Should health-care reform require insurers to cover chiropractors? Acupuncturists? Yoga? Spiritual healers? These are the questions raised by a recently noticed health-care amendment requiring insurers to consider covering "religious and spiritual health care."

The amendment, covered in this Los Angeles Times article, comes with backing from Senate heavyweights like Orrin Hatch, John Kerry, and the late Ted Kennedy. And while it does not mention Christian Science by name, it's been widely interpreted as a protection of the church's prayer treatments, which it encourages as an alternative to medical help. Others have understood the provision as even more far-reaching as to include any health provider acting within the scope of their license.The Freedom From Religion Foundation has criticized the amendment as an unconstitutional violation of church and state.

Even with its powerful supporters, the amendment seems unlikely to make the final bill; Pelosi already dropped it from the House version. But just the suggestion of covering religious health care highlights a difficult question for reformers: how, exactly, does prayer fit into the president's support for evidence-based medicine? Or, more broadly, is there a place for any sort of unproven, alternative medicine, religious or otherwise, in health-care reform?

by Jeneen Interlandi

Months after taking his anti-obesity crusade national, Cleveland Clinic CEO Delos M. Cosgrove has e-mailed an apology to clinic employees for any offense taken by remarks he has made about overweight people.

Since President Obama visited the Cleveland Clinic in July, Cosgrove has seized the national spotlight to infuse a message of personal responsibility into the health-care debate. Cosgrove has argued that the biggest cause of exorbitant health-care costs is not our deeply flawed insurance industry but the nation's high disease burden, caused largely by obesity, which he attributes almost exclusively to lifestyle choices. In The New York Times, The Wall Street Journal, NEWSWEEK, and elsewhere, he has likened obesity to smoking and said, repeatedly, that if it were legally permissible, he would not hire fat people at the clinic. When asked by NEWSWEEK and New York Times reporters earlier this summer if some obesity triggers were beyond the individual's control, he responded, "Not unless you prove the law of conservation of matter doesn't hold."

His comments have touched off a fresh round of debate about the extent to which individuals can control, and should be held responsible for, their own health. But at the Cleveland Clinic's own Obesity Summit last week, critics took Cosgrove to task for his remarks, calling them "unfortunate and misguided," and saying that they unfairly demonize overweight people. After that, Cosgrove issued a memo of contrition.

"My objective was to spark discussion about premature causes of death," Cosgrove said in a memo sent to staff earlier this week. "But some of my comments were hurtful to our community. That was certainly not my intent, and for that I apologize." The CEO was quick to describe his crusade as one against obesity, not obese people, and to cast it as just one in an array of personal choices that negatively affect health. "Smoking, poor nutrition and lack of physical activity are key contributors to the development of chronic diseases such as heart disease, diabetes and cancer," his memo read. "I feel strongly that we can lower this by working together and helping . . . people to lead healthier lives."

As critics point out, those key contributors don't always result in obesity. That makes body-mass index a somewhat arbitrary measure of health. For example, other factors being equal, a heavy person who eats right, exercises, and doesn't smoke is likely healthier than a lean person who substitutes diet pills and Marlboro Lights for a gym membership, as we discussed in last month's Fat Wars series. And while diabetes (the illness most commonly linked to obesity) certainly costs us─it affects 10 percent of the U.S. population and gobbles up $147 billion annually─it's just one of several diseases that can be attributed to lifestyle choices.

There are also reams of biological evidence suggesting that one's body size is not entirely within a person's control. As my colleague Sharon Begley wrote in this week's magazine, many of the chemicals we encounter in everyday life may influence our metabolism in ways that predispose us to being overweight. Other research has shown that intestinal microbes (a.k.a. our microbiomes) also play a role. On top of those are a host of genetic factors that scientists are only beginning to untangle. Add to those contributors a litany of cultural, economic, and political factors, and it becomes far less clear where the blame for our nation's growing waistline rests. As The New York Times recently pointed out, the real price of soda is 33 percent lower than it was in 1979, and the real price of fruit and vegetables is 40 percent higher. Put simply, McDonald's is a lot cheaper than Whole Foods. It's also far more ubiquitous. As my colleague Karen Springen wrote last year, families living in rural areas are often hard-pressed to find healthy food in the first place.

Still, there's merit to discussing how to reduce the nation's high and costly burden of disease. Cosgrove's remarks, unfortunately, were not the best way to start the conversation, and for obese people who have weighed in on the debate, his remorse has rung hollow. "His apology does not acknowledge the very real and pervasive weight-based workplace discrimination that he was perfectly happy to foment," one self-described "fat person" commented in response to the news of his apology. "This man has now encouraged employers everywhere to think twice before hiring a fat person," wrote another. "Hatred and bigotry does no good for anyone."

Happy, healthy, and heavy? You're not alone. Check out our fit and fat gallery of user-generated photos.

crossposted from The Gaggle

By Adam Weinstein

Poor Joe Wilson. The conservative Republican representative from South Carolina stepped in it Wednesday night when he broke with centuries of decorum by screaming, "You lie!" at President Obama during his health-care speech to a joint session of Congress.

Cut the man some slack. He's passionate! I know this because he told me, in the sole message that blazes across his campaign Web site: JOE WILSON IS PASSIONATE ABOUT STOPPING GOVERNMENT RUN HEALTH CARE!

Except that he's not—at least not when it comes to his, and his family's, government-run health care. As a retired Army National Guard colonel, Wilson gets a lot of benefits (one of which, apparently, was not a full appreciation of the customs, traditions, and courtesies that mandate respect for one's commander in chief). And with four sons in the armed services, the entire Wilson brood has enjoyed multiple generations of free military medical coverage, known as TRICARE.

Last week, thousands of Facebook users updated their status to reflect their support for health care reform. As Jenny Hontz reported at the time, small gestures like this can make a big difference not only by reminding progressive politicians that the Facebook Generation -- the same group of organized, plugged-in citizens who helped elect Obama -- are still a force, but also by countering the loud, angry town halls in a more tech savvy way.

But as our readers reminded us, political strategy isn't the only reason people changed their Facebook message to show support for health care. (Some pages still have the original message, "No one should die because they cannot afford health care, and no one should go broke because they get sick," but Facebook moves fast, and most updates have been long bumped to the bottom of an owner's respective page).

Whether it was to generate conversation with more conservative family members or because they liked the simple message of the post, we found several readers with varied motivation for changing their status, like Emily:

I changed my status yesterday. Mainly as a passive-aggressive ploy to get my family-in-law discussing healthcare, as they are hard core republicans who think any government intervention is just a hand out to lazy people who don't work for a living. And in the meantime, my husband has been out of work about 8 months out of the past 12, and if his hours aren't high enough, we could lose our insurance. And with 2 little kids, doctors visits and ER visits are just an inevitability. So without insurance, we could easily lose our house. And I think that the healthcare debate is viewed, on the right, in such abstract terms. "Keep your government hands off my health care" instead of, "wow, my son/cousin/brother really stands to suffer if something isn't changed in our system". The pre-written statement also brought up children missing doctors appointments because their parents can't afford it, and yesterday I had to cancel [my husband's] check up, because we just can't afford to pay $135 out of pocket. And that's with insurance. When I read that sentence, it resonated, and I want people to understand that it is real people who are suffering because of lack of healthcare, not some abstract stereotype of a lazy person.

In July, Iva Skoch wrote an amazing piece about cancertainment, the practice of dealing with a cancer diagnosis through comedy, happy hours, and online chat rooms. The piece was phenomenal, all the more so because Skoch herself was a survivor of colon cancer. In the piece, she wrote:

Last year, a genetic test revealed that my mother and I are carriers of the Lynch syndrome, an inherited gene mutation that causes not only significant risk of colorectal cancer (check), but also cancers of the uterus, ovary, stomach, small intestine, hepatobiliary tract, urinary tract, brain, and skin. So, aside from breast and lung cancers, I'm well suited for a BINGO on my oncology scorecard...Still, I have always joked about cancer, often to put other people at ease. At times, making jokes feels just as thin, forced, and fake as those HANG IN THERE kitten posters. But often, the reality is so overwhelming that all I can do is laugh.

I loved her piece: its honesty, its humor, its excellent reporting. As it turns out, I'm not the only one. On Tuesday, Fresh Air host Terry Gross spoke with Skoch and one of her sources, Kairol Rosenthal, author of Everything Changes: The Insider's Guide to Cancer In Your 20's and 30's (Wiley, 2009). People in their 20s and 30s with cancer are of particular interest now that the health-care debate is broiling: this generation is more likely to be underinsured, to work freelance or to move from job to job with superexpensive COBRA premiums in between. Then, of course, there's the total buzzkill of having cancer in your young, sexy, freewheeling days, as Skoch described to Gross on Fresh Air:

When you're in your 20s and 30s, you stick out. When you come for radiation of chemotherapy, you're surrounded by patients in their 50s and 60s, and no one knows how to talk to you. I've had people ask me repeatedly about what I eat, because when people hear colon cancer, they think, "That's the cancer you get from bad eating." I'm 29, I'm an athlete, and it made me feel like people were always trying to blame me.

The entire interview is a really interesting, thought-provoking listen, as is the original piece. 

We also interviewed Skoch after the piece; click here to learn about her perspective on cancer, humor and the meaning of life.

by Jenny Hontz

"No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day."

Sound familiar? If you logged on to Facebook or Twitter yesterday, you probably read this multiple times. You may have even posted it yourself. The onslaught of pro-health-care messages coming out of social-media sites yesterday painted a very different picture from the faces we've seen at town halls and on the news. But does updating your status in favor of health care really make a difference?

We all have one: a dotty but well-meaning grandma, the Lyndon LaRuche fanatic at your gym who spouts nonsense, but also happens to have killer abs, the paranoid, anti-government boss who is otherwise a pretty nice guy. Since a new survey shows that fifty percent of Americans believe misinformation about healthcare, there's a good chance you've run into someone  spouting off crazy nonsense about death panels or drawing little Hitler moustaches on posters of Obama.

Of course, most of the myths people believe are more like misinformation: facts that were twisted or misread or reinterpreted. But some, of course, are just plain crazy. Like, hut-in-the-woods, handwritten-manifesto nuts. Aaron Carroll, who ran the aforementioned study about the pervasivness of these health care myths, shared one he heard as a guest on a call-in radio show. "I had a caller that thought that if a woman found out she was going to have a baby with Down Syndrome, she would be forced to have an abortion, and if she didn't, she and the baby would lose their health insurance."

That's crazy, right? Crazy in thinking that the government would mandate abortions, crazy in that an American citizen would think, "Yes, that sounds factual," crazy that she then decided to spread this information over AM talk radio. (Ok, that part is less crazy). There are two options when faced with a barrage of outlandish accusations like these: you can cry at how divisive and delusional public discourse over health reform has become... or you can collect a bunch of incredibly unbelievable health reform myths and laugh at them.

 We're going with option B. Along with the ladies of The Gaggle, I'll be collecting the best of the worst. For instance, here are some of the other loopy myths we've heard at NEWSWEEK:
 
-      Doctors will be imprisoned if they provide life saving treatments not sanctioned by the government;
-      Private insurance will be outlawed;
-      Obama wants to revive a Nazi program of killing incurably or mentally ill people;
-      Medicare will be ended;
-      The bill allows the government to access your bank account.
 
Can you top these? What crazy myths are ending up in your inbox? Have you heard anything nutty from your relatives or friends? Let us know in the comments, and we'll post the wildest ones tomorrow. 

by Kate Dailey and Sarah Kliff

Yesterday, Barney Frank's takedown of a young woman comparing health care reform to Nazi policy was heralded by reform advocates as long-overdue counter-strike against an increasingly absurd campaign of misinformation. In fact,  one of the most difficult battles Obama has fought in the health care debate is explaining what exactly his health care plan entails—and then getting people to believe him. Myths about health care legislation have run rampant  to the point that the White House launched a website devoted to mythbusting.

It doesn’t seem to have done much good: Aaron Carroll of Indiana University’s Center for Health Policy and Professionalism Research has an interesting study out today looking at which myths have thus far taken hold in the health care debate. Turns out, nearly every myth that’s made its rounds in town halls and on viral emails has ginned up a serious following, with almost half of America believing myths about health care reform.

"When it comes to health care reform, all of these myths seem to be resonating," says Carroll, who writes extensively about medical myths. "I think people are so scared of the idea of reform in general that they're willing to believe anything."

Last week, Carroll and his research team polled of 600 Americans about 19 medical myths, and the results showed that at least half of the country is misinformed. Find out why these myths endure after the jump.

by Jeneen Interlandi

Texas has the highest uninsured population in the country, according to a Gallup poll released earlier today. More than one-fourth of Texans—26.9%—aged 18 and older were completely uninsured.

It’s not the first time Texas has topped such a list (it’s not even the first time this week; similar data were reported by the U.S. Census Bureau yesterday and Texas ranked number one on that list as well).

Texas republicans, who have staunchly opposed the health care reform efforts now underway, have been quick to pin the state’s abysmal insurance record on the high number of undocumented immigrants living within its borders. John Goodman, president of the National Center for Policy Analysis, a Dallas-based think tank suggested in a blog post that the numbers were artificially inflated. Because “even illegal aliens” are guaranteed care at emergency rooms, he wrote, everyone is effectively insured. In a press conference Friday, Senator Kay Hutchinson (R-TX) made a more explicit statement, saying “it’s mostly because of the illegal immigrant population.”

What they mean is this: illegal immigrants should not be counted among the uninsured because we aren’t obligated to provide them with health insurance in the first place. And when you remove the undocumented from the rolls, the picture is less bleak than the Gallup or Census numbers suggest.

It’s an obvious argument and because immigration is an emotionally fraught topic, it’s an easy one to make. Unfortunately, it’s not supported by the facts. (Even a casual glance at the data is enough to render the point moot: New York has one of the largest immigrant populations in the country, but only 11.9% of its residents are uninsured according to the Gallup poll; that’s one of the lowest uninsured populations in the country).

 Find out why after the jump

He started by Googling "hangnail." (Touchstone Pictures)

by Lisa Jones

It starts innocently. The big toe on your right toe doesn’t feel quite right—it’s kind of numb, a little tingly. Maybe I just tied my running shoes too tight at the gym, you think. It’s probably nothing.

But you’re curious. So soon you’re typing “numbness” and “tingly toe” into a search engine. And in no time you’re clicking on links about “Morton’s neuroma,” “transient ischemic attack (mini-stroke)” and “vitamin B deficiency.” Oh, no, you think. It’s a mini-stroke. You’re sure of it.

Sound familiar?

A 2008 study by Microsoft Research showed that Web search engines have the potential to cause an unfounded escalation of medical concerns, a.k.a. cyberchondria. This is because the Internet is designed for finding relevance—not capturing diagnostic factors like disease probability—so search engines link rare serious disorders and common symptoms (such as brain tumors and headaches), according to Eric Horvitz, one of the study researchers.

But if you look online for health information—61 percent of American adults do, according to a June report from the Pew Internet & American Life Project—you don’t have to end up in panic mode. Use the tips found after the jump to navigate through the mass of health and medical information without losing your perspective.

by Johannah Cornblatt

This February, a 26-year-old Californian woman and her mother boarded a Continental flight for Costa Rica. When they arrived at the San Jose International Airport, a driver in a white van picked them up and took them to the five-star Intercontinental hotel. But the woman (who asked only to be identified by her first name, Jessica) hadn’t traveled to the city known as the Big Pineapple only to relax by the pool. She had flown more than 2,500 miles to undergo a weight-loss surgery—for a fraction of the price back at home.

Including airfare and accommodations (for her and her mom), Jessica saved $7,500 by choosing to go under the knife in San Jose instead of San Diego. “I thought it was such a good deal,” says Jessica, who needed to lose weight for medical reasons.

Jessica is what’s known as a “medical tourist,” and she’s one of an increasing number of Americans now seeking health care abroad for financial reasons. A new survey funded by YourSurgeryAbroad, an online directory of medical tourism, found that more than 60 percent of Americans are willing to leave the country for cheaper medical services. “As people’s budgets in America are getting tighter, they’re much more inclined to start thinking about going abroad to save money,” says Adam Nethersole, the managing director of YourSurgeryAbroad.

Is this a money-saving master plan or a recipe for funky scars and medical complications? Find out after the jump.