By Christopher Weaver Torn between a Senate plan to pay for the health overhaul by taxing expensive insurance plans, and a House plan to pay for it by taxing the rich, President Obama has settled on a third way: Tax the rich, with a twist. The Medicare tax line could get bigger. (iStockphoto.com) The Medicare tax line could get bigger. (iStockphoto.com) The Medicare tax line could get bigger. (iStockphoto.com) --> Obama's February proposal would add a new 2.9 percent Medicare tax on wealthy people's investment income and increase the Medicare tax on their wages above $200,000 from 1.45 percent to 2.35 percent. For couples who file taxes together, the threshold would be $250,000. Kaiser Health News has the details. Here's an example of how it would work. In 2007 Barack and Michelle Obama earned $201,913 in wages. But, between Barack Obama's non-wage income from his two best-selling books and some investments, the couple's total adjusted income was $2,656,902. Under current law, the Obamas only paid about $3,000 in Medicare taxes that year, or 1.45 percent of their earned wages. If the new Medicare taxes had been in place then, the Obamas would have paid -- roughly - $75,000 more. The normal rate -- 1.45 percent -- would apply to their wages, since their earned income doesn't exceed the $250,000 threshold for couples. But, the new, 2.9 percent tax on unearned and investment income would have dinged most of their other non-wage income. Even though the tax would only hit the richest 2.6 percent of taxpaying Americans, the revenues would add up to a hefty sum, according to the Joint Committee on Taxation. The provision would bring in around $183 billion over nine years, based on the committee estimates of the proposal Obama outlined in broad strokes last month. According to the president's proposal, the money would be set aside to buttress the government trust funds that pay for Medicare. The main fund, the Hospital Insurance Trust Fund, is expected to be depleted as soon as 2017, and the Center for Budget and Policy Priorities, a progressive think tank that supports the tax says the new revenue could, on paper anyway, keep the fund out of the red for another decade. However, that assumes the government actually saves the money, rather than spending it on other programs, which federal budget rules allow. New subsidies and a Medicaid expansion that might help cover 31 million low- and moderate-income people as part of the overhaul, for instance, could cost about $830 billion over ten years. Historically, official Washington is not known as a big saver. As the Congressional Budget Office explained in December, "[B]ecause the government has used the cash from the trust fund surpluses to finance other current activities rather than saving the cash by running unified budget surpluses," the savings and revenue set aside for the fund are often no longer available by the time the Medicare program needs them. Weaver is a reporter for Kaiser Health News, a nonprofit news service.

By Nadja Popovich Conservative talk show host Rush Limbaugh is no fan of Democrats' plans to overhaul health care. But yesterday, he went so far as to say he'd leave the country for Costa Rica if the administration's proposal passes. Say what? His pledge caused quite a stir. But, Limbaugh didn't mean he'd pack his bags for good. He actually meant he'd leave the county for medical care. The problem? He doesn't cotton to any more government control of health care in this country. But before he books a trip down south, he might take a closer look at health care in the Central American country. A review in the American Journal of Public Health a couple of years back praises policies of the largely government-run health system that have emphasized universality and equity in health coverage. Government funding covers "the bulk of overall health expenditures," the report says, and private insurance is "virtually nonexistent." Life expectancy at birth for Costa Ricans was 78, a year longer than for Americans at the time. In fact, the public health academics who wrote the report argue that the Costa Rica's success should give pause to international aid agencies' drive to privatize health services there and elsewhere. Finally, it was only a few months ago that Limbaugh praised the care he got in Hawaii after experiencing chest pains: Based on what happened to me here, I don't think there is one thing wrong with the American health care system. It is working just fine, just dandy, and I got nothing special. As a big union for health workers pointed out at the time, Hawaii's health system goes even further in providing care than some planks in the Senate health bill, earning the 50th state an exemption from some of the legislation's provisions.

By Scott Hensley As health care overhaul enters the legislative home stretch, the administration pounded health insurers again Wednesday. This time, Health and Human Services Secretary Kathleen Sebelius delivered the tough talk right to the faces of executives from the nation's health insurers at a meeting of the trade group America's Health Insurance Plans. HHS Secretary Sebelius told insurers they need to make a choice about health overhaul. (Jessica Marcy/Kaiser Health News) HHS Secretary Sebelius told insurers they need to make a choice about health overhaul. (Jessica Marcy/Kaiser Health News) --> She challenged insurers to drop their opposition to health overhaul and to instead help fix a broken system, marked by spiraling costs and a lack of consumer choice for health coverage. While introducing Sebelius at the meeting in Washington, D.C., AHIP President and Chief Executive Karen Ignagni said on behalf of member companies, "We are very disturbed about what's happening with costs" and pledged insurers' commitment to greater transparency on what they charge. Sebelius wasn't buying it. "How many years in a row can we have the same discussion over and over again?" Sebelius asked, questioning insurers perennial opposition to changes. Last week, she met with executives from some of the nation's biggest insurers and prodded them to publicly explain the rationales for their premium increases. The administration has made insurance rate hikes--as high as 60 percent in some places--a central part of its argument for passing overhaul now. Today, Sebelius chided insurers for spending millions of dollars on advertising and lobbying to kill health reform in the past, and took a swipe at the latest move by the industry to spend big on advertisements to block overhaul. Insurers, Sebelius said, have to choose whether they will oppose an overhaul, an approach that could preserve profits in the short run, or instead work on making the health insurance system sustainable. "That's better for the American people," Sebelius said in prepared remarks. "I think it's better for the insurance industry. " Sebelius took no questions from the audience. Afterward, AHIP's Ignagni said the group would accept the secretary's challenge and come up with some "specifics that can be added to bring costs under control." Here's AHIP's latest TV ad, which casts the cost spotlight on doctors, hospitals and medicines.

By Richard Knox If you want to stop flu from spreading, start by vaccinating the kids. That little bit of common sense just got a big scientific boost from a study that shows unvaccinated adults can be protected against flu if enough nearby children vicinity get immunized. The idea is an old one. But the work, just published in JAMA, provides the strongest evidence so far that immunizing youngsters works to the benefit of an entire community. Public health people call it "herd immunity." If enough individuals in the "herd" are immune, the rest have a much lower chance of infection. If the virus is the spark, there's just a lot less dry kindling lying around. And there's no doubt that flu outbreaks are driven by children. In a typical flu season, more than 40 percent of school-age kids get the flu--up to four times the rate among adults. In the JAMA study, Canadian researchers enlisted the help of four dozen Hutterite communities to see if vaccinating schoolkids would indirectly protect unvaccinated adults. Hutterites are Anabaptists and live in tight-knit rural religious enclaves. In half the communities, 83 percent of children between 3 and 15 got flu vaccine -- and almost no adults did. In the other half, the schoolkids got vaccinated against hepatitis A, to serve as a control group. Both study participants and medical personnel were kept in the dark about who got which vaccine. By the end of the 2008-2009 flu season, adults living in communities where schoolchildren got flu vaccine had 60 percent lower flu rates than adults in control communities. This isn't the first study to suggest vaccinating schoolkids protects grownups against flu. Texas researchers have compared vaccinated and unvaccinated towns; but they weren't able to separate flu cases from other kinds of respiratory illness. Japan did an enormous "natural experiment" between 1977 and 1994, when a law required all schoolchildren to get flu shots. Wintertime flu deaths in the elderly virtually disappeared. But after the law was repealed, older Japanese started dying of flu again. But the Japanese experience wasn't a carefully controlled study. Now that the Centers for Disease Control and Prevention is saying everybody should get flu shots, does it matter if a study finally proves that vaccinating schoolchildren protects others? Yes, because nobody expects 100 percent of the population to get immunized, ever. So it might be smart to target schoolchildren for special efforts.

By Alix Spiegel The whole idea of social contagion is itself sort of contagious. Altruism: pass it on. (iStockphoto.com) Altruism: pass it on. (iStockphoto.com) Altruism: pass it on. (iStockphoto.com) --> Everything from obesity to happiness to smoking moves through social networks, so the behavior of one person can affect the lives of many others. Two of the people leading this charge are political scientist James Fowler of University of California, San Diego, and internist Dr. Nicholas Christakis of Harvard Medical School. They've had a hand in much of this work and really got the ball rolling with their take on data from the Framingham heart study, which documented how your social group can affect your health. The Dynamic Duo, as some call them, just put out a new study which focused on a potential bright side of social contagion: kindness and altruism. This time they looked at what happens when people participate in a game in which they are asked to give money to needy people they don't know directly. When one person gives money to help others, the recipients of that money are more likely to give their own money away in future games, the researchers found. So, even a little pot of money can lead to a lot of giving, as the altruistic spirit ripples through a network. So, for example, let's say you play the game and give $16 to a person you don't know, prompting him to give $4 to another person who will, in turn, give $1 dollar to someone else. At that point, the research finds, the network effect more or less dies off. The authors write that people mimic the behavior or others, spreading kindness from person to person, even though it was clear that the altruistic behavior didn't directly benefit themselves. The results were published online by the Proceedings of the National Academy of Sciences. We're hoping that peace and love just keeps rippling around the world. But some critics suggest that in much of the work, Fowler and Christakis are mistaking correlations for cause. Those critics argue, for example, that people who gain weight just tend to group with other people who gain weight, but that doesn't prove that social contagion is causing weight gain to move through the group.

By April Fulton You know those brightly-colored packages, complete with famous cartoon characters hawking sugary cereals, snacks and fast food? It's no accident. The industry spends $2 billion a year to put those products in front of your kids so they can whine at you to buy them. Toys in these boxes tempt kids to eat foods that are not necessarily good for them. (jasonippolito/via Flickr) Toys in these boxes tempt kids to eat foods that are not necessarily good for them. (jasonippolito/via Flickr) Toys in these boxes tempt kids to eat foods that are not necessarily good for them. (jasonippolito/via Flickr) --> Today, the Center for Science in the Public Interest gave most companies a failing grade for the way they market food to kids, and called on companies to agree to a uniform set of rules. The group studied 128 food and entertainment companies, including big ones like Disney and Denny's. They found that two-thirds of them didn't even have policies on marketing food to children. "The vast majority of food and entertainment companies have no protections in place for children," said CSPI nutrition policy director Margo Wootan. Of those that did have policies, CSPI says many didn't have comprehensive nutritional standards. For example, many cereal companies had sufficiently low standards on sodium intake, but not for sugar, while fast food restaurants did better with sugar, and left the salt standards out. Food advertisers immediately shot back, saying the 16 participants in the Council of Better Business Bureaus' voluntary standards "have led to significant changes in the landscape of child-directed food advertising." But CSPI says it's not enough. The food company that did the best in the CSPI study was Mars, which earned a B+. CSPI says that's not because of the nutrition of their food, but because its policy prohibits marketing its candy bars to kids under 12. The best entertainment company grade was a B, earned by the two-year-old Qubo Channel, a fairly new channel of 24-hour childrens' programming. Brandon Burgess, chairman and CEO of ION Media Networks, the parent company of the channel, says it takes very little food advertising at all, and aims to be considered a safe haven for kids. Among the worst? Lucasfilms. It's been licensing Star Wars characters to give away with McDonald's Happy Meals. We've heard much begging for this particular one from the back of the car, and even confess to giving in once or twice. CSPI's Wootan says the marketing of these products plays a direct role in the growing problem of obesity in kids. "If companies were marketing broccoli and bananas to kids, I wouldn't be concerned," she said. So what's a parent to do? Wootan tells her child she can pick one item per grocery trip as a special treat. When her daughter was younger, Wootan used to hide small toys in the healthier cereal boxes. And what does Wootan snack on herself in her guilty moments? "BBQ flavored Fritos. Or chocolate gelato. Only on the weekends," she says.

By Julie Rovner Never underestimate the power of a lovely spring day in the nation's capital to fuel a vigorous political demonstration. An unidentified demonstrator presses the case for health overhaul in Washington's Dupont Circle. (Courtesy of Health Care for America Now/Flickr) A demonstrator against for-profit health insurers presses his case in Washington's Dupont Circle. (Courtesy of Health Care for America Now/Flickr) A demonstrator against for-profit health insurers presses his case in Washington's Dupont Circle. (Courtesy of Health Care for America Now/Flickr) --> Today, health care activists marched on the Ritz-Carlton hotel, where the trade group America's Health Insurance Plans is meeting. The demonstration featured some famous people, including former Vermont Gov. Howard Dean, who has come around from wanting to scrap the Senate-passed bill and start over. "This bill has already passed the Senate by a large majority," Dean told the crowd gathered at D.C.'s Dupont Circle. "This bill has passed the House. We need a final vote. The president is right. The American people deserve a final vote." The crowd also included less famous people like Melanie Collins, a nurse and daycare provider who traveled to Washington from Falmouth, Maine, for the rally. "I think the insurance companies are directly involved in the problem," she said. "I don't know how long I'll be able to afford my own insurance." And then there was the guy dressed up as what looked to me like, well, a Giant Red Squid of Death. The man in a black bodysuit with a red paper mache monster growing from his shoulders called it "a vampire squid." His get-up, he said, was meant to dramatize the profit motive of publicly traded health insurers. Gotcha. Or hear him explain it here: var so = new SWFObject("/player/media1/mediaplayer.swf", "mediaplayer1", "400", "20", "8", "#FFFFFF"); so.addParam("allowScriptAccess", "sameDomain"); so.addParam("allowfullscreen", "true"); so.addVariable("callback", "http://www.npr.org/player/media1/track.php?Log=1"); so.addVariable("logo", "http://media.npr.org/player/media1/npr_watermark.png"); so.addVariable("file", "http://pd.npr.org/anon.npr-mp3/npr/blog/2010/03/20100309_blog_julie.mp3"); so.write("flashcontent20100309_blog_julie"); Meanwhile, inside the hotel, those attending the meeting couldn't even hear the demonstrators chanting: "What do we want? Health care. When do we want it? Now." They also couldn't see the wanted posters depicting insurance executives or chalked outlines depicting the bodies of the uninsured on the street. "We respect their right to have their voices heard," AHIP Spokesman Robert Zirkelbach said in an interview. And what about President Obama's latest push to get an overhaul passed by demonizing health insurers? "This is politics as usual," he said with a shrug. "No amount of vilification is going to get more people covered. It's not going to bring down costs. We support health care reform, but the current legislation needs to do far more to control the rapid increase in the underlying costs of medical care...."

By Scott Hensley The economic downturn is giving a nip and tuck to people's interest in plastic surgery. Laid-off worker Lyn Talent received a free Botox injection at an Arlington, VA, spa last June. (Win McNamee/Getty Images) Tally up all kinds of cosmetic procedures and the volume in 2009 dropped a little more than 2 percent to around 10 million compared with 10.3 million in 2008, according to data just out from the American Society for Aesthetic Plastic Surgery. But dig a little deeper and you'll find double-digit drops in some of the most popular--and expensive--surgical procedures: Tummy tucks--down 13 percent to 128,000; Making women's breasts bigger got smaller--procedures fell 12 percent to 312,000; and, Liposuction was off 17 percent to 284,000. No surprise, we suppose, that people would forgo discretionary medical procedures they have to pay for out of their own pockets. So what were the biggest movers to the upside? Look to your backside. Buttock lifts were up 25 percent to about 3,000, and buttock augmentation grew 37 percent to about 5,000. So what's still selling OK? Botox. Injections of the temporary wrinkle-smoother inched up nearly 4 percent to 2.6 million in 2009. The plastic surgery group put the average cost per Botox treatment at $397 and the national spending on the shots at a hair over $1 billion last year. In our neck of the woods, a clinic got with the times and offered free Botox treatments and employment counseling to the first 50 unemployed people to show up with proof of their joblessness last June. "Botox and job consulting. It's the most intuitive pairing since peanut butter and staplers," the Washington Post called the promotion last year. Laid-off worker Lyn Talent received a free Botox injection at an Arlington, VA, spa last June. Win McNamee/Getty Images) Laid-off worker Lyn Talent received a free Botox injection at an Arlington, VA, spa last June. (Win McNamee/Getty Images) -->

By Scott Hensley Your kids will have to look a lot harder to find a sugary soda at school. A joint project by the makers of drinks, the William J. Clinton Foundation and the American Heart Association to reduce the calories from beverages in schools is paying off. A report just out shows the initiative, launched in 2006, has cut total calories from drinks in schools by 88 percent since the first half of the 2004-05 school year. The shift came about from the implementation of guidelines on drinks that emphasized appropriate portions of water, reduced-fat milk and unsweetened juices starting in elementary school. Students at middle schools could get the same stuff in slightly larger portions. For high schoolers, the guidelines allowed a slightly wider variety of beverages, including some with more calories. But it still tamped down on the caloric mix of drinks available. One of the biggest changes: a 95 percent drop in full-calorie sodas shipped to schools since the guidelines went into effect in 2006. Even the nutrition advocates at the Center for Science and the Public Interest praised the project's progress, saying in a statement: We congratulate the beverage industry for working to remove sugary sodas from schools. Together with stronger state laws and local school wellness policies, the country is making good progress in getting sugary drinks out of schools. Still, CSPI says the job isn't done yet because about one-third of drinks sold in high schools have too many calories. Separately, researchers said raising taxes on sodas and junk food could aid the nation's battle with obesity. A 20-year study found that at 10 percent increase in the price of soda and pizza was associated with a 7 percent drop in consumption. An accompanying editorial in the Archives of Internal Medicine went even further by suggesting that "besides adding surcharges to unhealthful foods, we should also consider the more positive side of the coin, food subsidies" for more nutritious fare.

By Deborah Franklin It's a little early in the week for happy hour, but this medical tidbit is bound to come up over cocktails: A new report out of the Women's Health Study at Harvard suggests that women who drink lightly or moderately may gain less weight as the years go on than those who don't drink alcohol at all. Red wine is not the answer, it just seems like it. (iStockphoto.com) (iStockphoto.com) (iStockphoto.com) --> Really? Yes! But don't take it as advice to party hearty. As with most scientific studies, there are caveats. Here's the context you'll want to share with your pals: As part of an exhaustive survey of diet, health and lifestyle factors, the researchers from Brigham and Women's Hospital asked nearly 20,000 middle-aged nurses and other health care workers to keep track of what they ate and how much alcohol they drank over a several-year period. At the start of the study, all the women were healthy, at least 39 years old, and of normal weight. Thirteen years later, most of the volunteers had put on pounds. About 40 percent had put on enough weight to be considered overweight or obese. But the women who reported having a glass or so of wine, beer or a cocktail most days of the week were less likely to get fat. And wine, especially red wine, seemed to be the drink of choice among those with slightly less weight gain. The scientists, who published their work in this week's Archives of Internal Medicine aren't sure why the drinkers tended to gain less weight, though they suspect it's partly because women who drink moderately tend to eat less -- to compensate for the liquid calories. (As in, they pour another glass of wine and skip the dessert. Is that what you do, ladies?) It's also possible, the scientists say, that calories from alcohol are metabolized a little differently than other sugars. In any event, other work shows the finding doesn't hold true for men or for women who were overweight to start. And the Harvard docs point out that moderate drinking has also been linked to breast cancer and other health risks. So if you decide to make it a Marguerita Monday, do go easy on the jigger of gin.

By Scott Hensley In case you missed it, President Obama did pretty well on a recent annual checkup and some related medical tests. President Barack Obama turns to talk to reporters, as he walks across Lafayette Park in Washington, Monday, March 1, 2010. (Charles Dharapak/AP) President Barack Obama turns to talk to reporters, as he walks across Lafayette Park in Washington, Monday, March 1, 2010. (Charles Dharapak/AP) --> But now the president is coming in for criticism that he set a bad example by having a couple of high-tech tests that exposed him to radiation while providing no proven clinical benefit. His experience also shows it's easier to talk about cutting waste than to do it. For starters, take the whiz-bang CT scan that looked for traces of calcium in his coronary arteries, a screening test for heart disease. Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, writes she was "troubled" by that scan in the current issue of the Archives of Internal Medicine. How come? Redberg, who also edits the journal, says the scan poses a real, though low, cancer risk and a "lack of proven benefit" for people at low risk of heart disease. That's why the U.S. Preventive Services Task Force doesn't recommend itfor routine use. In fact, Redberg writes, Obama should just quit smoking--that would do more for him than any result he might get from the snazzy CT scan. Then there's the cost. For the CT scan, figure at least $500. See this New York Times article from a few years back on the debate about CT angiography. Obama also got screened for colon cancer, which isn't recommended for men under 50, Redberg notes. What's more, he got a virtual colonoscopy, another fancy sort of CT scan which also isn't recommended by the USPSTF. You might have trouble getting your insurance company to pay for one of those. But, as Redberg concludes, it's not likely Obama "will have a dispute with his insurance company over the costs of the tests performed at his physical examination, whether or not they were necessary...."

President Obama talks up health overhaul at Arcadia University, Monday, March 8, 2010. (Charles Dharapak/AP) President Obama talks up health overhaul at Arcadia University, Monday, March 8, 2010. (Charles Dharapak/AP) President Obama talks up health overhaul at Arcadia University, Monday, March 8, 2010. (Charles Dharapak/AP) --> By Scott Hensley President Obama is back in full campaign mode to drum up support for health overhaul. At Arcadia University, outside Philadelphia, the president hammered on the insurance industry again Monday. He put denial of coverage because of preexisting conditions and rising premiums--as high as 60 percent in Illinois--in the spotlight again. "Why is it we think this is normal?" he asked, to cheers and applause. Well, he said, health insurers "have made a calculation" that they'll do better by charging more for insurance policies, even if they lose some customers because of the increases. The president pointed to a recent Goldman Sachs report on the health insurance market to bolster his claims, a new talking point in the administration's attacks on insurers. The report, posted by the New York Times here, features an interview with Steve Lewis, an exec at Willis, an insurance broker. After a long and pretty much inside-baseball look at the insurance market, Lewis concludes: I think most people would acknowledge that there's a need for healthcare reform, employers continue to be very frustrated. So when they look at what the Obama administration and the Democratic Majority state as their goals to increase access and lower cost and rail at what maybe termed oligopolistic behavior of carriers in certain markets, I think employers really buy in to that message and have much of that frustration and anger at our lack of solutions. Still, Lewis says, a lot of unhappy business execs fret that the overhaul "medicine" coming out of Washington could be worse than the disease. So, many are beginning to think that "maybe nothing is better than something in this current environment." Back in Washington, Health and Human Services Secretary Kathleen Sebelius kept the heat on insurers with a follow-up letter to some company CEOs she met with last week. She challenged the companies to post justifications on their Web sites for increased premiums proposed for individuals and small businesses.

By Scott Hensley This morning you might be among the millions feeling just a little bit sleepier than usual after staying up late to watch the Oscars. But too little sleep is a nagging problem for many Americans, who often don't get the seven to eight hours a night recommended by experts. Asians may sleep best, but everybody could use a little more shuteye. (iStockphoto.com) ?s=12" alt="Asians may sleep best, but everybody could use a little more shuteye." class="img200" /> Asians may sleep best, but everybody could use a little more shuteye. (iStockphoto.com) Asians may sleep best, but everybody could use a little more shuteye. (iStockphoto.com) --> Now, just in time for Daylight Savings Time this coming Sunday, the National Sleep Foundation is out with a survey that shows some interesting differences in the sleep habits among ethnic groups. First, a few similarities. About one-quarter of people, regardless of race, said their work schedules didn't let them get enough sleep. About 20 percent of people said they missed a family, work or social activity in the past month because they were sleepy or had a sleep problem. And around 20 percent (slightly less for Asians) said sleepiness had affected their sexual relationships. So what are the differences? Asians apparently sleep best, with 84 percent saying they get a good night's sleep at least a few nights a week. Only 66 percent of Blacks said the same. On workdays, Whites and Asians got about seven hours of sleep, compared with six for blacks and 6 1/2 for Hispanics. When the weekend rolled around, everyone slept in about an hour longer, but Hispanics slept about an 1 1/2 hours longer. What keeps folks awake at night? For Blacks, Whites and Hispanics, the most common worry that disturbed sleep at least a few nights a week was personal finances--reported by around 20 percent. For Asians, finance troubles were in second place--at 9 percent--behind concerns about personal relationships at 12 percent. You can find an overview of the results here and here's a detailed report with enough numbers and charts to make you nod off. The group behind the survey gets money from a variety of sources, including companies that make sleep-related products, but the support is unrestricted. The polls, like this one, are developed by independent experts. Hat tip to Booster Shots over at the Los Angeles Times.

By Allison Aubrey Will using your phone to keep track of what you eat really help you stick to a diet? Counting calories is getting easier. (Click image to enlarge.) (Maggie Starbard/NPR) Counting calories is getting easier. (Maggie Starbard/NPR) Counting calories is getting easier. (Maggie Starbard/NPR) Counting calories is getting easier. (Maggie Starbard/NPR) --> The developers of an iPhone app called PhotoCalorie are betting on it. Users snap photos of everything they wolf down and enter short descriptions of the food. If it's common fare or a brand-name item, the food may already be in the PhotoCalorie database. Then the app automatically fills in the calorie count. Otherwise PhotoCalorie helps you estimate the calories from the ingredients. Either way, before long you've got a detailed visual log of the food you've eaten and how many calories you've consumed. "It's tough to remember what you've eaten," says Larry Istrail, a Boston University grad student who developed the app. But if you scroll through your food photos from a week, the visual diary may raise your awareness. "You can see if you've been skipping vegetables--or eating hamburgers every day," he says. Food journals aren't exactly new. Weight Watchers has demonstrated many times over that they can be part of an effective dieting strategy. So old-fashioned pen and pad still work fine, but calorie-tracking phone apps--and there are a bunch of them--can do so many tricks. Take FoodScanner. It turns your iPhone into a barcode scanner and tracks calories consumed from packaged goods. There's also Lose It!, which debuted way back in 2008. It helps you set goals and establish a daily calorie budget. My husband has been using LoseIt for about a month--and seems addicted. Though it drives me crazy that his iPhone has replaced the candle on our dinner table, his ritual of accounting for everything he's eaten seems to help. The best things about LoseIt are its simple interface, ease of use and large database of foods. The worst thing may be the weight-tracking graphs, which can remind you of just how slow your progress is. For fun, I tested PhotoCalorie's smarts on my colleague Jessica Goldstein's lunch salad. I entered spinach, carrots, onions and feta, estimating them at one serving each. PhotoCalorie spit back: calories 347, fat 15 grams, protein 11 grams. But wait, I forgot the dressing. Oops. The estimates are only as accurate as you are diligent. Our digital producer's tacos--looked tasty too. So I snapped a quick photo of his lunch. I typed in "steak tacos" but PhotoCalorie didn't recognize the entry. "We don't have every food yet" Istrail explained. A few hours later he wrote me back telling me that if I'd typed in "beef tacos" I would have gotten a match. So, I found PhotoCalorie to be fun, but maybe not as much of a time-saver as I'd expected. The best feature was the novelty of the visual diary. The worst feature? The gaps in the food database.

By Andrew Villegas With all the attention lavished on the bipartisan health summit and President Obama's speech signaling the beginning of the endgame for overhaul, you might have missed a move by physician assistants to get in on the health action. President Barack Obama, flanked by registered nurse Barbara Crane, left, and physicians assistant Stephen Hanson, speaks about health care overhaul at the White House. (Charles Dharapak/AP) President Barack Obama, flanked by registered nurseBarbara Crane, left, and physicians assistant Stephen Hanson, speaks about health care overhaul at the White House.(Jessica Marcy/Kaiser Health News) President Barack Obama, flanked by registered nurseBarbara Crane, left, and physicians assistant Stephen Hanson, speaks about health care overhaul at the White House.(Jessica Marcy/Kaiser Health News) --> But if you looked closely at the people in white lab coats behind Obama on Wednesday, you'd have seen Stephen Hanson, president of the American Academy of Physician Assistants. The president's inclusion of physician assistants in the event made Hanson feel that PAs "have arrived," he told Shots. Though Hanson wouldn't predict the ultimate outcome for overhaul, he called Obama's speech "very dramatic." The week before, more than 230 physician assistants from the American Academy of Physician Assistants came to Washington to lobby lawmakers on issues ranging from legislation that would allow them to treat federal employees hurt in the workplace to getting the authority to prescribe buprenorphine--a drug used to help wean addicts from heroin and cocaine. They're also pushing for more federal education funding to bolster the ranks of PA as primary care providers and for legislative changes that would give them greater latitude in caring for patients. PAs handle routine medical care under the close supervision of doctors, freeing them up to spend more time treating more complex cases. As some health watchers forecast a shortage of primary care doctors, PAs are pushing to provide more care. Turf battles brewing? Not so much. Doctors and PAs are pretty much on the same page, unlike nurse practitioners who have tussled with doctors. Nearly 74,000 PAs practice in America today, and last year they had more than 4 million visits with patients. Indeed, the U.S. Department of Labor's Bureau of Labor Statistics estimates that by 2018, nearly 104,000 PAs will be in practice, amounting to a 39 percent jump over a decade. Cindy Lord, a physician assistant in Connecticut and immediate past president of the AAPA, said that because of their quick training, PAs are particularly adept at fitting into the medical workforce when shortages emerge. Her successor agrees. "We are a solution to the problem because we can get people who are ready to care for Americans on the street quickly," said Hanson, who works at burn unit in California. "I think we will always practice with physician supervision," said Hanson, who added that in addition to helping doctors diagnose and treat patients, he also does paperwork and dictation work. "We have been very, very content for 50 years in our relationship with physicians," Lord said. "We're not looking for a lot of glory, we're just looking to take care of patients." Villegas is a reporter for Kaiser Health News, a nonprofit news service.

By Kathleen Masterson Sex addiction, nymphomania or sexual compulsion might sound like the stuff of novels or over-hyped celebrity angst. Yet excessive sexual behaviors have been documented for over two centuries in American medical literature. In fact, one of the signers of the Declaration of Independence, Benjamin Rush, wrote about it in his book Medical Inquiries and Observations upon the Diseases of the Mind, the first textbook of mental illness in the U.S. Treatment for mental illness has come a long way from the days of simply throwing people in a "madhouse," like this 1917 lithograph shows. (George Bellows/Library of Congress) (George Bellows/Library of Congress) (George Bellows/Library of Congress) --> Rush wrote that sexual appetite, "when excessive, becomes a disease both of the body and mind." He also concluded that "promiscuous intercourse with the female sex" or excessive masturbation could cause impotence, dyspepsia, vertigo, dimness of sight, memory loss, and even death. (He didn't mention the risk of political downfall, loss of sponsorships, or inescapable media obsession.) Still, even though excessive sexual behavior has been described for a long time, it has yet to be officially recognized by the psychiatrists' bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Instead, the category resides in the book's appendix. Dr. Martin Kafka, a Harvard professor and psychiatrist at the med school's McLean hospital, and his colleagues are trying to push it out of that back-of-the book diagnostic "wastebasket." They're proposing that "hypersexual disorder" be added to the next edition of the DSM. Kafka says research over the last few decades supports that idea that these extreme sexual behaviors are symptoms of a mental disorder. The problem goes beyond just having a lot of sex; it's when a person cannot stop engaging in things like promiscuity, porn, masturbation -- and this behavior causes significant impairment and stress in the person's life. (It's worth noting that even the DSM struggles to actually define what a mental disorder is. The working definition is that it's a clinically recognized syndrome that causes serious distress or impairment of the person's ability to function.) The proposed hypersexual disorder would be categorized alongside other sexual disorders, such as fetishistic disorder and exhibitionistic disorder. Criteria for hypersexual disorder would include spending a lot of time consumed by sexual fantasies and repetitively engaging in these sexual fantasies in response to stress, anxiety, boredom or depression. The person also makes repeated but unsuccessful attempts to control the behavior, and engages in the behavior disregarding the risk of physical or emotional harm for himself or others. And, to be diagnosed with hypersexuality, this behavior would have to cause the person significant distress or impairment. That last criterion is the kicker -- the person needs to present with "clinically significant personal distress." And how do you measure that -- as opposed to say, a politician who is caught sleeping with another woman and blames a sex addiction? Drawing the line between guilty indiscretions and an actual mental disorder has a lot of the public skeptical. "It's not often a condition you can tell from afar," says Kafka. "The only way to know if it's a moral excuse or a real disorder takes knowing the person, the extent of the behaviors, have they tried to control it, what risks have they taken." Kafka and the working group stops short of calling the sexual problem an addiction. He says the science just isn't there yet to prove that the behavior is addictive, that it operates the same way as, say, alcohol dependence. Addictions are defined by out-of-control drug use, cravings and activation of the brain's reward centers. There just hasn't been enough research to show that excessive sexual behavior works the same way as drug dependencies, says Dr. Charles O'Brien, the vice-chair of psychiatry at the University of Pennsylvania and director of UPenn's Center for Studies of Addiction. With someone with extreme sexual behavior, he says, " if you show them porn, it does activate this part of the brain (associated with addiction), but we don't have any evidence that this is associated with a loss of control. In the case of an addict, the brain activation makes them want to go out and use the drug." Instead, the proposed category would label the behavior as a disorder, more akin to anxiety or depression. Even without an official category for hypersexuality, people do seek help for this kind of sex problem. Currently most people are treated with fairly standard addiction treatment, says Kafka, which might mean individual therapy or 12-step groups based on chemical dependence quitting programs. An NYT reporter noted that Tiger Woods public apology speech mirrored several steps of the common 12-step recovery program. Does the treatment work? The scientific literature on treatment varies, says Kafka, and much more study is needed. Typically, when a new mental disorder gets added into the DSM, its inclusion stimulates a good deal of research on the topic. If accepted, the new definition could help garner more scientific attention.

By Scott Hensley Be honest. How many of you had even heard of hydrolyzed vegetable protein until the Food and Drug Administration said salmonella found in a batch of the stuff was reason enough to recall all sorts of processed foods? Turns out that HVP, as it's called in the trade, is a flavor enhancer that's produced by treating beans or grains with acid, breaking down their proteins into small tasty bits. The HVP, which can be a liquid, powder or paste, gets added to an incredible range of foods to make them taste more savory. Think soups, dips and snacks, for starters. The FDA said some flavoring goop made by a company called Basic Food Flavors in Las Vegas was found to be contaminated with a strain of salmonella. Nobody has gotten sick as far as the FDA knows, but the agency said the risk of illness warrants recalls of food containing the tainted ingredient. The ingredient is pervasive, if not well known. "I would say it's likely to be in thousands of food products," said FDA's Dr. Jenny Scott, according to CNN. Unfortunately, the FDA said consumers can't rely on an ingredient list to know whether HVP is inside the food or not. Some of the stuff you ought to pitch if it's in your kitchen: many Follow Your Heart brand foods, including quite a few tofu-based items, and some dips made by Reser's Fine Foods. For the full list, see this FDA database.

By Nadja Popovich Stamping out binge drinking is a tough task. Now research shows that common advertising approaches to curb drinking may actually backfire, leading people to consume more alcohol. Researchers used the image from an ad by the Liquor Control Board of Ontario in their study. (Courtesy of Kellogg School of Management) Agrawal used the image in this PSA from the Liquor Control Board of Ontario (LCBO) as a basis for the ads in her study. (Courtesy of the Kellog School of Management) --> Ads that rely on guilt or shame are problematic, according to research being published in the April issue of the Journal of Marketing Research. In five related studies that looked at roughly 1,200 undergraduates' responses to anti-drinking public service announcements, researchers found that students discounted the notion that bad things could happen to them. Shots caught up with Nidhi Agrawal, lead researcher and associate professor of marketing at the Kellogg School of Management of Northwestern University, to find out more. Here are edited highlights from our conversation: What prompted you to undertake this work? All of my research deals with two topics. First, the effect of emotions on people's responses to advertisements and consumption situations. And the second thing I'm very interested in is vulnerable consumers--consumers for whom it's very easy to make compromised decisions. What we examined was anti-drinking messages. We wanted to see if these messages are effective. So much money goes into them and they're intended to bring out good behaviors. But we weren't sure. So we wanted to study what makes ads effective or makes them backfire. And what our research shows is that well-intended anti-drinking messages can actually cause people to drink more. They're not just ineffective and wasting money, but could actually be causing harm. How were the studies carried out? Part of what we wanted to study was the effect of emotions, and the two emotions associated with risky behaviors such as binge drinking are guilt and shame. Often, once the damage has been done [after drinking] people feel like they've messed up. We got people to think about an instance where they felt very guilty or ashamed of themselves and then we exposed them to advertising messages that get them to feel ashamed or guilty. And once they've seen these messages, we measured how likely they were to binge drink in the next two weeks. In another study, we told people that they were taste-testing a juice that was going to be used as a mixer for alcohol. So, they then associated the juice with alcohol. Then we looked at how much of the juice they drank. What we found was that people binge drink more, in the first case, and they drink more of the juice mixer, in the second case, when they feel guilty. So, we don't want to overload the consumer with these feelings because they can have a bad effect. Why is shame used as the means toward change in so many PSAs? Shame and guilt are very interesting emotions because they are very intense. Consumers often respond to them in a very intense way. So many health messages employ these tactics: See what your risky behavior could lead to? But do these measures actually work? And in what conditions? We wanted to figure that out. That's why we focused on guilt and shame. Often, people react badly to this. A sort of defense processing encourages them to have another drink. What do you mean by defensive processing? The thing about these emotions is that they're so intense and negative because they're self- focused. When we feel guilt, it's because we messed up. No one wants to believe that. We all want to believe we're amazing people. Which is why, when you get people to feel guilty or ashamed, they want to defend against those feelings. They don't want to feel that they are vulnerable to the dangers of binge drinking if they already feel guilty or ashamed. And they want to drink more then. They have the incentive to show that they can handle it--they can drink and they won't mess up. They think others shouldn't be drinking because others can't handle it, but they can. So, they feel even more entitled to have a drink. What are the lessons to be learned here for advertisers? They should be very careful about using very powerful emotional tactics--when we use guilt or shame, or even sadness or anger. We have to have a carrot to go with the stick: it's OK to mess up; you can handle it; here's how. Or you put the ad in the middle of a positive, empowering situation. You want to put it in a situational comedy, something with a lighter mood. Positivity is very important. It can come from the [message] but also from the environment. How would that work? Our research suggested that maybe as you're talking to people about binge drinking, [don't just talk about] mess ups, tell them how they can get out of situations that lead to binge drinking. Saying "you're cool if you have only one drink". You need positive reinforcement: telling people new tactics for getting out of binge drinking situations and not telling them how they're going to mess up. Give them a tool to use. (You can check out an example of positive anti-binge drinking tactics employed by college students in this NPR story from 2008.)

By April Fulton Much is being made today of the power of congressional moderates, particularly Democratic Rep. Bart Stupak's vow that he and 11 other colleagues are willing to tank Democrats' health bill unless they get their way and increase restrictions on abortion funding. Michigan Democrat Bart Stupak at a House in February. (Tim Sloan/AFP/Getty Images) Michigan Democrat Bart Stupak at a House in February. (Tim Sloan/AFP/Getty Images) --> "It's accurate to say there are at least 12 of us who voted for health care that have indicated to the speaker and others that unless you change this [abortion] language, we will vote against it," Stupak told MSNBC last night. But it's too early to declare health care dead, Jennifer Duffy of the Cook Political Report tells Shots. "Can they be persuaded? Maybe.The Democrats in the Senate managed to persuade Ben Nelson," Duffy says of the hold-out Senator who raised concerns about the Senate abortion language and just about everything else in that bill before crying uncle. We're days and probably weeks away from seeing an actual piece of legislation on which a vote would be required. (If you really want to wonk-out about the torturous budget process known as reconciliation that will likely be used to move a health bill, hear this and check out this chart.) A vote is "not happening today," says Duffy, "which is good news for Stupak, but maybe not for the Democratic leadership." But, she acknowledges, anything can happen, and there's tons of time for the interest groups, the president, and the House leaders to maneuver. "Remember that pre-holiday siege on members offices, the phone calls, the visits, the e-mails? That's going to start again," Duffy says. Maybe it already has. Senate Minority Leader Mitch McConnell, who says the health bill is being "rammed through Congress," warned Democrats they'd be defending their efforts going into the midterm elections. A National Republican Campaign Committee project called Code Red is unleashing robocalls on voters in states represented by moderate Democrats. The mission, says the project Web site: Using various forms of traditional and direct media, Code Red will put pressure on these lawmakers to answer a simple question -- will they support a job-killing government takeover of health care or will they stand with the American people who want Congress to scrap the bill and start over with reforms that will lower costs? Nothing subtle about that message. But Democrats are stepping up, too, and won't let go of health without a battle. President Obama held a reception for supporters of the pay-as-you-go budget rules last night -- guaranteed to be a group of moderates. And he's slated for a meeting later today with members of the House New Democrat Coalition. He's planning visits around the country soon. All Things Considered host Melissa Block will speak with Stupak this afternoon.

By Phil Galewitz In a warm-up for a confab with insurers at the White House Thursday, Health and Human Services Secretary Kathleen Sebelius put them on notice this morning that they had a lot of explaining to do about what they charge for policies. HHS Secretary Kathleen Sebelius called some insurance rate hikes "jaw-dropping." (Jessica Marcy/Kaiser Health News) HHS Secretary Kathleen Sebelius called some insurance rate hikes "jaw-dropping." (Jessica Marcy/Kaiser Health News) --> "Something is not working well here," Sebelius said in 15-minute talk to the National Association of Black Journalists at the Kaiser Family Foundation. Members of the association are in town for a conference on health disparities. She said she was looking forward to her "chat" with executives of five companies that she said last year recorded a collective $12 billion in profits then tried to pass on "jaw-dropping," double-digit rate increases to policyholders. Sebelius was preparing to meet at 11 a.m. with executives from UnitedHealth Group, WellPoint, Aetna, Health Care Service Corporation and CIGNA HealthCare, along with leaders from the National Association of Insurance Commissioners. Sebelius and the White House have tried to vilify the insurance industry in recent weeks to revive their health overhaul efforts. They were given ammunition when Anthem Blue Cross, a subsidiary of WellPoint and California's largest for-profit health insurer, moved to raise rates by as much as 39 percent. The insurer has since delayed the rate increase until May. Update: After the meeting, the insurance execs talked with the press. Bloomberg covers it here. Galewitz is a reporter with Kaiser Health News, a nonprofit news service.