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4 Days, 690 Miles, Countless Stalls: Behold the ‘World’s Longest Yard Sale’

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To the visitor driving in from out of state, the 127 Yard Sale seems like a kind of Ironman for thrifters. The “world’s longest yard sale” is a test of endurance and attention. Spanning six states, 690 miles and thousands of stalls, it traverses dramatic landscapes, delicate cultural terrain and two time zones. Seeing it all in the four allotted days — Aug. 3 to 6 this year — is enough to induce vertigo in even the most stable-minded deal hunter. But some of us are foolish enough to try anyway.

The event was designed to promote cultural and economic exchange. In 1987, Mike Walker, then a 28-year-old county executive in Jamestown, Tenn., conceived of it as a way to lure travelers off the Interstate and into the small towns along U.S. Route 127, from Jamestown to Covington, Ky. In the following decades, it spread south to Georgia and Alabama and inched north to Ohio and then Michigan.

The 127 Yard Sale is fluid, kinetic, alive. This makes it a bit hard to find its official beginning. Driving down 127, I started to see “yard sale” signs long before reaching its northernmost point in Addison, Mich. We asked some guys at a gas station where they thought it started. They pointed to a nearby Baptist church, and soon we were standing in an orderly marketplace on a plot of pine and grass. Here I saw the first arrays of glassware, the first piles of free naked dolls, the dubbed VHS tapes, the loose silverware, the lines of floating dresses.

This couldn’t be a contiguous sale — or could it? The Facebook group I’d joined suggested that Michigan was the sparsest section. But even here, we could hardly drive a quarter mile without spying a Sharpied invitation to a “Barn Sale” a mile away, or “Thousands of Items, CHEAP, 4th House on Your Left.” A subtle terror began to take hold — a respect for the enormous scale of the thing.

“You’re never going to make it,” a gentleman in a chicken-patterned Havana shirt informed me, with his wife by his side, nodding. “You’re not even in Ohio yet and look how much time you spent talking to us.” I was ashamed to tell them that this was only our second stop. Tracy Tupman and Megan Mateer turned out to be co-owners of a prop rental company in Ohio — and veterans of the yard sale. They pull up here every year in an empty truck and trailer that they expect to fill up well before the last day. Intentional thrifters, they came prepared with a list of objects they hope to secure for future productions.

They showed me their DeLorme road atlas, dog-eared, with ballpoint asterisks. “That town around Carthagena has a big chicken,” Tracy said. “It’s about 20 feet tall. You can’t miss it.” We did miss it, but only because we ignored their parting advice: “Don’t go off-road. “If you’ve ended up in a single household front yard, you’re off-track.”

Before too long, the 127 Yard Sale starts to seem like a survey of American manufacturing. Flotsam from Michigan’s automotive industry has made its way downstream into the gumline of nearby Appalachia, and every lawn seemed to bear the car companies’ merch: plaques, plates, paperweights, duffel bags, key fobs, deadstock stationery, promotional wrench sets, watches engraved with commemorations of forgotten journeymen.

That first morning, I bought an old cotton sweater. After watching me pay for it and immediately return for some Wedgwood dessert plates, a fellow thrifter warned my boyfriend to keep our money separate, lest I wipe him out by Ohio. At the edge of the parking lot a sign said, “The Lord Will Provide.”

One of the remarkable things about exploring America by car is that you can begin to feel the states change long before you see the signs. Mile by mile, the landscape changes imperceptibly — the grass slowly changes hues, the sky inches closer or begins to hold its clouds differently. As we crossed the state line into Ohio, corn gave way to sunflowers, low fruiting trees replaced pines. Yellow roadside diamonds urged respect toward horse-drawn carriages.

Mennonites became fixtures of the sale. They sold traditional items: dilly beans, horse-churned ice cream, fresh-cut flowers, wooden carvings and a heartbreaking number of puppies. Their children were shy but excitable in the face of so many nonbelievers. Among the piles of pilled Lycra blends and polyesters, their plain dress stood out. It read as luxury, utilitarian haute couture. I bought myself a bonnet at one of their stands. Nodding approvingly, the seller informed me: “Most of our customers are defiant women.”

Deep in farm country, the pull of northern industrial towns could still be felt. One couple had a baroque volume of German sausage recipes, published by the Oscar Mayer corporation. The owners knew it was one of their prize pieces. The husband grew up in Wisconsin near one of the sausage conglomerate’s biggest factories and told me that it shut down a few years back. There were only a few copies left, he said.

The number of sales increased in Kentucky. People were friendly, chatty, open about everything but their politics. The church may reign supreme here, but people don’t pretend to be purists. They’re frank about their lapses and relapses. I heard people telling their neighbors, friends and perfect strangers about treatment centers for opioid addiction, about loved ones struggling through it, about those who didn’t make it and where their graves are.

Sometimes the friendliness and good humored conversation masked an anxiety about making a sale. My boyfriend flirted with buying a chicken-shaped fan, discounted because of its missing tail. The two women selling it — good-humored friends who had helped each other through a series of hardships — were proud of the piece, and disappointed when we left without it. “We’ve only made $8 so far,” they said. They had a bunch of photo frames for sale, one of them containing a sign for a diaper raffle. A sign over another stall advertised “Old Bottles and Basset Hound Puppies.” The seller’s son held one of the fat-bellied puppies — $450 each — tenderly in his lap, sad to see them go. A nearby needlepoint wall hanging, listed for 50 cents, read: “Friends are the best collectibles.”

The dream of interstate exchange seems to be flagging these days. Vendors seemed surprised when they learned I’d come from New York, and could recall the handful of other tourists they’d encountered.

To the novice, the sales seemed to be buzzing, but almost every vendor told us otherwise. A number of people speculated that high gas prices and heat were keeping people away. It was better attended in 2020, when Covid was moving like brush fire.

Like many vendors I spoke to, Lisa Hardin said this would probably be her last time participating. At a little intersection in Junction Station, Ky., she was selling oval bowls made from buckeye, Ohio’s slender state tree with a signature steel-blue grain. They were exquisite pieces, at once natural and high design. Her grandfather started making these in the 1970s. He taught her brother and cousin the craft, but wood dust and working life got in the way. Once these 10 bowls on the table were gone, the tradition would be, too.

Heat-dumb and anxious to keep moving, I found the $50 price tag a bit rich for my blood. About 15 miles away, the bowl started to haunt me as only a great shopping mistake can. That was a special item, I told myself; it had sung to me. I could imagine children I don’t have fighting over it when I’m dead. I tried to find Lisa’s bowls on the internet, but like a lot of the treasure here it was painfully offline.

Soon the temperature became unbearable. Vendors took open-mouth naps in their stadium chairs or vans. “I don’t know why the sale has to happen in August,” Ashley Klette, a teacher’s aid in Owenton, Ky., told me. Buyers moved slowly, looking closely as they navigated bins, shelves and boxes, the hedge maze of tents. They had the soft gaze of bird watchers, coming into ponderous focus when they spotted something that piqued their interest.

Almost every major stop had a Trump-merch stall. Confederate flags were another reliable presence, often alongside switchblades, crossbows, weed-leaf bucket hats and pink rhinestoned T-shirts. Some 50-odd yard sales in, the repetition became hypnotic. And we had yet to reach its epicenter, where the whole thing started.

When we drove into Tennessee, it was all blue fog, green leaves and black stone rivers. The roads switch-backed up mountains, a collar of trees protecting motorists from the fact of their ascension till the sky suddenly split open onto a vista. One sale, wedged in the curve of a mountain pass, had a table filled with Fisher-Price and Mattel toys that hummingbirds were trying to pollinate.

In Tennessee, the 127 Yard Sale scales up. The whole thing is professionalized. There were major stops every few miles. People ate ribbon potatoes, pulled pork, funnel cakes and fried pies, drank sweet tea from food trucks and lemonade from children’s stands. Ice-cold water was sold from coolers for $1.

Neighbors brought each other potatoes and tomatoes and eggs, gossiped, complained about the heat, shared their finds.

I met a man in Pall Mall, Tenn., minding his daughter’s yard sale and feeding her chickens the biscuit part of his breakfast sandwich. We introduced ourselves — “Joe Poor, spelled like the opposite of rich.” I gushed about how gothically pretty this part of the country is. “They say God waved his hand over Fentress County twice,” he replied.

Saturday, the third day of the sale, had a kind of euphoria to it. Sweaty and dirty, I’d snagged a hand-painted “Wizard of Oz” dish set for $20, a heavy cluster of silver Figaro chains with dice charms, a knockoff Gaultier dress, a silk handkerchief, a Victorian candy dish for my cat and a purse shaped like a bullfrog.

In the late afternoon, temperatures edged up toward 100. Deals happened fast. The objects on display, it seemed, were the last things worth buying; anything desirable would be snatched up this very hour, and it was only getting hotter, brighter and denser.

In Cumberland County, a Memphis-fever-dream dollhouse — aqua-glass brick exterior, heart-shaped Jacuzzi, a lacquered spiral staircase — caught my eye. The owner, Myra Ramsey, hadn’t missed the sale once in the last 35 years. I was curious to know how it’s changed. “The biggest change is less people,” she said. “A lot less people.”

In the early years, she told me, U.S. Route 127 was bumper-to-bumper traffic as far as the eye could see. Her husband had to perform makeshift crossing-guard duties to get their cows across the road for twice-a-day milking. Salegoers hung out in the backs of trucks with their van doors open, the road itself becoming a kind of event, even if it took an hour to go a mile.

On the last morning of the sale, a storm front announced itself, circling up from the Gulf. The southern tip of the sale had been hit a few days earlier. Extreme weather is the bane of all outdoor commerce. If vendors were checking their phones — a rare sight around here — it was to check the forecast, now so intimately intertwined with their fortunes.

The skies oscillated between drizzle and total downpour. It felt like the end of the party. What was left felt ragged, patchy, a mass grave of objects that failed to find their next home. Abandoning our end-to-end ambitions was unthinkable at this point, though, so despite the rain we sped south. There were another 100 miles and two states, after all.

On the short detour through northern Georgia, the sale departed from its eponymous route. The official website, which is charmingly early internet, gives turn-by-turn instructions, a throwback to the days of MapQuest, when you had to print out instructions and actually mind the road signs. It was a huge comfort to reach Alabama, where the sale returns to its one-road principle.

The day was still and loud, and the drizzle made steam rise off mulch piles and muddy fields. The sky was green, then gray. A full-blown tempest hit, the downpour overwhelming the wipers, wind shaking the car, lightning spraying horizontally across the sky. On this final stretch, the yard sales were plentiful but unmanned. Apparently, the sellers had warily rebuilt their displays after the storm had passed and abandoned them again at the first hint of recurrence.

Our hope flared up again during a short dry spell. We got out at a fairground and inspected a downed pole, twisted with a dozen sodden Trump flags, wrapped up like a crepe. As we neared the final stop, in Gadsden, Ala., we saw what had driven everyone away. Stalls had been tossed like chip bags in the wind, trees were snapped in half, power lines were down, shards of goods were tossed to the woods like offerings. The temporariness of the yard sale had reasserted itself, now as calamity.

Stepping out of the car in Gadsden, with no more sales to look forward to, felt like getting off a treadmill. The movement of the sale was now within me. Every time I saw old stuff piled outside someone’s house, something in me jumped. I was surrounded by a version of the world I had known before: multistory buildings, paved parking lots, so many cars headed in all directions, big businesses, and the people and their lives that maintain all this commerce, and I started to see it wholesale, and then in parts. I could imagine all these buildings turned inside out and shaken like jeans pockets, all the stuff splayed on the lawn — relics, fossils, salvage.

Kendall Waldman is a freelance photographer and location scout based in Brooklyn. You can follow her work on Instagram.


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Travel Apps and Websites for Last-Minute Labor Day Plans

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If you found a flight but aren’t purchasing a package, you’ll most likely need a place to stay. HotelTonight is a great resource for discount hotel rooms, with the home page search defaulting to “Tonight,” though you can book 100 days out. Unlocking the Daily Drop feature, available once a day for only 15 minutes, offers further discounts — but nonrefundable rates — on a specific hotel. (Like many travel websites, HotelTonight says many of its best deals are found only on its app.)

Hot Deals is a feature on Hotwire’s hotel results page after you have entered your search specifics. Click on the Hot Deals tab, and the page shows a list of hotels with their daily rates, ratings, location and amenities, but the traveler does not see the name of the hotel until booking. All sales are final.

Hotels.com shows deals directly on its home page, showing a range of destinations but limited to the upcoming weekend. (The company offers steeper discounts to members of its free loyalty program.) It’s also worth checking Roomer, an online marketplace for verified nonrefundable hotel rooms that other travelers are looking to unload.

For budget-minded travelers, consider a camping trip. On Tentrr, where you can search by region or type of location (think lake or river), campers can get $25 off on accommodations booked through Sept. 4. Hipcamp has a dedicated Labor Day weekend section, or try your luck on ReserveAmerica and Recreation.gov, the booking site for the National Park Service and other federal lands. If you plan on camping regularly in the next year, consider signing up for the Dyrt’s Pro Plan ($36 a year), which grants access to campsites, offline maps and discounts, or for Harvest Hosts, a membership platform that allows self-contained campers like camper vans and R.V.s to park at wineries, breweries, farms and more (from $99 a year).

Maybe you don’t feel like rushing to grab a last-minute flight this weekend. In general, Labor Day weekend centers on domestic travel, or three-day-friendly destinations, said Katy Nastro, a travel expert with Going. And more people drive, she added, than fly.

In Detroit, a French Brasserie That Feels Like a Portal to Paris

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The Brazilian artist Wanda Pimentel’s “Envolvimento” paintings (1968-84) are hard-edged domestic vignettes — kitchens, bathrooms, the insides of cars — rendered in a lean, almost festive palette of mostly reds, greens and yellows. In these claustrophobic spaces, feminine-seeming thighs, ankles, feet and hands make fetishistic cameos, jutting out at awkward angles or lingering near water puddles and toilet-paper rolls. Sometimes, they’re framed by thick, windowpane-like lines that cast the viewer as a peeping Tom. “The house is not only a space of intimacy but also of fear,” says Alexandre Gabriel of São Paulo’s Fortes D’Aloia & Gabriel gallery, which will present Pimentel’s work at the Independent 20th Century art fair in New York City next month.

If Pimentel’s scenes deliberately suffocate, those of the American abstractionist Mildred Thompson, who died in 2003, catapult us outward. Her show at Independent 20th Century, curated by Mary Sabbatino of Galerie Lelong & Co., will be the first time the public sees her 1970s “Window Paintings.” Thompson’s best-known canvases are crammed with marks resembling confetti explosions and colliding tornadoes, meant to show what is unseen in our world — particles, energy, the vibrations of sound — as a great cosmic funk. The motifs in the “Window Paintings” are more easily recognizable: Made in Tampa, Fla., they seem to be psychedelic beachscapes. In one from 1977, a vast green sky and block of sand are framed by beach-towel-bright curtains. It’s an idyllic, open vista, without a person in sight. Independent 20th Century runs from Sept. 7 through Sept. 10, independenthq.com.


Eat Here

On a sunny corner in Carroll Gardens, Brooklyn, Suea and Carol Song have opened Dae, a space inspired by Korean cafe culture. With backgrounds in food and fashion, respectively, the duo wanted to create a casual meeting place for coffee, cocktails and small plates, while also highlighting their favorite housewares creators. A window seat in the entryway is cozy beneath a white pillow installation by the artist Terry Park that cascades from the ceiling. Music plays softly from transparent acrylic speakers that were created especially for the space by the Seoul-based designer Erika Cox. For refreshments, you can choose coffee from the Korean roaster Anthracite, teas harvested on Jeju Island by the company Osulloc or cocktails like the Maesil Spritz (fermented green plum liqueur and yuzu). Dae’s seasonal menu also currently includes milk bread and butter, and pita with kimchi labneh. And for those who want to take some of that serene aesthetic away with them, Dae sells a selection of home goods such as incense from the Toronto-based Korean bathing brand Binu Binu and hand-hammered metal coffee filters and forks hung with charms by Studio YeoDong Yu. daenewyork.com.

Loro Piana, the Italian tailor and textile producer, is known as one of the world’s foremost manufacturers of cashmere wool. Every year, the company harvests it from the longhaired goats that reside in Central Asia, usually in early spring when the animals naturally shed their fur. Almost a century after its founding in 1924 in the Piedmontese village of Quarano, Loro Piana is introducing Loro, a seven-piece capsule collection of clothing and accessories made from recycled cashmere fibers extracted from the house’s knitwear production surplus, a fabric that the brand refers to as re-cashmere. The process, conceived to reduce waste and salvage material, begins with the manual removal of zippers, closures and stitching on leftover garments and accessories like sweaters, gloves and scarves. The fabric and knitwear scraps are sorted by color, washed, unraveled, then blended with undyed cashmere, resulting in a quality indistinguishable from that of an all-new knit. The yarns are not overdyed (a common technique to achieve bright color), resulting in an earthy palette that includes shades of oatmeal, rust and a smoky gray. Pieces include turtlenecks, V-neck sweaters, scarves and hats in an expansive size range running from a child’s M to 4XL. The whole collection is gender-inclusive; after all, loro translates from Italian to the neutral “they.” From $450, loropiana.com.


Visit This

Detroit has sometimes been called the Paris of the Midwest and, as of last week, the city has a new brasserie that might easily suit the French capital: Le Suprême, located in Book Tower, a recently restored mixed-use building downtown. Method Co., the company behind the Pinch hotel in Charleston, S.C., and the Quoin in Wilmington, Del., among others, oversaw the concept and design, which includes a green-tiled cafe and barroom, a main dining room accented with oxblood leather booths and antique sconces and a 24-seat private dining room. The breakfast menu includes housemade pastries and bread, which guests can eat while sitting on wooden benches designed to mimic the seating at Paris Metro stations. The eclectic artwork displayed on the walnut-paneled walls includes old jazz concert posters from Detroit and photographs inspired by France’s Le Mans car race. The restaurant’s menu features seafood towers as well as a range of Parisian specialties, such as moules frites, soupe à l’oignon gratinée and steak au poivre. lesupremedetroit.com.


For the past decade, the Paris and Marrakesh-based communications consultant Pierre Collet worked with the Swiss art patron Maja Hoffmann while she oversaw the transformation of an old rail yard in Arles, France, that would ultimately become the 27-acre Luma museum complex. As he helped establish a new cultural center for the city, Collet noticed something else was missing. “For some reason it was hard to find good bread in Arles,” he says. When he proposed launching a bakery, Hoffmann signed on as partner, and Le Sauvage opened this August, offering a short menu of artisanal breads and pastries, all made with organic flour. Soon Le Sauvage will also offer bouquets of local, seasonal wildflowers, as well as baking classes to local schoolchildren. The New York City-based Labo Design Studio created the interiors — a contrast of natural stone surfaces and a modern curved white terrazzo counter, with a wall of colored glass panels by the artist duo Aurélie Abadie and Sauques Samuel. “We want to celebrate original craftsmanship in all forms,” Collet says. instagram.com/le_sauvage_arles.


From T’s Instagram

Eurozone Inflation Holds Steady at 5.3 Percent

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Consumer prices in the eurozone rose 5.3 percent in August compared with a year earlier, sticking at the same pace as the previous month and defying economists’ expectations for a slowdown, according to an initial estimate by the statistics agency of the European Union.

While inflation has slowed materially from its peak of above 10 percent in October last year, there are signs that some inflationary pressures are persistent, even as bloc’s economy weakens. Food inflation was again the largest contributor to the headline rate, rising 9.8 percent from a year earlier on average across the 20 countries that use the euro currency.

Inflation was also given some upward momentum by a jump in energy costs, which rose 3.2 percent in August from the previous month.

Core inflation, which strips out food and energy prices, and is used as a gauge of domestic price pressures, slowed to 5.3 percent, from 5.5 percent in July.

In some of the eurozone’s largest economies, rebounding energy prices offset slowing food inflation. The annual rate of inflation accelerated to 5.7 percent in France and to 2.4 percent in Spain this month.

In Spain, inflation had fallen below 2 percent, the European Central Bank’s target, in June, but has since climbed back above it.

Inflation in Germany, Europe’s largest economy, was 6.4 percent in August, slowing only slightly from the previous month, as household energy and motor fuel costs increased.

The acceleration of inflation in some of the region’s largest economies arrives two weeks before the European Central Bank’s next policy meeting. As analysts parse the data, the question is whether the reports are troubling enough to persuade policymakers to raise interest rates again at their mid-September meeting. The central bank has raised rates nine consecutive times, by 4.25 percentage points in about a year, and there is growing evidence that higher rates are restraining the economy, particularly as lending declines.

Last month, Christine Lagarde, the president of the central bank, said she and her colleagues had “an open mind” about the decision in September and subsequent meetings. Policymakers are trying to strike a balance between raising rates enough to stamp out high inflation, while not causing unnecessary economic pain.

“We might hike, and we might hold,” she said. “And what is decided in September is not definitive; it may vary from one meeting to the other.”

On Thursday, before the eurozone data was released, Isabel Schnabel, a member of the bank’s executive board, said that “underlying price pressures remain stubbornly high, with domestic factors now being the main drivers of inflation in the euro area.” This meant a “sufficiently restrictive” policy stance was needed to return inflation to the bank’s 2 percent target “in a timely manner,” she added.

What Courtney Dauwalter Learned in the Pain Cave

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After running for 60 miles through snow, up steep, root-filled switchbacks with thousands of feet of elevation gain, Courtney Dauwalter entered what she calls her pain cave. For the next 40 miles of the Western States 100-Mile Endurance Run through California’s Sierra Nevada, she imagined she was holding a chisel and chipping away at the furthest reaches of her pain, while staying focused on every step she took. By the time Dauwalter crossed the finish line in 15 hours, 29 minutes and 33 seconds, she had obliterated the women’s course record by more than an hour and had run the 23rd-fastest time, by anyone, in the race’s 45-year history.

To put Dauwalter’s time in perspective, it would have won the men’s division of Western States — arguably the most competitive 100-mile race in the world — every year from 1978 through 2009. Scott Jurek won Western States seven times (most recently in 2005) but never once ran as fast as Dauwalter did this year. She beat a 1994 Western State record set by Ann Trason, who won the race 14 times, by more than two hours.

Dauwalter is one of the most colorful characters in ultrarunning. She is known for her love of candy, nachos and beer, as well as her loose shorts and her vivid on-course hallucinations, which are illustrated on hats and T-shirts. In the past 10 years, she has won more than 50 races of 30 miles or longer. In 2017, she won a 240-mile race in Moab, Utah, by 10 hours. In winning Big Dog’s Backyard Ultra in 2020, she ran 283 miles and hallucinated that Mickey Mouse was standing on a circus stage handing out T-shirts to a crowd.

Now she is trying to do something even the most accomplished ultrarunners would consider extraordinary: win three highly competitive 100-mile races in a single summer. Twenty days after her performance at Western States, she won the grueling Hardrock 100 in Silverton, Colo., breaking her own record by 20 minutes and placing fourth overall. This weekend, seven weeks after winning Hardrock, she will toe the line at the Ultra Trail du Mont-Blanc, a brutally steep, 106-mile race in Chamonix, France, with terrain more suited to billy goats than humans. She has won the race twice and currently holds the women’s record.

“In general, I am pretty tired,” said Dauwalter, whose mottos when things get tough in a race are “This is fine” and “Be brave and believe.” She said running all three races was not the plan at first, but that she just had to try it.

“I am so curious what will happen and excited to test myself,” she said.

Lanky and blond, with a deep tan, expressive blue eyes and permanent laugh lines, Dauwalter, 38, believes one of the greatest evolutions in her running career has been her embrace of the “pain cave.” Initially, she thought of it as the place where she could no longer bear the suffering and would have to stop running. Indeed, she quit the first 100-mile race she attempted in 2012 because she was overwhelmed by pain. But as she ran more races, she started to understand that she could work through it. She said she envisioned herself in a hard hat, wielding a chisel and “going to town, trying to make it a dust pile while I am in there.”

She continued: “It feels like this is a special opportunity every time it arrives because we can’t summon it whenever we want. We have to be doing something hard, push ourselves, and then maybe we will get the chance to go in. And if we do, we should celebrate that we get to be there.”

Sitting on a deck that overlooks the Rockies at her home in Leadville, Colo., on a sunny, mid-August afternoon, Dauwalter sipped a fruity seltzer and pointed to two 14,000-foot mountains that she often runs to from her house. In a sport where most elite runners have a coach and map out their training schedules weeks in advance, Dauwalter trains herself and does not know how many miles she will run on any given day. Her mornings usually begin around 4 a.m. with a cup of coffee with vanilla crunch creamer. She responds to emails, then does about 40 minutes of strength training. By 7 a.m., she hits the trail and runs for an hour to five hours. She often adds a bike ride and a second run with her husband, Kevin Schmidt.

“I try and go into every week really open to whatever happens so that I will actually tune into my body and listen to it,” said Dauwalter, who wears a running watch but does not post her workouts on popular running apps like Strava, as many ultrarunners do. “If I go into a week thinking it is going to be a really big mileage week or I have all these grand ideas about it, then I find it harder to listen to my body and actually respond to what it is telling me.” Her big mileage weeks are often 140 miles.

Schmidt, a software engineer who said he didn’t know about ultramarathons until he met Dauwalter over a decade ago, tracks the possible mile splits she could have and meticulously plans the support stations along the course. Though Schmidt sets time goals, the couple does not focus on them or get too confident about a race until Dauwalter is at the finish line. In 2019, she was leading Western States, but had to drop out at mile 80 because of a leg injury. In 2021, her stomach issues were so severe at Hardrock that she couldn’t go on. Even when all goes as planned, random events can intervene, like when Dauwalter had to go off course to avoid a moose or lost her vision when her corneas swelled from the dust on the trail.

The pair said that nutrition is now a big part of their plan. A friend who works as a dietitian said Dauwalter had stomach problems in races because she was not getting enough calories. Dauwalter now picks up a plastic bag at each support station filled with an assortment of gels and energy waffles and carries water and a sports drink. Her job is to hand back a bag with empty wrappers.

Schmidt believes Dauwalter’s supportive family and her athletic background in her home state of Minnesota helped her learn to be aware of what she was feeling. She ran cross-country in high school and was a state champion Nordic skier, which earned her a skiing scholarship to the University of Denver.

“She had fantastic parents who raised her really well, encouraged her to be competitive and didn’t put restrictions on her, so she never felt like she couldn’t compete against her brothers,” Schmidt said. “And she had really great coaches who taught her how to be in tune with her body, which I think has helped her have this very unstructured training format that works for her.”

Meghan Hicks, the editor in chief of iRunFar, an ultrarunning website, said many runners unintentionally set limitations on themselves by focusing on a course record and the splits it will take to beat it.

“Courtney does not work that way,” she said. “She goes and runs by the way she is feeling.”

Hicks said Dauwalter has “a wide-open approach that you don’t see a lot of runners doing and I think that is perhaps part of her key to success.”

Dauwalter’s performances have led some to wonder whether women will become faster than men as distances get longer. Dr. Sandra Hunter, the director for the Athletic and Human Performance Research Center at Marquette University, said they will not. Men’s physiological and anatomical advantages, including less body fat, greater hemoglobin and higher oxygen uptake, mean that they will always be faster overall, she said.

For example, Jim Walmsley, who holds the men’s record for Western States with a time that is about 9 percent faster than Dauwalter’s. According to an article in Sports Medicine, in major ultra trail races where the best men and women are present, this number rarely dips below 8 percent. That was the difference between Dauwalter’s time and the fastest men’s time at Ultra Trail du Mont-Blanc in 2021. The gap between the best male and female performances for running events from sprints to marathons usually hovers around 10 to 12 percent.

“There is a fundamental sex difference between males and females that won’t go away,” Hunter said. But Hicks said women have reached a place in ultrarunning where they need not be compared to men because their performances are valid without that comparison — a view widely held by women in the sport.

Hunter said Dauwalter’s running economy, which is measured by the oxygen consumption of a runner at a set speed and often improves as runners get older, may be superior to most other participants in the sport. While there has been a boom of women ultramarathoners, there are still far fewer women than men in ultra running, and they usually run shorter distances like the 50K. Hunter said that Dauwalter’s stellar performance shows that there is still a great deal of room for women to evolve.

Dauwalter, who is known for being generous with her time and cheering on the people around her, continues to elevate others in the sport, especially women, Hicks said. In 2020, when Hicks set the fastest known supported women’s time in a roughly 90-mile challenge called Nolan’s 14, which involves hiking and running 14 14,000-foot mountains, Dauwalter paced her through the night, telling jokes and stories to make the time pass. Around midnight, she asked Hicks if she wanted a bite of pizza and pulled out a slice wrapped in tinfoil from her pack.

“Who does that?” Hicks asked. “Maybe your husband or your best friend? But who in the top of the sport is doing that?”

Dauwalter’s approach to the business of running reflects her desire to lift others in the sport. She used her sponsorship with Salomon to influence a new line of women’s running shorts that are longer and looser than most shorts on the market. Dauwalter hopes that the shorts will give women another option to be comfortable and that maybe “the length is the thing that makes someone get out on the trail and try.”

She also wants to inject some humor into what can be an intense pursuit. Recently, Tailwind Nutrition debuted a “Make New Friends” line of T-shirts and hats featuring images that Dauwalter has seen in hallucinations on the trail: a giant cowboy, puppets on a swing set, a giraffe.

John Medinger, the former publisher of UltraRunning Magazine, has been at every Western States since 1983 and has collected statistics on the race for over four decades. Dauwalter’s performance can’t be quantified, he said. No runner has posted times like hers in such a wide range of races — fast ones, steep ones, extraordinarily long ones and races of attrition in which the last person standing wins.

“There are courses for horses and horses for courses, but I’m not sure there’s a course that isn’t a good one for Courtney,” he said.

How to Eat, Drink and Gallery Hop Like a Seoul Local

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South Korea’s capital is electric. Among its neon lights, K-pop and fast-paced energy, you can feel the current, the hum of activity moving through the streets. Nowhere is this more evident than in Itaewon, Samcheong-dong and Hongdae, neighborhoods popular with the city’s creatives.

The sprawling city isn’t always the easiest to navigate for visitors with mostly Korean signs and a complex transportation system, but the chef Mingoo Kang of the two Michelin-starred Mingles; the contemporary artist Wona Cho; and Hakjun Lee, the general manager of Christie’s Korea, take some of the work out it for tourists by sharing their favorite places in these neighborhoods and the surrounding areas.

As Seoul’s art scene grows more international, galleries like Lehmann Maupin and Pace have established outposts in this foreigner-friendly part of the city, adjacent to a former American military base, that is known for its nightlife, restaurants and shopping.

Ms. Cho, 41, who lives nearby, said this was a place to go to see what’s trendy and popular with young people in South Korea. “I’m in Itaewon the most often,” Ms. Cho said in a phone interview. “You can see what young people these days are up to, what style of clothes they’re wearing.”

For her, it is the brunch scene she enjoys the most. She frequents Oasis, an all-day brunch cafe; the Baker’s Table, a German bakery; and Pancake Shop. She also enjoys heading for a walk with her dog at Namsan park.

Mr. Kang, 39, who also opened Hyodo Chicken, a collaboration between himself and the chef Chang Ho Shin that specializes in Korean fried chicken, said his favorites in the area were the three Michelin-starred Mosu, the chef Sung Anh’s contemporary fine-dining restaurant; and the American casual dining restaurant Cesta.

If visitors need a good post-meal coffee, he said they should head to Hell Cafe. Mr. Lee described the coffee there as being like “a consistent, old friend.”

As for cultural experiences in the area, both Mr. Kang and Mr. Lee recommend the Leeum, Samsung Museum of Art, which shows traditional Korean art as well as contemporary Korean and Western art.

Mr. Lee, 58, also recommends the Hyundai Card Music Library. It holds more than 10,000 vinyl records, including rare releases, that can be listened to on-site on turntables. Next door, the Art Library houses thousands of art books and the Storage exhibition space displays contemporary visual art. The two libraries are part of a series of five cultural spaces created by the credit card company Hyundai Card. (Call ahead for entrance and admission information.)

If you’re hungry after taking all that in, Mr. Lee recommends heading to Bulgogi Love, a restaurant famous for its thinly sliced marinated beef, as well as Pyongyang-style naengmyeon, which are cold buckwheat noodles. The restaurant serves “very decent, authentic and simple Korean foods,” Mr. Lee said in an email.

This neighborhood is a maze of centuries-old houses, artisan workshops, museums and some of Korea’s most well-known galleries. “It’s hip, but it’s also quite peaceful, quiet, has a quaint, old-fashioned feel,” Ms. Cho said. The area abuts Gyeongbokgung Palace, the home of the last Korean royal dynasty, and it is where you can find many of the city’s hanok, or traditional Korean houses.

Here, Ms. Cho and Mr. Lee suggest gallery and museum hopping. The National Museum of Modern and Contemporary Art, Korea, is a must-see for its international and Korean art, as are longtime players in the Korean gallery scene, Kukje, Gallery Hyundai, Hakgojae and PKM Gallery. (Ms. Cho also recommends trying to get a reservation at PKM’s restaurant, which serves Italian and cafe fare.)

There are also newer galleries along the main stretch of Samcheongdong Road, including Gallery Afternoon, which Ms. Cho says have been exhibiting the works of young emerging artists.

Mr. Kang recommends heading to Fritz Coffee Company’s Wonseo branch, located inside the Arario Museum in Space. He often finds himself there on his days off, he said, taking in the atmosphere in the courtyard of the building, which is part modern and part traditional hanok.

Also nearby, Mr. Kang said, is Haap, a cafe that sells traditional Korean desserts and snacks, as well as the modern Korean fine dining restaurants Joo-ok and Onjium.

And for those in search of drinks, it’s Bar Cham that he recommends. It makes creative cocktails with Korean ingredients and traditional liquor, such as soju, as a base.

Home to one of South Korea’s top fine-arts colleges, Hongik University, this buzzing neighborhood is where young artists and musicians have gathered for decades to kick back, relax and be inspired. There’s a distinctly bohemian feel to the busker-friendly area, said Ms. Cho, who recommends wandering through the streets near the school to take in the collegiate atmosphere. “There’s a lot of bars and restaurants here, like Itaewon, but it’s different to Itaewon,” she said. “There’s a feeling of freedom.”

Mr. Kang recommends heading to the nearby Mangwon market, a traditional Korean market that was modernized but is still beloved by locals and tourists for its blend of modern and classic offerings, like deep-fried chicken, pigs’ feet, knife-cut wheat noodles.

He also recommends Miro Sikdang for its homestyle Korean food, including spring-onion pancakes, marinated meats and savory rice cakes; Soi Yeonnam for its Thai rice noodles, Izakaya Robataya Caden for affordable Japanese and Ongo Patisserie for pastries.

If you’ve had your fill of food and are looking for something good for the soul, Mr. Lee recommends heading to the Unplugged Hongdae to meet and listen to young, talented, independent music artists. There is a cafe on the ground floor and a small concert hall underground.

“It is a very interesting, unique spot that feels like a safe house for musicians,” he said.

Hareesh Veldandi – Accomplished Author, Healthcare Strategist and Technologist Celebrates The Success of His Critically Acclaimed Book – “The Hidden Crisis”

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The author revealed the “Inefficiency, Waste, and Overspending in the American Healthcare System”. Reader Testimonials are replete with praise and appreciation for the research and efforts the Hareesh was able to contribute to his game-changing book.

Frisco, Texas, August 30, 2023, When Hareesh Veldandi penned his insightful and captivating book, The Hidden Crisis, he had no idea how well it would be received. It is jam-packed with the latest facts, stats and citations that is a real eye opener for anybody concerned with the American Healthcare System. Ultimately, it’s no surprise that that the book secured a nomination for the 2022 MedPage Today Readers’ Choice Awards, standing alongside a work penned by a former Pulitzer Prize laureate.

There is nobody better qualified to have researched and written The Hidden Crisis, after all:

  • He is a recipient of the Director’s Award for his MBA in healthcare concentration from the University of Cambridge, UK. He has more than eighteen years of healthcare experience in the United States, United Kingdom, Asia Pacific, Middle East, Australia, and New Zealand. During his international journey, he also had brief engagements with the National Health Service in the UK, and the World Health Organization.
  • Hareesh advises senior leadership of several health systems, health plans, health plan operators, healthcare-technology companies, and consulting companies in areas like product, solution, business, and corporate strategy. He also worked for such companies as Microsoft, Epic Systems Corporation, and Orion Health.
  • He is a Healthcare Data Innovation Alchemist: Hareesh champions modern healthcare data platforms, and data lakes, enabling data consolidation across diverse sources to fuel data and AI initiatives. His expertise provides the essential building blocks for successful analytics use cases, ultimately saving millions in key areas such as value-based care and population health management.

“The Hidden Crisis” is a must-read for both healthcare professionals and American healthcare consumers. It addresses compelling topics, such as the startling statistics that over 2.5 million Americans acquire other health conditions during hospital stays each year. The book unravels the intricate US drug supply chain, the complexities of healthcare insurance programs, and the impact of medication errors and unnecessary radiation exposure.

The book also exposes inefficiencies, fraud, and waste plaguing the industry, revealing staggering potential savings in the years ahead. It contains nearly 600 references to back up data points, stories, facts, and nuances. The author’s observations in the real world enabled him to conceptualize many more intricacies and explain them in a simpler way to the readers.

Top Tier Literary Reviewers have praised The Hidden Crisis:

  • “An informative and comprehensive analysis of an industry’s shortcomings.” — Kirkus Reviews
  • “Loved it! A harsh but necessary treatise on the miasma plaguing the healthcare system in the United States of America, today.” — Reedsy Review
  • The Hidden Crisis is an incredibly detailed and no-nonsense read on the flaws of the North American healthcare system.” — Goodreads Review

Hareesh Veldandi is available for:

Speaking Engagements: From focusing on overall industry aspects, fundamentals, and complexities that I discussed in the book to detailed sections, topics, and value-based care concepts, I would love to speak to any audience to promote healthy discussion.

Consulting Engagements: Hareesh and his company have helped several health systems, health plans, life sciences, and medical devices companies in solving inefficiencies and changing the business models to be more consumer-centric / patient-centric.

Hareesh ardently expresses and embodies these words: “As a society, our goal is to make our populations healthier and enable providers, patients, and caregivers to have great experiences while containing rising healthcare costs. While the American Healthcare system is one of the finest in the world, it is currently in dire need of reform. The good news is that the industry has already embarked on a Value-Based Care journey. And, we work with several amazing companies and professionals in various parts of the industry. I am proud to be a part of this industry, and I work to make it better every day.”

For complete information, visit:  https://thehiddencrisis.com/

Media Contact:

Hareesh Veldandi
Attn: Media Relations
Frisco, TX
425.435.8787
veldandi@hotmail.com

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Biden Makes Lower Drug Prices a Centerpiece of His 2024 Campaign

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As he heads toward a re-election campaign next year, President Biden is betting that his success in pushing for policies intended to lower health care costs for millions of Americans will be rewarded by voters at the ballot box.

In speech after speech, Mr. Biden talks about capping the cost of insulin at $35, putting new limits on medical expenses for seniors, making some vaccines free and pushing to lower the prices of some of the most expensive drugs in the world.

At the White House, Mr. Biden and his advisers have already begun to elevate the issue as a centerpiece of his agenda. And at his campaign headquarters in Wilmington, Del., aides are preparing television ads, talking points and speeches arguing that Mr. Biden’s push for lower health care costs is a stark contrast with his Republican opponents.

“The president will have a very strong case to make,” said Senator Amy Klobuchar of Minnesota, a member of the president’s national campaign advisory board. “Not only will people want to keep the benefits they have seen, they are going to want to get the benefits that are coming their way.”

On Tuesday, the White House announced that the Biden administration will negotiate on behalf of Medicare recipients for lower prices on 10 popular — and expensive — drugs that are used to treat diabetes, heart disease and other chronic illnesses.

The move was made possible by passage last year of Mr. Biden’s Inflation Reduction Act, which for the first time allows Medicare to negotiate drug prices for older adults, a change that has been opposed by the pharmaceutical industry for decades.

Republicans also generally oppose giving the government the right to negotiate drug prices. But the candidates for the Republican presidential nomination have said little about the cost of medication, focusing instead on abortion, transgender medical issues and Covid lockdowns.

In his speeches, Mr. Biden rails against the industry and his Republican adversaries in Congress, all of whom voted against the law that included the prescription drug provisions. Aides say it is an effective message.

“Today is the start of a new deal for patients where Big Pharma doesn’t just get a blank check at your expense,” the president said at a White House event celebrating the change.

Since signing the law a year ago, Mr. Biden has repeatedly called it one of his proudest legislative victories. But his approval numbers have hardly budged. And while polls show that the new policy is widely popular among Americans who know about it, they also suggest that far fewer people are even aware that the change was made.

That is most likely because prices on just the first handful of drugs are not scheduled to actually drop until 2026 at the earliest, assuming Mr. Biden’s program survives legal challenges. Drug companies have filed numerous lawsuits against the administration that claim the law is unconstitutional. Court cases could drag on for years.

In its lawsuit against the administration, the Pharmaceutical Research and Manufacturers of America, an industry trade group, called the plan for negotiated prices “a government mandate disguised as negotiation.”

Even if Mr. Biden’s plan goes into effect, older adults who have made the choice to ration their drugs will have to continue doing so until more than a year after the 2024 presidential election.

Danny Cottrell, 67, a pharmacist who owns his retail pharmacy group in Brewton, Ala., said he regularly advised his Medicare patients on the ins and outs of the government’s prescription program. He welcomed Mr. Biden’s changes, but said it would be up to people like him to explain the complicated process.

“I got to remind them, this doesn’t start till 2026,” Mr. Cottrell said. “And then also remind them this thing will change several times between now and then.”

Neera Tanden, Mr. Biden’s top domestic policy adviser, said the White House was confident that the plan would survive the legal challenges.

“It is absurd to argue that negotiation is unconstitutional,” she said in an interview. “There’s nothing in the Constitution that says Medicare negotiating drug prices is unconstitutional.”

But more broadly, Ms. Tanden said that she and the president’s other advisers in the West Wing were determined to make the push for lower health care costs a central part of Mr. Biden’s message to Americans.

And next September, just weeks before Election Day, the administration will announce the results of the yearlong negotiations over the first 10 drugs.

“We plan to work extensively, to really remind folks of this issue,” Ms. Tanden said.

For the people leading Mr. Biden’s re-election campaign, the political benefits of focusing on lower health care costs are clear.

Some polls show that 80 percent of Americans support giving the government the ability to negotiate lower prices for Medicare, much the way it already does for veterans and members of the military.

Campaign aides said talking about lower costs of drugs or limits on out-of-pocket medical expenses is one way to help Mr. Biden win support among seniors, who traditionally have voted for Republicans in greater numbers. That is especially important in battleground states like Michigan, Arizona, Georgia and Ohio, where increasing support among older adults will be critical in close contests.

The campaign’s early television ads have included numerous references to the president’s efforts to lower health care costs. A spokesman for the campaign said the issue of health care would be a central feature of a $25 million ad blitz focusing on what the president has done to lower costs overall and make economic progress.

Kate Bedingfield, who served as Mr. Biden’s communications director for the first two years of his presidency, said the issue had political benefits even when it came to appealing to people who do not benefit directly from the specific cost reductions.

“It draws a really clear contrast with the Republicans, who have stood in the way and continue to stand in the way of getting more done on this,” she said.

Representative Michael C. Burgess, Republican of Texas and a doctor, said Mr. Biden’s drug price negotiations were akin to government-imposed price controls that would lead to drug shortages.

“This administration’s approach goes beyond ‘negotiation,’” he said in a statement. “Instead, it holds pharmaceutical companies hostage, jeopardizing their future innovation and the well-being of American patients.”

Mr. Biden’s campaign aides said a debate with Republicans about the cost of medical care was one they were eager to have.

“MAGA Republicans running for president want to repeal the Inflation Reduction Act, which would deliver a massive win for Big Pharma and increase costs for the American people,” said Julie Chávez Rodríguez, the president’s campaign manager, referring to Republicans loyal to former President Donald J. Trump.

She said the choice in the election was between Mr. Biden and “a slate of candidates focused on extreme policies that put their wealthy donors first.”

Robert Jimison contributed reporting.

Canada Issues Travel Warning for L.G.B.T.Q. Citizens Visiting U.S.

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The Canadian government is warning L.G.B.T.Q. travelers to the United States that they may be affected by a series of recently enacted state laws that restrict transgender and other gay people.

Global Affairs Canada, the foreign affairs department, added a brief notice on Tuesday to a long list of travel warnings involving the United States that had already included cautions about gun violence and terrorism.

“Some states have enacted laws and policies that may affect 2SLGBTQI+ persons,” the notice reads. “Check relevant state and local laws.” (The beginning of the Canadian government’s acronym, “2S,” represents two-spirit, an Indigenous term for someone with a masculine and a feminine spirit.)

Jérémie Bérubé, a spokesman for the department, said in a statement that the change was made because “certain states in the U.S. have passed laws banning drag shows and restricting the transgender community from access to gender-affirming care and from participation in sporting events” since the beginning of this year. The warning did not name specific states.

He added that, like all travel advisories, this one had followed a “thorough analysis of various information sources, including consular trends observed by Canadian diplomats in the field.”

Mr. Bérubé did not respond to a question about whether any Canadian travelers had sought help from Canadian diplomats because of recent state legislation pertaining to L.G.B.T.Q. people.

Moves by state lawmakers, particularly in Florida, to curtail L.G.B.T.Q. rights have received prominent attention in the Canadian news media, as has a rise in hate crimes directed toward that community. The Human Rights Campaign has calculated that 520 pieces of legislation that would limit or remove the rights of L.G.B.T.Q. people have been introduced this year in state legislatures, with 70 of them enacted.

Helen Kennedy, the executive director of Egale Canada, an L.G.B.T.Q. rights group in Toronto, said that while her organization had not heard of Canadians being affected by the state measures, she anticipated that some would inevitably be caught up in them.

“We applaud our government for taking this step,” she said. “It sends a clear message that even our closest neighbor can potentially be a hostile force toward our community.”

There has been far less political momentum in Canada to roll back L.G.B.T.Q. rights, which have strong court protection.

For almost two years, the Atlantic province of New Brunswick had a policy that required teachers to use the preferred names and genders of schoolchildren. Premier Blaine Higgs has changed it to require that teachers obtain the permission of parents if the child is under 16. But the move has not had wide support. Several members of the Legislature, including some cabinet ministers, quit Mr. Higgs’s Progressive Conservative caucus in protest. Despite that backlash, other conservative politicians have suggested that they will follow New Brunswick’s lead.

While the overall threat assessment for travel to the United States remains at the lowest level, the country now joins many others that the Canadian government warns L.G.B.T.Q. travelers about, most in language far stronger than the advice for the United States. The new advisory includes a link to a page of general safety guidance for the community regarding international travel.

Florida and some of the other states that have enacted anti-L.G.B.T.Q. laws and policies are popular tourist destinations for Canadians. Ms. Kennedy said that the legislation was increasingly causing L.G.B.T.Q. Canadians making travel plans to ask, “Is this the best place to spend my money?”

Narcan Available for Over-the-Counter Purchase: What to Know

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Narcan, the first opioid overdose reversal medication approved for over-the-counter purchase, is being shipped to drugstore and grocery chains nationwide, its manufacturer said Wednesday. Big-box outlets like Walgreens, CVS, Walmart and Rite Aid said they expected Narcan to be available online and on many store shelves early next week.

Public health experts have long called for greater accessibility to the drug, which they describe as a critical weapon against rising overdose rates. There were more than 100,000 opioid overdose fatalities in each of the last two years in the United States.

Narcan is already a staple for emergency personnel and street outreach teams. Now scientists and health officials are hoping Narcan will eventually become commonplace in public libraries, subways, dorms, corner delis and street vending machines.

They also predict it may become a fixture in medicine cabinets, as more people realize that illicit party drugs like cocaine and counterfeit Xanax pills may be tainted with deadly fentanyl, an opioid.

Here’s what you need to know about buying this lifesaving medication.

Narcan is a nasal-spray version of the drug naloxone, which blocks an opioid’s effects on the brain, rescuing a person overcome by drugs like fentanyl, heroin or oxycodone.

An individual may be overdosing if his or her breathing is slowed or stopped, and the pupils of the eyes narrow to a pinpoint. Naloxone is generally considered so safe that experts say that, when confronted with a possible overdose, it is better to risk using it than to hesitate.

Each carton contains two palm-size plunger devices, each filled with four milligrams of naloxone. The rescuer inserts the spray tip into the patient’s nostril and depresses the plunger.

Usually one dose is sufficient to reverse an overdose within two to three minutes. But addiction specialists have reported that in areas where the fentanyl supply is quite potent, a second dose may be needed.

The cost is likely to dictate the extent of Narcan’s uptake. The manufacturer, Emergent BioSolutions, suggests $44.99 as the price of the two-dose box.

“People with some money and motivation will seek this product out, which is fantastic,” said Brendan Solaner, an addiction policy expert at Johns Hopkins Bloomberg School of Public Health. “That may include concerned family members.”

But those who will need Narcan the most may not be able to afford it, he added, saying that “this includes people who are unhoused or financially insecure and are at greatest risk of overdose.”

When Narcan was available only by prescription, public and private insurance readily covered it. But those plans typically restrict coverage of over-the-counter drugs.

Some state Medicaid programs have already announced that they will cover Narcan when it becomes available over the counter. Those states include Missouri, California, Massachusetts, Washington, Rhode Island and Oregon.

Emergent said that prices would be lower for bulk sales to public interest groups and state health departments, which will in turn distribute Narcan to local outreach organizations and clinics.

Retailers often put pricier products or those that are likely to be stolen behind a counter or in a locked case. But behavioral health experts say that customers may be reluctant to ask store workers for Narcan, fearing raised eyebrows and dismissive comments — marks of the pervasive stigma surrounding drug use and addiction.

Through a spokeswoman, Rite Aid said Narcan would be available at its pharmacy counter and in pain care aisles. Many stores, including CVS, will also have it by the front register. Rite Aid, Walgreens, Walmart and CVS also said that Narcan could be purchased next week through their online sites, offering greater privacy.

“Stigma will always be there, but I think there’s been a sea change in how the public perceives naloxone over the last decade, and many more people are willing to carry it,” Dr. Solaner said.

Although Narcan is the first overdose reversal medicine to be sold over the counter, the field is likely to be crowded soon with less expensive competitors.

A generic naloxone spray by Teva Pharmaceuticals is still available by prescription, which means that public and private insurance policies typically cover it. Pharmacists in most states rely on a “standing order” for the spray, which means they don’t need a physician’s prescription to dispense it. For a person with Medicaid or commercial insurance, generic naloxone could well be less than $10.

CVS is encouraging customers to ask for Narcan at the pharmacy counter “so our pharmacy teams can check a patient’s insurance plan for potential savings on prescription naloxone products,” a spokesman said.

Earlier this summer, the Food and Drug Administration gave over-the-counter approval to RiVive, a naloxone spray expected in early 2024. RiVive, manufactured by Harm Reduction Therapeutics, is intended as a low-cost product largely for outreach groups.

Other forms of naloxone, including some with higher concentrations and some that are loaded in syringes, are already available by prescription.