Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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'Cliff' talks: Geithner invites GOP counteroffer

WASHINGTON (AP) -- President Barack Obama is ready to entertain Republican proposals for spending cuts, but GOP lawmakers must first commit to higher tax rates on the rich and specify what additional spending cuts they want in a deal to avoid the looming "fiscal cliff," Treasury Secretary Timothy Geithner said.

"The ball really is with them now," Geithner, one of the president's chief negotiators with Capitol Hill, said during appearances on five Sunday talk shows. He acknowledged that Republicans are "having a tough time trying to figure out what they can do, what they can get support from their members for." The White House "might need to give them a little more time to figure out where they go next."

Geithner presented congressional leaders Thursday with Obama's postelection blueprint for averting the combination of hundreds of billions in tax increases and spending cuts that will take effect beginning in January if Washington doesn't act to stop it.

But House Speaker John Boehner, R-Ohio, dismissed the plan as "not serious," merely a Democratic wish list that couldn't pass his chamber.

As outlined by administration officials, the plan calls for nearly $1.6 trillion in new tax revenue over the next decade, while making $600 billion in spending cuts, including $350 billion from Medicare and other health programs. But it also contains $200 billion in new spending on jobless benefits, public works and aid for struggling homeowners — and would make it virtually impossible for Congress to block Obama's ability to raise the debt ceiling.

"I was just flabbergasted," Boehner said, describing his meeting with Geithner. "I looked at him and I said, 'You can't be serious?" The speaker, noting the short time between the Nov. 6 election and the new year, said time has been lost so far "with this nonsense."

With the George W. Bush-era tax cuts expiring and across-the-board spending cuts hitting in under a month, Boehner said, "I would say we're nowhere, period." He said "there's clearly a chance" of going over the cliff.

But Geithner, also in interviews that were taped Friday, offered a somewhat rosier view. "I think we're far apart still, but I think we're moving closer together," he said.

He called the back-and-forth "normal political theater," voicing confidence a bargain can be struck in time, and said all that's blocking it is GOP acceptance of higher tax rates on the wealthy.

"It's welcome that they're recognizing that revenues are going to have to go up. But they haven't told us anything about how far rates should go up ... (and) who should pay higher taxes?" Geithner said.

He said so far, GOP proposals demonstrate "political math, not real math."

Republican leaders have said they accept higher tax revenue overall, but only through what they call tax reform — closing loopholes and limiting deductions — and only coupled with tough measures to curb the explosive growth of Medicare, Medicaid and Social Security.

But Geithner insisted that there's "no path to an agreement (without) Republicans acknowledging that rates have to go up for the wealthiest Americans." He also said the administration would only discuss changes to Social Security "in a separate process," not in talks on the fiscal cliff.

As to spending, Geithner said if Republicans don't think Obama's cutting enough spending, they should make a counter-proposal. "They might want to do some different things. But they have to tell us what those things are," he said.

Republicans have also rejected Obama's debt ceiling proposal. Geithner noted it was Senate Minority Leader Mitch McConnell who first suggested it, as a temporary measure in the summer 2011 deficit deal. The administration would make it permanent. "It was a very smart way by a senator with impeccable Republican credentials to ... lift this ... periodic threat of default," Geithner said. "And that's an essential thing for us."

Geithner voiced sympathy for Republicans leaders, saying they're caught between the voters' endorsement of higher taxes on the rich and a House GOP caucus that thinks all tax increases are job-killers.

"They really are in a difficult position," he said. "And they're going to have to figure out their politics of what they do next."

In the past week, Obama has held a series of campaign-style appearances — including one in a swing district in Pennsylvania — urging lawmakers to accept a Senate-passed measure extending tax cuts for all but the top 2 percent of wage-earners. He'll continue the effort when he meets with governors on Tuesday and speaks to the Business Roundtable on Wednesday.

GOP leaders contend letting top-end tax cuts run out would hit small businesses and cost jobs.

Still, Sen. Lamar Alexander, R-Tenn., said Republicans will "hold our nose and raise some revenues" if the result is a deal that reins in runaway debt. But he said the onus is on Obama to knuckle down to talks.

"I'm ready for the president to get off the campaign trail, and get in the White House and get a result," Alexander told reporters in Nashville on Saturday. "Right now he's got the presidential limousine headed toward the fiscal cliff with his foot on the accelerator."

Geithner appeared on CBS' "Face the Nation," NBC's "Meet the Press," CNN's "State of the Union," ABC's "This Week," and "Fox News Sunday." Boehner was on Fox, too.

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Associated Press Writer Erik Schelzig in Nashville contributed to this report.

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Lone Chinese home destroyed; farmer accepts deal

BEIJING (AP) — Authorities have demolished a five-story home that stood incongruously in the middle of a new main road and had become the latest symbol of resistance by Chinese homeowners against officials accused of offering unfair compensation.

Xiayangzhang village chief Chen Xuecai told The Associated Press the house was bulldozed Saturday after its owners, duck farmer Luo Baogen and his wife, agreed to accept compensation of 260,000 yuan ($41,000).

There was no immediate confirmation from Luo, whose cellphone was turned off Saturday.

The couple had been the lone holdouts from a neighborhood that was demolished to make way for the main thoroughfare heading to a newly built railway station on the outskirts of the city of Wenling in Zhejiang province.

The razing comes a week after images of the house circulated widely online in China, triggering a flurry of domestic and foreign media reports about the latest "nail house," as buildings that remain standing as their owners resist development are called.

Luo, 67, had just completed his house at a cost of about 600,000 yuan ($95,000) when the government approached him with their standard offer of 220,000 ($35,000) to move out — which he refused, Chen has previously said. The offer then went up to 260,000 yuan ($41,000) last week.

It was not immediately clear why Luo accepted the compensation in a meeting with officials Friday afternoon when the amount of money offered was the same as a week ago.

Village chief Chen said Luo was tired of all the media attention and voluntarily consented to the deal. "Luo Baogen received dozens of people from the media every day and his house stands in the center of the road. So he decided to demolish the house," Chen said.

Authorities commonly pressure residents to agree to make way for development with sometimes extreme measures, such as cutting off utilities or moving in to demolish when residents are out for the day. In Luo's case, however, he had told local reporters last week his electricity and water were still flowing.

Real estate is one of the big drivers of China's runaway growth in recent decades. But the rapid development has run into objections from many of the hundreds of thousands of residents who have been forced out to make way for new housing, factories and other business ventures, creating a major source of unrest.

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New job posting suggests Nokia may still be considering Android after all

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JLo tones down concert in Indonesia

JAKARTA, Indonesia (AP) — Jennifer Lopez wowed thousands of fans in Indonesia, but they didn't see as much of her as concertgoers in other countries — the American pop star toned down both her sexy outfits and her dance moves during her show in the world's most populous Muslim country, promoters said Saturday.

Lopez's "Dance Again World Tour" was performed in the country's capital, Jakarta, on Friday in line with promises Lopez made to make her show more appropriate for the audience, said Chairi Ibrahim from Dyandra Entertainment, the concert promoter.

"JLo was very cooperative ... she respected our culture," Ibrahim said, adding that Lopez's managers also asked whether she could perform her usual sexy dance moves, but were told that "making love" moves were not appropriate for Indonesia.

"Yes, she dressed modestly ... she's still sexy, attractive and tantalizing, though," said Ira Wibowo, an Indonesian actress who was among more than 7,000 fans at the concert.

Another fan, Doddy Adityawarman, was a bit disappointed with the changes.

"She should appear just the way she is," he said, "Many local artists dress even much sexy, much worse."

Lopez changed several times during her 90-minute concert along with several dancers, who also dressed modestly without revealing their chests or cleavage.

Most Muslims in Indonesia, a secular country of 240 million people, are moderate. But a small extremist fringe has become more vocal in recent years.

They have pushed through controversial laws — including an anti-pornography bill — and have been known to attack anything perceived as blasphemous, from transvestites and bars to "deviant" religious sects.

Lady Gaga was forced to cancel her sold-out show in Indonesia in May following threats by Islamic hard-liners, who called her a "devil worshipper."

Lopez will also perform in Muslim-majority Malaysia on Sunday.

"Thank you Jakarta for an amazing night," the 43-year-old diva tweeted to her 13 million followers Saturday.

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South Africa makes progress in HIV, AIDS fight

JOHANNESBURG (AP) — In the early '90s when South Africa's Themba Lethu clinic could only treat HIV/AIDS patients for opportunistic diseases, many would come in on wheelchairs and keep coming to the health center until they died.

Two decades later the clinic is the biggest anti-retroviral, or ARV, treatment center in the country and sees between 600 to 800 patients a day from all over southern Africa. Those who are brought in on wheelchairs, sometimes on the brink of death, get the crucial drugs and often become healthy and are walking within weeks.

"The ARVs are called the 'Lazarus drug' because people rise up and walk," said Sue Roberts who has been a nurse at the clinic , run by Right to Care in Johannesburg's Helen Joseph Hospital, since it opened its doors in 1992. She said they recently treated a woman who was pushed in a wheelchair for 3 kilometers (1.8 miles) to avoid a taxi fare and who was so sick it was touch and go. Two weeks later, the woman walked to the clinic, Roberts said.

Such stories of hope and progress are readily available on World AIDS Day 2012 in sub-Saharan Africa where deaths from AIDS-related causes have declined by 32 percent from 1.8 million in 2005 to 1.2 million in 2011, according to the latest UNAIDS report.

As people around the world celebrate a reduction in the rate of HIV infections, the growth of the clinic, which was one of only a few to open its doors 20 years ago, reflects how changes in treatment and attitude toward HIV and AIDS have moved South Africa forward. The nation, which has the most people living with HIV in the world at 5.6 million, still faces stigma and high rates of infection.

"You have no idea what a beautiful time we're living in right now," said Dr. Kay Mahomed, a doctor at the clinic who said treatment has improved drastically over the past several years.

President Jacob Zuma's government decided to give the best care, including TB screening and care at the clinic, and not to look at the cost, she said. South Africa has increased the numbers treated for HIV by 75 percent in the last two years, UNAIDS said, and new HIV infections have fallen by more than 50,000 in those two years. South Africa has also increased its domestic expenditure on AIDS to $1.6 billion, the highest by any low-and middle-income country, the group said.

Themba Lethu clinic, with funding from the government, the United States Agency for International Development and the President's Emergency Plan for AIDS Relief, is now among some 2,500 anit-retroviral therapy facilities in the country that treat approximately 1.9 million people.

"Now, you can't not get better. It's just one of these win-win situations. You test, you treat and you get better, end of story," Mahomed said.

But it hasn't always been that way.

In the 1990s South Africa's problem was compounded by years of misinformation by President Thabo Mbeki, who questioned the link between HIV and AIDS, and his health minister, Manto Tshabalala-Msimang, who promoted a "treatment" of beets and garlic.

Christinah Motsoahae first found out she was HIV positive in 1996, and said she felt nothing could be done about it.

"I didn't understand it at that time because I was only 24, and I said, 'What the hell is that?'" she said.

Sixteen years after her first diagnosis, she is now on anti-retroviral drugs and her life has turned around. She says the clinic has been instrumental.

"My status has changed my life, I have learned to accept people the way they are. I have learned not to be judgmental. And I have learned that it is God's purpose that I have this," the 40-year-old said.

She works with a support group of "positive ladies" in her hometown near Krugersdorp. She travels to the clinic as often as needed and her optimism shines through her gold eye shadow and wide smile. "I love the way I'm living now."

Motsoahae credits Nelson Mandela's family for inspiring her to face up to her status. The anti-apartheid icon galvanized the AIDS community in 2005 when he publicly acknowledged his son died of AIDS.

None of Motsoahae's children was born with HIV. The number of children newly infected with HIV has declined significantly. In six countries in sub-Saharan Africa — South Africa, Burundi, Kenya, Namibia, Togo and Zambia —the number of children with HIV declined by 40 to 59 percent between 2009 and 2011, the UNAIDS report said.

But the situation remains dire for those over the age of 15, who make up the 5.3 million infected in South Africa. Fear and denial lend to the high prevalence of HIV for that age group in South Africa, said the clinic's Kay Mahomed.

About 3.5 million South Africans still are not getting therapy, and many wait too long to come in to clinics or don't stay on the drugs, said Dr. Dave Spencer, who works at the clinic .

"People are still afraid of a stigma related to HIV," he said, adding that education and communication are key to controlling the disease.

Themba Lethu clinic reaches out to the younger generation with a teen program.

Tshepo Hoato, 21, who helps run the program found out he was HIV positive after his mother died in 2000. He said he has been helped by the program in which teens meet one day a month.

"What I've seen is a lot people around our ages, some commit suicide as soon as they find out they are HIV. That's a very hard stage for them so we came up with this program to help one another," he said. "We tell them our stories so they can understand and progress and see that no, man, it's not the end of the world."

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Why Obama is pushing for stimulus in 'fiscal cliff' deal

How about a little government economic stimulus?

That may sound incongruous considering the budget deficit and the push from Republicans to cut government spending.

But President Obama’s first offer to avoid going over the "fiscal cliff" holds out the hope of at least some stimulus. This would include extending the 2 percentage point Social Security payroll tax cut, boosting a tax incentive to businesses, establishing a $50 billion bank for long-term infrastructure projects, and extending unemployment benefits.

RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered

The total bill: about $255 billion out of the federal government's pocket – an amount the GOP would likely say needs to be offset by spending cuts elsewhere.

The argument in favor of such stimulus? The tax measures, at least, could minimize the drag on the economy from Mr. Obama's proposed tax increases on the wealthy.

“The increases in the top two income tax brackets would put a drag on consumption, so I think, from the Obama point of view, the spending or tax cuts are designed to offset that drag to consumption,” says Michael Brown, an economist at Wells Fargo Securities in Charlotte, N.C.

But to some budget experts, Obama’s list seems more like an opening round of negotiations, where he has asked for a lot more than he will get.

“It looks to me like these are bargaining chips,” says Pete Davis of Davis Capital Ideas, which advises Wall Street firms. “Even most Democrats had given up on the prospect of getting the payroll tax cut extended.”

Mr. Davis considers the odds of most of the stimulus proposals passing Congress “very low.”

What's needed most, say others, is just buckling down and negotiating an end to the fiscal cliff. “Cancelling the fiscal cliff is economic stimulus,” says Stan Collender, a budget expert and partner at Qorvis Communications in Washington.

If Obama's stimulus were passed, however, here is a look at the impact the four elements might have.

SOCIAL SECURITY PAYROLL TAX CUT

The largest chunk of the Obama plan is the extension of the payroll tax cut. This is the money that comes out of an individual’s paycheck as a contribution to Social Security. Two years ago, in an effort to stimulate the economy, Congress decreased the individual contribution from 6.2 percent to 4.2 percent. The employer’s contribution of 6.2 percent remained unchanged.

The Obama administration estimates extending the cuts would cost the government as much as $115 billion in revenue.

The argument for extending the tax cut is that it helps lower-income workers who live paycheck to paycheck. “The difference in the paycheck might be the ability to pay the electric bill for someone or the chance to go to a sit-down restaurant once a month,” says Chris Christopher, an economist at IHS in Lexington, Mass.

The argument against continuing the cut is that it is weakening the Social Security Trust Fund. In order to make up for the loss of contributions, the government taps the general tax revenues, says Pamela Tainter-Causey, a spokeswoman for the National Committee to Preserve Social Security and Medicare.

“It sets up Social Security to compete for funding from the general fund,” she says. “It’s a perfect set up for people who are gunning for the program and claim we can’t afford it now.”

BUSINESS TAX INCENTIVE

The second largest program proposed by Obama would be the extension of accelerated depreciation for business, which would cost the US Treasury about $65 billion in fiscal year 2013, according to the Congressional Budget Office.

Two years ago, business was allowed to accelerate the write-off of 100 percent of its spending on certain capital equipment. Capital spending on equipment and computer software soared by 18.3 percent in 2011.

Then, this year, the benefit to business was cut in half to 50 percent. Capital spending sank in the third quarter by 2.7 percent compared with the same quarter the prior year. With business interest in using the tax break diminishing, economist Gregory Daco of IHS says “it’s a goner.”

INFRASTRUCTURE BANK

Obama has also proposed a $50 billion infrastructure bank. The idea is to fund roads, bridges, tunnels and other large projects that last for a long period of time. “At the moment the funding is done on a cash basis – you have to pay for it as you build it,” says Mr. Collender.

Democrats have been trying to get Congress to fund the bank for the past 10 years, he says. “It does not have a chance of getting through the House," which is controlled by the Republicans, says Mr. Collender.

UNEMPLOYMENT BENEFITS

And, finally, Obama wants to extend unemployment benefits, which would cost about $30 billion.

Under current law, if Congress does nothing, the maximum number of weeks in which an individual could receive jobless will drop to 26 from the current 73 weeks for states with unemployment over 9 percent and 63 weeks for states with unemployment over 7 percent.

If Congress does nothing about the program during the lame-duck session, some 2.1 million jobless will lose their benefits in the first week of January, says Judy Conti, a federal advocacy coordinator at the National Employment Law Project (NELP) in Washington. By the end of the March, she says, another 900,000 people will lose their benefits.

“Forty percent of the unemployed are long term unemployed,” she says. “They have been out of the workforce for over six months.”

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Shoppers' habits not changed by garment plant fire

NEW YORK (AP) — Before purchasing a shirt, shoppers will run their hands over the fabric, look at the price tag and wonder how it will hold up in the washing machine. Some might even ask if it makes them look fat.

The one detail, however, that is rarely considered: What are the conditions like for the workers making the shirt?

A horrific fire that raced through a Bangladesh garment factory Saturday, killing 112 people, has put the spotlight — at least temporarily — back on those workers and their sometimes treacherous work environment.

The factory, owned by Tazreen Fashions Ltd., made clothing for several retailers around the globe including Wal-Mart, Sears and The Walt Disney Co. All three companies have distanced themselves from responsibility for the incident, saying they didn't know that their subcontractors were using the factory.

Holiday shoppers have also maintained their distance from the tragedy.

"Truthfully, I hadn't even thought about it," said Megan Miller of Philadelphia as she walked out of the Disney Store in Times Square. "I had Christmas on my mind and getting my kids something from New York."

Shoppers from Cincinnati to Paris to Singapore all said the same thing: They were aware of the fatal factory fire, but they weren't thinking about it while browsing stores in the days since. Brand name, fit and — above all — prices were on their minds.

"Either our pockets get lighter or we have to live with more blood on our hands," said Amy Hong, a college student who was at a store in Singapore. "I try not to think about it."

Experts who survey shoppers say the out of sight, out of mind attitude is nothing new.

"When you talk to them about their biggest concerns, where something is made, or the abuses in some country, almost never show up," said C. Britt Beemer, chairman of America's Research Group, which interviews 10,000 to 15,000 consumers a week, mostly on behalf of retailers. "The numbers are so small, I quit asking the question."

Convenience is much more important to shoppers.

Take Tammy Johnson who was at a Walmart in Bloomington, Minn. this week. She lives nearby and appreciates that the store has a large grocery section in addition to clothing and other goods.

"It's easier and it's cheaper," she said of her decision to shop there. "I hate that, but it is true."

Even those who want to make socially responsible purchases a priority have little information available to work with.

There's no widespread system in place to say where all the materials in a shirt come from let alone whether it was made in a sweatshop or not.

A label saying "Made in USA of imported fabrics" doesn't provide as much information to shoppers as they might think. Maybe tailors assembled it under good working conditions, but what about the people who wove the fabrics? Another label saying that a shirt is made from 100 percent organic cotton fails to say anything about the conditions of the factory in which it was made.

"What do they know at the point of sale about where it comes from, other than the tag?" said Paco Underhill, founder of Envirosell, which studies consumer behavior. "Our hearts are generally are in the right places. It's the question of making sure we have the knowledge and pocketbook to follow."

And it's not just clothing. It is hard to tell where televisions or laptop components are made.

Companies selling products say they even struggle to tell. Work is often given to subcontractors who themselves use subcontractors. While many major companies stipulate ethics and standards that their subcontractors must follow, policing them is a costly, time-consuming process that sounds easier than it is.

In the case of the Bangladesh factory, Wal-Mart said it had received a safety audit showing the factory was "high-risk" and had decided months before the blaze to stop doing business with Tazreen. But it said a supplier had continued to use Tazreen without authorization.

In recent years, consumers have become much more aware about the food they eat, and where it comes from.

Supermarkets are full of eggs laid by free-range chickens, organically-grown apples and beef from grass-fed, hormone-free cows. Some upscale restaurants now name the farm that provided them with pork chops. And customers pay a premium for these foods.

The difference: They perceive a direct benefit, since the food is going into their bodies.

Ethical choices when buying clothing — or the latest version of Apple's iPhone — are much more blurred.

Jean MacLeod, who was shopping at a Walmart on the south side of Indianapolis, is willing to pay more for goods if they are made in an ethically responsible manner and does it all the time when she buys food.

Walmart wants the best prices for its customers, she said, but the company also has power as a buyer to make sure factories have decent working conditions.

"They should be able to say, 'Look it, we don't want to buy from you unless you do things a little more our way,'" MacLeod said. "If they don't want to buy from them, then that means that factory will go out of business."

Arguments have been made that producing items with cheap labor isn't necessarily a bad thing.

Factories in the Third World can provide jobs with wages well above a region's average. They can help lift families out of severe poverty. The catch is that there are fewer safeguards to protect workers from being exploited from unscrupulous employers.

At the Bangladesh factory, locked exits prevented many workers from escaping after fire broke out.

It draws eerie parallels to New York's Triangle Shirtwaist Fire of 1911, where 146 people died within 18 minutes of a fire starting in a factory with locked exits.

That fire was the catalyst for widespread changes in labor laws in U.S. But in the 100 years since, the desire for cheap clothing hasn't abated and costly labor has just shifted to factories overseas.

"To put it maybe too frankly, profit and efficiency and competition always trump safety and health," said James A. Gross, a labor relations professor at Cornell University.

Not every company sees things that way.

Los Angeles-based American Apparel promotes itself as a line of "sweatshop free" clothing. Its founder and CEO, Dov Charney, said that companies can control working conditions — they just need to bring production closer to home. American Apparel knits, dyes, cuts and sews all of its products in-house.

"When the company knows the face of its worker, that's important," Charney said. "You can control working conditions and quality."

Yes, American Apparel spends more on labor, but it isn't as much as you would expect. Charney estimates that an imported T-shirt selling for $6 at Walmart would cost about $6.30 if produced domestically thanks to the company's massive scale.

"The consumer can care. They can buy from companies that are committed to fair trade and try to seek out those companies," he said.

Take Nike.

In the mid-1990s, the sneaker giant came under pressure to change its ways after numerous reports of child labor, low wages and poor working conditions. Eventually wages climbed, minimum age requirements were put in place and Nike increased monitoring at its factories.

But such change only comes after persistent public pressure.

"Clothes makers will always do what they want, but the buyer should educate himself," said Paris shopper Pierre Lefebvre.

Not all buyers have that luxury. Family budgets are tight.

"Especially with this economy, we like our money to go as far as it can," said Lesley Schuldt, who left a Cincinnati Macy's this week with five shopping bags worth of jewelry, cookware and gifts. "I have no idea where half the stuff I bought was made, but I imagine it was not in the U.S."

___

Associated Press reporters Amanda Lee Myers in Cincinnati, Josh Freed in Bloomington, Minn., Tom Murphy in Indianapolis, Meghan Barr in New York, Heather Tan in Singapore and Thomas Adamson in Paris contributed to this report.

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Scott Mayerowitz can be reached at http://twitter.com/GlobeTrotScott.

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The Xbox 720 Is Coming Sooner Than Anyone Anticipated

After almost three years without an update, and with Windows 8 sales flailing, Microsoft will release a new Xbox just in time for Christmas next year, sources told Bloomberg’s Dina Bass and Ian King. Last year Microsoft had said that it wouldn’t release a new version of the gaming system “anytime soon,” with other sources talking up a date sometime in 2013 “at the earliest.” This new Christmas launch makes perfect sense for the video-game nerd anticipated “Xbox 720,” as the rumorers refer to it. An Xbox is one of those it toys that gets people lining up at 3 a.m. during holiday shopping craziness. Even the aging 360 console has managed to double the sales of the new Nintendo Wii so far this holiday season, according to numbers from the NDP Group. Microsoft hasn’t put out an entirely new console since 2005, which led to riots during Black Friday of that year.

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And Microsoft needs a super-anticipated something, since Windows 8 sales fell so flat this year. After whispers that the new operating system wasn’t selling well, NDP research group found that sales fell 21 percent for new computers running Windows. The research group doesn’t measure sales from Microsoft stores or online, but Microsoft has said most of its sales come from third-party retailers like Best Buy anyway. Windows 8 tablet sales were almost “nonexistent” said the report, making up just 1 percent of all Windows 8 sales. Yeesh. However, Microsoft CEO Steve Ballmer has said he is playing the long game on this one, claiming that people will get used to the new look and when they do fall in love with it. Maybe the people will line up for Windows 8 next year, too? 

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If not, though, the new Xbox sounds like an upgrade that will get gamers excited and buying. As for what exactly the gadget will look like, the rumorers say it will be cheaper and smaller than the 360, which retails starting at $ 300. In addition, it will have an udpated Kinect controller, a quad core processor, 8GB Ram, Blu-Ray, and augmented reality glasses, according to “leaked reports.” 

Gaming News Headlines – Yahoo! News

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Adkins explains Confederate flag earpiece

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

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

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

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

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

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Online:

http://www.traceadkins.com

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