Friday, November 20, 2009


A few years ago, TIME magazine featured a cover story on type two diabetes. The cover photo was of an eleven-year-old girl who suffered from the disease. Type two diabetes is traditionally a disorder of overweight, middle-aged people, but recently more children have joined its ranks. The article mentioned that this girl weighed two hundred and twenty pounds when she was diagnosed. Then it blithely proceeded to a discussion of diabetes’ physiology and treatment.

Hang on, I thought, wait a minute. How does an eleven-year-old come to weigh two hundred and twenty pounds? Why is this article about diabetes rather than pathogenic behavior? This latter subject, after all, has been evading us. Even though we medical types know something about the roles of social pressure, genes, poverty, ignorance, adverse experiences, and neurotic intent in generating sickness, we’re still painfully ineffective at preventing it. We’d love to intervene before the person’s biochemistry has irreversibly gone south, but as things now stand, we’re limited to leaving American Heart Association flyers on the waiting room table and replacing them when they turn yellow.

Health education undoubtedly detours pathogenic behavior over the long haul. When I entered medical training, for example, a couple of my professors occasionally stepped outside for a cigaret, and now, forty-five years later, I don’t know a single physician who smokes. Every quantum of health education, though, is opposed by a score of clever seductions that push for even more consumption. Magazine ads, TV commercials, infomercials, and the very tone of pop culture all tend to encourage heedless glitz and gluttony.

There’s impressive talent behind these sales pitches, as literally billions of dollars ride on soft drinks, cheap fats, high-fructose corn syrup, and various legal addictions. On the other hand, no one gets rich encouraging people to think critically about their lifestyle.

Twenty years ago, Dr. David Spiegel and his colleagues at Stanford University published a study in the prestigious British medical journal Lancet which concluded that women with advanced breast cancer who participated in support groups survived twice as long as women not in support groups. (Since then, this conclusion has been in contention, but that’s not my point.) Afterward, Spiegel noted a conspicuous professional disinterest in his findings. He commented, “If…my intervention was a new chemotherapy agent, every hospital in the country would be doing it by now.”

In a private conversation he continued, “If it had been a drug, the manufacturer would promote it left and right. But the medicine in this case is only conversation, so who’ll promote it, chairmakers?”

Please forgive me, as it’s cold and rainy today, so maybe my mood’s a little dark. Still, I can’t help but hear the constant din of standards crumbling. Yesterday I read this headline: “Road Rage Incident Gets Out of Hand.”

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