Medicare paid $5.1B for poor nursing home care

SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

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On the Web:

The OIG report: http://1.usa.gov/VaztQm

The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1

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Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.

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Pope Benedict Prepares for Final General Audience

Agence France-Presse — Getty Images

Tens of thousands of believers gathered for Pope Benedict XVI’s final general audience in St. Peter’s Square on Wednesday.

ROME — In the waning hours of his troubled papacy, Pope Benedict XVI prepared on Wednesday to hold his final general audience as tens of thousands of believers gathered in St. Peter’s Square a day before his resignation takes formal effect.

Vatican officials said around 50,000 tickets had been requested for the occasion, which is likely to draw many more pilgrims into the broad boulevard leading toward the Vatican from the River Tiber.

The pope sent shock waves around the Roman Catholic world on Feb. 11 when he announced he would resign on Thursday — the first pope to have done so voluntarily in six centuries.

The announcement left officials scrambling to deal with the protocols of his departure as he ceases to be the leader of the world’s 1.1 billion Roman Catholics. Only on Tuesday did the Vatican announce that he will keep the name Benedict XVI and will be known as the Roman pontiff emeritus or pope emeritus.

He will dress in a simple white cassock, forgoing the mozzetta, the elbow-length cape worn by some Catholic clergymen, the Vatican spokesman, the Rev. Federico Lombardi, told reporters at a news briefing on Tuesday.

And he will no longer wear the red shoes typically worn by popes, symbolizing the blood of the martyrs, Father Lombardi said, opting instead for a more quotidian brown.

Benedict’s looming departure has also triggered a surge of maneuvering among the 117 cardinals who will elect his successor in a conclave starting next month, reviving concerns about the clerical abuse scandals that dogged Benedict’s time at the Vatican.

Indeed, the abrupt resignation of the most senior Roman Catholic cardinal in Britain on Monday — after accusations that he made unwanted sexual advances toward priests years ago — showed that the taint of scandal could force a cardinal from participating in the selection of a new pope.

His exit came as at least a dozen other cardinals tarnished with accusations that they had failed to remove priests accused of sexually abusing minors were among those gathering in Rome to prepare for the conclave.

But there was no indication that the church’s promise to confront the sexual abuse scandal had led to direct pressure on those cardinals to exempt themselves from the conclave.

Rachel Donadio reported from Rome, and Alan Cowell from Paris.

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Bobby Brown Sentenced to 55 Days in Jail in Drunk Driving Case

02/26/2013 at 09:30 PM EST

Bobby Brown has been sentenced to 55 days in jail and four years probation in his most recent drunk driving arrest.

Brown, 44, was pulled over in Studio City, Calif., on Oct. 24 for driving erratically and was arrested when the officer detected "a strong scent of alcohol." He was charged with DUI and driving on a suspended license.

He was also arrested for driving under the influence in March of 2012.

Brown pled no contest to the charges on Tuesday, reports TMZ. He was also ordered to complete an 18-month alcohol treatment program.

The singer, who married Alicia Etheredge in Hawaii in June of 2012, must report to jail by March 20.

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Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

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Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

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British Media to Challenge Secrecy Bid in Litvinenko Case

The British Broadcasting Corporation said it and other news organizations would oppose an effort on Tuesday by the British government to limit information disclosed to the planned inquest into the death of Alexander V. Litvinenko, a former officer in the KGB who died of radiation poisoning in London in 2006.

The BBC reported that the government had planned to apply for a so-called Public Interest Immunity certificate, usually issued on the grounds of national security. The case has strained ties between Britain and Russia, reviving memories of the cold war.

Mr. Litvinenko, who styled himself a whistle-blower and foe of the Kremlin, died in November, 2006, weeks after he secured British citizenship. He had fled from Russia to Britain in 2000.

Britain’s Crown Prosecution is seeking the extradition from Russia of Andrei K. Lugovoi, another former KGB officer, to face trial on murder charges. Mr. Lugovoi denies the accusation and Russia says its constitution forbids it from sending its citizens to other countries to face trial.

At a hearing in December in advance of the inquest, which is to start on May 1, Ben Emmerson, a lawyer representing Mr. Litvinenko’s widow, said that Mr. Litvinenko was a “registered and paid agent and employee of MI6, with a dedicated handler whose pseudonym was Martin.”

Mr. Litvinenko would meet his handler in central London, Mr. Emmerson said, and discuss the encounters with his wife, Marina.

Mr. Litvinenko also worked for the Spanish intelligence service, Mr. Emmerson said, and both the British and Spanish spy agencies made payments into a joint account with his wife. The lawyer added that the inquest should consider whether MI6 failed in its duty to protect him against a “real and immediate risk to life.”

The BBC said Marina Litvinenko would also oppose the British government’s effort to limit information about its knowledge of her husband his death.

Sir Robert Owen, a judge overseeing the inquest and its preparations, has said in previous hearings that he will examine what was known about threats to Mr. Litvinenko and would also seek to determine whether the Russian state bore responsibility. In a deathbed statement, Mr. Litvinenko directly blamed President Vladimir V. Putin, who dismissed the accusation.

Russian state prosecutors are expected to be represented at the inquest. Moscow has denied British suggestions that it may have been involved in killing Mr. Litvinenko, who died after ingesting polonium 210 — a rare radioactive isotope — at the Pine Bar of the Millennium Hotel in central London.

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The Bachelor's Sean Lowe Reveals Final Two

TV Watch

The Bachelor

02/25/2013 at 10:30 PM EST

From left: AshLee, Lindsay and Catherine

Kevin Foley/ABC(3)

And then there were two.

After three incredible dates in Thailand with the remaining women, The Bachelor's Sean Lowe faced a difficult decision at the end of Monday's episode: Would he send home AshLee, Catherine or Lindsay?

Keep reading to find out who got a rose – and who was left heartbroken ...

Sean said goodbye to early favorite AshLee in a surprising elimination that left her virtually speechless.

Visibly upset, AshLee left Sean's side without saying goodbye. She even asked him to not walk her to the waiting car that would take her away.

But Sean did get to explain. "I thought it was you from the very beginning," he said. "This was honestly the hardest decision I've ever had to make ... I think the world of you. I did not want to hurt you."

"This wasn't a silly game for me," AshLee said as the car drove away. "This wasn't about a joy ride. It wasn't about laughing and joking and having fun."

She added: "It's hard to say goodbye to Sean because I let him in ... It's the ultimate [rejection]."

Check back Tuesday morning for Sean Lowe's blog post to read all about his Thailand dates and why he chose to send AshLee home

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Koop, who transformed surgeon general post, dies

With his striking beard and starched uniform, former Surgeon General Dr. C. Everett Koop became one of the most recognizable figures of the Reagan era — and one of the most unexpectedly enduring.

His nomination in 1981 met a wall of opposition from women's groups and liberal politicians, who complained President Ronald Reagan selected Koop, a pediatric surgeon and evangelical Christian from Philadelphia, only because of his conservative views, especially his staunch opposition to abortion.

Soon, though, he was a hero to AIDS activists, who chanted "Koop, Koop" at his appearances but booed other officials. And when he left his post in 1989, he left behind a landscape where AIDS was a top research and educational priority, smoking was considered a public health hazard, and access to abortion remained largely intact.

Koop, who turned his once-obscure post into a bully pulpit for seven years during the Reagan and George H.W. Bush administrations and who surprised both ends of the political spectrum by setting aside his conservative personal views on issues such as homosexuality and abortion to keep his focus sharply medical, died Monday at his home in Hanover, N.H. He was 96.

An assistant at Koop's Dartmouth College institute, Susan Wills, confirmed his death but didn't disclose its cause.

Dr. Richard Carmona, who served as surgeon general a decade ago under President George W. Bush, said Koop was a mentor to him and preached the importance of staying true to the science even if it made politicians uncomfortable.

"He set the bar high for all who followed in his footsteps," Carmona said.

Although the surgeon general has no real authority to set government policy, Koop described himself as "the health conscience of the country" and said modestly just before leaving his post that "my only influence was through moral suasion."

A former pipe smoker, Koop carried out a crusade to end smoking in the United States; his goal had been to do so by 2000. He said cigarettes were as addictive as heroin and cocaine. And he shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of AIDS.

Chris Collins, a vice president of amFAR, the Foundation for AIDS Research, said many people don't realize what an important role Koop played in the beginning of the AIDS epidemic.

"At the time, he really changed the national conversation, and he showed real courage in pursuing the duties of his job," Collins said.

Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.

"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.

In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."

Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination met staunch opposition.

Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

But Koop, a devout Presbyterian, was confirmed after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.

In 1986, he issued a frank report on AIDS, urging the use of condoms for "safe sex" and advocating sex education as early as third grade.

He also maneuvered around uncooperative Reagan administration officials in 1988 to send an educational AIDS pamphlet to more than 100 million U.S. households, the largest public health mailing ever.

Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.

Koop further angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

Koop maintained his personal opposition to abortion, however. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.

Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.

At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day, but Reagan would not interfere.

Koop, worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, opened his institute at Dartmouth to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.

Koop was born in the New York City borough of Brooklyn, the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats.

He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.

Koop received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it.

In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children, one of whom died in a mountain climbing accident when he was 20.

Koop was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine.

He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.

Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.

Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was by far the best-known surgeon general and for decades afterward was still a recognized personality.

"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."

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Ring reported from Montpelier, Vt. Cass reported from Washington. AP Medical Writers Lauran Neergaard in Washington and Mike Stobbe in New York contributed to this report.

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World shares slide on Italy vote, German Bunds gain

LONDON (Reuters) - Italy's inconclusive election result sparked a selloff on world equity markets on Tuesday and sent safe-haven German bond yields sharply lower as investors feared a resurgence of the euro zone debt crisis.

The euro briefly touched a seven-week low against the dollar to trade near $1.30 after no clear majority emerged from the vote, raising the prospect of weeks of political uncertainty and potentially another election later in the year.

"This is the worst possible outcome from the market's point of view," said Alessandro Tentori, Citigroup's head of global rates.

Yields on 10-year Italian government bonds jumped 45 basis points to 4.82 percent while Italy's main stock market index <.ftmib> tumbled five percent with shares in some of the country's major banks down over 10 percent.

Other European markets were also slumping, with London's FTSE 100 <.ftse>, Paris's CAC-40 <.fchi> and Frankfurt's DAX <.gdaxi> down as much as 2.5 percent. The pan-European FTSEurofirst 300 index <.fteu3> was down 1.3 percent. <.eu/>

Italy's centre-left bloc led by Pier Luigi Bersani narrowly won control of the lower house but no party or coalition appeared to be in a position to take a majority in the equally powerful Senate. A party led by the anti-establishment comic Beppe Grillo gained more than 25 percent of the vote.

"The very close result and the stalemate between the two houses of parliament point to a non-trivial risk of new elections," Holger Schmieding, chief economist at Berenberg Bank, adding there was also a small risk that new elections could lead to a referendum in Italy on the euro.

The euro steadied at around $1.3080, up about 0.15 percent after falling as low as $1.3039, its lowest since January 10.

The focus will now be on an Italian treasury bill auction later, when Rome's borrowing costs could rise.

Ahead of the auction investors were showing a clear preference for safety, with the yield down 8 basis points at 1.5 percent on 10-year German bonds, while riskier Spanish and Portuguese bonds were coming under heavy selling pressure.

Elsewhere investors were awaiting testimony later in the day from U.S. Federal Reserve Chairman Ben Bernanke for further clues to when the central bank intends to slow down or stop its bond-buying program.

Financial markets were rattled last week by minutes of the Fed's January meeting showing some Fed officials were thinking of scaling back its monetary stimulus earlier than expected.

U.S. stock futures were flat to suggest a cautious Wall Street start. <.l><.eu><.n/>

(Reporting by Richard Hubbard. Editing by Alastair Macdonald)

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India Ink: On Kissing, Bollywood, and Rebellion

Gardiner Harris’s recent piece in the New York Times made me do a double take, not just because of the attachment of the word “bombshell” before Katrina Kaif, which to me is somewhat like using “razor-sharp” as the defining adjective for President George W. Bush, but because of the cultural “Rubicon-crossing” significance attributed to a scene in “Jab Tak Hai Jaan:”

A pivotal screen kiss reflected the changing romantic landscape here. Kissing scenes were banned by Indian film censors until the 1990s, and Shah Rukh Khan, a Bollywood heartthrob who is one of the world’s biggest movie stars, has been teasing Indian audiences in dozens of films since then by bringing his lips achingly close to those of his beautiful co-stars. But his lips never touched any of theirs until he kissed the Bollywood bombshell Katrina Kaif in “Jab Tak Hai Jaan,” which was released in December 2012.

Mr. Khan tried to soften the impact by saying in a published interview that his director made him do it. But the cultural Rubicon had been crossed.

As a longtime pop culture buff and dispassionate observer of screen-kisses, while I may agree with the author’s observation of Shah Rukh Khan’s lips historically tending toward those of his heroine’s but never quite getting there, like the limit of a function, I firmly dispute the notion that Mr. Khan’s tepid liplock has given the kiss the acceptability it did not have before. That’s because kisses have been in mainstream Indian movies since the late 1920s with reigning screen diva, Devika Rani’s kiss with her off-screen husband, Himanshu Rai, for a full four minutes in “Karma” (1933) being the veritable stuff of legends.

It is true, of course, that Indian movies have had far more people chasing each other around the trees than kissing, and that is primarily because of the dictates of the dreaded censor board, the cheerless cinematic embodiment of the Nehruvian ideal of big-government intruding into every aspect of national life, which made directors move the camera away at strategic moments to two flowers touching each other.

But around the time when I started watching movies, which was the mid-1980s, kisses and intimacy were very much part of big-banner Bollywood, be it in “Ram Teri Ganga Maili” (1985) or “Janbaaz” (1986) or “Qayamat Se Qayamat Se Tak” (1986) and the truly shuddering scene in “Dayavan” (1988) between the venerable Vinod Khanna and an upcoming actress by the name of Madhuri Dixit, a sequence responsible for many VCRs getting jammed due to excessive pausing and replaying (or so my unscientific survey tells me).

Then of course, there was Aamir Khan establishing his reputation for commitment to detail and the embracing of variety by kissing Juhi Chawla in “Qayamat Se Qayamat” (1986) and “Love Love Love” (1986), Pooja Bhatt in “Dil Hai Ki Manta Naheen” (1991), Pooja Bedi in “Jo Jeeta Hai Sikander” (1992) and then Karishma Kapoor in “Raja Hindustani” (1997) for a full 40 seconds, if experts are to be believed.

In the 2000s, there were movies that had 17 kissing scenes in them, and an actor by the name of Emran Hashmi had made kissing a calling card in each of his movies, earning the sobriquet “serial kisser.”

I don’t want to keep on inserting citations to prior art — after all, this is not a journal paper — but my point is that by 2012, when “Jab Tak Hai Jaan” came to pass, Indian audiences had been quite desensitized to on-screen kissing.

In other words, it is no big whoop. Or should I say, no big “mwah.”

So if it’s not the influence of movies, why then do we see more public displays of affection (of which kissing is but one manifestation) in Indian cities today than say 10 or 20 years ago?

Here is my explanation: The last decade or so has seen a social revolution in urban India. More men and more women are working together. There are more coeducational institutions than ever before. Social media have allowed people to find others with similar interests and points of view, subverting traditional social walls that prevent free interaction, and then they could keep in touch discreetly, through cellphones and instant messaging. (In my day, we had to use the single rotary phone kept in the living room, making it impossible to have a secret conversation.)

As a result, there are more opportunities for meeting people and maintaining relationships. This naturally leads to more unmarried couples or couples that are not married to each other.

Getting a room every time one wants to kiss one’s partner or hold hands is neither financially viable nor practically feasible. Budget hotels are loath to rent rooms to couples without proof of “marriage” because of the fear of police raids. Some even collude with crooked cops to do a bit of extortion, since couples are willing to pay to avoid being hauled to the police station. Being outside, in parks and deserted spaces, does not totally protect couples from the police, but at least it is better than being busted at a hotel.

Hence what one sees as increased public displays of affection is merely the inevitable effect of an increasing number of young couples in urban India, who, because of an antiquated legal system with ill-defined notions of “public decency,” unfortunately find themselves unable to have safe spaces of their own.

The biggest threat to their safety is not the police but young men described in Mr. Harris’s piece, those who “often sit and stare hungrily at kissing couples,” India’s increasingly angry and volatile class of getting-it-nots, those that desperately wish to have but do not, who see these displays of affection as arrogant flaunting of privilege. Many of these frustrated young men coalesce to form mobs of moral police, who then attack couples, especially women, in public places under the comforting banner of protecting Indian tradition.

And so an important cultural battle rages on, in the parks and in pubs and in other common spaces, one that reflects one of modern India’s defining conflicts, that between ordinary people in pursuit of individual happiness and a legal and social system that insists on imposing, interfering and getting in their way — where a kiss is no longer just a kiss but a small symbol of unintentional rebellion.

By the light of day, Arnab Ray is a research scientist at the Fraunhofer Center For Experimental Software Engineering and also an adjunct assistant professor at the Computer Science department of the University of Maryland at College Park. Come night, he metamorphoses into blogger, novelist (“May I Hebb Your Attention Pliss” and “The Mine”) and columnist. He is on Twitter at @greatbong.

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Relive the Best One-Liners and Tweets from the Oscars!

02/25/2013 at 12:00 AM EST

Jennifer Lawrence tumbled – to a standing ovation. Ben Affleck tearfully won Best Picure for Argo. And you all loved – or loved to hate – Oscar host Seth MacFarlane.

Yep, the Oscars are over, but it doesn't mean we're done talking about it! You can relive the best of the night! Check out what celebs, readers (and you!) had to say about the musical numbers, speeches – and a certain reigning Sexiest Man Alive! – on Twitter last night.

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