Question Mark: Women’s Eggs Diminish With Age

Baby girls enter the world with enough of them to populate perhaps 40 small cities. A dozen or so years later, the first will make a debut of its own. And in the months and years to come, others will appear regularly, sometimes greeted with relief, other times with disappointment, perhaps most often with a touch of annoyance.

Abdullah Pope/Agence France-Presse — Getty Images

Not women's eggs, obviously.

Now, for women in the baby boom generation, they may be coming more sporadically, or not at all, signaling unmistakably that one time of life is over, and another begun. But what happened to all those eggs?

When girls are born, they have about two million eggs in their ovaries, nestled in fluid-filled cavities called follicles. That may sound like a lot, but consider that months earlier, when they were still in utero, they may have had as many as six or seven million eggs. Those eggs are still immature, and the proper name for them, by the way, is oocytes (rhymes with: nothing).

The first eggs to bite the dust were those in the fetus, which waste away. And by the time a girl reaches puberty, most of her remaining eggs have also deteriorated and been reabsorbed. If that sounds ominously like something from a “Star Trek” episode about the Borg, imagine if all those eggs had to take the customary path out of the body.

Even with the Great Egg Disappearance, girls enter puberty with many more than they will use, 300,000 or more. Each month, the body produces a hormone, FSH, which stimulates the follicles to prepare an egg for maturation and release.

With eggs backed up like bowling balls on a busy Saturday night at the lanes, the ovaries can afford to be a little wasteful, and as many as several dozen follicles are called into action. Then a single mature egg — usually, anyway — gets the tap on the shoulder and begins its travels to the uterus.

As for the maturing eggs that didn’t make the grade, there is no second chance. But they do not go out on their own. “Each month you probably lose a thousand or so,” said Dr. James T. Breeden, president of the American Congress of Obstetrics and Gynecology. “There’s just a natural death of them.”

For all the eggs a woman begins with, in the end only about 400 will go through ovulation. While men produce sperm throughout their lives, over time the number of eggs declines, and they disappear with increasing frequency the decade or so before menopause. Those that remain may decline in quality. “When you have a thousand or less within the ovaries, you’re thought to have undergone menopause,” said Dr. Mitchell Rosen, the director of the Fertility Preservation Center at the University of California, San Francisco.

It’s true that women make far more eggs than they end up using, but men should not pass judgment. “They produce millions of sperm, millions,” Dr. Rosen said. “The whole process is not the most efficient in the world.”

Questions about aging? E-mail boomerwhy@nytimes.com

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at booming@nytimes.com.

This article has been revised to reflect the following correction:

Correction: February 5, 2013

An earlier version of this article incorrectly described estrogen levels at the time of ovulation. They rise, rather than fall.

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Deficit hits 5-year low, but cuts drag economy

WASHINGTON -- The federal deficit will drop to less than $1 trillion for the first time in five years, but massive spending cuts that have improved the budget outlook are also slowing the economy, according to a report released Tuesday by the Congressional Budget office.

The nonpartisan arbiter of federal budgets said the combination of new tax revenue from the "fiscal cliff" deal as well as looming cuts that kick in March 1 will push the deficit down to $845 billion for fiscal 2013. Deficits have topped $1 trillion in recent years.

The projections will fuel the coming budget debates, which started Tuesday as President Obama was calling on Congress to steer around the coming budget cuts.

The budget office said the cuts will contribute to an economy that lags in 2013. The unemployment rate likely will remain above 7.5% through the year. It predicted that the gross domestic product will be well below its potential, growing by just 1.4%, more than half a percentage point slower than would happen if the spending cuts were averted.

At the same time, the nation's debt load is expected to fluctuate but ultimately rise to record levels this decade, largely because of increased spending on healthcare and the federal safety net for older Americans with the aging of the baby boom population.

Additionally, the outlook shows how difficult it will be for House Republicans to accomplish their goal of balancing the budget in 10 years with potentially deep austerity measures.

Even though revenue is rising and spending is decreasing, the overall budget outlook remains stark. By the end of the decade, public debt is set to rise to 77% of GDP, a decade of highs on par with debt levels in World War II.

"The projected path of the federal budget remains a significant concern," the CBO wrote.

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Twitter: @LisaMascaroinDC

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Alabama hostage standoff ends with gunman dead, boy safe

MIDLAND CITY, Ala. -- The FBI stormed an underground bunker in rural Alabama on Monday, safely rescuing a 5-year-old boy held hostage for nearly a week and leaving his kidnapper, who had also killed a school bus driver, dead.

After a standoff of more than six days, FBI agents struck the bunker when they feared the kidnapped kindergarten student was in “imminent danger,” said Steve Richardson, special agent in charge in Mobile.

Authorities previously had thanked the suspect, identified as 65-year-old Jimmy Lee Dykes, for allowing them to deliver medication, coloring books and toys to the boy, who is due to celebrate his birthday on Wednesday.

But negotiations deteriorated in the 24 hours before agents rescued him, Richardson said during a nationally televised news conference.

“Mr. Dykes was observed holding a gun,” the FBI agent said.

It was not immediately clear how Dykes died.

The standoff gripped a rural corner of southeast Alabama with dread, shuttering local schools and prompting prayers and vigils for the boy identified only as Ethan.

By all accounts, Dykes had taken him from the bus at random, reinforcing concerns that have been raised about U.S. school safety and gun violence since the December shooting deaths of 20 children and six adults at a Connecticut elementary school.

The drama near Midland City, Alabama, began when Dykes, a retired trucker and veteran of the war in Vietnam, boarded a school bus ferrying more than 20 children home from school last Tuesday and demanded the driver let a student off the bus.

PHYSICALLY UNHARMED

When driver Charles Albert Poland Jr., 66, refused, Dykes shot him four times with a 9 mm handgun, local sheriff's department officials said.

Dykes then fled with the child to a homemade bunker on the man's property off a dirt road.

The child was being treated on Monday at a local hospital but appeared physically unharmed, Richardson said. He is said to suffer from Asperger's Syndrome and attention deficit-hyperactivity disorder.

A local law enforcement source said a stun or flash grenade was detonated as part of the operation to free the boy but further details were not immediately released.

Law enforcement officials had offered few insights about Dykes and their negotiations with him ahead of the rescue just after 3 p.m.

Earlier on Monday, Dale County Sheriff Wally Olson said the gunman had a “very complex” story to tell.

“Based on our discussion with Mr. Dykes, he feels like he has a story that's important to him, although it's very complex. And we try to make a safe environment for all for that,” Olson said, without elaborating.

According to neighbors, the notoriously reclusive Dykes moved into the Midland City area about two years ago and was often seen patrolling the property where he lived in a trailer with a gun and flashlight at night.

He had been due to appear for a bench trial last Wednesday after his recent arrest on a menacing charge involving one of his neighbors.

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Ed Koch remembered as quintessential New York City mayor

NEW YORK (Reuters) – Former New York City Mayor Ed Koch was memorialized on Monday as an in-your-face, wisecracking leader who helped transform the city from a symbol of urban decay to the vital, glittering metropolis it is today.

As Koch’s casket was led out of Temple Emanu-El, a soaring Fifth Ave. synagogue opposite Central Park, an organ played Frank Sinatra’s “New York, New York” while mourners including former U.S. President Bill Clinton and a who’s who of New York politics stood and applauded.

Koch died on Friday at the age of 88 in Manhattan — the only place other than heaven he could imagine living, as he was known to say.

“I come today with the love and condolences of 8.4 million New Yorkers who really are grieving with you at this moment,” said the city’s current mayor, Michael Bloomberg.

Speakers joked about the famously attention-loving Koch’s obsession with stage-managing his passing. His grave-stone, complete with an epitaph and a bench bearing Koch’s name, has been ready since 2008, and his friends said he had been planning the funeral for years.

“We started talking about his death in the ’80s,” said his former chief of staff Diane Coffey.

As mayor from 1978 to 1989, Koch, with his trademark phrase “How’m I Doin?”, was a natural showman and tireless promoter of both himself and the city. He helped repair the city’s finances as it teetered on the edge of bankruptcy, and later led a building renaissance that would see 200,000 units of affordable housing erected or rehabilitated in some of the city’s most crime-infested areas.

He could also be a divisive figure. His determination to shut Sydenham, a poorly-performing Harlem hospital that was one of the only city hospitals employing black doctors, angered black New Yorkers. And AIDS activists said he was too slow to react to the epidemic that ravaged the city’s gay population in the 1980s.

Tall, nearly bald and speaking with a high-pitched voice, Koch was an unmistakable presence. He was famously argumentative, and rarely walked away from verbal jousting.

His friend James Gill remembered Koch’s response to someone who had written a letter criticizing the former mayor.

“You are entitled to your opinion of me and I am entitled to my opinion of you,” Koch replied. “My opinion of you is that you are a fool.”

His nephews and grand-nephew and grand-niece remembered Koch, who never married, as devoted “Uncle Eddie” – eager to hear what they thought of his appearances on talk shows but also happy join his 11-year-old grand-niece for a manicure.

Clinton read from a stack of letters Koch had sent him over the years and said Koch had “a big brain, but he had an even bigger heart.”

Koch remained relevant in politics long after 1989, when he lost the Democratic nomination to David Dinkins for what would have been a record fourth term as mayor. But when asked if he would run for office again, he liked to say, “The people threw me out and the people must be punished.”

His endorsement was coveted by candidates decades after he left office. And his unwavering and loud support of Israel made Koch “one of the most influential and important American Zionists,” said former Ambassador Ido Aharoni.

At Monday’s memorial, Bloomberg noted the synagogue Koch had chosen for the funeral stood just a few blocks from the midtown bridge that had been renamed to honor him. Last year, the city released a video of Koch standing at the bridge’s entrance ramp, calling out to approaching cars: “Welcome to my bridge! Welcome to my bridge!”

“No mayor, I think, has ever embodied the spirit of New York City like he did. And I don’t think anyone ever will,” Bloomberg said. “Tough and loud, brash and irreverent, full of humor and chutzpah – he was our city’s quintessential mayor.”

(Reporting By Edith Honan; Editing by Paul Thomasch and Alden Bentley)

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Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”

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Have you written a poem about cancer? Please share them with us in the comments section below.

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Boeing asks FAA to allow Dreamliner test flights

Aerospace giant Boeing Co. has asked the Federal Aviation Administration to let it begin test flights on its grounded 787 Dreamliner passenger jet.

The new plane has been grounded since Jan. 16 by the FAA because of numerous incidents and high-profile fires involving the onboard lithium-ion batteries. Investigators around the world are looking into the matter.

The company disclosed its request for in-flight testing Monday in an email.

“Boeing has submitted an application to conduct test flights, and it is currently under evaluation by the FAA,” said Marc Birtel, a company spokesman, who would not comment further.

The FAA is reportedly looking into Boeing request, but would not comment.

The 787's battery systems were called into question Jan. 7 when a smoldering fire was discovered on the underbelly of a Dreamliner in Boston operated by Japan Airlines after the 183 passengers and 11 crew members had deplaned at the gate.

The National Transportation Safety Board is examining what went wrong. On Friday, the NTSB released its seventh update on the investigation into the lithium-ion battery systems. It said it has begun CT scanning the battery cells to examine their internal condition.

In addition, the NTSB disclosed that a battery expert from the Department of Energy joined the investigative team to lend additional expertise to ongoing testing.

In a separate incident Jan. 16 involving a 787 operated by All Nippon Airways in southwestern Japan, smoke was seen swirling from the right side of the cockpit after an emergency landing related to the plane's electrical systems. All 137 passengers and crew members were evacuated from the aircraft and slid down the 787's emergency slides.

The Japan Transport Safety Board, the country's version of the NTSB, is heading the investigation into All Nippon's emergency landing and reported fire.

No passengers or crew members were reported injured in the incidents. But the recent events have become a public relations nightmare for Boeing, which has long heralded the Dreamliner as a forerunner of 21st century air travel.

The 787, a twin-aisle aircraft that can seat 210 to 290 passengers, is the first large commercial jet with more than half its structure made of composite materials rather than aluminum sheets. It's also the first large commercial aircraft that extensively uses electrically powered systems involving lithium-ion batteries.

Boeing's lithium-ion batteries are made in Japan by Kyoto-based GS Yuasa Corp.

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Sea Launch mission fails; rocket, Intelsat satellite crash in ocean

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After power outage delay, 49ers trail Ravens 31-23

A 34-minute delay following a power outage helped generate the 49ers' offense.

Quarterback Colin Kaepernick used his feet to score on a 15-yard touchdown run, but the 49ers couldn't convert the two-point conversion as the Ravens now lead just 31-29 in the 4th quarter.

Kaepernick's 32-yard pass to Randy Moss help set up the touchdown. The touchdown run was the longest for a quarterback in Super Bowl history.

In the third quarter, 49ers cornerback Tarell Brown forced a rare Ray Rice fumble, putting the 49ers in position to close the gap to 28-23 on David Akers' 34-yard field goal with 3:10 left in third quarter. Akers missed a 39-yarder, but the Ravens were called for running into the kicker to give Akers a second chance.

The Ravens finally showed some life on offense to start the fourth quarter but had to settle for Justin Tucker's 19-year field goal as they increased their lead to 31-23.

The 49ers stepped up on defense to keep the Ravens out of the end zone, forcing the short field goal.

A bad punt followed by a 32-yard return by speedy Ted Ginn Jr. put the 49ers right back in it in the third quarter. Frank Gore's 6-yard touchdown run closed the gap to 28-20 in favor of the Ravens with plenty of time left.

Gore sprinted off the right side virtually untouched. He had been pretty much non-existent up until that score.

During Gore's touchdown run, Ravens defensive tackle Haloti Ngata was injured and then helped off the field.

Colin Kaepernick hit Michael Crabtree with a 31-yard touchdown pass to make the score 28-13 with 7 minutes, 20 seconds left in the third quarter.

The 80-yard drive was nearly flawless, save for Crabtree dropping a ball in his hands.

The Ravens opened their second half with a big score, as Jacoby Jones tied the record with an 108-yard kickoff return to start the half to give Baltimore a 28-6 lead.

It's Jones' second touchdown of the game, following his 56-yard touchdown catch.

At the end of the second quarter, a 27-yard field goal by David Akers on the final play of the half gave the 49ers a little life, but they still trailed the Ravens 21-6 at halftime.

Ravens quarterback Joe Flacco has been on fire, completing 13 of 20 passes for 192 yards and three touchdowns. He completed passes to seven different receivers in the first half.

Kaepernick completed 8 of 13 passes for 139 yards with an interception.

Flacco lofted a pass to Jacoby Jones, and the wide receiver did the rest as the Ravens took a commanding 21-3 lead with 1:45 left before halftime. Jones made a diving catch, then got up and danced around 49ers defenders to score the Ravens' third touchdown.

The 56-yard touchdown hookup was the longest play of the half. It was Flacco's third TD pass of the game and gave him a record-tying 11th of the postseason.

The score made up for the Ravens' inability to convert earlier on a fake field goal.

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Take-Two delays launch of Grand Theft Auto V video game

(Reuters) – Take-Two Interactive Software Inc said on Thursday it has pushed back the launch of the latest game from its hit “Grand Theft Auto” franchise to September 17 from its previously announced release window of spring 2013.

Shares of Take-Two were down six percent at $ 12.31 in early afternoon trading on the Nasdaq.

The delay was to allow Take-Two’s Rockstar Games studio, which develops “Grand Theft Auto” games, additional development time, the video game company said.

“Grand Theft Auto V” will be released worldwide for Microsoft Corp‘s Xbox and Sony Corp‘s PlayStation3 game consoles on September 17, the company said.

The action-adventure game lets players complete criminal missions in urban settings. The franchise’s last title “Grand Theft Auto IV” has sold over 25 million units since its release in 2008.

Grand Theft Auto V is set in a fictional city inspired by present-day Southern California.

The delayed launch pushes earnings from Grand Theft Auto V sales from June to September, Sterne Agee analyst Arvind Bhatia said. The new title of the massively popular franchise has the potential to rake in close to $ 1 billion in retail sales and sell 15 to 20 million units, according to Bhatia.

“It adds to their development cost and it’s launching closer to what we think is going to be a period where new consoles will be coming out and there will be more competition from other titles,” Bhatia said.

The video game industry has been struggling to cope with flagging sales over the last year. Analysts say consumers are holding back from buying hardware and software as they wait for rumored next-generation versions of Sony Corp’s PlayStation and Microsoft Corp’s Xbox, expected later this year.

The delay could mean Take-Two is possibly creating a “cross-generation” title that could work on current and next-generation consoles, said analyst Mike Hickey of National Alliance Capital Markets.

“Remember, Xbox signed an exclusive deal with Rockstar at the beginning of the prior cycle for episodic content, and Sony provided exclusive resources for the completion of Grand Theft Auto IV,” Hickey said.

(Reporting by Malathi Nayak in San Francisco; Editing by Leslie Adler and Alden Bentley)

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Keys sings national anthem on piano at Super Bowl

Alicia Keys performed a lounge-y, piano-tinged — and live — version of the national anthem ahead of the Super Bowl on Sunday.

The Grammy-winning singer played the piano as she sang “The Star Spangled Banner” in a long red dress with her eyes shut. Her publicist said the performance was live, days after halftime performer Beyonce admitted singing along to a prerecorded track at the Inauguration.

Keys’ version was soft and featured additional lyrics: She added “living in the home” before belting “home of the brave” as she finished the song.

Before Keys hit the field, Jennifer Hudson performed “America the Beautiful” with the 26-member Sandy Hook Elementary School chorus, a performance that had some players on the sideline on the verge of tears.

The students wore green ribbons on their shirts in honor of the 20 first-graders and six adults who were killed in a Dec. 14 shooting rampage at the school in Newton, Conn.

The students began the song softly before Hudson, whose mother, brother and 7-year-old nephew were shot to death five years ago, jumped in with her gospel-flavored vocals. She stood still in black and white as the students moved to the left and right, singing background.

Keys and Hudson warmed up the field for Beyonce, who is set to perform at the half-time show.

___

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Phys Ed: Helmets for Ski and Snowboard Safety

Phys Ed

Gretchen Reynolds on the science of fitness.

Recently, researchers from the department of sport science at the University of Innsbruck in Austria stood on the slopes at a local ski resort and trained a radar gun on a group of about 500 skiers and snowboarders, each of whom had completed a lengthy personality questionnaire about whether he or she tended to be cautious or a risk taker.

The researchers had asked their volunteers to wear their normal ski gear and schuss or ride down the slopes at their preferred speed. Although they hadn’t informed the volunteers, their primary aim was to determine whether wearing a helmet increased people’s willingness to take risks, in which case helmets could actually decrease safety on the slopes.

What they found was reassuring.

To many of us who hit the slopes with, in my case, literal regularity — I’m an ungainly novice snowboarder — the value of wearing a helmet can seem self-evident. It protects your head from severe injury. During the Big Air finals at the Winter X Games in Aspen, Colo., this past weekend, for instance, Halldor Helgason, a 23-year-old Icelandic snowboarder, over-rotated on a triple back flip, landed headfirst on the snow and was briefly knocked unconscious. But like the other competitors he was wearing a helmet, and didn’t fracture his skull.

Indeed, studies have concluded that helmets reduce the risk of a serious head injury by as much as 60 percent. But a surprising number of safety experts and snowsport enthusiasts remain unconvinced that helmets reduce overall injury risk.

Why? A telling 2009 survey of ski patrollers from across the country found that 77 percent did not wear helmets because they worried that the headgear could reduce their peripheral vision, hearing and response times, making them slower and clumsier. In addition, many worried that if they wore helmets, less-adept skiers and snowboarders might do likewise, feel invulnerable and engage in riskier behavior on the slopes.

In the past several years, a number of researchers have tried to resolve these concerns, for or against helmets. And in almost all instances, helmets have proved their value.

In the Innsbruck speed experiment, the researchers found that people whom the questionnaires showed to be risk takers skied and rode faster than those who were by nature cautious. No surprise.

But wearing a helmet did not increase people’s speed, as would be expected if the headgear encouraged risk taking. Cautious people were slower than risk-takers, whether they wore helmets or not; and risk-takers were fast, whether their heads were protected or bare.

Interestingly, the skiers and riders who were the most likely, in general, to wear a helmet were the most expert, the men and women with the most talent and hours on the slopes. Experience seemed to have taught them the value of a helmet.

Off the slopes, other new studies have brought skiers and snowboarders into the lab to test their reaction times and vision with and without helmets. Peripheral vision and response times are a serious safety concern in a sport where skiers and riders rapidly converge from multiple directions.

But when researchers asked snowboarders and skiers to wear caps, helmets, goggles or various combinations of each for a 2011 study and then had them sit before a computer screen and press a button when certain images popped up, they found that volunteers’ peripheral vision and reaction times were virtually unchanged when they wore a helmet, compared with wearing a hat. Goggles slightly reduced peripheral vision and increased response times. But helmets had no significant effect.

Even when researchers added music, testing snowboarders and skiers wearing Bluetooth-audio equipped helmets, response times did not increase significantly from when they wore wool caps.

So why do up to 40 percent of skiers and snowboarders still avoid helmets?

“The biggest reason, I think, is that many people never expect to fall,” said Dr. Adil H. Haider, a trauma surgeon and associate professor of surgery at Johns Hopkins University in Baltimore and co-author of a major new review of studies related to winter helmet use. “That attitude is especially common in people, like me, who are comfortable on blue runs but maybe not on blacks, and even more so in beginners.”

But a study published last spring detailing snowboarding injuries over the course of 18 seasons at a Vermont ski resort found that the riders at greatest risk of hurting themselves were female beginners. I sympathize.

The take-away from the growing body of science about ski helmets is in fact unequivocal, Dr. Haider said. “Helmets are safe. They don’t seem to increase risk taking. And they protect against serious, even fatal head injuries.”

The Eastern Association for the Surgery of Trauma, of which Dr. Haider is a member, has issued a recommendation that “all recreational skiers and snowboarders should wear safety helmets,” making them the first medical group to go on record advocating universal helmet use.

Perhaps even more persuasive, Dr. Haider has given helmets to all of his family members and colleagues who ski or ride. “As a trauma surgeon, I know how difficult it is to fix a brain,” he said. “So everyone I care about wears a helmet.”

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