Report: FDA wanted to close Mass pharmacy in 2003

WASHINGTON (AP) — Nearly a decade ago, federal health inspectors wanted to shut down the pharmacy linked to a recent deadly meningitis outbreak until it cleaned up its operations, according to congressional investigators.

About 440 people have been sickened by contaminated steroid shots distributed by New England Compounding Center, and more than 32 deaths have been reported since the outbreak began in September, according to the Centers for Disease Control and Prevention. That has put the Framingham, Mass.-based pharmacy at the center of congressional scrutiny and calls for greater regulation of compounding pharmacies, which make individualized medications for patients and have long operated in a legal gray area between state and federal laws.

The House Energy and Commerce Committee released a detailed history of NECC's regulatory troubles on Monday, ahead of a meeting Wednesday meeting to examine how the outbreak could have been prevented. The 25-page report summarizes and quotes from FDA and state inspection memos, though the committee declined to release the original documents.

The report shows that after several problematic incidents, Food and Drug Administration officials in 2003 suggested that the compounding pharmacy be "prohibited from manufacturing" until it improved its operations. But FDA regulators deferred to their counterparts in Massachusetts, who ultimately reached an agreement with the pharmacy to settle concerns about the quality of its prescription injections.

The congressional report also shows that in 2003 the FDA considered the company a pharmacy. That's significant because in recent weeks public health officials have charged that NECC was operating more as a manufacturer than a pharmacy, shipping thousands of doses of drugs to all 50 states instead of small batches of drugs to individual patients. Manufacturers are regulated by the FDA and are subject to stricter quality standards than pharmacies.

The report offers the most detailed account yet of the numerous regulatory complaints against the pharmacy, which nearly date back to its founding in 1998. Less than a year later, the company was cited by the state pharmacy board for providing doctors with blank prescription pads with NECC's information. Such promotional items are illegal in Massachusetts and the pharmacy's owner and director, Barry Cadden, received an informal reprimand, according to documents summarized by the committee.

Cadden was subject to several other complaints involving unprofessional conduct in coming years, but first came to the FDA's attention in 2002. Here are some key events from the report highlighting the company's early troubles with state and federal authorities:

__ In March of 2002 the FDA began investigating reports that five patients had become dizzy and short of breath after receiving NECC's compounded betamethasone repository injection, a steroid used to treat joint pain and arthritis that's different from the one linked to the current meningitis outbreak.

FDA inspectors visited NECC on April 9 and said Cadden was initially cooperative in turning over records about production of the drug. But during a second day of inspections, Cadden told officials "that he was no longer willing to provide us with any additional records," according to an FDA report cited by congressional investigators. The inspectors ultimately issued a report citing NECC for poor sterility and record-keeping practices but said that "this FDA investigation could not proceed to any definitive resolution," because of "problems/barriers that were encountered throughout the inspection."

__ In October of 2002, the FDA received new reports that two patients at a Rochester, N.Y., hospital came down with symptoms of bacterial meningitis after receiving a different NECC injection. The steroid, methylprednisolone acetate, is the same injectable linked to the current outbreak and is typically is used to treat back pain. Both patients were treated with antibiotics and eventually recovered, according to FDA documents cited by the committee.

When officials from the FDA and Massachusetts Board of Pharmacy visited NECC later in the month, Cadden said vials of the steroid returned by the hospital had tested negative for bacterial contamination. But when FDA scientists tested samples of the drug collected in New York they found bacterial contamination in four out of 14 vials sampled. It is not entirely clear whether FDA tested the same lot shipped to the Rochester hospital.

__ At a February 2003 meeting between state and federal officials, FDA staff emphasized "the potential for serious public consequences if NECC's compounding practices, in particular those relating to sterile products, are not improved." The agency issued a list of problems uncovered in its inspection to NECC, including a failure to verify if sterile drugs met safety standards.

But the agency decided to let Massachusetts officials take the lead in regulating the company, since pharmacies are typically regulated at the state level. It was decided that "the state would be in a better position to gain compliance or take regulatory action against NECC as necessary," according to a summary of the meeting quoted by investigators.

The FDA recommended the state subject NECC to a consent agreement, which would require the company to pass certain quality tests to continue operating. But congressional investigators say Massachusetts Board of Pharmacy did not take any action until "well over a year later."

__ In October 2004, the board sent a proposed consent agreement to Cadden, which would have included a formal reprimand and a three-year probationary period for the company's registration. The case ended without disciplinary action in 2006, when NECC agreed to a less severe consent decree with the state.

Massachusetts officials indicated Tuesday they are still investigating why NECC escaped the more severe penalty.

"I will not be satisfied until we know the full story behind this decision," the state's interim health commissioner Lauren Smith said in a transcript of her prepared testimony released a day ahead of delivery. Smith is one of several witnesses scheduled to testify Wednesday, including FDA Commissioner Margaret Hamburg.

The committee will also hear from the widow of 78-year-old Eddie C. Lovelace, a longtime circuit court judge in southern Kentucky. Autopsy results confirmed Lovelace received fungus-contaminated steroid injections that led to his death Sept. 17.

Joyce Lovelace will urge lawmakers to work together on legislation to stop future outbreaks caused by compounded drugs, according to a draft of her testimony.

"We now know that New England Compounding Pharmacy, Inc. killed Eddie. I have lost my soulmate and life's partner with whom I worked side by side, day after day for more than fifty years," Lovelace states.

Barry Cadden is also scheduled to appear at the hearing, after lawmakers issued a subpoena to compel him to attend.

The NECC has been closed since early last month, and Massachusetts officials have taken steps to permanently revoke its license. The pharmacy has recalled all the products it makes, including 17,700 single-dose vials of a steroid that tested positive for the fungus tied to the outbreak.

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Cal State and UC back off tuition hikes after Prop. 30 win

California's two public university systems retreated from various tuition hikes as Gov. Jerry Brown suggested the moves would be ill-timed coming just a week after voters approved a tax increase for education.

California State University trustees postponed action Tuesday on a plan to impose new student fees and University of California regents also agreed to shelve a proposal, scheduled for a vote Wednesday, to add supplemental fees to some professional degree programs.

Cal State's "incentive" fees were designed to encourage students to graduate more quickly, freeing space for new students. But Brown, who attended the meeting of the governing board in Long Beach, said the plan needed more study.

The governor also plans to attend the regents' meeting in San Francisco on Wednesday in a kind of victory lap for his Proposition 30 tax measure.

But he also carried a strong message to both systems.

"Right after the election is no time to be raising fees of any kind," the governor said, urging the universities to keep costs down and not pass them on to students. "Voters gave us a billion dollars in new revenues and now we have to use that very judiciously."

Students, he said, had been battered by the economy, successive years of tuition increases and large debt loads.

"The problem is we have a stratified society, those at the top are doing very well while those at the bottom are not doing well," he said. "I'm looking for segments to find ways of sharing the burden, but sharing according to the abilities people have."

Addressing the reduced class schedules that have made it difficult for students to progress toward graduation, Brown said universities might have to increasingly rely on online education. As governor, Brown is president of the Board of Trustees, but this was the first meeting he attended during his current term.

His timing was strategic: He acknowledged the support of students, trustees and faculty in working to pass Proposition 30, which raises $6 billion with a quarter-cent sales tax increase over four years and an income tax hike on high-income earners over seven years. Its failure would have triggered deep spending cuts to public education. After its victory, Cal State announced it would rescind a $249 per-semester tuition hike that took effect this fall, rolling it back to the 2011-12 cost of $5,472.

In opening remarks, board Chairman A. Robert Linscheid said he removed the fee proposal from the agenda to study its consequences further, in light of the passage of Proposition 30 and after hearing objections from students and others.

"The mission is still important, to free up space for other students, but there may be other avenues to get to that goal," Linscheid said.

Students expressed relief that the fee hikes were, at least temporarily, postponed.

"I'm really excited," said David Allison, a senior at Cal State San Bernardino who is president of the California State University Students Assn. "I hope this means they will look for ways to change behavior without raising fees on students."

The plan would have increased fees for students who accumulate more credits than they need to graduate, who carry more than a full load and who repeat courses. Officials said it would raise about $30 million in annual revenues, mainly by increasing enrollment at the system's 23 campuses.

Other students said they planned to continue with plans to hold a vigil late into the evening to keep pressure on trustees.

"Postponing this was one of our goals but ultimately, they need to get rid of this idea," said Miguel Garcia, 27, an anthropology major at the San Bernardino campus.

UC officials dropped consideration of a possible 20%, or $2,400, mid-year tuition hike for all students after Proposition 30 prevailed. But remaining on the agenda was the separate proposal to raise tuition next year for more than 50 graduate and professional degree programs in such areas as business, dentistry, law and social work.

Under the plan, the so-called professional degree supplemental tuition would have increased from 1.2% to 35%, depending on the campus and department. Most would have been 7% or lower.

Those supplemental fees are in addition to the basic $12,192 tuition. For example, the proposal would have raised the supplemental fee at UCLA's graduate business program to $28,052, an increase of $1,626; total tuition for that program would have been $40,244 a year.

The graduate nursing program at UC Irvine would have gone up to $10,440 with the supplemental fee, a $2,700 increase; total tuition would have been $22,632 under the plan.

According to a UC statement released Tuesday, the governor asked for "additional time to allow him to develop a better understanding of the policies and methodology" of the graduate and professional school charges.

carla.rivera@latimes.com

Times staff writer Larry Gordon contributed to this report.

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Afghan Warlord Ismail Khan’s Call to Arms Rattles Kabul

Bryan Denton for The New York Times

Mujahedeen commanders at a gathering in Herat, Afghanistan, to address the threat to security posed by the Taliban.

HERAT, Afghanistan — One of the most powerful mujahedeen commanders in Afghanistan, Ismail Khan, is calling on his followers to reorganize and defend the country against the Taliban as Western militaries withdraw, in a public demonstration of faltering confidence in the national government and the Western-built Afghan National Army.

Mr. Khan is one of the strongest of a group of warlords who defined the country’s recent history in battling the Soviets, the Taliban and one another, and who then were brought into President Hamid Karzai’s cabinet as a symbol of unity. Now, in announcing that he is remobilizing his forces, Mr. Khan has rankled Afghan officials and stoked fears that other regional and factional leaders will follow suit and rearm, weakening support for the government and increasing the likelihood of civil war.

This month, Mr. Khan rallied thousands of his supporters in the desert outside Herat, the cultured western provincial capital and the center of his power base, urging them to coordinate and reactivate their networks. And he has begun enlisting new recruits and organizing district command structures.

“We are responsible for maintaining security in our country and not letting Afghanistan be destroyed again,” Mr. Khan, the minister of energy and water, said at a news conference over the weekend at his office in Kabul. But after facing criticism, he took care not to frame his action as defying the government: “There are parts of the country where the government forces cannot operate, and in such areas the locals should step forward, take arms and defend the country.”

President Karzai and his aides, however, were not greeting it as an altruistic gesture. The governor of Herat Province called Mr. Khan’s reorganization an illegal challenge to the national security forces. And Mr. Karzai’s spokesman, Aimal Faizi, tersely criticized Mr. Khan.

“The remarks by Ismail Khan do not reflect the policies of the Afghan government,” Mr. Faizi said. “The government of Afghanistan and the Afghan people do not want any irresponsible armed grouping outside the legitimate security forces structures.”

In Kabul, Mr. Khan’s provocative actions have played out in the news media and brought a fierce reaction from some members of Parliament, who said the warlords were preparing to take advantage of the American troop withdrawal set for 2014.

“People like Ismail Khan smell blood,” Belqis Roshan, a senator from Farah Province, said in an interview. “They think that as soon as foreign forces leave Afghanistan, once again they will get the chance to start a civil war, and achieve their ominous goals of getting rich and terminating their local rivals.”

Indeed, Mr. Khan’s is not the only voice calling for a renewed alliance of the mujahedeen against the Taliban, and some of the others are just as familiar.

Marshal Muhammad Qasim Fahim, an ethnic Tajik commander who is President Karzai’s first vice president, said in a speech in September, “If the Afghan security forces are not able to wage this war, then call upon the mujahedeen.”

Another prominent mujahedeen fighter, Ahmad Zia Massoud, said in an interview at his home in Kabul that people were worried about what was going to happen after 2014, and he was telling his own followers to make preliminary preparations.

“They don’t want to be disgraced again,” Mr. Massoud said. “Everyone tries to have some sort of Plan B. Some people are on the verge of rearming.”

He pointed out that it was significant that the going market price of Kalashnikov assault rifles had risen to about $1,000, driven up by demand from a price of $300 a decade ago. “Every household wants to have an AK-47 at home,” he said.

“The mujahedeen come here to meet me,” Mr. Massoud added. “They tell me they are preparing. They are trying to find weapons. They come from villages, from the north of Afghanistan, even some people from the suburbs of Kabul, and say they are taking responsibility for providing private security in their neighborhood.”

Habib Zahori and Jawad Sukhanyar contributed reporting from Herat, Afghanistan, and an employee of The New York Times from Kabul.

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Belize wants to quiz anti-computer virus guru McAfee in murder probe

BELIZE CITY (Reuters) – Police in Belize want to question U.S. anti-computer virus software pioneer John McAfee in connection with the murder of a neighbor he had been quarrelling with, but they say he remains a person of interest at this time and is not a suspect.

McAfee, who invented the anti-virus software that bears his name, has homes and businesses in Belize, and is believed to have settled in the country sometime around 2010.

“He is a person of interest at this time,” said Marco Vidal, head of Belize’s police Gang Suppression Unit. “It goes a bit beyond that, not just being a neighbor.”

Police officers were looking for the software engineer, said Miguel Segura, the assistant commissioner of police.

Asked if McAfee was a suspect, he said: “At this point, no. Our job … is to get all the evidence beyond reasonable doubt that Mr A is the one that killed Mr B.”

“He (McAfee) … can assist the investigation, so there is no arrest warrant for the fellow,” added Segura, who heads the Criminal Investigation Branch.

McAfee’s neighbor, Gregory Viant Faull, a 52-year-old American, was found on Sunday lying dead in a pool of blood after apparently being shot in the head.

McAfee has been embroiled in controversy in Belize before.

His premises were raided in May after he was accused of holding firearms, though most were found to be licensed. The final outcome of the case is pending.

McAfee also owns a security company in Belize as well as several properties and an ecological enterprise.

Reuters was unable to contact McAfee on Monday.

Segura said McAfee had been at odds with Faull for some time. He accused his neighbor of poisoning his dogs earlier this year and filed an official complaint.

“There was some conflict there between (them) … prior to the death of the gentleman,” Segura said. “But those dogs didn’t have a post mortem to see if the toxicology would confirm what type of poison, if any.”

McAfee previously accused the police Gang Suppression Unit of killing his dogs during the May raid.

McAfee was one of Silicon Valley’s first entrepreneurs to amass a fortune by building a business off the Internet.

The former Lockheed systems consultant started McAfee Associates in 1989, initially distributing its anti-virus software as “shareware” on Internet bulletin boards.

He took the company public in 1992 and left two years later following accusations that he had hyped the arrival of a virus known as Michelango, which turned out to be a dud, to scare computer users into buying his company’s products.

(Reporting by Simon Gardner and Gabriel Stargardter in Mexico City and Jim Finkle; Editing by Kieran Murray and Todd Eastham)

Internet News Headlines – Yahoo! News

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Dancing with the Stars: Which Couple Had a Perfect Night?

11/12/2012 at 11:15 PM EST

Tom Bergeron and Brooke Burke Charvet

Adam Larkey/ABC

After performing twice last week, the remaining couples on Dancing with the Stars had double duty again Monday night. Each pair performed a tribute to America's troops as well as a trio dance with an eliminated pro or member of the DWTS troupe.

And it was a night of big scores! But the pressure is on ahead of Tuesday's double elimination.

Keep reading for all the details ...

Melissa Rycroft and Tony Dovolani furthered their lead after a night of perfect dancing. In the first round, they performed a quickstep that earned a standing ovation from the audience and 30 points from the judges. "It was like watching Ann Miller and Gene Kelly," Bruno Tonioli said. "It was as good as the best America has ever produced." Troupe member Henry Byalikov joined them for a trio paso doble in the second round – and another perfect score. "Of all of our celebrities," said Len Goodman, "you impress me the most."

Shawn Johnson and Derek Hough's Viennese waltz at the beginning of the night was well received. "You've turned into a beautiful, rich, in-depth performer," Carrie Ann Inaba said. They earned 29.5 points in the first round. But their trio with former partner Mark Ballas, a samba with tribal elements, caused a controversy in the ballroom. "It was very self-indulgent because there was very little samba content," Len said. "If you go home tomorrow don't blame me, blame those two." The second dance earned 26 points.

Apolo Ohno zip-lined across the ballroom to kick off his tango with partner Karina Smirnoff. "It was like Tom Cruise in Mission Impossible," Len said of the routine, which earned 29.5 points. "I absolutely loved it." For their trio the pair did a jive with troupe member Sasha Farber and earned another 29 points.

Gilles Marini and Peta Murgatroyd's quickstep to "Danger Zone" from Top Gun had a "few wobbles," according to Carrie Ann. Still, they earned 29.5 points. In the second round of competition, the pair performed a super sexy salsa with Chelsie Hightower. "I loved how you came out and you took control of the dance floor," Carrie Ann said of the routine, which earned them 29 more points.

Kelly Monaco proved she's "growing every week," according to Carrie Ann, who praised her 28-point Viennese waltz with Val Chmerkovskiy. Louis Van Amstel joined them for a trio jive in round two. "It had the F-factor," Len said of the 28.5-point routine. "It was fun, it was fast, it was flamboyant and it was fabulous."

Emmitt Smith and Cheryl Burke started off the night with a 28-point salsa that had Len saying, "This man puts the 'ooh' in smooth." Kym Johnson joined them at the end of the night for a salsa that earned a perfect 30 points. "You were in the red-hot, spicy jalapeño zone," Carrie Ann said.

Once again at the bottom are Kirstie Alley and Maksim Chmerkovskiy, who performed a Viennese waltz, which Len called their "very best dance," but earned just 27 points. Tristan MacManus joined them for a trio paso doble that Bruno said was "like watching Valley of the Dolls." "It did lack a bit of finesse," Len agreed. Their second routine scored just 24 points.

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British medical journal slams Roche on Tamiflu

LONDON (AP) — A leading British medical journal is asking the drug maker Roche to release all its data on Tamiflu, claiming there is no evidence the drug can actually stop the flu.

The drug has been stockpiled by dozens of governments worldwide in case of a global flu outbreak and was widely used during the 2009 swine flu pandemic.

On Monday, one of the researchers linked to the BMJ journal called for European governments to sue Roche.

"I suggest we boycott Roche's products until they publish missing Tamiflu data," wrote Peter Gotzsche, leader of the Nordic Cochrane Centre in Copenhagen. He said governments should take legal action against Roche to get the money back that was "needlessly" spent on stockpiling Tamiflu.

Last year, Tamiflu was included in a list of "essential medicines" by the World Health Organization, a list that often prompts governments or donor agencies to buy the drug.

Tamiflu is used to treat both seasonal flu and new flu viruses like bird flu or swine flu. WHO spokesman Gregory Hartl said the agency had enough proof to warrant its use for unusual influenza viruses, like bird flu.

"We do have substantive evidence it can stop or hinder progression to severe disease like pneumonia," he said.

In the U.S., the Centers for Disease Control and Prevention recommends Tamiflu as one of two medications for treating regular flu. The other is GlaxoSmithKline's Relenza. The CDC says such antivirals can shorten the duration of symptoms and reduce the risk of complications and hospitalization.

In 2009, the BMJ and researchers at the Nordic Cochrane Centre asked Roche to make all its Tamiflu data available. At the time, Cochrane Centre scientists were commissioned by Britain to evaluate flu drugs. They found no proof that Tamiflu reduced the number of complications in people with influenza.

"Despite a public promise to release (internal company reports) for each (Tamiflu) trial...Roche has stonewalled," BMJ editor Fiona Godlee wrote in an editorial last month.

In a statement, Roche said it had complied with all legal requirements on publishing data and provided Gotzsche and his colleagues with 3,200 pages of information to answer their questions.

"Roche has made full clinical study data ... available to national health authorities according to their various requirements, so they can conduct their own analyses," the company said.

Roche says it doesn't usually release patient-level data available due to legal or confidentiality constraints. It said it did not provide the requested data to the scientists because they refused to sign a confidentiality agreement.

Roche is also being investigated by the European Medicines Agency for not properly reporting side effects, including possible deaths, for 19 drugs including Tamiflu that were used in about 80,000 patients in the U.S.

____

Online:

www.bmj.com.tamiflu/

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Some thoughts from pot-smoking skaters

Well, they've finally done it. The potheads will soon be running wild and free in Boulder and Seattle.

By becoming the first states to legalize recreational marijuana last week, Colorado and Washington have jettisoned the whole mishmash of medical marijuana cards and dispensary permits that have tied California up in knots. How did they pull that off ahead of us? We gave the world the Emerald Triangle, not to mention a West Los Angeles skate park some clueless bureaucrat named Stoner Skate Plaza.

Is this the beginning of the end to the second great American Prohibition? Or a fluke?

For answers, I turned to a panel of experts at the Lafayette Skate Park in Westlake. The skater punks were sitting on a park bench beneath the palm trees, smoking blunts and swishers (weed packed into cigar papers) and sipping 40s of malt liquor.

In front of them, other skaters practiced kickflips and popping ollies on ledges, steps and a star-shaped ramp wrapped in concrete. Overhead, dozens of sneakers dangled by their laces from a power line, trophies, they informed me, not of drugs or gangs but of their skating prowess.

The skaters were well aware of Colorado's and Washington's electoral feat. But after the initial cries of "very cool" and "road trip to Colorado" died down, it became clear that the skaters were as ambivalent about throwing our state wide open to the demon weed as the rest of California. Most of them already get their marijuana from dispensaries. They insisted they got their cards for legitimate medical conditions: migraines, insomnia, attention deficit disorder, skating injuries.

Robert, whose bottom lip was pierced with several black beads, said he gets his weed from a homie whose doctor recommended it for pain from a broken arm.

"He wasn't even a smoker," Robert said.

Leslie, in dreadlocks and a charcoal hoodie, said he didn't bother renewing his card this year because he also has a friend who shares.

"He smokes me out," he said. "I give him $10 every once in a while."

In the same breath, the skaters admitted their smoking was mostly recreational, a social thing. Marijuana is healthier than tobacco or alcohol — but not if you get addicted, they qualified.

"People stop doing what they normally do and just smoke weed," Kevin said.

The smokers were ages 18 to 21. To a man, they said they'd never help a kid get weed.

Well, when did you start? I asked. One after another, they answered. "I was 14." "14." "14."

But they have the same distaste for pushing drugs on children as the next guy.

"Just because I did it, you still have feelings for other people." Kevin said.

Even after I pointed out that the state had decriminalized possession of small amounts, they insisted that most of the people in California prisons were there for marijuana possession. No one but me seemed to be worried about putting potheads behind the wheel.

I tried to ask if they'd seen the Cheech and Chong movie in which police find the comics oblivious and stalled on a traffic island in a cloud of smoke? But Michael insisted that weed helped him concentrate while driving.

They would only concede that marijuana can make it more likely that "stupid people do stupid things," like texting while driving.

"Smoking just makes it easier for that person to get distracted," Leslie said.

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The New Islamists: Tunisia Battles Over Pulpits and a Revolution’s Legacy

Moises Saman for The New York Times

Female students at the Grand Mosque in Kairouan, Tunisia, a site of anti-Western sermons.

KAIROUAN, Tunisia — On the Friday after Tunisia’s president fell, Mohamed al-Khelif mounted the pulpit of this city’s historic Grand Mosque to deliver a full-throttle attack on the country’s corrupt culture, to condemn its close ties with the West and to demand that a new constitution implement Shariah, or Islamic law.

Articles in this series are exploring the rise of political Islam in the Middle East, as Islamic movements struggle to remake the Arab world.

Moises Saman for The New York Times

Mohamed al-Khelif, who at the Grand Mosque in Kairouan has attacked Tunisian ties with the West and demanded Islamic law.

“They’ve slaughtered Islam!” thundered Dr. Khelif, whom the ousted government had barred from preaching for 20 years. “Whoever fights Islam and implements Western plans becomes in the eyes of Western politicians a blessed leader and a reformer, even if he was the most criminal leader with the dirtiest hands.”

Mosques across Tunisia blazed with similar sermons that day and, indeed, every Friday since, in what has become the battle of the pulpit, a heated competition to define Tunisia’s religious and political identity.

Revolution freed the country’s estimated 5,000 officially sanctioned mosques from the rigid controls of the previous government, which appointed every prayer leader and issued lists of acceptable topics for their Friday sermons.

That system pushed a moderate, apolitical model of Islam that avoided confronting a dictator. When the system collapsed last year, ultraconservative Salafis seized control of up to 500 mosques by government estimates. The government, a proponent of a more temperate political Islam, says it has since wrested back control of all but 70 of the mosques, but acknowledges it has not yet routed the extremists nor thwarted their agenda.

“Before, the state suffocated religion — they controlled the imams, the sermons, the mosques,” said Sheik Tai’eb al-Ghozzi, the Friday Prayer leader at the Grand Mosque here. “Now everything is out of control — the situation is better but needs control.”

To this day, Salafi clerics like Dr. Khelif, who espouse the most puritanical, most orthodox interpretation of Islam, hammer on favorite themes that include putting Islamic law into effect immediately, veiling women, outlawing alcohol, shunning the West and joining the jihad in Syria. Democracy, they insist, is not compatible with Islam.

“If the majority is ignorant of religious instruction, then they are against God,” said Sheik Khatib al-Idrissi, 60, considered the spiritual guide of all Tunisian Salafis. “If the majority is corrupt, how can we accept them? Truth is in the governance of God.”

The battle for Tunisia’s mosques is one front in a broader struggle, as pockets of extremism take hold across the region. Freshly minted Islamic governments largely triumphed over their often fractious, secular rivals in postrevolutionary elections. But those new governments are locked in fierce, sometimes violent, competition with the more hard-line wing of the Islamic political movements over how much of the faith can mix with democracy, over the very building blocks of religious identity. That competition is especially significant in Tunisia, once the most secular of the Arab nations, with a large educated middle class and close ties to Europe.

The Arab Spring began in Tunisia, and its ability to reconcile faith and governance may well serve as a barometer for the region.

Some analysts link the assertive Tunisian Salafi movement to what they consider a worrying spread of violent extremism across North Africa — including an affiliate of Al Qaeda seizing control of northern Mali; a murderous attack on the American diplomatic mission in Benghazi, Libya; a growing jihadi force facing Israel in the Sinai; and a mob looting an American school and parts of the United States Embassy in Tunis.

Senior government officials said the various groups share an ideology and are in contact with one another, suggesting that while they are scattered and do not coordinate their operations, they reinforce one another’s agendas. There have been several episodes of jihadists caught smuggling small arms from Libya to Mali or Algeria across Tunisia, for example, including two small trucks packed with Kalashnikovs and some manner of shoulder-fired missiles or grenades in June, said Ali Laarayedh, the interior minister.

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Tori Spelling Introduces Son Finn Davey

Mom & Babies
Celebrity Baby Blog

11/11/2012 at 08:00 PM ET

Michael Simon/Startraks

Meet Finn Davey McDermott!

Tori Spelling and Dean McDermott introduce their fourth child, posing inside the 10-week-old’s nursery in a set of recently released photos.

After a difficult pregnancy that included hospitalization and bedrest due to placenta previa, the actress delivered her son via c-section at 37 weeks.

“I would rub my belly and talk to Finn. I kept telling him, ‘We’re going to be fine’ and ‘I can’t wait to hold you,’” Spelling, 39, tells PEOPLE.

Now happy and healthy at home, Finn joins siblings Hattie, 13 months, Stella, 4, and Liam, 5½, as well as Jack, 14, McDermott’s son from a prior marriage.

Check back Monday, when PEOPLE.com will have an exclusive look at all of Finn’s nursery details.

Michael Simon/Startraks

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Food labels multiply, some confuse consumers

FRESNO, Calif. (AP) — Want to avoid pesticides and antibiotics in your produce, meat, and dairy foods? Prefer to pay more to make sure farm animals were treated humanely, farmworkers got their lunch breaks, bees or birds were protected by the farmer and that ranchers didn't kill predators?

Food labels claim to certify a wide array of sustainable practices. Hundreds of so-called eco-labels have cropped up in recent years, with more introduced every month — and consumers are willing to pay extra for products that feature them.

While eco-labels can play a vital role, experts say their rapid proliferation and lack of oversight or clear standards have confused both consumers and producers.

"Hundreds of eco labels exist on all kinds of products, and there is the potential for companies and producers to make false claims," said Shana Starobin, a food label expert at Duke University's Nicholas School of the Environment.

Eco-labels have multiplied in recent years in response to rising consumer demand for more information about products and increased attention to animal and farmworker welfare, personal health, and the effects of conventional farming on the environment.

"Credible labels can be very helpful in helping people get to what they want to get to and pay more for something they really care about," said Urvashi Rangan, director of consumer safety at Consumer Reports. "The labels are a way to bring the bottom up and force whole industries to improve their practices."

The problem, Rangan and other said, is that few standards, little oversight and a lot of misinformation exist for the growing array of labels.

Some labels, such as the USDA organic certification, have standards set by the federal government to which third party certifiers must adhere. Some involve non-government standards and third-party certification, and may include site visits from independent auditors who evaluate whether a given farm or company has earned the label.

But other labels have little or no standards, or are certified by unknown organizations or by self-interested industry groups. Many labels lack any oversight.

And the problem is global, because California's products get sold overseas and fruits and vegetables from Europe or Mexico with their own eco-labels make it onto U.S. plates.

The sheer number of labels and the lack of oversight create a credibility problem and risk rendering all labels meaningless and diluting demand for sustainably produced goods, Rangan said.

Daniel Mourad of Fresno, a young professional who likes to cook and often shops for groceries at Whole Foods, said he tends to be wary of judging products just by the labels — though sustainable practices are important to him.

"Labels have really confused the public. Some have good intentions, but I don't know if they're really helpful," Mourad said. "Organic may come from Chile, but what does it mean if it's coming from 6,000 miles away? Some local farmers may not be able to afford a label."

In California, voters this week rejected a ballot measure that would have required labels on foods containing genetically modified ingredients.

Farmers like Gena Nonini in Fresno County say labels distinguish them from the competition. Nonini's 100-acre Marian Farms, which grows grapes, almonds, citrus and vegetables, is certified biodynamic and organic, and her raisins are certified kosher.

"For me, the certification is one way of educating people," Nonini said. "It opens a venue to tell a story and to set yourself apart from other farmers out there."

But other farmers say they are reluctant to spend money on yet another certification process or to clutter their product with too much packaging and information.

"I think if we keep adding all these new labels, it tends to be a pile of confusion," said Tom Willey of TD Willey Farms in Madera, Calif. His 75-acre farm, which grows more than 40 different vegetable crops, carries USDA organic certification, but no other labels.

The proliferation of labels, Willey said, is a poor substitute for "people being intimate with the farmers who grow their food." Instead of seeking out more labels, he said, consumers should visit a farmers' market or a farm, and talk directly to the grower.

Since that's still impossible for many urbanites, Consumer Reports has developed a rating system, a database and a web site for evaluating environmental and food labels — one of several such guides that have popped up recently to help consumers.

The guides show that labels such as "natural" and "free range" carry little meaning, because they lack clear standards or a verification system.

Despite this, consumers are willing to pay more for "free range" eggs and poultry, and studies show they value "natural" over "organic," which is governed by lengthy federal regulations.

But some consumers and watchdog groups are becoming more vigilant.

In October, the Animal Legal Defense Fund filed a lawsuit against Petaluma, Calif., organic egg producer of Judy's Eggs over "free range" claims. The company's packaging depicts a hen ranging on green grass, and the inside reads "these hens are raised in wide open spaces in Sonoma Valley..."

Aerial photos of the farm suggest the chickens actually live in factory-style sheds, according to the lawsuit. Judy and Steve Mahrt, owners of Petaluma Farms, said in a statement that the suit is "frivolous, unfair and untrue," but they did not comment on the specific allegations.

Meanwhile, new labels are popping up rapidly. The Food Justice label, certified via third party audits, guarantees a farm's commitment to fair living wages and adequate living and working conditions for farmworkers. And Wildlife Friendly, another third-party audited program, certifies farmers and ranchers who peacefully co-exist with wolves, coyotes, foxes and other predators.

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Follow Gosia Wozniacka at http://twitter.com/GosiaWozniacka

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