President Obama made the announcement this afternoon in the White House Press room.

The new plan allows employers with religious objections to offering contraceptive coverage to turn the responsibility over to their health insurance company. Those insurers will be able to offer contraceptive coverage directly to employees without co-pays or other charges.

The original mandate issued last month drew sharp criticism from many Catholics, conservatives and even some Democrats, who argued that it was a violation of religious freedom. Churches, mosques and synagogues were exempt -- but other religious institutions that serve and employ people of other faiths were not eligible for exemption.

The new rule grew out of a report by the Institute of Medicine last year that recommended an expansion of birth control services to women as part of the health reform law. The Department of Health and Human Services issued a ruling that contraception should be provided free-of-charge as an "essential health benefit" in their insurance coverage.

The initial reaction to today's changes seemed to satisfy some key players on both sides on the debate.

Sister Carol Keehan, president and chief executive officer of the Catholic Health Association of the United States, which represents Catholic hospitals, said they are "pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions."

Keehan was a vocal critic of the Jan. 20 mandate.

Louise Melling, ACLU deputy legal director for the ACLU, also backed the decision, saying the group's main concern was that women had access to contraceptive coverage -- and that the president's announcement today ensured religious institutions have the ability to opt out and still let women retain coverage.

Marcia Greenberger, co-president of the National Womens Law Center in Washington, said her organization is "very hopeful that this goal will be met without burdensome obstacles for women, no matter where they work." She added that they will "closely monitor the implementation of this new rule" to make sure that all women have access to contraception coverage.

Watch PBS NewsHour tonight for more on the changes, including an interview with Health & Human Services Secretary Kathleen Sebelius. You can watch live online from 6 to 7 p.m. ET here.

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A New York Times bestseller, Rachel Simon's "The Story of Beautiful Girl" explores empathy and tolerance in the form of a love story where characters with disabilities overcome heavyweight obstacles. Judy Woodruff and Simon discuss how society deals with disabilities and how they are portrayed in literary works.

JEFFREY BROWN: And finally tonight: a love story that sheds light on how society deals with the disabled.

Judy Woodruff has our book conversation.

JUDY WOODRUFF: There are more than 50 million Americans who have some sort of disability, according to the Census Bureau. They range from profound, needing a wheelchair or other assistance with daily activity, to less restrictive, and from physical disabilities to cognitive and emotional.

Rachel Simon has given a lot of thought to their lives, how the rest of society sees them, since her sister is intellectually impaired. She wrote a memoir in 2002 called "Riding the Bus With My Sister." Her most recent book is a novel, "The Story of Beautiful Girl." It's about the lives of two people who meet living in an institution, and it follows them for four decades.

And Rachel Simon joins us now.

Thank you for being here.

RACHEL SIMON, author, "The Story of Beautiful Girl": Thank you. It's so wonderful to be here.

JUDY WOODRUFF: So, Rachel, you had written the book about your sister, "Riding the Bus With My Sister." What do you think you accomplished with that book?

RACHEL SIMON: Gosh.

Well, I was transformed, because I learned that during the course of my life and my sister's life, there had been some major civil rights development in the lives of people with disabilities. And the major one is called self-determination, that people with disabilities have the right to choose how to live their own lives.

This all started because of the closing of the institutions in which people like my sister were asked to live, forced to live for a lot of the time we have in American history, for about the last 150 years in American history.

JUDY WOODRUFF: So, after that experience, your story, your family's story, why did you want to write a novel? This is a novel, we should say, about a man and a woman who were in an institution. They met. He was not intellectually disabled, but he had a hearing impairment.

RACHEL SIMON: Yes.

JUDY WOODRUFF: She was intellectually impaired, could not speak.

Why that story?

RACHEL SIMON: Well, why that story and why fiction. I will try to do that why that story first.

My sister grew up at home. My sister did not grow up in an institution. And this was because of all -- funny coincidences in my family history. My father actually grew up in an orphanage. And, therefore, he knew what institutional life was like.

And when we were growing up, he used to say, "When you live in an institution, even if someone comes to visit you, which his father did, you know at the bottom of your heart that you're not really loved. So, no child of mine will live in an institution."

And this was then the family belief, that people deserve to be out in the world and have the same rights as everyone else and be raised with the family, which my sister was.

I then wrote "Riding the Bus With My Sister." It led me to do a lot of public speaking. And I met a lot of people who didn't have the experience my sister had, who had lived in institutions. And I felt like their stories were not being heard. A lot of people in America don't even know we had institutions for people with intellectual disabilities.

All they think of are people who had psychiatric issues. But there's a whole separate system of institutions for people like my sister, and we still have them in America.

JUDY WOODRUFF: And the story, you took two people who you have them essentially fall in love, have a baby.

RACHEL SIMON: Yes. Yeah.

JUDY WOODRUFF: And then you follow them for several decades.

RACHEL SIMON: Yes.

JUDY WOODRUFF: Why did you want to do it that way?

RACHEL SIMON: Sometimes, stories find you. This story actually emerged from my pen without me really planning to do it.

I had been thinking for years about writing something about institutions and the people who lived in them from the point of view of the people who lived in them, not the point of view of other people. And one day, I just started writing. I do write by hand.

And it just started coming out that there was the character of Beautiful Girl, also known as Lynnie, who had an intellectual disability and whose parents put her in an institution in the late 1950s, and then the man, who was a John Doe, John Doe number 42, who was deaf.

He actually was based on a real-life person who I discovered in a book called "God Knows His Name: The True Story of John Doe No. 24" by a writer named Dave Bakke. I came across that book. It was in fact about an African-American deaf teenager who was found in 1945 wandering the streets in Illinois. No one who knew he was. And so he was put in an institution for people who were called feeble-minded.

And he was there for 50 years until he died. And I was so moved by that, I thought I need to write about this sort of a character.

JUDY WOODRUFF: What did -- the fact that it's a novel, the fact that it's non-fiction -- the fact that it's fiction, what did that allow you to do in terms of telling the story of how society treats people like this?

RACHEL SIMON: Well, as a sibling of somebody with a disability -- my sister is only 11 months younger than I am -- I have spent my life translating -- translating the world for her and translating her to the world.

And so to the extent possible, I understand how her mind works. And to be able to write it as fiction, I was able to fully enter the mind of a character like my sister and the gentleman who is the male character in the story and write it from their points of view, as well as the point of view of an aide who works with them and a retired schoolteacher who ends up being involved in the whole story who we have left out of all of this.

So to be able to write it from multiple points of view, which, as a sibling, is kind of how I have seen the world, that there are all of these people who are involved in the lives of people with disabilities, and the people themselves, and we don't really give equal weight to all those stories. And we never hear from the people with disabilities.

I wanted to be able to do it from their point of view, see the world through their eyes, and show the world not just how the world treats them, but how they feel about how the world treats them.

JUDY WOODRUFF: You clearly seem to feel that their point of view, the point of view of people with disabilities, is just not understood.

RACHEL SIMON: It's not given respect. It's not treated in a dignified way.

They're infantilized. They're ignored. They're made fun of. And I think it's so incredibly important that if you are somebody who feels a passion for people with disabilities because you have a loved one who has a disability, that you need to go out and you need to fight for their rights.

And I have always felt that way as my sister's sister. But because I can write, it gave me the ability to do that in a book that therefore has led other people to seeing the world through the eyes of people like my sister.

I've had so many people get in touch with me and say, you know, when I go to the supermarket and there's the guy with Down syndrome who is bagging my groceries, I'm never going to look at him the same way again. Now I want to know who he is.

That means a lot.

JUDY WOODRUFF: Rachel Simon.

The story -- the book is "The Story of Beautiful Girl," your sixth book.

Thank you very much for talking with us.

RACHEL SIMON: Thank you so much. Thank you.

A new birth control mandate was under duress this week as Roman Catholic officials said it violated Church teachings and Republicans said it threatened religious freedom. Ray Suarez discusses the rule with Anthony Picarello of the U.S. Conference of Catholic Bishops and the Methodist Federation for Social Action's Jill Warren.

RAY SUAREZ: And to the battle over contraception coverage.

It's been nearly three weeks since the Obama administration announced new regulations, but the stakes are higher, as both sides harden their positions.

From the Capitol to the White House, the political heat has been rising all week over a new federal mandate on birth control. Under the rule, religious schools and hospitals will have to offer insurance policies that include contraceptive services for employees free of charge. Roman Catholic officials in particular say the rule would force them to violate church teachings.

And Republicans in Congress, like New Hampshire Sen, Kelly Ayotte, have raised their voices.

SEN. KELLY AYOTTE, R-N.H.: This is not a women's rights issue. This is a religious liberty issue. And it can apply to all faiths.

RAY SUAREZ: In a floor speech Wednesday, House Speaker John Boehner threatened legislative action, but it was unclear today what form that would take.

REP. JOHN BOEHNER, R-Ohio: I think the House is going to work, again, through the regular order with real deliberations, about how we protect the religious freedom of the American people. That's the issue. And we're -- and we're keenly focused on it.

RAY SUAREZ: Women rights groups and many Democrats, like California Senator Barbara Boxer, are now coming to the administration's defense.

SEN. BARBARA BOXER, D-Calif.: Women in this country are tired of being treated like a political football by Republicans in Congress, who have tried continually and are continuing to try to take away their benefits, to take away their rights.

RAY SUAREZ: White House officials, seeking to defuse the issue, suggest a still-undefined compromise is possible.

Tuesday, on the NewsHour, the president's senior campaign strategist, David Axelrod, pointed out that 28 states already have similar rules.

DAVID AXELROD, senior Obama campaign strategist: We're going to have a year's period of time in which to transition to this. And that will give us a chance to look at what these others -- how this is implemented elsewhere, how we can implement it here in the best and fairest way, but certainly advancing the principle that women deserve access to contraception.

RAY SUAREZ: The mandate is based on recommendations from the U.S. Institute of Medicine study that showed reproductive health services without co-pays leads to better women's health.

It was the second major birth control decision in recent weeks. In December, the administration barred selling the Plan B contraceptive to girls 16 and younger without a prescription.

We debate the Department of Health and Human Services decision now with Anthony Picarello, general counsel for the U.S. Conference of Catholic Bishops, and Jill Warren, executive director of the Methodist Federation for Social Action. It's not an official United Methodist Church body.

Guests, just a short time before tonight's program, the vice president of the United States, Joe Biden, said the White House is trying hard to address the concerns of the church -- quote -- "I'm determined to see that this gets worked out, and I believe we can work it out."

Given the position of the church, Anthony Picarello, and the current state of the ruling from the Obama administration, is there a middle ground? Can a compromise position be found that leaves both sides getting most, but not all of what they want?

ANTHONY PICARELLO, general counsel, U.S. Conference of Catholic Bishops: Well, the president and vice president, the executive branch, is entirely within -- has this decision entirely within their control.

So they can do what it is that we have been urging them to do from the outset, which is to remove these items from the mandate, so that people are not forced against their consciences to subsidize them, to sponsor them in health plans.

They could also dramatically increase the breadth of what is an extremely narrow religious exemption that they proposed in the first instance, which covers really only individual churches and basically a very small perimeter around that. So it leaves out charities. It leaves out hospitals. It leaves out schools.

So they have the power entirely within their hands to expand that. We have been hearing lots of talk for a long time about a desire to accommodate, but we haven't seen any action. And so I think we're going to wait until we see action before we . . .

RAY SUAREZ: But I'm trying to figure out what a broadened -- to use your term . . .

ANTHONY PICARELLO: Sure.

RAY SUAREZ: . . . a broadened ruling might look like . . .

ANTHONY PICARELLO: Sure.

RAY SUAREZ: . . . since the two positions are mutually contradictory.

ANTHONY PICARELLO: Well, I don't know that there's so much of a contradiction.

I think, again, what we're looking for in terms of breadth is to protect the religious liberty interests and consciences of all of those who would be affected by the mandate. So that means employers -- religious employers, yes, but also employers with religious people running them or other people of conviction who are running them.

It means religious insurers. And they do exist. Under this mandate, they're required to include in their policies that they write things that they don't agree with as a matter of religious conviction, and individuals as well who have to pay for it through their premiums.

So all of those entities are the folks whose conscience rights are affected. And the bishops are concerned with all of them, and they have advocated for all of them.

RAY SUAREZ: It sounds like you want something even broader, not just for the colleges and universities and hospitals, but even Catholic employers.

ANTHONY PICARELLO: Well, yes, because the principle here is that of religious liberty. And it's not only religious employers that are entitled to religious liberty under the Constitution.

So all of those should be protected. They should not be put in this situation in the first place. They shouldn't be required by the government to provide, through sponsorship and subsidy, benefits that are offensive to their moral beliefs.

RAY SUAREZ: Jill Warren, is there a middle ground? Is there a position that you can contemplate that gets Mr. Picarello more of what he wants, without giving away something that you view as essential?

JILL WARREN, executive director, Methodist Federation for Social Action: Well, first let me say how much I appreciate being able to be here on the show with you, Ray, and with Anthony.

The issue for me is that it's not about a religious exemption or creating some sort of compromise position. It's a position of health care and health care policy. And that is different than religion.

And even though I am part of a religious nonprofit, the United Methodist Church and the Methodist Federation for Social Action, we don't see this in any way as a religious issue. So, for me, in answer to your question, the compromise that might be sought by the Roman Catholic tradition isn't one that is of the best public good for all of us that would be covered by this policy.

RAY SUAREZ: Where does -- when you hear Mr. Picarello talk about conscience . . .

JILL WARREN: Yes.

RAY SUAREZ: . . . where does conscience attach at the nexus of three different entities, insurers, employers and the ensured, who all may want different things?

JILL WARREN: That's right. Yes, that's right.

I think that one of the points that I would like to make in our conversation is that we have a choice about what insurance we choose, whether we choose a sectarian plan or we choose a public plan, or whether we choose no plan at all, or even have access to health care as an insurance option in the first place.

So, as an individual, I can choose what health plan I might most benefit from. I think, in this case, there are insurers, as Anthony has mentioned, and there are hospitals, but they are -- there are already exemptions for conscience clauses. And there are sectarian organizations who don't have to provide these services in the first place.

RAY SUAREZ: So, Catholic insured could invoke different options when given a list of possible insurers?

ANTHONY PICARELLO: Well, I wish that were so. I mean, that's precisely the problem, is that what we have is a situation where the federal government has come in and mandated that certain things be included in all health insurance plans nationwide.

This is private plans offered by religious institutions. This isn't governments-only plan. This isn't plans that are offered by people who happen to be government-funded. It's everybody. And so that freedom to which she was referring is exactly the freedom that we're urging. It's not something that's extreme.

It's only what we have currently, which is, when a religious entity wants to purchase a health insurance policy, it goes to an insurance company. It says, I want these things and not these things. And, you know, the heavens have not fallen in the situation where we provide that.

For example, right now, even under the current pre-mandate environment, nine out of 10 employer-sponsored health insurance plans include contraception. So, there's no scarcity of this coverage available. People can simply -- they're not forced to work for the church.

If they value that benefit so much, they can just choose a different employer. And if they work for the church . . .

RAY SUAREZ: Well, let me jump in there . . .

ANTHONY PICARELLO: Sure.

RAY SUAREZ: . . . because you noted that the heavens haven't fallen.

ANTHONY PICARELLO: Right.

RAY SUAREZ: And I don't know if they've fallen in the more than two dozen states where these mandates already exist.

What have Catholic institutions done to comply in places that already have similar strictures to the one just announced by the Obama administration?

ANTHONY PICARELLO: Ray, I'm glad you asked that question because it's coming up a lot.

There are 28 states that have some kind of contraceptive mandate. None of them are as broad as the one that the federal government has imposed. For example, all but -- the federal government mandate includes a mandate to provide sterilization. Only Vermont does that among those 28 states.

On top of that, most of those states have religious exemptions. And of those, all but three are broader than the one that HHS has chosen. So, basically, there's a lot more accommodation for religious exercise at the state level. And on top of that, states don't even -- you don't even need to take advantage of the religious exemption in order to avoid it in other ways, for example, by self-insurance.

Even in the restrictive states, many Catholic entities are able to avoid this by self-insurance.

RAY SUAREZ: Jill Warren, you heard Sen. Kelly Ayotte say that this is not a women's rights issue, not a health issue. This is a religious liberty issue.

What about the health interests that a lot of people on your side of the argument are talking about?

JILL WARREN: Well, it's -- obviously, I have a difference of opinion, because it is a health issue. It's a basic health issue.

Contraception, controlling whether you can plan your family, whether you can space your children, whether you want to have children, is a basic health issue. It's a biological fact that women can be impregnated, and against our will, I might add. So it absolutely is a health issue.

Barriers to education, barriers to the work force all center around whether you can control your own reproductive health. And in this case, I don't see it at all as a religious issue because there are already religious exemptions and people who can follow their conscience in making their choices.

So, for me, the policy is just good public policy for the common good.

RAY SUAREZ: Jill Warren and Anthony Picarello, thanks for joining me.

ANTHONY PICARELLO: Thank you.

JILL WARREN: My pleasure. Thank you.

John Cassidy, who holds Guinness World Records for several balloon-related tricks, performs a balloon act for first lady Michelle Obama in the Diplomatic Reception Room. White House photo by Chuck Kennedy.

Michelle Obama may be spending her time these days dancing with Ellen and racing Jimmy Fallon through the White House, but all the fun began with a much more serious moment: "My pediatrician pointed out some changes in my kids' body mass index that he just sort of checked us on."

As the first lady told Jim Lehrer two years ago when her signature "Let's Move!" campaign launched, the typical American lifestyle got the best of the Obama family in their pre-White House days. "It was a life that most working parents are dealing with, where you're juggling jobs and trying to get kids to and from and you're trying to make life easier."

That's why the mother who once allowed her family to indulge in too much television and junk food became the national spokeswoman for nutrition and exercise: She knows how easy it is to lose control and what it takes for an entire family to get back on track. Two years after she launched a campaign against childhood obesity, it's time to take stock of the progress in implementing those same principles on a national scale.

But first, it's worth a look back to the very beginning. Watch Jim Lehrer's full interview here:

By many markers, Mrs. Obama's simple goal "to shine a spotlight on this issue in a way that I couldn't do as a regular mom on the South Side of Chicago" has far exceeded expectations.

National legislation has changed the face of school lunches for 32 million children. Walgreens, Wal-Mart and a number of other chains have agreed to build 1,500 stores in food deserts in the coming years, bringing 9.5 million more Americans better access to fresh and healthy foods. More than 5,700 groups have partnered with the USDA to spread the word about the new MyPlate food-selection diagram and get simple nutritional information to families across the country.

In a recent survey by The Washington Post and the Kaiser Family Foundation, more than eight out of 10 Americans say they have heard of "Let's Move!" Thirty five percent say they've heard a lot about it.

But the backlash has been plentiful, too. Some say "Let's Move!" is just another excuse for the Obama administration to meddle in the everyday decisions of Americans. Others criticize the links to Wal-Mart or worry that the emphasis on obesity could damage the self-esteem of American youth.

But some of the strongest resistance is coming from American children and adolescents themselves. When Brandi Thompson's Mississippi high school removed the deep-fried chicken and pork chops from the lunch menu and replaced them with potatoes that are baked instead of cooked in fat, the move didn't sit well.

"I understand the part about us being healthy, but the food they cook, we don't eat, because everybody can't cooked baked food the same. And it just don't taste right," she told health correspondent Betty Ann Bowser shortly after the initiative started.

Blogger Eddie Gehman Kohan has covered every twist, turn and shake of Let's Move! for the past two years on her Obama Foodorama blog. She's currently traveling with the first lady on a national tour to celebrate the anniversary. But she separated from the press pack for a few moments to answer our top questions on this massive program and its efforts to slim down America's youth.

What have been some of the major milestones in the past two years -- the indications that this thing is making a difference?

Gehman Kohan: Well broadly, for any first lady who has had a "first lady campaign," she is the only one to have such huge private-sector commitments. It's really an astonishing series of commitments that she's gotten from the private sector, where they're really serious and largely scaled and can impact millions of people. There's a commitment from Darden Restaurants -- which owns chains like Olive Garden and Red Lobster -- to revamp their children's menus and some other menu items for the campaign. Of course, there are large-scale commitments from Wal-Mart and Walgreens, which have both agreed to build or revamp stores in what USDA identifies as "food deserts" -- places where fresh and healthy foods, primarily produce, are not necessarily available.

And there are a huge number of other private-sector commitments, like from childcare facilities, including YMCA and Bright Horizons. These facilities can help implement early childhood interventions that will help prevent obesity right at the get-go. Mrs. Obama has also made progress with "Let's Move Faith and Communities," a subcomponent that brings in religious groups and community groups to participate in "Let's Move! activities. And the Healthier U.S. Schools Challenge, which is a USDA program that rewards schools for best-case scenarios in nutrition and fitness activities.

How much actual progress has been made so far? Are kids actually getting healthier?

Gehman Kohan: After two years, it's too early to point to any kind of statistical analysis in a childhood obesity reduction. Kids who are running around and moving and eating better can't help but be healthier. But most of what has been accomplished is a huge paradigm shift in the public's awareness of the relationship between food and health. And the coordination has been significant: All of these groups that existed before are now coordinated and mobilized and led by the White House while still operating independently. Clearly, there were plenty of food, gardening, health and physical fitness activities in the U.S. before this. But Mrs. Obama's efforts with the "Let's Move!" campaign has really given these groups a focal point while also bringing high-profile attention to the subject as crucially important.

You've written in your blog that "observers seem to misunderstand the scope and focus of Let's Move!" What exactly do you mean by that?

Gehman Kohan: This initiative is generational. It was designed with the intent that children who born in 2010 -- when this was launched -- will grow up in a very different food culture and a very different physical fitness culture. Take for example one of the long-term components -- the school lunch legislation. It is taking a couple of years to roll out, but when children born in 2010 are in kindergarten five years from now, the theory is they'll be walking into a school fitness and food environment that is profoundly different than the environment experienced by kindergartners today. They will have completely different school lunch standards and hopefully their schools will be focusing on more physical activity. And so the crucial importance of starting children out young is they won't grow up already suffering from obesity and all the related diseases.

Let's talk more about school lunches. How is this initiative actually changing policy?

Gehman Kohan: Federal law requires that certain things need to be served or cannot be served in the cafeterias. That's through the National School Lunch Program and the Healthy, Hunger-Free Kids Act. Every few years, Congress has to pass what's called "child nutrition reauthorization," and so the version that came along during the Let's Move! campaign, the Healthy, Hunger-Free Kids Act of 2010, is what changed school lunches in the U.S. It's the first significant change to menus in 15 years, and it's the first time in about 30 years the government is giving more for the federal reimbursement rate -- the amount they pay schools to serve the lunches. It also doubles the amount of fruits and vegetables that will be served on a weekly basis, it requires that water be served, that all milk be low- or nonfat, and that all grains are whole grain. And it sets high and low limits for calories, so portion sizes are controlled, depending on the age of the students being served. These changes impact 32 million children.

Are we seeing that kind of change in terms of school gym programs, in getting kids to actually move in school?

Gehman Kohan: Well the schools that participate in the Healthier U.S. Schools Challenge have improved gym components and physical activity. But generally, physical activity in schools has fallen a lot to the wayside for multiple reasons. Many don't have the staff to watch the kids on the playground, some have needed to reduce or eliminate PE because they've needed the students to study for standardized tests tied to state funding. So this recently passed legislation has a wellness policy but it doesn't mandate physical activity. More generally, every major sports association has joined in some high-profile way. They're working in their communities, encouraging after-school programs.

Let's turn to some of the criticism. Not everyone's completely happy with the campaign, right?

Gehman Kohan: By far, the Wal-Mart partnership has caused the most criticism. Wal-Mart is a flashpoint for controversy. It has this reputation for putting local businesses out of business when it moves into communities. Some people say Wal-Mart is using the first lady, that the company isn't serious about its commitment and is just aligning with the first lady because they're trying to build more stores. Labor didn't like the Wal-Mart partnership either because it's a non-union company. Even when Michael Pollan named Mrs. Obama the "Most Powerful Foodie in the World" in Forbes magazine, he said he was worried she was being duped by Wal-Mart and that the company's pledge to focus on "better-for-you processed foods" was really not what should be going on within the rubric of the campaign - that it should be a total focus on fresh, unprocessed foods.

Has there been much criticism of the broader message?

Gehman Kohan: Let's Move! has been pointed to by a lot of critics as an example of big government intervening and the Obama administration wanting to expand the role of government to the point that it controls what American citizens eat. For its part, the campaign says it's about giving people choice and educating them about food and nutrition and physical activity and allowing them to have access to a wide range of choices. There's also been the concern from a lot of people that focusing on childhood obesity would make children hyper-conscious of their body weight. Mrs. Obama always says, "It's not about how you look, it's about how you feel," which is the ultimate message. But that brings up a tricky subject -- there's no way to end an obesity epidemic if people aren't losing weight. So this is one of those murky areas of the campaign that is not much discussed.

If the president isn't re-elected in the fall and this all ends within a year, what's the implication for that?

Gehman Kohan: Well this three-day trip will actually be the last grand tour if the president doesn't get re-elected. But Partnership for a Healthier America - a separate nonprofit that was launched in conjunction with the campaign - was founded to ensure that "Let's Move!" continues on long after Mrs. Obama is not in the White House, whether it's next year or five years from now. Regardless, she's so passionate about this subject that I think she'll continue to work on this issue in some capacity for the rest of her life.

Last week, we met up with her to examine some of the ways the medical, technological, and political ideas swirling around in 2012 -- ideas still unhatched and far beyond her control -- might impact her future health 13 years from now. Using potential scenarios for U.S. health care as defined in a new report, our "time-traveling" pals at the Institute for Alternative Futures laid out four possibilities for Mary's health care in the year 2025.

Watch the videos below for a refresher on the four scenarios. Then, as promised, read the analysis of Clem Bezold, founder of IAF, who explains what would need to happen over the next 13 years for each of those scenarios to become reality.

And don't forget to check out the final results of our audience poll from last week -- found at the bottom of the post -- to see where your ideas on the future of U.S. health care stack up with the other participants.

SCENARIO 1: "Many Needs, Many Models," or the "Expectable Future"

Bezold: "Among many health care experts, this is the most likely forecast for U.S. health care. It may not be the most preferable, but there's enough inertia in the system to prompt a fair amount of positive change. In this scenario, we have electronic medical records that work, there are advances in system integration, digital coaches have become relatively effective, and the personalization of health care has improved significantly. The good news is we double the percentage of people in integrated care from 20 to 40 percent -- but the bad news is we only double it. The rest remain in fee-for-service or semi-integrated care. So we see improvements, but they're not uniformly distributed.

"To get to this scenario, we assume the Affordable Care Act has been implemented fairly successfully, but the improvements in changing the health care system are modest. We add people to the rolls for health coverage, but we end up with shortages. The employers generally look at the new health insurance exchanges and say they're effective enough, and that they'd prefer to get out of providing health care. So employers continue dropping coverage or shifting to consumer-directed health plans with defined contributions and high deductibles. The triple aim of health care reform -- enhancing the patient's experience, reducing per capita health care costs, and improving the overall health of the population -- has been accepted by most integrated health care systems. Most providers, though, remain unintegrated and the payers don't require it. And that's largely because health reform's Accountable Care Organizations, which were designed to integrate care, haven't been implemented as widely and successfully as they could have been by 2025."

SCENARIO 2: "Lost Decade, Lost Health," or a "Challenging Future"

Bezold: "In this scenario, the Supreme Court has ruled the individual mandate of health care reform unconstitutional, eliminating a major component of the Affordable Care Act. The United States has made huge investments in electronic medical records but they're not fully interoperable and therefore aren't very effective. In the meantime, prices keep going up, and a lot of people are now uninsured. So they seek out free digital coaches to substitute for regular check-ups. The problem is that advertising revenues fund many of these digital coaches that are free to patients, and many independent providers of these free digital coaches don't adequately check the quality, safety or efficacy of what their advertisers are selling.

"To top it all off, the United States has suffered recurring recessions, several tied to the European financial crisis. And due to that fact, there have been periodic and significant budget cuts -- 10 percent cuts in health care spending happened twice within two or three years of each other. One was in 2013 when Congress failed to find a patch for the Sustainable Growth Rate formula that reimburses doctors for their Medicare services. The second slashed Medicare and Medicaid reimbursement rates yet again to cope with ever-rising health care costs. Physicians are being told to do more and get less -- and their stresses continue to get worse. Some health care providers just go out of business, including some community health centers. To be sure, there have still been some developments, including the discovery of a successful treatment for Alzheimer's, but you have to be rich to get them. Even if you have health insurance, most plans have stopped covering a number of the cutting-edge, expensive treatments."

SCENARIO 3: "Primary Care That Works for All," or an "Aspiring Future"

Bezold: "In this scenario, the Affordable Care Act has done very well in moving people toward integrated care. In general, the system also continues to move health care delivery systems into integrated care that focuses on prevention, takes full advantage of digital health coaching and utilizes the entire health care team. Leading health care officials have made a concerted effort to ensure that patient-centered medical homes have evolved into robust community centered health homes. In practice, they see themselves as treating the entire community and addressing social determinants of health in a neighborhood or region, in addition to treating patients. Things have gone well due to a combination factors, including the successful implementation of the ACA - particularly the success of Accountable Care Organizations which have fully integrated and simplified care -- as well as greater transparency of costs and real competition among providers.

"All of that has resulted in much more patient satisfaction. Incentives have shifted enough to encourage the medical community to use the entire team more efficiently. There's less use of physicians and more use of others in the team, including community health workers. It's been found that more and better care can be provided by using people further down on the chain. Community health workers have less training than nurses, but they can visit patients in their homes and effectively reinforce the information, diagnosis and advice from the health care provider. The recommendations are based on the latest medical protocols, the patient's bio-monitoring and community health assessments. It's become increasingly apparent that by focusing on prevention and taking a community-focused approach, you can get better outcomes for less cost."

SCENARIO 4: "I Am My Own Medical Home," or a "Surprisingly Successful Future"

Bezold: "In scenario four, much of health care moves into integrated systems that work, but the United States also has some economic challenges that have interfered. So we don't get the same degree of access to the effective integrated health care we saw in Scenario 3. The individual mandate within health reform has been ruled unconstitutional, and that means no one is forced to have insurance. We're also seeing a continuing movement where employers stop offering their employees full benefits. Individuals have to be ready to shell out a fair amount of money to get good health insurance -- and many people do that -- but another 40 percent of them say they can handle their health care on their own.

"In fact, technology, competitive insurance plans, and transparency of quality and price for providers, tests and procedures have allowed many individuals and families to self-manage their health care quite well. Most of these people have determined that they either can't afford full health coverage and consumer-directed plans help people take control of their own health care. Forty percent end up using technology and consumer-directed plans to become their "own medical home" and an equal amount buy their health care though integrated plans. For those managing their own care, there are very effective tools that allow people to buy health care "by the piece." For example, if someone needs a test and she can't do it at home, there's an equivalent of Angie's List that links up with that individual's digital health coach to find the result that will work best for them. The same is true for routine care -- it's easy to shop around. Because this consumer-directed care is so effective and lowers cost, it puts a cost pressure on integrated systems to become more efficient and effective. Another positive development is that consumer-directed plans include a very effective digital health coach, with all accompanying advertisements vetted by health insurance companies to ensure the quality of their messages and the safety of consumers."

Which scenario do you think is most likely? Check out the results of the NewsHour poll conducted over the past week. While it's far from scientific, the poll does indicate that many of the participants have a "very gloomy" outlook for U.S. health care, Bezold said. He offers his own assessment below.

Here are the results of a NewsHour poll that asked viewers to rate the relative likelihood of each scenario. Raw scores have been converted to averages:

Scenario 1: "Expectable Future": 60 percent likelihood (average of 5.95 out of 10 for 65 voting)

Scenario 2: "Challenging Future": 70 percent likelihood (average of 6.96 with 78 voting)

Scenario 3: "Aspiring Future": 53 percent likelihood (average of 5.27 with 60 voting)

Scenario 4: "Surprisingly Successful Future": 42 percent (average of 4.15 with 61 voting)

The above results are based on ballots cast between Jan. 31 and Feb. 7. Continue voting here:

Rate SCENARIO 1: "Expectable Future"

Rate SCENARIO 2: "Challenging Future"

Rate SCENARIO 3: "Aspiring Future"

Rate SCENARIO 4: "Surprisingly Successful Future"

Bezold: "In terms of relative likelihood, my own opinion is that Scenario 1 is about 55 percent likely, Scenario 2 is about 45 percent likely, Scenario 3 is 38 percent likely, and Scenario 4 is 38 percent likely. I pick Scenario 1 as the likeliest because it includes the strongest aggregation of forces in terms of where we're headed. While I don't like that it's most likely -- especially because we've only doubled the number of people in integrated care -- we will see a number of advances in a whole range of things built into that scenario. So it's not all bad news."

The scenarios were developed in consultation with some of the top health care experts in the country, and with the support of The Kresge Foundation, which is also a NewsHour underwriter. Read the full report here.

Catholic leaders are pushing back against a new Department of Health and Human Services ruling requiring employers who offer health insurance to provide contraception free of charge. While churches are exempt from the rules, Catholic hospitals and universities must comply. Betty Ann Bowser reports on the controversy.

RAY SUAREZ: Now to the continuing fallout over the Obama administration's recent decision on covering contraceptives in insurance plans.

Leaders in the Catholic community are pushing back hard against a new mandate that requires coverage of contraceptives under the health reform law.

NewsHour health correspondent Betty Ann Bowser reports on the battle lines from both sides.

BETTY ANN BOWSER: Holy Ghost Catholic Church in downtown Denver is a popular parish with a chief mission of serving the poor. Yesterday, the focus was not on charity. It was on a new federal regulation regarding health insurance.

From the pulpit, Father Michael Warren had strong words.

REV. MICHAEL WARREN, Holy Ghost Catholic Church: The president of the United States, who has recently made a decision to impose upon Catholic institutions, hospitals, schools, charities that they must provide to their employees coverage for contraception, coverage for sterilization, coverage for drugs that would induce abortion, without choice, this is in direct contradiction to our Gospel values.

BETTY ANN BOWSER: When Father Warren finished his homily, the congregation broke out in wild applause.

(APPLAUSE)

BETTY ANN BOWSER: And when the mass ended, it was clear most of his flock stood behind him.

DR. ANDREW SCHREFFLER, churchgoer: Well, I think it's atrocious. Not only is it bad medicine, but it tramples on our First Amendment rights.

BRITTANY KERLIN, churchgoer: I feel that it's an affront on my citizenship. Entirely about religious freedoms. I am obviously against contraception, but we live in a free country.

BETTY ANN BOWSER: The new rule was issued last month by the Department of Health and Human Services. Not only did it say employers who offer health insurance must provide contraception, they must also do it free of charge. Churches are exempt from the regulation, but because Catholic hospitals and universities serve many Americans who aren't Catholic, the Administration said they must comply.

At the White House, Press Secretary Jay Carney explained.

JAY CARNEY, White House press secretary: The new guidelines require most private health plans to cover preventive services, including contraception, for women without charging a co-pay, co-insurance or a deductible. The guidelines were recommended by the non-partisan Independent Institute of Medicine.

BETTY ANN BOWSER: The new rule grew out of an IOM report last year that recommended a major expansion of birth control services to women.

The report said in part, women with unintended pregnancies account for almost half of pregnancies in the U.S., and those women are more likely to smoke, consume alcohol, be depressed and experience domestic violence. The IOM also said, expanded birth control services to women will cut down on the number of abortions and make women healthier.

The Obama administration says 28 states already have similar mandates requiring contraceptive coverage.

But some Catholic leaders say the states have broader exemptions than the new federal mandate.

Marcia Greenberger is co-president of the National Women's Law Center in Washington. She supports the new federal rule.

MARCIA GREENBERGER, National Women's Law Center: It's essential for women's health and for the health of their children and ultimately the health of their whole family. And that's why the Institute of Medicine, all of the scientists and medical experts said that contraception is an essential health benefit that should be available without co-pays, without deductibles.

BETTY ANN BOWSER: But the scope of the new regulation raises complex legal and moral questions.

John Garvey is the president of the Catholic University of America in Washington.

JOHN GARVEY, Catholic University of America: It is not about whether the health care law ought to provide for or even insist on coverage of contraceptive care for women. It is about whether every institution that provides a health care plan ought to be obliged to pay for that, even if they have religious objections to it.

BETTY ANN BOWSER: Garvey is also a legal scholar who focuses on constitutional law. He teaches a class weekly at the university and believes it doesn't matter that the students they serve are not all Catholics.

JOHN GARVEY: It requires us to contradict in our actions the very lessons that we're teaching with our words in classes and in our daily activities at the university. It makes us hypocrites in front of the students that we're trying to educate.

BETTY ANN BOWSER: But many university employees and students on the school's health plan have used birth control and want the school to comply with the regulation.

Twenty-seven-year-old Erin McCarthy, a non-practicing Catholic, is studying for her master's in social work there. Right now, she says she can't afford to pay for birth control out of pocket.

ERIN MCCARTHY, graduate student, Catholic University of America: A generic would cost $30 a month, something like that, which, you know, it may not seem like a lot, but times 12, without a full-time job, it adds up -- $30 can buy groceries for a few weeks, so --

BETTY ANN BOWSER: Recent studies have found the vast majority of Catholic women use birth control at some point in their lives.

And Greenberger believes it's a woman's right to have coverage.

MARCIA GREENBERGER: We don't see families of eight to 12 children these days in religious pews, whatever the religion may be, because of the widespread use of contraception.

And that's really reflective of the recognition that contraception is essential for women's health. It's essential to have healthier children. And, of course, it means that for the well-being of the whole family unit.

BETTY ANN BOWSER: Anthony Picarello, general counsel for the U.S. Conference of Catholic Bishops, says that's not the point.

ANTHONY PICARELLO JR., general counsel, U.S. Conference of Catholic Bishops: Whether or not individual Catholics or others in society happen to agree with that is really not the issue. Instead, it's the question of whether the government can force this religious institution that happens to have these commitments to violate those beliefs as a matter of federal law.

BETTY ANN BOWSER: The American Civil Liberties Union and other organizations in support of the Obama administration say the rule is not an infringement on religious liberty, because women are still free to follow their own beliefs. And, at this point, institutions like Catholic University can apply for a one-year extension to the mandate before having to comply.

But Picarello warns the bishops will still look for ways to stop it.

ANTHONY PICARELLO JR.: The bishops are highly motivated to pursue every means legally available to them to get rid of this mandate. And they will do it by litigation if they have to, by legislation if they can, by public advocacy. But, basically, they're not going to stop until it's gone.

BETTY ANN BOWSER: Supporters of the mandate hope it will not be expanded to cover Catholic institutions outside of the church.

MARCIA GREENBERGER: To broaden that exception to well over a million women and their families would be terrible health policy in this country. It's too essential for our efforts with respect to infant mortality, maternal mortality, the health and future of this country. And I put it in those major terms because that's really what contraception is all about.

BETTY ANN BOWSER: The new rule takes effect in August, but religious institutions like Catholic University can file for a one-year exemption.

Brandon Hostler's arm is usually among the first extended for the annual flu shot at Ruby Memorial Hospital in Morgantown, W.Va. He is, after all, a registered nurse -- he knows it can do some good.

But if that shot ever becomes mandatory, he will balk.

"I wouldn't quit or switch jobs," he said. "But we are health care professionals. We know the risks and the benefits, and to force us to do something like that and not have a say in it, I think it would be offensive and unwanted."

In this moment of looming change and controversial mandates in American health care, the debate over whether flu shots should be mandatory for hospital employees has become a smaller but important battle between those who feel government should force its hand to improve the health care system and those who believe that critical civil liberties are being steamrolled.

Mass Casualties

In the thick of the fray is a problem of massive proportion: Influenza kills between 3,000 and 49,000 people each year and sends 200,000 to the hospital for respiratory illnesses and heart conditions. That's according to a subcommittee of the federal government's National Vaccine Advisory Committee, which will meet this week to discuss potential strategies for dramatically boosting immunization and inching closer to a Healthy People 2020 goal.

The U.S. government would like to see 90 percent of America's health care personnel immunized annually against the flu by the end of the decade. But reaching that goal begs a major question: Should the government encourage organization-wide, state-based or even national mandates to get there?

In the 2010-11 flu season, 63.5 percent of health care personnel received a flu shot, according to the Centers for Disease Control and Prevention. In hospitals that required immunization, compliance was nearly universal.

"This should be mandated and it should have been done earlier," said Helen Darling, president and CEO of the National Business Group on Health.

The nonprofit organization, which represents more than 300 large employers, including 68 of the Fortune 100 companies, threw its support behind a flu shot requirement for health care workers last week, and it did so in part due to three additional statistics, Darling said. The virus can be transmitted to patients by both symptomatic and asymptomatic health care providers. One in four health care workers shows evidence of having the flu each year. And 70 percent of them continue to work despite having flu-like symptoms.

"The idea that a pregnant woman can enter a hospital and deliver a baby in a place where employees aren't required to take every step possible to guard against a preventable disease ... I just think that many people would be stunned by that," Darling said. "If hospital workers don't want to get the shot, they don't need to work in a hospital -- they can go work in a library and spread their germs to people checking out books."

Where's the 'Informed Consent?'

Needless to say, not everyone agrees. Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, says some of the studies supporting the effectiveness of the flu vaccine are "flawed" -- at least enough that workers should be allowed to exercise "informed consent." In a letter to the U.S. Department of Health and Human Services regarding the subcommittee's recommendation, Fisher and her team also called into question the CDC's estimate for annual flu-related deaths. All told, she said, the evidence is too shaky for any kind of government-imposed mandate.

Certainly, she said, the shots should be available for those that want them. "But there should be in America the right to make informed, voluntary choices about the preventive health care we use. Because when these hospital employees receive flu shots, they're engaging in a medical intervention that carries a risk of great sickness and even death."

Front Line Obligations

Those arguments don't hold much weight with health officials in Colorado who want the vaccine administered to all hospital and nursing home employees -- with no religious or personal exemptions allowed. A narrow set of individuals with documented medical conditions could apply for a waiver, but they would be required to wear a mask during flu season.

The Colorado Hospital Association supports the general idea, which will be taken up by the state board of health later this month.

"If we did face a serious epidemic, it serves no one's interest to have our health care workers on the front line at home, sick," said Steven Summer, the hospital association's president and CEO. "They would be the first-responders, and having them home sick wouldn't work so well. In the absence of a clear mandate, we can't get where we need to be."

On a more individual level, it's an "ethical responsibility," said Amy Garcia, chief nursing officer for the American Nurses Association.

"Part of nursing's code of ethics is that the patient comes first. So we believe if there is a chance that a nurse could expose a patient, it is the ethical responsibility of the nurse to be protected by vaccinations," Garcia said.

A strictly enforced policy is a little different, though, she said. Any formalized rule should always be accompanied by enough protections to ensure that "nurses are treated fairly."

That includes suitable exemptions for those allergic to the vaccine, the ability to opt-out for personal reasons, and bans on discrimination or punitive measures for those who choose not to participate. The policy should also be part of a larger "comprehensive infection control program" that includes the use of masks, gloves and aprons in appropriate settings, Garcia said. And immunization clinics should be free and convenient for employees working all shifts.

Swine Flu Fever

Few of those protections were in place in 2009, when the nation panicked under the building threat of H1N1 and New York state officials issued an edict that medical professionals either receive seasonal and swine-flu vaccines or lose their jobs.

"There was mass outrage because it was put forward without any discussion, there were no personal exemptions, no religious exemptions," said Renee Gecsedi, a registered nurse and director of education practice and research for the New York State Nurses Association. "There was a medical exemption but it was so narrow that people with egg sensitivities -- which often flare up after the vaccination -- weren't included "

The uproar coupled with the vaccine shortage that year caused state officials to rescind the policy. But it served as a telling measurement of public opinion, Gecsedi said: "If these mandates go into effect, employees need to have options."

Uncertain Steps Ahead

At the moment, the subgroup of the federal government's National Vaccine Advisory Committee isn't advocating a full-scale national mandate. In fact, its draft proposal only recommends that health care employers "strongly consider an employer requirement for influenza immunization" after a broader, multi-pronged approach fails to hit certain benchmarks in the build-up to the 90 percent goal for 2020.

Still, the federal government's not ruling anything out, said Dr. Don Wright, deputy assistant secretary for health care quality at the Department of Health and Human Services.

"The National Vaccine Advisory Committee can accept, modify or reject the subcommittee's proposal -- or they can come up with something else," he said. "I'm not sure where the committee will come out."

Do you think a flu vaccine for hospital workers is a good idea? Share your thoughts in the comments section below or on Twitter.

Komen officials said Friday they had no immediate plans to halt funding over concerns raised about Planned Parenthood's referrals. But in statements the Foundation provided to the NewsHour, it seemed to leave the door open to possibly doing so in the future.

"We will increasingly look to fund grants that can measure outcomes successfully, define outcomes that are important to us, and that meet the needs of the community," Komen officials wrote in a statement provided to the NewsHour.

"We are moving toward more outcomes-based granting, but that does not mean we will no longer fund education or pass-through grantees," the statement said.

The questions are lingering in part because Komen officials and spokespeople had emphasized two different reasons over two days for halting grants to 16 of 19 Planned Parenthood clinics that do breast cancer screenings.

On Wednesday, Komen officials had said the primary decision to cut future grants was due to new internal criteria that bar money to any organizations under investigation by federal, state or local governments. Rep. Cliff Stearns, R-Fla., is leading an investigation into whether Planned Parenthood may have used federal funds to provide abortions.

But on a conference call with reporters Thursday, Komen founder and CEO Nancy Brinker spoke instead about a different concern -- the way Planned Parenthood clinics provide referrals for mammograms. Planned Parenthood says its funding from Komen has been directly connected with nearly 170,000 clinical breast exams and more than 6,400 mammogram referrals.

Those referrals seemed to be the central issue cited Thursday. And it came after Planned Parenthood and many women said they believed Komen had caved to political pressure surrounding the fact that Planned Parenthood provides abortions.

"We have decided not to fund, wherever possible, pass-through grants," Brinker told reporters yesterday. "We were giving them money, they were sending women out for mammograms. What we would like to have are clinics where we can directly fund mammograms."

In an official statement released by Komen to the media Friday morning, Brinker directly addressed the question of investigations, saying that an "investigation must be criminal and conclusive" to disqualify a group from receiving a grant. But Brinker's statement this morning seemed to skirt the other concern raised less than 24 hours ago about mammograms and services.

Reporters openly wondered throughout the day whether Komen was leaving itself an out.

On Friday night, Komen spokespeople said there was no push to stop grants to Planned Parenthood for now over those reasons. But they noted that chapters and affiliates could make their own decisions.

"For the time being, grants are active and Planned Parenthood -- like all grantees -- is eligible to reapply," Komen said in the statement provide to the NewsHour. "The affiliates will make the decisions about the grants in their communities."

Komen provides $93 million in grants to communities throughout the United States.

One other story that is getting some attention in the outrage from the past three days is the role Planned Parenthood provides with breast cancer screenings and exams. The Associated Press has a good breakdown of it here.

On Friday's NewsHour broadcast, Hari Sreenivasan spoke with Amina Khan of The Los Angeles Times about the abrupt shift in message at the well-known breast cancer charity.

After two days of uproar and different explanations for its initial decision, the Susan G. Komen for the Cure charity reversed course Friday on cutting funding for Planned Parenthood. Hari Sreenivasan and Amina Khan of The Los Angeles Times discuss the abrupt shift in message at the well-known breast cancer charity.

JEFFREY BROWN: Next: After an uproar, the Susan G. Komen Foundation reverses course on its decision to cut funding to Planned Parenthood.

Hari Sreenivasan has our update.

HARI SREENIVASAN: The about-face came after two days of anger from many women and supporters, and after the breast cancer charity offered two different explanations for its decision.

First, Komen leaders said they would cut grants to Planned Parenthood because of a new policy barring money to organizations being investigated by the government. Then yesterday, Komen officials cited concerns over how Planned Parenthood provided mammograms and other follow-up services.

This morning, Komen's founder, Nancy Brinker, apologized in a statement saying: "We have been distressed at the presumption that the changes made to our funding criteria were done for political reasons, or to specifically penalize Planned Parenthood. They were not."

For more on what happened, we turn to Amina Khan of The Los Angeles Times.

Thanks for being with us.

AMINA KHAN, The Los Angeles Times: Thanks for having me.

HARI SREENIVASAN: All right. So help put us -- help put this in perspective a bit more. What did we learn today?

AMINA KHAN: Well, today we learned that Susan G. Komen for the Cure had reversed its decision to prevent any funding going to organizations that have been under any kind of investigation whatsoever.

They now say that they will allow funding to go to Planned Parenthood and other organizations so long as any sort of investigation is not conclusive and criminal. So this basically opens the door again for any of the affiliates around the United States to continue to receive funding from their local Komen organizations.

HARI SREENIVASAN: How severe were the past three days for the Susan Komen Foundation?

AMINA KHAN: You know, I mean, I don't think this was something that they really expected. And I don't think it's something that Planned Parenthood expected either.

They -- Komen received support from both sides. There were many people praising the decision. And there were many people condemning it. Planned Parenthood for their part didn't expect to receive the kind of support they received on social media, Twitter, Facebook.

And, you know, as Cecile Richards, the president of Planned Parenthood Federation of America, put it, it just really caught fire.

HARI SREENIVASAN: How powerful was that social media element of it?

AMINA KHAN: They say that it was pretty powerful.

I mean, basically, when you have something like Facebook providing a space for people to tell their own stories, to really lay out why this is important to them, that is something that can be a very, very powerful tool.

And Cecile Richards herself says she believes it wouldn't have caught quite as much attention from the mainstream media had it not been for this big social media push. So they give it a lot of credit.

HARI SREENIVASAN: And, at the moment, Planned Parenthood almost came out ahead in this entire event, right?

AMINA KHAN: Yes, it seems like they have done pretty well for themselves.

In the last few days, they have raised somewhere around $3 million, some of it from big donors like Michael Bloomberg, and others from smaller donors. And that's been to an emergency fund that has been set up since Komen said that it would be -- or since the announcement came out that Komen would be halting funding to Planned Parenthood, which has obviously since reversed.

But, clearly, yes, they have come out quite a bit ahead. That said, Komen has also received funds as well, probably from people who supported that initial decision. So it will be interesting to see, you know, how high their profiles are raised by this.

One of the things that Cecile Richards mentioned in a press conference this morning was that she got a call from Lance Armstrong's foundation, LIVESTRONG, and that is someone that they have never been able to work with before. So they are receiving opportunities from places that they had not expected before.

HARI SREENIVASAN: So how strained is the relationship between these two organizations? In part of that conference call, she said that she heard this turnabout like everybody else did. There wasn't a special phone call. There weren't letters back and forth.

AMINA KHAN: I don't know how strained the relationship is.

Yes, she did indeed hear it the same way that everyone else did, through a release on the Internet. And she said at that point in time that she had put a call in, but had not heard back yet. That said, I mean, the overall tone is they just want to put this behind them, that they are sort of very relieved and happy to move on, and they just want to go back to their goal of serving women.

So, right now, the tone is very much about building bonds and re-forging that and sort of moving on. And I think they attribute that a lot to the very good relationships that they have on the ground with the local affiliates of Komen.

HARI SREENIVASAN: All right, Amina Khan from The Los Angeles Times, thanks so much for your time.

AMINA KHAN: Thank you.

When Victoria Miller heard the news that presidential hopeful Rick Santorum had temporarily stepped off the campaign trail to sit by his daughter's hospital bed, Miller's thoughts traveled back to Germany.

It was there -- after being Medevaced from a U.S. military base in Bahrain -- that she gave birth. And it was there that she first heard a diagnosis that would upend her world and eventually afflict the Santorum family: Trisomy 18, sometimes known as Edwards Syndrome. Miller's son had it, and it was almost certain he wouldn't live long.

The devastating genetic disorder is brought on by an extra chromosome -- three copies of No. 18 rather than just two. For reasons that are still unknown, that extra chromosome means that nearly half of those born with Trisomy 18 die within three months -- and 90 percent are gone before their first birthday. Isabella, who is 3, is in the small minority. Miller's son Isaac died after just 11 days.

That's why the nation took note when Rick Santorum rushed his daughter to a Virginia hospital last weekend. The double pneumonia could have been fatal on its own, but the underlying Trisomy 18 -- which keeps her respiratory system fragile -- made the situation far more grim.

Nearly a week later, "Bella" has once again defied the odds. But as she struggles toward recovery, her family's openness about their battle with the condition has prompted a national question: What is it?

Below, Dr. Melanie A. Manning answers just that. She's one of the medical geneticists at Lucile Packard Children's Hospital at Stanford. You can also read more about Miller's story and the Trisomy 18 Foundation she created in the aftermath of Isaac's death and watch another very personal account of a third family's struggle with the syndrome here:

In layman's terms, what is Trisomy 18?

Dr. Melanie A. Manning: Trisomy 18 is a genetic condition in which an individual has one extra chromosome more than the typical 46 we have in our cells. That extra chromosome is No. 18. Chromosomes 1 through 22 are the same in boys and girls, and we have two copies of each. The last pair determines our sex.

What causes the extra chromosome?

Manning: We don't understand all the mechanisms, but the extra chromosome can be in a sperm cell or an egg cell. When those eggs or sperm are being formed and the chromosomes are being divided, they can't contain 46 chromosomes each -- that would be too many for the final genetic code. So each egg has 23 and each sperm has 23. But sometimes the division of chromosomes doesn't happen as expected and you get an extra one. In that case, when the egg meets the sperm, you get a total of 47 chromosomes.

And why is that a problem?

Manning: Our chromosomes contain the genes that are the individual units of inheritance or the determiners of all of the features that make us human beings. If additional information is there that shouldn't be, it can cause organ system development to be altered. There are really only three common Trisomies: 13, 18, and 21. Those children tend to survive after birth because the developmental differences in the brain might not be as severe. You can have Trisomies of all of the other chromosomes, but that extra information is just too much and makes the development of the fetus not viable. We don't understand all of it but that extra information is just something that's not tolerated.

Do we know what causes the irregular chromosome division?

Manning: Maternal age is associated with an increased likelihood of not having everything go quite right. But it can also happen in sperm, and that's been shown to not necessarily be associated with paternal age. For that matter, it's not always associated with maternal age. There are plenty of children born with Trisomy 13 or 18 to parents who are only 18 or 21 years old. So there must be something we don't understand yet.

What are the symptoms of Trisomy 18?

Manning: Often the babies are small at birth, they're underweight and their length is shorter than what's typical for their gestational age. There can also be differences in their facial appearance -- they often have very petite features. Their respiratory system is often weak, so things like pneumonia can be a common problem. One of the most characteristic features is they have an unusual overlapping of their fingers. Their hands can be clenched but their second and fifth fingers overlap the two middle ones. And finally, for whatever reason, the connections from the brain that tell the body to keep breathing are altered. So that's one of the reasons children with Trisomy 18 often expire -- they just stop breathing.

How common is this condition?

Manning: Some estimates say it's as common as 1 in 3,000 for live births, others say it's closer to 1 in 10,000. It's not as common as Trisomy 21 -- or Down Syndrome -- but it's still one of the more common that we would see that are live born. On the other hand, Trisomy 13 is even less common than Trisomy 18, and the birth defects are even more severe -- you see heart defects, severe abdominal wall defects, and clefting in the mid-portion of the face, which can be an indication of severe brain abnormalities.

It's possible to test the child for these conditions before birth, correct?

Manning: Yes, there are some different signs that might indicate abnormality. For Trisomy 18, an ultrasound might pick up that the baby keeps his or her hands clenched, or that there's a heart defect, or they're smaller than they should be. Noticing these clues can indicate that there might be a chromosome abnormality, and testing would be able to check which chromosome has been affected.

And finally, how long do children with Trisomy 18 usually live?

Manning: The vast majority of these conceptions are miscarried. More than half of those born alive will probably not survive past one month of age and 90 percent will not survive past one year. As with any child, it really depends on the severity of their birth defects and the general health of the child. Because those birth defects are so severe for children with Trisomy 18 -- even in the best-case scenario -- there can be some long-term survival but we would expect their development to be greatly affected despite their overall good-health.

In other news Wednesday, the drug maker Pfizer recalled 1 million packets of birth control pills. Some of the packages contained too many active tablets while others had too few, raising the risk of unintended pregnancy, the company said. Also, at least 73 people were killed in Egypt when a soccer match erupted into a riot.

KWAME HOLMAN: The day's economic news showed promise. Factory output rose in January by the most in seven months, and Chrysler reported its best January sales in four years. It also earned a profit last year, for the first time since 1997. Ford sales also rose in January, but business at General Motors was down slightly.

On Wall Street today, the Dow Jones industrial average gained 83 points to close at 12,716. The Nasdaq rose 34 points to close at 2,848.

Drug maker Pfizer has recalled a million packets of birth control pills. The company said today some of the packages contained too many active tablets, while others had too few. That raises the risk of an unintended pregnancy. The pills in question are manufactured by Pfizer, but sold in the U.S. under the Akrimax Pharmaceuticals brand.

At least 73 people were killed in Egypt today when a soccer match erupted into a riot. Fans of rival teams rushed the field in Port Said, hurling sticks and stones at each other. Egyptian state television reported at least 1,000 people were injured in the ensuing stampede.

U.S. forces now expect to end their combat role in Afghanistan some time in 2013. Defense Secretary Leon Panetta laid out that timeline today, the most explicit yet. He said a training role would continue through 2014. Meanwhile, a leaked NATO report said captured Taliban fighters believe their side will seize power again after NATO forces leave.

But a NATO spokesman in Kabul insisted the insurgents are losing the war.

BRIG. GEN. CARSTEN JACOBSON, International Security Assistance Force: We cannot really put that high a value on what they are saying, as they are talking about their perception of the campaign, what they believe how the campaign is going, and what they want us to believe how their campaign is going.

KWAME HOLMAN: The report also said the Pakistani intelligence service knows all about Taliban activities and the locations of their leaders.
But the foreign minister of Pakistan visited Kabul today, and she said the claims were nothing more than old wine in an even older bottle.

HINA RABBANI KHAR, Pakistani foreign minister: I don't think these claims are new. These claims have been made for many, many years. And we all know the reasons for that. So, I think I can just disregard this as potentially a strategic leak or otherwise.

KWAME HOLMAN: Also today, NATO said an Afghan soldier shot and killed a coalition soldier in the south. An Afghan commander said it was an accident, but Afghan-on-coalition attacks have numbered six since December. And a Pentagon report today counted more than 40 such incidents since 2007, with 70 coalition troops killed.

In Pakistan, fighting between militants and the military ratcheted up in a series of incidents. Pakistani fighter jets bombed militants in a border region. The army reported up to 31 insurgents were killed. To the south, gunmen attacked a paramilitary checkpoint in Baluchistan Province, killing 11 soldiers. A separatist insurgency there has raged for decades.

A deep freeze kept much of Central and Eastern Europe in its grip today, and the death toll rose to 83. The hardest-hit areas, in pink on this map, had temperatures as low as -26 degrees Fahrenheit, as cold air pushed down from Siberia. In Bosnia, small mountain villages were cut off by heavy snow, and helicopters had to airlift emergency supplies. Parts of the Black Sea froze near the Romanian coastline. And even farther south, parts of Italy were having the coldest week in nearly 30 years.

A shipwreck hunter in New England may have found one of the richest sunken treasures ever. Greg Brooks announced today he's located the wreck of a World War II cargo ship that carried 71 tons of platinum, valued today at $3 billion. A German U-boat torpedoed the ship off Cape Cod in 1942. Salvage operations may begin in March.

A stunning discovery rippled through the art world today. The Prado Museum in Spain announced it has a version of the Mona Lisa that is likely the earliest known copy. Officials said it was almost certainly painted by an apprentice as Leonardo da Vinci was painting his masterpiece. X-ray imaging taken two years ago allowed restorers to uncover a Tuscan landscape background similar to the original, but hidden under a black coating.

MIGUEL FALOMIR, Prado Museum (through translator): The most important thing is to return the painting to its original condition. The painting was covered for 250 years with a black dye. This painting can help us show the original painting from other points of view, and also help to document the practices in Leonardo's studio. While Leonardo was painting the original, the disciples were painting their versions.

KWAME HOLMAN: The painting has been a part of the Prado collection for years, but had not been displayed often.

A renowned Polish poet who won the Nobel Prize for literature died today at her home in Krakow. Wislawa Szymborska was awarded the Nobel in 1996. The Prize Committee said she mixed elegant language with the fury of Beethoven. Her work spanned more than six decades, starting in 1945. Wislawa Szymborska was 88 years old.

And another death of note: The creator and host of "Soul Train," Don Cornelius, was found dead of a gunshot wound at his Los Angeles home early today. Police said it was a suicide.

His TV dance show, with its trademark animated chugging train opening, aired nationally from 1971 to 2006. It showcased the best in R&B, soul and hip-hop music. Cornelius hosted the show for 22 seasons, until 1993. He was 75 years old.

Those are some of the day's major stories.

That's right, you're a 50-year-old, middle-income, single woman with diabetes. And your health has been impacted in dramatic ways by forces beyond your control.

How? Well, in a new report, the aptly named Institute for Alternative Futures lays out four scenarios that could become realities for primary care by 2025. And for you, Mary, that means the potential for four very different -- but equally plausible -- futures.

The various health policy decisions, technological advances and political outcomes that remain to be seen will determine the fate of your health care -- and health. Here, with the help of the officials behind the report, we launch you into four parallel health care worlds.

Behold, Mary. These are your lives.

SCENARIO 1: "Expectable Future"

In this scenario, which is a continuation of current trends, policymakers have ramped up access to preventive care, in part through a concept called the "patient-centered medical home." Back in 2014, the Affordable Care Act expanded coverage to most Americans, emphasized coordinated care and greatly boosted the use of electronic medical records. People like Mary have a primary care team that includes a physician, a nurse practitioner (who is actually her main point of contact), social workers and others who take care of the vast majority of her needs. They heavily reference her electronic medical record, which tracks her life history, her lifestyle and all bio-monitoring data that comes from devices she wears on her body -- earrings, a wristwatch, and a sleep pad that gives a pretty comprehensive picture of her health. Mary also has access to a digital health coach -- a virtual personality that helps condense all the medical information available online to advise her on behavior changes that she might want to consider.

SCENARIO 2: "Challenging Future"

To put it mildly, things don't look so bright in this second outcome. With greater economic difficulties prompting significant cuts in federal health care spending, many doctors grew fed-up with lowered reimbursement rates and retired early. That led to even greater health care shortages and decreased access for many Americans, including Mary. Most blame the hardships on the passage of the Affordable Care Act, which caused many employers to stop providing health insurance. Mary considers herself lucky to still have a low-paying job in the aftermath of the second Great Recession, but she can't really afford any kind of real health insurance on her own. So she relies on the minute clinics, online information and emergency rooms when necessary. But her diabetes is so out-of-control she may lose her eyesight or need a limb amputation.

SCENARIO 3: "Aspiring Future"

In this scenario, most health care initiatives embrace a triple aim promoted as the key implementation goal of the ACA -- enhancing the patients' experience, reducing per capita health care costs, and improving the overall health of the population. The latter means the "patient-centered medical home" has become a "community-centered health home" that monitors and contributes to the overall health of the general population. Mary works with Eva, a community health worker, to manage her diet and exercise. She has a health team: a doctor, nurse and access to all the health professionals. But Eva's her primary contact and the one who works with her on a daily basis -- the one who visits her three or four times per year and reviews Mary's health data so that she doesn't run the risk of diabetes-related conditions. To top it off, Mary has joined a group of other diabetics who like to walk together in the early evening, and for much of the year she gardens daily in one of the two community gardens started by her community health center.

SCENARIO 4: "Surprisingly Successful Future"

In our fourth scenario, primary care is divided into two major camps. The bulk of the health care system has been transformed into personalized programs supported by technologies that allow people to take over many functions of primary care for themselves. A second branch provides efficient, cost-competitive care for complex health needs -- services that are only necessary when people still need care despite all the new, preventive programs. Mary takes care of herself quite well. Her job doesn't cover her health insurance, but she has a consumer-directed plan through her state's Health Insurance Exchange that gives her what she needs. That includes a very effective digital health coach, which analyzes her personal bio-monitoring and genetic code and recommends steps she should take to improve her health. When she does need a doctor, the digital coach analyzes the quality and the price of the doctors in her neighborhood, relates those to the recommendations of her friends, and tells her the best option based upon her budget and health needs.

So, Mary, which do you prefer, and which do you think is most likely? Participate in the poll below -- which will remain open until Feb. 7 -- and share your thoughts in the comments section. Check back next week for the results, as well as expert analysis on the likelihood of the four scenarios and a look at what will need to happen for each to become reality.

Which Scenario Do You Think Is Most Likely? Click each scenario to rate its likelihood.

Rate SCENARIO 1: "Expectable Future"

Rate SCENARIO 2: "Challenging Future"

Rate SCENARIO 3: "Aspiring Future"

Rate SCENARIO 4: "Surprisingly Successful Future"

The scenarios were developed in consultation with some of the top health care experts in the country, and with the support of The Kresge Foundation, which is also a NewsHour underwriter. Read the full report here.

Pigeons are seen eating on a street in Hong Kong on January 6, 2012. Photo by Aaron Tam/AFP/Getty Images.

Earlier this month, the scientists who altered the H5N1 virus to create a more contagious strain that's transmissible between ferrets, agreed to a temporary moratorium, due to safety concerns. The NewsHour reported the story here and here.

That decision has, if anything, intensified the debate. What began as a question on whether scientific journals should publish the complete research has grown into an argument on whether to conduct these studies, and others like them, at all.

The Newshour asked three experts to weigh in on the matter: Richard H. Ebright, a molecular biologist at Rutgers, Vincent Racaniello, a microbiologist at Columbia, and Carl Zimmer, a journalist who has authored ten books about science, specializing in biology and evolution.

Answers have been edited for length.

What were the goals of either the Wisconsin or Dutch bird flu studies?

Zimmer: We know that sooner or later, new kinds of diseases hit our species. You just have to look at history--the way SARS appeared out of nowhere in 2003, for example. HIV crossed over from chimps to humans in the early 1900s, but no one even knew about it until the 1980s. That head start allowed HIV to become one of the most horrific killers of the twentieth century.

The only way to prepare for new outbreaks is to study dangerous viruses in the lab--and, in some cases, even make them from scratch.

There's been a lively debate about just how big of a risk H5N1 poses to humanity. It normally passes from bird to bird. When it manages to infect humans, it seems to be quite deadly. Flu viruses are continually evolving, adapting to their hosts, and yet H5N1 has not managed to spill over into our species for years now. That might mean that there are too many obstacles in the evolutionary landscape for H5N1 to reach a form that would allow it to become a human-to-human pathogen. The studies in Wisconsin and the Netherlands were designed to address that question.

Racaniello: The goal was to determine if H5N1 aerosol transmission could be achieved in ferrets in the laboratory, and if so, what mutations accompany this process. Avian H5N1 viruses do not transmit among mammals, and therefore such experiments provide invaluable insight into this process.

Ferrets were used because they are a good model for influenza virus infection. When ferret-to-ferret transmission was achieved, the amino acid changes involved can provide information on the mechanisms that regulate airborne transmission of viruses, a topic that is poorly understood. Furthermore, it makes it possible to look for these mutations in H5N1 viruses circulating in the wild, to provide an early warning of the emergence of viruses that might transmit among humans. It is important to point out that ferrets are not humans, and the viruses selected in ferrets are not likely to transmit among humans.

What are your concerns about the research?

Ebright: The primary risks are accidental release through accidental infection of a lab worker who then infects others -- for which there are many precedents -- and deliberate release by a disturbed or disgruntled lab worker, for which the 2001 US anthrax mailings provide a precedent. Bioterrorism and biowarfare also are risks.

Zimmer: I am concerned about the ad hoc way in which scientists are figuring out how to do this research. The possibility that the Wisconsin and Dutch researchers would produce mammal-ready H5N1 flu was baked into their grant applications. Surely the debate about the potential danger should have been conducted back then, rather than now, when the scientists are ready to publish their results. If scientists have to worry that they won't be able to publish their work after years of research, fewer people will address the pressing issue of dangerous new viruses.

Is there a way to safely conduct this study, or studies with similar risks, and achieve the goals of the research? If yes, how? If no, does shutting down this type of research raise concerns about scientific freedom?

Ebright: Future work with lab-generated transmissible avian influenza viruses should be performed only at the highest biosafety level, only at the highest biosecurity standard, and only after approval by, and under the oversight of, a national or international review process that identifies risks and benefits, weighs risks and benefits, mitigates risks, and manages risks.

The same should be the case for all other research directed at increasing a potential pandemic pathogen's virulence, transmissibility, or ability to evade vaccines and treatments.

Racaniello: Shutting down H5N1 transmission research is an overreaction proposed by individuals who do not understand the science or the reasons for doing the experiments.

This work can be safely conducted under Biosafety level 3* containment. Scientists have been conducting dangerous experiments for years under these conditions, and there have been no disasters. On the contrary, the only two bioterror attacks in history originated in government laboratories.

The [National Science Advisory Board for Biosecurity**] is selecting the wrong set of experiments with which to flex their regulatory muscles. There is little chance that the ferret-passaged H5N1 virus will infect and transmit among humans.

This is not the first time scientists have disagreed about conducting research in specific areas. Human genetic engineering is another example. Why has this debate been so intense?

Racaniello: Most virologists agree that the experiments should proceed and are not exceptionally dangerous. The exceptions are those who don't understand the science, and the bioterror community. These individuals have proliferated since 9/11 and the anthrax attacks. They are paid large sums of money to sit in offices and decree what scientists can or cannot do. They are not practicing scientists and they don't appear to understand the underlying science.

Entire academic departments and corporations have been funded by the U.S. government to ponder potential dangers and tell scientists what to do. We now have a bioterror-industrial complex that rivals the military-industrial complex that Dwight Eisenhower warned us about. It is a scam, and I hope one day the nature and extent of the wasted money will be revealed to the public.

Ebright: Decisions not to perform specific proposed research projects, or to perform them only after modifications to mitigate risk, are routine. However, no such mandatory review process occurs for research projects that involve the enhancement of a pathogens's virulence, transmissibility, or ability to evade countermeasures--even though such projects potentially place at risk tens, hundreds, or millions of humans.

In 2004, a National Academy of Sciences panel called for a mandatory review process to be implemented for projects that involve the enhancement of a pathogens's virulence, transmissibility, or ability to evade countermeasures. Unfortunately, the panel's recommendations were rejected by the National Science Advisory Board for Biosecurity, the panel's recommendations were not implemented by National Institutes of Health extramural research programs, and projects creating new potential pandemic pathogens were funded and performed with absolutely no risk-benefit review. We are now reaping the harvest of these poor decisions.

*Under federal law, bird flu must be investigated within a "Biosafety Level 3" lab, on a scale of 4.

*The National Science Advisory Board for Biosecurity recommended that the journals Science and Nature withhold some details of the bird flu research from publication.

The latest in Spanish-language soap operas, or telenovelas, have encased more than typical romance and personal scandal, debuting some very clear messages on health care for Latinos in the U.S., specifically Colorado. Health correspondent Betty Ann Bowser reports on the creators' reasoning in writing beyond the usual storylines.

JEFFREY BROWN: Next, romance, drama and some very direct messages about health care. It's all part of a Spanish-language soap opera that takes its viewers well beyond the usual storylines.

NewsHour health correspondent Betty Ann Bowser explains.

BETTY ANN BOWSER: It's a sad day for Alicia. She has just learned she is dying from colon cancer. Her boyfriend, Don Juancho, is overcome with grief. He knows if she'd sought medical attention sooner, the prognosis wouldn't be so grim.

This tragic storyline is all part of a unique Spanish soap opera called "Encrucijada: Sin Salud No Hay Nada," or "Crossroads: Without Health, There Is Nothing."

It's romance and drama and tears, but there's another powerful subtext: how to take better care of your health.

Actress Julieta Ortiz plays Alicia.

JULIETA ORTIZ, actress: We're trying to get people to get related with this character and then feel, it's such a shame that we lost her just because she didn't know in time what to do and how to take care of herself, because she could have saved her life.

BETTY ANN BOWSER: Spanish soap operas, or telenovelas, are one of the most popular forms of entertainment in the world, with an estimated audience in the tens of millions.

But the Latino audience in the United States has very high rates of obesity, diabetes, HIV, and asthma. More than 30 percent of American Hispanics also have no health insurance.

When executive producer Jesus Fuentes came to the United States from Mexico City, he was struck by how little Hispanic people knew about health care. So he came up with the idea for "Crossroads."

JESUS FUENTES, "Encrucijada": Soap operas are very powerful to deliver a message. The challenge was to add medical information to that, to create the message that has -- that people can believe in that, and not trying to oversell it.

BETTY ANN BOWSER: Fuentes turned to Denver public health consultant Cristina Bejarano for help in shaping the message.

CRISTINA BEJARANO, public health consultant: We say cancer. We mention the word cancer, but we try to define what it is, so they understand in a very, very simple way.

BETTY ANN BOWSER: And Bejarano works in other messages as well.

CRISTINA BEJARANO: I'm like, oh, there's my chance to talk about nutrition, to show the plate, the size that it should be, to model portions, to model protein, fruits and vegetables, to have orange juice and water, to have different things like that, so we're modeling the food that people should be eating.

BETTY ANN BOWSER: Fuentes says "Crossroads" is also trying to combat a Latino cultural mind-set.

JESUS FUENTES: It's very common: Like, I live my day just for today and I'm going to be fine. But I just need to go to work to get money for my family. And what if you get sick? No, I'm not. I'm fine. Everything is going to be fine. Like, we don't think about a future. We don't plan.

BETTY ANN BOWSER: UCLA Primary care physician Dr. Michael Rodriguez works extensively with Hispanics in the Los Angeles area, where "Crossroads" is shot. And he thinks it could have a significant impact.

DR. MICHAEL RODRIGUEZ, professor of medicine, UCLA: It can make an enormous amount of difference. Some of the studies that have been done looking at the relationship between viewers of telenovelas and behavior have seen big changes.

For example, some telenovelas that have focused on issues of cancer and leukemia have looked at the amount of people who are donating and registering to donate for bone marrow and other things go up from the single digits to hundreds.

BETTY ANN BOWSER: "Crossroads" tackles just about every health issue that affects Latinos, from diabetes, to asthma, to alcohol and drug abuse. And it dispenses advice on how to enroll in Medicaid.

Fuentes and his staff think the show is having a positive impact, based on the calls coming in to the show's hotline. They received 2,000 calls in the show's first season.

CRISTINA BEJARANO: They were getting ready as far as behavioral change. It was very specific. "I have been trying to eat more fruits and vegetables. I am finding out more about where to apply for Medicaid and SCHIP. I'm talking with my neighbors about the information that I'm learning."

BETTY ANN BOWSER: Fuentes is able to produce "Crossroads" with a grant from the Colorado Health Foundation, which is also an underwriter of the NewsHour.

Right now, the show is seen only on Univision in Colorado, where 20 percent of the population is Latino. But "Crossroads" has steadily been building an audience, which now numbers about 15,000.

Fuentes thinks he'll soon be able to bring the show to other television markets around the country because the message is getting through.

JESUS FUENTES: Another girl that went to the station and -- with her mom, and she showed her hands, and she was all cut. And she said, "But I got inspired and I think I'm going to be better and I want to live."

BETTY ANN BOWSER: She tried to kill herself?

JESUS FUENTES: Yes, she tried to kill herself. And now she is a different person.

That's the reason we are working and we are doing this project, is so somebody can be healthier, can save their lives. That's the reason we are doing this.

BETTY ANN BOWSER: "Crossroads"' second season premieres in February.

Alicia's entire life has been building to this one moment at the breakfast table. She's finally admitting to herself that the colon cancer will take everything ... her successful psychiatric practice, a comfortable home, her new love with Don Juancho.

Cue the tears. Sound up on the dramatic music. And cut.

On the Los Angeles set of "Encrucijada: Sin Salud No Hay Nada," the title says it all: "Crossroads: Without Health, There Is Nothing."*

Like most storylines in this emerging brand of Spanish-language soap opera, or telenovela, Alicia's dramatic past and harrowing future are intertwined with more basic things, like the importance of visiting the doctor regularly, catching cancer in its early stages and planning for end-of-life care. Last year's pilot season tackled everything from diabetes to melanoma to dental care -- with each storyline crafted to deliver public health messages to a notoriously difficult-to-reach audience.

As a group, Hispanics remain one of the nation's most uninsured, under-resourced and -- increasingly -- unhealthy segments of the population. Combine that with the seemingly unrelated fact that telenovelas are beamed directly into the living rooms of millions of them each week and the possibilities become "enormous," said Dr. Michael Rodriguez, professor of medicine at UCLA.

"These telenovelas are happening every day, so there's an opportunity to have numerous messages heard frequently, by different players, over a period of time." And that, he said, "translates into behavior changes."

On Wednesday's PBS NewsHour broadcast, health correspondent Betty Ann Bowser goes behind the scenes on the set of "Encrucijada" in Los Angeles to hear more about the long-term vision for this emerging public health tactic ... and, of course, to learn the fate of Alicia (scroll to the bottom if you want to know what happened to her).

In the meantime, Cara James, director of the Disparities Policy Project at the Kaiser Family Foundation, answered some questions about the status of the Hispanic health care gap and what -- besides the creation of socially conscious soaps -- is being done to close it.

What percentage of the Hispanic population remains uninsured today in the United States, and how does that compare with other groups?

Cara James: The Hispanic population has one of the highest uninsured rates in the country. About a third -- 34 percent of the non-elderly Hispanics who are less than 65 years of age -- are going without coverage. That's more than double the rate for whites and much higher than any other population. The only group that comes close is American Indians and Alaska Natives, and they still are less than Hispanics. There are many reasons for that. Coverage in this country is largely related to people's employment, and Hispanics tend to have a higher unemployment rate than other populations -- particularly compared with whites and Asians. And when they do have jobs, they tend to work for lower-income employers, so the low-wage jobs are less likely to offer coverage. When it is offered, because they have lower wages, they're less likely to be able to afford coverage.

What role does immigration status and legality play?

Cara James: There's an estimate that about 11 million individuals in this country are here and they are undocumented. They're not all Hispanic, but a large majority of them are. And our health care system currently bars undocumented immigrants from accessing Medicaid, and it makes it harder for them to purchase employer-based coverage. Even with health reform, they will still be barred from being able to purchase coverage through the private market and they still will be ineligible for coverage under Medicaid. They therefore tend to end up in the emergency room. And that's some of the most expensive care that people can receive.

How big of a barrier is language to health care coverage?

Cara James: Language is certainly an issue, and not just for the Hispanic population. In this country, we have about 55 million people who speak a language other than English at home. That's not necessarily a problem, but what we are more concerned about are the 25 million individuals who speak English less than "very well." And the majority of the individuals -- over 60 percent of the people who speak English less than "very well" -- speak Spanish. So this makes it difficult. Our health care system is complex enough even if you speak English very well. And so navigating through a system where providers may not speak your language, where materials aren't presented in your language, where you may not be able to get prescription medications with instructions in your language -- it all just adds another layer of difficulty.

Even for individuals who do speak English perfectly well, there's a challenge with regard to what we call "health literacy," and that is being able to understand what your provider is telling you. We also know that Hispanics are more likely than blacks or whites to report that their provider sometimes or never listened to them carefully and explained things clearly.

What about location? How does that affect Hispanic health?

Cara James: Where you live matters. The distribution of the Hispanic population across the U.S. is not uniform across all 50 states. We do see a little more than half the population in three states: Florida, Texas and California. So if you're thinking about ways to have a significant impact on this population -- a solution that may not require efforts across all 50 states -- focusing on those key states where there are large proportions of the population can have an impact.

When you think about health reform, we need to think about where those three states are in the process. Where are these states on their expansions of Medicaid? What are the struggles they're facing? Because if the states have difficulty with that expansion, and they're not messaging the Hispanic population in a culturally appropriate languages and in a culturally appropriate manner, we probably will not see these populations enrolled in programs that can help benefit them and provide them improved access to care.

Will health care reform improve the situation?

Cara James: This is to be seen. Health reform has not been fully implemented and won't be until 2014. But we do know that in the law as it is written, a lot of help is expected to come through the expansion of Medicaid -- the program for low-income individuals. That will have a significant impact on the Hispanic population. Part of that is because such a high proportion of this population has an income that is below 138 percent of the federal poverty level -- which is the level that would qualify you for Medicaid. Additionally, for those who are working, many of them would be eligible for some of the insurance subsidies for purchasing coverage through the health exchanges that are going to be set up through health reform.

Has the telenovela approach to health awareness been used before? Do you think it's effective?

Cara James: I think it probably is. When "ER" or "Chicago Hope" was on, there would be messaging inserted into those programs, and polls would be conducted to see what people remembered. And you do see a bump with some of these messages. But the bigger question is, What is the longer-term retention of that information, and what can be done to encourage people to do more. And I think part of the reasons we see those messages in a lot of these programs is because they are an effective way of getting that information out there, to get people to at least start to ask those questions when they go to their provider or to encourage people to go to their provider and find out more information.

Regarding Alicia's fate, we're sorry to report the character died from her colon cancer -- something that could have been prevented had she sought medical help earlier.

Also, check out The Power of the Telenovela

After a dreary winter day, you come home, slip out of your cozy waterproof coat and boots, and get the kids started on their homework. For a snack, you pop some popcorn in the microwave and order a pizza for dinner. A pretty normal mid-January day, by most accounts. The last thing you're thinking of, as you rush out the door to get the pizza, is your kids' vaccination schedule.

But, a new study out today may change that.

It found that the perfluorinated compounds (PFCs) in these products are associated with lowered immune response to vaccinations in children. It is the first study to document how PFCs can adversely affect vaccine response. These pollutants can be transferred to children prenatally (via the mother) and postnatally from exposure in the environment.

PFCs have thousands of industrial and manufacturing uses, and most Americans have the chemical compounds in their bodies. Prior studies have shown that PFC concentrations in mice similar to those found in people suppressed immune response, but the adverse effects on people had been poorly documented.

For this study, researchers looked at children recruited at birth at National Hospital in Torshavn, Faroe Islands, located between Iceland and Norway, from 1999 to 2001. A total of 587 participated in follow-up examinations. Children were tested for immune response to tetanus and diphtheria vaccinations at ages 5 and 7 years. PFCs were measured in maternal pregnancy serum and in the serum of children at age 5 to determine prenatal and postnatal exposure.

The study appears in the Wednesday issue of the Journal of the American Medical Association (JAMA).

We spoke to lead author Philippe Grandjean on the phone last week. He's an adjunct professor of environmental health at Harvard School of Public Health and the Chair of Environmental Medicine at the University of Southern Denmark.

Answers have been edited for clarity and length.

Tell us a little more about your study, and what it found.

Philippe Grandjean: What we found was that PFCs in the human body are associated with a deficient immune response to childhood immunizations. Children are less capable of maintaining an antibody concentration in the blood, which helps prevent getting the disease. The two vaccines we traced were tetanus and diphtheria.

How does this "pollution" happen? Where do children come in contact with these chemicals?

Grandjean: PFCs have been around for about 50 years. They're in the environment, and we're all exposed to them daily. They have been used for a long time for non-stick pans, and during this production, there's some environmental pollution. And because these compounds are so stable, they stay in the environment for a long period of time. Once they come into your body, it also takes several years before you eventually excrete them.

We also come in contact with these chemicals in our food. Takeout pizza boxes and microwave popcorn bags are coated with these chemicals because of their non-stick properties. They're also in our clothing -- in waterproof jackets and sneakers, and also in the compounds in protectant sprays for upholstered furniture. Some of this ends up in indoor dust.

Are the non-stick pans we use to cook on in this category?

Grandjean: No. By the time you get the pan as a consumer, that whole surface has actually stabilized. If there's any release of the PFC, it's minimal. It's during the production of that surface that is potentially harmful.

What causes the dip in the antibodies after exposure to PFCs?

Grandjean: It's something that's hard to examine in children. You can't take out their lymph glands and examine them. But we do know from studies in mice that there are different mechanisms that appear to play a role, but it is unclear what exactly is going on. All we can say is that what we are observing in these kids is quite parallel to what has been observed in the mice. And the mouse is a very good model for the immune system.

How does this all relate to public health?

Grandjean: Well, you might say tetanus and diphtheria are not such big threats, but we think that because the responses were quite similar for the two vaccinations, they could very well represent the capability of the immune system to deal with vaccinations in general.

And if that is true, it means that the whole childhood immunization program that we rely on to protect the population from epidemics and infectious diseases might not be as efficient as we think. If some kids simply do not respond, if the vaccination doesn't take, it means that some of the kids that we think are protected are not.

This study focuses on a relatively remote island sort of halfway between Iceland and Norway. Are the findings relevant to the U.S.?

Grandjean: The levels of PFCs in the children on these islands are actually slightly lower or just comparable to the U.S. levels. But the reason children have PFCs in their bloodstream in these islands is because of diet -- they eat a lot of fish, and PFCs travel up the food chain that way. But in the U.S., it is more likely the pollution is from food packaging.

It's important to note that this is just an observational study, and we cannot prove that there is a causal relationship. We need more studies.

But I also have a reaction as an individual, thinking about the next generation. We should take this very seriously because we are essentially looking at the tip of an iceberg. We have just looked at these kids at age 7, we don't know yet how these immune deficits will eventually work out and how quick they will be at fending off, lets say, cancer. The immune system plays a very important role whether they will get chronic infections of various kinds.

We just don't know. There are so many questions here, and the immune system is very complicated to study, but we have found this very clear and really strong signal that something is really going astray here.

Photo by Getty Images.

Credit card companies, airlines and hotels all have customer loyalty programs. Maybe it was only a matter of time before hospitals got in on the act.

A growing number of hospitals are seeking to attract new patients and keep existing ones by offering them an array of perks, from free parking and gift-shop discounts to wellness seminars and health screenings. Some of the most popular programs are social mixers that have nothing to do with health care. Field trip to a casino, anyone?

It's all part of a changing competitive environment in which hospitals market themselves directly to patients, who have begun to take a much more active role in choosing their health-care providers -- and are on the hook for a greater share of the costs.

Before managed care, hospitals focused more on appealing to physicians with new and advanced medical technologies, experts say. Physicians, it was thought, would bring in the patients.

Changes in health-care policies are giving hospitals added incentive to develop relationships with patients. Under the 2010 health-care overhaul, hospitals with higher than expected 30-day readmission rates for heart attack, heart failure and pneumonia will face financial penalties starting this year. The number of conditions subject to penalty will be expanded in subsequent years, and hospitals can help themselves by working with patients before they land in the hospital with an acute problem.

"Hospitals will have an expanding share of risk in their patient populations going forward," says Tony Paquin, chief executive of Paquin Healthcare, an Orlando consulting and technology firm that has worked with more than 150 hospitals to develop loyalty programs. "Health-care providers are just starting to figure out that they need to develop patient relationships if they're going to improve their health long term."

Botsford Hospital in Farmington Hills, Mich., started issuing free "Very Important Patient" cards in 2010. The program got its start as a referral service to link potential patients with Botsford doctors. The cards entitle VIP members to free parking and a 10 percent discount on nonprescription drugs at the outpatient pharmacy and the gift shop, says Lynn Anderson, marketing and public relations manager at the 330-bed hospital in the Detroit suburb. VIP members can also get discounts at restaurants and service establishments such as an oil-change garage.

The program, which has more than 900 members, is open to anyone in the community. In addition to financial perks, it offers regular health education seminars on such topics as hip replacements, back problems and acid-reflux disease, says Anderson.

"This is a way to get a mailing list and send them information," she says. "In this day and age, with so much competition, you need to make a connection with patients."

Luanne Dunigan, a 78-year-old retired nurse, signed up for Botsford's VIP program after receiving a letter from the hospital. Dunigan had never been a patient at Botsford Hospital, but she told her grandson to take her to the emergency department there twice recently, once when she was having trouble swallowing and again when she had chest pain.

The VIP program was a factor in her decision, she says, and she was pleased with the care she received. "It was the best hospitalization I ever had."

Since becoming a VIP member, Dunigan has parked for free and received discounts at the gift shop when visiting a friend.

She's also looking forward to taking advantage of another perk offered through the program: social events. VIP members get a free one-year membership in Generations, a Botsford Hospital program for people 50 and older that organizes outings, including trips to the symphony and theater as well as luncheons with lectures on health and other topics. Membership is normally $15 annually. Dunigan says she's especially looking forward to taking one of the overnight trips to a casino in Canada. "Now that I've retired, I plan to take advantage of those trips," she says.

One of the most popular loyalty program events sponsored by Baystate Health, a four-hospital system in Springfield, Mass., is the annual "Spirit of Women" conference, says Tracy Whitley, manager of loyalty programs. Up to 400 people attend the event, now in its 14th year, which showcases a nationally recognized motivational speaker. The conference also gives hospital officials a chance to showcase services they offer related to women, such as the comprehensive breast cancer center and urogynecology, she says.

Baystate also offers a range of free educational health programs aimed at women and at people age 55 and older. "We like to build relationships with all people, and hopefully they will use our services in the future," says Whitley.

These sorts of marketing activities make sense, say experts. "Customers will go to a provider and judge the experience based on things that they can understand: good food, ease of parking, attentiveness, nice sheets," says Paquin.

John Romley, a health economist at the University of Southern California who co-authored an article in the New England Journal of Medicine about the increasing importance of amenities in patient care, concurs. "Patient preferences about where they receive care seem to turn on creature comforts and amenities," he says, rather than on health-care-related measures such as complication or infection rates.

While there are no data to show that loyalty programs encourage patients to get unnecessary care, Romley says these marketing efforts are in some ways analogous to drugmakers' controversial advertising that "reach[es] out directly to consumers in order to have them drive the medical decision-making to a degree and have them demand the expensive drug," he says.

As for those casino trips? "It has nothing to do with what the hospital does," he says. "It's not necessarily a bad thing, but it's rather indirect."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Among the questions, would published studies by scientists working to engineer a potentially human-virulent strain to study its behavior in lab animals -- an important step to understanding the disease -- effectively provide a recipe for creating the dangerous virus, some wondered. Would it pose a national security risk? Just how much research should be made available to the public? Could the virus escape from the lab?

In response, the U.S. government asked the journals Science and Nature to withhold details on how these strains were created.

On Friday, these journals announced that researchers have agreed to pause their research for 60 days to allow "an international forum in which the scientific community comes together to discuss and debate these issues," according to this article in Nature. Also from the article:

Despite the positive public-health benefits these studies sought to provide, a perceived fear that the ferret-transmissible H5 HA viruses may escape from the laboratories has generated intense public debate in the media on the benefits and potential harm of this type of research. We would like to assure the public that these experiments have been conducted with appropriate regulatory oversight in secure containment facilities by highly trained and responsible personnel to minimize any risk of accidental release. Whether the ferret-adapted influenza viruses have the ability to transmit from human to human cannot be tested.

We recognize that we and the rest of the scientific community need to clearly explain the benefits of this important research and the measures taken to minimize its possible risks.

This move would be unprecedented, and it also raises questions about scientific freedom. Part of the ensuing scientific and policy debate, the Wall Street Journal reports, involves "whether the government was quashing scientific freedom with its request."

Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told Ray Suarez in December that all scientists and public health officials who need information on the virus would have access to the studies, should the full articles be limited to the public.

"We need to strike a balance, an appropriate balance of not impeding the science, but at the same time protecting the general public, who has concerns over the possibility that information like this may get into the hands of people who would use it for nefarious purposes," Fauci said.

Photo by Shutter Ferret via Flickr Creative Commons

On a Monday night in December, Lauretta Martin, 47, visited the sleep lab at the National Rehabilitation Hospital in Washington, D.C. for the second time. On her first visit, Martin, a heavyset woman whose husband reports she is a loud snorer, was diagnosed with sleep apnea. This time, she was being fitted for a CPAP machine, which helps keep a snorer's airway open throughout the night.

The sleep lab has six testing rooms, each of which looks just like a room at a Holiday Inn, with striped wallpaper, a floral bedspread, framed prints of the seaside and free wifi.

"They have a brochure that says it's just like being in a hotel room, and it is," says Martin, sitting on the edge of her bed wearing a pair of soft grey pajamas and watching a football game on her flat-screen TV. Aside from the two-dozen colorful electrodes taped to her body to monitor her every motion and the scuba-style mask on her face to enhance her breathing, she looked ready for a cozy night of slumber.

In the tech room a few doors down, a professional sleep technician observed her over a video monitor, testing the electrodes and preparing to listen in to the sounds of her sleep.

Snoring was once considered a simple annoyance for bed partners, but there is a growing awareness in the medical community that the grunts and snorts of noisy sleepers can also be a sign of sleep apnea, a condition shown to increase the risk of numerous serious illnesses, including heart disease, stroke and dementia. Critics, however, worry that overnight tests to diagnose apnea, particularly those done in sleep labs, may be over-prescribed at great cost to the health care system.

Testing can be a lucrative business, and labs have popped up in free-standing clinics and hospitals across the country. Over the past decade, the number of accredited sleep labs that test for the disorder has quadrupled, according to the American Academy of Sleep Medicine (AASM). At the same time, insurer spending on the procedure has skyrocketed. Medicare payments for sleep testing, for example, increased from $62 million in 2001 to $235 million in 2009, according to the Office of the Inspector General.

Sleep apnea occurs when the muscles in the back of the throat relax, causing an airway obstruction that can stop a person's breathing for several seconds or even minutes. It causes restless sleep and sometimes dangerously-low blood oxygen levels. The disorder can be diagnosed by monitoring a snorer's sleep patterns, either in an overnight visit to a sleep lab or at home using a portable testing device. It is then often treated with a CPAP machine, which helps keep a snorer's airway open during sleep.

Sleep apnea has likely gotten more common as the population has grown older and more obese, two major risk factors for apnea, and the National Institutes of Health estimates that more than 12 million Americans suffer from the disorder. Many are never diagnosed.

"I think the medical community is sort of dropping the ball" on apnea, explains Dr. David Gross, medical director of the sleep lab at the National Rehabilitation Hospital. "It's just sad when you walk through the hospital and you see these patients with heart failure--the person might be 35 years old, he's 350 lbs -- but no one's thinking that he has sleep apnea, which he statistically does." He says more than three-quarters of the patients who come to the lab are diagnosed with apnea.

But the testing isn't cheap: each night at a hospital sleep lab can cost $1,900 and is usually mostly covered by a patient's health insurance. Some patients, including Martin, end up spending two nights at the lab - one to test for apnea, and the second to try the CPAP machine.

Dr. Fred Holt, an expert on fraud and abuse and a medical director of Blue Cross Blue Shield in North Carolina, says some patients aren't having basic exams done first and are therefore being prescribed expensive tests they don't need. Not everyone who snores has a chronic disorder, he notes.

In other cases, Holt says the labs prescribe CPAP machines right away without first suggesting other strategies like losing weight or sleeping on your side, which can also reduce apnea.

"We are spending more and more money on sleep testing and treatment, and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value," says Holt. "This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of one's business."

It's no secret that the sleep business can be lucrative for physicians. A website for Aviisha, a sleep testing company, has a section for physicians showing a picture of a doctor with a stack of money in his lab coat pocket. And in February, the AASM is offering a seminar on the "business of sleep medicine for physicians" at a golf resort in Arizona.

Dr. Nancy Collop, president of the AASM, says that while many sleep centers offer comprehensive care for sleep disorders, others are largely focused on overnight sleep testing. "A lot of people have gotten into the sleep business specifically to do that procedure," she explains. The goal of the AASM's accreditation process, she says, is to make sure sleep labs are offering more because "many patients may not even need a sleep study."

Helen Darling, president of the National Business Group on Health, which represents large employers offering health insurance to their workers, says the tests are driving up the cost of premiums. "This is a good example of something where we have technology, we have financial incentives to use more of it then we have historically done, you have enough problems including a growing obesity epidemic, and you sort of put together the so-called perfect storm for driving up overuse and health care cost."

She says doctors should focus instead on common-sense approaches to sleep apnea, like losing weight, before turning to expensive testing and medical devices.

Another option are home sleep tests, which costs less than a fifth of the cost of a lab test, and are considered effective for most patients. Medicare began paying for home sleep tests in 2008, but the tests have had only modest growth.

"I believe lab tests, as opposed to the home tests, are being wildly overprescribed," says Mike Backus, senior vice president of American Imaging Management, a subsidiary of Wellpoint. Right now, he says, 99 percent of the sleep tests given to Wellpoint patients are done in the lab, but "it should be 70 percent at home and 30 percent in the lab."

Backus adds that the majority of patients who are diagnosed with apnea and then given CPAP machines stop using them within the first year.

Some insurers, including Wellpoint, are changing the way they pay for sleep testing to curb the costs. Many now require a special pre-authorization. They also ask the doctor whether a patient qualifies for a home sleep test instead of one at the lab.

Those changes are now widespread among Massachusetts insurers and are having an effect on the sleep industry in the state.

Dr. Lawrence Epstein, the chief medical officer of Sleep Healthcenters in Massachusetts, says the labs have already experienced a 20 percent drop in the number of patients coming in for testing. While the past decade was focused on industry growth, he says it's "now going to be about consolidation and provision of better quality, more efficient care."

Sleep Healthcenters has shut down three of its 15 sleep labs, and more closures may be on the way. Epstein says the company is focusing more on "sleep wellness," including treating and managing sleep disorders, and less on testing. The key, he explains, is to become more efficient without decreasing access to care for patients who need it.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This story was produced in collaboration with NPR.

She was a big, tall, red-headed drink of water with a face full of freckles and a smile that lit up a room the minute she walked in. She was a television producer at CBS News who was loved and respected for her work. She was incredibly funny.

And she was only 42 years old when she died from cancer.

Betty Ann Bowser prepares for a shoot while reporting on cancer research in Sacramento, Calif.

Mary and I had been friends for years. She was godmother to my youngest boy. She had been diagnosed with melanoma when she was just a teenager. At that time, doctors removed a large chunk of muscle from one of her arms where the cancer was found and for almost 30 years she had lived cancer-free.

But suddenly and without warning it came back when she was in her early 40s. This time, it was found in her lungs, and it was terminal. For months on end, Mary struggled with treatments that she knew, in her heart, weren't going to prolong her life or cure her.

And less than a year after she was diagnosed, she was gone.

I still get chills when I think of her godson Matthew, my youngest, standing in the cemetery on Long Island with a fist full of red balloons, which one by one he released into the air so they could go up to heaven to be with Aunt Mary.

So all through working on the NewsHour cancer series, I found all these memories of Mary coming back to me in ways that I can only describe as profound. Because if she had been diagnosed today, she might have at least had more time.

Melanoma is still one of the deadliest cancers. Each year it kills close to 9,000 Americans. And it is still considered incurable.

But like other deadly cancers, it is now treatable.

If Mary was alive today she might have been one of the lucky people to get into a clinical trial where doctors are prolonging the lives of patients who have incurable cancers not just for months but for years.

They do it by figuring out which genes are damaged, causing cancer cells to divide and make the disease grow more in the patient. Then researchers look for the right drugs to target that mutated gene and slow down or kill the spread of the cancer

Progress? Absolutely. But such treatment isn't the kind that just anybody can go and find. A leading oncologist who is prolonging the lives of lung cancer patients with clinical trials at the University of California Davis told us that only about 20 percent of Americans have access to this kind of therapy.

Two prominent Americans who died from cancer in the past two years received this kind of treatment: Elizabeth Edwards, the former wife of politician John Edwards, and Apple computer genius Steve Jobs.

Jobs had a form of pancreatic cancer that probably could have been cured when it was diagnosed if he had followed the advice of doctors and undergone traditional chemotherapy and radiation. But initially he refused and instead tried a special diet. So nine month later, when he finally accepted traditional treatment, the cancer had spread.

According to his biographer, Walter Isaacson, when Jobs finally accepted treatment, he did so with enthusiasm. In fact, he was one of the first people anywhere in the world to have his entire genetic makeup analyzed, at a cost of over $100,000.

Even though the price has come down quite a bit since then, most people still don't have the connections or the money to do such a thing. But the simple fact that it's now possible to map the human gene tells us that the day is coming when genetic cancer treatment will be something us ordinary folks can find and actually use.

Working on this NewsHour cancer series also triggered memories of all the other people I have known and loved who died from the disease: My father, my maternal grandmother, three of her sisters, my fraternal aunt and four other good friends.

Three of those people died from breast cancer -- something that is infinitely treatable today with conventional chemotherapy and radiation. I have wondered more than once or twice in the past few weeks if any of them might still be alive had their cancers been diagnosed today.

Of course, no one will ever know the answer to that question but just from doing the work on these cancer stories, I do know one thing. Today, at least they all would have had a fighting chance.

Watch Betty Ann's series on the personalized future of cancer treatment and the astonishing gains in pediatric cancer research since the start of Nixon's "War on Cancer" 40 years ago.

Listen to the Audio

In the 40 years since the federal government promised to find a cure for cancer, hundreds of billions of dollars have been spent and much has been learned. Still, the diseases continue to claim more lives each year. Health correspondent Betty Ann Bowser reports on the past, present and future of cancer treatment.

JUDY WOODRUFF: Now: the second in our two-part series on changes in treating cancer.

Last night, NewsHour health correspondent Betty Ann Bowser looked at the effects on childhood cancers. Tonight, she examines how researchers are tailoring individual treatments to cure or manage the disease in adults by attacking the genetic underpinnings.

BETTY ANN BOWSER: Sydney is a bone cancer patient, but even with just three legs, she is still no ordinary dog. The 11-year-old yellow Labrador retriever is part of a research project under way at the University of California, Davis.

Like thousands of people who also have incurable cancer, Sydney  is treatable. And what researchers learn from her and the other dogs in the program will be used to prolong the lives of humans.

Dr. Ralph deVere White is director of the Davis Cancer Center in Sacramento.

DR. RALPH DEVERE WHITE, Davis Cancer Center: They live in our environment. They have multiple genetic abnormalities in their tumors. We can biopsy that tumor. We can image that tumor. We can monitor how the tumor responds. We can do molecular analyses of the tumor before the treatment, during treatment and after treatment.

If they're cured, we will then look at all of that. If they are not cured, because they die at a younger age in terms of lifespan, we get more information, and hope that we will have a bigger hit rate.

BETTY ANN BOWSER: It has been 40 years since the federal government promised to find a cure for cancer. But after hundreds of billions of dollars have been spent on research, it still claims more lives every year than anything except heart disease.

Modern medicine has learned a lot in those years about what cancer is, that it's many hundreds of diseases, not just one, that it starts when the DNA in human genes is damaged, and that some cancers can be cured when treatments target those altered genes and stop cells from growing out of control.

But pancreatic, colon, liver, prostate, and lung cancer still kill more than half-a-million Americans every year. And some forms remain stubbornly resistant to cures.

Dr. David Gandara is an oncologist at U.C. Davis.

DR. DAVID GANDARA, U.C. Davis Cancer Center: These cancers have been described as smart cancers. The molecular biology is complex.

So, for contrast, for example, some leukemias, for instance, pediatric leukemias in children are simple cancers. There might be just a few genes which are altered. And, therefore, treatment is a lot more likely to have an impact.

But if you have a cancer like pancreatic cancer or lung cancer, where literally there might be hundreds of genes that might be altered in even one patient's cancer, then sorting that out and figuring out why Mrs. Jones has to be treated differently than from Mr. Smith, it is a major task. And now we're finding out, just like everything else, it's not as simple as we thought.

BETTY ANN BOWSER: But knowing more about the molecular nature of cancer has ushered in a new age where the disease is no longer an immediate death sentence.

Today, many cancers that once were fatal are now successfully treated. And even those that remain resistant to treatment, like lung cancer, while not always curable, can be managed for long periods of time.

Gandara manages people with incurable lung cancer in clinical trials. It's still the deadliest of all cancers, but he's able to prolong life by targeting each patient's individual molecular fingerprint.

DR. DAVID GANDARA: One person's fingerprint is different from another's. And if a doctor then can use that information to personalize treatment for that patient, so that they get the best chance of getting a remission or a cure from their cancer, then that's really an advance. And so it may be that, at the end of the day, we cure cancer one patient at a time.

BETTY ANN BOWSER: When 59-year old lung Jane Coyne came to Gandara 19 months ago, the lung cancer had spread to her brain and bones.

Were you scared?

JANE COYNE, lung cancer survivor: Petrified, absolutely petrified. I thought that, with a stage four lung cancer, that I was a goner. I had seen statistics online that I think my chance to make it the first year was 15 percent. The first thing he said to me was, "I can't cure you, but I can manage you."

BETTY ANN BOWSER: That meant using genetically engineered mice developed at the Jackson Laboratory in Sacramento. Gandara surgically removed small pieces of Coyne's tumor and had them grafted into the animals.

DR. DAVID GANDARA: That mouse is designed to allow that patient's cancer to grow. What this means is, that this is not a mouse cancer. It's a patient cancer. And not only is it a patient cancer. It's one patient's cancer.

BETTY ANN BOWSER: As Coyne's tumor tissue grew in the mice, Gandara and his colleagues found out more.

DR. DAVID GANDARA: We found from that analysis that she had a specific mutation in her cancer which is more common in people who have lung cancer that haven't smoked. It's called an EGFR mutation. And there is a drug for that. And we put her on that drug, and she has gone into a marvelous remission.

BETTY ANN BOWSER: Coyne is thrilled.

JANE COYNE: Absolutely miraculous. I mean, if there is any time to have the unfortunate experience of having lung cancer, I'm in the right place at the right time to be able to have a quality of life and to extend it.

BETTY ANN BOWSER: But the drug, Tarceva, is not a cure.

JANE COYNE: It's a chemotherapy drug. At some point, it's going to run out on me. And at this point in time, I don't think there is a next step. So instead of testing things on me, they can test the mice to see if any new drug therapies will be of help.

DR. DAVID GANDARA: What we are hoping to do in the meantime, of course, is to take her cancer that is growing in the mice at JAX and be able to study it molecularly, and also treat it in different ways, so that when and if she needs it, we will have the next step in her treatment.

BETTY ANN BOWSER: Coyne and her husband, Ed, know that, at some point, Gandara may run out of options, so she's living one day at a time.

JANE COYNE: I feel well. I was able to have a very good quality of life on the Tarceva. And I recently went to China for two weeks, was able to travel. I'm back at the gym, playing with my grandchildren, doing everything that I want to do.

BETTY ANN BOWSER: And what about the future?

JANE COYNE: You know, I don't ask. I don't want to have that date out there. I don't want him to tell me, oh, well the Tarceva might work for five years or seven years. I really don't want to have that number in my brain.

I go day to day, month to month. I think the thought of dying is always in my thoughts daily. And you think about that, that things are short. Better take care of what you need to take care of immediately. Don't delay. Take advantage of every day that you have.

BETTY ANN BOWSER: Coyne is one of the 20 percent of cancer patients with incurable disease who are in a clinical trial like Gandara's. Most Americans don't have access to this kind of sophisticated treatment, but Gandara sees a day coming when targeted treatment will be available on a widespread basis.

DR. DAVID GANDARA: What we would like to be able to do in the future is -- it's a little bit like "Star Trek," where a patient goes into a pharmacy, and they say here is my molecular profile of my cancer, and the pharmacist gives them a pill that's designed specifically for their cancer.

BETTY ANN BOWSER: Even with all the progress against incurable cancers, advocates are still worried about the future, because federal funding for important research has been drying up.

But for people like Jane Coyne, who 40 years ago would have had no future, they're grateful for what they've got.

It looked like someone was hurting Cooper Cochran. The bruises seemed to be everywhere when Cherie Trout picked up her two-year-old from daycare one day. Then came the fevers and distended stomach.

And finally, test results: He had acute lymphoblastic leukemia. Acute because the cancer cells were packed tightly into his spinal column with a direct pathway to his brain.

The call from the hospital ended with more news -- Cooper's condition was so bad that Cherie would need to drive him to the UC Davis Cancer Center in Sacramento within an hour for his first round of chemotherapy. And so it began. The single mother of three spent the next 14 months and juggling Cooper's hospital appointments and a job that kept the family afloat and -- critically -- covered by health insurance.

"We were already a paycheck-to-paycheck family so the financial burden has been huge," she said. "I've met many families since Cooper's diagnosis where they lose up to 40 percent of their income. As have I."

But it could have been worse, according to the bipartisan Children's Cause for Cancer Advocacy -- especially before 2010 and the passage of some key provisions in the health care reform law.

To be certain, in the eyes of many politicians, academics and regular Americans, the health reform law doesn't look like the right solution to what ails the health care system. And some of those critics who think the Affordable Care Act is too intrusive have their own ideas for protecting America's most vulnerable patients. But to the Children's Cause for Cancer Advocacy, the act clearly is going to translate into benefits for Cooper Cochran and his family -- now and in the years to come.

As Maureen Lilly, the group's executive director, sees it, some of the specific benefits include:

Job-Switching:

"The health care reform bill gives parents like Cherie the peace of mind to know that if she ever lost her job or switched jobs, Cooper's health wouldn't be put at risk. Under the old system, if you switched jobs, it's possible you might not have been able to get health insurance under a new employer because of a preexisting condition."

Pre-existing Conditions:

"The law contains a provision that prohibits companies from denying coverage based on pre-existing conditions. Prior to health care reform, many young adult survivors of childhood cancer trying to find coverage on their own were told they were 'uninsurable' as a result of their cancer, leaving one of our most vulnerable young populations at risk and unprotected. Cooper, however, won't ever have to worry about being denied access to health care coverage."

Survivorship:

"For children like Cooper - and the other 350,000 survivors of childhood cancer in the United States today, their battle isn't over once they are "cured" of their cancer. Oftentimes, they face a lifetime of challenges from the late effects of their disease or treatment. In fact, two-thirds of childhood cancer survivors face late effects that can be severe or life-threatening. For this population, access to comprehensive health care coverage is critical."

No Lifetime Caps:

"Finally, to protect families from the burden of sky-high, out-of-pocket health care costs, the law prohibits insurance companies from imposing lifetime caps on coverage. Previously, families like the Trouts could find that the many treatments and hospital visits would suddenly 'max out' their insurance coverage, forcing them to incur huge medical debt. Now that lifetime caps are no longer allowed, Cooper can continue to receive the best possible care throughout his life without worrying about hitting an arbitrary coverage ceiling."

Steps Ahead:

While health reform was a "a critical step forward," Lilly and her team would have liked to have seen a little more. They wish the law would have included more protections to ensure that childhood cancer survivors have coverage and access to comprehensive, long-term, follow-up care. Especially given that two-thirds of them face late effects "that can be severe or even life-threatening," she said.

It's a population that requires more screenings, psycho-social care and other services that a typical patient might not. For example, 27-year-old woman wouldn't usually need a yearly mammogram, but the yearly test is crucial for a 27-year-old that had cancer as a child. Organizations like Children's Cause continue to push for that kind of legislation.

In closing, one more note about Cooper: For the moment, he's feeling fine.

"Cooper's been in maintenance for about two and a half months," Cherie said. "And we do a lot of drugs at home now, as opposed to coming here four times per week, which is great. And I'm back to working more hours, which is helpful financially for all of us."

Not exactly a happy ending -- yet -- but a hopeful one.

Do you agree with Lilly's assessment? Leave your thoughts in the comments section below.

More of the NewsHour Health Unit's cancer series:

Watch health correspondent Betty Ann Bowser's full report on the astonishing gains made in pediatric cancer since 1971.

Tune in to the NewsHour broadcast Friday for a second report on the challenges that still remain in finding cures for certain cancers, even while new advances mean more effective treatment.

Hear an interview with The Who's Roger Daltrey on how teens need specialized care when diagnosed with cancer.

Top oncology experts propose metaphors to replace the often-used "War on Cancer."

And share your own photos and stories on the NewsHour's childhood cancer awareness board.

*Browse all of our health coverage and follow us on Twitter. For more on Cooper's story, visit his website.

Four decades ago, President Nixon signed a law that would change the way cancer research was funded in an effort to develop better treatments and cure more patients. Health correspondent Betty Ann Bowser explores the positive developments pediatric cancer research has realized in the last 40 years.

JUDY WOODRUFF: Now to the first of a two-part report about how patients and their doctors are faring in their efforts to cure or manage different cancers.

It's been four decades since President Nixon signed a law that would change the way cancer research was funded, in an effort to develop better treatments.

Tonight, NewsHour health correspondent Betty Ann Bowser looks at what's happening in the battle against pediatric cancer.

BETTY ANN BOWSER: Sixteen-year-old Kate Albrecht knows this drill all too well. After she lies down on the table, a big machine called a linear accelerator delivers high-energy radiation to shrink and kill the cancer cells she has from stage four Hodgkin's lymphoma.

While most teenaged girls busy themselves with boyfriends and text-messaging, Albrecht's days have been filled with more sobering activities, three months of chemotherapy followed by these radiation treatments. The cancer was discovered last summer.

KATE ALBRECHT, Hodgkin's Lymphoma survivor: I was totally surprised that I even had cancer. It wasn't something that I was expecting.

BETTY ANN BOWSER: Nobody saw it coming. Except for a slight cough, Albrecht had been an active, healthy competitive runner and skier in Lake Tahoe. But after the diagnosis, Albrecht and her mother, Linda, moved temporarily to Palo Alto to have treatment at Lucile Packard Children's Hospital at Stanford University.

LINDA ALBRECHT, mother of Kate Albrecht: How about this one, you and your grandpa?

KATE ALBRECHT: I actually like that one, even though I have no hair.

LINDA ALBRECHT: That's a pretty cute picture of you.

BETTY ANN BOWSER: Today, Albrecht is counting the days until her red hair grows back. Her prognosis is excellent. And her mother, who's been at her side through all the treatment, is optimistic.

Forty years ago, if this had happened, what do you suppose the two of you would have been looking at?

LINDA ALBRECHT: Oh, boy. Definitely not as good a prognosis as we have had. I don't know what they would have done 40 years ago, as far as all the drugs and treatments that they've come up with. They didn't have that then. So, we may have been looking at something a whole lot scarier.

BETTY ANN BOWSER: You will get no argument from cancer researchers on that point. Forty years ago, more Americans were dying from cancer than all the people killed in World War II.

But, in 1971, the National Cancer Act was signed. It provided billions of federal dollars for cancer research and became known as the war on cancer.

DR. MICHAEL LINK, American Society of Clinical Oncology: how are you?

BETTY ANN BOWSER: Dr. Michael Link was a young pediatric oncologist 40 years ago. Today, he's one of Albrecht's doctors at Stanford and the current president of the American Society of Clinical Oncology.

DR. MICHAEL LINK: At that time, we were curing about 40 percent of children with cancer. And in that interval, in that past 40 years or 35 years that I have been on scene, the cure rates have improved dramatically, such that now we cure probably 80 percent of all children with cancer. And we cure almost 90 percent of children with acute lymphoblastic leukemia, the most common childhood cancer, and a disease that was absolutely incurable in the 1960s.

BETTY ANN BOWSER: One of the discoveries that has led to success with children was learning the nature of the disease, something that was not fully understood 40 years ago.

DR. MICHAEL LINK: Cancers are diseases of our genetics, of our DNA. And we develop mutations in those cancer cells. And those mutations are what cause the cancer and what drive the cancer. And we now understand, for example, in a disease like leukemia, that there are multiple different types of leukemia, even though they look the same under the microscope, which are driven by a different one of these DNA mutations.

BETTY ANN BOWSER: Understanding the nature of cancers also led oncologists to learn that childhood cancers are genetically less complex than most adult cancers and respond better to both chemotherapy and radiation treatment.

But there was a time when doctors didn't have the resources they do today to target specific gene mutations with drugs. One of Link's first patients was Nancy McGee, diagnosed in 1978 with stage four Hodgkin's lymphoma, just like Kate Albrecht. Back in those days, oncologists tried to kill the cancer in children without killing the patient first.

McGee has vivid, painful memories of all that.

NANCY MCGEE, Hodgkin's Lymphoma Survivor: They put me into radiation. That was first -- and then from there into chemo, which was -- I wouldn't put that on my worst enemy. That's what, in my mind, almost killed me. I didn't have all my treatments because it was literally killing me. I was 100 pounds, and I went down to 64 pounds. Yeah. I was skin and bones, literally. I wasn't eating, because I was constantly sick.

BETTY ANN BOWSER: Dr. Link remembers those days, too.

DR. MICHAEL LINK: In the 1970s, we were desperate to have therapies that worked. And she was lucky to have a disease like Hodgkin's disease, which was responsive to radiation and chemotherapy. And so we threw the book at her, if you will, to try to cure. And she presented with very advanced-stage disease.

BETTY ANN BOWSER: Today, at 46, McGee is a lab manager at Stanford University's School of Medicine.

But like most of the pediatric cancer survivors of the 1970s, she has paid a high price for survival. She's had thyroid cancer, skin cancer and, in 2001, the biggest scare. A routine mammogram identified very early breast cancer.

McGee could have settled on a more conservative treatment, but, because of her previous radiation exposure, she opted for a double mastectomy.

NANCY MCGEE: I could not have a lumpectomy and radiation. I had to have a mastectomy. And as soon as I heard that I had breast cancer, I already knew in the back of my head I was having a double. I wasn't going to go through this twice, because I was heavily radiated on my right side. The breast cancer was on the left side of my left breast. So it wouldn't be if Nancy gets it on the right side, it's when.

NANCY MCGEE: Dr. Link, hi!

DR. MICHAEL LINK: How are you?

BETTY ANN BOWSER: Today, 32 years after being first diagnosed, McGee still sees Dr. Link and takes part in clinical trials.

DR. MICHAEL LINK: We've probably learned more from you than almost anybody else. You have had like every possible -- every possible thing that we see, so it was worth it.

NANCY MCGEE: I'm here. I was put on this planet for some reason. I'm still trying to figure out what. But, you know, I have a son, who I adore.

I never knew if I would have kids. Back then, I don't know if they really knew what chemo would do to a reproductive system of a 13-year-old child. So, when I conceived my son, it was like, in my mind, a miracle. You know, and so I just say, hey, carpe diem. I just -- I seize the day. I live each day to the fullest that I can, try to be happy.

BETTY ANN BOWSER: In the last decade, Dr. Link has seen the benefits of clinical trials, in which as many as 80 percent of all children with cancer participate.

DR. MICHAEL LINK: For the next generation of the Nancys that come to us for treatment, we are going to do a better job. We're going to do it with less morbidity, less complication, and hopefully so that they can have an improved quality of life.

This is way more complicated than we thought. Cancer is not one disease. Cancer is a multitude of diseases. The future is based on really understanding this molecular basis or the genetics and the DNA damage that causes cancers. We're understanding what are the -- what drives the cancer. And we're trying to develop very, very specific drugs that target those -- that target those specific abnormalities.

BETTY ANN BOWSER: While doctors like Link are excited about curing more pediatric cancers, many adult cancers remain stubbornly resistant, with no cures in sight.

JEFFREY BROWN: On our website, we're collecting photos of your connections to childhood cancer. You can find instructions on how to participate on our health page.

And Betty Ann's next report looks at some of the adult cancers and what's being done to find breakthrough treatments.

The PBS NewsHour's health unit has been reporting on the progress in cancer research and treatment 40 years after President Richard Nixon signed the National Cancer Act.

On the NewsHour Thursday, health correspondent Betty Ann Bowser will explore some of the astonishing gains made in pediatric cancer since 1971. A second report in the days ahead will focus on promising research developments in other branches of the field.

Before and after the reports air, we want to put faces to this very human story with your help.

You can share your own stories about the way pediatric cancer has touched your life by sending us a photo. The photo can be of anything that tells your story -- person, place or thing -- as long as it's G-rated.

We'll then add the photo to our childhood cancer awareness board on the social media site Pinterest.

Ways to share your photo:

Email: Attach the photo to an email and send to onlinehealth@newshour.org. Include a one to two sentence caption explaining it.

Twitter: Tweet @newshourhealth your photo. Include a short (within 140 characters of course) description.

Pinterest: Have a pin on Pinterest that applies already? Use the email button -- on the right-hand side when you're on a pin's page -- and email onlinehealth@newshour.org.

Links: Is your photo online already? Tweet the link to @NewsHourHealth with a description, or email the link to onlinehealth@newshour.org with a short description.

Keep in mind:

Unless otherwise asked by you, we will use your name on your photo, and may also use it on the PBS NewsHour's website in more posts in our series about cancer.

You must have rights to use the photo you send in.

The PBS NewsHour does not certify the fund allocations of the charities included with photo submissions, or intend the submissions posted as an endorsement of their work. Visit the website Charity Navigator, which independently evaluates charities, for more information on each organization.

Questions? Leave them in the comments or ask on Twitter.

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More Coverage:

Hear an interview with The Who's Roger Daltrey on how teens need specialized care when diagnosed with cancer.

Top oncology experts propose metaphors to replace the often-used "War on Cancer."

The teen drama at the end of Alexis Reilly's freshman year of high school ran deeper than awkward dates or bad friends. It was more definitive than that. After a night of uncomfortable sleep, she found a lump in her neck.

The blur of the next six months swirled around one central phrase: Hodgkin's lymphoma. To most teenagers, simply: cancer.

Seven years later, it's not the memory of chemotherapy, radiation or hair loss that sticks with Reilly most. It's the loneliness of that time -- the worried stares, isolation and realization that programs available to help her mentally cope with a cancer diagnosis were fairly sparse. In fact, Reilly only saw her social worker twice throughout the entire ordeal.

"Cancer as a teenager is not like cancer as a kid, where a lot of times you don't even remember much of the treatment when it's all over. As a teenager, I knew exactly what was going on, but I wasn't really old enough to deal with it myself," she said. "I was lucky to have a lot of friends and family, but we could have really used the extra support."

Reilly is on course to become that kind of person for future teens. She's now a social work graduate student at UCLA and part of a growing chorus -- one headlined by the likes of Roger Daltrey and Pete Townshend of the classic rock band The Who -- demanding more specific treatment and emotional programming for adolescents. Rather than funneling teens into adult or pediatric programs, where they generally feel like outsiders, they say that teens should receive specialized attention.

"The psychological benefit of putting teenagers with teenagers rather than 4-year-old children or geriatrics is enormous," Daltrey told the NewsHour. "One of the patients that I'm friends with is recovering from a brain tumor at the age of 15, and he was greeted by clowns with ukuleles and spoons, and a screaming 4-year-old in the next room. That's not very conducive to healing."

Between gigs for the past quarter-century, Daltrey has been helping Britain's Teenage Cancer Trust raise funds and awareness for more than 20 teen cancer centers, mostly in the UK. It's his way of repaying the demographic that made him famous: "Our whole business was founded on the backs of teenagers." But beyond that, he said, "It's a bloody good investment."

When hospitals provide the space, it costs about a million dollars to equip the centers and another million to keep them running for two years, Daltrey said. "This side of it -- environment -- is relatively cheap," he said. "But by doing that, the psychological benefit, we reckon, is about 15 percent addition to the benefit of the medicine."

In November, Daltrey announced his first expansion of the program into the United States: the Daltrey/Townshend Teen & Young Adult Cancer Program at UCLA.

Listen to the NewsHour's full interview with Daltrey here:

"Who Cares": Roger Daltrey Talks Teen Cancer by PBSNewsHour

When it's completed, patients will be treated in private rooms that surround a common lounge, including separate areas for hanging out, studying and listening to music. Teens consulted for the project opted for a "local L.A." look for the center -- dark paints, recessed lighting, palm trees and graffiti. Nurses are being trained to work with the mood swings of young adults, and the medical treatments are being tweaked. Chemo regimens, for instance, will be offered later in the day as a nod to the night-owl habits of some teen patients.

The set-up also provide better access to existing but sparsely used resources like teen-specific clinical trials, fertility counseling, and referrals to extracurricular and survivorship programs.

"We have to think outside the box in terms of the traditional care they receive," said Jackie Casillas, director of the center. "Particularly, we need to take the resources that have existed for these patients in two very separate silos -- pediatric and medical oncology -- and bring them together in this one space. It's a challenge, but we're not the only program recognizing it's one that's worthwhile."

The movement's been slowly building for a little over two decades now, according to Dr. Archie Bleyer, former chair of the Children's Cancer Group and one of the first to sound the alarm that teens were being "left behind" in the research and medical oncology community. In the early-1990s, Bleyer and his colleagues traced the trend to some key factors: Teen cancers are less prevalent, very different, and -- therefore -- relatively more expensive to study than their childhood counterparts.

But Bleyer believes there was probably also another reason: "It's very hard to take care of older adolescents and young adults. It's hard enough to go through that yourself, much less help someone else," he said. "But until we can really do that well, including understanding their needs, relating to them, becoming a better friend to them -- at this critical time of their lives -- we're not going to make much progress closing this gap."

From a medical standpoint, that's why teen cancer centers are so critical, he said. In the last decade, most large children's hospitals have struggled with this idea "and some have implemented real change," he said. "But these are a minority."

Not everyone feels that way. "In general, there is a wealth of support not just for teens but all children and families," said Fran Greeson, director of social work at St. Jude Children's Research Hospital in Memphis. St. Jude has a teen space of its own, but Greeson -- who was also a former board member of the Association of Pediatric Oncology Social Workers -- said that hospitals that don't have those kinds of resources are finding ways to meet the emotional needs of their teen patients.

But over the last several decades, she's also noticed a trend toward specialized support for teen cancer patients: "I think as more social work professionals focus on pediatric oncology, more will also continue specializing in teen issues," she said. "So this is building with time, and that's very positive."

In Bleyer's words, it's "become a bandwagon, a cause celeb, a point of great of reasonable acclaim." That "building" sensation is coming from academia -- from researchers who say it's medically and emotionally damaging to lump teens with other groups -- but also from the young people themselves through social media.

"They're saying it themselves quite clearly: 'We're under-studied. It's time for a change.' And as a result, things are turning around wonderfully. I've been able to sit back and enjoy it rather than pulling the wagon myself," Bleyer said, laughing.

Daltrey estimates that the bandwagon will ride across the entire United States within 10 years' time. But he's still puzzled as to why it's taken so long to get to this point. He excuses the medical profession for not recognizing teenagers as a distinct group through the 1950s. Things were much more regimented before that, he said, and there was little time or patience for the transition to adulthood.

Then came a cultural wave that "allowed teenagers to invest in themselves and be themselves at that age," he said. "Past James Dean and Elvis, there is no bloody excuse whatsoever."

Tune in to the NewsHour broadcast this week for health correspondent Betty Ann Bowser's full report on the progress made in pediatric oncology since the beginning of the so-called "War on Cancer" 40 years ago.

And we're collecting photos of your own connections to teen and childhood cancer for a NewsHour project. Find out how to participate here.

These are the things you should know about Bradford Tatum: In the past several years, he's turned 91, overcome a life-threatening bout with colorectal cancer and won more gold medals in the Olympics than he can count. And his biggest competitor at swim meets is his older brother John -- that's right, older brother -- age 92.

For decades, the Tatum brothers have been shaming their neighbors at their local pool in Washington, D.C., and dominating their peers at the annual National Senior Games, more commonly known as the Senior Olympics. But their brush with national fame only came after their story caught the attention of a pair of 20-something filmmakers gearing up for a new documentary.

"Age of Champions" doesn't exclusively focus on John and Bradford -- they're two characters in a hyperactive group of seniors from across the nation who have made a deliberate decision to dribble, dive and pole-vault into old age.

"But John and Brad were particularly standout inspirations," said Keith Ochwat, the film's producer. "They're still creating excitement and magic for themselves. As a 29-year-old, it's so impressive to see these men in their 90s content with their lives but constantly striving for more."

Ochwat calls it "enviable." John and Bradford say it's simpler than that.

They attribute their success to blunt determination. The brothers recently sat down with health correspondent Betty Ann Bowser to discuss their first swimming lessons, their decision to wade into the Senior Games and the fitness tips they hope will keep them kicking through many more swim meets.

Watch Betty Ann's conversation above. To see more clips from the film or to find out how to host a screening, click here.

Listen to the Audio

A new government report shows that the rise in health care spending slowed for the second consecutive year. Meanwhile, health insurance premiums continue to climb as workers pay an ever-growing share of the cost. Ray Suarez discusses what's behind these changes with Susan Dentzer of Health Affairs.

JUDY WOODRUFF: Finally tonight, what's slowing down the rise of health care spending?

Ray Suarez takes a look.

RAY SUAREZ: It's often reported that Americans spend more on health care than the citizens of any other industrialized country. What's also been true for many years is that the cost of health care has risen much faster than the cost of living overall.

Now a new report from the government shows the rise has slowed for the second consecutive year. It found that health care spending grew by 3.9 percent for 2010, the most recent year on record. That's just a shade higher than in 2009. Still, the total amount spent in 2010 was $2.6 trillion dollars, or about $8,400 a person.

Moreover, health insurance premiums continue to climb, while workers are paying an ever-growing share of the money.

To help flesh out what's behind these changes, we check in with Susan Dentzer. She's editor in chief of the journal "Health Affairs," where the report was published today. She's also an analyst for the NewsHour.

And, Susan, at 3.9 percent up, it's still going up much faster than the cost of living. But that's considered a tame number. Is it?

SUSAN DENTZER: It really is, Ray. And if you compare it to prior years, you can really see the difference.

For example, in 1980, the rate of growth of health spending jumped in one year by 13 percent. In 1990, it jumped by 11 percent in one year. In recent years, we've seen that rate of growth slow. These two most recent years, 2009 and 2010, represent the slowest rate of national health spending growth in 51 years.

Now, we know why that happened, largely. It's because the economy plummeted in 2009. We had the first decline in overall gross domestic product in 2009 than we've had in 60 years.

RAY SUAREZ: So, unpack that number. When you say we know why it happened, and it's the economy, were people buying less health care or able to pay less for it?

SUSAN DENTZER: Both.

RAY SUAREZ: Both.

SUSAN DENTZER: Exactly. Across the board, we see people were going to the doctor less. People were going to the hospital less. People were getting less outpatient surgery.

We had the slowest rate of growth in prescription drug spending in years. Retail prescription drug spending went up only 1.2 percent in one year. And that's over and against years that we have had relatively recently of 18 percent annual rates of increase.

So across the board in almost every sector, if there was an earthquake in the economy in 2009, the aftershocks were felt in health care well into 2010.

RAY SUAREZ: Now, 2010 was also the first year of the Obama administration's health care reform. Their stated intention was to bend the cost curve. Did that have anything to do with this lower spending?

SUSAN DENTZER: No.

But it's also true that anything that happened out of the Affordable Care Act had a negligible impact on all of this in 2010. The CMS actuaries, Centers for Medicare and Medicaid Services actuaries, say that the overall contribution of the Affordable Care Act was 0.1 percentage points as a contributor to the overall 3.9 percentage points of increase.

So it was negligible. Now, we know that most of the Affordable Care Act is yet to come. The big expenditures will hit in 2014, when we expand health insurance coverage, open up the new health insurance exchanges, expand Medicaid, et cetera, but, so far, very little impact.

RAY SUAREZ: One part of the economic effect which is directly tied to health insurance is employment. 2010 was a very high unemployment year. Did that drive people to more expensive ways of getting health care coverage or just keep them home, instead of going to the doctor?

SUSAN DENTZER: It pretty much kept them home. Not only did we have the highest rate of unemployment in 27 years, people also lost health coverage because of that. Private health insurance coverage declined almost 2 percent in the one year from 2009 to 2010.

And, of course, it had declined in the prior year as well. So people were losing their jobs, losing their health care coverage, having to pay more. Those people who did have coverage have had to pay more. We know that employers have been shifting more of the costs of health care to workers.

So, now if you go to the physician or if you go to the hospital, the likelihood is that you're going to have a higher co-insurance rate. You're going to pay more of that bill directly yourself. So all of those things came together. And it meant truly people went to the emergency department less. People went to doctor's offices less. People did less elective surgery in hospitals.

You can see that clearly in the rate of hospital use in 2010. So the economy in health care got hit as hard as the economy anyplace else.

RAY SUAREZ: But in that $2.6 trillion overall national health care bill, wasn't the federal government on the hook for more of it at the same time as well?

SUSAN DENTZER: Yes, indeed, in particular because of the stimulus law that was passed in 2009, which had the federal government pick up more of the share of Medicaid spending, Medicaid, of course, being the program that largely covers the poor and also some of the long-term care needs of the aged and disabled.

We know that the federal government kicked in more to help the states out through the worst period of the economic downturn. That did result in higher spending. But, even so, Medicaid spending in 2010 was still only up 7 percent which was much lower than it's been in prior years.

And if we look on a per-person basis, per person, in Medicaid, spending only went up 1.2 percentage points. So that's again a really low rate of spending per person relative to what we have seen as the historical norm in this country.

RAY SUAREZ: Two interesting pieces of data jumped out at me from the report. One was that co-pays were higher for things like prescription drugs. And, of course, insurance, the raw cost of insurance itself was higher. Yet, the household share of the overall national bill was lower.

Is that because other people in the chain were picking up more at the same time?

SUSAN DENTZER: Well, partly it's again this effect of the federal government stepping in and paying more of the Medicaid bills of the country in particular.

And, of course, we know people continue to qualify for Medicare, so that is rising as well. So there was this temporary adjustment of the federal government kicking in more money toward health care over that period.

But, as you say, a larger effect here going on is that people are having to pay more for health care out of pocket. To the degree that that persists, of course, the big question people are now asking is, what's going to happen when the economy comes back? Does all of this get thrown into reverse?

RAY SUAREZ: So, answer your question. What is going to happen when the economy comes back?

SUSAN DENTZER: Well, we don't know.

But if some of these things are just due to the economy and if people get employed and get insurance health insurance again -- and, of course, we have the big health insurance expansion coming down the line in 2014 -- it could throw all of this into reverse. And we could see health expenditures going up much more quickly.

In fact, that's what we're expecting now in 2014. On the other hand, if some of these things -- changes are more fundamental, if shifting more of the cost to individuals is making them more cost-conscious about health care, less likely to go to an emergency room when they could get care that they need, say, at an urgent care clinic, those could have more lasting effects. We'll have to see how all of this plays out.

RAY SUAREZ: Susan Dentzer, good to talk with you.

SUSAN DENTZER: Great to be with you, Ray.

Physicist Stephen Hawking onstage at the 2010 World Science Festival Opening Night Gala in June 2010 in New York City. Photo by Dimitrios Kambouris/WireImage.

Stephen Hawking turns 70 on Sunday, beating the odds of a daunting diagnosis by nearly half a century.

The famous theoretical physicist has helped to bring his ideas about black holes and quantum gravity to a broad public audience. For much of his time in the public eye, though, he has been confined to a wheelchair by a form of the motor-neuron disease amyotrophic lateral sclerosis (ALS). And since 1985 he has had to speak through his trademark computer system--which he operates with his cheek--and have around-the-clock care.

But his disease seems hardly to have slowed him down. Hawking spent 30 years as a full professor of mathematics at the University of Cambridge. And he is currently the director of research at the school's Center for Theoretical Cosmology.

But like his mind, Hawking's illness seems to be singular. Most patients with ALS--also known as Lou Gehrig's disease, for the famous baseball player who succumbed to the disease--are diagnosed after the age of 50 and die within five years of their diagnosis. Hawking's condition was first diagnosed when he was 21, and he was not expected to see his 25th birthday.

Why has Hawking lived so long with this malady when so many other people die so soon after diagnosis? We spoke with Leo McCluskey, an associate professor of neurology and medical director of the ALS Center at the University of Pennsylvania, to find out more about the disease and why it has spared Hawking and his amazing brain.

[An edited transcript of the interview follows.]

What is ALS--and is there more than one form of it?

ALS, which is also known as a motor-neuron disease--and colloquially as Lou Gehrig's disease in the U.S.--is a neurodegenerative disease. Each muscle is controlled by motor neurons that reside in the brain in the frontal lobe. These are controlled electrically and are synaptically connected to motor neurons that reside lower down in the brain--as well as motor neurons that reside in the spinal cord. The guys in the brain are called the upper motor neurons, and the guys in the spine are called the lower motor neurons. The disease causes weakness of either upper motor neurons or lower motor neurons or both.

It's been known for quite some time that there are variants of ALS. One is referred to as progressive muscular atrophy, or PMA. It appears to be an isolated illness of the lower motor neurons. However, pathologically, if you do an autopsy of a patient, they will have evidence of deterioration of upper motor neurons.

There is also primary lateral sclerosis--PLS--and clinically it looks like an isolated upper motor-neuron disorder. However, pathologically they also have lower motor-neuron disorder.

The other classic syndrome is called progressive baldor palsy--or progressive supranuclear palsy--which is weakening of cranial muscles, like the tongue, face and swallowing muscles. But it pretty much always spreads to limb muscles.

Those are the four classic motor-neuron disorders that have been described. And it was thought for quite some time that these disorders were limited to motor neurons. It's now clear that that's not true. It's now well recognized that 10 percent of these patients can develop degeneration in another part of the brain, such as other parts of the frontal lobe that don't contain the motor neurons or the temporal lobe. So some of these patients can actually develop dementia, called frontal-temporal lobe dementia.

One of the misconceptions about ALS is that it's only a motor-neuron disease, and that's not true.

What has Stephen Hawking's case shown about the disease?

One thing that is highlighted by this man's course is that this is an incredibly variable disorder in many ways. On average people live two to three years after diagnosis. But that means that half the people live longer, and there are people who live for a long, long time.

Life expectancy turns on two things: the motor neurons running the diaphragm--the breathing muscles. So the common way people die is of respiratory failure. And the other thing is the deterioration of swallowing muscles, and that can lead to malnutrition and dehydration. If you don't have these two things, you could potentially live for a long time--even though you're getting worse. What's happened to him is just astounding. He's certainly an outlier.

Has he lived so long because he got the disease when he was young and had the juvenile-onset type?

Juvenile-onset is diagnosed in the teenage years, and I don't know enough about his course to say. But it's probably something similar to juvenile-onset disorder, which is something that progresses very, very, very slowly. I have patients in my clinic who were diagnosed in their teens and are still alive in their 40s, 50s or 60s. But not having ever examined him or taken a history, it's a little hard for me to say.

He's a very good example of the sparing of the non-motor parts of the brain that can occur.

How frequent are these cases of very slow-progressing forms of ALS?

I would say probably less than a few percent.

How much do you think Stephen Hawking's longevity has been due to the excellent care that he has received versus the biology of his particular form of ALS?

It's probably a little bit of both. I just know him from television, so I don't know what kind of interventions he's had. If he really isn't on a ventilator, then it's his biology--it's the biology of his form of the neurodegenerative disease that determines how long he will live. For trouble swallowing you can elect to have a feeding tube placed, which basically takes malnutrition and dehydration off the table. But mostly it's about the biology of the disease.

Hawking obviously has quite the active mind, and previous statements that he has made seem to indicate he has a pretty positive mental outlook, despite his condition. Is there any evidence that lifestyle and psychological well-being do much to help with patients' outcomes? Or is the disease usually too quick for that to make a difference?

I don't believe that adds to longevity.

ALS still doesn't have a cure. What have we learned about the disease recently that might help us find one--or at least better treatments?

Beginning in 2006 it became clear that like a lot of other neurodegenerative diseases, ALS was determined by the accumulation of abnormal proteins in the brain. Ten percent of ALS is genetic and based on a gene mutation. I'm sure there are also at-risk genes for ALS, but there are now multiple genes that have been identified as potentially causing the disease. Each one of them are interesting in that they lead to the accumulation of different proteins in the brain. Knowing specific genes gives us particular mechanisms in the brain, and would potentially give us targets for therapies. But none of this has given us any robust therapies yet.

What does Stephen Hawking's case mean for people who have the disease?

It's just an incredible, incredible example of the variability of the disease--and the hope for patients who have it is that they could also live a long life. Unfortunately, it's a small percentage of people for whom that actually happens.

This article is reproduced with permission from Scientific American. It was first published on January 7. Find the original story here.

"Failure Again." It was the working title for Stuart Altman's new book on the latest push for health care reform.

Two years after President Obama's Affordable Care Act became law, Altman is the first to admit he happily changed the title to "Power, Politics and Universal Health Care: The Inside Story of a Century-Long Battle." But he had reason to be skeptical.

As an adviser and architect of health care reform policy for five U.S. presidents -- both Democrat and Republican -- Altman had seen every attempt at universal health care crippled by political maneuvering, special-interest propaganda, even multiple sex scandals.

He recently stopped by the PBS NewsHour to talk with health correspondent Betty Ann Bowser about "Power, Politics and Universal Health Care," which places President Obama's historic win in context: at the end of a century's worth of tough lessons, false hopes and broken promises. He also shares his thoughts on why health care prices keep skyrocketing, the prospects for a single-payer system and the person he believes is responsible for the reform law's structure: Richard Nixon.

A transcript is after the jump.

Transcript:

Betty Ann Bowser: Very few people know as much about health care and health care policy as Stuart Altman. He's been an adviser to five American presidents -- both Republicans and Democrats. And he's just written a new book, "Power, Politics, and Universal Health Care." It's really kind of a collection of all of the things from your 40-year-plus career. What's your favorite anecdote?

Stuart Altman: Well, I think it was the church. You know, back in 1974, I was working for President Nixon. And very few people know this, but there was a serious attempt by President Nixon and Caspar Weinberger, who was secretary, to work with Sen. Kennedy and Wilbur Mills, who was then the powerful chair of the Ways and Means Committee, to see if they could come up with a combined plan. But all the forces didn't want anybody to know that they were having these secret meetings. And so we met at a church up near the Capitol, St. Mark's Church, to try to see if we could reach agreement. Somehow in the church, we all thought we had agreement. But when it went out into broader politics, it all fell apart.

Bowser: And what was this? About getting more Americans insured?

Altman: It was a complete decision to bring everyone covered, to use the private sector where it worked, to have private insurance, to protect Americans, to use subsidies for people to buy insurance. And also, to sort of do away with any of the problems of the insurance industry for certain circles.

Bowser: People are probably surprised to hear that a Republican, Richard Nixon, had a lot of ideas about all this.

Altman: Well it is a surprise. And when I talk to people who have not always the most favorable view of Richard Nixon, and then they start looking into the kind of legislative history that was in his administration, like the Clean Air Act, civil rights, a whole variety of areas that you would never attribute to Republicans, and he was pretty forceful, as was Caspar Weinberger, that they wanted to provide a plan. And as it turns out, the plan that we put together was the model that was used by Obama during his ... actually Romney in Massachusetts. So recently I wrote a little piece that said, 'Rather than Obama borrowing from Romeny, both Romney and Obama borrowed from Nixon.'

Bowser: One of the major things that really is not addressed very much in the law that passed -- the federal health care reform bill -- is cost. Every time a foundation does a report on cost, just up, up, up, up. What do you think the answer is?

Altman: Well the answer is unfortunately that had this law really seriously dealt with costs, it could not pass. Really what it boils down to is just what I said before, every major constituent group -- I'm talking about the big health groups -- support universal coverage. But if it negatively affects them, which is what cost-containment would do -- they say, 'Maybe we should keep the status quo.

Bowser: Do you think we'll ever get to a point in this country where single-payer will be a realistic prospect?

Altman: As I said in the book, when a health policy analyst went to heaven, he asked God the same question: 'Will America ever have a single-payer system?' And God said, 'Absolutely. Just not in my lifetime.' I'm afraid that little story is true. Americans just are not prepared to let government be responsible for all of their health care. Even though it makes sense in terms of simplicity, and you can make the case that it's less expensive. But on the other hand, it changes the focus, and it puts a lot of power in the hands of government. And so I think, well I know, that every time we've ever talked about it, it's political suicide.

Eighty five percent of Americans, year in and year out, say they believe everyone should have universal coverage. The problem is everybody has a different idea of how to make it work. And unfortunately what you have is 85 percent of Americans are reasonably well-insured. And when you start thinking about how you're going to get the remaining 15 percent, everyone gets very nervous. Is it going to cost me money? Is it going to affect the quality of my care? Is somehow the health care system going to be worse off? And you see that right now. Here's this piece of legislation that covers everyone. And yet 50 percent of Americans think we should repeal it. And the reason is, they look at some aspect of it and say, 'Somehow my life is going to be worse off.' Whether it's true or not.

Bowser: You talk a lot about your mom in this book. And what was really fascinating to me is, here you are, this big health policy expert and when your mom got old and was close to the end of her life and had all of these things going wrong with her health and was on Medicare, you were just as confused as the next guy about what to do to take care of his mother. You think that's fairly typical regardless of where you are on the learning curve of health policy?

Altman: Well I think so. That's why I talk about my mother. First, my mother was symbolic in my mind of people who are sharp but of advanced age. And I tried to use my mother as an example of the pressures of an individual. And of course, you're right. I mean, here was me and my family trying to decide what to do for a 90-year-old who had serious heart problems. And we fell into the same problem that probably thousands, if not hundreds of thousands of families ... we didn't know what to do. And as we said in the book, we didn't know what to do, but the one thing we never thought about was the cost of the care. Ultimately, we did fairly extensive surgery and unfortunately it didn't work too well.

Bowser: Dr. Altman, thank you very much for being with us.

Altman: Thank you so much for letting me.

Bowser: And the book is "Power, Politics and Universal Health Care."

Mental health experts say a U.S. Army report on training aimed at enhancing soldiers' psychological resilience is flawed.

A top-priority program aimed at enhancing soldiers' psychological resilience and mental health has proven to be effective, the U.S. Army says in a forthcoming report. However, several leading mental health professionals say the findings do not prove the program works.

Last month, health correspondent Betty Ann Bowser explored the nuances of the Army's Comprehensive Soldier Fitness program. This new and anticipated report adds one more layer to the debate.

The program, launched in 2009 to teach soldiers how to better handle battlefield trauma as well as stress in their daily lives, seeks to improve well-being and reduce anxiety, depression and post-traumatic stress disorder, all of which have become prevalent among troops who have deployed to Iraq and Afghanistan over the last decade.

At the heart of the program is a 10-day class that non-commissioned officers take at the University of Pennsylvania's Positive Psychology Center, where they learn about their personal strengths, how to be more aware of their thoughts and emotions, and how to enhance relationships with loved ones so that during tough times they will have better support. Service personnel are also taught techniques for positive thinking and skills to reduce a negative focus when things go wrong.

Officers who finish the class are called "Master Resilience Trainers," and they, in turn, teach the skills to troops. 



The soon-to-be-released report, titled "The Comprehensive Soldier Fitness Program Evaluation, Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data," concludes, "There is now sound scientific evidence that Comprehensive Soldier Fitness improves the resilience and psychological health of soldiers."

The new study (an advanced draft was provided to the NewsHour) follows two others -- "Report #1: Negative Outcomes (Suicide, Drug Use, & Violent Crimes)" and "Report Number 2: Positive Performance Outcomes in Officers (Promotions, Selections, & Professions)" -- and finds that troops in four combat brigade teams instructed by Master Resilience Trainers "experienced significantly higher rates of growth" than soldiers without such training.

The report also concludes that soldiers in units with trainers did 1.6 percent less "catastrophizing" -- worrying that the worst case will happen -- than troops without the trainers. They also developed 1.3 percent better coping skills, were 1.3 percent more emotionally fit and were 1.1 percent more adaptable than soldiers in units without the trainers, whom the Army also studied.

But several leading psychiatrists and psychologists disagree. "The findings do not seem to be very impressive," George Bonanno, a professor of clinical psychology at Columbia University, wrote in an email to the NewsHour. The "report does not support the legitimacy" of the program, he contended. "It's not clear they actually showed anything."

Even if the Army study is accurate, "it's such a small effect one would have to question whether it was worth it," Bonanno said.

Dr. Bessel van der Kolk, a professor of psychiatry at Boston University, voiced similar concerns.

"This report reads more like propaganda than a serious scientific study," he said in an email after reviewing the Army study results. "The big question, though, has not yet been addressed: Does this intervention make combat soldiers more resilient and prevent PTSD and somatization [a condition in which a person has many physical symptoms but no physical cause that can be detected]?



"Does it make it easier," van der Kolk continued, "to tolerate the central traumatizing issues of combat: killing, witnessing or engaging in atrocities, seeing one's friends being blown up, and being reminded of horrendous scenes after returning home, and being able to sleep comfortably after combat?"

One of the main creators of the Comprehensive Soldier Fitness program, Martin Seligman, said the criticisms were "off base." The program is largely aimed at "creating a more resilient fighting force -- building the strengths of the top 90 percent" of the Army. 

The $140 million initiative should not only be measured on how well it meets the difficult goal of preventing PTSD, according to Seligman. The effects of the program "are large" when viewed in context, he said. The training is not only for soldiers who might be more at risk for developing mental health problems but for entire units of troops -- even those who might not need it -- without any prior screening. That "universal" approach means that relatively small percentages of the entire trained group will see improvement, but this would translate to a significant portion of at-risk troops who have benefited, Seligman said.

Referring to an alternative approach in which only those with the greatest need would be trained, Seligman said: "You don't know who is at risk and should be targeted, or you don't want to stigmatize those at risk. Both, I think, are relevant to why the Army is doing universal prevention."

The manner in which the study was conducted is also being criticized.

According to Bonanno, the study's design was weak. "If they wanted to conclude that there was something special" about providing units with resilience trainers, then for scientific proof, Army officials should have compared three different situations: units with resilience trainers; units with no trainers, and units receiving training in "how to relax, or how to be better leaders, or just about any alternative." 

Bonanno, who studies the impact of adverse events on individuals, said it is possible that the Army's program might even have a negative impact. 



Absent any specialized psychological training, soldiers are already "remarkably resilient," he wrote. This program does not "consider the possibility" that it "might somehow undermine" a natural resilience that soldiers have.

"The study isn't perfect," acknowledged Capt. Paul Lester, a research psychologist with the CSF program and author of the Army's report, wrote in an email.

At the same time, he said, the huge volume of troops assessed in the study should lend the analysis enormous credibility. Lester asked how many of the critics "have led a 15-month longitudinal study with 22,000 people on three continents and two war zones." 

Said Seligman: "I don't know how the Army could have ethically or practically instituted 12 or more hours of placebo to tens of thousands of soldiers in the middle of two wars. Since these soldiers are already getting hundreds of hours of other training, those constitute a pretty fair control [group]."

Seligman also said there is "not the slightest evidence" that the Army's program could have negative consequences. There have been "7,000 Military Resilience Trainers trained with no report of harm," and additionally "thousands of trained soldiers deployed with subjectively reported benefits, and no evidence of harm."

Lester emphasized the investigation's strengths: It was run on Army units rather than conducted in a laboratory; instead of sampling, they looked at large units that are representative of the Army's combat mission; and soldiers had anonymity and were not made aware of which group they were in. 

In addition, there was a "Chinese wall between the Army, stakeholders, and the data: we contracted for an independent data analysis team," Lester said. "It is important to note that my team alone interpreted the results without pressure from anyone outside of the team."

Frank Ochberg, founder of Columbia University's Dart Center for Journalism and Trauma, said that the analysis would benefit from a third party taking the lead, rather than having Army officials and contractors with a stake in the program's success evaluating their own effectiveness.

Reports on the effects of CSF training "would have higher credibility if they were conducted by an outside agency with no ties to the program management," Ochberg said.

The report is also being criticized for relying on soldiers' self-reporting. Some observers said that a study asking participants to evaluate his or her own psychological state is widely regarded as not fully scientific.

"As the subtitle of the report points out, this is a measure of 'self-reports' by the soldiers," said Bryant Welch, a clinical psychologist and former official with the American Psychological Association.  "It is not 'empirical' evidence of resilience as they claim."



"All the study shows," Welch wrote, "is that if soldiers are given a set of attitudinal questions to answer and then are given several months of instruction by a superior officer explaining why the attitude the Army would like them to have is better for them, then, when they are retested, more of them will endorse the answers the Army would like them to have."

He added: "In other words, the study suggests that the Comprehensive Soldier Fitness has the ability to indoctrinate the soldiers. It says nothing about resiliency and does not even attempt to measure resiliency with any empirical measures."

The Army disputes this notion. 

Asked if soldiers might be providing answers that they think the Army wants to hear, Lester said the data show an even distribution of scores by rank, military occupational specialty and location where troops were surveyed. When Lester and his team looked at the data, they concluded that only 16 percent of the answers were due to the fact that the soldiers did not trust the survey.
 
There is one aspect of the report that all sides agree on: The results are not based on hard behavioral data. Seligman "wholeheartedly agreed" with van der Kolk's point that there were no objective measures of domestic violence, suicide attempts, job performance, illness or amount of medication taken, or rates of PTSD.

Lester wrote that his team aimed to look at such objective outcomes next year. He said there was not enough time to do that in this current study.

Photos by Kael Alford/Liaison, Win McNamee/Getty Images, Chris Hondros/Getty Images, John Moore/Getty Images.