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Updated: Monday Dec 31, 2012 | 11:45 AM EST

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AP IMPACT: Big Pharma cashes in on HGH abuse

A federal crackdown on illicit foreign supplies of human growth hormone has failed to stop rampant misuse, and instead has driven record sales of the drug by some of the world's biggest pharmaceutical companies, an Associated Press investigation shows.

The crackdown, which began in 2006, reduced the illegal flow of unregulated supplies from China, India and Mexico.

But since then, Big Pharma has been satisfying the steady desires of U.S. users and abusers, including many who take the drug in the false hope of delaying the effects of aging.

From 2005 to 2011, inflation-adjusted sales of HGH were up 69 percent, according to an AP analysis of pharmaceutical company data collected by the research firm IMS Health. Sales of the average prescription drug rose just 12 percent in that same period.

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

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Unlike other prescription drugs, HGH may be prescribed only for specific uses. U.S. sales are limited by law to treat a rare growth defect in children and a handful of uncommon conditions like short bowel syndrome or Prader-Willi syndrome, a congenital disease that causes reduced muscle tone and a lack of hormones in sex glands.

The AP analysis, supplemented by interviews with experts, shows too many sales and too many prescriptions for the number of people known to be suffering from those ailments. At least half of last year's sales likely went to patients not legally allowed to get the drug. And U.S. pharmacies processed nearly double the expected number of prescriptions.

Peddled as an elixir of life capable of turning middle-aged bodies into lean machines, HGH — a synthesized form of the growth hormone made naturally by the human pituitary gland — winds up in the eager hands of affluent, aging users who hope to slow or even reverse the aging process.

Experts say these folks don't need the drug, and may be harmed by it. The supposed fountain-of-youth medicine can cause enlargement of breast tissue, carpal tunnel syndrome and swelling of hands and feet. Ironically, it also can contribute to aging ailments like heart disease and Type 2 diabetes.

Others in the medical establishment also are taking a fat piece of the profits — doctors who fudge prescriptions, as well as pharmacists and distributors who are content to look the other way. HGH also is sold directly without prescriptions, as new-age snake oil, to patients at anti-aging clinics that operate more like automated drug mills.

Years of raids, sports scandals and media attention haven't stopped major drugmakers from selling a whopping $1.4 billion worth of HGH in the U.S. last year. That's more than industry-wide annual gross sales for penicillin or prescription allergy medicine. Anti-aging HGH regimens vary greatly, with a yearly cost typically ranging from $6,000 to $12,000 for three to six self-injections per week.

Across the U.S., the medication is often dispensed through prescriptions based on improper diagnoses, carefully crafted to exploit wiggle room in the law restricting use of HGH, the AP found.

HGH is often promoted on the Internet with the same kind of before-and-after photos found in miracle diet ads, along with wildly hyped claims of rapid muscle growth, loss of fat, greater vigor, and other exaggerated benefits to adults far beyond their physical prime. Sales also are driven by the personal endorsement of celebrities such as actress Suzanne Somers.

Pharmacies that once risked prosecution for using unauthorized, foreign HGH — improperly labeled as raw pharmaceutical ingredients and smuggled across the border — now simply dispense name brands, often for the same banned uses. And usually with impunity.

Eight companies have been granted permission to market HGH by the U.S. Food and Drug Administration, which reviews the benefits and risks of new drug products. By contrast, three companies are approved for the diabetes drug insulin.

The No. 1 maker, Roche subsidiary Genentech, had nearly $400 million in HGH sales in the U.S. last year, up an inflation-adjusted two-thirds from 2005. Pfizer and Eli Lilly were second and third with $300 million and $220 million in sales, respectively, according to IMS Health. Pfizer now gets more revenue from its HGH brand, Genotropin, than from Zoloft, its well-known depression medicine that lost patent protection.

On their face, the numbers make no sense to the recognized hormone doctors known as endocrinologists who provide legitimate HGH treatment to a small number of patients.

Endocrinologists estimate there are fewer than 45,000 U.S. patients who might legitimately take HGH. They would be expected to use roughly 180,000 prescriptions or refills each year, given that typical patients get three months' worth of HGH at a time, according to doctors and distributors.

Yet U.S. pharmacies last year supplied almost twice that much HGH — 340,000 orders — according to AP's analysis of IMS Health data.

While doctors say more than 90 percent of legitimate patients are children with stunted growth, 40 percent of 442 U.S. side-effect cases tied to HGH over the last year involved people age 18 or older, according to an AP analysis of FDA data. The average adult's age in those cases was 53, far beyond the prime age for sports. The oldest patients were in their 80s.

Some of these medical records even give explicit hints of use to combat aging, justifying treatment with reasons like fatigue, bone thinning and "off-label," which means treatment of an unapproved condition

Even Medicare, the government health program for older Americans, allowed 22,169 HGH prescriptions in 2010, a five-year increase of 78 percent, according to data released by the Centers for Medicare and Medicaid Services in response to an AP public records request.

"There's no question: a lot gets out," said hormone specialist Dr. Mark Molitch of Northwestern University, who helped write medical standards meant to limit HGH treatment to legitimate patients.

And those figures don't include HGH sold directly by doctors without prescriptions at scores of anti-aging medical practices and clinics around the country. Those numbers could only be tallied by drug makers, who have declined to say how many patients they supply and for what conditions.

First marketed in 1985 for children with stunted growth, HGH was soon misappropriated by adults intent on exploiting its modest muscle- and bone-building qualities. Congress limited HGH distribution to the handful of rare conditions in an extraordinary 1990 law, overriding the generally unrestricted right of doctors to prescribe medicines as they see fit.

Despite the law, illicit HGH spread around the sports world in the 1990s, making deep inroads into bodybuilding, college athletics, and professional leagues from baseball to cycling. The even larger banned market among older adults has flourished more recently.

FDA regulations ban the sale of HGH as an anti-aging drug. In fact, since 1990, prescribing it for things like weight loss and strength conditioning has been punishable by 5 to 10 years in prison.

Steve Kleppe, of Scottsdale, Ariz., a restaurant entrepreneur who has taken HGH for almost 15 years to keep feeling young, said he noticed a price jump of about 25 percent after the block on imports. He now buys HGH directly from a doctor at an annual cost of about $8,000 for himself and the same amount for his wife.

Many older patients go for HGH treatment to scores of anti-aging practices and clinics heavily concentrated in retirement states like Florida, Nevada, Arizona and California.

These sites are affiliated with hundreds of doctors who are rarely endocrinologists. Instead, many tout certification by the American Board of Anti-Aging and Regenerative Medicine, though the medical establishment does not recognize the group's bona fides.

The clinics offer personalized programs of "age management" to business executives, affluent retirees, and other patients of means, sometimes coupled with the amenities of a vacation resort. The operations insist there are few, if any, side effects from HGH. Mainstream medical authorities say otherwise.

A 2007 review of 31 medical studies showed swelling in half of HGH patients, with joint pain or diabetes in more than a fifth. A French study of about 7,000 people who took HGH as children found a 30 percent higher risk of death from causes like bone tumors and stroke, stirring a health advisory from U.S. authorities.

For proof that the drug works, marketers turn to images like the memorable one of pot-bellied septuagenarian Dr. Jeffry Life, supposedly transformed into a ripped hulk of himself by his own program available at the upscale Las Vegas-based Cenegenics Elite Health. (He declined to be interviewed.)

These promoters of HGH say there is a connection between the drop-off in growth hormone levels through adulthood and the physical decline that begins in late middle age. Replace the hormone, they say, and the aging process slows.

"It's an easy ruse. People equate hormones with youth," said Dr. Tom Perls, a leading industry critic who does aging research at Boston University. "It's a marketing dream come true."

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Associated Press Writer David B. Caruso reported from New York and AP National Writer Jeff Donn reported from Plymouth, Mass. AP Writer Troy Thibodeaux provided data analysis assistance from New Orleans.

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AP's interactive on the HGH investigation: http://hosted.ap.org/interactives/2012/hgh

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The AP National Investigative Team can be reached at investigate(at)ap.org

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

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Wall Street rallies in choppy day after Obama's "cliff" talk

NEW YORK (Reuters) - U.S. stocks advanced on Monday in a choppy session after comments from President Barack Obama suggesting a deal on the "fiscal cliff" was drawing closer.

The S&P 500 jumped above 1 percent after Obama said it appeared a deal was within sight, but quickly cut some gains when the president noted an agreement was not complete yet. With just an hour left in the final session of 2012, though, the S&P 500 resumed its climb and shot above 1 percent.

A source familiar with the matter said an emerging deal, if adopted by Congress and President Barack Obama, would raise $600 billion in revenue over the next 10 years by increasing tax rates for individuals making more than $400,000 and households earning above $450,000 annually.

A plan is needed in order to avert a combination of tax hikes and spending cuts that many believe could push the U.S. economy into recession.

"There is positive momentum in the market, and we are building up to a deal - markets are definitely starting to price in a deal sometime before tomorrow," said Peter Kenny, managing director at Knight Capital in Jersey City, New Jersey.

"This sounds counterintuitive, but if that doesn't happen, even if we don't get a bridge deal done, that is just going to increase the pressure on a deal getting done."

The gains put the S&P 500 on track to snap a five-day losing skid, its longest losing streak since September.

The Dow Jones industrial average <.dji> gained 136.08 points, or 1.05 percent, to 13,074.19. The Standard & Poor's 500 Index <.spx> rose 19.82 points, or 1.41 percent, to 1,422.25. The Nasdaq Composite Index <.ixic> climbed 59.89 points, or 2.02 percent, to 3,020.20.

The S&P 500 is now up 13.1 percent for the year, compared with a flat performance in 2011. The Dow is up 7 percent and the Nasdaq is up 15.9 percent.

Gains in Apple Inc , the most valuable U.S. company, helped lift the Nasdaq. The stock rose 4.4 percent to $531.85, lifting the S&P information technology sector index <.gspt> up 1.9 percent. For the year so far, Apple is up 31.3 percent.

The Dow was bolstered by Caterpillar Inc and Home Depot , both up more than 1 percent. In late afternoon trading, Caterpillar shot up nearly 3 percent to $86.35.

While a deal on the cliff is not yet official, investors may be ready to take on more risk next year in hopes of a greater reward.

Bank stocks rose after a New York Times report that U.S. regulators are nearing a $10 billion settlement with several banks that would end the government's efforts to hold lenders responsible for faulty foreclosure practices.

Bank of America Corp was up 2.1 percent at $11.59.

Financial stocks were among the strongest of the year, with the S&P financial index <.gspf> surging 25.2 percent for 2012 so far. Bank of America is the top-performing Dow component, with its stock price more than doubling over the past 12 months.

(Reporting by Chuck Mikolajczak; Editing by Jan Paschal)

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Body of India rape victim cremated in New Delhi

NEW DELHI (Reuters) - The body of a woman, whose gang rape provoked protests and rare national debate about violence against women in India, arrived back in New Delhi on Sunday and was cremated at a private ceremony.

Scuffles broke out in central Delhi between police and protesters who say the government is doing too little to protect women. But the 2,000-strong rally was confined to a single area, unlike last week when protests raged up throughout the capital.

Riot police manned barricades along streets leading to India Gate war memorial - a focal point for demonstrators - and, at another gathering point - the centuries-old Jantar Mantar - protesters held banners reading "We want justice!" and "Capital punishment".

Most sex crimes in India go unreported, many offenders go unpunished, and the wheels of justice turn slowly, according to social activists, who say that successive governments have done little to ensure the safety of women.

The unidentified 23-year-old victim of the December 16 gang rape died of her injuries on Saturday, prompting promises of action from a government that has struggled to respond to public outrage.

The medical student had suffered brain injuries and massive internal injuries in the attack and died in hospital in Singapore where she had been taken for treatment.

She and a male friend had been returning home from the cinema, media reports say, when six men on a bus beat them with metal rods and repeatedly raped the woman. The friend survived.

New Delhi has the highest number of sex crimes among India's major cities, with a rape reported on average every 18 hours, police figures show. Reported rape cases rose by nearly 17 percent between 2007 and 2011, according to government data.

Six suspects were charged with murder after her death and face the death penalty if convicted.

In Kolkata, one of India's four biggest cities, police said a man reported that his mother had been gang-raped and killed by a group of six men in a small town near the city on Saturday.

She was killed on her way home with her husband, a senior official said, and the attackers had thrown acid at the husband, raped and killed her, and dumped her body in a roadside pond.

Police declined to give any further details. One officer told Reuters no criminal investigation had yet been launched.

"MISOGYNY"

The leader of India's ruling Congress party, Sonia Gandhi, was seen arriving at the airport when the plane carrying the woman's body from Singapore landed and Prime Minister Mannmohan Singh's convoy was also there.

A Reuters correspondent saw family members who had been with her in Singapore take her body from the airport to their Delhi home in an ambulance with a police escort.

Her body was then taken to a crematorium and cremated. Media were kept away but a Reuters witness saw the woman's family, New Delhi's chief minister, Sheila Dikshit, and the junior home minister, R P N Singh, coming out of the crematorium.

The outcry over the attack caught the government off guard. It took a week for the prime minister to make a statement, infuriating many protesters. Last weekend they fought pitched battles with police.

Issues such as rape, dowry-related deaths and female infanticide rarely enter mainstream political discourse.

Analysts say the death of the woman dubbed "Amanat", an Urdu word meaning "treasure", by some Indian media could change that, though it is too early to say whether the protesters can sustain their momentum through to national elections due in 2014.

U.N. Secretary General Ban Ki-Moon added his voice to those demanding change, calling for "further steps and reforms to deter such crimes and bring perpetrators to justice".

Commentators and sociologists say the incident earlier this month has tapped into a deep well of frustration many Indians feel over what they see as weak governance and poor leadership on social issues.

Newspapers raised doubts about the commitment of both male politicians and the police to protecting women.

"Would the Indian political system and class have been so indifferent to the problem of sexual violence if half or even one-third of all legislators were women?" the Hindu newspaper asked.

The Indian Express said it was more complicated than realizing that the police force was understaffed and underpaid.

"It is geared towards dominating citizens rather than working for them, not to mention being open to influential interests," the newspaper said. "It reflects the misogyny around us, rather than actively fighting for the rights of citizens who happen to be female."

(Additional reporting by Ross Colvin and Diksha Madhokin New Delhi and Sujoy Dhar in Kolkata; Editing by Louise Ireland)

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Fiscal deal stalls as clock ticks to deadline

WASHINGTON (Reuters) - Efforts to prevent the economy from tumbling over a "fiscal cliff" stalled on Sunday as Democrats and Republicans remained at loggerheads over a deal that would prevent taxes for all Americans from rising on New Year's Day.

One hour before they had hoped to present a plan, Democratic and Republican leaders said were still unable to reach a compromise that would stop the automatic tax hikes and spending cuts that could push the economy into recession.

"There are still serious differences between the two sides," Senate Democratic Leader Harry Reid said.

A sticking point appeared to be a Republican proposal floated late on Saturday, which would slow the growth of Social Security retirement benefits in an effort to narrow trillion-dollar budget deficits. Many Democrats, including Reid, have said Social Security should not be touched.

With negotiations at an apparent standstill on Capitol Hill, Senate Republican Leader Mitch McConnell said he would now try to hammer out an agreement with Vice President Joe Biden.

"I'm willing to get this done, but I need a dance partner," McConnell said.

Any agreement needs to be rushed through both chambers of Congress before midnight on Monday. Even if the two sides reach an agreement, procedural barriers in the Senate and the House of Representatives make quick action difficult.

If the politicians cannot agree, then tax increases and across-the-board government spending cuts will begin on January 1. That would take $600 billion out of the economy, push unemployment up and curb federal spending.

Another major disagreement was over tax hikes on the wealthy, an increase sought by President Barack Obama but opposed by Republicans, particularly fiscal conservatives in the House of Representatives.

Republicans aim to pair any tax increase with spending cuts to benefit programs that are projected to grow ever more expensive as the population ages in coming decades.

But their proposal to slow the growth of Social Security benefits by changing the way they are measured against inflation met fierce resistance from Democrats. Obama included the proposal, known as "chained CPI," in an earlier proposal, but many of his fellow Democrats remain opposed.

"POISON PILL"

"We consider it a poison pill - they know we can't accept it. It is a big step back from where we were on Friday," a Senate Democratic aide said.

Obama made a rare appearance on NBC's "Meet the Press" to pressure lawmakers into forging a deal.

Senators appearing on other Sunday morning shows expressed optimism that an agreement could be reached.

Republican Senator Lindsey Graham conceded that an agreement would end up raising income taxes on the wealthy, thus sparing the rest of the country from the looming income tax hikes.

"President Obama is going to get tax rate increases. The president won," Graham tweeted, echoing earlier comments he made on "Fox News Sunday." He told the show that the chances of a bipartisan deal before the New Year's deadline were "exceedingly good."

Obama has alternatively offered Republicans a deal to increase income taxes for households earning over $250,000 a year, and over $400,000 a year.

A White House aide said the president and his staff had been in touch with congressional leaders through the weekend.

Any deal on taxes in the Senate might meet resistance in the House from conservative Republicans.

On NBC, Obama warned of the fallout in financial markets if the two sides did not reach an agreement.

"If people start seeing that on January 1st this problem still hasn't been solved, that we haven't seen the kind of deficit reduction that we could have, had the Republicans been willing to take the deal that I gave them ... then obviously that's going to have an adverse reaction in the markets," Obama said, adding that he had offered Republicans significant compromises that had been rejected repeatedly.

He said he would avoid tax increases for most Americans, even if the talks fall apart.

"If Republicans do in fact decide to block it, so that taxes on middle class families do in fact go up on January 1st, then we'll come back with a new Congress on January 4th and the first bill that will be introduced on the floor will be to cut taxes on middle class families," Obama said.

John Boehner, the speaker of the House of Representatives, rejected Obama's accusations that Republicans were not being amenable to compromise.

"The president's comments today are ironic, as a recurring theme of our negotiations was his unwillingness to agree to anything that would require him to stand up to his own party," Boehner, who has had trouble convincing his Republican colleagues to support his own proposals, said in a statement.

(Additional reporting by Tabassum Zakaria, Rachelle Younglai, David Lawder, Fred Barbash and Richard Cowan. Writing by Andy Sullivan, Editing by Alistair Bell and Jackie Frank)

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Syria opposition leader rejects Moscow invitation

ALEPPO PROVINCE, Syria/BEIRUT (Reuters) - Syria's opposition leader has rejected an invitation from Russia for peace talks, dealing another blow to international hopes that diplomacy can be resurrected to end a 21-month civil war.

Russia, President Bashar al-Assad's main international protector, said on Friday it had sent an invitation for a visit to Moaz Alkhatib, whose six-week-old National Coalition opposition group has been recognized by most Western and Arab states as the legitimate voice of the Syrian people.

But in an interview on Al Jazeera television, Alkhatib said he had already ruled out such a trip and wanted an apology from Moscow for its support for Assad.

"We have clearly said we will not go to Moscow. We could meet in an Arab country if there was a clear agenda," he said.

"Now we also want an apology from (Russian Foreign Minister Sergei) Lavrov because all this time he said that the people will decide their destiny, without foreign intervention. Russia is intervening and meanwhile all these massacres of the Syrian people have happened, treated as if they were a picnic."

"If we don't represent the Syrian people, why do they invite us?" Alkhatib said. "And if we do represent the Syrian people why doesn't Russia respond and issue a clear condemnation of the barbarity of the regime and make a clear call for Assad to step down? This is the basic condition for any negotiations."

With the rebels advancing steadily over the second half of 2012, diplomats have been searching for months for signs that Moscow's willingness to protect Assad is faltering.

So far Russia has stuck to its position that rebels must negotiate with Assad's government, which has ruled since his father seized power in a coup 42 years ago.

"I think a realistic and detailed assessment of the situation inside Syria will prompt reasonable opposition members to seek ways to start a political dialogue," Lavrov said on Friday.

That was immediately dismissed by the opposition: "The coalition is ready for political talks with anyone ... but it will not negotiate with the Assad regime," spokesman Walid al-Bunni told Reuters. "Everything can happen after the Assad regime and all its foundations have gone. After that we can sit down with all Syrians to set out the future."

BRAHIMI TO MOSCOW

Russia says it is behind the efforts of U.N. mediator Lakhdar Brahimi, fresh from a five-day trip to Damascus where he met Assad. Brahimi, due in Moscow for talks on Saturday, is touting a months-old peace plan for a transitional government.

That U.N. plan was long seen as a dead letter, foundering from the outset over the question of whether the transitional body would include Assad or his allies. Brahimi's predecessor, Kofi Annan, quit in frustration shortly after negotiating it.

But with rebels having seized control of large sections of the country in recent months, Russia and the United States have been working with Brahimi to resurrect the plan as the only internationally recognized diplomatic negotiating track.

Russia's Middle East envoy, Deputy Foreign Minister Mikhail Bogdanov, who announced the invitation to Alkhatib, said further talks were scheduled between the "three B's" - himself, Brahimi and U.S. Undersecretary of State William Burns.

Speaking in Damascus on Thursday, Brahimi called for a transitional government with "all the powers of the state", a phrase interpreted by the opposition as potentially signaling tolerance of Assad remaining in some ceremonial role.

But such a plan is anathema to the surging rebels, who now believe they can drive Assad out with a military victory, despite long being outgunned by his forces.

"We do not agree at all with Brahimi's initiative. We do not agree with anything Brahimi says," Colonel Abdel-Jabbar Oqaidi, who heads the rebels' military council in Aleppo province, told reporters at his headquarters there.

Oqaidi said the rebels want Assad and his allies tried in Syria for crimes. Assad himself says he will stay on and fight to the death if necessary.

In the rebel-held town of Kafranbel, demonstrators held up cartoons showing Brahimi speaking to a news conference with toilet bowls in front of him, in place of microphones. Banners denounced the U.N. envoy with obscenities in English.

DIPLOMATS IMPOTENT

Diplomacy has largely been irrelevant to the conflict so far, with Western states ruling out military intervention like the NATO bombing that helped topple Libya's Muammar Gaddafi last year, and Russia and China blocking U.N. action against Assad.

Meanwhile, the fighting has grown fiercer and more sectarian, with rebels mainly from the Sunni Muslim majority battling Assad's government and allied militia dominated by his Alawite sect, an offshoot of Shi'ite Islam.

Still, Western diplomats have repeatedly touted signs of a change in policy from Russia, which they hope could prove decisive, much as Moscow's withdrawal of support for Serbian leader Slobodan Milosevic heralded his downfall a decade ago.

Bogdanov said earlier this month that Assad's forces were losing ground and rebels might win the war, but Russia has since rowed back, with Lavrov last week reiterating Moscow's position that neither side could win through force.

Still, some Moscow-based analysts see the Kremlin coming to accept it must adapt to the possibility of rebel victory.

"As the situation changes on the battlefield, more incentives emerge for seeking a way to stop the military action and move to a phase of political regulation," said Dmitry Trenin, director of the Carnegie Moscow Center.

Meanwhile, on the ground the bloodshed that has killed some 44,000 people continues unabated. According to the pro-opposition Syrian Observatory for Human Rights, a monitoring group based in Britain, 150 people were killed on Thursday, a typical toll as fighting has escalated in recent months.

Government war planes bombarded the town of Assal al-Ward in the Qalamoun district of Damascus province for the first time, killing one person and wounding dozens, the observatory said.

In Aleppo, Syria's northern commercial hub, clashes took place between rebel fighters and army forces around an air force intelligence building in the Zahra quarter, a neighborhood that has been surrounded by rebels for weeks.

(Additional reporting by Omar Fahmy in Cairo, Dominic Evans in Beirut and Steve Gutterman and Alissa de Carbonnel in Moscow; Writing by Peter Graff; Editing by Giles Elgood)

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Phaedra Parks Is Pregnant with Baby No. 2

TV Watch

By Jennifer Garcia

12/28/2012 at 03:00 PM EST

It's a very special holiday season for The Real Housewives of Atlanta star Phaedra Parks and her husband Apollo Nida!

The reality star couple tell PEOPLE exclusively they're expecting a second child together next year.

Parks showed off her growing baby bump while on the beach in the Bahamas, where she's vacationing with her family and friends.

The Atlanta entertainment lawyer married Nida, a certified personal trainer, in 2009 and the couple welcomed son Ayden a year later.

The pair recently released their first fitness DVD, Phine Body on Amazon.com.

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Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.

Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.

Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.

"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."

"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."

The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.

Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.

"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.

She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.

A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.

"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.

Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.

One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.

Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.

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Associated Press reporter Tom Odula contributed to this report.

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Wall Street extends losses, Dow slides 1 percent

When Mommy is away, Dad and son will play. And if your dad works in the video production business, that playtime gets filmed, turned into a time-lapse video and instantly goes viral. Emio Tomeoni, 30, of Kansas City, Mo., works odd hours and often finds...

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Russia's Putin signals he will sign U.S. adoption ban

MOSCOW (Reuters) - President Vladimir Putin signaled on Thursday he would sign into law a bill barring Americans from adopting Russian children and sought to forestall criticism of the move by promising measures to better care for his country's orphans.

In televised comments, Putin tried to appeal to people's patriotism by suggesting that strong and responsible countries should take care of their own and lent his support to a bill that has further strained U.S.-Russia relations.

"There are probably many places in the world where living standards are higher than ours. So what, are we going to send all our children there? Maybe we should move there ourselves?" he said, with sarcasm.

Parliament gave its final approval on Wednesday to the bill, which would also introduce other measures in retaliation for new U.S. legislation which is designed to punish Russians accused of human rights violations.

For it to become law Putin needs to sign it.

"So far I see no reason not to sign it, although I have to review the final text and weigh everything," Putin said at a meeting of federal and regional officials that was shown live on the state's 24-hour news channel.

"I intend to sign not only the law ... but also a presidential decree that will modify the support mechanisms for orphaned children ... especially those who are in a difficult situation, by that I mean in poor health," Putin said.

Critics of the bill say the Russian authorities are playing political games with the lives of children, while the U.S. State Department repeated its "deep concern" over the measure.

"Since 1992 American families have welcomed more than 60,000 Russian children into their homes, and it is misguided to link the fate of children to unrelated political considerations," State Department spokesman Patrick Ventrell said in a statement.

Ventrell added that the United States was troubled by provisions in the bill that would restrict the ability of Russian civil society organizations to work with U.S. partners.

Children in Russia's crowded and troubled orphanage system - particularly those with serious illnesses or disabilities - will have less of a chance of finding homes, and of even surviving, if it becomes law, child rights advocates say.

They point to people like Jessica Long, who was given up shortly after birth by her parents in Siberia but was raised by adoptive parents in the United States and became a Paralympic swimming champion.

However, the Russian authorities point to the deaths of 19 Russian-born children adopted by American parents in the past decade, and lawmakers named the bill after a boy who died of heat stroke in Virginia after his adoptive father left him locked in a car for hours.

Putin reiterated Russian complaints that U.S. courts have been too lenient on parents in such cases, saying Russia has inadequate access to Russian-born children in the United States despite a bilateral agreement that entered into force on November 1.

NATIONAL IDENTITY

But Putin, who began a new six-year term in May and has searched for ways to unite the country during 13 years in power, suggested there were deeper motives for such a ban.

"For centuries, neither spiritual nor state leaders sent anyone abroad," he said, indicating he was not speaking specifically about Russia but about many societies.

"They always fight for their national identities - they gather themselves together in a fist, they fight for their language, culture," he said.

The bid to ban American adoptions plays on sensitivity in Russia about adoptions by foreigners, which skyrocketed as the social safety net unraveled with the 1991 Soviet collapse.

Families from the United States adopt more Russian children than those of any other country.

Putin had earlier described the Russian bill as an emotional but appropriate response to the Magnitsky Act, legislation signed by President Barack Obama this month as part of a law granting Russia "permanent normal trade relations" (PNTR) status.

The U.S. law imposes visa bans and asset freezes on Russians accused of human rights violations, including those linked to the death in a Moscow jail of Sergei Magnitsky, an anti-graft lawyer, in 2009.

The Russian bill would impose similar measures against Americans accused of violating the rights of Russian abroad and outlaw some U.S.-funded non-governmental groups.

(Reporting By Alexei Anishchuk; additional reporting by Andrew Quinn in Washington; Writing by Alissa de Carbonnel and Steve Gutterman; Editing by Andrew Osborn and Doina Chiacu)

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