Heart pills and back surgeries aren't especially sensitive to consumer sentiment. Hence, health-care companies are expected to weather this year's profit downturn comfortably. Profits underlying the S&P 500 index, which tracks America's 500 largest companies, are expected to slide 12% this year on steep bank losses and less demand for "discretionary" goods -- things we want but don't need. Yet the index's health-care profits are seen increasing 9%.

That fact isn't lost on investors. Through October the S&P 500's health-care component fell 24% in value, outperforming the overall index by 10 percentage points. Perhaps for that reason, a screen for companies with recent earnings momentum turned up plenty of health-care names but few tempting valuations.

Intuitive Surgical (ISRG) makes the remarkable da Vinci surgical system. Picture one of those coin-operated crane games with plush toys for prizes. Now substitute vital organs for the toys, a surgeon for yourself and precise tools and fiber optics for the frustratingly feeble clasp. Machines cost $1.3 million apiece, plus around $130,000 for yearly service contracts and $2,000 per surgery for items that can't be reused. Demand is strong, since the system's tiny incisions keep healing times and hospital stays short, while its highly scalable movements turn clumsy hands into precise ones. But Intuitive stock is worrisomely popular. In an October 2007 look at the company's valuation I found "no shame in paying $240 for the stock, although perhaps no urgency to do so, either." It's $200 now, but that's still 38 times this year's earnings forecast at a time when low price/earnings ratios are suddenly plentiful. I'd pass.

Schering-Plough (SGP) offers the reverse proposition: lackluster growth potential, but at a cheap price. A key cholesterol drug the company markets with Merck (MRK) has lost momentum since a January report suggested that patients do just as well with a generic version of another medicine. In its third quarter Schering-Plough reported a 63% sales jump and 39% increase in adjusted earnings per share, easily beating analyst forecast. But results were driven largely by an acquisition late last year and by cost cutting. Next year's sales and earnings per share are expected to increase 2% and 4%, respectively. Schering's drug roster is less exposed than those of its peers to generic competition in coming years, making the stock's price of 9 times 2008 earnings seem sufficiently discounted. But the deal is soured by a 1.8% dividend yield -- too skimpy for such a mature company.

If Intuitive Surgical and Schering-Plough are too hot and too cold, respectively, then perhaps Express Scripts (ESRX) is just right. It manages prescription plans on behalf of health insurers and employers, bargaining with drug makers for better prices in the process. High health-care costs, drug patent expirations and thin new-drug pipelines help rather than hurt Express, since all make patients more likely to order generic drugs, on which Express earns larger profits. Third-quarter earnings for the company surged 41% from a year earlier as customers' rate of generic drug use climbed four percentage points to 66.2%.

Unlike Express's customers, its investors don't often get much of a break on price. The stock has multiplied fourfold in price since this column first brought it to readers' attention in March 2003 and has well more than doubles since a follow-up recommendation in March 2005. Over the past year it has fallen just 6%. It stands now at just under 20 times this year's earnings forecast. Wall Street foresees next year's earnings increasing 19%. Reported earnings have beaten estimates in each of the past four quarters. All that gives Express the best price/performance ratio of the bunch, although perhaps not one that warrants a rush to place a buy order.

My screen for companies that have beaten earnings forecasts of late and forced analysts to raise their remaining projections turned up six survivors in all. Run a similar search anytime you like using the full recipe of criteria and SmartMoney's stock screener.

Earnings Outperformers Screen Recipe

Percent upside earnings surprise last quarter above industry median
Next-year EPS forecast raised within past four weeks
Current-year EPS forecast raised within past four weeks
Coverage by at least there analysts
Trailing 12-month sales greater than $300 million
Average daily trading volume greater than 100,000 shares