How to dole out healthy Halloween treats

This year, why not offer your trick-or-treaters something that's actually good for them? I brainstormed with our Sensory Group Manager Maxine Siegel and Foods Senior Project Leader Ellen Klosz to come up with some alternative treats. Many of these are available in single-serving sizes, and you may even find them with Halloween packaging. Here are some goodies to consider:

• Fruit snacks: Look at the label before you buy. Some are no better than eating candy. You want the ones with real fruit. Consumer Reports tested nine fruit snacks and found good nutritional choices in three.
• Raisins: A real fruit snack offering real vitamins. Enough said.
• Pretzels: They contain salt and carbohydrates, but many versions of this treat have no fat.
• Popcorn: It may be high in salt and fat, but it’s better than candy because it offers some fiber.
• Cereal bars: Look at the nutrition label and opt for the lower-fat and lower-sugar versions.
• Animal crackers, cheese crackers, and cereal all come in individual serving sizes; some offer lower-fat, reduced-fat, or lower-sugar versions.

And if all else fails, try giving out stickers or pencils.

—Jamie Schaefer-Wilson, author, "The Consumer Reports Guide to Childproofing and Safety"

Check out our Halloween safety tips on our Cars blog.

Q&A: Severe cough syrup side effects?

I was recently prescribed a hydrocodone cough syrup, which cured my cough but left me with severe nausea. Is this typical?—L.F., Valhalla, N.Y.

Prescription cough syrups containing the narcotic hydrocodone can cause nausea as well as other side effects, such as constipation, dizziness, drowsiness, fatigue, vomiting, and psychological dependence. That's one reason that syrups containing hydrocodone—or the related ingredient codeine—should be used only for especially persistent and wrenching coughs, and only for adults.

Try milder measures first, such as humidifying the air to moisten dry airways, drinking hot liquids, and sucking on non-medicated lozenges. Most coughs actually stem from postnasal drip associated with the common cold. In those cases, using an over-the-counter antihistamine or nasal spray can help resolve the symptoms that cause dripping. Note that no cough product, either prescription or over-the-counter, is recommended for young children.

Find out more on home remedies for colds and coughs, and read our advice on treating your child's cold.

Study illuminates link between Parkinson's and vitamin D

More research is shedding light on the role that the sunshine vitamin (aka vitamin D) plays in maintaining good health. The latest study  has found that people with Parkinson's disease are more likely than healthy adults to have low levels of this nutrient. But researchers can't say yet whether a lack of vitamin D might be a cause of the disease or a consequence.

Vitamin D is known as the sunshine vitamin because your skin produces it when exposed to ultraviolet B light from the sun. You can get vitamin D from some foods, such as fatty fish (tuna, for example) and fortified milk, but the main source is usually sunlight.

We know that vitamin D performs many important jobs in the body, such as helping your bones to stay strong. Studies have also found that a lack of vitamin D increases the chance of getting problems with your immune system, some cancers, diabetes, multiple sclerosis and heart problems, among other illnesses. Researchers now think it could also play a role in Parkinson's.

Menopause: New advice on hormone treatment

About one in five women going through menopause have symptoms severe enough to make their lives miserable from time to time. No woman, after all, wants to start sweating profusely in public after a hot flash. And night sweats and difficulty sleeping can leave a woman tired, groggy, irritable, and less than productive for days on end.

But the main drugs used to treat such problems —the hormones estrogen and progestin—have long had a bad rap. They have been linked since 2002 to a broad array of serious risks, including breast cancer, heart attack, and stroke. In our research, we found that new studies of hormone use often get wide media attention, and add to an already confusing topic for women. Our Consumer Reports Best Buy Drugs project has taken a careful look at the evidence on hormone products in a new report that cuts through the confusion and gives women straightforward advice.

The good news is that hormone drugs are now deemed to be a viable option for younger, healthy women who have severe symptoms and desperately need relief. In particular, women under the age of 60 who are at a low risk for heart problems may not increase their risk of heart disease when they take hormones. However—and it's a big however—they still face an increased risk of breast cancer, blood clots, and stroke. So, hormones still need to be prescribed and taken with extreme care, even for women who have severe symptoms.

Open enrollment: Five mistakes to avoid

If your company offers health benefits to its employees, that means two things.

a. Your annual open enrollment period is probably coming up soon.
b. Count your blessings. The proportion of Americans under 65 who have coverage through an employer—theirs or a family member's—has declined steadily since 2000 and now rests at just 63 percent, according to the latest Census Bureau figures.

With the economy struggling and health-plan costs steadily increasing, it's an even worse idea than usual simply to default to your existing plan. Yet that’s exactly what three-quarters of insured adults say they expect to do for this coming year, according to a just-released national poll co-sponsored by the health insurer Aetna and the Financial Planning Association.

Even if you don't end up making changes, you owe it to yourself to review your coverage to make sure it’s still right for you and to take full advantage of your company's options. Here are five mistakes to avoid:

Is heart disease in women being misdiagnosed as stress?

If you have chest pain, breathlessness or an irregular heartbeat, you'd expect your doctor to check you out for heart disease. But if you're a woman, it's possible that might not happen. Instead, you might be told your symptoms are caused by stress.

A study presented at a recent conference looked at decisions made by 230 experienced American physicians. The study showed that doctors were more likely to put these symptoms down to stress if a woman appeared anxious, or if they knew she had been through stressful events.

The researchers asked family doctors and internists to look at a set of notes about a patient, all of which had the same symptoms, suggesting heart disease. But in some notes, the patient was identified as a man, and in others as a woman.

The whole truth about high fructose corn syrup

This ad has been making waves lately. It is one of three commercials that the Corn Refiners Association debuted last month to “change the conversation about high fructose corn syrup.”

In the ad, one mother begins to lecture another about the dangers of high fructose corn syrup in the “red juice” (as such products were always called in my house) that is being served at a children’s party. The second mother turns the tables and catches the other speechless about what exactly is wrong with the corn-derived sweetener, and finally delivers the Corn Refiners’ message, “It’s made from corn, doesn’t have artificial ingredients, and like sugar, it’s fine in moderation.”

Let’s take the Corn Refiners’ points one by one:

1. "It’s made from corn." True. High fructose corn syrup is indeed made from corn. But you won’t get the same beneficial nutrients in it that you would from eating an ear of corn.
2. "Doesn’t have artificial ingredients." Partly true. The claim about artificial ingredients is a tricky one, since high fructose corn syrup is processed using artificial agents. The U.S. Food and Drug Administration has stated that if the final product has come in contact with synthetic agent glutaraldehyde, then it cannot be called “natural,” which they define as meaning no artificial or synthetic ingredients were added.  But if the manufacturer uses the artificial agent in its production, and it does not come in contact with the corn starch, it can be considered a natural product. So its possible that some high fructose corn syrups may be able to claim “no artificial ingredients,” according to the FDA, while others would not be permitted the phrase. It’s distinctions like these that lead Consumers Union to consider the “natural” label not meaningful.
3. "Like sugar, it’s fine in moderation." True. Most foods are fine in moderation. It’s too much or too little that causes problems. However, some would probably argue that with high fructose corn syrup in so many products, to truly enjoy it in moderation you’d probably be better off leaving the “red juice” on the shelf.

Tip of the day: Be aware of herb-drug interactions

Did you know that St. John's wort can make your birth-control pills and many other drugs ineffective? The supplement causes the liver and intestines to produce higher levels of an enzyme that processes many drugs, causing them to move through your system more quickly. As a result, less of the drug may reach the bloodstream. Goldenseal, which is often packaged with echinacea to treat colds and gastrointestinal problems, can have the opposite effect. It enhances certain drugs, such as antidepressants and beta blockers, which can lead to toxic blood levels.

Read more about risky herb-drug interactions, and take a look at our Interaction Checker (subscribers only) to find out which natural medicines interact with your prescription drugs.

ADHD drug promotions don't tell you the whole story

Have you seen the recent ads and promotions for ADHD drugs? The ones that claim the drugs can help counter drug or alcohol abuse or help kids who have attention deficit hyperactivity disorder perform better in school?  Some of the promotions even fail to make it clear the drugs can cause dangerous side effects, like sudden death in those with heart abnormalities.

The Food and Drug Administration wants the ads and promotions out of the public eye. In late September the FDA sent warning letters to five drug companies to stop their campaigns: Shire for Adderall XR, Johnson & Johnson for Concerta, Novartis for Focalin XR, Mallinckrodt for Methylin, and Eli Lilly for Strattera.

An estimated 5 to 8 percent of school-aged kids in the US have ADHD. While the drugs used to treat the condition are generally effective and safe, they can in rare cases cause serious side effects, such as death and psychiatric disturbances. But in terms of how effective the drugs are, the ads in question go too far by claiming they can reduce problems that could arise from untreated ADHD, like poor school and job performance, social problems, and drug and alcohol abuse, the FDA said in its letters.

Q&A: A good night's sleep without pills?

I'm a healthy 60-year-old who has no problem falling asleep. But I wake up after a few hours and have trouble falling asleep again. Are there any ways to address this problem without taking pills? —G.H., El Paso, Texas

Yes. To help maintain slumber, block out disturbances by closing curtains, wearing a sleep mask, turning off the TV, and perhaps using a "white noise" device or earplugs. In addition, avoid liquids for at least an hour before bedtime, and alcohol and caffeine for about three and six hours, respectively. Other steps to consider include cognitive behavioral therapy; getting more exercise, particularly in the morning or afternoon; and possibly the supplements melatonin and valerian, though melatonin may only help you fall asleep, not stay asleep. In general, consider sleep drugs only if the problem persists for several weeks and the steps above haven't worked.

Read more on the trouble with drugs for insomnia, find out how using a sound machine can help you get some sleep, and check out our Treatment Ratings (subscribers only) for insomnia. 

Are parents too pessimistic about kids' asthma control?

Moms and dads often have sky-high expectations for their children in the classroom and on the playing field. But when it comes to controlling their child's asthma, many parents' expectations are unnecessarily low, according to a new study. And this may mean kids have too many days with asthma symptoms.

Research shows that around 4 in 10 children with asthma don't have adequate control of their condition, and a similar number don't use daily controller medications, which can prevent wheezing, coughing, and asthma attacks. In the new study, researchers explored whether parents' expectations and beliefs about asthma and its treatments might be partly responsible.

Researchers surveyed more than 700 parents of children ages 2 to 12 who had persistent asthma. They asked about each child's symptoms and how well parents believed these symptoms could be controlled. Specific questions covered whether they thought their child could be symptom-free, participate fully in gym class and other physical activities, and avoid emergency room visits. Researchers found that children were more likely to have frequent symptoms if their parents had low expectations for how well their asthma could be controlled.

Drug Alert: Treat your child’s cold and cough, but skip the drugs

If you have a child under age 4, what are you supposed to do now that the makers of children's cough and cold medicines are warning parents not to use their products? Actually, all children under age 6 shouldn't be given these medicines. And these drugs should only be used with caution, if at all, for children up to the age of 12, according to our team of medical advisers.

During any given week in the U.S., parents are still doling out these ineffective products to millions of children. Clinical trials so far have shown no benefit to giving children cough and cold products, except to sedate them. At the same time, these drugs pose a high health risk. Particularly dangerous are combination cough and cold medicines (for example, Benadryl Allergy & Cold Fastmelt Children's or Tylenol Cold Multi-Symptom Children's), on which kids can more easily overdose.

Instead, you can do what moms and dads have been doing for generations—using good old home remedies like these:

• Keep your child warm and dry in inclement weather, which can actually cut the chance of catching a cold in the first place.
• Give your child hot chicken soup, which can help with his or her congestion and sore throat, plus lessen the feeling of being sick.
• Ask your child to cough or sneeze into tissues, and dispose of them after using.
• Dole out honey (one-half teaspoon to children ages 2 to 5, 1 teaspoon to children 6 to 11, and 2 teaspoons to those ages 12 to 18), or give your child hard (sugarless) candy to suck on to help reduce coughing.
• Show your child how to gargle with warm, salty water, which can ease a painful throat.
• Remind your child to wash his or her hands often, which can reduce the likelihood of transmitting infections.

Fewer calories, longer life?

Previous research has shown that animals that eat 30 to 50 percent less food live significantly longer lives—sometimes up to 50 percent longer than animals fed regular diets—and have fewer age-related diseases compared to their peers. Those findings have led some people to adopt their own restricted-calorie diets in hopes of gleaning the same benefits. But there's been little evidence to date to show whether the approach works in humans the same way it does in animals.

That's why I was keen to attend a symposium titled "Calorie restriction and longevity" at the annual meeting of the Obesity Society, held October 3 - 7, 2008 in Phoenix. Among the presenters was Luigi Fontana, M.D., Ph.D., a professor at Washington University in St. Louis who, with colleagues, has been following a cohort of people who practice ongoing calorie restriction. They call themselves CRONies, for Calorie Restriction with Optimal Nutrition.

In an article published this month in the journal Aging Cell, Fontana and colleagues measured CRONies' levels of a chemical called IGF-1 (insulin-like growth factor-1). In animals, levels of IGF-1 decline by about 40 percent when calories are restricted; this reduction is believed to play a role in protecting against cancer and slowing aging. The researchers found no differences in IGF-1 levels between people on calorie restrictions and those who were not. But when they asked some of the CRONies to cut their intake of protein—also known to influence IGF-1—for three weeks, their levels of the chemical declined dramatically. The same researchers found similarly low levels of IGF-1 in vegans, even those who were heavier and had more body fat than the CRONies.

Are you missing out on life because of a weak bladder?

It can be all too easy to find reasons to skip an exercise class or turn down the chance to join a sports team. I know I do. The class runs too late or the session interferes with the little time I get to spend with kids/do the grocery shopping/catch up with the housework/relax. One thing I would never have suspected, though, was that women might be avoiding sport because of stress incontinence. But that’s exactly what one new study has found. Researchers report that women were not simply failing to turn up (which is the problem I have), but giving up a sport they enjoyed because of their fear of leaking urine. The researchers go so far as to suggest that the condition could be limiting health watch groups’ attempts to get people to exercise more.

The study looked at nearly 700 women who all took part in sports. It found that 1 in 7 women admitted to having stress incontinence, with half of them experiencing leakages during sporting activities. One third of the women said they had either given up their favorite sport or modified it in some way because of stress incontinence. The sport that caused the most problems was basketball, followed by athletics, tennis and squash.

The average age of the women in the study was 36. The researchers said that if they had asked older women about whether they had stress incontinence, the figures would have been considerably higher. Stress incontinence usually happens because muscles (called pelvic floor muscles) that help to keep the opening of your bladder closed have become weak and can't contract properly. This causes urine to leak out when extra pressure is put on the bladder, for example, when you sneeze, or laugh, or jump and run around. Stress incontinence is more common among women who have had children; other risk factors include getting older, smoking and obesity.

Getting the best from beef

Prefer a big steak or burger over your usual roasted chicken, but concerned that you might be overloading on saturated fat and putting yourself at risk for heart disease? Well, it turns out beef can be good for you—it's high in B vitamins, iron, protein, selenium, and zinc. And if you learn how to choose and prepare it properly, you may start to look at beef in a new light.

Sensible beef consumption means limiting portion sizes, choosing lean grades and cuts, and preparing them healthfully. When shopping, choose select or choice grade rather than marbled prime. You can also buy lean (less than 4.5 g of saturated fat per serving) or extra lean (less than 2 g saturated fat) cuts. In restaurants, look for cuts marked "loin" or "round," which are leanest.

If you’re concerned about the risk of mad cow disease, even though chances are low, buy beef labeled "organic," "biodynamic," or "100 percent grassfed," all of which come from cows that didn’t ingest animal byproducts. Beef labeled those ways was also probably raised without antibiotics or growth hormones. And grass-fed beef tends to have heart-healthy conjugated linoleic acid and omega-3 fatty acids like those in fish. But be aware that you’ll pay more for this type of beef. And because grass-fed beef is so lean, you’ll have to be careful not to overcook it. Portion control is paramount. A serving should be just 3 ounces, the size of a computer mouse or deck of cards. If you're served a huge slab of beef when dining out, slice off a reasonable portion and take the rest home.

Cooking technique matters, too. Choose broiling or roasting. Frying or sautéing adds fat. Cooking at very high temperatures can also contribute to the formation of carcinogenic compounds called heterocyclic amines. Marinating the meat in a mix of cider vinegar, olive oil, lemon juice, and spices can help cut back on certain HCAs. Whatever method you use, it's most critical to make sure meat is cooked thoroughly to kill bacteria that can make you sick. Always use a meat thermometer to make sure the meat reaches an internal temperature of at least 160 degrees for ground beef and steak to at least 145 degrees.

To learn more about labels on the foods you eat, read our recent blog "What nationality is your ground beef," and visit the Eco-labels center at www.GreenerChoices.org. 

Health-Care Savings Series—Day 10: Take advantage of condition-based programs

Yesterday we blogged about insurance for those facing financial difficulties. There are also public programs that expand low-income coverage to people with certain conditions who may not meet the stringent Medicaid means test, as well as private condition-based programs. We list several below, but if you are uninsured or underinsured, and have a condition that needs treatment, get in touch with your local department of social services or a health-care social worker to learn more about your options. And, as always feel free to list your tips in the comments.

Medicaid Special Coverage Programs:

·    Breast and Cervical Cancer Prevention and Treatment Program. Uninsured women screened through the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Early Cancer Detection Program, and found to have either pre-cancerous conditions, or cancer, may be eligible for special Medicaid coverage to treat the disease.

The screening program is available to uninsured and underinsured women whose incomes are at or below 250 percent of the federal poverty guideline. Cervical cancer screenings are available to women age 18-64, and breast cancer screenings are available to women age 40-64. Use the CDC website to find a screening program near you. And contact your state health department to inquire about the treatment program. Rules for this program are exacting and differ from state to state.

·    Tuberculosis. States may also expand eligibility to low-income people with a tuberculosis infection who otherwise don't qualify for Medicaid. Services are limited to tuberculosis treatment, but include prescription drugs, physicians, outpatient hospital services, clinics, federally qualified health centers, lab and X-rays, and case management. Contact your state health department to inquire about this treatment program.

As a substitute for soda, water's the winner

There's no question that soft drinks and other sweetened beverages add empty calories to kids' diets, and their widespread consumption is widely believed to be a factor in the obesity epidemic. But if you cut out the soda, will kids compensate for the missed calories by simply eating or drinking more of other things?

That question was among the topics discussed at a session I attended Monday at the annual meeting of the Obesity Society in Phoenix. (Yes, they serve food at the meeting, and no, it's not just vegetables.) Researchers at Columbia University, the Harvard School of Public Health, and Children’s Hospital in Boston analyzed data from nearly 3,100 children ages 2 through 19 in the nationally representative NHANES (National Health and Nutrition Examination Survey) survey, a large, ongoing government study of Americans' dietary behaviors.

They found that for every additional 8-ounce serving of sugar-sweetened beverages—including soft drinks, fruit-flavored drinks, sports beverages, and sweetened iced tea—consumed in a given day, the kids ingested an extra 111 calories compared to days with no sugar-sweetened beverages. But when the kids replaced sweetened beverages with water, they decreased their total caloric intake for the day without a compensatory increase in other food or beverages. In other words: Kids don't seem to miss the extra calories when they drink water instead of soda or other sugar drinks.

CR's Take. Strangely, drinking diet drinks instead of sweetened ones didn't result in the same overall calorie decrease that drinking water did. All of which makes a sound argument for encouraging kids to use good old H2O as their go-to thirst-quencher. It's healthy, it has no calories, and—perhaps best of all in these trying economic times—it's free. To give it some flavor, add a bit of 100 percent fruit juice or strongly brewed, flavored tea; squeeze in half a lemon, lime, or orange; or drop in frozen fruit or ice cubes made from fruit or juice.

Read our earlier coverage on soft drinks and other types of liquid calories.

—Jamie Kopf Hirsh, associate editor

Read our tips on how to keep your child at a healthy weight, and check out our Treatment Ratings (subscribers only) for obesity.

Q&A: Does organic milk last longer?

Why does the organic milk I buy last so much longer than regular milk? —J.H., Holden, Mass.

Organic milk often undergoes "ultrapasteurization," in which the milk is heated to a very hot 280° F (137.8° C) for 2 seconds, rather than the 161° F (71.7° C) for 15 seconds used in conventional pasteurization. By killing more bacteria, the extra heat extends the milk's expiration date. It's not clear whether organic-milk producers ultrapasteurize as an additional safeguard against bacteria, since organic cows consume no antibiotics, or simply to extend shelf life. Properly refrigerated, ultrapasteurized milk has a shelf life of 40 to 60 days unopened, compared with 15 to 17 days for milk pasteurized the regular way. But you should consume all milk within 7 to 10 days after opening.

Read more about organic fruits and veggies, and test your organic IQ.

Health-Care Savings Series—Day 9: Low-income programs and insurance for the unemployed

The economy has been a source of great anxiety for many of us lately. Healthcare is already out of reach for some 46 million Americans, and with unemployment on the rise, the ranks of the uninsured could grow even larger.

Those with serious financial hardships may be able to get some assistance from Medicaid. A joint state and federal program, Medicaid provides coverage for people with few assets and low income based on the federal poverty guidelines, but eligibility requirements and benefits vary by state. To learn more about your eligibility and how to apply, contact your state health department.

SCHIP (State Children's Health Insurance Program) offers free or low-cost health insurance to children from families who may not be eligible for Medicaid but still have limited incomes. As with Medicaid, states set their own eligibility requirements, but most states cover uninsured children under 19 years old, for a family of four that earns $36, 200 a year or less. Find your state's program to see if your family qualifies. Your state may have other services as well, so contact your local department of social services to find out more.

Could using a fan reduce the risk of sudden infant death syndrome?

Most parents of young babies know the feeling. You wake suddenly in the middle of the night with a sense of panic, and tiptoe to the crib to make sure your baby is still breathing. Losing a baby to sudden infant death syndrome (SIDS) is a very real fear for parents. It happens when a baby under 12 months old dies suddenly while sleeping, for no apparent reason. Although not common (it happens to around 1 in every 2,000 infants), SIDS is still the leading cause of death for babies age 1 month to 1 year.

Research shows that simple steps, such as putting a baby to sleep on his or her back, can greatly reduce the risk of SIDS. Now a new study suggests that having a fan on while a baby sleeps might help as well.

Researchers interviewed 185 mothers who had lost babies to SIDS. They asked several questions about the infant's last sleep, including whether a fan was on, if a window was open, what bedding and covers the infant had, what the room temperature was and whether the infant used a pacifier. They also asked 312 mothers of healthy babies the same questions, but about their infant's most recent sleep. The two groups of moms were matched for race, age and the area where they lived.

The study found that 11.7 percent of healthy babies had slept with a fan on, compared with 3.6 percent of babies who had died. After taking into account other things that might have affected the babies' risk of SIDS, researchers found that fan use was associated with a 72 percent drop in risk. Having a window open also seemed to help, but the difference in risk was small and might have been due to chance.

Health-Care Savings Series—Day 8: Avoid unnecessary visits, tests, and treatments

One of the major reasons that medical care is more expensive in the U.S. than anywhere else is overtreatment and overdiagnosis. In our fee-for-service system, doctors and hospitals actually profit by overpromoting and overusing unnecessary, unproven, or potentially harmful tests and treatments. Meanwhile, our system actually discourages simple low-cost counseling and treatments that are proven to save lives and reduce suffering by underpaying those who provide these services.

We investigated such treatment traps in November 2007, and came up with ten overused tests and treatments. Ranging from back surgery to whole-body CT scans, they have in common the fact that they have unproven benefits or are expensive or both.

People with chronic, long-term illnesses or other serious conditions also need to be wary of overtreatment. Studies by researchers at Dartmouth Medical School found that patients living in areas that have the most aggressive, expensive medical care don't enjoy a better quality of life or live any longer than those who are treated in areas that provide more conservative, less costly care. (For more on the Dartmouth findings, see our July report, Too Much Treatment?.) We worked with the Dartmouth researchers to rate hospitals using this data. You can use this tool to find out how your region's hospitals treat people with long-term, life threatening illnesses.

Want as natural a childbirth as possible? Talk to your doctor early on

My cousin's wife is expecting a baby next week. She wants to have a natural childbirth, and her birth plan includes requests to allow spontaneous rupture of membranes, to avoid pain relief/epidural unless she asks, to steer clear of the labor-inducing drug oxytocin, to avoid episiotomy, and also to only have intermittent fetal monitoring.

For expectant mothers like her, the recent report, Evidence-Based Maternity Care: What It Is and What It Can Achieve, is welcome news. It sheds light on several overused maternity practices, including labor induction, epidurals for pain, and Cesarean section. It points out that such practices can lead to a host of additional interventions, are associated with risk of maternal and newborn harm, and add considerable costs to patient care.

The report confirms what many women have asserted for decades: High-tech delivery is not better, and it's not backed by science. So why are those interventions used in a large percentage of childbearing women, often without consideration, or even disclosure, of other options?

Perhaps because there are mounting pressures on physicians to perform certain procedures in an attempt to reduce medical liability. (In the most recent American College of Obstetricians and Gynecologists (ACOG) survey, conducted in 2006, of the 10,450 respondents to the question, 65 percent reported having made one or more change to their practice as a result of the risk or fear of professional liability claims of litigation. Of those, 37 percent reported increasing the number of Cesarean deliveries they performed, 33 percent decreased the number of high-risk obstetric patients, and 33 percent stopped offering/performing vaginal births after Cesareans.)

Health-Care Savings Series—Day 7: Shop around for Rx drugs

Last week, we recommended talking to your doctor about lowering your prescription drug bill. But the work's not done once you have the prescription slip in your hand.

Prices for the drug can vary by store—a lot. In our recent study on drug prices, we found that the cost of the average price of a three-month supply of four common drugs had average total differences of as much as $340 between the highest and lowest priced sources.

Our study focused on 13 stores, and Costco offered the biggest savings overall. Note that you don't have to pay the $50 annual membership fee to use Costco's pharmacy. Web sites, such as AARP.com and Drugstore.com, were also relatively inexpensive, and have very low or no shipping costs. Mom-and pop pharmacies weren’t the lowest-priced overall, but many independent drug stores were competitive, and our survey showed they offer excellent service, so it's worth keeping them in the mix.

Got a serious illness? Think about moving to Vermont

U.S. hospitals often lead the world in providing innovative, life-prolonging treatments for cancer and other serious illnesses. But when it comes to adequately caring for the individual behind the illness, many hospitals aren't making the grade. According to a new report (links to PDF), U.S. hospitals get a C overall for how they care for the sickest patients.

The report provides the first state-by-state look at the availability of palliative care programs within hospitals. Palliative care focuses on improving the quality of life of seriously ill patients and their families. It typically involves a team of doctors, nurses and social workers who strive to improve patients' comfort, coordinate their care, and provide counseling and support for patients and their families. Identifying each patient's goals and wishes is also key, as this can help prevent overly aggressive treatment that may not improve the patient's lifespan or quality of life. Palliative care programs are open to anyone with a serious illness, regardless of their age or prognosis. Unlike hospice programs, they do not focus just on end-of-life care.

Health-Care Savings Series—Day 6: Use tax-free accounts to stretch your health dollar

If your employer offers Flexible Spending Accounts (FSAs), you can use them to stretch your health-care dollar. When you sign up, your employer will put whatever amount you want to contribute, typically up to $5,000 a year, from your wages straight into your spending account, before it's taxed. That means you won't pay income taxes on the money you spend on qualified health care expenses with your FSA. And employers may contribute as well.

Qualified expenses are generally anything that can be deducted, according to IRS Publication 502, which can include co-pays and prescription drugs. However, with an FSA, you can't pay for any insurance premiums, but you can pay for over-the-counter drugs.

The savings depend on your personal health spending and your tax bracket. The administrator of FSAs for federal employees, FSA FEDs, has an online calculator that can help you to estimate your savings.

The catch? It's use it or lose it. Whatever amount you put away in an FSA has to be used in that year; if you don't, it's gone forever. The remaining sum is forfeited back to your employer. So it pays to do some research up front.

Are chemicals in your cosmetics putting you at risk?

If you've ever tried to decode the ingredients list on a cosmetic product, you know it can be difficult to decipher. But since some of those products contain ingredients that might not be so good for you, knowing what to steer clear of can help.

WHAT ARE THE RISKS? The U.S. Food and Drug Administration is not required to review cosmetics for safety before they appear on store shelves. Aside from certain color additives and a handful of prohibited ingredients manufacturers can use any ingredient they deem safe, and safety testing is voluntary.

Some ingredients you'll come across are linked to known hazards at certain doses. One example is formaldehyde, a known carcinogen that has been used in small quantities as a hardener in nail treatments. Lead acetate is another example. It's a probable carcinogen that can be used as a color additive in some progressive hair dye products, provided it's only used on hair on the scalp in limited quantities.

Health-Care Savings Series—Day 5: Use available tax deductions and credits to lower your health care spending

Over the course of a year medical expenses can really add up, especially if there is an adverse health event in your family. In these cases, make sure you know the relevant tax laws to claim the appropriate end-of-year tax deductions. There’s also a tax credit to help unemployed workers pay for health coverage. And if you need to hire someone to take care of a sick child or spouse, there is a tax credit for those expenses as well.

• Medical and Dental Expenses. You may be able to claim a deduction on unreimbursed medical expenses for you, your spouse, or a dependent once your total spending exceeds 7.5 percent of your gross adjusted income. (That's about $3,750 in health-related spending for a person with adjusted gross income of $50,000 a year.)

This deduction may be more helpful for those with high out-of pocket medical costs on fixed or low incomes. It may also apply to families with major adverse health events in a year, and the self-employed with significant health care spending. But the deductions can apply to a wide-variety of expenses related to conditions and procedures, including individual health insurance premiums (you can't deduct most employer-sponsored premiums) and medications, as well as ancillary expenses related to a medical condition, such as legal fees, medical lodging, travel, and weight loss programs. If your family has a lot of medical expenses, it might pay to add them up and see if you qualify. For more on deducting medical and dental expenses, see IRS Publication 502*.

Q&A: Less exercise for seniors?

For years I've exercised fairly intensely six days a week, but now that I'm in my 60s I'm developing more muscle aches and minor injuries. Should I exercise less often, or just less intensely? —J.C.R., Fullerton, Calif.

Both. As you age, your body needs more rest between strengthening sessions and slightly lower-impact activities. At the same time, flexibility training, which helps maintain balance and mobility, becomes more important. Aim to strength-train twice a week, using somewhat lighter weights and more repetitions (10 to 15, rather than the 8 to 12 recommended for younger adults). Rest muscles for two days between sessions. Stretch each muscle group at least two to three times a week, or consider an activity like Pilates, tai chi, or yoga, which combine strengthening, stretching, and balance. And aim for at least four aerobic-style workouts a week, such as brisk walking, cycling, or water exercise.

Read more on exercise for every age group, and check out our interview with "Godfather of Fitness" Jack La Lanne.

Health-Care Savings Series—Day 4: Negotiate your medical bills and check for errors

The cost of medical care continues to rise, and the uninsured often have to pay a lot more for the same procedures than those who are covered. Insurance companies can negotiate group rates with hospitals and other health care providers, but when you don't have insurance, or your procedure isn't covered by your plan, there's nobody to negotiate on your behalf. As a result, the bill can be four or five times more than an insurance plan would pay. And even procedures that are covered can cost a lot more than you expect, especially as insurance covers less of rising health care costs. But you can negotiate on your own behalf.

If you have the means to pay, but the amount is too high, you may be able to get your bill reduced by more than fifty percent if you pay it at the time of service. Figure out how much you are willing to pay and ask to speak to the manager of patient accounts. Billing is an expensive and time-consuming process, so the hospital representative has an incentive to reduce the bill in order to get it off the books promptly.

If you can't pay up front, try to negotiate a reasonable payment plan that you can afford. Avoid putting your balance on your credit card, or on any special medical credit cards or loan programs, or you could end up paying high interest rates. See our full report on medical debt for more.

Exercise may slim down "fatty livers" in type 2 diabetes

If you have type 2 diabetes and exercise regularly, you may be trimming more than your waistline. According to a new study, regular exercise may also shrink hidden—and potentially harmful—fat in your liver.

Research shows that many people with type 2 diabetes also have excess liver fat, a condition called nonalcoholic fatty liver disease (NAFLD). This buildup of fat is often related to obesity and doesn't always cause problems. But if it results in liver inflammation and scarring, it can lead to liver failure, liver cancer and a higher risk of diabetes-related heart disease. NAFLD affects people of all ages, and most don't know they have it. Researchers estimate that up to 70 percent of people with type 2 diabetes are affected, and the rate goes up to 95 percent among those who are also obese.

Interestingly, NAFLD has been recognized as a disease only since 1980, and scientists are actively studying its causes, complications and treatments. But what's clear is that the fat we see in the mirror may not be the only fat we need to worry about.

Health-Care Savings Series—Day 3: Take advantage of free screenings and low-cost options

Many workplaces offer free flu-shots, blood-pressure tests, and other health screenings. Ask your human resources department if your company is planning any.

Community health fairs put on by local universities, medical centers, insurance companies, and other health organizations may offer screenings for common cancers including skin cancer and prostate cancer, as well as heart health tests, blood-lead screenings, and even dental exams. (We even saw one that offered health screenings for pets!) Keep an eye out for local announcements, or try contacting your local government's health authority to see if they can help you locate free services. Just make sure they are affiliated with health care professionals you can trust.

If you're looking to screen for a particular condition, you might try a national organization. For example, the American Diabetes Association provides locations and dates online for its Diabetes Expo, which includes free health screenings, and other educational programs. If you need to find a free clinic for more comprehensive medical or dental care, the federal Health Resources and Service Administration can help you locate one nearby.

Health-Care Savings Series—Day 2: Talk to your doc to save on prescription drugs

Last year, prices of name-brand drugs commonly used in Medicare Part D increased 7.5 percent last year, more than twice the rate of inflation, according to AARP. And consumers can expect to pay about 22 percent of drug costs out-of-pocket, based on data from 2006, the most recent year for which information is available.

In order to keep your prescription costs under control, plan a "brown-bag session" with your physician in which you bring in all the prescription medications, over-the-counter drugs, and any natural medicines or dietary supplements you use, even if infrequently, and even if prescribed by another doctor. It may turn out that you no longer need all the medications, or are taking more than one version of the same medication, or are at risk of harmful drug interactions. Your doctor might also identify brand-name medications for which an equally effective, but cheaper generic version is now available.

If your health plan has a prescription drug formulary, be sure to bring it with you so you and your doctor can see which medications are covered, and which ones are the best deals.

Don't be afraid to mention that cost is a concern for you; doctors don't necessarily take that into account when prescribing a drug.

Poisoned products: Is melamine in your milk?

No doubt you've heard about the contaminated milk that's sickened more than 50,000 children in China, hospitalized 13,000, and caused fatal kidney damage in at least three. Some 60 countries have now banned or recalled certain Chinese dairy products, including baby formulas and chocolates, because of contamination with melamine. That chemical can produce crystals that block tiny tubes in the kidneys, interfering with the production of urine and damaging the organ.

Melamine is the same chemical that contaminated pet food last year and killed many cats and dog. As we warned then, the appearance of a problem in pet food could signal a looming problem for our food supply too. (Marion Nestle, Ph.D., a New York University food expert who has an informative blog that's covered melamine, recently wrote a book called "The Chihuahua in the Coal Mine" about just that.)

The Food and Drug Administration and other organizations are now trying to determine how widespread and severe the problem really is. In the meantime, here are answers to three common questions about melamine.

Can soy supplements keep your blood vessels healthy?

In many Asian countries, soybeans have been part of the traditional diet for thousands of years. Soy has also become increasingly more popular in the West, both in Asian-style cooking and in vegetarian foods, like meat substitutes and non-dairy milk products.

A diet rich in pulses, including soy, along with plenty of fruits and vegetables, seems to be one of the healthiest ways to eat. While it's important to eat a balanced overall diet, researchers have also wondered whether specific chemicals from soy can be beneficial when they're taken on their own.

A new study has looked at capsules containing soy extracts called isoflavones. The study, based in Hong Kong, looked at around a hundred people who had all had a stroke at some point in the past. The average age was 66 years.

Half the people took the supplements for 12 weeks, and the rest were given a placebo, for comparison. Everyone kept on taking their usual medications, too.

Health-Care Savings Series—Day 1: Know your coverage

Choose or change your plan based on your needs

Open enrollment season begins in fall for health care and other benefits at many employers. If your employer offers multiple health plan choices, this is the time to review your current coverage to make sure it still meets your needs, and to explore your other options if it doesn't.

For example, if you're in your twenties or thirties, and don't have any health problems, you may roll the dice on a plan with lower premiums and higher co-pays and deductibles. But if you have developed a chronic condition or have young children, a higher premium with lower co-pays may be the wiser choice. Older people may also benefit from more comprehensive coverage with higher premiums and lower co-pays.

To make the right choice, you'll need to do some homework. A key first step: a worst-case calculation of the most you might pay in a year on health coverage. Add up the total annual cost of your premium, and your plan's annual out-of-pocket cap. If it's too high for comfort, you might want to trade a higher premium for a lower out-of-pocket limit. If you have the savings to take a health cost hit, your trade-off might go the other way. Our online calculator can help you decide.