Syrian rebels say they've seized strategic Taftanaz air base

BEIRUT – After weeks of fighting, Syrian rebels said Friday that they had seized a strategic air base in northwestern Idlib province, depriving the government of its ability to carry out helicopter airstrikes in the area.

The Taftanaz air base has been used by the government to stage helicopter attacks on rebels in the province, adjacent to the Turkish border. The campaign to seize it had been spearheaded by hard-line Islamic fighting groups, such as Al Nusra Front, which is affiliated with Al Qaeda.

"It was fully liberated, today in the morning. There are no elements from the regime at all, and now the FSA [Free Syrian Army] has complete control," a rebel said Friday in an interview by Skype. He called himself Ismaili Taftanazi, after the name of the air base.

The government of Syrian President Bashar Assad had no comment on the status of Taftanaz, but if the rebels' claim is confirmed, it will amount to a major strategic victory for the Islamist fighters, who have concentrated on peeling off air bases. If they can deprive the government of its bases, it will be harder for Assad's forces to resupply, move troops and unleash the punishing aerial strikes that have become a trademark of the nearly 22-month war.

A rebel victory would also solidify control of rebel-held territories in Idlib. The base is the province's biggest airstrip for attack helicopters. Finally, it would provide a morale boost to Islamic fighters carrying out a similar campaign against the three major air bases in Aleppo province. Many Syrians remain wary of the fighters, alarmed by the role of hard-line Islamist groups such as Al Nusra Front.

The rebels, though apparently winning the battle, were not on the verge of seizing the entire province, where the government still holds the city of Idlib and several key military installations. Even after losing the base, the Syrian air force was still able to use MIG fighter jets to shell it, Taftanazi said.

The current round of fighting lasted 10 days, according to another rebel, who gave his name as Hazem al Shami. "This is the biggest attack against the regime from the beginning of the revolution until now," Shami said in a phone interview that may have reflected more bravado than sober analysis. The rebels had tried to seize Taftanaz for months.

In the assault Friday, the rebels said, they pounded the base with a few tanks, artillery, mortars and heavy machine guns.

"Taftanaz is an important victory," said Jeffrey White, a defense fellow at the Washington Institute for Near East Policy. "The rebels showed their ability to take positions even if it takes a long time.... [And] it shows a paralysis in the regime command. They can't figure out how to deal with these situations. You have to wonder what effect it has inside the regime. What tales are being told in the inner circle about the air force's effectiveness."

White said the victory could free more rebel fighters to help take at least two more crucial bases in Idlib.

The rebels captured 15 to 20 MI-8/17 helicopters that were damaged and at least two T-72 tanks and one rocket, according to rebels and to White, who surveyed video posted on YouTube. Videos displayed the rebels showing off their captured spoils. One showed five or six rebels riding on the top of a tank, waving their hands in celebration.

Still, a military or diplomatic solution to Syria's conflict remains elusive. Last weekend, Assad unveiled a peace plan that amounted to a declaration that he alone would determine the war's end, not the United Nations or any other power. Special U.N. and Arab League envoy Lakhdar Brahimi angered the Syrian government by criticizing Assad's initiative.

Brahimi met in Geneva with U.S. Deputy Secretary of State William J. Burns and Russian Deputy Foreign Minister Mikhail Bogdanov in an effort to find common ground on Syria. Both countries say they agree on a peace initiative for Syria from last summer, but Russia refuses to back Washington's demand that Assad step down from power for a transitional government.

With Syria lambasting Brahimi publicly, it was unclear how much further the diplomat could push his peace plan. The meeting concluded without any major announcement.

"If you are asking me whether a solution is around the corner, I am not sure that is the case," Brahimi told reporters. "What I am certain of is that there is an absolute necessity for people to continue to work for such a peaceful solution."

ned.parker@latimes.com

Bulos is a special correspondent.

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In gun debate, video game industry defends itself

WASHINGTON (AP) — The video game industry, blamed by some for fostering a culture of violence, defended its practices Friday at a White House meeting exploring how to prevent horrific shootings like the recent Connecticut elementary school massacre.

Vice President Joe Biden, wrapping up three days of wide-ranging talks on gun violence prevention, said the meeting was an effort to understand whether the U.S. was undergoing a “coarsening of our culture.”

“I come to this meeting with no judgment. You all know the judgments other people have made,” Biden said at the opening of a two-hour discussion. “We’re looking for help.”

The gaming industry says that violent crime, particularly among the young, has fallen since the early 1990s while video games have increased in popularity.

There are conflicting studies on the impact of video games and other screen violence. Some conclude that video games can desensitize people to real-world violence or temporarily quiet part of the brain that governs impulse control. Other studies have concluded there is no lasting effect.

Cheryl Olson, a participant in Biden’s meeting and a researcher of the effect of violent video games, said there was concern among industry representatives that they would be made into a scapegoat in the wake of the Connecticut shooting.

“The vice president made clear that he did not want to do that,” Olson said.

Biden is expected to suggest ways to address violence in video games, movies and on television when he sends President Barack Obama a package of recommendations for curbing gun violence Tuesday. The proposals are expected to include calls for universal background checks and bans on assault weapons and high-capacity ammunition magazines.

Obama appointed Biden to lead a gun violence task force after last month’s shooting at a Newtown, Conn., elementary school that left 20 children and six educators dead.

Gun-safety activists were coalescing around expanded background checks as a key goal for the vice president’s task force. Some advocates said it may be more politically realistic — and even more effective as policy — than reinstating a ban on assault weapons.

The Brady Campaign to Prevent Gun Violence said some 40 percent of gun sales happen with no background checks, such as at gun shows and by private sellers over the Internet or through classified ads.

“Our top policy priority is closing the massive hole in the background check system,” the group said.

While not backing off support for an assault weapons ban, some advocates said there could be broader political support for increasing background checks, in part because that could actually increase business for retailers and licensed gun dealers who have access to the federal background check system.

“The truth is that an assault weapons ban is a very important part of the solution — and it is also much tougher to pass,” said Mark Glaze, director of Mayors Against Illegal Guns.

Restrictions on high-capacity ammunition magazines are also seen by some as an easier lift politically than banning assault weapons.

The National Rifle Association adamantly opposes universal background checks, as well as bans on assault weapons and high-capacity magazines — all measures that would require congressional approval. The NRA and other pro-gun groups contend that a culture that glamorizes violence bears more responsibility for mass shootings than access to a wide range of weapons and ammunition.

In a 2009 report, the American Academy of Pediatrics declared, “The evidence is now clear and convincing: Media violence is one of the causal factors of real-life violence and aggression.”

The report focused on all types of media violence. But for video games in particular, the pediatricians cited studies that found high exposure to violent ones increased physical aggression at least in the short term, and warned that they allow people to rehearse violent acts. On the other hand, it said friendly video games could promote good behavior.

A wide spectrum of the video game industry was represented at the meeting with the vice president, including the makers of violent war video games like “Call of Duty” and “Medal of Honor” and a representative from the Entertainment Software Ratings Board, which sets age ratings that on every video game package released in the United States.

The vice president met Thursday with representatives from the entertainment industry, including Motion Picture Association of America and the National Cable & Telecommunications Association. In a joint statement after the meeting, a half-dozen said they “look forward to doing our part to seek meaningful solutions” but offered no specifics.

Biden, hinting at other possible recommendations to the president, said he is interested in technology that would keep a gun from being fired by anyone other than the person who bought it. He said such technology may have curtailed what happened last month in Connecticut, where the shooter used guns purchased by his mother.

The vice president has also discussed making gun trafficking a felony, a step Obama can take through executive action. And he is expected to make recommendations for improving mental health care and school safety.

“We know this is a complex problem,” Biden said. “We know there’s no single answer.”

The president plans to push for the new measures in his State of the Union address, scheduled for Feb. 12.

___

Associated Press writers Lauran Neergaard and Darlene Superville contributed to this report.

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Britney Spears and fiance end yearlong engagement

LOS ANGELES (AP) — Britney Spears capped a week of changes Friday with a judge accepting the resignation of her former fiance from the conservatorship that oversees many of her personal and financial matters.

Jason Trawick submitted his resignation and it was accepted by Superior Court Judge Reva Goetz on Friday afternoon, when the singer announced her engagement had ended, only hours after she confirmed she was leaving the Fox competition show "The X Factor."

Spears and Trawick got engaged in December 2011 and he was added as her co-conservator in April.

"Jason and I have decided to call off our engagement," Spears said in the statement. "I'll always adore him and we will remain great friends."

Spears' publicist Jeff Raymond said the breakup was a difficult decision made by "two mature adults."

"I love and cherish her and her boys, and we will be close forever," Trawick said in a joint statement that was first reported by People magazine.

Spears has been under a court-supervised conservatorship since February 2008, with her father and another co-conservator, Andrew Wallet, having control over numerous aspects of her personal life. The case was opened after several incidents of erratic behavior by the pop singer and a pair of hospitalizations, but Spears has recovered and recently served as a judge on Fox's "The X Factor."

Spears informed the network this week that she would not return next season and planned to focus on her music.

Trawick and Spears were engaged in December 2011 and he was appointed a co-conservator along with her father, Jamie, in April. Jamie Spears met with Goetz for about an hour on Friday but left before a hearing where Trawick's resignation was announced.

Trawick has served as Spears' agent and the pair started dating in 2009.

Trawick did not have authority over Spears' finances, which have rebounded since her public meltdown. Goetz recently reviewed and approved of an accounting that showed Spears ended 2010 with more than $27.5 million in assets, including nearly $15 million in cash.

Attorneys handling the case are expected to file updated financial statements in the coming months.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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Flu Deaths Reach Epidemic Level, but May Be at Peak

Deaths in the current flu season have officially crossed the line into “epidemic” territory, federal health officials said Friday, adding that, on the bright side, there were also early signs that the caseloads could be peaking.

Officials from the Centers for Disease Control and Prevention, speaking on a telephone news conference, again urged Americans to keep getting flu shots. At the same time, they emphasized that the shots are not infallible: a preliminary study rated this year’s vaccine as 62 percent effective, even though it is a good match for the most worrisome virus circulating. That corresponds to a rating of “moderately” effective — the vaccine typically ranges from 50 percent to 70 percent effective, they said.

Even though deaths stepped — barely — into epidemic territory for the first time last Saturday, the C.D.C. officials expressed no alarm, and said it was possible that new flu infections were peaking in some parts of the country. “Most of the country is seeing a lot of flu and that may continue for weeks,” said Dr. Thomas R. Frieden, the C.D.C.’s director.

New outpatient cases — a measure based on what percentage of doctor visits were for colds or flu — dropped off slightly from the previous week, to 4 percent from 6 percent. The trend was more pronounced in the South, where this year’s season began.

Dr. Frieden cautioned that the new flu figures could be aberrations because they were gathered as the holiday season was ending. Few people schedule routine checkups then, so the percentage of visits for severe illness can be pushed artificially high for a week or two, then inevitably drop.

Deaths from pneumonia and the flu, a wavy curve that is low in summer and high in winter, typically touch the epidemic level for one or two weeks every flu season. How bad a season is depends on how high the deaths climb for how long.

So far this season, 20 children with confirmed flu tests have died, but that is presumably lower than the actual number of deaths because not all children are tested and not all such deaths are reported. How many adults die will not be estimated until after the season ends, said Dr. Joseph Bresee, the chief of prevention and epidemiology for the C.D.C.’s flu branch. Epidemiologists count how many death certificates are filed in a flu year, compare the number with normal years, and estimate what percentage were probably flu-related.

Many people are getting ill this year because the country is also having widespread outbreaks of two diseases with overlapping symptoms, norovirus and whooping cough, and the normal winter surge in common colds. Flu shots have no effect on any of those.

Spot shortages of vaccines have been reported, and there will not be enough for all Americans, since the industry has made and shipped only about 130 million doses. But officials said they would be pleased if 50 percent of Americans got shots; in a typical year, 37 percent do.

Dr. Bresee said that this year’s epidemic resembles that of 2003-4, which also began early, was dominated by an H3N2 strain and killed more Americans than usual.

Nevertheless, more Americans now routinely get flu shots than did then, and doctors are much quicker to prescribe Tamiflu and Relenza, drugs that can lessen a flu’s severity if taken early.

The C.D.C.’s vaccine effectiveness study bore out the point of view of a report released last year by the University of Minnesota’s Center for Infectious Disease Research and Policy. It said that the shot’s effectiveness had been “overpromoted and overhyped,” said Michael T. Osterholm, the center’s director.

Although the report supported getting flu shots, it said that new vaccines offering lifelong protection against all flu strains, instead of annual partial protection against a mix-and-match set, must be created.

“But there’s no appetite to fund that research,” Dr. Osterholm said in an interview Friday.

“To get a vaccine across the ‘Valley of Death’ is likely to cost $1 billion,” he added, referring to the huge clinical trials that would be needed to approve a new type of vaccine. “No government has put more than $100 million into any candidate, and the private sector has no appetite for it because there’s not enough return on investment.”

At the same time, he praised the C.D.C. for measuring vaccine effectiveness in midseason.

“We’re the only ones in the world who have data like that,” he said.

“Vaccine effectiveness” is a very different metric from vaccine-virus match, which is done in a lab. Vaccine efficacy is measured by interviewing hundreds of sick or recovering patients who had positive flu tests and asking whether and when they had received shots.

Only people sick enough to visit doctors get flu tests, said Thomas Skinner, a C.D.C. spokesman, so the metric means the shot “reduces by 62 percent your chance of getting a flu so bad that you have to go to a doctor or hospital.”

During the telephone news conference Friday, Dr. Frieden repeatedly described the vaccine as “far from perfect, but by far the best tool we have to prevent influenza.”

Most vaccinations given in childhood for threats like measles and diphtheria are 90 percent effective or better. But flu viruses mutate so fast that they must be remade annually. Scientists are trying to develop vaccines that target bits of the virus that appear to stay constant, like the stem of the hemagglutinin spike that lets the virus break into lung cells.

During the 2009 swine flu pandemic, many elderly Americans had natural protection, presumably from flus they caught in the 1930s or ’40s.

“Think about that,” Dr. Osterholm said. “Even though they were old, they were still protected. We’ve got to figure out how to capture that kind of immunity — which current vaccines do not.”

At Friday’s news conference, Dr. Bresee acknowledged the difficulties, saying: “If I had the perfect answer as to how to make a better flu vaccine, I’d probably get a Nobel Prize.”

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Irvine City Council overhauls oversight, spending on Great Park

Capping a raucous eight-hour-plus meeting, the Irvine City Council early Wednesday voted to overhaul the oversight and spending on the beleaguered Orange County Great Park while authorizing an audit of the more than $220 million that so far has been spent on the ambitious project.

A newly elected City Council majority voted 3 to 2 to terminate contracts with two firms that had been paid a combined $1.1 million a year for consulting, lobbying, marketing and public relations. One of those firms — Forde & Mollrich public relations — has been paid $12.4 million since county voters approved the Great Park plan in 2002.

"We need to stop talking about building a Great Park and actually start building a Great Park," council member Jeff Lalloway said.

The council, by the same split vote, also changed the composition of the Great Park's board of directors, shedding four non-elected members and handing control to Irvine's five council members.

The actions mark a significant turning point in the decade-long effort to turn the former El Toro Marine base into a 1,447-acre municipal park with man-made canyons, rivers, forests and gardens that planners hoped would rival New York's Central Park.

The city hoped to finish and maintain the park for years to come with $1.4 billion in state redevelopment funds. But that money vanished last year as part of the cutbacks to deal with California's massive budget deficit.

"We've gone through $220 million, but where has it gone?" council member Christina Shea said of the project's initial funding from developers in exchange for the right to build around the site. "The fact of the matter is the money is almost gone. It can't be business as usual."

The council majority said the changes will bring accountability and efficiencies to a project that critics say has been larded with wasteful spending and no-bid contracts. For all that has been spent, only about 200 acres of the park has been developed and half of that is leased to farmers.

But council members Larry Agran and Beth Krom, who have steered the course of the project since its inception, voted against reconfiguring the Great Park's board of directors and canceling the contracts with the two firms.

Krom has called the move a "witch hunt" against her and Agran. Feuding between liberal and conservative factions on the council has long shaped Irvine politics.

"This is a power play," she said. "There's a new sheriff in town."

The council meeting stretched long into the night, with the final vote coming Wednesday at 1:34 a.m. Tensions were high in the packed chambers with cheering, clapping and heckling coming from the crowd.

At one point council member Lalloway lamented that he "couldn't hear himself think."

During public comments, newly elected Orange County Supervisor Todd Spitzer chastised the council for "fighting like schoolchildren." Earlier this week he said that if the Irvine's new council majority can't make progress on the Great Park, he would seek a ballot initiative to have the county take over.

And Spitzer angrily told Agran that his stewardship of the project had been a failure.

"You know what?" he said. "It's their vision now. You're in the minority."

mike.anton@latimes.com

rhea.mahbubani@latimes.com

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Academy Launches Oscar App on Android, Amazon

LOS ANGELES (TheWrap.com) – The Academy launched its official Oscars app on Android and Amazon on Thursday, expanding its initiative to direct fans’ attention from the television to the second screen.

The app, already available on the iPad and iPhone, was made available for free on the Google Play store and the Amazon app store, the Academy said. According to iTunes, the iPad app was updated earlier on Wednesday.

Developed by the Academy and Disney/ABC Television Group’s digital media arm, the app allows users to see behind-the-scenes videos and stories with host Seth MacFarlane and search information about the nominees. It also features a “My Picks” ballot on which users can organize their dream-team of winners.

On Oscar night on February 24, the app will feature “Backstage Pass,” a live telecast from more than a dozen cameras placed on the Red Carpet and throughout the Dolby Theatre – in the press room, the control room, backstage and elsewhere.

And a ticker on the app will notify when a users’ favorite actor and actress arrives on stage.

“We’re always looking for ways to bring fans closer to the show and this app provides a unique and fun way to do that,” Josh Spector, the managing director of digital media and marketing for the Academy, said in a statement. “More fans than ever will be able to enjoy the full Oscar experience now that our app is available to Droid users.”

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Warner wins legal victory for control of Superman

SAN FRANCISCO (AP) — Just in time for the summer release of a hoped-for blockbuster movie "Man of Steel," Warner Bros. won a second significant legal victory Thursday giving it complete commercial control of the lucrative Superman franchise.

A three-judge panel of the 9th U.S. Circuit of Appeals unanimously ruled that the heirs of Superman's co-creator Jerome Siegel must abide by a 2001 letter written by the family's attorney accepting Warner Bros.' offer for their 50 percent share of Superman. Though the five-page letter was never formalized into a contract, the appeals court said it was still binding.

"Statements from the attorneys for both parties establish that the parties had undertaken years of negotiations, that they had resolved the last outstanding point in the deal during a conversation on Oct. 15, 2001, and that the letter accurately reflected the material terms they had orally agreed to on that day," Judge Stephen Reinhardt wrote for the panel.

The ruling Thursday undoes a 2008 trial court decision ordering Warner Bros. to share an undetermined amount of money earned since 1999 with the heirs, and to give the family control of key components of the Superman story, including his costume. If that decision were to stand, the studio would have had to negotiate a new costly royalty agreement with the family.

"The court's decision paves the way for the Siegel finally to receive the compensation they negotiated for and which DC has been prepared to pay for over a decade," Warner Bros. said in a prepared statement, referring to its DC Comics division. "We are extremely pleased that Superman's adventures can continue to be enjoyed across all media platforms worldwide for generations to come."

The family's attorney, Marc Toberoff, didn't respond to a request for comment.

Toberoff said earlier that he would appeal another significant Warner Bros. victory won in October involving the family of Superman's other creator, Joseph Shuster, and their bid for half the commercial rights. Toberoff also represents the Shuster heirs, who lost their bid to retain a 50 percent share of Superman.

A federal judge in Los Angeles had ruled that Shuster's sister and brother relinquished any chance to reclaim Superman copyrights in exchange for annual pension payments from DC Comics. U.S. District Judge Otis Wright noted in that case that the families of both creators have been paid in excess of $4 million since 1978, plus undefined bonuses and medical benefits.

In April, the $412 check that DC Comics wrote in 1938 to acquire Superman and other creative works by Shuster and Siegel sold for $160,000 in an online auction.

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F.D.A. Requires Cuts to Dosages of Ambien and Other Sleep Drugs

WASHINGTON — For two decades, millions of Americans have taken Ambien to help them sleep at night. But for years, the Food and Drug Administration has gotten complaints that people felt drowsy the morning after taking the medicine or its successors, and sometimes got into car accidents.

On Thursday, after laboratory studies and driving tests confirming the risks of drowsiness, the agency said that women should be taking half as much.

The new recommendation applies to drugs containing the active ingredient zolpidem, by far the most widely used sleep aid. Using lower doses means less of the drug will remain in the blood in the morning hours, and will reduce the risk that people who use it will be impaired while driving.

Sleeping pills have boomed in popularity with the increasingly frantic pace of modern American life. According to IMS, a health care information and technology company, about 60 million prescriptions were dispensed in 2011, up about 20 percent since 2006. About 40 million were for products containing zolpidem.

The agency’s announcement was focused on women because they take longer to metabolize the drug than men. An estimated 10 percent to 15 percent of women will have a level of zolpidem in their blood that could impair driving eight hours after taking the pill, while only about 3 percent of men do, said Dr. Robert Temple, an official in the agency’s Center for Drug Evaluation and Research.

Reports of aftereffects from sleeping pills have circulated for years, and some doctors questioned why the drug agency took so long to act. Mishaps with sleepy driving — and even strange acts of texting, eating or having sex in the night without any memory of it in the morning — have long been familiar to the medical community.

“In this case, the F.D.A. may be behind the 8-ball,” said Daniel Carlat, an associate clinical professor of psychiatry at Tufts University, referring to residual drowsiness. “This has been a known problem. Few doctors will be surprised hearing about this. They’ll say, ‘Oh yeah, we’ve already seen this in our patients.’ ”

He added that Thursday’s announcement “will be good for public health because it will get patients to ask their doctors about the appropriate dosage.”

Agency officials acknowledged that they had received about 700 reports of driving mishaps with people on zolpidem over the years, with a spike in 2007 after a change in labeling caused more people to call in complaints. But they said it was not easy to draw a direct connection between the reports and the drug. Patients often did not remember what time they took the pill. Sometimes they had been drinking.

It was not until the drug agency reviewed driving simulation studies from controlled trials of the drug Intermezzo, which was approved in 2011 for middle-of-the-night waking, that a more complete picture of the risks emerged. The agency linked the driving simulation information with data from manufacturers on the amount of zolpidem in patients’ blood and determined that levels above about 50 nanograms per milliliter increased the risk of crashing while driving, said Dr. Ellis Unger, an official at the agency’s Center for Drug Evaluation and Research.

Dr. Unger said that all makers of new sleeping drugs would now be asked to conduct driving trials; a spokeswoman clarified that it would not be required.

“A lot of people are wondering about the elephant in the room,” Dr. Unger said. “Why did this take so long? This is science, and our thinking evolves over time.”

The drug agency told manufacturers that the recommended dose for women should be lowered to 5 milligrams from 10 for immediate-release products like Ambien, Edluar and Zolpimist. Doses for extended-release products should be lowered to 6.25 milligrams from 12.5, the agency said. Most sleeping drugs containing zolpidem are now generic.

For men, the agency informed manufacturers that labels should recommend that health care providers should “consider” prescribing lower doses.

Patients taking the higher doses should continue them for the time being, officials said, but should consult with their doctors about lowering them. Doctors can still prescribe the higher dose if the lower one does not work. The lower doses are already commercially available, Dr. Unger said, as they are recommended for older patients.

Sanofi, the manufacturer of Ambien and Ambien CR, said in a statement that it agreed that people taking zolpidem “should always talk to their doctor about the most appropriate dose,” and that the label “provides important information” to determine what that is. The company added that it “stands behind the significant clinical data demonstrating the safety and efficacy of Ambien.”

The drug has also been known to cause sleepwalking incidents, and Dr. Unger said there was evidence that the lower dose might ease such events, though it is weaker than the evidence about next-morning-drowsiness. Dr. Carlat said one of his patients discovered that her weight gain while on the drug was from midnight trips to the kitchen she did not even remember taking.

Dr. Daniel Kripke, professor emeritus of psychiatry at the University of California, San Diego, and a leading critic of sleeping pills, welcomed the move but said the agency was still not doing enough to investigate other possible side effects.

“It’s a very small step in the right direction,” he said. He added that sleeping medications like zolpidem might increase total sleep time by 20 minutes a night, but that most studies suggest that the use of sleeping pills impairs a person’s performance the next day.

Critics of the drug agency said the label on Intermezzo, which very clearly denotes the risks for women, indicate that the agency was aware of these problems earlier.

But Thomas Roth, director of the sleep center at Henry Ford Hospital in Detroit who has been a consultant to sleeping pill makers, said that the drug agency had always been concerned about the potential risks with driving, “but they care about it more now.” He said he believed the lower dose would still be effective for many patients.

Agency officials say all patients are unique and doses will need to be tailored. They say the drugs should be prescribed at the lowest dose required.

Dr. Daniel J. Buysse, professor of psychiatry at the University of Pittsburgh School of Medicine, said he already prescribed the lower dose when he feels it is necessary, by telling patients to cut a tablet in half along the score.

“This just tells me, maybe be a little bit more cautious,” said Dr. Buysse, who has been a consultant for drug companies including the maker of Ambien. “But I do not think it will have a big effect on what I do.”

Andrew Pollack contributed reporting from San Francisco.

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Anthem's mail-order policy may have crossed a legal line

Anthem Blue Cross may be breaking California law by requiring some policyholders to buy their prescription drugs from a single mail-order pharmacy, according to the state attorney general's office.

Anthem, the state's largest for-profit health insurer, had notified members with conditions such as HIV/AIDS and cancer that they will have to buy their medications from the mail-order pharmacy CuraScript or pay full price at a retail drugstore.

Other Anthem members, including those with chronic conditions such as diabetes, face no such requirement.

"California law clearly states that no one can be discriminated against because of a medical condition," said Lynda Gledhill, a spokeswoman for Atty. Gen. Kamala D. Harris. "If patients are being required to get their prescriptions from a certain pharmacy because of their condition, that is likely illegal."

She declined to comment on specific measures officials may take if Anthem proceeds with its policy switch, but stressed that the attorney general's office "treats very seriously cases involving restricting access to care."

Darrel Ng, an Anthem spokesman, said the insurer's policies "do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws." He also said other insurers have similar policies.

I sought the attorney general's opinion after the California Department of Managed Health Care voiced concern that Anthem hadn't done a good enough job informing people about the change, which was scheduled to take effect Jan. 1 but has been delayed until March 1.

Along with the postponement, Anthem said it would clarify possible exemptions to the new rule. But that didn't mollify critics.

"This is still a very serious issue," said David Balto, a Washington antitrust lawyer and former policy director for the Federal Trade Commission. "It affects some of the most vulnerable people in society."

When I broke the news in November that Anthem was imposing the new requirement for so-called specialty medications used to treat major illnesses, the insurer said the limitation would help keep costs down for patients and businesses.

State healthcare officials didn't challenge that assumption. But they said Anthem failed to make it clear that some members may be able to avoid the mail-order-only requirement.

"That was our primary concern," said Marta Green, a spokeswoman for the Department of Managed Health Care. "There are individuals for whom a mail-order pharmacy may not be appropriate."

For example, people taking a variety of meds may benefit from face-to-face contact with a pharmacist, rather than dealing with a mail-order drugstore's call center. A pharmacist, for instance, would be in a better position to explain how different drugs interact.

Or consider the case of Irvine resident Jeffrey Beckwith, 60, who had a liver transplant in 1995 and ever since has received 90-day refills for his specialty meds. He told me that, thanks to Anthem's policy change, he'll now only get 30 days' worth of pills at a time.

Anthem's Ng said the company will "highlight the process to request a hardship waiver" so that Beckwith and others could try to avoid using the mail-order pharmacy.

Ng provided a copy of the revised notice being sent to people requiring specialty meds. It says at the very bottom that "if this specialty mandate poses a hardship for you, you may file a grievance with Anthem" or request a form to seek an exemption.

Balto, the former FTC official, has been retained by retail drugstores to challenge Anthem's requirement. He said cutting off personal access to a pharmacist can have dire consequences for people with HIV/AIDS who may require a "cocktail" of drugs to manage their condition.

"You may have to take them in a particular order or at particular times," Balto said. "As you go, you may have to adjust your doses. Not being able to speak with your own pharmacist can have very serious repercussions."

California's Unruh Civil Rights Act (Section 51 of the Civil Code) specifies that all people must be treated equally "no matter what their sex, race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status or sexual orientation."

Section 12926.1 of the California Government Code says that "physical and mental disabilities include, but are not limited to, chronic or episodic conditions such as HIV/AIDS, hepatitis, epilepsy, seizure disorder, diabetes, clinical depression, bipolar disorder, multiple sclerosis and heart disease."

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Through new budget, Brown maps out sweeping change in state

SACRAMENTO — The days of catastrophic deficits behind him, Gov. Jerry Brown is set to propose a state budget Thursday that would shift the Capitol's focus from fiscal triage to sweeping policy changes in education, criminal justice and healthcare.

Brown is expected to use his spending plan to shake up California's public university systems, according to administration officials. The governor has long complained that they are bloated and inefficient, and he wants to attach strings to some of their funding.

He has also signaled that the state's court and prison budgets could be cut, including a shift of 16,000 inmates to cheaper, lower-security housing.

The governor wants to change how the state funds its nearly 10,000 public schools, and he will present his plan for implementing President Obama's healthcare overhaul.

Although he is largely free of the financial crisis that has long gripped state government, Brown has made clear that many of his proposals would reshape the way California spends the money it has rather than create costly new programs. The revenue from tax hikes passed by voters in November is spoken for, and Brown said this week that he would be dogged about keeping spending in check.

"If we don't do that," he said, "then we have an illusion that things are good and we go back to this money-today, no-money tomorrow."

Legislative leaders, emboldened by their new Democratic supermajorities in the Senate and Assembly, are likely to test his resolve. They have already suggested they'll push to restore many government services that were rolled back in recent years.

The tussle among the governor, lawmakers and lobbyists representing interests with a stake in the roughly $95-billion general fund typically lasts for months. Lawmakers have until June to pass a final budget.

Meanwhile, remnants of red ink remain. Legislative analysts say Brown will need to close a deficit of $1.9 billion. The governor has signaled that cuts in the state court and prison budgets could help cover that shortfall.

Court officials said they've been told to expect a $200-million cut. The court system's administrative director, Judge Steven Jahr, called that scenario a "potential crisis that would further cripple our justice system." Other officials warned of potential courthouse closures and reduced hours.

The governor also wants to end federal control of the healthcare system in state prisons. If he succeeds, Sacramento could save hundreds of millions of dollars by ending contracts with out-of-state prisons used to alleviate overcrowding. He would also retake control of prison medical spending, which is now determined by a federal overseer.

"We're wasting a lot of money on nonsense" in the prisons, Brown told reporters Tuesday.

Even in areas where spending will increase under state formulas and federal law — public schools, universities and healthcare — Brown will face obstacles in determining how the money is spent.

The University of California and California State University systems were each promised at least $125 million more this year. Brown wants to tie some future funding to graduation rates and acceptance of transfer students from the state's community colleges.

Brown also wants the universities to more aggressively embrace online teaching, which he says could reduce the need for higher student fees.

University officials, who have bristled at many of those suggestions, are already saying the promised money is not enough. The University of California has said tuition hikes are likely unless state funding is increased by more than $400 million, a number the governor has said is unrealistic. He has not yet provided his own figure.

The governor will also propose a radical shift in the way elementary and secondary schools are funded, seeking to direct more money to districts that serve poor students and English learners, who cost more to educate than other students.

Brown wants to give local districts more control over the money they receive from the state, eliminating mandates for smaller classes, spending on new technology and dozens of other requirements set in Sacramento.

Education and legislative leaders have expressed support for the governor's goals — and skepticism about the administration's ability to ensure that money will be used in the way he intends.

Brown's proposed budget will outline his plans for expanding health coverage under the new federal healthcare law, which is set to require increased coverage beginning in January 2014. The law will put hundreds of thousands of new enrollees into California's public insurance program, but the governor has raised concerns about what that will cost.

In addition, Brown has said the state may reduce the roughly $2 billion it gives to counties to care for the uninsured, amid objections from advocates and county officials.

"There needs to be a safety net that survives even after health reform is fully implemented," said Anthony Wright, executive director of Health Access California, which promotes expanded health coverage.

This year, Brown has a new $1 billion to spend, generated by a change in corporate taxes that voters approved as Proposition 39 in November. Half of the money is dedicated to clean-energy programs, and Brown is expected to use most of that for a proposal to increase energy efficiency at thousands of public schools. The rest goes to the general fund.

While his plans will be subject to negotiations with lawmakers, Brown made it clear he feels his hand is strengthened by his recent victories at the polls.

"My position," he said, "has become more strategically important."

anthony.york@latimes.com

chris.megerian@latimes.com

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