Winter Swims, With Views, in New York City

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New Fast-Food Restaurants Are Banned From South L.A.

If the restaurant chains had their way in some parts of town, city officials say, no street would be without its own fast-food outlet.

Los Angeles is making one of the nation’s most radical food policies permanent by effectively banning new fast-food restaurants in South Los Angeles, a huge section of the city that has significantly higher rates of poverty andobesitythan other neighborhoods.

A handful of much smaller cities have enacted similar regulations for primarily aesthetic reasons, but Los Angeles, officials say, is the first to do so as part of a public health effort. The regulations, which the City Council passed unanimously last month, are meant to encourage healthier neighborhood dining options. Supporters envision more sit-down restaurants, produce-filled grocery stores and takeout meals that center on salad rather than fries.

“If people don’t have better choices or don’t have the time or knowledge or curiosity, they are going to take what’s there,” saidJan Perry, a city councilwoman who represents part of South Los Angeles and pushed for the regulations.“To say that these restaurants are not part of the problem would be foolish.”

The regulations are not quite an outright ban; existing restaurants can remain open, and exceptions are made for those opening inside a shopping center. Many mom-and-pop businesses or casual restaurants that serve equally unhealthy food can also get permits to open.

The City Council first enacted a one-year moratorium in 2008. Since then, no new stand-alone fast-food establishments have opened in the area. Instead, Ms. Perry said, the area got its first new supermarket in roughly a decade.

Bernard Parks, a city councilman who represents parts of South Los Angeles and also pushed for the change, said he was simply trying to apply land-use laws to limit fast-food restaurants the same way other communities do with bars orliquorstores.

“There are people who are accused of being the food police, of trying to control what goes into people’s mouths,” Mr. Parks said.“But we just don’t think that we need to give fast food more rights around here. We don’t think our community needs to have 10 or 15 or 18 ways to eat a hamburger.”

Daniel Conway, a spokesman for theCalifornia Restaurant Association, said the limits set a“troubling precedent” and could“throw up a big stop sign” for any potential owner looking to open any kind of food business in the area.

“They have good intentions, but they have taken a kind of approach that emphasizes sticks over carrots,” Mr. Conway said.“We recognize your intent, but you are singling out the wrong thing right now. We basically have a target on our back.”

ThePhysicians Committee for Responsible Medicine, an advocacy group in Washington that has long fought against fast-food chains, is pushing for other cities, including Detroit and Philadelphia, to enact similar limits. But so far, there has been relatively little support from community leaders there.

By the council’s estimate, there are nearly 1,000 fast-food restaurants in the 30 or so square miles of South Los Angeles covered by the regulations. Some 30 percent of the 750,000 residents in the area are obese, double the rate in wealthier parts of the city, according to the county’s Department of Health. Residents in the area older than 65 are far more likely to receive diagnoses ofdiabetesor heart disease, statistics show.

Astudyreleased in 2009 by the RAND Corporation, a research group based in Santa Monica, found that the moratorium was unlikely to effectively change the rate of obesity or diabetes in the area. The study argued that rather than focus oncaloriesthat come from fast food, policy makers should instead look at junk food snacks from gas stations and convenience stores.

“People get a lot more of their discretionary and unnecessary food from there than from a fast-food restaurant,” said Roland Sturm, a senior economist at RAND and a co-author of the study.“A lot of this is driven by sound bites overlooking what is actually going to have an impact. People talk about this area being a food desert, but it is more like a swamp— you are literally drowning in food, but none of it is really a good option.”

Waiting to find the perfect policy is futile, advocates for such regulations say. They compare the fight against junk food to the early efforts of antismoking initiatives. Later, policy experts can compare the regulations here to, say, New York City’s ban ontrans fats.

“There is something inevitable here— you get different things going on in different places and it will just be a matter of time before it starts to have a cumulative effect,” said Kelly D. Brownell, the director of theRudd Center for Food Policy and Obesity.“To intervene in any one part of the system and expect a significant result is just not possible.”

A trip along Crenshaw illustrates how difficult it might be to change the eating habits of people who have grown up on meals that come with soda and fries. Carl’s Jr., a popular burger chain on the West Coast, was packed in the early afternoon. A group of teenagers had stopped in on their way home from school, eager to gobble up Western Bacon Cheeseburgers— one boy called it his“before-dinner snack.” Cynthia Williams and her two young children sat at another table nearby, picking at their fried chicken stars.

“This is a fun thing for them and easy for me, so how can I not come at least once a week or something like that?” Ms. Williams said.“When you’re out, you are just going to look for the first decent thing around. If there are fewer of them, fine by me, but we’re still going to go to the ones we’ve got now.”

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After Tucson Shooting, a Race to Save Lives

Among the wounded was RepresentativeGabrielle Giffords, who had been shot in the head. Mr. Compagno was one of the first paramedics to reach the scene of theshooting rampageat a shopping center in Tucson last Saturday.

“Lots of people were laying on the ground,” said Mr. Compagno, from Fire Station 30 the in Northwest Fire/Rescue District of Tucson.

“The congresswoman, I could tell that she was still alive. People were giving a little girl CPR. My mind went away. I started counting, and then I thought,‘What am I counting, injured or dead?’ ”

There were 19 victims. Mr. Compagno’s job was triage: to assess the severity of injuries and label victims so that ambulance crews would know whom to tend to first.

He realized instantly that there was no time to write labels. Ambulances and fire engines were roaring up.

The victims dropped where they stood, forming a row 20 or 30 feet long.

Mr. Compagno could see quickly that five were dead, seven were“immediates,” needing help right away, and the rest could wait.

The child receiving CPR was not responding, but Mr. Compagno was not about to write her off.

“The little girl, I counted her as an immediate,” he said.

Instead of using labels, he simply directed each rescue team to a victim.

The goal was to stabilize them and get them to the hospital as quickly as possible, because people with severe gunshot wounds need trauma surgeons.

The first two patients were ready to go even before the helicopters landed: Nine-year-old Christina-Taylor Green, who had been receiving CPR, and Ms. Giffords were loaded into ambulances.

Ten patients were sent to the trauma center at theUniversity of Arizonamedical center. The first to arrive was Christina— still getting CPR, still not responding.

By normal standards, a gunshot victim who is unresponsive after 15 minutes of CPR has almost no hope of surviving and can be declared dead. Christina had already received 20 or 25 minutes, according to a report radioed in.

“This was a 9-year-old girl,” saidDr. Randall S. Friese, 46, a trauma surgeon.“Even though she had CPR beyond our guidelines, I decided to be aggressive.”

Dr. Friese said he could not be certain the radio report was correct. But he could not afford the minutes it would take to verify it.

“You decide, and you do,” he said.“It’s a personal decision, and I decided to be aggressive, just because she was 9.”

He tried a desperate last-ditch maneuver. Within about two minutes, he had cut open her chest, inserted a tube to fill her heart with blood and massaged the heart with his hand to try to start it beating again.

“I had her heart in my hand,” Dr. Friese said.“We filled it with blood. It still didn’t want to beat. So, it was over. We’re finished.”

At that moment, a resident stepped in to tell him a second patient had arrived, assigned to Trauma Room 5: Ms. Giffords. It was the first time Dr. Friese had heard that she was among the victims.

He told the resident assisting him to fill Christina’s heart and try once more to make it start beating again.

By the time he reached Room 5, the resident had tried, and failed. Christina was gone.

The team in Room 5 had already begun assessing Ms. Giffords when Dr. Friese arrived.

“I walked in and held her left hand, held it in both of my hands, and I thought to myself,‘I need to communicate with her,’ ” he said.“I was uncertain if she would hear me, that she would process my words. It turned out later that she probably did. That was my reward. I leaned in close to her, and I said,‘Ms. Giffords, you are in a hospital. We are going to take care of you.’ ”

He expected no response. Next, he asked her to squeeze his hand. She did. A few moments later he asked her again, and again she complied. It was cause for hope. But when he tried the same thing with her right hand, there was no response.

Because abrain injurycan suddenly impair a person’s ability to breathe, Dr. Friese had a breathing tube inserted into her throat. Then he ordered a chestX-rayand aCT scanof her brain.

Dr.Martin E. Weinand, a neurosurgeon, was ready to operate, but Dr. Friese thought that the chief ofneurosurgery, Dr.G. Michael Lemole Jr., who was supposed to have the day off, should also be involved.

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Ford Burkhart contributed reporting.

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Ginger Can Ease Muscle Soreness

Ginger’s ability to calm anupset stomachis well known. But more recently, scientists have wondered whether its soothing effects might extend to sore muscles.

Ginger, a member of the same plant family as turmeric, contains anti-inflammatory compounds and volatile oils— gingerols— that show analgesic andsedativeeffectsin animal studies. So last year a team of researchers looked at whether ginger might do the same in humans.

Inthe study, published in The Journal of Pain in September, the scientists recruited 74 adults and had them do exercises meant to inducemuscle painand inflammation. Over 11 days, the subjects ate either two grams of ginger a day or a placebo. Ultimately, the ginger groups experienced roughly 25 percent reductions inexercise-induced muscle pain 24 hours after a workout.

In a similardouble-blind study, scientists compared what happened when subjects consumed either two grams of ginger or a placebo one day and then two days after exercise. The ginger appeared to have no effect shortly after ingestion. But it was associated with less soreness the following day, leading the researchers to conclude that ginger may help“attenuate the day-to-day progression of muscle pain.”

Other studieshave shown that consuming ginger before exercise has no impact on muscle pain, oxygen consumption and other physiological variables during or immediately after a workout, suggesting that if ginger does have any benefits, they may be limited to reductions in soreness in the days after a workout.

THE BOTTOM LINE

Ginger may help ease pain and soreness, but only a day or more after a workout.

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Does Insight in Therapy Equal Happiness? Not Always

Perhaps, but recent experience makes me wonder whether insight is all it’s cracked up to be.

Not long ago, I saw a young man in his early 30s who was sad and anxious after being dumped by his girlfriend for the second time in three years. It was clear that his symptoms were a reaction to the loss of a relationship and that he was not clinically depressed.

“I’ve been over this many times in therapy,” he said. He had trouble tolerating any separation from his girlfriends. Whether they were gone for a weekend or he was traveling for work, the result was always the same: a painful state of dysphoria and anxiety.

He could even trace this feeling back to a separation from his mother, who had been hospitalized for several months forcancertreatment when he was 4. In short, he had gained plenty of insight in therapy into the nature and origin of his anxiety, but he felt no better.

What therapy had given this young man was a coherent narrative of his life; it had demystified his feelings, but had done little to change them.

Was this because his self-knowledge was flawed or incomplete? Or is insight itself, no matter how deep, of limited value?

Psychoanalysts and other therapists have argued for years about this question, which gets to the heart of how therapy works (when it does) to relieve psychological distress.

Theoretical debates have not settled the question, but one interesting clue about the possible relevance of insight comes from comparative studies of different types of psychotherapy— only some of which emphasize insight.

In fact, when two different types of psychotherapies have been directly compared— and there are more than 100 such studies— it has often beenhard to find any differencesbetween them.

Researchers aptly call this phenomenon the Dodo effect, referring to the Dodo bird inLewis Carroll’s“Alice in Wonderland” who, having presided over a most whimsical race, pronounces everyone a winner.

The meaning for patients is clear. If you’re depressed, for example, you are likely to feel better whether your therapist uses a cognitive-behavioral approach, which aims to correct distorted thoughts and feelings, or an insight-oriented psychodynamic therapy.

Since the common ingredient in all therapies is not insight, but a nonspecific human bond with your therapist, it seems fair to say that insight is neither necessary nor sufficient to feeling better.

Not just that, but sometimes it seems that insight even adds to a person’s misery.

I recall one patient who was chronically depressed and dissatisfied.“Life is just a drag,” he told me and then went on to catalog a list of very real social and economic ills.

Of course, he was dead-on about the parlous state of the economy, even though he was affluent and not directly threatened by it. He was a very successful financial analyst, but was bored with his work, which he viewed as mechanical and personally unfulfilling.

He had been in therapy for years before I saw him and had come to the realization that he had chosen his profession to please his critical and demanding father rather than follow his passion for art. Although he was insightful about much of his behavior, he was clearly no happier for it.

When he became depressed, though, this insight added to his pain as he berated himself for failing to stand up to his father and follow his own path.

Researchers have known for years that depressed people have a selective recall bias for unhappy events in their lives; it is not that they are fabricating negative stories so much asforgetting the good ones. In that sense, their negative views and perceptions can be depressingly accurate, albeit slanted and incomplete. A lot of good their insight does them!

It even makes you wonder whether a little self-delusion is necessary for happiness.

None of this is to say that insight is without value. Far from it. If you don’t want to be a captive of your psychological conflicts, insight can be a powerful tool to loosen their grip. You’ll probably feel less emotional pain, but that’s different from happiness.

Speaking of which, my chronically depressed patient came to see me recently looking exceedingly happy. He had quit his job and taken a far less lucrative one in the art world. We got to talking about why he was feeling so good.“Simple,” he said,“I’m doing what I like.”

I realized then that I am pretty good at treating clinical misery with drugs and therapy, but that bringing about happiness is a stretch. Perhaps happiness is a bit like self-esteem: You have to work for both. So far as I know, you can’t get an infusion of either one from a therapist.

Dr. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College in Manhattan.

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Root Vegetable Gratin - Recipes for Health

1 1/2 pounds turnips, kohlrabi, rutabaga, large parsnips or a combination, peeled and sliced thin (if the rutabagas are very large, cut them in half and slice in half-moons; slice the turnips and kohlrabi into rounds; quarter and core the parsnips, then slice them)

Salt and freshly ground pepper

1/2 teaspoon fresh thyme leaves

3/4 cup grated Gruyère cheese (3 ounces)

1 1/2 cups low-fat (1 percent or 2 percent) milk

1.Preheat the oven to 400 degrees. Butter a 2-quart gratin or baking dish. Place the sliced vegetables in a large bowl, and season generously with salt and pepper. Add the thyme, and toss together.

2.Arrange the vegetables in the gratin dish. Add the milk, season with more salt and pepper if you wish, and place in the oven on the middle rack. Bake 45 minutes; every 15 minutes, press the vegetables down into the milk with the back of your spoon. Add the cheese, and stir in carefully to incorporate. Return to the oven, and bake another 30 to 45 minutes, stirring or pressing the vegetables down with the back of your spoon every 10 minutes until the gratin is nicely browned and most of the liquid is absorbed. Remove from the heat and serve, or allow to settle and serve warm.

Yield:Serves four.

Advance preparation:You can make this several hours ahead of serving, and reheat in a medium oven.

Nutritional information per serving:200calories; 8 grams fat; 5 gramssaturated fat; 28 milligramscholesterol; 22 gramscarbohydrates; 6 gramsdietary fiber; 167 milligrams sodium (does not include salt to taste); 12 grams protein

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

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The Love Affair With the Fireplace Cools

But one of the features that many people in the city would pay a premium for is something the owners don’t like: the fireplace.

“A wood-burning fire in the city is a ridiculous luxury— we would never have put it in ourselves,” said Mr. Arpels, grandson of one of the founders of Van Cleef&Arpels and the former managing partner of Netto Collection, a baby furniture company bought by Maclaren.“In the city, it doesn’t make sense to burn fires, because it’s inefficient and it’s polluting.”

Hard as it may be to believe, the fireplace— long considered a trophy, particularly in a city like New York— is acquiring a social stigma. Among those who aspire to be environmentally responsible, it is joining the ranks of bottled water and big houses.

“The smoke from a fire smells very nice,” said Diane Bailey, a senior scientist with theNatural Resources Defense Councilin San Francisco.“But it can cause a lot of harm.” The tiny particles, she said,“can cause inflammation and illness, and can cross into the bloodstream, triggering heart attacks” as well as worsening other conditions.

Or as Starre Vartan, a 33-year-old blogger who goes by the name Eco-Chick, put it:“Any time you are burning wood or cow dung, you’ll be creating pollution. It’s like junk food: if you do it once a month, then who cares? But if it’s something you do every day, it’s important that you mitigate it somehow. It’s a hazard.”

Not surprisingly, the green community has been sounding the alarm for some time. For the last several years,TheDailyGreen.com, an online magazine, has advocated replacing all wood-burning fireplaces with electric ones; an article published in September by Shireen Qudosi, entitled“Breathe Easier With a Cleaner Fireplace,” argued that there is no such thing as an environmentally responsible fire:“Switching out one type of wood for another is still use of a natural resource that otherwise could have been spared,” Ms. Qudosi wrote. And last fall, an article on the Web siteGreenBlizzard.com,“Cozy Winter Fires— Carbon Impact,” called wood-burning fires“a direct pollutant to you, your family and your community.”

Organizations like the American Lung Association are issuing warnings as well: the group recommends that consumers avoid wood fires altogether, citing research that names wood stoves and fireplaces as major contributors to particulate-matter air pollution in much of the United States.

Wood smoke contains some of the same particulates as cigarette smoke, said Dr. Norman H. Edelman, the chief medical officer for the American Lung Association, as well as known carcinogens like aldehydes; it has also been linked to respiratory problems in young children.

“We now know from lots of studies that wood smoke is very, very irritating,” Dr. Edelman said.“It contains a lot of irritating gases and it also contains damaging particulate matter. It’s probably not good for anybody, and it’s especially bad for anybody who has a chronic respiratory problem.” So the association strongly advises people not to use the traditional fireplace, he said.

Certainly, there are many who consider this eco-overkill. In Greek mythology, fire is a gift from the divine, stolen from Zeus by Prometheus and handed over to shivering humanity. What could be more natural than sitting around a crackling fire on a winter night, at a campsite in the Berkshires or in a Brooklyn brownstone?

But growing concerns about the air pollution and health problems caused by smoke from wood fires are prompting a number of areas across the country to pass laws regulating them.

“A lot of municipalities are taking action,” said Ms. Bailey, adding that the weather-based measures called burn bans are perhaps the most widespread restriction. When the weather is cold and the air is still, or pollution is high, the Bay Area in California, Puget Sound, Wash., Denver and Albuquerque are among the places with restrictions on residential wood-burning. These measures can be mandatory or voluntary, and can become more restrictive as air quality declines. So far, most of the wood-burning regulations tend to be out West. A few examples: Idaho offers tax incentives to people who replace uncertified wood stoves with“greener” ones; San Joaquin County in California forbids selling a home unless its wood stove is replaced with anE.P.A.-certified one; and Palo Alto and other municipalities in California prohibit wood-burning fireplaces or stoves in new construction.

Perhaps not coincidentally, sales of wood-burning appliances dropped to 235,000 in 2009 from 800,000 in 1999, according to the Hearth, Patio and Barbecue Association. And the Brick Industry Association, which promotes brick construction, reports that roughly 35,000 masonry fireplaces were installed in the United States in 2009, compared to 80,000 in 2005. Certainly those numbers reflect the economic slowdown, but they may also be affected by growing ambivalence to wood fires.

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Celery Root, Potato and Apple Purée - Recipes for Health

1 pound Yukon gold potatoes, peeled and cut into large pieces

2 large celery roots, about 2 pounds, peeled and cut into large pieces

1 large or 2 small tart apples, such as a Granny Smith, peeled, cored and quartered

1/2 cup, approximately, warm milk or broth from the celery root

2 tablespoons butter or walnut oil (or a combination)

Salt and freshly ground pepper to taste

1.Place the potatoes in one saucepan and the celery root and apples in another. Add salt to taste to each, about 1/2 teaspoon. Bring to a boil, reduce the heat and simmer until tender, 15 to 20 minutes.

2.Drain the potatoes, and return to the pot. Cover tightly, and allow to sit for five minutes to steam and dry out. Drain the celery root and apples through a strainer set over a bowl. Purée all of the produce using a food mill or a potato ricer. Stir together, and whisk in the milk or the broth until the mixture is fluffy. Add the butter or walnut oil to the hot purée, stir until the butter melts, and season to taste with salt and pepper.

Yield:Serves six.

Advance preparation:You can make this up to an hour before serving. Make sure to have some extra broth or milk on hand to thin out the purée, as it will stiffen as it cools. Reheat gently on top of the stove.

Nutritional information per serving:185calories; 5 grams fat; 3 gramssaturated fat; 11 milligramscholesterol; 34 gramscarbohydrates; 5 gramsdietary fiber; 192 milligrams sodium (does not include salt to taste); 5 grams protein

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

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Bracing Your Wallet if Your Child Needs Braces

You can see that your child’s bite is misaligned or that his teeth are sticking out in all the wrong places. You know what’s coming: months of treatment and an orthodontist bill anywhere from $3,000 to $7,000. That’s a lot of money.

“The price of braces is outrageous,” said Tina Sigman, who, interestingly, is an orthodontist’s assistant in Norton, Mass. Ms. Sigman took her 13-year-old daughter, Victoria, to the orthodontist she works for, Dr. Jeff Kane, last year to see if something could be done about the slightly protruding teeth crowding her daughter’s mouth.

“It wasn’t a major case,” Ms. Sigman said,“but it was still going to cost $3,500.”

When Ms. Sigman told Dr. Kane she couldn’t afford to pay that much, he told her aboutSmiles Change Lives, a nonprofit organization that, for a low fee, connects children whose families cannot afford braces with orthodontists willing to provide the service free. Ms. Sigman’s daughter was accepted to the program and is about halfway through treatment with Dr. Kane.

Victoria is already feeling more confident.“She was worried that her teeth stuck out,” Ms. Sigman said.“It’s a great relief to know I could do this for her.”

Getting good orthodontic care is more than just an aesthetic issue. Severe crowding or crooked teeth can inhibit good brushing and flossing, making it harder to keep teeth and gums healthy. In addition, crooked teeth or a bite that doesn’t align may strain jaw muscles and wear down teeth over time.

But paying for orthodontics can be difficult. Dentalinsurancerarely covers more than a small percentage of orthodontic treatment. Few patients find or qualify for programs like the one Ms. Sigman used.

Moreover, a push for earlier detection of problems in children may mean parents will be facing these bills much sooner than they may think. And the costs are rising with the introduction of new technologies, like three-dimensional imaging, that help with diagnosis and more precise treatments.

Smart planning and budgeting can offset some costs and make the expense easier to handle, said Dr. Lee Graber, an orthodontist in Vernon Hills, Ill., and president of the American Association of Orthodontists. These tips will help.

PROVIDERS AND FEESOrthodontists’ fees can vary widely from one area to another and from one doctor to the next. Be sure to get several recommendations from your dentist, friends and family.

Consult with at least three orthodontists to get an idea of what treatment is involved and what the price will be. Often both are negotiable, or at least up for discussion.

“We have to take the individual into account,” Dr. Kane said.“If what I think is an ideal result would make the treatment more complex and in my eyes this should be a high priority, if in the patient’s eyes it isn’t, I have to deal with that. The orthodontist has to tailor a treatment plan accordingly.”

Choose an orthodontist whom your child likes and trusts. The average treatment time is 23 months. That’s a lot of office visits, and they will be much easier if patient and doctor have a good rapport.

A PAYMENT PLANMost orthodontists offer monthly payment plans extended over the time of treatment with no interest or other charges. If you intend to use a plan, discuss the terms— how much per month over how many months— before treatment starts.

Many orthodontists are willing to extend the length of payment and make other adjustments to help ease the burden. But you need to ask.

Some orthodontists offer discounts for upfront payments. If you can afford it, this is probably the best option for an uncomplicated treatment plan. That way you won’t unwittingly pay for treatment your child ends up not needing.

Use caution with third-party extended payment programs sometimes through orthodontists’ offices. These programs extend your payments over five to seven years, but you’ll often end up paying hefty interest charges.

AFFORDABLE ALTERNATIVESIf shopping around and payment plans don’t offer enough relief, look for a college or university near you with an orthodontics program.

Much like dental schools, you can get high-quality care from residents supervised by experienced orthodontists for about two-thirds the cost of care in private practice. To find a school near you, check the list of accredited schools on theWeb siteof the American Association of Orthodontists:www.aaomembers.org/Education/Accredited-schools.cfm.

Ask your orthodontist about other programs in your area that may offer assistance. In addition to Smiles Change Lives, theSmiles for Life Foundationalso provides help to needy families, as do many state programs.

“Orthodontists are aware that access to care is an important issue,” said Dr. Kane, adding that more doctors are getting involved in pro bono programs.

INSURANCE COVERAGEIf you have dental insurance through work, check the policy or your benefits department to see what orthodontics, if any, are covered.

Most policies that offer orthodontic coverage pay only 25 percent, at most 50 percent, according to LeAnn Smith, chief operating officer of Smiles Change Lives. Still, every bit helps.

If you don’t have dental insurance, try searching for a policy atwww.dentalplans.comthat covers orthodontics. For an annual fee of $100 to $200, you’ll receive discounts at participating orthodontists.

Be sure to read the fine print. These plans can be severely limited, especially when it comes to braces. Make sure any discount adds up to more than the annual fee.

Keep in mind you can also save pretax dollars to help pay for these treatments in a flexible spending account or health savings account, if you have one.

UNEXPECTED EXPENSESKeep in mind the orthodontist’s bill may not be the only cost you incur with braces.

For adult patients particularly, getting braces may also mean a deep cleaning and the replacement of old fillings before treatment begins. For adults and children, removing teeth is sometimes part of the pretreatment plan.

In addition, clear, invisible or colored braces often cost more, but for obvious reasons can be more appealing than the less expensive traditional metal braces. Weigh the pros and cons against your budget to determine what’s best for you.

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Test-Taking Cements Knowledge Better Than Studying, Researchers Say

The research, published online Thursday in the journal Science, found that students who read a passage, then took a test asking them to recall what they had read, retained about 50 percent more of the information a week later than students who used two other methods.

One of those methods— repeatedly studying the material— is familiar to legions of students who cram before exams. The other— having students draw detailed diagrams documenting what they are learning— is prized by many teachers because it forces students to make connections among facts.

These other methods not only are popular, the researchers reported; they also seem to give students the illusion that they know material better than they do.

In the experiments, the students were asked to predict how much they would remember a week after using one of the methods to learn the material. Those who took the test after reading the passage predicted they would remember less a week later than the other students predicted— but the results were just the opposite.

“I think that learning is all about retrieving, all about reconstructing our knowledge,” said the lead author, Jeffrey Karpicke, an assistant professor ofpsychologyatPurdue University.“I think that we’re tapping into something fundamental about how the mind works when we talk about retrieval.”

Several cognitive scientists and education experts said the results were striking.

The students who took the recall tests may“recognize some gaps in their knowledge,” said Marcia Linn, an education professor at theUniversity of California, Berkeley,“and they might revisit the ideas in the back of their mind or the front of their mind.”

When they are later asked what they have learned, she went on, they can more easily“retrieve it and organize the knowledge that they have in a way that makes sense to them.”

The researchers engaged 200 college students in two experiments, assigning them to read several paragraphs about a scientific subject— how the digestive system works, for example, or the different types of vertebrate muscle tissue.

In the first experiment, the students were divided into four groups. One did nothing more than read the text for five minutes. Another studied the passage in four consecutive five-minute sessions.

A third group engaged in“concept mapping,” in which, with the passage in front of them, they arranged information from the passage into a kind of diagram, writing details and ideas in hand-drawn bubbles and linking the bubbles in an organized way.

The final group took a“retrieval practice” test. Without the passage in front of them, they wrote what they remembered in a free-form essay for 10 minutes. Then they reread the passage and took another retrieval practice test.

A week later all four groups were given a short-answer test that assessed their ability to recall facts and draw logical conclusions based on the facts.

The second experiment focused only on concept mapping and retrieval practice testing, with each student doing an exercise using each method. In this initial phase, researchers reported, students who made diagrams while consulting the passage included more detail than students asked to recall what they had just read in an essay.

But when they were evaluated a week later, the students in the testing group did much better than the concept mappers. They even did better when they were evaluated not with a short-answer test but with a test requiring them to draw a concept map frommemory.

Why retrieval testing helps is still unknown. Perhaps it is because by remembering information we are organizing it and creating cues and connections that our brains later recognize.

“When you’re retrieving something out of a computer’s memory, you don’t change anything— it’s simple playback,” said RobertBjork, a psychologist at theUniversity of California, Los Angeles, who was not involved with the study.

But“when we use our memories by retrieving things, we change our access” to that information, Dr. Bjork said.“What we recall becomes more recallable in the future. In a sense you are practicing what you are going to need to do later.”

It may also be that the struggle involved in recalling something helps reinforce it in our brains.

Maybe that is also why students who took retrieval practice tests were less confident about how they would perform a week later.

“The struggle helps you learn, but it makes you feel like you’re not learning,” said Nate Kornell, a psychologist atWilliams College.“You feel like:‘I don’t know it that well. This is hard and I’m having trouble coming up with this information.’ ”

By contrast, he said, when rereading texts and possibly even drawing diagrams,“you say:‘Oh, this is easier. I read this already.’ ”

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Health Care Law Repeal Taken Up in House

Will the health care law, approved last year by Democrats with no Republican support, increase or reduce future federal deficits?

Will the law lead to the elimination of jobs by overburdened employers as Republicans assert, or will it create jobs as Democrats maintain?

Will the law raise or lower the cost of medical care for individuals and families, employers, and state and federal governments?

And, will the law achievePresident Obama’s goal of providing coverage to more than 30 million uninsured Americans?

Given the complexity of the issues, none of these questions can yet be answered definitively.

More certain is the fate of the Republicans’ bill to repeal the law, which contains 24 lines of legislative text and 38 lines of the names of the lawmakers sponsoring it. While House Republicans will vote to approve it on Wednesday, the Democratic-controlled Senate is highly unlikely to act on it.

Still, the assertions from the two sides highlight their radically different views about the proper role of government and market forces in the health care system. It is a policy fight that is likely to rage for the next two years in Congress and to figure prominently in the 2012 presidential campaign.

As floor debate on the repeal measure opened on Tuesday, RepresentativePaul Ryan, Republican of Wisconsin and chairman of the Budget Committee, who is a respected voice on fiscal issues, declared that the health care law would“accelerate our country’s path toward bankruptcy.”

Mr. Ryan expressed one of the Republicans’ main complaints: that Democrats and independent Congressional budget analysts have underestimated the costs of the law, which Republicans say will ultimately add hundreds of billions of dollars to future federal deficits.

The nonpartisanCongressional Budget Officedisagrees.

In its official analysis, the budget office estimated that the cost of new benefits in the health care law would be more than offset by revenues from new taxes and by cuts in projectedMedicarespending, reducing future deficits. Repealing the law, the budget office has predicted, would add $230 billion to federal deficits from 2012 to 2021.

Republicans dispute that, saying the cost will be far higher than expected.

“We believe that it is an unsustainable, open-ended entitlement that could very well bankrupt this country and the states,” the House majority leader, RepresentativeEric Cantor, Republican of Virginia, said at a news conference on Tuesday.

The budget office has said that its estimates are based on the most likely outcomes, and that the eventual cost of the bill is equally likely to be higher or lower.

The office has also said that lawmakers may find it difficult to follow through with some aspects of the law, particularly cuts in projected Medicare spending. If the cuts do not take hold, the cost of the law could soar.

Democrats, meanwhile, say the law could save even more money than expected because the budget office does not give them credit for likely improvements in the delivery of medical services that could slow the growth in costs for individuals, businesses and the federal and state governments.

Weighing into the debate, Mr. Obama said Tuesday that Americans were already enjoying many benefits of the new law, and that he would not let Republicans dismantle it.

“I’m willing and eager to work with both Democrats and Republicans to improve the Affordable Care Act,” Mr. Obama said in a statement.“But we can’t go backward.”

The White House and Congressional Democrats said the law would create more than 300,000 jobs, by slowing the growth of health costs so employers would have more to spend on wages and hiring. In addition, they said, the law provides tax credits to help many small businesses buy insurance for their employees.

By contrast, Representative Sam Graves, Republican of Missouri and chairman of the House Committee on Small Business, said the law“could cost our economy 1.6 million jobs, one million of which could come from small businesses.”

Many economists say the effects on jobs are likely to be modest. Most large companies already provide health benefits to employees. And many small businesses will be exempt from penalties if they fail to do so.

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Can Sleep Speed Healing?

A.“There is no evidence, even anecdotal, that more sleep promotes or accelerates bone healing,” said Dr. Melvin Rosenwasser, an orthopedic surgeon at New York-Presbyterian/Columbia University Medical Center.

“Fractures heal with proper alignment and immobilization,” he said, adding that healing is also affected by“the state of general health, nutrition and habits such as smoking.”

As for what might speed healing, Dr. Rosenwasser mentioned a study that indicates a slight acceleration of healing with ultrasonic stimulation in the treatment of wrist fractures. An analysis of several studies ofultrasoundtreatment for fractures,published in The Canadian Medical Association Journal in 2002, concluded that“there is evidence from randomized trials that low-intensity pulsed ultrasound treatment may significantly reduce the time tofracturehealing for fractures treated nonoperatively.”

But could sleep be a factor in healing other kinds of injury?A 2004 studyin the journal Psychoneuroendocrinology concluded that perceived stress and levels of stress hormones predicted the speed of wound healing but that several other factors, including alcohol consumption, exercise and sleep, did not.C. CLAIBORNE RAY

Readers are invited to submit questions by mail to Question, Science Times, The New York Times, 620 8th Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.

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Cases— When All Isn’t Enough to Foil Alzheimer’s

Alzheimer’s diseasehad been on his radar ever since his own father died of it. Witnessing the catastrophic deterioration of a man who had been sharp enough to work for Gen. Douglas MacArthur, my frightened father was inspired to become a neurologist. Perhaps the pursuit of medicine could stave off what he believed was a genetic inevitability.

As an ever-present reminder of that threat, he kept an atrophied brain in a jar on his desk. That brain, I recently discovered, belonged to his father.

As my father approached middle age he began to experiment on himself, with diet supplements. By age 60 he was taking 78 tablets a day. He tracked down anything that offered the possibility of saving brain cells and killing free radicals: Omega 3s, 6s, 9s;vitaminsE and C; ginkgo biloba, rosemary and sage;folic acid; flaxseed.

After retiring from his neurology practice in Naples, Fla., he spent hours a day doing math. Even when I was visiting, he’d sit silently on his leather recliner with a calculator to verify the accuracy of calculations he did by memory.

“What are you saving your mind for, Dad?” I often wondered to myself.“I’m here now, waiting to talk with you.”

On one of these occasions, he suddenly looked up from his Sudoku game and stared at me.

“Promise me something, gal,” he said.“Anything,” I answered.

“Swear on your grandmother’s Bible that you will put a gun to my head if I wind up like my father.”

He was dead serious.

How do you answer a man who watched his father wipe feces on the walls of their Virginia farmhouse? A man who took out a second mortgage to buy the first CT scanner in Florida?

“Swear to me,” he repeated. He collected guns and kept them under lock and key. He knew I could shoot them, because he’d taught me how.I put my hand on the leather-bound King James Bible that had belonged to my great-grandmother Nannie Dunlap and my grandmother Nancy Scott.

“I swear,” I said.

He nodded in approval.

A few years later, my father arrived at my home in Vermont with a suitcase full of supplements. He parceled out his pills for the week into Dixie cups, ready for swallowing with every meal.

“Gal, you should be taking these, too.”

“Why?”

“Because you are my genetic clone.”

Our physical resemblance and character traits were uncanny: tall, big-lipped, blue-eyed, loose-jointed, freckle-skinned, angst-ridden Bercaws. Except for our male and female chromosomes, nearly everything about us was a perfect match.

My father went on to explain that everyone inherits one copy of the APOE gene from each parent. The gene can indicate a predisposing genetic risk for Alzheimer’s. APOE-2 is relatively rare and may even provide some protection against the disease. APOE-3 is the most common and appears to have a neutral role. APOE-4 indicates the highest risk factor.

“I’m only 34! Can’t I think about this later?”

He shook his head.

Back in Florida, he sent me a genetic test kit via Federal Express, instructing me to have the blood drawn at my physician’s office but to have the results sent to him. It turned out that like my father I carry the APOE-3 gene, which means I may or may not get the disease.

But unlike my father, I will have to wait to find out. In 2009, at age 71, he had anM.R.I.that showed“atrophy consistent” with Alzheimer’s disease. He looked at the film and was confused by the sight of his own brain.

I recently spent time with my father while his wife had surgery. I took him to visit her at the hospital each day, and when we got home I stopped him from calling her every five minutes. I gave him dinner and pills at the appointed hours. I cleaned up his“accidents.”

While he watched a televised baseball game one afternoon, I walked into his den and eyed the wall of supplements he used to take— bookcase after bookcase of pills with names like Memoral and Sharp Mind. Won’t be needing them anymore.

I rested my hand on his gun cabinet.Won’t need you, either.

My father walked to the coffee shop with me every morning. The only thing he’d say on these walks was,“The hibisci are in full bloom.” Every time he said it— which was dozens— I wondered whether the plural of hibiscus is, in fact, hibisci.

On the final morning of my visit, he didn’t mention the blooms. But when we passed a particularly flourishing tree, he stopped to look at me.

“Gal,” he said, then paused to find the words.

His voice quivered.“I sure appreciate you coming down to take care of me.”

I composed myself long enough to say:“It was a pleasure, especially after all you have done for me. Besides, you don’t need so much taking care of.”

As we walked on, my father would repeat this latest sentence every few minutes— the same quiver in his voice at the exact same place.

Each time, my response got shorter and shorter, until I was the one who had nothing left to say.

Nancy Stearns Bercaw is a writer in Vermont.

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Will Johnson&Johnson Recalls Change the Firm’s Reputation?

“Looking for Tylenol pain relief products?” asks one of the signs. The notices at CVS serve as a stark reproof to Johnson&Johnson, whose brands have for more than a century been synonymous with quality. Some of its products are in short supply at drugstores and supermarkets because the McNeil Consumer Healthcare unit of J.&J. last year recalled about 288 million items, including about 136 million bottles of liquid Tylenol, Motrin, Zyrtec and Benadryl for infants and children.

Johnson&Johnson has had to recall such a variety of products because of quality-control problems across product lines, in multiple factories and in several units last year. Some of its consumer products, for instance, may have contained bits of metal. Others came in bottles with a moldy smell. And some products have gone missing from stores with hardly an explanation. All of this has put the company and its manufacturing under the intense scrutiny of lawmakers and officials at theFood and Drug Administration.

“It looks like a plane spinning out of control,” says David Vinjamuri, a former J.&J. marketing employee who now trains brand managers at his company, ThirdWay Brand Trainers.

While the drugstore signs that helpfully suggest“Try CVS/pharmacy brand” are intended to assist frustrated shoppers in identifying alternatives to missing brand-name products, they also serve as constant reminders of another of J.&J.’s continuing problems: It must persuade millions of disappointed customers to once again pay a premium for products that may no longer seem to be of any higher quality than the less expensive store brand.

“I don’t even consider buying them any more,” says Thien-Kim Lam, a mother of two and abloggerin Silver Spring, Md. In a post last spring titled“Makers of Tylenol, I’m Disappointed in You”on the blog DC Metro Moms, Ms. Lam wrote about the huge recall of J.&J. infants’ and children’s medicines.

Now, she says, the frequent recalls have prompted her to switch to generic cold and cough medicines for her children.“It’s like a breakup,” she says.“I’m done. I’ve moved on.”

Bonnie Jacobs, a McNeil spokeswoman, says the company is committed to restoring McNeil’s reputation as a world-class manufacturer of over-the-counter medicines.“We will invest the necessary resources and make whatever changes are needed to do so, and we will take the time to do it right,” she wrote in an e-mail last Thursday.

If Queen Elizabeth II had been the chief executive of Johnson&Johnson, she might have called 2010 an“annus horribilis.”

J.&J.’s troubles with some of its consumer products began in earnestlast January, when McNeil recalled millions of pill bottles after some consumers complained that they smelled like mold. By December, when itrecalled 13 million packages of Rolaids soft chewsthat may have been contaminated with metal or wood particles, the company had closed one plant in Fort Washington, Pa., for an overhaul and had yet to solve the quality problems at another, in Puerto Rico.

The response of J.&J.’s chief executive,William C. Weldon, has been to allocate more than $100 million to upgrade McNeil’s plants and equipment, appoint new manufacturing executives, hire a third-party consulting firm to improve procedures and systems at McNeil and shore up quality control companywide. InCongressional testimonylast fall, he promised that when the Pennsylvania plant reopened, it would“represent the state of the art in medicine production.” And he has repeatedly tried to reassure consumers, ashe didwhen he promised that J.&J. had“no higher concern than providing parents with the highest-quality products for their children.”

Those reassurances, however, have been followed by yet more recalls. What is most perplexing is the seeming inability of executives to solve— and satisfactorily explain— the manufacturing issues that dog the company. Federal regulators have continued to fault the McNeil unit for failing to identify and address systemic problems at its plants, and consumers remain mystified about why simple products like O.B. tampons can disappear from drugstore shelves.

In July, McNeil submitted a plan to the F.D.A. detailing how it intends to overhaul its operations. To comply with regulatory standards, McNeil is undertaking thorough manufacturing and quality-control reviews for all its products, Ms. Jacobs says.

That means the recalls may continue. Last Thursday, Ms. Jacobs said the company would“take whatever steps are needed to ensure our products meet quality standards, including further recalls if warranted.”

Only a day later, McNeil recalled 47 million units of Sudafed, Sinutab, Benadryl and other drugs from wholesalers because of issues like inadequate equipment cleaning practices. The company said that the recalls were not a result of health problems and that consumers could continue to use the products.

JOHNSON&JOHNSON, with about $62 billion in sales in 2009, makesthousands of different kinds of products, including Band-Aids, baby shampoo, cardiacstentsand advanced drug treatments forrheumatoid arthritis. It solidified a reputation for product quality witha company credo, dating from 1943, saying that the company owed its first responsibility to the mothers and fathers, doctors, nurses and patients who use its products.

With such a diversity of products and operating companies, Johnson&Johnson’s overall business has not suffered significantly. But the string of recent recalls at McNeil threatens to weaken the kind of trust that made many people willing to pay more for J.&J. brands.

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Justices Hear Arguments on Disclosure in Zicam Case

“What do you think about Satan?” Justice Scalia asked a lawyer for the government, who was just starting his argument.

The case,Matrixx Initiativesv. Siracusano, No. 09-1156, was a class action against Matrixx Initiatives, an Arizona company accused of committing securities fraud by failing to tell investors of reports that its main product, a nasal spray and gel called Zicam, might have caused some users to lose their sense of smell. The condition is known asanosmia.

After a link between Zicam and anosmia was reported on“Good Morning America” in 2004, the company’s stock dropped 24 percent. In 2009, theFood and Drug Administrationwarnedconsumers not to use the products, which had been sold as over-the-counter homeopathic medicines, and Matrixx recalled them.

Satan came into the case by way of analogy. Matrixx contended that it should not have been required to disclose small numbers of unreliable reports of adverse effects, which were all it said were available in 2004.

“For years many consumers would not purchase products fromProcter&Gamblebecause of a ridiculous rumor that the company was Satanic,” Matrixx said in a recentbrief.“But no decision of this court bases securities-law disclosure obligations on how ignorant or paranoid people might react to unreliable or even false information.”

The Supreme Court has said that companies may be sued under the securities law for making statements that omit material information, and it has defined material information as the sort of thing that reasonable investors would believe significantly alters the“total mix” of available information.

Much of the argument revolved around whether reasonable investors would want to know about false and outlandish assertions like the one about Satanism so long as the assertions might affect the price of securities.

“A reasonable investor is going to worry about the fact that thousands of unreasonable investors are going to dump their Matrixx stock,” Chief JusticeJohn G. Robertssaid.

Justice Scalia disagreed.“It seems to me ridiculous to hold companies to irrational standards,” he said.

Though the justices were divided about how to handle reports of Satanism and the like, Matrixx did not appear to get much traction for its main argument— that a failure to disclose reports of adverse effects should give rise to securities fraud liability only if the reports were collectively statistically significant.

It said the plaintiffs had found at most 23 reports of anosmia before the“Good Morning America” report, and it added that anosmia can have many causes.

“All drug companies receive on an almost daily basis anecdotal hearsay reports about alleged adverse health events following the use of their products,” Jonathan Hacker, a lawyer for Matrixx, told the justices.

But the justices appeared almost uniformly skeptical of imposing a requirement of statistical significance, particularly at the very outset of a case.

JusticeElena Kagansaid that the F.D.A. itself did not use that standard, and she added that she could imagine situations in which small numbers of reports of serious harm would meet the securities laws’ requirement of materiality.

Imagine, she said, that a drug company sold a single product, a new contact lens solution that hundreds of thousands of people had used without incident. But 10 went blind, and three who used it in only one eye went blind in that eye.

“There is no way that anybody would tell that you these 10 cases are statistically significant,” Justice Kagan said.

Nonetheless, she asked Mr. Hacker,“would you stop using that product and would a reasonable investor want to know about those 10 cases?” He said no.

Justice Kagan responded that“there are a lot of contact lens solutions in the world.”

“I’d stop using the product,” she said,“and if I were holding stock in that company, I would sell the stock.”

Pratik A. Shah, the government lawyer asked about rumors of Satanism by Justice Scalia, said there were circumstances in which a company should have to disclose such rumors.

Investors would almost certainly think it material to know, he said, for instance,“however ridiculous it is and untrue it is, that 10 percent of our consumer base has decided to boycott our products.”

Justice Scalia pressed the point.

“So the government’s position is that reports of adverse effects that have no scientific basis, so long as they would affect, irrationally, consumers, have to be disclosed?” he asked. Mr. Shah said yes, if the company had made affirmative statements about the subjects at issue. Matrixx had called attributing anosmia to Zicam“completely unfounded and misleading.”

Justice Scalia summarized the discussion near the end of the argument in the case.

“If Satan comes in,” he said,“surely lousy science comes in as well.”

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Buying Sunglasses, UV Rays in Mind

Skiing on fresh snow, skating on reflective ice or hiking at high altitudes can be harder on your eyes than a day at the beach. Snow, as many East Coast readers may have noticed this week, reflects nearly 80 percent of the sun’s rays. Dry beach sand? Just 15 percent.

Most of us already know that ultraviolet (UV) rays can causeskin cancerand other problems. But that’s not all there is to worry about.“Most people don’t appreciate the damage that UV rays can do to their eyes,” said Dr. Rachel J. Bishop, a clinical ophthalmologist at the National Eye Institute in Bethesda, Md.

Winter or summer, hours of bright sunlight can burn the surface of the eye, causing a temporary and painful condition known as photokeratitis. Over time, unprotected exposure can contribute tocataracts, as well ascancerof the eyelids and the skin around the eyes.

UV exposure also may increase the risk ofmacular degeneration, the leading cause ofblindnessin people over age 65. While cataracts can be removed surgically, there is no way to reverse damage to the macula, the area in the center of the retina.

Worried? Consider this article license to buy yourself a new pair of UV-protective shades. But don’t let price and style be your only guides.

“Some cheap sunglasses are great, some expensive ones are not,” said Dr. Lee R. Duffner, an ophthalmologist in Hollywood, Fla., and a clinical correspondent for the American Academy of Ophthalmology. In fact, some knockoff designer frames may do your eyes more harm than if you’d worn no glasses at all.

Below, some advice on how to find sunglasses that will protect your eyes without plundering your wallet.

READ THE FINE PRINTProlonged exposure to UV radiation damages the surface tissues of the eye as well as the retina and the lens. Yet while theFood and Drug Administrationregulates sunglasses as medical devices, the agency does not stipulate that they must provide any particular level of UV protection. The wares at the average sunglasses store therefore can range from protective to wholly ineffective.

Look for labels and tags indicating that a pair of sunglasses provides at least“98 percent UV protection” or that it“blocks 98 percent of UVA and UVB rays.” If you find sunglasses without labels, or they say something vague like“UV absorbing” or“blocks most UV light,” don’t buy them— the sunglasses may not offer much protection.

For the best defense, look for sunglasses that“block all UV radiation up to 400 nanometers,” which is equivalent to blocking 100 percent of UV rays, advised Dr. Duffner.

CHOOSE THE RIGHT STYLEIdeally, your sunglasses should cover the sides of your eyes to prevent stray light from entering. Wraparound lenses are best, but if that’s not an appealing style, look for close-fitting glasses with wide lenses. Avoid models with small lenses, such asJohn Lennon-style sunglasses.

Don’t be seduced by dark tints. UV protection is not related to how dark the lens is. Sunglasses tinted green, amber, red and gray may offer the same protection as dark lenses. For the least color distortion, pick gray lenses, said Dr. Duffner.

If you are frequently distracted by glare while driving, boating or skiing, look for polarized lenses, which block the horizontal light waves that create glare. But remember, polarization in itself will not block UV light. Make sure the lenses also offer 98 percent or 100 percent UV protection.

Though the F.D.A. does not require that sunglasses have UV protection, the agency does insist that they meet impact-resistance standards— which basically means they won’t shatter when struck. Even so, if you wear sunglasses while cycling, sailing or gardening, for instance, consider purchasing a pair with polycarbonate lenses, which are 10 times more durable than regular plastic or glass lenses.

AVOID SIDEWALK VENDORSBuy a pair of chic Chanel knockoffs that offer no UV protection, and you might look swell— but your eyes will suffer. The tinted lenses will relax your pupils, letting more damaging radiation hit your retina than if you were wearing no glasses at all.

To play it safe, buy glasses from well-established drug, chain or department stores, rather than from vendors on the street. Shop around: you should be able to find a pair of drugstore sunglasses for $10 to $20 that provide all the protection you need.

Among the recent offerings atSunglasswarehouse.com, for instance, were wraparound and aviator-style sunglasses that came with full UV protection for just $13.

DON’T FORGET THE CHILDRENUpgrade your children from their Dora and Spider-man toy sunglasses to legitimate shades that offer 98 percent to 100 percent UV protection. Children with light-colored eyes are especially vulnerable to sun damage, said Dr. Duffner. The injury is cumulative, so the earlier children get in the habit of wearing shades, the better off their eyes will be.

If your child plays sports regularly, consider also purchasing sport-specific goggles. Eye injuries are the leading cause of blindness in children, and most of those injuries occur when they are playing basketball, baseball, ice hockey or racket sports.

The National Eye Institute says it believes that protective eyewear could prevent 90 percent of sports-related eye injuries in children.

TEST THOSE OLD GLASSESReluctant to pop for a new pair of sunglasses? If you already have a favorite pair but don’t know what kind of protection they offer, ask your local eyewear store if they have a UV meter. This device can measure the UV protection of your glasses and help you determine whether you should buy a new pair.“Most opticians have such a meter and can do this very easily,” said Dr. Duffner.

Even if you wearcontact lensesthat offer UV protection, you’re not in the clear. Contact lenses sit on the cornea in the center of your eyes and so can’t protect the surrounding white area (the conjunctiva) and skin.

“I see many older patients who have growths on the whites of their eyes that were caused by sun damage,” Dr. Bishop said. These yellow bumps, calledpinguecula, often lead to eye irritation and dryness and may eventually disrupt vision. To prevent them, adults with contact lenses still must wear sunglasses outdoors.

Lastly, if you wear prescription glasses, you can avoid buying sunglasses by either purchasing clip-ons that attach to your frames or having a UV coating applied to your lenses. Presto, you’ll have two pairs in one.

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In Tucson Shootings, Legal Strategy May Hinge on Mental Assessment

Even if that is found to be true, the lawyers for Mr. Loughner, the 22-year-old college dropout who has been charged in theTucson shootings, may find it difficult to mount a successful insanity defense.

The rules regarding such a legal strategy were tightened over the years in the wake of the verdict forJohn W. Hinckley Jr., who was found not guilty by reason of insanity in the 1981 assassination attempt on PresidentRonald Reagan. The insanity argument is now seldom successful, legal experts said.

What is more likely, they say, is that Mr. Loughner’s lawyers will use anymental healthproblems they find to stave off the death penalty, if he should go to trial and be convicted.

His lawyer,Judy Clarke, is likely to begin a far-ranging investigation of his life and family history, going back several generations to learn as much as possible about his origins, the environment in which he grew up and how he has functioned in society, said David I. Bruck, who worked with Ms. Clarke in the defense of Susan Smith, the South Carolina woman who drowned her two young sons in 1994 and who received a life sentence.

Ms. Clarke“will present a case which is focused, grounded in the facts, thorough and heartfelt,” said Mr. Bruck, a veteran death-penalty lawyer and a professor at Washington and Lee University in Lexington, Va.“She won’t try to sell what she wouldn’t buy. She’s going to find this man’s story, and once she’s found it, she’s going to be confident about telling it to a jury.”

But just where Ms. Clarke will tell that story— and before how many juries— is unclear.

The defense could ask that Mr. Loughner’s case be moved from Arizona out of concern that potential jurors might be influenced by news accounts.

Mr. Loughner (pronounced LOF-ner) may also have to be defended in separate trials brought by federal and state prosecutors, who are both likely to seek the death penalty.

The federal government has charged Mr. Loughner in the killings of two federal employees— JudgeJohn M. Roll, the chief federal judge for Arizona, andGabriel Zimmerman, an aide to RepresentativeGabrielle Giffords— and the Pima County attorney, Barbara LaWall, has said she will“pursue charges on behalf of the nonfederal victims.”

Her office has been researching the issue of whether it can proceed at the same time as the federal prosecutors, or whether the state’s case will have to wait until the United States attorney’s office has finished its work.

“I think initially there’ll be some confusion as to who’s going to go first, and how fast they are going to go,” said Rory Little, a former Justice Department official in the Clinton administration who teaches at the Hastings College of the Law in San Francisco.

“I would guess that you’re having some pretty intense discussions now between the federal government and the state side, and it wouldn’t surprise me to see the case divided up,” he said.

Either way, federal and state prosecutors would have two opportunities to seek the death penalty against Mr. Loughner if they chose to do so. That occurred in the case stemming from the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, which killed 168 people, including infants and children in a day care center. One defendant,Timothy J. McVeigh, received the death penalty at his federal trial, but a second,Terry L. Nichols, did not.

Mr. Nichols was tried again, on state charges, in McAlester, Okla. He was again spared execution.

Beth A. Wilkinson, a member of the federal prosecution team in the Oklahoma City case, said of the Tucson shootings:“In a crime like this, it’s also very important to recognize the state’s interest in prosecuting murder and attempted murder of their citizens. The vast majority of murder cases are prosecuted by state authorities.”

Neither the Justice Department nor the Pima County attorney’s office have said if it would pursue the death penalty against Mr. Loughner.

One of Ms. Clarke’s critical early steps will be to argue against any federal death-penalty case through a written submission and in meetings with federal prosecutors in Arizona and with the Justice Department’s Capital Case Committee in Washington. Attorney GeneralEric H. Holder Jr.will have the final say.

Aitan D. Goelman, who also was involved in the federal prosecution of the Oklahoma City case, said he doubted that an effort to block a death-penalty prosecution would prevail.“These kinds of cases are essentially the reason we have the federal death penalty,” he said.

The federal complaint against Mr. Loughner charges him with the murders of Judge Roll and Mr. Zimmerman, along with the attempted murders of Ms. Giffords, who was struck in the head but survived, and of two of her staff members, Pamela Simon and Ronald Barber, who were both wounded and were expected to recover.

One complication is that Mr. Loughner’s lawyers can only pursue the insanity defense if the defendant approves, said Stephen J. Morse, a professor of law and psychiatry at the University of Pennsylvania.

“It cannot be imposed on a defendant over his objection,” Professor Morse said.

He said that lawyers in federal court tend to regard the insanity plea as“a defense of last resort, because juries are skeptical of claims that a defendant was not responsible for his actions.”

Still, he said, given early accounts of the evidence that has surfaced in the Tucson case— that Mr. Loughner appears to have carefully planned his attack on Ms. Giffords— his only chance might be to invoke such a defense.

“Based on the early information,” Professor Morse said,“I would be surprised if he didn’t, because he seems to have no other defense as far as I can tell.”

Marc Lacey contributed reporting from Tucson.

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Swallowed Objects That Went Straight Into History

A laryngologist who worked in the late 19th and early 20th centuries, he preserved more than 2,000 objects that people had swallowed or inhaled: nails and bolts, miniature binoculars, a radiator key, a child’s perfect-attendance pin, a medallion that says“Carry me for good luck.”

Jackson retrieved these objects from people’s upper torsos, generally with little or noanesthesia. He was so intent on assembling his collection that he once refused to return a swallowed quarter, even when its owner threatened his life.

“He was a fetishist, no question,” said Mary Cappello, the author of“Swallow” (New Press), a new book about Jackson and his bizarre collection.“But his obsession had the effect of saving lives. That’s kind of amazing, and lucky for us that his madness made possible forms of rescue.”

Jackson was an artisan and a mechanical prodigy, a humanist and an ascetic whom colleagues sometimes described as aloof or cold. He spent hundreds of hours crushing peanuts with forceps to learn exactly how much pressure to exert. He experimented extensively on mannequins and dogs.

In those days surgery was associated with high mortality, and few physicians were willing or able to peer into the air and food passages, let alone remove objects like open safety pins. Yet Ms. Cappello writes that the survival rate among patients from whom he removed objects was better than 95 percent.

“If Jackson could tell us how he wished to be remembered, I’m certain he would do so by assemblage, or meaningful collage,” said Ms. Cappello, an English professor at theUniversity of Rhode Island. For him, collecting was a form of self-portraiture as well as a clinical and scientific pursuit.

Jackson viewed the world as a precarious place. Small and bookish as a child, he endured intense torment and bullying; at one point other children blindfolded him and threw him into a coal pit, and he was rescued only after a dog happened to find him unconscious.

So in a sense, Ms. Cappello said, when Jackson became a physician— first in Pittsburgh, then Philadelphia— he“was saving lives, yes, but he was also saving himself.” He grew to be a pioneer of the upper body, developing new endoscopic techniques for peering into dark recesses.

He attached a tiny light called a mignon lamp to the end of a rod that he inserted into his scopes. (Previously, physicians who used endoscopes had worked mainly with light held outside the body.)

And he was an early and outspoken safety advocate, particularly when it came to children. As one of his assistants put it, his quest was to make the public and the medical profession“foreign-body-conscious” about swallowing.

If it had been up to him, Ms. Cappello said,“parents who fed peanuts to children without molars would be drawn and quartered.” Chew everything thoroughly, he exhorted the public:“Chew your milk!”

And he lobbied for passage of the Federal Caustic Poison Act of 1927, which required manufacturers to place warning labels on poisonous substances like lye, which burns the esophagus and causes severe scarring that can make it impossible to swallow.

Children often ingested lye because it was present in many households (where it was used to make soap) and because it looked like sugar. A 7-year-old girl who could not swallow even a drop of water was taken to Dr. Jackson, who fed an endoscope into her esophagus and removed a grayish mass— perhaps food, perhaps dead tissue— with a forceps. Afterward, one of his assistants gave the child a glass of water.

“She took a small sip expecting it to choke her and come back up,” Jackson recalled in his 1938 autobiography.“It went slowly down; she took another sip, and it went down. Then she gently moved aside the glass of water in the nurse’s hand, took hold of my hand and kissed it.”

Jackson also developed a technique for dilating the esophagus in children with scarring. He taught them to swallow a long tube and to do so regularly for an extended period. He suggested they might think of themselves as sword swallowers and imagine that the feat“inspires awe in other children.” This eventually helped many of them to eat and drink again normally.

To remove objects like keys and coins and pins, Jackson would insert a long, rigid tube into his patients— usually children, and usually awake, though his assistants did help to hold them still.“He must have had an exquisite gentleness and ability to calm people,” Ms. Cappello said. He also treated many poor children without pay.

Still, his eccentricities marked him.“Some people might have painted him as a socially phobic, friendless loner,” she added.“He was not a warm and fuzzy doctor.”

Nor would he compromise when it came to his collection. In the case of that swallowed quarter, he told the patient’s infuriated father that“all foreign bodies removed from the air and food passages were put into a scientific collection where they would be available to physicians working on the problems of relieving little children.”

The father had beaten the boy as punishment, and when he didn’t get the coin back he apparently beat him again, so viciously he broke his son’s arm.

At that point Jackson gave the family a half dollar. But he did not return the swallowed coin.

The Jackson collection is now owned by theMütter Museum of the College of Physicians of Philadelphia, which is refurbishing it for an exhibition that is to open Feb. 18. Ms. Cappello will help curate the exhibition; Anna Dhody, the museum’s curator, called her work a substantial contribution that“we’re very lucky to have.”

Dr. V. Alin Botoman, a gastroenterologist at theUniversity of Miamiwho has also done scholarly work on Jackson, called him“truly a renaissance man who made so many contributions to medicine and has been all but forgotten.” Until now. In October, Ms. Cappello gave a lecture on Jackson atthe Observatory, an art and events space in Brooklyn. She also presented black-and-white films from Jackson’s family that had never been seen in public.

In a series of clips, Jackson is shown on a small boat, looking out at the sky. He is riding in the back of a pickup truck, writing intently.

His granddaughter, then a toddler, wobbles across a lawn holding a stuffed animal and a flower. She looks at the camera, shakes the flower and puts it in her mouth.

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