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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Report: At least three dead after Japan tunnel collapse

TOKYO (Reuters) - A tunnel on a major highway in central Japan collapsed on Sunday, killing at least three people and starting a blaze, Japanese media reported.

Attempts to rescue those still trapped inside the smashed tunnel, which began spewing smoke after concrete ceiling panels fell onto the road, have been interrupted for fear they might trigger another collapse.

Three bodies have been found so far, television networks Fuji and Asahi said.

The fire service earlier said at least seven people were unaccounted for in the 4.7 km (2.8-mile) tunnel in Yamanashi prefecture, about 80 km (50 miles) west of Tokyo on the Chou Expressway, a main road connecting the capital to western Japan.

"Dense smoke was coming out as if it covers the entire mountain," witness Kiyoko Toyomura told Japanese news agency Kyodo.

The fire service said the blaze was extinguished about 11 a.m. - some three hours after the accident occurred.

The operator of the highway, Central Nippon Expressway, said a 50-60 meters (165 feet) long section of ceiling panels fell to the road, and it was looking into the cause of the accident.

Motorists described narrow escapes from falling debris, and a long walk through the darkness after abandoning their cars.

"When I was driving in the tunnel, concrete pieces fell down suddenly from the ceiling," a man in his 30s told public broadcaster NHK. "I saw a crushed car catching fire. I was frightened, left my car and walked for about an hour to get out of the tunnel."

In 1996 a tunnel in Hokkaido, northern Japan, collapsed and falling rocks crushed cars and a bus, killing 20 people.

NHK reporter Yoshio Goto, caught in Sunday's accident, hit the accelerator and managed to drive out.

"But it was a bit too late and pieces of ceiling fell on my car. I kept pressing the pedal and managed to get out," he said. "Then when I looked around, I saw half of the car ceiling was crushed."

(Reporting by Hideyuki Sano; Editing by Daniel Magnowski)

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Officials say bomb kills 3 in southern Afghanistan

KABUL, Afghanistan (AP) — Provincial officials say a suicide car bomber killed three civilians and wounded another six in Afghanistan's southern Uruzgan province.

Abdullah Himmat, a spokesman for the provincial governor, said Saturday's blast occurred near the police headquarters of Uruzgan's Dehra Wood district.

Fareed Ayal, a spokesman for the provincial police, says the car apparently detonated prematurely before it reached the gate of the headquarters.

Insurgents and Taliban fighters often use suicide bombers to target government buildings, convoys and foreign troops.

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JLo tones down concert in Indonesia

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

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

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

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

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

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

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

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

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

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

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

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

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South Africa makes progress in HIV/AIDS fight

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

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

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

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

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

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

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

Themba Lethu clinic, with funding from the government, USAID and PEPFAR, is now among some 2,500 ARV facilities in the country that treat approximately 1.9 million people.

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

But it hasn't always been that way.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How about a little government economic stimulus?

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

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

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

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

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

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

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

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

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

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

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

SOCIAL SECURITY PAYROLL TAX CUT

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

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

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

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

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

BUSINESS TAX INCENTIVE

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

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

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

INFRASTRUCTURE BANK

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

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

UNEMPLOYMENT BENEFITS

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

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

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

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

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Afghanistan presses Pakistan to free Taliban

ISLAMABAD (AP) — The Afghan foreign minister pressed Pakistan on Friday to free more Taliban detainees in Islamabad's custody in a bid to help coax the militant group into peace negotiations to end the 11-year-old war in Afghanistan, officials said.

Afghanistan's top diplomat, Zalmay Rasoul, pushed his case in talks with his Pakistani counterpart, Hina Rabbani Khar, during a one-day visit to Islamabad. Their discussions followed Pakistan's decision earlier this month to release nine Taliban prisoners in a move that Kabul welcomed as a positive first step and an indication that Islamabad supports the stalled Afghan peace process.

The cooperation of Pakistan, which has longstanding ties to the Taliban, is seen as key to jumpstarting an Afghan peace process that has made little headway since it began several years ago, hobbled by distrust among the major players, including the United States. The Afghan and U.S. governments accuse Islamabad of backing insurgents — an allegation Pakistan denies — and say many militant leaders are hiding in the country.

With Afghan presidential elections and the withdrawal of most foreign combat troops looming in 2014, Afghanistan and its international allies are trying to push a peace process with the Taliban to bring an end to the conflict.

Afghanistan needs Pakistan's help in reaching out to top Taliban leaders, but still insists that peace talks be led by Afghans, saying it will fight those who try to interfere.

Rasoul, the Afghan foreign minister, was expected to press Pakistan to free more Taliban prisoners during his one-day visit to Islamabad on Friday, including the militant group's former deputy leader, Mullah Abdul Ghani Baradar, said an Afghan official who spoke on condition of anonymity ahead of the talks.

It's unclear whether Pakistan made any concrete commitments to free additional prisoners, including Baradar, who was captured in Pakistan in 2010 because he reportedly was having secret talks with the Afghans.

The Pakistani foreign minister said during a joint news conference that the release of prisoners was "discussed thoroughly, and I'm quite sure that we would all agree that we are making forward movement."

Khar said that the two countries had "operationalized" a joint commission announced last year to address the prisoner release issue. They also agreed to hold a conference of Muslim scholars in January to speak out against terrorism.

Pakistan also shared with Afghanistan a draft of a strategic partnership agreement the two countries hope to negotiate over the next year, Khar said. Afghanistan signed a similar agreement with Pakistan's archenemy India last year, causing consternation in Islamabad.

The Afghan foreign minister welcomed Pakistan's efforts, saying "we want all Afghan Taliban to return in their country, join the constitutional political process there and play their part in furthering the construction and development of our nation."

The Taliban prisoners released earlier by Pakistan, including some senior leaders, are believed to still be in the country, said the Afghan official who spoke ahead of Rasoul's visit. Afghanistan hopes the freed militants will play a constructive role in the peace process, the official said, while acknowledging that it is too soon to know what role, if any, they will hold.

While it's unclear whether the Taliban are interested in negotiating peace, the official maintained that there are indeed key Taliban figures who support a political process to end the violence, but that some of them are afraid to establish direct contact with the Afghan government because some of those who did in the past were killed or detained.

Afghanistan wants Pakistan to encourage Taliban leaders to join the Afghan-led peace process and allow Taliban negotiators to travel to third countries for talks without detaining them or putting pressure on their families, the official said.

Informal contacts have been established with Taliban officials in recent years, but so far no formal negotiations have begun.

Waheed Muzhda, a political analyst in Kabul and an expert on Taliban issues, told The Associated Press in a recent interview that about two months ago he met informally in Qatar with several Taliban figures, including Tayyab Agha, a personal emissary of Taliban leader Mullah Omar, and Sher Mohammad Abbas Stanekzai, a former deputy at two ministries during the Taliban regime.

He said the Taliban are interested in talks, but with the U.S. and not with the Afghan government. If any negotiations begin, they would be between the U.S. and the Taliban, he said.

"If there was a good result from that, then the Afghan government could be involved," he said.

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Riechmann reported from Kabul, Afghanistan. Associated Press Writer Rahim Faiez contributed to this report from Kabul.

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Adkins explains Confederate flag earpiece

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

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

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

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

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

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Online:

http://www.traceadkins.com

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Kenya village of AIDS orphans hangs hopes on trees

NYUMBANI, Kenya (AP) — There are no middle-aged adults in the Kenyan village of Nyumbani. They all died years ago. Only the young and old live here.

The 938 children here all saw their parents die. The 97 grandparents saw their middle-aged children die. But put together, the bookend generations take care of one another.

UNAIDS says that as of 2011 an estimated 23.5 million people living with HIV resided in sub-Saharan Africa, representing 69 percent of the global HIV burden. Eastern and southern Africa are the hardest-hit regions.

Saturday is World AIDS Day.

Nyumbani is currently planting tens of thousands of trees for the fourth straight year in the hopes that the village will soon harvest the hardwood and become self-sustaining.

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Republican congressman makes waves in 'fiscal cliff' negotiations

Rep. Tom Cole (R-Okla.) made headlines this week when suggested that his Republican colleagues should join with President Obama on a quick "fiscal cliff" fix by voting to extend the Bush tax-rates for everyone but the highest income earners, and leaving the rest of the debate for later.

Cole's plan, which was first reported by Politico, was rejected by House Speaker John Boehner, who told reporters, "I disagreed with him…This is not the right approach." But his comments have gotten a lot of attention, and both Republicans and (perhaps less surprisingly) Democrats have come forward to say they agree with Cole.

"I have to say that if you're going to sign me up with a camp, I like what Tom Cole has to say," California Republican Rep. Mary Bono Mack said on CNN on Thursday.

"I'm hopeful that he can persuade other Republicans to do the right thing for middle class families and small business across the country," Democratic Senator Patty Murray told reporters on Wednesday.

One question likely being asked by Americans watching the 'fiscal cliff' negotiations going on in Congress, though is: Who is Tom Cole?

Cole, 63, represents Oklahoma's fourth congressional district in Congress. He was first elected in 2002 and he's about to start his sixth term. Cole is not at the tip-top of his party's ranks but he is in the leadership. He serves as as Deputy Whip. Cole is currently the only registered Native American in Congress.

The Oklahoma congressman may not have served in public office for as long as many of his Republican colleagues, but he's been a key figure in national Republican politics for some time. Before he was elected to Congress, Cole served as the executive director of the National Republican Congressional Committee, and as the chief of staff at the Republican National Committee.

As a Congressman, Cole has signed the so-called Norquist pledge- officially titled the Taxpayer Protection Pledge, which calls on members of Congress to oppose any and all tax increases. Cole told Politico that he believes a vote to extend the Bush tax cuts to 98 percent of taxpayers, leaving out the top earners, would not violate the pledge.

"I think we ought to take the 98 percent deal right now," he said. "It doesn't mean I agree with raising the top 2."

Cole's depth of experience, both as a member of Congress and as a top staffer, has earned him respect from his party, and as a result his suggestion for avoiding the fiscal cliff is significant on a symbolic level.

The bigger question - whether his suggestion will have a tangible effect - is unclear. Because he is not in a top leadership role, the likelihood that his plan would be adopted as an official approach for the GOP is slim.

Nevertheless, if Cole begins to build up a following, so to speak, of Republicans who come forward and say they agree with him, then it's possible you could see the leadership reconsider. A lot can happen in 33 days.

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