Adderall, a Drug of Increased Focus for N.F.L. Players

The first time Anthony Becht heard about Adderall, he was in the Tampa Bay locker room in 2006. A teammate who had a prescription for the drug shook his pill bottle at Becht.

“ ‘You’ve got to get some of these,’ ” Becht recalled the player saying. “I was like, ‘What the heck is that?’ He definitely needed it. He said it just locks you in, hones you in. He said, ‘When I have to take them, my focus is just raised up to another level.’ ”

Becht said he did not give Adderall another thought until 2009, when he was playing in Arizona and his fellow tight end Ben Patrick was suspended for testing positive for amphetamines. The drug he took, Patrick said, was Adderall. Becht asked Patrick why he took it, and Patrick told Becht, and reporters, that he had needed to stay awake for a long drive.

Those two conversations gave Becht, now a free agent, an early glimpse at a problem that is confounding the N.F.L. this season. Players are taking Adderall, a medication widely prescribed to treat attention deficit hyperactivity disorder, whether they need it or not, and are failing drug tests because of it. And that is almost certainly contributing to a most-troubling result: a record-setting year for N.F.L. drug suspensions.

According to N.F.L. figures, 21 suspensions were announced this calendar year because of failed tests for performance-enhancing drugs, including amphetamines like Adderall. That is a 75 percent increase over the 12 suspensions announced in 2011 and, with a month to go in 2012, it is the most in a year since suspensions for performance-enhancing drugs began in 1989.

At least seven of the players suspended this year have been linked in news media reports to Adderall or have publicly blamed the drug, which acts as a strong stimulant in those without A.D.H.D. The most recent examples were Tampa Bay cornerback Eric Wright and New England defensive lineman Jermaine Cunningham last week.

The N.F.L. is forbidden under the terms of the drug-testing agreement with the players union from announcing what substance players have tested positive for — the urine test does not distinguish among types of amphetamines — and there is some suspicion that at least a few players may claim they took Adderall instead of admitting to steroid use, which carries a far greater stigma. But Adolpho Birch, who oversees drug testing as the N.F.L.’s senior vice president for law and labor, said last week that failed tests for amphetamines were up this year, although he did not provide any specifics. The increase in Adderall use probably accounts for a large part of the overall increase in failed tests.

“If nothing else it probably reflects an uptick in the use of amphetamine and amphetamine-related substances throughout society,” Birch said. “It’s not a secret that it’s a societal trend, and I think we’re starting to see some of the effects of that trend throughout our league.”

Amphetamines have long been used by athletes to provide a boost — think of the stories of “greenies” in baseball clubhouses decades ago. That Adderall use and abuse has made its way to the N.F.L. surprises few, because A.D.H.D. diagnoses and the use of medication to control it have sharply increased in recent years.

According to Dr. Lenard Adler, who runs the adult A.D.H.D. program at New York University Langone Medical Center, 4.4 percent of adults in the general population have the disorder, of which an estimated two-thirds are men. Birch said the number of exemptions the N.F.L. has granted for players who need treatment for A.D.H.D. is “almost certainly fewer” than 4.4 percent of those in the league.

The rates of those with the disorder fall as people get older; it is far more prevalent in children and adolescents. A report from the Centers for Disease Control and Prevention, using input from parents, found that as of 2007, about 9.5 percent or 5.4 million children from ages 4 to 17 had A.D.H.D. at some point. That was an increase of 22 percent from 2003. Boys (13.2 percent) were more likely to have the disorder than girls (5.6 percent).

Of children who currently have A.D.H.D., 66.3 percent are receiving medication, with boys 2.8 times more likely to receive medication. Those 11 to 17 years old are more likely to receive medication than younger children.

But Adderall, categorized by the Drug Enforcement Administration as a Schedule II controlled substance because it is particularly addictive, is also used by college students and even some high school students to provide extra energy and concentration for studying or as a party drug to ward off fatigue.

Dr. Leah Lagos, a New York sports psychologist who has worked with college and professional athletes, said she had seen patients who have used Adderall. She said she believed the rise in its use by professional athletes mimicked the use by college students. Just a few years ago, she said, it was estimated that 1 in 10 college students was abusing stimulants like Adderall and Ritalin. That estimate, Lagos said, has almost doubled.

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After a billion, what next for Facebook?

MENLO PARK — In just eight years, Facebook signed up more than half the world's Internet population.

Now it's going after the rest.

Facebook wants to reach every single person on the Internet whether they are logging on from a laptop in Santa Monica, an iPhone in Tokyo or a low-tech phone with a tiny screen in Nairobi.

It's parachuting into market after market to take on homegrown social networks by currying favor with the locals and venturing where many people have spotty — if any — access to the Internet.

In Japan, it lets users list their blood types, which the Japanese believe — like astrological signs in the Western world — give insight into personality and temperament. In Africa, Facebook markets a stripped-down, text-only version of its service that works on low-tech mobile phones.

International growth is crucial to maintain its dominance as the world's largest social network. The company's scorching pace of growth has cooled especially in the United States. Facebook must coax users to sign up — and make sure it remains popular with the users it already has — or risk being knocked from its lofty perch.

"We're not a company that is just trying to add more people," said Chris Cox, Facebook's vice president of product. "What we are trying to do is build a service that everyone in the world can use."

But overseas growth that once seemed to come so easily is slower now. Facebook has already saturated most major markets around the globe. Eight out of 10 Facebook users are outside of the U.S.

"I don't think that Facebook has a chance of attracting another billion users," Wedbush Securities analyst Michael Pachter said.

Inside Facebook's Menlo Park, Calif., headquarters is a small army out to prove naysayers wrong. Above their desks they have hung flags from around the world that represent their nationalities. They obsessively scan screens that track user growth around the world.

They cheered and popped open champagne in September when the number of active Facebook users crossed 1 billion. But the moment of jubilation quickly passed as they redoubled their efforts to spread Facebook around the globe.

Naomi Gleit is the soft-spoken, headstrong 29-year-old product manager in charge of growth at Facebook. She says Facebook's future is on mobile devices, the medium by which most people will experience the Web in coming years. Facebook now works on more than 2,500 different phones, helping it gain a foothold in emerging markets. And it is forging relationships with mobile phone operators around the world.

Gleit's 150-member team has boots on the ground in far-flung places armed with low-tech phones and cheap data plans. Even team members here carry Nokia phones alongside their iPhones to update their status or check their News Feed.

"We originally built a product for ourselves," Gleit said. "This is different. Now we need to understand the experience of users who are not like us."

Analysts say Facebook already has established an impressive track record of uprooting entrenched competitors. In Britain, it displaced the dominant social network Bebo, forcing AOL to sell it at a huge loss. In Germany, Facebook overtook the homegrown StudiVZ. Facebook even broke Google social network Orkut's stranglehold on Brazil and India.

In 2009, it launched a clever tool to help Facebook users find their Orkut friends on Facebook and instantly send them friend requests. Two years later it swiped Google's top executive in Latin America, Alexandre Hohagen. Facebook sprinted ahead of Orkut one year ago, and now has 61 million active users in Latin America's largest country.

Facebook is treating India as a test lab for how it can spread in other emerging markets such as Indonesia. Facebook, which has offices in Hyderabad, India, has grown from 8 million users in 2010 to 65 million users today. It is aggressively targeting India's youth. A few hundred young Indian programmers recently jammed a Facebook hackathon at a Bangalore convention center to chug chai and brainstorm new apps that would appeal to their friends.

But Facebook has its eyes on a much bigger prize beyond the country's 100 million Internet users: the 900 million-plus Indians on mobile phones. Some analysts predict India will have more Facebook users than any other country including the United States by 2015.

The company also faces significant challenges in India. It must make the service captivating on low-tech mobile phones with unreliable Internet connections and it must gingerly navigate demands from the Indian government to remove objectionable content without alienating users.

Facebook is making some of its biggest moves in Russia, South Korea and Japan, the only major markets where it operates but has penetration of less than 50%, according to research firm ComScore.

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South L.A. frustrated by delays in building new King hospital

Earlier this year, Joane Austin rushed her elderly mother to the emergency room for fear she was having a heart attack.

Austin normally would have made the short trip to Martin Luther King Jr./Drew Medical Center, the landmark hospital in South Los Angeles. But King/Drew has been closed for five years, so Austin drove several miles to the emergency room at Centinela Hospital Medical Center in Inglewood.

"I prayed all the lights would stay green," she said. "It was scary."

Once they arrived, doctors determined that Austin's mother needed emergency surgery to remove scar tissue around her intestines.

For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years.

But the opening has been repeatedly delayed, and the community is still waiting. Originally, officials hoped to have the new facility ready by 2010. Then it was pushed to 2012. Now, officials say they plan to have construction completed next year and the hospital opening its doors in 2014.

Without a nearby hospital, patients have had to travel to such places as Bellflower, Inglewood and Long Beach for emergency room and inpatient care.

Several local hospitals — California Hospital Medical Center, L.A. County/USC Medical Center and Harbor-UCLA Medical Center — received an influx of former King patients after the closure. The closest hospital, St. Francis Medical Center in Lynwood, reported an increase of 20% to 30% in emergency room visits since King/Drew closed, though other factors also may have contributed to the rise.

Getting to other hospitals has presented a challenge for many in the low-income neighborhood, said William Hobson, president and chief executive of the Watts Healthcare Corp. "Just the fact that it is a long way away may discourage them from going," he said.

The closure of King/Drew, which was born out of the Watts riots and opened in 1972, created a healthcare gap in a community where rates of chronic disease are high and vast swaths of the population lack insurance, said David Carlisle, president of the adjacent Charles R. Drew University of Medicine and Science. South Los Angeles has a shortage of doctors, inpatient beds and outpatient services, according to both experts and research.

Despite King/Drew's many medical lapses, which earned it the nickname "Killer King," many in the community remained fiercely loyal to the hospital and the services it provided.

Studies examining the impact of King/Drew's closure found that it led to delays in care for elderly blacks and Latinos and a dramatic increase in patient admissions at other trauma centers. Physicians throughout the county also reported more overcrowding in other emergency rooms and said they saw sicker patients who didn't know where to go or couldn't afford transportation elsewhere.

"It is fearful to think about how many lives may have been saved had this thing been opened by now," said Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils. "It shouldn't take five years to build a facility."

Patrick Wooten, 49, went to St. Francis when he had a dislocated kneecap a few years ago. Wooten, who is uninsured, said he received good care at the private hospital but then got a $3,200 bill. Wooten said he is frustrated that the new King hospital still hasn't opened and won't until 2014. "What you do until then, God only knows," he said. "Hopefully we can wait it out."

Last year, Sandira Gonzalez, 29, took her 5-year-old son to the Martin Luther King urgent care center when he had a fever. But when the center closed for the night, her son had to be taken by ambulance to Harbor-UCLA near Torrance, where he was treated for an infection.

Community members and advocates said they are disappointed by the long wait, caused by a combination of bureaucratic delays and the complexity of the project. But when it does open, they said, they are hopeful that it will be a better, and safer, hospital.

The county is building the hospital and will help support it financially but will not be responsible for day-to-day operations. Instead, an independent, nonprofit organization will run the facility, to be known as Martin Luther King Jr. Community Hospital, and the University of California will help staff it and ensure the quality of patient care. Construction is progressing, but the grand opening may still be nearly two years away.

"It will be a significantly different kind of institution, with the right kind of accountability," said Robert K. Ross, president and chief executive of the California Endowment. "Now we just need the institution to open up on budget and on time."

Los Angeles County Supervisor Mark Ridley-Thomas said it takes time to create a state-of-the-art hospital — and a whole medical complex — that could become a model for others around the nation. "A lot of eyes are on this," he said. "We want to do this well and we want to do it right.... Nothing else is acceptable."

The nonprofit's board recognizes how critical the facility is to the area, said board President Manny Abascal. "Every day this hospital is not open, people are suffering," he said. At the same time, he added, the board is committed to ensuring that the new hospital is a high-quality institution. "If you open it … and there are some of the same problems you had before, then it's going to be devastating," he said.

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“Guardians of the Galaxy” director sorry for blog post seen as sexist, homophobic

LOS ANGELES (TheWrap.com) – James Gunn, the man entrusted with steering Marvel‘s “Guardians of the Galaxy” to the big screen, apologized publicly for a 2011 blog post that was criticized as sexist and homophobic.

Gunn, who is best known for directing the 2006 horror-comedy “Slither,” found himself under fire this week after reports about a blog post titled “The 50 Superheroes You Most Want to Have Sex With.” In it, he called the superhero Gambit a “Cajun fruit” and suggested that Iron Man could “turn” the lesbian Batwoman into a straight woman. He went on to joke that Batgirl, a masked avenger who happens to be a teen mother, was “easy.” The list was voted on by Twitter and Facebook users, but has since been removed from his site.

In a statement to the Gay & Lesbian Alliance Against Defamation (GLAAD), Gunn said his attempt at irreverence was misguided and stressed that he is a proponent of gay rights and women’s rights.

“A couple of years ago I wrote a blog that was meant to be satirical and funny,” Gunn said. “In rereading it over the past day I don’t think it’s funny. The attempted humor in the blog does not represent my actual feelings. However, I can see where statements were poorly worded and offensive to many. I’m sorry and regret making them at all.”

The post is an unwanted distraction from his efforts to give Marvel and its corporate owner the Walt Disney Company another hit. He plans to co-write the script for “Guardians of the Galaxy” in addition to directing. The film will be released in 2014.

“It kills me that some other outsider like myself, despite his or her gender or sexuality, might feel hurt or attacked by something I said,” he added in his apology. “We’re all in the same camp, and I want to do my best to make this world a better place for all of us. I’m learning all the time. I promise to be more careful with my words in the future. And I will do my best to be funnier as well. Much love to all.”

Internet News Headlines – Yahoo! News

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Glen Campbell considering more live shows in 2013

NASHVILLE, Tenn. (AP) — Glen Campbell may be wrapping up a goodbye tour but that doesn't mean he's done with the stage.

Campbell is considering scheduling more shows next year after playing more than 120 dates in 2012.

The 76-year-old singer has Alzheimer's disease and has begun to lose his memory. He put out his final studio album, "Ghost on the Canvas," in 2011 and embarked on the tour with family members and close friends serving in his band and staffing the tour.

Campbell's longtime manager Stan Schneider said in a phone interview from Napa, Calif., where the tour wrapped for the year Friday night, that recent West Coast shows have been some of the singer's strongest. Campbell will break for the holidays and if he still feels strong he'll begin scheduling more shows.

___

Online:

http://glencampbellmusic.com

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Doctors Who Work for Hospitals Face a New Bottom Line

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.

Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.

In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.

In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.

Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.

Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed.

Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know for sure. “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the F.T.C.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.”

A Drive to Consolidate

An array of new economic realities, from reduced Medicare reimbursements to higher technology costs, is driving consolidation in health care and transforming the practice of medicine in Boise and other communities large and small. In one manifestation of the trend, hospitals, private equity firms and even health insurance companies are acquiring physician practices at a rapid rate.

Today, about 39 percent of doctors nationwide are independent, down from 57 percent in 2000, according to estimates by Accenture, a consulting firm.

Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law.

“If you’re going to be paid for value, for performance, you’ve got to perform together,” said Dr. Ricardo Martinez, chief medical officer for North Highland, an Atlanta-based consultant that works with hospitals.

The recent trend is reminiscent of the consolidation that swept the industry in the 1990s in response to the creation of health maintenance organizations, or H.M.O.’s — but there is one major difference. Then, hospitals had difficulty managing the practices, contending that doctors did not work as hard when they were employees as they had as private operators. Now, hospitals are writing contracts more in their own favor.

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Cut Medicare and Social Security? What's the rush?

The question that normally comes to mind when someone claims to know the future is why he's out hustling rubes for pennies with his purported clairvoyance, instead of using it to make a fortune and retiring to the South Seas.

Of course, the answer is that nobody ever does know the future. And that leads to the question of why so much of the "fiscal cliff" debate in Washington is based on supposedly perfect knowledge of conditions that are 20, or even 70, years away.

We're talking about projections of the cost of "entitlements" — a noxious way of referring to Medicare and Social Security, excellent programs that most workers have paid for during their careers and that have kept millions of Americans healthy and out of poverty.

The customary talking point by the anti-deficit lobby is that the rising cost of these programs will eat us alive. That future, the argument continues, is coming at us like an onrushing train, so to avoid having to cut benefits when it arrives, we best cut benefits now.

The element of haste is a crucial element in this debate. That's because as real estate brokers and late-night TV hucksters know, pressure to Act Now! is what leads their marks to overlook that the basic premise is bogus.

Consider the prevailing assumptions about the future of Social Security and Medicare. One is that Social Security's trust fund will run dry in 2033, at which point the money coming in from payroll taxes will be enough to cover only about 75% of currently scheduled benefits. Will this happen? It might, but it might not:

The program's trustees, who are the source of the projection, don't bet the farm on it. They also project that under certain conditions of economic and employment growth — all of them perfectly plausible — it might never run dry. You don't hear much about that projection because it doesn't fit into the narrative that Social Security is "going broke."

Healthcare costs, with Medicare and Mediaid as big components, have been projected to rise to as much as 40% of gross domestic product by 2082 if not restrained. That's a fearsome prospect, but it's based on a long-outdated forecast by the Congressional Budget Office, which doesn't use the same methodology anymore. It was highly implausible, if not impossible, in the first place.

That CBO projection, like others employed by the anti-"entitlement" lobby to push for gutting the program, relied on projecting past experience into the future without adjusting for changes in behavior or policy.

This is a common fallacy well understood by pollsters. They know that if you ask people what the future will look like, they'll describe something that looks like today, except more so. If street crime is in the news, for example, they'll posit a future in which every community looks like Deadwood.

Investment experts try to moderate this tendency by reminding clients that trees don't grow to the stratosphere. To put it another way, just because your son is 4 feet tall at age 6 doesn't mean he'll be 12 feet tall at age 18. And just because the average American born today will live to the age of 78 doesn't mean that a baby born in 2032 will live to 100.

These questionable forecasts result in the nauseating spectacle of corporate CEOs such as Lloyd Blankfein of Goldman Sachs lecturing Americans that the retirement benefits and elder healthcare coverage they've paid for during their working lives are things we "can't afford."

Blankfein didn't worry about what the country could afford when Goldman pocketed $12.9 billion in taxpayer funds to cover its losses in the collapse of insurance giant AIG. But there he was on CBS on Nov. 19, saying, "You...have to do something to lower people's expectations — the entitlements and what people think that they're going to get, because they're not going to get it."

Blankfein proceeded to lecture his interviewer that Social Security "wasn't devised to be a system that supported you for a 30-year retirement after a 25-year career." This is fair enough, one supposes, though it's a mystery where Blankfein gets the idea that the average retiree today has spent only 25 years in the workplace, rather than 45, and lives to the age of 95. Does Goldman Sachs do all its math this way?

The Social Security projection is probably the most misused and misunderstood statistic in the fiscal-cliff debate. The trustees warn every year that its forecast is "inherently uncertain." They warn that it's a melange of projections of at least 17 factors, including fertility and mortality rates, economic growth, unemployment, wages and life expectancy, many of which are interrelated.

No one — no business, no government agency — makes plans today based on a vision of the world 20 years from now. IBM doesn't do it. Google doesn't do it. The Department of Defense doesn't do it. You and I don't do it. Not even life insurance companies, which might be said to live in the future, do it.

The reason smart people and companies don't make bets on the distant future is precisely because it's unknowable. Try the following thought experiment: Instead of looking ahead 20 years, look back 20 years, and try to list all the events that have had immense, material effects on today's economy, but were unimaginable in 1992.

Here's my list: 9/11. The Afghan war. The Iraq war. The housing bubble. The crash of 2000. The crash of 2008. The crash of Lehman Bros. The iPod. The iPhone. The iPad. The founding of Google. Hurricane Andrew, Hurricane Katrina, Superstorm Sandy. Obamacare.

What are the chances that another such list will make the U.S. economy in 2033 look utterly different from what we imagine in 2012? I'd say 100%.

Forecasting healthcare costs may be even more of a mug's game. In a 2008 paper, economists Glenn Follette and Louise Sheiner of the Federal Reserve observed that the CBO unwisely projected healthcare costs into the future by assuming that the trends of the past simply would continue.

But the trends of the past had included an unprecedented expansion of public and private insurance coverage, which cut average out-of-pocket spending from 51% of total healthcare outlays in 1960 to 13% in 2005. That created an explosion in demand.

Could the trend continue? Plainly not. The Fed economists also noted that any trend pointing toward healthcare consuming 40% of GDP would have such destructive effect on the rest of the economy that personal behavior or political action would change it before reaching that point. The CBO now acknowledges that.

Healthcare reform has made such projections even more uncertain today, in part because the reform act includes numerous cost-limiting initiatives, the success of which can only be guessed at. That's an argument against taking such radical steps as raising the Medicare eligibility age, as some fiscal-cliff pundits advocate.

Leaving aside that doing so would drive up costsfor employers, states and Medicare participants themselves by more than it would save the federal government (the Kaiser Family Foundation crunched the numbers), it's far too early to know if it's even necessary.

One might argue that the uncertainty of economic forecasts means there's no point in economic planning at all. But there are good reasons for looking ahead, just not good reasons for thinking your vision of the future is 20/20.

And there's a big difference between making a congressional budget and making fundamental changes in programs as complex as Social Security and Medicare. The life span of a congressional budget is two years, max, because no Congress can bind its successors. But changes in Social Security and Medicare are forever. So when you hear that we have to do it now, stat! or we're doomed, take it for the snake oil that it is.

Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.

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Away from Egypt's protests, the worries mount

CAIRO — Amid thimbles, pins and strands of silver thread, the tailor twitched his pencil-perfect mustache in disgust and said the country where he learned to sew and raised six children was edging into darkness.

"I'm worried," said Sayed Abdelwahab, leaning on a worn counter in a shop where he has mended suits for decades. "I have employees with three and four kids. I'm responsible for them. My customers are mostly foreigners, but they're leaving the country. My business is down 50%. Did you see what happened to the stock market?"

"It's Morsi," said his friend Awad Abdelhafez, a porter, referring to Egyptian President Mohamed Morsi. "He's taken all the power.... Who's responsible for those dying in this violence?"

Such was the talk Thursday on a shaded street in a Cairo neighborhood far from the protest banners in Tahrir Square and the political intrigue over a new constitution. After nearly two years marked by endless clashes and skies tinged with tear gas, the true Egypt is slipping deeper into its worries.

The ragged semblance of democracy that emerged from the 2011 uprising against Hosni Mubarak is dominated by Morsi and his Muslim Brotherhood. The opposition can fill the streets with demonstrators and slogans but so far lacks the momentum to unseat Islamists in the fight for the nation's character.

But on this street, where butcher knives flash quick and women sell dusty oranges stacked in pyramids, such thoughts seem strange abstractions. But then, so does the recent revelation by Morsi to Time magazine that he found the movie "Planet of the Apes" to be politically instructive. Heads shake in weary unison.

"I'm so worried and depressed I can't follow things anymore," said Dina Mohamed, a call center operator. "Morsi's been ruling us for four months but he's mixing the wrong ingredients. I'm scared we're facing a hunger revolution. The poor will rise up for bread, not politics or culture, but for their own lives."

This in a nation where the average annual income is reported to be about $4,000. More than 40% of the population lives on $2 a day. The revolution has not improved these statistics, and to many Egyptians, that is its central failing. All the promises that have echoed from mosques, political rallies and television studios have drifted past them like smoke.

The deeper worry is about prolonged civil strife between Islamists and secularists over how deeply Islam will be embedded in public life. This is the fierce debate that the country knew for generations had to come. But now that it has suddenly arrived, the sides have hardened to the point where even Mubarak loyalists have joined their onetime foes, the leftists, to take on Morsi and other Islamists.

"I respect Morsi very much," said Mahmoud Hashem, stepping out from behind the counter of a juice shop. He wears a beard and, as is customary for conservative Muslims, does not look an unveiled woman in the eye. "We elected him. He needs to make decisions as a president, and whether they're right or wrong we have to stand by him. We chose him for four years. He must be given a chance."

But then, step into the tailor's shop, a box of a place with mannequins in the window wearing half-finished jackets, pins in shoulders, strips of fabric whirling on the floor. Abdelwahab has been here since 1966. He started in the trade even before that, when he was 13, after his parents died and he quit school "because I had to look after myself."

That was a few years after Gamal Abdel Nasser, a charismatic army officer, led the 1952 revolution that won Egypt its independence, eventually leading to President Anwar Sadat's peace treaty with Israel, the rise of Mubarak and, Abdelwahab scoffed, the era of Morsi.

"It was good under Nasser and Sadat," he said. "It was good under Mubarak for the first 20 years, but the last 10, when he gave his son more power and started privatization, things started going bad."

Now?

"Worst time of all," he said. "The country is falling apart. We're going to hell."

Abdelhafez, the porter, nodded.

A man sewing upstairs, yelled down, "Half of us are slaves!"

"The people in Tahrir Square will never be slaves," said Abdelwahab. "They are fighting."

The men talked, voices rising and falling in an afternoon cool with the coming winter. Would the military step in again like it did immediately after Mubarak's fall? Would the stock market rebound? Would those killing the protesters be prosecuted? Why is it that every time U.S. Secretary of State Hillary Rodham Clinton visits Cairo, as she did last week to help seal a cease-fire between Israel and Hamas, something bad happens shortly after? (The porter's eyebrows danced at the question.) Why isn't the Muslim Brotherhood open to different views, different ways of seeing things?

So many discussions. But there was work to do, even if many of Abdelwahab's clients had left the country and there were only a few bags of ruffled shirts needing a needle and thread, a steam and a pressing.

This weekend, the Brotherhood has promised a huge rally in Cairo to support Morsi and pressure the protesters in Tahrir.

The porter and the tailor glanced at each other.

"We are entering a dangerous weekend," said Abdelhafez, who left his friend's shop and crossed the street, passing a man yelling into his cellphone. "The Islamists want to pass this constitution!" the man said. "They want to make this country their own!"

jeffrey.fleishman@latimes.com

Special correspondent Reem Abdellatif contributed to this report.

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he's a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America's battlefields and an "honest conversation about the country's history."

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Online:

http://www.traceadkins.com

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Man Indicted in New Hampshire in Hepatitis Infections

A traveling medical technician who is believed to have infected at least 39 people with hepatitis C through his use of stolen hospital drugs and syringes was indicted late Wednesday in New Hampshire on 14 new charges.

The technician, David Kwiatkowski, known as the “serial infector,” was arrested in July and charged with tampering with a consumer product and illegally obtaining drugs, primarily fentanyl, a powerful anesthetic that is about 80 times more potent than morphine.

After a lengthy investigation that ranged over several states, he was indicted Wednesday by a federal grand jury in Concord, N.H., and charged with seven counts of tampering with a consumer product and seven counts of illegally obtaining drugs.

If convicted on the pending charges, Mr. Kwiatkowski, 33, faces up to 10 years in prison for each count of tampering with a consumer product and up to four years in prison for each count of obtaining controlled substances by fraud. Each offense is also punishable by a fine of $250,000.

Mr. Kwiatkowski had pleaded not guilty to the original charges and remains in federal custody in New Hampshire.

In announcing the indictment, John P. Kacavas, the United States attorney in New Hampshire, said that Mr. Kwiatkowski “used the stolen syringes to inject himself, causing them to become tainted with his infected blood, before filling them with saline and then replacing them for use in the medical procedure.”

He continued, “Consequently, instead of receiving the prescribed dose of fentanyl, patients instead received saline tainted by Kwiatkowski’s infected blood.”

The problem was discovered after several patients in the cardiac catheterization lab at Exeter Hospital, where Mr. Kwiatkowski worked, tested positive for a specific strain of hepatitis C, a chronic disease that can lead to cancer and is a major reason for liver transplants. Mr. Kwiatkowski tested positive for the same strain, leading to the testing of thousands of patients in New Hampshire this summer.

The outbreak was one of the largest in recent history. The investigation has been complicated because Mr. Kwiatkowski worked at 18 hospitals in seven other states (Arizona, Georgia, Kansas, Maryland, Michigan, New York and Pennsylvania) over the last decade. He was fired from at least two hospitals but was hired subsequently by four others.

Since Mr. Kwiatkowski’s arrest, thousands of patients in the other states have been tested for hepatitis C. More than 30 patients in New Hampshire, about a half-dozen in Kansas and one in Maryland have tested positive for the same strain.

A report in August by the federal Centers for Medicare and Medicaid Services said that syringes at Exeter Hospital were left unattended on medication carts by nurses in the cardiac catheterization lab.

Hospital officials have said that they received reports of concerns about Mr. Kwiatkowski but not that he was diverting drugs. A statement on the hospital’s Web site said: “We understand that this has been a difficult time for our patients and the community. Our focus remains on all of our patients and while this situation has shaken the community, we will continue to do everything we can to restore the community’s confidence by providing excellent care to the hundreds of patients who receive care within our health system each day.”

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