Agency checks water after body found in hotel tank

LOS ANGELES (AP) — British tourist Michael Baugh and his wife said water had only dribbled out of the taps at the downtown Cecil Hotel for days.

On Tuesday, after showering, brushing their teeth and drinking some of the tap water, they headed down to the lobby and found out why.

The body of a Canadian woman had been discovered at the bottom of one of four cisterns on the roof of the historic hotel near Skid Row. The tanks provide water for hotel taps and would have been used by guests for washing and drinking.

"The moment we found out, we felt a bit sick to the stomach, quite literally, especially having drank the water, we're not well mentally," Michael Baugh, 27, said.

Los Angeles County Department of Public Health officials issued a do-not-drink order Tuesday while its lab analyzes the water, said Terrance Powell, a director coordinating the department's response. The disclosure contradicts a previous police statement that the water had been deemed safe. Results of the testing were expected by Thursday.

Powell said the water was also used for cooking in the hotel; a coffee shop in the hotel would remain closed and has been instructed to sanitize its food equipment before reopening.

"Our biggest concern is going to be fecal contamination because of the body in the water," Powell said. He said the likelihood of contamination is "minimal" given the large amount of water the body was found in, but the department is being extra cautious.

Powell said the hotel hired a water treatment specialist after the department required it to do so to disinfect its plumbing lines.

A call to the hotel was not returned.

The remains of Elisa Lam, 21, were found by a maintenance worker at the 600-room hotel that charges $65 a night after guests complained about the low water pressure.

Police detectives were working to determine if her death was the result of foul play or an accident.

LAPD Sgt. Rudy Lopez called it suspicious and said a coroner's investigation will determine Lam's cause of death.

Before she died, hotel surveillance footage showed Lam inside an elevator pushing buttons and sticking her head out the doors, looking in both directions. She was later found in the water tank.

Lam, of Vancouver, British Columbia, traveled alone to Los Angeles on Jan. 26 and was last seen five days later by workers at the hotel.

Lopez said the hotel has four cisterns on its roof that are each about 10 feet tall, 4.5 feet wide and hold at least 1,000 gallons of water pumped up from city pipes.

Lam's body was found Tuesday morning at the bottom of one cistern that was about three-quarters full of water, Lopez said.

The opening at the top of the cistern is too small to accommodate firefighters and equipment, so they had to cut a hole in the storage tank to recover Lam's body.

The cisterns are on a platform at least 10 feet above the roof.

To get to the tanks, someone would have to go to the top floor then take a staircase with a locked door and emergency alarm preventing roof access.

Another ladder would have to be taken to the platform and a person would have to climb the side of the tank.

Lopez said there are no security cameras on the roof.

Lam intended to travel to Santa Cruz, about 350 miles north of Los Angeles. Officials said she tended to use public transportation and had been in touch with her family daily until she disappeared.

The Cecil Hotel was built in the 1920s and refurbished several years ago. The hotel is on Main Street in a part of downtown where efforts at gentrification often conflicts with homelessness and crime. It had once been the occasional home of infamous serial killers such as Richard Ramirez, known as the Night Stalker, and Austrian prison author Jack Unterweger, who was convicted of murdering nine prostitutes in Europe and the U.S., the Los Angeles Times reported.

By noon Wednesday, the Cecil Hotel had relocated 27 rooms used by guests to another hotel, but 11 rooms remained filled, Powell said. Those who chose to remain in the hotel were required to sign a waiver in which they acknowledged being informed of the health risks and were being provided bottled water, Powell said.

Baugh and his wife, who were on their first trip to the U.S., had planned to go to SeaWorld on Wednesday. Instead, they were trying to find a new hotel. Their tour agency placed them in another downtown hotel with a less than sterling reputation, from what they heard.

"We're just going from one dodgy place to another," Baugh said, resigned, "but at least there's water."

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Tami Abdollah can be reached at http://www.twitter.com/latams. Shaya Tayefe Mohajer contributed to this report.

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M&A deals lift Wall Street shares nearer a record high

NEW YORK (Reuters) - U.S. stocks rose on Tuesday as this year's ongoing surge in merger activity suggested investors were still finding value in the market even as indexes closed in on all-time highs.

Office Depot Inc surged 9.4 percent to $5.02 after a person familiar with the matter said the No. 2 U.S. office supply retailer was in advanced talks to merge with smaller rival OfficeMax Inc , which jumped more than 20 percent.

News of the potential move came just days after Berkshire Hathaway and a partner agreed to acquire H.J. Heinz Co for $23 billion, and following a revised $20 billion takeover of Mexican brewer Grupo Modelo by Anheuser-Busch InBev .

Deal activity has helped equities resist a pullback as investors use dips in stocks as buying opportunities. The S&P is up about 7 percent so far in 2013 and has climbed for the past seven weeks in its longest weekly winning streak since January 2011, though most of the weekly gains have been slim.

The Dow industrials closed 0.9 percent away from their record high while S&P 500 was 2.2 percent off its peak.

"Deals are good for the market," said Frank Lesh, a futures analyst and broker at FuturePath Trading LLC in Chicago. "The fact that they're being done is a positive."

More than $158 billion in deals has been announced so far in 2013, more than double the activity in the same period last year and accounting for 57 percent of global deal volumes, according to Thomson Reuters Deals Intelligence.

The Dow Jones industrial average <.dji> gained 53.91 points, or 0.39 percent, to 14,035.67. The Standard & Poor's 500 Index <.spx> gained 11.15 points, or 0.73 percent, to 1,530.94. The Nasdaq Composite Index <.ixic> gained 21.56 points, or 0.68 percent, to 3,213.59.

Other stocks in the office supplies sector also rose. Larger rival Staples Inc shot up 13.1 percent to $14.65 as the best performer on the S&P 500.

"Equity investors have to be encouraged by M&A since, if the number crunchers are offering large premiums, that shows how much value is still in the market," said Mike Gibbs, co-head of the equity advisory group at Raymond James in Memphis, Tennessee.

On the downside, health insurance stocks tumbled, led by a 6.4 percent drop in Humana Inc to $73.01. The company said the government's proposed 2014 payment rates for Medicare Advantage participants were lower than expected and would hurt its profit outlook.

UnitedHealth Group lost 1.2 percent to $56.66. The Morgan Stanley healthcare payor index <.hmo> dropped 1.2 percent.

Wall Street's strong start to the year was fueled by better-than-expected corporate earnings, as well as a compromise in Washington that temporarily averted automatic spending cuts and tax hikes that are predicted to damage the economy.

The compromise on across-the-board spending cuts postponed the matter until March 1, at which point the cuts take effect. Ahead of the debate over the cuts, known as sequestration, further gains for stocks may be difficult to come by.

Some investors say the debate could be the catalyst for a long anticipated sell-off after the market's recent strong run.

Carter Worth, a technical analyst at Oppenheimer, pointed to the "especially complacent action of the past six weeks," noting that, as of Friday, stocks have gone 33 sessions without a dip of more than 1.5 percent.

"We would be selling aggressively into the market's current strength," he said in a research note.

Economic data showed the NAHB/Wells Fargo Housing Market index unexpectedly edged down to 46 in February from 47 in the prior month as builders faced higher material costs.

According to the Thomson Reuters data through Monday morning, of the 391 companies in the S&P 500 that have reported results, 70.1 percent have exceeded analysts' expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters.

Fourth-quarter earnings for S&P 500 companies have risen 5.6 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

Express Scripts rose 2.5 percent to $56.98 after the pharmacy benefits manager posted fourth-quarter earnings.

About two stocks rose for everyone that fell on the New York Stock Exchange and Nasdaq. About 6.48 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, in line with the daily average so far this year.

(Additional reporting by Chuck Mikolajczak Ryan Vlastelica and Rodrigo Campos; Editing by Chizu Nomiyama, Kenneth Barry and Nick Zieminski)

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Pistorius Denies Murdering Girlfriend

PRETORIA, South Africa — Early on Feb. 14, Oscar Pistorius says, he heard a strange noise coming from inside his bathroom, climbed out of bed, grabbed his 9-millimeter pistol, hobbled on his stumps to the door and fired four shots.

“I fail to understand how I could be charged with murder, let alone premeditated,” Mr. Pistorius said in an affidavit read Tuesday to a packed courtroom by his defense lawyer, Barry Roux. “I had no intention to kill my girlfriend.”

Prosecutors painted a far different picture, one of a calculated killer, a world-renowned athlete who had the presence of mind and calm to strap on his prosthetic legs, walk 20 feet to the bathroom door and open fire as his girlfriend, Reeva Steenkamp, cowered inside, behind a locked door.

“The applicant shot and killed an unarmed, innocent women,” Gerrie Nel, the chief prosecutor, said in court on Tuesday. That, Mr. Nel argued, amounted to premeditated murder, a charge that could send Mr. Pistorius to prison for life.

In court, Mr. Pistorius, a Paralympic track star who competed against able-bodied athletes at the London Olympics despite having lost both his lower legs as an infant, wept uncontrollably as Mr. Roux gave the runner’s account of the fateful early morning. At one point, Magistrate Desmond Nair called a recess to allow Mr. Pistorius, who was sobbing loudly, his face contorted, to regain his composure.

“My compassion as a human being does not allow me to just sit here,” Magistrate Nair said.

As the defense and prosecution laid out their competing versions of the shooting, some details were beyond dispute.

Mr. Pistorius and Ms. Steenkamp were alone in the house, having spent the evening there. Around 3 a.m., Mr. Pistorius shot Ms. Steenkamp through the bathroom door, fatally wounding her. He broke down the door and carried her down the stairs, where she died in the foyer of his upscale home in a highly secured compound.

The young woman, a model, was cremated Tuesday on the other side of the country in her hometown, Port Elizabeth. Her family and friends mourned her and called for the authorities to deal harshly with Mr. Pistorius.

“There’s a space missing inside all the people that she knew that can’t be filled again,” her brother, Adam Steenkamp, told reporters after the memorial service.

In court, Mr. Pistorius is seeking bail on the charge of premeditated murder, but he faces an uphill battle. Magistrate Nair ruled Tuesday that the case would be treated as the most serious kind of offense, which means bail will be granted only if the defense can prove extraordinary circumstances requiring it.

The court proceedings, though they concerned only whether Mr. Pistorius would receive bail, offered the first real glimpse into what unfolded at his home on the day of the shooting.

In his affidavit, Mr. Pistorius said that he and Ms. Steenkamp had decided to stay in for the night. He canceled plans with his friends for a night on the town in Johannesburg, while she opted against movies with one of her friends. They had a quiet evening, he said. She did yoga. He watched television. About 10 p.m., they went to sleep.

In the early morning hours, he said, he woke up to move a fan from the balcony and to close the sliding doors in the bedroom.

“I heard a noise in the bathroom and realized that someone was in the bathroom,” he said. “I felt a sense of terror rushing over me.”

He had already said in the affidavit that he feared South Africa’s rampant violent crime, and later added that he was worried because there were no bars on the window to the bathroom. Construction workers had left ladders in his garden, he said.

“I believed someone had entered my house,” he said in the affidavit. “I grabbed my 9-millimeter pistol from underneath my bed. On my way to the bathroom I screamed words to the effect for him/them to get out of my house and for Reeva to phone the police. It was pitch dark in the bedroom, and I thought Reeva was in bed.”

Walking on his stumps, he heard the sound of movement inside the toilet, a small room within the bathroom.

Alan Cowell contributed reporting from London.

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What's Next for Mindy McCready's Two Young Boys?

By Steve Helling

02/19/2013 at 07:00 PM EST

Mindy McCready's apparent suicide on Sunday has left her two young sons in custodial limbo.

The boys – Zander, 6, and Zayne, 10 months – had been in state custody since Feb. 7, when McCready called police to ask for help in making her father and stepmother leave her home. When police arrived, McCready appeared to be intoxicated, according to a Department of Human Services report.

In a subsequent petition, the singer's father, Tim McCready, asked the court to order her to undergo mental health and substance abuse evaluation and treatment, alleging that his daughter, who had recently lost her boyfriend, "hasn't had a bath in a week ... screams about everything ... [is] very verbally abusive to Zander."

After a judge granted the petition, the children were quickly removed and placed into foster care. Although McCready was released from treatment, the boys remained in state custody.

At the time, Zander's father, Billy McKnight, requested custody of his son. "My son needs me." he told PEOPLE on Feb. 8. "I'm married, working and successful. I'm on the right track and proud of it. I've been sober for years. I just want my son."

But McCready's mother and stepfather, Gayle and Michael Inge, also want custody of the children – and authorities seem to agree.

In a proposed order sent to Circuit Judge Lee Harrod, the Department of Human Services proposed that the Inges might be a better fit for the children, claiming that they have "a substantial relationship." The Inges had custody of Zander for much the past few years, during McCready’s rehab and jail stints.

With McCready's death, the judge will have to determine what is in the children's best interest. A custody hearing has been scheduled for April 5.

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Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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

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Yen firmer but near lows, Asian shares capped

TOKYO (Reuters) - The yen remained near recent lows on Tuesday, as attention turned to the appointment of a new Bank of Japan governor.

Regional share markets held to tight ranges as the absence of catalysts and a holiday in the U.S. overnight capped demand.

The yen, which has dropped 20 percent against the dollar since mid-November, fell further at the start of the week after financial leaders from the G20 promised not to devalue their currencies to boost exports and avoided singling out Japan for any direct criticism.

The choice of the next BOJ governor and two deputies has drawn market attention as a gauge to how strongly Prime Minister Shinzo Abe is committed to reflating the economy. The G20's message was that as long as Japan pursues aggressive monetary easing to achieve that goal, a weaker yen as a result of such domestic monetary policy will be tolerated, analysts say.

"But that means that some other economy's monetary conditions have been tightened," said Barclays Capital in a note.

"Japan hasn't even changed its policy stance thus far, and the effect of expectations of a looser setting have led to limited moves in domestic interest rates, but the sell-off of the JPY has been marked and has clearly caused unease in other economies."

Market reaction was muted to the release of the minutes of the BOJ's January 21-22 meeting, when the bank set a 2 percent inflation target and pledged to an open-ended quantitative easing from 2014, but the yen was bought when Finance Minister Taro Aso told reporters Japan has no plans to buy foreign currency bonds as part of monetary easing, a trader said.

The dollar was down 0.2 percent to 93.75 yen, but remained near its highest since May 2010 of 94.465 hit on February 11. The euro also eased 0.3 percent to 125.05 yen, below its peak since April 2010 of 127.71 yen touched on February 6.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> was nearly flat.

The Nikkei stock average <.n225> opened down 0.6 percent, after closing up 2.1 percent on Monday to approach its highest level since September 2008 of 11,498.42 tapped on February 6. <.t/>

Australian shares <.axjo> inched down 0.1 percent on the back of weakness in metals prices, with investors focusing on local corporate earnings for direction after a three-month rally that has taken the market to 4-1/2 year highs.

Seoul shares <.ks11> opened little changed, and were expected to struggle to find momentum on worries about the weak yen.

"The market has been taking a breather recently after staging a recovery earlier this month," said Lee Jae-man, an analyst at Tong Yang Securities in Seoul. "The weaker yen has been priced in to some extent, and the pace of its fall is expected to slow down."

Disappointing earnings pushed European shares lower on Monday for a third straight session of losses while U.S. markets were closed for the President's Day holiday.

The euro was steady around $1.3348. The currency eased slightly on Monday after European Central Bank President Mario Draghi said in a speech at the European Parliament that "the exchange rate is not a policy target but is important for growth and price stability" and that its rise is "a risk."

The risk of an inconclusive outcome in Italy's election this weekend added to investor concerns.

Sterling hovered near a seven-month low against the dollar touched on Monday after a key policymaker made comments about the need for further weakness, while recent poor data has spurred worries of another British recession.

U.S. crude fell 0.4 percent to $95.47 a barrel.

(Additional reporting by Hyunjoo Jin and Miyoung Kim in Seoul; Editing by Shri Navaratnam)

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For His Second Act, Japanese Premier Plays It Safe, With Early Results

Toru Hanai/Reuters

Prime Minister Shinzo Abe, whose policies have sent the Tokyo stock market up, will visit Washington this week.

TOKYO — Since taking office less than two months ago, Japan’s outspokenly hawkish new prime minister, Shinzo Abe, has been in what some political analysts are calling “safe driving mode.” He has carefully avoided saying or doing anything to provoke other Asian nations, while focusing instead on wooing voters with steps to revive the moribund domestic economy.

So far, his approach seems to be working. His plans for public-works projects, stimulus measures called “Abenomics,” have sent the Tokyo stock market surging along with Mr. Abe’s own approval rating, which is now at 71 percent, according to the latest poll by Yomiuri Shimbum. On Friday, he will seek to build on his strong start when he meets President Obama at a Washington summit meeting aimed at improving relations with the United States, which regards Japan as its most important ally in Asia.

Mr. Abe, 58, has said he wants to be what Japan has not seen in almost a decade: a steady-handed leader who lasts long enough in office to actually get things done. Analysts say his success hinges on whether he can lead his Liberal Democratic Party to victory in Upper House elections in July, and end the split Parliament that undermined many of his predecessors.

What is less clear is what he will do if he wins that election. One trait that makes Mr. Abe a bit of an enigma, some analysts say, is that he seems to have two sides: the realist and the right-wing ideologue. In analysts’ view, if he does jettison some of his current caution, for instance by trying to revise Japan’s antiwar Constitution to allow a full-fledged military instead of its current Self-Defense Force, he risks provoking a standoff with China over disputed islands, and possibly isolating Japan in a region still sensitive to its early-20th-century militarism.

“In his first six weeks, he has done everything he can to show he is a moderate,” said Andrew L. Oros, director of international studies at Washington College in Chestertown, Md. “But after July, he might feel he has a freer rein to do things that he thinks are justified.”

Part of the problem, Mr. Oros and others say, is that Mr. Abe faces conflicting political pressures. His base in the governing party’s most conservative wing expects bold steps to end what it sees as Japan’s overly prolonged displays of contrition for World War II. But he must also convince the broader public that he is a coolheaded, competent steward of a declining nation that also depends on China for its economic future.

There is also the ghost of his past failure. The last time he was prime minister, six years ago, he stepped down amid criticism that he had been “clueless” for having pursued a nationalistic agenda of revising the Constitution and history textbooks, and for not doing more to reduce unemployment and spur the economy.

This time, Mr. Abe is acting with the determined carefulness of a man given a second chance. He has focused on extricating Japan from its recession with steps that have quickly buoyed the country’s economy, the world’s third-largest. Since being named prime minister after his party’s election victory in December, Mr. Abe has promised $215 billion in public works spending to create jobs and promote growth.

He has also publicly pressured the central bank, the Bank of Japan, to move more aggressively to end years of corrosive price declines known as deflation — threatening, for example, to amend the law on the bank’s independence if it does not reach its target of 2 percent inflation. The bank’s governor, Masaaki Shirakawa, announced this month that he would step aside to allow Mr. Abe to appoint a new chief who will work more closely with the government by pumping more money into the economy to prompt banks to lend more and companies to spend more.

“Mr. Abe has clearly learned the lessons of his past failure,” said Norihiko Narita, a political scientist at Surugadai University, near Tokyo. “And the biggest lesson is that voters care more about the economy.”

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Burger King takes down Twitter account after hack attack

NEW YORK (Reuters) – Hackers breached the Twitter account of fast-food chain Burger King, posting the online equivalent of graffiti and sometimes making little sense.

Burger King Worldwide Inc suspended its Twitter account about an hour after it learned of the attack at 12:24 p.m. EST on Monday, company spokesman Bryson Thornton said in an email.

“It has come to our attention that the Twitter account of the BURGER KING® brand has been hacked,” the company said in a statement. “We have worked directly with administrators to suspend the account until we are able to re-establish our legitimate site and authentic postings.”

Several tweets carried the logo of Burger King’s larger rival McDonald’s, but spelled the latter company’s name incorrectly. Others sought to tarnish Burger King, the third-largest U.S. hamburger chain, and its employees.

“Just got sold to McDonalds,” one tweet said, adding “FREDOM IS FAILURE”.

(Reporting by Ilaina Jonas; Editing by Dale Hudson)

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Mindy McCready: Under Police Scrutiny at Time of Suicide?

By Steve Helling and Mike Fleeman

02/18/2013 at 06:00 PM EST

Mindy McCready and David Wilson

Courtesy Mindy McCready

When Mindy McCready talked to police in recent weeks, her account of how her boyfriend came to be found with a fatal gunshot wound to the head concerned police, a law enforcement source tells PEOPLE.

"At first, she said she hadn't heard the gunshot because the TV was too loud. Then she said she had heard the gunshot," the source says. "So obviously there were a lot of questions, and the Sheriff was asking for clarification."

But before investigators could re-interview her, the long-troubled country singer also would die under eerily similar circumstances, her body discovered at the same Heber Springs, Ark., house just feet away from where David Wilson died.

McCready's death was blamed on what "appears to be a single self-inflicted gunshot wound," the Cleburne County Sheriff's Office said in a statement.

This differed from how the sheriff characterized Wilson's case. His cause and manner of death still have not been established by the coroner. It was McCready's publicist, and not a law enforcement official, who announced that Wilson had died of a self-inflicted gunshot wound.

After Wilson's death, McCready, 37, spoke to investigators three times, but they didn't feel as if they were through with her.

"At no point did [police] tell her she was a suspect, and she wasn't officially one," says the source. "But she knew that some of her answers didn't stand up to questioning. She was very cooperative, but she just wasn't making a lot of sense."

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Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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