Irish Government Proposes Allowing Abortion in Emergencies

DUBLIN — The Irish government proposed legislation late Tuesday night that, if approved as expected, would allow abortions in cases where a threat existed to a woman's life, including from suicide.

Although the proposal has set off a heated debate, the prime minister, Enda Kenny, has argued that it would not alter Ireland's restrictive abortion laws.

"This bill restates the general prohibition on abortion in Ireland," Mr. Kenny said at a news conference on Wednesday before the Protection of Life During Pregnancy bill was introduced. "The law on abortion in Ireland is not being changed."

His assurances did little to persuade the country's powerful anti-abortion movement. The conservative Youth Defense group branded Mr. Kenny "The Abortion Taoiseach" — the Irish word for prime minister or leader — and vowed to step up its campaign to pressure members of his center-right Fine Gael party to oppose the bill.

"Enda Kenny's claim that this legislation is restrictive is seriously undermined by the experience of other countries, such as Britain, where mental health clauses were roundly abused," said a spokeswoman for Youth Defense, Claire Molloy.

While a substantial number of Fine Gael members have misgivings about the suicide clause, Mr. Kenny has ruled out a free vote on the bill, which Parliament is expected to enact before the summer recess.

The proposed legislation would allow for the termination of a pregnancy in cases where there is a real and substantive threat to the life of the woman, including from suicide. The government says the bill gives legal effect to rights that already exist as a result of a landmark Supreme Court judgment in 1992, known as the X Case.

Under the new proposals, a single doctor would be able to approve an abortion in an emergency situation. When a pregnant woman's life is at risk but the threat is not imminent, two medical practitioners — including one obstetrician or gynecologist — would have to sign off before the procedure could take place.

A woman citing the possibility of suicide as a reason for seeking an abortion would have to obtain approval from two psychiatrists and an obstetrician.

The government was prodded to action by the Council of Europe, which has pressured a succession of Irish governments to enact legislation to ensure that women's limited rights to abortion were actually carried out in practice.

Equally important, the uproar following the death of an Indian-born woman, Savita Halappanavar, in a Galway hospital in October reignited the entire abortion debate. Dr. Halappanavar, 31, a dentist who lived near Galway, was informed by her doctors that they were legally constrained from carrying out her repeated requests for a lifesaving termination of her nonviable fetus because the heart was still beating.

Irish commentators point out that the government may also have been emboldened by the waning influence of the Roman Catholic Church, which has been battered by a succession of sexual abuse cases against members of the clergy.

In a parliamentary debate after the release of the draft legislation, Clare Daly, a Socialist, said that the bill did not go far enough and that it would ensure that Irish women — 4,500 a year, by most estimates — would continue to travel every year to Britain for abortions.

Other commentators expressed disappointment that the proposals did not extend an automatic right to abortion under other categories, like rape or when a fetus has no chance of survival. At present, women who know their child will not survive outside the womb are forced to carry it to full term.

However, Mr. Kenny said any such proposals would be beyond the scope of the X Case and would require a referendum to change the Constitution.

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A Bid to Put Money Behind Slow Food Movement

Matthew Staver for The New York Times

About 650 food entrepreneurs and potential investors converged this week on the Boulder Theater in Colorado.

BOULDER, Colo. — "Welcome, pig lovers, and welcome, earthworms!" Woody Tasch bellowed from the stage of the Boulder Theater, where 650 food entrepreneurs and investors had wedged themselves for the opening day of the fourth Slow Money National Gathering.

Matthew Staver for The New York Times

Carlo Petrini, who founded the slow food movement, was part of the inspiration for the Slow Money National Gathering.

Matthew Staver for The New York Times

John Fullerton, left, a potential investor, spoke with Troy Simpson and Jay Reno of LocalBee, an online artisanal marketplace.

Mr. Tasch whipped the crowd into a frenzy on Monday morning — shouts of "It's crazy!" and the random boo and hiss ricocheted through the audience — as he discussed the moral failures of unsustainable corporate farming and financiers struggling to align their urge to buy low and sell high with socially conscious investing.

As venture capitalists increasingly bet on food start-ups, Slow Money, a nonprofit that catalyzes the flow of capital to small and local food enterprises, supports what Mr. Tasch called the heroic grunts: the food producers and their fiduciary counterparts, or "food-ish-iaries," committed to healing and investing in a broken system, either through manpower or money.

"We're planting the seeds of nurture capital," he said, an industry, he acknowledged, "that does not quite exist yet."

Mr. Tasch, the chairman emeritus of the Investors' Circle, a nonprofit network of angel investors, venture capitalists and foundations, established Slow Money on the heels of his 2008 book "Inquiries Into the Nature of Slow Money: Investing as if Food, Farms, and Fertility Mattered." Inspired in part by the slow food movement led by the Italian Carlo Petrini, Mr. Tasch envisioned his own movement as an antidote to big agriculture.

Joan Dye Gussow, the eat-locally-think-globally matriarch and a speaker at the gathering, said, "Like me, Woody is someone who took the red pill a long time ago, and it has affected his life."

Onstage at the theater, which was emblazoned with images of produce, pigs and grinning farmers, were such environmental gurus as Wes Jackson of the Land Institute, a research organization in Salina, Kan.; Mary Berry, the daughter of the writer Wendell Berry and founder of the Berry Center in New Castle, Ky.; Winona LaDuke, executive director of the White Earth Land Recovery Project in Minnesota; and investors like John Fullerton, founder and president of Capital Institute in Greenwich, Conn., which focuses on sustainable resources.

Offstage, entrepreneurs went in search of the brown ribbons that denoted "earthworm angels," or high net-worth investors, and networked with their fellow food producers. Over lunch, ranchers discussed grass-fed beef with Chad Arnold, chief executive of Door to Door Organics, an online grocery in Louisville, Colo., and one of 25 businesses competing for entrepreneur of the year and a $50,000 prize. (Revision International, a Denver cooperative that distributes food grown by low-income families, won that prize; Hayden Flour Mills of Phoenix, which works to revive heritage and ancient grains, won the people's choice award.)

"We're united in mission, in that we're all trying to change the food system," said Jeffrey Greenberg of the Kitchen Coop in Broomfield, Colo., which brings together small food manufacturers to share equipment, space and labor. "We're total compatriots before we're competitors."

Since 2010 Slow Money has helped to funnel $25 million into nearly 200 food enterprises, with 16 domestic chapters and one in France, six investment clubs and Gatheround, a new crowd-funding platform.

"It really is not just about building a better financial base but ultimately about community building," said Gary Paul Nabhan, a conservation biologist who took Mr. Tasch to an informational meeting in Elgin, Ariz., population 161, where $140,000 was pledged. "We had Woody in this little town to show that this kind of work isn't just for the Boulders and the Santa Fes of the world."

Paul Schwennesen, a partner in the Double Check Ranch in Clifton, Ariz., left the Boulder gathering with 27 potential investors in a fund to buy land that would be managed with environmental concerns in mind. "You get some business cards from a steely-eyed wealthy man who doesn't say anything, gives you a card and walks away," Mr. Schwennesen said. "And others who want to gush about the concept, but you don't know if they're serious."

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Florida Runs Out of Time on Medicaid

MIAMI — Prospects for Medicaid expansion in Florida, which was embraced, improbably, by the state's Republican governor in February, are all but dead this year.

With the Republican-dominated Legislature preparing to leave town on Friday, time has run out to draft a compromise bill between the House and Senate that would expand Medicaid with the help of billions of federal dollars. House Republicans voted last week to reject the Senate plan, which would take the federal money and use it to add low-income Floridians to private insurance plans.

The Legislature's inability to agree means that more than a million low-income Floridians will remain without insurance, at least in the short term. Florida has one of the nation's highest rates of uninsured people. Public hospitals also will suffer because they will continue to have to care for those one million uninsured who seek treatment in their emergency rooms.

Florida must have a plan to expand coverage passed and approved by the federal government as of Jan. 1, 2014, or it will lose an estimated $1 billion in Medicaid dollars in the first year. The federal government will fully finance the new enrollees for the first three years.

Outraged and outnumbered, Democrats called a protest on Tuesday to pressure House Republicans into changing their minds. They instituted a rare "slowdown" in the House, relying on a parliamentary tactic that requires a full reading of all House bills ready for floor votes. An Automated House Reader called "Mary," used for just such a protest, was called to duty by House Speaker Will Weatherford, and spent part of Tuesday and all day Wednesday speed-reading through bills.

"It's unfortunate that we have had to take such unusual action today, but my Democratic colleagues and I believe that a drastic situation requires drastic tactics," said Perry Thurston, the House Democratic leader, announcing the protest. "The 1.2 million people who can be provided medical coverage under proposed legislation may not be aware of what's transpiring in Tallahassee."

Democrats asked the governor, Rick Scott, either to call a special session of the Legislature to address the issue or to veto the budget in response. If he does not, the Legislature can try to tackle Medicaid expansion when it convenes in 2014, but by then it will be too late to collect the $1 billion.

In the Senate chamber, Democrats expressed deep frustration.

"I rank this as the biggest disappointment I have encountered as a member of the Florida Legislature," said Senator Arthenia Joyner. "It is unconscionable."

Democrats called on Mr. Scott, who has a relatively distant relationship with the Legislature, to use his power as governor to strong-arm House Republicans.

In a rare visit to the Florida Senate, where she once served, United States Representative Debbie Wasserman Schultz, who is chairwoman of the Democratic National Committee, chastised Mr. Scott for failing to lobby House Republicans more aggressively.

"While it's very nice that Governor Scott has had a deathbed conversion and decided that he does want to accept the federal funds, it's time for him to get off the sidelines," she said. "Either he is for accepting those funds and is willing to use his clout and his weight and put the full weight of his office behind that position, or he is not."

Ms. Wasserman Schultz went on to describe state House Republicans as "spoiled children who are stomping their feet because they didn't get their way."

Health care lobbyists said Mr. Scott was serious about Medicaid expansion at the start of the legislative session. Once it became apparent the House would not budge, he put all of his energy into teacher pay raises and a tax cut for manufacturers, they said.

"Given the position of the House and Senate, the way he acted was, 'Let's focus on what's achievable right now and get back to that,' " said a longtime hospital lobbyist in Tallahassee, Mark Delegal.

Asked by reporters last month whether he was forcefully pushing Medicaid expansion, Mr. Scott replied, "Both the House and Senate know exactly where I stand."

Florida now cares for 3.3 million people through Medicaid, using, in large part, a network of managed care programs.

Lizette Alvarez reported from Miami, and Christine Jordan Sexton from Tallahassee, Fla.

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U.S. to Defend Age Limits on Morning-After Pill Sales

The Obama administration moved Wednesday to keep girls under 15 from having over-the-counter access to morning-after pills, as the Justice Department filed a notice to appeal a judge's order that would make the drug available without a prescription for girls and women of all ages.

The appeal reaffirms an election-year decision by Mr. Obama's administration to block the drug's maker from selling it without a prescription or consideration of age, and puts the White House back into the politically charged issue of access to emergency contraception.

The Justice Department's decision to appeal is in line with the views of dozens of conservative, anti-abortion groups who do not want contraceptives made available to young girls. But the decision was criticized by advocates for women's reproductive health and abortion rights who cite years of scientific research saying the drug is safe and effective for all ages.

"Age barriers to emergency contraception are not supported by science, and they should be eliminated," Cecile Richards, the president of Planned Parenthood Federation of America, said in a statement on Wednesday.

In December 2011 the secretary of health and human services, Kathleen Sebelius, blocked the sale of the drug to young girls without a prescription, saying there was not enough data to prove it would be safe. In doing so, Ms. Sebelius took the unprecedented step of overruling the Food and Drug Administration, which had moved, based on scientific research, to lift all age restrictions.

Last month, Judge Edward R. Korman of United States District Court for the Eastern District of New York criticized that decision as overtly political and ordered the administration to make the contraceptive widely available. The Justice Department's appeal will not say at what age girls should have access to over-the-counter morning-after pill.

Instead, it will contend that Judge Korman did not have the authority to order the F.D.A. to take a specific action and should have sent the issue back to the agency for further action. And it will say the judge did not have the right to extend his order to versions of the pill not included in the lawsuit.

The decision to appeal is striking in part because, before Ms. Sebelius overruled it in 2011, the F.D.A. — the Justice Department's client in this case — had moved to do exactly what Judge Korman ordered last month.

"We aren't focused in this appeal on the merits of the secretary's decision," said a Justice Department official, who spoke on condition of anonymity. "What we're focused on is that the remedies that the judge ordered were beyond his authority."

For Mr. Obama's administration, the decision to appeal the judge's ruling provides an opportunity to reaffirm a moderate position in the broader abortion debate that had drawn praise from conservative groups that are normally highly critical of the president.

The appeal also reinforces Ms. Sebelius's original 2011 decision, which proved to be very good politics for Mr. Obama at the time. Facing a difficult re-election battle, the Democratic president enthusiastically supported Ms. Sebelius, saying that as a father of two young daughters, he thought it was the right call to have made.

"And I think most parents would probably feel the same way," he added.

Wednesday's announcement came a day after the F.D.A. said one well-known morning-after pill, Plan B One-Step, would be made available without a prescription for girls as young as 15 — instead of only to girls ages 17 and over, as has been the case. That decision also will make the drugs more accessible by putting them on the shelves with other over-the-counter medications.

The Justice Department's action will not affect that F.D.A. decision. Instead, the department is seeking to overturn a much broader order by the judge that removed restrictions for all ages and for generic versions of the pill, not just Plan B One-Step. The order, issued on April 5 by Judge Korman, gave the F.D.A. 30 days to comply.

On Wednesday, the Justice Department also asked Judge Korman to stay his order pending the results of the appeal.

In his ruling, Judge Korman said the Obama administration had put politics before science in restricting access to the drug. At the time, Ms. Sebelius said the pill had not been studied for safety in girls as young as 11. But advocates on both sides of the highly divisive issue of emergency contraception interpreted her decision in a political context, particularly since it fell during a presidential campaign cycle.

In 2011, a decision to allow distribution of emergency contraceptives to very young girls might have sparked a firestorm of criticism from anti-abortion groups. And it might have made it more difficult for the president, politically, when it came to other battles over contraception, including an effort to require some religious institutions to provide contraception free of charge.

By appealing the judge's ruling, Mr. Obama's Justice Department is essentially renewing the objections that Ms. Sebelius — backed by the president — had more than a year ago. In recent weeks, conservative groups had urged the Justice Department to appeal the judge's ruling so that the contraception would not be available to very young girls.

On Wednesday, a Justice Department official said the appeal would concentrate on the two areas where the department believes the judge overstepped his legal authority. The official also said the White House had not been involved in the decision of whether to appeal Judge Korman's ruling.

"This is a decision that the Justice Department is making in representing our client: F.D.A.," the official said. "This is not a political decision. It's not had White House intervention or involvement. This in our judgment is the right legal step to take in this case."

Officials at the White House declined to comment on Wednesday, referring all calls to the Justice Department. A spokesman for Ms. Sebelius also referred questions to Justice, saying it was an "ongoing legal matter."

The Justice Department official said the lawsuit before Judge Korman referred only to Plan B, the earliest morning-after pill, which is a two-pill dose of a drug called levonorgestrel. There are also two generic versions of Plan B.

And there is a newer single-pill version, called Plan B One-Step, which is the product that the F.D.A. this week made available over the counter to girls as young as 15. While scientists say the one- and two-pill versions are essentially identical, the Justice Department official said its appeal was not just a semantic matter.

"It is a deeply held belief on the part of F.D.A., when two different drugs are at issue, that F.D.A. has to keep those two different drugs separate," the official said.

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National Briefing | New England: Massachusetts: Aid Promised for Victims Who Lost Limbs

The American Orthotic & Prosthetic Association, a national trade group, has promised to provide artificial limbs to any people who lost a leg in the Boston Marathon bombings if they are uninsured or their insurance fails to cover the cost.  More than a dozen people lost limbs in the blasts; it is not yet known how many will need help paying for prostheses. The cost of an initial prosthesis could be $8,000 to $30,000, said Tom Fise, the group's executive director. Many insurance plans sharply limit coverage, he said.

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F.D.A. Lowers Age for Morning-After Pill

The Food and Drug Administration said Tuesday that it would make the most widely known morning-after pill available without a prescription to girls and women ages 15 and older, and also make the pill available on drugstore shelves, instead of keeping it locked up behind pharmacy counters.

Until this decision the pill, Plan B One-Step, which is used after sexual intercourse to help prevent pregnancy, was available without a prescription only for ages 17 and older.

The decision did not address a federal judge's ruling in early April that gave the drug agency 30 days to make the pill available for all ages without a prescription. In a scathing opinion handed down three weeks ago, Judge Edward R. Korman in the Eastern District of New York said the Obama administration had put politics before science in restricting access to the drug.

The F.D.A. and the White House said Tuesday that the Department of Justice was still deciding whether to appeal the ruling, something it can do independently of the drug agency's decision on Tuesday.

That decision, which takes effect immediately, represents a compromise on the politically charged issue of access to emergency contraception, which has pitted conservative and anti-abortion groups against advocates for women's health and reproductive rights.

The Justice Department is most likely weighing not only the substance of the judge's ruling, but also the precedent the ruling would set in countermanding an order by a White House cabinet member, Kathleen Sebelius, the secretary of health and human services. In 2011, she decided the pill would be available without prescription only to those 17 and older, despite the F.D.A.'s finding that it was safe and effective and should be available without any age restrictions. She said the pill had not been studied for safety in girls as young as 11. It was the first time the F.D.A. had been publicly overruled by a cabinet secretary.

After her order, the pill's manufacturer submitted an amended application seeking access for 15-year-olds. On Tuesday, a Health and Human Services Department official said that Ms. Sebelius was comfortable with the F.D.A.'s decision to approve that application.

Besides lowering the age restriction, the new rule addresses concerns of women who were unable to get the pill if their drugstore's pharmacy counter happened to be closed. Now, Plan B One-Step will be available in drugstore aisles where family planning or women's health products are displayed.

The packaging will include a product code that, when scanned by a cashier, will indicate that the customer's proof of age is required. To try to prevent theft, the manufacturer, Teva Pharmaceuticals, has arranged for each box to have a security tag, the drug agency said.

Margaret A. Hamburg, the F.D.A. commissioner, said in a statement that data proved that 15-year-olds "were able to understand how Plan B One-Step works, how to use it properly, and that it does not prevent the transmission of a sexually transmitted disease."

The agency's decision applies only to Plan B One-Step, which is a one-pill dose, not to the two-pill generic versions, because there is not enough data to show the two-dose versions can be used responsibly by younger teenagers without the intervention of a health provider, said an F.D.A. spokeswoman, Erica Jefferson.

Marty Berndt, a vice president and general manager for Teva, called the agency's decision "a significant milestone for women."

But it did not completely satisfy either side of the emergency contraception debate. Anna Higgins, the director of the Center for Human Dignity at the Family Research Council, accused the administration of trying to "placate both sides," adding that "allowing this to young teens will be something that we will remain very concerned about."

Cecile Richards, president of Planned Parenthood, called the decision "an important step forward" because it "will eliminate some of the biggest barriers and hurdles that women face in getting emergency contraception."

But Nancy Northup, president of the Center for Reproductive Rights, which filed the lawsuit that Judge Korman ruled on, said the decision on Tuesday was unsatisfactory.

"We will continue our battle in court to remove these arbitrary restrictions on emergency contraception for all women," she said.

Michael D. Shear contributed reporting.

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Colleges Tackle Illicit Use of A.D.H.D. Pills

Matt Black for The New York Times

Lisa Beach said it took months before Fresno State's health service would give her an A.D.H.D. diagnosis. She had to sign a contract for medications.

FRESNO, Calif. — Lisa Beach endured two months of testing and paperwork before the student health office at her college approved a diagnosis of attention deficit hyperactivity disorder. Then, to get a prescription for Vyvanse, a standard treatment for A.D.H.D., she had to sign a formal contract — promising to submit to drug testing, to see a mental health professional every month and to not share the pills.

"As much as it stunk, it's nice to know, 'O.K., this is legit,' " said Ms. Beach, a senior at California State University, Fresno. The rigorous process, she added, has deterred some peers from using the student health office to obtain A.D.H.D. medications, stimulants long abused on college campuses. "I tell them it takes a couple months," Ms. Beach said, "and they're like, 'Oh, never mind.' "

Fresno State is one of dozens of colleges tightening the rules on the diagnosis of A.D.H.D. and the subsequent prescription of amphetamine-based medications like Vyvanse and Adderall. Some schools are reconsidering how their student health offices handle A.D.H.D., and even if they should at all.

Various studies have estimated that as many as 35 percent of college students illicitly take these stimulants to provide jolts of focus and drive during finals and other periods of heavy stress. Many do not know that it is a federal crime to possess the pills without a prescription and that abuse can lead to anxiety, depression and, occasionally, psychosis.

Although few experts dispute that stimulant medications can be safe and successful treatments for many people with a proper A.D.H.D. diagnosis, the growing concern about overuse has led some universities, as one student health director put it, "to get out of the A.D.H.D. business."

The University of Alabama and Marist College, like Fresno State, require students to sign contracts promising not to misuse pills or share them with classmates. Some schools, citing the rigor required to make a proper A.D.H.D. diagnosis, forbid their clinicians to make one (George Mason) or prescribe stimulants (William & Mary), and instead refer students to off-campus providers. Marquette requires students to sign releases allowing clinicians to phone their parents for full medical histories and to confirm the truth of the symptoms.

"We get complaints that you're making it hard to get treatment," said Dr. Jon Porter, director of medical, counseling and psychiatry services at the University of Vermont, which will not perform diagnostic evaluations for A.D.H.D. "There's some truth to that. The counterweight is these prescriptions can be abused at a high rate, and we're not willing to be a part of that and end up with kids sick or dead."

Changes like these, all in the name of protecting the health of students both with and without attention deficits, involve legal considerations as well. Harvard is being sued for medical malpractice by the father of a student who in 2007 received an A.D.H.D. diagnosis and Adderall prescription after one meeting with a clinical nurse specialist.

Still, many student health departments regard A.D.H.D., a neurological disorder that causes severe inattention and impulsiveness, as similar to any other medical condition. Eleven percent of American children ages 4 to 17 — and 15 percent of high school students — have received the diagnosis, according to a survey by the Centers for Disease Control and Prevention.

New college policies about A.D.H.D. tend not to apply to other medical or psychiatric conditions — suggesting discrimination, said Ruth Hughes, the chief executive of the advocacy group Children and Adults With Attention-Deficit/Hyperactivity Disorder. Such rules create "a culture of fear and stigma," she said, adding that if students must sign a contract to obtain stimulants, they should have to do so for the painkillers that are also controlled substances and are known to be abused.

"If a university is very concerned about stimulant abuse, I would think the worst thing they could do is to relinquish this responsibility to unknown community practitioners," Ms. Hughes said. "Nonprescribed use of stimulant medications on campus is a serious problem that can't just be punted to someone else outside the school grounds."

Fresno State officials said a disquieting surge of students requesting A.D.H.D. diagnoses — along with news media reports of stimulant abuse and questionable diagnostic practices nationwide — led the university to change several policies last year. Now, students with an outside diagnosis of A.D.H.D. can fill their prescriptions at the Student Health Center only after providing documentation of a thorough evaluation by qualified mental health practitioners — which typically involves hours of neuropsychological testing and conversations with parents and teachers to assess impairment and other possible explanations.

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Well: The Problem of Breast Pain in Women Who Exercise

In the days before the London Marathon last year, scientists from the Research Group in Breast Health at the University of Portsmouth in England approached female racers at the event's registration center and asked them to complete an anonymous questionnaire about their exercise habits and breast health.

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Sore breasts are a common experience among women of all ages and sizes, athletes and nonathletes alike.

But scientists had not examined whether and to what extent exercise contributes to breast pain and, conversely, whether and to what extent breast pain alters how women exercise.

So they surveyed almost 1,300 of the women registered for the race and learned, as their new study, published in March in The British Journal of Sports Medicine, makes clear, that exercise does significantly impact breast pain and vice versa.

It should surprise no one, of course, that exercise influences breasts, just as it does virtually every tissue in the male and female body.

Female breast tissue is unusual, however, being weighty, even in small-breasted women, but with little natural anatomical support. As a result, unconstrained breasts move independently when a woman does, and that movement is exacerbated during exercise.

Earlier motion-capture research by the Portsmouth scientists established that unsupported female breasts —that is, those not contained within a bra — oscillate as much as eight inches in space when a woman runs, and not just up and down, but also side to side, forward and backward.

Even when the volunteers wore a standard sports bra, the scientists found their breasts often continued to sway considerably during running.

But whether this breast motion was linked to later soreness was unclear.

Which is why the researchers now set out to examine the real-world consequences of being an active woman and having sore breasts.

"It is an important quality of life issue for women," said Nicola Brown, a member of the Research Group in Breast Health at Portsmouth, a lecturer in exercise science at Saint Mary's University College in London and the lead author of the study.

It is also an issue with too many dimensions to effectively study in a single laboratory experiment, so the scientists decided instead to survey a cross section of active women. And contrary to popular belief, a cross section of active women is what the registration roll of a major marathon conveniently provides.

"Some people have the perception that female marathon runners" are all slender and boyish, as elite racers often are, "and don't have breasts," Dr. Brown said, but she and her collaborators focused their study on the London Marathon's "mass-participation runners, who are a variety of shapes and sizes," she said.

When the scientists analyzed the surveys from these runners, they found that they had data about women with 56 different bra sizes, from an AA cup to an HH and chest-band sizes from 28 to 40 inches. The women ranged widely in body weight, too, with the average being about 148 pounds.

More than 90 percent reported that they always wore a bra, including during exercise.

But these active women were not immune from breast pain. More than a third reported that their breasts were frequently were sore, although not necessarily because of exercise. Sore breasts most commonly were because of hormonal changes associated with the menstrual cycle, the runners reported.

The incidence of breast pain was highest among the women with the largest breasts. More than half of those wearing an F cup or larger reported frequent breast pain. But smaller-breasted women also were affected; about 25 percent of those who wore an A cup or smaller said that their breasts often were sore.

Motherhood reduced the likelihood that a woman would report breast pain, perhaps, the authors speculate, because pregnancy and breast-feeding alter the composition of the breasts.

What the researchers found particularly striking was that, for many of the women, exercise induced or aggravated breast soreness and, in consequence, breast pain often altered how the women trained. About a quarter of those with sore breasts said that they reduced the intensity of their workouts when their breasts hurt — walking in lieu of running, for example — while others skipped exercise altogether.

In aggregate, Dr. Brown said the results suggest that exercise-related breast pain can compromise the quality and quantity of physical activity for many women.

Of course, many of us might consider that a self-evident finding — anecdotal evidence suggests that my friends and I complain all the time about how our breasts feel when we're running. But this is the first study to formally examine and validate the issue.

It also, Dr. Brown said, "highlights the importance and significance of research into the treatment of breast pain." A well-fitting, supportive bra, she said, has been shown to lessen breast pain in about 85 percent of women with the condition. But a large number of women, including by inference many of the London runners, are not wearing the right bra.

The Research Group in Breast Health has published a handy online guide to bra fitting. But far more research is needed into sports bra design, Dr. Brown said, an undertaking that she hopes will progress rapidly, having herself just completed her first marathon and been hampered occasionally during training by sore breasts.

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Our Feel-Good War on Breast Cancer

I used to believe that a mammogram saved my life. I even wrote that in the pages of this magazine. It was 1996, and I had just turned 35 when my doctor sent me for an initial screening — a relatively common practice at the time — that would serve as a base line when I began annual mammograms at 40. I had no family history of breast cancer, no particular risk factors for the disease.

So when the radiologist found an odd, bicycle-spoke-like pattern on the film — not even a lump — and sent me for a biopsy, I wasn't worried. After all, who got breast cancer at 35?

It turns out I did. Recalling the fear, confusion, anger and grief of that time is still painful. My only solace was that the system worked precisely as it should: the mammogram caught my tumor early, and I was treated with a lumpectomy and six weeks of radiation; I was going to survive.

By coincidence, just a week after my diagnosis, a panel convened by the National Institutes of Health made headlines when it declined to recommend universal screening for women in their 40s; evidence simply didn't show it significantly decreased breast-cancer deaths in that age group. What's more, because of their denser breast tissue, younger women were subject to disproportionate false positives — leading to unnecessary biopsies and worry — as well as false negatives, in which cancer was missed entirely.

Those conclusions hit me like a sucker punch. "I am the person whose life is officially not worth saving," I wrote angrily. When the American Cancer Society as well as the newer Susan G. Komen foundation rejected the panel's findings, saying mammography was still the best tool to decrease breast-cancer mortality, friends across the country called to congratulate me as if I'd scored a personal victory. I considered myself a loud-and-proud example of the benefits of early detection.

Sixteen years later, my thinking has changed. As study after study revealed the limits of screening — and the dangers of overtreatment — a thought niggled at my consciousness. How much had my mammogram really mattered? Would the outcome have been the same had I bumped into the cancer on my own years later? It's hard to argue with a good result. After all, I am alive and grateful to be here. But I've watched friends whose breast cancers were detected "early" die anyway. I've sweated out what blessedly turned out to be false alarms with many others.

Recently, a survey of three decades of screening published in November in The New England Journal of Medicine found that mammography's impact is decidedly mixed: it does reduce, by a small percentage, the number of women who are told they have late-stage cancer, but it is far more likely to result in overdiagnosis and unnecessary treatment, including surgery, weeks of radiation and potentially toxic drugs. And yet, mammography remains an unquestioned pillar of the pink-ribbon awareness movement. Just about everywhere I go — the supermarket, the dry cleaner, the gym, the gas pump, the movie theater, the airport, the florist, the bank, the mall — I see posters proclaiming that "early detection is the best protection" and "mammograms save lives." But how many lives, exactly, are being "saved," under what circumstances and at what cost? Raising the public profile of breast cancer, a disease once spoken of only in whispers, was at one time critically important, as was emphasizing the benefits of screening. But there are unintended consequences to ever-greater "awareness" — and they, too, affect women's health.

Breast cancer in your breast doesn't kill you; the disease becomes deadly when it metastasizes, spreading to other organs or the bones. Early detection is based on the theory, dating back to the late 19th century, that the disease progresses consistently, beginning with a single rogue cell, growing sequentially and at some invariable point making a lethal leap. Curing it, then, was assumed to be a matter of finding and cutting out a tumor before that metastasis happens.

This article has been revised to reflect the following correction:

Correction: April 28, 2013

An article on Page 36 this weekend about breast cancer awareness misidentifies the reduction in the chance that a woman in her 50s will die of breast cancer over the next 10 years if she undergoes screening. It is .07 percentage points, not .07 percent.

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Video Scrutinizes Late-Term Abortion Practices at Bronx Clinic

Lila Rose, president of Live Action, said the group would release more videos as part of its campaign against late-term abortions. Sunday's video was shot at the Dr. Emily Women's Health Center on Southern Boulevard in the Bronx. The release comes as Gov. Andrew M. Cuomo, a Democrat, has thrown his support behind legislation that will guarantee a woman's right to an abortion after 24 weeks of pregnancy, if her health is in danger or if the fetus is not viable. The current law permits abortion after 24 weeks only if a woman's life is in danger, although it is not enforced because federal court rulings have allowed less restrictive late-term abortions.

"The gruesome and inhuman practices exposed in Gosnell's 'House of Horrors' are business as usual for the abortion industry in America," Ms. Rose said in a statement, calling on the New York State Health Department to investigate Dr. Emily and other clinics performing late-term abortions. Both the Health Department and Dr. Emily center did not respond to requests for comment.

Live Action, based in Arlington, Va., has previously made covert videos at several Planned Parenthood clinics in New York and other states in an effort to cut off the organization's government financing. On Sunday, the group posted two versions of its latest video, one condensed and one a few hours long.

When a pregnant woman posing as a patient asked what happens if the fetus accidentally "comes out" at home before the final procedure, a staff member replied, "If it comes out, it comes out. Flush it."

The woman also asked what happens if the removed fetus is still "twitching" or "breathing." The staff member said all aborted fetuses are placed in jars of solution and sent to a laboratory for weighing; if the fetus is still moving, "the solution will make it stop."

The longer video shows that the staff member has been assigned to record the woman's medical history, but is not an abortion counselor. In the same video, an abortion counselor gives the woman somewhat different explanations.

When the woman asks the counselor what will happen if the fetus emerges from the abortion breathing, the counselor explains that it is unlikely, but that the doctor will send it to a hospital or resuscitate it: "Once that pregnancy comes out alive, he will do everything he can to save it."

The counselor also explains that the woman will not be dilated enough to accidentally deliver at home.

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