Well: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

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Stanley Karnow, Historian and Journalist, Is Dead at 87

Stanley Karnow, a Pulitzer Prize-winning historian and journalist who produced acclaimed books and television documentaries about Vietnam and the Philippines in the throes of war and upheaval, died on Sunday at his home in Potomac, Md. He was 87.

The cause was congestive heart failure, said Mr. Karnow’s son, Michael.

For more than three decades Mr. Karnow was a correspondent in Southeast Asia, working for Time, Life, The Saturday Evening Post, The Washington Post, NBC News, The New Republic, King Features Syndicate and the Public Broadcasting Service. But he was best known for his books and documentaries.

He was in Vietnam in 1959, when the first American advisers were killed, and lingered long after the guns fell silent, talking to fighters, villagers, refugees, North and South Vietnamese political and military leaders, the French and the Americans, researching a people and a war that had been little understood.

The result was the 750-page book “Vietnam: A History,” published in 1983, and its companion, a 13-hour PBS documentary, “Vietnam: A Television History.” Unlike many books and films on Vietnam in the 1960s and ’70s and the nightly newscasts that focused primarily on America’s role and its consequences at home and abroad, Mr. Karnow addressed all sides of the conflict and traced Vietnam’s culture and history.

“Vietnam: A History” was widely praised and a best seller. The documentary, with Mr. Karnow as chief correspondent, was at the time the most successful ever produced by public television, viewed by an average of nearly 10 million people a night through 13 episodes. It won six Emmy Awards, as well as Peabody, Polk and duPont-Columbia awards.

Six years later, Mr. Karnow delivered his second comprehensive book and television examination of a Southeast Asian nation. The book, “In Our Image: America’s Empire in the Philippines” (1989), was a panorama of centuries of Filipino life under Spanish and American colonial rule, followed by independence under sometimes corrupt American-backed leaders. It won the 1990 Pulitzer Prize for history.

Narrated by Mr. Karnow, the three-part PBS documentary “The U.S. and the Philippines: In Our Image” traced America’s paternalistic colonial rule in the Philippines, the shared suffering of Filipinos and Americans under a cruel Japanese occupation in World War II, and Manila’s postwar independence under regimes nominally democratic but repressive, corrupt or indifferent to the miseries of its people.

Mr. Karnow also wrote “Mao and China: From Revolution to Revolution” (1972) and was a co-author of or contributor to books based on his years in Asia, including “Asian-Americans in Transition” (1992), “Passage to Vietnam” (1994), “Mekong” (1995) and “Historical Atlas of the Vietnam War” (1995).

Early in his career he lived in Paris for a decade, and in 1997 he published a memoir, “Paris in the Fifties.” A nostalgic reporter’s notebook of life among the cafe philosophers, berated musicians and pseudo-revolutionary artistes, it danced with digressions about taxes, restaurants, the guillotine, Hemingway, Charles de Gaulle and the Devil’s Island penal colony.

In its range, learning and appetite for fun, Bernard Kalb, the former CBS reporter and Mr. Karnow’s friend since Vietnam, told The Associated Press in 2009, the memoir was vintage Karnow. “Stanley has a great line about how being a journalist is like being an adolescent all your life,” he said.

Stanley Karnow was born in Brooklyn on Feb. 4, 1925, the son of Harry and Henriette Koeppel Karnow. He grew up in a city with more than a dozen daily newspapers and decided early that he wanted to become a reporter. He served in the Army Air Forces in World War II. After graduating from Harvard with a bachelor’s degree in 1947, he sailed for France, intending to spend the summer. He stayed for a decade.

This article has been revised to reflect the following correction:

Correction: January 28, 2013

An earlier version of this article misstated the year in which Stanley Karnow was a Nieman Fellow at Harvard University. It was 1958, not 2002. The article also misspelled the name of the Nieman Fellowship.

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IHT Rendezvous: The Clinton Doctrine of American Foreign Policy

The partisan political theater, of course, was top-notch. Sen. Rand Paul’s declaration that he would have fired Hillary Rodham Clinton; her angry rebuttal of Sen. Ron Johnson’s insistence that the Obama administration misled the American people about the Benghazi attack; Sen. John McCain’s continued outrage at the slapdash security the State Department provided its employees.

Beneath the posturing, though, ran larger questions: what strategy does the United States have to counter the militant groups running rampant across North and West Africa? And what kind of secretary of state has Ms. Clinton been? In her last Congressional hearing in that position, Ms. Clinton expressed exasperation with Washington’s political trench warfare.

“We’ve got to get our act together,” she said.

Ms. Clinton has been a very good but very cautious secretary of state, many analysts say – one who, for the most part, kept her distance from Afghanistan, Israel-Palestine and other seemingly intractable conflicts.

One State Department official, while praising Ms. Clinton’s tenure, nonetheless looked forward to the arrival of Sen. John Kerry, her designated successor: “I came to admire Clinton as secretary of state, her focus on women and innovation in particular,” the official told me. “But am really happy to have someone in the job who does not retain political ambitions.”

In a recent assessment of Clinton’s tenure, Michael O’Hanlon of the Brookings Institution argued that she had enjoyed some success, including restoring the United States’ image abroad, but she made no historic breakthroughs, he said.

Mr. O’Hanlon argued that Ms. Clinton’s famed work ethic paid off. She made few mistakes, no major gaffes and did not “needlessly antagonize” friends or enemies. O’Hanlon called Ms. Clinton’s role in the administration’s “pivot to Asia” and tough stance toward China arguably “her greatest and most memorable contribution.”

The problem, as last week’s hearing showed, is that the Middle East and the threat of terrorism continue to dominate American foreign policy. Even as the United States becomes more energy independent, terrorist attacks like the kidnappings in a remote oil facility in Algeria will make headlines and influence markets. And barring a massive shift in American domestic politics, Israel’s security will continue to be viewed as a vital interest of the United States.

Ms. Clinton, to her credit, made forty trips to Europe that helped produce crippling new sanctions on Iran. Last fall, she helped broker a ceasefire between Israel and Hamas in Gaza. But she failed to personally engage in Israeli-Palestinian peace talks.

To be fair, the Obama White House may have limited her options. After promising more open debate than occurred under President George W. Bush, the Obama White House tightly controlled the formulation of American foreign policy. Critics have also accused Mr. Obama of being overly cautious in foreign affairs.

With the exception of the Libya intervention and the raid that killed Osama bin Laden, Mr. Obama was “coolly calculating and reluctant to engage” in his first-term foreign policy, The Economist magazine recently argued.

Mr. Obama, of course, is trying to avoid the over-reach his predecessor displayed in Iraq. He also faces enormous fiscal pressures at home. But there is a risk that the pendulum is swinging too far toward a smug isolationism in Washington.

As Ms. Clinton departs, worrying trends are emerging in the way America engages with the world. The new U.S. weapon of choice is the drone strike – a tactic that carries zero political risk at home but spreads anti-Americanism abroad.

Complex foreign policy problems that threaten American security are increasingly seen as “entanglements” best avoided. And there is a convenient view that there are no “good guys” in the power struggles now unfolding in the post-Arab-Spring Middle East.

The potential lesson of the bruising political battle over Benghazi is simple: Take few risks, turn embassies into bunkers and avoid political firestorms at home. In her testimony, Ms. Clinton passionately argued against that approach.

Declaring Somalia and Colombia success stories, she said the United States could counter militancy in Africa and the Middle East by working with regional organizations and training local security forces. U.S. funding and training of an African Union Mission in Somalia, or AMISOM, Ms. Clinton said, had slowly succeeded in driving back al-Shabaab and other Islamist forces. In Colombia, the government has driven back FARC rebels and narco-traffickers.

There have been setbacks and the efforts in both countries are imperfect. But local security forces trained and funded by the international community slowly gained ground in painstaking efforts over many years.

“What we have to do is recognize that we’re in for a long-term struggle here,” Ms. Clinton said at the hearing. “And that means we’ve got to pay attention to places that historically we have not chosen to or had to.”

During their heated exchange, Mr. McCain criticized Ms. Clinton and the Obama administration for not doing enough to train Libya’s security forces. Secretary Clinton replied that House Republicans had put a hold on the funding the administration requested to train Libyans.

“If this is a priority and we are serious about trying to help this government stand up security forces,” she said, “then we have to work together.”

Ms. Clinton is right. And so is Mr. McCain. Congressional politicking hinders the State Department. And the State Department executed terribly in Benghazi. But Ms. Clinton, who I have criticized in the past, won the day.

“We are in a new reality,” she said, referring to the change sweeping across the Middle East. “We are trying to makes sense of events that nobody had predicted but that we’re going to have to live with.”

Ms. Clinton called for the United States to show “humility” abroad and stop making national security issues “political footballs” at home. She said a Cold War style bipartisan agreement should be reached to launch a long-term American effort to strengthen local security forces and promote democracy across Africa and the post-Arab-Spring Middle East.

“Let’s be smart and learn from what we’ve done in the past,” she said. “Put forth a policy that wouldn’t go lurching from administration to administration but would be a steady one.”

“We have more assets than anyone in the world,” Ms. Clinton added, “but I think we’ve gotten a little bit off track in trying to figure out how best to utilize them.”

A “little bit off track” is a euphemism for partisanship endangering national security. If the U.S. doesn’t get its act together, expect more Benghazis.

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In New Orleans, an unwelcome mat for Goodell

NEW ORLEANS (AP) — An effigy of NFL Commissioner Roger Goodell dangles from the front porch of a New Orleans home that is otherwise festively decorated with Saints paraphernalia.

With restaurants and bars gearing up for an influx of Super Bowl XLVII visitors, the "Refuse to Serve Roger Goodell" page on Facebook had 107 likes as of Friday.

A portrait of Goodell covers the bull's-eye on the dart board at Parkview Tavern.

And floats in the unabashedly lowbrow Krewe du Vieux parade in the French Quarter last weekend displayed larger-than-life likenesses of Goodell in acts that defy polite description.

New Orleans is celebrating the return of Saints coach Sean Payton after a season of NFL banishment as a result of the "bountygate" scandal — when the team ran a pay-for-hits program. But Goodell, who suspended Payton and other current and former Saints players and coaches last year for their roles in the system, is being ridiculed here with a vehemence usually reserved for the city's scandal-scarred politicians.

"They believe he completely used the Saints as an example of something that was going on league-wide," said Pauline Patterson, co-owner of Finn McCool's, an Irish Bar in the Mid-City neighborhood where the words "Go To Hell Goodell" are visible over the fireplace.

Some of Goodell's critics say the disarray resulting from what they believe were unfair suspensions led to the Saints' 7-9 performance this year — and a missed chance to make history.

"We had a real shot of being the first team in history to host the Super Bowl in our own stadium," Parkview Tavern owner Kathy Anderson said. "He can't give that back to us."

Goodell suspended the coaches and players after an investigation found the Saints had a performance pool offering cash rewards for key plays, including big hits. The player suspensions eventually were overturned, but the coaches served their punishments.

Mayor Mitch Landrieu is among those saying that people in this city, known for its hospitality and history, should mind their manners and remember the not-too-distant past.

"Roger Goodell has been a great friend to New Orleans, and it's a fact that he's one of the people instrumental to making sure that the Saints stayed here after Hurricane Katrina," Landrieu said in a statement. It was a reference to the days after the storm, when 80 percent of the city was underwater and the damaged Superdome became a shelter for thousands of the displaced.

Then-Commissioner Paul Tagliabue and his second-in-command, Goodell, are credited with working to keep the team from abandoning New Orleans for San Antonio.

"If not for Roger Goodell, we would not have this Super Bowl," Landrieu added. "And we will need him since we want to host another one."

Saints quarterback Drew Brees said the game is validation of everything the city's gone through to rebuild after Hurricane Katrina.

"There's no question, yeah. And I think people will see that when they come down, as soon as people come down that haven't been there in a while," Brees said Friday while in Hawaii for the Pro Bowl. "The city knows how to entertain, knows how to treat people right. The tourism industry's huge, so we're excited to host this big game. Obviously it's the biggest sporting event in the world, and the city will be ready for it."

But some are in no mood to back off when it comes to Goodell.

Anderson said she understands city leaders' desire to put their best foot forward, but that it also is important for Saints fans to be able to vent.

"Whether I have Roger Goodell's face on my dart board is not going to change anybody's mind about the Super Bowl," Anderson said.

People should not take the barbs too seriously, said Lynda Woolard, a Saints fan who has been tracking some of the barbs on social media. "Nobody's saying there should be violence against the man," Woolard said.

"It's tongue-in-cheek," Patterson agreed.

Still, some diehards are ready to put it all behind them.

Patrick Brower, owner and manager of the Dirty Coast T-shirt shop, said Friday that he's pushing black-and-gold wear at his shop, choosing to unify Saints fans without bashing the commissioner.

"We've got to look forward here," Brower said. "The more time we spend in the past, it's just not beneficial."

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Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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J. Richard Hackman, an Expert in Team Dynamics, Dies at 72

J. Richard Hackman, a Harvard psychology professor whose fieldwork sometimes took him to the cockpit of an airliner to observe the crew in a nearly five-decade quest to determine the dynamics of teamwork and effective leadership, died on Jan. 8 in Boston. He was 72.

The cause was lung cancer, his wife, Judith Dozier Hackman, said.

Dr. Hackman, the author or co-author of 10 books on group dynamics, was the Edgar Pierce professor of social and organizational psychology at Harvard.

In one of his best-known books, “Leading Teams: Setting the Stage for Great Performances” (2002), he replaced the popular image of the powerful “I can do it all” team leader with that of someone who, as he wrote, had the subtle skills “to get a team established on a good trajectory, and then to make small adjustments along the way to help members succeed.”

The conditions for a successful team effort — among them “a compelling direction, an enabling team structure, a supportive organizational context and expert team coaching” — “are easy to remember,” Dr. Hackman wrote.

“The challenge,” he continued, “comes in developing an understanding of those conditions that is deep and nuanced enough to be useful in guiding action, and in devising strategies for creating them even in demanding or team-unfriendly organizational circumstances.”

Besides tracking the interplay of pilots, co-pilots and navigators aboard civilian and military planes, Dr. Hackman observed corporate boards, sports teams, orchestra players, telephone-line repair crews, hospital workers and restaurant kitchen staff members.

And in recent years, for his 2011 book, “Collaborative Intelligence,” he was allowed to observe interactions within the American intelligence, defense, law-enforcement and crisis-management communities.

“Although my main aspiration has been to provide guidance that will be useful to team leaders and members,” he wrote, “there are no ‘one-minute’ prescriptions here — creating, leading and serving on teams is not that simple.”

Anita Woolley, a professor of organizational behavior and theory at the Tepper School of Business at Carnegie Mellon University in Pittsburgh, said, “The key thing about Dr. Hackman’s work is that it stands in contrast to some of the more popular models of leadership that focused very much on style or how leaders behave, versus what they do.”

Rather than viewing pay as a prime motivator for good performance, she continued, “he focused on features of people’s jobs that made them more intrinsically satisfied: the freedom to determine how they conduct their work, having a variety of tasks, having knowledge of the ultimate outcomes of their work, knowing how their work affects or is received by other people.”

He also liked to overturn some of the received wisdom about teamwork. In a 2011 article for The Harvard Business Review, Dr. Hackman listed “Six Common Misperceptions About Teamwork.” Among them was this:

“Misperception No. 2: It’s good to mix it up. New members bring energy and fresh ideas to a team. Without them, members risk becoming complacent, inattentive to changes in the environment, and too forgiving of fellow members’ misbehavior.

“Actually: The longer members stay together as an intact group, the better they do. As unreasonable as this may seem, the research evidence is unambiguous. Whether it is a basketball team or a string quartet, teams that stay together longer play together better.”

John Richard Hackman was born in Joliet, Ill., on June 14, 1940, the only child of J. Edward and Helen Hackman. His father was an oil pipeline engineer, his mother a schoolteacher.

Dr. Hackman received a bachelor’s degree in mathematics from MacMurray College in Jacksonville, Ill., in 1962, and a doctorate in psychology from the University of Illinois in 1966. He soon joined the psychology and administrative sciences department faculties at Yale, where he taught until 1986, when he moved to the psychology and business departments at Harvard.

Besides his wife, who is an associate dean at Yale, he is survived by two daughters, Julia Beth Proffitt and Laura Dianne Codeanne, and four grandchildren.

After Dr. Hackman died, The Harvard Crimson wrote that for years he had “devoted countless hours to improving one team in particular — the Harvard women’s basketball squad, for which he volunteered as an honorary coach.”

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India Ink: Jeet Thayil's Novel of Opium and Bombay Takes DSC Prize

Jeet Thayil, an Indian poet and author, won the DSC Prize for South Asian Literature at the Jaipur Literature Festival on Friday for his debut novel “Narcopolis.”

“Finally!” Mr. Thayil exclaimed when he was presented the award. His book, about the narcotic underbelly of Bombay 30 years ago, had been short-listed for four awards, but never won any.

The award is special because it is an Indian prize, he said. “How you are perceived at home does matter,” he said.

The Kerala-born author will take home a $50,000 prize purse. Mr. Thayil noted that it was a substantial amount of money, and part of the reason that the award was taken seriously.

“Writers like money,” he said. “We don’t have a job, but we have bills to pay.”

Mr. Thayil is the first Indian to win the award since its introduction by the infrastructure company DSC Limited in 2010. The first winner was a Pakistani writer, H.M. Naqvi, for his debut novel the “Home Boy.” Last year the Sri Lankan author Shehan Karunatilake’ s novel “Chinaman” won the prize.

A five-member jury received more than 80 entries for the prize, including translations of non-English writing. The contest is open to any writing about South Asia, not just to South Asian writers. The Indian poet and literary critic K. Satchidanandan, who led the jury, said, the award is significant because it is the first award that honors literary works about South Asia.

Other finalists included two Indians, two Pakistanis and a Bangladeshi writer.

Jamil Ahmed, a Pakistani author whose book, “The Wandering Falcon,” was a finalist, said that it took 40 years to publish the book. The retired bureaucrat wrote about the tribal population living along the Pakistan-Afghanistan border. He was born in pre-partition India and during his childhood he traveled across India with his family. That was when he said he first came in contact with tribes, which led him to “romanticize the tribes.”

“I want people to understand that tribes are not savage,” he said.

A work by the Indian author Uday Prakash, “The Walls of Delhi,” was also a finalist. The book, actually three novellas, was originally written in Hindi. The stories highlight the flaws of the state, including bureaucracy and the deep entrenchment of corruption, and it is narrated by three characters, a weaver, sweeper and a baby in a slum suffering from an undiagnosed disease. Mr. Prakash said these narratives symbolized the lives led by 70 percent Indians.

Other finalists included the Indian writer Amitav Ghosh for his book “River of Smoke,” the Pakistani writer Mohammed Hanif, for “Our Lady of Alice Bhatti” and Tahmima Anam, the author of “The Good Muslim,” from Bangladesh.

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Armstrong meeting with USADA appears unlikely

AUSTIN, Texas (AP) — Lance Armstrong's lawyers say the cyclist will talk more about drug use in the sport, just likely not to the U.S. Anti-Doping Agency that led the effort to strip him of his Tour de France titles.

In a testy exchange of letters and statements revealing the gulf between the two sides, USADA urged Armstrong to testify under oath to help "clean up cycling."

Armstrong's attorneys responded that the cyclist would rather take his information where it could do more good — namely to cycling's governing body and World Anti-Doping Agency officials.

USADA's response to that: "The time for excuses is over."

The letters, obtained Friday by The Associated Press, underscore the continuing feud between Armstrong and USADA CEO Travis Tygart, the man who spearheaded the investigation that uncovered a complex doping scheme on Armstrong's U.S. Postal Service teams.

Armstrong's seven Tour de France victories were taken away last year and he was banned for life from the sport.

In an interview with Oprah Winfrey last week, Armstrong admitted doping, said he owed a long list of apologies and that he would like to see his lifetime ban reduced so he can compete again.

His most realistic avenue toward that might be telling USADA everything he knows in a series of interviews the agency wants started no later than Feb. 6.

That seems unlikely.

Armstrong attorney Tim Herman responded to USADA's first letter, sent Wednesday, by saying his client's schedule is already full, and besides, "in order to achieve the goal of 'cleaning up cycling,' it must be WADA and the (International Cycling Union) who have overall authority to do so."

By Friday night, Herman strongly suggested Armstrong won't meet with USADA at all but intends to appear before the UCI's planned "truth and reconciliation" commission.

"Why would we cooperate (with USADA)?" Herman said in a telephone interview. "USADA isn't interested in cleaning up cycling. Lance has said, 'I'll be the first guy in the chair when cycling is on trial, truthfully, under oath, in every gory detail.' I think he's going testify where it could actually do some good: With the body that's charged with cleaning up cycling," Herman said.

In its last letter to Armstrong, sent Friday evening, USADA attorney William Bock said his agency and WADA work hand-in-hand in that effort.

"Regardless, and with or without Mr. Armstrong's help, we will move forward with our investigation for the good of clean athletes and the future of sport," Bock's letter reads.

The letters confirm a Dec. 14 meeting in Denver involving Armstrong, Tygart and their respective attorneys, which is when, in Tygart's words, Armstrong should have started thinking about a possible meeting with USADA.

"He has been given a deadline of February 6th to determine whether he plans to come in and be part of the solution," Tygart said in a statement. "Either way, USADA is moving forward with our investigation on behalf of clean athletes."

The letters were sent to the AP after details about a Tygart interview with "60 Minutes," being aired Sunday, were made public.

Among Tygart's claims: Armstrong is lying when he says he didn't dope during his 2009-10 comeback.

Tygart said USADA's report on Armstrong's doping included evidence Armstrong was still cheating in those years.

"His comeback was totally clean," Herman said. "It's pretty fashionable to kick Lance Armstrong around right now."

Tygart also reiterated that an Armstrong associate offered USADA a donation of more than $200,000. Armstrong denied that in his interview with Winfrey, too.

In advancing his claim that USADA is only a bit player in the investigation, Herman noted in his letter, sent to USADA on Friday, that most cycling teams are based in Europe.

"I'm pretty sick of people trying to blame a European cycling culture that goes back to the 1920s on one guy," Herman said.

Bock's response to that: "Your suggestion that there is some other body with which Lance should coordinate is misguided," he said in his final letter.

___

AP National Writer Eddie Pells contributed to this report.

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40 Years After Roe v. Wade, Thousands March to Oppose Abortion

Drew Angerer/The New York Times

Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.

WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.

On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.

Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.

“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”

Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.

“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”

Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”

The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.

Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.

“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”

Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”

“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.

The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”

Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.

Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.

“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”

This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.

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Labor Relations Board Rulings Could Be Undone

By ruling that Mr. Obama’s three recess appointments last January were illegal, the federal appeals court ruling, if upheld, would leave the board with just one member, short of the quorum needed to issue any rulings. The Obama administration could appeal the court ruling, but no announcement was made on Friday.

If the Supreme Court were to uphold Friday’s ruling, issued by the United States Court of Appeals for the District of Columbia Circuit, it would mean that the labor board did not have a quorum since last January and that all its rulings since then should be nullified.

Many Republicans and business groups applauded Friday’s ruling. They often assert that the appointments Mr. Obama made to the board have transformed it into a tool of organized labor. But many Democrats and labor unions say Mr. Obama’s appointments restored ideological balance to the board after it was tipped in favor of business interests under President George W. Bush

Mark G. Pearce, the board’s chairman, issued a statement saying the board disagreed with the ruling and suggested that other appeals courts hearing cases about the constitutionality of Mr. Obama’s appointments could reach a different conclusion.

“In the meantime, the board has important work to do,” said Mr. Pearce, whose agency oversees enforcement of the laws governing strikes and unionization drives. “We will continue to perform our statutory duties and issue decisions.”

Unless the Senate confirms future nominees to the board — Senate Republicans have blocked several of Mr. Obama’s board nominees — Mr. Pearce will be the only member left if Friday’s ruling is upheld. The board has five seats.

Representative Darrell Issa, a California Republican who is the chairman of the Oversight and Government Reform Committee, issued a statement that urged the recess appointees to “do the right thing and step down.” He added, “To avoid further damage to the economy, the N.L.R.B. must take the responsible course and cease issuing any further opinions until a constitutionally sound quorum can be established.”

The three disputed recess appointees included two Democrats, Sharon Block, deputy labor secretary, and Richard Griffin, general counsel to the operating engineers’ union; and one Republican, Terence Flynn, a counsel to a board member. Mr. Flynn resigned last May after being accused of leaking materials about the group’s deliberations. Another Republican member, Brian Hayes, stepped down when his term expired last month.

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