Face yourself !

Funny - my grandmothers, when I got to know them as 50+ year olds, had plenty wrinkles. But they were two of the most beautiful women I have ever known. That persepctive of beauty resided in me, i know, but isn't that where they WANTED it to reside? So, what is this about ?

The New York Times
April 30, 2006
Appearances
Fill 'er Up!
By DAPHNE MERKIN

The times they are a-changing, slowly but surely, when it comes to the obsessive pursuit of an eternally dewy appearance. If your face looks older than you feel but the thought of the operating table frightens you more than your reflection in the mirror, you haven't been paying close enough attention to the latest turn in the ever-evolving field of cosmetic rejuvenation. For the past decade or so, a quiet revolution has been taking place in the way the signs (also referred to, in the withering clinical manner, as "stigmata") of facial aging have been dealt with. The mighty face lift, once regarded as the prime weapon in the aesthetic armamentarium, is no longer the only — or, in some cases, the most desirable — option for the woman who is unwilling to resign herself to wrinkles, furrows and sunken cheekbones. These days the contours of a youthful face are just as likely to be recreated with a humble syringe as with a gleaming scalpel.

The traditional emphasis on surgery to excise and suspend the skin is now being complemented, and on occasion even replaced, by a new focus on restoring volume through the use of injectable dermal fillers. "Volume is half the issue," observes David Hidalgo, a New York plastic surgeon. "There's a place for addressing it, much more so than we recognized in the past." Although a small group of doctors, both here and abroad, have been proponents of this method for going on two decades, the demand for "lifting by filling" has grown exponentially in the past few years. This surge of interest is owing to a number of factors, including refinements in techniques, the shorter recovery period, the trend toward more frequent, less invasive procedures as well as a shift to a more natural, less Jocelyne Wildenstein look; and, perhaps, most significant, continuing advances in the materials. With the exception of collagen and human fat, most of the newer fillers (including a form of collagen derived from, take a deep breath, the cells of infant foreskins) have been F.D.A.-approved only for the past two or three years. These fillers have the sort of dreamy names — Restylane, Hylaform and Captique — that are easy to confuse with the names of sleeping pills, and they can be injected more aggressively to combat deeper grooves in the skin. They are often paired with Botox, the paralytic toxin that has been around since 1990 as a temporary muscle relaxant and has come to be synonymous with preternaturally smooth foreheads (and, all too frequently, a Stepford Wife lack of expression).

This is not to sound the death knell for face lifts; for some problems, like the laxity or redundancy of skin that results in ignominious turkey wattles and drooping jowls, they remain the definitive answer. But for a specified number of changes — which have less to do with the inexorable effects of gravity than the tendency of skin to lose its pleasing Scarlett Johansson-like fullness as we get older, leading to such perceived defects as crow's feet, frown lines, nasolabial folds and the appearance of hollowness around the eye — fillers are the way to go. "The techniques are not exclusionary," points out Gerald H. Pitman, another Manhattan practitioner who, like Hidalgo, often uses Botox and live fat grafts as an adjunct to surgery. "For many patients who come with problems of aging, it's a combination of loss of volume and loss of skin elasticity. The really nicest results," he adds, "are in patients who have a little of both."

Sydney Coleman, the plastic surgeon who is widely credited with pioneering the techniques for grafting live fat, suggests that the emphasis on adding rather than subtracting — restoring rather than "tailoring," as he terms it — is not as new as it may seem. "The first plastic surgeons to approach the face with volume," he points out, "were in the early 1900's. In the preface to his seminal textbook, "Structural Fat Grafting," Coleman notes that the first book on the subject of cosmetic surgery, published in 1911, "devoted more than one-fourth of the text to the use of hydrocarbon filler injections (paraffin and petrolatum jelly) for facial augmentation." Doctors abandoned this process after 1920 because of complications — "failing to recognize that it was the product," Coleman writes, "not the process, that needed to be improved."

Meanwhile, over on the other side of the Atlantic, an Algerian-born Frenchman named Jean-Louis Sebagh, who honed his surgical skills in Los Angeles in the late 80's after training in Paris, looked into the future, saw injectable volume restoration coming round the bend and thereby became a virtual demigod for women who preferred not to wear marionette or frown lines to lunch along with their bling. Having abjured the knife in favor of "surgery with a syringe," Sebagh spread the gospel of Botox in the early 90's before moving on to the wrinkle-zapping wonders of fillers (attracting throngs of anxious women to his London and Paris offices along the way). Sebagh's pared-down antiaging skincare line, which includes science-kit vials of powdered vitamin C to be blended with various moisturizers, a Mrs. Piggle-Wiggle-like elixir named Dark Circle Powder to be added to an eye cream, an apricot-colored "Deep Exfoliating Mask" that feels as if it's communing with your skin, an overnight "Serum Repair" as well as a wondrous little potion called Essential Glow, was introduced not long ago at Barneys New York and in Bliss catalogues. He also recently came out with a new filler technique, which claims to restore and tighten all three levels of facial tissue. The procedure, christened D.R.E.A.M. Sculpture, makes use of a hyaluronic acid filler that is not yet approved for use on these shores. (European endorsement of aesthetic procedures typically precedes F.D.A. approval, although some dermatologists and surgeons have circumvented these tighter strictures through an "off label" use of fillers that have been designated for other purposes, like Sculptra, which was has been approved only for patients with an H.I.V.-related loss of fatty tissue.)

Having read so many drooling press notices about this European youth guru, I figured I'd drop in on Dr. Sebagh's practice at 25 Wimpole Street — the same street where the medical establishment held thick-headed sway in Virginia Woolf's day — when I was in London some months ago. Seven o'clock of a Wednesday evening finds me cooling my heels in Sebagh's whimsically decorated office, which features artwork by his children as well as white Formica drawers bearing labels like "Intubation." The 51-year old Sebagh is a dark-eyed charmer who clearly understands what makes women tick — and better yet, especially in the Fountain of Youth business, spouts a seductive mixture of common sense and blunt opinions. (He prefers the term "age maintenance" to "antiaging"; says that American women are "pushed to surgery"; that face lifts are treated "like the messiah"; and that American aesthetic medicine is "backward.") Sebagh says he believes the resistance among surgeons to using fillers is more about professional ego ("It's not noble," he says dryly, "for a plastic surgeon to deal with syringes") and a lack of knowledge ("the technology can be overwhelming") than about fundamental philosophy. He also makes no bones about the fact that you have to start thinking about aging early: "Some women wake up too late. You're like a ruin."

The curious part is that I leave Sebagh's office feeling reassured rather than alarmed — notwithstanding the fact that the one injectable boost he gives me backfires by his own admission and leaves me with a tiny but vivid bruise for days. Perhaps this is because, unlike other rejuvenating magicians I've talked with, he manages to make the campaign to ward off the ravages of time sound pleasant and reasonable, nothing to get up in arms about as long as we are in it together. I suspect that it is this air of sang-froid, as much as his discerning eye and much-touted golden touch with a needle, that endears him to his patients.

Finally, of course, fillers are big business — one treatment with Botox can cost $1,500, while one syringe of Restylane goes for about $750. And where there is money to be made, there are turf wars (who has proprietary rights to fillers, dermatologists or surgeons?) and internecine battles (live fat as opposed to frozen fat?) to be waged. But as long as the demand for filler-related procedures continues to grow, the search for longer-lasting fillers will go on (Juviderm is the next one in the lineup for F.D.A. approval), new cosmeceuticals will be introduced (the latest, Tozzi Repair and Restore, a skin-care line aimed specifically at skin pre- and post-Botox injections) and the debate will continue to rage as to how far any of the gentler interventions will take an aging face. "There is no such thing as a nonsurgical face lift," says the cosmetic surgeon Steven Pearlman, who turns to fillers mostly to augment surgery. "Volume is frequently a large part of the issue but not the only issue." Hidalgo concurs that there is "only so much you can do with injectables. I can highlight things, enhance contours, put the icing on the cake. It's not common that I can solve major problems."

Then there is the view of Fredric S. Brandt, a dermatologist whose enthusiasm for what fillers can achieve (he is the world's largest user of Restylane) is matched only by his deftness with them: "I have patients," he observes, "who will do anything not to have surgery. Not everybody wants 100 percent." Going on to caution that "none of these procedures stop the clock from ticking," Brandt describes the rejuvenating concept du jour as "customized. Not one thing does it all. It's like taking a suit to the tailor: you may have to shorten the pants and pad the shoulders." So step right up, ladies, and take your pick. It's a buyer's market of smooth-skinned dreams out there.

Daphne Merkin is a contributing writer for the magazine.
###

A tool for every treat

Living well included following many rules, Here are some of them. Enjoy.

The New York Times
April 26, 2006
A Tool for Every Treat
By JULIA MOSKIN

I HAVE seen dinner guests recoil from the offer of a silver fork, and object when said fork was later dispatched to the dishwasher. But I refuse to be afraid of using real silverware: silver is strong stuff, and even when it is slightly tarnished, I like its warmth and heft.

But I'm in a shrinking minority: The number of American couples who register for sterling flatware goes down every year, according to Caroline Baize of Christofle, the silver company. "More couples want to save their money for a nice honeymoon," she said. Some of them may already be in possession of sterling silver that they consider "too good" for regular use.

"I have five complete sets of sterling in my basement" said Laurie Pascalino, who lives in Holmdel, N.J. Before she was married in 1987, she registered for Tiffany's perennial best seller, the 1871 Audubon pattern. "It's like that was a signal for people to give me their silver sets. I got one from my mother, one from my mother-in-law, et cetera. And I don't know the last time I used any of it."

But "Feeding Desire: Design and the Tools of the Table," an exhibition of Western eating utensils opening next week at the Cooper-Hewitt National Design Museum, may inspire people like Ms. Pascalino to use the good stuff.

In the paneled dining room of the old Andrew Carnegie mansion that houses the museum, visitors will gaze upon Renaissance-era utensils whose carved ivory handles are tiny religious masterpieces, Napoleon's traveling silverware, and modern upstart utensils like the spork and its relatives.

These items might sound trivial, even boring — the culinary equivalent of a museum show dedicated to old blankets or early toothbrush designs.

But passionate defenders of this declining art form see the show as a chance to revive the stature it once had at the table.

"These are the tools that turned eating into dining" said Sarah Coffin, a curator at the museum who has been researching the subject for almost 30 years. "Today we seem to be moving in the other direction, toward everyone eating in their cars with their hands, so it's pure pleasure to spend time with these objects and realize how useful they are."

"The fork, knife and spoon are clearly perfect forms," Ms. Coffin said as she pulled out drawer after drawer of them, all polished and ready for their moment in the spotlight. "How many things we use today have been virtually unchanged for the last 400 years?"

Western utensils are relative latecomers: while the Romans were sticking shells onto sticks to make early spoons, the Chinese had already refined the use of chopsticks over thousands of years.

In the West, knives were the first tool to come to the table, as personal weapons that were also used for cutting and spearing meat. In the 1600's, the pointed tip of the knife was rounded by decree of King Louis XIII of France. Some historians say this was to prevent violence at the dinner table; others say that it was meant to prevent unsightly tooth-picking by courtiers, a particular irritant to Cardinal Richelieu.

If the knife was associated with the hunt and the manly act of stabbing, the spoon was maternal, used for soft gruels or to feed babies and the elderly. "Spoons were originally round, but the advent of purées and smooth soups made a more oval shape more practical, to let you tip the liquid directly into the front of your mouth," Ms. Coffin said, demonstrating enthusiastically. And the fork, which came much later, brought with it associations of the Devil's pitchfork and the perceived effeminacy of the East; it was an 11th-century Byzantine princess who made its first recorded use in Europe, as a golden tool to prevent her fingers from getting sticky from candied fruit. Medieval Christians were frequently banned from using forks by the Church, and even Louis XIV, a monarch not known for his austerity, refused to eat with a fork because of its associations with an effete predecessor, Henri III.

The triumvirate of knife, fork and spoon was in common use in Europe by the end of the 1700's. All three pieces traveled from place to place with their owners — often worn on the body in a kind of holster — until the following century, when households began stockpiling utensils. This opened the door to flatware as a visible marker of wealth, with patterns, crests and flourishes that reflected the household's stature and taste.

And so we arrive at the late 19th-century sterling nut picks, strawberry spoons and monogrammed terrapin forks on display at the Cooper-Hewitt, which seem like artifacts of a civilization as distant as Pompeii, not our own relatively recent Gilded Age. When Mark Twain gave that title to his 1873 novel, it was a caustic reference to the era's rampant corruption in business and politics, but it is also tempting to apply it to its culture of excess in flatware. "One service at the time had over 300 different pieces," Ms. Coffin said as we inspected an ornate gold-covered dessert service presented to J. P. Morgan by the understandably grateful directors of the New York Central Railroad.

Not only Morgans and Carnegies were caught up in the frenzy for flatware.

"There is something very touching about many of these pieces" said Annamarie Sandecki, the director of the Tiffany and Co. archive, which loaned numerous pieces to the show. "We were such a young country, with no inherited wealth, no family silver. Buying silverware was a way to establish yourself as a person of substance."

Silver also became accessible to the new middle class in the form of silverplate, a process that Charles Christofle patented in 1830 in which a thin sheet of sterling covers a base metal.

The pieces from this era also reflect its enthusiasm for new and luxurious foods, many made possible by railroad transport. "Imagine the first time you had ice cream in the summer, or the first orange of your lifetime," Ms. Sandecki said. "These things were special, and they were treated accordingly." There is a silver hatchet for cutting ice cream and a delicate flat silver ladle for serving potato chips, invented in 1853 and all the rage at fancy dinner parties. Knowing what these instruments were and how to use them became a badge of membership in the newly wealthy middle class. One American manufacturer, Towle, offered 131 pieces in the Georgian pattern; a full service for 12 had 1,888 pieces.

"No rule of etiquette is of less importance than what fork we use," Emily Post wrote in 1928. By then, America was past its flatware frenzy, but Darra Goldstein, a co-curator of the show and the editor of Gastronomica, a journal of food culture, says that "fork anxiety" was well entrenched in the American class system, and still is.

"I see it today in all the courses offered on how to eat at a business dinner," she said. "There probably was never a time when all of these forks were in use, but you can see how the very existence of a tomato fork could generate anxiety."

In addition to providing opportunities for display, utensils provided much-needed entertainment at the table, said Ms. Sandecki.

"These pieces are a reminder that social circles were small, meals were long, and the silver on the table had to be interesting, beautiful, and even entertaining," Ms. Sandecki said. "American artists took it as the chance to create a whole American design iconography."

Gilded Age designers brought Japanese influence and playful naturalistic decoration to the table, affixing tiny silver birds' nests with eggs to egg spoons and applying scalloped edges to scallop forks.

"This was one of the first art movements to start in America and then make its way to Europe," Ms. Coffin said.

In return, modern designers in Germany and Scandinavia stripped utensils down to their unadorned essentials. Throughout the process, designers have tinkered with the basic forms to see if they could be improved on or consolidated. The spork, according to Ms. Coffin, is probably the earliest innovation, but the Cooper-Hewitt show also includes knorks, knoons and even an intriguing utensil that can act as all three.

"No one's come up with a name for that one yet," she said.

Answers to the quiz about 19th century serving pieces: A. 5, macaroni server; B. 3, ice cream hatchet; C. 4, scallop fork; D. 2, asparagus server; E. 1, sifting spoon.

From May 5 to Oct. 29, "Feeding Desire: Design and the Tools of the Table, 1500-2005," will be at the Cooper-Hewitt National Design Museum, 2 East 91st Street; (212) 849-8400.
###

Democracy redux

Democracy is a many-spintered thing. Enjoy.

The New York Times
April 23, 2006
The Way We Live Now
Export This?
By JIM HOLT

Democracy is a wonderful thing. We Americans have been enjoying it for over two centuries. Gradually, fitfully, much of the rest of the world has joined us. Although competing systems may menace it for a time, they will eventually collapse because of their internal contradictions. That is why the advance of democracy is inevitable. And the best the United States can do is to help history along by pushing it on recalcitrant parts of the world, like the Middle East.

But wait. Are we sure that what we are enjoying and promoting is democracy? True, we call it that. But the regimes of the former Soviet bloc also called themselves democracies. Suppose their system had won out — a possibility that may be hard to imagine now but that was once a source of anxiety in the West. They, too, would have proclaimed a triumph of democracy. But surely, you want to say, their democratic pretensions were ludicrous. When Kim Jong Il refers to his nation as the "Democratic People's Republic of Korea," it sounds like a case of a double positive yielding a negative. Our claim to be a democracy, by contrast, is fully merited. Just like the Greeks who, two and a half millennia ago, both coined the term and invented the thing, we have government by the people.

There are two problems with this line of thought. The first is that our form of government bears scant resemblance to what the ancients called demokratia. Tellingly, we hardly recognize the name of its inventor, Kleisthenes. The most distinctive feature of Athenian democracy, as the British political theorist John Dunn reminds us in his forthcoming book, "Democracy: A History," was its "fierce directness." Laws were made by an assembly that every full citizen had the right to attend, address and vote in as an equal. (Excluding women, resident aliens and slaves, that left about 30,000 participants.) The assembly's agenda for each meeting was decided on by a council of 500 citizens, chosen by lot. The only elected figures were military generals, and this was considered the least democratic aspect of the system.

Our own government, to the Athenians, would look like an elective oligarchy. In fact, it was deliberately set up to ensure, as James Madison wrote in the Federalist Papers, "the total exclusion of the people in their collective capacity, from any share" in it. Yet we insist on applying a Greek label to it as an honorific. And that is the second problem. For most of history, "democracy" was a term of abuse, connoting the rule of the vulgar multitude. The founding fathers fought shy of it, taking care to use "republic" instead.

Today, democracy is what has been called an "essentially contested concept." We project our various pet values onto it, and then are puzzled that it cannot consistently hold them all. Francis Fukuyama, who has argued that democracy is "the end point of mankind's ideological evolution," refuses to admit the Athenian demos to the club, on the grounds that it failed to protect human rights — notably, the right of its most famous citizen, Socrates, to corrupt the young and invent his own gods. Others are similarly loath to extend the rubric of democracy to present-day Iran, where elections are held under the supervision of a priestly caste, or to the Palestinian entity, on the grounds that the newly elected Hamas government is a terrorist organization.

The United States is governed neither by priests nor by terrorists (notwithstanding some overheated rhetoric to that effect) but by professional politicians — or "electoral entrepreneurs," as the economist Joseph Schumpeter called them — who compete for our votes. They are said to represent us, but representation is as vexed a notion as democracy itself. Clearly, politicians do not represent us in the sense of being like us: quite apart from some peculiar psychological characteristics common to the breed, they are older, maler, whiter and lawyers almost to a man. Ideally, though, they represent us in the sense of looking after our interests, the way a guardian represents an infant in law. Unlike an infant, we have an intermittent right to replace them with other politicians if we judge them to be ineffective in this representative role. But, owing to a byzantine division of labor, much of what politicians do is hidden away from the public eye. Moreover, in one of the more devastating theoretical arguments against democracy, Anthony Downs observed that most citizens have no economic incentive to learn enough about what politicians do to vote intelligently. Nearly half of American voters acquiesce in their infantilization by not voting at all.

Should any of this make us yearn for Athenian-style demokratia, where citizens come together on terms of equality to reach consensus about the common good? An innovation in this direction has been proposed by James Fishkin, a political scientist at Stanford, and Bruce Ackerman, a Yale law professor. They envisage a new national holiday, called "Deliberation Day," a couple of weeks before each major election. On this day, voters would gather in groups as large as 500 and hash out issues together, like the ancient Athenians. (Unlike the Athenians, participants in Deliberation Day would be paid $150 each.) If this sort of thing sounds appealing, keep in mind that the right to address your fellow citizens is accompanied by the less agreeable duty to heed what they have to say, and that means all of them.

If nothing else, the system we sloppily call democracy provides a way to get rid of a lousy regime without the bother of overthrowing it by force. As for its apparent historic inevitability, that may owe largely to the difficulty of finding any other source of legitimacy besides "the people." "Virtue"? That went out with Plato. "Embodying the national spirit" became unfashionable with Hitler, as did "expressing the will of the proletariat" with Stalin. True, some rulers continue to imagine that they were chosen by God. But almost no one takes that idea seriously anymore.

Jim Holt is a frequent contributor to the magazine.
###

London

London life on the cheap.

The New York Times
April 23, 2006
Frugal Traveler
A Family Vacation in London, Guided by Scrooge
By JENNIFER CONLIN

COZY and warm under a thick duvet in the small duplex I had rented for a long weekend in central London, I suddenly awoke to a strange, high-pitched moan. It was my 10-year-old daughter flailing around on the air mattress she was sharing with her younger brother in the downstairs living room.

Her cry was followed by a call for help. "It's so c-c-c-cold," she wailed, a fact confirmed by my husband when he reached the bottom of the spiral staircase. Next to our younger children's blow-up bed, our 14-year-old daughter shivered on the couch.

"Honey," my husband yelled up to me sarcastically as he began frantically turning up space heaters. "I think it's time for you to consider that it is not possible for a family of five to visit London for three nights and four days on a budget of £1,000!"

In dollars, that comes to roughly $445 a day, including lodging, in the third-most expensive city in the world after Tokyo and Osaka (New York seems positively cheap at No. 13), and at that chilly 2 a.m. moment, I thought he might just have a point.

But I was determined to prove him wrong, along with the Transport for London clerk who laughed at me when, seeking advice about the cheapest way to get around the city, I told him my total family budget.

In most European capitals, a budget of a little more than $400 a day for a family of five would be a relative snap. In Paris, comfortable hotels for well under $100 a night can be found even near the Eiffel Tower. In Rome, delicious pasta or grilled pizza can be had for as little as $8 a person, and in Barcelona, a single subway journey is less than $2, all well within the means of even the most cash-starved traveler.

But London, where my family and I have lived for the last seven years, is an altogether different challenge. Hotel rooms for under $250 a night are almost impossible to come by, and a restaurant dinner can easily wipe out a full day's food budget in less than two hours. A recent night out with my husband (casual dinner, movie and a short cab ride home) set us back more than £75, not including the babysitter.

So could a family of five, limited to that four-day budget of £1,000 ($1,780 at $1.78 to the pound) spend a vacation in London without feeling as poor as Tiny Tim? Several weeks ago, starting on a Thursday afternoon, and ending on Sunday evening, our family — experiencing London as tourists — was determined to find out.

The first step, besides quickly weaning my children off the occasional cabs they like to take, was to find affordable lodging.

After spending an entire day on the Internet, I was beginning to think our only affordable option was going to be a youth hostel when I remembered a Web site I had heard about from a friend: Vacation Rental by Owner, or VRBO.com. The site had several decent-looking properties that fell within our price range, including the one I ended up renting: a clean, modern duplex apartment right near the Tower of London and just a block from the Thames. The price: £114 a night. Though no palace, it was incredibly tidy, minimally but beautifully decorated (including a few antiques) and for a couple or family with one child able to sleep alone on the large downstairs sofa, it would actually have been quite luxurious. Our larger family, however, found the space more limited (when the air mattress was set up, we could not physically move around the downstairs).

Although the broken television upset my 9-year-old son's cartoon viewing, everything else, from the wide selection of teas to the well-stocked bathroom (baskets of shampoos and soaps, including kids' shampoo) was more than acceptable (and, once we turned up the heat, comfortable).

The next morning, acceptance turned to smugness as we strolled by the hotel across the street, a place where the cheapest double room cost £280 a night, with breakfast an additional £19.50 per person. (We had stocked up on groceries for breakfast most mornings at a nearby store for a total of £11.80.)

SO far, so good.

With calculator in hand, we set out — me, eagerly; my family less so. The first challenge was transportation. In a city where a 10-minute cab ride can easily set you back £15 or more, we bought unlimited four-day off-peak Travelcards (£54.40 for our family of five) that would give us free run of the city's underground trains and buses.

Westminster Abbey was our first stop, and our first indication that the cheapest option is often the best one. After buying a family ticket (£22), we plunked down another £15 for the five sound audios. That was £1 per person less than we would have been charged for the guided tour, and it was a good deal. The group tour was crowded with adults who would have towered over our children as they tried to peek at the various sights, and whose questions about the people buried here — among them Charles Dickens and Queen Elizabeth I — would have sorely tested their patience.

Afterward, we headed to the West End for lunch. The last restaurant meal we had eaten as a family — an upscale pub lunch — had set us back £80. My worst fear was that too many expenses like that would send us for our final evening to the Hare Krishna center, where a friend said they give free vegetarian meals on Sunday nights if you dance with them for a half hour before dinner.

Luckily, a poor art student — is there any other kind? — had recommended the Stockpot on Old Compton Street. It was perfect: a classic British cafe featuring dishes like expertly prepared fish and chips and bangers and mash. With dessert, the entire meal for the five of us cost just £31.46, including the 10-percent service charge. Why had we not discovered this place seven years ago?

Sated, we headed to the Half Price Ticket Booth in Leicester Square, hoping to find some cheap theater tickets for that night. Sadly, the hit musical "Mary Poppins" was not on the board showing available shows, but Shakespeare's "Measure for Measure," in a well-reviewed production playing at the famed National Theater, was. Ten minutes later, we had scored five tickets for seats in the upper circle. (Total cost: £90 pounds, about £20 off the full price.)

The rest of the afternoon was spent wandering through the British Museum, home of both the Elgin Marbles and the Rosetta Stone (free, though we again sprung for the audio tour, at a total cost of £13), and then on to nearby Covent Garden, where the kids were entertained by the street jugglers, opera singers and pantomimes.

Our pretheater dinner was at Chuen Cheng Ku in Chinatown, a stone's throw from Leicester Square, where we ordered plate after plate of steaming dim sum and half a crispy aromatic duck with a basket of extra pancakes for a total of £60.10, including two glasses of wine.

Then it was on to "Measure for Measure." Unfortunately, though extremely well-acted, this production turned out to be an untraditional production of Shakespeare's classic, one that opened with one of the play's characters performing a simulated sex act. I quickly moved to cover the eyes of my 10-year-old and 9-year-old and anxiously wondered what my 14-year-old was thinking. (Note to myself: read the reviews of a play before taking the kids.)

We decided the next morning to splurge on one breakfast out — after all, the full English breakfast is a famous meal — and so headed to the Star Café in Soho, where for £25.20 we feasted on eggs, bacon and sausages along with grilled tomatoes and baked beans. We spent the day checking out some of the more popular tourist attractions that were within our budget (the Tower of London, at £43 for a family ticket; the Globe Theater at £25), and skipping those that did not. (The London Eye would have cost us £40.95, even with the 10 percent online reservation discount, and Madame Tussaud's Wax Museum and adjoining planetarium would have been £107.95 for the five of us!)

We wandered — free — along the scenic south bank of the Thames, stopping in at the sprawling Borough Market, a food lover's paradise, where we spent £12.60 on snacks like smoked prawns wrapped in tortillas, steak sandwiches smothered with mushrooms and huge double-fudge brownies, and then visiting the area's many galleries.

After an early dinner (£56.03) at Tas Pide, a popular Anatolian restaurant that serves meze of hot and cold starters (hummus, tabbouleh and falafel) with endless baskets of sliced bread, as well as pides (pizzalike main courses of dough baked in a wood fire and filled with everything from sun-dried apricots and hellim cheese to chicken with red pepper and spinach), we headed to the Tate Modern (free), which stays open until 10 p.m on Friday and Saturday.

While my husband and I wandered through the galleries upstairs, checking out works by Rothko, Dali and Warhol, the three children played hide-and-seek among the current interactive ground floor installation of 14,000 stacked white cardboard boxes.

It seemed only fair that our agenda should be less cultural and more child-friendly the next day. We headed, inevitably, I suppose, to Buckingham Palace. It is with some embarrassment that I admit that my children had never seen the Changing of the Guard. Finally, the moment had come to experience this free pageantry. The historic ceremony, performed every day in the spring and summer, and every other day in the autumn and winter at 11:30 a.m., was both frustrating (the crowds were 10 people deep around the gate) and fantastic (the kids loved the synchronized marching and poker-faced guards).

After a brisk walk through St. James's Park and the adjacent Green Park, we used our travelcards to pick up one of only two Routemaster Heritage buses still crisscrossing the streets of London. These original London double-deckers (the Routemasters date back to the 1960's) are worth catching — they pass by St. Paul's Cathedral, Royal Albert Hall, Fleet Street and Trafalgar Square. Take the No. 9 or 15, but make sure it is marked "Heritage." What's more, it is much cheaper than the commercial hop-on-hop-off Big Bus in London, which costs £20 per adult and £10 per child per day.

We got off in Knightsbridge and followed the crowds into Harrods. After a quick run-though of the famed department store (all looking; no buying), we purchased a picnic lunch (£14) in the Food Halls. We ate by the nearby Serpentine, the lake that runs through Hyde Park, before deciding to rent one of the rowboats available at the boathouse for a half hour of family fun (£9.99).

Afterward, while the girls in our family spent £26.50 at Kensington Palace, which houses among other treasures a royal ceremonial dress collection that includes many of Princess Diana's favorites, the boys headed instead to the nearby (free) Peter Pan Playground, complete with an Indian Village with tepees and totem poles.

That evening's activity consisted of window-shopping on Kensington High Street and a meal at Wagamama, a trendy spot that serves Japanese noodle and rice dishes at communal tables. For only £50, thanks to a well-priced kid's menu, we enjoyed miso soups, dumplings, and various rice and noodle dishes filled with chicken, seafood and an array of vegetables.

ON our last day as tourists, we headed downriver to Greenwich, to see the Royal Observatory and the National Maritime Museum (both free). It seemed the most fitting way to get there was by boat, and so we purchased, for £26, a family ticket that would allow us to take one of the river cruises from the Tower of London and return by the Docklands Light Railway, a fast automatic train introduced in London in 1987 that winds through the city's newest developments, including Canary Wharf.

After learning more than we could absorb about Royal Astronomers in the Observatory, we ate our best-value meal of the weekend at Goddard's Pie House. For £18.50 total, we each ordered a pie (steak and kidney, cheese and onion, chicken and mushroom, to name just a few) served with mashed potatoes and peas, and left stuffed.

Tired, we headed back on the Docklands Light Railway. As the children nodded off, I had tallied up our spending and was pleased to find we still had £53.42 left for our final meal. We chose Masala Zone, an inexpensive but well reviewed new Indian restaurant chain. Sharing large dishes of butter chicken, lamb korma, chickpea samosas, and prawn thali, we discussed the highlights of the long weekend with the children. My teenage daughter even apologized to me for a conversation I overheard her having on her cellphone in which she said, "You won't believe what my Mom is making me do this weekend!" Be grateful, I told them. At least we were not reduced to repeating in unison a Vaishnava mantra at the Hare Krishna Center.

When the bill came, it totaled £45.40. Without hesitation, I quickly ordered my husband and myself a second celebratory beer and pocketed my calculator. "Cheers," he said, holding up his glass. "You win."

Pinching Pounds

WHERE TO STAY

VRBO.com (Vacation Rental by Owner) provides numerous listings of vacation properties around the world for rent by their owners. In London, nearly a hundred different rental properties, including many family houses, are listed.

WHERE TO EAT

The Stockpot, 18 Old Compton Street W1, 44-20-7287-1066, serves British specialties as well as burgers, pastas and omelets. Open seven days a week, and there are several other locations.

Chuen Cheng Ku, 17 Wardour Street W1 44-20-7437-1398, in the heart of Chinatown, specializes in dim sum, which is served every day of the week.

Tas Pide, 20-22 New Globe Walk SE1, 44-20-7928-3300, an Anatolian restaurant on the South Bank, is so good it makes you want to visit Anatolia (the Asian part of Turkey) for more of the food. Open seven days a week for lunch and dinner.

Goddard's Pie House, 45 Greenwich Church Street SE10, 44-20-8293-9313, serves pies (both veggie and meat) as well as stewed or jellied eels, a Cockney specialty. Open seven days a week.

Star Cafe, 22 Great Chapel Street W1, 44-20-7437-8778, serves a traditional English breakfast from 7 a.m Monday to Friday, including a national favorite, black pudding, for those who like pig's blood with their eggs.

Wagamama, with 24 locations around the city, including 26A Kensington High Street W8, 44-20-7376-1717, has a kid's menu unlike any other — featuring mini-ramen, minichicken Katsu and deep-fried prawns.

Masala Zone, 9 Marshall Street W1F, 44-20-7287-9966, and other locations, serves excellent curries, thalis and lamb roghan josh.

JENNIFER CONLIN, who lives in London, is a frequent contributor to the Travel section.
###

Paris - go there immediately.

Paris - need i say anything else ? Enjoy.

The New York Times
April 23, 2006
Affordable Europe: Paris
By ELAINE SCIOLINO

Now that the French government has withdrawn a disputed youth labor law, tourists can visit Paris without worrying too much about the disruption of massive protests and strikes. And no matter how expensive Paris can seem — especially with the weak dollar — there are endlessly creative ways to save money.

Where to Eat Cheaply

Around every corner is another bistro, where all day, every day, one can find good food, good wine and good value (for Paris, that is). A jewel, hidden in an unremarkable part of the 15th Arrondissement, is Le Troquet (21, rue François Bonvin; 33-1-45-66-89-00). Lively, Basque-inspired, sometimes smoke-filled, it has a 38-euro ($47, at $1.24 to the euro) six-course — yes, six-course — tasting menu that changes every week. One sample menu includes cream of cauliflower soup, vegetable barigoule with bacon and country ham, shellfish ravioli, confit of lamb shoulder, madeleines with a pot of vanilla cream, and macaroons with praline-dusted mousse and roasted banana. A three-course menu is 30 euros ($37), without wine. Closed Sunday and Monday.
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Lodging for Under 100 Euros

Damp in winter, stuffy in summer, dark all year round. That pretty much describes the world of cut-rate hotel rooms in Paris. An exception is the 30-room New Orient Hotel at 16, rue de Constantinople in the heart of the Eighth Arrondissement (33-1-45-22-21-64; www.hotel-paris-orient.com). A 10-minute walk from the Parc Monceau, the antiques-filled hotel feels, well, very French. The rooms are small but comfortable and clean, and 16 have small balconies. Rates: 82 euros for a single room (with shower), 105 euros for a double (with full bath).
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Best Deal on a Cultural Event

Museums in Paris are expensive. The two-, four- or six-day museum passes (38, 55 and 72 euros, respectively) make it less pricey — but only if a lot of museums can be crammed in. However, a number of Paris museums are free, including the newly restored Musée du Petit Palais. Just off the Champs-Elysées, the museum, with its sweeping staircases and collection of ancient sculptures, medieval tapestries and paintings, reopened last year after a five-year renovation. The garden of the Musée Rodin, which has many of his sculptures, costs only one euro (a visit to the museum's permanent collection is six euros).

Visitors who have had enough of museums can go to the free, half-hour haute couture and prêt-à-porter fashion show on the seventh floor of the Galeries Lafayette department store every Friday at 3 p.m. Both men's and women's fashions are featured. Reservations are a must (33-1-42-82-30-25; www.galerieslafayette.com). Le Printemps department store across the street offers a similar free fashion show on Tuesdays at 10 a.m.
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Best Things to Do Free

Every Friday night at 10, traffic is stopped for a three-hour in-line skating run through the capital. The 12-mile trip starts and ends at the Place Raoul Dautry, in the 14th Arrondissement. A gentler run that starts and ends at the Place de la Bastille takes place on Sunday afternoons. For the itineraries and more information, see www.pari-roller.com for Friday and www.rollers-coquillages.org for Sunday.
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Best Money-Saving Tip

The cheapest way to see Paris is with a one-hour one-way ride on the No. 69 public bus (1.40 euros). The bus starts and ends at two tourist destinations — the Eiffel Tower in the west (at the Avenue Joseph Bouvard) and Père Lachaise Cemetery in the east. Along the eastward route, the bus passes Les Invalides, the Seine, the Louvre, the Hôtel de Ville, the Marais, the Place de la Bastille. And you mingle with French people, not tourists.
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###

Rich Friends

We should ALL have such friends to help us live well. . . Enjoy.

The New York Times
Printer Friendly Format Sponsored By

April 23, 2006
How a Billionaire Friend of Bill Helps Him Do Good, and Well
By JOHN M. BRODER and PATRICK HEALY

After leaving the White House in 2001, former President Bill Clinton was inundated with business and job offers, from investment-bank partnerships to seats on corporate boards. He turned them all down, with one exception: He agreed to be an adviser to a family of funds run by the Yucaipa Companies, a California private equity firm controlled by one of his best friends, the billionaire Ronald W. Burkle.

Mr. Clinton's arrangement with Mr. Burkle is an unusual one for a former president, giving him the potential to make tens of millions of dollars without great effort and at virtually no risk, according to Mr. Burkle and advisers to Mr. Clinton.

Mr. Clinton's role is to help find investment opportunities for Yucaipa projects, give credibility to the funds and champion their mission of investing in poor areas to corporate executives, union leaders and others. But he has put up little of his own money and has no day-to-day responsibilities over how the more than $1 billion in the funds is invested.

Mr. Clinton, 59, spends most of his time on philanthropic ventures, like fighting AIDS in Africa and poverty around the world, and minimal time on Yucaipa, his advisers say. Mr. Burkle, 53, who made his fortune operating supermarkets, said that the time Mr. Clinton does spend on the funds is invaluable because of the incomparable access and political star power he provides.

Mr. Burkle said that Mr. Clinton had spoken with the chairmen of McDonald's and Boeing about possible projects that Yucaipa might have invested in, though those projects did not come to fruition.

The relationship brings together two outsize personalities who rose from modest beginnings to inhabit the glamorous heights of the political and financial worlds. The chubby young boy from Hope, Ark., and the grocery bag boy from Yucaipa, Calif., are now joined in a partnership that commands audiences of heads of state, business potentates and movie stars wherever they go in Mr. Burkle's Boeing 757.

It is a bond that is drawing news media attention, too, because of Mr. Burkle's allegations that a contributor to The New York Post, Jared Paul Stern, tried to extort $220,000 from him in exchange for keeping false stories about him out of the Post's gossip column, called Page Six.

Mr. Burkle, who by numerous accounts is devoted to Mr. Clinton, had become furious with gossip in The Post about them, like one story that suggested that Mr. Burkle was interested in buying a modeling agency for Mr. Clinton to run. Mr. Burkle and Clinton advisers said the two men never discussed that story or the claim of extortion, which remains under investigation. Mr. Stern has denied the allegations and says he was set up.

Interviews with Mr. Burkle and aides to Mr. Clinton have provided the first details of the business relationship between the former president and Mr. Burkle, a major Democratic donor who is now a fund-raising force for Senator Hillary Rodham Clinton. He served as host for a fund-raiser for Mrs. Clinton at his Beverly Hills estate on Friday night.

The three Yucaipa funds that Mr. Clinton advises total more than $1 billion, according to interviews and public records. Mr. Burkle would not disclose the precise amounts, citing competitive concerns, but Yucaipa manages in excess of $3 billion, of which these three funds are a subset. The funds are intended to inject investment capital into poor urban and rural areas in the United States and abroad that traditional equity funds and banks are reluctant to serve, Mr. Burkle said.

The funds Mr. Clinton advises invest in grocery stores, retail developments, manufacturing and distribution, and minority-owned businesses. Yucaipa has found significant growth opportunities in such areas because of the low cost of land and the relative lack of competition.

Under terms described by Clinton advisers and Mr. Burkle, Mr. Clinton will receive a share of Mr. Burkle's profits on two domestic funds should their returns exceed 9 percent over the life of the funds. One fund had reported a gain of 51.3 percent and the other 25.8 percent in 2005, according to reports to investors.

Mr. Clinton is also a partner in a Yucaipa fund that invests in overseas ventures, for which he receives regular payments and would draw one-third of the profits when the fund is dissolved at least five years from now.

"If we make money, he makes money," Mr. Burkle said. He would not be more specific about Mr. Clinton's compensation. But if the funds perform as well as Mr. Burkle's other investment funds have over the past two decades, Mr. Clinton's share of the profits could reach into the tens of millions of dollars.

While the business activities of ex-presidents are not always in public view, they are known to have pursued a variety of profit-making and charitable activities after leaving office. George H. W. Bush became a paid adviser to the Carlyle Group, a private investment house in Washington that does a lot of business with the Pentagon and other federal agencies.

Ronald Reagan received $2 million for a speech in Japan, but spent most of his post-presidency at home with Alzheimer's disease. Jimmy Carter has written many books and devoted himself to philanthropic pursuits like Habitat for Humanity.

Gerald R. Ford has been paid for speaking to groups but has generally kept a low profile. Richard Nixon wrote books and tried to rehabilitate his image.

The Clintons have a somewhat checkered history of investing with personal associates. An investment in the failed Arkansas real estate deal known as Whitewater led to a government investigation that nearly brought down Mr. Clinton's presidency and left the couple with millions of dollars in legal bills. During their time in Arkansas, a friend advised Mrs. Clinton in the investment of $1,000 in the cattle futures market that yielded a quick $100,000 in profit; the investment prompted questions about political favoritism once the Clintons moved to the White House.

The Clintons' chief source of income since leaving the White House has been lucrative book contracts and scores of six-figure speaking engagements for the ex-president.

The California Public Employees Retirement System, often called Calpers, is a major investor in the two domestic funds of Yucaipa,, committing $400 million since 2002 with an option to invest another $275 million, according to public records. Calpers officials said they chose to invest with Yucaipa because it has a stellar track record and it invests in communities that have trouble attracting other investment capital.

In announcing its decision in 2002, Calpers said that the firm had generated an internal rate of return of 45 percent annually on $14.6 billion in investments over the previous 16 years.

Mr. Burkle said it is impossible to put a dollar figure on the value that Mr. Clinton brings to his ventures. "He explains to people better than we can why these are good things to invest in," Mr. Burkle said in an interview on Thursday night in Mr. Clinton's Harlem office. "He'll talk about the importance to the economy, to the community. And he builds the brand of Yucaipa."

Mr. Clinton was not at the office during the interview. Some of Mr. Clinton's aides were granted anonymity to provide details about the business relationship with Mr. Burkle that are not otherwise publicly available.

In a speech to a teachers' retirement fund group in 2003, Mr. Clinton explained the attraction of working with Mr. Burkle. He said that he had many offers to go into business after he left the White House, but he turned them all down except the one proposed by Mr. Burkle. He explained that the Yucaipa Companies had " earned a phenomenal return investing in three things I care about: in underserved communities, in underperforming companies that are friendly to their workers and their families, and in minority-owned businesses."

Mr. Burkle said of his business philosophy: "You don't have to be smart. You just have to know enough to call someone who is smart."

The two men first met when Mr. Clinton was running for president in 1992 and touring neighborhoods in Los Angeles that had been torched during riots after the acquittal of several police officers charged with beating Rodney King. Mr. Clinton noticed that some supermarkets were still open, and asked why, his aides recalled. He was told that those stores were not burned because the owner, Mr. Burkle, treated his customers and employees fairly. Mr. Clinton asked to meet him.

A meeting was quickly set up at the Burbank airport with Mr. Burkle, then a registered Republican, who ran an empire of California supermarkets. The two men drove to a political event, then kept talking in the car for 45 minutes. Mr. Burkle said he came away in awe; he cast his first vote for a Democrat, Mr. Clinton, that fall.

Their relationship grew during his presidency, when Mr. Clinton was a frequent overnight guest at Mr. Burkle's Beverly Hills estate, Greenacres, the former home of Harold Lloyd, the silent screen star.

Mr. Burkle contributed millions of dollars to Mr. Clinton's campaigns and to the Democratic Party and has been a significant benefactor of the Clinton Library in Little Rock, Ark. He also helped pay part of the more than $11 million in legal bills Mr. Clinton accrued during the Whitewater and Monica Lewinsky investigations. Mr. Burkle was among the dozens of Democratic donors rewarded with a stay in the Lincoln Bedroom in the White House.

Now, Mr. Burkle says, that he and Mr. Clinton spend about 500 hours a year together, traveling the world aboard Mr. Burkle's plane to attend conferences and meetings with foreign leaders.

Mr. Burkle has been estranged from his ex-wife, Janet, since 1992. They are still battling in court over the financial terms of her settlement.

As the two men grew closer when Mr. Clinton was in office, there was at least one instance when the relationship touched on presidential authority: A potential pardon for Michael Milken, the former junk-bond baron who is a friend of Mr. Burkle's, as Mr. Clinton was leaving office in 2001.

In the interview, Mr. Burkle disputed newspaper accounts that he had directly asked Mr. Clinton to pardon Mr. Milken, who was convicted of securities fraud, and had offered a large contribution to the Clinton presidential library as an inducement. He said the he and Mr. Clinton had a late-night discussion about limitations on convicted felons voting or traveling overseas.

Mr. Burkle said he was troubled that Mr. Milken had been unable to take his family to the 2000 Olympics in Australia because of restrictions imposed on him as a condition of his parole. He said that Mr. Clinton noted that this was the kind of case the presidential pardon system was designed for and that it was relatively easy to apply.

Mr. Clinton ultimately declined to grant Mr. Milken a pardon, after Department of Justice and White House political aides warned that it would touch off a firestorm, as several of the pardons he ultimately granted did. Mr. Burkle said that Mr. Clinton called him personally to tell him he was rejecting Mr. Milken's pardon plea.

Clifford J. Levy contributed reporting for this article.
###

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April 23, 2006

Affordable Europe

Live well, spend less. It’s a nice concept — but one that’s often hard to pull off when you are an American tourist traveling through Europe and struggling to find ways to offset the weakness of the dollar. Here is some help: money-saving tips on everything from hotel rooms to cultural events from New York Times correspondents and contributors in 16 major European cities.

• Amsterdam by Gisela Williams
• Athens by Anthee Carassava
• Barcelona by Andrew Ferren
• Berlin by Richard Bernstein
• Copenhagen by Seth Sherwood
• Dublin by Brian Lavery
• Geneva by Anne Glusker
• Lisbon by Pavia Rosati
• London by Heather Timmons
• Madrid by Dale Fuchs
• Milan by Elisabetta Povoledo
• Oslo by Bruce Bawer
• Paris by Elaine Sciolino
• Prague by Evan Rail
• Rome by Brian Wingfield
• Venice by Elisabetta Povoledo

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a life in letters

i cannot imagine my life without poetry in it - and - by definition - Richard Wilbur. Enjoy, sumptuously.

The New York Times
April 19, 2006
Richard Wilbur Wins $100,000 Poetry Prize
By LAWRENCE VAN GELDER

The poet and translator Richard Wilbur has won the $100,000 Ruth Lilly Poetry Prize of the Poetry Foundation. In announcing the award yesterday, Christian Wiman, the editor of Poetry magazine and chairman of the selection committee, said: "If you had to put all your money on one living poet whose work will be read in a hundred years, Richard Wilbur would be a good bet."

Mr. Wilbur, 85, who lives in Cummington, Mass., is a former poet laureate of the United States and a winner of two Pulitzer Prizes, the National Book Award and the Bollingen Translation Prize. Established in 1986 by Ruth Lilly, the great-great-granddaughter of Eli Lilly, the annual prize that bears her name honors a living American poet whose lifetime accomplishments merit exceptional recognition.
###

Women and Heart Disease

This is confusing to say the least. We all know women are usually designed better than men from every standpoint. This raises puzzling questions.


--------------------------------------------------------------------------------

April 18, 2006
In Heart Disease, the Focus Shifts to Women
By DENISE GRADY
Kim Kachmann-Geltz did everything right. She ran five miles a day, dutifully ate oatmeal and wheat toast, stayed slim, never smoked. Her blood pressure was perfect. Her genes, she thought, were lucky: her great-grandmother had lived to 102.

"I'm the last person in the world I could ever imagine having heart disease," said Ms. Kachmann-Geltz, of Hilton Head, S.C., who is 39 and the mother of three children.

But since 2003 she has suffered from angina, chest pain caused by inadequate blood flow to the heart. In addition, one chamber of her heart has shown signs of enlargement, and her heart valves do not work properly. She takes four heart medicines and may eventually need more. Even with the drugs, chest pain keeps her from running. She walks instead, and does yoga.

"It's not a death sentence," she said. "You don't have to live your life depressed."

But her outlook is a mixed message. She describes her prognosis as good and yet also says the disease may shorten her life.

"We just don't know," she said. "That much has been made clear to me."

Her case is unusual: angina more often strikes older women. Still, coronary artery disease is the leading cause of death in women over 25, killing more than 250,000 a year in the United States. Before they reach their 60's, women are less likely than men to develop heart problems, but once the disease does occur, women often fare worse than men.

Since 1984, more women than men have died each year from heart disease, and though overall coronary death rates have dropped in recent decades, most of the improvements have been in men.

Puzzling differences have emerged between men and women with heart disease, making it plain that past studies, mostly done on men, do not always apply to women. Researchers have come to realize that to improve diagnosis and treatment for women, they must sort out the differences.

"Every time we turn around, we find more gender differences, so it's important to study," said Dr. C. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

Among the differences are these:

¶Women with chest pain and other heart symptoms are more likely than men to have clear coronary arteries when tests are performed, a surprising result that suggests there may be another cause for their problems.

¶When women do have blocked coronary arteries, they tend to be older than men with similar blockages and to have worse symptoms, including more chest pain and disability. These women are also more likely to have other problems like high blood pressure, high cholesterol and diabetes, which may make surgery riskier. And they are more likely than men to develop heart failure, a weakening of the heart muscle that can be debilitating and ultimately fatal.

¶When women have bypass surgery or balloon procedures for coronary blockages, they are less likely than men to have successful outcomes, and they are more likely to suffer from bad side effects.

¶Blood tests that reliably pick up signs of heart damage in men do not always work in women.

¶Women seem much more likely than men to develop a rare, temporary type of heart failure in response to severe emotional stress.

"We don't have good explanations for these gender differences," said Dr. Alice K. Jacobs, a cardiologist at Boston University.

She said that one reason women have not fared as well as men after bypass surgery and balloon procedures may be that women are smaller, and so are their blood vessels, and the vessels may tend to clog up again more easily after the procedures.

In addition, surgeons performing bypasses in women have been less likely to use an artery from inside the chest wall, because it is smaller and harder to work with — even though using the chest artery instead of a leg vein gives most patients better odds of long-term survival.

In the past, Dr. Jacobs said, cardiologists had only big balloons and bulky tubing to open blocked vessels, and some of the equipment may have been too large for women.

"Now we have tiny wires, balloons and stents, and it's less of an issue," she said, adding that success rates in women were improving.

Women like Ms. Kachmann-Geltz have become an important focus of study. Her doctors believe she has an insidious type of heart disease, more common in women than men, that researchers are just beginning to understand.

These patients have chest pain and abnormal stress tests. Their heart muscle is starved and aching for oxygen — and yet their coronary arteries look wide open on an angiogram, the test in which doctors inject the vessels with dye and then X-ray them to spot blockages.

Some of these women also score poorly on a simple survey — the Duke Activity Status Index — that gauges their strength and ability to exercise by asking questions like whether they can walk up a flight of stairs or run a short distance. A low score is a reliable predictor of more heart problems to come.

For those with symptoms, the real, underlying problem may be a disorder called microvascular disease, a narrowing or stiffening of the smaller arteries that nourish the heart, vessels too tiny to show up on an angiogram.

"These little arterioles are deciding where relatively low and higher blood flow should occur," said Dr. Bairey Merz, explaining that the smaller vessels are more muscular than large ones, and their walls contract or relax to regulate blood flow.

In microvascular disease, the small vessels lose their ability to dilate and increase blood flow to the heart. The cause does not seem to be fatty deposits like the ones that can block the coronary arteries.

Rather, the muscles in the arterioles thicken, a process called remodeling, and the walls may stiffen and begin to close in. The result is ischemia, lack of blood flow. Over time, it increases the risk of heart failure and heart attacks.

Three million women in the United States may have microvascular heart disease, said Dr. Bairey Merz, chairwoman of a government-sponsored study of the disorder, called Wise, for Women's Ischemia Syndrome Evaluation.

That study, begun in 1996, included 936 women who had angiograms because of symptoms like chest pain. Their average age was 58, but a quarter were younger and premenopausal.

The angiograms found that only a third had blockages in their coronary arteries. In men with similar symptoms, three-quarters or more would have had severe blockages, said Dr. Carl J. Pepine, an investigator in the study and the chief of cardiovascular medicine at the University of Florida.

Another third of the women had no blockages but did have low blood flow to the heart, most likely a result of microvascular disease. The deficiency was found by a test in which doctors first measured blood flow through the heart and then injected a drug that should have made the arteries dilate and increased the flow. If the flow did not rise, the patient most likely had microvascular disease.

Among those judged to have the disorder, the rate of deaths or heart attacks was 10 percent after four years — much higher than would be expected for women with normal angiograms.

The findings call for a major shift in the treatment of women with chest pain or other symptoms and normal angiograms, said Dr. George Sopko of the National Heart, Lung and Blood Institute. "Instead of tossing aside the angiogram and saying you're O.K., let's make sure we are not missing anything."

Doctors should use the Duke survey and consider other tests that can pick up signs of ischemia. And since recent studies have also suggested that women who score high on measures of hostility have an increased risk of heart problems, Dr. Sopko said: "If a woman comes in and has symptoms, let's be careful when we evaluate her. Let's listen to her, look at all the risk factors and include the psychosocial evaluation."

High cholesterol and high blood pressure are almost certainly among the causes of microvascular disease, and it is essential to treat them aggressively in women with chest pain, Dr. Pepine said, and to urge women to exercise, avoid smoking and lose weight if they are too heavy.

Recent studies have found that high blood pressure — particularly high readings in the top number, the systolic pressure — is a more serious risk factor in women before menopause than after, and researchers say it should be monitored and treated.

"You don't want to be disabled and lead a miserable life," Dr. Pepine said. "Women who develop heart failure tolerate it much more poorly than men, and they tolerate heart attacks and bypass surgery more poorly than men. We don't want them to get to that stage."

The meaning of other findings is less clear, Dr. Sopko said, adding that researchers were debating what if anything to do for women who had high levels of a substance called C-reactive protein, a marker for inflammation, which is thought to play a role in heart disease.

"We know it appears to be a marker for atherosclerosis," Dr. Sopko said, "but that is far from saying we have to act on that marker with such and such strategies. Simple, fairly appealing strategies may not work out that well. We have to go back and get better knowledge."

Why microvascular disease might be more common in women than men is unknown. Inflammation and anemia, both more common in women, have been suggested as possible factors, along with hormonal fluctuations, but none have been proved.

Some researchers think microvascular disease may help explain some of the other gender differences — why, for instance, women tend to have worse symptoms than would be expected based on the condition of their coronary arteries.

But microvascular disease is not easy to detect. When doctors see clean coronary arteries on an angiogram, they may not take a patient's chest pain seriously or recommend more tests or treatment.

"I was treated like a crazy woman," Ms. Kachmann-Geltz said, noting that one doctor offered her tranquilizers, implying that her problems were all in her head.

Her symptoms began during her third pregnancy, and her heart function deteriorated so much that she nearly died during labor, she said, recalling that a nurse in the delivery room actually asked whether she was an organ donor.

After her son was born, she suffered from angina for almost two years and had attacks that woke her up at night, before she found her way to Dr. Pepine.

Tests showed a blood flow deficit in her heart.

"It was 30 seconds that changed my life," she said. "It was the first time I felt acknowledged. This is real, it's not in my head, it's not some pregnancy thing. I shake when I think about it."

It is impossible to say why the disease developed, but she noted that her mother also has heart disease. In any case, Ms. Kachmann-Geltz she began treatment with a diuretic and other medicines to control her blood pressure and cholesterol.

"My world started coming back to me," she said. "It took about four months. I started to regain energy, and stopped having nighttime sweats and chest pain. I was able to start living my life again."



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Politeness Police

Now HERE'S a trend i can get behind ! Enjoy - or else !

The New York Times
April 16, 2006
New York Leads Politeness Trend? Get Outta Here!
By WINNIE HU

New Yorkers are known to throw things onto the field at Yankee Stadium when the Red Sox are in town. At times they boo their own mayor at parades. Some refuse to surrender their seats to pregnant women on the subway, while others cut in line and never apologize.

But somehow a city whose residents have long been scorned for their churlish behavior is now being praised for adopting rules and laws that govern personal conduct, making New York an unlikely model for legislating courtesy and decorum.

From tighter restrictions on sports fans and car alarms to a new $50 fine on subway riders who rest their feet on a seat, New York's efforts to curb everyday annoyances and foster more civility among its residents have increasingly been studied and debated far from home.

When Chicago's aldermen wanted to keep rowdy fans from descending upon Wrigley Field, they looked to New York, which has arrested 11 people at Yankee and Shea Stadiums under a 2004 law that makes it illegal to interfere with professional sports events.

When Boston and San Francisco lawmakers considered silencing cellphones in their movie theaters and playhouses, they, too, looked to New York, which imposed a $50 fine in 2003 on callers who brazenly dial up during movies, concerts and Broadway shows. And when community groups from Toronto to Washington looked for new ways to fight graffiti, they turned to New York, which passed a law in January that makes building owners responsible, for the first time, for cleaning up after the vandals.

With its precipitous drops in crime, New York has increasingly been able to turn its attention to policing offensive behavior, from the mere faux pas to outright misconduct that puts others at risk. And that has put it on the front line of a national crackdown on incivility.

"There's no excuse for that kind of thing," said Alderman Edward M. Burke, a leader of the Chicago City Council, who has introduced a sports fan law based on New York's. "I think it's a good idea to remind the general public of what is expected of them."

Letitia Baldrige, the White House social secretary during the Kennedy years, could not agree more. Ms. Baldrige, a former New Yorker, has heard more than her share of bellyaching over other people's rudeness.

"Most people just seem to ignore common sense and common courtesy so it does have to be legislated," she said. "To have this happen in New York is going to inspire a lot of other people. I cannot applaud it enough. My hands are tired from clapping."

The city has made sputtering attempts in the past to coax civility out of its residents. During the 2004 Republican convention, it gave protesters buttons saying "peaceful political activists." But nearly 1,800 were arrested that week. The famed Gray's Papaya hot dog chain tries a similar tack, selling "Polite New Yorker" buttons for $1. About 60 are sold a week, but most go to tourists who think they are a joke, says the owner, Nicholas Gray.

"I try to do my part," said Mr. Gray, who requires his employees to wear the button on their uniform even though he does not. "I'm not always that polite. I'm just another New Yorker."

And throughout New York's history, its political leaders have sought to restore order to the chaotic streetscape and fine-tune urban life. Fiorello H. La Guardia once banned street performances involving monkeys. Decades later, Rudolph W. Giuliani's campaign against squeegee men came to embody his philosophy that fighting crime began with the smaller, quality-of-life offenses.

But sometimes, the city's attempts to enforce the laws illuminated its hard-nosed nature: Mayor Edward I. Koch's favorite parking sign warned motorists: "Don't Even THINK of Parking Here."

Under Mayor Michael R. Bloomberg, the city has increasingly focused on social policies that were once thought to be beyond the realm of government. Mr. Bloomberg was largely responsible for the city's smoking ban, overcoming opposition from the tobacco companies and their lobbyists to clear bars, restaurants and nightclubs of a potential health hazard as well as inconsiderate smokers.

The mayor also overhauled the city's noise code for the first time in three decades, taking aim at loud nightclubs, barking dogs and even that staple of summer, the Mister Softee jingle, all in the interests of keeping the neighborhood peace.

Given the successes, some New York officials are moving to take things even further. Councilman Peter F. Vallone Jr., of Queens, got the Council to expand his sports fan law last fall to include penalties for those who throw things onto the field or spit at the players. The 11 people who have been arrested under the original law, all during Yankees and Mets games, include one man who was sentenced to nine weekends in jail, fined $2,000, and ordered to stay out of Shea Stadium for three years.

This month, Mr. Vallone, the chairman of the Council's Public Safety Committee, introduced another measure that he calls a lesson in Parenting 101: Children under the age of 10 would not be allowed in movie theaters after 10 p.m., to safeguard both the welfare of the children and the enjoyment of the other moviegoers.

It is not the first time that the city has tried to teach children — and their parents — how to behave in public. Under a code of conduct mandated by the Council since 2003, parents can be ejected from Little League games for unsportsmanlike behavior and allowed to return only after taking an anger-management class.

"There's nothing that makes you want to crawl under the bleachers faster than some parent screaming at a kid — even their own kid — in an abusive manner," said Councilman Lewis A. Fidler, of Brooklyn, who sponsored that law.

The crackdowns have left others wondering if the metropolis once known as Fun City is fun no more.

"It sounds like your City Council is getting really uptight," said Aaron Peskin, a member of the San Francisco Board of Supervisors, who, along with his colleagues, has nevertheless looked to New York's laws for guidance. "It all seems a little overwrought."

Donna Lieberman, executive director of the New York Civil Liberties Union, has not yet raised objections to these laws. But she cautioned that lawmakers could interfere with privacy rights or impose censorship when they, say, imposed a movie curfew on young children. "Legislation to set bedtime for Bonzo, or to interfere with how late parents can keep their child out at night, is a violation of privacy," she said.

Still, many New Yorkers say that the city is becoming a more civil place. The sports fan law, for one, is praised by Paul Lo Duca and other Mets players during a pregame video shown at Shea Stadium.

In the past, rowdy fans were simply escorted out of the stadium and released, which was "akin to a traffic summons," but now that they are faced with jail time, they think twice about misbehaving, said Robert J. Kasdon, the Mets' vice president of security. "It's the most effective law of its kind," he said. "Baseball is a family event, and this law helps us maintain that atmosphere."

Not all the city's laws have been as effective. For example, the ban on cellphones in movie theaters does not appear to ever have been enforced by the police. Some Council members and movie theater managers, though, contend that just having the law is enough in most cases to persuade moviegoers to turn off their phones.

But Peter Post, the director of the Emily Post Institute, which instructs schools, businesses and government organizations on etiquette, said that law or no law, good behavior could not simply be forced on unwilling people. Instead, he suggested that New York invest in a public relations campaign that reflected the sentiments of its residents.

"I think we've reached a tipping point with rudeness," he said. "Instead of people quietly putting up with rude behavior, they're finally saying, 'I don't have to put up with that anymore.' "
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Carnivoracious

Vegetarianism aside (way, way aside), there's simply something hard-wired into our DNA that likes eating cooked meat. This article is an excellent description of why. Enjoy.


The New York Times
April 12, 2006
Got a Crowd Coming Over? Think Big Cuts of Meat
By MATT LEE and TED LEE

IN the spring our entertaining ambitions seem to grow along with everything else that is sprouting. Friends emerge from deep winter thirsty for human contact, white wine and open windows, and we find ourselves bumping into people we know on the street more often. Houseguests, on the way to holiday gatherings, multiply.

By the time the dinner hour rolls around, that quiet supper for four can easily have mushroomed into a party for 10 or even 16.

Tripling the size of a soiree on short notice can be fun, but it is impossible to do without a veil of panic. This year we found a way to boost our confidence: by mastering the cooking of a few large cuts of meat.

They feed hordes, are simple to prepare, and inevitably arrive at the table to an ovation tinged with awe. These large cuts lead to great leftovers, too.

The centerpiece of a large informal dinner should be showstopping, but not showy — or bankrupting. And while it seems the height of luxury to tell a friend, "Of course, bring your six houseguests to dinner!" you can say so with little self-doubt when you pick the right meat.

We bypassed expensive choices like crown roast of lamb and standing rib roast in favor of three humbler cuts: fresh ham, whole beef brisket and bone-in leg of lamb.

With these, the larger the cut, the more meat you get for your money. If your favorite market is the kind of store that offers deeper discounts for untrimmed cuts, you can save even more with a minimum of knife skills.

The first big cut we tackled, bone-in leg of lamb, was the most common of the three we tried, and the costliest. A gorgeous specimen, it weighed nearly 12 pounds and set us back $40 and change.

An informal survey of our contemporaries revealed that few home cooks attempt this cut. They are intimidated by the silvery membrane between fat and flesh, and by the need to remove the hipbones and tying the resulting flaps of flesh with twine, all to facilitate the carving of presentable, large slices. Once you have a butcher trim these out, the reasoning goes, you may as well buy chops.

Surrender is not advisable. The membrane comes off in five minutes of trimming with a sharp knife — no specialized skill is necessary — and we leave the hipbones in. The meat around these bones cooks more quickly than other parts of the cut, and may not be as moist come carving time. But because so much of its surface is coated with the marinade, it is exceptionally delicious (especially with a spoonful of the intensely minty sauce, touched with garlic and vinegar, that we serve with it).

After trimming the fat, we rubbed the leg all over with a marinade. We chose one with Moroccan flavors: lots of lemon zest and lemon juice (a quick substitute for preserved lemons); the red chili paste called harissa; garlic; toasted coriander; and olive oil. We let it cure for about four hours before roasting.

The outside of the lamb should be seared gently, so we heated the oven to 450 degrees, then turned down the temperature to 350 upon placing the lamb in the oven. After an hour and 45 minutes (basting with pan juices every 25 minutes or so) it was beautifully done, the outside gently browned, the inside perfectly pink.

The bonus was lemony, fiery pan drippings, spooned over naked couscous. As with all large cuts of meat, when the main dish is spectacular, the side dishes can be as mild as couscous, white rice or mashed potatoes.

A whole beef brisket, which is a boneless breast, consists of two cuts separated by a layer of fat: the smaller cut is called the first cut, or flat half, and the thicker one is the second cut, or point half. Typically, the cuts are sold separately, trimmed of fat.

We kept ours whole by design. Our experience with brisket, limited mostly to the barbecued version in Texas, gave us the impression that brisket is prairie-dry, if flavorful, but almost never delectable. We suspected that if we braised the entire brisket we would not only have more protein to serve, but the layer of fat that encased the two cuts would baste the beef as it cooked, giving it the unctuousness we craved.

Even trimmed of its outer layer of fat, our brisket was brontosaurian.

We chose to spin our recipe toward Spain and Italy by rubbing the meat with crushed chili pepper and the Spanish smoked paprika called pimenton, and by slow-cooking it in a simple tomato-garlic-rosemary braise.

We began with a sustained blast of high heat, to almost sear the outside of the meat, then cranked it down to 325 degrees for a slow roast, tightly sealing the brisket in its roasting pan with foil to retain as much steam as possible. After three hours (and a couple of back flips) the brisket emerged beautifully browned, slightly reduced from its previous bulk, and swimming in sauce and melted fat. Making the sauce is as simple as sifting out the tomato and the onion from the pan with a slotted spoon and puréeing them in a blender. The fat is (mostly) left behind. The sliced hot brisket, with a dollop of its tangy tomato sauce, is as expressive of beef as a well-marbled porterhouse.

A LEG of pork, called fresh ham to distinguish it from the cured or smoked variety, was the final cut we tried. It yielded the most bang for the entertainment buck by far.

A 16-pound fresh ham is truly monumental. At the supermarket three customers stopped us on the way to the checkout line to marvel or inquire. The cashier looked up and said, "You know how good a deal that is, right?"

At $1.59 a pound, we did.

Since the pork was nearly twice as large as the other cuts, and would take the longest time in the oven, we aimed to keep kitchen prep to a minimum.

Some butchers and pork lovers like to leave the skin on, for its crackling qualities. To us, there is a reason footballs were once made with pigskin. It is not very appetizing and too tough to chew.

So we trimmed the skin off the ham, revealing a layer of snowy white fat about a quarter-inch to a third-inch thick that would render into pan drippings while getting crispy on top. We scored it all over and seasoned it with a toss of kosher salt, freshly ground black pepper and fresh thyme.

We were concerned that with such a large cut the meat at the narrow end would be dry before the thicker parts were even cooked. But when it comes to doneness, fresh ham can be very forgiving.

The temperature of a ham roasted for four hours may rise a few degrees once it is removed from the oven, so we cooked ours until a thermometer inserted into the thickest part registered 155 degrees, then let the ham rest for 15 minutes before carving. It yielded the variety of doneness needed for a big party: well-done white meat, pink slices for the medium-rare crowd, and crispy fat and dark-meat bits from the shank for those who like to snack.

Carving fresh ham is easy; you do not need a special knife, though you will want to choose the longest, sharpest one in the drawer. If you have an electric carving knife, this is a great time to use it.

To cut the ham into perfect slices for serving, grip the exposed end of the shank bone with one hand (if your prefer, use a clean kitchen towel); with the other, cut vertically — perpendicular to the bone — from the top of the ham until the knife hits bone.

Continue cutting slices about a quarter-inch to a third-inch thick (thicker slices tend to leave intact more trim of the crispy, seasoned fat), until you have cut enough for a few servings. Then make a single horizontal cut, parallel to the bone, that releases all the slices you have made.

As we said earlier, there are often leftovers with large cuts, which are critical to have around for a quick lunch or snack when you have houseguests.

We had seven people staying over the night we made the fresh ham; the next day at around lunchtime one of them plucked the ham bone from the fridge and began carving. Others took a trip to the market for tortillas, salsas, cilantro and sour cream, and soon we had assembled a taco party for nine.

Still the ham kept giving. The next morning we made pork hash, pan-frying morsels of ham with diced red potato, onion, garlic and a finely diced jalapeño chili, until the potatoes got crispy and browned on the bottom.

The softly poached eggs we draped over the top and a shake of Tabasco were the finishing touches, and we wanted to call the seven guests back just to appreciate the third act.
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