affiliates participated in the attacks. But the final version had been changed to say: "There are indications that extremists participated," and the reference to al Qaeda and its affiliates was deleted.


The report said that while James Clapper, the director of national intelligence, had offered to provide the committee with a detailed chronology of how the talking points were written and evolved, this had still not been delivered to Capitol Hill because the administration had spent weeks "debating internally" whether or not it should turn over information considered "deliberative" to Congress.


(Editing by Warren Strobel and David Brunnstrom)



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Oil prices rise on US cliff deal hopes






NEW YORK: Oil prices surged higher on Monday after US politicians signaled a last-minute compromise deal was in view to avert driving the economy over a fiscal cliff toward recession.

New York's main contract, light sweet crude for delivery in February, gained $1.02 from Friday to close at $91.82 a barrel.

Brent North Sea crude for February settled at $111.11 a barrel, up 49 cents.

Over the year, New York's West Texas Intermediate fell 7 percent from the last day of trade in 2011, while Brent rose 3 percent.

Oil prices earlier had been under pressure amid US political deadlock on a bipartisan deficit reduction deal that would avoid the cliff of automatic sharp tax hikes and spending cuts due to begin taking effect at midnight.

Oil prices surged after President Barack Obama, in a nationally televised statement from the White House, said an agreement to prevent the tax hike is "within sight."

"The market experienced significant volatility during Obama's comments on fiscal negotiations and ended up closing near today's highs," BMO Capital Markets analysts wrote in a market note.

"People are getting optimistic about the fiscal cliff," said Michael Lynch of Strategic Energy and Economic Research.

"They feel that if even it is not done tonight it will be done in the next day or so, so that there won't be any serious negative impact on the economy."

Lynch said that positive news in China, the world's biggest energy consumer and driver of global growth, also was making the oil market bullish.

China's manufacturing activity surged to a 19-month high in December, British bank HSBC said Monday, a further sign of stronger growth in the world's second-largest economy.

HSBC's purchasing managers' index (PMI) rose to 51.5, up from 50.5 in November, the first month of growth after a solid year of contraction.

- AFP/de



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80 witnesses in chargesheet

NEW DELHI: Delhi Police files around 500 chargesheets in rape cases every year, but the first one of 2013 will be their most elaborate ever. With the world's attention now on the Nirbhaya rape and torture case, police cannot afford to go wrong and the 1,000-page document is likely to include statements of close to 80 witnesses, besides crucial forensic reports. The statements of the 23-year-old victim and her male friend are expected to strengthen the police's case.

Sources say the draft of the chargesheet is almost ready and the final challan will be filed this week. The investigating officer is waiting for the postmortem report from Mount Elizabeth Hospital in Singapore which will be the most important evidence in the case. Liaison officers of the Indian High Commission in Singapore are working to have it sent quickly.

A team comprising four inspectors, two ACPs and the DCP (South) is working to finalize the chargesheet after getting it approved by legal experts. While police hope to meet their January 3 (commitment) for submission, it could be delayed till Saturday.

Among the 80 witnesses quoted in the chargesheet are police officers, including PCR officials, Vasant Vihar police station staff and the investigating officer who attended to Nirbhaya and registered the FIR, around 10 doctors of Safdarjung Hospital who looked after her for 11 days, three doctors of Mount Elizabeth Hospital, where she breathed her last, and her parents. The evidence includes DNA reports, forensic reports of clothes worn by the accused, results of the test identification parade, the bar used to hit the victims, the bus used in the crime, fingerprint reports etc.

The chargesheet, with a 30-page operative part, will detail the role of five accused and a separate report will be sent to the Juvenile Justice Board for the trial of the minor involved in the case.

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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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