Bedbugs Crawl, They Bite, They Baffle Scientists

Think of it, rather, as Cimex lectularius, international arthropod of mystery.

In comparison to other insects that bite man, or even only walk across man’s food, nibble man’s crops or bite man’s farm animals, very little is known about the creature whose Latin name means— go figure—“bug of the bed.” Only a handful of entomologists specialize in it, and until recently it has been low on the government’s research agenda because it does not transmit disease. Most study grants come from the pesticide industry and ask only one question: What kills it?

But now that it’s The Bug That Ate New York, Not to Mention Other Shocked American Cities, that may change.

This month, theEnvironmental Protection Agencyand theCenters for Disease Control and Preventionissued ajoint statement on bedbug control. It was not, however, a declaration of war nor a plan of action. It was an acknowledgment that the problem is big, a reminder that federal agencies mostly give advice, plus some advice: try a mix of vacuuming, crevice-sealing, heat and chemicals to kill the things.

It also noted, twice, that bedbug research“has been very limited over the past several decades.”

Ask any expert why the bugs disappeared for 40 years, why they came roaring back in the late 1990s, even why they do not spread disease, and you hear one answer:“Good question.”

“The first time I saw one that wasn’t dated 1957 and mounted on a microscope slide was in 2001,” said Dini M. Miller, aVirginia Techcockroach expert who has added bedbugs to her repertoire.

The bugs have probably been biting our ancestors since they moved from trees to caves. The bugs are“nest parasites” that fed on bats and cave birds like swallows before man moved in.

That makes their disease-free status even more baffling.

(The bites itch, and can causeanaphylactic shockin rare cases, and dust containing feces and molted shells has triggeredasthmaattacks, but these are allallergic reactions, not disease.)

Bats are sources ofrabies, Ebola, SARS and Nipah virus. And other biting bugs are disease carriers— mosquitoes formalariaand West Nile,ticksfor Lyme and babesiosis,licefortyphus,fleasfor plague, tsetse flies forsleeping sickness, kissing bugs for Chagas. Even nonbiting bugs like houseflies and cockroaches transmit disease by carrying bacteria on their feet or in their feces or vomit.

But bedbugs, despite the ick factor, are clean.

Actually it is safer to say that no one has proved they aren’t, said Jerome Goddard, a Mississippi State entomologist.

But not for lack of trying. South African researchers have fed them blood with theAIDSvirus, but the virus died. They have shown that bugs can retainhepatitis Bvirus for weeks, but when they bite chimpanzees, the infection does not take. Brazilian researchers have come closest, getting bedbugs to transfer the Chagas parasite from a wild mouse to lab mice.

“Someday, somebody may come along with a better experiment,” Dr. Goddard said.

That lingering uncertainty has led to one change in lab practice. The classic bedbug strain that all newly caught bugs are compared against is a colony originally from Fort Dix, N.J., that a researcher kept alive for 30 years by letting it feed on him.

But Stephen A. Kells, aUniversity of Minnesotaentomologist, said he“prefers not to play with that risk.”

He feeds his bugs expired blood-bank blood through parafilm, which he describes as“waxy Saran Wrap.”

Coby Schal ofNorth Carolina Statesaid he formerly usedcondomsfilled with rabbit blood, but switched to parafilm because his condom budget raised eyebrows with university auditors.

Why the bugs disappeared for so long and exploded so fast after they reappeared is another question. The conventional answer— that DDT was banned— is inadequate. After all, mosquitoes, roaches and other insects rebounded long ago.

Much has to do with the bugs’ habits. Before central heating arrived in the early 1900s, they died back in winter. People who frequently restuffed their mattresses or dismantled their beds to pour on boiling water— easier for those with servants— suffered less, said thebedbug historianMichael F. Potter of theUniversity of Kentucky.

Early remedies were risky: igniting gunpowder on mattresses or soaking them with gasoline, fumigating buildings with burning sulfur or cyanide gas. (The best-known brand was Zyklon B, which later became infamous at Auschwitz.)

Success finally arrived in the 1950s as the bugs were hit first with DDT and then with malathion, diazinon, lindane, chlordane and dichlorovos, as resistance to each developed. In those days, mattresses were sprayed, DDT dust was sprinkled into the sheets, nurseries were lined with DDT-impregnated wallpaper.

In North America and Western Europe,“the slate was virtually wiped clean,” said Dr. Potter, who has surveyed pest-control experts in 43 countries. In South America, the Middle East and Africa, populations fell but never vanished.

The bugs also persisted on domestic poultry farms and in a few human habitations.

One theory is that domestic bedbugs surged after pest control companies stopped spraying for cockroaches in the 1980s and switched to poisoned baits, which bedbugs do not eat.

But the prevailing theory is that new bugs were introduced from overseas, because the ones found in cities now are resistant to different insecticides from those used on poultry or cockroaches.

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Facing Long Mine Rescue, Chile Spares No Expense

Chileis sparing no expense or attempted innovation in trying to rescue the miners trapped by a cave-in on Aug. 5, fully aware that the country— and the world— is closely watching the ordeal.

But like everything else being done to maintain the psychological health of the miners over the weeks or months they may remain nearly half a mile underground, officials will carefully control what they are exposed to, down to the messages they receive from their families or the kind of movies that might be projected on the wall of the mine.

“Movies are possible,” said Ximena Matas, a local city councilwoman.“But the psychologists will decide what movies they will see. It’s up to them if something like‘Avatar’ would be too upsetting.”

No fewer than seven government ministers roam the dusty brown dirt of the makeshift camp outside the mine here in Chile’s Atacama Desert, not to mention the countless politicians, millionaire donors and observers who almost outnumber the family members camping in tents.

With his popularity already slipping, President Sebastián Piñera has staked his nascent presidency on rescuing the miners, and is keeping up a full-court media press that reflects both his background as the billionaire former head of a media empire and the strategy that helped get him elected, analysts said.

“With a conviction that seemed to border on political suicide, the authorities bet all or nothing, and this time the returns will have incalculable reach,” Max Colodro Riesenberg, a professor at the University Adolfo Ibáñez, wrote in a newspaper column this week.

Government officials said they held a teleconference on Wednesday afternoon with five NASA specialists, among them doctors who put astronauts through tests that simulate the grueling isolation of a voyage to Mars.

Dr. Jaime Mañalich, the health minister, said he had urged NASA to send a team to“monitor what we are doing here” and announced Thursday that three or four NASA specialists would arrive in Chile next week to assist medical officials with the miners.

“This is a unique experience,” Dr. Mañalich said.

The miners are in relatively good spirits, officials say, but psychologists are concerned that both the miners and their families may soon suffer from post-traumatic stress once the euphoria wears off from establishing contact on Sunday. Psychologists are coaching family members and the miners on what they should say to each other and are filtering notes before they are sent down to the miners.

“They are giving good advice,” said Margarita Lagos Fuentes, 54, the mother of Claudio Lagos, a 34-year-old miner trapped below.“If they are in hell, why should we make it worse?”

Health workers are organizing a special exercise and recreation program to keep the men fit during their long wait. And they are instructing the miners about the need to distinguish between daytime and nighttime activities. Beyond the immediate 600-square-foot chamber the miners have sought refuge in, there are ample tunnels in which to move around and find a little privacy, mining company officials said.

For days after discovering the miners alive, officials carefully avoided telling them that it could take months to get them out, for the sake of preserving morale. Then on Wednesday, the health minister announced that officials had informed the miners that they would not be rescued before Chile’s Independence Day on Sept. 18 and that“we hoped to get them out before Christmas.”

The miners reacted calmly to the news, Dr. Mañalich, the minister, said.“But we have the impression that in the days to come they are going to suffer from huge challenges regarding their psychological conditions.”

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Pascale Bonnefoy and Aaron Nelsen contributed reporting from Santiago, Chile.

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Book Review - The Pain Chronicles - By Melanie Thernstrom

Melanie Thernstrom, an accomplished journalist and the author of two well-­regarded previous books, suffered for years from chronic pain associated with a degenerative spinal condition. When an editor at The New York Times Magazine asked her to write an article about various treatments for chronic pain, the research became an obsession.“Why do some people get better?” she wanted to know.“Was there a recipe for healing?” The resulting book,“The Pain Chronicles,” is an expansive, invigorating mix of medical reportage, history, memoir and cultural criticism.

Thernstrom’s passion and intellectual curiosity are infectious. At times, she is the literary critic, contextualizing our relationship to pain throughSusan Sontag, Michel Foucault,Emily Dickinsonand the Bible. If Jesus died in pain to become a martyr, is pain a vehicle for transcendence? If God saddled Eve with pain after she ate from the apple, is pain punishment for sin? These cultural narratives complicate our relationship to pain, Thernstrom argues, pervading even our visits to the doctor.

At other times, she is a fiercely knowledgeable science writer, delivering case studies and research findings with a story­teller’s verve. To illustrate the power our minds have over the perception of pain, she cites a study conducted at Stanford. A researcher noticed that early stages of love looked similar to addiction. Could it be true that romantic love, like addiction, stimulates the opioid brain system? Does it“confer analgesia,” thus beating out pain? Students who volunteered for the study were asked to stare at a photo of their new beloved while researchers inflicted a“painfully hot stimulus.” Indeed,“love ameliorated the pain,” with those in the most passionate relationships experiencing the greatest relief.

Some of her other material is more sobering. She walks us through a world beforeanesthesia, when patients sometimes opted forsuicideover the scalpel. Reading the novelist Fanny Burney’s 1812 account of hermastectomy, I could see why.“When the wound was made and the instrument withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp poniards that were tearing the edges,” Burney wrote.“Indeed, I thought I must have expired.”

Pain causes distress— both physical and emotional. And Thernstrom displays an admirable testiness when confronted with absurd or disturbing ideas. She’s aghast at 19th-century studies that found“civilized” whites more sensitive to pain, and dismayed that such thinking still suffuses modern medicine. Minority sufferers, one study showed, are three times more likely than whites to get insufficient pain relief and to have their requests classified as“drug-seeking behavior.” (They are also more likely to be seen as noncompliant with doctors’ orders.) Women complaining of pain are much more likely than men to walk out of a doctor’s office with a prescription forantidepressants, while the men get opioids.“Women tend to be less aggressive in demanding pain treatment or aggressive in ways that are dismissed as mere hysteria,” she writes.

Thernstrom writes angrily about the“opioid backlash” following an increase in OxyContin abuse in the 1990s, which led doctors to withhold potentially addictive medication out of fear of prosecution. (It also led them to distrust their patients, arguably one of the most overlooked outcomes of the war on drugs.) She repeatedly warns about long-term use of over-the-counter pain medicine, which can rot the gut and cause liver failure.

Physicians are trained to treat pain as a symptom of injury or disease. But,“as lived experience,” Thernstrom writes,“the disease of pain turns into the individual suffering of illness, an understanding of which requires studying the patient as well as the disease.” What can doctors, pressed for time and responsible for the body, not for the story the patient tells about the body, really do with this knowledge? Thernstrom observed seven pain clinics and listened in on hundreds of interviews between doctors and patients. She describes the method of doctors at Stanford’s pain management clinic as“genius.” They cover five points, placing more emphasis on the patient’s perceptions of the pain than on the underlying pathology. Though the points are relatively simple— what does the patient think caused the pain? what meaning does she derive from it?— they reveal, according to the clinic’s director, whether the patient harbors“sinister ideas of pathology.” A chronic patient who believes that his pain stems from an underlying disease rather than from nerve damage will fare worse than a patient who understands that“although chronic pain feels like an alarm bell, it is often a false alarm signifying only that the alarm system is broken.” One patient, after hearing a resident explain that there was nothing to treat except the pain, said to Thernstrom,“The doctor doesn’t understand my problem.”

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Robin Romm is the author, most recently, of“The Mercy Papers: A Memoir of Three Weeks.”

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Collection of Cancerous Brains Helps Show Neurosurgery’s Rise

The cancerous brains were collected by Dr. Harvey Cushing, who was one of America’s first neurosurgeons. They were donated to Yale on his death in 1939— along with meticulous medical records, before-and-after photographs of patients, and anatomical illustrations. (Dr. Cushing was also an accomplished artist.) His belongings, a treasure trove of medical history, became a jumble of cracked jars and dusty records shoved in various crannies at the hospital and medical school.

Until now. In June 2010, after a colossal effort to clean and organize the material— 500 of 650 jars have been restored— the brains found their final resting place behind glass cases around the perimeter of the Cushing Center, a room designed solely for them.

These chunks of brains floating in formaldehyde bring to life a dramatic chapter in American medical history. They exemplify the rise ofneurosurgeryand the evolution of 20th-century American medicine— from a slipshod trial-and-error trade to a prominent, highly organized profession.

These patients had operations during the early days of brain surgery, when doctors had no imaging tools to locate atumoror proper lighting to illuminate the surgical field; whenanesthesiawas rudimentary and sometimes not used at all; whenantibioticsdid not exist to fend off potential infections. Some patients survived the procedure— more often if Dr. Cushing was by their side.

Most of the jars contain a single brain; a few hold slices of brains from several patients. Some postoperative photographs next to the jars show patients withtumorsbulging from their heads. When Dr. Cushing could not remove a tumor, he would remove a piece of the skull so the tumor would grow outward rather than compress the brain. It was not a cure, but it relieved the patient of many symptoms.

Dr. Cushing, born in Cleveland in 1869, was an undergraduate at Yale and finished his career here as a professor of history of medicine. In between, he went toHarvardfor medical school, did his early surgical training at Johns Hopkins and became a surgical professor there, and then spent most of his career as chief of neurosurgery, a new specialty, at Peter Bent Brigham Hospital at Harvard (now Brigham and Women’s).

When he began operating in the late 19th century, a few other doctors were also venturing into the brain, but for the most part the patients did not survive the procedure.

“In the first decade of the 20th century, Harvey Cushing became the father of effective neurosurgery,” the medical historian Michael Bliss wrote in“Harvey Cushing: A Life in Surgery” (Oxford, 2005).“Ineffective neurosurgery had many fathers.

“Cushing became the first surgeon in history who could open what he referred to as‘the closed box’ of the skull of living patients with a reasonable certainty that his operations would do more good than harm.”

Sometimes doctors went into the brain and could not find the tumor. Sometimes they talked to patients during surgery. Dr. Cushing, for one, often used only the local anesthetic Novocain. (The brain itself does not have pain receptors, but having one’s skull cut open must have been agonizing.) Mr. Bliss writes that in 1910, midway through a 10-hour operation on the renowned physician and Army Gen. Leonard Wood, Cushing wanted to stop operating and continue another day, but General Wood— fully alert— begged him to continue.

Dr. Dennis Spencer, the chairman of neurosurgery at Yale and the Harvey and Kate Cushing professor of neurosurgery, said Dr. Cushing’s major accomplishment was“his meticulous operative technique.”

“Whatever approach he was going to use to get to a tumor,” Dr. Spencer said,“he had this incredibly good judgment in terms of where the tumor was, getting there without harming the brain and then getting out.”

Brain surgeons in those days were medical sleuths, relying largely on patients’ accounts of their symptoms to figure out where the tumor was. Dr. Cushing popularized aneye examthat took advantage of the specific ways in which different tumors can distort vision— a strategy used into the 1970s, whenM.R.I.’s and other imaging tools replaced it. Even today, many tumors in the pituitary gland, which straddles the optic nerves, are initially detected because patients have trouble seeing.

Dr. Cushing also discovered that pituitary tumors could lead to vast changes in the body. Cushing’s disease and Cushing’s syndrome— two illnesses linked to hormones gone awry— are named for his discoveries.

Indeed, comparatively little progress has been made since Dr. Cushing’s time in actually prolonging life in brain-cancerpatients.“It is fascinating how far we’ve come in terms of technology but not really in terms of progress for most malignancies,” Dr. Spencer said.“Everything we’ve done in the last 100 years has changed the progress for malignantbrain tumorsvery little, extending life maybe eight months to two years.”

He added, though, that“in many tumors we are getting closer to the genetic understanding, and I’m optimistic in the next 10 years we will make a lot more progress.”

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The Cushing collection in the Cushing/Whitney Medical Library at Yale University at 333 Cedar Street, New Haven, is open to the public Monday through Friday, 8 a.m. to 8 p.m.; Saturday, 10 a.m. to 8 p.m.; and Sunday, 9:30 a.m. to 8 p.m. (203) 785-5352.

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Helping New Parents While Dealing With A.L.S. - Question

Always an activist with dreams of changing the world, Ms. Storek founded New Parents Network in 1988 and began to collect information. She distributed it through packets given to new parents as they left hospitals in and around Tucson.

The packets offered answers to vital questions: where to get immunization shots, where to get help for a child born with a disability and where to find support groups.

In 1991, on a donated computer with a 40-megabyte hard drive and a dial-up modem, Ms. Storek moved New Parents Network to an online community bulletin board. Three years later, she created theNew Parents NetworkWeb site and began to reach people not just nationally but internationally.

Today, the site receives as many as 4,000 page views an hour and an average of 30,000 unique visitors a month. New Parents Network, a nonprofit organization, is supported by foundation grants, individual donations and corporate financing from the likes of Walgreens and Cigna Healthcare.

For 23 years, Ms. Storek has run the organization by herself with the help of volunteers. But early this decade, she noticed that her handwriting was starting to look odd and that walking was becoming difficult. She learned she hadamyotrophic lateral sclerosis, Lou Gehrig’s disease. Ms. Storek, now 50, talked recently about coming to grips with her disease and her plans for her organization. A condensed version of the conversation follows.

Q.What were your first thoughts when the disease was diagnosed?

A.I went to theMayo Clinicin Scottsdale, and I simply did not accept their diagnosis. I ended up living nearly 10 years just pretending that I didn’t have it. That actually helped me get through each day. I am fortunate that I have a rare form of the disease where I can walk, I can swim. I’m very active, and I work full time. But that could change at any moment.

Q.Are you still in denial?

A.No. I have accepted that I have this awful disease, and I’ve seen how it progresses. My speech is slow. I’ve just begun to experience some respiratory problems. I had a baclofen pump installed in my abdomen in order to deliver an anti-spasticity medicine, which helps me walk. My hope and my doctor’s hope is that I could live another 20 years. But it could get much worse in a year, so I force myself to stay active.

Q.How has the illness affected your organization?

A.I feel that this job has given me a reason to live. And that’s such a gift. I used to complain about the 60 hours a week I was putting into N.P.N. as a divorced, single mother of two young boys. But now, in retrospect, I am incredibly grateful that I stuck with N.P.N. and that it is my full-time job.

Q.Are there activities you have had to give up?

A.I have problems with walking due to aloss of balance, and I’ve developed breathing problems, so I can’t go to as many meetings as I used to. I make an extreme effort to get out of the house every day so I am not totally isolated.

Q.What is a typical day like for you?

A.I get up at 5 a.m. and practice a form of meditation. I’ll then go swimming in our community pool. I’ve tried to create a regular schedule because having a routine is important. After I swim, I get on the computer and also the phone, raising money, incorporating new tips for the Web site and tweeting tips as well. My next step is to start a blog. I probably still work 45 hours a week.

Q.Has financial support for the site become an issue?

A.A lot of nonprofits are struggling because of the economy, but our funding has remained pretty consistent.

Q.Given all of the information on the Internet, is there still a need for a site like N.P.N.?

A.Of course. Hospitals and health-related companies are seeing more than ever the value of having one place to go to get this kind of information. That’s been the concept since the beginning, and it’s still working 23 years later.

Q.What are your plans for the organization if you become too ill to keep it going?

A.That is where my board of directors comes in. I only recently told them about my disease, and they are in the midst of creating a strategic plan with me right now that will outline where our funding will come from and what N.P.N. would look like without its founder.

Q.Have you found a successor?

A.I haven’t yet. It is something I am actively looking for, not only a successor but someone who can help me with N.P.N. should I live another 20 years.

Q.With all this happening, has N.P.N. been able to expand its reach?

A.My vision for N.P.N., which has really kept me going for the past six years, has been to create a multilingual, culturally sensitive cellphone app that would send parenting tips to people around the world. Even in the third world, people have cellphones, and this could be a free service supported by corporate advertising— for example, Honda could have a 10-second ad that would precede a safety tip about car seats.

These tips, which I’ve been collecting by the thousands for 23 years, can save a life. Letting a pregnant woman know, for example, that takingfolic acidduring pregnancy can prevent diseases such asspina bifidacould be a great benefit. I see this as a service that would not only reach new parents but educators and health care professionals as well. If there is a vision that has kept me alive and a project that has fueled me, it has been that.

Q.What are you doing to make the vision happen?

A.I have been working for the last few years with major cellphone providers and wireless companies to get this going. I don’t have a formal commitment yet, but I’m very close with one major cellphone company. My hope is that it will be a reality within the next six months.

Q.Have you considered doing a similar Web site for people trying to cope withLou Gehrig’s disease?

A.Yes. I’m thinking more of a blog than a Web site. I’d like to raise awareness about this disease because it is often labeled as a rare affliction, but I read somewhere that there are something like 320 new cases of Lou Gehrig’s disease diagnosed every day around the world. It’s rare, but not as rare as some people think.

Q.What kind of advice would your blog give?

A.I’d share my journey from being a healthy adult, and how I took jumping out of bed and living my life so much for granted. When something like this happens, you feel very grateful for every moment. I am not religious, and I’m very practical about my relationship with God. I am not angry about my disease. I’m incredibly empathetic to the untold numbers of people who are really suffering. My blog would describe my growth as a human being through this process and how it affected my work and my empathy for others— how I’ve realized that walking well is so incredibly underrated.

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Can Preschoolers Be Depressed?

But there were worrisome signs. For one thing, unlike your typical joyful and carefree 4-year-old, Kiran didn’t have a lot of fun.“He wasn’t running around, bouncing about, battling to get to the top of the slide like other kids,” Raghu notes. Kiran’s mother, Elizabeth (her middle name), an engineer, recalls constant refrains of“Nothing is fun; I’m bored.” When Raghu and Elizabeth reminded a downbeat Kiran of their coming trip to Disney World, Kiran responded:“Mickey lies. Dreams don’t come true.”

Over time, especially in comparison with Kiran’s even-keeled younger sister, it became apparent that guilt and worry infused Kiran’s thoughts.“We had to be really careful when we told him he did something wrong, because he internalized it quickly,” Raghu says. He was also easily frustrated. He wouldn’t dare count aloud until he had perfected getting to 10. Puzzles drove him nuts. After toying with a new set of Legos, he told his father,“I can’t do Legos.” He then roundly declared:“I will never do them. I am not a Legos person. You should take them away.”

One weekend when he was 4, Kiran carried his blanket around as his mother ferried him from one child-friendly place to the next, trying to divert him. But even at St. Louis’s children’s museum, he was listless and leaned against the wall. When they got home, he lay down and said he couldn’t remember anything fun about the whole day. He was“draggy and superwhiny and seeming like he was in pain.” Elizabeth remembers thinking, Something is wrong with this kid.

After talks with the director of Kiran’s preschool, who was similarly troubled by his behavior, and a round of medical Googling, Kiran’s parents took him to see a child psychiatrist. In the winter of 2009, when Kiran was 5, his parents were told that he had preschooldepression, sometimes referred to as“early-onset depression.” He was entered into a research study at the Early Emotional Development Program atWashington UniversityMedical School in St. Louis, which tracks the diagnosis of preschool depression and the treatment of children like Kiran.“It was painful,” Elizabeth says,“but also a relief to have professionals confirm that, yes, he has had a depressive episode. It’s real.”

Is it really possible to diagnose such a grown-up affliction in such a young child? And is diagnosing clinical depression in a preschooler a good idea, or are children that young too immature, too changeable, too temperamental to be laden with such a momentous label? Preschool depression may be a legitimate ailment, one that could gain traction with parents in the way thatattention deficit hyperactivity disorder(A.D.H.D.) andoppositional defiant disorder(O.D.D.)— afflictions few people heard of 30 years ago— have entered the what-to-worry-about lexicon. But when the rate of development among children varies so widely and burgeoning personalities are still in flux, how can we know at what point a child crosses the line from altogether unremarkable to somewhat different to clinically disordered? Just how early can depression begin?

The answer, according to recent research, seems to be earlier than expected. Today a number of childpsychiatristsand developmentalpsychologistssay depression can surface in children as young as 2 or 3.“The idea is very threatening,” says Joan Luby, a professor of childpsychiatryat Washington University School of Medicine, who gave Kiran his diagnosis and whose research on preschool depression has often met with resistance.“In my 20 years of research, it’s been slowly eroding,” Luby says of that resistance.“But some hard-core scientists still brush the idea off as mushy or psychobabble, and laypeople think the idea is ridiculous.”

For adults who have known depression, however, the prospect of early diagnosis makes sense. Kiran’s mother had what she now recognizes was childhood depression.“There were definite signs throughout my grade-school years,” she says. Had therapy been available to her then, she imagines that she would have leapt at the chance.“My parents knew my behavior wasn’t right, but they really didn’t know what to do.”

LIKE MANY WHOtreat depression, Daniel Klein, a professor of clinicalpsychologyatState University of New York at Stony Brook, repeatedly heard from adult patients that they had depression their whole lives.“I’ve had this as long as I can remember,” Klein told me they said.“I became convinced that the roots of these conditions start very early.”

So Klein turned to the study of temperament and depressive tendencies in young children. About a decade later, he is one of several academics focusing on preschool depression.

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Pamela Paul is the author of“Parenting, Inc.,” a book about the business of child-rearing. Her mostrecent articlefor the magazine was about a lesbian couple trying to adopt a baby.

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Recipes for Health - Bruschetta With Tomato Topping

4 thick slices whole grain country bread

1/4 cup finely chopped red onion

1 pound ripe, locally growntomatoes

1 tablespoon sherry vinegar or red wine vinegar

1 tablespoon capers, rinsed

1 garlic clove, minced or pureed

1 tablespoon chopped fresh dill or parsley

2 tablespoons plus 1 teaspoon extra virgin olive oil

1 to 2 ounces feta, crumbled (optional)

2 teaspoons dried oregano

1.Toast the bread and set aside, or dry it in a very low oven (a pilot light provides sufficient heat, if you have one) for eight to 10 hours. Sprinkle rusks with a little water to reconstitute.

2.Place the onion in a bowl, and cover with cold water. Allow to sit for five minutes, drain, rinse and dry on paper towels. Cut the tomatoes in half at the equator, and grate on the large holes of a box grater set in a wide bowl. Combine the grated tomatoes with the vinegar, capers, garlic, onion and dill or parsley. Season with salt and pepper.

3.Drizzle 1 teaspoon of the olive oil over each of the toasted bread slices or rusks. Top with the tomato mixture. Sprinkle on the cheese and oregano, drizzle on the remaining olive oil and serve.

Yield:Serves two as a meal, four as a starter, side dish or light lunch.

Advance preparation:The tomato topping can be made several hours ahead.

Nutritional information per serving(two servings): 419calories; 20 grams fat; 3 gramssaturated fat; 4 milligramscholesterol; 49 gramscarbohydrates; 10 gramsdietary fiber; 486 milligrams sodium (does not include salt added during preparation); 14 grams protein

Martha Rose Shulman can be reached atmartha-rose-shulman.com.

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Recipes for Health - Tomatoes Pack a Nutritional Punch

Unfortunately, the high-lycopene tomatoes I found at the supermarket did not taste as sweet as the tomatoes I buy at the farmers’ market. No matter how red a tomato is, if it was picked to be shipped to a faraway supermarket, then it was picked too soon.

In many of this week’s recipes I’m using a technique that may be new to some of you. Rather than peeling, seeding and dicing the tomatoes, I grate them on the large holes of a box grater. This is a technique I learned in Greece; it’s used throughout the Mediterranean. Cut the tomatoes in half, squeeze out the seeds if instructed to do so, and rub the cut side against the grater. Don’t worry, the skin is tough and you won’t scrape your hands. When you feel the holes of the grater against the inside of the tomato skin, you’re done. It goes quickly, and it’s a nifty time-saver.

Pasta With Salsa Crudo and Green Beans

You can make this uncooked grated tomato sauce while you’re waiting for the water to boil for the green beans andpasta. Choose a type of noodle that will catch the sauce, such as orecchiette, penne, fusilli or farfalle.

3/4 pound ripe, locally grown tomatoes

1 to 2 garlic cloves, green shoots removed, finely chopped or pureed

Salt and freshly ground pepper to taste

1 teaspoon balsamic or sherry vinegar

1 tablespoon extra virgin olive oil

6 ounces green beans, trimmed

3/4 pound orecchiette, penne, farfalle or fusilli

2 tablespoons slivered basil leaves

1/4 cup (1 ounce) freshly grated Parmesan, pecorino, orricotta salatafor serving

1.Begin heating a large pot of water. Cut the tomatoes in half across the equator, and grate on the large holes of a box grater into a wide bowl. Stir in the garlic, salt and pepper, vinegar and olive oil.

2.When the water comes to a boil, salt generously and add the green beans. Parboil four minutes. Transfer to a bowl of cold water, then drain and dry on paper towels. Keep the water in the pot boiling for the pasta. Cut the beans into 2-inch lengths, and add to the bowl with the tomatoes.

3.Cook the pasta in the boiling water until al dente. Follow the timing instructions on the package but check the pasta about one minute sooner than the suggested cooking time. When it’s done, drain and toss with the tomato mixture, basil and cheese.

Yield:Serves four.

Advance preparation:You can make the tomato sauce several hours before you cook the beans and the pasta.

Nutritional information per serving:397calories; 6 grams fat; 2 gramssaturated fat; 4 milligramscholesterol; 70 gramscarbohydrates; 4 gramsdietary fiber; 89 milligrams sodium (does not include salt added during preparation); 14 grams protein

Martha Rose Shulman can be reached atmartha-rose-shulman.com.

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What to Tell Alzheimer’s Patients After a Trial Goes Awry

So when Eli Lillyannounced last weekthat its promising Alzheimer’s drug was making patients worse and that it was halting two large clinical trials, it seemed likely that Dr. Ross would hear from family members of his patients. Are other experimental Alzheimer’s drugs safe? they might ask. Should they get their family members out of those Alzheimer’s studies?

Not a single family member called. And Dr. Ross is not sure why.

If a study of an experimentalbreast cancerdrug was ended because it made thecancergrow and spread, women in other breast cancer studies of similar drugs would be calling their doctors and asking what to do.

But Alzheimer’s is different.“It may reflect the incredible desperation surrounding Alzheimer’s disease,” said Baruch Brody, director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine.

There is no treatment and no way to prevent Alzheimer’s. It is a leading cause of death, ravaging patients and their families.“Possibly, the overworked caregiver has precious little time to listen to news or read a paper,” Dr. Ross said.

Whatever the reason, the silence of Alzheimer’s family members gives rise to an ethical question. Do families now need extra protection or warnings about the Lilly experience when they sign up Alzheimer’s patients for studies?

There are no easy answers, ethicists and drug companies say, in part because it is not known what went wrong with the Lilly drug.

When patients enter studies or, in the case of patients with Alzheimer’s, when caregivers sign them up for studies, they or their caregivers sign an informed consent document. The forms are reviewed by ethics panels known as institutional review boards.

When the federal government conducts studies, it makes the consent forms public. Drug companies, though, generally insist that their forms be confidential. Investigators conducting studies for companies and institutional review boards must agree not to distribute the forms.

But every form contains a statement that warns patients that a drug might not help, said Angela Bowen of the Western Institutional Review Board, a private group which does ethical reviews of research on human subjects, including studies of Alzheimer drugs. The forms say a clinical trial is aimed at helping future patients. It is not a treatment for a disease.

The forms also say“there may be side effects that are not known at this time” and“your condition may not get better or may get worse during this study.”

It is often difficult to convey those ideas, said Dr. John Ennever, Western’s vice president for medical affairs.“We realize drugs can cause side effects and that sometimes they don’t work but we don’t think they can make conditions worse,” he said.

“We are dealing with humans who have hopes and aspirations,” he added.“The whole idea of research is a difficult concept. We all forget that if we knew the answer we wouldn’t be doing the research.”

The Lilly drug disabled an enzyme needed to make a protein, beta amyloid, that accumulates in plaques in the brains of people with Alzheimer’s disease. Other companies are testing different drugs that disable that enzyme, gamma secretase.

Researchers at other companies like Elan and Bristol-Myers Squibb said the Lilly drug, among the first of the gamma secretase inhibitors, took a sledgehammer to the enzyme. As a result, it probably affected levels of many other proteins besides beta amyloid. They say gamma secretase inhibitors now under development are much more selective and may be much safer.

Elan is one of those companies with a newer-generation gamma secretase inhibitor, and its chief scientific officer, Dr. Dale Schenk, said he did not think it necessary to emphasize the Lilly drug result to people taking his company’s drug.

“To be fair, this is the first anti-amyloid drug that has demonstrated a negative effect,” Dr. Schenk said.“I’m not worried about the class.”

Ted Yanock, Elan’s head of global research, agreed. Telling people taking the Elan drug about the Lilly results“would almost be misleading,” he said.

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Book Review - Book of Days - Personal Essays - By Emily Fox Gordon

Her memoir of that experience,“Mockingbird Years: A Life In and Out of Therapy,”published in 2000, was praised by critics and won her fans for its unflinching honesty and aseptic prose, free from the maudlin melodrama that has suffused so many recent memoirs. Her second memoir,“Are You Happy? A Childhood Remembered,”published in 2006— again to some critical success— described her 1950s childhood, deeply enmeshed in the lives of her alcoholic mother and auto­cratic father, yet simultaneously estranged from them. (A 2009 novel, a satire set in academia, received mixed reviews.)

So readers might be eager for“Book of Days,” in which Gordon explores her preferred form— not memoir, but personal essay— nor does it hurt thatPhillip Lopate,il miglior fabbroof the art, gives his rousing approval in the introduction.

Many of the essays, including the one that prompted the book“Mockingbird Years,” have been previously published, but not all. She writes with a stringent delicacy about sickness and marriage in“Fantastic Voyage,” one of the more polished pieces in the collection. Her husband’s routinecolonoscopyfills her with a curious mortal dread, inspiring both waiting-­roomanxiety— what if he has some terriblecancer?— and then an egocentric reverie: Will she get to play the part of the martyred caretaker? How will she face the“dire glamour” of a life-changing diagnosis?

(The sickness-as-glamour leitmotif runs through Gordon’s work. She writes in the essay“Mockingbird Years” that going to Austen Riggs as a teenager would not only make her college-bound friend jealous but was“the fulfillment of an adolescent fantasy. The status of mental patient would invest me with significance.”)

In“Fantastic Voyage,” she writes, tartly and honestly, that she is deeply envious of her husband’s organized mind, his promptly scheduled medical exams and command over the minutiae of life she can never seem to control.“He was the one who had made himself pure and ready, while last night’s furtively eaten supper of leftovers rotted invisibly in my own unexamined colon. He was the one who would walk into the waters ofanesthesiathis morning; he was the one who would emerge on the other side while I remained in this anteroom, fully dressed and conscious, a fugitive from medical justice.” The fantastic voyage, of course, is not the colonoscopy but their 30-year marriage, which she describes as combative but sustainable:“We’re like two boxers who have fought so many rounds together that we’ve decided to forgo the late ones in favor of an extended, exhausted clinch.” It’s a funny and brutal moment of self-recognition.

Gordon dissects female friendship, femininity and feminism, and the changing state of marriage, in“The Most Responsible Girl.” Sometimes the writing is fresh and amusingly self-lacerating— she writes of getting into“male-pattern trouble”— and sometimes it’s distressingly academic. Marriage has changed over the last few decades, certainly, but I am not sure if writing that“the hierarchical rolebound form which found its origins in the division of labor has now been replaced by the companionate egalitarian dyad” is the most inviting way to put it.

In“Here Again,” Gordon describes her 25th or so visit to a meeting of the American Philosophical Association, as companion to her husband. (He is George Sher, a former chairman of the philosophy department atRice University.) Anyone who has spent time at an academic conference recognizes this scene: having to spend“a bleary interval at avegansteam-table restaurant where I sat opposite a graduate student who spoke at length about her five-year plan to penetrate the upper echelons of the administration at some northwestern Florida university.” Some of her best passages linger on mortality. She describes the shock of seeing people only once a year, who have“tumbled abruptly into a new category of age.” One elderly visitor at the convention is so brittle her colleagues, upon greeting her, will not actually touch her, but give air kisses and pretend pats around her shoulders, offering an“airy substitute for human contact: the idea of an embrace.”

But Gordon meanders. Sitting in on a colloquium about mental disorders— something she knows a bit about— she throws up her hands and writes that she is helpless to form a coherent narrative:“Instead, I’ll simply transcribe my notes.” Sample:“Visual system is modular. Mind is not. Central nonmodular STUFF WE CARE ABOUT.” This makes for a page of— well, calling it filler seems a bit forgiving. Isn’t her mandate as an essayist to take the stuff of life and form a narrative, a thought, a juicy little bit for the reader? I felt neglected by these dreary excursions into her notebook.

The title essay is a strange kind of apologia for her previous work, a description of how she was lured by New York publishing types into writing memoirs instead of collections of personal essays. A New York editor with“a voice like sun-­softened caramel” called her after reading the essay“Mockingbird Years” in a literary journal.“His voice evoked a feeling I hadn’t had in many, many years— the sense of submitting, with token resistance, to a stranger’s seduction.” He seduced, an agent was hired, an auction conducted, and Gordon suffered misgivings as she wrote the book, believing she had made a Faustian pact with the publisher.

Gordon raises the flag of cultural fatigue against the memoir and questions the essential honesty of memoir-writing.“I regret having written‘Mockingbird Years’— the memoir, that is, not the essay. Perhaps I should say I regret its dishonesty.” The dishonesty inherent in memoir, she argues, is that an entire life cannot be contained in one book, and so the writer is forced to follow only one story line: Me and drugs, me and my dysfunctional family, me and mydepression, me and myeating disorder.

The publishers forced her, she writes, to create a narrative arc to bolster her original personal essay— and that necessitated that her book become not the full story of her life but what Lopate suggests in his introduction is the predictable contemporary memoir, a by-now threadbare template of dissolution, struggle and (cue sunlight parting the clouds) requisite redemption.“Preferably,” Lopate writes, the story should be“one revolving around addiction, abuse, poverty or some other nasty problem whose overcoming will yield the desired triumph-of-the-human-spirit results.” Lopate writes that Gordon“tells ruefully the tale of how she was seduced, not once but twice, to write and publish memoirs, instead of being allowed to bring out a collection of personal essays.” This all sounds a bitungrateful. I can practically hear the rooms full of M.F.A. students shrieking, Please don’t throw me in the brier patch! Please, we want a phone call from that editor with the voice like sun-softened caramel!

No one will take Gordon to task as a writer for her memoir-regret. She didn’t actually make anything up; she told no outright lies.“It was no sin against literature to write as if the story of my life in therapy had been the story of my life,” she writes.“But I think it may have amounted to a sin against myself, or a sin against my life, or— more accurately yet— a sin against the true story of my life, the one I can never tell and never know.” But no memoirist worth his madeleine could possibly pack an entire life’s worth of meaning into anything less than a seven-­volume work. I’m not sure I could read seven volumes about Gordon’s life. But a few­essays? Yes.

Alex Kuczynski is the author of“Beauty Junkies: Inside Our $15 Billion Obsession With Cosmetic Surgery.”

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U.S. Inaction Lets Look-Alike Tubes Kill Patients

But in a mistake that stemmed from years of lax federal oversight of medical devices, the hospital mixed up the tubes. Instead of snaking a tube through Ms. Rodgers’s nose and into her stomach, the nurse instead coupled the liquid-food bag to a tube that entered a vein.

Putting such food directly into the bloodstream is like pouring concrete down a drain. Ms. Rodgers was soon in agony.

“When I walked into her hospital room, she said,‘Mom, I’m so scared,’ ” her mother, Glenda Rodgers, recalled. They soon learned that the baby had died.

“And she said,‘Oh, Mom, she’s dead.’ And I said,‘I know, but now we have to take care of you,’ ” the mother recalled. And then Robin Rodgers— 24 years old and already the mother of a 3-year-old boy— died on July 18, 2006, as well. (She lived in a small Kansas town, but because of a legal settlement with the hospital, her mother would not identify it.)

Their deaths were among hundreds of deaths or serious injuries that researchers have traced to tube mix-ups. But no one knows the real toll, because this kind of mistake, like medication errors in general, is rarely reported. A2006 surveyofhospitalsfound that 16 percent had experienced a feeding tube mix-up.

Experts and standards groups have advocated since 1996 that tubes for different functions be made incompatible— just as different nozzles at gas stations prevent drivers from using the wrong fuel.

But action has been delayed by resistance from the medical-device industry and an approval process at theFood and Drug Administrationthat can discourage safety-related changes.

Hospitals, tube manufacturers, regulators and standards groups all point fingers at one another to explain the delay.

Hospitalized patients often have an array of clear plastic tubing sticking out of their bodies to deliver or extract medicine, nutrition, fluids, gases or blood to veins, arteries, stomachs, skin, lungs or bladders.

Much of the tubing is interchangeable, and with nurses connecting and disconnecting dozens each day, mix-ups happen— sometimes with deadly consequences.

“Nurses should not have to work in an environment where it is even possible to make that kind of mistake,” said Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who is a vocal advocate for changing the system.“The nuclear power and airline industries would never tolerate a situation where a simple misconnection could lead to a death.”

Tubes intended to inflate blood-pressure cuffs have been connected to intravenous lines, leading to deadly air embolisms. Intravenous fluids have been connected to tubes intended to deliver oxygen, leading to suffocation. And in 2006 Julie Thao, a nurse at St. Mary’s Hospital in Madison, Wis., mistakenly put a spinal anesthetic into a vein, killing 16-year-old Jasmine Gant, who was giving birth.

Ms. Thao, who had worked two eight-hour shifts the day before, was charged with felony neglect. She pleaded no contest to two misdemeanor charges. But experts say such mistakes are possible only because epidural bags are compatible with tubes that deliver medicine intravenously.

“This is a deadly design failure in health care,” said Debora Simmons, aregistered nurseat theUniversity of TexasHealth Science Center who studies medical errors.“Everybody has put out alerts about this, but nothing has happened from a regulatory standpoint.”

An international standards group is seeking consensus on specific designs on how tubes for different bodily functions should differ, but the group has been laboring for years and its complete recommendations will take years more. Some manufacturers have used color-coding to distinguish tubes for different functions, but with each manufacturer using a different color scheme, the colors have in some cases added to the confusion.

An Alarm Is Raised

Advocates in California got legislation passed in 2008 that would have mandated that feeding tubes no longer be compatible with tubes that go into the skin or veins by 2011. But in 2009, AdvaMed, the manufacturers’ trade association, successfully pushed legislation to delay the bill’s effects until 2013 and 2014 or until the international standards group reaches a decision.

In the meantime, F.D.A. reviewers have begun to question whether feeding tubes that could mistakenly be connected to intravenous tubes should be declared fundamentally unsafe.

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Moose Offer Trail of Clues on Arthritis

But now the moose of Isle Royale have something to say— well, their bones do. Many of the moose, it turns out, havearthritis. And scientists believe their condition’s origin can help explain humanosteoarthritis— by far the most common type of arthritis, affecting one of every seven adults 25 and older and becoming increasingly prevalent.

The arthritic Bullwinkles got that way because of poornutritionearly in life, an extraordinary 50-year research project has discovered. That could mean, scientists say, that some people’s arthritis can be linked in part to nutritional deficits, in the womb and possibly throughout childhood.

Themoose conclusionbolsters a small but growing body of research connecting early development to chronic conditions like osteoarthritis, which currently affects 27 million Americans, up from 21 million in 1990.

Osteoarthritis’s exact cause remains unknown, but it is generally thought to stem from aging and wear and tear on joints, exacerbated for some by genes. Overweight or obese people have greater arthritis risk, usually attributed to the load their joints carry, and the number of cases is increasing as people live longer and weigh more.

But the moose work, along with some human research, suggests arthritis’s origins are more complex, probably influenced by early exposures to nutrients and other factors while our bodies are developing. Evenobesity’s link to arthritis probably goes beyond extra pounds, experts say, to include the impact on the body of eating the wrong things.

Nutrients, experts say, might influence composition or shape of bones, joints or cartilage. Nutrition might also affect hormones, the likelihood of later inflammation or oxidative stress, even how a genetic predisposition for arthritis is expressed or suppressed.

“It makes perfect sense,” saidDr. Joanne Jordan, director of the Thurston Arthritis Research Center at theUniversity of North Carolina.“Osteoarthritis starts way before the person knows it, way before their knee hurts or their hand hurts. It’s very clear that we’re going to have to start looking back” at“things in the early life course.”

Such research could lead to nutritional steps people can take to protect against osteoarthritis, a condition that is often painful or debilitating, and according tofederal data, costs billions of dollars annually in knee and hip replacements alone.

“It would be helpful to know if we want to make sure pregnant moms are taking certainvitaminsor if you need to supplement with such and such nutrition,” saidDr. David Felson, an arthritis expert atBoston UniversitySchool of Medicine.“The moose guy is right in that we probably should study weight or some other nutritional factor almost throughadolescencewhen the bones or joints have stopped forming.”

The“moose guy” isRolf Peterson, a Michigan Technological University scientist on theIsle Royale project, which began in 1958 and is reportedly the longest-running predator-prey study.

For half the year, Dr. Peterson and his colleagues are the only humans allowed on the 45-mile-long island, part of a national park. They stay in yurts, a log cabin or a wood-stove-heated lodge, navigate the wilderness without roads or cars, and share a single staticky phone line. They analyze everything from wolves’ moose-hunting strategies to moose feces. Collecting bones of more than 4,000 moose, they noticed that out of 1,200 carcasses they analyzed, more than half had arthritis, virtually identical to the human kind. It usually attacked the hip and instantly made the moose vulnerable.

“Arthritis is a death sentence around here— you need all four legs,” Dr. Peterson said.“Wolves pick them off so quickly that you don’t even see them limping.”

What is more, the arthritic moose were often small, measured by the length of the metatarsal bone in the foot. Small metatarsals indicate poor early nutrition, and scientists determined that the arthritic moose were born during times when food was scarce, so their mothers could not produce enough milk.

Dr. Peterson said if the arthritis were caused by excess wear and tear on the moose’s joints, that would have meant that times of food scarcity occurred when the moose were already grown, since the extra wear would have happened to moose walking farther to find edible plants. But the arthritic moose had had plentiful food as adults.

For people, several historical cases may suggest a nutritional link. Bones of 16th-century American Indians in Florida and Georgia showed significant increases in osteoarthritis after Spanish missionaries arrived and tribes adopted farming, increasing their workload but also shifting their diet from fish and wild plants to corn, which“lacks a couple of essential amino acids and is iron deficient,” said Clark Larsen, anOhio State Universityanthropologist collaborating with Dr. Peterson. Many children and young adults were smaller and died earlier, Dr. Larsen said, and similar patterns occurred when an earlier American Indian population in the Midwest began farming maize.

British scientists studying people born in the 1940sfoundlow birth weight (indicating poor prenatal nutrition) linked to osteoarthritis in the men’s hands, Dr. Felson said. AndDr. David Barker, a British expert onhow nutrition and early development influence cardiac and other conditions, said“studies of people in utero during the Great Chinese Famine” of the late 1950s found that“40, 50 years later, those people have got disabilities.”

Overeating can be as problematic as undereating.Dr. Lisa A. Fortier, a large-animal orthopedist atCornell University’s College of Veterinary Medicine, said she saw“abnormal joint and tendon development from excessive nutrition” in horses overfed“in utero or in the postnatal life,” probably ingesting“too much of the wrong type of sugar that may cause levels of inflammation.”

Dr. Peter Bales, an orthopedic surgeon affiliated withUniversity of California, Davis, Medical Center, who has written about nutrition and arthritis, sees similar problems in overweight patients. He said the causes were not as“simplistic” as“carrying more weight around,” but might involve nutritional imbalances that could hurt joints and erode cartilage. Much is unknown about nutrition’s relevance. Isle Royale moose, for example, also seem to have genetic predispositions for arthritis, suggesting that nutrition might be amplifying or jump-starting the genes.

“Genes are not Stalinist dictators,” said Dr. Barker, now at Oregon Health and Science University.“What they do, how they’re expressed, is conditional on the rest of the body. The human being is a product of a general recipe, and the specific nutrients you get or don’t get.”

Studying nutrition in people is much more complicated than in moose. Dr. Peterson said the early moosehood developmental window occurred in utero through 28 months, but humans’ developmental time frame lasted into the teens. Some experts say prenatal nutrition is most critical; others see roles for nutrients after birth and beyond.

“Up until the growth plates close, which is through adolescence and even early adulthood, the effects of nutrition are magnified,” saidDr. Constance R. Chu, director of the Cartilage Restoration Center at theUniversity of Pittsburgh, who said nutrients might affect the number of healthy cells in cartilage and its thickness.“But in my opinion, it’s relevant throughout life.”

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Recipes for Health - Lasagna With Spinach and Cottage Cheese

1 1/2 cups low-fat or nonfat cottage cheese

2 1/2 cupsfresh tomato sauceorsimple marinara saucemade with cannedtomatoes

12 ounces baby spinach, or 1 generous bunch spinach (about 12 ounces), stemmed and washed

Salt and freshly ground pepper

1/2 pound no-boil lasagna noodles

1/2 cup freshly grated Parmesan (2 ounces)

2 tablespoons bread crumbs

1 tablespoon extra virgin olive oil

1.Preheat the oven to 375 degrees. Oil a 2-quart baking dish or lasagna dish. Bring a large pot of water to a boil.

2.Place the cottage cheese in a food processor fitted with the steel blade, and blend until smooth. Add 1/2 cup of the tomato sauce, and blend until smooth. Scrape into a bowl.

3.Wash the spinach, and wilt in a large frying pan over high heat in the water left on the leaves after washing. Transfer to a colander, rinse briefly and squeeze out excess water. Chop fine (by hand or in a food processor), then stir the spinach into the cottage cheese. Season to taste with salt and pepper.

4.When the water comes to a boil, salt generously and add enough lasagna noodles to cover the surface of the baking dish (for my rectangular dish, that’s three lasagna noodles). Boil just until thepastais flexible, about two or three minutes for no-boil lasagna. Using tongs, remove the pasta from the water, and drain on a clean dish towel. Spread a thin layer of tomato sauce on the bottom of the baking dish, and top with a layer of noodles. Top the noodles with a third of the cottage cheese mixture. Use a spatula to spread it evenly over the noodles. Top with 1/2 cup of the tomato sauce, and spread in an even layer. Sprinkle on 2 tablespoons of the Parmesan.

5.Repeat these layers two more times, using up the cottage cheese/spinach mixture but retaining tomato sauce and Parmesan for the top layer. Cook one more batch of lasagna noodles, and top with the remaining tomato sauce and Parmesan. Sprinkle on the bread crumbs, and drizzle on the olive oil. Cover tightly with foil, place in the oven and bake for 30 minutes until bubbling. If you wish to brown the top, uncover and continue to bake until the top just begins to color, about five minutes. Remove from the heat, allow to sit for five to 10 minutes, and serve.

Yield:Serves six.

Advance preparation:The lasagna can be assembled up to a day ahead of time, covered with plastic and refrigerated. Replace the plastic with foil before baking. It can also be frozen for up to a month.

Nutritional information per serving(using 2 percent low-fat cottage cheese): 320calories; 9 grams fat; 2 gramssaturated fat; 12 milligramscholesterol; 42 gramscarbohydrates; 5 gramsdietary fiber; 360 milligrams sodium (does not include salt added during preparation); 18 grams protein

Nutritional information per serving(using fat-free cottage cheese): 311 calories; 8 grams fat; 2 grams saturated fat; 8 milligrams cholesterol; 44 grams carbohydrates; 5 grams dietary fiber; 389 milligrams sodium (does not include salt added during preparation); 18 grams protein

Martha Rose Shulman can be reached atmartha-rose-shulman.com.

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Personal Health - Few Rules for Donors, but Many Wait for Organs

Just ask Stacey Oglesby of Lockwood, Mo., whose 15-year-old daughter, Colbey, died in a car accident in 2001. Colbey had told her mother that when she got her driver’s license, she was going to sign up to be an organ donor. So when hospital personnel asked about organ donation, Ms. Oglesby said,“we had nohesitancy.”

Seven people got Colbey’s organs. Her lungs went to Valerie Vandervort, a 29-year-old Oklahoma woman withcystic fibrosis. In the nine years since, Ms. Vandervort has run three 5K races, hiked a mountain, danced at her sister’s wedding, doted on her nieces and nephews, and won medals in swimming at the 2010 National Kidney Foundation United States Transplant Games.

Ms. Oglesby also befriended the recipient of Colbey’s heart, Judy Kaufman of Chesterfield, Mo., who was near death withcongestive heart failure. When they met, Ms. Oglesby took a stethoscope to listen to the beat of her daughter’s heart.

Ms. Oglesby, who speaks often about Colbey’s legacy, said she has inspired others to become potential organ donors. If not for donating her daughter’s organs and connecting to the recipients, she said,“it would have been hard to get through the grief.”

A Widespread Need

At any given time in the United States, more than 100,000 people are waiting for donor organs, more than 10 times as many as become available. Some die waiting; others get sicker and sicker, sometimes too ill to survive when a suitable organ finally becomes available.

In addition to kidneys, heart, lungs, liver, pancreas and intestines, donations can include tissues like corneas, skin, heart valves, bone, veins, cartilage, middle ear, tendons and ligaments that can be stored in tissue banks and used when needed.

Most donations come from people who die suddenly, usually from an accident, a gunshot or a brief illness that resulted in brain death. (A small but growing number of donations follow cardiac death.) Some adults indicate their wish to be donors by signing the back of their driver’s license or a donor card or simply telling their next of kin. For minors, hospital personnel often ask the distraught parents if they would consider donating their child’s organs.

But when 6-year-old Katie Coolican died in 1983 from an undiagnosed heart malformation, it was her mother, Maggie, a nurse, who asked about donating the child’s organs—“to make some sense of it all,” Ms. Coolican, of East Hampton, Conn., said in an interview.

“We were willing to donate anything,” she added,“but at the time all they could use were Katie’s corneas and kidneys.”

Likewise for Julie Schlueter of Winsted, Minn., whose daughter, Missy, 10, died of acerebral hemorrhagein 1992: donating the girl’s organs meant her loss was not in vain.

Missy’s liver and one kidney went to a man who four years later won a silver medal in the Summer Olympics in Atlanta; he sent the medal to the Schlueters to thank them for enabling him to live. Two toddlers, one from Italy and the other from Colorado, got Missy’s heart valves. And an Iowa woman, then 47, got her other kidney and is still doing well 18 years later.

Rose D’Acquisto of St. Paul said that donating all her husband’s usable organs“has led to things I’d never imagined.”

Her husband, Tony, died in 1996 at age 35 when an undiagnosedbrain tumorhemorrhaged and left him in an irreversiblecoma. Ms. D’Acquisto said the recipient of his liver— an Indiana man near death with a rareliver disease— had now been married more than 30 years and has three grown children.

And the Minnesota farmer who got one of Tony’s kidneys got his life back; he had spent three years traveling three hours a day three times a week fordialysis.

Ms. D’Acquisto, now remarried, says she continues to write and speak about organ donation as love’s greatest gift. Along with Ms. Schlueter, she was among more than 7,000 people who attended the Transplant Games last month in Madison, Wis.

When Katie Coolican died, there was no follow-up care for families who donate the organs of their loved ones. After a few years of struggling with grief, her mother wrote about her experience in The American Journal of Nursing and began speaking about organ donation all over the country.

She went back to school, got a master’s degree and wrote a booklet,“For Those Who Give and Grieve,” that was published by the National Kidney Foundation. (The foundation also publishes a quarterly newsletter with that title, edited by Ms. D’Acquisto.)

“Katie’s had a wonderful legacy that continues to this day,” Ms. Coolican said. In 1992 she founded the National Donor Family Council for the kidney foundation to help grieving families that donate loved ones’ organs and tissues. The two-year follow-up program she created for families has become a model for organ donation programs throughout the country.

(To read more“gift of life” stories about organ donation, see the Web siteorg/gift/index.html.)

Who Is Eligible to Give?

Do not rule yourself out as a potential donor because you think you may be too ill or too old. Only a few circumstances, like pervasive infection or activecancer, absolutely preclude organ donation, and there is no age limit. People in their 80s and 90s have been successful donors of certain tissues, as have newborns. But for anyone under 18, a parent or guardian must approve the donation.

Even if a person dies after an illness that precludes organ donation, or if too much time elapsed after death for organs to be viable, there is still the opportunity of whole-body donation to a medical college, where the body can be used in research or to help students learn anatomy.

While it is best to register one’s interest in whole-body donation with a medical school in advance of death, after death it is up to the next of kin to make it happen. You no longer own your body after you die. If this is something you would want for yourself, discuss it with your spouse and children, who must agree with your wishes.

Most religions support organ donation as a charitable act, although some may not condone whole-body donation. Check the Web sitewww.organdonor.govand click on“Religious Views on Donation” for guidance.

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