Governors express frustration with Washington gridlock, sequestration

The nation’s governors had a message Saturday for Americans frustrated that Washington’s persistent partisan gridlock appears likely to trigger an across-the-board budget cut March 1 that could delay airline travel and result in hundreds of thousands of layoffs: They’re frustrated too.

Meeting in Washington for the winter meeting of the National Governors Association, state chief executives from both parties expressed deepening concern about the mindlessness of the $85 billion budget cut, which will be split between military and domestic programs but will otherwise offer an equal whack to every affected government program. They asked to be allowed more discretion in how spending cuts are implemented.

It’s the result of Congress’ failure to agree on a more targeted deficit reduction package. Congress will return to work Monday after a week-long recess, but despite political posturing, there’s been no sign of serious negotiations between the parties to prevent the cut from hitting on schedule Friday.

Republican governors Saturday stressed they are on board with reductions in federal spending even if they could result in further cuts to already stressed state budgets. But many slammed the across-the-board hack as a silly way to go about deficit reduction.

In Tennessee, Gov. Bill Haslam (R) said he fears what Washington has dubbed “sequestration” could result in delays to toxic-waste cleanup at Oak Ridge National Laboratory.

“Every line item gets cut, regardless of what it is,” he said. “This is not a smart way to do government.”

In Hawaii, 19,000 workers at the naval station at Pearl Harbor could face furloughs, which Gov. Neil Abercrombie (D) said would undermine military preparedness.

Abercrombie said Pearl Harbor, where a surprise Japanese attack in 1941 propelled the United States into World War II, is a place that “everybody can understand symbolizes . . . what happens when you’re not prepared.”

Governors in both parties said they worried that the latest of a series of Washington budget crisis moments could inject new uncertainty into state economies that had only just begun to fully stabilize after the end of the recession.

“We’re talking about real lives. We’re talking about families. We’re talking about their pocket books,” said Oklahoma Gov. Mary Fallin (R), the association’s vice-chairman. “It is not good to have the sequester talk every couple of months.”

After attending weekend sessions on tax reform, cybersecurity and coping with extreme weather, the bipartisan group of governors will meet with President Obama on Monday, with the looming budget ax likely to be a central topic of discussion.

Democratic governors also met separately with Obama on Friday and emerged from the White House to blame Republicans for cuts they said would hit police, firefighters, teachers and National Guard units.

Although governors on a bipartisan basis Saturday pressed Congress and Obama to come up with a more surgical plan than sequestration, they offered no joint solution to the central issue dividing Washington: Whether more tax revenue should be used alongside additional spending cuts.

Democrats agreed with the president that a balanced plan should include both — and blamed the imminent cut on the GOP’s unwillingness to consider higher taxes in a plan to avert them.

“It seems like every three months, the House Republicans find another way to fell a tree in the path of our economic recovery,” said Maryland Gov. Martin O’Malley (D). He warned of particularly damage to the Washington area economy.

Republicans, however, agreed with their congressional counterparts that higher taxes would hurt the economy and the across-the-board cut should be replaced with other spending cuts. Many stressed their desire to see the federal government shrink in other ways, pointing to their own experiences balancing state budgets.

“I’m just worried about the federal government really destroying the economy of this country by continuing to spend more than they take in and not making the tough decisions,” said Gov. Terry E. Branstad (R). “And the president has provided no leadership. He’s not really brought people together.”

Some noted that the Republican-held House twice last year passed bills that would have spared military spending by shifting defense cuts onto other domestic programs. Democrats rejected that approach as hitting the social safety net too hard.

This week, the Senate will consider a Democratic alternative that would replace the sequester with cuts to agriculture subsidies and higher taxes on those making more than $1 million a year. That measure is unlikely to survive a filibuster.

Discuss this topic and other political issues in the Post’s Politics Discussion Forums.

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'Citizen tide' of protests swamps Spain

MADRID: Fuming Spaniards massed in cities across the country on Saturday in a "citizens' tide" of protests.

Tens of thousands converged in Madrid, Barcelona and other cities to the din of drums and whistles and yells of "Resign!" directed at Prime Minister Mariano Rajoy and his government.

"We have come because of it all -- unemployment, corrupt politicians, the young people who have no future -- it's a combination of everything," said Luis Mora, 55, a construction worker in Madrid.

He joined a multitude of nurses, doctors, teachers, firemen, miners with lamps on their helmets and numerous other groups.

The grouping of civil associations that called the protests chose February 23 for the anniversary of an attempted coup in 1981 by officers who tried to restore military rule six years after the death of the dictator Francisco Franco.

The protestors' manifesto said the demonstrations targeted the "coup of the financial markets" which they largely blame for the crisis brought on by the collapse of the housing market.

Thousands of people also rallied in cities such as Valencia, Seville and A Coruna and the movement called demonstrations in scores of other towns.

Spain has been seeing weekly protests against the spending cuts and tax hikes imposed by Rajoy's conservative government to slash the public deficit.

The cuts are squeezing the public sector, while the current recession that started in late 2011 has shut down companies and thrown millions out of work, driving the unemployment rate above 26 per cent.

"Rajoy get out," and "No to bank dictatorship," read some of the signs in the sea of banners, plus placards reading "No" with scissors representing the cuts.

"We have been struggling all our lives and now with one snip they take away everything," said Mora, dressed in a white shirt with envelopes pinned on it marked "20,000 euros" -- a reference to political corruption.

Public anger has been fanned over recent weeks by a corruption scandal in Rajoy's conservative Popular Party.

Newspapers alleged that Rajoy and other party members received irregular payments, which he and the party have denied.

A separate corruption case being investigated on the island of Majorca has implicated the royal palace. King Juan Carlos's son-in-law Inaki Urdangarin and a palace official were questioned by an investigating judge in that affair on Saturday.

Many protestors in Saturday's demonstrations waved or wrapped themselves in the red, yellow and purple Spanish Republican flag -- a symbol of a pre-Franco, non-monarchical Spain.

Rajoy defended his government's record during a state of the nation address in parliament on Wednesday, saying that his austere measures had saved Spain from financial disaster.

"We have left behind us the constant threat of imminent disaster and we are starting to see the path for the future," he said.

In Madrid on Saturday, demonstrators converged on Plaza de Neptuno near the lower house of the Spanish parliament -- scene of a huge protest in September that led to clashes with riot police.

A crowd stood angrily shouting in front of a police barrier blocking access to the parliament before most of them dispersed.

"We're fed up," said Luis Miguel Herranz, 38, a hospital doctor in the Madrid demonstration.

"In any other country this would be of some use, but here it is not," he added. "The government is not listening to us."

- AFP/jc

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'Dabas is not the only rotten apple'

NEW DELHI: The illegal attempt to procure the call details of BJP leader Arun Jaitley has brought to fore the unholy nexus among police, detectives and city's bigwigs, including politicians and industrialists.

The subversion of official procedure to procure Jaitely's CDR (call details records) has attracted an angry response from the BJP, and led many to marvel at conspirators' audacity to target an A-list politician. The scam has also reinforced fears of invasion of privacy. But sources in the police say that obtaining a person's CDR was never a big deal and that the arrested policeman Arvind Dabas is probably just one of the many in the department who do this for making a fast buck. It is only that they had so far managed to remain under the radar.

They say sneaking in that one extra number into a bundle of numbers being sent officially will never be a difficult task for the policemen and will go undetected even by the designated officer of the rank of ACP sending the official request. The list has only numbers, and no names are mentioned. In the current instance, the alleged conspirators were not caught until they put Jaitley's name against his number: a mistake that alerted the nodal officer of the cellphone service provider and resulted in the unraveling of the crime.

What helps such snooping is the unstated liaison of police personnel with private detectives like Anurag Singh, who is emerging as the key protagonist in Jaitley CDR saga. Sources confirmed that Delhi Police and central intelligence agencies had in the past engaged services of Singh, a trained doctor who graduated from a reputed medical college in the city but never practiced medicine because of his fascination for technology. It is recognized that the association, which started more than a decade ago because Delhi Police had lacked sophisticated know-how to track information technology-savvy criminals at the time, may have helped the detective familiarize himself with the loopholes in the official procedures, besides providing him the opportunity to befriend officers.

Sources say that the serious risk of assault on privacy of unsuspecting citizen is aggravated by the trend among some intelligence officials to outsource the dirty part of the job, including illicit surveillance on political opponents of the government and others, to private detectives whose inventory of espionage equipment, sourced from Israel and other places, can match official capabilities.

This is why there is skepticism that the Jaitley CDR scam will put an end the menace. Sources say that the adverse publicity may at best lead to a break until the police 'complete' their probe. After that it will be business as usual though possibly with one big difference: the private players and their collaborators in police may hike their rates citing heightened risk. "A job which could be done for Rs 2,000-Rs 5,000 could escalate to Rs 20,000? It can fluctuate depending on how stringent the process is made. But if they are saying they will put an end to this, they must be kidding. If they make the process difficult, it's their probe which will get hampered," says a source.

Officially, private detectives cannot access call records of any person. It's only the owner of a number who can access the call details of his number by asking the service provider. Otherwise, police are the only authority who can do so, that too for the limited purpose of an ongoing investigation..

However, the reality is different. Call details, being an important tool for investigation, used as much by police as private detectives. In fact, the first thing that a private detective does after landing a case is, just like a policeman, is to seek CDR. These are in great demand also among businessmen who either hire private detectives or rely on 'contacts' among police to track their rivals.

And the process is simple. That one number that the client is interested in is sneaked in amid various numbers which are officially sent to the mobile company from the e-mail id of the nodal officer, an officer of the rank of ACP. The ACP, however, seldom uses the email-himself, leaving the job for head constables and juniors like, as Jaitley case showed, Dabas.

The CDR of a number is an elaborate list divided into several columns like, the calling number, the called number, time of call, duration of call, location at the time of call, the instrument used to make the call and etc.

However, there are no names. Even the investigators probing a particular case are not aware about who owns the number. And that's the catch. "We get the CDR and then begin investigations. Each number is analyzed and a person is assigned to go through each and every number on the CDR list and call up the suspicious. Sometimes all the numbers on the list may get called up. They speak to the person; ask him about his identity and other questions. Those who emerge as "persons of interest" are summoned for detailed questioning. The CDR of those who may evoke more suspicions are obtained and that yields investigators further leads," a source says.

An officer says that the fact that identity of persons whose CDR are sought remains unknown until the first stage, leaves a big gap in the procedure to be exploited by the nexus of resourceful private detectives and cops, greedy, compromised as well as regime-loyalists. For example, on November 20, two offices — the Special Staff (November 20) and Vasant Vihar police Station (November 29) — sought call details of Jaitley's number's during the Ponty Chadha case as his number had figured in Hardeep's call records. Neither knew that the number belonged to the BJP leader: On December 3, even the crime branch asked for the number's details. The CDR were scrapped as soon as the identity was ascertained.

Private detectives argue it's not all about money making, but it comes along with it. "If a businessman approaches me to find out the details/activities and friend circle about a man who is going to get married to his daughter, we will use his CDR to check his antecedents. It is crucial for us. And since we don't have access to it, , it s obvious we will need to seek help from our friends in the police. And why not? After all, they seek our help too. What do you think Anurag, who has been arrested by the special cell, did in the past? He has helped the sleuths in the cell so much and so many times but he is paying for it now," says a south Delhi-based detective.

The private players also remain confident that the illegal practice will continue. "Do you really think the cops can end this? Everybody will be back in business in a couple of months. The ACP will have jobs other than asking his men about explanation and requirement of each and every number whose call details are being procured," says a source.

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Elderly Abandoned at World's Largest Religious Festival

Every 12 years, the northern Indian city of Allahabad plays host to a vast gathering of Hindu pilgrims called the Maha Kumbh Mela. This year, Allahabad is expected to host an estimated 80 million pilgrims between January and March. (See Kumbh Mela: Pictures From the Hindu Holy Festival)

People come to Allahabad to wash away their sins in the sacred River Ganges. For many it's the realization of their life's goal, and they emerge feeling joyful and rejuvenated. But there is also a darker side to the world's largest religious gathering, as some take advantage of the swirling crowds to abandon elderly relatives.

"They wait for this Maha Kumbh because many people are there so nobody will know," said one human rights activist who has helped people in this predicament and who wished to remain anonymous. "Old people have become useless, they don't want to look after them, so they leave them and go."

Anshu Malviya, an Allahabad-based social worker, confirmed that both men and women have been abandoned during the religious event, though it has happened more often to elderly widows. Numbers are hard to come by, since many people genuinely become separated from their groups in the crowd, and those who have been abandoned may not admit it. But Malviya estimates that dozens of people are deliberately abandoned during a Maha Kumbh Mela, at a very rough guess.

To a foreigner, it seems puzzling that these people are not capable of finding their own way home. Malviya smiles. "If you were Indian," he said, "you wouldn't be puzzled. Often they have never left their homes. They are not educated, they don't work. A lot of the time they don't even know which district their village is in."

Once the crowd disperses and the volunteer-run lost-and-found camps that provide temporary respite have packed away their tents, the abandoned elderly may have the option of entering a government-run shelter. Conditions are notoriously bad in these homes, however, and many prefer to remain on the streets, begging. Some gravitate to other holy cities such as Varanasi or Vrindavan where, if they're lucky, they are taken in by temples or charity-funded shelters.

In these cities, they join a much larger population, predominantly women, whose families no longer wish to support them, and who have been brought there because, in the Hindu religion, to die in these holy cities is to achieve moksha or Nirvana. Mohini Giri, a Delhi-based campaigner for women's rights and former chair of India's National Commission for Women, estimates that there are 10,000 such women in Varanasi and 16,000 in Vrindavan.

But even these women are just the tip of the iceberg, says economist Jean Drèze of the University of Allahabad, who has campaigned on social issues in India since 1979. "For one woman who has been explicitly parked in Vrindavan or Varanasi, there are a thousand or ten thousand who are living next door to their sons and are as good as abandoned, literally kept on a starvation diet," he said.

According to the Hindu ideal, a woman should be looked after until the end of her life by her male relatives—with responsibility for her shifting from her father to her husband to her son. But Martha Chen, a lecturer in public policy at Harvard University who published a study of widows in India in 2001, found that the reality was often very different.

Chen's survey of 562 widows of different ages revealed that about half of them were supporting themselves in households that did not include an adult male—either living alone, or with young children or other single women. Many of those who did live with their families reported harassment or even violence.

According to Drèze, the situation hasn't changed since Chen's study, despite the economic growth that has taken place in India, because widows remain vulnerable due to their lack of education and employment. In 2010, the World Bank reported that only 29 percent of the Indian workforce was female. Moreover, despite changes in the law designed to protect women's rights to property, in practice sons predominantly inherit from their parents—leaving women eternally dependent on men. In a country where 37 percent of the population still lives below the poverty line, elderly dependent relatives fall low on many people's lists of priorities.

This bleak picture is all too familiar to Devshran Singh, who oversees the Durga Kund old people's home in Varanasi. People don't pay toward the upkeep of their relatives, he said, and they rarely visit. In one case, a doctor brought an old woman to Durga Kund claiming she had been abandoned. After he had gone, the woman revealed that the doctor was her son. "In modern life," said Singh, "people don't have time for their elderly."

Drèze is currently campaigning for pensions for the elderly, including widows. Giri is working to make more women aware of their rights. And most experts agree that education, which is increasingly accessible to girls in India, will help improve women's plight. "Education is a big force of social change," said Drèze. "There's no doubt about that."

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Jessica Ridgeway Murder Suspect to Stand Trial

The teenage suspect in the murder and dismemberment of 10-year-old Jessica Ridgeway will stand trial after a judge ruled there is enough evidence, including an alleged 911 confession, to move forward with the case.

Prosecutors played the 911 recording on Friday at a preliminary hearing for Austin Sigg, 18, in which the teen confessed to murdering the fifth grader and trying to kidnap a female jogger.

"I murdered Jessica Ridgeway, I have proof that I did. I'm giving myself up completely, there will be no resistance whatsoever," Sigg said on the Oct. 23, 2012, recording, according to ABC News Denver affiliate KMGH-TV.

The dispatcher then asked about his criminal history.

"The only other [incident] was Ketner Lake, where a woman was attacked. That was me," Sigg said in the recording.

A lead investigator on the case testified that Mindy Sigg, the teen's mother, told the dispatcher her son had hidden Jessica's remains in a crawl space under the family home, KMGH reported.

Authorities arrested Sigg at his Westminster, Colo., home that evening.

Sigg is charged with murder, kidnapping, sexual assault and robbery in the Ridgeway case.

He faces an attempted kidnapping charge for the May 28, 2012, attack on a 22-year-old female jogger. Police said a man tried to grab her from behind on a trail around Ketner Lake.

Courtesy Westminster Police Department

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The woman said the man tried to put a rag over her mouth that had a chemical smell. She was able to get away and call 911.

A judge ruled Friday that Sigg should be held without bail. He is scheduled to be arraigned March 12.

Jessica Ridgeway Disappearance Rattles Community

The search last fall for Jessica Ridgeway had the Westminster, Colo., community on edge as they grappled with the notion a cold-blooded predator could be hiding in their midst.

The fifth-grader was last seen on Oct. 5, 2012, when she left for school. She never showed up at a nearby park where she was supposed to meet friends for the one-mile walk to her elementary school. It was a route she took every day, but this time she never arrived.

An extensive FBI search included knocking on doors, road blocks, and encouraging people to report any suspicious behavior observed in friends and family members.

Jessica's dismembered torso was found inside a bag in Arvada, Colo., on Oct. 10. Her legs, arms and head were found in the crawl space under Sigg's home, Detective Luis Lopez told the court on Friday, according to KMGH. Her cause of death was asphyxiation, he said.

Authorities turned their attention to Sigg after a neighbor called a tip line Oct. 19 to report Sigg wore a cross similar to the one police believed the killer wore, and said the teen had a fascination with death. Two FBI agents took a DNA sample from Sigg, who was 17 years old at the time.

It wasn't until the 911 call on Oct. 23 that Sigg was taken into custody.

Sigg had been a student at Arapahoe Community College in Littleton, Colo., according to his arrest report, where classmates said he was studying mortuary science.

The Ridgeway and Sigg families attended the hearing on Friday. Both families were dressed in purple, which was Jessica's favorite color.

ABC News' Christina Ng contributed to this report.

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Tennis: Kvitova beats another champion to reach Dubai final

DUBAI: Former Wimbledon champion Petra Kvitova, showing her best form for more than a year, beat her second champion in a row to reach the Dubai Open final here on Friday.

Kvitova, who ended the title defence of Agnieszka Radwanska on Thursday, beat the 2011 titleholder Caroline Wozniacki, breaking serve in the opening game and rarely looking back in a 6-3, 6-4 win.

In her first final in six months, she now meets fifth seed Sara Errani of Italy, the French Open finalist, who beat her best friend and doubles partner Roberta Vihnci 6-3, 6-3.

The Czech's win over the Dane was full of characteristically fierce ground strokes, struck flat and hard to read, as well as a rising buoyancy which has not been evident over the past year.

Kvitova was delighted to have beaten three top 12 opponents in a row and, beaming at her success, said she was hopeful about her strengthened physical condition despite claiming that her "body was confused".

Asked for an explanation, she said: "I'm trying to be stronger in my legs and to have like stronger muscles, so I can be quicker and stay quite low for the fast shots.

"That's something I didn't like doing in the past. But I'm still thinking about the bad position I had before, and I'm trying to have the good position - that's why I'm, like, quite confused."

Nevertheless there was definite improvement in her movement, which helped her to break Wozniacki's serve in the opening game, to keep up a fierce attack, and to hold right through to the penultimate game of the first set when she broke Wozniacki again.

Wozniacki often moved superbly, but in the second set she also tried to serve harder, play faster, and generate more pressure of her own.

This helped her break for 3-2, and save break points in the eighth game. In between these two moments of resistance however Kvitova's attack was still too forceful, and she broke back for 3-3, and then broke again to win the match.

There was a frustrating end for Wozniacki, whose final shot, a backhand drive, was questionably called out - but she could do nothing about it because she had used up all her challenges.

"I don't know (if it was out) but it would have been nice to be able to challenge it," she admitted. "It was close, but, you know, I just have to believe it was out."

If Errani and Vinci thought that by taking a break from doubles to play singles only, they would spend time apart it was not entirely successful.

Instead Errani and Vinci found themselves battling against each other for an hour and 23 minutes of old-style rallies in which slice and accurate placement played a bigger part than power and flailing topspin.

Errani prevailed because she imposed her busy approach on the rallies. However it was noticeable that she toned down her some of her grunts, suggesting that comradeship may occasionally have vied with competitiveness for priority.

"It's tough to play against one person who knows what you're going to do with every shot," she admitted of the partner with whom she says she spends 300 days a year, while Vinci described it as like "playing against a sister."

The match finished with a symbolic moment as Errani's drive landed near the baseline, with Vinci surprisingly stopping the rally and calling for a computer review. On seeing that the shot was shown to be in, Vinci discovered that she had inadvertently ended the contest without striking the ball back against her friend.

- AFP/jc

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UK, Canada, Australia issue travel advisories

NEW DELHI: The UK, Canada and Australia have issued travel advisories asking their citizens to exercise caution within hours of the twin blasts in Hyderabad. The Australian advisory is significant as it comes a week before the second Test match between India and Australia scheduled to be played in Hyderabad on March 2. Though officials have said that the match will be held as scheduled, tour operators apprehend cancellations by spectators.

In its advisories, the UK's Foreign and Commonwealth office said, ``On 21st February two bombs exploded in Hyderabad in the busy Dilsukhnagar area of the city killing 14 people and injuring 80. You should avoid the area.''

Australian advisory asked its citizens to monitor the situation through media and follow the advice of local authorities. ``We advice you to exercise a degree of caution in India at this time because of the risk of terrorism...''

The Canadian government clarified ``There is no nationwide advisory in effect for India. However, you should exercise a high degree of caution due to a continuing threat of terrorist attacks throughout the country at all times.''

Travel industry executives said that while one advisory would not have had such an impact, there had been a series of bad news in the last few months. ``It first started with the Delhi gang-rape, then swine flu and now the blasts such incidents send out the message that India is not a safe place to travel and hurts our global image,'' Subhash Goyal, president of Indian Association of Tour Operators (IOTA), said.

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Jodi Arias' Friends Believe in Her Innocence

Accused murderer Jodi Arias believes she should be punished, but hopes she will not be sentenced to death, two of her closest friends told ABC News in an exclusive interview.

Ann Campbell and Donavan Bering have been a constant presence for Arias wth at least one of them sitting in the Phoenix, Ariz., courtroom along with Arias' family for almost every day of her murder trial. They befriended Arias after she first arrived in jail and believe in her innocence.

Arias admits killing her ex-boyfriend Travis Alexander and lying for nearly two years about it, but insists she killed Alexander in self defense. She could face the death penalty if convicted of murder.

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Nevertheless, she is aware of the seriousness of her lies and deceitful behavior.

The women told ABC News that they understand that Arias needs to be punished and Arias understands that too.

"She does know that, you know, she does need to pay for the crime," Campbell said. "But I don't want her to die, and I know that she has so much to give back."

Catching Up on the Trial? Check Out ABC News' Jodi Arias Trial Coverage

The lies that Arias admits she told to police and her family have been devastating to her, Bering said.

""She said to me, 'I wish I didn't have to have lied. That destroyed me,'" Donovan said earlier this week. "Because now when it's so important for her to be believed, she has that doubt. But as she told me on the phone yesterday, she goes, 'I have nothing to lose.' So all she can do is go out there and tell the truth."

During Arias' nine days on the stand she has described in detail the oral, anal and phone sex that she and Alexander allegedly engaged in, despite being Mormons and trying to practice chastity. She also spelled out in excruciating detail what she claimed was Alexander's growing demands for sex, loyalty and subservience along with an increasingly violent temper.

Besides her two friends, Arias' mother and sometimes her father have been sitting in the front row of the courtroom during the testimony. It's been humiliating, Bering said.

"She's horrified. There's not one ounce of her life that's not out there, that's not open to the public. She's ashamed," she said.

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Pictures: Best News Photos from 2013 World Photo Press Contest

Photograph courtesy Maika Elan, Most, via WPP
 
 

In Da Nang, Vietnam, Phan Thi Thuy and her partner, Dang Thi Bich Bay, relax after studying at school.

The couple, who has been together for a year, lives in a country that has historically been hostile to same-sex relations, but could also become the first Asian country to recognize gay marriage, despite past human rights issue and a long-standing stigma.

"We were all enchanted by this series," Tucker said. "They're tender portraits, but some are complicated. Some make you wonder if all is well with the couples."

The photo series, titled "The Pink Choice," took first prize in the "Contemporary Issues Stories" category for photographer Maika Elan's ability to both stir the viewers' imagination and engage with her subjects.

"A good picture stimulates imagination and you go with it. You're delighted to be stimulated and encouraged to think," Tucker said.

"You feel like you've been given access to people, and even a world, that you normally wouldn't have access to, but in a respectful way," she added.

Published February 22, 2013

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Group releases list of 90 medical ‘don’ts’

Don’t use feeding tubes in patients with advanced dementia. Don’t use drugs to aggressively treat diabetes in those older than 65. Don’t automati­cally use imaging technology for minor head injuries in children and headaches in adults. And don’t give antacids to babies with reflux.

Those are among the 90 medical “don’ts” on a list being released Thursday by a coalition of doctor and consumer groups. They are trying to discourage the use of tests and treatments that have become common practice but may cause harm to patients or unnecessarily drive up the cost of health care.

It is the second set of recommendations from the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, which launched last year amid nationwide efforts to improve medical care in the United States while making it more affordable.

The recommendations run the gamut, from geriatrics to opthalmology to maternal health. Together, they are meant to convey the message that in medicine, “sometimes less is better,” said Daniel Wolfson, executive vice president of the foundation, which funded the effort.

“Sometimes, it’s easier [for a physician] to just order the test rather than to explain to the patient why the test is not necessary,” Wolfson said. But “this is a new era. People are looking at quality and safety and real outcomes in different ways.”

The guidelines were penned by more than a dozen medical professional organizations, including the American Academy of Pediatrics and the American College of Obstetricians and ­Gynecologists.

The groups discourage the use of antibiotics in a number of instances in which they are commonly prescribed, such as for sinus infections and pink eye. They caution against using certain sedatives in the elderly and cold medicines in the very young.

In some cases, studies show that the test or treatment is costly but does not improve the quality of care for the patient, according to the groups.

But in many cases, the groups contend, the intervention could cause pain, discomfort or even death. For example, feeding tubes are often used to provide sustenance to dementia patients who cannot feed themselves, even though oral feeding is more effective and humane. And CT scans that are commonly used when children suffer minor head trauma may expose them to cancer-causing radiation.

While the recommendations are aimed in large part at physicians, they are also designed to arm patients with more information in the exam room.

“If you’re a healthy person and you’re having a straightforward surgery, and you get a list of multiple tests you need to have, we want you to sit down and talk with your doctor about whether you need to do these things,” said John Santa, director of the health ratings center at Consumer Reports, which is part of the coalition that created the guidelines.

Health-care spending in the United States has reached 17.9 percent of the nation’s gross domestic product and continues to rise, despite efforts to contain costs. U.S. health-care spending grew 3.9 percent in 2011, reaching $2.7 trillion, according to the journal Health Affairs.

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