Taliban suicide bomber kills 23 in Pakistan

ISLAMABAD (AP) — A Taliban suicide bomber struck a Shiite Muslim procession near Pakistan's capital, killing 23 people in the latest of a series of bombings targeting Shiites during the holiest month of the year for the sect, officials said Thursday.

The bomber attacked the procession around midnight Wednesday in the city of Rawalpindi, located next to the capital, Islamabad, said Deeba Shahnaz, a state rescue official. At least 62 people were wounded by the blast, including six policemen. Eight of the dead and wounded were children, said Shahnaz.

Police tried to stop and search the bomber as he attempted to join the procession, but he ran past them and detonated his explosives, said senior police official Haseeb Shah. The attacker was also carrying grenades, some of which exploded, said Shah.

"I think the explosives combined with grenades caused the big loss," said Shah.

Local TV footage showed the scene of the bombing littered with body parts and smeared with blood. Shiites beat their heads and chests in anguish.

"It was like the world was ending," said one of the victims, Nasir Shah, describing the blast. He was being treated at a local hospital for wounds to his hands and legs.

Earlier Wednesday, the Taliban set off two bombs within minutes outside a Shiite mosque in the southern city of Karachi, killing one person and wounding 15 others, senior police official Javed Odho said.

Pakistani Taliban spokesman Ahsanullah Ahsan claimed responsibility for the attacks in Rawalpindi and Karachi.

"We have a war of belief with Shiites," Ahsan told The Associated Press by telephone from an undisclosed location. "They are blasphemers. We will continue attacking them."

The Sunni-Shiite schism over the true heir to Islam's Prophet Muhammad dates back to the seventh century.

Shiites are currently observing the holy month of Muharram. On Saturday, Shiites will observe the holiest day of the month, Ashoura, which commemorates the seventh century death of Imam Hussein, the Prophet Muhammad's grandson.

The country has a long history of sectarian violence carried out by both extremist Sunni and Shiite Muslims against the opposite sect. Most attacks in recent years have targeted Shiites, who make up a minority in the overwhelmingly Muslim country.

The Pakistani government increases security every Muharram to protect Shiites. But attacks regularly occur, and activists criticize the government for not doing enough to safeguard the minority sect.

Hamid Ali Shah Moasvi, head of the main Shiite political party in Pakistan, Tehrik-e-Nifaz-e-Fiqh Jafariya, condemned the recent attacks, but vowed that Shiites would not be deterred from attending religious gatherings during Muharram.

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Associated Press writers Rasool Dawar in Peshawar, Pakistan, and Adil Jawad in Karachi, Pakistan, contributed to this report.

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Chevy Chase is leaving NBC's sitcom 'Community'

LOS ANGELES (AP) — The NBC series "Community" will finish the season without Chevy Chase.

Sony Pictures Television said Wednesday that the actor is leaving the sitcom by mutual agreement with producers.

His immediate departure means he won't be included in the last episode or two of the show's 13-episode season, which is still in production.

Chase had a rocky tenure playing a bored and wealthy man who enrolls in community college. The actor publicly expressed unhappiness at working on a sitcom and feuded last year with the show's creator and former executive producer, Dan Harmon.

The fourth-season premiere of "Community" is Feb. 7, when it makes a delayed return to the 8 p.m. EST Thursday time slot. The show's ensemble cast includes Joel McHale and Donald Glover.

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Study finds mammograms lead to unneeded treatment

Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.

"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

___

Online:

Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Screening advice: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Violence flares as Clinton seeks Gaza truce

GAZA/JERUSALEM (Reuters) - U.S. Secretary of State Hillary Clinton on Wednesday pursued a Gaza truce, with Israel and Hamas still at odds over key terms, as Israeli air strikes shook the enclave and a bomb exploded on a Tel Aviv bus.

After talks in Ramallah with Palestinian President Mahmoud Abbas, Clinton held a second meeting with Israeli Prime Minister Benjamin Netanyahu before heading to Egypt, the main broker in efforts to end eight days of fighting and avert a possible Israeli ground offensive.

In Tel Aviv, at least 10 people were wounded when a bus was blown up on a main street near the Defence Ministry and military headquarters. Israel's government called it a terrorist attack.

The explosion, which police said was caused by a bomb placed on the vehicle, touched off celebratory gunfire from militants in Gaza and threatened to complicate truce efforts.

Israel's best-selling Yedioth Ahronoth newspaper said an emerging outline of a ceasefire agreement called for Egypt to announce a 72-hour ceasefire followed by further talks on long-term understandings.

Under the proposed document, which the newspaper said neither party would be required to sign, Israel would hold its fire, end attacks against top militants and promise to examine ways to ease its blockade of the enclave.

Hamas, the report said, would pledge not to strike any Israeli target and ensure other Palestinian factions in the Gaza Strip also stop their attacks.

An Israeli political source said differences holding up a deal centered on a Hamas demand to lift the Gaza blockade completely and the kind of activity that would be allowed along the frontier, where Israeli troops often fire into the enclave to keep Palestinians away from an area near a border fence.

Hamas official Ezzat al-Rishq said the main stumbling block was "the temporary timeframe for a ceasefire that the Israelis want us to agree to".

"GOOD INTENTIONS"

The London-based Al Hayat newspaper, citing sources in Hamas and Islamic Jihad, said Israel wanted a 90-day period to determine "good intentions" before discussing Palestinian demands, a position the report said the groups have rejected.

Rishq said a short-term truce, whose proposed duration he did not disclose, "would only buy (Israel) time" until a general election in January and "we would have accomplished nothing in the way of a long-term truce".

Hamas sources said the group was also demanding control over Gaza's Rafah borders with Egypt, so that Palestinians could cross easily, and Israeli guarantees to stop assassinating Hamas leaders.

Israel, one of the Hamas sources said, wanted a commitment from the group to stop smuggling through tunnels that run into Gaza under the Egyptian border. The tunnel network is a conduit for weapons and commercial goods.

News of the Tel Aviv bus bombing, the first serious blast in Israel's commercial capital since 2006, emerged just after Clinton and Netanyahu ended their meeting. A spokesman for Netanyahu declined to give details on their discussions, which followed talks on Tuesday.

Clinton, who flew to the region from an Asian summit, said in her public remarks after Tuesday's meeting with Netanyahu that it was "essential to de-escalate the situation".

"The rocket attacks from terrorist organizations inside Gaza on Israeli cities and towns must end and a broader calm restored," she said.

Clinton earlier assured Netanyahu of "rock-solid" U.S. support for Israel's security, and praised Egyptian President Mohamed Mursi's "personal leadership and Egypt's efforts thus far" to end the Gaza conflict and promote regional stability.

"As a regional leader and neighbor, Egypt has the opportunity and responsibility to continue playing a crucial and constructive role in this process. I will carry this message to Cairo tomorrow (Wednesday)," she said.

"LONG-TERM" SOLUTION

Netanyahu told Clinton he wanted a "long-term" solution. Failing that, Netanyahu made clear, that he stood ready to step up the military campaign to silence Hamas' rockets.

"A band-aid solution will only cause another round of violence," said Ofir Gendelman, a Netanyahu spokesman.

While diplomatic efforts continued, Israel struck more than 100 targets in Gaza overnight, killing a Hamas gunman and destroying a cluster of Hamas government buildings.

Palestinians militants fired 31 rockets at Israel, causing no casualties, and Israel's Iron Dome interceptor system shot down 14 of them, police said.

Israel has carried out more than 1,500 strikes since the offensive began. Medical officials in Gaza said 139 Palestinians, most of them civilians, including 34 children, have been killed. Nearly 1,400 rockets have been fired into Israel, killing four civilians and a soldier, the Israeli military said.

In the West Bank city of Ramallah, Clinton held talks with Palestinian President Abbas, whose bid to upgrade the Palestinians' status at the United Nations, in the absence of peace negotiations with Israel, is opposed by Washington.

"Secretary Clinton informed the president that the U.S. administration is exerting every possible effort to reach an immediate ceasefire and the president expressed his full support for this endeavor," said Palestinian chief negotiator Saeb Erekat.

"Once the Israelis accept to stop their bombardments, their assassinations, there will be a comprehensive ceasefire sustained from all parties," Erekat said.

A Palestinian official with knowledge of Cairo's mediation told Reuters that Egyptian intelligence officials would hold further discussions on Wednesday with leaders of Hamas and the Islamic Jihad group.

"There may be a response from Israel that Egyptian mediators want to present to Hamas and Islamic Jihad leaders," the official said. "Let's be hopeful it would be something Palestinian factions can accept."

Like most Western powers, Washington shuns Hamas as an obstacle to peace and has blamed it for the Gaza conflagration. A U.N. Security Council statement condemning the conflict was blocked on Tuesday by the United States, which complained that it "failed to address the root cause," the Palestinian rockets.

Hamas for its part is exploring the opportunities that last year's Arab Spring has given it to enjoy favor from new Islamist governments, and from Sunni Gulf powers keen to woo it away from Shi'ite Iran.

It may count on some sympathy from Mursi, although Egypt's first freely elected leader, whose Muslim Brotherhood inspired Hamas' founders, has been careful to stick by the 1979 peace deal with Israel struck by Cairo's former military rulers.

Along the Gaza border, Israeli tanks, artillery and infantry remained poised for a possible ground offensive in the densely populated enclave of 1.7 million Palestinians.

But an invasion, likely to entail heavy casualties, would be a major political risk for Netanyahu, who is currently favored to win the upcoming Israeli election. More than 1,400 Palestinians were killed in Israel's three-week war in the Gaza Strip in 2008-9, prompting international criticism of Israel.

(Additional reporting by Ari Rabinovitch in Jerusalem and Cairo bureau; Writing by Jeffrey Heller; Editing by Giles Elgood)

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S'pore opposition leader freed from bankruptcy

SINGAPORE (AP) — Prominent Singapore opposition leader Chee Soon Juan has been discharged from bankruptcy, the government said Wednesday, after an unprecedented concession by two former prime ministers to whom he owed about $408,000.

Ex-prime ministers Lee Kuan Yew and Goh Chok Tong agreed to accept a reduced amount of 30,000 Singapore dollars ($24,500) from Chee, which will free him from bankruptcy proceedings formally on Friday, said a statement by the Insolvency and Public Trustee's Office.

Chee, the firebrand leader of the Singapore Democratic Party, was declared a bankrupt in 2006 after he failed to pay S$500,000 in court-ordered damages to Lee and Goh. The two had sued him for defamation for comments he made against them during the 2001 general elections.

The development means Chee, 50, will be able to travel outside the country freely and also contest the next elections, which are due in 2016. Still, some commentators saw the concession by Lee and Goh as a political maneuver — allowing Chee to contest the elections could split the fragmented opposition's votes further at a time the ruling People Action Party itself has lost much popular support because of rising prices and an influx of foreigners.

"It could be that Lee Kuan Yew has mellowed, but it's hard to believe that he has changed because it doesn't fit his character," said respected political commentator and former newspaper editor P.N. Balji.

"The other possibility, to discharge Chee from bankrupt, could be to 'muddy the waters' especially for the coming general elections. Chee's party and the (other opposition) Workers' Party do not see eye to eye and there might be a split in votes for the opposition," Balji told the Associated Press.

Lee, modern Singapore's founding father, and Goh have frequently and successfully sued opposition leaders and other critics for defamation. A report published by the Human Rights Watch in January criticised the country for resorting to charges of contempt of court, criminal and civil defamation as well as sedition to rein in its critics. Among those sued are publications such as The Economist, the International Herald Tribune and Far Eastern Economic Review.

Lee was Singapore's prime minister from 1959 to 1990, when he handed over power to Goh. Lee continued to work for the government, first as "senior minister," a non-executive advisory post specially created for him, and from 2004 until 2011 as "minister mentor." Goh was prime minister from 1990 to 2004, when the prime ministership went to Lee's son, Lee Hsien Loong.

Chee, a trained neuropsychologist, raised the S$30,000 primarily through donations and proceeds from the sale of his books on politics. He was informed in September that both Lee and Goh were willing to accept the reduced amount.

"As the creditors have not objected to Dr. Chee's debt settlement proposal, it is deemed that they have accepted the proposal, as provided for under the Bankruptcy Act," the statement from the Insolvency and Public Trustee's Office said.

As a bankrupt, Chee was required to seek government's permission to travel. Earlier this year his request to attend the Oslo Freedom Forum — a conference on human rights where Chee was scheduled to be a guest speaker — was denied.

"The important thing (is that) being discharged from bankruptcy means it will allow me to plan and lead the party into the next general election," Chee told the AP.

"The big strategy that we're banking on right now is to come up with shadow policies on healthcare and housing as alternatives to that of the government. The PAP is floundering in these policies and in taking the country forward."

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Republic Wireless Now Offering $19/Month Unlimited Smartphone Service to All

Prepaid wireless carrier Republic Wireless has been offering its $ 19 per month, unlimited everything, prepaid smartphone plan since about this time last year. At the time, though, there were a few catches; you had to buy a very low-end smartphone from them, you had to use its Hybrid Calling technology for most of your calls, and you could only get in if you were lucky enough to be accepted to an exclusive “beta wave.”

Since then, Republic Wireless has upgraded to the slightly more modern Motorola Defy XT as its flagship smartphone model, and has changed to allow unlimited calling, texting, and data over Sprint’s nationwide network, for the same $ 19/month price. Now the North Carolina-based startup is dropping its last restriction; the doors are open for anyone to preorder up to four Defy XT phones, “and they’ll begin shipping in mid-December.”

​The phone

The Motorola Defy XT is designed to be dustproof and waterproof, with rubber bumpers covering each port and an unlocking switch keeping the back cover sealed. Its specs are decidedly last year’s; powered by a 1 GHz, single-core processor, it often shows Kindle Fire-style lag when swiping between home screens on its 3.7 inch display. It runs 2010′s Android 2.3 Gingerbread, with no OS upgrades announced, and it doesn’t have much room to store games and apps, although it comes with a 2 GB microSD card.

​The service

Republic Wireless’ low monthly fee is partly made possible by its Hybrid Calling technology, which is basically an app that loads on startup and lets you make calls and send texts over Wi-Fi. Call quality is generally good, although it depends on how good your Wi-Fi connection is and how many people are streaming video over it while you’re trying to make your call. You can switch off Hybrid Calling by disabling Wi-Fi, if you want to make calls over Sprint’s network instead; this happens automatically if your Wi-Fi signal drops, which has the effect of hanging up your call.

​The support

“Here at Republic,” its Support page explains, “we believe in helping each other out as much as possible.” What this translates to is that there’s no number to call for questions or tech support. Instead, customers are directed to a community wiki and forums, for answers to their issues. If all else fails, you can contact Republic using an online form, and receive a response within 24 hours.

​The price

It costs close to $ 300 to begin using Republic Wireless’ service; $ 249 for the phone, a $ 10 startup fee, and $ 19 for your first monthly fee, before any applicable taxes. That $ 19 is charged once your phone ships, and if Republic’s difficulty keeping up with orders for its first beta waves is any indication, just because the phones “begin shipping in mid-December” doesn’t necessarily mean that that’s when you’ll get yours.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.
Linux/Open Source News Headlines – Yahoo! News

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Elmo left behind on 'Sesame Street' as actor exits

NEW YORK (AP) — Even on "Sesame Street," where everything is famously A-OK, problems can arise for its residents.

And that includes the Muppets. Cookie Monster grapples with an eating disorder. Oscar the Grouch gets cranky. Mr. Snuffleupagus gets the blues.

But Elmo seemed immune to any of that. Since enjoying his breakout success more than two decades ago, the 3 1/2-year-old red monster has radiated good cheer, love and trilling giggles. No wonder everyone — adults as well as children — adore him.

The key to Elmo is "his innocence, his positiveness and his sweetness," according to Kevin Clash, the man who created him and once told The Associated Press, "I would love to be totally like Elmo."

Now Clash has been scandalously separated from Elmo and from "Sesame Street," the TV series where he reigned behind the scenes for 28 years.

Clash spoke of "personal matters" as the cause of his resignation Tuesday after an unthinkable nine-day stretch that began with an unnamed man in his 20s claiming he had sex with Clash at age 16. That allegation was quickly recanted. But then came another accusation of sexual abuse, and a lawsuit.

That second accuser, a 24-year-old college student named Cecil Singleton, said the actor had engaged in sexual behavior with him when he was 15. He is suing Clash for $5 million.

"I am deeply sorry to be leaving," said Clash in his parting statement, "and am looking forward to resolving these personal matters privately."

But privacy may no longer be possible for Clash, the 52-year-old divorced father of a grown daughter who acknowledged last week that he is gay. Singleton's lawyer, Jeff Herman, said he has been contacted by two other potential victims of Clash and expects additional legal action.

At a news conference Tuesday, Singleton said he and Clash met on a gay chat line and then, for a two-week period, they engaged in sexual contact, though not intercourse. Sex with a person under 17 is a felony in New York if the perpetrator is 21 or older.

Singleton said he didn't know Clash's profession until years later, when he Googled the man's name.

"I was shocked when I found out what he did for a living," said Singleton.

Now that career has ended for Clash, who, in his dream job as a puppeteer for "Sesame Street," was assigned a little-used puppet now known as Elmo, then turned him into a star. In the process, Clash won 23 daytime Emmy awards and one prime-time Emmy. He published his 2006 autobiography, "My Life as a Furry Red Monster," and was the subject of the 2011 documentary "Being Elmo: A Puppeteer's Journey."

Elmo overshadowed Big Bird and other "Sesame" Muppets in popularity and screen time, while marginalizing the cast of live actors. Since 1998, he has had his own show-within-a-show on "Sesame Street" in addition to appearances elsewhere in the hour.

He is also a major moneymaker for Sesame Workshop, the New York-based company that produces the show, and for licensees. At his merchandising height in 1996, he inspired the Tickle Me Elmo doll, which became a cultural phenomenon and that Christmas season's hottest toy.

This year's Elmo dolls, "LOL Elmo," which giggles, and "Let's Rock! Elmo," which sings and comes with a microphone and drum set, haven't made any of this year's hot toy lists. Even so, Elmo toys probably account for one-half to two-thirds of the $75 million in annual sales the "Sesame Street" toy line generates for toy maker Hasbro, estimates BMO Capital Markets analyst Gerrick Johnson.

Johnson said he wasn't sure how this week's news might affect sales of Elmo toys this holiday.

"How many people are going to want to explain to their kid why they're not getting an Elmo?" he asked.

On Tuesday, Hasbro issued a statement saying "We are confident that Elmo will remain an integral part of Sesame Street and that Sesame Street toys will continue to delight children for years to come."

Despite his resignation, Clash will remain an integral part of "Sesame Street" for the foreseeable future. Taping of season No. 44 will wrap by mid-December and will begin airing next September, according to someone close to the show who spoke on condition of anonymity because the person was not authorized to publicly discuss details of its production. That means new episodes with Clash performing as Elmo will presumably continue well into 2014.

As for who might take over as Elmo, other "Sesame Street" puppeteers were already being trained to serve as Clash's stand-in, Sesame Workshop said. It's part of an understudy policy being adopted for all the major Muppet characters.

But no one knows how Elmo will fare going forward. Will the jokes spurred by Clash's downfall leave a lasting mark on Elmo's image? Will there be parents who see him tainted by association with the man who brought him to life?

In the wake of a personal tragedy that may still be unfolding, Elmo's innocence, positiveness and sweetness will be put to the test.

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AP Television Writer David Bauder and AP Retail Writer Mae Anderson contributed to this report.

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OB/GYNs back over-the-counter birth control pills

WASHINGTON (AP) — No prescription or doctor's exam needed: The nation's largest group of obstetricians and gynecologists says birth control pills should be sold over the counter, like condoms.

Tuesday's surprise opinion from these gatekeepers of contraception could boost longtime efforts by women's advocates to make the pill more accessible.

But no one expects the pill to be sold without a prescription any time soon: A company would have to seek government permission first, and it's not clear if any are considering it. Plus there are big questions about what such a move would mean for many women's wallets if it were no longer covered by insurance.

Still, momentum may be building.

Already, anyone 17 or older doesn't need to see a doctor before buying the morning-after pill — a higher-dose version of regular birth control that can prevent pregnancy if taken shortly after unprotected sex. Earlier this year, the Food and Drug Administration held a meeting to gather ideas about how to sell regular oral contraceptives without a prescription, too.

Now the influential American College of Obstetricians and Gynecologists is declaring it's safe to sell the pill that way.

Wait, why would doctors who make money from women's yearly visits for a birth-control prescription advocate giving that up?

Half of the nation's pregnancies every year are unintended, a rate that hasn't changed in 20 years — and easier access to birth control pills could help, said Dr. Kavita Nanda, an OB/GYN who co-authored the opinion for the doctors group.

"It's unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem," said Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International.

Many women have trouble affording a doctor's visit, or getting an appointment in time when their pills are running low — which can lead to skipped doses, Nanda added.

If the pill didn't require a prescription, women could "pick it up in the middle of the night if they run out," she said. "It removes those types of barriers."

Tuesday, the FDA said it was willing to meet with any company interested in making the pill nonprescription, to discuss what if any studies would be needed.

Then there's the price question. The Obama administration's new health care law requires FDA-approved contraceptives to be available without copays for women enrolled in most workplace health plans.

If the pill were sold without a prescription, it wouldn't be covered under that provision, just as condoms aren't, said Health and Human Services spokesman Tait Sye.

ACOG's opinion, published in the journal Obstetrics & Gynecology, says any move toward making the pill nonprescription should address that cost issue. Not all women are eligible for the free birth control provision, it noted, citing a recent survey that found young women and the uninsured pay an average of $16 per month's supply.

The doctors group made clear that:

—Birth control pills are very safe. Blood clots, the main serious side effect, happen very rarely, and are a bigger threat during pregnancy and right after giving birth.

—Women can easily tell if they have risk factors, such as smoking or having a previous clot, and should avoid the pill.

—Other over-the-counter drugs are sold despite rare but serious side effects, such as stomach bleeding from aspirin and liver damage from acetaminophen.

—And there's no need for a Pap smear or pelvic exam before using birth control pills. But women should be told to continue getting check-ups as needed, or if they'd like to discuss other forms of birth control such as implantable contraceptives that do require a physician's involvement.

The group didn't address teen use of contraception. Despite protests from reproductive health specialists, current U.S. policy requires girls younger than 17 to produce a prescription for the morning-after pill, meaning pharmacists must check customers' ages. Presumably regular birth control pills would be treated the same way.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don't require a prescription.

Switching isn't a new idea. In Washington state a few years ago, a pilot project concluded that pharmacists successfully supplied women with a variety of hormonal contraceptives, including birth control pills, without a doctor's involvement. The question was how to pay for it.

Some pharmacies in parts of London have a similar project under way, and a recent report from that country's health officials concluded the program is working well enough that it should be expanded.

And in El Paso, Texas, researchers studied 500 women who regularly crossed the border into Mexico to buy birth control pills, where some U.S. brands sell over the counter for a few dollars a pack. Over nine months, the women who bought in Mexico stuck with their contraception better than another 500 women who received the pill from public clinics in El Paso, possibly because the clinic users had to wait for appointments, said Dr. Dan Grossman of the University of California, San Francisco, and the nonprofit research group Ibis Reproductive Health.

"Being able to easily get the pill when you need it makes a difference," he said.

___

Online:

OB/GYN group: http://www.acog.org

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Clinton heads to Mideast amid Gaza crisis

GAZA CITY, Gaza Strip (AP) — Efforts to end a week-old convulsion of Israeli-Palestinian violence drew in the world's top diplomats on Tuesday, with President Barack Obama dispatching his secretary of state to the region on an emergency mission and the U.N. chief appealing from Cairo for an immediate cease-fire.

Israel and Gaza's militant Hamas rulers have staked out tough, hard-to-bridge positions, and the gaps keep alive the threat of an Israeli ground invasion. On Tuesday, grieving Gazans were burying militants and civilians killed in ongoing Israeli airstrikes, and barrages of rockets from Gaza sent terrified Israelis scurrying to take cover.

From Egypt, U.N. chief Ban Ki-moon said he came to the region because of the "alarming situation."

"This must stop, immediate steps are needed to avoid further escalation, including a ground operation," Ban said. "Both sides must hold fire immediately ... Further escalation of the situation could put the entire region at risk."

U.S. Secretary of State Hillary Rodham Clinton departed for the Mideast on Tuesday from Cambodia, where she had accompanied Obama on a visit. Clinton is to meet with Israeli Prime Minister Benjamin Netanyahu in Jerusalem, Palestinian President Mahmoud Abbas in the West Bank and Egyptian leaders in Cairo, according to U.S. and Palestinian officials.

The U.S. considers Hamas, which has killed hundreds of Israelis in suicide and other attacks, to be a terror group and does not meet with its officials. Washington blames Hamas rocket fire for the latest eruption of violence and says Israel has the right to defend itself. At the same time, it has cautioned that a ground invasion could send casualties spiraling.

By Tuesday, 115 Palestinians, including 54 civilians, have been killed since Israel mounted an air onslaught that has so far included nearly 1,500 strikes. Some 840 people have been wounded, including 225 children, Gaza health officials said.

Three Israeli civilians have also been killed and dozens wounded since the fighting began last week, the numbers possibly kept down by a rocket-defense system Israel developed with U.S. funding. More than 1,000 rockets have been fired at Israel this week, the military said.

Netanyahu said Tuesday that Israel wouldn't balk at a broader military operation.

"I prefer a diplomatic solution," Netanyahu said in a statement after meeting with Germany's foreign minister, Guido Westerwelle, who is also in the region trying to advance peace efforts. "But if the fire continues, we will be forced to take broader measures and will not hesitate to do so."

Successive Israeli governments have struggled to come up with an effective policy toward Hamas.

Neither Israel's economic blockade of the territory of 1.6 million people nor bruising military strikes have cowed Gaza's Islamists, weakened their grip on the coastal strip or fire rockets at the Jewish state.

An Israeli ground invasion would risk Israeli troop losses, and could send the number of Palestinian civilian casualties ballooning — a toll Israel could be reluctant to risk just four years after its last invasion drew allegations of war crimes.

Still, with Israeli elections just two months away, polls show Israeli public sentiment has lined up staunchly behind the Netanyahu government's offensive.

Turkey's foreign minister and a delegation of Arab League foreign ministers headed to Gaza on Tuesday on a separate truce mission. Before setting off, Foreign Minister Ahmet Davutoglu signaled Turkey was in contact with Israel bout a truce — an important development given the two countries' chilly ties.

"We would be involved in all kinds of efforts if it amounted to saving the life of a single brother from Gaza," Davutoglu said. "We are determined to keep all direct or indirect channels (of dialogue) open."

Turkey's once-close ties with Israel frayed badly over the high civilian toll during Israel's 2009 war in Gaza.

With tens of thousands of Israeli soldiers dispatched to the Gaza border, awaiting a possible order to invade, the truce missions were all the more urgent.

Egypt, the traditional mediator between Israel and the Arab world, has been at the center of recent diplomatic efforts.

Israel demands an end to rocket fire from Gaza and a halt to weapons smuggling into Gaza through tunnels under the border with Egypt. It also wants international guarantees that Hamas will not rearm or use Egypt's Sinai region, which abuts both Gaza and southern Israel, to attack Israelis.

Hamas wants Israel to halt all attacks on Gaza and lift tight restrictions on trade and movement to and from the territory imposed after Hamas seized Gaza by force in 2007. Israel has rejected such demands in the past.

Resurgent rocket fire set off the Israeli offensive, launched with the assassination of the Hamas military chief and followed by hundreds of airstrikes on militant rocket launchers and weapons stores.

The onslaught turned deadlier over the weekend, as airstrikes began targeting the homes of suspected Hamas activists, leading to a spike in civilian casualties. Israel sent warnings in some cases, witnesses said, but in other instances missiles hit suddenly, burying residents under the rubble of their homes.

Hamas is deeply rooted in densely populated Gaza, and the movement's activists live in the midst of ordinary Gazans. Israel says militants are using civilians as human shields, both for their own safety and to launch rocket strikes from residential neighborhoods.

In one case, a senior member of the military wing of Islamic Jihad rented a small apartment in a 15-story high-rise of offices and news outlets. The militant, Ramez Harb, was killed Monday in a rocket strike that damaged the building.

One journalist said he and others were furious that Harb had apparently used their building as a hideout, putting others at risk. He spoke on condition of anonymity because he feared repercussions from Gaza militants.

Early Tuesday, Israeli aircraft targeted another Hamas symbol of power, the headquarters of a bank senior Hamas officials set up to sidestep international sanctions on the militant group's rule. After Hamas overran Gaza, foreign lenders stopped doing business with its militant-led government, afraid of running afoul of international terror financing laws.

The inside of the bank was destroyed and a building supply business in the basement was damaged.

"I'm not involved in politics," said the business owner, Suleiman Tawil. "I'm a businessman. But the more the Israelis pressure us, the more we will support Hamas."

Israel and Gaza's militants have a long history of fighting, but the dynamics have changed radically since they last warred four years ago. Though their hardware is no match for the Israeli military, militants have upgraded their capabilities with weapons smuggled in from Iran and Libya, Israeli officials claim.

Only a few years ago, tens of thousands of Israelis were within rocket range. Today those numbers have swollen to 3.5 million, as the militants' improved weapons reached Tel Aviv and Jerusalem for the first time this past week.

Hamas, a branch of the region-wide Muslim Brotherhood, is also negotiating from a stronger position than four years ago. At that time, Hamas was internationally isolated; now, the Muslim Brotherhood is in power in Egypt and Tunisia, and Hamas is also getting political support from Qatar and Turkey.

At home, too, the military offensive has shored up Hamas at a time when it was riven by internal divisions over its direction and the new Egyptian government's refusal to lift the blockade it imposed along with Israel after Hamas seized the territory.

This newfound backing contrasts radically with the loss of stature the Western-backed Palestinian President Mahmoud Abbas has endured as Palestinians lose faith in his ability to bring them a state through negotiations with Israel.

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Teibel reported from Jerusalem. With contributions from Ibrahim Barzak in Gaza City and Suzan Fraser in Ankara, Turkey.

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Obama sends Clinton to Mideast amid Gaza crisis

PHNOM PENH, Cambodia (AP) — President Barack Obama dispatched Secretary of State Hillary Rodham Clinton to the Middle East on Tuesday as the U.S. urgently seeks to contain the bloody conflict between Israel and Hamas.

Clinton hastily departed for the region from Cambodia, where she had joined Obama for summit meetings with Asian leaders. The White House said she would make three stops, meeting with Israeli Prime Minister Benjamin Netanyahu in Jerusalem, Palestinian officials in Ramallah, in the West Bank, and Egyptian leaders in Cairo. Clinton was expected to arrive in Israel on Tuesday night and return to Washington late Wednesday or very early Thursday after making all three stops.

Clinton's trip marks the Obama administration's most forceful engagement in the weeklong conflict that has killed more than 100 Palestinians and three Israelis, with hundreds more wounded. While the U.S. has backed Israel's right to defend itself against rocket fire from Gaza, the Obama administration has warned its ally against pursuing a ground assault that would further escalate the violence and could dramatically increase casualties on both sides.

Still, Obama's deputy national security adviser Ben Rhodes said the U.S. believes "Israel will make its own decisions about the military operations and decisions that it undertakes."

"At the same time, we believe that Israel, like the United States, like other countries, would prefer to see their interests met diplomatically and peacefully," Rhodes said. "It's in nobody's interest to see an escalation of the military conflict."

Obama and Clinton have consulted about the widening crisis throughout their three-day tour of Southeast Asia, their final joint trip before Clinton leaves her post as the top U.S. diplomat. They spoke again about the situation Tuesday morning, aides said, and made the decision for her to travel to the region.

Still, it was unclear what impact Clinton's presence would have on the spiraling violence or whether she was heading to the Mideast with any specific overtures from the U.S.

Rhodes said "there are a number of ideas that are in play," but offered no further details. And he insisted the ramped up U.S. involvement was "a matter of what's in everybody's best interests", not a matter of "leverage."

Obama and Clinton each have held multiple telephone calls with their counterparts in Israel and Egypt, which is at the center of negotiations to quell the violence. Because the U.S. considers Hamas a terrorist organization and prohibits contact between its members and American officials, it is relying on Egypt, as well as Turkey and Qatar, to deliver its message to the Hamas leadership in Gaza.

Israel and Hamas say they are open to diplomatic mediation efforts being led by Egypt, but they are far apart in their demands.

Hamas wants Israel to halt all attacks on Gaza and lift tight restrictions on trade and movement in and out of the territory that have been in place since Hamas seized Gaza by force in 2007. Israel demands an end to rocket fire from Gaza and a halt to weapons smuggling into Gaza through tunnels under the border with Egypt.

The widening conflict has threatened to overshadow Obama's three-country tour of Southeast Asia, his first overseas trip after winning re-election. The president, after a marathon day that took him from Thailand to Myanmar to Cambodia, worked the phones with Mideast leaders into the early hours of Tuesday morning, aides said.

The White House said Obama would stay in contact with the key players in the conflict while Clinton was on the ground. The president is scheduled to depart Cambodia later Tuesday, arriving back in Washington before dawn Wednesday.

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Associated Press writer Matthew Lee in Washington contributed to this report.

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Follow Julie Pace at http://twitter.com/jpaceDC

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