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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Stock index futures signal more gains

LONDON (Reuters) - U.S. stock index futures pointed to a slightly firmer open on Wall Street on Wednesday, with futures for the S&P 500 and Dow Jones 0.1 percent higher at 0936 GMT, while those for the Nasdaq 100 added 0.2 percent.

U.S. producer prices, housing starts and building permits for January are all due at 1330 GMT, with the data expected to show a slight acceleration in factory price pressures alongside a continued recovery in the housing market.

The market focus, though, is likely to be on the minutes from the U.S. Federal Open Market Committee's January meeting, due at 1900 GMT, which will be scanned for clues on how long monetary policy is likely to remain ultra accommodative.

The earnings season continues, with Devon Energy Corp., Fluor Corp. and Newfield Exploration among those due to report.

With the season now three quarters of the way through, 28 percent of S&P 500 companies have missed full-year earnings forecasts, with 41 percent undershooting on revenues, according to Thomson Reuters StarMine data.

Dell Inc : The world's No.3 maker of personal computers reported a 31 percent drop in profit, hurt by a shrinking consumer business, as investors weighed founder Michael Dell's offer to buy out the firm.

Demand Media Inc : The company said it is exploring the separation of its media business from its domain name service, a disclosure that sent its shares up nearly 20 percent in after-hours trading.

Boeing : The aircraft maker has found a way to fix battery problems with its grounded 787 Dreamliner jets which involves increasing the space between cells, a source familiar with the U.S. company's plans told Reuters.

Life Technologies : An $11 billion-plus sale of Life Technologies Corp is looking less likely as a gap in price expectations with the company has left potential buyer Thermo Fisher Scientific Inc skeptical about a deal while buyout firms' offers came up short, people familiar with the matter said this week.

Herbalife : The diet supplements company raised its 2013 earnings forecast late on Tuesday.

Heinz : The FBI is looking into possible insider trading in the options of the ketchup maker before its blockbuster deal last week to be acquired by Warren Buffett and Brazil's 3G Capital.

Sina Corp : The operator of China's largest online portal posted better-than-expected fourth-quarter revenue and profit amid concerns about the slowing growth of Chinese online advertising.

Milennial Media : The mobile advertising firm's fourth-quarter sales missed Wall Street expectations, and the company forecast first-quarter revenue below analysts' estimates, sending its shares down as much as 33 percent after the bell.

Marriott International : The hotel operator reported better-than-expected quarterly results, aided by rising international travel and higher rates, and said it expects per-room revenue to rise further in 2013.

Nabors Industries : The owner of the world's largest onshore drilling rig fleet, reported a 44 percent jump in profit, but revenue fell as its major customers curtailed spending amid the worst slowdown in gas-directed drilling in more than a decade.

Total System Services Inc : The Payment processor said it will buy prepaid debit card provider NetSpend Holdings Inc for about $1.4 billion in cash to expand its presence in the prepaid card market and target new customers.

European shares traded flat on Wednesday, consolidating after the previous session's sharp gains, held back by weak earnings newsflow and as traders cited caution ahead of the minutes to the U.S. Federal Reserve's January policy meeting. <.eu/>

The Dow Jones industrial average <.dji> gained 53.91 points, or 0.39 percent on Tuesday to 14,035.67 points - just 0.9 percent away from its record high. The Standard & Poor's 500 Index <.spx> closed up 0.73 percent at 1,530.94, while the Nasdaq Composite Index <.ixic> added or 0.68 percent to 3,213.59.

(Reporting By Toni Vorobyova; Editing by Susan Fenton)

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IHT Rendezvous: Q and A: Nina Hoss, at Home at the Berlinale

BERLIN — The German actress Nina Hoss has been a fixture at the Berlinale in recent years. She won the best actress prize in 2007 for Christian Petzold’s “Yella,” served on the jury in 2011 and starred in one of the most acclaimed titles in last year’s competition, “Barbara,” also directed by Mr. Petzold (with whom she has made five movies in the past dozen years).

This year Ms. Hoss returned to the festival with “Gold,” her first film with Thomas Arslan, the German director often grouped with Mr. Petzold as a founding member of the Berlin School movement. A laconic and methodical neo-western, “Gold” chronicles the arduous expedition of several German fortune seekers into the Klondike hinterlands. Ms. Hoss plays Emily Meyer, a poised and somewhat enigmatic divorcée who may be the most driven member of the group, determined to forge ahead at all costs. It’s a typically restrained yet suggestive performance from an actress who has made an art of holding back.

Ms. Hoss, who will next be seen opposite Philip Seymour Hoffman in Anton Corbijn’s adaptation of John le Carré’s novel “A Most Wanted Man,” spoke about “Gold” and her collaborations with Mr. Arslan and Mr. Petzold in an interview at the Hotel Mandala during the festival.

Here are edited excerpts from the conversation:

Q.

When you take on a period role, as you’ve done with “Gold” and “Barbara,” do you approach it differently?

A.

As a character you always deal with the environment you live in — that helps you understand why they react the way they do. With Emily, for instance, she wears a corset at the beginning, so there’s a restriction right away, but eventually she lets go. These aren’t problems a modern woman would deal with. But they were only allowed to wear skirts in those days, and they even had to take care of the length of the skirt — the Canadian police would actually fine them if they weren’t long enough. Knowing that, even if we don’t talk about it in the movie, helps you to create the character.

Q.

What else did the research involve?

A.

There’s a Canadian writer, Pierre Berton, who wrote books about the Klondike Gold Rush with loads of photographs. But the thing that helped me the most was making a research trip to Dawson City [the destination in “Gold”] three weeks before shooting. I wanted to see where they wanted to go. When you get to this place in the middle of nowhere — really, you drive for six hours and maybe you see 15 cars, no houses, and it’s still wild — you have this feeling of wanting to stay for some weird reason. I understood what they were longing for.

The people who live there are adventurous, they’re open, and they have to work with each other because otherwise they’re never make it through the winter. I could feel it, this simplicity but also the possibility of a new society, which was particularly interesting for a character like Emily. There are not so many books on women during that time but in Dawson City I found some books on local history. There were women who went there looking for adventure and for freedom and to create themselves again. There was no one to tell you that you couldn’t, so women succeeded there and that was a very interesting perspective on those days.

Q.

What about physical preparations?

A.

We had riding lessons here outside of Berlin, and there were lots of preparations with all the props. There was a specialist who taught us how they made fire. We had to practice packing and unpacking the horses, how to saddle them properly. It was practical training more than intellectual discussions.

Q.

Was it a difficult shoot?

A.

It was quite exhausting. Because it’s a low-budget project there are not too many people around to help with the horses, for example. You can imagine, these seven actors in a dense forest, holding their horses for hours, until the camera is ready. They get crazy — the horses, I mean.

Q.

To what extent did you think of “Gold” as a western?

A.

More a road movie. I think it’s not as lawless as a western. It has parts of the genre in it, like revenge and a shootout. But what I found quite interesting is being German in this country, it’s as if they bring the law with them, and there are all these restrictions that they put on themselves. When you see this German group in the forests of Canada, it immediately tells you how far they’ve traveled. What I found interesting was thinking about what makes people follow their dreams, how hope keeps you going and how it can destroy you.

Q.

Did you see similarities between Emily and Barbara? They’re living in very different circumstances but both are extremely focused women, self-sufficient out of necessity.

A.

In that sense, maybe, and also in that they have principles. Emily has strong principles and is very pragmatic, and same with Barbara. They are women with principles and also they don’t want to let go. For me there’s something very positive underneath with both of them. They believe in life and they want to live, with all its ups and downs. They want to die and say, I lived. No one took it away from me.

But Emily doesn’t have to hold back as much. She does in the beginning because it was dangerous for women to be on their own, so she can’t just be too openhearted.

Q.

Since your characters often reveal little about themselves, do you create back stories for them?

A.

To be so restricted in some of these roles, especially in Christian’s films, can be a tough job. That’s why I need to do other types of films and theater — you become an actor to express yourself, and it’s tough to restrain yourself all the time. I love it, of course, because it’s a specific kind of task and I love the characters Christian writes for me. But I need to know everything about her. From the script I can guess that’s probably why she reacts a certain way, maybe because of the past, so I construct something.

With these characters you don’t just react and say what you think. It’s more like, oh, I would like to say this now but I can’t, so I’m saying this instead. There are so many things going on that I need to exactly know what she wanted to say. That has to be precise, otherwise I go crazy. But I don’t force it. I don’t feel like I need to tell the audience what I’m thinking right now. I love that it can be very precise for me, but when you watch it your mind creates your own story for her.

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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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Swiss say U.S. not in touch over Heinz insider trading case

ZURICH (Reuters) - Swiss authorities said on Monday they have not yet been asked to help a U.S. investigation into alleged insider trading in call options of H.J. Heinz Co the day before the company announced it would be sold, even though a Zurich account is at the heart of the matter.

U.S. securities regulators filed suit on Friday against as-yet-unidentified traders in Heinz options alleging they traded on inside information before the company made public the deal to be bought for $23 billion by an investor group made up of Warren Buffett's Berkshire Hathaway Inc and Brazil's 3G Capital Partners.

The U.S. Securities and Exchange Commission said in a statement on Friday it had obtained "an emergency court order to freeze assets in a Zurich, Switzerland-based trading account that was used to reap more than $1.7 million from trading in advance of yesterday's public announcement about the acquisition of H.J. Heinz Company."

The order from the U.S. District Court for the Southern District of New York freezes the traders' assets and prohibits them from destroying any evidence, the SEC statement said.

SEC spokesman John Nester said on Monday that the assets concerned had been frozen in the United States, not Switzerland, though the "beneficial owners" were those allegedly behind the Swiss account. He did not respond immediately when asked if the U.S. authorities were in contact with their Swiss counterparts.

With the assets frozen, the SEC would have had no immediate need for Swiss assistance in the case, although it eventually may need help to identify the account holders.

Rainer Borer, a spokesman for the Swiss financial markets watchdog known as FINMA, said a U.S. court cannot by itself freeze assets in an account of a bank operating in Switzerland.

"For that, it has to ask for legal or administrative assistance," he told Reuters. "Up to now, FINMA has not received a U.S. request for administrative assistance in the mentioned case of potential insider trading."

Justice ministry spokesman Folco Galli said the ministry had not received an official request for legal assistance either.

"Either a request for administrative or legal assistance would be necessary because a U.S. court cannot enforce a coercive measure in Switzerland," he said.

U.S. bank Goldman Sachs has said it is co-operating with the SEC probe. The SEC suit filed Friday refers to the account in Switzerland as the "GS Account.

Heinz had no comment, Michael Mullen, a company spokesman, said by email. Berkshire Hathaway and 3G Capital likewise declined to comment, said Gemma Hart, a spokeswoman for the investor group.

(Reporting by Silke Koltrowitz; Additional reporting by Martin de Sa'Pinto in Zurich and Jim Wolf in Washington; Editing by Marguerita Choy)

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South African Leader Launches New Political Party

JOHANNESBURG (Reuters) - Respected anti-apartheid activist Mamphela Ramphele launched a new political party on Monday to challenge South Africa's ruling ANC, saying self-interested and corrupt leaders were threatening the continent's biggest economy.

Invoking the spirit of Nelson Mandela and the optimism that prevailed at South Africa's first all-race elections in 1994, Ramphele said the dream of the "Rainbow Nation" was dying under the African National Congress (ANC).

"Our society's greatness is being undermined by a massive failure of governance," she said, urging South Africans to "build our nation into the country of our dreams".

Ramphele, 65, faces a formidable challenge. Although political support for the ANC is weakening 19 years after the end of white-minority rule, it remains an unrivalled political machine and commands a nearly two-thirds majority in parliament.

But the medical doctor and former World Bank managing director has the respect of much of the country's black majority as a partner of Black Consciousness leader Steve Biko, who died in 1977 in apartheid police custody.

She was also placed under house arrest for seven years by the apartheid government because of her political work. She has regularly challenged authority and the ANC on its failings.

The new party, which will contest elections due early next year, will be called 'Agang', the Sesotho word for "Let us build".

The ANC "noted" her announcement but said Ramphela's launch speech, outside the Constitutional Court in central Johannesburg, offered nothing new.

The 101-year-old liberation movement also dismissed Ramphele's accusation that it was to blame for income inequality, social violence, failing education and other problems.

"The criticism of the ANC is a failure to acknowledge that many of the challenges were not created by the ANC. It is historical," party spokesman Keith Khoza said.

"Any party that won elections would have faced the same societal issues in education, health, housing and so on."

A group of ANC heavyweights split off in 2008 to form the Congress of the People (COPE) but the party fared poorly in elections the following year and has since all-but imploded amid infighting and wrangling.

(Reporting by Jon Herskovitz; Writing by Ed Cropley; Editing by David Dolan and Andrew Heavens)

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Beyoncé & Jay-Z Celebrate All-Star Weekend in Houston

Caught in the Act

02/18/2013 at 06:00 AM EST

It's Beyoncé's world and we're all just living in it.

On Saturday night, Blue Ivy's pop star mom, her husband Jay-Z and LeBron James held court in Houston at the Sprite Two Kings private dinner at RDG + Bar Annie.

While fans were buzzing about the singer's new documentary, Life Is but a Dream, Beyoncé slipped into the late night event dressed in a white pantsuit with her honey-hued hair in curls.

As the event continued, Chef Robert del Grande served mixed surf and turf with starters of Maine lobster salad, seared foie gras poor boys and entrees including wood grilled prime beef and gulf red snapper.

After dinner, things took a lively turn as deejay Mick Boogie played hits late into the night. Other attendees included P. Diddy, Drake, Ne-Yo, and Scottie and Larsa Pippen.

– Heather Staible

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Euro, dollar up after G20, stocks ease on growth concern

LONDON (Reuters) - The euro and the dollar rose against the yen on Monday after the G20 decided not to criticize Japan for its expansionist policies, but shares eased as Europe's weak growth outlook weighed on sentiment.

Financial leaders from the world's 20 biggest economies promised on Saturday not to devalue their currencies to boost exports, aiming to defuse talk of currency wars that had been roiling the markets.

The euro gained 0.2 percent to 125.32 yen, edging up toward a 34-month high of 127.71 yen hit earlier this month, while the dollar rose 0.6 percent to 94 yen, closer to its highest level since May 2010 of 94.46 hit on February 11.

"Future yen direction will continue to be driven by domestic monetary policy from the Bank of Japan and improving international investor confidence, which are both driving the yen weaker," said Lee Hardman, currency analyst at Bank of Tokyo-Mitsubishi UFJ.

Japanese Prime Minister Shinzo Abe is poised to nominate a new BOJ governor. Sources told Reuters that former financial bureaucrat Toshiro Muto, considered likely to be less radical than other candidates, was leading the field.

Abe said on Monday that buying foreign bonds was a future option for the Bank of Japan, which would entail selling of the yen by the central bank.

The euro was also rising against the dollar, gaining 0.1 percent to $1.3375 ahead of address by European Central Bank president Mario Draghi to the region's parliament which may touch on the outlook for the single currency after the G20 meeting.

In European markets, attention was also switching to the release of euro area Purchasing Managers' Indexes for February and German sentiment indices due later in the week, and the upcoming general elections in Italy.

Analysts expect Thursday's euro area flash PMI indices, which point to economic activity around six months out, to show growth stabilizing across the recession-hit region, leaving hopes for a recovery in the second half of the year intact.

Concerns over an inconclusive outcome in Italian elections at the end of the week added to the weaker sentiment as a fragmented parliament could hamper a future government's reform efforts.

The worries about the outlook for Italy were encouraging investors back into safe have German government bonds on Monday, with 10-year Bund yields easing 3.6 basis points to be around 1.63 percent.

"Political uncertainty will keep Bunds well bid this week," ING rate strategist Alessandro Giansanti said, adding that only better than expected economic data could create selling pressure on German debt near term.

EARNINGS HIT

European equity markets were taking their lead from corporate earnings reports which have been reflecting the sluggish economic conditions across the region.

Danish brewer Carlsberg , which generates just over 60 percent of its sales in western Europe, became the latest company to report a weaker-than-expected quarterly profit, sending its shares to lowest level in nearly a month.

The 5 percent drop in price for shares in the world's fourth biggest brewery helped send the FTSEurofirst 300 index <.fteu3> of top European shares down 0.4 percent in morning trade. Germany's DAX <.gdaxi>, the UK FTSE <.ftse> and France's CAC-40 <.fchi> were all also slightly weaker. <.l><.eu/>

Earlier, the effect of the G20 statement and the comments from Abe indicating a renewed drive to stimulate the economy lifted the Nikkei stock index <.n225> by 2.1 percent, near to its highest level since September 2008.

U.S. stock futures were barely changed and are expected to stay little changed as Wall Street will be closed on Monday for the Presidents' Day holiday. <.n/>

MSCI's world equity index <.miwd00000pus> was flat as markets extended two-week period of consolidation that has followed the big run up in January when demand was buoyed by the efforts of global central banks to stimulate the world economy.

Data from EPFR Global, a US-based firm that tracks the flows and allocations of funds globally, shows investors pulled $3.62 billion from U.S. stock funds in the latest week, the most in 10 weeks after taking a neutral stance the prior week.

But demand for emerging market equities remained strong, with investors putting $1.81 billion in new cash into stock funds, the fund-tracking firm said.

CHINA RETURN

In the commodity markets traders played catch up after a week-long holiday last week in China, the world's second biggest consumer of many raw materials, had kept activity subdued, with worries about the euro zone economy weighing on sentiment.

Copper, for which China is the world's largest consumer, fell 0.8 percent to $8,135 a metric ton (1.1023 tons) on the London futures market.

Gold rebounded by 0.3 percent from a six-month low to be $1,614 an ounce as jewelers in China returned to the physical market after the Lunar New Year holiday.

Crude oil markets were mostly steady after some weak U.S. industrial production data on Friday [ID:nL1N0BF44A] was seen dampening demand, while tensions in the Middle East lent some support.

U.S. crude fell 20 cents to $95.66 a barrel but Brent inched up two cents $117.86.

(Reporting by Richard Hubbard; editing by Philippa Fletcher)

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IHT Rendezvous: In Singapore's Immigration Debate, Sign of Asia's Slipping Middle Class?

BEIJING — Immigration is a hot-button issue nearly everywhere in the world, though the contours of the debate vary from place to place. In the United States, sweeping changes to the law may offer legal residency for millions of people who have entered the country illegally, my colleague Ashley Parker reports.

Here in Asia, in the nation of Singapore, the debate looks somewhat different: The government plans to increase the population from just over five million to a possible high of nearly seven million by 2030, via regulated, legal immigration. It’s provoking opposition.

So much so that on Saturday, about 3,000 people turned out for what some commentators said was one of the biggest demonstrations in the nation’s history. (If the number seems small, it reflects the tight political control exerted over Singapore life by the People’s Action Party, which has run the country for about half a century and discourages public protest.)

What are the contours of the debate in Singapore?

Concern over booming immigration, often focused on new arrivals from increasingly rich China, has been simmering in the nation, with many feeling that the immigrants don’t play by the same rules, that their manners are poor and that they are pushing up prices. That feeling crystallized last year when a wealthy Chinese man driving a Ferrari at high speed killed three people (including himself) in a nighttime accident.

(Similar sentiments are found in Hong Kong, as my colleagues Bettina Wassener and Gerry Mullany wrote.)

Vividly illustrating the resentment, Singaporeans sometimes call the wealthy immigrants “rich Chinese locusts,” according to an article in the Economic Observer’s Worldcrunch.

Less controversially, the article quoted Peng Hui, a professor of sociology at National Singapore University, as saying: “Singaporeans do not discriminate against the Chinese. On the contrary, they very much identify with their Chinese ancestry.” (Of course, rich Chinese are not the only new immigrants, but they are a major group, many commentators have pointed out.) “What the local people do not appreciate is the fact that Chinese people talk loudly in public, eat on the subway and like to squeeze through in a crowd or grab things,” Mr. Peng was quoted as saying.

So the Singapore government’s Population White Paper that passed in Parliament earlier this month, just before Chinese New Year, was bound to stir things up.

The government is presenting the rise in immigration as a target that is needed if Singapore, where immigrants already make up about 40 percent of the population, and which has the highest concentration of millionaires in the world, is to continue to flourish, reports said. Singaporeans just aren’t having enough children, said the prime minister, Lee Hsien Loong.

“In my view, in 2030, I think 6 million will not be enough to meet Singaporeans’ needs as our population ages because of this problem of the baby boomers and bulge of aging people,” Mr. Lee said in Parliament, adding that 6.9 million was not a target but a number to be used to help plan for infrastructure.

“Do we really need to increase our population by that much?” wrote a person called Chang Wei Meng in a letter to The Straits Times, according to Reuters. “What happened to achieving the Swiss standard of living?”

Gilbert Goh, a main organizer of the rally Saturday at Singapore’s Speaker’s Corner in a public park, said the protesters had a message: “They want to tell the government, please reconsider this policy. The turnout is a testimony that this policy is flawed and unpopular on the ground,” The Associated Press quoted Mr. Goh as saying.

Yet amid the familiar rhetoric about immigrants, heard around the world – they don’t fit in, they’re rude, they’re different – might something more important be going on here?

In a blog post on Singapore News Alternative, Nicole Seah, a politician who has run for Parliament and comments on social issues, wrote: “Along with many other Singaporeans, I oppose the White Paper.”

Why? She is looking for “a society that lives in harmony, rather than tense and overcrowded conditions,” she writes.

“Not the Singapore Inc. that has been aggressively forced down our throats the past few years – a Singapore which is in danger of becoming a transient state where people from all over, come, make their fortunes, and leave.”

Not “a Singapore that has become a playground for the rich and the people who can afford it. A Singapore where the middle class is increasingly drowned out because they do not have the social clout or sufficient representatives in Parliament to voice their concerns.”

Ms. Seah’s statements raise an interesting question: Is this part of a phenomenon that the columnist Chrystia Freeland has written about so ably for this newspaper, the ascendancy of a wealthy, “plutocrat” class and the slipping status of the middle class?

As Ms. Freeland wrote last week: “The most important fact about the United States in this century is that middle-class incomes are stagnating. The financial crisis has revealed an equally stark structural problem in much of Europe.” Is it hitting Asia, too, and does Singapore’s protest speak, at least in part, to this? Hong Kong’s dissatisfaction too?

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