Halle Berry's ex arrested after fight at her house

LOS ANGELES (AP) — Halle Berry's ex-boyfriend Gabriel Aubry was arrested for investigation of battery Thursday after he and the Oscar-winning actress's current boyfriend got into a fight at her Hollywood Hills home, police said.

Aubry, 37, was booked for investigation of a battery, a misdemeanor, and released on $20,000 bail, according to online jail records. He's scheduled to appear in court Dec. 13.

Aubry came to Berry's house Thanksgiving morning and police responded to a report of an assault, said Los Angeles Police Officer Julie Boyer. Aubry was injured in the altercation and was taken to a hospital where he was treated and released.

Emails sent to Berry's publicist, Meredith O'Sullivan, and Aubry's family law attorney, Gary Fishbein, were not immediately returned.

Berry and Aubry have been involved in a custody dispute involving their 4-year-old daughter, Nahla. The proceedings were sealed because the former couple are not married. Both appeared in the case as recently as Nov. 9, but neither side commented on the outcome of the hearing.

Berry has been dating French actor Olivier Martinez, and he said earlier this year that they are engaged.

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AP PHOTOS: Simple surgery heals blind Indonesians

PADANG SIDEMPUAN, Indonesia (AP) — They came from the remotest parts of Indonesia, taking crowded overnight ferries and riding for hours in cars or buses — all in the hope that a simple, and free, surgical procedure would restore their eyesight.

Many patients were elderly and needed help to reach two hospitals in Sumatra where mass eye camps were held earlier this month by Nepalese surgeon Dr. Sanduk Ruit. During eight days, more than 1,400 cataracts were removed.

The patients camped out, sleeping side-by-side on military cots, eating donated food while fire trucks supplied water for showers and toilets. Many who had given up hope of seeing again left smiling after their bandages were removed.

"I've been blind for three years, and it's really bad," said Arlita Tobing, 65, whose sight was restored after the surgery. "I worked on someone's farm, but I couldn't work anymore."

Indonesia has one of the highest rates of blindness in the world, making it a target country for Ruit who travels throughout the developing world holding free mass eye camps while training doctors to perform the simple, stitch-free procedure he pioneered. He often visits hard-to-reach remote areas where health care is scarce and patients are poor. He believes that by teaching doctors how to perform his method of cataract removal, the rate of blindness can be reduced worldwide.

Cataracts are the leading cause of blindness globally, affecting about 20 million people who mostly live in poor countries, according to the World Health Organization.

"We get only one life, and that life is very short. I am blessed by God to have this opportunity," said Ruit, who runs the Tilganga Eye Center in Katmandu, Nepal. "The most important of that is training, taking the idea to other people."

During the recent camps, Ruit trained six doctors from Indonesia, Thailand and Singapore.

Here, in images, are scenes from the mobile eye camps:

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Thanksgiving Day parade offers respite for storm victims

GENEVA (Reuters) - Kris Kristofferson -- Oxford scholar, athlete, U.S. Army helicopter pilot, country music composer, one-time roustabout, film actor, singer, lover of women, three times a husband and father of eight -- seems ready to meet his maker. At least, that was the clear impression he left with an audience of middle-aged-and-upwards fans at a concert in Geneva this week, a message underscored by his 28th and latest album, "Feeling Mortal" and its coffin-dark cover. ...

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Pakistan: Malala's wounded friends back in school

MINGORA, Pakistan (AP) — For one month the dreams kept coming. The voice, the shots, the blood. Her friend Malala slumped over.

Shazia Ramazan, 13, who was wounded by the same Taliban gunman who shot her friend Malala Yousufzai, returned home last week after a month in a hospital, where she had to relearn how to use her left arm and hand. Memories of the Taliban bullets that ripped into her remain, but she is welcoming the future.

"For a long time it seemed fear was in my heart. I couldn't stop it," she said. "But now I am not afraid," she added, self-consciously rubbing her left hand where a bullet pierced straight through just below the thumb.

Now Shazia and her friend Kainat Riaz, who was also shot, return to school for the first time since the Oct. 8 attack when a Taliban gunman opened fire on Malala outside the Khushal School for Girls, wounding Shazia and Kainat in the frenzy of bullets.

The Taliban targeted Malala because of her outspoken and relentless objection to the group's regressive interpretation of Islam that keeps women at home and bars girls from school.

Malala is still undergoing treatment and unable to come back. But among her friends in her hometown of Mingora in the idyllic Swat Valley, she is a hero.

"Malala was very brave and she was always friendly with everyone. We are proud of her," said the 16-year-old Kainat, wrapped in a large purple shawl and sitting on a traditional rope bed. Her mother Manawar, a health worker, sat by her side, praised her daughter's bravery and with a smile said: "She gets her courage from me." Although conservative and refusing to have her picture taken, Kainat's mother slammed attacks on girls' education and warned Pakistan will fail if girls are not educated.

Quick to laugh, Kainat — who comes from a long line of educators in her family — looked forward to returning to school. "I want to study. I am not afraid," she said.

The authorities however are not taking any chances. Armed policemen have been deployed to both Shazia's and Kainat's home and will escort them both to school.

Kainat's home is hidden behind high walls with 8- foot-high steel gates, tucked away in a neighborhood of brown square cement buildings. A foul smelling sewer runs the length of the street where armed policemen patrol, eyeing everyone suspiciously.

Outside Shazia's home, a policeman wearing a bullet proof vest sits on a plastic garden chair with a Kalashnikov resting across his knees. Three policemen patrol a nearby narrow street that is flanked by roaring open fires where vats of hot oil boil and sticky sweets are made and sold.

Shazia, who has ambitions to become an army doctor, is a stubborn teenager. She doesn't want the police escort.

"They say I need the police. But I say I don't need any police," she said, pushing her glasses firmly back on her nose. "I don't want the police to come with me to school because then I will stand out from the other students. But I shouldn't."

At their school, the students are quick to attack the Taliban and display a giant poster of Malala. The school, which has more than 500 students, only closed its doors briefly at the height of the Taliban's hold on the region in 2008 and early 2009. It was then that Malala began to blog, recording her unhappiness with Taliban edicts ordering girls out of school.

Although she was barely 9 years old then, Shazia remembers those days.

"Times were very bad. Girls were hiding their books under their burqas. Compared to then, now is a very good time," she said, her pink shawl covering her head. "We are strong."

Both the army and the police are deployed outside the school, whose name means "happy," and journalists were not permitted to pass its black iron gate until last week when an Associated Press reporter and photographer were allowed inside. Authorities feared drawing attention, but the students within seemed unconcerned, often offering words of support for Malala and saying they weren't afraid to come to school.

Even the shiest among them would whisper in a friend's ear to say: "Tell her I will not stop studying."

Each morning the school principal gave the students a progress report on Malala's condition.

"She is getting better every day and she asks about all of us and what we are doing," said 15-year-old Mahnoor, one of Malala's close friends. "When it happened we just cried and prayed. We weren't worried for ourselves. We were just worried for her."

Twelve-year-old Emar said of the Taliban: "They are thinking that she is a girl and she cannot do anything. They are thinking that only boys can do things. They are wrong. Girls can do anything."

In a strong voice and speaking in English, Gulranga Ali, 17, said students have "gotten courage from her (Malala) and everyone is attending school. No one is staying home." She said the attack has turned the country against extremists and "now every girl and child is saying 'I want to be Malala.'"

Malala's father says the family will return to Pakistan after his daughter is well enough.

But even her classmates worry for her safety.

"I don't think she will come for education anymore in Swat. She will not be safe here. Now she is a celebrity," said Gulranga.

There is also a deepening concern that Malala's attacker has not been arrested, that the outrage her shooting generated throughout Pakistan has subsided without substantive changes and that fear will prevent real change.

Ahmed Saeed, a close friend of Malala's father, said politicians and Pakistan's military establishment still have to decide if they will support Malala's worldview or that of the Taliban. Saeed said the teenager will have another operation in three months to reconstruct her skull but that she is talking and walking "and gossiping with her family."

In what has been cheered as a first step toward compulsory education for both boys and girls in Pakistan, Parliament last week introduced legislation making it a crime to keep a child at home. Offending parents can be fined upward of $500.

Still, earlier this month the Taliban attacked on a busload of girls returning from school in the tribal regions, throwing acid in their faces. In a statement, the Taliban accused the girls of embracing the West through education.

"I don't know if this has changed Pakistan," Shazia's father said of the shooting. Still, he wants his daughter to continue at school.

"Now I want to be an example to other girls," Shazia said. "They (Taliban) can't stop us from going to school."

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Kathy Gannon is AP Special Regional Correspondent for Pakistan and Afghanistan and can be reached at www.twitter.com/kathygannon

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Chevy Chase is leaving NBC's sitcom 'Community'

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

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

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

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

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

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Study finds mammograms lead to unneeded treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Online:

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

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

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

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Mistrust runs deep despite cease-fire

CAIRO/GAZA (Reuters) - A ceasefire between Israel and Gaza's Hamas rulers took hold on Thursday after eight days of conflict, although deep mistrust on both sides cast doubt on how long the Egyptian-sponsored deal can last.

Even after the ceasefire came into force late on Wednesday, a dozen rockets from the Gaza Strip landed in Israel, all in open areas, a police spokesman said. In Gaza, witnesses reported an explosion shortly after the truce took effect at 9 p.m (2 p.m. Eastern Time), but there were no casualties and the cause was unclear.

The deal prevented, at least for the moment, an Israeli ground invasion of the Palestinian enclave following bombing and rocket fire which killed five Israelis and 162 Gazans, including 37 children.

But trust was in short supply. The exiled leader of Hamas, Khaled Meshaal, said his Islamist movement would respect the truce if Israel did, but would respond to any violations. "If Israel complies, we are compliant. If it does not comply, our hands are on the trigger," he told a news conference in Cairo.

Israeli Prime Minister Benjamin Netanyahu said he had agreed to "exhaust this opportunity for an extended truce", but told his people a tougher approach might be required in the future.

Both sides quickly began offering differing interpretations of the ceasefire, brokered by Egypt's new Islamist government and backed by the United States, highlighting the many actual or potential areas of discord.

If it holds, the truce will give 1.7 million Gazans respite from days of ferocious air strikes and halt rocket salvoes from militants that have unnerved a million people in southern Israel and reached Tel Aviv and Jerusalem for the first time.

At the United Nations, the Security Council called on both Israel and Hamas to uphold the ceasefire and commended Egypt's President Mohamed Mursi and others for brokering the truce.

The council said in a statement it "deplored the loss of civilian lives resulting from this situation and reiterated the need to take appropriate steps to ensure the safety and well-being of civilians and their protection in accordance with international humanitarian law."

"Allahu akbar, (God is greatest), dear people of Gaza you won," blared mosque loudspeakers in Gaza as the truce took effect. "You have broken the arrogance of the Jews."

Fifteen minutes later, wild celebratory gunfire echoed across the darkened streets, which gradually filled with crowds waving Palestinian flags. Ululating women leaned out of windows and fireworks lit up the sky.

Meshaal thanked Egypt for mediating and praised Iran for providing Gazans with financing and arms. "We have come out of this battle with our heads up high," he said, adding that Israel had been defeated and failed in its "adventure".

Some Israelis staged protests against the deal, notably in the southern town of Kiryat Malachi, where three people were killed by a Gaza rocket during the conflict, army radio said.

Netanyahu said he was willing to give the truce a chance but held open the possibility of reopening the conflict. "I know there are citizens expecting a more severe military action, and perhaps we shall need to do so," he said.

The Israeli leader, who faces a parliamentary election in January, delivered a similar message earlier in a telephone call with U.S. President Barack Obama, his office said.

"AN OPEN PRISON"

According to a text of the agreement seen by Reuters, both sides should halt all hostilities, with Israel desisting from incursions and targeting of individuals, while all Palestinian factions should cease rocket fire and cross-border attacks.

The deal also provides for easing Israeli restrictions on Gaza's residents, who live in what British Prime Minister David Cameron has called an "open prison".

The text said procedures for implementing this would be "dealt with after 24 hours from the start of the ceasefire".

Israeli sources said Israel would not lift a blockade of the enclave it enforced after Hamas, which rejects the Jewish state's right to exist, won a Palestinian election in 2006.

However, Meshaal said the deal covered the opening of all of the territory's border crossings. "The document stipulates the opening of the crossings, all the crossings, and not just Rafah," he said. Israel controls all of Gaza's crossings apart from the Rafah post with Egypt.

Hamas lost its top military commander to an Israeli strike in the conflict and suffered serious hits to its infrastructure and weaponry, but has emerged with its reputation both in the Arab world and at home stronger.

Israel can take comfort from the fact it dealt painful blows to its enemy, which will take many months to recover, and showed that it can defend itself from a barrage of missiles.

"No one is under the illusion that this is going to be an everlasting ceasefire. It is clear to everyone it will only be temporary," said Michael Herzog, a former chief of staff at the Israeli ministry of defense.

"But there is a chance that it could hold for a significant period of time, if all goes well," he told Reuters.

U.S. Defense Secretary Leon Panetta, in a phone call with his Israeli counterpart, praised the performance of a U.S.-backed Israeli anti-rocket system known as "Iron Dome," which the Pentagon said intercepted over 85 percent of rockets fired at Israeli civilians.

Iron Dome "provided decision space for Israel to achieve its strategic goals without forcing further military actions," the Pentagon said in a statement.

Egypt, an important U.S. ally now under Islamist leadership, took center stage in diplomacy to halt the bloodshed. Cairo has walked a fine line between its sympathies for Hamas, an offshoot of the Muslim Brotherhood to which Mursi belongs, and its need to preserve its 1979 peace treaty with Israel and its ties with Washington, its main aid donor.

Announcing the agreement in Cairo, Egyptian Foreign Minister Mohamed Kamel Amr said mediation had "resulted in understandings to cease fire, restore calm and halt the bloodshed".

U.S. Secretary of State Hillary Clinton, standing beside Amr, thanked Mursi for peace efforts that she said showed "responsibility, leadership" in the region.

The Gaza conflict erupted in a Middle East already shaken by last year's Arab uprisings that toppled several veteran U.S.-backed leaders, including Egypt's Hosni Mubarak, and by a civil war in Syria, where President Bashar al-Assad is fighting for survival.

BUS BOMBING

The ceasefire was forged despite a bus bomb explosion that wounded 15 Israelis in Tel Aviv earlier in the day and despite more Israeli air strikes that killed 10 Gazans. It was the first serious bombing in Israel's commercial capital since 2006.

Israel, the United States and the European Union all classify Hamas as a terrorist organization. It seized the Gaza Strip from the Western-backed Palestinian President Mahmoud Abbas in 2007 in a brief but bloody war with his Fatah movement.

"This is a critical moment for the region," Clinton said. "Egypt's new government is assuming the responsibility and leadership that has long made this country a cornerstone for regional stability and peace."

In Amman, U.N. chief Ban Ki-moon urged both sides to stick to their ceasefire pledges. "There may be challenges implementing this agreement," he said, urging "maximum restraint."

(Additional reporting by Noah Browning in Gaza, Ori Lewis, Allyn Fisher-Ilan and Crispian Balmer in Jerusalem, Yasmine Saleh, Shaimaa Fayed and Tom Perry in Cairo, Suleiman al-Khalidi in Amman, Michelle Nichols at the United Nations and Margaret Chadbourn and Phil Steward in Washington.; Writing by Alistair Lyon and David Stamp; Editing by Louise Ireland and Christopher Wilson)

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Suicide blasts hit near US base in Afghan capital

KABUL, Afghanistan (AP) — Two men wearing suicide vests blew themselves up near a U.S. base in the Afghan capital early Wednesday, killing two Afghan guards in what looked like a thwarted attempt to attack the American base, police said.

The blast reverberated around Kabul's Wazir Akbar Khan neighborhood shortly after 8 a.m. local time. An alarm started going off at the nearby U.S. Embassy, warning staff to take cover. The neighborhood also is home to many high-ranking Afghan officials, international organizations and the headquarters of the international military coalition.

The Taliban claimed responsibility for the bombing in an email to reporters.

The attack came as foreign and Afghan forces tightened security around the capital ahead of the holy day of Ashoura on Saturday, when Shiite Muslims commemorate the seventh century death of Imam Hussein, the Prophet Muhammad's grandson.

Last year, the commemoration saw the first major sectarian attack since the fall of the Taliban regime. In that strike, a suicide bomber on foot detonated his vest amid scores of worshippers at a Shiite shrine, killing 56 people and wounding more than 160 others.

Wednesday's bombers were on foot and were spotted by Afghan security guards as they approached Camp Eggers, the Kabul police chief's office said in a statement. The police fired on the attackers and they detonated their vests. Two Afghan security guards were killed and five civilians were injured in the explosion, the statement said.

Associated Press video of the scene shows what looks like an undetonated suicide vest, suggesting not all the explosives went off.

An international coalition vehicle was also damaged in the attack but there were no initial reports of casualties among the foreign forces, said Jamie Graybeal, a NATO troops spokesman.

Police had already set up extra checkpoints around Kabul and specifically near shrines to search cars and people in the run up to the Ashoura.

"All our police units are in the first security alert position," Gen. Mohammad Daoud Amin, the city's deputy police chief, said Tuesday, the day before the Kabul attack. "We are at the service of the people and doing our best to provide good security and prevent any possible incident on Ashoura."

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One Direction's 2nd CD hits No. 1, sells 540,000

NEW YORK (AP) — One Direction's "Take Me Home" is the taking the boys to the top of the charts — and to new heights.

The group's sophomore album has sold 540,000 in its first week, according to Nielsen SoundScan. It's the year's third-highest debut behind Taylor Swift's "Red," which sold 1.2 million units its first week earlier this month, and Mumford & Sons' "Babel," which sold more than 600,000 albums in September in its debut week.

"We just want to say a massive thanks to all the fans who have supported us," band member Harry Styles, 18, said in an interview Tuesday from London. "We can send tweets and thank them, but 140 characters is never going be enough to say how much it means."

The album also debuted at No. 1 in the United Kingdom this week and is No. 1 in more than 30 countries, Columbia Records said Wednesday. The fivesome's debut, "Up All Night," came in at No. 2 in the United Kingdom last year; it was just released in March in America, where it hit No. 1 and has achieved platinum status.

"We were a little bit nervous about how people were going to take it," 19-year-old Niall Horan said of the new album during tour rehearsals. "Everyone gets that second album syndrome."

They say though they're excited, they won't be celebrating too much: "We're finishing rehearsing soon and we're going home to bed."

One Direction, who placed third on the U.K. version of "The X Factor" in 2010, is signed to Simon Cowell's Syco label imprint. In just a year, the band has become worldwide sensations, thanks to its feverish fans. They released a book and have a 3D movie planned. They also made the cut for Barbara Walters' most fascinating people of 2012 list, which includes New Jersey Gov. Chris Christie and U.S. gold medalist Gabby Douglas.

One Direction says those experiences have helped the group mature.

"We've been working hard. We're starting to grow up," Horan said. "We're still young, but we've passed the initial teenage years. ...We've grown up quite quick in the job we have to do and we became a lot more independent."

The group — which includes Zayn Malik, Liam Payne and Louis Tomlinson — will launch a worldwide tour in February. They hope to work with Katy Perry and are still trying to adjust to the celebrity and fame that has taken over their lives.

"I can see how it gets to people. I guess it's quite easy to get wrapped up in it all," Styles said. "We do the same things every other lad our age does. We go out, we have fun, we meet girls and stuff like that. Sometimes it gets written about, which, yeah, we think about it and it's absolutely crazy. It's still a bit weird thinking that that's the way it is."

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Online:

http://www.onedirectionmusic.com/us/home/

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Follow Music Mesfin on Twitter at http://twitter.com/MusicMesfin

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

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

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

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

Still, momentum may be building.

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

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

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

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

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

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

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

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

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

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

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

The doctors group made clear that:

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

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

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

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

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

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

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

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

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

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

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Online:

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

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