Congress unlikely to meet midnight deadline on 'fiscal cliff'









Agonizingly close to a New Year's Eve compromise, the White House and congressional Republicans agreed Monday to block across-the-board tax increases set for midnight, but held up a final deal as they haggled away the final hours of 2012 in a dispute over spending cuts.


"It appears that an agreement to prevent this New Year's tax hike is within sight," President Barack Obama said in an early-afternoon status report on negotiations. "But it's not done," he added of legislation that redeems his campaign pledge to raise taxes on the wealthy while sparing the middle class.


Senate Republican leader Mitch McConnell — shepherding final talks with Vice President Joe Biden — agreed with Obama that an overall deal was near. In remarks on the Senate floor, he suggested Congress move quickly to pass tax legislation and "continue to work on finding smarter ways to cut spending" next year.











The White House and Democrats initially declined the offer, preferring to prevent the cuts from kicking in at the Pentagon and domestic agencies alike. Officials said they might yet reconsider, although there was also talk of a short-term delay in the reductions.


Even if agreement could be reached to have a Senate vote before the midnight deadline, Speaker John A. Boehner (R-Ohio) was unlikely to call a vote in the House until Tuesday.


While the deadline to prevent tax increases and spending cuts was technically midnight, passage of legislation by the time a new Congress takes office at noon on Jan. 3, 2013 — the likely timetable — would eliminate or minimize any inconvenience for taxpayers.


The scene at both ends of historic Pennsylvania Avenue was remarkable, even for a government grown accustomed to gridlock. As darkness fell on the last day of the year, Obama, Biden and their aides were at work in the White House, while the lights burned in the House and Senate.


For now, more than the embarrassment of a gridlocked Congress working through New Year's Eve in the Capitol was at stake.


Economists in and out of government have warned that a combination of tax hikes and spending cuts could trigger a new recession, and the White House and Congress have spent the seven seeks since the Nov. 6 elections struggling for a compromise to protect the economy.


Even now, with time running out, partisan agendas were evident.


Obama used his appearance to chastise Congress, and to lay down a marker for the next round of negotiations early in 2013 when Republicans intend to seek spending cuts in exchange for letting the Treasury to borrow above the current debt limit of $16.4 trillion.


"Now, if Republicans think that I will finish the job of deficit reduction through spending cuts alone — and you hear that sometimes coming from them ... then they've got another think coming. ... That's not how it's going to work at least as long as I'm president," he said.


"And I'm going to be president for the next four years, I think," he added.


Officials in both parties said agreement had been reached to prevent tax increases on most Americans, while letting rates rise on individual income over $400,000 and household earnings over $450,000 to a maximum of 39.6 percent from the current 35 percent. That marked a victory for Obama, who campaigned successfully for re-election on a platform of requiring the wealthy to pay more.


Any agreement would also raise taxes on the value of estates exceeding $5 million to 40 percent, as well as extend expiring jobless benefits for two million unemployed, prevent a 27 percent cut in fees for doctors who treat Medicare patients and likely avoid a near-doubling of milk prices.


Much or all of the revenue to be raised through higher taxes on the wealthy would help hold down the amount paid to the Internal Revenue Service by the middle class.


In addition to preventing higher rates for most, any agreement would retain existing breaks for families with children, for low-earning taxpayers and for those with a child in college.


In addition, the two sides agreed to prevent the Alternative Minimum Tax from expanding to affect an estimated 28 million households for the first time in 2013, with an average increase of more than $3,000. The law was originally designed to make sure millionaires did not escape taxes, but inflation has gradually exposed more and more households with lower earnings to its impact.


To help businesses, the two sides also agreed to extend an existing research and development tax credit as well as other breaks designed to boost renewable energy production. Details on those provisions were sketchy.


Obama's remarks irritated some Republicans.





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Ban on demanding Facebook passwords among new 2013 state laws






CHICAGO (Reuters) – Employers in California and Illinois will be prohibited from demanding access to workers’ password-protected social networking accounts and teachers in Oregon will be required to report suspected student bullies thanks to new laws taking effect in 2013.


In all, more than 400 measures were enacted at the state level during 2012 and will become law in the new year, according to the National Conference of State Legislatures (NCSL).






Some of the statutes, which deal with everything from consumer protection to gun control and healthcare, take effect at the stroke of midnight. Others will not kick in until later in the year.


The raft of measures includes a new abortion restriction in New Hampshire, public-employee pension reform in California and Alabama, same-sex marriage in Maryland, and a requirement that private insurers in Alaska cover autism in kids and young adults, NCSL said.


In New Hampshire, a rarely used form of late-term abortion will become illegal except to save the life of the mother – and even then only if two doctors from separate hospitals certify the procedure is medically necessary.


John Lynch, the state’s outgoing Democratic governor, had vetoed the measure, saying it would threaten the lives of women in rural areas. But the state’s Republican-controlled legislature later overrode him.


In California and Illinois, laws that take effect at 12:01 a.m. local time will make it illegal for bosses to request social networking passwords or non-public online account information from their employees or job applicants.


Michigan’s Republican Governor Rick Snyder signed a similar measure into law earlier this month that took effect immediately. The Michigan law also penalizes educational institutions for dismissing or failing to admit a student who does not provide passwords and other account information used to access private internet and email accounts, including social networks like Facebook and Twitter.


But workers and job seekers in all three states will still need to be careful what they post online: Employers may continue to use publicly available social networking information. So inappropriate pictures, tweets and other social media indiscretions can still come back to haunt them.


Gun violence – in places where it’s all too common, such as Chicago, and in places where it’s unexpected, such as Sandy Hook Elementary School in Newtown, Connecticut – was big news in 2012. But only a handful of new state firearms laws are set to take effect in 2013.


In Michigan, the definition of a “pistol” under the law will now include any firearm less than 26 inches in length. The new definition encompasses some rifles with folding stocks and will make the weapons subject to the same restrictions as pistols.


In Illinois, certain guns currently regulated by state law, including paintball guns, will be excluded from the definition of a firearm and participants in military re-enactments will be exempt from some weapons laws.


Another big story in 2012 was the effort by lawmakers in a number of cash-strapped states to put their public employee pension funds on a sounder financial footing.


In California and Alabama, reforms designed to begin to address the unfunded liabilities of those retirement systems will take effect in 2013.


Among the other new laws on the books in 2013:


* In California, prison workers and peace officers will now be prohibited from having sex with inmates and prisoners in transport.


* In Illinois, sex offenders will be prohibited from distributing candy on Halloween, or playing Santa or the Easter Bunny.


* In Oregon, employers won’t be allowed to advertise a job vacancy if they won’t consider applicants who are currently out of work.


* In Kentucky, residents will be prohibited from releasing feral or wild hogs back into the wild and Illinois will ban the possession and sale of shark fins.


* And in Florida, the term “motor vehicle” will no longer apply to the specialized all-terrain vehicles with over-sized tires known as “swamp buggies” that are popular in some parts of the state.


(Reporting by James B. Kelleher; Editing by Greg McCune and Nick Zieminski)


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Kardashian, West feel ‘blessed’ over baby news






ATLANTIC CITY, N.J. (AP) — Kim Kardashian and Kanye West are feeling lucky about their first child together.


“It’s true,” the 32-year-old reality TV star said in a statement on her site Monday. “Kanye and I are expecting a baby. We feel so blessed and lucky and wish that in addition to both of our families, his mom and my dad could be here to celebrate this special time with us.”






Kardashian’s father, Robert Kardashian, died in 2003. West’s mother, Donda West, died in 2007.


Kardashian added in the blog post that she was “looking forward to great new beginnings in 2013 and to starting a family.”


The 35-year-old rapper revealed to a crowd of more than 5,000 in song form at a concert Sunday that his girlfriend is pregnant. Kardashian was in the crowd at Revel Resort’s Ovation Hall with her mother, Kris Jenner, and West’s mentor and best friend, Jay-Z.


The news instantly went viral online, with thousands posting and commenting on the expecting couple.


Most of the Kardashian clan tweeted about the news, including Kim’s sisters. Kourtney Kardashian wrote: “Another angel to welcome to our family. Overwhelmed with excitement!”


West told concertgoers to congratulate his “baby mom” and that this was the “most amazing thing.”


Representatives for West and Kardashian didn’t immediately respond to emails about the pregnancy.


The rapper and reality TV star went public with their relationship in March.


Kardashian married NBA player Kris Humphries in August 2011 and their divorce is not finalized.


West’s Sunday-night show was his third consecutive performance at Revel. He took the stage for nearly two hours, performing hits like “Good Life,” ”Jesus Walks” and “Clique” in an all-white ensemble with two bandmates.


Kardashian is expected to spend New Year’s Eve at public appearance at a Las Vegas nightclub.


___


AP Writer Bianca Roach contributed to this report.


___


Follow Mesfin Fekadu on Twitter at http://twitter.com/MusicMesfin . Follow Bianca Roach at http://twitter.com/B__Roach


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F.D.A. Approves Sirturo, a New Tuberculosis Drug





The Food and Drug Administration announced on Monday that it had approved a new treatment for multidrug-resistant tuberculosis that can be used as an alternative when other drugs fail.




The drug, to be called Sirturo, was discovered by scientists at Janssen, the pharmaceuticals unit of Johnson & Johnson, and is the first in a new class of drugs that aims to treat the drug-resistant strain of the disease.


Tuberculosis is a highly infectious disease that is transmitted through the air and usually affects the lungs but can also affect other parts of the body, including the brain and kidneys. It is considered one of the world’s most serious public health threats. Although rare in the United States, multidrug-resistant tuberculosis is a growing problem elsewhere in the world, especially in poorer countries. About 12 million people worldwide had tuberculosis in 2011, according to Johnson & Johnson, and about 630,000 had multidrug-resistant TB.


A study in September in The Lancet found that almost 44 percent of patients with tuberculosis in countries like Russia, Peru and Thailand showed resistance to at least one second-line drug, or a medicine used after another drug had already failed.


Treating drug-resistant tuberculosis can take years and can cost 200 times as much as treating the ordinary form of the disease


“This is quite a milestone in the story of therapy for TB,” Dr. Paul Stoffels, the chief scientific officer at Johnson & Johnson, said in an interview. He said the approval was the first time in 40 years that the agency had approved a drug that attacked tuberculosis in a different way from the current treatments on the market. Sirturo works by inhibiting an enzyme needed by the tuberculosis bacteria to replicate and spread throughout the body.


Sirturo, also known as bedaquiline, would be used on top of the standard treatment, which is a combination of several drugs. Patients with drug-resistant tuberculosis often must be treated for 18 to 24 months.


Even as it announced the approval, however, the F.D.A. also issued some words of caution.


“Multidrug-resistant tuberculosis poses a serious health threat throughout the world, and Sirturo provides much-needed treatment for patients who have don’t have other therapeutic options available,” Edward Cox, director of the office of antimicrobial products in the F.D.A.’s center for drug evaluation and research, said in a statement. “However, because the drug also carries some significant risks, doctors should make sure they use it appropriately and only in patients who don’t have other treatment options.”


The consumer advocacy group Public Citizen opposed approval in a letter to the F.D.A. in mid-December, saying that the results of a limited clinical trial showed that patients using bedaquiline were five times as likely to die than those on the standard drug regimen to treat the disease.


“Given that bedaquiline belongs to an entirely new class of drugs, it is entirely feasible that death in some cases was due to some unmeasured toxicity of the drug,” the letter said.


Sirturo carries a so-called black box warning for patients and health care professionals that the drug can affect the heart’s electrical activity, which could lead to an abnormal and potentially fatal heart rhythm. The warning also notes deaths in patients treated with Sirturo. Nine patients who received Sirturo died compared with two patients who received a placebo. Five of the deaths in the Sirturo group and all of the deaths in the placebo arm seemed to be related to tuberculosis, but no consistent reason for the deaths in the remaining Sirturo-treated patients could be identified.


Doctors Without Borders and the Bill and Melinda Gates Foundation, both active in the fight against tuberculosis and other global diseases, applauded the F.D.A.’s decision.


Jan Gheuens, interim director of the TB Program for the Gates Foundation, called it a “long-awaited event” and said the fight against TB had not benefited from new drugs in the way H.I.V. had. Beyond the benefits of the drug itself, he said the quick approval process could be a model for other drugs sorely needed in the developing world.


He also suggested, however, that more trials should be conducted to get a better understanding of the side effects that led to the black box warning.


The F.D.A. approved bedaquiline under an accelerated program that allows the agency to conditionally approve drugs that are viewed as filling unmet medical needs with less than the usual evidence that they work. The drug’s approval was based on studies that showed it killed bacteria more quickly than a control group taking the standard regimen, but it did not measure whether in the end patients actually fared better on bedaquiline. Johnson & Johnson will conduct larger clinical trials to investigate whether the drug performs as predicted.


In a statement responding to Public Citizen’s letter, a spokeswoman for Johnson & Johnson said the company was committed to supporting appropriate use of Sirturo and would “work to ensure Sirturo is used only where treatment alternatives are not available.”


Dr. Stoffels said the hope was that other new tuberculosis drugs would also be approved that, when used in combination with bedaquiline, could shorten and simplify the current standard of treatment. “That is still a long time away,” he acknowledged, but “this is a first step in a new regimen for TB.”


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Tribune Co. emerges from bankruptcy









The last day of 2012 is the first of a new era for Tribune Co.

After spending more than four years embroiled in a contentious Chapter 11 bankruptcy case, the reorganized Chicago-based media company emerged Monday under new owners and a newly appointed board, freed from its massive debt and facing an uncertain future.

Senior creditors Oaktree Capital Management, Angelo, Gordon & Co. and JPMorgan Chase & Co. are set to take control of Tribune Co.’s storied portfolio of publishing and broadcasting assets, including the Chicago Tribune, officials said.

It was an almost anticlimactic end to a long and painful chapter in Tribune Co.'s 165-year history. Late Sunday, the new Tribune Co. named its board of directors, filed notification with the Delaware bankruptcy court where the bulk of legal wrangling took place and declared its existence.

"It took a long time to get here," said Ken Liang, a managing director at Oaktree and a new member of the board. "It was a tough restructuring. We're pretty excited about the exit."

The new board also will include Tribune Co. CEO Eddy Hartenstein; Ross Levinsohn, who recently left as interim chief executive of Yahoo Inc.; Craig Jacobson, a well-known entertainment lawyer; Peter Murphy, a former strategy executive at Walt Disney Co. and Ceasars Entertainment; Bruce Karsh, Oaktree president; and Peter Liguori, a former top television executive at Fox and Discovery.

Liguori is expected to be named chief executive of Tribune Co. going forward.

Hartenstein, who is publisher of the Los Angeles Times, has been CEO of Tribune Co. since May 2011. He will remain in the role until the board convenes its first meeting in the next several weeks, where it will name the company’s executive officers, according to a company statement.

“Tribune will emerge from the bankruptcy process as a multi-media company with a great mix of profitable assets, strong brands in major markets and a much-improved capital structure,” Hartenstein said in the statement.

Tribune Co. owns 23 television stations, including WGN-Ch. 9, WGN America, eight daily newspapers and other media assets, all of which the reorganization plan valued at $4.5 billion after cash distributions and new financing. Eventually, all the assets are expected to be sold, according to the new owners.

They take the reins of a company that saw its worth essentially cut in half since 2007, when Chicago billionaire Sam Zell took it private in an $8.2 billion leveraged buyout. The rapid decline was mostly due to falling newspaper valuations in the face of digital competition. The anticipated hiring of Liguori suggests that broadcasting will be the operational focus going forward, according to several media analysts.

Los Angeles-based Oaktree, the largest shareholder, with about 23 percent of the equity, appointed two of seven board members. Both Angelo Gordon and JPMorgan have roughly a 9 percent stake and appointed one seat each. The three jointly appointed two more board members, with the final seat occupied by the chief executive.

Among the outgoing board members is Zell, whose deal was seen at the time as an alternative to the squabbles within Tribune Co. that threatened to break apart the then-publicly traded company. But the Great Recession and plummeting advertising revenues across all media, especially the struggling newspaper industry, made the company’s resulting $13 billion debt load untenable.

Tribune Co. filed for Chapter 11 bankruptcy protection in December 2008. Zell blamed a “perfect storm” of industry and economic forces. But the bankruptcy case turned on charges leveled by junior creditors that saddling the company with such a debt burden left it insolvent from the outset.

Led by an aggressive distressed debt fund called Aurelius Capital Management, the junior creditors pressed litigation that stretched out the case for three and a half years in a Delaware court before U.S. Bankruptcy Judge Kevin Carey confirmed the reorganization plan in July. An emergency appeal to stay that decision was dismissed by the 3rd U.S. Circuit Court of Appeals in September. In November, the Federal Communications Commission signed off on waivers needed to transfer Tribune Co.’s broadcast properties to the new ownership, clearing the last hurdle to its emergence from Chapter 11.

“Usually, bankruptcy cases like this take much less time and cost less money,” said Douglas Baird, a bankruptcy expert and law professor at the University of Chicago.

Baird said legal fees for most large corporate bankruptcies run 3 to 4 percent of the company’s total worth. The Tribune Co. case, which will likely cost the company more than $500 million in legal and other professional fees, was more than twice that percentage, due to both the extended litigation and the company’s declining valuation.

Before cash distributions and new financing, a 2012 analysis by financial adviser Lazard valued the broadcasting assets, including the TV stations, WGN-AM 720, CLTV and national cable channel WGN America, at $2.85 billion. Other strategic assets, such as online job site CareerBuilder and cable channel Food Network, are worth $2.26 billion.

Tribune Co.’s newspaper holdings, including the Tribune, Los Angeles Times and six other daily publications, have withered to $623 million in total value, according to Lazard. In 2006, entertainment mogul David Geffen made a $2 billion cash offer for the Los Angeles Times.

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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 Senate leaders said they were still unable to reach a compromise that would stop the automatic tax hikes and spending cuts that could push the U.S. economy back into recession.






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

Progress still appeared possible after the two sides narrowed their differences on tax increases and Republicans indicated they would withdraw a contentious proposal to slow the growth of Social Security retirement benefits.

Failure to secure a deal would deliver a heavy blow to the U.S. economy just as it is showing signs of a quicker recovery. Planned tax increases and spending cuts would suck $600 billion out of the economy and again force up unemployment, which had shown signs of improving.

Senate Republican leader Mitch McConnell talked several times to Vice President Joe Biden by phone in the hope of breaking the standstill. "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. But, even if the two sides reach a deal, procedural barriers in the Senate and the House of Representatives make quick action difficult.

Buoyed by his re-election in November, President Barack Obama has insisted that any deal must include a tax increase on the wealthiest Americans, who have seen their earnings rise steadily over the past decade at a time when income has stalled for the less affluent.

Many conservative Republicans in the House of Representatives oppose a tax hike on anyone, no matter how wealthy.

The two sides were close to agreeing to raise taxes on households earning around $400,000 or $500,000 a year - higher than Obama's preferred threshold of $250,000 - several senators told reporters.

Republicans aim to pair any tax increase with government 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.

Several Senate Republicans said they would support taking that idea out of the discussion. "Most of us agree the chained CPI is off the table in these negotiations," Senator John McCain said on Twitter.

In a rare appearance on NBC's "Meet the Press," Obama pressured lawmakers to reach a deal.

"If people start seeing that on January 1st this problem still hasn't been solved... then obviously that's going to have an adverse reaction in the markets," he said, adding that he had offered Republicans significant compromises that had been rejected repeatedly.

Obama said he would try to reverse the tax hikes for most Americans if Congress fails to act.

John Boehner, the House speaker, 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," he said in a statement. (Additional reporting by Tabassum Zakaria, Jeff Mason, David Lawder, Fred Barbash and Richard Cowan. Writing by Andy Sullivan; editing by Alistair Bell and Jackie Frank)

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Purported photo of new BlackBerry phone with QWERTY keyboard leaks









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“The Hobbit” keeps box office crown for third week






(Reuters) – The dwarfs and elves of “The Hobbit: An Unexpected Journey” prevailed at the North American box office again over the weekend, as its $ 32.9 million in ticket sales topped both the star-packed musical “Les Miserables” and the western “Django Unchained.”


Despite surging past “The Hobbit” on Christmas day with an $ 18.1 million opening, “Les Miz” managed only third place in U.S. and Canadian sales with $ 28 million as Christmas shoppers returned from the malls to boost Hollywood‘s box office, according to studio estimates.






The Hobbit,” in its third week of release, has now grossed $ 222.7 million domestically, Warner Bros said.


Quentin Tarantino’s “Django Unchained,” a western starring Jamie Fox as a slave turned bounty hunter, took second with an impressive $ 30.7 million.


Tom Cruise’s crime drama “Jack Reacher,” which features author Lee Child’s former military investigator solving a fatal sniper attack, landed in fifth with $ 14 million, outpaced by “Parental Guidance,” the Billy Crystal-Bette Midler as grandparents comedy which took in $ 14.8 million to nab fourth.


Chris Aronson, president of domestic distribution for Fox, said the “Parental Guidance” performance was “just a tremendous result for our little engine that could.”


Backed by a musical score that made it a Broadway icon, “Les Miz” surged past “The Hobbit” on Christmas day, collecting $ 18.1 million to pass “High School Musical 3: Senior Year” with the biggest midweek opening day by a musical.


But it was not enough to conquer the “Hobbit” juggernaut, which scored its third straight box office weekend win.


Universal’s president for domestic distribution Nikki Rocco called the “Les Miz” $ 28 million take “phenomenal, especially considering we went into the weekend with $ 40 million,” an unexpectedly strong figure for its first few days in release.


“People really love this movie, which is even more rewarding and gratifying,” Rocco said.


“Les Miserables,” which stars Hugh Jackman, Russell Crowe and Anne Hathaway, benefited from Oscar buzz and its star power, said Paul Dergarabedian, president of Hollywood.com’s box office division, who said he wouldn’t be surprised to see the musical pass $ 200 million before it’s done.


That would put it among the Hollywood‘s Top 20 best-selling musicals. It would pass the 1972 film “Cabaret,” which grossed $ 191 million in box office sales adjusted for higher ticket prices, and put it close to “Camelot,” which sold $ 204.5 million in 1967, according to the web site the-numbers.com.


The most successful musical is “Snow White and the Seven Dwarfs,” which grossed more than $ 6.3 billion but has been re-released by Walt Disney nine times since its 1937 premiere, according to the site.


A rush of high-profile films in December is expected to push 2012 to a domestic box office record. The current record is $ 10.6 billion, set in 2009.


Jack Reacher” debuted just days after the Newtown, Connecticut, school shooting sparked new debate about the impact of movie violence. “Reacher” begins with a sniper killing a handful of seemingly random victims. A red-carpet premiere and a screening to promote the $ 60-million production were postponed after the December 14 Newtown tragedy.


Adult comedy “This is 40″ starring Paul Rudd and Leslie Mann as a middle-aged couple was sixth with $ 13.2 million. The Judd Apatow $ 35 million film totaled $ 37 million after two weeks. The seventh spot went to Steven Spielberg’s historical film “Lincoln,” with $ 7.5 million for a $ 132 million domestic total.


Comedy “The Guilt Trip,” starring Barbra Streisand and Seth Rogen as a mother and son on a cross-country drive, pulled in $ 6.7 million for eighth.


Also this week the latest James Bond hit “Skyfall” topped $ 1 billion in worldwide sales, despite falling out of the week’s top 10 films at the box office.


The Hobbit” was distributed by Time Warner Inc’s Warner Bros studio. Paramount Pictures, a unit of Viacom Inc released, “Jack Reacher” and “The Guilt Trip.” Comcast Corp’s Universal Studios released “Les Miserables” and “This is 40.” “Django Unchained” was released in the United States by the Weinstein Company.


(Reporting By Ronald Grover; Editing by Cynthia Osterman)


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Questcor Finds Profit for Acthar Drug, at $28,000 a Vial


Kevin Moloney for The New York Times


Christina Culver with her son Tyler, 6, at home in Colorado Springs this month. In 2007, Tyler was hospitalized when the price of Acthar soared.





THE doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.


The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.


“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.


How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers.


At least until recently, that is. Now some doctors, insurance companies and investors are beginning to have doubts about whether the drug is really any better than much cheaper alternatives. Short-sellers have written scathing criticisms of the company, questioning its marketing tactics and predicting that its shareholders are highly vulnerable.


 That Acthar is even a potential blockbuster is a remarkable turn of events, considering that the drug was developed in the 1950s by a division of Armour & Company, the meatpacking company that once ruled the Union Stock Yards of Chicago. As in the 1950s, Acthar is still extracted from the pituitary glands of slaughtered pigs — essentially a byproduct of the meatpacking industry.


The most important use of Acthar has been to treat infantile spasms, also known as West syndrome, a rare, sometimes fatal epileptic disorder that generally strikes before the age of 1.


For several years, Questcor, which is based in Anaheim, lost money on Acthar because the drug’s market was so small. In 2007, it raised the price overnight, to more than $23,000 a vial, from $1,650, bringing the cost of a typical course of treatment for infantile spasms to above $100,000. It said it needed the high price to keep the drug on the market.


“We have this drug at a very high price right now because, really, our principal market is infantile spasms,” Don M. Bailey, Questcor’s chief executive, told analysts in 2009. “And we only have about 800 patients a year. It’s a very, very small — tiny — market.”


Companies often charge stratospheric prices for drugs for rare diseases — known as orphan drugs — and Acthar’s price is not as high as some. Society generally tolerates those costs to encourage drug companies to develop crucial, possibly lifesaving drugs for these often neglected diseases.


But Questcor did almost no research or development to bring Acthar to market, merely buying the rights to the drug from its previous owner for $100,000 in 2001. And while the manufacturing of Acthar is complex, it accounts for only about 1 cent of every dollar that Questcor charges for the drug.


Moreover, the tiny “orphan” market soon became much bigger. Before long, Questcor began marketing the drug for multiple sclerosis, nephrotic syndrome and rheumatologic conditions, even though there is little evidence that Acthar is more effective for those other conditions than alternatives that are far cheaper. And the company did so without being required to prove that the drug actually works. That is because Acthar was approved for use in 1952, before the Food and Drug Administration required clinical trials to show a drug is effective for a particular disease. Acthar is essentially grandfathered in.


Today, only about 10 percent of the drug’s sales are for infantile spasms. The new uses, Mr. Bailey has told analysts, represent multibillion-dollar opportunities for Acthar and Questcor, its sole maker.


The results have been beyond even the company’s wildest dreams. Sales of Acthar, which accounts for essentially all of Questcor’s sales, totaled nearly $350 million in the first nine months this year, up 145 percent from the period a year earlier. In the same period, Questcor’s earnings per share nearly tripled, to $2.12. In the five years after the big Acthar price increase in August 2007, Questcor shares rose from around 60 cents to about $50, in one of the best performances of any stock in any industry.


But in September, the shares plummeted after Aetna, the big insurer, said it would no longer pay for Acthar, except to treat infantile spasms, because of lack of evidence the drug worked for other diseases. The stock now trades at $26.93.


Peter Wickersham, senior vice president for cost of care at Prime Therapeutics, a pharmacy benefits manager that has found the drug is possibly being overused, says the huge increase in Acthar’s price for patients “just invites the type of scrutiny that it’s received.”


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Airlines' plans for 2013 up in the air









Airfares will be on the rise in 2013, and those niggling airline fees will metamorphose into optional bundles of services.


Meanwhile, onboard amenities, such as Internet access, entertainment options and refreshed interiors, will abound among U.S. carriers, but tight seating in coach probably won't improve.


And 2013 might be the year you'll finally be able to keep your smartphone, iPad or Kindle turned on during takeoffs and landings.





Those are some of the predictions airline industry experts foresee in the new year. Here's the lowdown on fares, fees and flight experience for 2013.


Higher fares forecast


Airlines pushed through six fare increases in 2012. Expect a similar number in the new year, said Rick Seaney, co-founder of FareCompare.com.


"I wouldn't be surprised to see airfares rise like they did this year, between 3 and 6 percent domestically," Seaney said. That's because airlines will succeed in properly balancing supply and demand by trimming the number of seats they offer to match "decent, but bordering on tepid, demand."


Fares are typically driven by four main factors: competition, most of all, then supply, demand and oil prices. "If you look at those drivers, they are, for the most part, on the airlines' side, which gives them pricing power," Seaney said.


That doesn't mean there won't be good airfare deals on some flights on some routes. And consumers will still see lower prices during off-peak days, such as Tuesday, Wednesday and Saturday departures and off-peak seasons, such as late January and early February. Like this year, summertime fares probably will stay relatively high, he said.


Airline mergers can also affect fares, and a huge one could take place early in 2013. American Airlines and US Airways are in talks about combining.


The general consensus among consumer advocates is that airline mergers aren't good for passengers.


"Any time you have two big airlines merging, that means consumers have less choice and competition is reduced, which only translates to higher prices," said Charlie Leocha, director of the Consumer Travel Alliance.


However, a bit of new evidence bucks that conventional wisdom. Despite four mega-mergers in the U.S. airline industry during the past seven years, fares have not increased significantly, just 1.8 percent per year, according to a December report from professional services firm PwC. In fact, average domestic fares decreased 1 percent from 2004 to 2011 when inflation is factored in, the report found.


Fliers know full well, however, that the fare isn't all that counts nowadays. There are those fees.


Fees get a makeover


The most noticeable trend in recent years with airline fees is that there are more of them: fees for checked bags, aisle seats, onboard meals, among many others. 


"What we hear is that people pay their fare and get to the airport and feel they're constantly being nickeled-and-dimed to death for things that used to be included," said Kate Hanni, founder of FlyersRights.org. 


The top five U.S. carriers alone generated more than $12 billion in fees in 2011, with even more expected through 2012, according to the PwC report.


What consumers call fees, airlines call "unbundling" — making a la carte choices from services that used to be included in the fare.


A likely trend for 2013 might be called "rebundling," airlines packaging a few now-optional services and charging for a tier of service.





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