A Conversation With Julian L. Seifter, Nephrologist and Patient

We spoke at his Harvard office for three hours about his new book,“After the Diagnosis: Transcending Chronic Illness,” which was written with his wife, Betsy Seifter. It’s about living with diabetes, heart disease, lupus, even AIDS. An edited version of that conversation and subsequent e-mails follows.

Q.You are a doctor who treats people with chronic diseases. But you have one—diabetes. Are you a good patient?

A.Mixed. When I was diagnosed— 30 years ago— my first response was to run away from the illness. I was just at the beginning of my career, I had a young family and I didn’t want to be held back by my metabolic problems. Yes, I took insulin. But staying on a restrictive diet and monitoring myblood sugar levelswas harder. I pretended to myself and others that I wasn’t sick.

I’ve had complications associated with three decades of diabetes— an eye hemorrhage, neuropathies. Over time I’ve tried for better control of my blood sugar levels, but I’ve never been perfectly successful. Good control means trying to duplicate what the pancreas does, and I never really wanted to become my pancreas.

Q.Has being a patient helped you be a doctor?

A.I’ve certainly learned things I’ve brought back to the clinic. I have a retinopathy, for instance, which can be a complication of diabetes. I don’t have good vision in my right eye, as a result. When this first happened, I said to my ophthalmologist,“I can’t lose vision. I need to read.” And he said,“Any vision is better than no vision.”

That was important. I started thinking,“Concentrate on things you still can do and develop some new things.” I’ve since started gardening, which doesn’t require the most acute vision. It’s something I probably wouldn’t have done otherwise. I counsel my patients to replace what they’ve lost with something new.

Q. Can you give an example?

A.I had one patient who was a scuba diver and who loved discovery. I had to tell him that with his condition scuba diving isn’t safe for him. So I’ve encouraged him to prospect for Native American relics in the Southwest desert, which he’s also interested in. It’s a way he can still be an explorer, but not risk his kidney.

Q. You write that a chronic disease can provide an opportunity for growth and personal development. That’s hard to imagine.

A.It can shake you out of old habits and routines. It takes away the“taken for granted.” You’re invited, almost forced, to find new directions and pursue unexplored potentials.

I had a patient, Cassandra, an opera singer, who first came to me because it was thought she had a kidney problem. It turned out she had a severe inflammatory condition in the head and neck— in the larynx, her instrument. She could no longer sing professionally. With no science background, she began reading the papers on her treatment and cultivated an interest in the illness. Eventually, she went back to college, took science courses and got accepted to medical school. She’s about to become a nephrologist.

Q. So a chronic disease diagnosis doesn’t have to be seen as The End?

A.It doesn’t have to be. Sometimes it is, though. I had another patient, a policeman, very overweight, with diabetes. He could drink a case of beer at a time. And he totally enjoyed his social life. By the time he was 60, he needed amputation anddialysis. He said,“I don’t want that.” I wasn’t going to talk him out of it. He hadhospice careand he died peacefully.

If someone rejects dialysis, I want to make sure they’re not doing that because of depression. If a patient is wavering, I’ll say:“At least try it. You can always come off.” I had a patient who, at first, rejected dialysis, but who agreed to a trial and then found that the treatments made him feel so much better that he then wanted to stay on. It was a three-times-a-week commitment, but he came to see how he could fit it into his life— which he’d still have.

Q. Is it difficult to get patients to agree to a treatment as difficult as dialysis?

A.The alternative is death. I try to meet my patients wherever they are so that they will do it.

I had one who wanted to go to Florida a last time before starting dialysis. I worried about him. His condition was such that he might haveheart failure. But I also knew he’d never go onto dialysis without doing this. I said,“O.K., call me when you land in Miami.” He said,“Doctor, you don’t understand, I’m driving down.”

Now, this was really dangerous. So I said,“Call me from each state and I’ll have the address of someone you can check in with in case there’s an emergency.”

The phone calls came in regularly until the last day of his trip. I was worried and I called his home in South Florida, and there was such an incredible noise in the background that I could hardly hear his wife.“What’s going on?” I asked.“That’s the rescue helicopter on the front lawn,” she said. He’d made it there, but then needed to be airlifted to the hospital!

Q. Do you regret enabling this journey?

A.No. From my own experiences, I understood why patients sometimes resist doing what’s best. The idea of sticking yourself with a needle every day for life: that wasn’t easy for me to accept. I hated the thought that every morning I was going to wake up knowing,“I have diabetes.” So I’m not a puritan with my patients. You have to do what is possible.

Q. In your book, you suggest a heretical idea: that chronic disease patients deny their situation, a little. You’d better explain.

A.They should do that, within reason. Everyone needs the opportunity to forget their disease for a while and think of other things. Otherwise, they can become their disease. So: I’m not a diabetic. I’m a doctor whohasdiabetes.

Of course, they should do everything that modern medicine offers. I always tell them that it is serious, but it’s not the end of all possibilities— you’re alive till you are dead.“It’s not over till it’s over.”Yogi Berra, he could have been a great clinician!

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Limited Coverage Health Plans Are Criticized

Or so went theargumentoffered by SenatorJohn D. Rockefeller IV, the West Virginia Democrat, in a hearing on Wednesday about a controversial kind of health plan that seems destined to remain on the market for the next several years.

More than a million Americans enrolled in these plans think they havehealth insuranceto protect them from financial catastrophe if they become seriously ill or hurt, Mr. Rockefeller said.“In fact, they don’t,” he said.

“It’s worse than nothing because of the false expectations and the false hope,” Mr. Rockefeller said.

He and other proponents of the new health care law are voicing concerns about the Obama administration’s recent decision to allow these plans, known as limited benefit or mini-med policies, to escape some of the legislation’s early requirements.

Taking the opposite view of Mr. Rockefeller, administration officials contended that coverage provided by these policies was better than nothing at all, and promised that more comprehensive plans would be available through state exchanges in 2014, when all plans will have to comply with the law.

Companies likeMcDonald’s, which was one of the first to seeka waiverfrom the new rules so it could continue offering plans that offer as little as $2,000 a year in benefits, say these plans are often the only affordable alternative for many of its part-time or low-income workers.

Critics, including Mr. Rockefeller, say people buying these policies often have no idea of how limited the coverage is. They say the employers and insurers, which include major companies likeAetnaandCigna, do not always make it clear to a worker that these policies will not protect them if they develop an expensive medical condition.

What is more, many of these plans are designed in such a way to pay less than the amount they say they will cover. While a policy might promise coverage up to $50,000 a year, for example, the fine print may actually limit what it will pay toward doctors’ visits at just $2,000 or a hospital stay at $250 a day. People who become seriously ill or hurt can end up with tens of thousands of dollars inunpaid medical bills.

“The language in these policies can be very confusing and lead people to believe they have insurance coverage or security if they experience illness or injury,” said Mark Rukavina, the director of the Access Project, a not-for-profit group in Boston that helps people who accumulate large sums of medical debt.

At the hearing, for example, Eugene Melville, a retail worker in California who bought a limited-benefit policy from Aetna, testified about his experience after learning he hadoral cancer. While he said he understood that the policy was capped at $20,000 a year, he discovered that it paid only $2,000 for doctors’ visits and care provided outside a hospital.

Others claim to have been similarly surprised.“In no way did I expect the bill that arrived,” said Jessica Lynn Carroll, 30, a resident of San Jose, Calif., who also bought an Aetna policy. When she had to go to the emergency room because she lost feeling in one of her arms, she found her Aetna policy paid only $500 toward the bill. She ended up owing more than $16,000.“If I had known the insurance I had in the first place was absurd, I wouldn’t have purchased it,” said Ms. Carroll, who said the hospital has agreed to significantly reduce her bills.

At the hearing, McDonald’s insisted that its workers knew what they were paying for.“McDonald’s works hard to make sure that its employees understand the coverage limitations as well as the benefits provided by these plans,” testified Rich Floersch, an executive vice president at the company, who said about 90 percent of those enrolled never reached the limits.

Employees pay $11 a week, nearly $600 a year, for coverage that is capped at $2,000, Mr. Floersch said, and they can pay more for plans that limit benefits at $5,000 or $10,000 a year. McDonald’s also says it offers a more comprehensive— and more expensive— plan.

Aetna says its materials are clear.“We want people to know what they’re buying. We recognize that health insurance is complex and we have continually improved our member materials to make them clear so they are not surprised by the limited benefits in these plans,” the company said in a statement.

Cigna also defended the plans, saying they are a choice for people who cannot afford more comprehensive coverage. The company“is committed to helping our customers understand benefits plans before they purchase them,” Cigna said in a statement.“We work to educate our customers about how to best use their benefits after they enroll.”

But insurers also emphasize that customers should be sure to understand what they are buying.“Any consumer should know exactly what benefits their coverage provides before purchasing a policy,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade association. Even policies that provide as much as $1 million in coverage may limit the amount they will pay for specific services.

The federal waivers are only good for a year, and regulators say they plan to ask the plans for more information so they can decide how to handle these policies. Administration officials also say they plan to make sure the insurers are clear that the policies do not meet the requirements of the federal law

“We are working to bring unprecedented transparency to the insurance market, and improve the quality of health insurance, while helping to ensure that people can keep the coverage they have,” said Steve Larsen, director of the Office of Oversight in the Health and Human Services’ Office of Consumer Information and Insurance Oversight.“As part of this effort, we will be requiring insurance companies that offer mini-med plans to tell consumers in plain language that their plan has limited coverage.”

Still, some consumer advocates say individuals may sometimes be better off if they have no insurance at all. If they are uninsured, they may qualify for deeply discounted or even free charity care from the hospital, which they might not get if they had some kind of coverage.“For some people, frankly, they may be better off with no coverage if this is the alternative,” Mr. Rukavina said.

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Food Safety Overhaul Approved by Senate

The legislation, which passed by a vote of 73 to 25, would greatly strengthen theFood and Drug Administration, an agency that in recent decades focused more on policing medical products than ensuring the safety of food. The bill is intended to keep unsafe foods from reaching markets and restaurants, where they can make people sick— a change from the current practice, which mainly involves cracking down after outbreaks occur.

Despite unusual bipartisan support on Capitol Hill and a strong push from the Obama administration, the bill could still die because there might not be enough time for the usual haggling between the Senate and the House, which passed its own version last year. Top House Democrats said Tuesday that they were considering simply passing the Senate version to speed approval but that no decision had been made.

“With the Senate’s passage of theFood SafetyModernization Act, we are one step closer to having critically important new tools to protect our nation’s food supply and keep consumers safe,” saidPresident Obama, who made improving the safety of the nation’s food supply an early priority of his administration. He urged the House to act quickly.

Both versions of the bill would grant the F.D.A. new powers to recall tainted foods, increase inspections, demand accountability from food companies and oversee farming. But neither would consolidate overlapping functions at the Department of Agriculture and nearly a dozen other federal agencies that oversee various aspects of food safety, leaving coordination among the agencies a continuing challenge.

While food safety advocates and many industry groups prefer the House version because it includes more money for inspections and fewer exceptions from the rules it sets out, most said the Senate bill was far better than nothing.

“This is a historic moment,” said Erik Olson, deputy director of the Pew Health Group, an advocacy organization.“For the first time in over 70 years, the Senate has approved an overhaul of F.D.A.’s food safety law that will help ensure that the food we put on our kitchen tables will be safer.”

Among the Senate bill’s last major sticking points was how it would affect small farmers and food producers. Some advocates for small farms andorganic foodproducers said the legislation would destroy their industry under a mountain of paperwork. Senator Jon Tester, Democrat of Montana, pushed for a recent addition to the bill that exempts producers with less than $500,000 in annual sales who sell most of their food locally.

That provision led theUnited Fresh Produce Association, a trade group, to announce recently that it would oppose the legislation since small food operations have been the source of some food recalls in recent years.

But Randy Napier of Medina, Ohio, said the Senate bill was much needed. Mr. Napier’s 80-year-old mother, Nellie Napier, died in January 2009 after the nursing home where she lived continued to give her contaminated peanut butter even after she got sick.“I am appalled at what I have found out since my mother’s death about how poorly food is regulated and how these companies cut corners to save money,” Mr. Napier said.

The legislation greatly increases the number of inspections of food processing plants that the F.D.A. must conduct, with an emphasis on foods that are considered most high risk— although figuring out which those are is an uncertain science. Until recently, peanut butter would not have made the list.

Staunch opposition to the bill by SenatorTom Coburn, Republican of Oklahoma, forced months of delay and eventually required the Senate majority leader,Harry Reidof Nevada, to call a series of time-consuming procedural votes to end debate. Mr. Coburn offered his own version of the legislation. It eliminated many of the bill’s requirements because he said that more government rules would be deleterious and that the free market was working. That version was rejected.

Despite Mr. Coburn’s opposition, the bill is one of the few major pieces of bipartisan legislation to emerge from this Congress. Some Republican and Democratic Senate staff members— who in previous terms would have seen one another routinely— met for the first time during the food bill negotiations. The group bonded over snacks: Starburst candies from a staff member of SenatorMichael B. Enzi, Republican of Wyoming, and jelly beans from a staff member of SenatorRichard J. Durbin, Democrat of Illinois.

“This legislation means that parents who tell their kids to eat their spinach can be assured that it won’t make them sick,” said SenatorTom Harkin, Democrat of Iowa, who, as chairman of the Senate health committee, shepherded the legislation through months of negotiations.

Health advocates are hoping the legislation will rekindle the progress— now stalled— that the nation once enjoyed in reducing the tens of millions of food-contamination illnesses and thousands of deaths estimated to occur each year. In the case of toxicsalmonella, infections may be creeping up, according to government figures.

Part of the problem is the growing industrialization and globalization of the nation’s food supply. Nearly one-fifth of it, including as much as three-quarters of its seafood, is imported, but the Food and Drug Administration inspects less than one pound in a million of imported foods. The bill gives the agency more control over food imports, including increased inspection of foreign processing plants and the ability to set standards for how fruits and vegetables are grown abroad.

As food suppliers grow in size, problems at one facility can sicken thousands of people all over the country: ThePeanut Corporation of America’s contaminated paste, which was recalled in 2009, was in scores of brands of cookies and snacks made by big and small companies. The new legislation would raise standards at such plants by demanding that food companies write plans to manufacture foods safely and conduct routine tests to ensure that those plans are adequate.

The bill would give the F.D.A. the power to demand immediate food recalls. For years, theGeorge W. Bush administrationopposed such powers, saying that food manufacturers invariably complied when asked by the government to undertake a recall. But last year, the agency asked a distributor of pistachios to recall its entire 2008 crop after tests showed salmonella contamination at its processing plant. Days passed before the company complied.

Consumer advocates were jubilant over the Senate’s action.

“Everyone who eats will benefit,” said Caroline Smith DeWaal, food safety director for theCenter for Science in the Public Interest, an advocacy group.

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Sports Training Has Begun for Babies and Toddlers

Ms. Bolhuis turned her exercises into a company,Gymtrix, that offers a library of videos starting with training for babies as young as 6 months. There is no lying in the crib playing with toes.

Infant athletes, accompanied by doting parents on the videos, do a lot of jumping, kicking and, in oneexercise, something that looks like baseball batting practice.

“We hear all the time from families that have been with us,‘Our kids are superstars when they’re in middle school and they get into sports,’ ” Ms. Bolhuis said.

Future Robinson Canos and Sidney Crosbys are getting their start in sports earlier than ever. Kindergartners play in soccer leagues and at an annual T-Ball World Series in Milton, Fla. But now children are being groomed as athletes before they can walk.

The growing competition in marketing baby sports DVDs includes companies with names likeathleticBabyandBaby Goes Pro. Even experts in youth sports seem startled that the age of entry has dipped so low.

“That’s really amazing. What’s next?” said Dr. Lyle Micheli, an orthopedic surgeon and founder of the first pediatric sports medicine clinic in the United States at Children’s Hospital in Boston.

Dr. Micheli said he did not see any great advantages in exposing babies to sports.“I don’t know of any evidence that training at this infancy stage accelerates coordination,” he said.

One of his concerns, he said, is“the potential for even younger ages of overuse injury.”

Bob Bigelow, aformer National Basketball Association playerand a critic of competitive sports for young children, is also skeptical.

“This is Baby Mozart stuff; you play Mozart for the baby in utero and it comes out some sort of fine arts major,” he said.“There are millions of American parents worried to death that their children might fall behind somebody else’s kid. So the emphasis in youth sports has become more, more, more, younger, younger, younger.”

The Little Gym, based in Scottsdale, Ariz., begins classes for children at 4 months old. Bob Bingham, the company’s chief executive, said that about 20,000 youngsters under 2— about a quarter of the total enrollment— were signed up for classes at locations in the United States, Canada and Puerto Rico. That is a sizable increase from last year, he said. The company, which has gyms in 20 countries, plans to open 100 locations in China over the next five years.

My Gym, based in Sherman Oaks, Calif., said 55 percent of those who attend classes at its 200 locations— 157 in the United States— were 2½ or younger.

The entrepreneurs behind these businesses— gym teachers, accountants and former professional athletes among them— make no claims about turning today’s babies into tomorrow’sSuper Bowlstar. In the past, marketing claims for products geared toward babies have caused trouble for companies. Disney, which owned the popular Baby Einstein brand, dropped the term“educational” after a children’s-rights group objected to contentions that babies who watched“Baby Einstein” were learning.Disney also offered refunds.

Most sports-video entrepreneurs promote their products as early intervention for combating childhoodobesity. Others say they provide time that parents and children can spend together.

“We’re not suggesting your kid will turn pro; we have to be careful about that,” said Gigi Fernandez, a former professional tennis player, who is one of the founders of Baby Goes Pro.

Ms. Fernandez and a business partner started the company this year. A women’s doubles star in the 1990s and a new member of the International Tennis Hall of Fame, she said she got the idea after an unsuccessful search for a DVD she could play for hertwins,Madison and Karson,who will turn 2 in April.

“There was one introducing kids to golf that I didn’t care for,” Ms. Fernandez said.“It was kids running around a golf course whacking balls. They had a driver on the putting green.”

Baby Goes Pro’s“Discover Sports” video would not likely exciteESPNdie-hards, but there is a lot for a baby. The $10.95 DVD covers five sports— baseball, basketball, golf, soccer and tennis— touches on rules and equipment, and features an animated monkey named Emkei.

When she plays the DVD for her toddlers, Ms. Fernandez said, she lays sports equipment, like rackets and softballs, around the room. When she comes back, she finds them swinging away, she said.

Someday, Ms. Fernandez predicted, this could give them an edge— a small one, perhaps.“The first time they go to a baseball field or tennis court, they’ll have a clue,” she said.

Sports doctors question whether very young children gain from watching the DVDs or attending sports classes. It is common for such programs to accept students before they have turned 2.

Lisa Mullen said she was not concerned about whether her toddler developed into a baseball or soccer star. She recently visited several children’s gyms in the Baltimore area in hopes of finding“a physical outlet for our high-energy son.”

The one she settled on for 16-month-old Michael was appealing for its low-key atmosphere and varied activities. During the first class, Michael and his two classmates swung from a bar and walked on a low balance beam. They also banged drumsticks.

Other programs can appear more serious. AtLil’ Kickers, a soccer academy with franchises in 28 states, parents can enroll their children at 18 months old; about 55 percent of the 100,000 children signed up this year are 3 years or younger. In beginner classes, toddlers run and kick. Lil’ Kickers also hands out improbably small soccer jerseys.

But the program, which was developed by child-development experts, is relaxed, said its chief executive, Don Crowe.

“Our emphasis is on the child, not trying to turn them into the next Pelé,” he said.

That’s not enough to sell Dr. Micheli on the idea of sports classes for tykes. Before rushing off to a day of treating injured athletes, he said,“We won’t be putting their brochures in our clinic.”

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Arsenic-Eating Bacteria Force New Thinking on What Constitutes Life

The bacterium, scraped from the bottom of Mono Lake in California and grown for months in a lab mixture containing arsenic, gradually swapped out atoms of phosphorus in its little body for atoms of arsenic.

Scientists said the results, if confirmed, would expand the notion of what life could be and where it could be.“There is basic mystery, when you look at life,” said Dimitar Sasselov, an astronomer at the Harvard-Smithsonian Center for Astrophysics and director of an institute on the origins of life there, who was not involved in the work.“Nature only uses a restrictive set of molecules and chemical reactions out of many thousands available. This is our first glimmer that maybe there are other options.”

Felisa Wolfe-Simon, aNASAastrobiology fellow at theUnited States Geological Surveyin Menlo Park, Calif., who led the experiment, said,“This is a microbe that has solved the problem of how to live in a different way.”

This story is not about Mono Lake or arsenic, she said, but about“cracking open the door and finding that what we think are fixed constants of life are not.”

Dr. Wolfe-Simon and her colleagues publish their findings Friday in Science.

Caleb Scharf, an astrobiologist atColumbia Universitywho was not part of the research, said he was amazed.“It’s like if you or I morphed into fully functioning cyborgs after being thrown into a room of electronic scrap with nothing to eat,” he said.

Gerald Joyce, a chemist and molecular biologist at the Scripps Research Institute in La Jolla, Calif., said the work“shows in principle that you could have a different form of life,” but noted that even these bacteria are affixed to the same tree of life as the rest of us, like the extremophiles that exist in ocean vents.

“It’s a really nice story about adaptability of our life form,” he said.“It gives food for thought about what might be possible in another world.”

The results could have a major impact on space missions toMarsand elsewhere looking for life. The experiments on such missions are designed to ferret out the handful of chemical elements and reactions that have been known to characterize life on Earth. The Viking landers that failed to find life on Mars in 1976, Dr. Wolfe-Simon pointed out, were designed before the discovery of tube worms and other weird life in undersea vents and the dry valleys of Antarctica revolutionized ideas about the evolution of life on Earth.

Dr. Sasselov said,“I would like to know, when designing experiments and instruments to look for life, whether I should be looking for same stuff as here on Earth, or whether there are other options.

“Are we going to look for same molecules we love and know here, or broaden our search?”

Phosphorus is one of six chemical elements that have long been thought to be essential for all Life As We Know It. The others are carbon, oxygen, nitrogen, hydrogen and sulfur.

While nature has been able to engineer substitutes for some of the other elements that exist in trace amounts for specialized purposes— like iron to carry oxygen— until now there has been no substitute for the basic six elements. Now, scientists say, these results will stimulate a lot of work on what other chemical replacements might be possible. The most fabled, much loved by science fiction authors but not ever established, is the substitution of silicon for carbon.

Phosphorus chains form the backbone of DNA and its chemical bonds, particularly in a molecule known as adenosine triphosphate, the principal means by which biological creatures store energy.“It’s like a little battery that carries chemical energy within cells,” said Dr. Scharf. So important are these“batteries,” Dr. Scharf said, that the temperature at which they break down, about 160 Celsius (320 Fahrenheit), is considered the high-temperature limit for life.

Arsenic sits right beneath phosphorus in the periodic table of the elements and shares many of its chemical properties. Indeed, that chemical closeness is what makes it toxic, Dr. Wolfe-Simon said, allowing it to slip easily into a cell’s machinery where it then gums things up, like bad oil in a car engine.

At a conference at Arizona State about alien life in 2006, however, Dr. Wolfe-Simon suggested that an organism that could cope with arsenic might actually have incorporated arsenic instead of phosphorus into its lifestyle. In a subsequent paper in The International Journal of Astrobiology, she and Ariel Anbar and Paul Davies, both ofArizona State University, predicted the existence of arsenic-loving life forms.

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Risotto With Turkey, Mushrooms and Peas - Recipes for Health

1 ounce dried porcini mushrooms (about 1 cup)

5 cups well-seasoned chicken or vegetable stock

2 tablespoons extra virgin olive oil

1/2 cup minced onion

1 1/2 cups arborio rice

1 to 2 garlic cloves (to taste), minced

Salt and freshly ground pepper to taste

1/2 cup dry white wine, such as pinot grigio or sauvignon blanc

1 1/2 cups diced turkey

1 cup thawed frozen peas or cooked fresh peas

2 tablespoons minced chives

1/4 to 1/2 cup freshly grated Parmesan cheese (1 to 2 ounces)

1.Place the mushrooms in a large Pyrex measuring cup, and pour in 2 cups boiling water. Allow to sit for 30 minutes. Line a strainer with cheesecloth, place it over a bowl and strain the mushrooms. Squeeze the mushrooms over the strainer then rinse several times to rid them of sand. Set aside. Combine the mushroom soaking liquid with the stock in a saucepan.

2.Bring the stock to a simmer over low heat, with a ladle nearby or in the pot. Make sure that the stock is well seasoned.

3.Heat the olive oil over medium heat in a wide, heavy nonstick skillet or a wide, heavy saucepan. Add the onion and a generous pinch of salt, and cook gently until the onion is just tender, about three minutes. Do not brown.

4.Stir in the rice, porcinis and garlic. Stir until the grains separate and begin to crackle. Add the wine, and stir until it is no longer visible in the pan. Begin adding the simmering stock a couple of ladlefuls (about 1/2 cup) at a time. The stock should just cover the rice and should be bubbling neither too slowly nor too quickly. Cook, stirring often, until it is just about absorbed. Add another ladleful or two of the stock, and continue to cook in this fashion, adding more stock and stirring when the rice is almost dry. You do not have to stir constantly, but stir often. After 15 minutes, stir in the turkey and the peas, and continue to add stock as instructed above. The risotto is done in 20 to 25 minutes, when the rice is just tender all the way through but still chewy. Taste now and adjust seasoning.

5.Add another ladleful or two of stock to the rice. Stir in the chives and Parmesan, and remove from the heat. The mixture should be creamy (add more stock if it isn’t). Serve right away in wide soup bowls or on plates, spreading the risotto in a thin layer rather than a mound.

Yield:Serves four to six.

Advance preparation:You can begin up to several hours before serving. Proceed with the recipe and cook halfway through Step 3— that is, for about 15 minutes. The rice should still be hard when you remove it from the heat, and there should not be any liquid in the pan. Spread it in an even layer in the pan and keep it away from the heat until you resume cooking. If the pan is not wide enough for you to spread the rice in a thin layer, transfer it to a sheet pan. Fifteen minutes before serving, bring the remaining stock back to a simmer, and reheat the rice. Resume cooking as instructed.

Nutritional information per serving(four servings): 527calories; 12 grams fat; 3 gramssaturated fat; 44 milligramscholesterol; 69 gramscarbohydrates; 7 gramsdietary fiber; 639 milligrams sodium (does not include salt added during preparation); 31 grams protein

Nutritional information per serving(six servings): 352 calories; 8 grams fat; 2 grams saturated fat; 30 milligrams cholesterol; 46 grams carbohydrates; 5 grams dietary fiber; 426 milligrams sodium (does not include salt added during preparation); 20 grams protein

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

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Can Coffee Ease Asthma Symptoms?

The suspicion stems in partfrom its chemical structure, which resembles that of theophylline, a common asthma medication that relaxes the airway muscles and relieveswheezing,shortness of breathand other respiratory problems. Indeed, when caffeine is ingested and broken down by the liver, one byproduct is small amounts of theophylline.

In a 2007 study in the Cochrane Database of Systematic Reviews, researchers pooled and analyzed the results of a half dozen clinical trials looking at the effects of caffeine on asthmatics. They found that caffeineproduced small improvements in airway function for up to four hours, compared with a placebo, and that even a small dose— less than the amount in a cup of Starbucks coffee— could improve lung function for up to two hours.

In other words, in a pinch, a cup of coffee or strong tea might provide some momentary relief.

But the improvements are very slight, studies show— certainly not enough to make caffeine a replacement for medication. The other problem is that because of their chemical similarities, consuming too much caffeine can compound any side effects of theophylline. As a result,doctors advise people taking that medication to watch their consumption of coffee, tea, chocolate and other foods with caffeine.

THE BOTTOM LINECaffeine’s benefits for asthma are real but minimal.

ANAHAD O’CONNORscitimes@nytimes.com

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