Something that looks good enough to eat can sometimes turns out to be a really big mistake.

Take those small, brightly colored single-use packs of laundry detergent that are becoming popular. To a curious toddler or small child, they look like candy.

But once inside childrens' mouths, the tempting packs can burst, releasing a concentrated blast of irriitating detergent. Already this year there have been at least 250 cases of illness from the packs reported to poison control centers across the country.

And the particulars of the illnesses are worrisome. Children vomit. More than you would expect, says Dr. Michael Beuhler, medical director of the Carolinas Poison Center in Charlotte, N.C. And the kids often get much sicker in a hurry. "Children grow excessively tired and lethargic," he tells Shots. Some then develop so much trouble breathing they need help from a ventilator.

"We don't have a good handle on exactly what's going on," he says. But the symptoms are worse than with other types of detergent that kids ingest. One hypothesis, he says, is that something in these detergent packs is acting like a strong, short-acting sedative.

Within a few hours those symptoms usually pass. The prognosis for kids is very good overall, he says, assuming they get prompt medical care. "It's really just a matter of supporting their breathing for that short period of time," he says.

There haven't been any reports of deaths, but an analysis of the data from poison control centers continues. The specific hazards posed by the detergent packs were only recognized this month.

Buehler says parents need to treat the detergent packs with respect. "They can't be left where a child can find them," he says.

For its part, Procter & Gamble, maker of Tide Pods, said Friday it would add a double-latch to the containers of pods as a safeguard. Those will show up in stores starting in July.

For what it's worth, injuries to kids from household cleaning products dropped by almost half to about 12,000 in 2006 from around 22,000 in 1990. Kids between 1 and 3 years old remain the most vulnerable, accounting for almost three-quarters of the cases.

You know all those lawsuits now pending around the country charging that the Obama administration's rule requiring most health insurance plans to offer no-cost contraception is a violation of religious freedom?

Well, a whole bunch of supporters of the rule are chiming in now to say that argument has no legal merit.

The dozen new suits, representing some 43 Catholic dioceses, universities and charities "have made a splash by virtue of their number, but when you take a moment to actually look at them, there's nothing to see," Sarah Lipton-Lubet, policy counsel for the American Civil Liberties Union, wrote in a blog post. "The rule is constitutional, it violates no federal law, and it's incredibly important for women."

 

Lipton-Lubet is talking about the rules issued in January (and amended in February to address the religious backlash) that require prescription contraception and sterilization services to be available without additional copays as part of most health insurance packages.

While those filing the lawsuits charge that offering the coverage (or even being forced to facilitate it) in violation of their religious belief runs afoul of the First Amendment's guarantee of freedom of religion, Lipton-Lubet points out that the Supreme Court has already weighed in on the question.

"The Free Exercise Clause does not require any exemptions from a neutral law of general applicability. As the Supreme Court held two decades ago, in an opinion authored by Justice Antonin Scalia, to do otherwise would be to create a system "in which each conscience is a law unto itself." Translation? If it applies equally and doesn't target any faith, it's not a First Amendment violation."

(Backers of the church challenges, however, point to a more recent case, a unanimous ruling this past January, where the justices said religious organizations should have broader hiring and firing power than other businesses.)

But even setting the Supreme Court aside, pointed out Ian Milhiser of the Center for American Progress, more than half the states already require contraceptive coverage. And the issue has already been litigated at that level by the Catholic church — and the challengers lost.

In 1999, in California, Milhiser wrote, "five of the court's six Republican justices held that, even if the law were examined under the strictest level of constitutional scrutiny, California's contraceptive access law is constitutional."

And even if the issues hadn't been litigated before, the current cases are premature, says Nancy Northup of the Center for Reproductive Rights. That's because the work on the regulations remains ongoing.

"This is the most cynical kind of political theater and nothing more," she said in a statement. "Rather than working constructively with the Administration and allowing the rulemaking process to reach a resolution, these groups have chosen to grab headlines with a political stunt that will only burden the courts with untimely claims."

But even though most religious-based organizations will have an additional year – until August 1, 2013 – to come into compliance with the new requirements, some are already taking action.

The 2,800 student Franciscan University of Steubenville in Ohio, for example, announced earlier this month that it would stop offering health insurance coverage for students this fall rather than comply with the mandate.

The needle and syringe are icons of modern medicine.

But a device developed at MIT to squirt medicines quickly and pretty much painlessly through the skin suggests that the future of medicine could be needle-free.

The idea is to shoot an extremely thin, extremely fast jet of medicine straight through skin and into muscle. "It's sort of like a laser beam," project leader and mechanical engineering professor Ian Hunter tells Shots.

But because the jet is so thin — he compares it to a mosquito's proboscis — it's unlikely to produce much pain. Details of the prototype are published in the journal Medical Engineering and Physics.

 

Needles, as we all know, can be quite painful, and it's estimated that at least 10 percent of the population has needle phobia. There's also the risk of accidental jabs, which can spread disease. Jet injections could avoid these problems.

Jet injection technology has been around for quite a while. It's been used in mechanical devices for more than a century (think of a car's fuel injector), and was first used to deliver vaccines in the 1960s. The technology even showed up on Star Trek as "hypospray." Nor is it the only needle-free alternative in the works for vaccines and other medicines.

But Hunter says this device has big advantages, thanks to some 21^st-century technology.

Existing medical jet injectors use a spring or other mechanical method to force liquid out. All the medicine comes rushing out at once, at a fixed speed and pressure. It gets the job done, but it's not very precise. The diameter of the jets also tends to be several times bigger than those from Hunter's device, causing more pain and raising the risk of infection.

Hunter's injector uses a piston made from a coil of wire wrapped around a magnet. A computer chip calls the shots for the injection, so to speak, allowing for millisecond-by-millisecond control over the speed and pressure of the jet.

Once the skin is penetrated with a quick burst, the injector can back off a bit to deliver a precise quantity of the drug, exactly where it's needed.

"I think that's the big difference between this device and other devices, is the degree of precision," Hunter says. "We have a degree of control that hasn't been possible before."

The new injector has yet to be tested on people, but has been used on animals, like sheep, without apparent discomfort. "The sheep did not seem to even be aware that they were being injected," Hunter says. But it will be a few years yet before the injector could be ready for use at home or in a hospital near you.

In the meantime, Hunter's team will work on additional features that take advantage of the injector's built-in computer. They want to combine it with a separate device that can sense the thickness and elasticity of the patient's skin, so the injector could adjust its speed and pressure accordingly. It could also tell the difference between the patient's skin and that of the health care worker, to prevent accidental self-injections.

Nurses are the backbone of the hospital — just ask pretty much any doctor or patient. But a new poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health finds 34 percent of patients hospitalized for at least one night in the past year said "nurses weren't available when needed or didn't respond quickly to requests for help."

Since nurses provide most of the patient care in hospitals, we were surprised at the findings. We wanted to find out more. We wanted to know what was going on from nurses themselves. So we put a call-out on Facebook.

We received hundreds of responses and read them all: piles of stories about nurses feeling overworked, getting no breaks, no lunches and barely enough time to go to the bathroom. Even worse, many nurses say breaks and lunchtimes are figured into their salaries and deducted, whether they take them or not.

 

When we asked nurses who responded to our call-out if we could interview them for broadcast, most said no. They worried about their employers' reaction. Many would be interviewed only anonymously.

"We're always afraid that something will happen to our patients during the time we're off the floor," one nurse says, "and I personally don't feel comfortable leaving them unless I know that a co-worker is actually looking after them during the time that I'm off the floor."

This nurse says she rarely stops. Not for 12 hours. She's an emergency room nurse in a busy urban hospital. The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more — often eight, if she's covering for a colleague taking a lunch break. She says there are times when she can't leave patients' bedsides.

"Maybe I was injecting medication that you have to push slowly over five to 10 minutes so it doesn't harm them," she says, "and I can see the call bell going off in the hallway, and there's no way I could respond to that."

The only option is to literally yell down the hallway and hope another nurse hears her and responds to the patient call bell. There have been times when she has driven home at the end of her 12-hour shift, white-knuckling the steering wheel and wondering whether she "missed something."

Another nurse likens her job to "spinning plates," just "praying," she says, that one doesn't fall. "And these are human beings," she says, "not products on conveyor belts."

Stories like this suggest there's a shortage of nurses. But Linda Aiken, a researcher and professor of nursing at the University of Pennsylvania School of Nursing, says that's not the case. There was a shortage about a decade ago, she says. Today, that has changed. The number of RNs graduating has increased dramatically over the past decade, but many can't find jobs.

"There's not an actual nursing shortage," Aiken says. "There's a shortage of nursing care in hospitals and other health care facilities."

Nancy Foster, a vice president with the American Hospital Association, says hospitals are facing big financial challenges.

"In part, it's because our patients are sicker — coming to us with more intense diseases and disorders than they did 25 years ago," she says. "In part, it's because there's so many more medications and devices and other interventions at our fingertips; we can help many more patients and restore them to health."

That is terrific, of course, but it's not cheap. Any reduction in nurse staffing at a time of increasing patient demand jeopardizes patient care, Aiken says.

"Nurses are the surveillance system in hospitals for early detection and intervention [to save patients' lives]," she says.

According to one nurse, little clues from patients are critical.

"I mean, you might walk into a room, and they are breathing and answering your questions," the nurse says, "but if you look at their neck and the jugular vein is slightly distended ... taking the time to pick up on the small details like that are the early warning signs that somebody is getting sicker fast."

In our poll, 51 percent of those who were hospitalized overnight in the past year said they were "very" satisfied with their care. An additional 32 percent said they were "somewhat satisfied" — some things could have been better. Only 16 percent said they were dissatisfied.

It's not all bad news, but with a rapidly aging population, the fear is that the nursing staff will be stretched even more thinly. Plus, while our call-out to nurses on Facebook was not scientific, the NPR/RWJ/Harvard poll is, and it does point to significant problems when it comes to the availability of nurses at the hospital bedside.

Your chances of surviving a sudden heart attack may depend on where you live; some American cities have survival rates five times higher than others. One difference can be 911 dispatchers.

If they coach someone over the phone to give CPR, the chance of surviving goes up. There's now a push to make it universal, but some cities are slow to implement the necessary training.

Becky Cole was eight months pregnant with her fourth child when she collapsed against the bathroom door. It was January 2011 in the Seattle suburb of Woodinville.

"I got up to go brush my teeth, and that's the last thing I remember," she says.

Her husband, Jon, heard the loud crash and called 911.

"She's fallen down, and she doesn't look like she's breathing. I need an emergency ambulance right now," he told the dispatcher.

 

What happened next is typical in many cities across the country, but it's not nearly as universal as you might expect. When Jon Cole explained that his wife was unconscious and appeared to not be breathing, the dispatcher instructed him on how to perform CPR.

He switched to speakerphone and the dispatcher led him through the process, step by step.

"I was so worried about doing it wrong that I clung to every word that dispatcher said. Because this is my wife, this is my best friend," he says.

Soon, the medics arrived and took over, but Jon Cole had kept her blood flowing with CPR for six minutes.

"Every minute of delay, the likelihood of survival falls by 10 percent. So, you can do the math," says Dr. Mickey Eisenberg, medical director for emergency response in King County, Wash.

Back in 1981, he launched an experiment in the Seattle area, using emergency dispatchers to coach CPR. He was inspired by a pioneering program in Phoenix. He says one hurdle to giving instructions over the phone, in a panic situation, is using the right words.

"Such things as 'center' versus 'middle' versus 'half-way down.' All these things evoke different images," Eisenberg says.

Another huge challenge is figuring out for sure, over the phone, that the person's heart really has stopped. In many cases, there's an illusion of breathing, like a "last gasp." That happened with Jon and Becky Cole. Becky Cole gasped, and her husband told the dispatcher she was trying to breathe.

"That doesn't sound like breathing," the dispatcher told him. "We're going to have to still keep on going on this, OK?"

Eisenberg says recognizing normal breathing is the focus for a lot of training at the 911 call center.

"To an untrained person, they think the person is breathing, but they are not breathing normally," he says.

The call center training paid off right away. CPR rates in those first critical minutes went up by 50 percent across King County. Hundreds of cities have adopted similar programs.

But many still have not, and some have been slower to come around. For example, in Oak Creek, Wis., outside Milwaukee, paramedic Jerry Biggart says he used to pester his bosses about starting a program, but they gave him excuses. The said they would do it once the state mandated it, but otherwise they told Biggart they did not have the resources to do it.

Today, those bosses are retired, and Oak Creek decided it's actually not that expensive to train everyone in the call center. Plus, CPR has gotten simpler and easier to explain, since bystanders don't need to perform mouth-to-mouth anymore. Still, the dispatchers were concerned at first.

"Just because you're talking to people during the most critical incidents," Biggart says, "but it turns out that they really enjoy playing in that role."

And possibly saving a life — while giving a bystander a way to be helpful, instead of just waiting anxiously for the medics to arrive. In fact, Biggart thinks every state should make it a requirement for the local emergency dispatch systems.

The American Heart Association has stopped short of proposing regulations, but recently urged every city and county to voluntarily have its 911 dispatchers coach CPR over the phone.

Dr. Brooke Lerner, a professor of emergency medicine at the Medical College of Wisconsin, says having operators give coaching is a good way to increase the number of bystanders who take action.

"We need to move people away from feeling like if they haven't had a class that they're going to hurt somebody," she says, "to understanding that if they don't do something, people are going to die — and that it's as simple as putting your hands in the middle of their chest, and pushing hard and fast."

To physician Larry Shore of My Health Medical Group in San Francisco, it's no surprise that patients give doctors low marks for time and attention.

"There's some data to suggest that the average patient gets to speak for between 12 and 15 seconds before the physician interrupts them," Shore says. "And that makes you feel like the person is not listening."

A doctor's impatience, though, is often driven more by economics than ego. Reimbursement rates for a primary care visit are notoriously low, and Shore laments the need to hustle patients in and out.

 

"When you have that pressure to see three, four, maybe five patients an hour, you can't wait for the exposition of the patient's story. Which is exactly what you should do. But you can't," he says.

A new poll by NPR, the Robert Wood Johnson Foundation and Harvard School of Public Health found about 3 out of 5 patients think their doctors are rushing through exams. That's nearly the exact same number as three decades ago.

NPR's survey asked people the same questions as another poll did back in 1983. We found doctors got better marks on some patient interactions. For example, 64 percent of people said doctors usually explained things well to them, versus 49 percent in 1983. They also are more likely to say doctors are trying to hold down medical costs.

But when it comes to time, there is a stubborn feeling that doctors are in too big of a hurry. That is troubling — and frustrating — to physicians like Shore who feel that they are already packing more into every workday and are stretched thin by paperwork.

"I think a lot of physicians in smaller practice realized they were becoming both the clerk and the HR and the accounts payable and the accounts receivable and the office manager — things which they may not have an interest in and certainly had no training for," Shore says. But he says many doctors just didn't have the cash flow to hire administrative staff.

Two months ago, Shore opened a new office in which he's trying to break from the day-to-day grind. Appointments are now 20 minutes, instead of 15. And he's hired several other doctors to spread the workload around. But there's also been a shift in his thinking about the way he provides care to his patients: He's trying to treat them more like customers, and focus on making them happy.

"Who are your customers? What do they want? Try to meet those needs," Shore says.

And what his customers want, he believes, is access to him and his staff — how they want it, like over email, and when they want it, like after-hours. To do that, Shore has given up on the model of the doctor as a lonely superhero. Instead, everything is about the team.

Shore hunkers down each morning with his medical assistants for a "care huddle," a rare, quiet moment to strategize about the patients coming in that day. Those assistants now play a bigger role in care, renewing prescriptions and briefing the doctor before he enters the exam room. A check-out assistant guides "customers" out the door.

Shore is trying to make up the financial difference of hiring these additional people by getting the office manager to badger insurance companies to pay more money per patient for better patient health.

That doesn't include patients getting any test or treatment they demand. But Shore's younger colleague Payal Bhandari sounds as much a marketer as family physician when she talks about her hopes for a better assembly line.

"It will actually produce a much better product, where you can actually listen to patients," Bhandari says. "And the physician is a lot happier because they don't feel like, 'Ugh! Another person!' They can actually do their job, but there are others helping them in the process."

Will these improvements be enough to move the stubborn poll number? Shore is optimistic, a belief reflected in a fortune cookie message taped to his office window: It says: "Be not afraid of growing slowly. Be afraid only of standing still."

Varney is a reporter with NPR member station KQED.

Forgive me, if you're suffering from PSA policy fatigue.

But there are a few more things I thought you might want to know about the new guideline from the U.S. Preventive Services Task Force that says men of all ages should forgo routine blood tests to detect prostate cancer.

Research from Johns Hopkins suggests the chances that doctors will listen aren't great.

In case you missed it, which I doubt is possible, the influential task force concluded that the harms from PSA testing outweigh the benefits when it comes to routine use. The recommendation left the door open for men and their doctors to talk things over and go ahead with the test if they agreed it would be worthwhile.

 

Urologists are hopping mad about the guideline. They're the ones who treat prostate cancer once it's found. But how do internists, family doctors and others who order the initial screening tests feel?

The Hopkins researchers surveyed some after a draft version of the task force guidelines was released last October. Among the more than 100 providers of primary care who were familiar with the draft guidelines, only 1.8 percent said they would no longer order PSA tests. And just 21.9 percent said they were much less likely to order the tests. The findings were published in the Archives of Internal Medicine.

Why? Nearly three-quarters of the respondents said patients expected regular PSA screening to continue. Two-thirds said, essentially, it would take too much time to explain. And about half cited malpractice concerns.

Other details on their findings about barriers to change in the use of PSA tests were published in Cancer.

The American Cancer Society's Dr. Otis Brawley, who supports the task force's recommendation, told NPR reporters Tuesday: "I'm going to predict that people will continue to be unscientific."

The drive to wipe polio from the face of the earth is in jeopardy.

Afghanistan, Nigeria and Pakistan are the only three countries left where poliovirus remains endemic. But work to put the paralyzing virus on the ropes there is in danger of failing. Cases in all three countries jumped last year.

Weak public health systems, armed conflicts and corruption have hurt vaccination efforts. Now leading public health officials have proposed an emergency plan of action to get things back on track..

"Polio eradication is at a tipping point," says a report published by the World Health Organization today. "If immunity is not raised in the three remaining countries to levels necessary to stop poliovirus transmission, polio eradication will fail."

 

The emergency plan calls for stepped-up vaccination campaigns in areas of all three counties where polio poses the biggest threat.

Another goal: raise more money for eradication. There's about a $1 billion shortfall in funding for eradication.

Despite setbacks, there's also been reason for hope. New cases are at an all-time low — 55 cases so far this year.

And in January, India marked a year without a new case of polio. That's a milestone in the global effort to eliminate polio. It wasn't that long ago that India reported as many as 100,000 cases a year.

Medical marijuana is legal in 16 states, and that number is expected to grow. But these state laws put colleges in a bind. That's because under federal law, marijuana is still illegal. So colleges that let students make use of their pot prescription on campus risk losing their federal funding.

For 25-year-old University of Maine junior Robyn Smith, this situation has led to a new kind of "reefer madness": Even though he has his doctor's authorization to use medical marijuana, when he self-medicates, Smith either goes home or retreats to his SUV, which he parks across the street from the university so that he doesn't violate school policies on smoking and drug use on campus.

 

Smith is an Army veteran who spent 15 months in Afghanistan; he has been diagnosed with anxiety and a joint disorder. He also suffers from severe and frequent migraines. He has been prescribed a half-dozen painkillers and other drugs to ease his symptoms — and he's free to bring those on campus. But Smith says he doesn't like the way they make him feel. He also worries about becoming dependent on them. Instead, he prefers medical marijuana.

"I was told to use a very small dose," he says. "So I took two or three hits, and I have to say that it made me feel quite a bit better than the painkillers or the migraine medication or the muscle relaxers."

University administrators say they sympathize, but they can't afford to violate the Drug Free Schools and Communities Act and the Drug Free Workplace Act by allowing Smith or other student patients to use pot.

"It's not a question of right or wrong, ethical or not ethical, any of that," says Stephen Nelson, who oversees student misconduct at the University of Southern Maine. "Right now, we just can't run the risk of losing federal dollars."

He says the university receives more than $60 million worth of Title 4 financial aid. Couple that with research funding, and Nelson says hundreds of millions of dollars could be withheld. Allen St. Pierre, executive director of the group NORML, the National Organization for the Reform of Marijuana Laws, calls that scenario "far-fetched."

"There's no historical precedent," he says, adding, "If a student patient can have really dangerous and addictive drugs like Percocet, Vicodin and morphine, then there's no moral or pharmacological reason why they can't have a mildly psychotropic vegetable matter."

Jill Creighton of the University of Colorado, Denver, says colleges don't have much choice. Creighton has been presenting on the topic of medical marijuana to college administrators around the country for the past several years.

"Some student codes of conduct are much more lax about marijuana use in general, but the assumption is if we were to allow medical marijuana on our campuses, we would then be jeopardizing our Title 4 funding," she says.

Requests for comment from the U.S. Department of Education were not returned. In a written statement, Alison Price, a spokesperson for the U.S. Department of Justice, said, "The Department of Justice is focusing its limited resources on significant drug traffickers, not seriously ill individuals who are in compliance with applicable state medical marijuana statues."

Robyn Smith says he won't wait for his university to relax its policy. He plans to stop taking classes on campus and stick with online courses next year.

The dust is nowhere near settled over advice that men of all ages should forgo a routine blood test to detect prostate cancer.

The harms, such as false alarms and unnecessary surgeries that leave some men impotent and incontinent, outweigh the benefits of the PSA test, according to the U.S. Preventive Services Task Force.

So the influential group this week made an official recommendation against a regular PSA.

To be sure, if doctor and patient want to go ahead with a PSA test, that's OK, as long as there's been a frank discussion about the pros and cons. "The decision to start or continue screening should be an informed one that reflects an understanding of the possible benefits and harms and should respect an individual man's preferences," as a summary for patients puts it in the Annals of Internal Medicine.

Love or hate the recommendations, will they stick?

 

Probably not.

Previously, for instance, the task force had recommended against PSA testing of men over 75. And, as the case of 81-year-old financier Warren Buffett showed recently, that advice has not been universally heeded.

"I'm going to predict that people will continue to be unscientific," Dr. Otis Brawley, chief medical officer of the American Cancer Society, told a group of reporters and editors at NPR in Washington Tuesday. And, among other things, that means doctors will "continue to practice faith-based medicine" instead of one rooted in the best evidence, he said.

The latest guideline shouldn't be such a surprise. The American Cancer Society has been saying since 1997 that the evidence for benefits from PSA screening haven't been proved.

And even the American Urological Association, which expressed outrage over the task force's latest advice, has acknowledged in prior advice to doctors:

"Patients need to be informed of the risks and benefits of testing before it is undertaken. The risks of overdetection and overtreatment should be included in this discussion."

But habits haven't changed, Brawley said, adding, "Nobody is listening to us."

Ultimately, Brawley says men and their doctors need a better test than PSA, one that can detect prostate cancers that both can be cured and need to be cured. Many men with slow-growing prostate cancers will die of other causes.

For more on the fallout from the recommendation, see this roundup of a chat on Twitter Wednesday featuring Brawley, Nancy Metcalf from Consumer Reports and urologist Deepak Kapoor. Liz Szabo, health reporter at USA Today, moderated the lively discussion.

No one likes to go to the hospital.

But some hospitals around the nation are trying to make their patients' stays a little less unpleasant.

They're members of an organization called Planetree, which was founded by a patient named Angelica Thieriot, who had a not-so-good hospital experience back in the 1970s.

"She herself became very ill and was hospitalized," says Planetree President Susan Frampton. "And while she felt she got good clinical quality care, she was really horrified by the human experience that she had. So she founded Planetree with a very lofty goal: to change the health care system to be more patient- and family-centered. And that has been our mission ... for the last three and a half decades."

 

Today Planetree has certified, or "designated," 30 hospitals and nursing homes in the U.S. and four countries as meeting a specific list of criteria that qualify them as providing truly patient-centered care.

Among the 14 Planetree hospitals in the U.S. is Fauquier Hospital, a 97-bed facility in Warrenton, Va., on the outskirts of Washington, D.C.

CEO Rodger Baker says there was an element of business to his decision to transform his hospital into a more patient-centered place. "We felt it could differentiate us in a market with giants around us," he says.

But mostly he wanted to make the change because he was convinced that something was wrong with the way hospitals were treating patients.

"We put patients in rooms with gowns that don't have backs on them; we strip them of their dignity; we don't explain things to them. And that's really not what they want," he says.

Baker says he first heard of Planetree in the early 1990s. But he had his epiphany while listening to the head of a Planetree hospital in Oregon, Mid-Columbia Medical Center, several years later.

"He talked about all the things they did in that hospital," Baker remembers. "And for some reason it seemed to click with me in terms of it was the right thing to do ... He talked about healing the whole person, dealing with individuals in terms of not just doing the science, but also healing the whole body, in terms of the spirit as well."

Indeed, Fauquier, which achieved its Planetree designation in 2007, offers a wide array of services not usually found in your average hospital.

Not only is every one of its patient rooms a private one, it has food cooked and delivered to order, some from its own organic garden.

The walls are decorated with local art, which is sold monthly to raise funds for the hospital's foundation. And the hallways are carpeted, to keep the noise level down.

"We have massage therapy; we do hand massages," says Lisa Spitzer, the hospital's concierge. "We bake cookies; every week we have volunteers come in once a week for this wonderful vanilla aromatherapy."

Spitzer — whose job is essentially to make sure that patients, staff and families have whatever they need, whenever they need it — describes Fauquier as "having a different energy about it" since it adopted the Planetree model.

Doctors and patients seem to agree.

Interventional radiologist Adam Winick admits he was a skeptic at first.

Winick says he was particularly concerned about doing away with set visiting hours, which among other things gave patients' families open access to the intensive care unit.

"My own little area that I was most worried about was in a code setting when the patient's heart stops. And having the family members standing there watching I felt would traumatize the patients' families, because they don't understand what's going on," he says.

But that hasn't turned out to be a problem after all: The hospital always makes sure a staff member is on hand to explain to the family what's going on in those situations.

Winick also says that communication has improved between patients and staff, and between doctors and nurses as a result of the changes. Poor communication in the hospital was a key complaint in the poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

"It puts everybody in the mindset that I'm doing this for the patient," he says. "A doctor doesn't mistreat a nurse out of anger because he's doing it or she's doing it — asking a question for the patient's benefit."

Patients also seem to appreciate what they see as more personal care.

"It's friendly, it's more like home," says Marianna Traczuk, who's been in and out of Fauquier several times being treated for ovarian cancer. She says she prefers Fauquier to the hospital where she used to get care in Maryland. "It's nice to have someone walk in and say, 'Hi, how are you today?' instead of walking by and acting as if you're invisible."

And how much more does all this pampering cost?

Actually, unlike many hospitals, Fauquier doesn't charge extra for private rooms or fancy food.

And Planetree President Susan Frampton says that providing the kind of care that involves patients and their families, and that patients actually want, can cut costs. She says that one hospital system that has some hospitals in the Planetree system and some that aren't compared its orthopedic patients.

"And they found that the length of stay was actually shorter" in the Planetree hospitals, she says. "People healed quicker, they were discharged more quickly, and so the cost of care came down. So [it was] interesting to counter that misbelief that care has to be more expensive if it's done in a patient-centered context, or in a place that's more pleasant to be in."

But health quality experts like Don Berwick, the former head of Medicare, warn that the most important part of places that are designated by Planetree aren't the fancy extras like alternative therapies or fancy food — it's the actual involvement of patients and families in their own care.

"The amenities are nice, of course," he says. "But what really counts in patient-centered care is that the more patients and families and their loved ones participate in their own care, really play an active role in the care itself, the better the care gets. Outcomes get better, costs fall, and satisfaction increases. So this isn't about the amenities; this is about the core of health care."

Berwick and other quality experts also warn that being a patient-centered facility doesn't itself guarantee high-quality care. Patients still have to make sure the medical staff is following proper guidelines for care and getting those good outcomes. But they say that keeping the patient and family highly involved in their care is one important indicator of a good hospital.

When we first kicked around the idea of asking people to share their opinions about compensating organ donors, it was pretty clear that we were on to something. Everybody in the newsroom seemed to have a strong feeling about it.

Our NPR-Thomson Reuters Health Poll found that about 60 percent of Americans would support modest compensation in the form of credits toward future health care needs of people who made donations while alive of kidneys, bone marrow and portions of liver.

Bioethicist Dr. Stuart Youngner, from Case Western Reserve's med school, and I joined Neal Conan on NPR's Talk of the Nation Tuesday to chat about the findings and hear from people across the country.

 

The callers helped give voice to the core issue. There's a persistent shortage of organs in this country, and it's getting worse. The rate of organ donations has fallen 2 percent since 2005, and the waiting list of recipients has grown 25 percent, Youngner pointed out.

Federal law bans financial incentives for organ donations. But is it time to reconsider?

Andrew from New Orleans told us about his father's search for kidney after a car accident 10 years:

"And I know we're desperately searching and on the lists and have had no avail. But I know if we had the chance to actually buy one, you know, and get us off of that waiting period, we would jump all over the - jump all over it to get him the kidney."

Taber (spelled phonetically by our transcript service) weighed in from Tuscon with his experience as both a donor and recipient. He's got ligaments in one knee from a cadaver, and he's given bone marrow. When he gave bone marrow, he was out of work. All his expenses were covered, but he said there can be "hidden expenses," such as lost earnings or travel costs. So, he said:

"I think I personally would be against any kind of compensation for a deceased donor. But for living donors who actually have expenses and the like, I can definitely see some sort of limited compensation making a big difference."

By email, Michael in Casper, Wyo., said he's willing to donate his organs free of charge once he dies, but not before:

"I would not be willing to sell any of my organs. As soon as I'm clinically dead, then they can have what can be of use. But up until that point, I will keep what I have no matter what the monetary compensation might be."

For more, listen to the show or read the transcipt.

Infections with the bacterium Clostridium difficile hit record numbers in recent years. Now there's evidence the hard-to-treat infections are becoming a problem for children.

The infections often strike the elderly, especially those who've been taking antibiotics that clear out competing bacteria in people's intestines. People sickened by the bug have persistent diarrhea that can, in severe cases, lead to dehydration.

C. diff, as it's known, is resistant to common broad-spectrum drugs and used to lurk mainly in hospitals. But as NPR's Rob Stein reported in March, more and more people are contracting C. diff elsewhere.

Mayo Clinic researcher Sahil Khanna and his colleagues have found that children are contracting the disease at ever-higher rates, too. And most of them are being infected outside of hospitals. He presented the findings at the annual Digestive Disease Week medical conference ending today.

 

Although C. diff infections were first documented in the late 1970s, Khanna tells Shots, "there haven't been any studies of children in and outside the hospital." So he and fellow researchers examined data from Olmsted County, Minn., where they had access to detailed records for the entire community, going back decades.

What they found, Khanna says, is a huge increase in infection rates. Between 2004 and 2009, the rate of C. diff infections among children was a whopping 12 times higher than it was between 1991 and 1997. Most of the infected kids had been taking antibiotics, which was no big surprise. But what was surprising was that 75 percent of them became infected outside of the hospital.

It's important to note that these results haven't been published yet. Khanna says a manuscript is just about ready for submission to medical journals.

The latest findings do jibe with a previous study, published in January, in which Khanna and colleagues found that about 40 percent of all C. diff infections are cropping up outside hospitals. The people infected out in the community also tended to be younger.

The CDC estimates that there are more than 300,000 cases of C. diff in the U.S. each year, causing about 14,000 deaths. A more toxic, more antibiotic-resistant strain appeared in 2000 and caused outbreaks in several cities, but Khanna says its not clear to what extent that strain might be related to the increases he's documented.

One way to avoid C. diff is to minimize the use of broad-spectrum antibiotics, which kill off healthy bacteria in your system and allow the resistant C. diff to move in. "To not take antibiotics if you don't need them, I think that's the big one," Khanna says. When a patient does need to treat an infection, he says, "they should probably be given targeted, narrow-spectrum antibiotics."

Another tip: wash your hands with soap and water. Alcohol-based hand sanitizers won't do the trick with C. diff.

Amber Cooper and her husband were doing OK. They had jobs, a healthy 5-year-old son, a house in Riverbank, Calif., and health insurance from her job in the accounting department of a small manufacturing company.

Then one day everything changed.

"We were in a conference room ... and I had heard rumors but didn't know if it was true, and I started crying in front of everyone and actually had to excuse myself to gather myself together and go back in. It was devastating for me," Cooper said.

Devastating because the rumors — her worst fears — had come true. She was in that conference room for a meeting about her health insurance.

Cooper had a liver transplant when she was 10. She takes a drug twice a day so her body won't reject her liver.

 

"Every year my company changes the insurance. And instead of giving us three different choices for insurance plans, they were changing to one, which was a high-deductible plan with no prescription coverage," she said.

Cooper was stunned. Her anti-rejection medicine costs way more than she could afford on her own — more than $1,000 a month.

Cooper, 30, started a frantic search for help. Finally, she found the HealthWell Foundation, which was willing to pay for her medication. But she still couldn't afford the $300 blood test she needs every month to make sure she's not rejecting her liver.

"It is scary because the only way to tell if you're going to go into rejection is by the blood work. Your numbers will be a little bit crazy, and then the doctors will be like, 'OK, you need to get in and we need to check you out and make sure you're OK.' So I really took a risk not getting that blood work done. But I couldn't afford to get it done. I really couldn't," she said.

What happened to Cooper is happening more and more these days.

Health insurance has been changing dramatically "beneath the surface," said Drew Altman, president and CEO of the Kaiser Family Foundation, a private, nonprofit, nonpartisan research group. "In plain language, it's becoming skimpier and skimpier and less and less comprehensive."

Paul Fronstin of the Employee Benefit Research Institute says that is the trend nationally.

"Deductibles have gone up. Copays have gone up. You see cost-sharing for out-of-network services have gone up," Fronstin said. "It seems to have accelerated in the last few years. Health care is just continuing to take a bigger bite out of take-home pay."

So even people with insurance are paying thousands of dollars out of pocket before their insurance kicks in. And even when it does, insurance picks up less than it used to — often a lot less.

More than 1 in 5 Americans had a problem getting insurance to pay for a hospital, doctor or other health care in the past year, according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

Altman says this comes as many families are struggling to get by.

"This affects not only how people seek health care — they're more reluctant to get it if they can put it off. But it also affects family budgets in a very real way, especially as we're still coming out of recession and families are still crunched by a weak economy," Altman said.

Cooper's family has stopped taking trips, eating out, fixing up their house or spending money on anything else they don't have to. Their son gets by with hand-me-downs, she said.

"He's 5 and growing out of everything. I haven't been able to buy him any clothes and shoes. Those are things I haven't been able to purchase because of the increase in the health care," she said.

And Fronstin says the weak economy is driving more and more companies to cut back on coverage because of simple math: It's the only way they can keep up with rising health care costs.

"Employers are trying to manage those costs. They're trying to keep those cost increases as close to inflation as possible. And they're doing everything they can to get their workers so that they think twice about the health care that they are using," Fronstin said.

Cooper is just grateful she's getting her drugs every month. And she started those monthly blood tests again when her company changed insurance again this year. But it's still not as good as it used to be. So she and her husband don't go to the doctor when they get sick if they can avoid it. The same goes for their son.

"There were a couple of times where he got sick where I just tried to do the best I could with what I had, whether it was children's ibuprofen or cooling him down with cool rags and that sort of thing," she said.

She can't help but worry about the next company meeting about her family's health plan.

"It changes every year, so I really have no clue what's going to happen next year and with them making that change, I really don't know what to expect every year," she said.

A big study of a colon cancer test called flexible sigmoidoscopy may provide a good example of how a cheaper, easier-on-the-patient and possibly better technology isn't always the one American doctors choose to use.

Over the past decade or so, sigmoidoscopy has been largely abandoned by the doctors in the U.S. in favor of colonoscopy to detect and prevent colon cancer. Indeed, colonoscopy largely gets the credit for a 30 percent drop in colon cancer incidence since the 1980s, much of it the past decade.

But a lot of Americans over 50 — about 40 percent — aren't getting colonoscopy exams, which require an unpleasant colon-purging ordeal beforehand and light anesthesia while the gastroenterologist snakes a tube through the 6-foot length of the colon.

 

By comparison, sigmoidoscopy examines only the last two feet of colon. It doesn't require such rigorous prep or anesthesia. It takes less time and costs hundreds of dollars less. And it has a lower risk of side effects, such as perforation of the colon.

The new study of sigmoidoscopy versus "usual care" in 155,000 Americans shows that those in the "scope" group had 21 percent fewer diagnoses of colorectal cancer and were 29 percent less likely to die of it.

(In absolute terms, there were 12 colorectal cancer cases in the screened group versus 15 who got usual care per 10,000 people followed for a year. The cancer death rate was 3 per 10,000 person-years among those who were scoped, versus 4 in the comparison group.)

In fact, the benefits of sigmoidoscopy were probably bigger than that because nearly half of the "usual care" group also got scoped. That diluted the difference between the two groups.

The study, paid for by the National Cancer Institute, was unveiled on Monday at the Digestive Disease Week conference in San Francisco and published online by the New England Journal of Medicine.

Now that there's gold-plated evidence that a cheaper, easier colon cancer screening test prevents cancer and saves lives, you might expect the balance might shift away from colonoscopy, at least a little bit. After all, "no randomized clinical trial proving that colonoscopy can reduce cancer mortality has yet been published," as Dr. John Inadomi of the University of Washington notes in an accompanying editorial.

But it's not that simple. Gastroenterologists in the U.S. already have a substantial investment (in all senses) in colonoscopy. Some say that scoping only the left side of the colon, as sigmoidoscopy does, is like doing mammography on only one breast. You might be missing something important.

On the other hand, 2 of 3 precancerous colon polyps arise on the left side. And it's not clear how good colonoscopy is in identifying and removing right-sided polyps, which are flatter.

These right-sided polyps might be biologically different too, perhaps giving rise to cancers that are more aggressive and less amenable to cure. That could undercut the effectiveness of colonoscopy — even if they're found and removed, it might make less difference than removing left-sided polyps.

Still, many doctors would be nervous about sigmoidoscopy's inability to find deeper polyps. Authors of the new study estimate that sigmoidoscopy found more than 1,000 tumors but missed 97.

"We missed some tumors, so I think that having colonoscopy is probably the better first test," study leader Christine Berg told Shots. "But if you don't want to have a colonoscopy and would feel more comfortable having a flexible sigmoidoscopy, you should have it."

Dr. Michael LeFevre, a professor of family practice and community medicine at the University of Missouri, thinks many people would prefer it.

"The prep is dramatically different," LeFevre says. "Compared to that gallon of liquid you have to drink the night before your colonoscopy that makes you feel like you're about to explode, with sigmoidoscopy it's typically a laxative the night before and a couple of enemas in the morning and you're ready."

And as Dr. Inadomi of the University of Washington says: "The best test is the one that gets done."