10/07/2012

Rare meningitis cases now at 91

  • Tennessee has most reported cases with 32 people, three of whom have died
  • Fungal meningitis is extremely rare, usually not mild
  • Pharmaceutical maker has recalled all of its products
  • CDC has compiled list of facilities that received contaminated injections

Atlanta (CNN) -- The number of people who have contracted fungal meningitis linked to contaminated steroid injections soared to 91 on Sunday, the Centers for Disease Control and Prevention said.

The reported figure jumped by 27 people in one day, while the death toll remained at seven.

Patients in nine states contracted the deadly meningitis after being injected in their spine with a preservative-free steroid called methylprednisolone acetate that was contaminated by a fungus. The steroid is used to treat pain and inflammation.

What is meningitis?

The New England Compounding Center (NECC), the Massachusetts-based pharmacy that made the contaminated injections, voluntarily recalled three lots of the injected steroid last week.

On Saturday, the same pharmacy announced a voluntary nationwide recall of all its other products as well. NECC said the new recall was being announced out of an abundance of caution and that there is no indication any of its other products are contaminated.

The Food and Drug Administration has already asked doctors, clinics, and consumers to stop using any of the pharmacy's products. The pharmacy on Wednesday voluntarily surrendered its license to operate until the FDA investigation into the contamination is complete.

Health officials say 76 medical facilities in 23 states received the contaminated steroid injections from NECC. A list of the 76 affected medical facilities is on the CDC's website at www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html.

The CDC raised the death toll Saturday after two people died in Michigan. Other deaths have been reported in Maryland, Tennessee, and Virginia.

Tennessee is reporting the most number of overall cases -- 32 -- which includes three deaths, according to the CDC.

There are also confirmed cases in Florida, Indiana, Minnesota, North Carolina and Ohio.

The other states that received the contaminated products from NECC are California, Connecticut, Georgia, Idaho, Illinois, New Hampshire, New Jersey, Nevada, New York, Pennsylvania, Rhode Island, South Carolina, Texas and West Virginia.

Federal health inspectors began inspecting the NECC plant last Monday. Inspectors found foreign particles in unopened vials, and after testing one of the unopened vials, they determined the substance was a fungus.

The investigation is still under way.

Nearly 10% of drugs administered in the United States come from compound pharmacies, according to a 2003 Government Accountability Office report.

Drugs manufactured by compound pharmacies do not have to go through FDA-mandated pre-market approval. Instead, oversight and licensing of these pharmacies comes from state health pharmacy boards.

Compound pharmacists create customized medication solutions for patients for whom manufactured pharmaceuticals won't work, according to the International Academy of Compounding Pharmacists.

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. It is usually caused by an infection, frequently with bacteria or a virus, but it can also be caused by less common pathogens like fungi, according to the CDC.

Fungal meningitis is very rare and, unlike viral and bacterial meningitis, it is not contagious.

Symptoms of fungal meningitis are similar to symptoms from other forms of meningitis, but they often appear more gradually and can be very mild at first, the CDC says.

Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University Medical Center, told CNN that fungal infections are not usually mild. He said when a fungus invades small blood vessels, it can cause them to clot or bleed, which can lead to symptoms of small strokes.

In addition to typical meningitis symptoms like headache, fever, nausea and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness and discomfort from bright lights. Patients might just have one or two of these symptoms, the CDC says.

Health officials say any patients who received an injection at one of the facilities beginning July 1 and who began showing symptoms between one and three weeks after being injected should see their doctor right away.

The earlier a patient gets treatment, the more likely he or she will survive.

Patients are treated with anti-fungal medication, which is given intravenously so patients have to be admitted to the hospital, the CDC said. Patients may need to be treated for months.

The FDA is urging anyone who has experienced problems following an injection with the NECC product to report it to MedWatch, the FDA's voluntary reporting program, by phone at 1-800-FDA-1088 or online at www.fda.gov/medwatch/report.htm.

CNN's Miriam Falco contributed to this report.

Naked student shooting: Mother asks why

By Isolde Raftery, NBC News

A day after a naked student at the University of South Alabama was fatally shot in the chest by a campus security guard, his mother and friends are asking why no other means were used to subdue the 18-year-old.

According to a statement released by the university, an officer heard loud banging on the police station window early Saturday and left his post to investigate. The man banging on the window was Gilbert Thomas Collar, an 18-year-old freshman who had graduated high school the previous spring. He was naked.

Collar was a wrestler whose favorite quotation, according to his Facebook profile, was "Be easy." His profile photo is of himself, sporting a skinny black tie and light facial hair, his arm wrapped around his mother.


According to the university statement, the officer "was confronted by a muscular, nude man who was acting erratically. The man repeatedly rushed and verbally challenged the officer in a fighting stance."

The officer allegedly asked Collar to stop, but the young student chased him "in a threatening manner and ignored the officer's repeated commands."

That's when the officer drew his police sidearm and shot Collar once, striking him in the chest.

Collar "got up once more and continued to challenge the officer further before collapsing and expiring," the report said. The officer has been placed on paid administrative leave pending an investigation.

Collar's mother told CNN she doesn't understand why the officer had to shoot her son. Her son, she said, was 5-foot-7 and weighed 135 pounds.

"He was wearing no clothes and he was obviously not in his right mind," Bonnie Collar said. "Obviously he was not armed. He was completely naked."

Sophomore Tyler Kendrick was also dissatisfied.

"Really, it just upsets me that there's no other way to apprehend an unarmed student rather than shooting him. I don't understand that," Kendrick told The Associated Press.

Campus officials said the confrontation was recorded by security cameras. The video and other information has been turned over to the district attorney and the Mobile County Sheriff's Office, which will review the shooting.

A university spokesman declined to say Saturday whether Collar was under the influence of alcohol or drugs.

The University of South Alabama is in Mobile and serves 15,000 students. 

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Case count rises to 91 in fungal meningitis outbreak

By Maggie Fox, NBC News

At least 91 people have been infected with an unusual type of meningitis caused by contaminated steroid injections, federal health officials said Sunday, with seven deaths. They are urging anyone who has had an injection for lower back pain to watch for symptoms of meningitis, which include a stiff neck and balance problems.

Cases have been identified in nine states and health officials fear the numbers will rise as doctors check patients for the symptoms. Doctors and patients alike may not know to look for the unusual infection, which can takes weeks to develop after an injection.

"Several of these patients have had strokes related to the meningitis," the Centers for Disease Control and Prevention says in a statement posted on its website. "In several patients, the meningitis was found to be caused by a fungus that is common in the environment but rarely causes meningitis. This form of meningitis is not contagious. The source of the fungus has not yet been identified, and the cause of infections in the other patients is still being assessed."

The drug is question is called methylprednisone and is used mostly to treat older patients for lower back pain.

The contaminated drugs have been traced to a single pharmacy in Massachusetts, the New England Compounding Center. The pharmacy has closed voluntarily and recalled its products, which include steroids, painkillers and dozens of other drugs. At least one sealed vial of drug has been found to have fungus growing in it, the Food and Drug Administration says. The FDA does not regulate pharmacies like the one in Massachusetts but can be called in when contamination is suspected.

Compounding pharmacies usually make drugs to order, and the steroids suspected of causing the infections did not contain preservatives that can keep fungi and bacteria from growing.

The pharmacy sent products to clinics in California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia, the CDC says.

In this case, the patients appear to have had contaminated drugs injected directly into their spinal fluid. CDC says the clinics do not appear to be to blame. The CDC says it has found fungus, including Aspergillus and Exserohilum, in specimens from 9 patients.

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. Bacteria or viruses are the usual cause, but meningitis can also be caused by fungi and parasites. "In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or two of these symptoms," CDC says.

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Report: Mother was drunk when she killed 4 kids, self

Tonya Thomas is seen in a 2002 booking mug provided by the Brevard County, Fla., Sheriff's Office. Authorities say Thomas, 33, shot and killed her four children before killing herself on May 15 in Port St. John, Fla.

By NBC News staff

A Florida woman who fatally shot her four children before killing herself in May was drunk at the time, according to autopsy reports.

Tonya Thomas had a blood-alcohol level of 0.16 percent  -- two times the legal limit, according to reports cited by floridatoday.com. That's the equivalent of approximately 10 drinks for a woman her height and weight, Bruce Goldberger, a professor and the director of toxicology in the Department of Pathology, Immunology and Laboratory Medicine at the University of Florida College of Medicine, told floridatoday.com.


Thomas, 33, of Port St. John, used a .38-caliber revolver to shoot Joel Johnson, 12, Jazzlyn Johnson, 13, Jaxs Johnson, 15, and Pebbles Johnson, 17, before killing herself at the family's home early May 15, police said.  A total of 19 shots were fired and each child was struck multiple times.

Though Thomas was impaired by alcohol at the time, police still don't know why she killed her children.

"We're not going to know the answer to that question, because she's deceased," Brevard County Sheriff's Lt. Tod Goodyear told floridatoday.com. "She's the lone person responsible for the deaths."

With the results of the autopsy in, investigators will now close the case.

Roberto Gonzalez / Getty Images

Brevard County crime scene workers conduct an investigation after Tonya Thomas shot her four children and then herself May 15, 2012 in Port St. John, Florida. The children ranged in ages 12 to 17 and the family had a history of domestic complaints.

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Israel eyes Lebanon as drone source

  • "We know it originated in Lebanon," an Israeli security analyst says
  • Israel is investigating the craft's origin and hasn't pointed any fingers yet
  • The drone was shot down over Israel's Negev Desert on Saturday
  • The craft was several dozen miles from the top-secret Dimona nuclear plant

Jerusalem (CNN) -- Israeli military experts Sunday worked around the clock to examine the remains of a mysterious drone that was shot down after penetrating Israeli airspace from the Mediterranean Sea.

The Israeli military announced Saturday that the unmanned aerial vehicle was shot down over the northern Negev Desert. They say the drone did not take off from Gaza, leading them to consider the possibility that it originated in Lebanon.

Israeli security experts point the finger at Israel's longstanding rival Hezbollah, the Shiite militia based in southern Lebanon.

"We know it originated in Lebanon," said Ron Ben Yishai, an Israeli national security and defense commentator for Israeli news portal Ynet. "It is entirely clear the UAV was sent by an Iranian proxy. The Iranians provided Hezbollah with their very first drones and they have also funded the organization."

While Israel has yet to officially announce who it sees as responsible for the penetration into its airspace, Lebanon's national news agency on Sunday reported that Israeli fighter jets have flown into Lebanese airspace, causing sonic booms in the area.

Military spokeswoman Avital Leibovich said Saturday that the drone did not carry any weapons or explosives. Leibovich would not discuss the drone's route or whether it had flown over military installations.

If Hezbollah is the responsible for launch of the drone, flying it for more than 200 km (125 miles) down the Mediterranean and deep into Israel, that would represent a significant upgrade to its aerial capacities. But Ben Yishai said neither Hezbollah nor the Palestinian militant groups Hamas and Islamic Jihad in Gaza have claimed responsibility for launching the drone.

"I can imagine they are quiet, concerned of the Israeli response to this operation, but it is not for me to say what Israel's reaction would be," he said.

Iran, which supports Hezbollah, has had no comment.

While the Israeli military has stated that the drone did not carry explosives, the objective of the flight was a mystery Sunday.

"The question is, what exactly did they look to achieve? Was it merely a demonstration of strength, or an operational mission for collecting intelligence?" says Ben Yishai.

One possible target for any of Israel's enemies is the secret nuclear plant at Dimona, in the Negev. Built with the help of the French government in the 1960s, the reactor stands several dozen miles from where the drone was shot down.

Israel does not comment on whether it has nuclear weapons, but details leaked by a former technician at Dimona in the 1980s led international observers to conclude that it could have produced as many as 200 nuclear bombs. In December 2010, the Israeli military announced it has shot down an unidentified flying object over the nuclear plant.

Ben Yishai said crashing a drone carrying explosives onto the plant would be considered a phenomenal achievement for Hezbollah, even though the aircraft can't carry a big enough bomb to inflict serious damage. Even photographs of the tightly guarded plant would be an intelligence prize, he said.

An Israeli warplane shot down the drone, Leibovich said. Ben Yishai said small drones are difficult to spot on radar, and missiles aren't designed to hit such slow-moving targets.

The decision to closely follow the drone for almost 30 minutes within Israeli airspace was a wise choice by the decision makers, Ben Yishai said.

"Having identified the drone flying over the Mediterranean, the Israeli air force could have chosen to shoot it down right away," he said. "The ability to track the drone, take pictures of it from all directions and examine its capabilities serves as an outstanding resource for intelligence information."

Student loans, backed by government, crushing families

Mark Abramson for The Chronicle of Higher Education

Steve Lance, a marketing consultant, put both his sons through college by participating in the Loans Plus program. He has yet to begin to start paying off the debt, he says.

By Marian Wang, ProPublica; Beckie Supiano, Andrea Fuller, Chronicle of Higher Education

More than a decade after Aurora Almendral first set foot on her dream college campus, she and her mother still shoulder the cost of that choice.

Almendral had been accepted to New York University in 1998, but even after adding up scholarships, grants, and the max she could take out in federal student loans, the private university — among nation's costliest — still seemed out of reach. One program filled the gap: Aurora's mother, Gemma Nemenzo, was eligible for a different federal loan meant to help parents finance their children's college costs. Despite her mother's modest income at the time — about $25,000 a year as a freelance writer, she estimates — the government quickly approved her for the loan. There was a simple credit check, but no check of income or whether Nemenzo, a single mom, could afford to repay the loans.

Nemenzo took out $17,000 in federal parent loans for the first two years her daughter attended NYU. But the burden soon became too much. With financial strains mounting, Almendral — who had promised to repay the loans herself —withdrew after her sophomore year. She later finished her degree at the far less expensive Hunter College, part of the public City University of New York, and went on to earn a Fulbright scholarship.

Today, a dozen years on, Nemenzo's debt not only remains, it's also nearly doubled with fees and interest to $33,000. Though Almendral is paying on the loans herself, her mother continues to pay the price for loans she couldn't afford: Falling into delinquency on the loans had damaged her credit, making her ineligible to borrow more when it came time for Aurora's sister to go to college.

Total Disbursements in Millions of Plus Loans

While the number of parents taking out Plus loans has nearly doubled since 2000, loan volume has grown much faster. All values are adjusted for inflation.

Source: U.S. Education Department

Source: U.S. Department of Education

Nemenzo is not alone. As the cost of college has spiraled ever upward and median family income has fallen, the loan program, called Parent Plus, has become indispensable for increasing numbers of parents desperate to make their children's college plans work. Last year the government disbursed $10.6 billion in Parent Plus loans to just under a million families. Even adjusted for inflation, that's $6.3 billion more than it disbursed back in 2000, and to nearly twice as many borrowers.

A joint examination by ProPublica and The Chronicle of Higher Education has found that Plus loans can sometimes hurt the very families they are intended to help: The loans are both remarkably easy to get and nearly impossible to get out from under for families who've overreached. When a parent applies for a Plus loan, the government checks credit history, but it doesn't assess whether the borrower has the ability to repay the loan. It doesn't check income. It doesn't check employment status. It doesn't check how much other debt — like a mortgage, or other student-loan debt — the borrower is already on the hook for.

"Right now, the government runs the program by the seat of its pants," says Mark Kantrowitz, publisher of two authoritative financial-aid websites. "You do have some parents who are borrowing $100,000 or more for their children's college education who are getting in completely over their heads. Those parents are going to default, and their lives are going to be ruined, because they were allowed to borrow far more than is rational."

Much attention has been focused on students burdened with loans throughout their lives. The recent growth in the Plus program highlights another way the societal burden of paying for college has shifted to families. It means some parents are now saddled with children's college debt even as they approach retirement.

Unlike other federal student loans, Plus loans don't have a set cap on borrowing. Parents can take out as much as they need to cover the gap between other financial aid and the full cost of attendance. Colleges, eager to boost enrollment and help families find financing, often steer parents toward the loans, recommending that they take out thousands of dollars with no consideration to whether they can afford it.

When it comes to paying the money back, the government takes a hard line. Plus loans, like all student loans, are all-but-impossible to discharge in bankruptcy. If a borrower is in default, the government can seize tax refunds and garnish wages or Social Security. What is more, repayment options are actually more limited for Parent Plus borrowers compared with other federal loans. Struggling borrowers can put their loans in deferment or forbearance, but except under certain conditions Parent Plus loans aren't eligible for either of the two main income-based repayment programs to help borrowers with federal loans get more affordable monthly payments.

The U.S. Department of Education doesn't know how many parents have defaulted on the loans. It doesn't analyze or publish default rates for the Plus program with the same detail that it does for other federal education loans. It doesn't calculate, for instance, what percentage of borrowers defaulted in the first few years of their repayment period — a figure that the department analyzes for other federal student loans. (Schools with high default rates over time can be penalized and become ineligible for federal aid.) For parent loans, the department has projections only for budgetary — and not accountability — purposes: It estimates that of all Parent Plus loans originated in the 2011 fiscal year, about 9.4 percent will default over the next 20 years.

But according to an outside analysis of federal survey data, many low-income borrowers appear to be overburdening themselves.

Total Recipients of Plus Loans

The number of parents taking out Plus loans has nearly doubled since 2000.

Source: U.S. Education Department

Source: U.S. Department of Education

The analysis, by financial-aid expert Kantrowitz, uses survey data from 2007-08, the latest year for which information is available. Among Parent Plus borrowers in the bottom 10th of income, monthly payments made up 38 percent of their monthly income, on average. (By way of contrast, a federal program aimed at helping struggling graduates keeps monthly payments much lower, to a small share of discretionary income.) The survey data does not reflect the full Plus loan debt for parents who borrowed through the program for more than one child, as many do.

The data also show that one in five Parent Plus borrowers took out a loan for a student who received a federal Pell Grant — need-based aid that typically corresponds to a household income of $50,000 or less.

When Victoria Stillman's son got into Berklee College of Music, she couldn't believe how simple the loan process was. Within minutes of completing an application online, she was approved. "The fact that the Plus loan program is willing to provide me with $50,000 a year is nuts," says Stillman, an accountant. "It was the least-involved loan paperwork I ever filled out and required no attachments or proof."

She decided against taking the loan, partly because of the 7.9-percent interest rate. Although it was a fixed rate, she found it too high.

Of course, Parent Plus can be an important financial lifeline — especially for those who can't qualify for loans in the private market. An iffy credit score, high debt-to-income ratio, or lack of a credit history won't necessarily disqualify anyone for a Plus loan. Applicants are approved so long as they don't have an "adverse credit history," such as a recent foreclosure, defaulted loan, or bankruptcy discharge. (As of last fall, the government also began disqualifying prospective borrowers with unpaid debts that were sent to collection agencies or charged off in the last five years.)

The Education Department says its priority is making sure college choice isn't just for the wealthy. Families have to make tough decisions about their own finances, says Justin Hamilton, a spokesman for the department. We "want folks to have access to capital to allow them to make smart investments and improve their lives," Hamilton says. In the years after the credit crisis, department officials point out, other means of financing college — such as home-equity loans and private student loans — have become harder for families to get.

The department says it's trying to pressure colleges to contain costs, and working to inform students and families of their financing options. "Our focus is transparency," says Hamilton. "We want to make sure we're arming folks with all the information they need."

Colleges' tricky role
Colleges rarely advise families on how much is too much. After a student's own federal borrowing is maxed out, financial-aid offices often recommend large Plus loans for parents.

Using Education Department data, The Chronicle and ProPublica took a closer look at colleges where borrowers took out the highest average Plus loan amounts per year. (See a breakdown of the top schools.) NYU ranked 11th, with an average annual loan of $27,305. The university generally gives students less financial aid than many of its peers. Last year, parents of NYU students borrowed more than $116 million through the Plus program, the second-largest sum taken on for a single university, trailing only Penn State University's $160 million.

"Our first suggestion is the Plus loan," says Randall Deike, vice president for enrollment management at NYU. Yet he has misgivings about the program. "Getting a Plus loan shouldn't be so easy," he says.

"It doesn't make me feel great, truthfully," Palmer says. "But then again, what can I do? We have to pay our bills."Among the top 25 institutions with the largest average Plus loans, more than a third focus on the arts. Tenth on the list is New York Conservatory for Dramatic Arts, a for-profit acting school.

The school's sticker price for the current year adds up to nearly $53,000 for a year's worth of tuition, fees, room, board, and other expenses. Without an endowment, says David Palmer, the conservatory's chief executive, the school can't provide much financial aid — so families are often left to make difficult decisions about how borrowing is too much. Ideally, families would have saved for college, according to Palmer, but often tuition payments come in the form of Plus loans.

Last year, 150 parents borrowed for their children to attend the institution of 330 undergraduate students. Palmer knows that sometimes families borrow too much, and students have to drop out. "It makes me sick to my stomach," he says. "Because they've got half an education and a mountain of debt."

Still, he says, "I don't know that it's the institution's responsibility to say we'll take a glimpse of what your individual situation is and say maybe this isn't a good idea."

To the dismay of consumer advocates, some universities lay out offers of tens of thousands of dollars in Parent Plus loans directly in the financial-aid packages of prospective students — often in the exact amount needed to cover the gap between other aid and the full cost of attendance. That can make it look like a family won't have to pay anything at all for college, at least until they read the fine print. The offers are often included in financial-aid packages even for families who clearly can't afford it.

"It is deceptive," says Greg Johnson, chief executive of Bottom Line, a college access program in Boston and New York. His organization's counselors have seen firsthand how students and families can get confused: When Agostinha Depina first got her financial aid award letter from New York's St. John's University, her first choice, she was excited. But upon taking a closer look at the package with her counselor at Bottom Line, she realized that a $32,000 gap was being covered by a Parent Plus loan that her parents would struggle to afford.

"It made it seem like they gave me a lot of money," says Depina. In reality, "it was more loans in the financial-aid package than scholarship money." Depina, 19, opted to go to Clark University, where she had a smaller gap that she covered with a one-year outside scholarship. A spokeswoman for St. John's did not respond to requests for comment.

There's considerable debate among financial-aid officials about whether and how to include Plus loans in students' financial-aid award letters. Some universities opt not to package in a loan that families might not qualify for or be able to afford. Instead, they simply provide families with information about the program.

"We inform them about the different options they have, but we wouldn't go in and package in a credit-based loan for any family," says Frank Mullen, director of financial aid at Berklee College of Music. "To put a loan as part of someone's package without knowing whether they'd be approved? I just wouldn't feel comfortable with it."

Others say it isn't so simple. "This is one of those knives that cuts both ways," says Craig Munier, director of scholarships and financial aid at the University of Nebraska at Lincoln.

"If we leave a huge gap in the financial-aid package, families could reach the wrong conclusion that they cannot afford to send their children to this institution," says Munier, who is also chair-elect of the National Association of Student Financial Aid Administrators. "The other side," he says, "is we package in a loan they can't afford, and they make a bad judgment and put themselves into debt they can't manage. You can second-guess either decision."

For parents in exceptional circumstances, colleges have some discretion to bypass the Plus application process and give a student the additional amount of federal student loans that would be available in the case of a Plus denial — up to $5,000. Those are judgment calls, says Justin Draeger, president of the aid administrators' group. Cases of a parent who is incarcerated or whose only income is public assistance are more straightforward, but the prospect of evaluating a parent's ability to pay is fraught. Deciding to tell them what they can afford "leaves the schools in sort of a moral dilemma," Draeger says.

But encouraging Plus loans for parents who would struggle to repay them lets colleges shirk their own responsibility to help families with limited means, says Simon Moore, executive director of College Visions, a college-access program based in Rhode Island. "Colleges can say, 'We want to enroll more low-income students,' but don't really need to step up and offer students good aid packages," he says. Plus loans "offer colleges an easy way to opt out."

Middle class struggles to repay
Some parents who have borrowed through Plus have found themselves working when they could be retired, and contemplating whether to pay off the debt by raiding their retirement nest eggs.

Galen Walter, a pharmacist, has put three sons through college. All told, the family racked up roughly $150,000 in loans, about $70,000, he estimates, in the Parent Plus program.

Average Plus Loan Amount

Even when inflation is taken into account, the average Plus loan has increased by roughly a third, to almost $12,000. All values are adjusted for inflation.

Source: U.S. Education Department

Source: U.S. Department of Education

Walter is 65. His wife is already collecting Social Security. "I could have retired a couple years ago," he says, "but with these loans, I can't afford to stop." His sons want to help with the Plus payments, but none are in the position to do so: One son is making only $24,000. Another is unemployed. The youngest is considering grad school.

Before the downturn, Walter says, he might have been able to sell his house and use the profit to pay off the loans. But given what his house is worth now, selling it wouldn't cover the loan. With his sons in a challenging job market, he thinks he may be repaying the loans for at least a decade.

Many parents are more than willing to take on the burden. Steve Lance, 58, is determined to pay for the education of his two sons, whose time at private universities has left him saddled with $133,000 in Parent Plus loans. (He also says he's committed to paying for his sons' federal and private student loans, which bring the total to $317,000 in debt.)

"The best thing I thought I can do as a parent is support them in having their dreams come true," says Lance, a creative director who writes and speaks on advertising and marketing. "There's no price tag on that." Out of necessity, he has put some loans in deferment.

Often, students and families set their hearts on a specific college and will do whatever it takes to make it work, betting that the rewards will outweigh the financial strain.

That's what happened with J.C., who asked that her name not be used. J.C. took out about $41,000 to help her daughter, an aspiring actress, attend NYU. A high-school valedictorian, her daughter could have gone to a public university in their home state of Texas debt-free, J.C. says. But the opportunities in theater wouldn't have been the same. It had to be NYU.

"The night she got there she said: Mom, this is the air I was meant to breathe," J.C. says of her daughter.

J.C., 58, is divorced and makes about $50,000 a year. She anticipates Plus loan payments between $400 and $500 a month, which she says she can handle. "I'll never retire. I'll work forever, that's OK," she says. Still, the hope is that her daughter makes it to the big time in her acting career: "If she's really, really successful I'll retire sooner rather than later," J.C. says.

Changes to Parent Plus, uncertain results
The Education Department's recent change in how it defines adverse credit history — adding unpaid collections accounts or charged-off debt as grounds for denial — is meant to "prevent people from taking on debt they may not be able to afford while protecting taxpayer dollars," Hamilton, the department spokesman, wrote in an email message.

The change may result in significantly more Parent Plus loan denials, according to Kantrowitz — and some financial-aid officers' recent observations seem to bear that out. But new denials may actually target the wrong people. After all, the tightened underwriting still examines aspects of credit history, not ability to repay.

"It's not going to make much of a difference for people who overborrow. It's not going to prevent people from overborrowing," Kantrowitz says. Instead, the new policy may preclude borrowers who once fell behind on a debt, he says, but now pose little credit risk.

Borrowers who are denied can appeal the decision and still get the loans if they convince the Education Department that they have extenuating circumstances. Or they can reapply with somebody cosigning on the loan.

It's not yet clear how much the change to the credit check will alter the scope of the Parent Plus program. Early tallies for the 2011-12 year show a modest dip in borrowing over the previous year, but the data is incomplete and won't be fully updated for months.

For now, the Parent Plus program is part of a stopgap solution to the complex problem of college affordability. And the factors that drive parents to borrow too much won't be changing anytime soon.

Kantrowitz believes that the student-loan system is in need of much broader solutions. The current federal loan limits for undergraduates are arbitrary, he says, and not based on the type of program or a student's estimated future earnings. More grant money could also help alleviate overborrowing, especially for low-income families.

"We need a complete overhaul of the student-loan system so there's a more rational set of limits" to curb the debt problem, says Kantrowitz. The government can't keep "magically sweeping it under the parent rug."

Clock ticking on election, campaigns look to next debates

By Michael O'Brien, NBC News

Mitt Romney is fighting to earn a new look from voters with 30 days remaining until the election, as President Barack Obama looks to close the window on his Republican challenger. 

Romney, the Republican presidential nominee, has hopes of building momentum off of his strong debate performance this week, in which he generally outperformed Obama with energetic and crisp arguments.

But a top spokesman for the president vowed Sunday that Obama wouldn't allow Romney a repeat performance in their second showdown.

"It's not rocket science to believe the president was disappointed in the expectations he has for himself," former White House press secretary Robert Gibbs said on "Meet the Press" of Obama's debate performance, which was panned as lethargic and lacking in aggression.

Of the second debate, scheduled for Oct. 16, Gibbs said, "I think you're going to see a very engaged president that is ready and willing to call out whichever Mitt Romney shows up."

Romney "walked over" Obama in Denver, former House Speaker Newt Gingrich, one of Romney's erstwhile primary opponents, contended. But Gingrich also acknowledged that the GOP nominee had "changed" from the primary, when he vowed to cut taxes for individuals in all income brackets. (Romney said in Wednesday's debate that, in his reform plan, the wealthy wouldn't end up paying any less in taxes.)

Whether Romney has made up much ground versus Obama hasn't yet been fully reflected in polls conducted since the debate. The Republican hopeful entered the matchup trailing the president, and must make up ground — especially in battleground states like Ohio — if Romney is to have any hope of winning on Nov. 6.

"The real question to me, of this campaign, is, can the Romney campaign take this moment and run with it?" asked Mike Murphy, a longtime Republican consultant with ties to Romney.

Romney won the endorsement of a newspaper in one such swing state, Nevada, as the editors of the Las Vegas Review-Journal said Romney "has the principles and experience needed to put America back on the road to prosperity."

But Obama's case for re-election was bolstered Friday by a new jobs report that showed the unemployment rate at 7.8 percent in September, clearing the psychological barrier of 8 percent, above which the unemployment rate had sat for months. 

"I think it was a significant help to the president," Gingrich said of that report.

Obama's advantage over Romney was fueled partly by improving perceptions of the economy, which could be cemented by the new employment data. If nothing else, the president will have a new cudgel to wield against Romney in their next debate matchup. 

Both Romney and Obama will leave it to their running mates this week to carry the banner on Thursday, at the vice presidential debate. 

"I know Vice President Biden is anxious and ready to do this," Gibbs said of Biden's impending debate versus Wisconsin Rep. Paul Ryan, the Republican vice presidential nominee.

In the meanwhile, both the president and Romney aren't taking the weekend off; instead, they're both on the campaign trail this Sunday. Romney will hold a rally this afternoon in Florida, while Obama attends a "30 days to victory" fundraising concert tonight in Los Angeles.