Setback for New Stem Cell Treatment

 

The research involved so-called induced pluripotent stem cells, or iPS cells, which can be made from skin cells and which appear to have the characteristics of embryonic stem cells. That means they can theoretically be turned into nerve, heart, liver or other types of cells and transplanted to repair damaged organs.

The initial creation of human iPS cells in 2007 electrified scientists because the cells seemed to have two big advantages over embryonic stem cells. They were not controversial, because their creation did not entail the destruction of human embryos. And since the stem cells could be made from a particular patient’s skin cells, they could be used to make tissues that presumably would not be rejected by that patient’s immune system.

But that latter assumption was never really tested, until now. When Yang Xu, a biologist at the University of California, San Diego, and colleagues did so, they found that iPS cells made from mouse skin cells were nonetheless rejected by genetically identical mice.

Other scientists said the results, published online on Friday in the journal Nature, were surprising.

“The path to the clinic has just gotten a lot murkier,” said Dr. Robert Lanza, chief scientific officer of Advanced Cell Technology, a company trying to develop medical treatments using both embryonic stem cells and induced pluripotent stem cells.

He said it was not clear that the results in mice would hold true for humans, though some other scientists said they assumed they would.

The new report is just the latest to take some of the shine off iPS cells. In recent months other researchers have reported that the cells are prone to various types of genetic abnormalities.

“As with any new technology, there is always this initial phase of infatuation, and then the reality sets in,” said Dr. George Q. Daley, director of the stem cell transplantation program at Children’s Hospital Boston. “I think it goes to the heart of the issue of how ignorant we really are in understanding these cells.”

Dr. Daley said the finding about the immune reactions “happened to be a particularly startling result that I wasn’t anticipating.”

Still, he added, years of work lie ahead before iPS cells would be ready to use in treating people, so it is too early to be discouraged. Many scientists say iPS cells for now will be used to create cells — like brain cells from someone with Alzheimer’s disease — that can be used to study diseases in the laboratory.

Dr. Xu, whose research was paid for by the National Institutes of Health and by California’s stem cell program, created both embryonic stem cells and iPS cells from an inbred strain of mice and implanted those stem cells into other mice of the same strain.

The mice did not have an immune response to the implanted embryonic stem cells. But their immune systems attacked the implanted iPS cells.

Further experiments suggested that the reaction was caused by the abnormal activation of certain genes in the iPS cells, resulting in the production of proteins that seemed foreign to the immune systems of the mice.

The degree of immune response depended on how the iPS cells were made. The strongest response was to cells made by incorporating genes for certain growth factors into the DNA of the skin cells. Cells made that way are not likely to be used for medical treatments anyway because at least one of the inserted genes can cause cancer.

Dr. Rudolf Jaenisch, a professor of biology at the Massachusetts Institute of Technology and a founding member of the Whitehead Institute, said that in practice, iPS cells themselves would not be implanted into people. Rather, the stem cells would first be turned into specific types of cells, like brain cells or heart cells. He said it was unclear whether such differentiated cells would elicit the same immune response as the stem cells did in the mice.

Jeanne F. Loring, director of the center for regenerative medicine at the Scripps Research Institute, said the new findings would not preclude use of the iPS cells for therapy because immune-suppressing drugs could always be used.

But the potential problem with iPS cells might make some scientists take another look at making patient-specific tissues by creating an embryo from a patient’s cell through so-called therapeutic cloning. That approach, which is not known to have been accomplished using human cells, is controversial because the same technique might also be used to create a baby.

“This reopens the whole need for S.C.N.T, which will be controversial,” said Dr. Lanza of Advanced Cell Technology, referring to somatic cell nuclear transfer, the scientific term for cloning. “We had thought we had put that aside with this technology.”

Rhode Island’s Medicaid Experiment Becomes a Talking Point for Budget Cutters

The experiment is the closest to an example of the kinds of changes that Republicans say they want to make — limiting federal spending for Medicaid while giving states more freedom to decide what benefits to offer and how to control the costs.

But an examination of Rhode Island’s experience shows it has not yielded the kinds of savings its supporters claim.

Federal spending on Medicaid continues to rise in Rhode Island, including payments the federal government would not be making otherwise. And unlike a Republican plan that passed the House last month, under which states could lose a substantial amount of federal financing for Medicaid, Rhode Island is virtually guaranteed more money than the state itself has estimated it needs.

Under the experiment, which was born in a 2009 agreement between the state and the federal Centers for Medicare and Medicaid Services, spending on Medicaid was capped at $12 billion through 2013. The state would be responsible for all costs above that amount, rather than sharing those expenses with the federal government.

In exchange, the federal government granted Rhode Island more flexibility in how it runs its Medicaid program.

State health officials predicted the agreement would allow them to offer better and more efficient health care at less cost to taxpayers.

Some Republican governors, members of Congress and conservative commentators have seized on the Rhode Island experiment as proof that the Republican plan to turn Medicaid into a “block grant” program can work. Under such a program, states would get a set amount of federal money to spend on health care for the poor and disabled, along with the autonomy to decide how best to spend it.

Gary D. Alexander, a Republican and former Rhode Island secretary of health and human services, praised the agreement, which he negotiated, in a paper published this year. He said the state had saved more than $100 million in the first 18 months.

But Mr. Alexander’s Democratic successor, Steven M. Costantino, said he “cannot substantiate those savings at this point.”

Still, Mr. Alexander’s estimates have been widely cited by those who support overhauling Medicaid.

Representative Cathy McMorris Rodgers, Republican of Washington State, is the co-sponsor of a plan introduced last week in Congress to lift rules that forbid states from changing Medicaid eligibility requirements. She considers the Rhode Island agreement to be a model for other states, said her press secretary, Riva Litman.

“That plan is supported by both parties in Rhode Island and has saved hundreds of millions of dollars through competition-driven efficiencies and accountability,” Ms. Litman said.

The Rhode Island agreement shares the same goals as the block-grant plan proposed by Representative Paul D. Ryan, Republican of Wisconsin, and contained in the budget resolution that passed the House last month, said Conor Sweeney, a spokesman for Mr. Ryan. The idea is to give states the “freedom to tailor Medicaid to meet the needs of their unique populations,” he said.

“Rhode Island’s experience underscores the positive gains from loosening Washington’s misguided one-size-fits-all approach that ties the hands of too many state governments,” Mr. Sweeney said. “Governors across the country continue to demand less onerous restrictions from Washington so they can better deliver quality, affordable health care to their Medicaid populations.”

During a Senate Finance Committee hearing in February, Senator Tom Coburn, Republican of Oklahoma, also pointed to the experiment in Rhode Island as a success.

“Why don’t we just block-grant every state, take the rules off and let them do these strategies,” he asked. “Rhode Island’s obviously already figured it out.”

Nursing Homes Seek Exemptions From Health Law

The numbers are stark. Among workers who provide hands-on care to nursing home residents, one in four has no health insurance. Among those who provide care to people living at home, one in three is uninsured.

The new health care law is supposed to fix the problem by guaranteeing access to affordable coverage for all. But many nursing homes and home care agencies, alarmed at the cost of providing health insurance to hundreds of thousands of health care workers, have started a lobbying effort seeking some kind of exemption or special treatment.

Mark Parkinson, president of the American Health Care Association, the largest trade group for nursing homes, says the problem is that reimbursement rates for Medicaid and Medicare, set by government agencies, do not pay them enough to offer their employees medical coverage. “We do not have much ability to increase prices because we are so dependent on Medicaid and Medicare” for revenue, he said.

Mr. Parkinson acknowledged that when nursing homes do offer health insurance to employees, the benefits are often limited. The coverage “is probably not up to what will be required” by the federal law, he said.

Medicaid covers about two-thirds of nursing home residents. States set Medicaid rates, and many states, facing severe budget problems, have reduced payments for nursing homes.

Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize nursing home, that penalty could easily exceed $200,000 a year. Nursing home executives are urging Congress and the Obama administration to spare them from the penalties.

Vanessa Valerio, 25, a certified nursing assistant who earns $10 an hour at Lakeview Christian Home in Carlsbad, N.M., said she was uninsured because she could not afford the coverage offered by her employer.

The chief executive of the Lakeview nursing home, Joanna D. Knox, said the company used to pay the entire premium for employees. It now requires workers to pay $25 of the $585 monthly premium for individual coverage.

“When we started charging $25 a month,” Ms. Knox said, “many employees dropped coverage.” Of the home’s 200 employees, only 87 have elected it, she said, adding, “I don’t know how we could possibly absorb the additional cost of providing coverage for the other employees.”

Charlene A. Harrington, a professor at the School of Nursing at the University of California, San Francisco, said it would be a mistake for Congress or the administration to relieve nursing homes of the obligation to provide coverage to employees.

“It’s scandalous to have nursing home employees taking care of people when they themselves lack coverage and go without care,” Ms. Harrington said. “If employees have health insurance, they are more likely to be treated for illnesses, less likely to pass on infections to nursing home residents and more likely to get early treatment for occupational injuries.”

The rate of injuries in nursing homes is about twice the rate for all occupations, according to the Labor Department. Back injuries are common among those who lift patients and help them get in and out of bed.

Since the law was signed 14 months ago, the focus of lobbying has shifted. A tumultuous battle over the future of the health care system has given way to more concentrated efforts to undo or rewrite particular provisions.

Mr. Parkinson, a former Democratic governor of Kansas who is now the top Washington lobbyist for nursing homes, is pushing several ideas.

One option would give nursing homes more time to comply with the requirement to offer coverage. Another proposal, according to a list of options prepared by lobbyists for the industry, would waive or reduce the penalties for nursing homes “placed in financial distress as a result of the new mandates and fines.” Alternatively, Mr. Parkinson said, Congress could allow nursing homes to take tax deductions for the penalties, which under the 2010 law are nondeductible.

New Jersey Dining | Gluten-Free: Eating Out Gets Easier for Celiac Patients

IN 2009, Deborah Gianelli, 58, of Montclair, was told she had celiac disease, a disorder in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley.

The diagnosis was “devastating,” she said. Pasta and bread were among her favorite foods. She also enjoyed eating out, especially at Italian restaurants. La Riviera Trattoria in Clifton, where she and her family had been regulars for 15 years, was a favorite.

“I thought, ‘Well, that’s the end of that,’?” she said.

Then, a week after Ms. Gianelli’s disease was diagnosed, Maria Carlino, the daughter of Franco and Danica Carlino, the owners of La Riviera Trattoria, also learned she had celiac disease.

For Ms. Gianelli, being in the same dietary boat as Maria Carlino has helped restore her lifestyle.

“I’m at La Riviera once a week now, almost every Friday night,” she said. A gluten-free menu has been in place, along with the regular menu, since shortly after Ms. Carlino received her diagnosis.

Ms. Carlino, 32, of Bernardsville, is the manager of the 1,200-square-foot, 75-seat restaurant. She is also at the forefront of what Susan Goodstadt-Levin of Glen Rock sees as an effort to “normalize” the dining-out experience for celiac patients in New Jersey. Ms. Goodstadt-Levin is a leader, with Diane Caleca McGee of Paramus, of the Northern New Jersey Celiac Disease Support Group, also in Paramus.

“A lot of restaurants have become aware of gluten-free products, and they see the value of having them on their menu,” Ms. Goodstadt-Levin said.

Several chain restaurants, including P. F. Chang’s and Uno’s Chicago Grill, offer gluten-free selections, and a few independent New Jersey restaurants, including La Riviera Trattoria and Hailey’s Harp & Pub, an Irish-themed bar in Metuchen, carry Red Bridge, a gluten-free beer introduced by Anheuser-Busch in 2006. (Park & Orchard, an eclectic restaurant in East Rutherford that offers a celiac-friendly menu, stocks Greens, a double-dark wheat-free beer from Belgium.)

“We started the gluten-free menu two years ago because we just had so many requests,” said Steven Chia, the owner of A Taste of Asia in Chatham; it serves mostly Malaysian cuisine and has been open since 2000.

On a recent afternoon tour of La Riviera Trattoria’s kitchen, Mr. Carlino, of West Caldwell, who is the restaurant’s chef — his son, Antonio Carlino, is the sous-chef — demonstrated what went into accommodating diners who avoid foods containing gluten.

A separate pot is used to boil the pasta. Stainless-steel vats of wheat-free farina, through which cuts of veal and chicken used for parmigiana dishes are dragged, are kept clear of the regular flour vats. Marinara sauces are prepared in a designated skillet with designated products. Even serving dishes are stacked separately.

“We don’t want anybody getting sick,” Mr. Carlino said.

Ms. Carlino hosted two invitation-only gluten-free dinners at La Riviera Trattoria last year. In June, 20 people came. At the second, in November, which included product presentations and sales — Ms. Carlino travels to Italy regularly to investigate new gluten-free foods — attendance swelled to 60. Monday, she will host a third dinner — $50 a person, including appetizers, entree, beverage, dessert and tip — and expects up to 80 people. “That’s all my father can handle,” she said.

The growth in the event may parallel a general increase in the awareness of and interest in gluten-free dining options. According to Diane Holtaway, associate director of client services at the Rutgers Food Innovation Center in Bridgeton, which is part of Rutgers University, “Europe has been ahead of us on gluten-free dining, but now it’s growing by leaps and bounds” in the United States. Dr. Sch?r U.S.A., a division of a European gluten-free food manufacturer, is making gluten-free bread at the center, she said, and building a production plant in Gloucester County.

“Everyone’s seeing there’s a critical need here,” said Ms. Holtaway, of Turnersville. That is evident at two gluten-free New Jersey bakeries. Kathie Schwarz of Millington opened Gluten Free Gloriously in Stirling in 2009 after years of home baking.

Ms. Schwarz, 52, said her disease was diagnosed nine years ago. “I was baking out of my house, out of necessity, because anything you could get gluten-free nine years ago tasted like Styrofoam,” she said. “Now we have people coming from New York, from Pennsylvania.”

Ms. Schwarz, who specializes in Italian bread and wraps, makes her products at the 1,000-square-foot bakery but sells most of them frozen, to avoid staleness. “They defrost great,” she said.

At Fallon’s Gluten Free Bake Shop in Fords, the emphasis is on fresh-baked products. “We do biscotti, muffins, cupcakes, pizza shells,” said Bob Hyer, an owner of the 800-square-foot shop with his wife, Tina, and daughter Fallon. “They’re all fresh, not frozen, because that’s hard for people with celiac to find.” Fallon Hyer, 23, who has celiac disease, is the baker.

The cost of the New York crumb cake, a popular item there ($3.50 a slice), reflects the price of its ingredients.

“One of the hardships when you eat gluten-free is the cost of food,” Ms. Holtaway said. “It’s very expensive, and you have to use totally different ingredients and processes.”

At La Riviera Trattoria, some gluten-free entrees cost $2 to $3 more than their counterparts on the regular menu. Holding up a small package of gluten-free pasta during the kitchen tour, Ms. Carlino said, “A bag of this pasta costs $7 retail.”

Where to Go

These restaurants offer gluten-free options; the bakeries are entirely gluten-free. For a more extensive list of establishments: glutenfreeceliacweb.com.

LA RIVIERA TRATTORIA 421-27 Piaget Avenue, Clifton; larivieratrattoria.com or (973) 478-4181. $16.95 for spruzzo pasta with marinara, basil, garlic and olive oil to $21.95 for veal parmigiana.

HAILEY’S HARP & PUB 400 Main Street, Metuchen; haileysharpandpub.com or (732) 321-0777. $8.99 for “naked” chicken wings to $12.99 for corned beef and cabbage.

PARK & ORCHARD 240 Hackensack Street, East Rutherford; (201) 939-9292 or parkandorchard.com. $19.95 for dairy- and wheat-free lasagne to $27.95 for Jasper’s crabmeat pasta with rice penne or linguine (both include soup or salad).

A TASTE OF ASIA 245 Main Street, Chatham; atasteofasianj.com or (973) 701-8821. $11 for Asian bok choy (baby greens lightly stir-fried with ginger and garlic) to $18.50 for Asam fish fillet (turbot fillet simmered in tamarind broth with vegetables).?

GLUTEN FREE GLORIOUSLY 267 Main Avenue, Stirling; glutenfreegloriously.com or (908) 647-7337. $1 to $2 each for cookies and brownies to $16 for a 14-inch pepperoni pizza.

FALLON’S GLUTEN FREE BAKE SHOP 339 Crows Mill Road, Fords; (732) 710-3338 or fallonsglutenfreebakeshop.com. $3.50 for a slice of New York crumb cake; $8 for a pound-and-a-half loaf of multigrain bread; about $65 for an eight-inch birthday cake.

Merck’s Hepatitis C Drug Wins F.D.A. Approval

The new drug, Victrelis from Merck, effectively cured more than 60 percent of patients in clinical trials when used along with existing drugs. That compared with 20 to 40 percent of patients cured by the existing drugs alone.

“This new medication provides an effective treatment for a serious disease, and offers a greater chance of cure for some patients hepatitis C infection compared to currently available therapy,” Dr. Edward Cox, director of the F.D.A.’s office of antimicrobial products, said in a statement.

An estimated 3.2 million Americans have a chronic infection of the hepatitis C virus. The virus can cause serious liver disease, including cirrhosis and liver cancer, though these problems may take decades to develop and may not develop at all.

The existing treatment consists of nearly a year of weekly injections of long-lasting alpha interferon combined with ribavirin, a pill taken daily. The regimen is considered extremely harsh, with side effects including flulike symptoms, depression and anemia. It is not entirely clear how those drugs work.

Victrelis, also known as boceprevir, inhibits an enzyme, called protease, that the virus needs in order to replicate. By blocking viral enzymes, Victrelis borrows a page from the strategy that has been successful in treating H.I.V.

Vertex Pharmaceuticals is expected to win F.D.A. approval this month for its own hepatitis C protease inhibitor, starting a fierce marketing war with Merck. Based on clinical trial results, analysts generally expect Vertex’s drug to outsell Merck’s. Both drugs received unanimous recommendations from an F.D.A. advisory committee late last month.

Many other companies are not far behind, making hepatitis C one of the hottest areas in the pharmaceutical industry.

“Regardless of the ultimate success of this drug, it’s a harbinger of a great new era in treating patients with hepatitis C,” said Dr. Scott L. Friedman, chief of liver diseases at the Mt. Sinai School of Medicine in New York. While the Vertex drug, called telaprevir, and Victrelis must be used with the existing drugs, the hope is that in several years, three or four new drugs might be combined, as is done for H.I.V., doing away with the need for the interferon injections.

For now, though, the Merck and Vertex drugs could allow some patients to clear the virus from their bodies with shorter durations of treatment. In Merck’s clinical trial, 44 percent of patients who had not previously been treated were able to complete their treatment in 28 weeks instead of the usual 48.

Dr. Ira M. Jacobson, professor of medicine at Weill Cornell Medical College in New York, said many patients have been forgoing treatment in order to wait for the approval of the new drugs. “There are also patients who have tried to be treated in the past, often more than once, and have been waiting for something that gives them a significant chance of success,” said Dr. Jacobson, who is a consultant to both Merck and Vertex and a speaker for Merck.

Victrelis is approved for treatment of the genotype 1 strain of hepatitis C, which represents about 70 percent of the cases in the United States and is one of the toughest strains to treat.

Merck set the wholesale price of Victrelis at $1,100 a week, meaning a full course of treatment will cost $26,400 to $48,400. Although the treatment takes 28 to 48 weeks, Victrelis is not used for the first four weeks.

In Merck’s clinical trials, about half the patients who got Victrelis suffered from anemia, roughly double the rate for those who got only the existing drugs. The risk of having low white blood cell counts was also higher for those who got Victrelis.

Moreover, patients will have to take a lot of pills. Victrelis is taken three times a day, with a total of 12 capsules daily. Ribavirin is taken twice a day, usually with a total of five or six pills. If patients do not take Victrelis faithfully, the virus might become resistant to the drug.

Most people who are infected with hepatitis C virus do not know it, health authorities say. The biggest group consists of baby boomers who might have been infected decades ago through needles used to inject drugs, or through sex, blood transfusions or hemophilia medications.

Health Insurers Making Record Profits as Many Postpone Care

 

The UnitedHealth Group, one of the largest commercial insurers, told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna, another insurer, talked about the “low level” of medical use.

Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care.

Even with a halting economic recovery, doctors and others say many people are still extremely budget-conscious, signaling the possibility of a fundamental change in Americans’ appetite for health care.

“I am noticing my patients with insurance are more interested in costs,” said Dr. Jim King, a family practice physician in rural Tennessee. “Gas prices are going up, food prices are going up. They are deciding to put some of their health care off.” A patient might decide not to drive the 50 miles necessary to see a specialist because of the cost of gas, he said.

But Dr. King said patients were also being more thoughtful about their needs. Fewer are asking for an MRI as soon as they have a bad headache. “People are realizing that this is my money, even if I’m not writing a check,” he said.

For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn’t feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, “I can’t afford to use it.” Delaying care could keep utilization rates for insurers low through the rest of the year, according to Charles Boorady, an analyst for Credit Suisse. “The big question is whether it is going to stay weak or bounce back,” he said. “Nobody knows.”

Significant increases in how much people have to pay for their medical care may prevent a solid rebound. In recent years, many employers have sharply reduced benefits, while raising deductibles and co-payments so people have to reach deeper into their pockets.

In 2010, about 10 percent of people covered by their employer had a deductible of at least $2,000, according to the Kaiser Family Foundation, a nonprofit research group, compared with just 5 percent of covered workers in 2008.

Doctors, for one, say patients’ attitudes are changing. “Because it’s from Dollar 1 to Dollar 2,000, they are being really conscious of how they spend their money,” said Dr. James Applegate, a family physician in Grand Rapids, Mich. For example, patients question the need for annual blood work.

High deductibles also can be daunting. David Welch, a nurse in California whose policy has a $4,000 deductible, said he was surprised to realize he had delayed going to the dermatologist, even though he had a history of skin cancer. Mr. Welch, who has been a supporter of the need to overhaul insurance industry practices for the California Nurses Association union, said he hoped his medical training would help him determine when to go to the doctor. “I underestimated how much that cost would affect my behavior,” he said.

Dr. Rebecca Jaffe, a family practice doctor in Wilmington, Del., said more patients were asking for the generic alternatives to brand-name medicines, because of hefty co-payments. “Now, all of a sudden, they want the generic, when for years, they said they couldn’t take it,” she said.

The insurers, which base what they charge in premiums largely on what they expect to pay out in future claims, say they still expect higher demand for care later this year. “I think there’s a real concern about a bounce-back, a rebound, in utilization,” said Dr. Lonny Reisman, the chief medical officer for Aetna.

Because they say they expect costs to rebound, insurers have not been shy about asking for higher rates. In Oregon, for example, Regence BlueCross BlueShield, a nonprofit insurer that is the state’s largest, is asking for a 22 percent increase for policies sold to individuals. In California, regulators have been resisting requests from insurers to raise rates by double digits.

Some observers wonder if the insurers are simply raising premiums in advance of the full force of the health care law in 2014. The insurers’ recent prosperity — big insurance companies have reported first-quarter earnings that beat analysts expectations by an average of 30 percent — may make it difficult for anyone, politicians and industry executives alike, to argue that the industry has been hurt by the federal health care law. Insurers were able to raise premiums to cover the cost of the law’s early provisions, like insuring adult children up to age 26, and federal and state regulators have largely proved to be accommodating.

But 2014 and 2015 are likely to be far more challenging, as insurers are forced to adjust to the law’s greatest changes, like providing coverage to everyone regardless of whether they have an expensive pre-existing condition. “I think they’re going to go through a winter,” said Paul H. Keckley, executive director of the?Deloitte Center for Health Solutions, a research unit of the consulting firm Deloitte.

And while the slowing down of demand is good for insurers, at least in the short term, the concern is that patients may be tempted to skip important tests like colonoscopies or mammograms. The new health care law will eventually prevent most policies from charging patients for certain kinds of preventive care, but some plans still require someone to pay $500 toward a colonoscopy.

In recent times, insurers have prospered by pricing policies above costs, said Robert Laszewski, a former health insurance executive who is now a consultant in Alexandria, Va. The industry goes through underwriting cycles where the companies are better able to predict costs and make room for profits. “They’re benefiting from a very positive underwriting cycle,” he said.

“Maybe managed care is finally working,” he said. “Maybe this is the new normal.”

Still, he emphasized, health care costs, even if they are rising at 6 percent or 7 percent a year, are increasing at a much faster pace than overall inflation. “We haven’t solved the problem,” Mr. Laszewski said.

Gingrich Calls G.O.P.’s Medicare Plan Too Radical

Mr. Gingrich, the former speaker of the House who led a conservative resurgence in the 1990s, said the Republican Medicare plan was “too big a jump” for Americans and compared it to the health care overhaul championed by President Obama.

“I’m against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change,” Mr. Gingrich said on the NBC program “Meet the Press.”

“I don’t think right-wing social engineering is any more desirable than left-wing social engineering,” he said. “I don’t think imposing radical change from the right or the left is a very good way for a free society to operate.”

The Republican plan calls for the most extensive overhaul of the Medicare program since it was created. It would end direct payment for medical care and would instead subsidize health coverage for older Americans.

While House Republicans have portrayed the plan as a way to address the nation’s long-term financial problems, Democrats and their allies have sought to seize on public concerns over it, arguing that the changes would hurt the elderly, an influential voting group.

After facing waves of protests in public meetings after introducing the Medicare proposal in early April, House Republicans have begun signaling that they are prepared to shelve it, at least for now.

In leveling criticism at the Republican Medicare proposal, Mr. Gingrich appeared to be acknowledging the political difficulties and risk of abruptly changing a highly popular entitlement program.

“I think we need a national conversation to get to a better Medicare solution for seniors,” Mr. Gingrich said, suggesting that any Medicare overhaul would have to include a system in which beneficiaries voluntarily opt out of the program.

Also on Sunday, Representative Paul D. Ryan of Wisconsin, the chairman of the House Budget Committee and the author of the Medicare proposal, defended the plan during an appearance on the CNN program “State of the Union.”

“We have got to reform this program for the next generation if we’re going to save it for the next generation, and that’s what we’re proposing to do,” Mr. Ryan said.

Mr. Ryan also addressed his own future in the interview, saying he was considering running for the seat now held by Senator Herb Kohl, a four-term Democrat from Wisconsin who announced on Friday that he would not seek re-election next year.

Foods With Benefits, or So They Say

In Aisle 5: vitamin-packed water for your immune system. In the dairy case: probiotic yogurt for your insides and milk for your brain.

Push a cart through the D’Agostino store in Midtown Manhattan, or any supermarket anywhere in America, and you just might start believing in miracles — or at least in miracle foods.

In aisle after aisle, wonders beckon. Foods and drinks to help your heart, lower your cholesterol, trim your tummy, coddle your colon. Toss them into your cart and you might feel better. Heck, you might even live longer.

Or not. Because this, shoppers, is the question: Are all these products really healthy, or are some of them just hyped?

The answer to that question matters to millions of Americans who are wagering their money and their waistlines on hot new products in the grocery aisles called “functional foods.”

Food giants like Dannon, Kellogg and General Mills don’t claim these products actually prevent or cure diseases. Such declarations would run afoul of federal regulations. Nor do they sell them as medical foods, which are intended to be consumed under a doctor’s supervision.

Rather, food companies market functional foods with health-promoting or wellness-maintaining properties. Such claims are perfectly legal, provided that they are backed up by some credible science.

All those heart-healthy red hearts on your box of Quaker Oats cereal or that can of Planters peanuts? That happy-colon yellow arrow on the tub of Activia yogurt? It’s all part of the marketing of functional food.

Over the past decade, despite all those sales pitches for “natural,” “organic” and “whole” foods, functional food has turned into a big business for Big Food. And more Americans are buying into the functional story. Sales of these foods and beverages totaled $37.3 billion in the United States in 2009, up from $28.2 billion in 2005, according to estimates from the Nutrition Business Journal, a market research firm.

But as sales soar, federal regulators worry that some packaged foods that scream healthy on their labels are in fact no healthier than many ordinary brands. Federal Trade Commission officials have been cracking down on products that, in their view, make dubious or exaggerated claims. Overwhelmed regulators concede that they are struggling to police this booming market, despite recent settlements with makers of brands like Kellogg’s Rice Krispies and Dannon’s Activia, which the authorities say oversold their health benefits.

Consumer advocates and some nutritionists are equally blunt. They say shoppers are being bamboozled by slick marketing. Many people grab products with healthy claims on the front of the package and overlook crucial nutritional information, like calorie counts, in the small print on the back.

“Functional foods, they are not about health,” says Marion Nestle, a professor of nutrition, food studies and public health at New York University. “They are about marketing.”

Walk through any supermarket, and you’ll see what Ms. Nestle means.

Here in Aisle 2 is a box of Quaker Oatmeal Squares cereal, made by the Quaker Oats Company. The front of the box, in large white print, proclaims: “Oatmeal helps reduce cholesterol!” Scientists generally agree that fiber can be good for your heart. But read the adjacent smaller print, which the Food and Drug Administration requires, and you’ll find that one serving of Quaker Oatmeal Squares contains only a third of the amount of soluble fiber needed daily to help reduce the risk of heart disease. In other words, you may have to eat three bowls of cereal daily — 630 calories’ worth, without milk — to benefit.

Down the aisle is Welch’s 100% Grape Juice, with no fat and emblazoned with a red-heart certification from the American Heart Association. An eight-ounce glass has 36 grams of sugar; a regular-sized Snickers, by comparison, has 30.

No one is saying that these products are unsafe or unhealthy, or that there isn’t science behind them. But nutritionists like Ms. Nestle contend that the kaleidoscopic array of functional foods on offer, with all those different claims, has left many consumers confused about the products’ actual health value. And, in some cases, regulators say, manufacturers are bending, or even breaking, the rules about how they market these products.

“If people can’t rely on even the most trusted food brands to have good science backing up their claims, who can they rely on?” asks Mary K. Engle, the director of the advertising practices division at the Federal Trade Commission in Washington.

Slow Recovery Worsens Financial State of Medicare

The estimates, in the annual report by the Medicare trustees, were immediately swept up into the already inflamed political battle over federal spending, debt and the future of entitlement programs.

The trustees said that payroll tax revenues, which provide most of the money for Medicare’s hospital insurance trust fund, were lower than expected last year because earnings were “considerably lower than projected” and the economy was weaker than expected.

Republicans said the bleaker picture for Medicare showed a need for immediate action to shore up the finances of the program, which insures 47.5 million people who are 65 and older or disabled.

“The biggest threat Medicare faces right now is the status quo,” said the House speaker, John A. Boehner, Republican of Ohio. “The trustees’ report makes it clear that if we do nothing, Medicare will not be able to pay promised benefits to American seniors.”

Democrats said that the financial outlook for Medicare would have been much worse without the new health care law. The law, which President Obama cites as one of his greatest political accomplishments, promises to be a central point of conflict in the 2012 presidential election.

Without the new law, said Kathleen Sebelius, the secretary of health and human services, “Medicare would have gone bankrupt in 2016, only five years from now.”

Senator Max Baucus, Democrat of Montana and chairman of the Senate Finance Committee, said, “The current economic crisis has hit the Medicare trust fund, and hit it hard.” Mr. Baucus, an architect of the new law, and other Democrats vowed to resist Republican efforts to repeal it.

The trustees said the financial outlook for Social Security had changed little. They said the Social Security trust fund would be exhausted in 2036, one year sooner than projected in last year’s report, and even then, they said, tax revenue would be sufficient to pay three-fourths of promised benefits through 2085.

It is inconceivable that politicians would allow either program to run out of money. The projected dates of insolvency are widely used as a measure of the financial condition of Social Security and Medicare, which together account for more than one-third of all federal spending.

In unveiling the new estimates, Treasury Secretary Timothy F. Geithner, the managing trustee of the trust funds, noted the need for additional borrowing to keep the government’s myriad commitments in other programs.

“On Monday,” Mr. Geithner said, “just three days from today, the United States will reach the debt limit set by Congress. Because Congress has not yet acted, we have now set in motion a series of extraordinary measures that will give Congress some additional time to raise the debt limit.”

As a condition of increasing the debt limit, many Republicans are demanding changes in benefit programs. But House Republicans have discovered that they are playing with political dynamite when they propose major changes in Medicare.

The reports were signed by the six trustees: three cabinet officers, the Social Security commissioner and two public representatives.

The Medicare report included a disclaimer by the chief Medicare actuary, Richard S. Foster. “The financial projections shown in this report for Medicare do not represent a reasonable expectation for actual program operations” in the short term or the long range, said Mr. Foster, a civil servant whose independence is protected by law.

The projections assume that Medicare will cut doctors’ fees by 29 percent on Jan. 1, as required under current law, but Congress routinely intercedes to block such cuts.

Moreover, the report says that projected Medicare costs over 75 years are about 25 percent lower because of the new health care law.

Under the law, Medicare will hold down payments to hospitals and other health care providers to reflect presumed increases in productivity. But, Mr. Foster said, if these constraints are kept in place, Medicare payments to providers will eventually be “far below the levels paid by private health insurance.”

Studied: Rejection May Hurt More Than Feelings

THE GIST Being socially rejected doesn’t just feel bad. It hurts.

THE SOURCE “Social Rejection Shares Somatosensory Representations With Physical Pain,” by Ethan F. Kross, Marc G. Berman, Walter Mischel, Edward E. Smith and Tor D. Wager; published in Proceedings of the National Academy of Sciences.

NOBODY would deny that being ostracized on the playground, mocked in a sales meeting or broken up with over Twitter feels bad. But the sting of social rejection may be more like the ouch! of physical pain than previously understood.

New research suggests that the same areas in the brain that signify physical pain are activated at moments of intense social loss. “When we sat around and thought about the most difficult emotional experiences, we all agreed that it doesn’t get any worse than social rejection,” said the study’s lead author, Ethan F. Kross, an assistant professor of psychology at the University of Michigan.

The image of a bunch of social scientists inflicting pain on laboratory volunteers seems creepily Mengelian, but in this case the experiments involved were markedly less cruel. First off, the subjects weren’t socially rejected by the laboratory technicians — each of the 40 volunteers was recruited specifically because he or she felt intensely rejected as a result of a recent (unwanted) breakup.

Once in the lab, participants were hooked up to functional M.R.I. scanners, which measure brain activity. They were then asked to look at photos of their former lovers and brood over a specific rejection experience involving that person. (Sob.) Later, they were asked to look at a photograph of a friend and to think about a recent positive experience they had with that person.

On to more fun! Next was the physical pain component, also in two parts. First, participants experienced noxious thermal stimulation on their left forearms (the “hot trial”), simulating the experience of spilling hot coffee on themselves. Then, they underwent a second, nonnoxious thermal stimulation (the “warm trial”). Technicians monitored their brain activity to see which areas lighted up.

Lo and behold, bad breakups and hot coffee elicited a similar response in the brain, at least as measured by fMRI machines.

Previous research had shown that while social rejection hurt, it did not activate parts of the brain associated with physical distress. But this team found that when the emotional pain was awful enough, those parts of the brain were affected as well, and in equal part. According to the authors, the emotional pain simulated in previous experiments (being told a stranger dislikes them, looking at rejection-themed paintings) wasn’t powerful enough to elicit a true-to-life response. “We were shocked because no prior research had demonstrated this same connection,” Dr. Kross said.

What the team doesn’t yet know is what region of the body feels the physical pain or whether it’s diffused. And while people have long taken painkillers to cope with emotional distress, there’s no telling, in this instance, whether a Tylenol can help.

Vital Signs: Screenings: When It’s Too Soon for a New Colonoscopy

While many uninsured patients cannot afford to undergo colonoscopy screening as often as they should, a new study suggests many older Medicare beneficiaries receive the colon cancer test too often.

In a sample of 24,000 Medicare beneficiaries 66 and older, almost half of those who had a normal colonoscopy between 2001 and 2003 underwent a repeat exam within seven years, instead of waiting the recommended 10 years, researchers reported in a study published online on May 9 in Archives of Internal Medicine.

Yet, 42 percent of those repeat patients had no symptoms indicating another screen had been necessary — meaning that almost one in four had a second colonoscopy for no apparent reason.

Although current guidelines recommend against routine screening after age 75, the researchers found that many patients in their late 70s and 80s with a normal test also repeated it within seven years.

With rare exceptions, the costs, nearly $1,000 per colonoscopy, were paid by Medicare.

Colonoscopies do pose some small risks, including perforation of the colon. “This screen is not benign,” said Dr. James S. Goodwin, the study’s lead author. “When you do it every 10 years, the benefit far outweighs any potential harm. But you get no added benefit by screening every five years, and you double the harm.”

Dessert, Laid-Back and Legal

With names like Lazy Cakes, Kush Cakes and Lulla Pies, these products are sold online and at stores like 7-Eleven, Walgreens, smoke shops and even at the Harvard Square Coop, the university’s student bookstore, for roughly $3 to $4 each. (A bottle of 60 8-milligram melatonin tablets costs about $11.) At some places, the drug-packed desserts can be paid for with food stamps.

Although the Food and Drug Administration has not approved melatonin as a food additive or deemed it safe, the dessert makers are marketing their products as a harmless way to promote relaxation. And the snacks are increasingly being endorsed by fans on Facebook and Twitter as an antidote to stress and sleep deprivation. (Who needs yoga?) On the Facebook page for Lazy Cakes, one woman who said she has bipolar disorder wrote that the treat “helps a lot with my sleeping and panic attacks I can lay off my Xanax a little.”

Gabby Bevel, 22, a writer from Norman, Okla., and an insomniac who took Ambien and Lunesta in high school, said in an interview that she slept 13 hours after eating one Lazy Cakes snack recently. “I don’t like the idea of needing something unnatural to help me with anything,” she said. “Really, I think part of the appeal is it does come in a brownie.”

But these snacks contain roughly 8 milligrams of melatonin per brownie or cookie, so selling them is similar to a parent serving an unsuspecting child applesauce containing a crushed aspirin tablet to make it go down easier. “It’s making it much more difficult for the consumer to recognize that they are taking a drug,” said Dr. Charles A. Czeisler, the chief of the division of sleep medicine at Harvard’s Brigham and Women’s Hospital.

Nick Collado, a 26-year-old insomniac and the founder of Lulla Pies, argued that the melatonin they contain, while synthetic, is more “natural” than the Ambien he used to take. “I realized there’s got to be more people like me who don’t want to take prescription drugs anymore, who want to take an alternative,” Mr. Collado said.

But Dr. David S. Seres, the director of medical nutrition at Columbia Medical Center, cautioned that consumers should consult their doctors before trying such products.

“The promoters of these are appealing to people who think it’s better to do things outside of the medical establishment,” he said, adding that “the desire to help people is an extremely strong motivator, but so is money.” He pointed to a section of the National Institutes of Health’s Web site that lists several drugs, including sedatives like clonazepam and birth control pills, whose efficacy might be altered by melatonin.

“A hangover effect has been reported” with large doses, said Anna Rouse Dulaney, a toxicologist with the Carolinas Poison Center. But she added, “I don’t want to go on the record saying this drug ‘can’ cause respiratory issues, that should be a ‘may.’?”

Lazy Cakes appear harmless, even amusing, with swirly purple packaging; Kush Cakes have a tie-dye-printed wrapper. But they are not to be underestimated.

Of melatonin, Dr. Seres warned, “If you take it while you’re driving a car, you will find yourself in a ditch.”

Maybe. Dr. Alfred J. Lewy, a professor of psychiatry at Oregon Health and Science University who has studied melatonin, a neurohormone, estimated that only a third of the population is susceptible to its effects in a supplement.

And yet Tracy Evans, who owns a bar where musicians perform in Erie, Pa., that has sold hundreds of Lazy Cakes, said she instructs employees to tell partygoers, “I highly recommend you wait to where you’re going to be at the end of the night before eating.”

Why? “It knocks you out — in a good way, not a bad way,” said Ms. Evans, 34. “For me, it’s not to chill. For me, it’s to get a good night’s sleep.”

Yet the products, intended for adults only, are being marketed as a novel way to relax in a stressed-out, wired world. Labels on Lazy Cakes and Mary J’s brownies that were bought online urge users to “Take ? brownie, two times a day.” With tiny type, the labels warn against operating heavy machinery or driving.

But some medical professionals are concerned that the chocolate taste might encourage indiscriminate gobbling.

“It’s a colossally bad idea to put melatonin in food,” Dr. Czeisler said. “It should not be permitted by the F.D.A.”

Technically, it is not. Stephanie Yao, a spokeswoman at the F.D.A., wrote in an e-mail that any item that uses melatonin “as an additive may be subject to regulatory action.”

That is why the makers of these new baked goods label them “Not for food use.” They want them to be considered dietary supplements, which do not need the F.D.A.’s premarket approval and are not required to be proved safe or effective.

“It sounds to me like they are trying to claim that the entire brownie is like a tablet, which is, of course, preposterous,” Dr. Czeisler said.

Tim Barham, the vice president of HBB, the maker of Lazy Cakes, said, “We look at the brownie as a supplement.”

News reports have classified Lazy Cakes as dietary supplements, but last month, Douglas Karas, an F.D.A. spokesman, said in an e-mail that the agency “has?not made a determination on Lazy Cakes’ status as either a food or a dietary supplement.”

In January last year, the F.D.A. sent a warning letter to Peter Bianchi, the creator of Drank, a purple drink with 2 milligrams of melatonin in each can that went on the market in 2008, spawning several competitors.

The letter cited safety concerns about melatonin in food, specifically research indicating that melatonin reduced glucose tolerance for people with Type 1 diabetes and that some men using it had reported enlarged breasts. It also warned that women who are pregnant or trying to conceive should avoid melatonin “based on possible hormonal effects.” (Drank’s bottle now say it is a dietary supplement.)

Dr. Lewy dismissed the idea that harm might lurk in a melatonin-laced brownie. “It really doesn’t have any documented side effects except for making you sleepy at bedtime, which is good,” he said. That said, he would not advise eating Lazy Cakes, partly because he was not sure that their other purportedly sleep-inducing ingredients like valerian root work and partly because food delays rather than hastens the absorption of melatonin.

Also, Dr. Lewy said, “I don’t need the calories.”

The Health Consumer: Speed Bumps on the Way to an A.D.H.D. Diagnosis

In school, she would procrastinate and then pull desperate all-nighters to study for an exam. She’d become hyperfocused on a project and let everything else fall by the wayside. Maintaining relationships was tricky. “I would concentrate intensely on a friend and then move on,” she said. She commuted to college one year simply because she had missed the deadline to apply for housing.

“I managed to achieve a lot, but it was difficult,” said Ms. Goldberg, a mother of three who lives near Philadelphia. “I sensed something was wrong, but others would always talk me out of it.”

Finally, in her late 40s, Ms. Goldberg was given a diagnosis of attention deficit hyperactivity disorder, a condition caused by signaling problems in the brain. The primary symptoms are impulsiveness, inattention, restlessness and poor self-regulation. Children with the condition tend to be hyperactive, but adults who have it often just seem distracted and disorganized.

Undiagnosed, A.D.H.D. can wreak havoc on relationships, finances and one’s self-esteem. Adults with the disorder are twice as likely as those without it to be divorced, for instance, and four times as likely to have car accidents. It’s no surprise that they also tend to have poor credit ratings.

“A.D.H.D. is a very debilitating mental disorder,” said Russell Barkley, a clinical professor of psychiatry at the Medical University of South Carolina. “It can produce more severe impairment, and in more domains of life, than depression or anxiety.”

More than 5 percent of adults have A.D.H.D., according to a recent study by Dr. Barkley. But just 10 percent of those adults have a formal diagnosis.

It’s an expensive problem for many consumers. Adults with the condition, particularly women, are frequently given a diagnosis of depression, anxiety or bipolar disorder instead — or their symptoms are dismissed, as Ms. Goldberg’s were.

Ms. Goldberg said of her eventual diagnosis: “It was so freeing. I realized, ‘I’m not stupid — I have a mental disorder.’?”

Just getting the correct diagnosis can be costly. “Many clinicians do not know how to spot the signs,” said Ari Tuckman, a psychologist in West Chester, Pa., and author of a book about A.D.H.D., “More Attention, Less Deficit” (Specialty Press, 2009).

Clinicians may arrive at the diagnosis with a snap judgment, or they may send patients for lengthy and expensive neuropsychological evaluations. Both approaches tend to miss the main symptoms — and therefore waste the patient’s time and money.

If you think that you may have A.D.H.D., or that a friend or family member may, the first thing to do is get a proper diagnosis. Here’s how to get tested and what to avoid.

Step 1: Test yourself.

Cost: Free.

If you’re not quite sure if you or a family member has the disorder, start by printing out the Adult A.D.H.D. Self-Report Scale and answering the 18-question assessment. It was developed by a team of psychiatrists in conjunction with the World Health Organization, and it is used by many clinicians to diagnose A.D.H.D.

The test is simple and has a straightforward scoring system. Use the results only as a guide to gauge your symptoms or a family member’s; it should not serve as a final diagnosis.

Bear in mind that A.D.H.D. is not something you suddenly develop as an adult; you are born with it. “If you tell me, ‘My life was fine until I was 24,’ you don’t have this disorder,” said Dr. Barkley.

Avoid: Snap diagnoses.

Diagnosing this disorder takes time. A quick assessment, even by your favorite doctor or therapist, can miss important signs.

“I can’t guess how many clients I have had who have seen other psychologists, psychiatrists and primary care physicians who missed their A.D.H.D., even though it was burning like a bonfire,” said Dr. Tuckman. “It’s possible to make a diagnosis by using a rating scale and a 10-minute discussion, but it’s also far too easy to make an inaccurate diagnosis or miss a diagnosis.”

Step 2: Find an experienced clinician.

Cost: $200 to $500.

Make an appointment, or more than one, with a psychiatrist, psychologist or neurologist who has expertise in diagnosing A.D.H.D. Ask your doctor or a psychotherapist for a recommendation, or contact a local chapter of the organization Children and Adults With Attention Deficit/Hyperactivity Disorder (informally known as Chadd) and inquire about local professionals.

Dr. Barkley also suggests calling a nearby medical school or university psychiatry program and asking whether there is a doctor on staff who specializes in adult A.D.H.D.

Gold Mania in the Yukon

  Finlay MacKay for The New York TimesShawn Ryan outside Whitehorse, Yukon Territory.

When I first met Shawn Ryan and Cathy Wood, in 2005, they were living with their two young children in a small cabin outside Dawson City, at the northernmost end of the paved road system in Canada’s Yukon Territory. It was a beautiful site in the summertime, with clear water lapping the banks of the Klondike River and the sky still bright at midnight. But the sun hit their roof for the last time each year in early December and didn’t show up again for six weeks. Temperatures in the dead of winter could reach 50 below zero. Wood sometimes feared that their children would freeze. Back then Ryan and Wood already knew they had found gold, but they didn’t have proof.

A rock sample from one of Shawn Ryan's first gold discoveries in the Yukon.

Recently, I went to see them again in their new home in Whitehorse, the territorial capital, and I sat with Ryan one night as he talked business over the phone. His right arm was stretched around the back of his head, holding his BlackBerry to his left ear. “Those guys were at 6 cents a share last year, now they are over a buck, and they got nothing,” he said. “When you look at it, it’s like a hundred claims.” The shares Ryan was talking about belonged to a mineral-exploration company, one of his many competitors. The claims are mining claims, a government license to extract minerals from a 50-acre patch of wilderness. To Ryan, a hundred claims is pathetic. He and Wood own more than 35,000 claims. “We just passed Luxembourg, and over the summer we’ll be the size of Samoa,” he continued, describing just one of his projects. Credible estimates of the amount of gold still buried in his properties run to the billions of dollars.

Ryan is the king of a new Yukon gold rush, the biggest since the legendary Klondike stampede a century ago. Behind this stampede is the rising price of gold, and behind this price is fear. As the Federal Reserve keeps interest rates very low to stimulate the economy, gold bugs make nightmarish predictions that loose money and a huge federal deficit will crush the value of the dollar and bring ruinous inflation. Gold holds its value when national currencies collapse and is easily imported and universally traded. It feels like the perfect investment for the apocalypse. A few weeks ago, gold passed $1,500 an ounce, an astonishing level. George Soros warned of a bubble back when gold was barely over $1,000. Glenn Beck cried that the run was just beginning: just wait until the United States is bankrupt and the real trouble starts. Gold bulls talk of $2,000 gold, $5,000 gold, even $10,000 gold. But 10 years ago, when Ryan made his first discoveries, nobody cared at all.

Ryan has been in the woods his whole life. At age 15, he was snaring foxes, martens and mink near Timmins, Ontario, where his father worked in a mine. Trapping in Canada is regulated through licenses called trap lines, and Ryan didn’t have a trap line of his own, he just went where he pleased. This is called poaching, and eventually he was caught. Instead of turning him in, the trapper he was poaching from put him to work. Ryan would skin animals until midnight, then go to school without bathing. Looking back, he understands why he was socially isolated. In his 20s, Ryan came west to work a trap line of his own in the sparsely populated expanse of the Yukon, but his plan changed when he learned about mushrooms.

Twenty years ago there was a kind of gold rush in mushrooms that enticed itinerant pickers to make a long circuit through British Columbia, Alaska and the Yukon, collecting chanterelles, matsutakes and morels. The market was driven by demand in Paris and Tokyo, and brokers built a network of little buying stations wherever mushrooms were fruiting. It was cash on the ground, and the pickers taunted one another with stories of thousand-dollar days. Ryan eventually settled near Dawson, once the roaring center of the Klondike gold fields, now a community of about 2,000 people surrounded by wilderness and close to good morel-picking territory.

Ryan met Wood in 1992 at the height of the mushroom season. He was down in Whitehorse shopping for supplies when he noticed a young woman standing outdoors in spangled tights selling bundles of sage. Wood, who was from New Brunswick, had been working for a Toronto bank, but she didn’t like it. After she quit, she took her savings and rode across the continent on a motorcycle. By the time she got to Whitehorse, her cash was gone. When Ryan walked up, she was reorganizing the last of the sage into smaller packets so she wouldn’t run out of stock before something else turned up. He was a striking person, compact and strong, with hair braided nearly to his waist. And he had a good thing going: the banks of the White River should be thick with morels. Did she want to come pick with him?

Louisiana Spillway Opened to Relieve Flooding

  Patrick Semansky/Associated PressWater diverted from the Mississippi River spills through a bay in the Morganza Spillway in Morganza, La., on Saturday.

MORGANZA, La. — After declaring that “public safety is our No. 1 priority,” officials from the Army Corps of Engineers opened the Morganza spillway, sending water from the engorged Mississippi River rushing into the pastures and cropland here to forestall potentially catastrophic damage farther downstream.

As Col. Ed Fleming, commander of the corps’ New Orleans district, had said beforehand, one bay of the giant structure was opened Saturday at 3 p.m. local time, sending water out at a predicted 10,000 cubic feet per second. If current forecasts hold, officials would eventually open enough bays to allow water out at 125,000 cubic feet per second, a quarter of the spillway’s capacity.

That diversion would relieve the already enormous pressure on the levee system as the river courses past Baton Rouge, New Orleans and a corridor of chemical plants and oil refineries. But it would also flood hundreds of thousands of acres of farmland and thousands of homes, as it pours out into the Atchafalaya River basin. Evacuations have been taking place for days in the towns and communities throughout the basin, along with large scale operations to protect these towns with sand bags and other barriers.

The Morganza, one of four floodways in the Mississippi River and tributaries flood control system, has only been opened once, in 1973. “We’re using every flood control tool that we have in the system,” said Gen. Michael J. Walsh, commander of the Mississippi Valley Division of the Corps of Engineers.

General Walsh added that the system was still under “tremendous pressure” and would remain so for weeks as the crest slowly moves down the river to the Gulf. The Morganza, which is triggered to open when the river is flowing at 1.5 million cubic feet per second past the Red River Landing north of Baton Rouge, was likely to remain open for weeks, ensuring that the river remains below that flow rate downstream. Any more pressure would put the levees past their design capacity.

With the opening closed to the general public, the occasion did not have the festive, tailgate atmosphere as when another spillway outside of New Orleans, the Bonnet Carre, was opened earlier this week. But there were some who wanted to mark — and capitalize on — this historic moment:? a stand by the road into town was selling T-shirts for $20 that read: “Morganza Spillway 2011 Gates Finally Opened.” A live video stream has been set up by the Corps to show the flooding.

Just about everyone in southern Louisiana had come to expect the decision to open the spillway and had resigned themselves to the bitter but necessary trade-off behind it.

The water will take days to pour out into the Atchafalaya River basin, filling up marshes, engorging bayous, submerging hundreds of thousands of acres of farmland and seeping into thousands of homes. It will also test the network of federally and locally built levees that wall off towns and small Cajun communities throughout the basin. The water levels in the area will remain high for weeks.

According to maps released by the corps, these areas would be flooded to some degree whether the spillway was opened or not, given the extraordinary amount of water in the system.

There are about 2,500 people in the direct path of the spillway, and around 22,500 others who would be threatened by swollen backwaters. Gov. Bobby Jindal urged people remaining in these areas to begin evacuating.

Noam Cohen in New York contributed reporting

News Analysis: Chicago Braces for the Unknown and a New Mayor

Desk or no desk, however, Rahm Emanuel was already sounding like the mayor. He announced that outsiders would lead the Police Department and the school system. He pressed for state legislation that would let him increase the length of Chicago’s school day. He warned of painful budget cuts immediately ahead, $75 million in his first 100 days.

“We can’t continue with the government we have,” Mr. Emanuel said in an interview in a hotel lobby down the street from City Hall. “It has not been fundamentally reformed.”

After 22 years under the reign of a single, singular mayor and much of the last half-century with someone named Daley at the helm, even the slightest adjustment would feel enormous to Chicago. But Mr. Emanuel, who will officially take over on Monday after a ceremony in Millennium Park, the city’s front yard, is promising seismic shifts.

A 71-page, slickly bound transition plan Mr. Emanuel issued last week used the word “change” 19 times. Many here — including members of a City Council accustomed to Mr. Daley, whom they rarely bucked, and city workers, who fear that Mr. Emanuel will clean house, cut benefits and privatize city services — are bracing for something Chicago, the nation’s third largest city, has rarely known: the unknown.

“You don’t have a crystal ball,” said Jorge Ramirez, president of the Chicago Federation of Labor, which chose to endorse no mayoral candidate in the February election that Mr. Emanuel won with 55 percent of the vote.

But if Mr. Emanuel, who is 51 and will become this city’s first Jewish mayor, seems intent on changing Chicago, this city, too, seems certain to change Mr. Emanuel.

Known for his frenetic, blunt, relentless style, Mr. Emanuel, who has been a top adviser to two presidents and a member of Congress, will for the first time work as an elected chief executive. And while machine politics may have faded in Chicago, old alliances and neighborhood tribalism are hardly forgotten, and voters expect their mayor to spend time plenty of time with them. All of this as the city, shrinking in population, is facing a budget crisis of crippling proportion.

“It is an enormous challenge,” said Dick Simpson, a political scientist at the University of Illinois at Chicago who once served as one of the city’s 50 aldermen. “He’s going to have to find a way to build consensus, collaborations and cooperation to an extent he hasn’t ever had to do at the White House.”

Mr. Emanuel has been walking a careful line: saying sweeping changes are needed but, at the same time, never quite pointing out a failing or misstep by Mr. Daley.

The two men are Democrats, political allies and personal friends. Long ago, Mr. Emanuel raised money for one of Mr. Daley’s campaigns. Though Mr. Daley never publicly chose sides in the mayoral race last winter, he is widely believed to have given a tacit nod to Mr. Emanuel. And Mr. Emanuel said he had been consulting with Mr. Daley lately. “I would be crazy not to call on him,” Mr. Emanuel said.

Besides, criticizing the mayor might not be politically wise. Although voters here like to moan about his dictatorial style and imperfect syntax, Mr. Daley has won six elections, and seemed likely to win another had he not decided to retire. For weeks, Mr. Daley has been conducting a farewell tour of neighborhoods, and banners in the city read, “Chicago; A World-Class City; Thank You Mayor Daley.”

Mr. Emanuel, too, is effusive about his city. But he also has plans — lots of them. He wants Chicago parents to start signing “parent-teacher agreements” at the start of each school year, laying out expectations for learning that will happen at home. He wants to ban mayoral appointees from instantly turning around and lobbying City Hall colleagues when they leave office. He wants to streamline licensing for businesses. He wants to shrink City Council committees. He wants to freeze spending and tackle unfunded pension liabilities, a politically fraught realm.

So many ideas may quickly land Mr. Emanuel in his first clashes with Chicago’s vast City Council, with all its disparate alliances and with one of its most powerful and veteran members, Edward M. Burke, having worked against Mr. Emanuel’s candidacy.

Some aldermen — few are willing to speak publicly in unflattering tones about the arriving mayor — already sound a bit skeptical.

News Corp. Will Disclose Its Political Donations

The move comes after the company was highlighted for donating $1.25 million to the Republican Governors Association and $1 million to the U.S. Chamber of Commerce ahead of the midterm elections last year.

Critics of the company seized on the donations — which were made public only in news reports — as evidence of bias on the part of the News Corporation, which owns the Fox News Channel and The Wall Street Journal, and Mr. Murdoch, who has long been a supporter of conservative causes.

The News Corporation said at the time that the company’s corporate side had made the donations with no involvement by its news operation, and that the gifts would not have any impact on newsgathering operations. Still, the Democratic Governors Association argued that during the election season, Fox’s coverage of governors and campaigns should include disclaimers about the donations.

After the controversy over those donations, the News Corporation’s board of directors decided to revisit its policies about disclosure, and on April 12 it adopted a policy “to publicly disclose corporate political contributions annually on News Corporation’s corporate Web site.”

The first such statement will be published by July 15, and later statements will be published each January. A News Corporation spokeswoman declined to comment further.

The decision may have stemmed from shareholders who raised questions about the donations at an annual meeting last October. “Our concern was not only that shareholders found out not through the standard decision-making process but through media reports, but more importantly that this was shareholder money that was being used — but it was not being used for a clear rationale for furthering shareholder value,” Laura Shaffer Campos, the director of shareholder activities for the Nathan Cummings Foundation, told The Associated Press.

At the annual meeting, Mr. Murdoch said the donations were “unusual” and were “in the interest of our shareholders and the country,” according to the liberal monitoring organization Media Matters, which posted audio clips of his comments. The interest, Mr. Murdoch suggested, was in bringing “change” to Washington.

The policy statement appears to bring the News Corporation in line with media companies like Time Warner that disclose donations.

The decision was announced on the News Corporation’s Web site toward the end of April, and gained attention this weekend when The A.P. reported it.

Obama Shifts to Speed Oil and Gas Drilling in U.S.

It was at least a partial concession to his critics at a time when consumers are paying near-record prices at the gas pump. The Republican-led House passed three bills in the last 10 days that would significantly expand and accelerate oil development in the United States, saying the administration was driving up gas prices and preventing job creation with antidrilling policies.

Administration officials said the president’s announcement, which included plans for expanded drilling in Alaska and the prospect of new exploration off the Atlantic coast, was intended in part to answer those arguments, signal flexibility and demonstrate his commitment to reducing oil imports by increasing domestic production.

But in fact the policies announced Saturday would not have an immediate effect on supply or prices, nor would they quickly open any new areas to drilling.

“These spikes in gas prices are often temporary,” Mr. Obama said, “and while there are no quick fixes to the problem, there are a few steps we should take that make good sense.”

The president’s turn to a domestic pocketbook issue comes after two weeks of intense focus on the killing of Osama bin Laden, terrorism more broadly and the multiple crises in the Middle East.

In his weekly radio and Internet address, Mr. Obama said the administration would begin to hold annual auctions for oil and gas leases in the Alaska National Petroleum Reserve, a 23-million-acre tract on the North Slope of Alaska. The move comes after years of demands for the auctions by industry executives and Alaska’s two senators, Lisa Murkowski, a Republican, and Mark Begich, a Democrat.

The administration will also accelerate a review of the potential environmental impact of drilling off the southern and central Atlantic coast and will consider making some areas available for exploration. The move is a change from current policy, which puts the entire Atlantic Seaboard off limits to drilling until at least 2018.

The president also said he would extend leases already granted for drilling in the Arctic Ocean off Alaska and the Gulf of Mexico that had been frozen after the BP spill last year. The extension will allow companies time to meet new safety and environmental standards without having to worry about their leases expiring.

And the government will provide incentives for oil companies to more quickly exploit leases they already hold. Tens of millions of acres onshore and offshore are under lease but have not been developed.

The actions signal a return to a more industry-friendly approach to offshore operations that Mr. Obama had adopted early in his presidency, though they do not reverse some of the steps the administration made to slow drilling after the gulf disaster.

Hastening the review of drilling permits in Alaska and the possibility of offering parts of the Atlantic Coast for lease in the next few years, in particular, represent a significant change from the administration’s attitude toward drilling after the spill.

The moves come after the House passed a series of bills that would force the administration to move much further and faster to open public lands and waters to oil and gas development. The administration formally opposed the bills as written, but officials said Friday that the White House might accept some provisions in the bills, like extending the frozen leases in the gulf and in Alaska.

Responding to the shift by the administration, Brendan Buck, a spokesman for Speaker John A. Boehner, said, “The president just conceded what his party on Capitol Hill still denies: more American energy production will lower costs and create jobs. This reversal is striking, since his administration has consistently blocked American-made energy.”

Although Mr. Buck characterized the policy changes as “not terribly substantial,” he added that they should “pave the way for legislation, like the bills the House passed in the past two weeks, to reduce the damage from the restrictions he imposed in the past.”

Republicans Optimistic About Retaking Senate

With Democrats defending 23 seats to their 10, top Republicans believe they have a built-in advantage in their drive to pick up at least the four seats that would vault them into the majority even if President Obama wins a second term and Vice President Joseph R. Biden Jr. remains able to break Senate ties. And they calculate that their chances are enhanced because important races will be in relatively conservative states like Montana, Nebraska and North Dakota.

“With our encouragement, I do think people are focusing on the Senate and how that can be the place where we can pick up the most yardage in 2012,” said Senator John Cornyn of Texas, chairman of the National Republican Senatorial Committee.

Democrats are hardly conceding the Senate, and even though the election is 18 months off, campaigns are quickly moving into high gear and contenders are scurrying to raise the millions of dollars they will need.

In Montana, Senator Jon Tester, the Democratic incumbent, is already engaged in a full-blown fight with his Republican opponent, Representative Denny Rehberg. An advocacy group is advertising in Massachusetts against Senator Scott P. Brown, a Republican and a top target of Democrats. Potentially vulnerable incumbents are busily crisscrossing their states.

“I am going like there is no tomorrow,” said Senator Bill Nelson, Democrat of Florida, who faces a tough race in a major battleground state.

The announcement Friday by Senator Herb Kohl, the four-term Wisconsin Democrat, that he would not seek re-election only added to the difficulties facing Democrats, depriving them of a relatively popular incumbent who could have financed his own campaign. Mr. Kohl’s exit instead left Democrats with another open seat to protect — their sixth — and added Wisconsin to the list of more than a dozen high-wattage races that will decide control of the Senate, which is now split 53 to 47.

Republicans are even trying to turn concerns about their uncertain prospects in the presidential race into an opportunity in the battle for Senate supremacy, arguing that a Senate takeover could fundamentally alter the balance of power in Washington even if Mr. Obama won a second term. They are making the case to donors and voters that winning a Senate majority would give the party control of Congress and a united front against the president from Capitol Hill if Republicans hold the House.

It is not lost on Republicans that the last time a Democratic president won a second term, when Bill Clinton was re-elected in 1996, Senate Republicans still expanded their numbers.

“I am hoping he is not re-elected,” Senator Mitch McConnell of Kentucky, the top Senate Republican, said about Mr. Obama. “But it is notable to look back at 1996, when we gained two seats even when we did not succeed. We are focused like a laser on trying to get over the top in the Senate, and we have a reasonable shot.”

Reince Priebus, the chairman of the Republican National Committee, said that the fight for control of the Senate was among the highest priorities for the party, and that while activists were eager to reclaim the White House, the Senate provided an easier path to changing the direction of Washington.

“The fact that Democrats are running for the hills is making it easier for us to win back the Senate and take full control of the legislative agenda,” Mr. Priebus said in an interview.

But Democrats say the struggle for the Senate is more than a numbers game. Acknowledging that the landscape looked grim in the days after the midterm elections, they say the outlook has improved, partly because House Republicans have pursued a conservative agenda that has allowed voters a good look at the policies Republicans would enact if they controlled both chambers on Capitol Hill.

Running on Moderation in Immoderate Times

Mr. Lugar himself had reminded the room about the Rolodex of international leaders he had accumulated in 34 years in the United States Senate (a hint of his clout), about his 604-acre family farm in Marion County (his local roots) and about his ability to speak, without notes, of the intricacies of the federal budget (lest anyone think that at age 79, he no longer had the legislative chops for the seventh term he was seeking).

Still, facing his first primary challenge since 1976, here was another constituent with a question reminding him how difficult it was to be a Republican like Richard Lugar right now.

“About a third of our federal debt is borrowed,” Judy Proctor, 64, began. “That is insane.

“China doesn’t want to lend us money, Canada doesn’t want to lend, we’re obviously irresponsible,” she continued, her voice rising and almost breaking. “Then we have Senator Lugar saying: ‘Well, maybe we can make it a little better next year. Maybe after that we can make it a little more better.’ It’s not enough. We have to stop. A third of our budget is borrowed! If we don’t do something dramatic, and soon, we’re done.”

Loud applause.

Mr. Lugar is trying to run on moderation in an immoderate time. He is betting that the Tea Party call of alarm and partisanship is drowning out a majority that prefers Republicans who specialize in reason and reaching across the aisle.

Whether he is right will reveal something about the strength of the Tea Party. The fact that he is even struggling says a lot about the identity crisis in the Republican Party.

“I take very seriously the point you are making,” Mr. Lugar began, his voice even as ever. At the same time, he continued, the government cannot simply tear up its credit cards. Even under the most optimistic scenarios, it would take five to seven years to get the budget deficit to zero.

“I understand the anguish that was just expressed,” he said finally, “that there are many citizens of our country who are angry and anguished, who really don’t know how to move on this particular situation and wish that somebody would cure it much more rapidly than I am suggesting. So I hear that. But nonetheless, we will try to move along the path I suggested, with your great help and counsel, and I think we can make it.”

Running in 2006, Mr. Lugar was considered so unbeatable that Democrats did not challenge him. But with national and local Tea Party groups naming him a top target, he began his campaign for 2012 a month before the 2010 elections, sending two senior staff members from Washington to Indiana to manage his re-election efforts.

With the primary still a year away, he is already attending twice as many events statewide as he did in his last competitive race. He is holding fund-raising events across the country and has already raised more money than he has ever spent in previous races.

His primary opponent, Richard Mourdock, the state treasurer, has won some local straw polls and the support of Tea Party groups. Mr. Mourdock’s slogan is “It’s time” — a swipe, Lugar aides complain, at their boss’s age.

Mr. Lugar does sometimes seem like a Republican from a different era. He is a centrist on foreign policy. He eschews labels — campaign aides dole out stickers calling him an “effective conservative,” but Mr. Lugar rarely if ever describes himself that way. He does not refer to liberals or socialism the way so many in his party do.

“People are representing what they believe is the anger of their constituents, who want angry people, who want angry statements, who want outrageous statements,” Mr. Lugar said in an interview. “I understand, and I understand the predicament of everybody involved in this, but I also understand, after 35 years of service, that at least a few people need to make sure that the country continues onward and upward.”

A Rhodes scholar and a former Navy officer, Mr. Lugar has spent almost all his life in public service. As mayor of Indianapolis, he was credited with saving the city’s tax base, and therefore the city, by merging it with nearby suburbs. In the Senate, he is most proud of his work with Sam Nunn, Democrat of Georgia, to initiate a program of disarmament in the former Soviet Union.

Secret Desert Force Set Up by Blackwater’s Founder

  Erik Prince, the founder of Blackwater, has a new project.

ABUDHABI, United Arab Emirates — Late one night last November, a plane carrying dozens of Colombian men touched down in this glittering seaside capital. Whisked through customs by an Emirati intelligence officer, the group boarded an unmarked bus and drove roughly 20 miles to a windswept military complex in the desert sand.

Sheik Mohamed bin Zayed al-Nahyan of Abu Dhabi hired Erik Prince to build a fighting force.

The Colombians had entered the United Arab Emirates posing as construction workers. In fact, they were soldiers for a secret American-led mercenary army being built by Erik Prince, the billionaire founder of Blackwater Worldwide, with $529 million from the oil-soaked sheikdom.

Mr. Prince, who resettled here last year after his security business faced mounting legal problems in the United States, was hired by the crown prince of Abu Dhabi to put together an 800-member battalion of foreign troops for the U.A.E., according to former employees on the project, American officials and corporate documents obtained by The New York Times.

The force is intended to conduct special operations missions inside and outside the country, defend oil pipelines and skyscrapers from terrorist attacks and put down internal revolts, the documents show. Such troops could be deployed if the Emirates faced unrest in their crowded labor camps or were challenged by pro-democracy protests like those sweeping the Arab world this year.

The U.A.E.’s rulers, viewing their own military as inadequate, also hope that the troops could blunt the regional aggression of Iran, the country’s biggest foe, the former employees said. The training camp, located on a sprawling Emirati base called Zayed Military City, is hidden behind concrete walls laced with barbed wire. Photographs show rows of identical yellow temporary buildings, used for barracks and mess halls, and a motor pool, which houses Humvees and fuel trucks. The Colombians, along with South African and other foreign troops, are trained by retired American soldiers and veterans of the German and British special operations units and the French Foreign Legion, according to the former employees and American officials.

In outsourcing critical parts of their defense to mercenaries — the soldiers of choice for medieval kings, Italian Renaissance dukes and African dictators — the Emiratis have begun a new era in the boom in wartime contracting that began after the Sept. 11, 2001, attacks. And by relying on a force largely created by Americans, they have introduced a volatile element in an already combustible region where the United States is widely viewed with suspicion.

The United Arab Emirates — an autocracy with the sheen of a progressive, modern state — are closely allied with the United States, and American officials indicated that the battalion program had some support in Washington.

“The gulf countries, and the U.A.E. in particular, don’t have a lot of military experience. It would make sense if they looked outside their borders for help,” said one Obama administration official who knew of the operation. “They might want to show that they are not to be messed with.”

Still, it is not clear whether the project has the United States’ official blessing. Legal experts and government officials said some of those involved with the battalion might be breaking federal laws that prohibit American citizens from training foreign troops if they did not secure a license from the State Department.

Mark C. Toner, a spokesman for the department, would not confirm whether Mr. Prince’s company had obtained such a license, but he said the department was investigating to see if the training effort was in violation of American laws. Mr. Toner pointed out that Blackwater (which renamed itself Xe Services ) paid $42 million in fines last year for training foreign troops in Jordan and other countries over the years.

The U.A.E.’s ambassador to Washington, Yousef al-Otaiba, declined to comment for this article. A spokesman for Mr. Prince also did not comment.

For Mr. Prince, the foreign battalion is a bold attempt at reinvention. He is hoping to build an empire in the desert, far from the trial lawyers, Congressional investigators and Justice Department officials he is convinced worked in league to portray Blackwater as reckless. He sold the company last year, but in April, a federal appeals court reopened the case against four Blackwater guards accused of killing 17 Iraqi civilians in Baghdad in 2007.

Mark Mazzetti reported from Abu Dhabi and Washington, and Emily B. Hager from New York. Jenny Carolina González and Simon Romero contributed reporting from Bogotá, Colombia. Kitty Bennett contributed research from Washington.

Student Is Allowed to Attend Prom in Connecticut

SHELTON, Conn. (AP) — A high school headmaster here has reversed her decision to bar a senior from the prom after he broke the rules by hanging an invitation to the event at the school entrance.

The senior, James Tate, and some friends had taped cardboard letters on the wall that read, “Sonali Rodrigues will you go to prom with me? HMU — Tate.” (HMU means hit me up, or contact me.)

Ms. Rodrigues said yes, but officials at Shelton High School suspended Mr. Tate for posting the invitation, saying it was a safety risk.

The suspension lasted one day, but, according to school rules, he could not attend the prom, scheduled for June 4, because the punishment occurred after April 1.

On Saturday, however, the headmaster, Beth A. Smith, announced a shift in policy. Now, she said, the school would decide whether suspended students could go to the prom on a case-by-case basis. In Mr. Tate’s case, he will be allowed to attend.

Dr. Smith acknowledged the “international notoriety” the case had received on social networks and in the news media. Mr. Tate, who plans to attend Syracuse University, appeared on the “Today” show and “Jimmy Kimmel Live” after his suspension.

Students also staged a sit-in to protest the decision.

Tackling the Problems of Appalachia, Theatrically

“I was interested in addressing issues, rather than endlessly naming them,” Mr. Gipe said.

So with two colleagues from Southeast Kentucky Community and Technical College, where he teaches, Mr. Gipe did the one thing he thought might help lift Harlan County — or at least its spirits.

He staged a series of plays.

The series, “Higher Ground,” describes in nuanced tones and local accents the hard realities of life here in Harlan, the heart of Kentucky coal country, which has been battered by decades of decline.

The title “Higher Ground” comes from the places communities flock to escape rising flood waters and is a metaphor for the monumental problems facing the area — drug abuse, strip mining, dwindling populations of young people.

The plays — the first of which was staged in 2005 and the third and most recent, “Talking Dirt,” over two weekends in late April and early May — take on those issues through characters that are part fiction, part real.

“Talking Dirt” tells the story of James and Beth, young people torn between the slim prospects in their hometown and the specter of having to leave. An environmental twist comes when a mining company wants to buy James’s land.

Mr. Gipe, a self-effacing 47-year-old from Tennessee, went to graduate school in Massachusetts but has spent most of his career in Appalachia, first in nonprofit work and later as a professor of Appalachian studies. He said he wanted to involve the entire county in the productions.

He and his colleagues, Ann Schertz, a music professor, and Theresa Osborne, a folklorist, recruited performers in schools, churches, civic organizations, even the grocery store and the post office. “Talking Dirt” has a cast of 75, including several families with children.

In the old days, rural culture came from getting together, telling stories and making music, and Mr. Gipe wanted to replicate that. Bluegrass melodies anchor many of the scenes and are played by local musicians, including two father-and-son duos.

“We need entertainment,” Mr. Gipe said. “We need something of our own. And we have these hard things that we should talk about.”

Harlan has lost three-fifths of its population since its peak in 1940, according to census data, and has lost nearly half of its under-35 population since 1980.

A character named Roger describes what that is like: “My high school graduation was my mother crying like I was dead, because she was so sure I was leaving and she would never see me again.”

That line and others in the play are drawn from real stories collected by Southeast Kentucky Community students in a long-running oral history project.

Harlan is also among the country’s poorest counties. (Last week, phone and Internet service in the area was cut when copper thieves ripped out lines.)

“Talking Dirt” offers an empathetic twist to its otherwise gloomy view of strip mining. While Beth, who has been offered a scholarship, opposes strip mining, Roger, a young miner, shows her that her privileged status gives her the luxury to choose.

“There wasn’t anybody standing there offering me a scholarship when I graduated high school,” he tells her.

Harlan County’s fortunes are still tied to coal, so mining is a sensitive subject. Coal jobs represent just 14 percent of employment in Harlan, down from more than 60 percent in 1940. But according to Roy Silver, a sociology professor at Southeast, they generate about a third of the income.

While Mr. Gipe would not use the phrase “community building” to refer to the play — though he admitted he would in a grant proposal — that has clearly been its effect.

Carlton Hughes, a professor at Southeast, said the play had changed the attitude of his 15-year-old son, Noah, who for some time had been chafing at life in Harlan County.

“With every breath, he would say, ‘I can’t wait to get out of here,’?” Mr. Hughes said.

But Noah agreed to take a role in the play, and during a recent performance, Mr. Hughes was pleased to see him laughing and cavorting with a retired coal miner many times his age.

Despite the unconventional subject matter, the play has a fairly standard happy ending. Mr. Gipe makes no apologies for it.

“Somewhere along the line, artistic validity became associated with everything ending in a mess,” he said. “But if you articulate what’s best in us and put characters in front of people who don’t resort to their basest instincts, that’s real, too.”

Robert Gebeloff contributed reporting from New York.

The Bay Citizen: Big Deal. I Just Said It. I Didn’t Say It Was True.

In an expansive, nuanced and thoughtful conversation, Ross Mirkarimi, a San Francisco supervisor and candidate for sheriff, told us recently that the city’s tenants might now have too much power. A constituent’s demand for $70,000 to vacate a rent-controlled apartment, he said, amounted to “extortion.”

But those comments, Mr. Mirkarimi said in The San Francisco Bay Guardian the following week in response to tenant blowback, “do not reflect my views or my record.”

In short, Mr. Mirkarimi reassured voters that his actions and policies will in no way be affected by his actual beliefs, even after he has observed with alarm the real-world effect of laws he has personally championed.

As it enters the election season, San Francisco finds itself with a clutch of political figures who, like Mr. Mirkarimi, seem determined to turn prevarication into a comical art form.

Perhaps they should take some tips from Stephen Colbert and footnote their remarks with “Not intended to be a factual statement.” Mr. Colbert minted that disclaimer last month and has had a lot of fun with it on Twitter, after Jon Kyl of Arizona declared on the Senate floor that more than 90 percent of Planned Parenthood’s budget was spent on abortions — and then had an aide explain, when confronted with the real number (3 percent), that his boss had never intended his statement to be understood as being actually true.

Mr. Mirkarimi and other candidates here are hard at work perfecting their own routines. Consider these developments from just the past week or so:

? Dennis Herrera, the city attorney and a leading mayoral candidate, hired a registered lobbyist, Alex Tourk, as his campaign manager. A 2004 law — passed when Mr. Tourk was Mayor Gavin Newsom’s deputy chief of staff and Mr. Herrera was already city attorney — made it illegal for campaign consultants to lobby their clients.

Nonetheless, Mr. Tourk reports lobbying Mr. Herrera on behalf of a hospital seeking city approval to expand.

(The same day that the lobbying reportedly took place, the hospital’s chairman made a donation to Mr. Herrera’s campaign.)

“Dennis does not believe those meetings” with his registered lobbyist/campaign manager “were lobbying,” said Mr. Herrera’s campaign spokeswoman, Jill Nelson. Are there any records of what was said, considering that Mr. Tourk certainly regarded those meetings as lobbying when he submitted his report to the city ethics commission?

There are “no records,” Ms. Nelson said, “because they are not meetings. If Dennis doesn’t have those meetings on his calendar, they didn’t happen.”

Last week Mr. Tourk left Mr. Herrera’s campaign.

? In February, Edwin Lee, the interim mayor, affirmed to a roomful of Bay Citizen reporters and editors that $300 million to $400 million had to be cut from what the city spends annually on pensions and benefits. If not, he said, the city could be bankrupt in five to 10 years. Recording devices rolling, he also vowed that under no circumstances would he run for mayor. Is that unequivocal, he was asked? Yes, he responded.

Three months later, Mr. Lee is about to declare victory with a plan to trim roughly $100 million in pension costs. He steadfastly refuses to entertain questions about how a $300 million bankruptcy-inducing emergency has been transformed into a $100 million victory. Oh, and that mayoral run? Stay tuned.

? State Senator Leland Yee, also a mayoral candidate, is a lover of shark-fin soup, and he loudly opposed a proposed ban on the dish as an insult to Chinese-Americans.

But this week at least, Mr. Yee is a lover of sharks.

“We totally share concerns about what is happening to the sharks,” Jim Stearns, Mr. Yee’s campaign strategist, said Monday. What changed? A coterie of Chinese and Chinese-American shark-loving celebrities appeared together in San Francisco last week, and a poll found that 70 percent of the state’s Chinese-Americans are perfectly content to renounce shark-fin soup to protect the world’s shark population.

So Mr. Yee is “95 percent” in favor of the ban, said Mr. Stearns. And he is floating this compromise: shark-fin soup is fine, as long as it comes from a legally caught shark whose entire corpse is eaten. “If you are selling shark-fin soup, you’d better have a receipt showing” that the rest of the animal was consumed, Mr. Stearns said.

Mr. Yee’s proposal is comically unenforceable, akin to passing a law decreeing that filet mignon cannot be served unless the pulverized hooves of the cow in question are eaten for dessert.

Really. In all truthiness.