Well: How to Carbo-Load for a Marathon

It appears that despite the depredations of the big storm, the New York City Marathon is likely to take place as scheduled on Sunday. While the 47,000 runners entered have too little time to remedy any major lapses in training, there is one element that can still be tweaked, two new studies show: what to eat in the days before the race.

Phys Ed

Gretchen Reynolds on the science of fitness.

The ideal composition of a pre-marathon diet has been somewhat in dispute recently. For years, marathoners were told that they should swallow as many carbohydrates as possible in the week leading up to the race in order to "load" their muscles with stored carbohydrates, or glycogen, the readiest energy source for working muscles.

But such prolonged carbo-loading often leaves runners bloated and heavy; when muscles pack in glycogen, they also add water, and therefore weight, which must be hefted throughout the 26.2 miles of the marathon. Women, in particular, have been found in some studies to benefit little, if at all, from prolonged carbo-loading before marathons.

However, a study published last month in The International Journal of Sport Nutrition and Exercise Metabolism found that carbo-loading can be effective for both men and women — but is best if it's truncated, encompassing only a day or so of dietary manipulation.

For the study, researchers at the University of Minnesota turned to a ready-made pool of volunteers, consisting of students enrolled in Physical Education 1262: Marathon Training, who were aiming to finish the local Eau Claire Marathon for class credit.

Forty-six students joined the study, 36 of them women and all but two of them first-time marathon runners.

Several weeks before the event, the runners completed a two-mile time trial, to determine their endurance and running ability.

Then, beginning three days before the race and continuing through breakfast on race morning, they kept detailed food diaries. They also noted, to the extent possible, what they ate and drank during the race.

All of the students finished the race, with an average time of 4 hours 43 minutes (and, one would hope, an A grade in P.E.).

But, statistical analysis showed, those runners, both men and women, who'd eaten the most carbohydrates on the day before the race finished faster than those who'd eaten fewer carbohydrates that day.

These results neatly replicate those of a larger study published last year of 257 male and female runners who completed the 2009 London Marathon. Those runners also kept detailed food and training diaries, which researchers compared with their finishing times. In this case, the scientists also tracked each runner's pace at five-kilometer increments throughout the race.

They found that, as in the Minnesota study, runners who'd loaded up on carbohydrates the day before the race ran faster than those who had eaten fewer carbohydrates. The difference was especially striking beginning at about the 18-mile mark, just when many runners famously "hit the wall" and feel their energy flag. The carbo-loaded runners jauntily maintained their pace. The others did not.

In both studies, carbohydrates eaten at breakfast on race day, during the race itself or on days earlier in the week were relatively unimportant. It was primarily what people ate on the day before the race that mattered.

And yet, few of the runners in either study actually consumed enough carbohydrates to benefit, even if they thought that they were doing so. In both studies, the minimum effective "dose" of carbohydrates was at least six or seven grams for every kilogram of a person's body weight, or about a quarter-ounce of carbohydrates for every 2.2 pounds of body weight. By that formula, a 220-pound runner would need to consume at least 25 ounces, or more than a pound and a half, of carbohydrates on the day before a marathon to finish faster.

In the Minnesota study, fewer than a quarter of the marathoners consumed that many of carbohydrates on the day before the race. In the London study, barely 12 percent did.

What those numbers suggest is that many more marathon runners could benefit from a brief bout of carbo-loading than currently do. And the process itself is relatively simple, says Patrick Wilson, a graduate student at the University of Minnesota who led the study of novice runners. You don't need to increase your food volume or calories the day before a race; just replace some fats or proteins with carbohydrates.

"I often tell people to choose relatively concentrated sources of carbs, like juices, pasta, rice and sweets," Mr. Wilson says. "That way, the volume of food needed isn't so enormous." In addition, he says, "lower-fiber foods may be good, since that could reduce the potential for stomach distress during the race." (According to a rather intrusive study this year, extremely high intake of carbohydrates was associated with faster times during endurance races but also with "nausea and flatulence.")

Don't completely upend your normal diet, though. "Stick to foods that are familiar," Mr. Wilson says. "It's always a bad idea to experiment right before a race."

And don't expect that diet alone will lift you from the back of the pack. In the British study, every increase of 1 gram per kilogram of body weight in the carbohydrates that runners consumed on the day before the race increased their speed by about 0.1 miles per hour.

Far more important in the overall determination of people's finishing times was their training and their fundamental fitness. In the Minnesota study, the runners who were fastest during the time trial were fastest in the marathon, too.

You can't alter your training or talent at this point. You can, though, have a chocolate chip cookie on Saturday and call it race preparedness.

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Patients Evacuated From NYU Langone After Power Failure

Chang W. Lee/The New York Times

N.Y.U. Langone began transporting all 215 patients after a backup power system failed on Monday evening. More Photos »

A backup power system failed at one of New York City's premier medical centers on Monday night, forcing the evacuation of all patients to nearby hospitals amid the storm's strong gusts, officials said.

The medical center, NYU Langone Medical Center, a sprawling complex in the low 30s near the East River, began transporting all 215 patients at the hospital to other facilities on Monday evening, They were still being transported to other nearby hospitals, including Sloan Kettering and Mount Sinai, early on Tuesday, a spokeswoman for the hospital said.

"They evacuated everybody," said the spokeswoman, Lorinda Klein, who said the main communications systems at NYU Langone — phones and e-mail — were down. She could not say what had caused the failure of the hospital's emergency systems, which power critical care units there.

NYU Langone said in a statement that the evacuations were "due to the severity of Hurricane Sandy and the higher than expected storm surge." It added, "We are having intermittent telephone access issues and for this reason the receiving hospital will notify families of their relatives arrival."

By 11 p.m., dozens of ambulances from various companies across the city were lined up in front of hospital extending down First Avenue and west on 30th Street.

On the ground floor of the hospital, medical staff members, firefighters and emergency medical technicians moved about as patients on gurneys — at least one in an oxygen mask — were wheeled from the building and lifted into the ambulances outside.

A spokeswoman for Memorial Sloan-Kettering Cancer Center, on the Upper East Side, said at least 26 patients had been taken there.

In a statement, Mount Sinai Medical Center described joint efforts to evacuate patients "in the areas of adult critical care, pediatric critical care, neonatal intensive care and obstetrics." It said the patients were "being transported to Mount Sinai via ambulance and will be accompanied by NYU Langone staff and physicians."

In southern Brooklyn, Coney Island Hospital also saw its backup power systems fail on Monday, said the city's Office of Emergency Management, but there were no evacuations. Critical patients had been evacuated on Friday during storm preparations and the 209 remaining patients would be re-evaluated in the morning, the office said.

The trouble at NYU Langone began Monday evening as hospital officials began to detail in e-mails the spread of large-scale power failures in critical areas, including the emergency room, the transplant unit and labor and delivery. The emergency systems did not kick in, the hospital said.

Where necessary, patients were connected to battery-operated monitors and pumps, hospital employees reported, and the hospital appeared to have no emergency or land-line phones on some units.

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As Sales Fall, Allergan Seeks a Buyer for Lap-Band

Allergan said Tuesday that it was looking to divest itself of its Lap-Band, the once-popular weight-loss device that has experienced several years of falling sales, loss of market share and controversies about its safety and effectiveness.

The falling sales "do not fit the profile of a high-growth company like Allergan," David E. I. Pyott, the company's chief executive, told analysts Tuesday morning on a call announcing the company's third-quarter financial results.

In an interview, Mr. Pyott said Allergan had already hired an investment banking firm, which he would not name, and was sending letters to other medical device companies and private equity firms seeking a buyer for its obesity business, which also includes a balloonlike device that is not approved in the United States but is used in some other countries.

The Lap-Band, a silicone ring that is wrapped around the stomach and can be inserted in an outpatient procedure, once appeared to have a bright future as a less drastic, if less effective, alternative to gastric bypass, which involves rerouting the digestive tract.

But Allergan's obesity business sales have fallen from a peak of $296 million in 2008 to an expected $160 million this year. In the third quarter, the sales fell by 25 percent to $37.4 million from a year earlier.

The obesity business, while still profitable, represents less than 3 percent of total product sales for Allergan, which is known most for its Botox treatment for wrinkles, migraine headaches and other conditions.

Although one-third of American adults are obese, the number of weight loss surgeries in the United States — about 160,000 a year — has stopped growing, largely because of the economy, Mr. Pyott said. Many patients pay out of pocket for weight loss surgery, and even when the procedure is covered by insurance, there can be a co-payment of thousands of dollars.

Mr. Pyott said Allergan had made progress in the last year in lowering barriers to insurance coverage, but it was not sufficient to reverse the decline in sales of the Lap-Band.

But gastric banding has also lost market share among weight loss surgeries, falling to about one-third from 44 percent a year ago, Mr. Pyott said. Lap-Band has most of the market among bands, although Johnson & Johnson also sells such a product.

Gaining in popularity has been sleeve gastrectomy, which involves cutting out part of the stomach. It is considered midway between banding and bypass in terms of both effectiveness and the degree of invasiveness of the surgery.

Dr. Marc Bessler, director of the center for metabolic and weight loss surgery at Columbia University, said that Lap-Band had lost some luster among bariatric surgeons because studies suggested it was not effective in the long run for one-third to two-thirds of patients.

"You had data coming out that 10-year outcomes are not what we were expecting," Dr. Bessler said.

One study in Europe, for instance, published in The Archives of Surgery last year, reported that over 12 years, 60 percent of patients needed another operation, often to remove the band, because of complications or lack of weight loss. Allergan has said that techniques have improved since the patients in that study received their bands.

In 2011, Allergan succeeded in getting the Food and Drug Administration to approve use of the Lap-Band for patients with lower weight than had been previously required. But that did not bolster sales, in part because of difficulty getting insurance to pay.

The company dropped efforts to get the Lap-Band approved for use in teenagers after controversy arose about the product's safety.

There have been news reports about problems, including deaths, from the band.

Allergan said its overall product sales for the third quarter rose 6.1 percent from a year earlier to $1.39 billion. Earnings per share, after adjustments, rose to $1.06 from 92 cents.

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Recipes for Health: Roasted Beet and Winter Squash Salad With Walnuts

Andrew Scrivani for The New York Times

The colors of the vegetables were the inspiration behind this beautiful salad. You may be fooled into thinking the orange vegetables next to the dark beets are sliced golden beets, but they are slices of roasted kabocha squash.

2 pounds kabocha or butternut squash

1 bunch beets, with greens

2 tablespoons red wine or sherry vinegar

1 teaspoon balsamic vinegar

Salt and freshly ground pepper

1 small garlic clove, minced or put through a press

4 tablespoons extra virgin olive oil

2 tablespoons walnut oil

3 tablespoons chopped walnuts (about 1 1/2 ounces)

2 tablespoons mixed chopped fresh herbs, like parsley, mint, tarragon, chives

1. Roast the beets. Preheat the oven to 425 degrees. Cut the greens off of the beets, leaving about 1/2 inch of the stems attached. Scrub the beets and place in a baking dish or ovenproof casserole. Add about 1/4 inch water to the dish. Cover tightly with a lid or foil, and bake 35 to 40 minutes, until the beets are tender. Remove from the heat and allow to cool. If not using right away, refrigerate in a covered bowl.

2. Line another roasting pan with foil or parchment and brush with olive oil. Peel the squash and cut in 1/2-inch thick slices. Toss with 2 teaspoons of the olive oil and salt to taste and place on the baking sheet. Roast for 20 to 30 minutes, turning halfway through, until lightly browned and tender. You can do this at the same time that you roast the beets, but watch carefully if you need to put the baking sheet on a lower shelf. Remove from the heat and allow to cool.

3. Meanwhile, bring a large pot of water to a boil while you stem and wash the greens. Add salt to the water, and blanch the greens for 1 minute or until tender. Transfer the greens to a bowl of cold water, then drain and squeeze out the water. Chop coarsely.

4. Mix together the vinegars, garlic, salt, pepper, the remaining olive oil and the walnut oil. When the beets are cool enough to handle, trim the ends off, slip off their skins, cut in half, then slice into half-moon shapes. Toss with half the salad dressing. In a separate bowl, toss the roasted squash with the remaining dressing.

5. Place the greens on a platter, leaving a space in the middle. Arrange the beets and squash in alternating rows in the middle of the platter. Sprinkle on the fresh herbs and the walnuts. If desired, sprinkle on crumbled feta. Serve.

Yield: 6 servings.

Advance preparation: Roasted beets and squash will keep for 4 to 5 days in the refrigerator. Cooked beet greens will keep for about 3 days, and can be reheated. The salad will hold in the refrigerator for a couple of hours, but it's prettiest when served right away.

Nutritional information per serving (6 servings): 248 calories; 16 grams fat; 2 grams saturated fat; 6 grams polyunsaturated fat; 8 grams monounsaturated fat; 0 milligrams cholesterol; 26 grams carbohydrates; 6 grams dietary fiber; 88 milligrams sodium (does not include salt to taste); 4 grams protein

Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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First Mention: First Mention: Monoclonal Antibodies in The New York Times

The theoretical work that would lead to the production of monoclonal antibodies started in the early 1970s, but The New York Times would not mention the term until May 1, 1979, in a roundup of science news. "A new San Diego firm," an article on Page C2 said, "plans to manufacture and sell antibodies produced artificially by tissue-culture techniques."

Antibodies circulate in the body until latching on to foreign cells, called antigens, which they destroy. Monoclonal antibodies are manufactured in the laboratory and then cloned, producing custom-designed and uniform antibodies that can attach to specific disease cells — bacteria, viruses or cancer cells — without injuring healthy tissue.

By the late 1970s, several new biotechnology companies, including Genentech and Hybritech, had already concluded that drugs made with monoclonal antibodies might be used to treat cancer and other diseases. On Jan. 27, 1980, in a front-page article headed "Advances in Gene Splicing Hint Scientific-Industrial Revolution," Harold M. Schmeck Jr., took note of the dizzying speed at which the field was progressing. But he may have been somewhat too optimistic in predicting that "these feats of biological alchemy may be only spectacular curtain raisers for a new scientific-industrial revolution."

On Aug. 18, 1984, Stuart Diamond would report in an article on Page 31 that "a biotechnology research company says it has produced the first commercial levels of human monoclonal antibodies for the treatment of disease."

The Times announced the winners of the Nobel Prize in Physiology or Medicine on Page 1 on Oct. 16, 1984. The headline read "3 Immunology Investigators Win the Nobel Prize in Medicine," and on the same day the paper published two other articles on the winners, along with an editorial by Nicholas Wade titled "Triumph of an 'Unworkable' Idea."

Dr. Niels K. Jerne, who laid the theoretical groundwork, and Dr. George J. F. Köhler and Dr. César Milstein, who produced the first monoclonal antibodies, shared the prize. Yet it would be more than a decade before the first monoclonal antibody drug for use in humans would come to market.

On May 1, 1997, The Times reported that Genentech had filed for Food and Drug Administration approval of Rituximab, for the treatment of a specific form of non-Hodgkin's lymphoma, a cancer of the lymph system. In clinical trials, the drug appeared to shrink tumors in about half the patients who took it. Rituximab is used today to treat not only non-Hodgkin's lymphoma, but also chronic lymphocytic leukemia, rheumatoid arthritis and other diseases.

While none has proved to be a "magic bullet" for curing any disease, there are now dozens of monoclonal antibody drugs approved for diagnosis or treatment of various diseases, and hundreds more in development. 

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Sports of The Times: With No One Looking, Mental Illness in Athletes Can Stay Hidden

We've seen it hundreds of times. An athlete is injured and within seconds is surrounded by an armada of medical personnel: trainers, assistant trainers, team doctors. The athlete is helped off the field, given a diagnosis, treated and sent to physical therapy, often to return miraculously in a week or two.

But when that same athlete has a mental disorder, there is no armada of trainers, no team doctors. That athlete is often abandoned. For all of the current focus on traumatic brain injury as a result of concussions, mental illness, often overlooked, exists at every level of sports.

Sports too often is a masking agent that hides deeply rooted mental health issues. The better the athlete, the more desperate to reach the next level, the less likely he or she will reach out for help. The gladiator mentality remains a primary barrier.

"Mental health has a stigma that is tied into weakness and is absolutely the antithesis of what athletes want to portray," said Dr. Thelma Dye Holmes, the executive director of the Northside Center for Child Development, one of New York's oldest mental health agencies, serving more than 1,500 children and their families.

"Mental health is not something that you can easily know," Holmes said. "You feel a pain in your side, you have discomfort. Mental illness is vague and makes us uneasy. Especially when it comes to athletes, there tends to be a stigma around coming forward."

Holmes was among a group of health care professionals and former professional athletes who met recently at the Schomburg Center for Research in Black Culture in New York to discuss the problem of mental health and mental illness in athletes. The gathering was part of a series of salons initiated by Schomburg's director, Khalil Muhammad, to explore the relationship between sports and the African-American community.   But mental illness knows neither race nor ethnicity, and at a time when brain trauma has become front and center of a national conversation about safety in sports, mental illness is the silent spike of the sports industry. Asking for help is looked upon as a weakness in a community in which coaches preach mental toughness.

"They believe nothing can go wrong, they don't need help, they can overcome," Dr. Ira Glick, professor emeritus of psychiatry and behavioral sciences at Stanford University School of Medicine, said in a telephone interview.

He added: "And just for that alone, they don't want to go to therapy either for psychotherapy or medication. You have to start to change the culture beginning in Little League, imbue in them from the time they are Little League players."

There is, of course, a related issue: confidentiality. Whom can a player trust?

"Players want to have somebody to talk to, but they don't want their teammates or the team to find out because of the stigma and they're afraid of being dropped," Glick said.

Luther Wright can attest to that. He was a high school star in New Jersey, attended Seton Hall, then was a first-round pick of the Utah Jazz.

Wright published an intriguing memoir — "A Perfect Fit" — that chronicled his journey from the celebrity of being the largest baby born in New Jersey that year to stardom in high school and college, to a season in the N.B.A., to drug and alcohol abuse and, finally, to a diagnosis of mental illness.

According to Wright, who attended the conference, an athlete desperate to provide for his family — and to reach the professional level — may not feel he has the luxury to divulge, much less explore, a mental health issue.

"You can't get sick," Wright said. "At the college level, that's your proving ground. There's no room for any type of diagnosis for mental health issues because that would put up a red flag and maybe block you from going to the next level.

 "I don't think they would even recruit you if they knew you had some illness or some mental health issues, that you were mentally incapable of performing at the highest level."

 A complicating factor is that coaches are often ill-equipped to recognize and deal with mental health issues. But the coach of the future, Holmes of the Northside Center suggested, may need to be better prepared.

Indeed, coaches could be required to have a certificate, if not an advanced degree, in mental health. Professional leagues and governing bodies at the high school and college levels could ensure coaches work with mental health practitioners who could train them to look for signs of trauma, bipolar disorder and depression, among other maladies.

"Coaches need to know they've got somebody to talk with if things get out of hand," Holmes said.

Coaches aren't the only ones who fail to recognize mental health problems. General managers and team executives may look the other way, or go into denial, when mental health problems emerge in an enormously talented athlete.

 Glick argued that owners by and large do not want to address the notion that athletes face mental illness. In fact, Glick said he felt some owners feel that disclosures could hurt business.

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Recipes for Health: Lasagna With Roasted Kabocha Squash and Béchamel

Andrew Scrivani for The New York Times

This rich-tasting lasagna is inspired by my favorite northern Italian pumpkin-filled ravioli. It would make a terrific vegetarian item on a Thanksgiving buffet. Making the lasagna is not time-consuming if you use no-boil lasagna noodles. Be sure to season the squash well as you assemble this.

3 pounds kabocha squash

3 tablespoons extra virgin olive oil

3 tablespoons minced shallot or onion

3 tablespoons sifted all-purpose flour

3 cups low-fat milk (1 percent)

Salt and freshly ground pepper

Pinch of freshly grated nutmeg

2 tablespoons chopped fresh sage

1/2 pound no-boil lasagna noodles (or a little more, depending on the size of your lasagna pan)

4 ounces Parmesan cheese, grated (1 cup)

1. Preheat the oven to 425 degrees. Line a baking sheet with foil. Cut the squash into big chunks, brush the exposed flesh with 1 tablespoon of the olive oil and place on the baking sheet. Bake 45 minutes or until squash is tender enough to be pierced through to the skin with a paring knife. Remove from the heat and allow to cool until you can handle it, then cut away the skin and cut in thin slices. Turn the oven down to 350 degrees.

2. While the squash is in the oven, make the béchamel. Heat the remaining oil over medium heat in a heavy medium saucepan. Add the shallot or onion and cook, stirring, until it has softened, about 3 minutes. Stir in the flour and cook, stirring, for about 3 minutes, until the mixture is smooth and bubbling, but not browned. It should have the texture of wet sand. Whisk in the milk all at once and bring to a simmer, whisking all the while, until the mixture begins to thicken. Turn the heat to very low and simmer, stirring often with a whisk and scraping the bottom and edges of the pan with a rubber spatula, for 10 to 15 minutes, until the sauce is thick and has lost its raw flour taste. Season with salt, pepper and nutmeg. Strain while hot into a large measuring cup or a medium bowl and stir in 1/4 cup of the Parmesan and 1 tablespoon of the sage.

3. Preheat the oven to 350 degrees. Oil a rectangular baking dish. Spread a spoonful of béchamel over the bottom. Top with a layer of lasagna noodles. Spread a thin layer of the béchamel over the noodles. Top with half the squash. Season the squash with salt and pepper and sprinkle with Parmesan. Repeat the layers, ending with a layer of lasagna noodles topped with béchamel and Parmesan. Sprinkle the remaining sage over the top. Make sure the noodles are well coated with béchamel so they will soften during baking.

4. Cover the baking dish tightly with foil and place in the oven. Bake 40 minutes, until the noodles are tender and the mixture is bubbling. Uncover and, if you wish, bake another 5 to 10 minutes until the top begins to brown. Remove from the heat and allow to sit for 5 minutes before serving.

Yield: 6 to 8 servings.

Advance preparation: You can assemble this up to a day ahead and refrigerate, or freeze for a month. The lasagna can be baked several hours ahead and reheated in a medium oven.

Nutritional information per serving (6 servings): 430 calories; 14 grams fat; 5 grams saturated fat; 1 gram polyunsaturated fat; 7 grams monounsaturated fat; 23 milligrams cholesterol; 58 grams carbohydrates; 5 grams dietary fiber; 353 milligrams sodium (does not include salt to taste); 19 grams protein

Nutritional information per serving (8 servings): 322 calories; 11 grams fat; 4 grams saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 17 milligrams cholesterol; 43 grams carbohydrates; 4 grams dietary fiber; 264 milligrams sodium (does not include salt to taste); 15 grams protein

Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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My Story: Running for the Music (on My Playlist)

I have always hated running.

A steep hill does not entice me. My labored breathing makes me sound the way I feel: miserable. To keep up with my life, I'm always in a flailing hurry, so why would I want my exercise to mimic that?

I have no idea. Nonetheless, the other chilly morning when I went out for a run, I wore a long-sleeved race T-shirt: Seven Mile Run, Central Park, Feb. 1, 1987.

I've been running at least since then — with years lost to knee and bunion surgeries, physical therapy for running-induced lower back pain as well as flings with treadmills and exercycles.

That's a long time to be doing something you hate as aggressively as I do.

But I do not run to run. I run to listen — which real runners consider not only dangerous but apostasy.

I can run only with music in my head, and heart. For decades I've fussed over playlists, a nod to my years as a college D.J., when free-form FM radio was in ascent. The music lifts my spirits, eases up on my knees, pushes me to one more song.

From the 30-minute Walkman cassettes I made with a turntable and a tape recorder to the hour-plus playlists on my iPod, the lists reflect changes in my taste, my life, my runs. They have been my personalized soundtrack.

The tumult of a single woman in New York ("Love Stinks!" J. Geils Band). Rent struggles ("Pressure Drop," the Maytals). New boyfriend ("Kiss," Prince and the Revolution).

Years later, a salute to my first daughter: "My Girl." Then she turned 4 ("She Drives Me Crazy," Fine Young Cannibals). Next, her sister, my brown-eyed girl, whom Katy Perry now conjures with "Firework."

The author's "Tumultuous Life of Single Woman in the City" playlist, circa 1989. (You'll need to download Spotify to listen.)

Oh, right, my husband. Serious runner. He would never listen to music while charging up hills. But I include nods to his taste: Santana's "Smooth."

Radio was always my musical lifeline. In high school, I interned at a local station. D.J.'s there critiqued one another's sets. ("Carrie Anne," the Hollies, followed by "Carry On," Crosby Stills Nash and Young? Cheap. Trick.)

When I went on air at my college station, I realized that although I couldn't personally make music, I could make music personal. On Sunday mornings, I would play hangover-recovery music from 10 a.m. to 2 p.m. ("Good Morning Little Schoolgirl," Taj Mahal). For the 2 a.m. to 6 a.m shift, I would play term-paper-due, all-nighter music ("Midnight Rider," the Allman Brothers Band).

After I graduated, jobs for this niche talent were few and unsalaried. To stay in the music conversation by proxy, I wrote about the radio industry, and reviewed and interviewed musicians.

But eventually journalism moved me to covering domestic violence and murder trials. My relationship with music and an audience — listeners or readers — disappeared.

I'd heard that joining the New York Road Runners Club was a good way to meet guys. So, with skepticism, I started running.

Blisters! Worse still, it bored me silly.

But at the path around the Central Park reservoir, I spotted runners with headphones. Music? I could be a D.J. again, programming sets for a devoted listenership of one.

Ever since, my playlists have followed a few rules. Joy is essential, a great hook critical, tempo crucial. Because I'm too lazy to stretch, the first songs are warm-ups, an invitation to do this thing. I heartily recommend "Sexual Healing" (Marvin Gaye).

The lists are intuitively shaped to my pace. Some are more knee-forgiving than others. Within 10 minutes, the backbeat picks up. I select songs long enough to build running momentum, but not so long that I quickly flag. The urgent patterns of one drummer lead into the smack-smash response of the next ("I Wanna Be Sedated," the Ramones; "Middle of the Road," the Pretenders).

Do you have a favorite playlist for workouts? Please share it in the comments section.

You can follow Booming via RSS here or visit nytimes.com/booming.

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Practicing Yoga, Family Style

Jeff Minton for The New York Times

The Killicks posing near the North Saskatchewan River in Alberta. From left, Sami, 15; Tobi, 13; Gil, 17; Von, 21; Glenna (mother); Tyler (father).

Dropping in on the Killick family, 45 minutes outside Edmonton, Alberta, feels like dropping into a Wes Anderson movie about Canadian rustics. Glenna and Tyler Killick and their four children — Von, 21; Gil, 17; Sami, 15; Tobi, 13 — live off a dirt road in a farmhouse they built themselves. A 1965 Ford Galaxie 500 sits out front, near the cow trough where they all bathed straight through Canadian winters, before they installed indoor plumbing in 2005. Out back are raspberry bushes that won't fruit, chickens that run away and corn that's starting to bolt. "We're terrible farmers!" Glenna says.

For a while, the kids, who are home-schooled, got their exercise in the home-schoolers' basketball league, but they didn't like it much. As Sami, the lone girl, says, "Half the court are people scared of the ball, and the other half are kids whose dad plays with them three hours a day." Then three years ago, Tyler, a plumber, threw out his back on a job, and his client gave him a 10-day pass to a Bikram yoga studio in West Edmonton. Tyler and Glenna practiced for a month and loved it. Then they took their kids. Attending four or five classes a week, the children learned quickly. Tobi was 9 at the time, too young for the 104-degree yoga room, so he sat in the lobby with his siblings while his parents took a class, then with his parents when his siblings took class. Eventually he joined in.

After about a year, a teacher invited the Killick children to train for a yoga competition in Alberta. Yogis have mixed feeling about the discipline being a competitive sport, and the Killicks rarely seek official validation. As Glenna puts it, "We are not institution-style people." But they prepared, did well in Alberta and in June flew to Los Angeles for the International Yoga Asana Championship. Gil, Sami and Tobi placed in their divisions. (Only five boys and eight girls entered the competition.) Gil lost points when he fell out of Peacock Pose a second too soon. "It's a very hero-to-zero scenario," Tyler says.

One rainy day recently, the Killicks drove from the prairie to the studio. Inside, Sami, the family cook (the older boys are trained as plumbers), placed a tin filled with vegan pumpkin muffins in the kitchen to be shared after class. Then she stripped down to a sports bra and hot pants and joined her family in the furnacelike yoga room for the 90-minute class. Gil likes the strength poses; his siblings grouse, "He was born with a six-pack!" Sami, according to her brothers, is a "legalist"; she has to do every posture exactly right. When Sami did Half Moon Pose, pressing her hands together overhead and leaning to one side, the bottom of her rib cage touched the top of her pelvic bone.

Back at home, the kids fanned out in the living room and played music — Sami and Von on guitars, Gil on ukulele, Tobi on a Peruvian box drum. Like an updated Partridge Family, they sang delightful indie-rock covers of "Five Years Time," by Noah and the Whale, and "Hey Ho," by the Lumineers. Along with being good at singing and yoga, the Killicks are also excellent whistlers. Von, who last year declared he was moving out of the house but then decided to stay, explained, "We have a lot of time to practice in the winter."

Shortly after the sun set, the Killicks went down to the basement and, on black interlocking mats near a wall of mirrors, worked more advanced yoga poses. Von pressed into a handstand and then folded his legs in lotus. Sami extended one foot behind her and up over her head, until her ankle rested under her chin. Tobi worked on Bowlegged Peacock, balancing his body in a horizontal plank atop his elbows with his knees bent all the way back. The siblings like the intimacy of family yoga. "The facade is gone," Von says. "Everybody is stripped down to the basics. There's no real hiding."

Elizabeth Weil is a contributing writer for the magazine and the author of a memoir about marriage, ''No Cheating, No Dying.''

Editor: Ilena Silverman

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Well: There's Homework to Do on School Lunches

Nutritionists and health-conscious parents applauded when last year the Department of Agriculture finally set new standards for the nation's school lunches in an effort to foster good health and counter the epidemic of obesity afflicting youngsters.

The makeover — the first major improvement in the nutritional quality of school meals in 15 years — expands access to fresh fruits and vegetables for children at lunch and snack time. For the first time, both fruits and vegetables must be served daily and should make up two-thirds of lunch.

Depending on the child's age, daily fruit servings range from half a cup to a full cup, and daily vegetables from three-fourths of a cup to one cup. The amount of meat or meat alternative should be the size of the palm of a child's hand. At least half of grains should be whole, milk must be nonfat or 1 percent, and only nonfat milk can be flavored.

This is a vast improvement over the mystery dishes loaded with fat and flour and the mushy, overcooked vegetables that long defined school lunch. Having seen the offerings when my sons were in school, I chose to give them lunch from home until they went off to college. They learned that foods that were good for them could also taste good, a lesson retained for nearly 40 years.

But the new school lunch menu, it seems, is not going down well with many school-age diners, who are tossing the mandated fruits and vegetables into the garbage or refusing school lunch altogether. Instead, they are choosing competitive foods sold in the cafeteria or buying lunch from vending machines and snack bars in school or from outside purveyors, where the typical choices include chips, candy, cookies, pizza, hot dogs, burgers, fries and sugary soft drinks.

In a 2010 study, published in what was then called The Journal of the American Dietetic Association, researchers at the Centers for Disease Control and Prevention found that among a representative sample of 4,322 students in 73 Florida middle schools, 18 percent bought a snack or beverage from a vending machine two or more times a week instead of school lunch.

Breaking Old Habits

Of course, no matter the menu, schoolchildren have long been known to discard some or all of the food they are served at lunch and to grab some sweet or caloric snack to suppress their hunger. Even those who bring lunch from home often trade or give away the most nutritious items that caring parents put in their lunchboxes. But complaints about school lunch and resulting waste have clearly escalated with the revised meal plan. Despite decades of education about healthy eating, too many American children still snub their noses at fruits, vegetables, whole grains, beans and peas.

There are many possible reasons for this sad turn of events.

Many parents, pressed for time, money or both, don't introduce their children to foods that foster good nutrition and a healthy weight, allowing them instead to feast mainly on produce-poor fast foods that are high in fat, calories and salt.

When families rely on packaged or store-prepared meals, children grow up familiar with the Golden Arches but know little about where foods come from, how they are prepared and how delicious fresh foods can be. And with family meals only a sometime event in many households, children don't get to learn by example from seeing what their parents eat.

Instead of expecting children to eat what is set before them, as most did in my generation, parents have become short-order cooks, serving children only what they like. Yet studies have shown that children typically require repeated exposure to once-rejected foods before they acquire a taste for them.

Few schools provide inviting introductions to the changes in school lunch and don't prepare the new foods in tasty, attractive ways that might tempt reluctant diners.

Changes at Home and School

All is not lost. It may take time, but with sensible and consistent strategies at home and in school, children can adjust to the changes in the lunch program and learn to enjoy them.

Acceptance necessarily starts with the foods and drinks that are purchased and served at home. Hungry children will naturally go for what is readily available, so stock the cupboard with good-for-you fare. When my sons were toddlers, I decreed that vending machines were off limits, and they soon stopped asking for whatever was in them.

Chips, cookies and soda were not on my weekly shopping list, purchased only for special occasions like parties and trips. Instead, a bowl of fresh fruit sat on the table, a fresh fruit salad was front and center in the fridge, and the top shelf held nonfat milk, orange juice and water. If children are given a choice between an apple or a cookie, most will choose the latter. The choice should be between an apple or grapes, for example.

For an after-school snack, the boys got milk with a homemade low-fat, low-sugar muffin or quick bread (baked in big batches and frozen). While dinner was being prepared, they snacked on cut carrots, celery and cucumbers with a low-fat dip. A bowl of Wheaties with raisins and milk was their usual bedtime snack.

Whenever possible, take children to the grocery store or, better yet, a farmers' market and talk about the different choices and why you are making them.

Have the children help prepare meals — if they've made it, they'll be more likely to eat it. Even a toddler can add grapes or cherry tomatoes to a salad bowl.

Take an extra minute to present foods attractively, say, by arranging fresh vegetables and fruits in an appealing design. I made a face on oatmeal with raisins and apple slices for my toddlers. And I gave some foods playful names, like "baby tree" for broccoli.

But schools, too, have work to do. When children learn about foods in the classroom and have hands-on experience with them, they are more likely to eat them in the lunchroom.

How about restoring kitchens run by well-trained cooks who know how to prepare nutritious and inviting meals, and offering cooking classes to boys and girls starting in the first grade? Schools today are so focused on stuffing children's heads with facts and figures they have forgotten that a good mind needs a well-nourished (and well-exercised) body.

Student groups can be formed to consult with the lunchroom staff, and special days, like "Try-It Tuesdays," created to give children a chance to sample new foods and make suggestions for improvements.

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Poor Sanitation Found at Pharmacy Linked to Meningitis Outbreak

Bryce Vickmark for The New York Times

The building housing the New England Compounding Center and the nearby recycling center.

WASHINGTON — A federal inspection of a company whose tainted pain medicine has caused one of the worst public health drug disasters since the 1930s found greenish-yellow residue on sterilization equipment, surfaces coated with levels of mold and bacteria that exceeded the company's own environmental limits, and an air-conditioner that was shut off nightly despite the importance of controlling temperature and humidity.

The findings, made public on Friday by the Food and Drug Administration, followed a report from Massachusetts regulators on Tuesday and offered disturbing new details in an emerging portrait of what went wrong inside the New England Compounding Center, the pharmacy at the heart of a national meningitis outbreak in which 25 people have died, 313 more have fallen ill and as many as 14,000 people are believed to have been exposed.

Instead of producing tailor-made drugs for individual patients, as the law allowed, the company turned into a major drug maker that supplied some of the most prestigious hospitals in the country, including ones affiliated with Harvard, Yale and the Mayo Clinic, all with minimal oversight from federal regulators.

Federal officials also drew attention to the company's proximity to a recycling plant where excavators and freight trucks heaped old mattresses, plastics and other materials, generating large amounts of dust. The plant, which is owned by one of the same people as the pharmacy, has not always complied with regulations and has drawn complaints, according to records in Framingham, Mass., where the company is located.

And as the death toll continues to rise, the F.D.A.'s commissioner, Dr. Margaret Hamburg, who was appointed by President Obama, has stayed mostly silent.

Some observers said that weighing in loudly and publicly on a contentious issue was simply not Dr. Hamburg's style. Others said that it was because the agency was preparing a criminal case and would not want to endanger that with statements construed to be prejudicial. David Kessler, a former F.D.A. commissioner, pointed to the impending presidential election and efforts to keep the outbreak from becoming a political issue.

"Everyone is closed down right now," he said. "People are being very careful. No one wants to make a mistake."

The inspection report offered the clearest indication yet that the fungus that contaminated the company's vials of methylprednisolone acetate, an injectable pain medicine, may have gotten there because of the company's own practices.

Inspectors said that 83 out of 321 vials from one of the lots linked to the meningitis outbreak that they observed contained "greenish black foreign matter" and another 17 vials had "white filamentous material."

The report said the company had tested only one sample from that lot, and it had proved sterile. When the F.D.A. tested 50 vials from that same lot, all of them contained some microbial growth.

Experts said that perhaps the most worrisome finding was that the company's own testing between January and September found surfaces in the clean rooms contaminated with either bacteria or mold exceeding the levels at which the company's own procedures called for remedial measures. In some cases, there were so many bacteria or fungi in a sample that the whole testing dish was overrun with a so-called overgrowth.

"Think of a plant just growing out of control," said Steven Lynn, director of the Office of Manufacturing and Product Quality at the F.D.A. Yet, according to the agency, there was no evidence the company took remedial actions.

"This is pretty heinous stuff," said Lou Diorio of LDT Health Solutions, a consultant to compounding pharmacies. "This just shows a general lack of basic clean-room principles."

Russell E. Madsen, a consultant on sterility issues to the pharmaceutical industry, said of the inspection report: "In all my time in the pharmaceutical industry, which is 45 years, I've never seen one this bad."

Another problem was the company's air-conditioning system, which employees said was switched off between 8 p.m. and 5:30 a.m. in the room where sterile drugs were made. Maintaining proper temperature and humidity is important for retarding the growth of microbes.  

Sabrina Tavernise reported from Washington, and Andrew Pollack from Los Angeles. Abby Goodnough contributed reporting from Boston, and Denise Grady from New York. Sheelagh McNeill contributed research.

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Massachusetts Shuts Down Another Compounder

BOSTON — Massachusetts shut down another compounding pharmacy after a surprise inspection last week found conditions that called into question the sterility of its products, state officials said Sunday.

The pharmacy, Infusion Resource in Waltham, voluntarily surrendered its license over the weekend, said Dr. Madeleine Biondolillo, director of the Bureau of Health Care Safety and Quality at the Massachusetts Public Health Department. Inspectors who visited Infusion Resource on Tuesday found "significant issues with the environment in which medications were being compounded," Dr. Biondolillo said during a news conference here. She would not disclose details, but said that in another troubling discovery, patients had apparently been receiving intravenous medications at the pharmacy, against state regulations.

The findings led the state to immediately issue a cease-and-desist order, Dr. Biondolillo said, preventing Infusion Resource from dispensing any drugs. But she added that as of yet, there was no evidence of any contaminated drugs produced there.

The latest shutdown comes amid a continuing investigation of New England Compounding Pharmacy, the company believed responsible for a national meningitis outbreak in which 25 people have died, at least 344 others have fallen ill and as many as 14,000 people are thought to have been exposed. State and federal inspections in recent weeks found unsanitary conditions at New England Compounding, from surfaces coated with mold and bacteria to residue on sterilization equipment.

New England Compounding has suspended operations and laid off most of its employees.

Gov. Deval Patrick last week directed the state's Board of Registration in Pharmacy to immediately start unannounced inspections of compounding pharmacies that prepare sterile, injectable medications. There are 25 such pharmacies in Massachusetts, and Mr. Patrick has acknowledged that the state rules governing them were insufficient. Although the Food and Drug Administration can inspect compounding pharmacies and issue warnings, the agency says states have ultimate jurisdiction.

At the news conference on Sunday, Dr. Lauren Smith, the interim commissioner of the Massachusetts Department of Public Health, said the state was bringing on five additional inspectors to help with unannounced visits to compounding pharmacies. The goal is to inspect all of them by Jan. 1, she added.

Dr. Smith also said the state had asked Sophia Pasedis, a member of the pharmacy board who works at Ameridose, a sister company to New England Compounding that is also under investigation and currently shut down, to resign from the board. State officials said earlier this month that Ms. Pasedis had recused herself from any board actions concerning New England Compounding and Ameridose. But on Sunday, Dr. Smith said there was "no definitive proof" that Ms. Pasedis, the vice president of regulatory affairs and compliance at Ameridose, had consistently done so.

Ms. Pasedis has so far declined to step down, Dr. Smith said, but her term expires next month. She has been on the pharmacy board since 2004.

Dr. Biondolillo said the manager of record at Infusion Resource used to work at Ameridose.

Infusion Resource was last inspected by the state when it opened in December 2009, she said, and was found to be in compliance at the time. The state has not received any complaints about the pharmacy since then, she added.

In an e-mailed statement, Bernard F. Lambrese, the chief executive of Infusion Resource, said, "No issues were cited relating to the integrity of our products nor to the quality of our compounding practices." He added that the pharmacy was working to address concerns cited by the inspectors, including the condition of the flooring in the room where the pharmacy mixes drugs, and would then seek to be relicensed.

Dr. Biondolillo said that Infusion Resource supplies specialized medications to patients after they have been discharged from a hospital. According to its Web site, Infusion Resource is part of a company based in East Providence, R.I.

Also on Sunday, Representative Edward J. Markey, a Massachusetts Democrat in whose district New England Compounding is located, issued a report on the practice of compounding that stated there had been "adverse medical incidents" related to compounding in at least 34 states.

Citing F.D.A. records, the report said there had been 23 deaths and at least 86 serious illnesses associated with the practice of compounding. The statistics did not include the current meningitis outbreak.

The report also included a review of state pharmacy boards and found that they do not generally undertake enforcement actions that relate to the safety or scope of compounding. Instead, the report said, their focus tends to be more on traditional pharmacy activities, including licensing and controlled substances.

Massachusetts officials have said that tracking volume from compounding pharmacies was not part of their regulatory mandate. But Dr. Smith said the state would soon issue emergency rules requiring compounding pharmacies to submit frequent reports on production and distribution of injectable drugs.

"I know that we face great challenges," she said. "At the same time, though, we have a rare opportunity to create meaningful change."

Sabrina Tavernise contributed reporting from Washington.

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Rachel Carson’s Lessons, 50 Years After ‘Silent Spring’

SHE was a slight, soft-spoken woman who preferred walking the Maine shoreline to stalking the corridors of power. And yet Rachel Carson, the author of "Silent Spring," played a central role in starting the environmental movement, by forcing government and business to confront the dangers of pesticides.

Carson was a scientist with a lyrical bent, who saw it as her mission to share her observations with a wider audience. In the course of her work, she also felt called upon to become a leader — and was no less powerful for being a reluctant one.

As a professor at Harvard Business School, I encountered the great depth of her work when I was creating a course on the history of leadership. I was amazed to learn she wrote "Silent Spring" as she battled breast cancer and cared for a young child. After the book was published, 50 years ago last month, she faced an outburst of public reaction and a backlash from chemical companies. Yet throughout her personal and public struggles, she was an informed spokeswoman for environmental responsibility.

She was a classic introvert who exhibited few of the typical qualities associated with leadership, like charisma and aggressiveness. But as people like Susan Cain, author of "Quiet: The Power of Introverts in a World That Can't Stop Talking," have pointed out, leadership can come in less obvious forms.

Carson's life shows that individual agency, fueled by resolution and hard work, has the power to change the world. In this election year, when so much influence seems concentrated in "super PACs," lobbying groups and other moneyed interests, her story is a reminder that one person's quiet leadership can make a difference.

The natural world had fascinated Carson since she was a young girl growing up near Pittsburgh. At the Pennsylvania College for Women, later Chatham College, she majored in biology and earned her master's degree in zoology at Johns Hopkins.

In the 1930s, there were few professional opportunities for women in the sciences. But in 1935, she found a job writing radio scripts about the ocean for what would become the United States Fish and Wildlife Service. Within four years, she was editor in chief of all the agency's publications, a position that connected her with researchers, conservationists and government officials.

Her work at the agency fed her larger calling as a writer. Throughout the 1930s and '40s, she wrote freelance articles about the natural world for Colliers, the Atlantic Monthly and other magazines. In 1941, she published her first book, "Under the Sea-Wind," a narrative account of the birds and sea creatures of North America's eastern shores.

Carson wrote within the crevices of a busy life, and often with serious health problems. In 1950, she had surgery to remove a tumor from her left breast. The next year, she published "The Sea Around Us," a wide-ranging history of the ocean. It was an instant best seller. Readers responded to her graceful prose and marshaling of scientific facts, as well as to her long-term perspective. The book's success enabled her to leave her position at the wildlife agency and devote herself to writing.

IN early 1958, she began working intently on "Silent Spring" while serving as both a breadwinner and a caregiver. The previous year, her niece died after an illness and she adopted her 5-year-old grandnephew. Unmarried and living in Silver Spring, Md., she also cared for and financially supported her ailing mother.

For the next four years, she gave all the time and energy she could spare to researching and writing "Silent Spring." A diligent investigator, she reached out to a network of scientists, physicians, librarians, conservationists and government officials. She found colleagues, clerks, whistle-blowers and others who had studied pesticide use and were willing to share their knowledge.

With an assistant's help, she spent weeks in the research libraries of Washington. Many of her contacts generated even more leads.

Carson was particularly interested in possible connections between cancer and human exposure to pesticides. In late 1959, she wrote this to Paul Brooks, her editor at Houghton Mifflin: "In the beginning I felt the link between pesticides and cancer was tenuous and at best circumstantial; now I feel it is very strong indeed."

Her research, she wrote, "has taken very deep digging into the realms of physiology and biochemistry and genetics, to say nothing of chemistry. But I now feel that a lot of isolated pieces of the jigsaw puzzle have suddenly fallen into place," she said, as quoted in "Rachel Carson: Witness for Nature," a book by Linda Lear.

In late 1958, Carson's mother died. And the next summer, her grandnephew's illness slowed her work. By late 1959, she knew that the book would take longer than she originally planned. Yet she remained confident, writing to her editor that she was building her work "on an unshakable foundation."

As she researched her book, Carson knew she was playing with fire. Still, she realized she had to bring her findings to a large audience. "Knowing what I do," she wrote to a close friend in 1958, "there would be no future peace for me if I kept silent."

In early 1960, medical problems interrupted Carson's work again. She learned that she had an ulcer, and she developed pneumonia. In early April, she had surgery in Washington to remove two tumors in her left breast. One was apparently benign, she told a friend. The other was "suspicious enough to require a radical mastectomy." Her doctors stopped short of diagnosing cancer and recommended no further treatment.

She went home to recover from the surgery and slowly resumed work. In November, Carson discovered a mass in her left chest. This led her to seek a second opinion at the Cleveland Clinic.

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The Island Where People Forget to Die

Andrea Frazzetta/LUZphoto for The New York Times

Stamatis Moraitis tending his vineyard and olive grove on Ikaria. More Photos »

In 1943, a Greek war veteran named Stamatis Moraitis came to the United States for treatment of a combat-mangled arm. He'd survived a gunshot wound, escaped to Turkey and eventually talked his way onto the Queen Elizabeth, then serving as a troopship, to cross the Atlantic. Moraitis settled in Port Jefferson, N.Y., an enclave of countrymen from his native island, Ikaria. He quickly landed a job doing manual labor. Later, he moved to Boynton Beach, Fla. Along the way, Moraitis married a Greek-American woman, had three children and bought a three-bedroom house and a 1951 Chevrolet.

Andrea Frazzetta/LUZphoto for The New York Times

Residents of the island Ikaria in Greece live profoundly long and healthful lives. More Photos »

One day in 1976, Moraitis felt short of breath. Climbing stairs was a chore; he had to quit working midday. After X-rays, his doctor concluded that Moraitis had lung cancer. As he recalls, nine other doctors confirmed the diagnosis. They gave him nine months to live. He was in his mid-60s.

Moraitis considered staying in America and seeking aggressive cancer treatment at a local hospital. That way, he could also be close to his adult children. But he decided instead to return to Ikaria, where he could be buried with his ancestors in a cemetery shaded by oak trees that overlooked the Aegean Sea. He figured a funeral in the United States would cost thousands, a traditional Ikarian one only $200, leaving more of his retirement savings for his wife, Elpiniki. Moraitis and Elpiniki moved in with his elderly parents, into a tiny, whitewashed house on two acres of stepped vineyards near Evdilos, on the north side of Ikaria. At first, he spent his days in bed, as his mother and wife tended to him. He reconnected with his faith. On Sunday mornings, he hobbled up the hill to a tiny Greek Orthodox chapel where his grandfather once served as a priest. When his childhood friends discovered that he had moved back, they started showing up every afternoon. They'd talk for hours, an activity that invariably involved a bottle or two of locally produced wine. I might as well die happy, he thought.

In the ensuing months, something strange happened. He says he started to feel stronger. One day, feeling ambitious, he planted some vegetables in the garden. He didn't expect to live to harvest them, but he enjoyed being in the sunshine, breathing the ocean air. Elpiniki could enjoy the fresh vegetables after he was gone.

Six months came and went. Moraitis didn't die. Instead, he reaped his garden and, feeling emboldened, cleaned up the family vineyard as well. Easing himself into the island routine, he woke up when he felt like it, worked in the vineyards until midafternoon, made himself lunch and then took a long nap. In the evenings, he often walked to the local tavern, where he played dominoes past midnight. The years passed. His health continued to improve. He added a couple of rooms to his parents' home so his children could visit. He built up the vineyard until it produced 400 gallons of wine a year. Today, three and a half decades later, he's 97 years old — according to an official document he disputes; he says he's 102 — and cancer-free. He never went through chemotherapy, took drugs or sought therapy of any sort. All he did was move home to Ikaria.

I met Moraitis on Ikaria this past July during one of my visits to explore the extraordinary longevity of the island's residents. For a decade, with support from the National Geographic Society, I've been organizing a study of the places where people live longest. The project grew out of studies by my partners, Dr. Gianni Pes of the University of Sassari in Italy and Dr. Michel Poulain, a Belgian demographer. In 2000, they identified a region of Sardinia's Nuoro province as the place with the highest concentration of male centenarians in the world. As they zeroed in on a cluster of villages high in Nuoro's mountains, they drew a boundary in blue ink on a map and began referring to the area inside as the "blue zone." Starting in 2002, we identified three other populations around the world where people live measurably longer lives than everyone else. The world's longest-lived women are found on the island of Okinawa. On Costa Rica's Nicoya Peninsula, we discovered a population of 100,000 mestizos with a lower-than-normal rate of middle-age mortality. And in Loma Linda, Calif., we identified a population of Seventh-day Adventists in which most of the adherents' life expectancy exceeded the American average by about a decade.

This article is adapted from new material being published in the second edition of "Blue Zones," by Dan Buettner, out next month from National Geographic.

Editor: Dean Robinson

This article has been revised to reflect the following correction:

Correction: October 28, 2012

An article on Page 36 this weekend about the reasons people on the Greek Island of Ikaria live long lives misstates the period when fasting is practiced by the island's inhabitants. They fast before Orthodox feast days, not during Orthodox feast days.

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My Multiday Massage-a-Thon

Illustrations by Paul Pope

About a month ago, editors from this magazine, which employs me, and from which I am therefore loath to turn down assignments even when they are horrifying, assigned me to get a series of massages and other body treatments here in the coastal town where I live, Wilmington, southeastern N.C., Port City of Progress and Pleasure. There was a semi-legitimate journalistic impulse behind it, but it was also billed as an act of mercy. I'd been traveling and writing a lot for them, spending a lot of time in middle seats on international flights, and my body had reached new levels of vileness. The yellowish gray-green circles under my eyes had a micropebbled texture, and my skin gave off a sebaceousy sheen of coffee-packet coffee. My calves had developed a vague thrombotic throb. It was the kind of premature aging where you think, I'll come back from this but not all the way.

When you feel like that, you don't leap to be naked in rooms with an assortment of strangers while they rub their hands all over your bare flesh — there's probably a fetish group for becoming as physically disgusting as you can and then procuring massages, but that's not my damage. Also, there's something about massage in general that makes me less, not more, relaxed. The boredom of it, the entrapment. Like you, probably, I know a couple of people who go around parties rubbing other people's backs, and I cringe at their approaching hands. One of these shoulder-pirates laughed at me for it once, after I flinched, telling me I needed to "learn to receive love," and I thought, That's probably true, I'd bet I do. Faux-wise passive-aggressive hippie maxims always seem true and wounding in the moment.

Still, everyone, including my mother, who was visiting, said: "Your job! To get paid to get massages!" So I tried to embrace that. It seemed churlish not to. Even my body deserved to be touched, to be kneaded and ministered to. I drove around town checking out different places — only a couple looked sketchy; I think Wilmy has a pretty light scene when it comes to massage of the highway-billboard variety. I made a few appointments and then canceled them. Massage and I were just teasing each other.

Then one morning, inevitably, I woke up with a headache. Not a migraine, but a kind of necky, achy number. I rang up Miller-Motte College, a technical school on Market Street with a locally recognized department in Massage Therapy.

The next morning, a brown-haired young woman who looked to be in her very early 20s — and turned out to be 19 — introduced herself as Victoria and said that she would be my therapist. The room she led me to was spare, with a kind of maroon-gray-olive palette, hotel-conference-room colors. Victoria opened the blinds on the door window — it was one of the things the therapists had to do, so that their teachers could look in.

The erotic element of nonerotic massage is somehow comical. Even to mention it seems louche, but to glide past it is bizarre. My spouse, for instance, would say it's creepy that I noticed it, but if I were blind to it, that would mean I was a sexually dead person, and she wouldn't love me, and would be seen to be keeping me around purely in a "Weekend at Bernie's" kind of way. When you think about it, there's no other situation in life in which a man or woman touches you the way a massage artist touches you except in bed, or on the way there. It doesn't matter if your person is attractive to you or not, and it can be the opposite sex from the one you're attracted to if you're attracted to only one. It's just the simple act of someone rubbing her hands all over you, and not with the precise, deliberate motions of a medical procedure, but with, you hope, a certain tenderness and warmth. Even the traditional phrases — "I'm going to step out; you undress to your comfort level" — imply a problem, that a wrong move could make things uncomfortable. Nothing wrong with all this, of course — it probably adds to the health benefits — I merely mark the static.

I can't say that the first massage penetrated very far. I had thousands of hours of Quasimodo-like keyboard-hunching stored in my torso, so it would have taken a genius to break through in an hour. Thankfully, Wilmington is full of massage places — there's one in every strip mall practically — and I'd soon booked some tables. My take had shifted. The first massage was nice, and now I remembered that I could get unlimited free massages anywhere, which suddenly seemed exciting and like something I'd been cryptically but deeply deserving for a long time. I shaved, I took a shower, I took a couple of walks, I didn't want to be quite as gross for the next one — motivation was creeping in. It's like what they say: If you leave the house, you'll want to go out more.

This article has been revised to reflect the following correction:

Correction: October 28, 2012

An article on Page 30 this weekend about one man's experience in the world of massages and other body treatments misspells the given name of an artist known for his densely-painted, realist studies of the human body.  He was Lucian Freud, not Lucien.

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U.S. to Sponsor Health Insurance Plans Nationwide

WASHINGTON — The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

These multistate plans were included in President Obama's health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.

Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been "extraordinarily successful" in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.

John J. O'Brien, the director of health care and insurance at the agency, said the new plans would be offered to individuals and small employers through the insurance exchanges being set up in every state under the 2010 health care law.

No one knows how many people will sign up for the government-sponsored plans. In preparing cost estimates, the Obama administration told insurers to assume that each national plan would have 750,000 people enrolled in the first year.

Under the Affordable Care Act, at least one of the nationwide plans must be offered by a nonprofit entity. Insurance experts see an obvious candidate for that role: the Government Employees Health Association, a nonprofit group that covers more than 900,000 federal employees, retirees and dependents, making it the second-largest plan for federal workers, after the Blue Cross and Blue Shield program.

The association, with headquarters near Kansas City, Mo., was founded in 1937 to help railway mail clerks with their medical expenses, and it generally receives high scores in surveys of consumer satisfaction.

Richard G. Miles, the association's president, expressed interest in offering a multistate plan to the general public through insurance exchanges, but said no decision had been made.

"Our expertise in the Federal Employees Health Benefits Program would be useful in the private marketplace," Mr. Miles said in an interview. "But we are concerned about the underwriting risk in providing insurance to an unknown group of customers."

To be eligible to participate in the multistate program, insurers must be licensed in every state. The Government Employees Health Association recently bought a company that has the licenses it would need.

The new health care law stipulates that at least one of the multistate plans must provide insurance without coverage of abortion services. If a plan does cover abortions, it must establish separate accounts, one with money for abortion and one for all other medical services.

National insurance plans will be subject to regulation by the federal government, state insurance commissioners and state insurance exchanges. That mix could cause confusion for some consumers who have questions or complaints about their coverage.

The federal standards will pre-empt state rules in at least one respect: the national health plans will automatically be eligible to compete against other private insurers in the new exchanges, regardless of whether they have been certified as meeting the standards of those exchanges.

The administration has promised to "work cooperatively with states." But it is unclear whether the government-sponsored plans will have to comply with all state laws and consumer protection standards; whether they will have to comply with state benefit mandates; and whether they will have to pay state fees and taxes levied on other insurers to finance exchange operations.

The National Association of Insurance Commissioners, which represents state regulators, expressed alarm at the prospect of a double standard.

"It is absolutely essential that multistate plans compete on a level playing field with other qualified health plans, which are subject to state insurance law," the association said in a letter to the Office of Personnel Management.

Consumer groups expressed similar concerns. The national insurance plans and other carriers must be subject to identical standards, they say, or consumers cannot make valid comparisons.

"Multistate plans have real potential benefits for consumers," said Ronald F. Pollack, the executive director of Families USA, a liberal-leaning consumer group. "But there is also potential trouble if the multistate plans are exempted from some consumer protection standards."

Robert E. Moffit, a senior fellow at the conservative Heritage Foundation, said he worried that "the nationwide health plans, operating under terms and conditions set by the federal government, will become the robust public option that liberals always wanted."

Insurers are pleading with the Office of Personnel Management to provide more detailed guidance.

"We are concerned that O.P.M. has not yet released rules specifying the requirements for the multistate plan," said Jay A. Warmuth, a lawyer at UnitedHealth Group, one of the nation's largest insurers.

Rules for the new program have been under review by the White House for three months, and officials said they would be issued soon.

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Poor Sanitation Found at Pharmacy Linked to Meningitis Outbreak

Bryce Vickmark for The New York Times

The building housing the New England Compounding Center and the nearby recycling center.

WASHINGTON — A federal inspection of a company whose tainted pain medicine has caused one of the worst public health drug disasters since the 1930s found greenish-yellow residue on sterilization equipment, surfaces coated with levels of mold and bacteria that exceeded the company's own environmental limits, and an air-conditioner that was shut off nightly despite the importance of controlling temperature and humidity.

The findings, made public on Friday by the Food and Drug Administration, followed a report from Massachusetts regulators on Tuesday and offered disturbing new details in an emerging portrait of what went wrong inside the New England Compounding Center, the pharmacy at the heart of a national meningitis outbreak in which 25 people have died, 313 more have fallen ill and as many as 14,000 people are believed to have been exposed.

Instead of producing tailor-made drugs for individual patients, as the law allowed, the company turned into a major drug maker that supplied some of the most prestigious hospitals in the country, including ones affiliated with Harvard, Yale and the Mayo Clinic, all with minimal oversight from federal regulators.

Federal officials also drew attention to the company's proximity to a recycling plant where excavators and freight trucks heaped old mattresses, plastics and other materials, generating large amounts of dust. The plant, which is owned by one of the same people as the pharmacy, has not always complied with regulations and has drawn complaints, according to records in Framingham, Mass., where the company is located.

And as the death toll continues to rise, the F.D.A.'s commissioner, Dr. Margaret Hamburg, who was appointed by President Obama, has stayed mostly silent.

Some observers said that weighing in loudly and publicly on a contentious issue was simply not Dr. Hamburg's style. Others said that it was because the agency was preparing a criminal case and would not want to endanger that with statements construed to be prejudicial. David Kessler, a former F.D.A. commissioner, pointed to the impending presidential election and efforts to keep the outbreak from becoming a political issue.

"Everyone is closed down right now," he said. "People are being very careful. No one wants to make a mistake."

The inspection report offered the clearest indication yet that the fungus that contaminated the company's vials of methylprednisolone acetate, an injectable pain medicine, may have gotten there because of the company's own practices.

Inspectors said that 83 out of 321 vials from one of the lots linked to the meningitis outbreak that they observed contained "greenish black foreign matter" and another 17 vials had "white filamentous material."

The report said the company had tested only one sample from that lot, and it had proved sterile. When the F.D.A. tested 50 vials from that same lot, all of them contained some microbial growth.

Experts said that perhaps the most worrisome finding was that the company's own testing between January and September found surfaces in the clean rooms contaminated with either bacteria or mold exceeding the levels at which the company's own procedures called for remedial measures. In some cases, there were so many bacteria or fungi in a sample that the whole testing dish was overrun with a so-called overgrowth.

"Think of a plant just growing out of control," said Steven Lynn, director of the Office of Manufacturing and Product Quality at the F.D.A. Yet, according to the agency, there was no evidence the company took remedial actions.

"This is pretty heinous stuff," said Lou Diorio of LDT Health Solutions, a consultant to compounding pharmacies. "This just shows a general lack of basic clean-room principles."

Russell E. Madsen, a consultant on sterility issues to the pharmaceutical industry, said of the inspection report: "In all my time in the pharmaceutical industry, which is 45 years, I've never seen one this bad."

Another problem was the company's air-conditioning system, which employees said was switched off between 8 p.m. and 5:30 a.m. in the room where sterile drugs were made. Maintaining proper temperature and humidity is important for retarding the growth of microbes.  

Sabrina Tavernise reported from Washington, and Andrew Pollack from Los Angeles. Abby Goodnough contributed reporting from Boston, and Denise Grady from New York. Sheelagh McNeill contributed research.

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World Briefing | Europe: France: Free Abortions for Teenagers

The lower house of the French Parliament voted on Friday to fully reimburse all abortions and to make contraception free for minors from the age of 15 to 18. France's national medical insurance pays for abortions for minors and the poor, while other women are reimbursed for up to 80 percent of the procedure's cost, which can be as much as $580. Contraception is partly reimbursed. The bill now goes to the Senate, where it is likely to pass.

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Energy Drink Disclosures Expose Gaps in Safety Policy

The disclosure this week that the deaths of five people since 2009 may be linked to a popular energy drink has revealed major gaps in the way federal regulators and companies monitor product safety.

Food and Drug Administration officials say that they are aggressively investigating the death reports, which are associated with Monster Energy, a highly caffeinated beverage. And its producer, the Monster Beverage Corporation, insists its products are safe, adding that it was unaware, apart from one fatality report, of other filings about deaths and serious injuries linked to its drinks.

But while the F.D.A. regularly makes adverse event reports about drugs and medical devices publicly available, it does not do so for dietary supplements like energy drinks. Because of that policy, consumers had no way of knowing of the complaints about Monster Energy drinks before incident reports were released by the F.D.A. in response to a formal Freedom of Information Act request.

Also, while supplement makers have been required since late 2007 to alert the F.D.A. to possible product-related deaths and injuries, Monster Beverage submitted just one such report to the agency over the last four years, agency officials said.

But the recently released F.D.A. documents show that over that time, the agency received 20 other filings about Monster Energy from consumers, doctors and others that included reports of four more deaths as well as life-threatening injuries.

Citing pending litigation, Monster Beverage, a publicly traded company in Corona, Calif., declined to respond to written questions about those episodes, including whether it routinely monitored F.D.A. reports on its products and, if not, why it did not do so.

The fact that the F.D.A. receives a report of a fatality or an injury linked to a drug, medical device or dietary supplement does not mean the product was at fault. But Senator Richard Durbin, Democrat of Illinois who sponsored the law that requires supplement producers to file such reports, said the agency needed to both enforce it and make the filings available to consumers.

"The reality is that the F.D.A. has not done its job," Mr. Durbin said.

On Friday, he and Senator Richard Blumenthal, Democrat of Connecticut, sent a letter to the F.D.A. commissioner, Margaret Hamburg, urging the agency to take action on energy drinks. Both lawmakers have been critics of the agency's stance on the popular beverages.

F.D.A. officials have said that they do not believe that data currently supports taking action on caffeine levels in energy drinks, but they also said the agency was continuing to look into the cases of reported deaths.

An F.D.A. spokeswoman, Shelly Burgess, said it was "going through a series of steps" to develop a way to make adverse reports about supplements publicly available. She would not say when the agency expected to complete that project.

She also said that the agency notified supplement makers when it received a report of a possible product fatality, and that the F.D.A. did so in the case of a 2009 death associated with Monster Beverage, as well as more recent fatality reports. She would not say when the agency notified the company, then known as Hansen Natural, and the company did not respond to questions.

Since mandatory reporting started in 2007, the only report of an adverse event submitted by Monster Beverage to the F.D.A. involved the highly publicized death last year of a Maryland teenager, Anais Fournier, Ms. Burgess said.

The girl's mother, Wendy Crossland, also filed an incident report to the F.DA.; the additional Monster Energy-related reports came to light when she sought such filings under the Freedom of Information Act.

She has sued the company, which says its product played no role in the teenager's death.

Steven Mister, the president of the Council for Responsible Nutrition, a trade group that represents supplement makers, said the F.D.A. had the authority to make adverse event reports public in a place like a Web site.

But he added that he was concerned that consumers would misinterpret the reports because they were inconclusive and that lawyers would seize on them to file frivolous lawsuits.

"It gives consumers information, but it doesn't give them an understanding of what the adverse event report means," said Mr. Mister.

Individual adverse event reports about drugs and medical devices also are inconclusive, but physicians and watchdog groups monitor them for trends that point to problems.

It was in 2006 that Congress passed the F.D.A. Dietary Supplement and Nonprescription Drug Consumer Protection Act, the law that requires producers of supplements and over-the-counter drugs to file adverse event reports with the F.D.A.

The law, sponsored by Senator Durbin, followed a scandal involving ephedra, a supplement sold for weight loss that was linked to dozens of deaths. Information from lawsuits later showed that producers had known of possible fatalities, the lawmaker said.

But the new law, which is intended to prevent a repeat of that episode, has resulted in few filings, either from industry or consumers and doctors. In 2009, for example, the F.D.A. received 907 mandatory reports from industry about possible adverse events involving all dietary supplements and weight-loss aids, a very large category of products that includes both larger energy drinks and smaller energy shots.

But in that same year, another federal agency, the federal Substance Abuse and Mental Health Services Administration reported that there were more than 13,000 emergency room visits associated with energy drinks alone.

In late 2011, Senator Durbin and a House Democrat, Henry Waxman of California, asked the Government Accountability Office to examine the F.D.A.'s adverse reporting system for dietary supplements.

A 2009, a report from the accountability office noted that the number of incident reports to the F.D.A. had increased because of the mandatory reporting rules, but the office said "underreporting of adverse events remains a concern."

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