The shortage of organs for transplant continues to grow, despite years of work to get more donors on board.

Facebook jumped in this month by making organ-donation status something you could add to your profile. And the social media giant made it easy to connect with a registry to sign up as a donor.

Federal law bans payments for organs. But given the need, we wondered what Americans thought about compensation for three kinds of donations that can be made while people are alive: kidneys, bone marrow and a portion of liver big enough to help someone whose liver is failing.

So we asked 3,000 adults across the country as part of the NPR-Thomson Reuters Health Poll, and here's what they told us.

 

If compensation took the form of credits for health care needs, about 60 percent of Americans would support it. Tax credits and tuition reimbursement were viewed favorably by 46 percent and 42 percent, respectively. Cash for organs was seen as OK by 41 percent of respondents.

Among people who said some form of compensation was acceptable, 72 percent said it should come from health insurers, followed by private charities at 62 percent and the federal government at 44 percent.

For all forms of compensation, rates of support tended to fall among older respondents.

There's been longstanding resistance to compensating donors financially in this country. There are concerns about exploitation and also worries that even small amounts of compensation would undercut a system that depends on altruism.

But it may be time to reconsider, Dr. Stuart Youngner, a bioethicist at Case Western Reserve University's med school, told Shots. "I think the market has become such an important guiding principle in so many areas of lives, including health care, that it becomes harder to say why shouldn't a person who donates organs make some money too," he said. "Altruism is very, very important, but in this case the lives of people are very, very important."

After reviewing the results of our poll, Youngner said it would have been stronger if we had asked people whether or not they were registered as organ donors and then investigated how financial incentives might have influenced their decisions.

As it was, we asked about three different donations, and the results came in about the same. About 87 percent of respondents in favor of compensation though it was OK for kidneys. About 85 percent felt that way about livers, and 83 percent for bone marrow.

It seems worth noting that the 9th U.S. Circuit Court of Appeals in March affirmed an earlier decision that compensating people for marrow cells drawn from their blood wouldn't run afoul of the federal law banning payment for organ donations.

OK, so let's say donors could be compensated. How much should it be? Thirty-seven percent of respondents said it should be less than $10,000, and 27 percent said it should be more than $10,000 and less than $25,000.

Finally, we asked if there is a difference between compensating people for organ donations compared with buying them outright. Around 40 percent don't see one. Sixty percent of people said compensation isn't the same thing as a purchase.

"It's clear they're saying there is a difference," Dr. Ray Fabius, chief medical officer for Thomson Reuters' health unit, told Shots. And, overall, the results show that a majority believes "any living donor should be recognized, and it should be handled by insurance companies," he said.

The telephone poll across the country was conducted during the first half of February. The margin for error is plus or minus 1.8 percentage points. Click here to read the questions and complete results. You can find the previous polls here, or by clicking on the NPR-Thomson Reuters Health Poll tag below.

U.S. government spending to fight HIV/AIDS in developing countries is also preventing death from other diseases, a new study finds.

Some experts worry the billions of dollars the United States spends to treat people with HIV in poor countries may crowd out prevention and treatment of other illnesses.

But the findings of a study just published in JAMA, the Journal of the American Medical Association, suggest the opposite. The analysis indicates the President's Emergency Plan for AIDS Relief, or PEPFAR, has had substantial spillover benefits.

Stanford's Dr. Eran Bendavid, lead author of the study, says deaths from all causes dropped nearly 20 percent over five years in nine African countries where PEPFAR operates.

 

That works out to nearly three-quarters of a million lives saved. Many would have died from other diseases. Bendavid thinks that's because PEPFAR improved the general quality of health care.

In an editorial about the study, the University of Pennsylvania's Dr. Ezekiel J. Emanuel says the report "is welcome news in helping to document the even greater benefits of PEPFAR not only on HIV/AIDS but on overall mortality in countries." But, he writes, it's fair to ask: "Is PEPFAR worth it?"

From 2003 to 2008, $20.4 billion was poured into PEPFAR. And during the three years that ended in 2011, more than $20 billion more has been given to PEPFAR, he writes, which has helped bring the number of people to receiving antiretroviral drugs for HIV/AIDS to 4 million.

Other health programs of value aren't getting funded to the same tune. "The fundamental ethical, economic, and policy question is not whether PEPFAR is doing good," he writes, "but rather whether other programs would do even more good in terms of saving life and improving health."

To be perfectly honest, I'm not sure I've ever walked in my sleep. There's a family story that I'd like to label fiction about a somnolent bathroom run that ended in a closet. But if it ever happened, I don't remember it.

Turns out sleepwalking is pretty common though. At some point in life, 29 percent of adults in the U.S. walk in their sleep, according to a study published in the journal Neurology.

Some 3.6 percent of adults had engaged in "nocturnal wandering," as the researchers put it, in the year before they answered questions during an interview for the study. One percent had two or more episodes of sleepwalking a month in the previous year.

Sleepwalking by kids is "very common," with some studies finding as many as 30 percent of children strolling around while they doze, the researchers note. The behavior tends to decrease with age.

 

The researchers on the latest study, which involved more than 15,000 people, say it's the first to show how common sleeping walking is in the general population.

What leads to sleepwalking? The researchers looked at a lot of factors, though this is the kind of study that can't pinpoint a cause.

Sleeping less than seven hours a night was associated with a slight increase in the odds of sleepwalking. Sleep that's interrupted often, or fragmented in the researchers' lingo, could be an issue. But further analysis suggested the cause of the interruptions, such as sleep apnea or insomnia, might be more important.

Taking antidepressants and other drugs for mental health conditions appeared at first to be a significant factor. But the researchers did some additional analysis and concluded that the drugs, rather than causing the wandering, "appear to trigger events in predisposed individuals."

The study had limitations, including the fact that it relied on people being aware of the sleepwalking incidents. If anything, the researchers figure their estimates of sleepwalking prevalence are on the low side.

Sleepwalking can lead to real trouble, as the researcher note, saying it can result in injuries.

Comedian Mike Birbiglia, a sleepwalker, has made mined humor from some of his misadventures, including one that could have gotten him killed. He jumped through a hotel window while escaping, he thought, a missile with his name on it. He had been dreaming. But the blood on his legs was real, as he told NPR's Talk of the Nation in 2009.

He talked with Fresh Air's Terry Gross the following year about his book Sleepwalk With Me. And most recently, he made a pretty funny video with Goss that is kind of like a bad dream for an encore of This American Life's live show. You can check it out below.

If you've got cancer, chances are you'd rather take a pill to fight the cancer cells than sit for hours hooked up to an IV line as the chemotherapy drips slowly into you.

The difficulty is, many of the new cancer pills, which often target cancer cells for destruction but leave healthy cells intact, are pricey, costing tens of thousands of dollars for a course of treatment. And how some insurers pay for treatments means that pills can wind up costing a patient more than chemotherapy given by IV.

Nineteen states and the District of Columbia now require private health plans to cover cancer-fighting pills, if they're available, to the same degree and without charging patients more than they would for traditional intravenous infusion therapy, according to the National Patient Advocate Foundation.

So, for example, a health plan that has a $1,500 limit on out-of-pocket spending for outpatient services like IV chemotherapy can't charge more than that annually for their treatment pills.

But Medicare beneficiaries don't benefit from these laws.

 

They're tied to whatever coverage they have through their Medicare prescription drug plan, which may or may not provide affordable coverage for their anti-cancer pills, if they're covered at all.

High drug costs are a problem for all patients, but those on fixed incomes can be hit especially hard.

One study by researchers at Avalere Health found that about 46 percent of Medicare beneficiaries faced more than $500 in cost sharing for their initial anti-cancer drug prescription. Sixteen percent of Medicare beneficiaries didn't fill their initial prescriptions for anti-cancer pills, compared with 9 percent of patients with private insurance.

Under the Medicare Part D drug benefit, beneficiaries are responsible for paying 100 percent of their prescription drug costs from the time they reach $2,930 in total drug spending until they hit the $4,700 maximum out-of-pocket limit for the year. Once they're through that so-called doughnut hole in coverage, they're usually responsible for 5 percent of their drug costs.

A new lung cancer drug might cost $10,000 a month. "It's a real problem for people on Social Security who don't have any other income," says Len Lichtenfeld, deputy medical director for the American Cancer Society.

Several states, including Kansas and New Jersey, are debating so-called "wrongful birth" laws that would prevent parents from suing a doctor who fails to warn them about fetal problems.

Abortion rights activists say the laws give doctors the right to withhold information so women don't have abortions.

In Suffern, N.Y., Sharon and Steven Hoffman's son, Jake, was born with Tay-Sachs, a genetic disease that mainly affects Jewish families and is usually fatal by age 4 or 5.

"There's no treatment. There's no cure. There's nothing," Sharon says.

 

She says her doctor did not test for the disease. At six months, Jake was diagnosed with it. The couple says he lost control of his muscles and had constant seizures. He died two years later before reaching his third birthday. Sharon says she would have had an abortion if she had known.

"There is no quality of life," Sharon says. "The only thing that you would be bringing this child into the world to do is to suffer. And die."

This couple sued their doctor for wrongful birth and settled for an undisclosed amount.

In most states, parents can sue for negligence or if doctors fail to provide information about the condition of a fetus. But more than a half-dozen states have adopted laws that ban those lawsuits, and several others have been debating the idea this year.

In Arizona, state Sen. Nancy Barto sponsored a new law that prohibits wrongful birth lawsuits. She says parents should not be allowed to claim that the life of a disabled child is worth less than the life of a healthy child.

"It's a pro-life bill on every account, yes," Barto says. "It sends the message that all life is worth protecting, is worth living, whether you are born with a disability or not."

The Arizona law does allow parents to sue for "intentional or grossly negligent acts," but bills in New Jersey and Kansas do not have that exception. Abortion rights activists say that means doctors could omit information about a pregnancy.

"I believe it would allow them to lie about the results of an amniocentesis or simply opt out of even performing an amniocentesis that would normally be a part of standard care," says Kari Ann Rinker of the Kansas chapter of the National Organization for Women.

It's important, Rinker says, for parents to get all the information from their doctors so that in these tough cases, families can prepare for a child with a disability or make decisions about whether to have an abortion.

"No one wants to state out loud, 'I would have chosen to abort my child,' but this is often the only way for a parent to seek legal recourse," she says.

But Kathy Ostrowski with Kansans for Life says the measure does not undermine parental rights or allow doctors to lie to patients.

"The child has dignity. There shouldn't be a cause of action that this child shouldn't be alive ...," she says. "No way do we want doctors to be lying, and in no way does this say you can lie in this one area."

These lawsuits are relatively rare, and they are often complicated.

A Florida couple recently won a $4.5 million award because their son was born with just one limb. A jury agreed the doctor did not adequately screen for birth defects. An Oregon couple won a nearly $3 million judgment after their daughter was born with Down syndrome even though the mother had a prenatal test to detect it.

Steven Hoffman watched his son struggle though his short life and says if lawmakers had firsthand experience, they might not find it so easy to pass these laws.

"My heart is broken, and it is broken for the rest of my life," he says. "And it's something no parent should have to go through."

Attorneys and parents who have sued for wrongful birth say states shouldn't turn medical malpractice cases into a fight over abortion.

President Obama's pronouncement last week in favor of same-sex marriage has no legal effect on employers' decisions on whether to offer benefits to workers' domestic partners.

But some advocates say it could reinforce a decade-long trend toward coverage.

Last year, a little more than half of employers offered health benefits for domestic partners, according to a nationally representative sample of about 3,000 employers surveyed by benefit consultant Mercer. That's up from a little less than one-third in 2010.

The biggest factors driving that change are employers' views on whether such benefits help them attract and retain desirable workers.

 

"Employers started doing this because they felt they needed to be competitive in the labor market, just like with other benefits," said Paul Fronstin of Employee Benefit Research Institute, a think tank in Washington D.C. "I don't see that changing."

The Village Voice newspaper in New York is credited with being the first private employer to offer workers domestic partner benefits in 1982. In 1995, Vermont became the first to offer coverage to state workers.

"There's been a steady growth for a long time," says Joan Smyth, a partner at Mercer. In the early days, some employers worried that adding coverage for domestic partners could make their costs skyrocket by attracting people with higher-than-average health risks, she said, but it didn't turn out that way.

The District of Columbia and almost half of states currently offer benefits to domestic partners or same-sex spouses of state workers, according to the advocacy group Human Rights Campaign.

Same-sex partners of federal workers are not eligible for coverage under the Federal Employees Health Benefits Program because the Defense of Marriage Act, passed in 1996 and signed into law by President Bill Clinton, defines marriage as a legal union between a man and woman, the FEHB website says.

That law is being challenged and may well end up before the Supreme Court. The Obama administration has said it will not defend the statute.

The proportion of companies offering coverage varies widely by region and industry. In the Mercer survey, coverage of same-sex partners was most common in the West, with 79 percent of large employers offering such benefits. It was least common in the South, at 28 percent.

Among manufacturing firms, for example, the coverage rate ranged from a high of 96 percent for pharmaceutical companies to 18 percent for machinery and heavy equipment makers.

Public sector jobs had a lower rate of coverage, averaging 26 percent across state, county and municipal workers, the Mercer survey found.

While Smyth at Mercer doesn't think the president's pronouncement will sway employers, the Human Rights Campaign's state legislative director Sarah Warbelow has a different take. "Hearing the president supports this as well makes this even easier for corporations to get on board," says Warbelow, adding that 58 percent of Fortune 500 companies currently offer domestic partner benefits. Some of those companies limit those benefits to same-sex couples, while others include domestic partners of opposite sexes.

It's just after nightfall as Anandrag Davinder, an outreach worker among Mumbai's mostly hidden community of gay men, wanders down a dark alley beside a busy railway station in Mumbai. His stop is a squalid row of urinal buildings where gay men go to meet, hidden from public view. The stench inside is overwhelming.

"This is a loo. This is a cruising center," Davinder says, stepping into the crowded, nearly pitch-black room. "All the gays are standing here only and saying, 'I like these guys. I want to do sex with this person.' "

The men here are among what Davinder calls India's "key population" — those most at risk of contracting HIV. He and his colleague, Husefa Saigoonwala, come here every week to pass out handfuls of condoms.

 

Davinder and Saigoonwala are with the Humsafar Trust, which provides free HIV tests and other health services to Mumbai's gay community. Its CEO, Vivek Anand, says the reach of organizations like this has increased tenfold in just the past three years thanks in part to a 2009 benchmark ruling in Delhi's High Court.

The ruling struck down a 148-year-old law known as Section 377, a holdover from British colonial rule that made homosexual acts illegal. Many former British colonies still have Section 377 laws. And Anand says that under the legislation, gay men and women were largely ignored by India's efforts to tackle HIV/AIDS in the country.

"Three years ago, we were providing services to 30,000 [people]. Three years later, we are providing services to 300,000," says Anand. "That wouldn't have been possible had the Delhi High Court judgment not been in place."

He says that wider level of outreach has allowed health workers to more accurately measure HIV among India's gay population. "That's the idea, that more and more people come out so that we know what is the exact number of HIV positive people in the community," he says.

The government estimates that 7 percent of gay and bisexual Indian men have HIV, compared with less than 1 percent in India as a whole.

A handful of religious leaders and conservative groups are using those figures to argue that homosexuals are fueling a rise of HIV in India. They argue that homosexuality doesn't have a place in Indian culture, and they're petitioning India's Supreme Court to overturn the Delhi High Court ruling.

Efforts to reach several of those groups for this story were unsuccessful. But members of India's government have, at times, expressed similar views. Speaking at an AIDS conference in Delhi last year, India's health minister, Ghulam Nabi Azad, referred to homosexuality as a disease.

"Unfortunately this disease, where a man has a sex with another man — found more in the developed world — has spread in our country," Azad said. "Gay sex is completely unnatural. It should not exist, but it does."

The minister later played down those comments. And earlier this year, the Indian government reversed its position before the Supreme Court. It now says it supports legalizing homosexuality and abolishing Section 377. India's Supreme Court began a six-week-long recess Monday without ruling on the landmark case, which has captivated many in the country. It could decide the case when it returns to session in July.

However, Anand of the Humsafar Trust warns that even if the court upholds the ruling that homosexuality is legal, gay men and women in India still face widespread discrimination by police and health care providers. He points to the death of an HIV-positive team member last year after a hospital initially refused to give him advanced treatment for HIV because of his sexual orientation.

"I was totally ashamed of myself and guilt-ridden that my boy died," Anand says. "My boy died because his second-line treatment was delayed. If this is happening to my team, with all our resources and all our work behind us, you can imagine what must be the situation outside."

He says changing the law is one thing. Changing minds is a whole other challenge.

Christopher Werth reported from India with the help of the International Reporting Project in Washington, D.C.

Times are tough for young people. Unemployment is high, and college costs are soaring.

For those who've been diagnosed with autism, the challenges of life after high school are even steeper, according to a study just published in the journal Pediatrics.

Within the first six years of getting out of high school, only a little more than one-third of young people previously diagnosed with an autism spectrum disorder, or ASD, had gone to college, and only a slim majority — 55 percent — had held paying jobs.

The first two years after high school are particularly hard, the researchers found, with less than half of the young people with an ASD having had any work.

 

The researchers compared the experience of the young people with autism to those with mental retardation, learning disabilities and impaired language or speech. Those with autism fared worse than the others when it came to jobs, the researchers found.

On the college front, those with autism were more likely than those with mental retardation to have attended some college but less like to have done so than those in the other two comparison groups.

"It appears that youth with an ASD are uniquely at high risk for a period of struggling to find ways to participate in work and school after leaving high school," the researchers wrote. The findings, they said, point to a need for support during the transition from high school to life afterward.

The data for the analysis came from a long-running study of young people and concentrated on those receiving special education services. The researchers looked at the experience of more than 600 people in the autism category, and more than 400 each in the comparison categories.

The ranks of candidates for such intervention are growing. According to the latest federal estimates for autism, released in March, the number of children diagnosed with autism jumped 23 percent between 2006 and 2008. About 1 in 88 kids has been diagnosed with autism, the figures from the Centers for Disease Control and Prevention showed.

There have been hints that the obesity epidemic's rise has slowed a bit among certain populations, but for the most part, it continues to dominate American health. One third of children and teenagers are now overweight or obese. And researchers forecast as many as half of our nation's population could be obese — not overweight but obese — by 2030.

With obesity comes a host of health-related problems: diabetes, high blood pressure, heart disease and even certain cancers. Perhaps most worrisome of all, pediatricians report seeing the beginning of these diseases — previously considered problems among adults only — in children as young as 3.

And this is why the American Academy of Pediatrics and federal health officials recommend that doctors routinely screen children for high blood pressure. But diagnosing hypertension in children is more complicated than it is among adults.

"In adults, anything over 140 over 90 is considered abnormal," says family physician Dr. Margaret Riley with the University of Michigan Medical School. Not so for kids.

 

Normal blood pressure values for children and adolescents are based on age, sex and height. This means doctors need to not only measure a child's blood pressure but also compare it to standardized charts that indicate what's normal for children based on age, sex and height.

"A normal blood pressure for [a 15-year-old boy] is different from that of an 8-year-old girl," Riley says.

She recently published a review of available data in the journal American Family Physician to remind doctors about the importance of not only taking children's blood pressure but also comparing it to standardized tables.

Earlier data show doctors often overlook taking a child's blood pressure during routine visits. Among children eventually diagnosed with high blood pressure, only 26 percent of them had it written in their medical records.

"A physician often will put the blood pressure value in their notes, but they won't address it as high because they won't have recognized it as an abnormal value for that specific child," Riley says, adding, "I think clinicians are used to seeing a number like 100 over 60, and that looks good at first glance, but if you actually look at that for a specific child's age and height, then it may be high for them."

Dr. Reginald Washington, a pediatric cardiologist at Rocky Mountain Hospital for Children, says not diagnosing high blood pressure early can set off a dangerous chain reaction.

"The problem is the body doesn't forgive this; so, if you have high blood pressure or cholesterol as a child, you're setting yourself up for premature problems," says Washington, adding that patients can have strokes in their 20s or 30s if they have high blood pressure that's untreated.

According to one estimate, about 2,000 children and teens suffer strokes every year as a result of hypertension. But the good news, says Washington, is that medication is generally not needed for this age group. Simple lifestyle changes can do the trick. Cutting down on high-fat foods and high-sugar drinks, along with active family outings, can make a big difference, he says. And, because they have higher metabolism, kids have an easier time shedding pounds than adults.

Washington adds that families are often more motivated when their child's health is at stake. Parents should model healthy lifestyles, too, says Riley, by exercising regularly and eating as few processed foods as possible.

Ask family members of someone with Alzheimer's or another dementia: Trying to talk with a loved one who doesn't even remember exactly who they are can be very frustrating.

But here at a senior center in Seattle, things are different.

On one recent day, 15 elderly people were forming a circle. The room is typical — linoleum floors, cellophane flowers on the windows, canes and wheelchairs, and walkers lined up against the wall.

Linda White is leading a session based on a program called TimeSlips. The idea is to show photos to people with memory loss, and get them to imagine what's going on — not to try to remember anything, but to make up a story.

 

Storytelling is one of the most ancient forms of communication — it's how we learn about the world. It turns out that for people with dementia, storytelling can be therapeutic. It gives people who don't communicate well a chance to communicate. And you don't need any training to run a session.

White walks around the circle holding up a stock photo of a fit elderly man. He's wearing a banana-yellow wet-suit vest and is water-skiing.

The man is smiling broadly at the camera, perfectly framed by a big arc of water.

"He's experienced and he's cool; he's happy," says White. "Look at the grin on his face."

Many of the people in this group don't talk much on their own. But they're enthusiastic about making up a life story for the water-skier — he's a retired guy who's been divorced several times. He's got four children and a wife onshore, waiting to be taken out to dinner.

Most people with dementia live at home and don't have the opportunity for this kind of session, run by someone who's been trained to do it. But storytelling can be done at home, according to the founder of the program, Anne Basting.

"Anybody can do this," says Basting.

She directs the Center on Age and Community at the University of Wisconsin, Milwaukee. She started work on storytelling as a way to give people with dementia a low-stress way to communicate, one that did not rely on their memories. She sees it as giving caregivers a chance to reconnect with their loved ones.

"People with dementia start to forget their social role; they might not remember they're a spouse ... a parent," says Basting. "They need a social role through which they can express who they are, and the role of storyteller really supplies that."

One study co-authored by Basting in The Gerontologist, a journal, found that storytelling made people more engaged and alert, and that staff members at residential facilities had more positive views of their patients. An independent study published in Nursing Research showed participants were happier and better able to communicate in general.

Basting says one of the biggest hurdles to getting the program going has been skeptical family members.

"Resistance comes when people say, 'My dad would never do that; he's a very distinguished man. It's beneath him; it's childish,' " says Basting.

And then Dad hops right in.

Basting tells of one man who came to her in tears of thanks. For the past three years, he had been driving his wife crazy, trying to get her to talk about shared memories. He tried her on storytelling so they could talk about the story and play with the plot line. And eventually, he was able to communicate with her again.

In what could mark a watershed in the fight against HIV/AIDS, a panel of experts recommended that the Food and Drug Administration give a green light to a pill that can cut the risk of infections.

The daily pill, Truvada, made by Gilead Sciences, combines two medicines that inhibit the reproduction of HIV. It's already approved as a treatment for HIV, but its use could soon expand to include protection of uninfected people.

The advisory panel concluded Thursday that the benefits to healthy people vulnerable to HIV infection outweigh the risks, including such side effects as kidney damage and a dangerous increase in acid in the blood.

 

The people the panel has in mind are gay and bisexual men and heterosexual couples in which one partner is positive for HIV.

About 50,000 people in the U.S. become infected with HIV each year, according to the Centers for Disease Control and Prevention. The majority of new infections are in gay or bisexual men.

There's no guarantee the FDA will heed the panel's advice, but the agency typically does so. A decision is expected by June 15.

Studies have shown that Truvada can reduce the risk of HIV infection by 63 percent or more over the course of a year. But the drug is expensive — about $11,000 a year in the U.S.

Some critics think money would be better spent on other means of prevention.

Now, it's already the case that doctors in the U.S. are free to prescribe an approved medicine for any use they see fit. And some do.

But even after data first showed Truvada's ability to protect against HIV infection, a doctor at a Boston clinic told Bloomberg News that people weren't beating the door to get it.

One worry, some doctors say, is that healthy people may not stick with the daily Truvada regimen, undercutting its effectiveness.

Who's really hooked on tanning beds?

Odds are she's young, white and lives in the Midwest.

Figures just published in the Morbidity and Mortality Weekly Report paint a detailed picture of indoor tanning habits across the country.

Overall, in 2010 about 5.6 percent of adults used a tanning bed, or other device that blasts UV rays at skin to darken it. Tanning sprays didn't count.

But the most likely adult users, as you might have guessed, are women between 18 and 25. Around 30 percent of white women in that age group had used an indoor tanning machine of some sort in 2010.

"I am astounded" by the results, Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, told the Associated Press.

People who go in for indoor tanning tend to do it quite a bit. About 58 percent of white women who tanned indoors did it 10 times or more in a year. For white men who tanned indoors, the comparable figure was 40 percent.

Indoor tanning equipment that exposes a person to UV rays (not tanning spray) carries the risk of skin cancer. The frequent tanning sessions found in the survey increase the risk.

"What tanning beds are doing is concentrating the same kind of rays that we get from the sun; so, you're getting a much bigger dose" than you would from the same amount of time outdoors, Memorial Sloan-Kettering Cancer Center's Dr. Allan Halpern, told Shots when we talked to him about an earlier study on the risks of indoor tanning.

Melanoma, a type of skin cancer, is on the rise. And the increase in melanoma is greatest among young women, a point the researchers say could be related, in part, to tanning bed use. "Indoor tanning is particularly dangerous for younger users because indoor tanning before age 35 years increases the risk for melanoma by 75%," wrote the researchers, who are from the National Cancer Institute and the Centers for Disease Control and Prevention.

Remember McAllen? It's the Texas border town that became synonymous with wasteful medical spending during the nation's big health care debate. Even Barack Obama was talking about it.

In part because of McAllen's bad reputation, based on studies by the Dartmouth Atlas, Congress ended up instructing Medicare to reward hospitals that provide care efficiently, and take money away from those where patients end up getting a lot more tests, doctors' visits and procedures.

In an ideal world, the thinking went, patients with the same health and diagnosis should cost the same to treat — especially since Medicare pays set fees and doesn't haggle with providers the way private insurers do.

Fast forward two years later, and the government has identified hundreds of hospitals where Medicare patients are incurring especially high or low bills. Hospitals around McAllen, it turns out, aren't as terrible as they were made out to be, according to Medicare's calculations of how much it spent for the average patient from three days before admission to a month after discharge.

 

Look at Doctors Hospital at Renaissance, which was singled out in the influential New Yorker article by Atul Gawande that popularized the Dartmouth findings. The average patient from Doctors Hospital cost Medicare $18,708, 4 percent more than the national median per patient payment of $17,988.

Sure, treatment of patients at Doctors was more expensive than those at 2,555 hospitals in the nation. But the costs to Medicare were the same or less than those for patients at 790 hospitals. Medicare paid as much for the average patient at Doctors as it did for patients at MedStar Georgetown University Hospital in Washington, D.C., Florida Hospital in Orlando or Wyoming Medical Center in Casper.

Hospitals in other regions look much worse than McAllen, where the priciest hospital — South Texas Health System — cost Medicare 7 percent more than the median. In Las Vegas, patients at 14 of 16 hospitals cost Medicare 9 percent or more above the national median. Los Angeles has hospitals whose patients cost Medicare 30 percent or more above the national median.

The Medicare data can pinpoint differences between hospitals wherever they might be — across the country from one another or right next door. Los Angeles Community Hospital's patients cost Medicare $24,644, which is $7,000 more than it cost for Ronald Reagan UCLA Medical Center's patients. If Medicare's calculations are right, there may be a little bit of McAllen in a lot of places.

Washington state is in the midst of a whooping cough outbreak. The state has more than 1,100 confirmed cases so far this year — that's 10 times as many as this time last year, and health officials fear the number may rise.

The state is desperately trying to raise awareness of the epidemic. Take this public service announcement featuring a mother whose baby contracted the disease.

"My name is Chelsey Charles. In 2011, my baby Kaliah died of pertussis, or whooping cough, a completely preventable disease. It devastated my family."

Last week, Gov. Christine Gregoire asked for federal help, so investigators from the U.S. Centers for Disease Control and Prevention rushed to the state. Now the feds are helping local health officials figure out what's behind the whooping cough epidemic.

 

Gregoire is also dipping into the state's emergency funds for more outreach efforts.

The message: Whooping cough is serious. About 1 in 5 infants who get pertussis will get pneumonia, and in some cases die.

Young children are supposed to get the vaccine against whooping cough, also known as pertussis, in several doses spread out over the first four to six years of life. Infants are particularly vulnerable as they don't yet have full protection against the disease.

By the time people reach their teens and early adulthood, the vaccine is wearing off. The best prevention is for adults and teens to get a booster shot. Gregoire emphasizes there's no excuse not to.

"I don't come in contact with infants often," she explained at a press conference last Thursday. "I'm sure others out there would say the same thing. I don't care. I made sure I have a current booster because I can come in contact with another adult; I can pass it on. It's up to us as adults to step up to the responsibility because our infants, our children, our babies are at risk."

The state is also making available 27,000 doses of the pertussis vaccine for adults who have no health insurance.

Whooping cough has been on the rise in the U.S. since the 1980s, but in the past two years, the CDC has noted an increase in young children. It is a highly contagious respiratory infection. Many adults may not know they're carrying the bacterium.

Washington Secretary of Health Mary Selecky says infected adults have symptoms similar to a common cold, usually followed by a persistent cough. It's the reason whooping cough is easily misdiagnosed in adults.

"Our symptoms are very different," she explains. "We don't get the same kind of coughing fit that a baby would get. We don't turn blue like a baby does when a baby has a coughing fit."

Whooping cough causes babies to cough violently. It forces them to inhale with a loud whoop — hence the name. Some babies have little or no cough, but they still may have difficulty breathing. It can be tricky to diagnose in them, too.

Washington's Department of Health is also reaching out to hospitals and health care providers. They want them to ask patients if their immunizations are current, and urge new mothers to get vaccinated.

If the current pace of infection continues, Selecky says the state could see as many as 3,000 cases this year.

"Bugs rule — there are more of them than people," she says. And bugs move much quicker than we do.

Over in the U.K. there's a set of principles being floated in support of collaboration between the drug industry and doctors.

A sample of the dos and don'ts for doctors reads a little like dating advice:

"Don't establish blanket policies denying interaction with industry or regard it merely as a source of funding.

Do look for opportunities to get involved: in clinical trials, in joint working and/or with opportunities provided by industry for medical education."

Yes, there have been problems in the past. But the document suggests not letting those issues scare doctors off:

 

"Opportunities may be missed or even rejected because of misconceptions stemming from historical practices that are no longer acceptable, or the actions of a few individuals that are not typical of the working relationship between healthcare professionals and the industry."

Go ahead and see sales reps, the document counsels, and help drugmakers by serving on their advisory boards. And look for ways to take advantage of industry-sponsored education.

I'd overlooked the guidelines until today, when Australian journalist Ray Moynihan, a frequent critic of financial conflicts in medicine, made me take notice with a piece in BMJ, the British Medical Journal.

He makes quick (and footnoted) work of them. In his own tongue-in-cheek way, he advises would-be collaborators with some more dos and don'ts. A sample:

• Don't read a review that found no evidence that doctors who saw drug reps were any better off when it came to prescribing medicines well.
• Don't read an analysis that found doctors who had positive views of the controversial diabetes drug Avandia were more likely to have financial conflicts involving drug companies.
• Don't read a proposal to control conflicts of interest in medicine by reducing the sway industry has on continuing medical education.

Moynihan takes a hard line. But it's not that hard to see why. Recent history provides plenty of cautionary tales.