MyHealthNewsDaily

Experiencing breathing problems during sleep may raise your risk of depression, a new study suggests.

Women with sleep apnea, in which breathing becomes shallow or pauses briefly during sleep, were 5.2 times as likely to have depression compared with women without the condition. Men with sleep apnea were 2.4 times as likely to have depression as men without the condition, according to the study from researchers at the Centers for Disease Control and Prevention (CDC).

Participants in the study who had other breathing problems during sleep also had an increased risk of depression. However, the researchers found no increased likelihood of depression among people who snore.

"Snorting, gasping or stopping breathing while asleep was associated with nearly all depression symptoms, including feeling hopeless and feeling like a failure," said study researcher Anne Wheaton, an epidemiologist with the CDC. "We expected persons with sleep-disordered breathing to report trouble sleeping or sleeping too much, or feeling tired and having little energy, but not the other symptoms."

Both depression and breathing problems during sleep are common, and both are underdiagnosed, the researchers wrote. Screening people who have for one disorder for the other could lead to better diagnosis and treatments, they said.

The researchers took into account other factors that might influence the results, such as age, sex and weight. The results are in line with those of the other studies, the researchers said.

The study found an association, not a cause-and-effect link. However, the researchers wrote that evidence from other research suggests that breathing problems during sleep may contribute to the development of depression. For example, one previous study found a link between the severity of breathing problems during sleep and the odds of later developing depression. And other studies have shown that people who received treatment for sleep apnea showed improvement in their depression.

"Mental health professionals often ask about certain sleep problems, such as unrefreshing sleep and insomnia, but likely do not realize that [breathing problems during sleep] may have an impact on their patients' mental health," the researchers wrote in their conclusion.

Although exactly how the link might work is unclear, it could partly be explained by the fact that people with breathing problems experience sleep that is fragmented, or may have low levels of oxygen in the blood during sleep.

The researchers used data collected from 9,714 adults who participated in the National Health and Nutrition Examination Survey, which is an ongoing study conducted by the CDC.

Participants were considered to have depression based on their answers to a questionnaire asking about how often they experienced symptoms of depression.

Six percent of men and 3 percent of women in the study reported having physician-diagnosed sleep apnea.

The study was limited in that participants' depression and sleep problems were measured at only one point in time, and in that it relied on self-reported symptoms. People may not be aware they have breathing problems during sleep, and there was no information about whether participants were being treated for depression.

The study is published in the April issue of the journal Sleep.

More from MHND:

7 Tips to Sleep Soundly Tonight

Top 10 Spooky Sleep Disorders

5 Experts Answer: Is Lack of Sleep Bad Really for Health?

A chagrined man with a girlie magazine under his arm, shuffling into a small, clinical-looking room, has helped turn the act of semen collection into a sitcom staple. Now, a few sperm banks are hoping to change that unappealing image by inviting men to skip the office altogether.

On Monday, the Cleveland Clinic launched its “NextGen” sperm banking kit. Potential customers can request the kit, collect the sample “in the comfort of their own home,” as the cliché goes, and then send the kit back by overnight express.

That sounds much less embarrassing, but are American men really crying out for such a service? And while sperm are pretty hearty swimmers in their intended environment, can they really survive the punishment meted out by the UPS guy?

Sperm banking has traditionally been used for just a few reasons: for storing donor sperm for in vitro fertilization (IVF) when a would-be father is infertile, or a woman is single or part of a lesbian couple; to secure a man’s, or a boy’s, fertility before he begins cancer treatments that could kill off his sperm-making ability; men having a vasectomy who want to hedge their bets; and, in rare cases, as a repository for the sperm of men who have just died, or for men about to engage in some dangerous event, like going to war.

Those are pretty limiting reasons, and since sperm banks usually serve a local area, most have never been regarded as much of a profit center. They’ve been more of a necessary adjunct service for IVF providers and cancer centers.       

Now, though, by offering shipping, Ashok Agarwal, director of the Cleveland Clinic’s andrology laboratory and sperm bank said, the market becomes “anywhere in the U.S.” and the customer any man who’s worried about his future fertility for whatever reason.  

To use the NextGen kit, customers call the lab and request it. The lab sends out a box with a specimen cup, sperm preservation media, ice packs, and a return shipping label. The media is stored in the refrigerator, the ice packs in the freezer. A man masturbates, ejaculating into a specimen cup, dumps in the media (essentially sperm food), packs the box with the sample and the ice packs, and sends it off. According to Agarwal, there’s virtually no difference in sperm quality between shipped and locally collected samples.

The andrology lab at the University of Illinois at Chicago also offers an at-home sperm banking kit, which it calls “OverNite Male.” It works about the same way.

The Chicago lab charges $50 for the kit, $150 for cryopreservation, and $275 per year for storage.  The Cleveland Clinic’s program charges $689 for the first banked sample, including the first year of storage, and an annual storage fee of $140 thereafter.

But Cappy Rothman, a pioneering UCLA urologist and the founder of the world’s largest sperm bank, California Cryobank, isn’t so sure either of these is a good idea. 

“It’s almost like gambling,” he declared. “The survivability [of sperm] is poor.” His outfit experimented with such kits, once over a decade ago and again more recently and “we found it unreliable. We did not think the results were good enough to encourage people to do it.”

Dr. Robert Oates, professor of urology at Boston University and president of the Society for Male Reproduction and Urology, agreed with Agarwal that when everything goes exactly according to plan, the kits can work. But, he said, the creation of such systems “is really about marketing a product” to men who may not need it.    

Of course, the fees and the risk may be worth it if they really do help people preserve their fertility. David Sampson, a spokesmen for the American Cancer Society (ACS), said the organization encourages doctors and patients to discuss fertility before beginning treatments, and, according to the ACS, “sperm banking is an effective way for men who have gone through puberty to store sperm for future use.” It encourages oncologists to offer banking to all men and boys. (Soon, female egg banking – which has recently shown improved results -- may be standard, too.)

But both Oates and Rothman pointed out that the mail-in option ought to be a last resort used mainly by men located in very rural areas, for example, where sperm banking may be unavailable. Most oncology, fertility and urology practices have local systems in place for storing sperm. “Practically every city has sperm banks,” Oates said.

“It would be more prudent for anybody having difficulty finding a sperm bank to go through an IVF center and have the specimen processed [frozen], and sent to the sperm bank of their choice,” Rothman said.  

And as for the idea of banking against risks, Oates believes some facilities seem to be encouraging very unlikely scenarios as a way to drum up business. “Marketing to those in dangerous professions means they’d have to get their testicles shot off,” he said. “I mean, if you do get them shot off, you are going to be happy you banked sperm, but those are very limited numbers of people.”  

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• Soda-drinking men at higher risk for heart attack
• Yearly prostate cancer screening fails to reduce deaths

By Michelle Fox
CNBC.com

More than one-third of American adults are obese, according to the Centers for Disease Control and Prevention. The obesity epidemic has been going on for decades, and today health-care costs associated with obesity are estimated at $147 billion a year.

To be considered obese, a person has a body mass index (BMI) of 30 or higher. With the extra weight comes myriad health issues — obesity contributes to heart disease, diabetes, stroke, and some cancers.

Recently, the Gallup-Healthways Well-Being Index ranked the 10 most obese metropolitan areas in the U.S., offering perspective on the cities that are affected by the country’s obesity woes.

The health implications are apparent — of the metro areas with the highest obesity levels, 58 percent of their residents were more likely to report having had a heart attack over the course of their lifetimes, and 34 percent were more likely to report having high blood pressure.  Combined, residents of these cities also pay an estimated $1 billion more in medical costs each year thanks to their high obesity rates.

In 2010, the government announced its goal to lower the prevalence of obesity to 15 percent. In 2011, only three out of the 190 areas surveyed in the Gallup-Healthways Well-Being Index had an obesity rate below that level: Fort-Collins-Loveland, Colo.; Bridgeport-Stamford-Norwalk, Conn.; and Boulder, Colo. Boulder ranked as the least obese city, with an obesity rate of 12.1 percent.

It’s not all bad news, however. According to the CDC, although there was a rise in obesity between 1983 and 2000, the rates actually have stabilized over the past 10 years.

“There has been no change in obesity prevalence in recent years,” CDC scientist Heidi Blanck said. “However, over the last decade there has been a significant increase in obesity prevalence among men and boys, but not among women and girls overall.”

The government is aiming to eventually reduce the rate of obesity. In 2010, the Childhood Obesity Task Force released 70 recommendations to prevent and control childhood obesity.

Look ahead to see the most obese metro areas in the U.S., and how much their citizens are paying in obesity-related health-care costs every year, according to the recent Gallup survey.

10. Reading, Pennsylvania

Obesity rate: 32.7 percent

Annual obesity-related costs: $190.2 million

Located approximately 60 miles northwest of Philadelphia, Reading, Pa., ranks 10th on the Gallup-Healthways Well-Being Index. It’s the most obese city in Pennsylvania, which has a statewide obesity rate of 28.6 percent, according to the CDC .

With 88,000 people residing in the city, more than 28,000 residents are considered obese. In Reading, 10 percent report having diabetes, a chronic disease associated with obesity. Even higher than the obesity rate is the poverty rate: 35 percent of the population in the city lives below the poverty level. According to the nonprofit Food Research and Action Center, women and children in poverty are at the highest risk for obesity.

9. Kennewick-Pasco-Richland, Washington

Obesity rate: 33.2 percent

Annual obesity-related costs: $116.5 million

This metropolitan area in southeastern Washington is called Tri-Cities. It’s also known as “The Heart of Washington Wine Country,” with more than 160 wineries. However, according to Gallup, the region has one of the highest obesity rates in the country — at 33.2 percent — which shows an increase from the 31.5 percent obesity rate a CDC survey found for the area in 2010.

8. Topeka, Kansas

Obesity rate: 33.3 percent

Annual obesity-related costs: $109.8 million

More than 42,000 of the 127,473 residents of Topeka, Kan., suffer from obesity, according to data from Gallup. The good news is the city’s situation appears to be improving: Topeka had an obesity rate of 36 percent in 2010, almost three percentage points above where it is today, according to the CDC survey.

Topeka, the capital of Kansas, was also named as one of the 10 best cities for the next decade by Kiplinger’s Personal Finance Magazine in 2010.

7. Lakeland-Winter Haven, Florida

Obesity rate: 33.5 percent

Annual obesity-related costs: $279.3 million

According to Gallup, the Lakeland-Winter Haven, Fla., metro area has the potential to save more than $154 million in health-care costs if its obesity rate dropped to 15 percent. Instead, 33.5 percent of its residents suffer from obesity, racking up more than $279 million a year in medical bills.

The metropolitan area, which includes the cities of Lakeland and Winter Haven, has more than 75 lakes and is located in central Florida between Orlando and Tampa. In 2010, 37.9 percent of its residents were obese, according to the CDC study.

6. Charleston, West Virginia

Obesity rate: 33.8 percent

Annual obesity-related costs: $146.9 million

Charleston is the capital of West Virginia and is dubbed the cultural, recreational and business capital of the Appalachian Mountains. It’s home to several golf courses and parks, including the Haddad Riverfront Park along the Kanawha River.

There are more than 51,000 people living in the city, as of the 2010 census, and based on the rates from Gallup approximately 17,000 of them are obese. In addition, about 17 percent of the population has also reported having diabetes.

The Gallup-Healthways’ number is up from the CDC survey’s obesity rate of 32.3 percent for the city in 2010. According to the CDC, the state of West Virginia had a 32.5 percent obesity rate in 2010, placing Charleston higher than the state average.

5. Beaumont-Port Arthur, Texas

Obesity rate: 33.8 percent

Annual obesity-related costs: $182.8 million

Located in southeast Texas, this metro area includes the cities of Beaumont and Port Arthur. Oil is big business for the region, with refineries throughout the area. The metro area has been a major player in the oil industry ever since the Lucas Gusher exploded on Spindletop Hill in 1901.

According to the Gallup-Healthways Well-Being Index, the metro area could potentially save $101.6 million in medical costs if its obesity rate dropped to 15 percent, instead of the almost 34 percent it has now. Beaumont-Port Arthur is the second most obese metro area in Texas, which has a statewide obesity rate of 31 percent.

4. Rockford, Illinois

Obesity rate: 35.5 percent

Annual obesity-related costs: $179.4 million

Located in northern Illinois, Rockford calls itself the “City of Gardens” because of the 7,000 acres of parks, trails, tree-lined streets and public gardens within its borders. That’s not the only nickname the city has had — it has also been called “Forest City,” because of its woods and was once known as the “Screw Capital of the World” due to factories that produced screws and bolts. Manufacturing is still the area’s biggest industry.

Rockford also ranks as the fourth fattest city in the country, however, with an obesity rate of 35.5 percent. Of the more than 152,000 people who live in Rockford, nearly 54,000 are considered obese, while 10 percent have diabetes and 23 percent live below the poverty line.

3. Huntington-Ashland, West Virginia-Kentucky-Ohio

Obesity rate: 36 percent

Annual obesity-related costs: $146.9 million

The Huntington-Ashland metropolitan area encompasses three states — West Virginia, Kentucky and Ohio — at the point where they all meet by the Ohio River.

The metro area first gained national attention in 2008 after an Associated Press story called it the nation’s unhealthiest. That led Jami Oliver to bring his ABC reality show, “Jamie Oliver’s Food Revolution” into Huntington, W.Va., to give schools and the town a nutrition make-over. Oliver has called his time there a success. However, the larger metro area still appears to be struggling — 36 percent of its citizens are obese, according to the Gallup-Healthways Well-Being Index, and nearly 20 percent suffer from diabetes.

2. Binghamton, New York

Obesity rate: 37.6 percent

Annual obesity-related costs $131.5 million

In the city of Binghamton, more than 17,000 residents are obese, according to rates from the Gallup-Healthways Well-Being Index. It's surprising then that 54 percent of respondents also said they exercise frequently.

Located at the junction of the Susquehanna and Chenango rivers in southern New York, Binghamton has the highest obesity rate in the state, compared to New York State’s rate of just below 24 percent. Meanwhile, 27.8 percent of Binghamton’s population lives below the poverty level.

1. McAllen-Edinburg-Mission, Texas

Obesity rate: 38.8 percent

Annual obesity-related costs: $410.9 million

Located near the Mexican border in southern Texas, this metro area is the most obese in the nation, according to the Gallup-Healthways Well-Being Index. If the region dropped the rate from 38.8 percent to 15 percent, it could potentially save a whopping $252 million a year in medical costs annually. That’s a big savings, especially considering 50 percent of residents report being uninsured.

In 2010, 33.3 percent of the McAllen-Edinburg-Mission metropolitan area’s population was obese, according to a CDC survey, so the data suggest that the country’s most obese city is also getting worse, bucking the nationwide trend of stabilization in obesity rates.

See the full list: America's fattest cities

 “Fat & Fatter” premieres Thursday, March 29 at 9 p.m. ET, with a re-air Sunday, April 1 at 10 pm ET.

The Gallup-Healthways Well-Being Index results are based on telephone interviews throughout 2011, with a random sampling of 353,492 adults living in the U.S. Health-care costs were based on the National Institute of Health’s estimate of $1,429 per person, per year, in additional health-care costs for people considered obese, compared to those of non-obese individuals.

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By Robert Bazell
Chief science and medical correspondent
NBC News

During the briefing for reporters Thursday on the CDC’s latest findings that one in 88 children in the U.S. (one in 54 boys) has a diagnosis of some brain disorder that falls on the “autism spectrum,” there was a polite but revealing dust up.  Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, conceded –in response to a question– that the increase in cases could be the result in changes in the way such disorders are diagnosed.  Then Mark Roithmayr, president of Autism Speaks, the biggest activist organization concerned with the disorder, said he begged to differ.  Maybe half the cases, Roithmayr insisted, must be due to some as yet identified environmental factors.

Click here to read what every parent should know about autism.

Last January  Dr. Fred Volkmar, director of the Yale Child Study Center, created a far bigger controversy when the New York Times reported he had said new definitions of autism about to come from The American Psychiatric Association could effectively end the autism surge. ''We would nip it in the bud,'' the Times quoted Dr. Volkmar.

Related story: Better diagnosis, screening behind rise in autism

Volkmar was not available today, but I interviewed his colleague Dr. James McPartland, who did not back down from that view.

“People who might have been diagnosed with something else in the past are now being diagnosed with an autism spectrum disorder," McPartland said.  By “something else,” McPartland means problems that used to be labeled as ranging from “mental retardation” to “learning disabilities.”

“The way we diagnose autism spectrum disorder has changed,” McPartland continued.  “We're more inclusive. We include people with more cognitive ability and less severe problems then we have in the past.”

Anyone who spends time around children diagnosed on the “autistic spectrum” knows that it is indeed wide.  Many have the severe withdrawal and lack of ability to engage in social interactions that characterize classical autism.  But others seem high functioning and verbal.

Scientists have spent a lot of time looking for genetic changes that might account for disorders labeled as autism.  More than 500 genes have so far been implicated indicating that no clear genetic cause will be implicated.

As for environmental factors, there are strong suggestions that older parents, especially fathers can increase the risk as can multiple births. But none of that could account for more than a fraction of the enormous increase (78 per cent since 2002 when the CDC started tracing autism.)  The alleged association with childhood vaccinations has been widely discredited by scientists although a few hard core activists still cling to it.

So that takes us back to diagnosis.  Whatever it is called, there can be no doubt that a lot of kids need special attention – and the sooner they get it, the better off they are.  What a problem is called matters less than how society copes with it.

Courtesy of Barney Fields

Joe Fields, an 82-year-old jazz producer from Long Island, suffered some hearing damage after his adult granddaughter kissed him on the ear a few years ago.

Where's the one place you should never kiss a baby -- or anyone else? The ear, according to a professor of audiology at Hofstra University in Hempstead, N.Y.

An innocent kiss right on the ear opening creates strong suction that tugs on the delicate eardrum, resulting in a recently recognized condition known as "cochlear ear-kiss injury." Such a kiss can lead not only to permanent hearing loss, but a host of other troubling ear symptoms including ringing, sensitivity to sound, distortion and aural fullness.

Hofstra University's Dr. Levi Reiter has been studying the phenomenon ever since a woman came to him five years ago with a strange story about going deaf in one ear immediately after her five-year-old kissed her there.

"I thought this lady was a unique case," says Reiter. After a bit of research, though, he discovered another case of ear-kiss injury reported in the 1950s.

Once the so-called "kiss of deaf" was written up in Newsday, however, Reiter started hearing from people worldwide. He has now identified more than 30 ear-kiss victims (and hopes to hear from more), and is preparing to submit his most recent findings to the International Journal of Audiology and the International Journal of Pediatric Otorhinolaryngology.

Ear-kiss patients exhibit a characteristic pattern of hearing loss, Reiter said, with hearing most diminished in the frequency range of unvoiced consonants, such as "ch" and "sh."

"There are a lot of cases of unknown unilateral hearing loss in kids, and I am sure that a good portion are from a peck on the ear," he says.

Babies and small children are particularly vulnerable to hearing damage via kiss, simply because their ear canals are smaller. A baby will cry after such a painful kiss, he says, but "kids cry for a lot of reasons." Unfortunately, hearing loss usually isn't identified until years later, during a school screening.

Unilateral hearing loss can be acquired from a blow to the ear, impulse noise (like an exploding firecracker) on one side of the head, or a Q-tip pushed too far. 

An ear-kiss is another cause, formerly undiscovered, said Paul Farrell, associate director for audiology practices at the American Speech-Language-Hearing Association. "It is a fascinating phenomenon," he said. "I would consider it an emerging topic in the field." 

Reiter believes that the intense suction on the eardrum pulls the chain of three tiny bones in the ear. The third bone, the stirrup-shaped stapes, then tugs on the stapedial annular ligament, causing turbulence in the fluid of the cochlea, or inner ear.

Reiter is full of horror stories of ear-kiss injuries resulting from normal everyday activities: a hairdresser sending a client off with a nice hairdo and a smack on the ear; a relative's air-kiss going astray after a quick turn of the head; a mother seeing her little girl off to school with a loving smooch.

Still, the prevalence of the injury is unknown.

"People are going to doctors who are pooh-poohing this," says Reiter. "One reason these people wrote to me in the first place was that they were getting nowhere. The doctors were making fun of them. They felt humiliated."

Joe Fields, an 82-year-old jazz producer from Long Island, received a kiss on the ear from his adult granddaughter a few years ago that left him with a host of hearing problems.

"It felt like if you got hit by a ball on the ear," he says. "It's like hearing through a screen of some sort. In the kissy ear, speech is totally muffled."

Fields, a patient of Reiter's, now wears hearing aids, but still experiences intermittent sensations of aural fullness as well as a "deep-seated itch."

"At times, it feels terrible," he says.

Reiter speculates that an injection of steroids through the eardrum, which is used in cases of sudden idiopathic deafness, could help if administered within days of an ear kiss. 

But there is currently no treatment and symptoms don't tend to resolve. As a result, Reiter -- and patients like Joe Fields -- preach prevention.

"My granddaughter is a kindergarten teacher and I tell her never kiss any of your little tykes on the ear," he says.

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By Joan Raymond

The Supreme Court is expected to deliver its ruling on the validity of the individual mandate requiring nearly all Americans to buy insurance or face a penalty-- and perhaps the validity of the entire reform package -- in June.

Two years ago when the most sweeping legislation regarding health care was first enacted, msnbc.com talked to numerous people about their health care needs, and their hopes or fears regarding health care reform. We wanted to know if the people we spoke with back in 2010 had changed their minds about healthcare reform, due perhaps, to changes in personal circumstances. Here is an update on some of the people we interviewed. 

Readers reveal real-world impact of health reform

Billy Weeks / for msnbc.com

Aubree Sullivan Carpenter

Name: Aubree Carpenter (formerly Sullivan), 28, Chattanooga, Tenn.

Occupation: Education director, Epilepsy Foundation, Southeast Tennessee

Income: $29,500 annually

Current insurance: Blue Cross Blue Shield personal plan, excludes coverage for melanoma 

When she was 19, Carpenter was diagnosed with melanoma, the most serious, potentially deadly, form of skin cancer. Surgery was successful, but getting insurance with a pre-existing condition was tough. When she went to work full-time at the local chapter of the Epilepsy Foundation, she still had trouble qualifying for insurance, but found a plan that would cover everything, except her melanoma. Her situation is still the same today.

Although she’s now happily married, her husband, Keelan, is a full-time college student studying computer science and doesn’t have a group health insurance plan. Her employer does pay for her plan, which costs $330 a month, and for that she is very grateful.

Today, Carpenter is healthy. But she has concerns. “It always crosses my mind that I might get another lesion,” she says. “I don’t know what I would do. It can be worrisome, but you have to do what you have to do.”

She is somewhat confused about the individual mandate, but feels that health care reform must happen, especially for those with pre-existing conditions. “I appreciate what President Obama has done to move the conversation forward,” she says. “Insurance companies shouldn’t be able to discriminate or drop you. But I don’t know if a mandate is the answer. There are a lot of questions.”

What she would like to see is the government offer competition to the private sector insurers that would provide competition at affordable rates for people.  “Fed Ex and UPS are competition for the postal service, and I would like to see something similar for health care, that doesn’t discriminate against those with pre-existing conditions, and the self-employed or those, like me, who work for small organizations,” she says. “Because I’m not in a group plan, I have no options.” 

Her only recourse, she says, would be to change jobs and find an employer with a group plan, which would hopefully take her.

She does not want to see the entire reform package get dismantled. “I don’t want them to repeal the whole thing,” she says. “There are thousands of people with more tragic stories than mine. I would be sad for them I am afraid that things will go back to status quo and nothing would ever be done.”

Charles Mason / for msnbc.com

Robb Myers
Fairbanks, Alaska

Name: Robb Myers, 28, Fairbanks, Alaska

Occupation: Truck driver

Income: $45,000 annually

Current insurance: Employer-sponsored Plan

Back in January 2010, Myers was a single guy who lived in a modest apartment, drove a 2000 Hyundai and tried to keep his living expenses as low as possible. He turned down health insurance coverage because he was young and healthy.

Today, Myers, now 28, is married and lives in a slightly larger apartment in Fairbanks, but still drives the same car, he and his wife, Dawna, share. The couple is expecting their first child in the middle of May. Myers now works as a full-time truck driver. His wife is a part-time nanny. Myers now carries health insurance, which costs $460 a month. When their child is born, the premium, he says, will double. They also carry a high deductible of $3,000, but his employer runs a program in which costs over $1,000 are reimbursed until the deductible is reached.  

Myers, a “news junkie”, has been following the hearings. “I think the individual mandate is a stupid idea,” he says. “Ultimately, responsibility needs to fall on the individual person and not the government telling us what we need to buy. I know what I need to buy and what I can afford to buy.”

He believes that the government is on the “wrong track” with healthcare changes. “It’s going to be an economic issue, and they took a look at the demand side, not the supply side.” To cut costs, he’d like it to be less expensive to study medicine and become a doctor, and to have other medical professionals, such as nurses, “. . . do some of the things,” that traditionally fall under the purview of a doctor.

“Today, my situation has changed but I don’t see that the healthcare law is really helping much,” says Meyers, who has been with his new company since June 2011. 

His colleagues have told him that insurance coverage used to be more encompassing, but after the Affordable Care Act passed, premiums actually rose. “It makes me wonder, if something in the bill kicked up the premiums,” he says.

He does believe there is “a social dimension,” to the entire issue, to be, in a sense, “. . .our brother’s keeper.”

He mentions friends who used Facebook to fundraise for monthly pledges to help offset costs for their daughter’s residential treatment program, which is out of state. Within a week, they had more than half the money needed to cover the $40,000 charge insurance would not cover. “We have a have a responsibility to each other, and having the government do it for us isn’t fulfilling that responsibility,” he says.

John Makely / msnbc.com

Greg Mohr and his wife Susan in Randolph, NJ, Jan. 4, 2010.

Name: Greg Mohr, 49; Susan Mohr, 43, Randolph, N.J.

Occupation: Self-employed computer technician, owner of cat kennel

Income (household): $92,000 annually

Current insurance: Small group HMO

Greg Mohr still runs his New Jersey computer network business and with his wife, Susan, a cat kennel owner. Mohr remains opposed to the health care overhaul and is vehemently opposed to the individual mandate. “My personal hope is that they (the Supreme Court) rule it (the individual mandate) unconstitutional and illegal,” says Mohr, who does believe, however, that health care does need to be changed.

Today, Mohr, whose income has stayed the same as it was two years ago, is paying significantly more for health insurance. The rub: He’s paying more for less coverage. Back in 2010, Mohr’s plan, which covered him, as well as his wife and two children, cost $14,640 a year. Today, he’s paying $16,500 a year, under a new policy, with higher co-pays and a few more restrictions. He recently talked to his broker and is bracing himself for a significant increase when he renews his policy in October.  “It turns my stomach,” says Mohr, who estimates that 10 years ago his health insurance ate up only about 5 percent of his income. “If I raised my rates like this I would be out of business, but the insurance companies have an attitude that they want to get as much as they can.” 

Instead of the current plan, some of the changes Mohr would like to see include liability limits, deterrence of nuisance lawsuits, as well as an elimination of cost differentials in procedures depending on where you live. He would also like to see hospitals and health insurers become not-for-profit entities.  “I can sympathize with both sides, but in our interest it would be best for us to have the entire (health reform) package overturned and go back to the drawing board,” he says. “Not enough time was spent truly looking at options.”

Allen Brisson-smith / for msnbc.com

Ed and Sharon Blanding of Danbury, Wisconsin, at their home on Thusday, April 8, 2009. Photo/ Allen Brisson-Smith

Name: Sharon Blanding, 67; Ed Blanding, 63, Danbury, Wis.

Occupation: Retired

Household income: $45,000

Current insurance: Traditional Medicare, plus Part D for prescription drugs and a supplemental policy

With Sharon retired and having chronic medical problems, and with her husband Ed, on disability with his own set of chronic health issues, the past two years have been a little tough for the couple, both economically and physically.

Sharon takes 14 medications, up from nine. Ed, she says, now takes six prescription drugs, instead of four. They have a retirement income, but the costs of health care are “staggering,” Sharon says. They pay about $600 for a Part D Medicare supplement and supplemental health insurance coverage. Their prescriptions can run more than $250 every month. Last year, Sharon came in just a few dollars short of hitting the magic number of $4,000 to reach a point in which “catastrophic” coverage would kick in after paying out-of-pocket costs.

Reform did help the Blandings a little, focusing on the so-called “doughnut hole,” a gap in Medicare's prescription drug coverage until an individual hits certain thresholds. Under reform, the Blandings each received a check for $250. “It was nice, and it did help us, but not really a lot,” says Sharon.

Because of the economy and their health conditions, the Blandings have been trying to sell their Wisconsin property for the last year and move to a warmer, drier climate. “If it doesn’t sell, though I think it will eventually, we’ll be in bigger trouble,” she says.

She does not want to see the individual mandate or healthcare reform overturned. “Ditching the individual mandate would be bad, but ditching the entire package would be horrible,” she says. “Every year it would get better for us and people like us, and if they take it away they take away a lot of help, a lot of hope.”

But she says her sense of “dread,” may have a bright side. “Maybe that will be good and maybe we’ll go to a single payer system, which is what we should have done in the first place,” she says.

She says that in her all her years she has never been so disgusted with politics. “We’ve done everything right all of our lives, but people need to understand, almost everyone will get sick and even with insurance, it can be horrible,” she says. “There is a horrible mindset among the right wing that I think they would do absolutely anything to get rid of President Obama and his policies. I truly hope the Supreme Court sides with the law, rather than their politics.”

Related:

Court signals entire health care law might need to be struck down

Justices express skepticism over constitutionality of health care mandate

 By Robert Bazell
Chief science and medical correspondent
NBC News

Two thought provoking and disturbing studies out Wednesday raise major questions about conduct of the “War on Cancer.” One examines  the quality of basic research and the other concludes that half of current cancer deaths could be prevented.

Almost 90 percent of early stage cancer research looking for improved treatments is wrong, according to scientists at biotechnology giant Amgen and the MD Anderson Cancer Center.  The researchers describe their findings as “shocking.”

Read Wednesday's news about the decline in cancer death rates.

The allegations about questionable research in the quest for treatments appear in the prestigious journal Nature.  C. Glenn Begley, the former head of cancer research at Amgen, and surgical oncologist Lee M. Ellis of MD Anderson Cancer Center in Houston describe how scientists at the Thousand Oaks, Calif.-based Amgen tried to replicate the results of 53 landmark cancer research papers.  By landmark, they mean papers cited by others as significant progress.  All were so-called “pre-clinical,” meaning they were studies in rodents or with cells in petri dishes. The scientists were able to replicate only 11 percent of the conclusions.  In science, replication is proof.  If a study can’t be reproduced reliably, it is wrong. 

Most of the papers in question describe gene mutations or other changes in cancer cells that could be potential targets for new cancer treatments.  Such research is obviously critical for companies like Amgen deciding how to spend hundreds of millions testing potential drugs in humans.  The findings at Amgen do not differ greatly from those at a team at Bayer HealthCare in Germany, which reported last year that it could not replicate 25 per cent of studies.

Begley and Ellis assume that fraud plays little or no role in the bad science. “These investigators were all competent, well-meaning scientists who truly wanted to make advances in cancer research,” they write.

So, what is the problem? Scientists often ignore negative findings that might raise a warning, cherry picking the results and putting the best face on their research. The practice involves many parties -- not just the scientists -- in the research process who turn blind eyes to questionable actions.

As Begley and Ellis detail it, “To obtain funding, a job, promotion or tenure, researchers need a strong publication record…Journal  editors, reviewers, and grant review committees [and I might add journalists—R.B.] often look for a scientific finding that is simple, clear and complete—a ‘perfect’ story.  It is therefore tempting for investigators to submit suspected data sets for publication, or even to massage data.” 

Whatever the motivation, the results are all too often wrong.

Begley and Ellis call for nothing less than a change in the culture of cancer research.  They demand more willingness to admit to imperfections and an end to the practice of failing to publish negative results. 

“We in the field,” the say, “must remain focused on the purpose of cancer research: to improve the lives of patients.”

While the Amgen report casts doubt on cancer research, a separate study concludes that fully half of all cancers occurring today are preventable.  It raises questions about the billions spent searching for treatments and concludes that “we must vigorously implement what we already know about preventing cancer.”

The article about prevention appears in the top-tier journal Science Translational Medicine. Epidemiologists Graham Colditz, Kathleen Wolin and public health researcher Sarah Gehlert of Washington University in St. Louis review the best data. 

According to the careful Washington University study, smoking remains the biggest cancer-causing environmental factor  -- responsible for  33 percent of cancer deaths, almost 189,000 lives a year in the U.S. alone.  Obesity now follows closely, causing 20 percent of cancer deaths, or 114,000 people a year.  Pollution and radiation (most of it from medical sources) each account for only about 2 percent of cancers. 

The argument about allocation of funds for reducing the risk of cancer versus treatment is as old as our efforts to confront cancer.  But as these authors show the evidence and the need to act on it grow ever stronger.

As a society, we have shown we can do a great deal — but not nearly enough  – about tobacco. Obesity is another story, but we must do better if we want to be serious about cancer – and all the other attendant diseases.

Even short of the huge social challenges in confronting tobacco and obesity, there are many proven relatively simple methods to cut cancer deaths.  They include effective screening tests, such as pap tests and colonoscopies. The vaccines against HPV and hepatitis B both prevent cancer-causing viral infections, and aspirin is looking ever better as a cancer control agent.

Only 1.5 percent of the U.S. cancer research budget now goes to risk reduction. The rest seeks to find treatments, an effort that Begley and Ellis show is seriously flawed.  As these two powerful studies out Wednesday show, it is high time we reorder our priorities.

Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and Twitter.

 Related:

Daily aspirin linked to reduced cancer risk

What kills one person every six seconds? 

More from Robert Bazell:  

Could weight-loss surgery end diabetes?

Women have more sexual fantasies during fertile periods of the month, a new study finds.

The research is one of many studies finding differences in women's sexual interest across the menstrual cycle. For example, a 2007 study in the journal Hormones and Behavior found that around ovulation, when pregnancy is possible, women say they prefer macho, masculine guys. An April 2011 study even suggested that women who are in the more fertile phase of the month are more likely to see Georgia O'Keeffe's suggestive paintings as erotic.

The new study finds that sexual fantasies increase, and lead to more arousal in women, during fertile periods. Women also reported a higher proportion of men in their fantasies during fertile times of the month.

"When it mattered most, women were fantasizing more about men," said study author Samantha Dawson, a graduate researcher at the University of Lethbridge in Alberta, Canada.

Dawson and her colleagues focused on fantasies because such sexual daydreams aren't dependent on the availability of sex partners or other outside forces. That means fantasies may be more representative of sexual interest than how much real-life sex a woman has, Dawson told LiveScience. [ How to Spot a Fertile Woman ]

The researchers paid 27 single heterosexual women, mostly college students, to keep a daily online diary of their sexual fantasies for one month. None of the women were on hormonal birth control. By counting back from the last menstrual period, the researchers targeted a 10-day window in which each woman would likely ovulate.

During those 10 days, each woman took a do-it-yourself urine test to detect ovulation, much like the fertility tests available at drug stores. The tests were in neutral packaging, and women weren't told that they being tested for ovulation.

The women in the study reported, on average, 0.77 sexual fantasies a day — much higher than earlier work, which had suggested that men fantasize about once per day and women only once a week. Those earlier studies, however, asked participants to look back over time and recall their fantasies. A day-by-day approach is likely more accurate, because it does not rely so much on memory, the researchers reported online March 10 in the journal Archives of Sexual Behavior.

In the three days surrounding ovulation, fantasies became more frequent, reaching an average of about 1.3 per day. Women's reports also indicated these fantasies were more arousing than fantasies during nonfertile periods. [ Sex Quiz: Myths, Taboos & Bizarre Facts ]

The researchers expected to see fertile women become more "malelike" in their fantasies during fertile periods, given this increased interest in sex. Men generally report that their fantasies are more visual and explicit than female fantasies, which tend to contain more focus on emotion. But in fact, women actually became more femalelike in their fertile fantasies.

"They're still focusing on the emotions and the feelings that they have toward this partner in the fantasies as opposed to what the partner looks like, how masculine they are and what sexual acts they're actually engaging in," Dawson said.

The researchers did find, however, that women's interest in men peaked during fertile periods. Women are generally more fluid in their fantasies than men, Dawson said. One 2006 study presented at the International Academy of Sex Research in the Netherlands found that 25 percent of heterosexual women reported that their fantasies included other women, while only 10 percent of heterosexual men included other men in their sexual fantasies.

In the current study, 52 percent of participants reported fantasies that included women. Still, fantasies were primarily populated by men, with about 95 percent male characters across the menstrual cycle. During ovulation, however, the proportion of men went up by a percentage point or so, suggesting that fertility hormones do influence straight women's sexual interests.

"You're going to want to have sex with someone who can actually pass genes on to you, so a man versus a woman," Dawson said.

The researchers also had the women look at images of masculine and feminine men and women at three points across the menstrual cycle, but they did not find more interest in masculine men, or men in general, during fertile periods. The lack of a finding probably has more to do with the fact that the same photographs were repeated at each session than anything hormonal, Dawson said.

The message of the research is that psychologists need to be careful when studying female sexual desire, Dawson said.

"It's really important that we are conscious in these changes of female sexuality when we are researching components of women's sexual interest," Dawson said, adding that little things could make a big difference, "even the timing of when they're answering the questionnaire or when we're assessing sexual arousal."

Related:

• 10 Surprising Sex Statistics
• 7 Surprising Facts about The Pill
• 5 Myths About Women's Bodies 

More from Vitals:

• Can oral sex give you cancer?
• Santorum says porn is bad for you. Is it?
• Sex ed less effective in red states

University of Maryland Medical Center

Patient Richard Lee Norris after his face transplant.

For the past 15 years Richard Lee Norris has lived as a recluse, his face covered by a mask after being shattered in a gun accident. By day he hid from the public, shopping only at night to avoid the curious stares of children and adults.

In a groundbreaking, 36-hour surgery that began in the early morning of March 19, a team of surgeons from the University of Maryland gave 37-year-old Norris a new visage: a transplant that included not just the facial tissue from the hairline to the neck, but also the upper and lower jaws, teeth and a portion of tongue. Doctors called it the most extensive full face transplant yet completed.

A week later, Norris is further along than his doctors had ever hoped. Just three days after the surgery he asked for a mirror to see his new face. He is now able to move his jaws and open and close his mouth.

Norris has even started to shave and brush his teeth again, said the leader of the surgical team, Dr. Edwardo D. Rodriguez, chief of plastic, reconstructive and maxillofacial surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center.

University of Maryland Medical Center

Richard Lee Norris before his face transplant. Due to a gunshot accident, Norris lost his lips and nose and had limited movement of his mouth.

“This individual has not lived for the past 15 years as you and I know it,” Rodriguez said. “He’s been living behind a mask. This is clearly a transforming event.”

Norris came to the University of Maryland five years ago looking for help. Doctors wouldn't discuss details, but said that Norris' face had been ravaged by a gunshot. The 12 plastic surgeries helped, but not enough. Norris still lived behind a mask, hiding from the rest of humanity. Rodriguez realized that the only way to give Norris back his life was a full face transplant.

When the team was ready to embark on its first face transplant they picked Norris as the patient who most needed help. The hope was to give him back a face that would be as close to normal as possible – right down to the teeth and the tip of the tongue.

“Richard always said he wanted to have teeth again,” Rodriguez said, pointing to a photo showing the puffy faced, but normal looking, Norris six days after the procedure.

Norris may also benefit from more than a decade of research on immunosuppressing drugs. University of Maryland scientists discovered that by transplanting the jaw as well as the face, they would need lower levels of the medications to keep the body from rejecting the new tissue and bone, said Dr. Steven Bartlett, chair of the Department of Surgery at the University of Maryland Medical Center.

University of Maryland Medical Center

Norris in his prom picture.

Animal research showed that marrow from the jawbone could make all the difference.

“We realized that there was a massive amount of bone marrow in the jawbone that was vascularized with its own unique blood supply,” Bartlett said. “In that scenario you required much lower than expected long term immunosuppression.

The surgery itself took place at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center and involved a multi-disciplinary team of faculty physicians from the University of Maryland School of Medicine and a team of over 150 nurses and professional staff.

Ultimately, Norris’s appearance may seem like a combination of both his and his donor’s faces since his new tissue will drape over his cheekbones and his donor’s jawbones.

Including Norris, there have been 23 face transplant procedures around the world since the first surgery was performed seven years ago in France on a woman who had been mauled by her dog. In the U.S., 25-year-old Dallas Wiens was the first person to receive a full-face transplant.

While Norris was getting his face transplant five other patients were receiving organs from the same donor. “This patient was able to donate five organs to five other recipients,” said Charles Alexander of the Living Legacy Foundation of Maryland.

As for Norris, Alexander said, “it gives this man back more than aesthetics. It gives him back his life.”

Related stories:

19-year-old transplant patient sees new face for the first time    

Chimp attack victim reveals her new face    

First face transplant patient to Charla Nash: 'Go, girl!'       

Related:

• Shock therapy mystery closer to being solved
• Facebook takes a toll on your mental health
• All that stress is shrinking your brain

A "sensational" new finding could be the beginning of a cure for type 2 diabetes, a disease described in an editorial accompanying the research in the New England Journal of Medicine as “one of the fastest growing epidemics in human history.”

Two studies find that weight loss surgery can eliminate the symptoms of type 2 diabetes in a large proportion of volunteers. That might not seem surprising, since obesity is the major risk factor for the disease. But in these studies, published in the New England Journal of Medicine and presented Monday at the annual meeting of the American College of Cardiology, many of the patients got better within weeks, days, sometimes even hours after the surgery -- long before they lost any weight.

“It’s pretty amazing,” said Dr. Phil Schauer of the Cleveland Clinic, the lead author on one of the studies. Schauaer’s study divided 150 patients with out-of-control diabetes into three groups. One-third got the best drug therapy, one-third got the surgical procedure sleeve gastrectomy, and the last group gastric bypass. The goal was to get the patients’ blood sugar (measured by the A1C test familiar to diabetics) below the normal level of 6 percent. Forty-two percent of the bypass patients reached the goal after one year compared to 37 percent of the sleeve patients and only 12 percent on medical therapy.

But those numbers “don’t even begin to show how successful this was," according to Dr. Steve Nissen, another author of the paper from the Cleveland Clinic. He points out that at the beginning of the study most of the patients were taking three or more medications to control their diabetes. But after a year almost none of the gastric-bypass patients needed medication.  Forty-four percent required daily insulin injections before surgery and none did after.  Diabetes is a major risk factor for heart disease.  Most of the surgery patients saw their HDL, the good cholesterol, shoot way up and their artery clogging triglycerides drop sharply.

“This is sensational,” Nissen told me.

The second study from the Catholic University of Rome and Weill Cornell Medical College followed 60 patients for two years and produced even stronger results.  In that experiment one-third of the volunteers got drug therapy, one third bypass surgery, and the last group underwent bilopancreatic diversion, an even more severe weight-loss operation where surgeons block part of the small intestine.

After two years none of the patients on drug therapy reached the goal of normal blood sugar levels while 75 percent of those who underwent bypass did and as did fully 95 percent of those undergoing the bilopancreatic diversion.  The authors of the study say these patients have achieved “complete diabetes remission.” Though the doctors have followed them for only two years, there is no indication that the diabetes is returning in any of them.

Why, in some patients, do the positive effects take place long before they lose weight? Marla Evans, 56, one of the volunteers who got a sleeve gastrectomy in the Cleveland study put it this way, “I was a diabetic, and then after the surgery, within a few days, the diabetes was much better, and within a month or two there was no diabetes in my blood at all.”

Most experts believe the operations somehow set off massive changes in the body’s hormones. Exactly what and how remains a mystery.

“This is hotly debated area,” Dr. Rudy Leibel of Columbia University, an authority on metabolic hormones told me.  And it is critical because if scientists can figure out how to bring about the changes that control the diabetes without surgery or with far less invasive surgery, the treatment could easily be more widespread.

But even now medicine faces the question:  Is it worth undergoing surgery that costs about $25,000 and carries a significant risk of dangerous complications and unpleasant side effects to treat type 2 diabetes? The answer, most experts say, is that most type 2 diabetics (type 1 diabetes is an auto-immune disease not impacted by this research) can stay well with diet, exercise and medication. But those who cannot control their disease face complications including heart and kidney disease, along with loss of limbs and visions. One person with uncontrolled diabetes can run up millions in medical bills.  So a surgery that was considered extreme not long ago may become a standard treatment for many people with one of the most common diseases of modern times.

Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and Twitter.

To read the articles:

• Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
• Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes
• Surgery or Medical Therapy for Obese Patients with Type 2 Diabetes?

Related: 

• Opinion: Deen's diabetes confession a sticky hypocrisy
• White rice may increase your risk of diabetes

Watch NBC's Robert Bazell speak with Dr. Philip Schauer, surgeon and director of the Cleveland Clinic's Bariatric and Metabolic Institute.

Attention, germaphobes. Exposure to the microscopic bugs is crucial for keeping kids healthy, according to new research in the prestigious journal Science. The study strongly supports a growing body of evidence that you need to put away the disinfectant and expose children to the real world of germs and microbes. 

Getty Images stock

We're meant to encounter some microbes and dirt when we're young. It's how we build our immune systems.

Scientists Richard S. Blumberg and Dennis L. Kasper and a team of researchers at Harvard Medical School showed that in mice exposure to germs in early life helped reduce the body’s inventory of invariant natural killer T (iNKT) cells. These cells help protect us against diseases like inflammatory bowel disease and asthma. But, if there are too many of them with too much time on their hands, they can actually cause these conditions. By exposing young mice to common microbes the scientists saw that the animals were protected from accumulating T cells -- and were healthier than those who were not.  

The scientists reached an admittedly geeky conclusion: “These results indicate that age-sensitive contact with commensal microbes is critical for establishing mucosal iNKT cell tolerance to later environmental exposures,” they wrote in the journal Science. In other words, exposing baby mice to common germs got their immune systems appropriately busy and able to not over-react when encountering nasty bugs and other biological stuff later in life.

This is a big deal.

The rapid rise in food allergies, asthma and other immunological diseases is due, at least in part, to our modern obsession with cleanliness, scientists increasingly believe. The 'hygiene hypothesis', first advanced in 1989 by the British epidemiologist David Strachan, contends that these diseases are becoming more common because young children are not exposed to them at an early age. We spend so effort trying to prevent exposure to germs with antibiotics, antibacterials and soaps that letting kids get dirty seems like a violation of basic parental duty.

Parents are constantly being told to make their kitchens spotless, to kill 99.9 per cent of the germs lurking in their bathrooms and to wash themselves and their babies all the time.

This world of purity sounds good but it does not fit how we are designed. We are meant to encounter some microbes and dirt when we are young. It is how we built our immune systems. We need a certain amount of grunginess as kids to be healthy adults. 

As the Harvard study shows, filth can be good -- at least in tiny amounts when you are very young.

Arthur Caplan, Ph.D., is a Professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania

A new study finds that pharmacies often offered inaccurate information when they thought 17-year-old girls were seeking emergency contraception such as Plan B One-Step.

 Even though it’s legal for 17-year-olds to get the so-called morning-after pill, a new study shows that pharmacy employees often dole out the wrong information, telling the teens they’re not allowed to have the drug.

An undercover survey found that many of the pharmacies that told girls they were too young to get emergency contraception offered correct information when a doctor called seeking the pill for a 17-year-old patient, according to a report in the latest issue of the journal Pediatrics.

“I was shocked that 19 percent of 17-year-olds were told they couldn’t get the medication at all,” said Dr. Tracey Wilkinson, the study’s lead author and a general pediatrics fellow at Boston Medical Center/Boston University School of Medicine.

“That’s like one in five. And I think if you told an adolescent once that she couldn’t get the medication, she probably wouldn’t call another pharmacy. It would be the end of her attempts.”

Wilkinson’s study was aimed at evaluating the real-world availability of Plan B One-Step and other emergency contraception drugs, which are available without prescription to girls and women starting at age 17. Girls younger than 17 require prescriptions to obtain the medication.

Proponents say that using emergency contraception could prevent half of all unplanned teen pregnancies. Each year in the U.S., nearly 750,000 girls ages 15 to 19 become pregnant, and about 85 percent of those are unplanned, according to the Guttmacher Institute.

For the new study, researchers posing as either a 17-year-old girl or a doctor seeking help for a 17-year-old girl called every pharmacy in each of five U.S. cities asking about the availability and accessibility of emergency contraception.

All callers asked questions from a script. The first question was whether the pharmacy had the medication in stock -- 80 percent of the 943 pharmacies said they did. Next, the researcher posing as a teen asked if she could get the drug, while the researcher posing as the doctor of a 17-year-old patient asked if the patient could get the medication.

There was a huge disparity between the answers given to the teens and those offered to the physicians, with 19 percent of the 17-year-olds being told that they couldn’t get it under any circumstances, compared with only 3 percent of the physicians.

The next question was asked only by teen callers who had been told a 17-year-old could get the morning-after pill: “My friends said there is an age rule [regarding access without a prescription] -- do you know what it is?”

Pharmacy employees answered that incorrectly 43 percent of the time.

The researchers can’t say anything for sure about the motivation behind the misinformation because that wasn’t part of the experiment. It might be partly explained by the fact that the doctors in the study tended to get actual pharmacists on the phone while “teens” often got lower-level pharmacy employees who might have been less informed about the FDA rules. The researchers found that, in general, teens were put on hold more often and that they spoke less often to pharmacists.

It’s also possible that the misinformation was given on purpose by pharmacy employees who didn’t want to dole out morning-after pills to 17-year-olds.

“It’s a controversial topic," Wilkinson said. “It shouldn’t be, but it is. And anything with controversy heightens a person’s personal beliefs.”

Indeed, the topic has been so controversial that it forced a showdown in December over whether to make the drug available without prescription to girls younger than 17. Health and Human Services Secretary Kathleen Sebelius invoked her authority to overrule the recommendation of a Food and Drug Administration center and the agency's head, Commissioner Margaret Hamburg, who supported the move.

Wilkinson hopes the new study will raise awareness about the problem of pharmacists dispensing inaccurate information.

“This was disappointing,” she said. “I hope this study will instigate some sort of change on all fronts, for teenagers, pharmacists, staff and also clinicians.”       

Related stories:

Plan B won't be available OTC to younger teens, HHS says

Bioethicist: Plan B ruling trumps good science with bad policy

Dick Cheney has just joined a list of high-profile people, including Steve Jobs, Mickey Mantle, Evil Knievel and David Crosby who, received a transplant and thereby created a controversy. Cheney received a heart on Saturday from an anonymous donor at Inova Fairfax Hospital in Virginia after a 20-month wait. What is controversial about that? Cheney is 71 years old.

He has been through numerous previous operations that indicate he has other serious medical problems. He has only been able to survive due to the implantation of a left-ventricular assist device (LVAD) — a partial artificial heart -- that has kept him going long past the point where his own heart could have kept him alive.

For some patients, it's a bridge until a transplant may be possible. Others, who do not qualify for a transplant, live out the rest of their lives with an LVAD.  So despite his age and health problems, how was Cheney able to get a heart while many others wait?  

It is concerning that a 71-year-old got a transplant. Many of those who manage to even make the waiting list for hearts die without getting one. More than 3,100 Americans are currently on the national waiting list for a heart transplant. Just over 2,300 heart transplants were performed last year, according to the United Network for Organ Sharing. And 330 people died while waiting.

According to UNOS, 332 people over age 65 received a heart transplant last year. The majority of transplants occur in 50- to 64-year-olds.

Most transplant teams, knowing that hearts are in huge demand, set an informal eligibility limit of 70. 

Cheney is not the first person over 70 to get a heart transplant.  He is, however, in a small group of people who have gotten one. Why did he?

Cheney has an advantage over others. It is not fame or his political prominence. It is money and top health insurance. 

Heart transplants produce bills in the hundreds of thousands of dollars. The drugs needed to keep these transplants working cost tens of thousands of dollars every year. Organ donations are sought from the rich and poor alike. But, if you do not have health insurance you are far less likely to be able to get evaluated for a heart transplant much less actually get a transplant. 

The timing of Cheney’s transplant is ethically ironic given that the battle over extending health insurance to all Americans reaches the Supreme Court this week.

If the President’s health reform bill is deemed unconstitutional, those who are wealthy or who can easily raise money will continue to have greater access to heart, liver and other forms of transplantation than the uninsured and underinsured.

It is possible that Cheney was the only person waiting for a heart who was a good match in terms of the donor’s size, blood type and other biological and geographical factors. If not, then some tough ethical questions need to be asked. 

When all are asked to be organ donors, both rich and poor, shouldn’t each one of us have a fair shot at getting a heart? And in a system in which donor hearts are very scarce, shouldn’t the young, who are more likely to benefit both in terms of survival and years of life added, take precedence over the old? 

Let’s hope we get some answers to these tough questions as we watch both Cheney’s recovery and the fate of health care legislation that is intended to minimize the advantages that the rich now have over the poor when it comes to proven life-saving treatments.

Msnbc.com news services contributed to this report.

Correction: An earlier version of this report incorrectly characterized how patients typically fare after getting a left-ventricular assist device (LVAD). Studies show that many patients improve and experience better quality of life on an LVAD. The device is approved to be used in two ways, as a Bridge-To-Transplant for those who qualify for a transplant and as Destination Therapy for those who do not.  

Jonathan Ernst / Reuters

People wait in line days before to be guaranteed seats to watch the arguments on President Barack Obama's healthcare legislation before the Supreme Court in Washington, D.C., March 23.

 Analysis: Why high court may uphold healthcare law

Health care ruling could send fight back to Congress

By Stephanie Pappas
LiveScience 

With a statement decrying the Obama administration's "blind eye" toward enforcement of federal obscenity laws, Republican presidential candidate Rick Santorum has brought the subject of pornography into the presidential campaign. But some of Santorum's statements about the ills of explicit material may not hold up.

In a statement first posted last week on his campaign website, Santorum cites "a wealth of research" demonstrating that pornography causes "profound brain changes" and widespread negative effects in both adults and children, including violence against women. There's no such evidence of brain changes, researchers say — though the question of pornography's harmfulness is still in some dispute.

"It's very easy if you want to support one side or the other, to pull a particular study," said Paul Wright, an assistant professor of telecommunications at Indiana University, Bloomington, who has studied sex in the media. "Anybody can support one side or another by simply isolating a particular study and talking about it."

Most experimental studies on the effects of pornography have focused on college students, given their easy proximity to the psychology lab. Looked at individually, these studies seem mixed. Some find that exposing young men to porn increases sexist attitudes and even a willingness to inflict pain, often tested by having the men inflict what they believe are real electric shocks on a woman. (The shocks are fake.) Other studies find little to no effect. [Sex Quix: Myths, Taboos & Bizarre Facts]

To pull this disparate research together, psychologists depend on meta-analyses, or studies that analyze data from multiple single studies. Using this technique, Wright said, the effects of pornography are "fairly clear."

"In experimental settings where actual aggressive behavior is measured as the outcome measure among males, both violent pornography and nonviolent pornography increased the probability of subsequent aggression," Wright told LiveScience.

Not all researchers put stock in experimental findings, however.

"The question became do these little tests that we're having these guys do [in the lab], do they really apply to real life?" said Chris Ferguson, a psychologist at Texas A&M University who studies the link between media and violent behavior.

In real life, of course, researchers can't carry out controlled experiments on pornography. One alternative strategy has been to look at sexual violence rates in countries right after pornography is decriminalized. These studies, many done by Milton Diamond, the director of the Pacific Center for Sex and Society at the University of Hawaii at Manoa, usually find that rates of sexual violence go down after pornography becomes more prevalent. Diamond sees this as evidence that pornography actually provides a catharsis for men who have sexually aggressive tendencies. [A Brief History of Porn]

"The majority of the pornography dissipates the arousal by masturbation and I think that works both for males and females," Diamond told LiveScience. "And usually after somebody masturbates and they have their orgasm, they're not as interested in sex as they were 10 minutes before, so I think it dissipates the interest to go out and do anything illegal."

There's no proof of this catharsis effect in the countrywide studies. It's not even possible to firmly link the drop in violence to pornography at all, given the large number of other factors that could play a role. The decriminalization of pornography could go hand-in-hand with other societal changes that influence sexual violence, Ferguson said. Women might even be influenced by a more porn-saturated society to accept violence against themselves and not report sexual aggression, Wright pointed out. Or some other, non-porn-related factor might play a role.

Nonetheless, some researchers see the countrywide correlations as telling.

"When you have people that are making these kinds of claims, that it's a major contributor to men's aggression toward women, it makes sense to look at if that societal data point exists," Ferguson said. [Internet Pornography Statistics]

If the laboratory studies are correct that pornography does increase male violence, it's a small to moderate effect, said Wright, who is quick to point out that he does not advocate censorship in any case.

Researcher Neil Malamuth of the University of California, Los Angeles, has found that exposure to pornography doesn't affect the average man. But for men with other risk factors that predispose them toward sexual violence, "it can add fuel to the fire," Malamuth said.

"It can make a person who perhaps has a certain proclivity, a certain inclination, a certain risk profile even more likely to act out in a sexually aggressive way," Malamuth said.

Risky characteristics include hostility toward women, a narcissistic personality, and a tendency to derive gratification from power and control over women, as well as background characteristics such as growing up in a violent home.

Perhaps different studies are capturing different proportions of men with these characteristics, which would explain the conflicting results, Malamuth said.

The focus on the link between pornography and aggression glosses over other potential pitfalls of porn, including working conditions for the porn actors and the pressure on women to look or act like a porn star. But some researchers are taking a closer look at the potentially positive sign of sexually explicit media. In surveys, pornography users generally see porn as a boon, said Malamuth.

"Pornography may have many beneficial effects for some people in their sexual lives, and many don't see themselves as harmed in any way," Malamuth said.

In one study published this month in the International Journal of Intercultural Relations, University of Hawaii at Manoa researchers compared poses of women in photographs taken from popular pornography websites, magazines and porn-star portfolios, in Norway, the United States and Japan. These three countries were chosen because they fall in different portions of the United Nations' Gender Empowerment Measure, a measure of women's political and economic power in a nation. Norway is No.1 globally on the scale, the U.S. is No. 15, and Japan is No. 54.

The researchers compared "empowering" and "disempowering" poses in the popular pictorial pornography of each nation. An example of a disempowering photograph would be a woman tied up or contorted, with little care given to her own comfort. An empowering photograph would be the opposite, for example an unbound woman facing the camera with confidence.

The researchers found that disempowering photographs were equally common across all three countries. But Norway had the highest number of empowering photographs, followed by the U.S. The findings suggest that pornography may mirror the gender equality or lack thereof of society at large, according to study researcher Dana Arakawa, a doctoral student at the University of Hawaii at Manoa.

"It's a reflection of what our culture produces to show what is sexy about women or what should be considered a sexual ideal," Arakawa told LiveScience. The fact that relatively equal Norway exhibits more examples of "empowering" images of sexual women is heartening, Arakawa said. Most Americans have a vision of porn stars as stereotypically pouting Playboy bunnies, but that view of sexuality is limited in scope, she said.

"There is variety," Arakawa said. "Pornography isn't just what we know of in the U.S."

More from LiveScience:

• 10 Surprising Sex Statistics
• Fight, Fight, Fight: The History of Human Aggression
• 6 (Other) Great Things Sex Can Do For You

Read the latest health news from Vitals:

• Can oral sex really give you cancer?
• Whitney's death: How cocaine hardens arteries
• CDC: Only half of first marriages last 20 years

More from Vitals: 

• Trial herpes vaccine misses mark for protection in young women
• FDA cracks down on DIY sperm donor in Calif.
• The scent of a man? It could be an STD

The bare-bones release of Whitney Houston’s cause-of-death Thursday by the Los Angeles Country Department of the Coroner’s office wasn’t shocking, but it did raise some questions.

The singing great died at age 48 of drowning (in a hotel room bathtub), atherosclerosis (hardening of the arteries), and cocaine use, the report indicated.

The primary cause was accidental drowning and it’s uncertain whether she had a heart attack. But the L.A. Coroner’s office indicated that cardiovascular disease was a contributing factor and there were signs of “chronic usage” of cocaine.

According to a spokeswoman for the San Diego County Medical Examiner’s Office -- who stressed she was not commenting on Whitney Houston’s death in particular -- “the chronic use of cocaine can have various effects on the heart” and cardiovascular system.

“Cocaine, like other stimulants, can exacerbate pre-existing heart disease, such as coronary artery disease or hypertension. In the presence of these pre-existing diseases, cocaine can cause heart failure, heart attack or sudden death,” the spokeswoman Sarah Gordon said.

Chronic use of cocaine has been shown to accelerate the development of atherosclerosis, the formation of plaques inside blood vessels, even in young people. Those plaques can eventually lead to severe narrowing of the vessels, causing heart attack, stroke, or a transient ischemic attack, a so-called “ministroke.”

As many older people who have experienced a TIA can attest, a ministroke can leave you disoriented, cause fainting, and falls. If one happens to be in a bathtub at the time, that could be deadly.

A University of California San Francisco study found that “ischemic stroke/TIA is a common neurovascular presentation in patients with a remote history of cocaine use, often as a result of atherosclerotic disease.”

Additionally, bits of plaque can break off and block a vital vessel, also causing a heart attack or stroke.

There’s more danger of that happening after something stimulating, like exercise. A study of sports-related deaths among schoolchildren in Australia concluded that “the fatal episodes often resulted from a complex interplay of a variety of factors, including physical exertion, possible trauma, and underlying organic disease” including, in one case, atherosclerosis.

Smoking a cigarette and getting the rush of nicotine, or, as Whitney Houston did, taking cocaine, can have similar cardiovascular effects as exercise. So can hot water. 

A 1991 study of 151 drowning and hyperthermia deaths in spas, Jacuzzis and hot tubs found that in 14 percent of them, cocaine – with or without alcohol ingestion – was implicated as a contributing factor. 

The anti-anxiety prescription medication Xanax and the antihistamine Benadryl were also found in her system but are not believed to have contributed to her death. However, nothing can be confirmed until the final report is released.

On TODAY Friday, chief medical editor Dr. Nancy Snyderman noted that the coroner didn't connect the other medications to her death, but that the drug interactions shouldn't be ignored.

"It doesn’t have to be one drug in a whopping amount; it can be a lot of little things, and when you compound it, it can be enough to cause death," Snyderman said.

Whatever the combination of factors that led to her death, there is an important message in Houston’s sad story: The effects of chronic cocaine use can cause physical damage capable of haunting users even long after they’ve stopped.  

 Related:

Whitney Houston had signs of 'chronic" cocaine usage

Stroke risk lower among women who drink moderately

By Mary Agnes Carey
Kaiser Health News

Friday marks the two-year anniversary of the 2010 health care overhaul law, and despite an upcoming challenge in the Supreme Court, it has already begun to be implemented.

While some of the key features don’t kick in until 2014, the still-controversial law has already altered the health care industry and established a number of consumer benefits.

Here’s an FAQ about some of the law’s provisions that are already in place as well as major features of what’s to come, if the law stays in place.

Q: I don’t have health insurance. Will I have to buy it and what happens if I don’t?

A: Right now, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.

For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater by 2016 and beyond. The requirement to have coverage, known as the individual mandate, can be waived for several reasons, including financial hardship or religious beliefs.

Millions of additional people will qualify for Medicaid or federal subsidies to buy insurance under the law.

Q: I get my health coverage at work and I’d like to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?

A: If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.

You may have seen some law-related changes already. For example, most plans now ban lifetime coverage limits  and include a guarantee that an adult child up to age 26  who can’t get health insurance at a job can stay on her parents’ health plan.

Q: What are some other parts of the law that are now in place?

A: You are likely to be eligible for preventive services with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.

Health plans can’t cancel your coverage once you get sick -- a practice known as “rescission” -- unless you committed fraud when you applied for coverage.

Children with pre-existing conditions cannot be denied coverage (this will apply to adults in 2014).
Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.

Some existing plans, if they haven’t changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these “grandfathered” plans  can still charge beneficiaries part of the cost for preventive services.

If you’re currently in one of these plans, and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then have to abide by all aspects of the health law.

Q: I want health insurance but I can’t afford it. What will I do?

A: Depending on your income, you might be eligible for Medicaid, the state-federal program for the poor and disabled. Currently, in most states nonelderly adults without minor children don’t qualify for Medicaid. But beginning in 2014, anyone with an income at or lower than 133 percent of the federal poverty level, (which currently would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid (based on current poverty guidelines).

Q: What if I make too much money for Medicaid but still can’t afford to buy insurance?

A: You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.

These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current poverty guidelines).

Q: Will it be easier for me to get coverage even if I have health problems?

A: Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.

Q: I own a small business. Will I have to buy health insurance for my workers?

A: No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don’t provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of up to $2,000 per full-time employee. The firm’s first 30 workers would be excluded from the fee.

However, if you have a firm with 50 or fewer people you won’t face any penalties.

In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.

Q: I’m over 65. How does the legislation affect seniors?

A: The law is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That’s when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.
That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs.

The law also has expanded Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor.

The federal government’s payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare, were cut in 2011 and will continue to be reduced in future years. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships that they now provide.

Q: Will I have to pay more for my health care because of the law?

A: No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.

That said, there are some new taxes and fees. For example, starting in 2013, individual with earnings above $200,000 and married couples making more than $250,000 will pay a Medicare payroll tax of 2.35 percent, up from the current 1.45 percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends and interest.

Starting in 2018, the law will also impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a “Cadillac” tax because it hits the most generous plans.

Q. Has the law hit some bumps in the road?

A: Like any major piece of legislation, some aspects have not worked out as well as its authors intended.
For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the pools has been less than expected. In February, the Obama administration announced that almost 50,000 people had signed up for the high-risk pools, but the program, which began in June 2009, was initially expected to enroll between 200,000 to 400,000 people. The cost and the requirements have been difficult for some to meet.

For example, applicants must be uninsured for six months because of a pre-existing medical condition before they can join a pool. And because participants are sicker than the general population, the premiums are higher.

Enrollment has increased since the summer, after the premiums were lowered in some states by as much as 40 percent and some states stepped up advertising.

Another feature of the law that hasn’t worked as envisioned is its long-term care provision. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials effectively suspended the program even before it was slated to begin,  saying they could not find a way to make it work financially.

 Related stories:

Amid controversy, health care law changes marching on

File

Some hospitals have had to discard cyatarabine, a cancer drug in such short supply that it has been rationed.

Amid ongoing shortages of critical drugs, 60 percent of hospital pharmacists surveyed said they’ve been forced to trash life-saving or expensive medications because of misguided government rules, a new poll shows.

Discarded have been more than 100 different drugs, including 80 percent that are now or have been in short supply, and costly medications such as Velcade, a cancer treatment that can go for between $1,500 and $2,500 per 3.5-milligram vial. 

That’s according to a just-published survey of 715 hospital pharmacy directors, managers and clinicians nationwide who responded to queries by the Institute for Safe Medication Practices.

“We wanted to do some research and see how big of a problem it is,” said Mike Cohen, president of ISMP, a drug safety advocacy organization. “It’s really a major issue.”

Cohen said the results weren't surprising to him, given the concerns he'd previously heard. But he said they should spark new discussion.

About 61 percent of pharmacists and managers who responded said they “feel compelled” to discard injectable drugs, the survey found. Most fear facing industry or government sanctions if they don't.

Some hospitals have been cited by officials at the Centers for Medicare & Medicaid Services or by the Joint Commission, an accrediting agency, for not following explicit directions in drugmakers’ package inserts.

In the new survey, the drugs tossed include cancer medications such as cytarabine and bleomycin, which have been so scarce that some hospitals have turned patients away or resorted to rationing.

Nearly 80 percent of the pharmacists said that existing rules “often” or “always” lead to unnecessary waste, contributing to the crisis that saw a record shortage of 267 drugs last year, the survey found.

At issue are rules imposed by regulators, including CMS, which require hospital pharmacists to follow drug manufacturers’ written instructions for storage, stability and by-use-dates for injectable drugs -- even when that information is outdated or incomplete.

The most current evidence-based data about how long a drug can be used or stored is often available not from the manufacturers, but from widely used compendia, or summaries, such as the American Hospital Formulary Services drug information database.

That information is available in the package inserts that are approved by the federal Food and Drug Administration when a new drug is cleared. But it can be costly and time-consuming to seek new FDA label approval, so updated information often isn’t added to the directions.

Many times, having the latest information can mean the difference between being able to store a diluted drug for a week rather than a day, as in the case of an IV blood pressure medication, nicardipine, which has been in shortage.

The crucial neuro-muscular blocker succinylcholine can be stored for a week, according to manufacturers’ directions. But it can be used for up to a month according to updated data in Trissel’s Handbook, a widely used compendium.

Often, drugs are packaged in sizes that don't lead to easy dosing, forcing pharmacists to discard unused portions.

About 40 percent of pharmacists buck the rules and decline to discard injectable drugs based solely on manufacturers’ guidelines, the survey found. Only about half of the pharmacists said they “always” follow package instructions, when they exist.

Nearly all of the pharmacists, 97 percent, felt that CMS rules contribute to the crisis, the survey found.

"That's an alarming response," said Dr. Ana McKee, the chief medical officer for the Joint Commission.

McKee says her agency is in frequent conversations with CMS and either has or will soon consider the issue of using package instructions only to determine drug storage and stability parameters.

CMS officials did not immediately respond to requests for comment about the survey findings. Previously, Dr. Patrick Conway, CMS chief medical officer, said the agency would work with the ISMP to resolve the issue.

The survey results should help with discussions already underway, said Erin Fox, manager of the Drug Information Service at the University of Utah, which tracks drug shortages.

“Overall, I am very hopeful that the CMS rule regarding package inserts will be reversed,” she said in an email to msnbc.com.

In the meantime, she noted that stepped-up federal attention seems to be slowing reported drug shortages.

“We are at 34 new shortages for this year. Half the rate of last year!” Fox said. “I think the FDA’s efforts are paying off."

Related stories:

Amid shortages, rules force hospitals to trash scarce drugs

Bugs in sterile drugs? Behind the shortage of critical meds

Lingering shortage of ADHD drugs unravels lives

Even though Americans are marrying older, the divorce rate has remained high, a new government report shows.

Centers for Disease Control and Prevention researchers found that the median age for women getting hitched for the first time has risen to almost 26 and to over 28 for men.

Among women there was just a 52 percent chance that a first marriage would survive for 20 years, according to the report from the CDC’s National Center for Health Statistics. Men appeared to be slightly more successful, with a 56 percent chance of a first marriage surviving for two decades.

The older marriage age doesn’t mean that people aren’t getting into relationships – they’re just choosing to live together instead.  “There’s been a real rise in the prevalence of cohabitation,” said the report’s lead author, Casey E. Copen, a demographer with the National Survey of Family Growth at the National Center for Health Statistics.

The percentage of women living with a partner (as opposed to marrying him) has nearly quadrupled from 3 percent in 1982 to 11 percent in the newest survey. The earlier surveys included data only from women so the researchers couldn’t look at whether there had been a change in the rate at which men were choosing to live together rather than to marry.  

The new report includes information from 22,682 Americans between the ages of 15 and 44 who were interviewed in their homes between 2006 and 2010. The researchers also had data from six earlier surveys dating back to 1973 to compare with the new information.

One intriguing finding from the study is that more highly educated people wedded later -- and had longer lasting marriages. Copen and her colleagues found that 78 percent of women with at least a bachelor’s degree had made it to their 20^th anniversary as compared to 41 percent of women with only a high school diploma. Similarly, 65 percent of college educated men saw a 20^th anniversary as compared to 47 percent of the men who hadn’t gone beyond high school.

That falls in line with other new research showing that blue collar folks are less likely to get married than their white collar counterparts, Copen said. “Research has shown that there’s a socioeconomic divide between those who marry and those who don’t,” she added. “People may be more likely to transition to marriage when they feel more economically stable.”

The researchers also found that the lack of a marriage certificate isn’t keeping people from having babies. “A lot of women and men have children while cohabitating,” Copen said.

So, did the new report shed any light on what it takes to stay married? Maybe - depending on how you interpret the results.

For one thing, if you want to stay hitched, you probably shouldn’t choose someone who’s gotten divorced. Looking only at first marriages, just 38 percent of women who chose to wed a divorced man were still married by their 20^th anniversary, as compared to 54 percent of those who wed a man who’d never been married.

Another possible predictor of a shortened wedded bliss: marrying someone who already has kids. Looking only at women in a first marriage, just 37 percent of those marrying a man with kids made it to their platinum anniversary as compared to 54 percent of those who wed a man with no children.

Still, children may indeed be the glue that keeps people together – if they’re conceived and born after the couple marries.

Among women who remained childless just 50 percent reached their platinum anniversary as compared to 77 percent of those who bore children at least 8 months after getting married.

In the end, the report may be telling us something good about the way Americans view marriage.  

Although women are taking longer to decide to get hitched, they are still doing it at about the same rate as they were back in 1995.