Courtney Lopez: Gia Thinks Our Dog Is Having a Baby

Mom & Babies
Celebrity Baby Blog

02/22/2013 at 01:00 PM ET

Denise Truscello/Wireimage

Mario Lopez is a man of his word.

Following a December wedding, the EXTRA host declared he and wife Courtney would get to work expanding their family immediately — and he wasn’t kidding.

In January, the couple discovered they were indeed expecting.

“Mario and I are so excited to add to our family! I found out a month ago and surprised Mario with the good news at breakfast,” Courtney tells PEOPLE.

But the proud parents aren’t the only ones gearing up for a new addition. Big sister Gia Francesca, 2, already has babies on the brain.

“Gia kind of understands that there is a baby in my belly,” Courtney notes. “She also told me our dog Julio has a baby in his belly — so who knows!”

Despite a bumpy start — “I had a rough couple of weeks when I first found out,” she shares — the mom-to-be is feeling better and already sporting quite the blossoming belly. “I am showing so much faster this time around,” she says.

And with warmer weather on the way, Courtney will be swathing her bump in floor-length frocks — but plans on forgoing a few fashion ensembles from her past.

“I love being pregnant in the summer! I live in maxi dresses,” she says. “Looking back at my first pregnancy, there are certain things that I wore and I have no idea why. I looked horrible and I won’t do that again!”

Originally from Pittsburgh, the expectant mama is thrilled to have settled down with her growing family on the West Coast. Her only wish? That her children will one day enjoy a winter wonderland.

“I don’t miss the East Coast at all — especially the humidity,” she explains. “The one thing I do want my children to experience from an early age is snow. There is nothing like being a kid playing in the snow.”

– Anya Leon

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FDA approves new targeted breast cancer drug

WASHINGTON (AP) — The Food and Drug Administration has approved a first-of-a-kind breast cancer medication that targets tumor cells while sparing healthy ones.

The drug Kadcyla from Roche combines the established drug Herceptin with a powerful chemotherapy drug and a third chemical linking the medicines together. The chemical keeps the cocktail intact until it binds to a cancer cell, delivering a potent dose of anti-tumor poison.

Cancer researchers say the drug is an important step forward because it delivers more medication while reducing the unpleasant side effects of chemotherapy.

"This antibody goes seeking out the tumor cells, gets internalized and then explodes them from within. So it's very kind and gentle on the patients — there's no hair loss, no nausea, no vomiting," said Dr. Melody Cobleigh of Rush University Medical Center. "It's a revolutionary way of treating cancer."

Cobleigh helped conduct the key studies of the drug at the Chicago facility.

The FDA approved the new treatment for about 20 percent of breast cancer patients with a form of the disease that is typically more aggressive and less responsive to hormone therapy. These patients have tumors that overproduce a protein known as HER-2. Breast cancer is the second most deadly form of cancer in U.S. women, and is expected to kill more than 39,000 Americans this year, according to the National Cancer Institute.

The approval will help Roche's Genentech unit build on the blockbuster success of Herceptin, which has long dominated the breast cancer marketplace. The drug had sales of roughly $6 billion last year.

Genentech said Friday that Kadcyla will cost $9,800 per month, compared to $4,500 per month for regular Herceptin. The company estimates a full course of Kadcyla, about nine months of medicine, will cost $94,000.

FDA scientists said they approved the drug based on company studies showing Kadcyla delayed the progression of breast cancer by several months. Researchers reported last year that patients treated with the drug lived 9.6 months before death or the spread of their disease, compared with a little more than six months for patients treated with two other standard drugs, Tykerb and Xeloda.

Overall, patients taking Kadcyla lived about 2.6 years, compared with 2 years for patients taking the other drugs.

FDA specifically approved the drug for patients with advanced breast cancer who have already been treated with Herceptin and taxane, a widely used chemotherapy drug. Doctors are not required to follow FDA prescribing guidelines, and cancer researchers say the drug could have great potential in patients with earlier forms of breast cancer

Kadcyla will carry a boxed warning, the most severe type, alerting doctors and patients that the drug can cause liver toxicity, heart problems and potentially death. The drug can also cause severe birth defects and should not be used by pregnant women.

Kadcyla was developed by South San Francisco-based Genentech using drug-binding technology licensed from Waltham, Mass.-based ImmunoGen. The company developed the chemical that keeps the drug cocktail together and is scheduled to receive a $10.5 million payment from Genentech on the FDA decision. The company will also receive additional royalties on the drug's sales.

Shares of ImmunoGen Inc. rose 2 cents to $14.32 in afternoon trading. The stock has ttraded in a 52-wek range of $10.85 to $18.10.

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Investors face another Washington deadline

NEW YORK (Reuters) - Investors face another Washington-imposed deadline on government spending cuts next week, but it's not generating the same level of fear as two months ago when the "fiscal cliff" loomed large.

Investors in sectors most likely to be affected by the cuts, like defense, seem untroubled that the budget talks could send stocks tumbling.

Talks on the U.S. budget crisis began again this week leading up to the March 1 deadline for the so-called sequestration when $85 billion in automatic federal spending cuts are scheduled to take effect.

"It's at this point a political hot button in Washington but a very low level investor concern," said Fred Dickson, chief market strategist at D.A. Davidson & Co. in Lake Oswego, Oregon. The fight pits President Barack Obama and fellow Democrats against congressional Republicans.

Stocks rallied in early January after a compromise temporarily avoided the fiscal cliff, and the Standard & Poor's 500 index <.spx> has risen 6.3 percent since the start of the year.

But the benchmark index lost steam this week, posting its first week of losses since the start of the year. Minutes on Wednesday from the last Federal Reserve meeting, which suggested the central bank may slow or stop its stimulus policy sooner than expected, provided the catalyst.

National elections in Italy on Sunday and Monday could also add to investor concern. Most investors expect a government headed by Pier Luigi Bersani to win and continue with reforms to tackle Italy's debt problems. However, a resurgence by former leader Silvio Berlusconi has raised doubts.

"Europe has been in the last six months less of a topic for the stock market, but the problems haven't gone away. This may bring back investor attention to that," said Kim Forrest, senior equity research analyst at Fort Pitt Capital Group in Pittsburgh.

OPTIONS BULLS TARGET GAINS

The spending cuts, if they go ahead, could hit the defense industry particularly hard.

Yet in the options market, bulls were targeting gains in Lockheed Martin Corp , the Pentagon's biggest supplier.

Calls on the stock far outpaced puts, suggesting that many investors anticipate the stock to move higher. Overall options volume on the stock was 2.8 times the daily average with 17,000 calls and 3,360 puts traded, according to options analytics firm Trade Alert.

"The upside call buying in Lockheed solidifies the idea that option investors are not pricing in a lot of downside risk in most defense stocks from the likely impact of sequestration," said Jared Woodard, a founder of research and advisory firm condoroptions.com in Forest, Virginia.

The stock ended up 0.6 percent at $88.12 on Friday.

If lawmakers fail to reach an agreement on reducing the U.S. budget deficit in the next few days, a sequester would include significant cuts in defense spending. Companies such as General Dynamics Corp and Smith & Wesson Holding Corp could be affected.

General Dynamics Corp shares rose 1.2 percent to $67.32 and Smith & Wesson added 4.6 percent to $9.18 on Friday.

EYES ON GDP DATA, APPLE

The latest data on fourth-quarter U.S. gross domestic product is expected on Thursday, and some analysts predict an upward revision following trade data that showed America's deficit shrank in December to its narrowest in nearly three years.

U.S. GDP unexpectedly contracted in the fourth quarter, according to an earlier government estimate, but analysts said there was no reason for panic, given that consumer spending and business investment picked up.

Investors will be looking for any hints of changes in the Fed's policy of monetary easing when Fed Chairman Ben Bernake speaks before congressional committees on Tuesday and Wednesday.

Shares of Apple will be watched closely next week when the company's annual stockholders' meeting is held.

On Friday, a U.S. judge handed outspoken hedge fund manager David Einhorn a victory in his battle with the iPhone maker, blocking the company from moving forward with a shareholder vote on a controversial proposal to limit the company's ability to issue preferred stock.

(Additional reporting by Doris Frankel; Editing by Kenneth Barry)

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IHT Rendezvous: North Korea Widens Access to Internet, but Just for Visitors

HONG KONG — North Korea will finally allow people to search the Internet from their mobile devices and laptops within the country’s borders. But if you’re a North Korean, you’re out of luck — only foreigners will be given the privilege.

Cracking the door open ever so slightly to wider Internet use, the government has allowed a company called Koryolink to give foreigners access to 3G mobile Internet service by March 1, The Associated Press reported.

The decision, made public Friday, comes just a month after Google’s chairman, Eric E. Schmidt, visited Pyongyang and prodded officials on allowing Internet access, noting how easy it would be to set up through Koryolink’s expanding 3G network. Presumably, his appeal was directed at giving North Koreans such capability.

“As the world becomes increasingly connected, their decision to be virtually isolated is very much going to affect their physical world, their economic growth and so forth,” Mr. Schmidt told reporters after arriving at Beijing International Airport following his visit to North Korea. “We made that alternative very, very clear.”

Foreigners were only recently given access to cellphones while traveling in the country. Previously, they had to surrender their phones with customs agents.

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American Idol: Sudden-Death Round Begins for Men

TV Watch

By Steve Helling

02/21/2013 at 11:00 PM EST

From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj and Keith Urban

George Holz/FOX

On Wednesday, 10 women sang for five spots on American Idol's live shows. On Thursday, it was the remaining guys' turn.

The judges have their own euphemisms when they don't like a performance – it's usually easy to read between the lines: If they compliment a singer on his shoes, he won't advance. On Thursday, Nicki Minaj actually told a contestant, "Kudos to you for being really freshly, nicely groomed." They might as well have had a stagehand pull him offstage with an oversized vaudeville hook.

After several weeks of good behavior by the judges, Thursday's episode showed a spark of life when Nicki – who was wearing her very best Jan Brady wig – began rolling her eyes whenever Randy Jackson spoke. At one point, Ryan Seacrest even tried to get them to kiss and make up. There was talk about lipstick, and Mariah Carey did her best to look at anything other than the awkward air kiss that followed.

But the theatrics did not eclipsed some solid singers – and a few performances that just weren't good enough for the competition.

The Good: Curtis Finch Jr. wowed judges with his version of Luther Vandross's "Superstar." It was oversung. But there was no denying Finch's vocal talent. Charlie Askew's rendition of Elton John's "Rocketman" was interesting and well-suited to his voice. And Devin Velez pleased the crowd when he infused Spanish lyrics into Beyoncé's "Listen." The three of them advanced easily.

The Okay: Elijah Liu chose Bruno Mars's "Talking to the Moon," a song that felt current and new. Paul Jolley sang Keith Urban's "Tonight I'm Gonna Cry." Generally, it's a risky move to sing a song made popular by one of the judges, but Jolley's performance was pleasant, if a little shaky. Both advanced, although the judges were split on their assessment of Jolley.

The Others: Johnny Keiser, Kevin Harris, Chris Watson and Jimmy Smith sang unspectacular versions of various songs that everyone knows. Each of them had a decent voice, but none of their performances were all that unique, and none of them advanced. On the other side of the spectrum, J'DA performed an over-the-top rendition of Adele's "Rumor Has It." It wasn't enough for him to advance, but his performance – at one point he collapsed on the floor but continued singing – was by far the most memorable of the night.

There are ten contestants – five men and five women – who have made it to the next round. Next week, the remaining 20 contestants will complete for the remaining 10 spots – and all will hope the judges don't compliment what they're wearing.

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APNewsBreak: Govs to hear Oregon health care plan

SALEM, Ore. (AP) — Oregon Gov. John Kitzhaber will brief other state leaders this weekend on his plan to lower Medicaid costs, touting an overhaul that President Barack Obama highlighted in his State of the Union address for its potential to lower the deficit even as health care expenses climb.

The Oregon Democrat leaves for Washington, D.C., on Friday to pitch his plan that changes the way doctors and hospitals are paid and improves health care coordination for low income residents so that treatable medical problems don't grow in severity or expense.

Kitzhaber says his goal is to win over a handful of other governors from each party.

"I think the politics have been dialed down a couple of notches, and now people are willing to sit down and talk about how we can solve the problem" of rising health care costs, Kitzhaber told The Associated Press in a recent interview.

Kitzhaber introduced the plan in 2011 in the face of a severe state budget deficit, and he's been talking for two years about expanding the initiative beyond his state. Now, it seems he's found people ready to listen.

Hospital executives from Alabama visited Oregon last month to learn about the effort. And the U.S. Department of Health and Human Services announced Thursday that it's giving Oregon a $45 million grant to help spread the changes beyond the Medicaid population and share information with other states, making it one of only six states to earn a State Innovation Model grant.

Kitzhaber will address his counterparts at a meeting of the National Governors Association. His talk isn't scheduled on the official agenda, but a spokeswoman confirmed that Kitzhaber is expected to present.

"The governors love what they call stealing from one another — taking the good ideas and the successes of their colleagues and trying to figure out how to apply that in their home state," said Matt Salo, director of the National Association of Medicaid Directors.

There's been "huge interest" among other states in Oregon's health overhaul, Salo said, not because the concepts are brand new, but because the state managed to avoid pitfalls that often block health system changes.

Kitzhaber persuaded state lawmakers to redesign the system of delivering and paying for health care under Medicaid, creating incentives for providers to coordinate patient care and prevent avoidable emergency room visits. He has long complained that the current financial incentives encourage volume over quality, driving costs up without making people healthier.

Obama, in his State of the Union address this month, suggested that changes such as Oregon's could be part of a long-term strategy to lower the federal debt by reigning in the growing cost of federally funded health care.

"We'll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn't be based on the number of tests ordered or days spent in the hospital — they should be based on the quality of care that our seniors receive," Obama said.

The Obama administration has invested in the program, putting up $1.9 billion to keep Oregon's Medicaid program afloat over the next five years while providers make the transition to new business models and incorporate new staff and technology.

In exchange, though, the state has agreed to lower per-capita health care cost inflation by 2 percentage points without affecting quality.

The Medicaid system is unique in each state, and Kitzhaber isn't suggesting that other states should adopt Oregon's specific approach, said Mike Bonetto, Kitzhaber's health care policy adviser. Rather, he wants governors to buy into the broad concept that the delivery system and payment models need to change.

That's not a new theory. But Oregon has shown that under the right circumstances massive changes to deeply entrenched business models can gain wide support.

What Oregon can't yet show is proof the idea is working — that it's lowering costs without squeezing on the quality or availability of care. The state is just finishing compiling baseline data that will be used as a basis of comparison.

One factor driving the Obama administration's interest in Oregon's success is the president's health care overhaul. Under the Affordable Care Act, millions more Americans will join the Medicaid rolls after Jan. 1, and the health care system will have to be able to absorb the influx of patients in a logistically and financially sustainable way.

The federal government will pay 100 percent of the costs for those additional patients in the first three years before scaling back to 90 percent in 2020 and beyond.

"There are a lot of governors who are facing the same challenges we're facing in Oregon," Kitzhaber said. "They recognize that the cost of health care is something they're going to have to get their arms around."

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Jobs, factory, inflation data favor easy Fed policy

WASHINGTON (Reuters) - A raft of U.S. economic data on Thursday from claims for jobless aid to factory activity and consumer prices pointed to a still tepid recovery and supported the argument for the Federal Reserve to maintain its monetary stimulus.

The Fed is currently buying $85 billion in bonds per month and has said it would keep up purchases until the labor market outlook improves substantially, although officials are increasingly divided over the wisdom of that course.

"The economy is in a holding pattern. It's not going to strengthen sufficiently to justify an end of the current program," said Millan Mulraine, senior economist at TD Securities in New York.

Initial claims for state unemployment benefits increased 20,000 last week to a seasonally adjusted 362,000, unwinding the bulk of the prior week's decline, the Labor Department said.

A second report from the department showed consumer prices were flat for a second straight month in January as gasoline prices fell and the cost of food held steady.

In the 12 months through January, consumer prices rose 1.6 percent, the smallest gain since July. That suggested there was little inflation pressure to worry the Fed.

Concerns over tepid job growth prompted the U.S. central bank last year to embark on its open-ended bond buying program.

However, minutes of the Fed's January 29-30 policy meeting published on Wednesday showed some policymakers feel the central bank may have to slow or stop the asset purchases before it sees an acceleration in job growth because of concerns over the financial risks of the program.

Those diverging views were evident on Thursday, with two Fed officials signaling support for scaling back the program, while another outlined the case for maintaining bond purchases until well into the second half of the year.

MANUFACTURING SLOWING

News on the manufacturing sector, which has supported the economy's recovery from the 2007-09 recession, was downbeat.

The Philadelphia Fed's business activity index dropped to minus 12.5 in February, the lowest level since June. The index, which measures factory activity in the mid-Atlantic region, had fallen to minus 5.8 in January.

A reading below zero indicates contraction in the region's manufacturing sector. The survey covers factories in eastern Pennsylvania, southern New Jersey and Delaware.

Another report from financial data firm Markit that tries to gauge overall national factory activity showed manufacturing growth slowed in February but remained near a nine-month peak.

"We believe manufacturing activity will continue to expand early in 2013," said Daniel Silver, an economist at JPMorgan in New York.

The claims and factory reports, as well as weak data from Europe weighed on U.S. stocks. The Standard & Poor's 500 index recorded its worst two-day loss since November.

Prices for U.S. government debt rose and the dollar touched a 5-1/2-month high against a basket of currencies.

Growth in the U.S. economy braked sharply in the fourth quarter, but it expanded at a 2.2 percent clip for the full year. Output is being hampered by lackluster demand as employment struggles to gain traction.

Job growth has been far less than the at least 250,000 per month over a sustained period that economists say is needed to significantly reduce the ranks of unemployed. The unemployment rate rose 0.1 percentage point to 7.9 percent in January.

Last week's claims data covered the survey period for the government's closely watched monthly tally of nonfarm jobs. Claims were up 27,000 between the January and February survey periods.

However, the increase probably does not suggest any material change in the pace of job growth given that claims have been very volatile since January because of difficulties smoothing the data for seasonal fluctuations.

Despite the weak factory and jobs data, there is reason for optimism about the economy. The housing market recovery is gaining momentum.

A report from the National Association of Realtors showed existing home sales rose 0.4 percent last month, pushing the supply of homes on the market to a 13-year low. The median home price rose 12.3 percent from a year earlier.

Rising home values should help to support consumer spending.

Although consumer prices excluding food and energy rose 0.3 percent - the largest gain since May 2011 - most of that reflected outsized increases in apparel and education costs.

"January is a tough month because you get a lot of price hikes at the start of the new year and the seasonals have a hard time sort of adjusting," said Omair Sharif, an economist at RBS in Stamford, Connecticut.

"I don't expect the core CPI to maintain that pace of increase in the near term."

(Additional reporting by Jason Lange in Washington and Steven C Johnson in New York; Editing by Andrea Ricci and James Dalgleish)

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IHT Rendezvous: What of the Ringleaders, Chinese Ask About Cultural Revolution Case

BEIJING — It’s reminiscent, perhaps, of the trials of people accused of Nazi-era crimes, a John Demjanjuk, or a Samuel K.: in China this week, a man was tried for murdering a doctor during the Cultural Revolution, the China News Service reported.

A rare episode of justice for a neglected era? Judging by a discussion on China’s biggest microblog, Sina Weibo, ordinary people don’t necessarily see it just that way; rather, some are angry that a little guy, and not the masterminds of the violence, is being punished. What about the “ringleaders,” chief among them Mao Zedong, they are saying, often obliquely?

According to the report, which was widely disseminated online via news aggregators and other sites, the defendant at the rare trial this week, in Ruian in Zhejiang province, was a 80-plus-year-old man identified only as Mr. Qiu. He strangled a Mr. Hong with a rope in 1967, on the orders of a civilian militia, which suspected Mr. Hong of spying for a rival militia, the report said. Mr. Qiu had been on the run for decades and was arrested last July.

(For an English-language account, see this article in the South China Morning Post, which may be behind a paywall.)

After the killing Mr. Qiu cut off Mr. Hong’s lower legs with a shovel “to make it easier to bury him,” and then he buried him, the report said.

Violence was common during the era: yesterday, I examined this painful time in a Letter from China and Rendezvous post about Ping Fu, the businesswoman who wrote a controversial memoir.

As I wrote in my Letter, to this day, the state tightly controls discussion about the era – when many got away with, literally, murder.

“Have the main culprits who started the Cultural Revolution been punished?” asked a person with the handle Sansu dage, who added an angry red face to the posting.

“Actually, the biggest criminals of the Cultural Revolution have not been held responsible,” wrote a person with the handle Keji huangdan menwei chuangxin. “To pursue an ordinary criminal, decades later, is absurd.”

A_Jing wrote: “There should be mandatory courses in universities to talk clearly about the crimes against humanity during the Cultural Revolution!”

Wrote another: “All the cases from the Cultural Revolution should be tried.”

That’s extremely unlikely. A few key players were tried beginning in 1980, when Jiang Qing, Mao Zedong’s wife, and other members of the Gang of Four received lengthy sentences.

Yet, “I was Chairman Mao’s dog,” Ms. Jiang said in her defense. “Whomever he told me to bite, I bit.”

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American Idol: Women Face Sudden-Death Round

American Idol

By Jamie Bufalino

02/20/2013 at 11:00 PM EST

Mariah Carey

Mario Anzuoni/Reuters/Landov

American Idol threw yet another new twist at its 40 remaining contestants: a sudden-death round.

"One song, one chance, no mercy," Ryan Seacrest said as the first group of 10 female contestants gathered in Las Vegas to try to finally sing their way – in front of a boisterous studio audience – through to the "America votes" phase of the competition.

Five women moved on, five went home.

Kentucky high school junior Jenny Beth Willis, whose rendition of a Trisha Yearwood song earned mixed reviews from the judges, was the first up. Although Keith Urban appreciated her "effortless confidence," Nicki Minaj said her performance lacked excitement (a comment that elicited the first audience boos of the season). Final result: It was the end of the road for Willis.

Tenna Torres, 28, – who attended Mariah Carey's camp for kids as a youngster – took the stage next and impressed the judges with her take on the Natasha Bedingfield's "Soulmate." But she lost style points with Minaj, who didn't like one particular aspect of her look. "Lose the hair," said Minaj, who felt the contestant's coif aged her. Final result: She made it through to the Top 20.

The three most powerful performances of the night all made it to the next round: Nashville's Kree Harrison, who despite taking a decidedly plain-Jane approach to styling, wowed the judges with her version of Patty Griffin's "Up to the Mountain." "You sang the hell out of that song," said Carey.

Angela Miller, 18, of Massachusetts, belted out Jessie J's hit "Nobody's Perfect." But she pretty much was.

And Amber Holcomb, an assistant teacher from Texas, closed the show with a rousing (and well received) rendition of "My Funny Valentine."

For the final spot of the night, it came down to Anchorage, Alaska, resident Adriana Latonio, 17, who tackled Aretha Franklin's "Ain't No Way," and Shubha Vedula, a Michigan high school senior who sang Lady Gaga's "Born This Way."

Although the judges saw potential in both contestants, they ultimately picked Lantonio's powerhouse vocals in a final emotional moment.

Thursday will bring out the guys. The first round of 10 will take the stage to try to make the top 20 – but once again, five will go home.

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Doc groups issue list of overused tests, therapies

WASHINGTON (AP) — Don't be afraid to question your doctor and ask, "Do I really need that?"

That's the advice from leading medical groups who came up dozens of tests and treatments that physicians too often prescribe when they shouldn't.

No worrisome stroke signs? Then don't screen a healthy person for a clogged neck artery, the family physicians say. It could lead to risky surgery for a blockage too small to matter.

Don't routinely try heartburn medicine for infants with reflux, the pediatric hospitalists say. It hasn't been proven to work in babies, and could cause side effects.

Don't try feeding tubes in people with advanced dementia, say the hospice providers. Helping them eat is a better option.

These are examples of potentially needless care that not only can waste money and time, but sometimes can harm, says the warning being issued Thursday from medical specialty groups that represent more than 350,000 doctors.

Too many people "think that more is better, that more treatment, more testing somehow results in better health care," said Dr. Glen Stream, former president of the American Academy of Family Physicians, which contributed to the list. "That really is not true."

The recommendations are part of a coalition called Choosing Wisely, formed by the American Board of Internal Medicine Foundation. Participating medical societies were asked to identify five tests or treatments that are commonly overused in their specialty. The list is aimed at doctors and includes references to published studies. Consumers Reports and other consumer groups are publicizing the information in more patient-friendly terms.

Last year, the coalition listed 45 overused tests and treatments. It included some of the best known examples, such as too much imaging for back pain and repeating colonoscopies too frequently.

This year's list adds 90 more overused kinds of care. Some are the result of doctors' habits, hard to overcome despite new evidence, Stream said. Others come about because patients demand care they think they need.

Some other examples:

—Don't use opioid painkillers for migraines except as a last resort, say the neurologists. There are better, more migraine-specific drugs available without the addictive risk of narcotics. Plus, frequent use of opioids actually can worsen migraines, a concept known as rebound headache.

—Just because a pregnant woman misses her due date, don't race to induce labor if mom and baby are doing fine, say the obstetricians. Inducing before the cervix is ready often fails, leading to an unneeded C-section. "Just being due by the calendar doesn't mean your body says you're due," Stream notes.

—Don't automatically give a child a CT scan after a minor head injury, say the pediatricians. About half of children who go to the ER with head injuries get this radiation-heavy scan, and clinical observation first could help some who don't really need a CT avoid it.

—And don't leave an implanted heart-zapping defibrillator turned on when a patient is near death, say the hospice providers. This technology clearly saves lives by guarding against an irregular heartbeat. But if someone is dying of something else, or is in the terminal stages of heart disease, it can issue repeated painful shocks, to no avail. Yet fewer than 10 percent of hospices have formal policies on when to switch off the implants.

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