Tuesday, June 7, 2011

Health - Brain Calisthenics for Abstract Ideas

Health - Brain Calisthenics for Abstract Ideas

Brain Calisthenics for Abstract Ideas

Posted: 07 Jun 2011 12:00 PM PDT

Like any other high school junior, Wynn Haimer has a few holes in his academic game. Graphs and equations, for instance: He gets the idea, fine — one is a linear representation of the other — but making those conversions is often a headache.

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Michal Czerwonka for The New York Times

LEARNING TOOLS Joe Wise, a physics teacher at New Roads School, said, "The brain is very good at sorting out patterns if you give it the chance at the right feedback."

Or at least it was. For about a month now, Wynn, 17, has been practicing at home using an unusual online program that prompts him to match graphs to equations, dozens upon dozens of them, and fast, often before he has time to work out the correct answer. An equation appears on the screen, and below it three graphs (or vice versa, a graph with three equations). He clicks on one and the screen flashes to tell him whether he’s right or wrong and jumps to the next problem.

“I’m much better at it,” he said, in a phone interview from his school, New Roads in Santa Monica, Calif. “In the beginning it was difficult, having to work so quickly; but you sort of get used to it, and in the end it’s more intuitive. It becomes more effortless.”

For years school curriculums have emphasized top-down instruction, especially for topics like math and science. Learn the rules first — the theorems, the order of operations, Newton’s laws — then make a run at the problem list at the end of the chapter. Yet recent research has found that true experts have something at least as valuable as a mastery of the rules: gut instinct, an instantaneous grasp of the type of problem they’re up against. Like the ballplayer who can “read” pitches early, or the chess master who “sees” the best move, they’ve developed a great eye.

Now, a small group of cognitive scientists is arguing that schools and students could take far more advantage of this same bottom-up ability, called perceptual learning. The brain is a pattern-recognition machine, after all, and when focused properly, it can quickly deepen a person’s grasp of a principle, new studies suggest. Better yet, perceptual knowledge builds automatically: There’s no reason someone with a good eye for fashion or wordplay cannot develop an intuition for classifying rocks or mammals or algebraic equations, given a little interest or motivation.

“When facing problems in real-life situations, the first question is always, ‘What am I looking at? What kind of problem is this?’ ” said Philip J. Kellman, a psychologist at the University of California, Los Angeles. “Any theory of how we learn presupposes perceptual knowledge — that we know which facts are relevant, that we know what to look for.”

The challenge for education, Dr. Kellman added, “is what do we need to do to make this happen efficiently?”

Scientists have long known that the brain registers subtle patterns subconsciously, well before a person knows he or she is learning. In a landmark 1997 experiment, researchers at the University of Iowa found that people playing a simple gambling game with decks of cards reported “liking” some decks better than others long before they realized that those decks had cards that caused greater losses.. Some participants picked up the differences among decks after just 10 cards.

Experts develop such sensitive perceptual radar the old-fashioned way, of course, through years of study and practice. Yet there is growing evidence that a certain kind of training — visual, fast-paced, often focused on classifying problems rather then solving them — can build intuition quickly. In one recent experiment, for example, researchers found that people were better able to distinguish the painting styles of 12 unfamiliar artists after viewing mixed collections of works from all 12 than after viewing a dozen works from one artist, then moving on to the next painter. The participants’ brains began to pick up on differences before they could fully articulate them.

“Once the brain has a goal in mind, it tunes the perceptual system to search the environment” for relevant clues, said Steven Sloman, a cognitive scientist at Brown University. In time the eyes, ears and nose learn to isolate those signs and dismiss irrelevant information, in turn sharpening thinking.

Good teachers at all levels already have their own techniques to speed up this process — multiplication flash cards, tips to break down word problems, heuristic rhymes — but scientists are working to tune students’ eyes more systematically and to build understanding of very abstract concepts.

Well: Piercing the Fog Around Cellphones and Cancer

Posted: 07 Jun 2011 10:22 AM PDT

Well: A Doctor Who Must Navigate a Contentious Divide

Posted: 06 Jun 2011 02:39 PM PDT

Recipes for Health: Seeded Semolina and Rice Flour Breadsticks

Posted: 07 Jun 2011 11:30 AM PDT

This breadstick has a particularly satisfying crunch. I used a combination of sesame, poppy and sunflower seeds, along with a teaspoon of nigella seeds for flavor.

Recipes for Health

Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat.

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2 teaspoons active dry yeast

1 1/2 cup lukewarm water

1 teaspoon honey, agave nectar, malt extract or rice syrup

1/4 cup extra virgin olive oil

2 cups fine hard wheat durum semolina flour

1 1/4 cups rice flour

About 1/4 cup whole wheat flour or unbleached all-purpose flour

1 1/2 teaspoons salt

1 egg white, beaten

1/2 to 3/4 cup mixed seeds such as sesame, sunflower, poppy, fennel and nigella (more as desired)

1. Dissolve the yeast in the water in a large bowl or in the bowl of a stand mixer. Stir in the honey, agave nectar, malt extract or rice syrup. Let stand for five minutes. Stir in the olive oil.

2. Combine the semolina, rice flour and salt, and add to the liquid mixture. If kneading by hand, stir until you can turn the dough out onto a lightly floured surface; knead for 10 minutes, adding flour as necessary to keep the dough from sticking to your hands and worktop.

If using an electric mixer, mix at medium speed for eight to 10 minutes. Add additional flour as necessary so that the dough comes away from the sides of the bowl. The dough should be elastic and just slightly sticky.

3. Lightly flour your work surface or brush with olive oil. Using your hands or a rolling pin, roll the dough into a 14 x 4-inch rectangle. Make sure there is enough flour or oil underneath the dough so that it doesn’t stick to the work surface. Brush the top with oil. Cover with plastic wrap, then with a damp kitchen towel. Allow to rise for 1 to 1 1/2 hours until nearly doubled. (If you need the workspace, lightly oil the underside of a sheet pan and place the dough on top.)

4. Preheat the oven to 400 degrees with the racks positioned in the middle and upper thirds of the interior space. Brush sheet pans with olive oil. Cut the dough crosswise into four equal pieces. One at a time, cut each piece crosswise into six equal pieces. Roll each piece between the board and your hands as you as if you were making a rope until it is as long as the baking sheet. For a tighter strip, twist the strands from one end to the other. As you shape each breadstick, brush it with beaten egg white and roll it in the seed mixture (1 to 1 1/2 teaspoons of seeds per breadstick). Place 1 inch apart on the baking sheets until you’ve filled two baking sheets. Continue to shape the remaining breadsticks while the first batch is baking.

5. Place in the oven, and bake 15 minutes. Switch the pans top to bottom and front to back, and bake another 10 minutes until the breadsticks are nicely browned (they will be darker on the bottom). Remove from the heat, and cool on a rack. Shape and bake any remaining dough as instructed.

Yield: Two dozen breadsticks.

Advance preparation: The breadsticks will keep for several days wrapped in an airtight container or in foil. They can be frozen and re-crisped in a medium oven for 10 minutes.

Nutritional information per breadstick: 124 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 0 grams cholesterol; 19 grams carbohydrates; 1 gram dietary fiber; 150 milligrams sodium; 3 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

In Update on Sperm, Data Show No Decline

Posted: 06 Jun 2011 10:13 PM PDT

It is one of the most fraught topics in environmental health. Are men becoming less fertile, with declining sperm counts and diminishing sperm quality? If they are, then sperm might be an early warning sign of environmental dangers. And the prime suspects have been substances like plastics and pesticides that can have weak estrogenlike effects on cells.

But now 15 years of data from 18-year-old Danish men taking their military physicals show no decline in sperm counts, after all. The idea that sperm counts were plummeting began with an alarming paper published in 1992 by a group of Danish researchers. Sperm counts, they reported, declined by 50 percent worldwide from 1938 to 1991, and the trend would continue, they said.

Many other researchers criticized the data’s quality, citing flaws like a lack of standardized methods of collecting semen, methodological issues in semen analysis, biases in the ways men were selected, and variations in the length of time men abstained from ejaculating before their semen was collected.

The study, said Dolores Lamb, a fertility expert at Baylor College of Medicine and president-elect of the American Society of Reproductive Medicine, “was problematic and raised alarms in society without critical thinking about the caveats and weaknesses inherent in the data and its analysis.”

Nonetheless, the paper was highly influential. It was cited by 1,000 subsequent scientific papers.

Other researchers soon published their own studies, but methodological problems persisted. And the later studies came to contradictory conclusions, with some saying sperm counts were declining and others saying they were not. The result was a body of evidence so poor that a panel of experts assembled by the National Academy of Sciences in 1999 said its members could not come to a consensus on whether counts were declining, mostly because of seriously flawed studies.

Meanwhile, the same Danish group that got the debate started began a study that analyzed annual semen samples collected from 18-year-old men who were being examined for their fitness for the military — a requirement in Denmark. Over the past 15 years, a total of 5,000 men provided semen for analysis.

That design was an improvement over older studies, Dr. Lamb said. The data are from men of the same age and from one geographic area (sperm numbers and quality can vary from one region to another). Analysis of sperm is better now than it was in years past. And with 15 years of data, she said, any decline in sperm numbers or quality should have been evident.

The problem was that the group did not publish its data, even though, said Dr. Jens Peter Bonde, a fertility researcher at Copenhagen University Hospital, “we have asked for these findings — they are of great public interest.” Dr. Niels Erik Skakkebaek of the University of Copenhagen, who initiated the study, said he wouldn’t comment on the data before the research appears in a scientific journal. And he would not say when that might be.

But the data have been published anyway, in an unusual manner.

In a telephone interview, Dr. Skakkebaek said the research group’s current leader, Niels Jorgensen, sent the data to the Danish Ministry of Health, which helped pay for the study, and the ministry then posted the data on its Web site. Dr. Skakkebaek was angry, saying in an e-mail: “The trend data has not been appropriately scientifically scrutinized. Also, I cannot guarantee that the civil servant in the ministry put our data into the figure without mistakes.”

Now, an American journal, Epidemiology, has published the data in a commentary and discussed them in an editorial.

The commentary, by Dr. Bonde, includes a graph of the data and says they constitute “the best longitudinal semen data yet available.”

The journal’s editor, Dr. Allen Wilcox, said he decided to reproduce the figure from the ministry Web site because the data are so important. Yet, he wrote in the editorial, “the presentation of a few raw data on a Web site — or in a commentary — is hardly the preferred way to advance science.” But, he added, “neither is it acceptable for valuable data to be held in storage.”

Piercing a Tongue, in the Name of Mobility

Posted: 06 Jun 2011 08:40 PM PDT

CHICAGO — Martin Mireles says his mother was not happy with his tongue piercing: It didn’t fit his image as a former church youth leader.

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Steve Kagan for The New York Times

TEST Martin Mireles is part of a clinical trial at Northwestern's medical school.

But as Mr. Mireles told her, it was for research. Paralyzed from a spinal cord injury since he was shot in the neck almost two decades ago, he was recently fitted with a magnetic stud that allows him to steer his wheelchair with his tongue.

Now he is helping researchers at the Northwestern University School of Medicine here in a clinical trial of the technology, being financed with almost $1 million in federal stimulus funds.

Mr. Mireles, 37, tested the equipment one recent afternoon by guiding a wheelchair through an obstacle course lined with trash cans. Mouth closed, he shifted the magnet to travel forward and backward, left and right.

The study was one of about 200 projects selected from more than 20,000 applicants.

“There was a ‘wow’ factor here,” said Naomi Kleitman, a program director at the National Institutes of Health and an expert on spinal cord injury research. “This is kind of a cool idea. The question is: Will it work well enough not to just be cool, but to be practical too?”

A quarter-million Americans have severe spinal cord injuries, and experts estimate that there are about 10,000 new injuries each year. Millions more have some form of paralysis from an array of conditions, including stroke, multiple sclerosis and cerebral palsy.

Wheelchair users do have several options now, including the “sip and puff” technology, used by the actor Christopher Reeve before his death in 2004, in which the chair is steered by breathing through a straw.

But Maysam Ghovanloo, assistant professor of electrical and computer engineering at the Georgia Institute of Technology, wanted to create a technology that would be more aesthetically pleasing — without a straw obscuring the face — and more intuitive for users, with better control and greater flexibility.

After working on the tongue drive system for about five years, Dr. Ghovanloo is now conducting the clinical trials with Northwestern, the Rehabilitation Institute of Chicago and the Shepherd Center in Atlanta.

To operate the system, the user wears a headset with sensors that pick up magnetic signals from the tongue ring. Moving the tongue to the mouth’s upper left corner, for instance, moves the wheelchair forward. (The researchers hope that in the future, touching each tooth could signal a different command, from turning on the television to answering the phone to opening a door.)

Researchers decided to use the tongue because they wanted to take advantage of some of the functions a severely disabled person still had. The tongue does not tire easily, they said, and it is not usually affected by a spinal cord injury because it is directly connected to the brain through a cranial nerve.

At first they just glued the magnet to the user’s tongue, but it often fell off after a few hours. The idea for the piercing came from Dr. Anne Laumann, an associate professor of dermatology at Northwestern who had studied body art.

Ann Carias, a nondisabled volunteer who had her tongue pierced for the study, said it hurt for a few days but healed faster than she expected. When she tested the wheelchair, she said it became easier to steer the more she used it.

Ms. Carias, a 30-year-old Ph.D. student who has several other piercings and large tattoos, said she sometimes felt judged because of her piercings. She thinks the technology will give disabled people more freedom — and could have a side benefit for others as well.

“I think it’s great that something taboo can be used for therapeutic reasons,” she said.

Global Update: Drugs: Steep Vaccine Price Reductions Could Help in Reaching More Children

Posted: 06 Jun 2011 09:40 PM PDT

Several makers of children’s vaccines announced Monday that they would lower prices in the world’s poorest countries, a move that could save donors billions of dollars and help bring the vaccines to more children (above, a polio vaccination in Congo).

GlaxoSmithKline cut the price of its rotavirus vaccine by two-thirds. Merck offered to do the same with its cervical cancer vaccine and to reduce the cost of its rotavirus vaccine by an unspecified amount. Indian companies like the Serum Institute and Panacea Biotec said they would cut their prices on a vaccine protecting against five diseases.

The announcement — made jointly by vaccine manufacturers and the GAVI Alliance, which collects donor money — comes in anticipation of a pledging conference in London next Monday at which GAVI hopes to raise at least $4 billion.

It also comes 10 days after the United Nations Children’s Fund — which actually orders and distributes the vaccines bought by GAVI — for the first time publicly posted the prices it paid each year for the last decade. That revealed wide disparities in prices charged by manufacturers and showed that prices drop when Indian competitors enter the field.

Daniel Berman, deputy director of the global access campaign for Doctors Without Borders, said the cuts “will really make a difference.” He did not know how much Unicef’s disclosure influenced the cuts, but said donors have a “growing awareness” of paying unnecessarily high prices.

News Analysis: Elusive Explanations for an E. Coli Outbreak

Posted: 06 Jun 2011 10:30 PM PDT

The hit-and-miss struggle of German health authorities to identify the contaminated food behind one of the deadliest E. coli outbreaks in recent years underscores the difficulties of following a pathogen through the complex food supply chain, as well as deficiencies in even the most modern health systems in diagnosing this deadly illness.

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Gero Breloer/Associated Press

A doctor treated a victim of the E. coli outbreak at a hospital in Germany on Monday. The source of the germ remains unknown.

After mistakenly suggesting that Spanish cucumbers were the likely culprit several days ago, German authorities focused Sunday on bean sprouts from a German farm, only to report on Monday that the first 23 of 40 samples from that farm had tested negative for E. coli. The results from the remaining samples had yet to come back. That does not entirely eliminate the farm as the outbreak’s origin, since even one positive test is sufficient to make the connection.

But determining the origins of an outbreak that has killed 22 and left 600 people in intensive care presents a difficult mystery to unravel, with vital clues disappearing day by day as contaminated food is thrown away and farm and factory equipment is cleaned. Patients — whose illnesses first alerted health authorities to the outbreak — may have only cloudy memories of the meal that landed them in the hospital. Did the sandwich last month in Hamburg contain sprouts, tomatoes, lettuce, cucumbers — or all four?

After E. coli infection, diarrhea can take a week or more to emerge and it takes another week before the most serious complications, like kidney failure and anemia, occur.

That means that as German investigators interview patients and visit farms to hunt for traces of the germ, the smoking gun may be long gone. Finding the offending food “is sometimes going to be easy and sometimes going to be difficult and I think this is one of those,” said Dr. Robert Tauxe, deputy director of the division that handles food-borne diseases for the United States Centers for Disease Control.

“What did you eat four weeks ago?” Dr. Tauxe said. “You’re dealing with memory here — so it’s hard to pull apart.”

He said that even if hundreds of patient stories pointed investigators to a particular food — say, bean sprouts — it might be impossible to prove conclusively that they are to blame. To do so, scientists must visit the restaurant, farm or food processing plant and find the germ in water, or on food or other material.

“Even if all the samples are negative, maybe you just missed it,” Dr. Tauxe said. “You can go to a place reeking of chlorine, and find nothing.”

Indeed the largest serious outbreak of E. coli, which sickened more than 8,000 people in Japan in 1996 has been widely attributed to eating contaminated radish sprouts, but scientists were never able to prove contamination in the laboratory.

To identify suspected sources, scientists painstakingly question victims about what they have eaten, searching for statistically significant patterns.

Some scientists complain that health systems in the United States and Europe are not using all available tools to better diagnose toxic E. coli; earlier detection would allow for more effective treatment and limit the scope of outbreaks, they say. Routine tests for patients with bloody diarrhea look for other germs — shigella, salmonella and campylobacter — but not E. coli. Such tests are readily available but more expensive.

“This suffered from a lack of primary diagnosis, and that’s crucial because no one is looking for it,” said Dr. Flemming Scheutz, the Copenhagen-based head of a World Health Organization collaborating center that specializes in E. coli. “The first alert didn’t go out until people were hospitalized.”

Likewise, Dr. Scheutz expressed concern that the decentralized German health system had made doctors initially unaware of the scope of the outbreak, familiar only with the cases in their region. A nationwide reporting system collects such information in the United States.

Dr. Lothar H. Wieler, a professor of veterinary medicine at the Free University of Berlin, said he was reluctant to criticize health officials. But he said German vets had a faster warning system for infectious disease than doctors who treated humans did. Germany has strict laws on sharing patient data.

“It would certainly be good to have a reporting system where officials get data very fast,” he said. “That is technically possible but must be implemented.”

But over all, said Frederic Vincent, a European Commission spokesman for health and consumer policy, German officials had acted logically in confronting “one of the worst E. coli outbreaks ever.”

Jack Ewing contributed reporting from Frankfurt.

Abused and Used: A Disabled Boy’s Death, and a System in Disarray

Posted: 07 Jun 2011 11:06 AM PDT

Jonathan Carey did not die for lack of money.

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A Failure to Protect
Witness to Abuse
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Records of Abuse
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High Costs at Centers for Disabled

Abused and Used

Institutional Offenses

Articles in this series examine the treatment of the developmentally disabled in New York State and how money is spent on their care.

New York State and the federal government provided $1.4 million annually per person to care for Jonathan and the other residents of the Oswald D. Heck Developmental Center, a warren of low-rise concrete and brick buildings near Albany.

Yet on a February afternoon in 2007, Jonathan, a skinny, autistic 13-year-old, was asphyxiated, slowly crushed to death in the back seat of a van by a state employee who had worked nearly 200 hours without a day off over 15 days. The employee, a ninth-grade dropout with a criminal conviction for selling marijuana, had been on duty during at least one previous episode of alleged abuse involving Jonathan.

“I could be a good king or a bad king,” he told the dying boy beneath him, according to court documents.

In the front seat of the van, the driver, another state worker at O. D. Heck, watched through the rear-view mirror but said little. He had been fired from four different private providers of services to the developmentally disabled before the state hired him to care for the same vulnerable population.

O. D. Heck is one of nine large institutions in New York that house the developmentally disabled, those with cerebral palsy, autism, Down syndrome and other conditions.

These institutions spend two and a half times as much money, per resident, as the thousands of smaller group homes that care for far more of the 135,000 developmentally disabled New Yorkers receiving services.

But the institutions are hardly a model: Those who run them have tolerated physical and psychological abuse, knowingly hired unqualified workers, ignored complaints by whistle-blowers and failed to credibly investigate cases of abuse and neglect, according to a review by The New York Times of thousands of state records and court documents, along with interviews of current and former employees.

Since 2005, seven of the institutions have failed inspections by the State Health Department, which oversees the safety and living conditions of the residents. One was shut down altogether this year.

While Jonathan Carey was at O. D. Heck, Health Department inspectors accused its management of routinely failing to investigate fractures and lacerations suffered by residents.

Similar problems can be found across the state. The Broome Developmental Center in Binghamton has been cited for repeatedly failing to protect residents from staff members. One employee there was merely reassigned after encouraging adolescent residents to fight one another.

Patterns of abuse appear embedded in the culture of the Sunmount Developmental Center in the Adirondacks. Last year, one supervisor was accused of four different episodes of physical and psychological abuse of residents within a span of two and a half months; another employee bragged on Facebook about “beating retards.”

The most damning accounts about the operations come from employees — thwarted whistle-blowers from around the state — and the beleaguered family members of residents.

Dozens of people with direct experience in the system echoed a central complaint about the Office for People With Developmental Disabilities: that the agency fails to take complaints seriously or curtail abuse of its residents.

“I’ve never seen any outfit run the way this place is,” said Jim Lynch, a direct-care worker in Brooklyn. “You report stuff, and then you get retaliated against. They want everything kept quiet. People that are outspoken attract the heat. I don’t know who to talk to when I see a problem. Nothing ever gets done.”

Paul Borer, a dietitian who works for the agency in the Hudson Valley, said he saw another employee punch a resident twice in the face in 2008, but little ever came of the many complaints he made about the episode, to his supervisors, to the commissioner of the agency at the time, Diana Jones Ritter, and to the office of Gov. David A. Paterson.

“You can see a person get hit, then you can go through three years of writing back and forth and nothing happens, so why even report it?” Mr. Borer said.

Mary Maioriello, who worked at O. D. Heck, reported seeing several cases of abuse, including the repeated beating of a resident with a stick that staff members called “the magic wand.”

Well: Answers About Feeding Dogs and Cats

Posted: 07 Jun 2011 08:37 AM PDT

Well: Is Your Pet Eating Better Than You Are?

Posted: 04 Jun 2011 10:20 PM PDT

Personal Health: Law on End-of-Life Care Rankles Doctors

Posted: 06 Jun 2011 08:50 PM PDT

I shouldn’t be surprised when doctors object to laws telling them how to practice medicine, as does New York State’s new Palliative Care Information Act — not surprised, but in this instance, distressed.

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Yvetta Fedorova

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Vehemently opposed by the Medical Society of the State of New York, the law passed last summer by a two-thirds majority of the Legislature and took effect in February. The legislation was written in collaboration with Compassion and Choices of New York, an organization that advocates for informed choices and greater physical and emotional comfort at the end of life.

The act, which I discussed in this column last August, states that when patients are found to have a terminal illness or condition, health care practitioners must offer to provide information and counseling about appropriate palliative care and end-of-life options. Patients or their surrogates are entirely at liberty to refuse an offer to discuss these options.

California passed a similar law in 2009, and other states are considering them. These measures promise to reduce the cost of care at the end of life, as well as the suffering often associated with it; palliative care is meant to reduce the severity of disease symptoms, pain and stress.

Although there are penalties for violation, it is not the specter of punishment that raises the hackles of some physicians. Rather, they say the new requirement interferes with how they choose to deal with their patients and does not take into account the nuances of a doctor-patient relationship.

In an article in The New England Journal of Medicine last month, Dr. Alan B. Astrow and Dr. Beth Popp of Maimonides Medical Center in Brooklyn wrote that they were troubled by “the law’s heavy-handed intrusion into the doctor-patient relationship.” They stated, “In asserting power over the way in which deep and troubling human questions should be addressed, the New York Legislature seems likely only to generate cynicism at the times when critically ill patients and their families are most in need of honesty, kindness and engagement.”

Another New York physician, Dr. Yashar Hirshaut, an oncologist at NewYork-Presbyterian/Weill Cornell Medical Center who also objects to the act, said in a letter to me that “the new law is going to have a direct negative effect on too many cancer patients.” He wrote that when he explained what the law required to a patient with a life expectancy of six months, her response was, “What, are they trying to kill me?”

How the Law Can Help

This law is not about ending a patient’s life. Rather, it is intended to make the end, when that end is near, as physically and emotionally painless as possible. The law is intended to spare terminally ill patients from futile medical interventions that can detract from the quality of their remaining days.

Despite their opposition to this legislation, Dr. Astrow and Dr. Popp acknowledged that “seriously ill patients and their families need accurate information about prognosis and treatment options; physicians’ repeated failure in this realm is clearly a public health problem that the profession should be required to address.”

David C. Leven, who heads Compassion and Choices of New York, said in an e-mail that “the law simply requires physicians to do what the authors say should be required of them. The profession has not addressed this public health problem. The Legislature did.”

While legislation may not be the ideal way to go about this, the fact is that too many doctors fail to inform their terminally ill patients about the risks of continuing aggressive treatments to the bitter end and the benefits of opting only for treatment of discomforting symptoms through palliative or hospice care.

Doctors are notorious death-deniers, often more reluctant than their patients to admit that it is pointless to pursue treatment that is medically futile. They either fail to mention hospice care or suggest it far too late — usually within a week of death, when hospice personnel have little time to get to know the patient and family and to provide the kind of care that can make for a graceful exit from this world.

Studies have shown that patients with a short life expectancy who choose hospice over continued treatment and last-ditch assists like ventilators and feeding tubes live not only better but, surprisingly, longer on average. Researchers also have found that surviving family members are less likely to experience prolonged depression and grief when their loved ones are spared grotesque medical interventions and receive only comfort care at the end of their lives.

Even knowing these facts, some patients are likely to choose to take advantage of anything and everything in the medical armamentarium that could conceivably grant them extra days, weeks or months of life. And such a choice is the prerogative of every terminally ill patient; the new law does not in any way deny that choice. It merely says that patients should be offered the chance to learn about the alternatives.

Nor does the law prohibit patients (or families) from changing their minds and requesting aggressive measures after an initial acceptance of palliative care.

Communication Skills Needed

Many physicians fear that merely broaching the subject of palliative care will strip terminally ill patients of hope. But I have to wonder whether offering unrealistic hope for a cure, or overly optimistic prognoses, isn’t more harmful to patients and their families. If patients are unaware that the remaining time is short, they may lose the chance to resolve important personal issues, say meaningful good-byes, and leave legacies or memories that survivors can cherish long after death.

Few physicians trained more than a decade ago were taught how to communicate emotionally challenging information to their patients. But in recent years the medical literature and continuing education courses have sought to fill in this gap.

For example, Dr. James A. Tulsky of the Center for Palliative Care at Duke University Medical Center wrote in The Journal of the American Medical Association that “talking about treatment choices at the end of life does not necessarily rob patients of hope. Redirecting the patient’s goal toward realistic hopes and being present with compassion can serve as a powerful act in helping patients make decisions while maintaining a hopeful outlook.”

Dr. Tulsky advised that patients be told, in effect, to hope for the best but to prepare for the worst. Their goals can be broadened to include not just successful treatment, he suggested, but also the measures they want taken if they cannot be cured and advice on how to accomplish important tasks that might otherwise be left undone.

Terminally ill patients may fear not just death, but also that in choosing palliative or hospice care, they will be abandoned by their primary physicians. Disappearing doctors are all too common when curative treatment options are exhausted. If doctors truly want to preserve hope, they owe it to their patients to stick around until the end.

Really?: The Claim: Cranberry Juice Can Cure Ulcers.

Posted: 06 Jun 2011 09:40 PM PDT

THE FACTS

Christoph Niemann

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Cranberry juice has a long history as a home remedy for bladder infections. But scientists in recent years have quietly studied whether it might also work against Helicobacter pylori, the bacterium responsible for most ulcers.

Scientists have known for some time that the juice effectively prevents some species of bacteria from adhering to the cell receptors along the urinary tract, which in theory should reduce the risk of bladder infections. The same mechanism is believed to work against ulcer formation: Compounds in cranberry juice called proanthocyanidins are thought to keep H. pylori from adhering to the lining of the stomach.

Most studies have found that consuming cranberry juice does seem to produce improvement in people prone to ulcers. In one randomized, double-blind study published in the journal Nutrition in 2008, researchers followed 271 children and teenagers who tested positive for H. pylori. Over three weeks, one group drank 200 milliliters of cranberry juice daily, another was given a probiotic supplement containing competing bacteria, and another received a placebo. At the end of the study, the cranberry group had significantly higher “eradication rates” of H. pylori than the placebo group, and a slightly better rate of improvement than the group taking only probiotics.

A study of almost 200 people published in 2005 had similar results. Drinking one cup of cranberry juice daily eliminated H. pylori in three times as many subjects as a daily cranberrylike placebo juice, though some of the subjects experienced no benefit.

THE BOTTOM LINE

Researchers have found that cranberry juice may help prevent ulcers.

ANAHAD O’CONNOR

scitimes@nytimes.com

Letters: United Against Aids (2 Letters)

Posted: 06 Jun 2011 08:30 PM PDT

To the Editor:

Re “30 Years In, We Are Still Learning From AIDS” (The Doctor’s World, May 31): Dr. Lawrence K. Altman cites the role of clinicians, researchers and public health officials in confronting the epidemic. Unfortunately, he does not mention that AIDS was thefirst disease whose patients and affected communities themselves took a lead role in prevention and improving care, through direct education of others and advocacy for real research budgets.

Indeed, in the United States, largely volunteer-run needle exchanges are mainly responsible for the plunging rates of H.I.V. among injection drug users, thereby also preventing transmission.

Understanding community involvement is crucial not only against AIDS, but for appreciating a model that is key to fighting the United States’ high rates of chronic disease.

Chris Norwood

The Bronx

The writer is executive director of Health People: Community Preventive Health Institute.

♦

To the Editor:

Dr. Altman may have written the first piece about the AIDS epidemic in The Times, but he doesn’t mention that this and subsequent articles were buried on the inside pages. Nor does he mention that AIDS became a national issue largely through the efforts of heroic activists in the gay community, led by Gay Men’s Health Crisis and ACT-UP. While he discusses the pioneering work of scientists and physicians, it should be remembered that these advances did not come without sustained pressure from gay advocates.

Steven F. Lawson

and Nancy A. Hewitt

Metuchen, N.J.

Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Letters: Brain Trauma and Art (1 Letter)

Posted: 06 Jun 2011 08:30 PM PDT

To the Editor:

Re “Broad Brushstrokes Obscure a View of Brain Trauma” (Books, May 31): In reviewing my book “Shadows Bright as Glass,” Dr. Abigail Zuger’s chief complaint appears to be that I didn’t write the book she wanted to read. She also professes annoyance that she had no idea what Dr. Jon Sarkin’ s art looks like because pictures were not included in the book. Why Dr. Zuger felt the need to wait until she finished reading the book to view the art is perplexing, since it is widely available online.

More importantly, her contention that I “come up surprisingly short” in the description of Dr. Sarkin’s family life is disturbing, since scores of pages are devoted to Dr. Sarkin’s wife, Kim, and their children, as well as to the problems of living with a post-stroke loved one.

Contrary to Dr. Zuger’s review, the book is not narrated from Dr. Sarkin’s perspective alone, but rather includes the perspectives of his wife, children, friends, doctors, musicians, artists and art critics, et al. This fact may not seem important to a casual reviewer, but it certainly is to an author.

Amy Ellis Nutt

Watchung, N.J.

Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

A Doctor Who Must Navigate a Contentious Divide

Posted: 06 Jun 2011 08:40 PM PDT

After years of weighing in on issues like secondhand tobacco smoke and radon exposure, Dr. Jonathan Samet is accustomed to controversy.

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And last week, Dr. Samet, a University of Southern California physician and epidemiologist, found himself at the center of debate again as chairman of a World Health Organization committee ruling on the health effects of cellphone use. The International Agency for Research on Cancer, which consisted of 31 scientists from 14 countries, concluded that cellphones are “possibly carcinogenic,” putting the devices in the same category as about 260 chemicals, pesticides and other substances, including coffee, that might lead to certain cancers.

The finding, which is the first time a major health organization has concluded there is a possible risk to cellphone use, drew an immediate rebuke from the cellphone industry. It also put Dr. Samet, who has a  presidential appointment to the National Cancer Institute’s advisory board, at odds with two of the country’s top cancer groups. The American Cancer Society said the findings were based on flawed data and should be interpreted with “great care.” More surprising is the fact that a representative from the National Cancer Institute skipped the vote. The institute says the committee member will join dissenters in writing a minority opinion.

“It is our belief that to date the evidence of cellphones causing brain tumors is minimal,” said Dr. Otis Brawley, the society’s chief medical officer. “All the studies pointing to them being associated with brain tumors have significant methodologic flaws.”

Dr. Samet said he knew the panel’s decision would be met with resistance from some quarters.

“I’m not feeling uncomfortable about it,” said Dr. Samet, who said he knew that no matter what decision the panel made, the finding would be controversial.

“No matter what the agency said, one group or another would be likely, predictably, to find fault,” he said. “I was totally cognizant of that. This was an exhaustive review and interpretation of the evidence.”

Dr. Samet said the discussion among the committee members about cellphone safety was “at times contentious,” but the group eventually reached consensus. The committee declined to label the devices as a “probable,” carcinogen, but the majority agreed with the more limited classification of cellphones as “possibly carcinogenic.”

“My feeling is, the word is ‘possible,’ ” Dr. Samet said. “No one should overreact to the word ‘possible.’ ”

Dr. Samet has a long history with the International Agency for Research on Cancer, beginning with work on his first report on tobacco 25 years ago. He also worked on studies related to the cancer risks of radon and secondhand smoke. The work is important, he said, because most countries don’t have the equivalent of the Environmental Protection Agency or the Food and Drug Administration to review the evidence on issues of public health.

“The work they do there on carcinogen classifications has global impact,” he said of the agency. Dr. Samet, 65, graduated from Harvard and earned a medical degree from the University of Rochester School of Medicine and Dentistry. He later completed a master’s degree at the Harvard School of Public Health. A self-described “committed outdoor type,” Dr. Samet said he will run, swim, kayak, cycle or snowshoe, “you name it,” to include exercise in his day.

After medical school, he considered a career in psychiatry and the neurosciences, but he was drafted by the army and ended up working in a military hospital in the Panama Canal zone from 1971 to 1973. During that time, Dr. Samet worked as an anesthesiologist, filling in because of a shortage of doctors in the specialty, an experience that piqued his interest in issues affecting breathing and the lungs.

“It was the early 1970s during so many environmental problems and pollution,” said Dr. Samet. “I became interested in looking at issues of environment and health.”

He is now viewed as an international authority on the effects of smoking and air pollution on health. In addition to his work at the agency, he has contributed to several reports from the surgeon general and was senior scientific editor on two major reports, a surgeon general’s report on smoking in 2004 and a report on secondhand smoke in 2006.

While Dr. Samet rose to national and international prominence for his work on air pollution issues, he is widely known for his skill at managing potentially contentious committee gatherings and harnessing the discussion into a useful policy analysis, said Dr. Frank E. Speizer, a professor of environmental science at the Harvard School of Public Health who has known Dr. Samet for 30 years.

“He is a very good assessor of published literature and does a very good job of directing a committee that’s working on the evaluation of public work,” Dr. Speizer said. “He’s very good at listening to a group of experts reviewing material and helping to keep the discussion going and summarizing appropriately. That’s a role he plays very well.”

Before joining U.S.C., he directed the Institute for Global Tobacco Control at Johns Hopkins and served as chairman of the department of epidemiology.

Dr. Samet says he doesn’t see any meaningful parallels between tobacco as a public health issue and the cellphone debate.

“By 1986, certainly the evidence was in about smoking, and the secondhand smoke story was mounting,” Dr. Samet said. “That’s a contrast to the cellphone story, where there’s a lot of uncertainty.”

Dr. Samet said he hopes the agency findings will prompt environmental health researchers to start a new research effort exploring the health effects of cellphones, particularly on children.

“There wouldn’t be controversy if we had the best information we could have,” Dr. Samet said. “There has not been a sufficiently strategic approach to getting at the difficult scientific questions. We’ve hit the point where today’s children are going to use a cellphone or something like a cellphone for most of their lives. We do need to understand if there is a risk of cancer or anything else.”

Meanwhile, Dr. Samet says he is just getting started in his position as on the National Cancer Advisory Board. There, he said he hopes to pursue an agenda focused on cancer prevention.

“What I particularly enjoy is trying to piece together the pieces of evidence,” Dr. Samet said. “I want to try to understand what we really know and don’t know.”

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Drugs Show Promise Slowing Advanced Melanoma

Posted: 06 Jun 2011 09:30 PM PDT

CHICAGO — Two new drugs have been found to prolong the lives of people with advanced melanoma, representing what researchers say is notable progress against the deadly skin cancer after decades of futility.

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Target Cancer

This series from 2010 chronicles the first human trial of an experimental drug to treat melanoma.

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S. Taylor Chance is a patient.

The drugs represent success in two new approaches to combating cancer: one by attacking a specific genetic mutation that accelerates tumor growth; the other by unleashing the body’s immune system to fight the disease

“This is an unprecedented time of celebration for our patients,” Dr. Lynn M. Schuchter, a melanoma specialist at the University of Pennsylvania, told reporters Sunday in Chicago at the annual meeting of the American Society of Clinical Oncology, where the results were presented.

The drugs do not cure melanoma, except perhaps in rare cases. But experts said they might add two to several months to the expected lifespans of people with advanced melanoma. Right now people with metastatic melanoma — meaning it has spread to distant organs — typically live 6 to 10 months.

In one trial, 84 percent of patients taking the experimental drug vemurafenib (pronounced vem-yoo-RAF-en-ib) were still alive after six months, compared with 64 percent of those getting an older chemotherapy drug, dacarbazine. Using another statistical measure, the risk of dying was reduced 63 percent.

The effect was so marked that the trial was stopped early for ethical reasons, so that patients in the control group could be offered the new drug. Because of that, researchers do not yet know the median survival.

“You don’t need to wait for 50 percent of 675 patients to die to conclude that one drug is much better than the other,” said Dr. Antoni Ribas of the University of California, Los Angeles, who was an investigator in the trial and has been a consultant to the developer of the drug.

The other new drug, ipilimumab (pronounced ip-ee-LIM-yoo-mab), when combined with dacarbazine, extended median survival to 11.2 months compared with 9.1 months for those who received dacarbazine alone. After three years, 20.8 percent of those who got that new drug were alive, compared with 12.2 percent of those in the control group.

The results of both trials were published online by The New England Journal of Medicine in addition to being presented here.

To be sure, more than half of patients with metastatic melanoma would not be helped all that much by either drug. Experts say more needs to be done, especially since melanoma affects more young adults than many other types of cancer.

Even if the new drugs allow patients with metastatic melanoma to live two years, “Two years is nothing when you’re 30,” said Dr. Anna C. Pavlick, head of the melanoma program at New York University.

Still, doctors and patient groups welcomed the progress because until now treatment of melanoma that had spread beyond the skin to distant organs “was terrible even by routine cancer standards,” said Dr. Vernon K. Sondak, chairman of cutaneous oncology at the Moffitt Cancer Center in Tampa, Fla.

Also, the number of melanoma cases has been rising, unlike for many other types of cancer. Doctors say that is because of unprotected sun exposure years ago, the proliferation of tanning salons and perhaps more attention to detecting the disease.

There were about 68,000 new cases of melanoma and about 8,700 deaths last year in the United States, up from 48,000 cases and 7,700 deaths in 2000, according to the American Cancer Society. Particularly fast increases have occurred among people older than 65 and among women 15 to 39 years old.

Vemurafenib is the latest so-called targeted therapy, which inhibits the effects of genetic mutations that spur tumor growth and spread. In particular, the drug counters the effect of a mutation in a gene called B-RAF that was discovered in 2002 to be common in melanomas. (The drug’s name comes from V600E mutation in RAF.)

The drug, which is taken orally twice a day, would be used only by the roughly half of melanoma patients whose tumors have this mutation. The drug significantly shrinks tumors in about half of these patients — or about a quarter of all melanoma patients.

It was developed by Roche and Plexxikon, a biotechnology company in Berkeley, Calif., that was recently acquired by Daiichi Sankyo of Japan. The drug is expected to be approved by the Food and Drug Administration within a few months.

Ipilimumab, the other new drug, releases a brake on the body’s immune system, allowing it to more effectively attack the tumor. Developed by Bristol-Myers Squibb, it was approved in March and is sold under the name Yervoy.

A series of articles in The New York Times last year followed the development of vemurafenib, then known as PLX4032, and recounted how some patients close to death seemed to make miraculous recoveries.

The effect, however, typically lasts only about seven months before the cancer starts to grow again, though some patients benefit for more than two years.

S. Taylor Chance, a 67-year-old real estate agent in Rancho Cucamonga, Calif., has been taking vemurafenib in a clinical trial since March 2010. “If it weren’t for the trial I wouldn’t be here,” she said.

It has not been all good. Ms. Chance said the drug caused such extreme pain at one point that “I called in the children and said, ‘I’m done, I can’t do this any more.’ ” But she had her dose reduced and took other medications for the pain.

In the trial, sponsored by Roche and led by Dr. Paul B. Chapman of the Memorial Sloan-Kettering Cancer Center in New York, 38 percent of participants had to stop taking the drug or lower the dose because of side effects, including rash and joint pain. Many patients get minor skin cancers that can be removed by dermatologists.

The trial of ipilimumab, paid for by Bristol-Myers, involved 502 patients with late-stage melanoma.

Last year at this conference, researchers presented results of a trial showing a survival advantage for patients who had undergone a previous treatment. The new trial of this drug, by contrast, involved patients who were getting treated for the first time.

While the extension of median survival of two months, from about 9 months to about 11 months, was less than some experts expected, researchers said the real benefit was that a small number of patients, perhaps 10 to 20 percent, could live a long time.

Because it unleashes the immune system, ipilimumab can have serious side effects. In the latest trial, a big one was liver damage.

A course of treatment of ipilimumab costs $120,000. The price of vemurafenib has not been announced, but is expected to be at least tens of thousands of dollars per year.

Doctors are eager to try the two drugs together. Roche and Bristol-Myers said Thursday that they would conduct such tests.

Recipes for Health: Whole Wheat Breadsticks With Sesame

Posted: 07 Jun 2011 11:31 AM PDT

Sesame seeds are used both in the dough and the coating of these nutty tasting breadsticks.

Recipes for Health

Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat.

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2 teaspoons active dry yeast

1 1/2 cup lukewarm water

1 teaspoon honey, agave nectar, malt extract or rice syrup

1/4 cup extra virgin olive oil

2 cups whole wheat flour

About 1 1/3 cups unbleached all-purpose flour

1/2 cup sesame seeds

1 1/2 teaspoons salt

1 egg white, lightly beaten

1. Dissolve the yeast in the water in a large bowl or in the bowl of a stand mixer. Stir in the honey, agave nectar, malt extract or rice syrup. Let stand for five minutes. Stir in the olive oil.

2. Combine the whole wheat flour, 1 cup of the unbleached all-purpose flour, 1/4 cup of the sesame seeds and the salt. Add to the liquid mixture. If kneading by hand, stir until you can turn the dough out onto a lightly floured surface; knead for 10 minutes, adding flour as necessary to keep the dough from sticking to your hands and worktop.

If using an electric mixer, mix at medium speed for eight to 10 minutes. Add additional flour as necessary so that the dough comes away from the sides of the bowl. The dough should be elastic and just slightly sticky.

3. Lightly flour your work surface or brush with olive oil. Using your hands or a rolling pin, roll the dough into a 14 x 4-inch rectangle. Make sure there is enough flour or oil underneath the dough so that it doesn’t stick to the work surface. Brush the top with oil. Cover with plastic wrap, then with a damp kitchen towel. Allow to rise for 1 to 1 1/2 hours until nearly doubled. (If you need the workspace, lightly oil the underside of a sheet pan and place the dough on top.)

4. Preheat the oven to 400 degrees with the racks positioned in the middle and upper thirds of the interior space. Brush sheet pans with olive oil. Cut the dough crosswise into four equal pieces. Brush each piece with beaten egg white, then roll each piece in 1 tablespoon of the remaining sesame seeds, until coated. Cut each piece crosswise into six equal pieces. Roll each between the board and your hands as if you were making a rope until it is as long as the baking sheet. For a tighter strip, twist the strands from one end to the other. Place 1 inch apart on the baking sheets until you’ve filled two baking sheets. Continue to shape the remaining breadsticks while the first batch is baking.

5. Place in the oven, and bake 15 minutes. Switch the pans top to bottom and front to back, and bake another 10 minutes until the breadsticks are nicely browned (they will be darker on the bottom). Remove from the heat, and cool on a rack. Shape and bake any remaining dough as instructed.

Yield: Two dozen breadsticks.

Advance preparation: The breadsticks will keep for several days in an airtight container or in foil. They can be frozen and re-crisped in a medium oven for 10 minutes.

Nutritional information per breadstick: 102 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 0 grams cholesterol; 13 grams carbohydrates; 2 grams dietary fiber; 150 milligrams sodium; 3 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Recipes for Health: Building a Better Breadstick

Posted: 07 Jun 2011 11:24 AM PDT

I often get requests from readers for healthy snacks, and whole grain breadsticks fit the bill. Commercially made varieties, however, are rarely healthy -- little more than insipid junk food, just crispy and salty enough to keep you reaching for more. Fortunately, breadsticks are easy and fun to make on your own.

Recipes for Health

Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat.

Related

I’ll start out this week with a simple whole wheat dough and follow up with several variations, including a sesame seed breadstick and one made with semolina and rice flours and a mix of seeds. The rye caraway version is a nice variation on deli breadsticks, and by substituting walnut oil for olive oil, I came up with a walnut breadstick I think you’ll like.

I didn’t test a gluten-free breadstick. If you need one, try substituting the gluten-free flour mix by my colleague Melissa Clark for the wheat flour in this week’s recipes.

Whole Wheat Breadsticks

These grainy breadsticks can be irresistible, but that’s okay -- they’re much healthier than the restaurant variety.

2 teaspoons active dry yeast

1 1/2 cup lukewarm water

1 teaspoon honey, agave nectar, malt extract or rice syrup

1/4 cup extra virgin olive oil

2 cups whole wheat flour

About 1 1/3 cups unbleached all-purpose flour

1 1/2 teaspoons salt

1. Dissolve the yeast in the water in a large bowl or in the bowl of a stand mixer. Stir in the honey, agave nectar, malt extract or rice syrup. Let stand for five minutes. Stir in the olive oil.

2. Combine the whole wheat flour, 1 cup of the unbleached all-purpose flour and the salt. Add to the liquid mixture. If kneading by hand, stir until you can turn the dough out onto a lightly floured surface; knead for 10 minutes, adding flour as necessary to keep the dough from sticking to your hands and worktop.

If using an electric mixer, mix at medium speed for eight to ten minutes. Add additional flour as necessary so that the dough comes away from the sides of the bowl. The dough should be elastic and just slightly sticky.

3. Lightly flour your work surface or brush with olive oil. Using your hands or a rolling pin, roll the dough into a 14 x 4-inch rectangle. Make sure there is enough flour or oil underneath the dough that it doesn’t stick to the work surface. Brush the top with oil. Cover with plastic wrap, then with a damp kitchen towel. Allow to rise for 1 to 1 1/2 hours until nearly doubled. (If you need the workspace, lightly oil the underside of a sheet pan and place the dough on top.)

4. Preheat the oven to 400 degrees with the racks positioned in the middle and upper thirds. Brush sheet pans with olive oil. Cut the dough crosswise into four equal pieces. One at a time, cut each piece crosswise into six equal pieces. Roll each piece between the board and your hands, as if you were making it into a rope, until it is as long as the baking sheet. For a tighter strip, twist the strands from one end to the other. Place 1 inch apart on the baking sheets until you’ve filled two baking sheets. Continue to shape the remaining breadsticks while the first batch is baking.

5. Place in the oven, and bake 15 minutes. Switch the pans top to bottom and front to back, and bake another 10 minutes until the breadsticks are nicely browned (they will be darker on the bottom). Remove from the heat, and cool on a rack. Shape and bake any remaining dough as instructed.

Yield: Two dozen breadsticks.

Advance preparation: The breadsticks will keep in an airtight container or wrapped in foil for several days. They can be frozen and re-crisped in a medium oven for 10 minutes.

Nutritional information per breadstick: 81 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 2 grams monounsaturated fat; 0 grams cholesterol; 13 grams carbohydrates; 1 grams dietary fiber; 146 milligrams sodium; 2 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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