Gays in Pakistan Move Cautiously to Gain Acceptance

Max Becherer for the International Herald Tribune

HIDING IN PLAIN SIGHT Ali, a gay man who lives in Lahore, is in a support group for lesbian, gay, bisexual and transgender Pakistanis. “The gay scene here is very hush-hush,” he says.

LAHORE, Pakistan — The group meets irregularly in a simple building among a row of shops here that close in the evening. Drapes cover the windows. Sometimes members watch movies or read poetry. Occasionally, they give a party, dance and drink and let off steam.

The group is invitation only, by word of mouth. Members communicate through an e-mail list and are careful not to jeopardize the location of their meetings. One room is reserved for “crisis situations,” when someone may need a place to hide, most often from her own family. This is their safe space — a support group for lesbian, gay, bisexual and transgender Pakistanis.

“The gay scene here is very hush-hush,” said Ali, a member who did not want his full name used. “I wish it was a bit more open, but you make do with what you have.”

That is slowly changing as a relative handful of younger gays and lesbians, many educated in the West, seek to foster more acceptance of their sexuality and to carve out an identity, even in a climate of religious conservatism.

Homosexual acts remain illegal in Pakistan, based on laws constructed by the British during colonial rule. No civil rights legislation exists to protect gays and lesbians from discrimination.

But the reality is far more complex, more akin to “don’t ask, don’t tell” than a state-sponsored witch hunt. For a long time, the state’s willful blindness has provided space enough for gays and lesbians. They socialize, organize, date and even live together as couples, though discreetly.

One journalist, in his early 40s, has been living as a gay man in Pakistan for almost two decades. “It’s very easy being gay here, to be honest,” he said, though he and several others interviewed did not want their names used for fear of the social and legal repercussions. “You can live without being hassled about it,” he said, “as long as you are not wearing a pink tutu and running down the street carrying a rainbow flag.”

The reason is that while the notion of homosexuality may be taboo, homosocial, and even homosexual, behavior is common enough. Pakistani society is sharply segregated on gender lines, with taboos about extramarital sex that make it almost harder to conduct a secret heterosexual romance than a homosexual one. Displays of affection between men in public, like hugging and holding hands, are common. “A guy can be with a guy anytime, anywhere, and no one will raise an eyebrow,” the journalist said.

For many in his and previous generations, he said, same-sex attraction was not necessarily an issue because it did not involve questions of identity. Many Pakistani men who have sex with men do not think of themselves as gay. Some do it regularly, when they need a break from their wives, they say, and some for money.

But all the examples of homosexual relations — in Sufi poetry, Urdu literature or discreet sexual conduct — occur within the private sphere, said Hina Jilani, a human rights lawyer and activist for women’s and minority rights. Homoeroticism can be expressed but not named.

“The biggest hurdle,” Ms. Jilani said, “is finding the proper context in which to bring this issue out into the open.”

That is what the gay and lesbian support group in Lahore is slowly seeking to do, even if it still meets in what amounts to near secrecy.

The driving force behind the group comes from two women, ages 30 and 33. They are keenly aware of the oddity that two women, partners no less, have become architects of the modern gay scene in Lahore; if gay and bisexual men barely register in the collective societal consciousness of Pakistan, their female counterparts are even less visible.

“The organizing came from my personal experience of extreme isolation, the sense of being alone and different,” the 30-year-old said.

She decided that she needed to find others like her in Pakistan. Eight people, mostly the couple’s friends, attended the first meeting in January 2009.

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No. 8 Florida avoids scare, beats Missouri 14-7

GAINESVILLE, Fla. (AP) — Mike Gillislee took a screen pass and went 45 yards for a touchdown, and No. 8 Florida survived a scare to beat Southeastern Conference newcomer Missouri 14-7 on Saturday.

The Gators rebounded from a turnover-filled loss to rival Georgia and kept alive hopes of winning the SEC's Eastern Division. They need the Bulldogs to lose one of their remaining games, against Mississippi on Saturday or Auburn next week, to clinch a spot in the league title game.

At times, Florida looked less than interested in staying in the SEC hunt. The Gators (8-1, 7-1) were shut out in the first half, managing just 111 yards and failing to contain Missouri quarterback James Franklin.

Like so many other games this season, though, Florida played considerably better in the second half.

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Second Illness Infects Meningitis Sufferers

Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.

The new problem, called an epidural abscess, is an infection near the spine at the site where the drug — contaminated by a fungus — was injected to treat back or neck pain. The abscesses are a localized infection, different from meningitis, which affects the membranes covering the brain and spinal cord. But in some cases, an untreated abscess can cause meningitis. The abscesses have formed even while patients were taking powerful antifungal medicines, putting them back in the hospital for more treatment, often with surgery.

The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.

“We’re hearing about it in Michigan and other locations as well,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the Centers for Disease Control and Prevention. “We don’t have a good handle on how many people are coming back.”

He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”

In the last few days, about a third of the 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, Mich., have returned with abscesses, said Dr. Lakshmi K. Halasyamani, the chief medical officer.

“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”

She and other experts said they were especially puzzled that the infections could occur even though patients were taking drugs that, at least in tests, appeared to work against the fungus causing the infection, a type of black mold called Exserohilum.

The main symptom is severe pain near the injection site. But the abscesses are internal, with no visible signs on the skin, so it takes an M.R.I. scan to make the diagnosis. Some patients have more than one abscess. In some cases, the infection can be drained or cleaned out by a neurosurgeon.

But sometimes fungal strands and abnormal tissue are wrapped around nerves and cannot be surgically removed, said Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan. In such cases, all doctors can do is give a combination of antifungal drugs and hope for the best. They have very little experience with this type of infection.

Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.

A spokesman for the health department in Tennessee, which has had 78 meningitis cases, said that a few cases of epidural abscess had also occurred there, and that the state was trying to assess the extent of the problem.

Dr. Chiller said doctors were also reporting that some patients exposed to the tainted drug had arachnoiditis, a nerve inflammation near the spine that can cause intense pain, bladder problems and numbness.

“Unfortunately, we know from the rare cases of fungal meningitis that occur, that you can have complicated courses for this disease, and it requires prolonged therapy and can have some devastating consequences,” he said.

The meningitis outbreak, first recognized in late September, is one of the worst public health disasters ever caused by a contaminated drug. So far, 29 people have died, often from strokes caused by the infection. The case count is continuing to rise. The drug was a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. Three contaminated lots of the drug, more than 17,000 vials, were shipped around the country, and about 14,000 people were injected with the drug, mostly for neck and back pain. But some received injections for arthritic joints and have developed joint infections.

Inspections of the compounding center have revealed extensive contamination. It has been shut down, as has another Massachusetts company, Ameridose, with some of the same owners. Both companies have had their products recalled.

Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.

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In Election-Night Party Planning, Flexibility Is a Must

Isaac Brekken for The New York Times

Frank Roskowski, director of technical services at the Aria Resort in Las Vegas, says it's difficult to determine the contours of an election-night party.

Isaac Brekken for The New York Times

A sign points to an early-voting site in Las Vegas, a city well suited to election parties because many of its ballrooms can expand or contract to accommodate victory or loss.

WHEN empty, the Bristlecone ballroom at the Aria Resort and Casino here is 57,000 square feet of beige carpeting and fluorescent lights. But two years ago, it was briefly the overstuffed epicenter of American politics.

This is where Senator Harry Reid, the Nevada Democrat and majority leader, held his election-night party after prevailing in a race that many had predicted he would lose. To Democrats, this was a site for triumph and relief; for Republicans, it was one for disappointment and loss.

For Frank Roskowski, it was something else entirely. “It was carnage. It was goofy,” he said, grinning as he surveyed the room last week.

Mr. Roskowski, whom everyone calls Mustache Frank, is Aria’s director of technical services, and he is reminiscing about the chaos and bustle of Nov. 2, 2010. Democrats lost a bunch of races across the country, not to mention control of the House of Representatives, and in the days before the votes were tallied it looked possible that Mr. Reid would be a casualty. Twenty-two television crews were jockeying for position in the Bristlecone, starting at 4 a.m.

“The TV trucks all were fighting because the thing is, they have to run cable to a connection point,” Mr. Roskowski recalls. “So the guy in the truck, if he gets here early, he only has to run 100 feet. If he’s late, he’s got to run 500. At 3 in the morning, they’re out there, I’m out there, my guys are out there and these TV guys are like: ‘Hey, you want doughnuts? You want beer? 50 bucks?’ I’m like: ‘Whoa. Here’s what was sent to me. You’re here, you’re here, you’re here.”

As a feat of event planning, there is nothing quite like an election-night party. At most festivities that call for banquet halls and cocktails, there is little doubt about the basic contours of the main event. If it’s a wedding, two people are married and the union is celebrated. Organize a conference, and a crowd will mingle and drink. But an election-night party could be an evening of triumph or fiasco, a celebration or a wake. It’s like a trip to the hospital that might culminate with a fatal diagnosis or a healthy baby.

Both tragedy and triumph must be accommodated. It’s fine for politicians to say, “When I’m elected” or “When I’m re-elected,” but the election-night party planner toils in the realm of the possible, not the fondly wished for. If you anticipate an enormous, victory-hailing crowd and you lose, you are looking at not just a defeated candidate but also a tableau that accentuates all the empty space where supporters were supposed to revel. So, what to do? Order a few thousand balloons but don’t fill them until the polls close? Hide the confetti until the victory is certified?

What is far more essential, it turns out, is a room that can be shrunk or enlarged, quickly. Which is why Las Vegas is arguably the greatest election-night city in the country. Expandable banquet rooms are a specialty here, and turning a space that fits 100 into a space that fits 2,000 — and vice versa — is a feat that can be pulled off in places like the Bristlecone ballroom in a matter of minutes. The trick is air walls, huge movable slabs that slide back and forth like pocket doors.

Ultimately, on election night in 2010 here, the space in front of all the television cameras fit a mere 150 people. That was a tiny fraction of the entire room, and it left a tundra of emptiness out of view of all those cameras. But priority No. 1 was making the room look packed.

“When you tuned in at home,” Mr. Roskowski says, “it looked body-to-body tight.”

THE worlds of electioneering and catering will again intersect on Tuesday, as candidates await the public’s verdicts in settings of their choosing. For catering, it is often an evening of modest profit — a typical event with a couple of hundred people will cost $50,000, depending on the quality and quantity of food and drink. For the campaigns, devising these get-togethers can seem both fraught and irrelevant at the same time. Yes, all the stagecraft and planning matter. But what is the point of worrying about the finish line when the race is in the last sprint? Many campaigns contacted for this article would not discuss their plans, or they kept the discussion to a bare minimum.

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Petraeus’s Lower Profile at C.I.A. Leaves Void in Benghazi Furor

WASHINGTON — In 14 months as C.I.A. director, David H. Petraeus has shunned the spotlight he once courted as America’s most famous general. His low-profile style has won the loyalty of the White House, easing old tensions with President Obama, and he has overcome some of the skepticism he faced from the agency’s work force, which is always wary of the military brass.

But since a terrorist attack killed four Americans seven weeks ago in Benghazi, Libya, his deliberately low profile, and the C.I.A.’s penchant for secrecy, have left a void that has been filled by a news media and Congressional furor over whether the tragedy could have been prevented. Rather than acknowledge the C.I.A.’s presence in Benghazi, Mr. Petraeus and other agency officials fought a losing battle to keep it secret, even as the events there became a flash point in the presidential campaign.

Finally, on Thursday, with Mr. Petraeus away on a visit to the Middle East, pressure from critics prompted intelligence officials to give their own account of the chaotic night when two security officers died along with the American ambassador, J. Christopher Stevens, and another diplomat. The officials acknowledged for the first time that the security officers, both former members of the Navy SEALs, worked on contract for the C.I.A., which occupied one of the buildings that were attacked.

The Benghazi crisis is the biggest challenge so far in the first civilian job held by Mr. Petraeus, who retired from the Army and dropped the “General” when he went to the C.I.A. He gets mostly high marks from government colleagues and outside experts for his overall performance. But the transition has meant learning a markedly different culture, at an agency famously resistant to outsiders.

“I think he’s a brilliant man, but he’s also a four-star general,” said Senator Dianne Feinstein, the chairwoman of the Senate Intelligence Committee. “Four-stars are saluted, not questioned. He’s now running an agency where everything is questioned, whether you’re a four-star or a senator. It’s a culture change.”

Mr. Petraeus, who turns 60 next week, has had to learn that C.I.A. officers will not automatically defer to his judgments, as military subordinates often did. “The attitude at the agency is, ‘You may be the director, but I’m the Thailand analyst,’ ” said one C.I.A. veteran.

Long a media star as the most prominent military leader of his generation, Mr. Petraeus abruptly abandoned that style at the C.I.A. Operating amid widespread complaints about leaks of classified information, he has stopped giving interviews, speaks to Congress in closed sessions and travels the globe to consult with foreign spy services with little news media notice.

“He thinks he has to be very discreet and let others in the government do the talking,” said Michael E. O’Hanlon, a Brookings Institution scholar who is a friend of Mr. Petraeus’s and a member of the C.I.A.’s advisory board.

Mr. Petraeus’s no-news, no-nonsense style stands out especially starkly against that of his effusive predecessor, Leon E. Panetta, who is now the defense secretary. Amy Zegart, a Stanford professor who has studied how often C.I.A. directors have appeared in the news since 1980, ranks Mr. Panetta first in public profile and Mr. Petraeus, ascetic and now tight-lipped in public, near the bottom.

Mr. Panetta, a gregarious politician by profession, was unusually open with Congress and sometimes with the public — to a fault, some might say, when he spoke candidly after leaving the C.I.A. about a Pakistani doctor’s role in helping hunt for Osama bin Laden, or about the agency’s drone operations.

Mr. Petraeus’s discretion and relentless work ethic have had a positive side for him: old tensions with Mr. Obama, which grew out of differing views on the wars in Iraq and Afghanistan, appear to be gone. Mr. Petraeus is at the White House several times a week, attending National Security Council sessions and meeting weekly with James R. Clapper Jr., the director of national intelligence, and Thomas E. Donilon, Mr. Obama’s national security adviser. Mr. Donilon said recently that the C.I.A. director “has done an exceptional job,” bringing “deep experience, intellectual rigor and enthusiasm” to his work.

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NYC Marathon is canceled following storm damage

NEW YORK (AP) — Under growing pressure with thousands still shivering from Sandy, the New York City Marathon was canceled Friday by Mayor Michael Bloomberg after mounting criticism that this was not the time for a race.

With the death toll in the city at 41 and power not yet fully restored, many New Yorkers had recoiled at the prospect of police officers being assigned to protect a marathon, storm victims being evicted from hotels to make way for runners, and big generators humming along at the finish-line tents in Central Park.

Around 47,500 runners — 30,000 of them from outside New York — had been expected to take part in the 26.2-mile event Sunday, with more than 1 million spectators usually lining the route. The world's largest marathon had been scheduled to start in Staten Island, one of the storm's hardest-hit places.

Bloomberg had pressed ahead with plans to run the marathon on schedule, but opposition intensified quickly Friday afternoon from the city comptroller, the Manhattan borough president and sanitation workers unhappy that they had volunteered to help storm victims but were assigned to the race instead.

Finally, about three hours later, the mayor relented.

"We would not want a cloud to hang over the race or its participants, and so we have decided to cancel it," Bloomberg said in a statement. "We cannot allow a controversy over an athletic event — even one as meaningful as this — to distract attention away from all the critically important work that is being done to recover from the storm and get our city back on track."

City and race officials considered several alternatives: a modified course, postponement or an elite runners-only race. But they decided cancellation was the best option.

Organizers will donate various items that had been brought in for the race to relief efforts, from food, blankets and portable toilets to generators already set up on Staten Island.

The cancellation means there won't be another NYC Marathon until next year.

"I understand why it cannot be held under the current circumstances," Meb Keflezighi, the 2009 men's champion and a former Olympic silver medalist, said in a statement. "Any inconveniences the cancellation causes me or the thousands of runners who trained and traveled for this race pales in comparison to the challenges faced by people in NYC and its vicinity."

Bloomberg called the marathon an "integral part of New York City's life for 40 years" and "an event tens of thousands of New Yorkers participate in and millions more watch."

He still insisted that holding the race would not have required diverting resources from the recovery effort. But he said he understood the level of friction.

"It is clear it that it has become the source of controversy and division," Bloomberg said. "The marathon has always brought our city together and inspired us with stories of courage and determination.

Bloomberg's decision came just a day after he appealed to the grit and resiliency of New Yorkers, saying, "This city is a city where we have to go on."

The nationally televised race winds through the city's five boroughs and has been held annually since 1970, including 2001, about two months after the 9/11 terrorist attacks.

Mary Wittenberg, president of the organizing New York Road Runners, said it was the right move to cancel.

"This is what we need to do and the right thing at this time," she said.

"It's been a week where we worked very closely with the mayor's office and felt very strongly, both of us together, that on Tuesday it seemed that the best thing for New York on Sunday would be moving forward. As the days went on, just today it got to the point where that was no longer the case."

Wittenberg said she sensed an animosity toward runners in general as the week wore on. About 10,000 runners were expected to drop out after the storm arrived, she said.

Howard Wolfson, deputy mayor for government affairs and communications, said the mayor's office consulted with officials in all levels of government during the week. There was no one tipping point, he said.

Wolfson acknowledged that local businesses won't take in all of the $340 million the marathon was estimated to attract. But because many runners had already traveled to the city, money will still pour in.

Wittenberg said the relief fund announced Thursday had already raised $2.6 million.

Patrick Lynch, president of the Patrolmen's Benevolent Association — the police department's largest union — called the decision to cancel the marathon "a wise choice."

ING, the financial company that is the title sponsor of the marathon, said it supported the decision to cancel. The firm's charitable giving arm has made a $500,000 contribution to help with relief and recovery efforts, and is matching employee donations.

As of now, NYRR is sticking to its policy of no refunds for the runners, but will guarantee entry to next year's marathon. But Wittenberg said that stance will be reviewed.

Eric Jones said he was part of a group from the Netherlands that collected $1.5 million to donate to a children's cancer charity if the runners competed.

"We understand, but maybe the decision could have been made earlier, before we traveled this far," said Jones, whose group came to New York a day earlier.

Steve Brune, a Manhattan entrepreneur, was set to run his fourth NYC Marathon.

"I'm disappointed, but I can understand why it's more important to use our resources for those who have lost a lot," he said.

Brune said he thinks foreign runners who traveled for the race will be even more disappointed.

"When you have a significant amount of people voicing real pain and unhappiness over its running, you have to hear that. You have to take that into consideration," Wolfson said.

"Something that is such a celebration of the best of New York can't become divisive. That is not good for the city now as we try to complete our recovery effort, and it is not good for the marathon in the long run," he said.

Earlier in the day, race preparations seemed under way as normal.

White tents where the runners would meet were already erected. Plastic crates lined the park's wall for two blocks, with tangles of electric wires and other setup equipment where workers buzzed around. A few TV news crews set up camp.

Along the race route in Queens, a couple of marathon banners hung from street lamps.

"I'm not a fan of what he's doing," Manhattan resident Michael Folickman said of Bloomberg's decision. "I think that if the bridge is cleared and the streets are clear, I don't think it'll wreak any more havoc than what's already been wreaked."

"And I think it could be an uplifting experience for the city to have something exciting like that happen on top of this terrible hurricane," he said.

In Brooklyn, the effects of the storm were more apparent. One gas station had a long line of cars extending down the block. Another had dozens of people standing on the sidewalk, clutching red fuel cans.

In Staten Island, Eddie Kleydman said ruined neighborhoods like his are still waiting for help.

"Look at this," he said, motioning toward the huge piles of discarded furniture and household items that line his street. "Who cares about the marathon? We need garbage trucks, we need FEMA to act quicker. He's worried about the marathon; I'm worried about getting power.

"So he called it off. He has to come here and help us clean," Kleydman said.

At the midtown New Yorker Hotel, the lobby was filled with anguished runners, some crying and others with puffy eyes. In one corner, a group of Italian runners watched the news with blank looks.

"I have no words," said Roberto Dell'Olmo, from Vercelli, Italy. Then later: "I would like that the money I give from the marathon goes to victims."

Gisela Clausen, of Munich, told her fellow runners about the cancellation as they walked in.

"You don't understand. We spend a year on this. We don't eat what we want. We don't drink what we want. And we're on the streets for hours. We live for this marathon, but we understand," she said.

___

Associated Press writers Cara Anna, Verena Dobnik, Melissa Murphy, Christina Rexrode, Michael Rubinkam in New York contributed to this report.

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Urban Athlete: Discover Outdoors Offers Mountain Fitness Class

Willie Davis for The New York Times

Rey Soriano, foreground, holding himself on suspension trainers in a workout run by Discover Outdoors.

I HAVE spent a small fortune over the years on gym memberships. But all you really need to get in shape, I now know, are a few granite paving stones, some sandbags and a backpack full of water jugs.

Willie Davis for The New York Times

David Tacheny, center, leading an exercise known as “pack mule,” as Courtney McBride pulls May Yu Whu.

Willie Davis for The New York Times

Mr. Tacheny explaining how to use paving stones as weights.

Willie Davis for The New York Times

Wendy Tsang, left, lifting a Bulgarian sandbag.

Early one Sunday morning I arrived at the entrance to Riverside Park for an exercise class called Mountain Fitness. A Manhattan adventure outfitter, Discover Outdoors, describes the class as a way to “train like a guide,” and uses rocks, logs, sandbags and water jugs in a quest to improve “functional fitness.” The company started offering the class a year ago after customers asked how they should train for the more challenging hiking and trekking adventures it offers.

Our instructor, David Tacheny, a guide and personal trainer, told us that a typical gym workout doesn’t engage all the muscles you’ll use on, say, a rock-climbing excursion. A leg press machine, for instance, works the pushing muscles of the legs. Squatting while raising a heavy rock above your head, on the other hand, also uses the back, abdominal muscles and shoulders, and it better approximates what it’s like to lift an overstuffed backpack.

“This is how guides train,” he said. “We don’t go run miles on flat terrain. We don’t just pump iron.”

All the exercises can be adapted to different levels of fitness. Our group of eight (including one man) looked plenty fit and included several people who belonged to social sports clubs in the city and competed in triathlons. Melanie Pessin, a triathlon competitor, did an eight-mile run before showing up for class. “I’m training for a half-marathon,” she said.

After a 10-minute warm-up, Mr. Tacheny took us to a pile of rectangular paving stones, each weighing 25 to 40 pounds. Standing with legs apart, we swung our stones out from between our legs into the air, using our hips instead of our arms for power.

The “halo” routine entailed holding the stone at chin level and circling it in a tight arc around the head. Next were squat presses, with the stones raised over our heads. At this point my back muscles went on strike, forcing me to switch to an imaginary stone.

Why just lift stones, though, when you can run with them — or throw them? Mr. Tacheny had us hold our stones at chest level, heave them as far as we could toward a tree in the distance, then run to pick them up; we were to repeat the move until we reached the tree.

Next, he divided us into two groups for a rousing game of what I came to call ducking stones. Each team started with an equal number of stones at the base of a tree. We were supposed to fetch a stone and run with it, depositing it at the base of the opposing team’s tree. After two minutes, whichever team had the fewest stones remaining would win. Mayhem ensued, with stones flying everywhere, to the point where I would yell out, “Don’t hit me!” whenever I stooped to pick one up.

Next, Mr. Tacheny introduced the “pack mule” exercise. Each team of two received a harness made of straps. One person held the straps and pulled while the teammate, attached to the harness at the other end, resisted. To inspire us, he recounted the story of two guides who pulled 100-pound sleds up a glacier while carrying 85-pound backpacks.

Freed from their harnesses, the class members followed Mr. Tacheny on a five-minute jog to a remote section of the park. There, he had stored a jump rope, a backpack full of water jugs, two crescent-shaped Bulgarian sandbags and some straps that he tied around tree branches. Instant exercise stations: pull-ups and push-ups using the straps; squats and leg lifts with the backpack or with a sandbag draped over the shoulders; a cardio workout using the jump rope.

After completing our circuits, we gathered in a circle and applauded ourselves for our hard work. “You got a sense of how to vary your workouts a little,” Mr. Tacheny told us, adding that gym routines didn’t appeal to him anymore, and that riding his bike 60 to 70 miles a day had gotten old. “But this stuff,” he said as we all dragged ourselves out of the park, “you won’t get bored with it.”

Discover Outdoors holds 90-minute Mountain Fitness classes for $20 at Riverside Park in Manhattan; (212) 579-4568, discoveroutdoors.com.

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A Promising Drug With a Fatal Flaw

Dr. Bryan A. Cotton, a trauma surgeon in Houston, had not heard much about the new anticlotting drug Pradaxa other than the commercials he had seen during Sunday football games.

Then people using Pradaxa started showing up in his emergency room. One man in his 70s fell at home and arrived at the hospital alert and talking. But he rapidly declined. “We pretty much threw the whole kitchen sink at him,” recalled Dr. Cotton, who works at Memorial Hermann-Texas Medical Center. “But he still bled to death on the table.”

Unlike warfarin, an older drug, there is no antidote to reverse the blood-thinning effects of Pradaxa.

“You feel helpless,” Dr. Cotton said. The drug has contributed to the bleeding deaths of at least eight patients at the hospital. “And that’s a very bad feeling for us.”

Pradaxa has become a blockbuster drug in its two years on the market, bringing in more than $1 billion in sales for its maker, the privately held German drug maker Boehringer Ingelheim.

But Pradaxa has been linked to more than 500 deaths in the United States, and a chorus of complaints has risen from doctors, victims’ families and others in the medical community, who worry that the approval process was not sufficiently rigorous because it allowed a potentially dangerous drug to be sold without an option for reversing its effects.

Pradaxa is an example, some critics say, of what can happen when a drug that performs well in tightly controlled trials is released into the messy world of real-life medicine. Boehringer Ingelheim said it was working on developing an antidote but that even without one, patients in a large clinical trial died at roughly the same rate as those who were taking warfarin.

The Food and Drug Administration released a report on Friday that found that the drug did not show a higher risk of bleeding than for patients taking warfarin. The report did not address the lack of an antidote for Pradaxa.

“The evolving spontaneous reporting patterns do not indicate a change in the favorable benefit-risk profile of Pradaxa, when used correctly according to the approved label,” Boehringer Ingelheim said in a statement. In other words, the drug is still safe. But some reports have indicated that doctors are not sufficiently cautious when prescribing Pradaxa, giving the drug to older people or those with kidney problems even though there is evidence that the bleeding risks are higher in those groups. The company recommends testing patients’ kidney function before prescribing Pradaxa and notes that the risk of bleeding increases with age.

“The problem is that the people that prescribe this, as a general rule, are cardiologists and family practitioners,” said Dr. Mark L. Mosley, director of the emergency room at Wesley Medical Center in Wichita, Kan. “The people that see the harm are your E.R. docs and your trauma docs.”

Critics say that at least until an antidote is found, better disclosure or more limited use of Pradaxa may be preferable. Patients’ lawyers have begun turning their attention to the drug. More than 100 lawsuits have been filed in federal courts and lawyers say thousands more are expected.

When the F.D.A. approved Pradaxa in October 2010, the drug was hailed as the first in a new category of replacements for warfarin, the nearly 60-year-old drug used to prevent strokes in people with a heart-rhythm disorder known as atrial fibrillation.

Warfarin requires careful monitoring of a patient’s diet and drug regimen, and frequent blood tests to ensure that it is working. Pradaxa required no such monitoring and, compared with warfarin, appeared to be better at preventing strokes.

Sales of the drug took off. By the end of 2011, after just over a year on the market, 17 percent of patients with atrial fibrillation were being prescribed Pradaxa, compared with 44 percent for warfarin, according to a study released in September. About 725,000 patients in the United States have used the drug, according to the F.D.A.

But almost as soon as doctors started prescribing Pradaxa, concerns surfaced about its safety. Pradaxa was identified as the primary suspect in 542 patient deaths reported to the F.D.A. in 2011, and was linked to more reports of injury or death than any of the more than 800 drugs regularly monitored by the Institute for Safe Medication Practices, a nonprofit based in Pennsylvania that monitors medicine safety.

Dr. Mosley said he found it “shocking, just shocking” that the F.D.A. approved Pradaxa, which is also called dabigatran, even though no antidote was available.

In a statement, the F.D.A. said, “the lack of an antidote notwithstanding, dabigatran was superior to warfarin in preventing strokes in a large clinical trial. The rates of bleeding were similar.” In the study it released on Friday, the F.D.A. examined health insurance claims and hospital data and reached a similar conclusion.

Warfarin, which is also known by the brand name Coumadin, can often be reversed by giving a patient vitamin K or other substances. Warfarin, too, can be deadly but, doctors said, they at least have options.

“The practical experience is that once hemorrhagic complications occur in this drug, it is much more likely to be a catastrophe than with Coumadin,” said Dr. Richard H. Schmidt, an associate professor of neurosurgery at the University of Utah, who treated an 83-year-old man who died from bleeding and was using Pradaxa.

Boehringer Ingelheim recommends treating bleeding patients with dialysis to help flush the drug from the body, although it notes that “the amount of data supporting this approach is limited.”

Several doctors said that option was not realistic. “People that are bleeding to death aren’t going to tolerate being put on dialysis,” Dr. Cotton said.

Two other new drugs intended as warfarin replacements also lack antidotes. Doctors said they had not seen as many bleeding deaths associated with Xarelto, which was approved in 2011 and is sold by Bayer and Johnson & Johnson. On Friday, the F.D.A. approved Xarelto to also treat deep vein thrombosis and pulmonary embolism, two kinds of blood clots. Pradaxa is approved in the United States only to prevent stroke in patients with atrial fibrillation. A third drug, Eliquis, by Bristol-Myers Squibb and Pfizer, has not yet been approved by the F.D.A. Representatives for both drugs said trials showed their products were safe, adding that the companies were investigating different antidotes. Boehringer Ingelheim is expected to present several new studies of Pradaxa’s safety and efficacy — including one that examines potential antidotes — at the American Heart Association scientific conference next week in Los Angeles.

Some cardiologists have said that Pradaxa and the other new drugs represent real advances over warfarin. Around 40 percent of people with atrial fibrillation do not take any drugs for it, a recent study showed, putting them at risk for strokes.

“I think the benefit of the drug clearly exceeds the risk because to me, a disabling stroke has a greater weight than a bleeding complication,” said Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles and a member of the F.D.A. committee that voted to approve Pradaxa.

But those calculations make little sense to Walter Daumler, who said he watched his 78-year-old sister, Doris, bleed to death in May. Mr. Daumler, who lives in Wisconsin, has hired a lawyer and is considering suing. He said the doctors told him that because she was on Pradaxa, there was nothing they could do.

“My No. 1 goal is to stop this insidious drug,” Mr. Daumler said. “To get this off the market, so others will not undergo or witness what I saw.”

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