New rules to cut confusion on sunscreen claims (AP)

WASHINGTON � Help is on the way if you're confused by the maze of sun protection numbers and other claims on sunscreens.

Starting next summer, you can start looking for SPF 15 bottles and tubes with the label "broad spectrum" and feel confident they're lowering your risk of skin cancer.

Under new rules published Tuesday, sunscreens will have to filter out the most dangerous type of radiation to claim they protect against skin cancer and premature aging. "Broad spectrum" is the new buzzword from the Food and Drug Administration to describe a product that does an acceptable job blocking both ultraviolet B rays and ultraviolet A rays.

If a sunscreen doesn't protect against both, or the sun protection factor is below 15, then it has to carry a warning: "This product has been shown only to help prevent sunburn, not skin cancer or early skin aging."

The guidelines, which spent more than 30 years in bureaucratic limbo, are designed to help consumers like Paul Woodburn, who says he's not sure of the difference between UVA and UVB rays and that he judges sunscreen by one factor alone.

"The SPF number is what counts for me," the 55-year-old Indianapolis resident said as he sat next to a public pool. "Beyond the SPF, I don't think anybody really watches."

The new regulations require that sunscreens be tested for the ability to block the more dangerous UVA rays, which can penetrate glass and pose the greatest risk of skin cancer and wrinkles. FDA currently requires testing only for protection against UVB rays, which primarily cause sunburn but can also cause cancer and other damage. That's what the familiar SPF measure is based on.

"For the first time, the FDA has clearly defined the testing required to make a broad-spectrum protection claim in a sunscreen," said Dr. Ronald L. Moy, president of The American Academy of Dermatology Association.

Under the new rules FDA will:

� Prohibit sunscreen marketing claims like "waterproof" and "sweatproof," which the agency said "are exaggerations of performance." Water-resistance claims will be allowed, but companies must explain how much time consumers can expect to get the same benefit while swimming or sweating.

� Cap the highest SPF value at 50, unless companies can provide results of further testing that support a higher number.

� Require that manufacturers phase out a four-star system currently used by some companies to rate UVA protection.

In reviewing more than 3,000 comments submitted to the agency, the FDA decided the star system was too confusing. Instead, protection against UVA should be proportional to protection against UVB, which is already measured using SPF.

SPF measures the amount of sun exposure needed to cause sunburn on UV-protected skin versus unprotected skin. The level of exposure varies by geography, time of day and skin complexion.

There is a popular misconception that SPF relates to time of solar exposure. Many consumers believe that if they normally get sunburn in one hour, then an SPF 15 sunscreen allows them to stay in the sun for 15 hours without burning. This isn't true because SPF is not directly related to length of sun exposure.

The U.S. market for sunscreens has been growing steadily because of worries about cancer and an aging population. It now totals about $900 million annually, according to research firm IBISWorld.

The new rules were decades in the making.

FDA announced its intent to draft sunscreen rules in 1978 and published them in 1999. The agency then delayed finalizing the regulations until it could address concerns from both industry and consumers.

Some consumer advocates complained the agency's final guidelines did not go far enough.

"FDA's rule will allow most products on the U.S. market to use the label `broad spectrum sunscreen,' even though some will not offer enough protection to assure Americans they can stay in the sun without suffering skin damage from invisible UVA radiation," said David Andrews, senior scientist with the Environmental Working Group.

The FDA is still working on updated guidelines for spray-on products, which use different formulations from other sun-protection solutions.

Many companies have already adopted some of the language. For example, all Coppertone products from Merck & Co.'s Schering-Plough unit and Neutrogena Sunblock from Johnson & Johnson boast "broad spectrum UVA and UVB protection."

Most dermatologists recommend a broad spectrum, water-resistant sunscreen of SPF 30 or higher every two hours while outside.

Last year an estimated 68,130 people in the U.S. were diagnosed with melanoma � the most dangerous form of skin cancer � and an estimated 8,700 died, according to the National Cancer Institute. Nearly $2 billion is spent treating the disease each year.

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AP Business Writer Tom Murphy contributed to this report from Indianapolis.

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On the Net:

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm258468.htm

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FDA wants more sunscreen protections (AP)

WASHINGTON � Federal regulators will require sunscreen manufacturers to test their products' effectiveness against sun rays that pose the greatest risk of skin cancer. Under new rules published Tuesday, they also will have to follow stricter guidelines when describing how well their products block ultraviolet B rays.

The Food and Drug Administration announced new regulations Tuesday designed to enhance effectiveness of sunscreens and make them easier to use.

Sunscreens that don't protect against both ultraviolet A and B rays and have a sun protection factor, or SPF, below 15 will have to carry warning label: "This product has been shown only to help prevent sunburn, not skin cancer or early skin aging."

Currently, the FDA only requires testing for ultraviolet B rays that cause sunburn. That's what the familiar SPF measure is based on.

But the new regulations require testing for the more dangerous ultraviolet A rays, which can penetrate glass and are most commonly linked to wrinkles and skin cancer.

FDA will also prohibit sunscreen marketing claims like "waterproof" and "sweatproof," which the agency said "are exaggerations of performance."

Products that protect against UVA and UVB will be labeled "broad spectrum." In an effort to clear up the confusing mix of numbers, acronyms and symbols on sunscreen labels, the FDA says manufacturers must phase out a four-star system currently used by some companies to rate UVA protection.

The FDA rules will also standardize the older SPF protection rankings for UVB rays. Only sunscreens with an SPF of 15 or higher can claim to lower the risk of cancer. The FDA also proposed capping the highest SPF value at 50, unless companies can provide results of further testing that support a higher number. Some products on the market claim to offer SPF protection of a 100 or higher.

The SPF figure indicates the amount of sun exposure needed to cause sunburn on sunscreen-protected skin compared with unprotected skin. For example, an SPF rating of 30 means it would take the person 30 times longer to burn wearing sunscreen than with exposed skin.

FDA announced its intent to draft sunscreen rules in 1978 and published them in 1999. The agency then put the plan on indefinite hold until it could address issues concerning both UVA and UVB protection.

The delay in FDA regulations means many companies have already adopted the some of the language. For example, all Coppertone products from Merck & Co.'s Schering-Plough unit and Neutrogena Sunblock from Johnson & Johnson already boast "broad spectrum UVA and UVB protection."

Most dermatologists recommend a broad spectrum, water-resistant sunscreen of SPF 30 or higher every two hours while outside.

Last year an estimated 68,130 people in the U.S. were diagnosed with melanoma � the most dangerous form of skin cancer � and an estimated 8,700 died, according to the National Cancer Institute. Nearly $2 billion is spent treating the disease each year.

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Author Terry Pratchett defends right-to-die film (AP)

LONDON � Writer Terry Pratchett said Tuesday that watching a man being helped to die had reaffirmed his support for assisted suicide, while anti-euthanasia groups criticized the televised death as propaganda.

The suicide, filmed for a BBC documentary, has reopened debate on Britain's decades-old law against helping another person end their life.

Pratchett watched Peter Smedley, a 71-year-old British businessman with motor neuron disease, take a lethal dose of barbiturates at a Swiss suicide clinic.

Best-selling fantasy author Pratchett was diagnosed with early onset Alzheimer's disease in 2007 and is a vocal supporter of the right to die.

He said he was moved by Smedley's death at a clinic run by the Dignitas group, broadcast Monday on BBC television.

"He said to me 'Have a good life.' And then he shook (my PA) Rob's hand and said 'Have a good life, I know I have,'" 63-year-old Pratchett told the broadcaster.

"The incongruity of the situation overtakes you. A man has died, that's a bad thing, but he wanted to die, that's a good thing."

Pratchett said he was ashamed that British people had "to drag themselves to Switzerland, at considerable cost, in order to get the services that they were hoping for."

Anti-euthanasia campaigners criticized the decision to show Smedley's death. The former Bishop of Rochester, Michael Nazir-Ali, called the program "propaganda on one side."

"I think an opportunity had been bypassed of having a balanced program � the thousands of people who use the hospice movement and who have a good and peaceful death, there was very little about them," Nazir-Ali told BBC radio.

The BBC denied bias, saying it was "giving people the chance to make their own minds up on the issue."

Assisted suicide is illegal and carries a maximum 14-year sentence in England and Wales, but few people have been prosecuted in recent years for helping friends or relatives die abroad.

After a series of legal test cases, the chief prosecutor last year drew up guidelines to clarify when criminal charges would be more or less likely.

Mitigating factors include a motive of compassion, evidence the victim had made a voluntary and informed decision to end their lives and evidence a suspect tried to talk the victim out of suicide.

In Switzerland, "passive assisted suicide" � giving another person the means to kill themselves � is legal provided the helper isn't a medical doctor and doesn't personally benefit from a patient's death.

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John Heilprin in Geneva contributed to this report.

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Doc's arthritis struggle shows illness' severity (AP)

WASHINGTON � Dr. Sue Zieman can almost set her watch by her disease: Twice a day, she gets a fever and the already arthritic joints in her arms and hands, legs and feet abruptly, painfully swell even more. During the evening flare, even the tendons in her feet puff up, rope-like worms just under her skin.

The rest of the day, her joints are so stiff that the once robust Maryland physician frequently uses a scooter to get around. Just shaking hands hurts the 47-year-old.

Inflammatory arthritis is disabling Zieman but exactly what kind and what caused it to attack suddenly is a mystery. Nor do her fellow doctors know what treatment to suggest next. She's tried all of today's arthritis medications with little relief.

Say arthritis, and people tend to shrug it off as a rite of passage of aging. The reality is much more complicated. Arthritis encompasses 100 different conditions and affects about 46 million people in the U.S.

Osteoarthritis � where cartilage gradually erodes with the wear-and-tear of aging � is by far the most common type.

But inflammatory types � such as rheumatoid arthritis, psoriatic arthritis, lupus � occur when something makes the immune system run amok and attack the body's own tissues, eating away cartilage and eventually harming bone. It can strike at far younger ages.

Zieman's saga highlights not just how much doctors still have to learn about arthritis, but how devastating a severe case can be.

"It totally stripped my identity," says Zieman, whose illness cost her career as a cardiologist and her love of sailing. "I just don't think people realize how debilitated you can be, and young."

She uses humor to help cope, nicknaming her scooter Bella and joking that "I know I'm going to turn into a pumpkin each night" when that 7 p.m. flare sends her to bed.

Infections sometimes trigger inflammatory arthritis, and that's what probably happened with Zieman. She'd just returned from a business trip to India in December 2008 when she came down with a fever, fatigue and pain in her shoulder and knee. Antibiotics didn't help.

A month later, Zieman became short of breath and both legs swelled. An emergency hospital admission prompted a battery of tests for infections, even super-rare ones she might have encountered abroad. Again, nothing. Maybe it was cancer? Nope.

Then the joints in her wrists and hands began swelling. Soon she couldn't lift a glass. Swelling and pain moved to her ankles and toes.

Her joints had the classic look of rheumatoid arthritis, a disease that affects 1.3 million Americans and that can begin with a low fever and fatigue.

But it wasn't a slam-dunk diagnosis. Blood tests check for specific markers of the disease, such as a substance called rheumatoid factor, and Zieman's results were negative, something that occurs occasionally.

More important, a variety of drugs hit the market in the last 15 years that can rein in the disease and target some of the immune cells doing the damage.

But drug after drug failed, and the illness was spreading to her elbows, knees, hips, even her jaw.

Within a few months, she was on leave from her cardiology job. She couldn't walk up the stairs at home and moved to a one-floor apartment that's walking � or scootering � distance from her new job in aging research at the disability-friendly National Institutes of Health.

She even had episodes of an irregular heartbeat, as inflammation struck part of the heart.

Then six months ago, she started having those bizarre twice-a-day flare-ups. When she joined some friends for a vacation in France recently, the flares just switched time zones.

That's not typical rheumatoid arthritis, leaving in question Zieman's diagnosis and what to do next.

While Zieman's case is extreme, it's not unusual for inflammatory arthritis to become debilitating so quickly, especially in young or middle-aged women, says Dr. Assil Saleh, a Washington rheumatologist and internist who, along with doctors at Johns Hopkins University and the NIH, treats Zieman.

When an infection is the suspected trigger, patients desperately want to know which bug even though it's usually long gone by the time joints swell, leaving rogue immune cells in its wake.

"Now we're left with a forest fire, and we try to extinguish it," Saleh explains. Most cases of inflammatory arthritis "are not curable but they are treatable in this day and age."

Zieman gets modest relief from very high doses of the steroid prednisone, along with injections of the drug Kineret that targets an inflammation-causing protein named interleukin-1.

She's still hopeful scientists will point her to better treatment as she enters an NIH study. Researchers will videotape her evening flare-ups and try to measure what role that interleukin-1 is playing.

And while she wants to know what's fueling her disease � "I'm as geeky as most cardiologists" � her bigger frustration is how few services help arthritis patients with daily functioning: "I need to know how to open the fridge."

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Could prenatal DNA testing open Pandora's box? (AP)

NEW YORK � Imagine being pregnant and taking a simple blood test that lays bare the DNA of your fetus. And suppose that DNA could reveal not only medical conditions like Down syndrome, but also things like eye color and height. And the risk for developing depression or Alzheimer's disease. And the chances of being gay.

So far that's still science fiction. But scientists have been taking some baby steps in that direction. And some ethics experts say it's time to start talking now about what that could mean for parents and society.

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This is the second story in a two-part series on fetal DNA testing and the ethical issues raised by it.

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Scanning fetal DNA from a blood test will be "without question a major medical advance that promises to greatly improve current prenatal care," says Jaime King, an associate professor at the UC Hastings College of Law in San Francisco who studies genetic testing. But bringing it into practice "raises significant practical, legal, ethical and social challenges," she says.

"This really changes the experience of what it will be like to be pregnant and have a child," said Marcy Darnovsky of the Center for Genetics and Society in Berkeley, Calif. "I keep coming up with the word, game-changer."

She wonders if parents would withhold their commitment to a pregnancy until test results show a fetus is "good enough" to be born. And what, she asks, is good enough?

She and others worry about how well couples will be able to understand this flood of information, and just what should be revealed.

The issues have been discussed before. The DNA of a fetus has long been recoverable through medical procedures, with a small risk of miscarriage. But a blood test would be free of that risk, which should make many more women interested in it and doctors willing to test for a wider range of conditions, some experts say. And the results could come early enough to allow for an abortion before the pregnancy is even obvious.

The trigger for the new round of discussion is a couple of papers published last December. In preliminary results, two research teams showed that they could essentially reconstruct a baby's genetic makeup by recovering fragments of fetal DNA from the mother's bloodstream. That ability, plus the rapidly falling cost of analyzing DNA, would open the door to inspecting individual genes.

That would go well beyond the more accurate prenatal blood test for Down syndrome that some companies hope to market within a year.

Within five to 10 years, doctors may be able to test for 100 or 200 diseases, albeit many of them rare, estimates Stanford University law professor Hank Greely, who studies the implications of biomedical technologies.

Prenatal testing "is going to put a lot more information about the genetics of a child into the hands of a lot more parents," said King.

That knowledge has a flip side. "How much responsibility are we expecting people to take for the genetic makeup of any child they might have?" asks Josephine Johnston, a research scholar at the Hastings Center, a bioethics think tank near New York City.

If a child is born with a condition that could have been detected, the presence of the test changes that outcome "from something that happened to you, to something that you participated in," she says.

"That's a very big burden to place on would-be parents," she said, adding that it's hard for a pregnant woman to refuse any test for a medical condition because it feels like the responsible thing to do.

Johnston has personal experience; she gave birth to a girl just two years ago. When offered a medical screening test for the fetus, she generally felt compelled to take it.

"At the moment these things happen, it's just you there by yourself," she said. Some people might like that level of control, but others "would be happier to leave things up to chance a little more."

She said if she were pregnant again and offered a wider range of tests, she'd restrict herself to "really, really serious disabilities and disorders."

King, who had a son 18 months ago, said she wouldn't have wanted to know about any risk for incurable diseases that show up in adulthood. Those are "things that would have caused us to spend a lot of time worrying about what his future would look like even though there's nothing we could do about it," she said.

In the future, such testing could also look for other genes � some of which aren't yet identified � that affect non-medical traits.

"If no limitations are put on, you can have a couple get a prenatal genetic test in the future saying their fetus has ... a 60 percent chance of having breast cancer at the age of 60 and a 30 percent chance of being gay," says Dr. Brian Skotko, a board member of the National Down Syndrome Society.

Since such information would come early enough for an abortion, Skotko says, "The ultimate question for society is, What forms of human variation are valuable?"

Then there's the possibility of direct-to-consumer companies stepping in to fill demand, King said. Couples who go that route may miss out on getting help in understanding the nuances of what the test results really mean, said Dr. Mary Norton, a Stanford professor of obstetrics and gynecology.

Once the prenatal information is available, another question arises, King said: Should a woman be allowed to get an abortion for any reason, even a trivial one like test results about height or eye color? Some state governments have passed laws outlawing abortions on the basis of sex, she said. But it's not clear whether those are constitutional, and a woman might simply not reveal her true reasons for wanting the abortion, King said.

Skotko points out that people use their own personal perspective in deciding what they want for their children. Some couples who are deaf from a genetic condition already use current technology to avoid having children with normal hearing. "It's their lens by which they view the world, and they want a child who views the world through that same lens," he said.

Greely sees other concerns. Will the testing become so routine that women won't even realize they authorized it, and then be faced with information and an abortion decision they didn't necessarily want? How can they be helped to make an informed decision on whether to be tested? And if offered a choice of genes to be tested, or results to be told about, who will help them sort through the long list to decide what they want to know? Few doctors are informed enough, and there aren't enough genetic counselors go around, he said.

The same problem arises later when it comes time to help couples understand what the results really mean, he said. "How do you tell somebody about 100 different genetic things?" he asked. "Who's going to do that? Who's going to listen to that? Who's going to pay for that?"

Results can be complex. For example, how is a woman supposed to balance a 25 percent increase in risk for one disease versus a 15 percent decrease in another, Darnovsky asks.

On a societal level, King said she's concerned that the prenatal diagnosis might become seen as a way of "curing" diseases by aborting fetuses that have them.

Greely recently spoke about prenatal diagnosis before the Presidential Commission for the Study of Bioethical issues, a federal advisory board. Valerie Bonham, executive director, said the commission may pursue the topic further as part of a project on DNA technology. "It's an important and emerging issue," she said.

Norton doesn't believe the arrival of a blood test for DNA analysis would raise all the issues some observers cite. But she thinks it's still a good idea to talk about what the new technology could mean.

"I think that it is always better and helpful and important to bring up all of these issues, whether they are likely to really become reality or not," she said.

"Once you've opened Pandora's box, it's harder to close it."

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Comfort or conflict: Earlier Down syndrome test (AP)

NEW YORK � The results of the blood test revealed only a risk, but when she saw them, she still threw up. Now she had to find out for sure.

So she lay on her back at a doctor's office, praying, comforted by her Christian faith and her mother at her side, while a needle was slipped into her belly.

Erin Witkowski of Port Jervis, N.Y., was going to find out if the baby she was carrying had Down syndrome.

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This is the first of a two-part series on prenatal testing and the ethical issues raised by it.

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For years, many women have gone through an experience like hers: a blood or ultrasound test that indicates a heightened risk of the syndrome, followed by a medical procedure to make a firm diagnosis by capturing DNA from the fetus.

Usually it's the needle procedure Witkowski had, called amniocentesis, done almost four months or more into the pregnancy. Sometimes it's an earlier test called CVS, or chorionic villus sampling, which collects a bit of tissue from the placenta. Both pose a tiny but real chance for miscarriage, and experts say highly skilled practitioners are not available everywhere.

But by this time next year there may be an alternative � one that offers accurate results as early as nine weeks into the pregnancy.

Companies are racing to market a more accurate blood test than those available now that could spare many women the need for an amnio or CVS. It would retrieve fetal DNA from the mother's bloodstream. And the answer could come before the pregnancy is obvious to others. For some women, that might mean abortion is a more tenable choice. For others it could be a mixed blessing.

Down syndrome slows mental and physical development, and people with it usually show mild to moderate disability in intellect and skills for everyday living. Physically, they often have a flat face with a short neck and smaller hands and feet. They're at risk for complications like heart defects and hearing problems. Life expectancy is about 60 years.

Most cases are diagnosed after birth now, but if the blood test is widely adopted it could become chiefly a prenatal event.

A diagnosis before birth can pose a difficult challenge for couples as they decide whether to continue the pregnancy. It's not only about child-rearing, but also about what happens as the child grows into an older adult and may need care that the aging parents struggle to provide, says Dr. Mary Norton, a Stanford University professor of obstetrics and gynecology.

Dr. Brian Skotko, a Down syndrome specialist at Children's Hospital Boston who has written a research paper for doctors on how to deliver a diagnosis, said "the vast majority of people with Down syndrome and families affirm that their contributions to their communities are significant, and their lives are very valuable."

Current prenatal screening has already cut into the number of babies born with the syndrome, which now stands at about 6,000 each year in the United States, or about 1 in every 691 babies, says Skotko, who serves on the board of the National Down Syndrome Society. He cites one study that concludes the number of Down syndrome births in the nation dropped 11 percent between 1989 and 2006, a time when it would otherwise be expected to rise 42 percent.

Initially, doctors are expected to use the new blood test with women at risk for a Down syndrome pregnancy, such as those older than 35. A negative result would indicate a woman could skip the amnio or CVS; a positive result would suggest she get one done to be sure.

Eventually it might replace the routine screening tests offered to all pregnant women. Since the test sounds fewer false alarms than current tests, fewer women would be told they need the invasive follow-up procedures, experts say. And some suggest that with further fine-tuning, it could largely replace amnio and CVS. With no miscarriage risk, more women might be willing to take it, and so more women would find out they have a Down syndrome pregnancy.

Two California companies, Sequenom Inc. and Verinata Health Inc., hope to offer the test to doctors in the United States by next April. They say it could be done in the first trimester, with Sequenom aiming as early as 10 weeks, and Verinata as early as eight weeks. Results would be available 7 to 10 days later. In addition, LifeCodexx AG of Germany says it wants to start offering its test in Europe by the end of this year, to be performed at 12 to 14 weeks initially. None of the companies would discuss its cost.

"I would have definitely taken a noninvasive test over the struggle for deciding whether to do an amnio or not," says Nancy McCrea Iannone of Sewell, N.J., who gave birth six years ago to a daughter with Down syndrome. She'd been alerted by screening results, but hesitated to get amniocentesis because of the risk of a miscarriage and the prospect of "a needle in my belly," she recalls. Ultimately, she did have one.

Iannone now counsels women who plan to deliver babies with Down syndrome. Her charitable group, Down Syndrome Pregnancy Inc., lists several reasons for getting a diagnosis before birth, such as more time to adjust, grieve and learn about the condition, preparing friends and family, and checking on available medical care and insurance.

But detecting the condition earlier in a pregnancy through the new blood test would be a mixed blessing, Iannone said.

The time between diagnosis and birth is "an unnatural state," she said, and "the longer that time period is, the harder it is."

"All you know is that they have Down syndrome. You're coping with that diagnosis in a vacuum, without a baby... It's fear of the unknown, you haven't met your baby yet. You spend a lot of time worrying."

That might weigh heavily on women who haven't decided whether to continue the pregnancy or not, she said.

Since the new blood test could deliver an answer so early � before a pregnancy is showing or the baby is kicking � it might make getting an abortion easier, several observers said. Women haven't bonded so much, and "they wouldn't have to explain to as many people," said Christie Brooks, who moderates an online support group for women who've gotten abortions for medical reasons.

"No one needs to know you're pregnant," said Skotko. "Maybe you haven't even told your husband."

Skotko said he respects that a woman's right to continue or terminate a pregnancy is a personal one for couples. But he's concerned that in the case of Down syndrome, many women may be getting bad information about what having the baby would mean. And if the new test became routine it would only exacerbate that problem, he said.

Studies show medical students are poorly trained about people with disabilities and that some doctors who make a prenatal diagnosis emphasize negative information about the condition, he said.

"We have a fleet of physicians who are saying they're untrained, unprepared and sometimes knowingly inserting their own personal bias," he said. "How are women today able to make a truly informed decision?"

Others say the blood test could thrust some women into a choice they didn't ask to make.

Hank Greely, a Stanford University law professor, said women sign forms for plenty of blood tests during prenatal care and often don't focus on them. Many California women are surprised to learn they'd authorized the screening test for Down syndrome, he said.

If these tests are someday replaced by the new blood test, many women may be told out of the blue not simply that they're at risk, but that in fact their baby almost surely has Down syndrome, Greely says.

"They're going to jump directly to the final answer, which is not necessarily something they wanted to get," Greely said. So the new test poses a challenge to the medical establishment about how to assure that women get adequate counseling to make an informed choice, he said.

Witkowski, who prayed as that needle was slipped into her swollen belly in 2009, got her answer: It was Down syndrome. As her doctor gave her the news, her baby kicked her and "I could see my belly move," she recalled.

Her doctor started talking immediately about abortion, a step Witkowski rejected. She changed doctors and gave birth to Grady in February 2010.

"When they first gave him to me," Witkowski said, "I saw tiny little hands, and he had the most beautiful eyes... He didn't have `Down syndrome' stamped on his forehead. He cried and he peed and he pooped. He was a baby."

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Online:

Current prenatal tests: http://bit.ly/iev0ZG

National Down Syndrome Society: http://www.ndss.org/

Erin Witkowski's blog: http://skiingthroughlife.wordpress.com/

Down Syndrome Pregnancy Inc.: http://downsyndromepregnancy.org

Brooks' group about pregnancy termination: http://bit.ly/jJzQuy

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