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.

___

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

Read More..

Cliff fight may knock out December rally

NEW YORK (Reuters) - In normal times, next week's slew of U.S. economic data could be a springboard for a December rally in the stock market.


December is historically a strong month for markets. The S&P 500 has risen 16 times in the past 20 years during the month.


But the market hasn't been operating under normal circumstances since November 7 when a day after the U.S. election, investors' focus shifted squarely to the looming "fiscal cliff."


Investors are increasingly nervous about the ability of lawmakers to undo the $600 billion in tax increases and spending cuts that are set to begin in January; those changes, if they go into effect, could send the U.S. economy into a recession.


A string of economic indicators next week, which includes a key reading of the manufacturing sector on Monday, culminates with the November jobs report on Friday.


But the impact of those economic reports could be muted. Distortions in the data caused by Superstorm Sandy are discounted.


The spotlight will be more firmly on signs from Washington that politicians can settle their differences on how to avoid the fiscal cliff.


"We have a week with a lot of economic data, and obviously most of the economic data is going to reflect the effects of Sandy, and that might be a little bit negative for the market next week, but most of that is already expected - the main focus remains the fiscal cliff," said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.


Concerns about the cliff sent the S&P 500 <.spx> into a two-week decline after the elections, dropping as much as 5.3 percent, only to rally back nearly 4 percent as the initial tone of talks offered hope that a compromise could be reached and investors snapped up stocks that were viewed as undervalued.


On Wednesday, the S&P 500 gained more than 20 points from its intraday low after House Speaker John Boehner said he was optimistic that a budget deal to avoid big spending cuts and tax hikes could be worked out. The next day, more pessimistic comments from Boehner, an Ohio Republican, briefly wiped out the day's gains in stocks.


On Friday, the sharp divide between the Democrats and the Republicans on taxes and spending was evident in comments from President Barack Obama, who favors raising taxes on the wealthy, and Boehner, the top Republican in Congress, who said Obama's plan was the wrong approach and declared that the talks had reached a stalemate.


"It's unusual to end up with one variable in this industry, it's unusual to have a single bullet that is the causal factor effect, and you are sitting here for the next maybe two weeks or more, on that kind of condition," said Sandy Lincoln, chief market strategist at BMO Asset Management U.S. in Chicago.


"And that is what is grabbing the markets."


BE CONTRARY AND MAKE MERRY


But investor attitudes and seasonality could also help spur a rally for the final month of the year.


The most recent survey by the American Association of Individual Investors reflected investor caution about the cliff. Although bullish sentiment rose above 40 percent for the first time since August 23, bearish sentiment remained above its historical average of 30.5 percent for the 14th straight week.


December is a critical month for retailers such as Target Corp and Macy's Inc . They saw monthly retail sales results dented by Sandy, although the start of the holiday shopping season fared better.


With consumer spending making up roughly 70 percent of the U.S. economy, a solid showing for retailers during the holiday season could help fuel any gains.


Ryan Detrick, senior technical strategist at Schaeffer's Investment Research in Cincinnati, believes the recent drop after the election could be a market bottom, with sentiment leaving stocks poised for a December rally.


"The concerns on the fiscal cliff - as valid as they might be - could be overblown. When you look at a lot of the overriding sentiment, that has gotten extremely negative," said Detrick.


"From that contrarian point of view with the historically bullish time frame of December, we once again could be setting ourselves up for a pretty nice end-of-year rally, based on lowered expectations."


SOME FEEL THE BIG CHILL


Others view the fiscal cliff as such an unusual event that any historical comparisons should be thrown out the window, with a rally unlikely because of a lack of confidence in Washington to reach an agreement and the economic hit caused by Sandy.


"History doesn't matter. You're dealing with an extraordinary set of circumstances that could very well end up in the U.S. economy going into a recession," said Phil Orlando, chief equity market strategist at Federated Investors in New York.


"And the likelihood of that is exclusively in the hands of our elected officials in Washington. They could absolutely drag us into a completely voluntary recession."


(Wall St Week Ahead runs every Friday. Questions or comments on this column can be emailed to: charles.mikolajczak(at)thomsonreuters.com )


(Reporting by Chuck Mikolajczak; Editing by Jan Paschal)


Read More..

Amid Egypt’s Duel on Democracy, Morsi Calls for Vote





CAIRO — Egypt’s highest court on Sunday postponed its much-awaited ruling on the legitimacy of the legislative assembly that drafted a new charter last week, accusing a crowd of Islamists of blocking judges from entering their building on what it called “a dark black day in the history of the Egyptian judiciary.”




Although hundreds of security officers were on hand to ensure that judges of the Supreme Constitutional Court could get into the court, and civilians came and went without any problems, the accusations intensified a standoff between the Mubarak-appointed judges and Egypt’s new Islamist leaders that has thrown the political transition into a new crisis 22 months after the ouster of Hosni Mubarak.


Upon approaching the court on Sunday morning, the judges said in a statement that they saw crowds “closing the entrances of the roads to the gates, climbing the fences, chanting slogans denouncing its judges and inciting the people against them.”


The judges were prevented from entering “because of the threat of harm and danger to their safety,” the statement said, calling it “an abhorrent scene of shame and disgrace.”


As a result, the judges announced that they were “suspending the court’s sessions” until they can resume their work without “psychological and physical pressures.”


Anticipation of the court’s decision on the new constitution had set off the latest political crisis. Fear that the court would dissolve the assembly and undo months of work led President Mohamed Morsi, of the Muslim Brotherhood’s political party, to announce 10 days ago that his edicts were not be subject to judicial review until the completion of the constitution.


Despite Mr. Morsi’s attempt, the same anticipation of dissolution drove the Islamist-dominated assembly to rush out a hurried constitution before the court could act and against the objections of Egypt’s secular parties and the Coptic Christian church. Mubarak-appointed judges have previous dissolved the elected parliament and the first constitutional assembly.


The sudden push by the president and his Islamist allies to push through a constitution over any objections from their secular factions or the courts has unified the opposition, brought hundreds of thousands of protesters to the streets, and set off a wave of attacks on a dozen offices of the Brotherhood’s Freedom and Justice Party. A judicial trade association has urged judges across the country to go on strike, and some of the highest courts have joined it.


Over the weekend, Mr. Morsi continued to push his plans for the new constitution, setting a national referendum on it for Dec. 15.


“I pray to God and hope that it will be a new day of democracy in Egypt,” he said in a nationally televised speech, calling for a “national dialogue.”


But his recent tone and actions reminded critics of the autocratic ways of his predecessor, and have aroused a new debate here about his commitment to democracy and pluralism at a time when he and his Islamist allies dominate political life.


Mr. Morsi’s advisers call the tactics a regrettable but necessary response to genuine threats to the political transition from what they call the deep state — the vestiges of the autocracy of former President Mubarak, especially in the news media and the judiciary.


But his critics say they hear a familiar paranoia in Mr. Morsi’s new tone that reminds them of talk of the “hidden hands” and foreign plots that Mr. Mubarak once used to justify his authoritarianism.


“I have sent warnings to many people who know who they are, who may be committing crimes against the homeland,” Mr. Morsi declared in an interview with state television on Thursday night, referring repeatedly to secret information about a “conspiracy” and “real and imminent threats” that he would not disclose. “If anybody tries to derail the transition, I will not allow them.”


In a speech to supporters that unveiled his new push to seize control of the transition’s end, Mr. Morsi was even more zealous. “To the corrupters who hide under respectable cover, I say, ‘Never imagine that I can’t see you,”’ he declared. “I’m on the lookout for them and will never let them go.”


The Muslim Brotherhood has mobilized hundreds of thousands of supporters to rally on Mr. Morsi’s behalf.


On Saturday, crowds gathered at Cairo University to rally in support of the president and against the court. Demonstrators held up banners picturing the court’s judges, and chants derided a deputy chief of the court known for their outspoken political activism and opposition to the Islamists. By the end of the night, some speakers had urged the crowd to gather outside the court the next day.


By about 10 a.m. Sunday, hundreds of Islamists had done just that. Like many demonstrations called by the Muslim Brotherhood, the mainstream Islamist group, it was a mostly middle-aged and middle-class crowd of men in sweaters and a few neckties. Many carried placards with Mr. Morsi’s picture or banners with logo of his party. “Freedom is coming, coming!,” they chanted, denouncing the Mubarak-loyalist who called the judges strike and celebrating the new constitution.


But several armored personnel carriers and hundreds of riot police formed a barrier holding back the demonstration to ensure that the judges could enter the court.


Magdy Hamed, 47, a businessman and member of the Brotherhood’s party attending the rally, said the demonstrators had done nothing to stop the judges from entering. “We didn’t stop them. We are asking them to come down and do their job,” he said, faulting the judges for failing to show up.


Mahmoud Akhas, 51, another businessman and party member, interrupted. “We are here to exert pressure on the Supreme Constitutional Court to comply with the will of the people,” he added, repeating the fears of many Islamists that the court might dissolve the constitutional assembly or even seek to annul the presidential decree granted Mr. Morsi power over the generals.


“The Egyptian people like stability,” Mr. Hamed said. “We don’t want chaos, and we don’t want to start this transition all over again.”


Mayy El Sheikh contributed reporting.



Read More..

Microsoft’s next-gen Xbox again said to launch ahead of 2013 holidays












Read More..

Dr. Andrew Moore Performs Life-Changing Surgeries for Free






Heroes Among Us










12/01/2012 at 09:40 AM EST







Dr. Andrew Moore (center, in scrubs) with staff members, from left: Shirley Ramsey, Barry Bussell and Tony Reyes


John Chiasson


When an increasing number of his patients couldn't pay for their life-saving surgeries, Dr. Andrew Moore decided he wasn't going to just stand by or send them away without doing anything.

So he found a way to make the procedures completely free of charge.

The Lexington, Kentucky-based plastic surgeon initially started waiving his fees for some patients, but soon found that wasn't reaching far enough. He grew disheartened every time a patient told him he couldn't afford to have a melanoma removed because he had no insurance. "It was so frustrating," says Moore, 63. "How was I going to take care of them?"

"We figured out the things we needed to do to make this work," says Moore. "It makes a difference in individual lives."

In 2005 the doctor launched Surgery on Sunday, a nonprofit group of more than 400 volunteer surgeons, nurses and medical professionals who perform free gall bladder removals, orthopedic repairs and other outpatient procedures in a donated surgical facility in Lexington.

To date, Moore's group has performed about 4,500 surgeries – and has a waiting list of more than 500. The program has also spawned offshoots in Louisville and three other Lexington hospitals, with the hope to expand nationwide.

Raising funds through grants and donations to cover malpractice insurance and medical supplies, Moore's band of medical good Samaritans has changed the lives of people like Michael Weyls, who lived in pain and terror after being diagnosed with a cancerous lesion he couldn't afford to have removed.

A doctor he knew referred him to Surgery on Sunday; Moore performed three surgeries and rebuilt Weyls's nose. "It could've killed me, and Dr. Moore worked a miracle," says Weyls. "I thank God for this man."

Know a hero? Send suggestions to heroesamongus@peoplemag.com. For more inspiring stories, read the latest issue of PEOPLE magazine

Read More..

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 ARV (anti-retroviral) 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/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, USAID and PEPFAR, is now among some 2,500 ARV 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 ARV 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."

Read More..

Cliff fight may knock out December rally

NEW YORK (Reuters) - In normal times, next week's slew of U.S. economic data could be a springboard for a December rally in the stock market.


December is historically a strong month for markets. The S&P 500 has risen 16 times in the past 20 years during the month.


But the market hasn't been operating under normal circumstances since November 7 when a day after the U.S. election, investors' focus shifted squarely to the looming "fiscal cliff."


Investors are increasingly nervous about the ability of lawmakers to undo the $600 billion in tax increases and spending cuts that are set to begin in January; those changes, if they go into effect, could send the U.S. economy into a recession.


A string of economic indicators next week, which includes a key reading of the manufacturing sector on Monday, culminates with the November jobs report on Friday.


But the impact of those economic reports could be muted. Distortions in the data caused by Superstorm Sandy are discounted.


The spotlight will be more firmly on signs from Washington that politicians can settle their differences on how to avoid the fiscal cliff.


"We have a week with a lot of economic data, and obviously most of the economic data is going to reflect the effects of Sandy, and that might be a little bit negative for the market next week, but most of that is already expected - the main focus remains the fiscal cliff," said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.


Concerns about the cliff sent the S&P 500 <.spx> into a two-week decline after the elections, dropping as much as 5.3 percent, only to rally back nearly 4 percent as the initial tone of talks offered hope that a compromise could be reached and investors snapped up stocks that were viewed as undervalued.


On Wednesday, the S&P 500 gained more than 20 points from its intraday low after House Speaker John Boehner said he was optimistic that a budget deal to avoid big spending cuts and tax hikes could be worked out. The next day, more pessimistic comments from Boehner, an Ohio Republican, briefly wiped out the day's gains in stocks.


On Friday, the sharp divide between the Democrats and the Republicans on taxes and spending was evident in comments from President Barack Obama, who favors raising taxes on the wealthy, and Boehner, the top Republican in Congress, who said Obama's plan was the wrong approach and declared that the talks had reached a stalemate.


"It's unusual to end up with one variable in this industry, it's unusual to have a single bullet that is the causal factor effect, and you are sitting here for the next maybe two weeks or more, on that kind of condition," said Sandy Lincoln, chief market strategist at BMO Asset Management U.S. in Chicago.


"And that is what is grabbing the markets."


BE CONTRARY AND MAKE MERRY


But investor attitudes and seasonality could also help spur a rally for the final month of the year.


The most recent survey by the American Association of Individual Investors reflected investor caution about the cliff. Although bullish sentiment rose above 40 percent for the first time since August 23, bearish sentiment remained above its historical average of 30.5 percent for the 14th straight week.


December is a critical month for retailers such as Target Corp and Macy's Inc . They saw monthly retail sales results dented by Sandy, although the start of the holiday shopping season fared better.


With consumer spending making up roughly 70 percent of the U.S. economy, a solid showing for retailers during the holiday season could help fuel any gains.


Ryan Detrick, senior technical strategist at Schaeffer's Investment Research in Cincinnati, believes the recent drop after the election could be a market bottom, with sentiment leaving stocks poised for a December rally.


"The concerns on the fiscal cliff - as valid as they might be - could be overblown. When you look at a lot of the overriding sentiment, that has gotten extremely negative," said Detrick.


"From that contrarian point of view with the historically bullish time frame of December, we once again could be setting ourselves up for a pretty nice end-of-year rally, based on lowered expectations."


SOME FEEL THE BIG CHILL


Others view the fiscal cliff as such an unusual event that any historical comparisons should be thrown out the window, with a rally unlikely because of a lack of confidence in Washington to reach an agreement and the economic hit caused by Sandy.


"History doesn't matter. You're dealing with an extraordinary set of circumstances that could very well end up in the U.S. economy going into a recession," said Phil Orlando, chief equity market strategist at Federated Investors in New York.


"And the likelihood of that is exclusively in the hands of our elected officials in Washington. They could absolutely drag us into a completely voluntary recession."


(Wall St Week Ahead runs every Friday. Questions or comments on this column can be emailed to: charles.mikolajczak(at)thomsonreuters.com )


(Reporting by Chuck Mikolajczak; Editing by Jan Paschal)


Read More..

EBay’s double tax base prompts calls for investigation












LONDON (Reuters) – Britain and Germany may have missed out on a combined $ 1 billion in sales tax since online marketplace eBay picked a tiny Luxembourg office as its base for EU sales, a shift that lawmakers say should now be investigated.


EBay’s nomination of Luxembourg unit eBay Europe Sarl – with a staff of nine – as its provider of services to EU clients allows it to charge customers in Europe a low rate of sales tax, often known as Value Added Tax, helping it to compete against rivals.












However, the unit doesn’t actually receive the money from sales. Instead, eBay said it continues to channel revenues through a Berne-based unit, allowing the company also to benefit from what Swiss tax lawyers say is the most competitive corporate income tax regime in Europe.


EU rules allow companies to establish subsidiaries in Luxembourg and levy VAT at Luxembourg’s low VAT rate on sales to customers across the bloc.


However, the rules also allow individual EU taxmen to challenge any claim to Luxembourg residence, and the right to charge Luxembourg VAT, in their domestic courts, if the taxman feels a Luxembourg-based subsidiary does not have sufficient staff or assets to support its claim to be the true supplier of goods or services.


Tax experts say eBay’s arrangement, which appears to give eBay the best of both income and sales tax worlds, could be open to challenge, and lawmakers in the UK and Germany want their taxmen to investigate.


“I hope that HMRC (UK tax authority Her Majesty’s Revenue and Customs) takes note … and takes prompt action,” said Margaret Hodge, member of parliament and chairman of the Public Accounts Committee (PAC), which monitors government finances.


“I will be seeking assurance that they are, next time we take evidence from HMRC,” she added. Officials from HMRC are due to testify to the PAC in early December as part of the committee’s investigation into tax matters.


Sven Giegold, member of the European Parliament for Germany’s Green Party, said he wanted the German tax authorities to “have a very critical look at this”.


It is common for companies to seek to reduce their tax bills, and a number of multinationals have established bases in Luxembourg so they can charge customers lower levels of VAT.


EBay said HMRC was aware of all its tax arrangements and that it was confident it met all its tax liabilities in the UK and elsewhere.


“In all countries and at all times, eBay is fully compliant with national, EU and international tax rules (including the OECD) including the remittance of VAT to the appropriate authorities,” an eBay spokesman said in an emailed statement.


The UK, German, French and Luxembourg tax authorities declined to comment on eBay, citing rules on taxpayer confidentiality.


LOWER THRESHOLD


Big companies’ tax practices have risen to the top of the political agenda in Europe in the past year, with lawmakers growing increasingly frustrated with the way in which companies such as search engine company Google pay almost no income tax in countries where they have billions of dollars in sales.


The companies escape liability for income taxes in countries like the UK by arguing the value created by their business, and therefore the location where the profit should be realized, is not the place where the customer resides, but rather in the location where the intellectual property underpinning the product or service is based.


Chas Roy-Chowdhury, head of taxation at the Association of Chartered Certified Accountants, said this was a valid economic argument and that if, for example, HMRC wants to claim more income tax from Google, it has to prove the company is generating more value in the UK than it is declaring.


This would require a thorough deconstruction of its business model and supply chain.


However, it is easier to establish liability to VAT, since this tax hinges simply on the location of the buyer and seller.


“The threshold is lower,” said Simon Newark, head of VAT at accountants UHY Hacker.


“There are a lot more aspects for HMRC to challenge in VAT than in direct (income) tax.”


For tax purposes, the EU deems eBay’s online platform an “electronically supplied service”, a category that also covers e-Books and music downloads.


Under EU rules, suppliers of such services based within the bloc are supposed to charge EU customers VAT at the rate prevailing in the country where the supplier is based.


A number of suppliers of electronic services, including Amazon.Com Inc and Apple Inc’s iTunes have established European headquarters in Luxembourg to enable them to charge customers lower VAT rates than prevail in their customers’ countries.


Luxembourg has traditionally charged the lowest standard VAT rates in the European Union. Its 15 percent rate compares with rates of 19-25 percent in most other EU members.


By charging customers VAT at Luxembourg’s rate eBay is better able to compete with rivals based elsewhere in the EU, such as Britain’s eBid, which must charge customers VAT at the standard UK rate of 20 percent.


However, to be entitled to charge Luxembourg rates, a company has to be able to prove in British, German or EU courts that it is genuinely based in the Grand Duchy.


Companies selling to EU customers from outside the EU – as eBay was until the 2007 nomination of eBay Europe Sarl as supplier to EU clients – must charge European customers VAT at the rate prevailing in the country where the customer resides, and to pay that VAT to the taxman in the customer’s country.


There is no definitive checklist that determines the true base of a company and any decision by a national court can be challenged in the European Court of Justice. In the UK, HMRC said it approached the matter on a case-by-case basis, and disputes are often resolved in court.


“HMRC will challenge any arrangements where it is claimed that supplies are made from a particular country but the business does not have the necessary resources to make those supplies,” a spokesman said.


EUROPE EXPANSION


EBay, which is headquartered in San Jose, California, moved into Europe in 1999 when it established eBay International in Berne. Switzerland’s low income tax regime for foreign companies was highly beneficial for the auction site. “We do have a very favorable international tax structure,” then-Chief Financial Officer Rajiv Dutta told analysts in 2002 when asked how the company managed to pay such low taxes on its non-U.S. income.


The Swiss base also meant, initially, that the company didn’t have to charge EU customers VAT. But in 2003, Brussels changed the rules, which forced eBay to charge EU sellers on its platform VAT based on their residence. The VAT gathered was remitted to the tax authority in the customer’s country.


Not all customers are charged VAT. Most medium-sized and big businesses are legitimately exempted from paying VAT on some purchases, such as eBay seller fees.


EBay’s Swiss-based European public relations head declined to say what portion of its EU customers were liable to be charged VAT. James Cordwell, equities analyst at Atlantic Equities, estimated that such customers accounted for 40-50 percent of sales in Europe.


Since the 2007 creation of its Luxembourg operation, eBay has had German fee revenues of $ 6.1 billion and UK revenues of $ 5 billion, its annual accounts show.


If the services were supplied from Switzerland or another non-EU country, and assuming only half of customers should have been charged VAT, EU rules would have obliged eBay to collect $ 580 million in VAT for the German taxman and $ 500 million in VAT for HMRC since 2007.


EBay’s entitlement to charge Luxembourg VAT on sales and to pay this to the Luxembourg taxman rests on being able to prove in court that eBay Europe Sarl is the provider of services to EU clients.


But despite German and UK fee income of $ 3.1 billion last year, eBay Europe Sarl recorded turnover of only 5 million euros in 2011.


John Hemming, an MP with the Liberal Democrats, the junior partner in the British coalition government, said the fact eBay’s sales revenues did not go through the Luxembourg unit undermined the claim that it was the true provider of services to EU clients.


“If it’s a real transaction, you would expect the money to pass with it, and not pass someplace else,” he said.


Rather than going to Luxembourg, the money generated from customers continues to go to Berne-based eBay International AG, a spokeswoman said.


When Reuters visited in mid November, staff at the Luxembourg office, just opposite the central post office, declined to discuss what operations the unit conducted for eBay.


A spokesman later said the office conducted activities including billing, data privacy, contracting, regulatory, management and some customer services operations.


By contrast, Amazon and iTunes do report their sales of ebooks and music downloads to EU customers through their Luxembourg units.


Prem Sikka, professor of accounting at Essex University, along with Newark and Roy-Chowdhury said a cash trail through a unit was one of the key factors used as evidence that the unit was the true supplier of a service.


UK and German tax authorities could argue that the shift in eBay’s supply base to Luxembourg from Berne was therefore not genuine. If successful, they could claim back the VAT lost.


EBay declined to say why it channeled sales through Switzerland. Tax advisors say the country can still offer some companies lower tax rates than other European low-tax jurisdictions such as Ireland and Luxembourg.


Indeed, EBay’s closest rival Amazon, which channels about half its non-U.S. earnings through Luxembourg, reported average income tax on overseas earnings of 6 percent in the past four years. EBay paid just 3 percent over the same period.


(Additional reporting by Brenda Goh; Editing by Will Waterman)


Tech News Headlines – Yahoo! News


Read More..

Katie Holmes Plants Her Stake on Broadway - and Succeeds















11/30/2012 at 09:45 AM EST







Katie Holmes and Norbert Leo Butz at the curtain call of Dead Accounts on opening night


Andrew H. Walker/Getty


bgwhite bgwhite   

You'll want to know what sort of performance Katie Holmes gives in Theresa Rebeck's Dead Accounts, which marks the actress's second Broadway appearance and her first since she slipped out of the orbit of That Superstar Who Declared His Love by Jumping on a Sofa.

She's good.

That’s a lot, considering there's not much meat to this comedy, and that most of it has been thrown into the sizable, eager mandibles of Tony-winner Norbert Leo Butz. It's a showcase role, and he's up for it. The performance is so full of outbursts, jokes, feints and tics he could have marked every moment with Post-it notes left across the set, a middle-class kitchen in Cincinatti: Here is where he manically gobbles his way through cartons of ice cream. Here is where he falls to the floor in a (very convincing) burst of hysterical laughter. And here, here, here and here are moments in which his manic comedy seems to be shading off into something closer to a genuine breakdown.

I don't think audiences would really be ready to see Katie Holmes have to go through all that.

Butz plays Jack, a Wall Street type who has returned to – fled back to? – the family home in Ohio, bringing with him a whirlwind of confusion. Why are his pockets full of prescription pills? Where did he get those wads of money he keeps throwing on the kitchen table? Why does he keep joking that he's murdered his wife? Why, in general, does he behave like Charlie Day from It's Always Sunny in Philadelphia?

Holmes plays Jack’s unmarried, sad-sack sister, Lorna, who is helping their father (unseen offstage) through a bout of kidney stones. In the first act, the role consists mostly of moving to and from the kitchen table and filling in a lot of expositional and background details that don't seem necessary. If your brother had turned up late at night, possibly out of his mind and yammering about how Cincinnati makes the best ice cream, would you and your mother spend the next morning discussing Catholicism and whether or not Jack should go to Mass? No.

However, Holmes gets her moments in the second act: Lorna is given a simple, tender monologue about planting a tree when she was a child, followed by a full-throttle, over-the-top tirade against money, banks and fiduciary wickedness.

Holmes gets a big laugh there, but you have the nagging realization that the little memory about the tree slipped by without registering emotionally – that it was a lot more meaningful than the tirade, and that Holmes should have been directed to dig deeper. Or that Rebeck, creater of NBC’s Smash, should have written deeper.

Apart from being unhappy – and who isn't? – is Lorna pathetic, depressed, neurotic, stupid? We never know.

By this point, we've found out Jack's secret, and the puncturing of that mystery leaves us with little more than a tangle of themes messily duking it out: death, family, money, New York vs. Cincinnati and, toward and right up to the end, more and more about that symbolic tree.

Based on a rather pretty stage effect at the finale, I would say the tree wins.

I would even speculate that the play would have been better if it had actually have been about trees, about their beauty, their cycle of renewal, their longevity through time.

But then (1) Rebeck would have had to abandon her thin sitcom plot, or (2) Holmes would have had to learn to be a tree.

I doubt audiences are ready to see Holmes play a tree.

Read More..

Ukraine fights spreading HIV epidemic

BUCHA, Ukraine (AP) — Andrei Mandrykin, an inmate at Prison No. 85 outside Kiev, has HIV. He looks ghostly and much older than his 35 years. But Mandrykin is better off than tens of thousands of his countrymen, because is he receiving treatment amid what the World Health Organization says is the worst AIDS epidemic in Europe.

Ahead of World AIDS Day on Saturday, international organizations have urged the Ukrainian government to increase funding for treatment and do more to prevent HIV from spreading from high-risk groups into the mainstream population, where it is even harder to manage and control.

An estimated 230,000 Ukrainians, or about 0.8 percent of people aged 15 to 49, are living with HIV, the virus that causes AIDS. Some 120,000 are in urgent need of anti-retroviral therapy, which can greatly prolong and improve the quality of their lives. But due to a lack of funds, fewer than a quarter are receiving the drugs — one of the lowest levels in the world.

Ukraine's AIDS epidemic is still concentrated among high-risk groups such as intravenous drug users, sex workers, homosexuals and prisoners. But nearly half of new cases registered last year were traced to unprotected heterosexual contact.

"Slowly but surely the epidemic is moving from the most-at-risk, vulnerable population to the general population," said Nicolas Cantau of The Global Fund to Fight AIDS, Tuberculosis and Malaria, who manages work in Eastern Europe and Central Asia. "For the moment there is not enough treatment in Ukraine."

Stigma is also a big problem for those with HIV in Ukraine. Liliya, a 65-year-old woman who would give only her first name, recently attended a class on how to tell her 9-year-old great-granddaughter that she has HIV. The girl, who contacted HIV at birth from her drug-abusing mother, has been denied a place in preschool because of her diagnosis.

"People are like wolves, they don't understand," said Liliya. "If any of the parents found out, they would eat the child alive."

While the AIDS epidemic has plateaued elsewhere in the world, it is still progressing in Eastern Europe and Central Asia, according to Cantau. Nearly 21,200 new cases were reported in Ukraine in 2011, the highest number since the former Soviet republic registered its first case in 1987, and a 3 percent increase over 2010. As a result of limited and often delayed treatment, the number of AIDS-related deaths grew 17 percent last year to about 3,800.

Two years ago, Mandrykin, the prisoner, was on the verge of becoming part of that statistic, with his level of crucial CD4 immune cells — a way to measure the strength of the immune system — dropping to 11. In a healthy person, the CD4 count is usually over 600.

"I was lying in the hospital, I was dying," said Mandrykin, who is serving seven years for robbery, his fourth stint in jail. "It's a scary disease."

After two years of treatment in a small prison clinic, his CD4 count has risen to 159 and he feels much better, although he looks exhausted and is still too weak to work in the workshop of the medium-security prison.

The Ukrainian government currently focuses on testing and treating standard cases among the general population. The anti-retroviral treatment of more than 1,000 inmates, as well as some 10,000 HIV patients across Ukraine who also require treatment for tuberculosis and other complications and all prevention and support activities, are paid for by foreign donors, mainly the Global Fund.

The Global Fund is committed to spending $640 million through 2016 to fight AIDS and tuberculosis in Ukraine and then hopes to hand over most of its programs to the Ukrainian government.

Advocacy groups charge that corruption and indifference by government officials help fuel the epidemic.

During the past two years, Ukrainian authorities have seized vital AIDS drugs at the border due to technicalities, sent prosecutors to investigate AIDS support groups sponsored by the Global Fund and harassed patients on methadone substitution therapy, prompting the Global Fund to threaten to freeze its prevention grant.

Most recently, Ukraine's parliament gave initial approval to a bill that would impose jail terms of up to five years for any positive public depiction of homosexuality. Western organizations say it would make the work of AIDS prevention organizations that distribute condoms and teach safe homosexual sex illegal and further fuel the epidemic. It is unclear when the bill will come up for a final vote.

AIDS drug procurement is another headache, with Ukrainian health authorities greatly overpaying for AIDS drugs. Advocacy groups accuse health officials of embezzling funds by purchasing drugs at inflated prices and then pocketing kickbacks.

Officials deny those allegations, saying their tender procedures are transparent.

Much also remains to be done in Ukraine to educate people about AIDS.

Oksana Golubova, a 40-year-old former drug user, infected her daughter, now 8, with HIV and lost her first husband to AIDS. But she still has unprotected sex with her new husband, saying his health is in God's hands.

"Those who are afraid get infected," Golubova said.

Read More..