Flu shot doing a poor job of protecting elderly

ATLANTA (AP) — It turns out this year's flu shot is doing a startlingly dismal job of protecting senior citizens, the most vulnerable age group.

The vaccine is proving only 9 percent effective in people 65 and older against the harsh strain of the flu that is predominant this season, the Centers for Disease Control and Prevention said Thursday.

Health officials are baffled as to why this is so. But the findings help explain why so many older people have been hospitalized with the flu this year.

Despite the findings, the CDC stood by its recommendation that everyone over 6 months get flu shots, the elderly included, because some protection is better than none, and because those who are vaccinated and still get sick may suffer less severe symptoms.

"Year in and year out, the vaccine is the best protection we have," said CDC flu expert Dr. Joseph Bresee.

Overall, across the age groups studied, the vaccine's effectiveness was found to be a moderate 56 percent, which means those who got a shot have a 56 percent lower chance of winding up at the doctor with the flu. That is somewhat worse than what has been seen in other years.

For those 65 and older, the vaccine was only 27 percent effective against the three strains it is designed to protect against, the worst level in about a decade. It did a particularly poor job against the tough strain that is causing more than three-quarters of the illnesses this year.

It is well known that flu vaccine tends to protect younger people better than older ones. Elderly people have weaker immune systems that don't respond as well to flu shots, and they are more vulnerable to the illness and its complications, including pneumonia.

But health officials said they don't know why this year's vaccine did so poorly in that age group.

One theory, as yet unproven, is that older people's immune systems were accustomed to strains from the last two years and had more trouble switching gears to handle this year's different, harsh strain.

The preliminary data for senior citizens is less than definitive. It is based on fewer than 300 people scattered among five states.

But it will no doubt surprise many people that the effectiveness is that low, said Michael Osterholm, a University of Minnesota infectious-disease expert who has tried to draw attention to the need for a more effective flu vaccine.

Among infectious diseases, flu is considered one of the nation's leading killers. On average, about 24,000 Americans die each flu season, according to the CDC.

This flu season started in early December, a month earlier than usual, and peaked by the end of year. Hospitalization rates for people 65 and older have been some of the highest in a decade, at 146 per 100,000 people.

Flu viruses tend to mutate more quickly than others, so a new vaccine is formulated each year to target the strains expected to be the major threats. CDC officials have said that in formulating this year's vaccine, scientists accurately anticipated the strains that are circulating this season.

Because of the guesswork involved, scientists tend to set a lower bar for flu vaccine. While childhood vaccines against diseases like measles are expected to be 90 or 95 percent effective, a flu vaccine that's 60 to 70 percent effective in the U.S. is considered pretty good. By that standard, this year's vaccine is OK.

For senior citizens, a flu vaccine is considered pretty good if it's in the 30 to 40 percent range, said Dr. Arnold Monto, a University of Michigan flu expert.

A high-dose version of the flu shot was recently made available for those 65 and older, but the new study was too small to show whether that has made a difference.

The CDC estimates are based on about 2,700 people who got sick in December and January. The researchers traced back to see who had gotten shots and who hadn't. An earlier, smaller study put the vaccine's overall effectiveness at 62 percent, but other factors that might have influenced that figure weren't taken into account.

The CDC's Bresee said there is a danger in providing preliminary results because it may result in people doubting — or skipping — flu shots. But the figures were released to warn older people who got shots that they may still get sick and shouldn't ignore any serious flu-like symptoms, he said.

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Online:

CDC report: http://www.cdc.gov/mmwr

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Wall Street ends lower on growth worries

NEW YORK (Reuters) - U.S. stocks fell for a second straight day on Thursday and the S&P 500 posted its worst two-day loss since November after reports cast doubt over the health of the U.S. and euro-zone economies.

But a late-day rally helped stocks erase some of their losses with most of the pullback concentrated in the technology- heavy Nasdaq. The move suggested investors were still willing to buy on dips even after the sharp losses in the last session.

In Europe, business activity indexes dealt a blow to hopes that the euro zone might emerge from recession soon, showing the downturn across the region's businesses unexpectedly grew worse this month.

"The PMI numbers out of Europe were really a blow to the market," said Jack De Gan, chief investment officer at Harbor Advisory in Portsmouth, New Hampshire. "The market was expecting signs that recovery is still there, but the numbers just highlighted that the euro-zone problem is still persistent."

U.S. initial claims for unemployment benefits rose more than expected last week while the Federal Reserve Bank of Philadelphia said its index of business conditions in the U.S. mid-Atlantic region fell in February to the lowest in eight months.

Gains in Wal-Mart Stores Inc shares helped cushion the Dow. The shares gained 1.5 percent to $70.26 after the world's largest retailer reported earnings that beat expectations, though early February sales were sluggish.

The Dow Jones industrial average <.dji> fell 46.92 points, or 0.34 percent, to 13,880.62 at the close. The Standard & Poor's 500 Index <.spx> lost 9.53 points, or 0.63 percent, to 1,502.42. The Nasdaq Composite Index <.ixic> dropped 32.92 points, or 1.04 percent, to close at 3,131.49.

The two-day decline marked the U.S. stock market's first sustained pullback this year. The Standard & Poor's 500 has fallen 1.8 percent over the period and just managed to hold the 1,500 level on Thursday. Still, the index is up 5.3 percent so far this year.

The abrupt reversal in markets, which started on Wednesday after minutes from the Federal Reserve's January meeting suggested stimulus measures may end earlier than thought, looks set to halt a seven-week winning streak for stocks that had lifted the Dow and the S&P 500 close to all-time highs.

Wall Street will soon face another test with the upcoming debate in Washington over the automatic across-the-board spending cuts put in place as part of a larger congressional budget fight. Those cuts, set to kick in on March 1 unless lawmakers agree on an alternative, could depress the economy.

Semiconductor stocks ranked among the weakest of the day, pressuring the Nasdaq as the Philadelphia Semiconductor Index <.sox> fell 1.8 percent. Intel Corp fell 2.3 percent to $20.25 while Advanced Micro Devices lost 3.7 percent to $2.60 as the S&P 500's biggest percentage decliner.

The Dow also got a helping hand from personal computer maker Hewlett-Packard Co , which rose 2.3 percent to end the regular session at $17.10. The company was scheduled due to report first-quarter results after the closing bell.

Shares of Boeing Co rose 1.6 percent to $76.01 as a senior executive was set to meet with the head of the U.S. Federal Aviation Administration on Friday and present a series of measures to prevent battery failures that grounded its 787 Dreamliner fleet, according to a source familiar with the plans.

In other company news, shares of supermarket operator Safeway Inc jumped 14.1 percent to $22.97 after the company reported earnings that beat expectations.

Shares of VeriFone Systems Inc tumbled nearly 43 percent to $18.24 after the credit-card swipe machine maker forecast first- and second-quarter profits well below expectations.

Of the 427 companies in the S&P 500 that have reported results so far, 69.3 percent have exceeded analysts' expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data through Thursday morning.

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 5.9 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

Berry Petroleum Co jumped 19.3 percent to $46.02 after oil and gas producer Linn Energy LLC said it would buy the company in an all-stock deal valued at $4.3 billion, including debt. Linn Energy shares advanced 2.8 percent to $37.68.

About two stocks fell for everyone that rose on the New York Stock Exchange and Nasdaq. About 7.64 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, well above the 20-day moving average of around 6.6 billion shares.

(Editing by Jan Paschal)

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IHT Special: Women Face Fight to Keep Their Rights in Tunisia

TUNIS — At the funeral this month of Chokri Belaid, the murdered secular opposition leader in Tunisia, his widow Basma Khalfaoui, a prominent feminist, stood on the ambulance carrying his casket, her head uncovered, raising her arm to wave a defiant victory sign.

“My husband was denouncing Ennahda’s double talk and we will continue his struggle,” Ms. Khalfaoui, 42, said at the funeral, referring to the moderate Islamist party that governs the country. “We will not give up the fight.”

Tunisia, perceived by the West as the most secular country in the Arab world and a staunch promoter of women’s rights, has gone through a rocky transition since the revolution two years ago that ousted President Zine el-Abidine Ben Ali. While political pluralism exists for the first time in decades, new freedoms for some are threatening long-cherished ones for others — in particular those for Tunisian women.

After Tunisia gained its independence from France in 1956, the government passed laws to expand women’s rights, including the right to education and gender equality. Over the following decades, Islamists were persecuted and exiled while the government pushed the secularization of society to such an extent that a decree in 1981 banned women from wearing a veil in public buildings and universities.

After the fall of Mr. Ben Ali’s regime, the Ennahda party won elections in October 2011 with a comfortable majority. Since then, worries have grown that one of its aims is to restrict women’s freedoms in a country where, until recently, those rights had been taken for granted for decades.

“I think it’s normal that the Islamists are so vocal — veiled women used to be harassed and the frustration came out all at once,” said Sarah Ben Hamadi, 28, a blogger and journalist. “We are simply paying today for Ben Ali’s mistakes.”

“I don’t think the country is more radical,” she added. “There is more freedom so we see more of the religious people who were hiding in the past.”

Certainly, the religious ultraconservatives known as Salafists are more visible. The University of Manouba, in suburban Tunis, experienced months of tension last year after Salafist students rioted against the ban on the niqab, the face-covering veil.

More worrying are legal overhauls, human rights officials say. As Tunisia’s Constituent Assembly writes a new constitution, there have been repeated confrontations between Islamists, who dominate the assembly and want to roll back some rights acquired by women, and secular liberals, who want an expansion of those rights to include, for example, equal inheritance rights.

“We cannot speak of an obvious rollback since the legal reality is still the same,” said Amna Guellali, the director of Human Rights Watch in Tunis. “But acquired rights are being threatened by repeated attacks by Salafist groups on those they consider infidels or on behavior they deem contrary to Islamic morality.”

When a young woman was allegedly raped by police officers in September, she was charged with indecency and risked six months in prison before the charges were dropped, after a huge uproar. Human rights organizations cite the case as an example of how rights are under threat.

“Under the old regime, there were similar cases,” Ms. Guellali acknowledged. “Now with the new freedoms in the country, the media is paying attention to these kinds of stories.” Still, she said, even allowing for the amplifying effect of the news coverage, something has changed.

Chema Gargouri, the president of the Tunisian Association for Management and Social Stability, a nongovernmental organization that provides training and microloans for women and young people in poor areas, said women were more secure under Mr. Ben Ali.

“What was really striking to me after the revolution was that women started to lose their self-esteem,” Ms. Gargouri said. “The dictatorship was pro-woman. The hatred against the dictatorship is expressed through action against women.”

The rise of social and religious repression and the loss of self-confidence “prevents any entrepreneurial initiative for women,” she added.

Ms. Gargouri, who is in her 40s, said that women of her generation had never previously had to debate or defend their rights. But recent developments had pushed her to work to raise awareness of the challenge now facing them.

“What scares me is that the Tunisian woman seems lost,” she said. “In many places I go to, people ask what the government can do for them. We try to teach them to do it on their own.”

The fact is that Tunisia has an Islamist majority, said Ms. Ben Hamadi, the blogger. “Article 1 of the Tunisian Constitution states that it is an Islamic state,” she said. “If we want real democracy, we must listen to everyone’s voice.”

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Jodi Arias Testifies: I Don't Remember Stabbing My Lover 27 Times

Update

By Howard Breuer

UPDATED
02/20/2013 at 05:45 PM EST

• Originally published 02/20/2013 at 05:00 PM EST

Jodi Arias

Charlie Leight/The Arizona Republic/AP

Nearly two months into her murder trial in a Phoenix courtroom, Jodi Arias told jurors Wednesday morning that she killed Travis Alexander in self-defense – but doesn't remember stabbing him nearly 30 times.

"I just remember dropping the knife and being very freaked out and screaming," Arias, 32, said after two weeks of explicit direct testimony about her sex life with Alexander, including their kinky sex shortly before his death. She says the knife was the same one Alexander had used that afternoon when he tied her up for sex.

Facing the death penalty if convicted, Arias says her memory of June 4, 2008, clears up when she put the knife in the dishwasher. Driving off barefoot, she brought with her the rope she said Alexander had used to tie her up and a gun that she pulled from the top of his walk-in closet before shooting him.

"I was very scared and very upset. ... I just wanted to die," Arias testified. "I thought, 'My life is probably done now.'"

She says she decided to bury those feelings and try to act normal as she drove north into Utah to visit another man with whom she already had plans to see.

She says she tossed the gun in the desert, dropped the rope in a Dumpster near St. George, Utah, washed the blood from her hands with a case of bottled Costco water she kept in her trunk and put on a spare pair of work shoes.

The man she met, Ryan Burns, earlier testified that Arias was frisky and affectionate when she visited on June 5. Arias testified that she kissed Burns and cuddled with him the day after killing Alexander because, "I felt safe right there and, I figured, I just wanted to seem normal, like I didn't just do what I just did."

Centerpiece of Defense

Arias's testimony was the long-anticipated centerpiece of her defense. Once that's done, prosecutors are expected to spend several days trying to pick apart her story.

Arias also talked about how she and Alexander, a charismatic Mormon motivational speaker, had an off-and-on relationship in which he sometimes become violent or sadistic.

She says she had arrived at his Mesa, Ariz. home at 5 a.m. and although they took photos and video of themselves having sex, Alexander repeatedly became enraged with her – first for giving him badly scratched CDs of photographs of their trips together, then for dropping his camera.

She says that as Alexander chased her through a walk-in closet "like a linebacker," she grabbed a gun that she knew he kept on a top shelf. She says that she held up the gun, expecting that Alexander would stop charging at her, but he didn't.

"The gun went off, I didn't even mean to shoot, I didn't know my hand was on the trigger," Arias testified. She says that, as they wrestled on the ground, she assumed that she'd shot a hole in the wall, not that she'd hit Alexander. After that, she says, "there's a lot of that day that I don't remember, there's a lot of gaps.

"I have no memory of stabbing him," Arias told jurors, who have heard graphic testimony that Alexander was shot in the head and repeatedly stabbed, and that his throat was slashed ear to ear.

Arias testified she remembers standing in his bathroom, dropping the knife on the hard floor, and thinking, "that I just couldn't believe what had just happened and I couldn't rewind the clock and take it back." She did not recall dragging him to the bathroom or placing him in the shower, she said.

Arias also testified that she still loves Alexander – "It's a different love but yes, I do."

Since the slaying, Arias has changed her story, first saying she had no connection to the crime, then saying two masked intruders killed Alexander and almost killed her. "I basically told everyone what I could remember of the day, and that the intruder story was all B.S.," Arias said Wednesday afternoon at the close of her testimony.

Prosecutors suggest Arias killed Alexander out of jealousy after he pushed her out of his life and started dating someone else, and that the gun was actually a pistol that she stole from her grandparents' home in Yreka, Calif., weeks earlier.

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Florida governor backs limited Medicaid expansion

MIAMI (Reuters) - Florida Governor Rick Scott backed a limited expansion of healthcare coverage for the poor on Wednesday, joining six other Republican governors who have agreed to the move under President Barack Obama's landmark reform law.

Scott, a vocal critic of the law known as Obamacare who had balked at expanding Medicaid, only agreed to the expansion after the federal government granted Florida a conditional waiver to privatize Medicaid statewide.

Scott said in a statement that he would only agree to the expansion for three years, however, while the federal government picks up all the costs.

"We will support a three year expansion of our Medicaid program under the new healthcare law, as long as the federal government meets their commitment to pay 100 percent of the cost during this time. This legislation would sunset after three years and need to be reauthorized," the statement said.

Scott's conditional endorsement of an expanded Medicaid program in Florida, a move that officials have said could add at least 1 million people to the state's Medicaid rolls, must still be approved by the Florida Legislature.

(Reporting by Tom Brown; editing by Andrew Hay)

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Wall Street ends down sharply after Fed minutes

DEAR ABBY: My boyfriend, "Doug" (24), and I (22) have been in a long-distance relationship for a year, but we were friends for a couple of years before that. I had never had a serious relationship before and lacked experience. Doug has not only been in two other long-term relationships, but has had sex with more than 15 women. One of them is an amateur porn actress.I knew about this, but it didn't bother me until recently. Doug had a party, and while he was drunk he told one of his buddies -- in front of me -- that he should watch a certain porn film starring his ex-girlfriend. ...

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Memo From Mexico City: Mexico Anticrime Plan Challenged by Unabated Violence

Dario Lopez-Mills/Associated Press

A man guarding a roadblock at the entrance to Cruz Quemada, a rural town near Ayutla in the state of Guerrero. A recent spate of violence in the area has led communities to take up arms.

MEXICO CITY — The new Mexican president, Enrique Peña Nieto, campaigned on a promise to reduce the violence spawned by the drug trade and organized crime, and to shift the talk about his nation away from cartels and killings.

But even as he rolled out a crime prevention program last week and declared it the government’s new priority, a rash of high-profile mayhem threatened to undercut his message and raise the pressure to more forcefully confront the lawlessness that bedeviled his predecessor.

The southwestern state of Guerrero, long prone to periodic eruptions of violence, has proved a challenge once again. Gang rapes of several women have occurred in and around the faded resort town of Acapulco, including an attack this month on a group from Spain that garnered worldwide headlines, and an ambush killed nine state police officers in a mountainous no-man’s land. Out of frustration that the state was not protecting them, rural towns in Guerrero have taken up arms to police themselves.

Elsewhere, grenades were set off this month near the United States Consulate in the border town of Nuevo Laredo during a battle among gangs, and 17 members of Kombo Kolombia, a folk band in northern Mexico, were kidnapped and killed last month.

The bloodshed continued despite some indications that the violence leveled off last year, according to a report released on Feb. 5 by the University of San Diego’s Trans-Border Institute, which analyzed a range of government homicide statistics. Mr. Peña Nieto’s government also released statistics this month that it said showed that homicides presumably related to organized crime had dipped from December to January, but analysts have long questioned how those numbers were compiled, given the chronic lack of criminal investigations.

Still, the appetite of criminal groups for shocking violence seems unabated and presents a challenge for the president. Can he manage to avoid being drawn into the iron-fisted approach of his predecessor and effectively change the focus of the national discussion to other matters, like the economy?

“They are trying to have the president not use the crime issue as his political priority,” said Ana Maria Salazar, a security analyst who worked in the American government and now hosts a radio show here. “But at the same time, it doesn’t seem what they are talking about is confronting or going to have an impact on the current violence and criminal organizations.”

She added, “They haven’t laid out what they are going to do in the short term to retake Mexican territory in control of criminal organizations.”

Government officials have asked for patience, saying Mexico’s crime problems cannot be solved overnight.

They have made it clear that they want to break with the approach of former President Felipe Calderón, who heavily enlisted the military and the federal police against crime gangs, but the new government has taken a similar tack in recent flare-ups, including sending a cadre of federal police officers to Acapulco after the attacks there. Government officials have pledged closer coordination between the federal police and the state authorities.

Officials are promoting the less militaristic crime prevention program introduced last week as a linchpin, with Mr. Peña Nieto personally announcing it and Interior Secretary Miguel Ángel Osorio Chong briefing reporters extensively on it. On Thursday, an under secretary presented a slick brochure on the program to foreign journalists and answered questions for 45 minutes.

“It’s clear that we must put special emphasis on prevention, because we can’t only keep employing more sophisticated weapons, better equipment, more police, a higher presence of the armed forces in the country as the only form of combating organized crime,” Mr. Peña Nieto said in announcing the program in Aguascalientes, one of the more peaceful precincts in the country.

The program calls for creating an interagency commission that would spend $9 billion in the coming years in 250 of the most violent cities and towns, beginning with the worst. The plan envisions longer school days, drug addiction programs and other social efforts in addition to public works projects, but officials said specifics were still being worked out and would be detailed later.

It resembles a plan Mr. Calderón put in place a few years ago for Ciudad Juárez, one of the bloodiest cities in Mexico, but government officials said that while they studied that project, they believed that their plan differed in ambition and scope.

Few argue with the need for such programs and alternatives to crime for young people. But security analysts faulted Mr. Calderón for not attacking corruption by building effective, accountable local and state police and judicial institutions, a herculean task that Mr. Peña Nieto so far has not shown much sign of taking on either.

This article has been revised to reflect the following correction:

Correction: February 19, 2013

An earlier version of this article referred incompletely to Chris Kyle’s academic affiliation. He is an anthropologist at the University of Alabama at Birmingham; the University of Alabama’s flagship campus is in Tuscaloosa.

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How Does Fergie's Maternity Style Stack Up to Kate, Jessica and Kim?

Stylewatch
Style News Now

02/19/2013 at 03:31 PM ET

Getty; GSI; Abaca; Xposure

When we heard that Fergie was expecting a baby Black Eyed Pea, we were on the edge of our seats waiting to see how the famously funky star‘s maternity style would play out. Luckily she didn’t keep us waiting long, stepping out with husband Josh Duhamel Tuesday in a shearling bomber jacket, yellow sweater dress and circular sunglasses.

“It’s clear to see how happy they are,” a source close to the couple tells PEOPLE. ”They are really excited.” And we are really excited to see how her outfits fit into the range of maternity style — from low-key to high-wattage — that we’ve been spotting from L.A. to London.

On the “mild” end of the spectrum is the Duchess of Cambridge (left), who has dressed her barely-there bump in conservative coats and this elegant Max Mara wrap dress.

A little wilder is Jessica Simpson, wearing a pink jacket with Jessica Simpson Maternity leggings, who sticks to the same styles she favors even when not pregnant (blazers, maxis and sky-high heels) but isn’t shy about putting her fuller curves on display with plunging V-necks.

And on the far end of the “mild to wild”-o-meter: Kim Kardashian, of course, who has put her bump on display in feathers, crop tops, mesh, sequins and sheer numbers — including this onesie pantsuit.

As it turns out, these stars’ maternity style isn’t so different from how they dressed pre-baby … which makes us even more excited to see how the rest of their pregnancy wardrobe will go. Tell us: Who’s the best-dressed mom-to-be?

–Alex Apatoff

PHOTOS: SEE MORE STAR MATERNITY STYLE HERE!

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Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com

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As Assad Holds Firm, Obama Could Revisit Arms Policy

WASHINGTON — When President Obama rebuffed four of his top national security officials who wanted to arm the rebels in Syria last fall, it put an end to a months-long debate over how aggressively Washington should respond to the strife there that has now left nearly 70,000 dead.

Reuters

A Free Syrian Army member smokes a cigarette inside a factory producing improvised mortar shells.

But the decision also left the White House with no clear strategy to resolve a crisis that has bedeviled it since a popular uprising erupted against President Bashar al-Assad almost two years ago. Despite an American program of nonlethal assistance to opponents of the Syrian government and $365 million in humanitarian aid, Mr. Obama appears to be running out of options to speed Mr. Assad’s exit.

With conditions continuing to deteriorate, officials said, the president could reopen the question of whether to provide weapons to select members of the resistance in an effort to break the impasse in Syria. The question is whether a wary Mr. Obama, surrounded by a new national security team, would come to a different conclusion.

“This is not a closed decision,” a senior administration official insisted. “As the situation evolves, as our confidence increases, we might revisit it.”

Mr. Obama’s refusal to provide arms when the proposal was broached before the November election, officials said, was driven by his reluctance to get drawn into a proxy war and his fear that the weapons would end up in unreliable hands, where they could be used against civilians or Israeli and American interests.

As the United States struggles to formulate a policy, however, Mr. Assad has given no sign that he is ready to yield power, and the Syrian resistance is adamant that it will not negotiate a transition in which he has a role. Mr. Obama, in his State of the Union address, did not repeat his oft-stated confidence that Mr. Assad’s days are numbered.

Even if Mr. Assad was overthrown, the convulsion could fragment Syria along sectarian and ethnic lines, each supported by competing outside powers, said Paul Salem, who runs the Beirut-based Middle East office for the Carnegie Endowment for International Peace. “Syria,” he said, “is in the process, not of transitioning, but disintegrating.”

The State Department has funneled $50 million of nonlethal assistance to the Syrian opposition, including satellite telephones, radios, broadcasting equipment, computers, survival equipment and the training in how to use them. This support, officials say, has helped Syrians opposed to the Assad regime communicate with one another and the outside world, despite efforts by Syrian forces to target rebel communications using Iranian-supplied equipment. A Syria-wide FM radio network is to connect broadcasting operations in several cities in the next several days. The State Department has also helped train local councils in areas that have freed from the Syrian government’s control.

But the State Department does not provide non-lethal assistance to armed rebel factions. This has greatly limited the influence the United States has with armed groups that are likely to control much of Syria if Mr. Assad is ousted..

“The odds are very high that, for better or worse, armed men will determine Syria’s course for the foreseeable future,” said Frederic C. Hof, a former senior State Department official and a senior fellow at the Atlantic Council. “For the U.S. not to have close, supportive relationships with armed elements, carefully vetted, is very risky.”

Because units of the anti-Assad Free Syria Army have captured prisoners and detained criminals in the areas they control, Mr. Hof said, it is essential that either the United States or an ally train rebel staff officers in judicial procedures and sensitive them to human rights concerns.

While the White House has focused on the risks of providing weapons, other nations have had no such reservations. Russia has continued to provide arms and financial support to the Assad government. Iran has supplied the regime with weapons and Quds Force advisers. Hezbollah has sent militants to Syria to help Mr. Assad’s forces. On the other side of the struggle, anti-government Qaeda-affiliated fighters have been receiving financial and other support from their backers in the Middle East.

The arming plan that was considered last year originated with David H. Petreaus, then the director of the Central Intelligence Agency, and was supported by former Secretary of State Hillary Rodham Clinton. The goal was to create allies in Syria with whom the United States could work during the conflict and if Mr. Assad was removed from power. Each had their reasons for supporting it.

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