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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Amid Protest, NRA Calls for Armed Guards in Schools

The National Rifle Association stood its ground today in arguing that the answer to gun violence in schools is an armed security force that can protect students, while blaming the media and violent entertainment and video games for recent deadly shootings.

"The only thing that can stop a bad guy with a gun is a good guy with a gun," NRA executive vice president Wayne LaPierre said in presenting the NRA's first comments about the Connecticut school shooting since it occurred a week ago today.

LaPierre offered no olive branch to gun-control advocates who have called for tougher laws in the wake of the shooting at Sandy Hook Elementary School. Instead, he called for schools across the country to recruit armed security professionals to protect their students.

"It's not just our duty to protect [our children], it's our right to protect them," LaPierre said at a news conference. "The NRA knows there are millions of qualified active and reserved police, active and reserve military, security professionals, rescue personnel, an extraordinary corps of qualified trained citizens to join with local school officials and police in devising a protection plan for every single school."

He was interrupted twice by protestors who stood in front of LaPierre's podium holding signs and shouting that the NRA "has blood on its hands" and that the NRA is "killing our kids." The protestors were eventually escorted out of the room.

LaPierre also scoffed at the notion that banning so-called assault weapons or enacting gun control laws would stop school violence. He instead cast blame for gun violence in schools on violent entertainment, including video games, and the media.

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"How many more copycats are waiting in the wings for their moment of fame from a national media machine that rewards them with a wall of attention they crave while provoking others to make their mark?" he asked.

LaPierre announced that former U.S. congressman Asa Hutchinson of Arkansas would lead the NRA's effort to advocate for school security forces. Hutchinson specified that the NRA is calling for volunteers to act as the armed guards, rather than requiring funding from local or federal authorities.

"Whether they're retired police, retired military or rescue personnel, I think there are people in every community in this country who would be happy to serve if only someone asked them and gave them the training and certifications to do so," Hutchinson said.

NRA leaders have held off on interviews this week after refusing to appear on Sunday morning public affairs shows. They said they would grant interviews beginning next week to discuss their position.

NRA News anchor Ginny Simone said Thursday that in the wake of the Sandy Hook shooting, membership surged "with an average of 8,000 new members a day."

New York City Mayor Michael Bloomberg has said the NRA is partially to blame for the tragedy.

"We're not trying to take away your right to advance the interests of gun owners, hunters, people who want to protect themselves," Bloomberg told "Nightline" anchor Cynthia McFadden in an interview Thursday. "But that's not an absolute right to encourage behavior which causes things like Connecticut. In fact, Connecticut is because of some of their actions."

The guns used in the attack were legally purchased and owned by the shooter's mother, Nancy Lanza, whom Adam Lanza shot to death before his assault on the school.

In the aftermath of the shooting, many, including Bloomberg, have called for stricter regulations on the type of weapons used in this and other instances of mass gun violence this year.

Sen. Dianne Feinstein, D-Calif., has said she intends to introduce a bill banning assault weapons on the first day of next year's Congress -- a step the president said he supports.

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Syrian rebels fight for strategic town in Hama province

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

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

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

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

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

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

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

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

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

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

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

SECTARIAN FEARS

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

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

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

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

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

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

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

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

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

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

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

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

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

LEBANON BORDER POST TAKEN

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

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

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

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

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

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

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

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

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

(Reporting by Erika Solomon; Editing by Andrew Osborn)

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Football: We must remain focused: Duric

BANGKOK: Thanks to Baihakki Khaizan's late strike sealing a 3-1 win for Singapore over Thailand in the first leg of the ASEAN Football Federation Suzuki Cup final on December 19, it now appears that the Lions have one hand firmly on the trophy.

But forward Aleksandar Duric has declared that there is absolutely no room for thoughts like that in the Singapore camp.

The 22-man squad arrived in Bangkok on Thursday for the return leg, which will be played on December 22 at the Supachalasai Stadium, and the veteran marksman has urged his team-mates to keep their eye on the ball.

"Sure it's a nice score at 3-1 for us, but it's only half-time," said Duric, 42.

"The Thais will have a second chance and I'm sure they will want to grab it. For us it's important to stay cool and not do anything stupid on the field.

"I have been telling the younger players how important it is not to lose sight of the mission that is yet to be completed.

"To be overconfident at this stage is the worst thing that can happen to us. Stay cool, stay focused, keep up the hard work and we will be fine."

Duric was speaking upon the team's arrival at their hotel in Bangkok, following a long journey made more tiring by Bangkok's notorious evening rush hour. But despite the many hours spent seated in the coach, the squad looked relaxed.

After a quick meal, the players spent 90 minutes in the hotel's swimming pool as part of the recovery process.

It was also revealed that left-back Shaiful Esah, who received a knock to his head on Wednesday, has been declared fit.

"It has been one tiring day," said Lions team manager Eugene Loo.

"Getting to the airport, clearing immigration and the slow bus ride to the hotel. But we knew what to expect, so there is no irritation or frustration on our part. We are here to do a job and finish it successfully."

- TODAY

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Customs books seven diesel smuggling cases since 2009

NEW DELHI: After gold, it's diesel that is increasingly being smuggled into the country. Multiple cases of diesel smuggling from West Asian nations have come to the notice of the finance ministry, and the government has asked Customs and Coast Guard to enhance surveillance along the western coast.

Most of the cases have been detected along Maharashtra and Gujarat coastline. Customs authorities have booked at least seven cases of diesel smuggling — all in Maharashtra — over the last three years.

Four cases were filed in 2009-10 following seizure of diesel consignment valued at Rs 24 lakh. In 2011-12, three more cases were registered, and the value of diesel seized was Rs 115 lakh.

In a written response to the Rajya Sabha, minister of state for finance S S Palanimanickam said on Thursday that no involvement of Customs officials has come to light so far.

In one of the cases, a vessel from the UAE carrying 890 tonnes of diesel had anchored off Mumbai coast. The Colombo-bound vessel, after offloading half of the consignment, sailed for another destination off Gujarat coast and offloaded part of its consignment mid-sea there.

For more than three weeks, the vessel was shuttling between Gujarat and Mumbai coasts before it was apprehended by Coast Guard officials.

Typically, diesel smuggled from Gulf nations are sold to dealers in western Indian states, and comes at a fraction of the cost of legal procurement that involves Customs and other state duties.

The government is grappling with the surge in gold smuggling after it imposed certain curbs to discourage huge imports of yellow metal since it created major current account deficit.

Gold bars and ornaments were diverted from Singapore and Hong Kong to Thailand and then brought to India, using the loopholes in the free trade agreement. Customs authorities have booked several such smuggling cases in recent months.

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AP IMPACT: Steroids loom in major-college football

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

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

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

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

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

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EDITOR'S NOTE — Whether for athletics or age, Americans from teenagers to baby boomers are trying to get an edge by illegally using anabolic steroids and human growth hormone, despite well-documented risks. This is the first of a two-part series.

___

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Doping is a bigger deal at some schools than others.

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

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

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

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

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

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

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

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

Whether for athletics or age, Americans from teenagers to baby boomers are trying to get an edge by illegally using anabolic steroids and human growth hormone, despite well-documented risks. This is the first of a two-part series.

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Winter Weather Threatens Christmas Travel

A pre-Christmas blizzard that is battering at least eight states in the middle of the nation could trip up travelers headed home for Christmas in the coming days.

Nearly 20 inches of snow have been reported in Colorado just west of Denver. Nebraska has reported 6-to-10 inches so far. Between 3 and 8 inches have accumulated in Iowa already and more is possible. Snow is falling 2 inches per hour in Wisconsin.

No planes were able to land at Iowa's Des Moines International airport. All flights were cancelled until at least 11:45 a.m.

But it's Chicago that will prove most problematic for travelers. Rain has cancelled 300 flights into and out of Chicago O'Hare today so far, according to data from FlightAware. Snow and wind that are expected tonight will further complicate travel and likely cancel more flights.

Several airlines have already issued flexible travel policies, allowing travelers with flights into, out of and through affected areas to change their plans without penalty. For example, travelers headed to O'Hare today on American Airlines can change their flight to any day Dec. 21 to Dec. 25. Delta, United and others have similar policies.

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Airlines for America, an airline industry trade group, estimates that 42 million passengers will fly on U.S. airlines for the 21-day holiday travel period from Dec 17 to Jan 6. Daily passenger volumes are expected to range from 1.5 million to 2.3 million.

The busiest days of the Christmas travel season are expected to be Dec. 21, 22, 23 and 26; and Jan 2. Foul weather in major hub cities, particularly on these days, will most certainly cause travel headaches on the roads and in the skies.

When bad weather grounds flights at major airports, delays pile up around the nation, stranding travelers even in places where the weather is good. And because planes fly so full around the holidays, it's difficult for the airlines to find empty seats to accommodate fliers whose flights have been cancelled.

Passengers are also entitled to a refund if their flight is cancelled.

Travelers should confirm their flight is taking off as planned on their carrier's website before leaving their homes. If you are at the airport by the time you find out, use every avenue available to get re-accommodated. While you stand online to talk to a customer service agent, also call your carrier and use Twitter to get in touch with your airline. Many airlines are faster to respond on Twitter than on the phone. Delta Airlines and JetBlue are particularly active.

A few Twitter handles to know:
@JetBlue
@DeltaAssist
@AmericanAir
@United
@SouthwestAir
@FlyFrontier
@USAirways.

Travelers who find themselves stranded and in need of a hotel room should use apps such as HotelTonight, Travelocity's LastMinute.com Hotel Booking App and the Priceline app to find deals on last-minute hotel stays.

RELATED: The Best Last-Minute Hotel Booking App

The Midwest storm moves east tonight, spreading rain into the Northeast with some areas from Washington, D.C., to Boston getting up to 2 inches. Behind the storm, cold air comes in and changes rain to snow in Western Pennsylvania, Maryland, New York and West Virginia, where 3 to 14 inches (in the highest elevations) could accumulate.

ABC News' Max Golembo and Ginger Zee contributed to this report.

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Clinton not responsible for Benghazi shortcomings: inquiry

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

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

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

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

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

State Department officials declined to comment.

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

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

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

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

"GROSSLY INADEQUATE"

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

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

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

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

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

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

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

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

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

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

The report concluded that there was no such protest.

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

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

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Qantas-Emirates alliance gets conditional approval

SYDNEY: Australia's competition watchdog on Thursday gave its draft approval to a global alliance between struggling carrier Qantas and Dubai-based Emirates, but only for five years initially.

The Australian Competition and Consumer Commission (ACCC) said the benefits, which will see the carriers coordinating ticket prices and flight schedules, would likely outweigh reduced competition on certain routes.

A final decision will be made by March.

"The ACCC considers that the alliance is likely to result in material, although not substantial, benefits to Australian consumers," ACCC chairman Rod Sims said in a statement to the Australian Stock Exchange.

"The main benefit arising from the alliance is an improved product and service offering by the two airlines to their customers.

"This includes increased customer access to each others' flights, destinations and frequent flyer programmes."

Sims added that the alliance would lessen competition on some international routes, but competition from other airlines should mitigate that impact.

However, he said Qantas and Emirates could reduce or limit capacity on routes between Australia and New Zealand under the partnership, which could result in higher airfares.

It was for this reason that the ACCC only gave an initial five-year approval, half the 10 years requested by the airlines. The decision would then be reviewed.

Under the alliance, Qantas will shift its hub for European flights to Dubai from Singapore in a bid to stem losses after this year posting its first annual loss since privatisation in 1995.

The deal goes beyond code sharing to include coordinated pricing, sales and scheduling and a benefit-sharing model, although neither airline will take equity in the other.

For Emirates customers, the alliance will open up Qantas' Australian domestic network of more than 50 destinations and nearly 5,000 flights per week.

- AFP/de

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Delhi HC dismisses PIL challenging Tendulkar's nomination to Rajya Sabha

NEW DELHI: The Delhi high court on Wednesday approved the decision of the Centre to nominate cricketer Sachin Tendulkar to the Rajya Sabha.

Dismissing a PIL challenging Tendulkar's nomination to the Upper House, a division bench of Chief Justice D Murugesan and Justice Rajiv Sahai Endlaw agreed with the Centre's argument that his craft is an art for which he deserves to be considered an artist.

Additional solicitor general Rajeev Mehra and standing counsel Neeraj Chaudhari had maintained on behalf of the Centre that Tendulkar's nomination is as per constitutional provision that also allows induction of experts from the field of sports.

They had said the provision under Article 80 of the Constitution is not confined to inducting experts only from the fields of science, arts, literature and social services, but also from sports, education and other disciplines.

The court had on November 21 reserved its order on the PIL filed by Ram Gopal Singh Sisodia, a former Delhi MLA, challenging Tendulkar's nomination alleging that he does not possess any of the qualifications prescribed under Article 80 of the Constitution for being nominated to the Rajya Sabha.

"A bare reading of the article makes it clear that the person to be nominated should have special knowledge or practical experience in matters like literature, science, arts and social service, but the expertise so required for nomination is not confined to the specific illustrations given in the article," he had said in his petition.

In an affidavit to the HC, the Centre had earlier said, "The special knowledge and practical experience required for the purpose is not confined to the said four categories only but would also include categories like sports, education, law, history, academics attainments, Indology, economics, journalism ... or other similar fields of human endeavour."

Appearing for Sisodia, his counsel R K Kapoor had told the bench that the Constitution allowed the government to nominate to the Rajya Sabha persons only from four disciplines — arts, science, literature and social science — and argued that the nomination of a sportsperson to the Upper House was unconstitutional.

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