Wal-Mart 3Q profit up but sees sales shortfall

NEW YORK (AP) — Wal-Mart Stores Inc. reported a 9 percent increase in net income for the third quarter, but revenue for the world’s largest retailer fell below Wall Street forecasts as its low-income shoppers continue to grapple with an uncertain economy.

The discounter issued a fourth-quarter profit outlook that fell short of Wall Street expectations, and the company’s stock price slid more than 3 percent.

Wal-Mart is considered an economic bellwether because the retailer accounts for nearly 10 percent of nonautomotive retail spending in the U.S. The company’s latest results show that many low-income Americans — it’s estimated that the typical Wal-Mart customer has an average household income of between $ 30,000 and $ 60,000, rents their homes and doesn’t own stock — continue to struggle even as the housing and stock markets are improving.

The disappointing revenue comes as Wal-Mart, like other retailers, is preparing for the busy winter holiday shopping season in the U.S. next week. The period, which runs roughly from November throughout December, is a time when stores can make up to 40 percent of their annual revenue. Wal-Mart has said that it plans to offer deeper discounts and a broader assortment of merchandise during this year’s season to draw in shoppers.

“Macroeconomic conditions continue to pressure our customers,” said Charles Holley, Wal-Mart’s chief financial officer. “The holiday season is predicted to be very competitive but we are well prepared to deliver on the value and low prices our customers expect.”

The disappointing revenue results come a year after Wal-Mart’s U.S. namesake business turned a corner by reemphasizing low prices and restocking stores with thousands of basic items that it had gotten rid of in an overzealous bid to reduce clutter.

During the third quarter of last year, the division reversed nine straight quarters of declines in revenue at stores opened at least a year, which is considered a key measure of a retailer’s health. The U.S. namesake business has recorded five consecutive quarters of gains since the division rebounded, including a 1.5 percent increase in the third quarter.

But the third-quarter gain is just shy of the 1.8 percent increase analysts polled by Thomson Reuters were expecting. It’s also a slowdown in growth from the 2.2 percent gain the business posted in the second quarter and the 2.6 percent increase it had in the first quarter.

Analysts say that Wal-Mart’s previous results had benefited from the increase in prices shoppers were paying for groceries due to inflation for some items, a trend that is now subsiding. They also say that Wal-Mart is facing tougher revenue comparisons from a year ago when its business first began to rebound.

Ken Perkins, president of Retail Metrics, a research company, said Wal-Mart’s revenue is headed in the right direction. But he cautioned that the company will need to continue to keep prices low in order to compete with rivals that have stepped up discounting.

“Overall, it’s a relatively good report,” he said. “But it shows that its consumer is still struggling.”

In the third quarter, Bentonville, Ark.-based Wal-Mart earned $ 3.63 billion, or $ 1.08 per share, in the quarter ended Oct. 31. That compares with $ 3.33 billion, or 96 cents per share, in the year-ago period.

Net revenue, excluding Sam’s Club membership fees, rose 3.4 percent to $ 113.2 million. Excluding the currency impact, net revenue would have been $ 114.9 million. Analysts were expecting $ 1.07 per share on net revenue of $ 114 billion.

Nearly all areas, including food and clothing, registered gains. However, the company’s entertainment category, which includes gaming, suffered a decline, dragged down by price deflation. Part of the weakness is also due to the company’s layaway business, which winds up deferring sales to the fourth quarter.

For the entire U.S. business, sales at stores opened at least a year rose 1.7 percent, below the 2.1 percent Wall Street estimate. At Sam’s Club, the figure was up 2.7 percent, below the 3.8 percent increase Wall Street expected and the 4.2 percent gain it posted in the second quarter.

The company said its business members at Sam’s Clubs are being hurt by the economic downturn, and are switching to less-expensive chicken from beef. To boost sales, Sam’s Club is increasing its offering of rotisserie chicken, and has reduced prices in several varieties of apples and beauty products.

“Our business members continue to experience economic pressure and uncertainty,” said Rosalind Brewer, president of Sam’s Clubs.

For the full year, Wal-Mart now said it expects earnings per share to be between $ 4.88 per share and $ 4.93 per share. It originally expected earnings per share of $ 4.83 to $ 4.93. For the fourth quarter, it forecasts earnings per share to be $ 1.53 per share and $ 1.58 per share. Analysts had expected $ 1.59 per share.

Separately, in a filing with the U.S. Securities and Exchange Commission, Wal-Mart said Thursday that it was looking into potential violations related to the Foreign Corrupt Practices Act in Brazil, China and India. This comes after Wal-Mart initially began investigating its Mexico operations following report that surfaced in April that the retailer allegedly failed to notify law enforcement when company officials authorized millions of dollars in bribes in Mexico to speed building permits and gain other favors. The company continues to work with government officials in the U.S. and Mexico on that investigation.

On Thursday, Wal-Mart’s stock fell $ 2.61 to close at $ 68.70. Over the past 52 weeks, Wal-Mart stock has been trading between $ 56.26 and $ 77.60.

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France urges Mali to step up talks with rebels

PARIS (AP) — France‘s president called Thursday for stepped-up talks between Mali’s government and any leaders from its breakaway north “who reject terrorism,” even as African nations geared up for a possible military operation against Islamic extremists there.

President Francois Hollande‘s comments suggested a growing openness to dialogue with the extremists, but he remained committed to supporting the military planning effort.

Northern Mali fell to Islamic extremists in April, after coup leaders toppled the government in Bamako, Mali‘s capital. Fearing that northern Mali could become the latest hotbed of terrorism, France has been a driving force in international efforts to bolster Mali’s army to drive the Islamists from power.

Hollande spoke with interim Mali President Dioncounda Traore by phone on Thursday, partly to detail European efforts to help strengthen Mali’s army.

In recent days, representatives from the most moderate of three al-Qaida-linked groups that control northern Mali have been meeting with Burkina Faso‘s president, appointed as a mediator.

“France reiterates its wish that political dialogue will intensify between Malian authorities and representatives of northern populations who reject terrorism,” Hollande’s office said in a statement. “The acceleration of this dialogue must accompany the progress in African military-planning efforts.”

Earlier this week, the African Union approved a plan that calls for 3,300 African troops to be deployed in order to win back Mali’s north. European countries including France and Germany have expressed a willingness to provide military trainers and logistics support, but have stopped short of committing combat troops.

France, like many European countries, fears that the arid, northern Sahel region of Mali could become a breeding ground for terrorism, where al-Qaida and its allies could plot hostage-takings and attacks in Europe or beyond.

France has millions of people whose families hail from former French colonies in north and west Africa. Authorities have long been concerned that French-born militants could travel abroad for terrorism training and return home later to possibly carry out attacks.

French authorities are already investigating two French citizens who were arrested in Mali and neighboring Niger and are suspected of seeking to join up with the al-Qaida-linked extremists, a judicial official told The Associated Press.

Ibrahim Ouattara, a 24-year-old native of the northern Paris suburb of Aubervilliers who has dual French and Malian nationality, was arrested inside Mali this month and remains in custody there, the official said.

Separately, a 27-year-old Frenchman was arrested in August in Niger and has since been handed over to authorities in France, the official said, speaking on condition of anonymity because she was not authorized to discuss terrorism cases publicly.

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NASCAR’s Keselowski can’t tweet in car anymore

CHARLOTTE, N.C. (AP) — Brad Keselowski became a social media darling after hopping on Twitter during a lengthy delay in the Daytona 500.

Keselowski was the center of attention, and NASCAR seemed trendy and hip — a description its executives surely adored.

Turns out, tweeting from the car isn’t cool with NASCAR.

Keselowski was fined $ 25,000 on Monday for tweeting during the red flag at Phoenix International Raceway. The punishment was confusing to fans who vented on Twitter, of course, wondering why Keselowski was punished for Sunday’s tweets when he was celebrated by NASCAR for doing the exact same thing in February’s season-opening race.

Some alleged the Sprint Cup Series points leader was actually being disciplined for his profanity-laced outburst after Sunday’s crash- and fight-marred race.

NASCAR spokesman Kerry Tharp on Tuesday dismissed the conspiracy theories, and said drivers had been told after the Daytona 500 that electronic devices — including cellphones — could not be carried inside the race cars going forward.

“Brad’s tweeting at the Daytona 500 was really our first introduction to the magnitude of the social media phenomenon at the race track, especially how we saw it unfold that evening,” Tharp said. “We encourage our drivers to participate in social media. We feel we have the most liberal social media policy in all of sports, and the access we provide is the best in all of sports.

“But we also have rules that pertain to competition that need to be enforced and abided by. Once the 500 took place, and in the days and weeks following the 500, NASCAR communicated to the drivers and teams that while social media was encouraged and we promoted it, the language in the rule book was clear and that drivers couldn’t carry onboard their cars electronic devices, like a phone.”

Keselowski, who takes a 20-point lead over Jimmie Johnson into Sunday’s season finale in his quest to win his first Sprint Cup Series title, has not commented on his penalty.

But with the championship on the line, his crew chief indicated Tuesday he’ll be doing his best to keep the phone out of the No. 2 Dodge this weekend.

“Never even crossed my mind, to be honest with you,” Paul Wolfe said. “We get so involved in worrying about how to make the race car go around the track that, obviously, Brad’s cellphone is not on my mind a whole lot. I’ll definitely remind him this weekend.”

The Daytona 500 was stopped for nearly two hours when Juan Pablo Montoya crashed into a jet dryer that was cleaning the track during a caution period. The crash caused a fuel explosion, and Keselowski used his phone to tweet pictures, answer questions and give updates on the cleanup during the delay.

The race, which had been rained out for the first time in 54 runnings, was being aired on Monday night in prime time for the first time in history and Keselowski’s tweeting drew worldwide headlines.

Afterward, NASCAR specifically said Keselowski did not violate a rule barring onboard electronic devices and would not be penalized.

“Nothing we’ve seen from Brad violates any current rules pertaining to the use of social media during races,” NASCAR said the day after the race. “We encourage our drivers to use social media to express themselves as long as they do so without risking their safety or that of others.”

NASCAR did not issue a technical bulletin to clarify phones could no longer be inside cars, and the clarification to drivers was apparently done quietly. In fact, Keselowski tweeted from Victory Lane at Bristol in March, and from inside his car parked on pit road during a rain delay at Richmond in September. It’s possible someone could have handed him his phone both times.

A year ago, the outspoken Penske Racing driver was fined $ 25,000 headed into the finale for criticizing electronic fuel injection. At the time, NASCAR had been privately punishing drivers for making disparaging remarks about the series, but word of Keselowski’s fine leaked and forced NASCAR to change its policy during the offseason.

Still, many fans were convinced this week’s fine against Keselowski was actually for his post-race comments about the aggressive racing at Phoenix.

He’d been criticized by several drivers for racing Johnson hard over a pair of late restarts at Texas a week earlier, and felt his aggressive driving paled in comparison to Jeff Gordon intentionally wrecking Clint Bowyer with two laps to go on Sunday. Gordon’s retaliation also collected Joey Logano and Aric Almirola, and forced Keselowski to weave his way around the accident.

“It just drives me absolutely crazy that I get lambasted for racing somebody hard without there even being a wreck and then you see stuff like this … from the same people that criticized me,” he said. “It’s OK to just take somebody out. But you race somebody hard, put a fender on somebody and try to go for the win, and you’re an absolute villain. We can just go out and retaliate against each other and come back in and smile about it, and it’s fine. That’s not what this sport needs. It needs hard racing, it needs people that go for broke, try to win races and put it all out there on the line. Not a bunch of people that have anger issues.”

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Judge tosses anti-paparazzi counts in Bieber case

LOS ANGELES (AP) — A law aimed at combating reckless driving by paparazzi is overly broad and should not be used against the first photographer charged under its provisions, a judge ruled Wednesday.

Superior Court Judge Thomas Rubinson dismissed counts filed under the law against Paul Raef, who was charged in July with being involved in a high-speed pursuit of Justin Bieber.

The judge cited numerous problems with the 2010 statute, saying it was aimed at newsgathering activities protected by the First Amendment, and lawmakers should have simply increased the penalties for reckless driving rather than targeting celebrity photographers.

Attorneys for Raef argued the law was unconstitutional and wasn’t meant to protect the public.

“It’s about protecting celebrities,” attorney Brad Kasierman said. “This discrimination sets a dangerous precedent.”

Prosecutors argued that the law, which seeks to punish those who drive dangerously in pursuit of photos for commercial gain, could apply to people in other professions, not just the media.

“The focus is not the photo. The focus is on the driving,” Assistant City Attorney Ann Rosenthal argued.

While the media is granted freedom under the First Amendment, its latitude to gather news is not unlimited, Rosenthal argued.

“This activity has been found to be particularly dangerous,” she said of chases involving paparazzi.

Raef still faces traditional reckless driving counts and has not yet entered a plea,

Prosecutors claim he chased Bieber at more than 80 mph and forced other motorists to avoid collisions while trying to get shots of the teen heartthrob on a Los Angeles freeway.

The chase prompted several 911 calls from scared motorists and led to Bieber being pulled over.

Rubinson cited hypothetical examples in which wedding photographers or even those rushing to do a portrait shoot with a celebrity could face additional penalties if charged under the new statute.

Rosenthal also argued that the judge should look at factors specific to Raef’s case, not hypothetical scenarios.

Kaiserman said the ruling only applies to Raef’s case but could lead to the law being struck down if prosecutors appeal.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP

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Scientists identify new risk gene for Alzheimer’s

CHICAGO (Reuters) – Two international teams of scientists have identified a rare mutation in a gene linked with inflammation that significantly increases the risk for the most common form of Alzheimer’s disease, the first such discovery in at least a decade.

The findings, published on Wednesday in the New England Journal of Medicine, offer new insights into the underpinnings of Alzheimer’s, a deadly, brain-wasting disease that robs people of their memories, their independence and their lives.

In separate studies, teams led by privately held deCode Genetics and John Hardy of University College London found that people with a mutation in a gene called TREM2 were four times as likely to have Alzheimer’s as people who did not have the gene.

“It quadruples the risk of Alzheimer’s,” said Dr. Kari Stefansson of Reykjavik-based deCode in a telephone interview.

The level of risk compares with ApoE4, the best-known genetic cause of late-onset Alzheimer’s, the form of the disease that occurs in older adults.

But this new gene variant is 10 times more rare than ApoE4, which is present in about 40 percent of people with late-onset Alzheimer’s.

Rare or not, scientists say the discovery represents a big breakthrough for Alzheimer’s research.

“This is one of the most common, most devastating illnesses in humans and we still don’t have a very good understanding of what causes the disease,” said Dr. Allan Levey, director of the Emory Alzheimer’s Disease Center of Excellence in Atlanta, which helped confirm the deCode findings.

“In my mind, this is very important. It gives us another important clue as to one of the biological factors that contribute to causing the disease,” he said.

Despite numerous costly attempts, drug companies have been stymied in their efforts to develop drugs that can alter the steady course of Alzheimer’s, which affects more than 5 million Americans and costs the United States more than $ 170 billion annually to treat.

Current research efforts have focused on removing sticky clumps of a protein called beta amyloid that accumulate in the brains of people with Alzheimer’s disease. But several drugs that have been developed to remove these proteins have failed to produce a significant improvement in patients with mild to moderate forms of dementia.

With the new finding, researchers say the focus will turn on the role of inflammation in Alzheimer’s disease.

INFLAMMATORY RESPONSE

TREM2 is a gene that affects a protein expressed on the surface of cells in various tissues that “clean up garbage,” Stefansson said. These cells, called microglia, are often associated with inflammatory response.

A genetic mutation that alters the function of these housekeeping cells could affect how well the brain deals with an excess of toxic proteins from beta amyloid, Stefansson and others said.

And that suggests that even though TREM2 is rare, the way it works in the brain may be important for brain health.

“It is certainly plausible that TREM2 is involved in all of Alzheimer’s disease,” said Andrew Singleton of the National Institute on Aging, who worked on the paper with Hardy and colleagues at University College London.

“I think it may be very generalizable,” Singleton said.

For their study, Hardy and colleagues used a number of gene sequencing techniques to study 988 people with Alzheimer’s disease and 1,004 healthy volunteers.

The team also tested brain tissues from deceased Alzheimer’s patients, and they studied the expression of the TREM2 gene in genetically engineered mice.

For the deCODE study, researchers sequenced the genomes of 2,261 Icelanders and identified variations likely to affect protein function. Then, they looked specifically for these variants in people with Alzheimer’s and those with healthy brains, and found those with the TREM2 variant had a significantly higher risk.

To make sure the gene was not specific to Iceland, they replicated their findings in populations at Emory University in the United States, as well as groups in Norway, the Netherlands and Germany.

“We’ve essentially found exactly the same thing,” said Singleton of the NIA, which is part of the National Institutes of Health. “In a way which you don’t often see in science, the two studies point in the same direction.

In July, a team at deCODE discovered a rare mutation in a gene called APP that protects against Alzheimer’s.

“It is a complex disease,” Stefansson said. “I’m not surprised to see there are many ways to bring about this deterioration in cognitive function.”

Levey said while the TREM2 mutation is rare, it is likely changing the function of brain cells.

“It helps identify the microglial cells as an important possible (drug) target,” he said.

Dr. Ralph Nixon, director of the New York University Center of Excellence on Brain Aging and a scientific adviser to the Alzheimer’s Association, said the findings suggest there are likely many more genes that increase the risk of Alzheimer’s disease.

“It’s a good illustration that we need to intensify this type of research and identify what these genes are doing so we can finally translate it into therapy,” he said.

(Editing by Cynthia Osterman)

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Bank predicts protracted recovery

14 November 2012 Last updated at 12:35 ET

Bank of England cuts UK growth forecast for 2013

The Bank of England has cut its growth forecast for next year to about 1% from nearer 2%, and said recovery will be “slow and protracted”.

It now thinks that the economy will not get back to pre-crisis levels until 2015, two years later than it previously predicted.

The Bank also believes inflation will remain higher for longer.

Governor Sir Mervyn King also welcomed the latest jobs figures which showed a continued fall in unemployment.

He was presenting the Bank’s quarterly Inflation Report, which forecast that inflation would not now fall towards the government’s 2% target until mid-2013, rather than in the first half of next year as previously thought.

Continue reading the main story

“Start Quote

This is going to be a long and challenging recovery from a very substantial crisis”

End Quote David Gauke Treasury Minister

The report said the UK could be stuck in a “low-growth” environment, with economic problems in the eurozone and the rest of world continuing to have an impact domestically.

As the BBC’s economics editor Stephanie Flanders put it: “The Bank hasn’t just lowered its growth forecasts for the next year or so – it has more or less given up hope of being pleasantly surprised.”

Sir Mervyn warned that growth from quarter to quarter would continue to fluctuate. In the April-June quarter growth was depressed by one-off factors such as the unseasonably bad weather and had given a misleadingly weak picture of the economy.

Similarly, growth in the July-September period was boosted by one-off factors including ticket revenue from the Olympics and Paralympics and gave “an overly optimistic impression of the underlying trend,” he said, adding that the data was not necessarily “a reliable guide to the future”.

He said: “Continuing the recent zig-zag pattern, output growth is likely to fall back sharply in Q4 [between October and December] as the boost from the Olympics in the summer is reversed. Indeed, output may shrink a little this quarter,” he said.

The Bank has previously predicted that inflation might fall towards the government’s 2% target in the first half of next year.

But it now expects inflation to stay higher for longer. “We face the rather unappealing combination of a subdued recovery, with inflation remaining above target for a while,” Sir Mervyn said.

“The road to recovery will be long and winding, but there are good reasons to suggest we are travelling in the right direction,” he said.

‘Long process’

Treasury minister David Gauke said he recognised that these were tough times, but insisted that the economy was “moving in the right direction”.

Continue reading the main story

“Start Quote

What is new is that the Bank now thinks that the UK economy will not get back to where it was at the start of 2008 until well into 2015”

End Quote

Asked on BBC Radio 4′s The World At One if he agreed with Sir Mervyn’s warning about a potential sharp fall in output, Mr Gauke said: “The independent Office for Budget Responsibility forecasts growth in the economy in the autumn statement in three weeks’ time. I’m not going to pre-judge that.

“Clearly, there are international pressures on our economy that mean that this is going to be a long and challenging recovery from a very substantial crisis. That is what we are going through at the moment. I think the British people understand that this is going to be a long process,” he said.

However, shadow chancellor Ed Balls said: “This sobering report shows why David Cameron and George Osborne’s deeply complacent approach to the economy is so misplaced.

“Their failing policies have seen two years of almost no growth and the Bank of England is now forecasting lower growth and higher inflation than just a few months ago.

“Britain needs a plan to create the jobs and growth we need to get deficits down, including using funds from the 4G auction to build 100,000 affordable homes and create hundreds of thousands of jobs,” Mr Balls said.

The Bank’s report came on the day that the Office for National Statistics said that the UK unemployment rate fell to 7.8% in the July-September quarter, down from 8% in the previous three months.

The 49,000 fall in number of jobless, to 2.51 million, was almost entirely due to a fall in youth unemployment, the ONS said. It means that the jobless total is now 110,000 lower than for the July-September quarter last year.

Continue reading the main story

However, the claimant count went up in September, leading some economists to suggest that the recent resilience of the jobs market was beginning to weaken. And the number of people unemployed for longer than a year also rose.

Sir Mervyn told the news conference: “I don’t think one would say that the data released this morning were weak.

“This is still a pretty strong labour market and, of course, it is not easy to reconcile that with the picture of underlying growth being still so weak,” he said.

Sir Mervyn also told a press conference that he had not “lost faith” in quantitative easing as a way to stimulate economic growth.

The Bank has kept the amount it injects into the economy by buying up government bonds at £375bn since July this year.

Some have questioned its effectiveness, but the Bank said it had not ruled out further asset purchases to try to stimulate growth.

He said that with the global economy still struggling, “there are limits to the ability of domestic policy to stimulate private sector demand as the economy adjusts to a new equilibrium”.

“But the [Monetary Policy] Committee has not lost faith in asset purchases as a policy instrument, nor has it concluded that there will be no more purchases.”

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Egypt recalls envoy to Israel after Gaza strike

CAIRO (AP) — Egypt has recalled its ambassador to Israel after an Israeli airstrike killed the military commander of Gaza‘s ruling Hamas.

In a statement read on state TV late Wednesday, spokesman Yasser Ali said that President Mohammed Morsi recalled the ambassador and asked the Arab League‘s Secretary General to convene an emergency ministerial meeting in the wake of the Gaza violence.

Morsi also called for an immediate cease fire between Israel and Hamas, an offshoot of Morsi’s Muslim Brotherhood. Israel says it struck in response to rocket attacks from Gaza.

Hours earlier, Morsi’s Muslim Brotherhood group denounced the Israeli airstrike as a “crime that requires a quick Arab and international response to stem these massacres.”

Relations between Israel and Egypt have deteriorated since longtime President Hosni Mubarak was ousted last year.

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Zynga CFO leaves for Facebook

SAN FRANCISCO (Reuters) – Zynga Inc‘s chief financial officer, David Wehner, will leave the company for an executive position at Facebook Inc, the gaming company announced Tuesday as it reshuffled its upper ranks.

David Ko, chief mobile officer, has been elevated to become Zynga‘s new chief operations officer.

Mark Vranesh, Zynga’s top accounting executive, will replace Wehner as CFO, Zynga said.

(Reporting By Gerry Shih; Editing by Steve Orlofsky)

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Charlie Chaplin’s bowler and cane to hit auction block

LOS ANGELES (Reuters) – One of Charlie Chaplin’s iconic bowler hats and canes, the staple of Hollywood silent-era comedy, will go under the hammer in Los Angeles this weekend, auction house Bonhams said on Tuesday.

Chaplin’s hat and cane – synonymous with his trademark “Little Tramp” character in films such as “City Lights” and “Modern Times” – are expected to fetch between $ 40,000 and $ 60,000 in the November 18 auction.

It is unknown how many of Chaplin’s bowlers and canes still exist, said Lucy Carr, a memorabilia specialist at Bonhams. The ones up for auction come from a private collection but have a direct link to Chaplin, Carr said.

The waddling and bumbling Little Tramp character propelled Chaplin to global fame. The character, which Hollywood legend says was created by accident on a rainy day at Keystone Studio, first appeared in 1914′s “Kid Auto Races at Venice” and lastly in 1936′s “Modern Times.”

Chaplin’s hat and cane are the highlights of an auction of popular culture artifacts including a saxophone that belonged to jazz pioneer Charlie Parker ($ 22,000-$ 26,000) and a handwritten letter from John Lennon in which The Beatle sketched himself and wife Yoko Ono nude ($ 18,000-$ 22,000).

Other items hitting the block range from an archive of Marilyn Monroe photographs ($ 15,000-$ 20,000), an early Charles Schulz “Peanuts” comic strip ($ 10,000-$ 15,000) and a wicker chair from Rick’s Cafe in “Casablanca” ($ 5,000-$ 7,000).

(Reporting By Eric Kelsey, editing by Jill Serjeant)

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Many hospital patients get too much acetaminophen

NEW YORK (Reuters Health) – In a new study from two Boston hospitals, one in every 15 patients treated with acetaminophen got more than the maximum daily recommended dose at least once.

Acetaminophen – sold as Tylenol – is a common painkiller on its own, but also an ingredient in stronger narcotics such as Percocet and Vicodin. So without careful monitoring, it’s not always obvious how much a patient has taken.

To protect against liver damage from an acetaminophen overdose, the U.S. Food and Drug Administration sets the maximum daily dose at 4 grams for most people or 3 grams for people 65 and older and those with liver disease.

Dr. Robert Fontana, a liver specialist from the University of Michigan Health System in Ann Arbor, called the new findings “a bit alarming.”

“On the flip side, it doesn’t look like there was any toxicity in these patients,” Fontana, who wasn’t involved in the new research, told Reuters Health.

“I certainly don’t want people thinking, ‘If I go to the hospital I’m going to get acetaminophen toxicity.’”

Researchers led by Dr. Li Zhou from Partners HealthCare System Inc in Wellesley, Massachusetts, reviewed the electronic health records of 23,750 adults treated at two hospitals during the summer of 2010. That included 14,411 people who took any acetaminophen during their stay.

Based on calculations from the electronic records, Zhou’s team determined that 955 of those patients were given over 4 grams of acetaminophen in a 24-hour period, most on more than one occasion.

More than 20 percent of elderly people, and close to that many patients with liver disease, were given over 3 grams in a day.

People in the surgical and intensive care units were especially likely to be over-administered acetaminophen, as were those who took multiple different products containing the drug, according to findings published in the Archives of Internal Medicine.

Nobody developed liver failure due to acetaminophen during the study period. Patients given more than the recommended limit had higher levels of one liver-related enzyme in their blood – but it’s not clear that would have any health consequences.

Fontana said the likelihood of doctors and nurses over-administering acetaminophen will probably drop in the future as the FDA cracks down on high doses of acetaminophen in narcotics.

There’s also a need for more advanced health information technology systems that can track aggregate doses of ingredients that, like acetaminophen, are in multiple medications given to a single patient, according to Zhou.

“This is what we want to see,” she told Reuters Health. “I really think it’s doable.”

As it is, she said, the technology that doctors and nurses use doesn’t make acetaminophen limits obvious. And it’s very difficult for them to calculate by hand exactly how much a patient has received if it’s from different sources.

“It’s so easy to exceed the 4-gram limit,” Zhou said.

SOURCE: http://bit.ly/TwzwS7 Archives of Internal Medicine, online November 12, 2012.

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