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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California still hasn't bought land for bullet train route

Construction of California's high-speed rail network is supposed to start in just six months, but the state hasn't acquired a single acre along the route and faces what officials are calling a challenging schedule to assemble hundreds of parcels needed in the Central Valley.

The complexity of getting federal, state and local regulatory approvals for the massive $68-billion project has already pushed back the start of construction to July from late last year. Even with that additional time, however, the state is facing a risk of not having the property to start major construction work near Fresno as now planned.

It hopes to begin making purchase offers for land in the next several weeks. But that's only the first step in a convoluted legal process that will give farmers, businesses and homeowners leverage to delay the project by weeks, if not months, and drive up sales prices, legal experts say.

One major stumbling block could be valuing agricultural land in a region where prices have been soaring, raising property owners' expectations far above what the state expects to pay.

"The reality is that they are not going to start in July," said Anthony Leones, a Bay Area attorney who has represented government agencies as well as property owners in eminent domain cases.

State high-speed rail officials say it won't be easy, but they can acquire needed property and begin the project on time.

"It is a challenge," said Jeff Morales, the rail agency's chief executive. "It is not unlike virtually any project. The difference is the scale of it."

Quickly acquiring a new rail corridor is crucial to the project, which Gov. Jerry Brown touted last week as the latest symbol of California's tradition of dreaming big and making major investments in its future.

Delays in starting construction could set in motion a chain reaction of problems that would jeopardize the politically and financially sensitive timetable for building the $6-billion first leg of the system. Under its deal with the Obama administration, which is pushing the project as an integral part of its economic and transportation agenda, the state must complete the first 130 miles of rail in the Central Valley by 2018, an aggressive schedule that would require spending about $3.6 million every day.

California voters in 2008 approved plans for a 220-mph bullet train system that would initially link the Bay Area and Southern California at a cost of $32 billion, less than half the estimated cost of the project.

If the construction schedule slips, costs could grow and leave the state without enough money to complete the entire first segment. Rail agency documents acknowledge initial construction may not get as close to Bakersfield in the southern Central Valley as planned.

In addition to property, the rail authority still needs permits from the Army Corps of Engineers and approval by the San Joaquin Valley Air Pollution Control District, two more potential choke points that Morales says can be navigated.

The land purchases are waiting on the hiring of a team of specialized contractors, but they cannot start their work until the rail agency gets approval from another branch of the state bureaucracy. About 400 parcels are needed for the first construction segment, a 29-mile stretch from Madera to Fresno.

The formal offers will start an eminent domain action, the legal process for seizing land from private owners. The owners have 30 days to consider the offer, and then the state must go through a series of steps that can add 100 more days of appeals and hearings, assuming the state can get on the court calendar, according to Robert Wilkinson, an eminent domain litigator in Fresno. If the state fails to convince a judge that a quick takeover of property is justified, formal trials could stretch on for 18 months, he added.

"I would think a lot of these are going to end up in litigation," he said. "It is a tight schedule, no question about it."

Indeed, the rail authority's formal right-of-way plan indicates it does not expect to acquire the first properties until Sept. 15, despite other documents that indicate construction would start in July. Rail officials said they padded the schedule to avoid claims for additional payments by construction contractors should land not be available by July.

Last month, the federal Government Accountability Office reported that about 100 parcels were at risk of not being available in time for construction.

That assessment was based on information the office collected last August. Susan Fleming, a GAO investigator, testified at a House hearing last month: "Not having the needed right of way could cause delays as well as add to project costs."

Morales said in a recent interview that he would not argue with the warning in the GAO report but still sees nothing that would delay the start of construction. Technically, the rail authority could meet the July target date by beginning demolition or other construction on a single piece of property, he said.

Anja Raudabaugh, executive director of the Madera County Farm Bureau, which is suing to halt the project under the California Environmental Quality Act, said the rail authority will face strong opposition to condemnation proceedings in the Central Valley. The bureau has hired a condemnation expert to help battle the land seizures.

"It is a harried mess," she said.

She noted that agricultural land prices rose rapidly last year across the nation. In the Central Valley, the average price of farmland is $28,000 per acre, while the rail authority's budget anticipates an average price of $8,000 per acre, she said.

Kole Upton, an almond farmer who leads the rail watchdog group Preserve Our Heritage, questioned the rail agency's expertise in conducting complex appraisals of agricultural land that has orchards, irrigation systems and processing facilities.

"I am not sure this thing has been well thought out by people who have a deep understanding of agriculture," Upton said. "I live on my farm, and my son lives on my farm. My dad started it after World War II. This is our heritage and our future."

Morales said he believes the agency's budget for property acquisitions is adequate and he did not want to negotiate prices publicly.

"We don't think we are wildly off," he said.

ralph.vartabedian@latimes.com

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“Sleepless in Seattle” musical sets world premiere with new director

LOS ANGELES (TheWrap.com) – A musical adaptation of “Sleepless in Seattle” has set its world premiere for May 24 at the Pasadena Playhouse with a new director in place.

Pasadena Playhouse Artistic Director Sheldon Epps will take over directing chores from Lonny Price, who was originally supposed to stage the show. Price was dropped because of “creative differences” with members of the creative team as well as other commitments, an individual with knowledge of the production told TheWrap.

“Sometimes it seems that life in the theatre is all about change,” Epps said in a statement. “I am pleased that a recent change in my own schedule allows me to take on the joy and excitement of directing this musical.”

The production will run from May 24, 2012, to June 23, 2013, with a press opening night scheduled for June 2.

The musical is aiming for a move to London or to Broadway after its run at the Playhouse, perhaps following the path of “Sister Act,” which opened on London’s West End before transferring to Broadway, another individual with knowledge of the musical told TheWrap.

Epps has been tasked with re-imagining the hit romantic film, which starred Tom Hanks and Meg Ryan in two of their best known roles and boasted a crackling script from the late Nora Ephron, as a love story set to music. Like the film, the play will center on a widower and single father, who ends up attracting the interest of a woman across the country after his son calls into a talk radio program looking for a new mother.

Epps staged has directed “Blues in the Night,” “Play On!,” “Baby It’s You” and “Scenes and Revelations” on Broadway. The theater company is partnering with David Shor Productions on the world premiere of “Sleepless in Seattle – The Musical.”

A developmental workshop is also scheduled to take place in early March.

The musical version of the hit romantic comedy has a book by Jeff Arch, music by Ben Toth and lyrics by Sam Forman. The theater company said casting will be announced at a later date.

The change in directors is not the only shakeup the play has endured during its journey to the stage. Last July, Toth and Forman were tapped to replace the previous songwriting team of Michelle Citrin, Michael Garin and Josh Nelson, with producer David Shor explaining that they had not composed enough “great music” to justify an entire show.

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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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Death sentences in soccer riot spark clashes in Egypt

CAIRO—

Deadly clashes erupted in the Egyptian city of Port Said after 21 soccer hooligans were sentenced to death for killing rival fans in a riot last year that became a dangerous subplot to the nation’s wider unrest and political schisms.

Gunshots and teargas volleys rang out between security forces and supporters of the Masry soccer club after the verdicts were read. Relatives of the accused attempted to storm the jail where soccer fans and former police officials charged in the 2012 stadium melee are imprisoned.

Two police officers and five protesters were reported killed Saturday. Mobs ran through the streets chanting, “Oh, you dirty government.” Tensions intensified over fears that angry bands of men would take up guns, which have streamed onto Egypt’s black market from Libya and other countries.

By late morning, the Egyptian army had deployed to Port Said to protect the prison and other government buildings.

The violence, which followed Friday’s deadly protests against the Islamist-led government, revealed how frayed and desperate Egypt has become two years after the toppling of autocrat Hosni Mubarak. The verdict in the soccer riot case was nervously anticipated as another flashpoint for bloodshed.

The accused Masry fans were charged in the deaths of 74 fans from Cairo’s Ahly soccer club during a match in Port Said last February. Hardcore Ahly supporters, known as Ultras, had in recent days threatened to attack police and government institutions across the country if death penalties were not handed down.

Former police officers charged in the case are expected to be sentenced in March. The Ahly Ultras claim security forces orchestrated the stadium attack as retribution for the group’s long resistance to the police state and its role in the uprising that brought down Mubarak. The Ultras said Saturday they would not react until the sentencing of 54 other defendants, including the former officers.

  “We are waiting for the March 9 verdict,” said an Ultra fan who asked not to give his name. “This fight was between us and those responsible from the military, police, and government. We vowed retribution or chaos. We will take our revenge.”

 The father of one of those killed in the stadium riot was happy with Saturday’s sentencing.

“We are satisfied with this verdict and God willing the rest of the defendants will receive the same sentence,” said Bassem El Dessouky. “I thank God first and then the Ultras, they are respectful youth who helped us and stood by us every step of the way."

But across Port Said women wailed and men raced through the streets in rage. Many said that that the verdicts made scapegoats of the fans while postponing the fates of former police and security officers. Masry supporters believe former members of the Mubarak regime instigated the soccer riot to destabilize the country.

"The police are thugs!" families yelled inside the courtroom before the verdict was read. 

jeffrey.fleishman@latimes.com  

 

 

 

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Lena Dunham says “Girls” season 3 starts shooting in March

LOS ANGELES (TheWrap.com) – HBO has yet to announce whether “Girls” has been renewed for a third season, but that’s okay, because Lena Dunham may have done it for them.

The writer, director and star of the critically-acclaimed comedy told Alec Baldwin during his WNYC podcast, “Here’s the Thing,” that she is preparing to start shooting the next season in March.

“I just finished season two,” the Golden Globe-winning actress said on Monday. “We’re starting at the end of March. I’m so excited.”

And much to delight of million of the 1.6 total overall viewers that tuned in to watch three airings of the premiere on January 13, Dunham says the episode order may have been increased from 10 to 12.

“Well, we’ve been doing 10,” she continued. “I think between you, me and McGee, I think we might do 12 next year.”

HBO wouldn’t officially confirm the renewal to TheWrap, but Dunham’s interview makes it sound like she will call the premium cable network home for years to come. She admits it’s “not clear” how many seasons of “Girls” she is contractually obligated to continue writing and directing, but says she’s locked in as an actor for six years.

“HBO contractually has me I think as an actor for six years but as a writer and director – I should pay more attention to my deals, but I’m just so excited to have my job,” she said. “I just go, ‘Okay, whatever you say.’”

Another thing she should start getting excited about is the possibility of not just talking to Baldwin – one of her idols – but working with him, too.

After she revealed a third season, the “30 Rock” star was quick to add: “I’ll be available. I’ll come and play your therapist.”

“That would be the most fun thing in the world,” she responded before later adding: “Working with you is one of my longstanding dreams.”

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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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