Study: Drug coverage to vary under health law

WASHINGTON (AP) — A new study says basic prescription drug coverage could vary dramatically from state to state under President Barack Obama's health care overhaul.

That's because states get to set benefits for private health plans that will be offered starting in 2014 through new insurance exchanges.

The study out Tuesday from the market analysis firm Avalere Health found that some states will require coverage of virtually all FDA-approved drugs, while others will only require coverage of about half of medications.

Consumers will still have access to essential medications, but some may not have as much choice.

Connecticut, Virginia and Arizona will be among the states with the most generous coverage, while California, Minnesota and North Carolina will be among states with the most limited.

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Online:

Avalere Health: http://tinyurl.com/d3b3hfv

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Wall Street slips as investors seek cliff progress

NEW YORK (Reuters) - Stocks finished slightly lower in a quiet session on Tuesday as the back-and-forth wrangling over the "fiscal cliff" gave investors little reason to act.

Trading volume was light as legislators continue to negotiate a deal to avoid a $600 billion package of tax hikes and federal spending cuts that would begin January 1 and could push the economy into recession.

Just 5.86 billion shares changed hands on the New York Stock Exchange, the Nasdaq and the NYSE MKT, below the year's daily average of 6.48 billion shares.

A key measure of investor anxiety has remained muted. The CBOE Volatility Index or VIX <.vix>, a gauge of market anxiety, was at 17.12, up 2.9 percent. It has not traded above 20 since July.

Optimism for progress was dented after remarks by President Barack Obama, who rejected a Republican proposal to resolve the crisis as "out of balance" and said any deal must include a rise in income tax rates on the wealthiest Americans.

"People don't know if what's going on is political posturing or real negotiations that represent progress," said Bernard Baumohl, managing director and chief global economist at the Economic Outlook Group in Princeton, New Jersey.

Expectations of higher taxes on dividends beginning in 2013 have pushed many companies to pay special dividends this year or advance their next payback to investors. Coach became the latest to move up the date of its next dividend payment, and the news lifted shares of the upscale leather-goods maker earlier in the session. By the close, though, Coach was down 1.2 percent at $57.52.

One of the S&P 500's top sectors for the day was health care <.gspa>, considered a defensive group.

The Dow Jones industrial average <.dji> fell 13.82 points, or 0.11 percent, to 12,951.78 at the close. The Standard & Poor's 500 Index <.spx> dipped 2.41 points, or 0.17 percent, to 1,407.05. The Nasdaq Composite Index <.ixic> shed 5.51 points, or 0.18 percent, to close at 2,996.69.

The market has been sensitive to rhetoric from Washington, as a failure to reach an agreement could send the U.S. economy back into recession. Still, many expect a resolution to be found, which could extend the S&P 500's rally of 12 percent so far this year.

Differences within the Republican Party came to the fore on Tuesday as one senator opposed to raising taxes lashed out at Republican House Speaker John Boehner for proposing to increase revenue by closing some tax loopholes.

Congressional Republicans recently proposed steep spending cuts to bring down the budget deficit, but gave no ground on Obama's call to raise tax rates on the rich. The proposal was quickly dismissed by the White House.

"We're on hold trying to figure it out, but investors are stressed since they have to make decisions soon about how to proceed with their investments if taxes are indeed going up. We could see a real pick-up in volume over the next week or so," Baumohl said.

Netflix Inc was the S&P 500's top percentage gainer, advancing 14 percent to $86.65 after Walt Disney Co agreed to give the company exclusive TV distribution rights to its movies, starting in 2016.

Intel Corp shares rose 2.2 percent to $19.97 after the top chipmaker sold $6 billion in bonds to fund stock buybacks and other business activities.

Darden Restaurants Inc shares plunged 9.6 percent to $47.40 as the S&P 500's worst performer after the company warned that its latest quarter would miss expectations after unsuccessful promotions led to a decline in sales at its Olive Garden, Red Lobster and LongHorn Steakhouse chains.

In contrast, Big Lots Inc surged 11.5 percent to $31.27 after the close-out retailer posted a smaller-than-expected loss and boosted its full-year adjusted earnings forecast.

MetroPCS Communications shares tumbled 7.5 percent to $9.96 after Sprint Nextel appeared unlikely to make a counter-offer for the wireless service provider.

Almost half of the stocks traded on the New York Stock Exchange closed lower, while 50 percent of Nasdaq-listed shares closed in negative territory.

After the closing bell, Pandora Media Inc

shares plunged 23 percent after the company reported its third-quarter results.

(Editing by Jan Paschal)

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Clinton Warns Syria Against Using Chemical Weapons

Narciso Contreras/Associated Press

 A kitchen in a home in Aleppo, Syria showed signs of heavy fighting Sunday.

WASHINGTON — President Obama warned Syria’s government on Monday that it would be “totally unacceptable” to use chemical weapons against its own people and vowed to hold accountable anyone who did, as American intelligence officials picked up signs that such arms might be deployed in the ongoing insurgency.

The White House said that some recent actions by the government of President Bashar al-Assad were indicators that Syrian forces were preparing to use such weapons, following earlier reports that intelligence agencies had noticed signs of activity at chemical weapons sites. Mr. Obama’s spokesman said the administration had “an increased concern” of possible use of chemical weapons.

In a speech later in the day that echoed earlier comments by Secretary of State Hillary Rodham Clinton, Mr. Obama sternly asserted again that he would punish Syria for using chemical weapons, although he did not say how. The administration has been preparing contingency plans that include the dispatch of tens of thousands of troops to secure such weapons, although it is not clear whether Mr. Obama would go that far.

“Today I want to make it absolutely clear to Assad and those under his command: The world is watching,” Mr. Obama said in a speech at the National Defense University in Washington. “The use of chemical weapons is and would be totally unacceptable. If you make the tragic mistake of using these weapons, there will be consequences and you will be held accountable.”

During an earlier briefing at the White House, Jay Carney, the president’s press secretary, hinted at possible military action in response, although he declined to specify what options Mr. Obama would consider. “We think it is important to prepare for all scenarios,” Mr. Carney said. “Contingency planning is the responsible thing to do.”

The president’s statements on Syria amplified similar warnings issued by Mrs. Clinton earlier in the day in Prague, the Czech capital, where she was stopping on her way to meetings in Brussels.

“This is a red line for the United States,” Mrs. Clinton said, using the same language that the White House later would use. “I am not going to telegraph in any specifics what we would do in the event of credible evidence that the Assad regime has resorted to using chemical weapons against their own people. But suffice it to say we are certainly planning to take action if that eventuality were to occur.”

There have been signs in recent days of heightened activity at some of Syria’s chemical weapons sites, according to American and Israeli officials familiar with intelligence reports. Mrs. Clinton did not confirm the intelligence reports or say what sort of activity was occurring.

The Syrian Foreign Ministry, in a swift response, said the government “would not use chemical weapons, if it had them, against its own people under any circumstances.” The statement was reported on Syrian state television and on the Lebanese channel LBC.

The crisis has been worsening in Syria, where about 40,000 people have been killed in 20 months of conflict that has also spilled into neighboring countries. The warning from the White House came as developments elsewhere suggested the political terrain could be shifting.

The spokesman for Syria’s foreign ministry, Jihad Makdissi, was reported by the Hezbollah-run television station, Al Manar, as having been fired, although Lebanese news Web sites reported the departure as a defection. Mr. Makdissi, one of the highest ranking Christians to defect, had been one of the most accessible Syrian officials for foreign journalists. Al Manar reported that he was fired for making statements that did not reflect the government’s point of view, though it was unclear what those statements might have been.

But in recent months he had not taken phone calls and had not made public statements, leading some to speculate that he had either fallen out of favor or had doubts about the government. A security source said Mr. Makdissi flew to London from Beirut on Monday morning with his family.

Michael R. Gordon reported from Brussels. Reporting contributed by Anne Barnard from Beirut, Lebanon, and Sebnem Arsu from Istanbul.

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Jon Bon Jovi Had 'No Idea' About His Daughter's Drug Trouble

By Dahvi Shira

12/03/2012 at 07:20 PM EST

Jon Bon Jovi and daughter Stephanie

Dave M. Benett/Getty

Jon Bon Jovi isn't just livin' on a prayer following the apparent heroin overdose that hospitalized his daughter Stephanie Rose Bongiovi last month.

Speaking out about the issue with his daughter, the legendary rocker, 50, says he's "confident" Bongiovi, 19, will be okay, telling the Associated Press, "You surround them with the best help and love and move on, and that's where we're at with it."

Although the musician and his family are getting past the Nov. 14 incident that occurred in Bongiovi's Hamilton College dorm room in Clinton, N.Y., the musician is still surprised it happened.

"I'm shocked as much as the next parent with this situation and had no idea," Bon Jovi explains. "Steph is a great kid. Great GPA. Cool school … everything about it is idyllic. She was doing great, then a sudden and steep decline."

Reflecting back, Bon Jovi says when he first became a father he wasn't sure how best to raise a little girl, but he and his wife provided a loving, stable home for their daughter.

"I didn't have any sisters," he says. "We bring home this girl the first day. Now what? Where's the manual? There was no manual. So you bring her up the best you can, you surround her with hugs and kisses and know that she may eventually fall down," he says. "I appreciate the outpouring of kindness in light of what happened in my household … No one knows the future. It is what it is."

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Fossil fuel subsidies in focus at climate talks

DOHA, Qatar (AP) — Hassan al-Kubaisi considers it a gift from above that drivers in oil- and gas-rich Qatar only have to pay $1 per gallon at the pump.

"Thank God that our country is an oil producer and the price of gasoline is one of the lowest," al-Kubaisi said, filling up his Toyota Land Cruiser at a gas station in Doha. "God has given us a blessing."

To those looking for a global response to climate change, it's more like a curse.

Qatar — the host of U.N. climate talks that entered their final week Monday — is among dozens of countries that keep gas prices artificially low through subsidies that exceeded $500 billion globally last year. Renewable energy worldwide received six times less support — an imbalance that is just starting to earn attention in the divisive negotiations on curbing the carbon emissions blamed for heating the planet.

"We need to stop funding the problem, and start funding the solution," said Steve Kretzmann, of Oil Change International, an advocacy group for clean energy.

His group presented research Monday showing that in addition to the fuel subsidies in developing countries, rich nations in 2011 gave more than $58 billion in tax breaks and other production subsidies to the fossil fuel industry. The U.S. figure was $13 billion.

The Paris-based Organization for Economic Cooperation and Development has calculated that removing fossil fuel subsidies could reduce carbon emissions by more than 10 percent by 2050.

Yet the argument is just recently gaining traction in climate negotiations, which in two decades have failed to halt the rising temperatures that are melting Arctic ice, raising sea levels and shifting weather patterns with impacts on droughts and floods.

In Doha, the talks have been slowed by wrangling over financial aid to help poor countries cope with global warming and how to divide carbon emissions rights until 2020 when a new planned climate treaty is supposed to enter force. Calls are now intensifying to include fossil fuel subsidies as a key part of the discussion.

"I think it is manifestly clear ... that this is a massive missing piece of the climate change jigsaw puzzle," said Tim Groser, New Zealand's minister for climate change.

He is spearheading an initiative backed by Scandinavian countries and some developing countries to put fuel subsidies on the agenda in various forums, citing the U.N. talks as a "natural home" for the debate.

The G-20 called for their elimination in 2009, and the issue also came up at the U.N. earth summit in Rio de Janeiro earlier this year. Frustrated that not much has happened since, European Union climate commissioner Connie Hedegaard said Monday she planned to raise the issue with environment ministers on the sidelines of the talks in Doha.

Many developing countries are positive toward phasing out fossil fuel subsidies, not just to protect the climate but to balance budgets. Subsidies introduced as a form of welfare benefit decades ago have become an increasing burden to many countries as oil prices soar.

"We are reviewing the subsidy periodically in the context of the total economy for Qatar," the tiny Persian gulf country's energy minister, Mohammed bin Saleh al-Sada, told reporters Monday.

Qatar's National Development Strategy 2011-2016 states it more bluntly, saying fuel subsides are "at odds with the aspirations" and sustainability objectives of the wealthy emirate.

The problem is that getting rid of them comes with a heavy political price.

When Jordan raised fuel prices last month, angry crowds poured into the streets, torching police cars, government offices and private banks in the most sustained protests to hit the country since the start of the Arab unrest. One person was killed and 75 others were injured in the violence.

Nigeria, Indonesia, India and Sudan have also seen violent protests this year as governments tried to bring fuel prices closer to market rates.

Iran has used a phased approach to lift fuel subsidies over the past several years, but its pump prices remain among the cheapest in the world.

"People perceive it as something that the government is taking away from them," said Kretzmann. "The trick is we need to do it in a way that doesn't harm the poor."

The International Energy Agency found in 2010 that fuel subsidies are not an effective measure against poverty because only 8 percent of such subsidies reached the bottom 20 percent of income earners.

The IEA, which only looked at consumption subsidies, this year said they "remain most prevalent in the Middle East and North Africa, where momentum toward their reform appears to have been lost."

In the U.S., environmental groups say fossil fuel subsidies include tax breaks, the foreign tax credit and the credit for production of nonconventional fuels.

Industry groups, like the Independent Petroleum Association of America, are against removing such support, saying that would harm smaller companies, rather than the big oil giants.

In Doha, Mohammed Adow, a climate activist with Christian Aid, called all fuel subsidies "reckless and dangerous," but described removing subsidies on the production side as "low-hanging fruit" for governments if they are serious about dealing with climate change.

"It's going to oil and coal companies that don't need it in the first place," he said.

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Associated Press writers Abdullah Rebhy in Doha, Qatar, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report

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Karl Ritter can be reached at www.twitter.com/karl_ritter

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Fed officials laud stimulus, quibble over future plans

NEW YORK/LITTLE ROCK, Arkansas (Reuters) - Central bankers appear satisfied with the impact of their latest monetary stimulus, though there is some disagreement over how forcefully to continue purchasing bonds, remarks by two top policymakers on Monday showed.

Boston Federal Reserve Bank President Eric Rosengren, one of the most vocal proponents of Fed asset purchases, said there was a "strong case" for the Fed to stay the course on accommodative policies next year and continue buying a total of $85 billion in bonds each month.

In September, the Fed announced an open-ended bond buying scheme that began with $40 billion per month in mortgage-backed securities.

That new effort to boost the economy comes on top of a separate program in which the Fed was buying $45 billion of longer-term Treasury securities per month with proceeds from sales of a like amount of shorter-term debt.

The latter plan, known as Operation Twist, is set to expire at the end of this month, and most analysts expect the central bank to substitute an equal amount of long-term Treasury buying.

However, James Bullard, president of the St. Louis Fed, argued the central bank should not replace its expiring 'Operation Twist' program on a dollar-for-dollar basis. He said purchases that expand the Fed's $2.8 trillion balance sheet would have a bigger effect than Twist, which does not add to the balance sheet.

"If the goal is to keep policy on its present course, the replacement rate should be less than one-for-one," Bullard told the Little Rock Chamber of Commerce, suggesting $25 billion as an adequate monthly amount.

THRESHOLDS

Whether to expand the Fed's balance sheet further will be a key topic of debate at Fed policymakers' next meeting on December 11-12. Also under consideration: tweaking Fed communications by adopting numerical thresholds for inflation and joblessness to signal when rates might rise.

Bullard on Monday said he supported the adoption of such thresholds as long as the Fed can address his concerns, especially his worry that the Fed is seen as trying to target unemployment. That approach was badly discredited in the 1970s, he said, when rates were kept low to boost jobs and inflation skyrocketed.

Bullard had previously sounded more skeptical on thresholds, saying they could rob the central bank of flexibility.

But the idea has recently gained traction, with Fed Vice Chair Janet Yellen voicing strong support for the idea, first advocated by Chicago Fed President Charles Evans a year ago.

Evans wants the Fed to keep rates low until unemployment drops to at least 6.5 percent, as long as inflation does not threaten to rise above 2.5 percent. Minneapolis Fed President Narayana Kocherlakota and Boston Fed's Rosengren have also pitched specific proposals.

GROWTH

The U.S. economy grew at a 2.7 percent annual rate in the third quarter but is expected to have slowed in the final months of the year. Unemployment remains elevated at 7.9 percent.

Bullard said he expects the expansion to pick up steam in 2013, allowing gross domestic product to rise about 3.5 percent. But he added that estimate was predicated on a successful resolution of a year-end budget crunch, still a big "if".

William Dudley, head of the New York Fed, argued the Fed's mortgage-backed securities purchases have provided much-needed support to the economy, even if their benefits in easing financial conditions have not been fully passed through from financial institutions down to customers.

"Our policy has been and continues to be effective - though it is certainly not all-powerful in current circumstances," he said at a conference on mortgage finance at the New York Fed, at which his Boston Fed counterpart Rosengren was the keynote speaker.

The conference was aimed at exploring some of the blockages in the transmission of Fed policy to American consumers, Dudley said.

"We are focusing on ... the significant widening of the spread between yields on mortgage-backed securities and primary mortgage rates," he said.

In response to the financial crisis and deep recession of 2007-2009, the Fed had already slashed official rates to zero and bought some $2.3 trillion in government and mortgage-backed bonds prior to the launch of its latest stimulus.

(Writing by Pedro Nicolaci da Costa; Editing by Chizu Nomiyama)

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Egyptian Court Postpones Ruling on Constitutional Assembly

Wissam Nassar

Egyptian police officers stood guard outside Egypt's Supreme Constitutional Court on Sunday, while supporters of President Mohamed Morsi protested near the entrance of the building.

CAIRO — Egypt’s constitutional court on Sunday put off its much-awaited ruling on the legitimacy of the Islamist-led legislative assembly that drafted a new charter last week, accusing a crowd of Islamists outside the courthouse of intimidating its judges.

What actually took place at the courthouse, however, is a matter of dispute.

Calling Sunday “a dark black day in the history of the Egyptian judiciary,” the Supreme Constitutional Court charged in a statement that a mob of Islamists had blocked the judges from entering the courthouse, in an “abhorrent scene of shame and disgrace.”

Approaching the court, the judges saw crowds “closing the entrances of the roads to the gates, climbing the fences, chanting slogans denouncing judges and inciting the people against them,” the statement said, adding that “the threat of harm” prevented the judges from entering. The judges said they were suspending the court’s sessions until they could resume their work without “psychological and physical pressures.”

While the judges blamed the Islamists, the Islamists accused the judges of manufacturing a melodramatic excuse for failing to show up. And the contradictory narratives captured a clash between the judges — appointed by Hosni Mubarak, the former president — and Egypt’s new Islamist leaders that has thrown the political transition into a new crisis 22 months after Mr. Mubarak’s ouster.

Egyptian courts had previously dissolved both the elected Parliament and an earlier Constitutional Assembly, and the breakup of the current one would have completely undone the transition. President Mohamed Morsi cited the pending ruling on Nov. 22 when he put his own edicts above judicial review until ratification of the constitution, saying that he intended to protect the assembly until it finished its work.

That same apprehension about the ruling drove the assembly to rush to approve a constitution just before dawn on Friday, over the objections of secular parties and the Coptic Christian Church, before the court could act.

The judges’ statement on Sunday was a counterattack, and the scene outside the courthouse was much quieter than their statement described. A line of hundreds of riot police officers backed by a fire truck and several armored personnel carriers were on hand to secure the judges’ entry to the courthouse, and several people were seen coming and going without any difficulty.

The Interior Ministry said in a statement on its Web site that it had arranged to secure the entrance and protect the judges, that the protests were “peaceful,” and that a number of judges had already arrived safely.

On the other side of the police line was a relatively staid crowd of a few hundred demonstrators from the Muslim Brotherhood, Egypt’s mainstream political group, and its political arm, Mr. Morsi’s Freedom and Justice Party. Like many of the group’s demonstrations, it was a mostly middle-aged, middle-class crowd of men in sweaters and a few neckties. By around 10 a.m., some were chanting slogans, but others were sitting on the ground reading newspapers. Many carried placards with Mr. Morsi’s picture or banners with the logo of his party, and one was reading its Web page on his iPad.

“We immunize the constituent assembly, and dissolve the constitutional court,” they chanted. “Freedom is coming, coming.” Some chants were directed at Judge Tahani el-Gebali, who is known for her political activism and opposition to the Islamists.

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

Mahmoud el-Akhas, 51, another businessman and party member, interjected, “We are here to exert pressure on the Supreme Constitutional Court to comply with the will of the people.” He reiterated the fears of many Islamists that the court might even seek to annul the presidential decree that granted Mr. Morsi power over the generals who ruled after Mr. Mubarak was ousted.

“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.

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Here’s How to Turn Nicki Minaj into Jay-Z

We realize there’s only so much time one can spend in a day watching new trailers, viral video clips, and shaky cell phone footage of people arguing on live television. This is why every day The Atlantic Wire highlights the videos that truly earn your five minutes (or less) of attention. Today:

RELATED: It’s Sort of Fun Watching Pippa Middleton Squirm

This is silly, but it’s Friday and a unicorn lair has been found in North Korea, rendering all other silliness moot. But the folks over at Reddit seem to dig the idea of slowing down Nicki Minaj’s songs so much that they sound like an over-enunciating Jay-Z. And well, it’s oddly relaxing: 

RELATED: ‘Roseanne’ Predicted Internet Addiction; A Weather Alert from Hell

RELATED: The Honey Boo Boo Nature Special; Everyone’s Favorite Sleepwalking Mom

Another week has passed by and we still haven’t figured out the Fiscal Cliff situation. Let’s fix it—and not just because we want to avoid getting downgraded (again). Because honestly, we just don’t think CNBC’s Rick Santelli can make it another two weeks: 

RELATED: Cookie Monster Takes a Bite Out of ‘Call Me Maybe’

RELATED: Paul Ryan Was In a Band Called Steak Baby

James Lipton, let’s hang out: 

Finally, it’s Friday. What are you still doing here?  Go enjoy the weekend or something or … watch this video of a husky which sort of sounds like Dame Edna at time imitating a baby until 6 p.m. rolls around: 

Wireless News Headlines – Yahoo! News

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Kellan Lutz, Hugh Jackman Take Bites and Swipes &#38; More Casting News

By Julia Haskins

12/02/2012 at 07:00 PM EST

Kellan Lutz (left) and Hugh Jackman

Christopher Polk/Getty, Han Myung-Gu/WireImage

It's comeback time. Whether seeking revenge or reprising beloved roles, a fresh crop of movies shows that the best characters always come back for more.

Twilight's Kellan Lutz feasts on others as a vampire, but this time, he's utilizing his own body for powers, Zimbio reports.

The actor will star in Tatua as a tattooed assassin whose weapons are extracted from the ink on his body. The process is a strain on the hit man, but he must put that aside when his son is kidnapped by a dangerous foe.

Hugh Jackman is set to reprise his role as Wolverine in
X-Men: Days of Future Past, the Hollywood Reporter. Ian McKellen (Professor Xavier) and Patrick Stewart (Magneto, will also be joining Jennifer Lawrence, James McAvoy, Michael Fassbender and Nicholas Hoult.

Charlize Theron will star in an adaptation of the final installment of a South Korean revenge trilogy, the Hollywood Reporter also says. The original movie revolves around a woman wrongfully imprisoned for 13 years who then sets out to seek her long-awaited revenge. Writer William Monahan says the English-language remake will be "very American – and very unexpected."

The made-for-TV Disney channel movie Life-Size is getting a sequel, Variety reports. Tyra Banks will reprise her role as Eve, the doll who comes to life, and also executive produce the movie. No word yet on whether Lindsay Lohan, who played Eve's owner, will be making a return.

Also coming soon:

Beyoncé won't be slowing down after her Super Bowl performance in February. Just a couple weeks later, she'll introduce her still untitled, feature-length documentary on HBO, Deadline reports. The documentary airs Feb. 16.

Bridesmaids' Rose Byrne will be going through the motions as a newlywed in I Give it a Year, Zimbio reports. As if being newly married wasn't tough enough, the "too perfect" ex Anna Faris will be shaking up an already teetering balance.

Cate Blanchett will be stirring up her wicked ways as the evil stepmother in a live-action adaptation of Disney's Cinderella, also according to Zimbio.

And George Clooney is sticking to his winning formula by joining forces with his Argo team to produce an untitled crime drama, Variety reports.

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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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