Sandy Hook Shootings: How to Cope

By Howard Breuer

12/23/2012 at 06:00 PM EST

State police personnel lead children to safety away from the Sandy Hook Elementary School

Shannon Hicks/Newtown Bee/Reuters/Landov

The Sandy Hook massacre, in which 20 innocent children and six heroic elementary school faculty members were gunned down last Friday, is particularly difficult for people – even those thousands of miles away from Newtown, Conn. – to process, according to mental health experts.

"This tragedy is so deeply affecting the national psyche, reminding us of 9/11, because of its assault on Norman Rockwell's vision of America," psychiatrist Carole Lieberman tells PEOPLE.

Friday was proclaimed a national day of mourning for those lost a week ago, with a moment of silence called for at 9:30 a.m. Eastern time, as 26 churchbells rang in Newtown and elsewhere. In addition, First Lady Michelle Obama sent an open letter of condolence to the town, saying the entire nation "is holding you in our hearts."

But how do those directly involved with the tragedy find the strength to cope?

To do that, family members who lost loved ones need immediate counseling and to maintain their normal routines. They also need to draw support from other affected families who can relate to what they're going through, says Dr. Stephanie N. Marcy, a psychologist at Children's Hospital Los Angeles.

"I think the people on the ground are feeling a sense of hopelessness because there is no way to justify what happened," Marcy says. "They need to be around other people who have experienced and understand it. If you were all involved together, you can empathize and grieve together."

In many of these families, the remaining children might have survivor's guilt, she adds.

"They rethink what they did that day and wonder if they in some way contributed to the death of a sibling, or they wonder, why did I survive?" Marcy says.

Therapists will need to explain to kids who lost a sibling that their "false belief that they should have been able to prevent it is not correct," adds Marcy.

Children at Sandy Hook may also have Post-Traumatic Stress Disorder and will need therapy, Lieberman says.

What to Tell Children

And what do parents whose children were not involved in the tragedy tell their own youngsters about what happened? That, Marcy says, depends on how old they are and how much they know already.

"Kindergarteners and first graders don't need to be told about it unless you think they will hear it somewhere else. For older kids, you have to get to know what they know, answer any questions they might have, and be truthful – but don't say too much," Marcy says. "Say that a person who was having problems, that was sick, went into a school and injured some people for no particular reason. Tell them it would never happen at their school."

"Yes," she adds, "it could happen anywhere. But there's no point in letting your child think that, [because] they may be flooded with fear."

For the adults and children across the country who have been vicariously traumatized, Marcy says, "We need to regain our sense of control, because this type of event makes us feel completely helpless."

Lieberman adds that Americans "are also feeling a generalized anxiety, a fear that no place is safe anymore. They need to talk to friends and family, get involved in championing causes that make society better, to volunteer for charities, and to get psychotherapy if the sadness and anxiety persist."

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Acton man who built 'Phonehenge West' receives 539 days in jail

An Acton man convicted of building-code violations who failed to repay thousands of dollars he owed Los Angeles County for demolishing the elaborate structure he dubbed "Phonehenge West" was sentenced this week to almost 18 months in jail.

The jailing of Alan Kimble Fahey marked the end of a more than 20-year saga that pitted the retired phone technician against county code enforcement officials and led him in and out of court for the last five years.

Prosecutors argued that Fahey showed a deliberate disregard for authority and had no one but himself to blame for his fate. But Fahey's supporters insisted that he was unfairly punished for what they described as a "victimless crime."

Fahey, who failed to obtain the proper building permits to construct Phonehenge, was facing six years in jail for 12 misdemeanor counts of building code violations, according to Sandi Gibbons, a spokeswoman for the L.A. County district attorney's office. But on Wednesday, L.A. County Superior Court Judge Daviann L. Mitchell sentenced Fahey to 539 days in jail.

Pleading financial hardship, Fahey had repaid only $1,250 of the $83,488 he owed the county. Mitchell questioned Fahey's inability to pay, charging that he had made false statements to the court about his financial status and had "knowingly and willfully disobeyed" the terms of his probation, Gibbons said.

Restitution to the county would now have to be resolved in civil court because the criminal case was over, Gibbons said.

Fahey's attorney, Jerry E. Lennon, said that given the nonviolent nature of his client's offense and his documented heart condition, Fahey would probably be eligible for early release.

Fahey spent about 30 years erecting Phonehenge — a 20,000-square-foot labyrinth of interconnected structures, some made from telephone poles. County code enforcement officers argued that the creation wasn't structurally sound and was a fire and earthquake risk, and therefore had to come down.

But Fahey's supporters called Phonehenge a "work of art" worthy of preservation. Many accused county officials of being too aggressive in its code enforcement and of "stifling creativity."

"It's very difficult because your chances of winning against them are very slim," said Fahey's wife, Pat. "People will look at us and say, 'I'm not going to take a chance.'"

ann.simmons@latimes.com

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At Western Wall, a Divide Over Prayer Deepens

Rina Castelnuovo for The New York Times

Members of Women of the Wall prayed this month while wearing tallits, fringed prayer shawls, and tefillin, leather prayer boxes, both of which Jewish men are told to wear.

JERUSALEM — The face-off at the security gate outside the Western Wall one Friday this month was familiar: for more than two decades, women have been making a monthly pilgrimage to pray at one of Judaism’s holiest sites in a manner traditionally preserved for men, and the police have stopped them in the name of maintaining public order.

Rina Castelnuovo for The New York Times

Bonna Devora Haberman, 52, of Women of the Wall, was confronted by the police this month after trying to bring in her prayer shawl.

But after a flurry of arrests this fall that set off an international outcry, the women arrived for December’s service to find a new protocol ordered by the ultra-Orthodox rabbi who controls the site. To prevent the women from defying a Supreme Court ruling that bars them from wearing ritual garments at the wall, they were blocked by police officers from bringing them in.

“How can you say this to me?” demanded a tearful Bonna Devora Haberman, 52, a Canadian immigrant who helped found the group Women of the Wall in 1988. “I’m a Jew. This is my state.”

The officer was unmoved. “At the Western Wall, you can’t pray with a tallit,” he said, referring to the fringed prayer shawl in Ms. Haberman’s backpack. “You can’t go in with it.”

After years of legislative and legal fights, the movement for equal access for people to pray as they wish at the site has become a rallying cause for liberal Jews in the United States and around the world, though it has long struggled to gain traction here in Israel, where the ultra-Orthodox retain great sway over public life.

This has deepened a divide between the Jewish state and the Jewish diaspora, in which some leaders have become increasingly vocal in criticizing Israel’s policies on settlements in the Palestinian territories; laws and proposals that are seen as antidemocratic or discriminatory against Arab citizens; the treatment of women; and the ultra-Orthodox control over conversion and marriage.

“When my kids start expressing frustration with Israel as a society because what they hear and see from a distance is not welcoming to them in their religious practice — that’s not good for the Jewish people, let alone for the state of Israel,” said Rabbi Steven C. Wernick, the director of the United Synagogue of Conservative Judaism.

Rabbi Levi Weiman-Kelman, an American immigrant who runs Kol Haneshama, a leading Reform synagogue here, said Women of the Wall “is an issue that really brings out the gap between Israeli Jews and American Jews.”

While more than 60 percent of Jews in the United States identify with the Reform or Conservative movements, where women and men have equal standing in prayer and many feminists have adopted ritual garments, in Israel it is one in 10. Instead, about half call themselves secular, and experts say that most of those consider Orthodoxy as the true Judaism, feel alienated from holy sites like the Western Wall, and view a woman in a prayer shawl as an alien import from abroad.

(Jewish law requires only men to pray daily, and it prohibits women from dressing like men.)

“Secular Israelis do not see this as their problem; to them it’s a bunch of crazy American ladies,” said Shari Eshet, who represents the New York-based National Council of Jewish Women here. “It’s embarrassing for Israel, it’s embarrassing for Jews, and the American Jewish community is beginning to understand that it’s a slippery slope here.”

The increased agitation around the wall is part of a broader clash over Judaism and gender that has roiled Israel in recent months. Women have won lawsuits against segregation on buses and sidewalks imposed in religious neighborhoods. But a bus line recently stopped accepting advertisements with images of people after religious vandals routinely blacked out women’s faces in the name of modesty.

In January, speakers at a conference on health and Jewish law canceled their appearances because women were barred from the podium — a demand of the most Orthodox — while the chief rabbi of the air force quit after religious soldiers were not excused from events where women sang.

These controversies concern the imposition of Orthodox doctrine in secular spheres. More complicated are questions of how Judaism itself should be practiced. This spring, the Supreme Court ruled that the government must pay the salary of a Reform rabbi along with hundreds of Orthodox ones. A small group of Jerusalem restaurants has been seeking an alternative kosher certification system to the one run by the government’s rabbinical council.

“The next chapter of what it means to be a Jewish state is being defined right now,” said Elana Sztokman, the director of the Jewish Orthodox Feminist Alliance, who is writing a book that includes a chapter about Women of the Wall. “We have to figure out what does Israel want, what role do we really want religion to have in this state? And it’s happening on the backs of women.”

Women of the Wall began in December 1988, when tourists attending a feminist conference decided to take a Torah scroll they had brought from the United States to a prayer service at the Western Wall, a remnant of the retaining wall that surrounded the ancient Temple Mount. The group has since returned 11 times a year to pray on Rosh Hodesh, the first day of the Hebrew month, an occasion embraced by Jewish feminists.

Irit Pazner Garshowitz and Myra Noveck contributed reporting.

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Drew Barrymore: My Dogs Are So Protective of Baby Olive

People Pets
Only on People.com

By Julie Jordan and Amy Jamieson

12/22/2012 at 05:30 PM EST

Drew Barrymore, Will Kopelman and dog Douglas

NPG

She may have been a nervous wreck after baby Olive arrived this fall, but the Drew Barrymore could have rested easy because her dogs had everything under control.

"They're so protective of her. They're so sweet," she tells PEOPE of her pups, Douglas and shepherd mix Oliver. "And Douglas, the little blonde one, just comes and licks [Olive's] head, and it's just so goofy and silly and I always say, 'Douglas, is this your baby?' "

The first-time mom, 37, and her husband Will Kopelman were careful when it came to introducing their furbabies to the real baby.

"We brought her stuff home to them to sniff and play with," she tells PEOPLE. "I put her with them right away. I was holding her and protective but there are all these wonderful studies that kids that grow up with dogs have better immunities because of the dander and the pollen. And it's a proven fact that dogs just improve the quality of your life."

In just a few months, Douglas has assumed the role of bodyguard over 10-week-old Olive, whom Barrymore calls "Super Baby" because she sleeps and eats so well.

"He's literally sitting [and] looking out the window," she says, "in, like, a guard dog position."

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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

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

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Pot farms wreaking havoc on Northern California environment

EUREKA, Calif. — State scientists, grappling with an explosion of marijuana growing on the North Coast, recently studied aerial imagery of a small tributary of the Eel River, spawning grounds for endangered coho salmon and other threatened fish.

In the remote, 37-square-mile patch of forest, they counted 281 outdoor pot farms and 286 greenhouses, containing an estimated 20,000 plants — mostly fed by water diverted from creeks or a fork of the Eel. The scientists determined the farms were siphoning roughly 18 million gallons from the watershed every year, largely at the time when the salmon most need it.

"That is just one small watershed," said Scott Bauer, the state scientist in charge of the coho recovery on the North Coast for the Department of Fish and Game. "You extrapolate that for all the other tributaries, just of the Eel, and you get a lot of marijuana sucking up a lot of water.… This threatens species we are spending millions of dollars to recover."

The marijuana boom that came with the sudden rise of medical cannabis in California has wreaked havoc on the fragile habitats of the North Coast and other parts of California. With little or no oversight, farmers have illegally mowed down timber, graded mountaintops flat for sprawling greenhouses, dispersed poisons and pesticides, drained streams and polluted watersheds.

Because marijuana is unregulated in California and illegal under federal law, most growers still operate in the shadows, and scientists have little hard data on their collective effect. But they are getting ever more ugly snapshots.

A study led by researchers at UC Davis found that a rare forest carnivore called a fisher was being poisoned in Humboldt County and near Yosemite in the Sierra Nevada.

The team concluded in its July report that the weasel-like animals were probably eating rodenticides that marijuana growers employ to keep animals from gnawing on their plants, or they were preying on smaller rodents that had consumed the deadly bait. Forty-six of 58 fisher carcasses the team analyzed had rat poison in their systems.

Mark Higley, a wildlife biologist on the Hoopa Indian Reservation in eastern Humboldt who worked on the study, is incredulous over the poisons that growers are bringing in.

"Carbofuran," he said. "It seems like they're using that to kill bears and things like that that raid their camps. So they mix it up with tuna or sardine, and the bears eat that and die."

The insecticide is lethal to humans in small doses, requires a special permit from the EPA and is banned in other countries. Authorities are now regularly finding it at large-scale operations in some of California's most sensitive ecosystems.

It is just one in a litany of pollutants seeping into the watershed from pot farms: fertilizers, soil amendments, miticides, rodenticides, fungicides, plant hormones, diesel fuel, human waste.

Scientists suspect that nutrient runoff from excess potting soil and fertilizers, combined with lower-than-normal river flow due to diversions, has caused a rash of toxic blue-green algae blooms in the North Coast rivers over the last decade.

The cyanobacteria outbreaks threaten public health for swimmers and kill aquatic invertebrates that salmon and steelhead trout eat. Now, officials warn residents in late summer and fall to stay out of certain stretches of water and keep their dogs out. Eleven dogs have died from ingesting the floating algae since 2001.

The effects are disheartening to many locals because healthier salmon runs were signaling that the rivers were gradually improving from the damage caused by more than a century of logging.

"Now with these water diversions, we're potentially slamming the door on salmon recovery," said Scott Greacen, director of Friends of the Eel River.

In June, Bauer and other agency scientists accompanied game wardens as they executed six search warrants on growers illegally sucking water from tributaries of the Trinity River. At one, he came upon a group of 20-somethings with Michigan license plates on their vehicles, camping next to 400 plants. He followed an irrigation line up to a creek, where the growers had dug a pond and lined it with plastic.

"I started talking to this guy, and he says he used to be an Earth First! tree-sitter, saving the trees," Bauer said. "I told him everything he was doing here negates everything he did as an environmentalist."

The man was a small-timer in this new gold rush. As marijuana floods the market and prices drop, many farmers are cultivating ever bigger crops to make a profit. They now cut huge clearings for industrial-scale greenhouses. With no permits or provisions for runoff, the operations dump tons of silt into the streams during the rainy season.

Scanning Google Earth in his office recently, Bauer came upon a "mega grow" that did not exist the year before — a 4-acre bald spot in the forest with 42 greenhouses, each 100 feet long.

Figuring a single greenhouse that size would hold 80 plants, and each plant uses about 5 gallons of water a day, he estimated the operation would consume 2 million gallons of water in the dry season and unleash a torrent of sediment in the wet season.

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Brain Benefits for the Holidays? Stuff the Stocking with Video Games

Title Post: Brain Benefits for the Holidays? Stuff the Stocking with Video Games
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See If You Can Spot the One Color That Popped on the Carpet This Week

Stylewatch
Style News Now

12/21/2012 at 12:00 PM ET

Getty; Splash News Online; WireImage

Even though we didn’t see as many stars on the red carpet this week as last — it’s quiet in Hollywood this holiday season! — we still saw some strong trends emerge at various events. What were they? Let’s get to it!

Up: Pops of red. You can thank the holidays for this festive mini-trend, which we spotted on Hailee Steinfeld’s purse, Bella Heathcote’s dress and Rose Byrne’s jacket. Adding just a hint of the bold hue to your outfit is an easy way to look all holiday-y without going overboard.

Up: Head-to-toe black. What, are stars sick of sequined dresses already? This week we saw nearly one dozen leading ladies wear all black: Britney Spears, Demi Lovato, LeAnn Rimes, Alexa Chung, Jessica Chastain, Miley Cyrus, Krysten Ritter and Kerry Washington … to name a few. As New Yorkers, we’re always happy to see all-black ensembles en force, and it is a look that’s usually pretty failsafe — and slimming.

Down: Stick-straight hair. Rita Ora was the only woman we saw with pin-straight locks this week; everyone else went for bouncy curls and elegant updos (and cropped cuts, if you count Miley Cyrus!). With Christmas and New Year’s Even upon us, we predict we’ll be seeing a lot more exciting hairdos and less of the minimalist straight looks.

Tell us: Which color are you more likely to wear at the holidays: red or black?

Want more Trend Report? Click to hear our thoughts on mini dresses, cut-outs and collars.

FIND ALL THE LATEST RED CARPET NEWS AND PHOTOS HERE!

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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.

___

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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Flawed data stall California's 911 upgrades

A three-year effort by California to improve 911 emergency service has been stymied by flawed data and aging computers at local fire departments and rescue agencies across the state, a Times investigation has found.

Since 2009, the state Emergency Medical Services Authority has been seeking to centralize reports on millions of emergency medical responses, a project that officials see as critical to improving life-saving practices.

State officials hoped to capture information from the moment dispatchers answer a call until the victim is transferred to a hospital. The program would for the first time give public officials, medical researchers and regulators the ability to compare response times and patient treatment across local jurisdictions.

But the project has floundered because many fire departments and ambulance operations have been unable to provide usable information.

One problem is that fire departments report basic information inconsistently, including how long it takes them to reach victims. Some begin counting the second a 911 call is answered. Others, including the Los Angeles Fire Department, have started the clock when rescue crews are alerted at fire stations.

Moreover, nearly half of the state's 32 regional emergency medical agencies have failed to contribute reports to the system, officials said. And many of those who do file reports use paper records.

The shortcomings, officials and experts said, underscore how fire agencies lag behind police departments and the private sector in using technology to better manage and evaluate their performance.

"There's been a lot of benign neglect in the fire service as far as collecting data," said Robert Upson, a Connecticut fire marshal who has analyzed data for a nationwide group that sets performance standards for fire departments.

"There's so much sloppiness in recording data. It's just built into the system."

Similar troubles have fueled a months-long controversy over faulty response time data at the Los Angeles Fire Department. In March, top commanders admitted that the department had repeatedly published reports overstating how fast rescuers reached victims in need of help. The flawed reports have been blamed on the use of unqualified firefighters to analyze data and outdated computer systems.

In an effort to improve such data, California officials launched their program to collect rich, comparable details on medical emergencies statewide. Incident reports were to be gathered by regional regulatory agencies and forwarded to the state.

But three years and about $1.6 million later, the voluntary project is plagued by lack of participation, money problems and inconsistent information. The root of the problem is that some agencies rely on outmoded, "home-brewed" computer systems, said Tom McGinnis, the state official overseeing the project.

"We can't compare apples to apples. We compare apples to oranges and peaches," McGinnis said.

The state isn't forcing cash-strapped local agencies to participate because doing so would require many to replace computer systems, McGinnis said. "Really what it comes down to is money," he said.

Some experts say the state program won't be able to deliver on its promise until reporting standards are clarified and participation is mandatory.

"It should become a requirement tomorrow," said Bruce Wagner, the top administrator for the emergency medical services agency in Sacramento County.

His agency is among those that have not provided data to the state. That's because fire departments and ambulance firms under his jurisdiction are hesitant to spend time and money gathering records if they are not required to do so, Wagner said.

"It's hard for us to tell them they are going to incur additional costs if it's not mandated," he told The Times.

Los Angeles County, where a third of the state's 911 medical rescues take place, is a year behind in processing performance information because 28 of the county's 31 fire departments submit paper reports, said Cathy Chidester, the local oversight agency's top executive. Voluminous pages of information must be individually scanned into electronic files or manually typed into a county computer system.

"It's like sweeping sand off the beach," Chidester said.

Of the county's three largest fire departments — Los Angeles city, Los Angeles County and Long Beach — only the LAFD collects medical records electronically.

The county Fire Department has not filed reports on more than 300,000 incidents over the last two years because budget cuts eliminated employees working on the records, officials said. Next year, the agency is launching a test program in which paramedics will use iPads to create electronic reports, Chief Deputy Mike Metro said.

The state data project, known as CEMSIS, short for California Emergency Medical Services Information System, has also struggled for funding. It began as a $240,000-a-year demonstration project using federal grants and philanthropic donations. But no permanent funding has been secured.

Where possible, officials are attempting to use the partial records they have compiled for research. But thus far, they haven't been able to answer fundamental questions, including how different agencies' 911 response times compare, McGinnis said.

Ideally, McGinnis said, regulators could use the database to compare "the entire spectrum" of emergency medical care in California. "I want everybody to participate and see what we're doing statewide," he said.

Detailed data could improve understanding of what works best in the field. For example, researchers could examine how often rescuers are able to restore heartbeats after arriving on the scene, a key step in increasing cardiac-arrest survival rates, said Dr. Marc Eckstein, the medical director for the Los Angeles Fire Department.

"You have to really drill down to make sure we are talking about the right things," he said.

Slipping response times at the LAFD were only documented when outside experts, the city controller and The Times dug into the department's data. A series of Times reports found breakdowns and delays in processing 911 calls, dispatching units and summoning the nearest medical rescuers from neighboring jurisdictions.

Los Angeles Fire Commissioner Alan Skobin, who is overseeing a task force charged with overhauling the LAFD's data management, said programs such as California's fledgling 911 records system could help his agency compare its performance to other departments and improve service.

"There's a benefit to looking outside," Skobin said. "That's something the LAFD has to do."

Full coverage: Life on the line, 911 breakdowns at LAFD

Map: How fast is LAFD where you live?

Download: Open-source maps of California's emergency medical agencies

ben.welsh@latimes.com

robert.lopez@latimes.com

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