Tai chi, the Chinese martial art involving slow and rhythmic movement, has been shown to benefit older people by maintaining balance and strength. Now, researchers have found that tai chi also helps patients who suffer from Parkinson's disease.

Leona Maricle was diagnosed with Parkinson's two years ago. At the time, she was teaching math, and she says she had experienced the telltale tremors of Parkinson's for a number of years. She learned how to cope.

"The students began to notice that my hands were trembling," she recalls, "so I started learning how to compensate by keeping that hand under the table and using the other hand to pass out papers, interact with students and hand out pencils."

But soon it became clear that Maricle just couldn't give teaching her "best" anymore. She retired at age 67.

 

Parkinson's disease, a progressive disorder of the nervous system, affects movement and motor control. "I would need to think two or three times about moving a particular part of my body," says Maricle. "When I was sitting in a chair and needed to get up, it would take two or three mental messages to my muscles to actually move my body."

Maricle had difficulty walking upstairs, downstairs, to the car or down the street. So it's no wonder that, when she heard about a new study at the nearby Oregon Research Institute to look at the potential benefits of tai chi for Parkinson's patients, she jumped at the chance. Hoping for help but also loving all things Chinese, Maricle saw the study as a perfect fit for her.

The study, which appears in the current New England Journal of Medicine, was headed by research scientist Fuzhong Li, who practices tai chi himself. Tai chi is sometimes described as "meditation in motion," because it promotes serenity through gentle movements, connecting the mind to the body. It has been shown to help with loss of balance during normal aging and can help relieve stress. Typically, the positions and postures of tai chi involve slow, focused movements that flow from one to the next.

In the study, Li divided Parkinson's patients into three groups. One group did resistance training with weights. Another, stretching classes. And the third took up tai chi. Each group participated in a 60-minute class twice a week for six months.

When they finished, Li found that the tai chi patients were stronger and had much better balance than patients in the other two groups. In fact, Li says their balance was "four times better than those patients assigned to the stretching group and about two times better than those in the resistance-training group."

That led to significantly fewer falls for patients in the tai chi group. Maricle says that before tai chi, she would lose her balance eight to 10 times a day. Now it hardly ever happens. She recently even saved herself from what would have been a sure fall before tai chi. It was raining and dark, and she tripped on the curb as she got out of her car. She was able to hop onto the curb and steady herself.

"That would have been a fall for sure six or eight months ago," she says.

Researchers don't know exactly how tai chi works to restore balance. UCLA psychiatrist and brain scientist Michael Irwin says it may work by literally re-training areas of the brain that control movement.

"There's a memory component of our nerves, and they're receiving signals from our body all the time that are integrated by the brain," Irwin says. "And it may be that what happens with tai chi is that it's bringing awareness of the brain to these areas of the body" — thereby strengthening those areas of the brain.

You didn't have to look hard to see this one coming.

Catholics and GOP candidates have attacked the Obama administration's plans to require most employers — including religious hospitals and schools — to provide coverage of prescription contraceptives. Now the debate is moving to Capitol Hill.

Republicans are vowing to pass legislation to overturn the requirement, which they say violates religious freedom. Democrats say they will fight to maintain it to protect women's health.

"If the president does not reverse the (Health and Human Services) department's attack on religious freedom, then the Congress, acting on behalf of the American people, and the Constitution that we're sworn to uphold and defend, must," House Speaker John Boehner, R- Ohio, said in a speech on the House floor Wednesday.

That echoed a similar vow made a day earlier by Senate Minority Leader Mitch McConnell, R-Ky.: "This is a huge mistake that I hope the administration is currently reconsidering, and if they do not, Congress will act."

But Republicans won't pass their legislation to overturn the mandate without a fight.

 

"There are religions that believe divorce is a sin," said Sen. Jeanne Shaheen, D-N.H. "Should these institutions be exempt from our labor laws and be allowed to discriminate based on marital status? Of course not, and this is no different."

In fact, pointed out Sen. Barbara Boxer, D-Calif., many women don't even use prescription contraception in ways that violate the church's teachings. "A full 14 percent of women who use birth control pills — that is 1.5 million women — use them to treat serious medical conditions, not to prevent pregnancies," she said.

And some Democrats are arguing that Republicans are using the issue as little more than a diversion.

"I am concerned that Republicans are using women's right to choose as a little birdie on the wall to look at over here, so that the American public doesn't see that they are blocking us from passing legislation to get this economy back on track," said Sen. Patty Murray, D-Wash.

Republican objections do reflect a real outcry from Catholics and other religious groups who argue that providing such coverage in their health plans would force them to violate their religious teachings.

Even so, other religious groups are now joining with the White House to support the policy.

"We believe that women and men have the right to decide whether or not to apply the principles of their faith to family planning decisions, and to do so they must have access to services," read a statement from some two dozen progressive religious organization, including Catholics for Choice and the United Church of Christ. "The administration was correct in requiring institutions that do not have purely sectarian goals to offer comprehensive preventive health care."

If that case of diarrhea just doesn't get better, your heartburn drug could be the reason.

The Food and Drug Administration just warned doctors and consumers that popular medicines called proton pump inhibitors may raise the risk for chronic diarrhea caused by Clostridium difficile, a bacterium that you'd rather not have colonizing your intestines.

The drugs include Nexium and Protonix and over-the-counter remedies Prilosec and Prevacid. If you're taking these drugs (or others in tables 1 and 2 here) and have diarrhea that won't let up, the FDA says you should see your doctor right away.

These drugs suppress stomach acid, which may help protect against infection with the germ. Your doctor can test to see if you've got an infection with C. difficile, the agency says, and treat it.

 

Why did the FDA issue this advice now?

After looking at a database of problem reports for the drugs and various published studies, the agency concluded that "the weight of evidence suggests a positive association between the use of PPIs and C. difficile infection and disease."

Now, that's not ironclad proof, but the agency says it's strong enough to tell the world about. The agency says the studies show that using PPIs may raise the risk for infection by 1.4 to 2.75 times.

FDA said it wants makers of the drugs to add information about the risk to the instructions for the drugs.

Hints about problems with PPIs have been mounting for a while. Some studies published two years ago in the Archives of Internal Medicine highlighted the possible heightened risk of infection with C. difficile for people taking the drugs.

"The increases in the risk of Clostridium difficile infection with PPIs are not at all modest," an accompanying editorial said at the time. And the editorial advised doctors to think it over before prescribing PPIs.

Update 6:30 p.m.:

I asked AstraZeneca, maker of some of the best-selling PPIs, about the FDA's action. A company spokeswoman emailed a statement saying, "AstraZeneca remains confident in the positive benefit-risk and safety profiles of Nexium, Prilosec and Vimovo."

AstraZeneca is working with the FDA to add information about the increased risk of C. difficile infection to the labels of those drugs, the statement said.

"Patients should speak directly to their physicians if they have questions or concerns about their treatment," the company said. And it took note of the FDA's advice to patients: They shouldn't stop taking PPIs before talking to their doctors.

Teen pregnancies are at their lowest rate in nearly 40 years, according to the latest data from the Guttmacher Institute, a research organization focused on sexual and reproductive health.

The report shows that about 7 percent of U.S. teen girls between the ages of 15 to 19 were pregnant in 2008 — a decline from the high of more than 11 percent in 1990. Abortions among teen girls fell from a peak of more than 4 percent in 1988 to about 1.8 percent in 2008, the latest year for which data are available.

While overall rates have dropped, there is still a major gap separating white, Hispanic and black teenagers.

Non-Hispanic white teen pregnancy rates fell by 50 percent from their peak; Hispanic teen pregnancy rates, 37 percent; black teen pregnancy rates, 48 percent.

 

Yet, according to the report, "the abortion rate among black teenagers was four times the rate for non-Hispanic whites, while the rate among Hispanic teenagers was twice the rate for non-Hispanic white teenagers."

"The disparity has pretty much been unchanged," said Kathryn Kost, a Guttmacher researcher and co-author of the report. "If you think of these rates as lines on a graph, they are all going down, but the distance between them is pretty much unchanged."

The report does not distinguish between married and unmarried teens.

Kost said the increase in contraceptive marketing has helped to reduce pregnancies, but Heather Boonstra, a senior public policy associate at Guttmacher said the cost of contraceptives continues to be a factor. Boonstra said increasing the age limit for dependent health care coverage to 26 will increase access to birth control for many teens.

"There's plenty of evidence that shows that if you take away cost in the equation,there is going to be better contraceptive use, fewer unintended pregnancies, fewer abortions, better birth outcomes," she said. "The health care reform law was not designed with teens in mind, but ... the more parents that are insured, the more teens or their dependents are insured, so certainly that will help."

Bill Albert, the chief program officer of The National Campaign to Prevent Teen and Unplanned Pregnancy, said the decreased rates are a sign of progress, but more remains to be done. He noted that 3 in 10 girls are pregnant by age 20.

"In a way the message is let's celebrate today, and then get back to work this afternoon," Albert said. "I think this underscores the need to continue to invest as the current administration has in proven efforts to prevent teen pregnancy."

Update 11:45 a.m.: A commenter was curious about the apparent discrepancy between Guttmacher's total percentage of pregnant teens — 7 percent — and Bill Albert's statement that 3 in 10 girls are pregnant by the time they are 20. So we asked Albert, who explained that the figure he gave is cumulative, accounting for the overall odds of a teen getting pregnant by 20. The Guttmacher figure of 7 percent comes from 2008 data. Albert also referred us to a National Campaign fact sheet explaining the math.

When a vaccine for rotavirus debuted in 1998, it was hailed as a huge plus for children's health. Before that, rotavirus killed more than 400,000 young children a year worldwide by causing severe diarrhea. Problem solved? Not quite.

Shortly after the Rotashield vaccine was introduced, doctors noticed an increase in cases of a serious intestinal problem called intussusception, when the intestine doubles back into itself. It is fatal if not treated, sometimes with emergency surgery.

Investigations determined that Rotashield, made by Wyeth (now part of Pfizer), increased a baby's risk of intussusception up to 30 times. As a result, the vaccine was yanked off the market in 1999.

The scientists never did figure out why the vaccine increased the risk of the intestinal problem. Newer rotavirus vaccines were developed, tested and licensed in 2006 and 2008. (Here's an NPR story on efforts to develop a safer vaccine.)

But concerns persist, fueled by two recent studies that found a fivefold increased risk of intussusception in babies in Australia and Mexico during the first week after they were given the vaccine.

 

So researchers looked at a big database of American children who had been given the new RotaTeq vaccine (made by Merck) between 2006 and 2010. They looked at 786,725 doses, of which 309,844 were first doses. They found no increase in intussusception. The results were published in JAMA, the Journal of the American Medical Association.

"The benefits of rotavirus vaccine do outweigh risks," says Irene Shui, an epidemiologist at Harvard Medical School and Harvard-Pilgrim Health Care Institute who is the lead author of the study. This study was funded in part by a contract with the Centers Disease Control and Prevention.

But she told Shots that that doesn't mean that these new vaccines are completely risk-free. "It's important for the public to realize that every treatment or intervention does have some risk." This study, she says, will help parents get a better grasp on those risks.

If you're interested in more details, there's a JAMA video with Shui.

In 2004, after an extensive review, the Food and Drug Administration issued a strong warning to doctors who prescribed antidepressants to teens and children.

Antidepressants, the FDA said, appeared to increase suicide among kids and teens. Doctors needed to be careful. The FDA even mandated that a "black-box warning," the strongest type, be placed on antidepressant packaging.

This warning and worries that giving antidepressants to children might cause them to kill themselves was front-page news for weeks and appeared to changed the prescribing behavior of doctors.

Fewer doctors used antidepressant medications with their young patients and, according to at least one study, the number of suicides among kids and teens began to rise.

This week the Archives of General Psychiatry published an analysis that finds no increase in suicide among young people taking Prozac. The findings put a new wrinkle in the long-running debate over the safety of the medicines when used to treat depressed young people.

The study reviewed detailed data from over 9,000 patients — including 700 youths — who took the antidepressant Prozac and found that the drug didn't increase suicidality in children at all. It also looked at data for adults taking Effexor.

 

Now, the main author of the study is Robert Gibbons, a statistician at the University of Chicago's medical school. Gibbons sat on the panel of experts that advised FDA to issue the warnings, but he always felt ambivalent about the panel's decision.

"I worried that what we might end up with was a real epidemic of suicide," Gibbons told Shots. "And the data suggests that that is exactly what happened. Rather than the black-box warning leading to decreases in child suicide rates, they were followed by some of the largest increases in child suicide rates both here in America and around the world."

So why did the new study come to such a different conclusion about the risks of suicide in kids?

According to Gibbons, the FDA's findings and his findings are similar in some respects. Both found that when doctors asked their patients about suicidal thoughts and behavior in the context of regularly scheduled checkups there was no difference between the medications and placebos.

But when it came to what are called adverse event reports, there was a difference between his study and the review done by the FDA.

Adverse event reports occur when patients spontaneously contact their doctors with problems associated with taking a medication. When the FDA looked at these patient reports, they found that patients on antidepressant medications reported 80 percent more suicidal thoughts and behavior than patients on placebos.

Gibbons didn't look at these spontaneous reports in the same way. He only considered them when patients acted on their suicidal thoughts with a suicide attempt. He found that the small number of people who acted on their suicidal thoughts did not affect the overall risk of suicide.

The original FDA study also included all antidepressants — not just Prozac. That might account for some of the differences found.

Gibbons, who has become a vocal opponent of the black-box warnings since his stint on the committee that advised FDA, says that he hopes this study will reassure clinicians about the safety of the drugs. It's not clear whether other researchers will agree with him that the new study's findings present a fundamental challenge to the FDA's previous conclusions.

The FDA was contacted for this report, but a spokeswoman emailed that the agency doesn't respond to every report or study.

The Gibbons study was funded by the National Institute of Mental Health and the federal Agency for Healthcare Research and Quality. Gibbons has been an expert witness for the Justice Department and Pfizer in cases related to antidepressants, anticonvulsants and suicide.

One of the driving forces behind the now-reversed decision to cancel funding to Planned Parenthood has stepped down from her executive position at the Susan G. Komen for the Cure foundation.

But the resignation of Karen Handel, an outspoken opponent of the reproductive health group, hasn't slowed down foes of Planned Parenthood.

Even as Handel was on her way out the door, two anti-abortion groups were releasing a report intended to push Republicans in Congress to continue their investigation of Planned Parenthood.

A 23-page memo from the Susan B. Anthony List and the Alliance Defense Fund outlines what those groups' leaders say are a series of funding irregularities uncovered in various state and federal audits of Planned Parenthood affiliates.

 

"These problems reveal a pattern of gross financial mismanagement," said Marjorie Dannenfelser, president of SBA List.

Steven Aden, the Alliance Defense Fund's senior counsel, added, "The 10 state audits amounted to nearly 8 million dollars in waste, abuse and potential fraud."

Planned Parenthood, however, brushed off the accusations. "This document is part of a campaign by conservative groups seeking to outlaw access to reproductive health care and uses recycled or overstated allegations," the organization said in a statement.

The Planned Parenthood statement also noted that "the same groups pushing for a congressional inquiry have also been behind the pressure campaign aimed at the Susan G. Komen for the Cure Foundation and other important organizations."

But in her first public statements since resigning, Handel said it was Planned Parenthood making things political. "The last time I checked, private nonprofit organizations have a right and a responsibility to be able to set the highest standards and criteria on their own without interference, let alone the level of vicious attacks and coercion that has occurred by Planned Parenthood," she told Fox News. "It's simply outrageous."

Handel, however, who ran unsuccessfully for governor of Georgia in 2010 on a platform that included defunding Planned Parenthood, acknowledged that she urged Komen to defund the organization. Komen officials have now apologized for that decision.

The Susan G. Komen for the Cure foundation has been in the news because of its clash with Planned Parenthood Federation of America.

But another aspect of Komen's activities hasn't received much attention: Komen's position on research using human embryonic stem cells.

Despite raising millions of dollars for breast cancer research, Komen hasn't funded any of this work, prompting questions about whether that decision is rooted in politics.

"We find this disappointing and really fairly ironic for a group that is 'for the cure' to walk away from research that many scientists think could unlock cures for diseases, including cancer," said Sean Tipton of the Coalition for the Advancement of Medical Research, which lobbies for research with human embryonic stem cells.

Many scientists think human embryonic stem cells could lead to cures for many ailments, including heart disease, diabetes, some forms of blindness and possibly cancer. But human embryos have been destroyed to obtain some of the cells. So the research has long been controversial.

 

"Anything that involves reproductive biology, whether it's a sex survey among high school students or it's contraceptive services, abortion, immediately stirs up political passions," said Daniel Greenberg, who studies the intersection of science and politics.

No one from Komen agreed to be interviewed for this story. But officials maintained that the group doesn't have a formal ban on research involving human embryonic stem cells. They say they just haven't found anything worth funding yet.

But Tipton and others say there are many ways stem cells could help fight breast cancer. "Embryonic-stem-cell work is a powerful research tool for all kinds of diseases and conditions, and breast cancer would certainly be one of those candidates," Tipton said.

For example, stem cells could be used to study the genetic causes of breast cancer, decipher the basic biology of breast cancer tumors and perhaps test new drugs to treat the disease, Tipton and others said.

Now, it turns out, Komen isn's alone. Neither the American Cancer Society nor the American Heart Association funds research with human embryonic stem cells. That's frustrating for many scientists.

"Funding science is supposed to be based on merit," said George Q. Daley, a stem-cell researcher at Harvard University. "Scientific funding should support the best ideas. And if someone has a brilliant idea relevant to breast cancer research or heart disease that uses human embryonic stem cells, it'd be a huge lost opportunity to have one of these foundations refuse to fund it."

Charitable groups can be skittish about politically sensitive research because of fears of alienating some of the legions of volunteers and donors they depend on for survival, Greenberg said.

"These groups live on handouts from the public and they are very, very concerned about offending any donors or potential donors. It's very easy to scare them off," Greenberg said. "Various groups that have a particular issue to push know about this sensitivity and vulnerability of charitable organizations and they're able to manipulate it very well."

Rose Marie Robertson, chief science officer at the American Heart Association. acknowledged that embryonic stem cells could lead to breakthroughs for the nation's leading killer. That's why, she said, her group supports federal funding of the research. But the heart association has banned funding the work itself because of fears of offending volunteers and donors.

"There are people who have varying views in terms of whether they find this personally or ethically, or from a religious perspective, something that is reasonable," Roberton said. "If, in fact, donors chose not to support the heart association because of a particular view in terms of human-embryonic-stem-cell research that would really be harmful."

The American Cancer Society wouldn't make anyone available for an interview. In a statement, the group said it funds research into promising alternatives to human embryonic stem cells. But the "nature" of human embryonic stem cell research "make it imperative that it be pursued under appropriate protections," the groups said. And the federal government, not the cancer society, is "best suited" to "oversee it," according to the statement.

A high-ranking official at the Susan G. Komen for the Cure foundation has resigned amid fallout from the charity's move, since reversed, to halt funding for breast cancer screening by Planned Parenthood.

Karen Handel, a former Republican candidate for governor in Georgia, resigned her job, effective immediately, as senior vice president for public policy. The Associated Press first reported the move. The Komen foundation confirmed the report in an email to Shots.

The Atlanta Journal-Constitution posted a copy of Handel's resignation letter. In it, Handel wrote that the decision to "exit the controversy surrounding Planned Parenthood and its grants was fully vetted by every appropriate level within the organization." And, she wrote, "No objections were made to moving forward."

 

She defended the policy shift, saying:

Neither the decision nor the changes themselves were based on anyone's political beliefs or ideology. Rather, both were based on Komen's mission and how to better serve women, as well as a realization of the need to distance Komen from controversy.

Komen said last week that it had changed its grant-making criteria. Its new approach would bar Planned Parenthood from future funding because the group was under investigation.

Komen then said it was a move for efficiency's sake, not one motivated by politics. After a swift backlash, Komen reversed itself, saying Planned Parenthood wouldn't be banned from funding after all.

The group issued a statement, attributed to Nancy G. Brinker, CEO and co-founder of the charity, confirming Handel's departure:

"Susan G. Komen for the Cure's mission is the same today as it was the day of its founding: to find a cure and eradicate breast cancer.

"We owe no less to our partners, supporters and, above all, the millions of people who have been and continue to be impacted by this life-threatening disease. We have made mistakes in how we have handled recent decisions and take full accountability for what has resulted, but we cannot take our eye off the ball when it comes to our mission. To do this effectively, we must learn from what we've done right, what we've done wrong and achieve our goal for the millions of women who rely on us. The stakes are simply too high and providing hope for a cure must drive our efforts.

"Today I accepted the resignation of Karen Handel, who has served as Senior Vice President for Policy since April 2011. I have known Karen for many years, and we both share a common commitment to our organization's lifelong mission, which must always remain our sole focus. I wish her the best in future endeavors."

Does it help or hurt children to know they have high cholesterol? We're about to find out.

New guidelines from the National Heart, Lung and Blood Institute say every child should be screened for high cholesterol once between the ages of 9 and 11 and again between 17 and 21.

Intended primarily as a way to identify the 1 in 500 kids who have a genetic predisposition to dangerously high cholesterol levels called familial hypercholesterolemia, universal screening will also identify millions more whose cholesterol levels are a little high but who aren't likely to develop premature heart disease.

For those kids, being labeled a child with high cholesterol could have psychological side effects, says Matthew Gillman, director of the obesity prevention program and a professor of population medicine at Harvard Medical School. He co-authored a recent article in JAMA, the Journal of the American Medical Association, that looked at the pros and cons of universal screening.

Obsessing about the results is one potential con. "You tell an 11-year-old that his cholesterol is high, and the parents get overly concerned about that," Gillman says. "And then they may spend an inordinate amount of time on that, and it may overtake their lives."

Meanwhile, the heart health benefits of widespread screening are uncertain. The effect of high cholesterol is cumulative over time, and reducing cholesterol levels in children appears to delay hardening of the arteries, at least in those with familial hypercholesterolemia. But it's unknown whether long-term treatment of kids with only moderately high cholesterol will reduce their risk of heart disease or death.

Research into the psychological effect on children of labeling them with a medical condition is scant, says Gillman. But there are other examples in medicine that have demonstrated that telling people they've got something can have a negative effect.

For example, in a group of men with high blood pressure, researchers told half of them that they had hypertension and left the others in the dark. Result? "The anxiety levels were higher in those who were told," he says.

Since the recommended treatment for most kids with only moderately elevated cholesterol would be to eat better and exercise more, it's not clear that there's an advantage in sticking a label on them. "You could argue that everyone should get the same lifestyle interventions anyway," says Gillman.

No parent holds a new baby and thinks that within a year they will have seriously injured or even killed that child. Or that the violence could be sparked by something as common as a baby's cry.

But each year, more than 4,000 young children are hospitalized because they've been seriously injured, usually by a parent, and about 300 die. Babies under age 1 are the most likely victims, according to a study in the journal Pediatrics.

"We'd like the number to be 20, or 10 or zero," says John Leventhal, a professor of pediatrics at the Yale's medical school and lead author of the study. "Figuring out how to do that is one of the challenges we face as a nation."

 

He's one of a number of researchers around the country who are trying to do just that.

Leventhal points to successful public health campaigns to reduce the risk of SIDS, or sudden infant death syndrome, by telling new parents they should put babies to sleep on their backs. Those efforts have halved the death rate from SIDS, to about 50 per 100,000 births. That's now less than the number of babies hospitalized for abuse — 58 per 100,000.

In this study, head trauma, also known as shaken baby syndrome, was the cause of hospitalization just half the time. That, the authors say, suggests that public health efforts shouldn't focus on shaken baby syndrome alone. Other forms of violence included bruises, broken bones and burns.

State and national organizations track child abuse, but this study is the first to look at the seriousness of injuries and hospitalizations.

Fathers, stepfathers, and boyfriends tend to be the most likely attackers, Leventhal says. That's partly because they often don't have much experience taking care of children. "They're feeling overwhelmed, the baby's crying. Bingo, something terrible happens."

At Yale-New Haven Hospital, where Leventhal works, new parents are told that any parent can get overwhelmed by a baby's cries. "If they feel like they're about to lose it, they need to step away, take five, take a break. Put the baby in a safe place. Call a friend, call a doctor."

Other researchers are testing outreach programs to see what techniques work best at getting that message across. But because serious child abuse is relatively rare, it takes studies with lots of families to figure that out.

"One of the challenges is not just to reach the moms but to reach the fathers," Leventhal says. "Figuring out how to reach them is critical."

Sitting in a car with a smoker is about as close to lighting up as a nonsmoker can get.

And quite a few schoolchildren get exposed to secondhand smoke this way, according to an estimate by researchers at the Centers for Disease Control and Prevention.

About 1 in 5 nonsmoking kids in middle and high school reported sharing a car with a smoker who had lit up within a week of answering a survey in 2009. The researchers say the survey, which included responses from thousands of students, gives an accurate snapshot of what's happening across the country.

 

"The car is the only source of exposure for some of these children, so if you can reduce that exposure, it's definitely advantageous for health," CDC researcher Brian King told The Associated Press. The findings appear in the latest issue of Pediatrics.

The American Academy of Pediatrics says that any exposure to secondhand smoke is unsafe for kids.

And the latest report does find that nonsmoking kids' exposure to secondhand smoke in cars declined to 22.9 percent in 2009 from 39 percent in 2000. The researchers figure that laws barring smoking in many public places may have been a factor.

A decline in smoking prevalence and a hardening of attitudes against secondhand smoke also could be helping.

Still, researchers say more should be done. They recommend a ban on smoking in cars when children are present. That's already the law in a few places, they note, including California and Arkansas (for children under 14).

When Lisa Rentz decided she'd had enough of birth control pills, she walked into her local drug store and picked up something different: a vaginal contraceptive film that contains the spermicide nonoxynol-9, or N-9.

She admits that she didn't read the instructions all that closely but simply assumed any over-the-counter product was safe. Though N-9 was once thought to protect against HIV, public health officials now know that it can actually increase a person's HIV risk. Even so, people who use these products may not be fully informed.

"I was not aware of the increased chances of HIV transmission, which is alarming," Rentz says. "That does seem to me something that should be printed larger on the box."

Dozens of condoms, vaginal films, jellies, foams and sponges containing the N-9 spermicide are available online or at local pharmacies without a doctor's prescription. Medical professionals say they are perfectly safe as long as they are used as directed: not used more than once a day, and not used for anal intercourse, with multiple partners or with a partner who has HIV.

 

"One of the risks that everybody who uses spermicide should be aware of is that if there is a likelihood that your partner may have one of these sexually transmitted diseases, then it should probably be used with caution," says Michael Rosenberg, a former researcher at the Centers for Disease Control and Prevention. "A product like this is probably best used with a couple who is monogamous."

Ironically, N-9 is actually very effective at killing the microorganisms that cause sexually transmitted diseases such as chlamydia, gonorrhea and HIV, Rosenberg says. There's just one small problem — it also irritates the cells that line the vagina and the rectum, making them more vulnerable to attack by those same viruses and bacteria.

"Nonoxynol-9 is a detergent, and what that means is that it disrupts the layers of the cell membranes," he says. "When you use it frequently, it can actually erode a lot of the cells that are present that help protect against these diseases."

So why are products containing N-9 still available at all? One reason is that less than 1 percent of U.S. women use spermicides. Medical professionals say most of them are unlikely to have an HIV-infected partner. It's also because barrier birth control methods, like the diaphragm or cervical cap, must be used with a spermicide. Pulling N-9 — the only spermicide available in the U.S. — off the market would effectively eliminate those few existing nonhormonal sources of birth control.

For some women, like Rentz, who have been in a monogamous relationship for years with an HIV-negative partner, there is virtually no risk at all, according to Mayo Clinic OB-GYN Petra Casey. Women simply need to be well-informed so they can choose a birth-control method that's right for them.

"Those that don't go to their health care provider and just obtain these over-the-counter products may or may not read the package labeling from top to bottom, so they may not be as aware," she says. It's a fairly small group of women and a low-risk population in most situations, though, she says, and it's not a huge public health problem.

Another factor is that the studies that demonstrated an increased risk for HIV were done with sex workers who used the products multiple times a day, Rosenberg says. And the risk is thought to be lower for women who use spermicides less frequently.

"If you use these a couple of times a week, I suspect that you're fine," he says. "If there is any increased risk at all, it's very minimal, and it might even be protective. It's hard to know in these populations because they haven't been studied."

But for high-frequency users, or women at high risk for HIV — such as sex workers or those with HIV-infected partners — medical professionals say a condom is a much better choice.

Access to emergency contraception has swirled at the center of a recent flurry of debate over insurance coverage. It's a pill women can take if their birth control fails or they forget to use it.

The most popular brand of emergency contraception is called "Plan B One-Step." You might better know it as the "morning after" pill. Today, about 10 percent of sexually active women say they've used it.

Katie Wilcox, a 20-something college graduate, is a typical example of who uses it. She's working now and has a boyfriend. She's used Plan B twice. The first time she was still in college.

"We kind of got caught up in the moment," she says. "[We] woke up in the morning and decided that we needed to go get Plan B, because neither of us were ready for any sort of pregnancy."

 

So Wilcox and her boyfriend headed to their local pharmacy. She presented ID and was able to buy Plan B without a prescription. (The age requirement to buy Plan B is 17, despite a recent push by the Food and Drug Administration to make it more accessible.) After that, Wilcox and her boyfriend decided to use condoms. Then one broke. Again, they turned to Plan B.

"I can't even describe how important it was," she says. "It's an important option for girls at that age to have because ... things happen."

Wilcox didn't get pregnant. Emergency contraception prevents pregnancy 89 percent of the time if women take it within three days of unprotected sex. And it's very safe, causing only minor side effects, such as nausea or headache.

Dr. Katherine White says most of her patients take Plan B right away, but it can work even if they wait a lot longer. "Emergency contraception, or Plan B, can be very effective up to ... five days after the act of unprotected intercourse," says White, an obstetrician at Baystate Medical Center in Springfield, Mass.

Plan B is a synthetic dose of the hormone progesterone. It's the same hormone that's in typical birth control pills — but at a higher dose. It works primarily by stopping the ovaries from releasing an egg. No egg, no pregnancy.

But if an egg has already been released, Plan B can still prevent the egg from getting fertilized. The dosage literally slows down the movement of the egg and, at the same time, it slows down the movement of the sperm, making it unlikely the two will meet, she says.

Now, here's where things get a bit controversial. If sperm has actually succeeded in fertilizing an egg, Plan B could possibly thin the lining of the uterus so the fertilized egg won't attach and grow. Scientists have no proof that actually happens, but in theory, it could.

White points out that that's still very different than what happens with the abortion pill — which causes a miscarriage. "If a pregnancy has already started, Plan B won't do anything to stop it," she says. Most patients don't use Plan B instead of regular birth control, she says.

Megan Kavanaugh, a senior researcher at the Guttmacher Institute, found the same thing when she looked at nationwide use. She says, "Most emergency contraception users have actually only used it once" as a backup plan — the way Katie Wilcox described using it.

Emergency contraception isn't cheap. On average, it costs $50. But it can cost as much as $90. Despite the expense, this type of contraception is slowly becoming more popular among women who don't want to get pregnant.

Just three days after announcing it would no longer fund cancer screenings at Planned Parenthood, the pink-ribboned breast cancer charity Susan G. Komen for the Cure abruptly reversed course today. But the Komen foundation's actions still leave many questions unanswered — not to mention a public relations challenge.

In a brief statement posted on the group's website, Komen founder and CEO Nancy Brinker apologized "for recent decisions that cast doubt upon our commitment to our mission of saving women's lives." She explained that Komen would revise the criteria that earlier in the week appeared to disqualify Planned Parenthood from receiving almost $700,000 in grants for breast cancer screening.

Komen's original justification for excluding Planned Parenthood from future funding was that the group was the subject of a congressional investigation. But in a conference call Thursday, Brinker insisted that the foundation's new funding guidelines had less to do with that and more to do with the fact that Planned Parenthood doesn't perform mammograms.

"Wherever possible, we want to grant to the provider that is actually providing lifesaving mammograms," she said.

The statement reversing course doesn't actually address the question of what kind of services Planned Parenthood provides; the women's health service does about 700,000 breast exams each year.

But Komen has backed down on how it defines an investigation. Now organizations can only be excluded from funding if those investigations are "criminal and conclusive in nature and not political," the statement said.

 

Komen officials wouldn't elaborate beyond the statement, but Planned Parenthood president Cecile Richards told reporters that as far as she's concerned, the organization is back in Komen's funding good graces.

"I've read this Komen statement; I think it's very clear," Richards said. "And I really take them at their word that this is behind us."

Planned Parenthood backers were also happy, but a little more grudgingly so.

"I guess I'm pleased that they've made this reversal, but it's really a shame that they made the decision in the first place," said Rep. Diana DeGette, D-Colo. "And it seems like the only reason they reversed it is because they came under so much pressure."

But not everyone is convinced that Komen has done a complete 180, particularly the anti-abortion groups that urged the cutoff of funding to Planned Parenthood in the first place.

"The Komen foundation did not say that Planned Parenthood could not seek funds, but that presently they were not qualified for the funds," said Kristi Hamrick of Americans United for Life, which is also a force behind the congressional investigation of Planned Parenthood. "And that has not changed."

Hamrick said that because Planned Parenthood doesn't do mammograms, it still shouldn't be eligible for future funding. "And should they wish to change that and buy mammogram machines and reapply, I'm sure the Komen foundation would consider it," she said.

But whether or not that's the case, the perception is that Komen reversed itself. And given the enormous backlash against the original decision, crisis communications professionals say that was probably Komen's only play..

"The brand has to come above all else," said Patrick Kinney of Connecticut's Gaffney Bennet Public Relations. "The Komen brand is a very well-respected one, and one that's associated with helping women and a leader in breast cancer research and treatment. So I think you need to put your brand and your mission over any criteria that was at the crux of this controversy."

Davidson Goldin, meanwhile, who practices crisis communications in New York, says Komen may have already damaged its brand by making what appeared to be a political decision.

"Just because they fixed the mistake quickly, which was the right and advisable thing to do, doesn't mean they can wipe away the impact of the mistake in the first place," he said.

And Goldin warned that just about the worst thing Komen can do now from a public relations point of view is to deny Planned Parenthood grants in the future, when it appears funding has been restored.

"Perhaps the only bigger mistake that Komen could make than the mistake they made the other day, would be trying to parse words and be cute and continue to deny funding after they've now given the world the impression they plan to restore funding," he said.