Predicting who's at risk for violence isn't easy

CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.

Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.

But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.

"They're yellow flags. They only become red flags once the blood is spilled," he said.

Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.

Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)

Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.

Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.

"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."

The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."

In a guidelines for families, the academy lists several risk factors for violence, including:

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.

Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.

Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.

According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.

Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.

Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.

And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.

All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.

Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.

Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.

Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.

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Online:

American Academy of Child & Adolescent Psychiatry: http://www.aacap.org

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

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Egypt's constitution approved in vote, say rival camps

CAIRO (Reuters) - A constitution drafted by an Islamist-dominated assembly was approved by a majority of Egyptians in a referendum, rival camps said on Sunday, after a vote the opposition said drove a wedge through the Arab world's most populous nation.

The Muslim Brotherhood, which propelled President Mohamed Mursi to power in a June election, said 64 percent of voters backed the charter after two rounds of voting that ended with a final ballot on Saturday. It cited an unofficial tally.

An opposition official also told Reuters their unofficial count showed the result was a "yes" vote.

The referendum committee may not declare official results for the two rounds until Monday, after hearing appeals. If the outcome is confirmed, a parliamentary election will follow in about two months.

Mursi's Islamist backers say the constitution is vital for the transition to democracy, nearly two years after the overthrow of autocrat Hosni Mubarak in an uprising. It will provide stability needed to help a fragile economy, they say.

But the opposition accuses Mursi of pushing through a text that favors Islamists and ignores the rights of Christians, who make up about 10 percent of the population, as well as women. They say it is a recipe for further unrest.

"According to our calculations, the final result of the second round is 71 percent voting 'yes' and the overall result (of the two rounds) is 63.8 percent," a Brotherhood official, who was in an operations room monitoring the vote, told Reuters.

His figures were confirmed by a statement issued shortly afterwards by the group and broadcast on its television channel.

The Brotherhood and its party, as well as members of the opposition, had representatives monitoring polling stations and the vote count across the country.

The opposition said voting in both rounds was marred by abuses and had called for a re-run after the first stage. However, an official said the overall vote favored the charter.

"They (Islamists) are ruling the country, running the vote and influencing the people, so what else could we expect," the senior official from the main opposition coalition, the National Salvation Front, told Reuters.

PROTESTS

The vote was split over two days as many judges had refused to supervise the ballot.

"I'm voting 'no' because Egypt can't be ruled by one faction," said Karim Nahas, 35, a stockbroker, heading to a polling station in Giza, in greater Cairo, in the last round.

At another polling station, some voters said they were more interested in ending Egypt's long period of political instability than in the Islamist aspects of the charter.

"We have to extend our hands to Mursi to help fix the country," said Hisham Kamal, an accountant.

The build-up to the vote witnessed deadly protests, sparked by Mursi's decision to award himself extra powers in a decree on November 22 and then to fast-track the constitution to a vote.

Hours before polls closed, Vice President Mahmoud Mekky announced his resignation. He said he wanted to quit last month but stayed on to help Mursi tackle the crisis that blew up when the Islamist leader assumed wide powers.

Mekky, a prominent judge who said he was uncomfortable in politics, disclosed earlier he had not been informed of Mursi's power grab. The timing of his resignation appeared linked to the lack of a vice-presidential post under the draft constitution.

The new basic law sets a limit of two four-year presidential terms. It says the principles of Islamist sharia law remain the main source of legislation but adds an article to explain this. It also says Islamic authorities will be consulted on sharia - a source of concern to Christians and others.

TURNOUT

Rights groups reported what they said were illegalities in voting procedures. They said some polling stations opened late, that Islamists illegally campaigned at some polling places and complained of irregularities in voter registration.

But the committee overseeing the two-stage vote said its investigations showed no major irregularities in voting on December 15, which covered about half of Egypt's 51 million voters. About 25 million were eligible to vote in the second round.

The Brotherhood said turnout was about a third of voters.

The opposition says the constitution will stir up more trouble on the streets since it has not received sufficiently broad backing for a document that should be agreed by consensus, and raised questions about the fairness of the vote.

In the first round, the district covering most of Cairo voted "no," which opponents said showed the depth of division.

"I see more unrest," said Ahmed Said, head of the liberal Free Egyptians Party and a member of the National Salvation Front, an opposition coalition formed after Mursi expanded his powers on November 22 and then pushed the constitution to a vote.

He cited "serious violations" on the first day of voting, and said anger against Mursi was growing. "People are not going to accept the way they are dealing with the situation."

At least eight people were killed in protests outside the presidential palace in Cairo this month. Islamists and rivals clashed in Alexandria, the second-biggest city, on the eves of both voting days.

Late on Saturday, Mursi announced the names of 90 new members he had appointed to the upper house of parliament, state media reported, and a presidential official said the list was mainly liberals and other non-Islamists.

A spokesman for the National Salvation Front, which groups opponents who include liberals, socialists and other parties and politicians, said the Front's members had refused to take part.

Legislative powers, now held by Mursi because the lower house of parliament was dissolved earlier this year, will pass to the upper house under the new constitution.

Two-thirds of the 270-member upper house was elected in a vote this year, with one third appointed by the president. Mursi, elected in June, had not named them until now. Mursi's Islamist party and its allies dominate the assembly.

(Writing by Edmund Blair and Giles Elgood; Editing by Mark Trevelyan and Todd Eastham)

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S.Korea sheds some Christmas light on North

SEOUL: South Korean church groups have displayed Christmas lights near the tense border with North Korea, an official said on Sunday, despite concerns about a violent response from Pyongyang.

Dozens of church leaders and followers put up the giant display -- featuring thousands of glittering light bulbs on a tree-shaped steel tower -- near the heavily-fortified border on Saturday, a defence ministry spokesman told AFP.

The lights on a military-controlled hill in Gimpo, west of Seoul, will be displayed until early January and can apparently be seen several kilometres away in the impoverished North suffering from chronic power shortage.

Before the South's "Sunshine Policy" of engagement with North Korea launched in 1998, the seasonal lighting displays were common.

Pyongyang repeatedly condemned them as "psychological warfare" by its capitalist neighbour aimed at spreading Christianity in the isolated communist state.

In 2004 the two Koreas agreed to halt official-level cross-border propaganda and the South stopped the Christmas border illuminations completely.

They were resumed in 2010 after North Korea shelled a frontline island, but were postponed last year in a conciliatory gesture following the death of North Korean leader Kim Jong-Il.

But the latest illumination has provoked fear among some local residents who staged a protest amid concerns about potential retaliation from the North, according to Yonhap news agency.

"All residents here are left to tremble in fear... as long as the light tower stays here," a group of residents said in a statement.

Before Kim's death Pyongyang warned of "unexpected consequences" if Seoul displayed Christmas lights in 2011 and vowed unspecified retaliation.

Cross-border tensions have been high since the nuclear-armed North this month staged a long-range rocket launch widely condemned as a disguised ballistic missile test by the international community.

- AFP/ck

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Delhi gang rape: Hazare calls for stricter laws

AHMEDNAGAR (Maharashtra): Extending his support to the protests by youths demanding justice for the Delhi gang-rape victim, anti-corruption crusader Anna Hazare today called for stringent laws and fast-track trials in such cases.

"Youths gathered on the streets to demonstrate are passionate patriots. Their anger and the non-violent ways of demonstration shows that they have full faith in the country's democratic system and the Constitution," Hazare told PTI at Ralegan Siddhi, his native place in the district this morning.

"The incident of gang-rape in the national capital shows that criminal and anti-social elements are not afraid of the government machinery," he said.

"Therefore, government has to change the laws to give severe punishment to those who indulge in crime against women. Fast-track trials are needed against such crimes in the country," Hazare said.

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Predicting who's at risk for violence isn't easy

CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.

Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.

But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.

"They're yellow flags. They only become red flags once the blood is spilled," he said.

Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.

Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)

Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.

Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.

"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."

The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."

In a guidelines for families, the academy lists several risk factors for violence, including:

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.

Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.

Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.

According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.

Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.

Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.

And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.

All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.

Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.

Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.

Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.

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Online:

American Academy of Child & Adolescent Psychiatry: http://www.aacap.org

___

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

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Obama, Congress Waving Bye-Bye Lower Taxes?

The first family arrived in the president's idyllic home state of Hawaii early today to celebrate the holidays, but President Obama, who along with Michelle will pay tribute Sunday to the late Sen. Daniel Inouye at the National Memorial Cemetery of the Pacific, could be returning home to Washington sooner than he expected.

That's because the President didn't get his Christmas wish: a deal with Congress on the looming fiscal cliff.

Members of Congress streamed out of the Capitol Friday night with no agreement to avert the fiscal cliff -- a massive package of mandatory tax increases and federal spending cuts triggered if no deal is worked out to cut the deficit. Congress is expected to be back in session by Thursday.

It's unclear when President Obama may return from Hawaii. His limited vacation time will not be without updates on continuing talks. Staff members for both sides are expected to exchange emails and phone calls over the next couple of days.

Meanwhile, Speaker of the House John Boehner is home in Ohio. He recorded the weekly GOP address before leaving Washington, stressing the president's role in the failure to reach an agreement on the cliff.

"What the president has offered so far simply won't do anything to solve our spending problem and begin to address our nation's crippling debt," he said in the recorded address, "The House has done its part to avert this entire fiscal cliff. ... The events of the past week make it clearer than ever that these measures reflect the will of the House."

Fiscal Cliff Negotiations Halted for Christmas Watch Video

Cliffhanger: Congress Heads Home after 'Plan B' Vote Pulled from House Floor Watch Video

Fiscal Cliff: Boehner Doesn't Have Votes for Plan B Watch Video

Senate Minority Leader Mitch McConnell echoed the sentiment while lamenting the failure to reach a compromise.

"I'm stuck here in Washington trying to prevent my fellow Kentuckians having to shell out more money to Uncle Sam next year," he said.

McConnell is also traveling to Hawaii to attend the Inouye service Sunday.

If the White House and Congress cannot reach a deficit-cutting budget agreement by year's end, by law the across-the-board tax hikes and spending cuts -- the so called fiscal cliff -- will go into effect. Many economists say that will likely send the economy into a new recession.

Reports today shed light on how negotiations fell apart behind closed doors. The Wall Street Journal, citing unnamed sources, reported that when Boehner expressed his opposition to tax rate increases, the president allegedly responded, "You are asking me to accept Mitt Romney's tax plan. Why would I do that?"

The icy exchange continued when, in reference to Boehner's offer to secure $800 billion in revenue by limiting deductions, the speaker reportedly implored the president, "What do I get?"

The president's alleged response: "You get nothing. I get that for free."

The account is perhaps the most thorough and hostile released about the series of unsuccessful talks Obama and Boehner have had in an effort to reach an agreement about the cliff.

Unable to agree to a "big deal" on taxes and entitlements, the president is now reportedly hoping to reach a "small deal" with Republicans to avoid the fiscal cliff.

Such a deal would extend unemployment benefits and set the tone for a bigger deal with Republicans down the line.

In his own weekly address, Obama called this smaller deal "an achievable goal ... that can get done in 10 days."

But though there is no definitive way to say one way or the other whether it really is an achievable goal, one thing is for certain: Republican leadership does not agree with the president on this question.

Of reaching an agreement on the fiscal cliff by the deadline, Boehner said, "How we get there, God only knows."

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Egypt's constitution seen passing in referendum

CAIRO (Reuters) - Egyptians voted on a constitution drafted by Islamists on Saturday in a second round of balloting expected to approve the charter that opponents say will create deeper turmoil in Egypt.

After a first round last week in which unofficial results showed 57 percent of those who voted approved the constitution, the opposition cried foul, saying a litany of alleged abuses meant the first stage of the referendum should be re-run.

But the committee overseeing the two-stage vote said their investigations showed no major irregularities in voting on December 15, which covered about half of Egypt's 51 million eligible voters.

Islamist supporters of President Mohamed Mursi, who was elected in June, say the constitution is vital to moving Egypt towards democracy two years after Hosni Mubarak was overthrown in a popular uprising. They say it will help restore the stability needed to fix an economy that is on the ropes.

If the basic law is passed, a parliamentary election will be held in about two months.

However, the opposition says the constitution is divisive and accuses Mursi of pushing through a document that favors his Islamist allies and ignores the rights of Christians, who make up about 10 percent of the population, as well as women.

"I'm voting 'no' because Egypt can't be ruled by one faction," said Karim Nahas, 35, a stock market broker, heading to a polling station in Giza, a province included in this round of voting which covers parts of greater Cairo.

Polling stations opened at 8 a.m. (0600 GMT) and close at 7 p.m. (1700 GMT) though voting could be extended as it was last week. Queues formed at some polling stations around the country.

Unofficial tallies are likely to emerge within hours of the close, but the referendum committee may not declare an official result for the two rounds until Monday, after hearing appeals.

Shahinaz Shalaby, a housewife, said she would be voting "yes" even though she disagreed with some clauses. "We feel our voice matters," she said, adding that a "yes" vote would not stop protests but "then it will stabilize afterwards".

Cairo districts covered in the first round voted "no", but overall the vote in that round was in favor.

Analysts expect another "yes" vote on Saturday because it covers rural and other areas seen as having more Islamist sympathizers. Islamists may also be able to count on many Egyptians who are simply exhausted by two years of turmoil.

MORE UNREST

But, even if it is approved, the opposition say it is a recipe for trouble since the charter has not received broad consensus backing from the population. They say the result may go in Mursi's favor but will not be the result of a fair vote.

"I see more unrest," said Ahmed Said, head of the liberal Free Egyptians Party and a member of the National Salvation Front, an opposition coalition formed after Mursi expanded his powers on November 22 and then pushed the constitution to a vote.

Citing what he said were "serious violations" on the first day of voting, he said anger against Mursi and his Islamist allies was growing: "People are not going to accept the way they are dealing with the situation."

At least eight people were killed in protests outside the presidential palace in Cairo this month. Islamists and rivals clashed on Friday in the second biggest city of Alexandria, hurling stones at each other. Two buses were torched.

Mohamed Beltagy, a senior official in the Muslim Brotherhood, the group that propelled Mursi to elected office, said the constitution was crucial to holding a parliamentary election and setting up the essential institutions of state.

"What is the catastrophe of this constitution?" he asked the assembly which drafted the document, during a sitting on Friday that was called to challenge opposition criticism of the text.

Opponents, who had earlier quit the drafting assembly saying their voices were not heard, were invited but stayed away.

The vote was staggered after many judges refused to supervise the vote, meaning there were not enough to hold the referendum on a single day nationwide.

The first round was won by a slim enough margin to buttress opposition arguments that the text was divisive. Opponents who include liberals, leftists, Christians and more moderate-minded Muslims accuse Islamists of using religion to sway voters.

"The problem is not whether the majority approves, it is that they rallied the people in the name of the religion," said Mustafa Shuman, who is among dozens of people who have been camped outside Mursi's palace in Cairo in protest.

Islamists, who have won successive ballots since Mubarak's overthrow albeit by narrowing margins, dismiss charges that they are exploiting religion and say the document reflects the will of a majority in the country where most people are Muslim.

(Additional reporting by Tamim Elyan; Writing by Edmund Blair; Editing by Andrew Osborn)

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Egyptians vote on divisive new constitution

CAIRO: Egyptians voted on Saturday in the final round of a referendum on a new constitution championed by President Mohamed Morsi and his Islamist allies against fierce protests from the secular-leaning opposition.

The proposed charter is expected to be adopted after already garnering 57 percent support in the first round of the referendum a week ago.

But the slim margin and the low first-round turnout, in which fewer than one in three eligible voters cast a ballot, has emboldened the opposition, which looks likely to continue its campaign against Morsi after Saturday's voting.

Egypt has already been shaken by a month of protests, some of them violent.

On December 5, eight people were killed and hundreds injured in clashes between rival demonstrators outside the presidential palace in Cairo.

On the eve of Saturday's polling, more clashes erupted in Egypt's second city Alexandria, injuring 62 people, including 12 police officers. Twelve people were arrested, as stone-throwing mobs torched vehicles, the interior ministry said.

Some 250,000 police and soldiers were deployed to provide security during the referendum. The army has also positioned tanks around the presidential palace in Cairo since early this month.

The constitution was drafted by a panel dominated by Morsi's Muslim Brotherhood and ultra-orthodox Salafist groups. Christians and liberals who criticised changes they saw as weakening human and women's rights boycotted the process.

The protests began a month ago on November 22, when Morsi decreed sweeping powers putting himself above judicial review to force through the draft charter.

Although he gave up those powers weeks later under pressure from the protests, he pressed ahead with the referendum.

To do so, he split the voting over two successive Saturdays after more than half of Egypt's judges said they would not provide the statutory supervision of polling stations.

The main opposition group, the National Salvation Front, launched a last-ditch campaign to vote down the charter after deciding a boycott would be counter-productive.

But it and Egyptian human rights groups alleged the first round was marred by fraud, setting up a possible later challenge to the results.

Preliminary tallies from the final round were expected by early Sunday.

"I am voting 'yes' because Egypt needs a constitution to be stable," Mohamed Mamza, a 49-year-old driver lining up to vote in Giza, southwest Cairo, told AFP.

Nearby, another voter, Sayyed Mostafa, a 25-year-old accountant, said he was "of course voting 'no'."

He explained: "This constitution doesn't respect Egyptians. It forgets that there was a revolution in Egypt. We deserve better."

If, as expected, the new constitution is adopted, Morsi will have to call parliamentary elections within two months, to replace the Islamist-dominated assembly ordered dissolved by Egypt's top court in June.

Continued instability will imperil Egypt's economy, which has been limping along ever since the 2011 revolution that overthrew autocratic leader Hosni Mubarak.

The International Monetary Fund has put on hold a $4.8-billion loan Egypt needs to stave off a currency collapse, and Germany has indefinitely postponed a plan to forgive $316 million of Egypt's debt.

National Salvation Front chief Mohamed ElBaradei, a former UN atomic energy agency chief, warned in an online video that "the country is on the verge of bankruptcy."

But he said "a solution is still possible" if Morsi is prepared for "sincere dialogue" and allows a new constitution to be drafted through a more inclusive process.

- AFP/al

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Newly elected Himachal MLA booked for murder, on the run

SHIMLA: Ahead of the Congress Legislature Party (CLP) meeting on Saturday to elect Himachal Pradesh's next chief minister, one of the party's newly elected legislators has gone underground after being booked in a murder case.

Ram Kumar Chaudhary, a first-time MLA from Doon constituency in Solan district, is one of the four suspects in the murder of a 24-year-old woman in Panchkula in Haryana Nov 22.

"Police raided his (Chaudhary's) house in Sandholi (near Baddi) and other places today (Saturday) but he managed to evade arrest. He and other accused have not been joining investigations for quite some time," superintendent of police S Arul said.

Arul said arrest warrants against all the four accused, booked under Section 302 of the Indian Penal Code, were issued on Friday.

The murdered woman's father Butti Ram had lodged a police complaint alleging Chaudhary was in touch with his daughter.

The Punjab and Haryana high court on Thursday directed Haryana Police to expedite the probe.

Congress leaders said Chaudhary had not contacted any senior party leader and was unlikely to attend the CLP meeting in the evening.

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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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