India Expands Its Global Role in Drug Production

Business is so brisk that Sun, with revenue of 41 billion rupees ($880 million) last year, predicts sales will grow 20 percent this year and is expanding its Halol factory.

“This site specializes in making difficult things,” Sampad Bhattacharya, Sun’s vice president in charge of operations, said during a recent factory tour. The blue and gray concrete building, which will be nearly 800,000 square feet after the expansion, would not look out of place in the pharmaceutical manufacturing centers of New Jersey, except for the herds of cattle and buffalo wandering nearby.

India’s drug industry— on track to grow about 13 percent this year, to just over $24 billion— was once notorious for making cheap knockoffs of Western medicines and selling them in developing countries. But India, seasoned in the basics of medicine making, is now starting to take on a more mainstream role in the global drug industry, as a result of recent strengthening of patent law here and cost pressures on name-brand drug makers in the West.

And while the Indian industry has had quality-control problems, it nonetheless benefits from growing wariness about the reliability of ingredients from that other historically low-cost drug provider— China. The United States is India’s top export customer for drugs.

India is becoming a“base for manufacturing for the global market,” said Ajay G. Piramal, the chairman of Piramal Healthcare, a drug maker based in Mumbai. Eventually, in Mr. Piramal’s perhaps overly optimistic forecast, only the very first and very last steps of the business— molecular drug discovery and marketing— will be run by the West’s global drug giants.

Those companies“don’t create much value” in the steps in between, he said.

It is not only Indian executives, though, who are bullish about thepharmaceuticalsindustry here. Analysts, research groups and consultants have been making similar predictions in recent months.

Big pharmaceutical companies have come calling, too. This year, Mr. Piramal sold his generic drug business toAbbott Laboratoriesfor $3.7 billion, the latest in a string of takeovers and joint ventures here.

Daiichi Sankyo of Japan helped kick off the foreign drug push into India in 2008 by buying a stake in Ranbaxy Laboratories, this country’s biggest drug maker. Last year, among other deals,GlaxoSmithKlineformed a partnership withDr. Reddy’s Laboratories;Pfizertied up with Claris Lifesciences;Sanofi-Aventistook control of Shantha Biotechnics, andBristol-Myers Squibbopened a research center in India with Biocon.

“There is a lot of good talent at a much lower price in India,” said Jim Worrell, the chief executive of Pharma Services Network, a Charlotte, N.C.-based consulting firm that is organizing tours of Indian factories for Western pharmaceutical executives who are considering outsourcing some of their business.“What I see happening now is manufacturing and even packaging and even formulation are moving to India,” Mr. Worrell said.

The shift to pharmaceuticals is part of a subtle, broader shift in the Indian economy. Moving beyond less sophisticated, outsourced services like telephone call centers, India has been advancing up the business value chain, particularly in law and medical diagnostics. Now it is showing a flair for manufacturing, particularly in goods demanding high-skill production and superlow prices.

Until recently, pharmaceuticals has been“an incredibly arrogant industry that has never outsourced,” said Sujay Shetty, an associate director with PricewaterhouseCoopers in Mumbai. But over the next several years, he predicts,“everything in the value chain will move to different parts of the world that are cheaper,” with India a major beneficiary.

The next opportunities for India could come at the more sophisticated end of the drug making spectrum, including research and development for the world’s drug giants and even development of proprietary medicines.

“We can crack the problem of patented drug discovery in India at a much lower cost” than in the West, predicted Mr. Piramal, who held onto his research and development operation, Piramal Lifesciences Limited, when he sold the rest of his company to Abbott.

At Piramal’s main laboratory in north Mumbai, about 300 scientists are researching new drugs aimed at inflammation, metabolic disorders and cancer. Mainly because of lower wages, if it costs big pharmaceutical companies“$1 billion to $1.5 billion to discover a new drug, we can do it in a tenth of the cost,” Mr. Piramal predicts.

G. V. Prasad, chief executive of Dr. Reddy’s Laboratories, said that Indian drug makers had the“ability to handle product development on a massive scale at a low cost.” Dr. Reddy’s originaldiabetesdrug has completed Phase 3 clinical trials— the last step before seekingFood and Drug Administrationapproval— the farthest of any of its peers.

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Personal Health - Taking the‘Wild’ in Wildlife Seriously

Wildlife experts say that human activities, as well as groups that oppose culling troublesome animals, are directly or indirectly responsible for many of the risks to people. To save life and limb, it pays to know what is out there and how to reduce the chances of hazardous encounters with wildlife in our midst.

At least six coyotes have found their way into New York City this year, including one that crossed the Hudson via the Holland Tunnel. The animals move easily into residential areas along travel corridors like greenways, power lines and train tracks, according toPaul D. Curtis, a wildlife specialist atCornell Universitywho studies human-wildlife interactions and ways to minimize their negative consequences.

Although coyotes are rarely a threat to people, Dr. Curtis said in an interview that they can be aggressive when breeding and rearing pups. In just the last week and a half, in separate instances, two young girls, ages 6 and 3, were attacked by coyotes in their Rye, N.Y., backyards. Small children have been attacked in Los Angeles and Arizona, Dr. Curtis said, and small dogs everywhere are at risk, even when on a leash.

In January 2009, a flock of Canada geese got sucked into the two jet engines of a loaded US Airways flight and forced an emergency landing in the Hudson, a stone’s throw from Manhattan. The resident population of urban and suburban geese has soared to more than 4 million of these 10-pound birds, each of which deposits a pound of slippery excrement a day, often on park paths, golf courses and athletic fields.

Raccoons, the most adaptable of urban wildlife, rummage through trash cans, snack on pet foods left outside and occasionally break into homes, where they can cause serious destruction in search of food.

The animals may bite when cornered. But their main risk to humans and pets israbies. There are now rabid raccoons in many areas east of Ohio, including Central Park and Nassau County, where wildlife experts are studying novel ways to get them vaccinated.

White-tailed deer wander fearlessly into suburban yards and fields, munching on crops and ornamental plantings, spreading dreadedticksthat causeLyme disease. A hungry deer consumes six to eight pounds of vegetation a day, often with little respect for lists of deer-resistant plants.

Deer kill far more people each year than do alligators, and cause over 1.5 million car accidents a year (more than 70,000 in New York State alone).

You need not have seen black bears roaming around Woodstock, N.Y., in April to know that they had ended their hibernation. Overturned garbage cans, with their nonedible contents strewn over lawns and roadsides, were a dead giveaway. The animals are well established on the west side of the Hudson, where they have caused an occasional fatality. Get between a mother and her cub and you may become history.

The range of black bears has more than doubled along the entire southern border of New York State and across the Hudson in the last decade.“I don’t think black bears will come to New York City, but I’d never say never,” Dr. Curtis remarked.

Dos and Don’ts

Heading the list of negative human behaviors is feeding wild animals, directly or unintentionally. Providing food can cause them to lose their fear of people and bring potentially aggressive quick-footed creatures, like coyotes, bears and raccoons, much too close to potential prey, like children and pets.

Edible garbage should not be left outside in unsecured containers where bears and raccoons can forage. If you live near a city park, like Prospect Park in Brooklyn, and you find your trash can ravaged, chances are a raccoon was responsible. Garbage should be placed in metal cans with tight-fitting lids and enclosed in a bin or attached to a solid object.

In residential areas like Woodstock, the bears seem to know what night people put out their garbage for morning collection. They are capable of overturning almost any can except a bear-proof dumpster.

Composting food items is also a bad idea, unless it is done behind a fence that can keep out bears and raccoons. Otherwise, limit compost to nonfood items like leaves.

Pets should be fed indoors; never leave pet food outside. Dr. Curtis recommends taking down bird feeders in summer (bears love bird food) and picking up fruit that drops from trees.

Make sure your chimney has a cap; raccoons without a tree den will use chimneys to raise their young. You can keep out skunks by sealing off openings under porches, decks and crawl spaces.

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Among Some, High Marks for Health Care Overhaul’s Beginnings

But it remains unclear whether a substantial number of people will see tangible benefits before the November elections, and whether those benefits will help Democrats who voted for the legislation and are facing resistance from voters who view it as fiscally irresponsible and overly intrusive.

The administration has issued a blizzard of regulations, including a patient’s bill of rights, and has persuaded insurance companies to make some changes sooner than required by the law. It has also assembled a team of insurance experts to help carry out the law, under close supervision from the White House.

“I give them an A for effort,” said Stuart M. Butler, a vice president of the conservativeHeritage Foundation.“But there are land mines down the road because the law is fundamentally flawed.”

Stephen E. Finan, a health economist at theAmerican Cancer Society, said:“I am extremely impressed with what the administration has accomplished. They have cranked out a lot of regulations. They’re doing it methodically, and they’re doing it well.”

On Thursday, the administration unveiled a Web site,HealthCare.gov, where consumers can obtain information about public and privatehealth insuranceoptions in their states. The administration and many states are also setting up high-risk insurance pools for people who have been denied coverage because of pre-existing conditions.

In the last three months, administration officials have issued rules allowing young adults to stay on their parents’ policies and forbidding insurers to deny coverage to children with pre-existing conditions. They have notified nearly four million small businesses of a new tax credit to help defray the cost of insurance.

On Tuesday, they began accepting applications for a separate program that will reimburse employers for some of the cost of providing health benefits to early retirees. And the government has begun sending $250 checks toMedicarebeneficiaries with high drug costs.

Ronald F. Pollack, executive director ofFamilies USA, a liberal-leaning consumer group, described these initial steps as confidence-builders.“If they work well,” Mr. Pollack said,“they will give people confidence that the broader reforms will be helpful.”

Insurers, who fought the legislation, now say they hope it will succeed.“We are working to get new products on the market by Sept. 23,” said Alissa Fox, a senior vice president of theBlue Cross and Blue Shield Association.“After that date, we can’t sell new policies to individuals or small groups unless they comply with the new standards.”

While Mr. Obama hopes to gain political benefits from the law, he is, in some ways, caught in a political trap. No Republicans voted for the final bill. Republican leaders say their goal is to“repeal and replace” it. In response to daily Republican attacks, the White House defends every feature of the law, potentially creating expectations that will be difficult to fulfill in the near future.

Representative Dave Camp of Michigan, the senior Republican on the House Ways and Means Committee, said the White House had significantly overstated the benefits of the law, most recently in a brochure sent to people on Medicare. The brochure looks like“taxpayer-funded propaganda,” Mr. Camp said.

The new poll, conducted June 17-22 by theKaiser Family Foundation, found that 48 percent of Americans had favorable views of the law, while 41 percent had unfavorable views. The favorable share was 41 percent in May and 46 percent in April.

Americans remain deeply divided. Roughly a third of voters say that a candidate who voted for the health care law is more likely to get their vote, a third say less likely, and nearly a third say it does not make much difference.

By far the least popular feature of the law, according to the poll, is a requirement for most Americans to have insurance or pay a fine, starting in 2014. The public may not accept the requirement until courts rule finally on its constitutionality. A federal district judge in Richmond, Va., heard arguments on the question on Thursday.

In recent weeks,Kathleen Sebelius, the secretary of health and human services, has emerged, in effect, as the national insurance commissioner. She criticizes insurers by name when she believes they are seeking excessive rate increases, and she urges states to reject such requests.

To date, economists see no evidence that the law has slowed the explosive growth of health spending, and some administration officials worry that it could fuel medical inflation. Mr. Obama has become adept at jawboning insurers. He told insurance executives last week that they must not use the law as an excuse for big rate increases.

Insurers say they wish that Mr. Obama would put similar pressure on doctors andhospitals, whose services account for about half of all health spending.

Consumer advocates, insurance companies and state insurance regulators have been working together to develop one of the most important new rules, requiring insurers to return at least 80 percent of premium dollars to policyholders in the form of health benefits or rebates.

“This experience is restoring my faith in the ability of government and people from different sectors to work together constructively when there is a clear imperative and a set of deadlines,” said Amy R. Bach, executive director ofUnited Policyholders, a national consumer rights organization based in San Francisco.

But several developments in recent days point to problems that could threaten the success of the new law.

TheCongressional Budget Officesaid that federal health spending, including“all the effects of the recently enacted health care legislation,” was still on an unsustainable course.

Mr. Obama just signed a bill providing temporary relief to doctors who treat Medicare patients. But doctors face a 21 percent cut in their Medicare fees in December, with a further cut of 5 percent scheduled for January.

The new law calls for a major expansion ofMedicaid, the program for low-income people, but it became apparent this week that some states could not afford the programs they had. Governors said they would have to cut services and lay off employees if they did not receive more help from the federal government.

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What Big Eyes You Have. Are Those Lenses Risky?

Lady Gaga’s wider-than-life eyes were most likely generated by a computer, but teenagers and young women nationwide have been copying them with specialcontact lensesimported from Asia. Known as circle lenses, these are colored contacts— sometimes in weird shades like violet and pink— that make the eyes appear larger because they cover not just the iris, as normal lenses do, but also part of the whites.

“I’ve noticed a lot of girls in my town have started to wear them a lot,” said Melody Vue, a 16-year-old in Morganton, N.C., who owns 22 pairs and wears them regularly. She said her friends tended to wear circle lenses for theirFacebookphotos.

These lenses might be just another beauty fad if not for the facts that they are contraband and that eye doctors express grave concern over them. It is illegal in the United States to sell any contact lenses— corrective or cosmetic— without a prescription, and no major maker of contact lenses in the United States currently sells circle lenses.

Yet the lenses are widely available online, typically for $20 to $30 a pair, both in prescription strengths and purely decorative. On message boards and in YouTube videos, young women and teenage girls have been spreading the word about where to buy them.

The lenses give wearers a childlike, doe-eyed appearance. The look is characteristic of Japanese anime and is also popular in Korea. Fame-seekers there called“ulzzang girls” post cute but sexy head shots of themselves online, nearly always wearing circle lenses to accentuate their eyes. (“Ulzzang” means“best face” in Korean, but it is also shorthand for“pretty.”)

Now that circle lenses have gone mainstream in Japan, Singapore and South Korea, they are turning up in American high schools and on college campuses.“In the past year, there’s been a sharp increase in interest here in the U.S.,” said Joyce Kim, a founder ofSoompi.com, an Asian pop fan site with a forum devoted to circle lenses.“Once early adopters have adequately posted about it, discussed it and reviewed them, it’s now available to everyone.”

Ms. Kim, who lives in San Francisco and is 31, said that some friends her age wear circle lenses almost every day.“It’s like wearing mascara or eyeliner,” she said.

Sites that sell contact lenses approved by theFood and Drug Administrationare supposed to verify customers’prescriptionswith their eye doctors. By contrast, circle lens Web sites allow customers to choose the strength of their lenses as freely as their color.

Kristin Rowland, a college senior from Shirley, N.Y., has several pairs of circle lenses, including purple ones that are prescription strength and lime green ones that she wears behind her glasses. Without them, she said, her eyes look“really tiny”; the lenses“make them look like they exist.”

Ms. Rowland has a part-time job at a Waldbaum’s supermarket, where customers sometimes tell her,“Your eyes look huge today,” she said. Even her manager expressed curiosity, asking,“Where did you get those things?” she said.

Karen Riley, a spokeswoman for the F.D.A., was a bit surprised, too. When first contacted last month, she did not know what circle lenses were or the extent to which they had caught on. Soon after, she wrote in an e-mail message,“Consumers risk significant eye injuries— evenblindness” when they buy contact lenses without a valid prescription or help from an eye professional.

Dr. S. Barry Eiden, an optometrist in Deerfield, Ill., who is chairman of the contact lens and cornea section of theAmerican Optometric Association, said that people selling circle lenses online“are encouraging the avoidance of professional care.” He warned that ill-fitting contact lenses could deprive the eye of oxygen and cause seriousvision problems.

Nina Nguyen, a 19-year-old Rutgers student from Bridgewater, N.J., said she was wary at first.“Our eyes are precious,” she said.“I wasn’t going to put any type of thing in my eyes.”

But after she saw how many students at Rutgers had circle lenses— and the groundswell of users online— she relented. Now she describes herself as“a circle lens addict.”

“What made me comfortable is so many girls out there wearing them,” Ms. Nguyen said.

A makeup artist named Michelle Phan introduced many Americans to circle lenses through a video tutorial on YouTube, where she demonstrates how to get“crazy, googly Lady Gaga eyes.”Ms. Phan’s video, called“Lady Gaga Bad Romance Look,” has been viewed more than 9.4 million times.

“In Asia, it’s all about the eyes in makeup,” said Ms. Phan, a Vietnamese-American blogger who is now Lancôme’s first video makeup artist.“They like the whole innocent doll-like look, almost like anime.”

These days girls of many races are embracing the look.“Circle lenses are not just for Asian people,” said Crystal Ezeoke, 17, a second-generation Nigerian from Lewisville, Tex. In videos she posts to YouTube, Ms. Ezeoke’s gray lenses make her eyes look an otherworldly blue.

AtLenscircle.com, which is based in Toronto, most of the customers are Americans, ages 15 to 25, who heard about circle lenses through YouTube reviewers, said Alfred Wong, 25, the site’s founder.“A lot of people like the dolly-eyed look, because it’s cute,” he said.“It’s still an emerging trend” in America, he added, but“it’s getting more and more popular.”

Jason Aw, an owner ofPinkyParadise.com, a site based in Malaysia, is well aware that his shipments to the United States are illegal. But he is convinced that his circle lenses are“safe; that is why a lot of customers will recommend” them to others.

His“job,” he wrote in an e-mail message, is“to provide a platform” for people who want to buy the lenses but cannot do so locally.

Girls like Ms. Vue, the 16-year-old in North Carolina, help steer customers to sites where circle lenses are sold. She has posted 13 reviews of circle lenses on YouTube, enough to merit her a coupon code attokioshine.com, which gives her viewers 10 percent off.“I have been getting tons of messages asking where to get circle lenses, so this is finally a legitimate answer for you,” she said in a recent video.

Ms. Vue was 14 when she begged her parents to get her first pair, she said. These days, however, she is having second thoughts about them— but not for health or safety reasons.

Circle lenses have just grown too popular, Ms. Vue said.“It kind of makes me not want to wear them anymore, because everyone is wearing them,” she said.

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Noticed - Too Much Red Bull? Relaxation Drinks For Sale

But, as it turns out, the drinks may have worked a little too well.

The nation is so wired that it looks as if consumers are now thirsting for anti-energy drinks.

“Relaxation shots” like Snoozeberry and iChill and soporific beverages with names like Unwind, Dream Water, Koma Unwind Chillaxation and Drank are aiming to take away the very buzz their caffeinated predecessors were designed to deliver. There are already more than 350 kinds of relaxation drinks on the market, according to Agata Kaczanowska, an analyst with the research company IBISWorld. Instead of slogans like Jolt’s“All the sugar and twice the caffeine,” these new drinks proffer serenity with maxims like Unwind’s“Tired of being wired?” and Drank’s“Slow your roll.”

Though that’s not all they are promising.

Drank claims it can help prevent jet lag. A drink called Blue Cow says it can improve concentration, relieveanxietyandirritabilityfrom fatigue, and even diminishPMSsymptoms. Another brand, Mini Chill, says that because it lessens tension, some users have reported better sex lives.

These would-be wonder drinks are coming soon to more grocery, big-box and convenience stores across the land. In the beverage industry they are known as“relaxation drinks”— and they are a big business.

The industry is expected to generate $500 million in sales revenue this year, according to IBISWorld, a year-over-year increase of about 327 percent.

The drinks often contain melatonin, valerian root and rose hips. But relaxation drinks are not regulated by theFood and Drug Administration. Dr. Wahida Karmally, director of nutrition for the Irving Institute for Clinical and Translational Research atColumbia University Medical Center, said that while melatonin is sometimes prescribed for jet lag, it affects other hormones. For instance, it can interfere with normal sexual development in children and altersperm count. And she said“it shouldn’t be used by women who are trying to get pregnant or who are pregnant orbreast-feeding.” Melatonin can also interact with prescription medications.

Not all relaxation drinks contain melatonin or valerian, though. Blue Cow, for instance, does not. Some brands have a lot of sugar; others have none. Yet even an ingredient as seemingly benign as rose hips, which containvitamin C, can be problematic because too much vitamin C can harm your stomach.

The beverage makers say on their Web sites that the levels they recommend are safe. Doctors say there is no way to know, and that consumers should confer with their physicians before drinking a bottle— which typically costs several dollars.

Dr. Karmally offered some alternatives: take a warm bath before bedtime, listen to relaxing music, practiceyoga, sip warm milk.

“A cup of skim milk,” she said,“is about 25 cents.”

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Economy Wreaks Havoc on Federal AIDS Drug Program

As with other safety-net programs, ballooning demand caused by persistent unemployment and loss of health insurance is being met with reductions in government resources. Without reliable access to the medications, which cost individuals in the AIDS Drug Assistance Program an average of $12,000 a year, people with H.I.V. are more likely to develop full-blown AIDS, transmit the virus and require expensive hospitalizations.

Eleven states have closed enrollment in the federal program,most recently Florida, which has the nation’s third-largest population of people with H.I.V. Three other states have narrowed eligibility, and two of them— Arkansas and Utah— have dropped scores of people from the program.

Last week, because of swelling numbers here in South Florida, thenationwide waiting listsurged past record levels set in 2004, to 1,781 people, according to the National Alliance of State and Territorial AIDS Directors. The growth is expected to continue when Georgia starts deferring enrollment in its drug assistance program on July 1, and Illinois may soon follow.

Louisiana capped enrollment on June 1 but decided against keeping a waiting list.“It implies you’re actually waiting on something,” said DeAnn Gruber, the interim director of the state’s H.I.V./AIDS program.“We don’t want to give anyone false hope.”

Ten states’ programs have stopped covering drugs that do not directly combat H.I.V. or opportunistic infections. Unless money is found by Aug. 1, Florida plans to pare 53 of 101 medications from its formulary, including those for conditions that are often related to H.I.V., like diabetes, high blood pressure and anxiety.

In many states, there is a sense of reverting to the 1980s and early 1990s, before the development of protease inhibitors reversed the inexorable rise in AIDS deaths.

“The worry then was that there were no medications for AIDS,” said Dr. Wayne A. Duffus, medical director of the drug assistance program in South Carolina.“The worry now is that there are medicines, but you can’t afford them. A lot of patients are certainly old enough to remember what happens if you don’t get your medicines.”

For the moment, pharmaceutical companies have stepped into the breach, negotiating discounts for the state drug plans and accepting needy patients into programs that temporarily provide free medications. Although there is no data to prove it, state AIDS directors said a vast majority of people on waiting lists seemed to be getting medications one way or another.

But they concede that some patients may be going without, and that caseworkers are being diverted from critical tasks while navigating a thicket of cumbersome applications seeking drug companies’ help.

“The drug companies are trying their best to lower prices,” said Carl Schmid, deputy executive director of the AIDS Institute, an advocacy group.“But we cannot rely on them to finance the health care of poor people living with H.I.V. and AIDS.”

Tim Sweeney, 49, a Fort Lauderdale man who has depended on the assistance program for a dozen years, said he was put on Florida’s waiting list because he was four days late to re-enroll, as is required every six months. Mr. Sweeney, who has AIDS, takes six H.I.V. pills twice a day, as well as three other medications. Their total retail cost: $4,500 a month.

Unemployed for 18 months, Mr. Sweeney said he spent three days filling out forms to apply for aid from pharmaceutical companies. While awaiting responses, he is being supplied with drugs, one week at a time, by the AIDS Healthcare Foundation, a social service agency.

The patchwork arrangement gives him little comfort.“My biggest fear,” said Mr. Sweeney, who credits the drugs with vastly improving his immune cell counts,“is that I’ve done all this hard work over 20 years and now I’m going to fall back.”

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Recipes for Health - Creamed Spinach

2 tablespoons extra virgin olive oil

2 tablespoons finely chopped shallot or onion (optional)

2 tablespoons flour

2 cups low-fat (1 percent) milk, plus additional for thinning out the creamed spinach if desired

Salt to taste

Freshly ground white or black pepper

2 pounds spinach, stemmed and washed thoroughly, or 1 pound baby spinach, rinsed

Pinch of freshly grated nutmeg

1.Make the béchamel. Heat the oil over medium heat in a heavy medium saucepan. Add the shallot or onion, and cook, stirring, until softened, about three minutes. Stir in flour, and cook, stirring, for about three minutes until smooth and bubbling but not browned. It should have the texture of wet sand. Whisk in the milk all at once, and bring to a simmer, whisking all the while, until the mixture begins to thicken. Turn the heat to very low, and simmer, stirring often with a whisk and scraping the bottom and edges of the pan with a rubber spatula, for 10 minutes until the sauce has thickened and lost its raw flour taste. Season with salt and pepper. Strain while hot into a heatproof bowl or a Pyrex measuring cup, then return to the saucepan.

2.Bring large pot of generously salted water to a boil and add the spinach. Blanch for 30 seconds, and transfer to a bowl of ice water. Drain and squeeze dry, taking the spinach up by the handful. Chop fine, and stir into the béchamel. Add the nutmeg. Thin out with 2 tablespoons milk if desired, or more to taste. Bring to a simmer over low heat, and simmer very gently for five minutes, stirring often. Serve.

Yield:Serves four to six.

Advance preparation:You can make a béchamel and blanch the spinach up to a day ahead; keep separately in the refrigerator. Combine, thin out if desired with a little milk, and heat gently in a heavy saucepan before serving.

Nutritional information per serving (based on four servings):176calories; 8 grams fat; 2 gramssaturated fat; 8 milligramscholesterol; 21 gramscarbohydrates; 5 gramsdietary fiber; 245 milligrams sodium (does not include salt added during cooking); 8 grams protein

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

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