Ever wonder why some people can run a 50-mile ultramarathon while for others even the thought of such endurance sports borders on torture?

Exceptional physical fitness, of course, sets the ultramarathoners apart from the rest of us. But scientists say what might be more important is athletes' excellent ability — both psychologically and physically — to cope with pain.

It turns out that most athletes' high tolerance for pain while exercising may also help them deal with it when they're at rest.

A fresh analysis of studies on pain perception by researchers at the University of Heidelberg in Germany finds that athletes can tolerate more pain than non-athletes. And, the researchers conclude, regular physical activity can change the way practically anyone perceives and tolerates pain.

 

Of course one size doesn't fit all when it comes to pain relief, but the German researchers think that exercise could help people with chronic pain learn how to better deal with it. The findings appear today in the journal Pain.

The researchers looked at 15 studies that evaluated people's pain threshold, comparing the jocks with the couch potatoes. The athletes — and especially endurance athletes — consistently seem better equipped to grin and bear pain than non-athletes.

But athletes don't seem to have a higher threshold for pain than others. In other words, most people recognize pain the same way. Athletes can just stand more of it longer.

That seems to be because athletes tend to develop coping skills in their training. "Athletes are frequently exposed to unpleasant sensory experiences during their daily physical efforts, and high physical and psychological resistances must be overcome during competitions or very exhausting activities," the researchers write. "However, athletes are forced to develop efficient pain-coping skills because of their systematic exposure to brief periods of intense pain."

The researchers hope that non-athletes will take a cue from athletes and use exercise as a form of treatment to build up these skills. Exercise is far from a new treatment for pain, but neurobiologists are just starting to learn how it works on the brain's perception of pain.

Still, as Jonas Tesarz, a pain specialist who lead the study, said in a statement, "Further research is needed to clarify the exact relationship between physical activity and modifications in pain perception."

As we've reported, researchers are also exploring how meditation might also help people suffering from chronic pain, as another way to relieve it without highly addictive drugs, or their side effects.

So what do you do when you're accused of hitting up sick patients in the hospital to pay their bills — sometimes even before they get treatment?

Well, if you're Chicago-based Accretive Health, under fire by not only the Minnesota Attorney General but key members of Congress and possibly the Obama Administration, you fight fire with fire. You line up your own set of political defenders.

To back up a bit, this story began last year with a stolen laptop, which led to a January lawsuit filed by Minnesota Attorney General Lori Swanson charging Accretive with privacy violations.

The resulting investigation led, in turn, to an April story in The New York Times, that chronicled how Accretive workers allegedly posed as employees in Minnesota hospitals, and included "embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment."

 

Accretive struck back, charging that that Attorney General Swanson's report contained "inaccuracies, innuendo and unfounded speculation." The company also enlisted a formidable political ally – Chicago Mayor and former Obama Chief of Staff Rahm Emanuel. He personally asked Swanson to back off, noting in a letter that the company "does important work for hospitals and good things for our City, particularly for our neediest citizens."

Swanson, however, declined Emanuel's entreaty. "We will continue to interview witnesses and perform our law enforcement responsibilities over charitable hospitals in Minnesota," she said in a statement.

So now Accretive is upping the ante. It has enlisted a veritable who's who in health policy to come up with "national standards for how hospitals and other providers interact with patients regarding their financial obligations." In other words, how aggressive can debt collectors be without running afoul of federal law, various or regulation or good public relations.

The group includes some well-connected heavy-hitters, including former Bush administration Health and Human Services Secretary Mike Leavitt and Medicare chief Mark McClellan, former Senate GOP leader Bill Frist,. There some prominent Democrats too, including former Clinton Administration HHS Secretary Donna Shalala and former Senate Democratic leader Tom Daschle.

For all of Accretive's alleged misdeeds, however, the collection of outstanding bills is a serious one for hospitals, particularly as they await the Supreme Court's decision about the 2010 health law. Hospitals agreed to take significant reductions in Medicare payments with the expectation they would make that money back when currently uninsured patients whose care now goes unpaid would gain coverage.

Should the high court strike down the requirement for most people to obtain insurance, however, that could leave hospitals in a financially difficult spot.

Dr. Michael Cooper cringes when he thinks about the time he was a family practice doctor working in Kotzebue, Alaska.

Three years ago, he worked in this remote arctic community, which is home to 3,000 people, mostly Inupiat Eskimos. Cooper occasionally saw patients complaining of a persistent cough. They may also have been experiencing night sweats or weight loss — classic signs of tuberculosis. But, he says, "TB was rarely on my list of diagnoses when I would see a patient. I hate to admit that. And as I look back now, I go through these patients some nights and I think, that patient could have had TB, and why didn't I at least do this? Why wasn't I even aware of it?"

Last July, Cooper came to Anchorage for a position with Alaska's Health Department. His new job: to lower the state's high rate of tuberculosis — in 2011, the highest rate in the United States.

 

Cooper is learning from his mistakes. He's focusing part of his efforts on educating other doctors and nurses in Alaska about tuberculosis. That starts with explaining why the TB rate is so high.

"We experienced probably the highest rates of TB back in the early 20th century found anywhere in the world at the time," he says. Many Alaska Natives were living in crowded conditions that allowed TB to spread easily.

"Imagine a nice cold winter and a packed house full of people, and one person having picked up this brand new disease that they have no immunity against, and then spreading it. It just can spread like wildfire," he says.

Until 1950, TB was the No. 1 cause of death in Alaska. That legacy means that a large number of Alaskans still carry the bacteria that can cause the disease. They have no symptoms and they aren't contagious, but full-blown TB can flare up at anytime and then spread.

Karen Martinek, a nurse who works with Cooper, is part of a team that responds quickly when a new case pops up.

"If we see a small, isolated village — usually, they are accessible only by air or snow machine in the winter — and we have a case or two of active tuberculosis identified in that village, we can be quite confident that there's transmission going on," she says.

The treatment for active TB is a long course of powerful drugs. For people with inactive TB, there is a new, relatively short regimen of drugs that is much less complicated and eliminates TB. Cooper hopes that will encourage more people with latent disease to complete the treatment, which would eventually help bring down the high rate of active TB in Alaska. Until then, Cooper worries about the potential for epidemics in the state.

Cooper and others are also worried about strains of TB that are resistant to many of the available drugs. But so far, so-called multidrug-resistant TB is not widespread here. And the overall rate of TB in Alaska over the past 20 years has been on a slow decline.

Cooper hopes he can keep that trend going. With a sheepish smile, he says that will involve making sure more doctors in Alaska think about the possibility of TB when each new patient walks through their clinic door.

This story is part of a project with the Alaska Public Radio Network, NPR and Kaiser Health News.

Preventing the exposure of kids to lead is a great idea, the Centers for Disease Control and Prevention said today.

The public health honchos agreed with an expert panel that recommended in January that anything greater than 5 micrograms per deciliter of blood for kids 5 and younger should be considered dangerous. That's half the current standard and represents the first reduction since 1991.

With that change, the number of kids in the U.S. who would be considered to have lead poisoning that needs medical attention would rise to nearly a half-million, almost double the number before the change.

"This new definition of childhood lead poisoning will provide an enormous public health difference for all young children in the U.S., because it is evident that the prior level of 10 micrograms/deciliter did not protect the developing brains of young children," John Rosen, a pediatrician at Children's Hospital at Montefiore in New York, told Shots in an e-mail.

 

Lead is a neurotoxin that's particulary dangerous for children, even in small amounts. The damage it wreaks can't be reversed.

But the CDC acknowledged in its response to the panel's recommendations that it doesn't have the resources to fulfill several of them, such as implementing a national policy to prevent kids from being exposed to lead in the first place, even though it agrees with them in principle.

Dr. Robert W. Block, president of the American Academy of Pediatrics, praised the CDC's decision in a statement, saying it "affirmed what pediatricians have recognized for decades: there is simply no safe level of lead exposure for children."

Budget cuts have reduced CDC's funding for lead prevention from $30 million to around $2 million this fiscal year. Block said pediatricians "call on Congress to reinstate funding for lead prevention programs" at the CDC "as soon as possible."

"Despite the near elimination of CDC funding for lead poisoning, this is the right policy for the nation's children. Parents will now have the information they need to protect their families from lead," Rebecca Morley, executive director of the National Center for Healthy Housing, said in a statement.

No more ifs, ands or butts about the claims that Skechers USA made for its goofy-looking toning shoes.

The company has agreed to pay $40 million to settle claims that it deceived customers by saying its Shape-ups shoes would help people who wore them shed pounds and tone their abs, buttocks and legs, the Federal Trade Commission said.

The FTC alleged there's no evidence the Skechers shoes would do a better job by those measures than regular old gym shoes.

If you bought Skechers' line and the shoes, you can now apply for a refund here.

"Skechers' unfounded claims went beyond stronger and more toned muscles," said a statement by David Vladeck, head of the FTC's Bureau of Consumer Protection. "The company even made claims about weight loss and cardiovascular health." So, Vladeck said, the Skechers settlement should send a message to advertisers: "shape up your substantiation or tone down your claims."

 

Previously, the American Council on Exercise, a nonprofit group, compared toning shoes from Skechers and two other companies with running shoes. The group concluded there is "simply no evidence to support the claims that these shoes will help wearers exercise more intensely, burn more calories or improve muscle strength and tone."

The "studies found that there was no significant difference between any of the toning shoes and the standard running shoe," ACE's Todd Galati told All Things Considered two years ago. "These shoes are not a magic pill. It is the walking that will make a difference in your life. Not the shoe," he said.

Under the settlement the company can't say its toning shoes strengthen muscles, lead to weight loss or do much of anything related to health, unless the claims "are true and backed by scientific evidence," the FTC said.

Skechers claims had also been the subject of class-action litigation and an investigation by state attorneys general across the country.

For its part, Skechers said it continues to "vigorously deny the allegations made in these legal proceedings and looked forward to vindicating these claims in court," according to a statement by David Weinberg, the company's chief financial officer. But, he said, "Skechers could not ignore the exorbitant cost and endless distraction of several years spent defending multiple lawsuits in multiple courts across the country."

For a little while longer you'll still be able to buy suncreen labeled as waterproof or with a sun protection factor of 100.

Almost a year ago, the Food and Drug Administration proposed a slew of new rules to make the labels of sunscreens more helpful — and realistic. Sunscreen that says it's waterproof or has an SPF greater than 50 was supposed to be verboten by next month.

But after companies complained they'd have trouble complying in time, the FDA gave them a reprieve. The agency was concerned that without an extension some companies might stop making some sunscreens and that there could be a shortage of so-called broad spectrum sunscreens.

 

For most makers of the protective goops, sprays and lotions, the new rules will take effect in December. Small companies will have another year to get their products squared away.

Waterproof sunscreen, as you've probably discovered in your own experiments, doesn't really exist. Same for the allegedly sweatproof stuff. So those descriptions will be off limits, eventually.

Water-resistant sunscreen passes muster, and that will be OK on the new labels. But the makers will have to give you an idea of how long you can swim or sweat and still be protected against the sun.

The FDA's new rules would also require sunscreen makers to say how effective their products are in protecting against ultraviolet A (UVA), as well as ultraviolet B (UVB) rays, a longstanding measure. Both types raise the risk of skin cancer. UVA rays get deeper into skin and contribute to its premature aging. UVB rays put the burn in sunburn.

Only sunscreens that pass a new FDA test on UVA and UVB protection could say "broad spectrum" on the label after the rules take effect. The agency suggests people use a broad spectrum suncreen with an SPF of 15 or more to guard against the sun.

There are more than 2 million new cases of skin cancer in U.S. each year. Melanoma, the type that causes the most deaths, is expected to afflict more than 75,000 people this year and to lead to the deaths of almost 9,000, according to the American Cancer Society.

Despite the delay in the official rules, the FDA says you may start seeing new labels on some sunscreens anyway, as manufacturers that were ready to comply make the changes.

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.