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GP 27 December 2006: A Votre Sante

I’ll Take Manhattan.  Time again for us to toast practically everybody, this year at a Cole Porter party.  We have selected the oysters, music is in hand, and our court poets are working up the salutations. 

There probably will be martinis.  More importantly, there will be Old-Fashioned’s.  Fortunately Dr. Don Beinfang has given us advice on their preparation, advice which can be found at “Old-Fashioned Manhattans.”  We urge you to get steeped in Old-Fashioned mythology in Robert Hess’s “Renewing an Old Fashion.”  In any event, we plan on having our drinks with Porter’s “Make it Another Old-Fashioned, Please” warbling  in the background: 

Since I went on the wagon, I’m certain drink is a major crime
For when you lay off the liquor, you feel so much slicker
Well that is, most of the time
But there are moments, sooner or later
When it’s tough, I got to say, love to say ... Waiter 

Make it another old-fashioned, please
Make it another, double, old-fashioned, please
Make it for one who’s due to join the disillusion crew
Make it for one of love’s new refugees 

Well, as you can tell, we think a toast to one’s health has absolutely nothing to do with our healthcare system, and that wellness has even less to do with doctoring.  Health, my friends, is a state of mind and is the spiritual essence of a happy community.  The health we seek will not arrest nature’s course nor deny the claims of death. 

The Health Bug.  Our parochial, narrow healthcare system, which more or less depicts health as the absence of disease, continues to expand its parasitic claims on us.  As you know, it is gobbling up 15% of our GNP and is now widely admitted to be a peril to our economy.  A third or so of its expensive offerings are worthless.  And most know that we are not getting better, but are, in fact, getting sicker. 

We’ve talked a lot previously about happiness and unhappiness-- and their intimate connection with our health.  At least in the developed nations the spread of depression is epidemic, the biggest unchecked disease in these United States.  The main salve offered by the healthcare system is anti-depressants, which are widely prescribed but effective for only about 1/2 those ingesting them.  Reaching neurotransmitters, they only affect proteins from perhaps 20 of the 15,000 genes in the brain.  Happiness, as we said in “Happiness in Oaxaca,” is an elusive business, and we should toast health, by which we mean the happy life, at every turn. 

Personal Health Records.  The latest pie-in-the-sky nostrum, and yet another layer of expense, offered up by the apothecaries are personal health records.  Personal health records and electronic health records are closely related and rather ill defined.  Basically they encompass any health and miscellaneous other information someone would like to gather about you and keep in some databank somewhere.  As far as we know there are somewhere between 50 and 100 cockeyed PHR iterations cooked up out there in America, and we may be undercounting.  They’re all supposed to nurse the healthcare system back into partial health.  All sorts of people are flogging them as panacea for everything that ails you. 

Doctors, hospitals, big companies, health plans, even pharmaceuticals and others have a hand in them.  The general thought is that doctors can treat you better if they have ready access to all the health information about you; that huge administrative costs can be avoided if data is captured and passed on to claims departments, billing departments, etc. etc; and that every citizen will somehow better control his or her health when every whisper about his or her corporeal flaws is captured digitally in a permanent archive.  We expect that to work just about as well as Homeland Security.  For more on this appetite for healthcare data, see “An Introduction to Personal Health Records.” 

Of course, this sort of activity does arouse privacy concerns, since many schemes put the information in the hands of parties who have a pecuniary interest in the data.  We ourselves are more concerned about what goes into the personal health record (PHR).  The architects are not citizens and patients but bureaucrats who are cog in our inherently flawed healthcare system.  We think the dossiers under development will serve the unchecked bureaucracy, and not the citizen whose health is at stake.  We don’t think the records will help you much. 

What Do You Think?  Do you think PHRs will better your health or your pocketbook?  Where should the data be housed and secured?  What would you like to be in your PHR?  Would you use it to help you with your health—to remind you about doctor appointments, and immunizations, and drugs you should take?  Are you managing your health well now or is there a phone or computer tool that can help you lose a few pounds or do a few other sensible things? 

Self-Reliance.  “Self-Reliance” is even today the most popular essay of the 19th-century Transcendental philosopher Ralph Waldo Emerson.  In it he connected up energetic self-starters with the very well-being of our nation.  To him it was clear that our democracy could not function without reasonably educated, highly motivated individuals who would keep rot out of government and out of the other institutions we tolerate to sustain our society. 

Dependence, not self-reliance, is the core principle of our health system today, and it does not work very well.  In it, we rely on experts to put us in the grave, and we could do that job more simply ourselves.  This makes us wonder if you should put together your own personal health record and decide whom to share it with and when.  This makes us wonder if you can tell the health system what healthy means, so that health does not come to mean a vegetative existence.  Major portions of the nation’s health bill are spent on the barely living, neglecting, for instance, infants and infant mortality rates.  Only a nation askew will support living death.  Liberty is the necessary prerequisite for the enjoyment of life and the pursuit of happiness. 

The DeBakey Incident.  “The Man on the Table Was 97, but He Devised the Surgery,” New York Times, December 25, 2007, p. A1 and A14, is a case in point.  Dr. Michael DeBakey, who could be called the father of modern heart surgery and who operated on more than 60,000 patients himself, went under the knife last year.  But just barely.  For legal, psychological, and career reasons, the doctors at Methodist Hospital in Houston dithered endlessly about operating, though his aneurysm had expanded from 5.2 centimeters to 7.5 centimeters, putting DeBakey close to death.  Only when Mrs. DeBakey charged into a meeting of the hospital’s ethics committee and said, “My husband’s going to die before we even get a chance to do anything—let’s get to work,” only then could the doctors rise to action.  Then he had the operation he had invented.  His rescue only came because his wife intervened, energizing the docs who were foot-and-tongue-tied (also known in Texas as hoof-and-mouth disease).  Without his Mrs., DeBakey would have been toast. 

Time and again, the lesson is to never surrender your freedom or your body to anyone—outside the family.  So as we toast your health, understand that we mean that you should “Die with Your Boots On,” utterly in charge of your destiny.  Health is when you are still in the driver’s seat.  

The Tale of the Oyster.   In “Fifty Million Frenchmen” (1929), Cole Porter relates the hijinks trip of a Long Island oyster into New York City’s high society and back out to sea again. It’s not about how long the oyster lived, but how well it traveled.  That’s the goal: 

Back once more where he started from,
He murmured, “I haven’t a single qualm,
For I’ve had a taste of society,
And society has had a taste of me.”
Wise little oyster. 

Safe journeys to you in 2007. 

P.S.  As you are drinking to the lees, we recommend that you bring high style to your libations.  For instance, you may want to read a primer on toast protocol

P.P.S.  The toasts we remember best took place at great banquets where the fire was roaring.  What is it about food and drink that makes the toasts so worthy.  With drink alone, the toasting is tepid. 

P.P.P.S.  We would venture to say, incidentally, that Methodist in Houston is one of the country’s finer hospitals.  If we remember rightly, it once had a heart healthy gourmet restaurant that brought smiles to visiting patients, but that’s gone the way of all false economies.  The services here work pretty well.

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