Some of the action stems from an expanded concept of The Neighborhood Pharmacy into a modified supermarket selling milk to nuts to fans to sniffers, Prozac and medicated smears. Some reason also must be the implacable growth in medical expenditure and drug costs, hand in hand with the increasing number of codgers who require expensive treatment as their own internal systems grow frail and fail. And who needs the neighborhood druggist when online services provide drugs by mail, by the gross or the gallon? After barely half a year of operation, Drugstore.com has nearly 430,000 customer accounts. Spacious ads everywhere from U.S. News & World Report to the E train generated no less than $716,000,000 in sales for the allergy drug Claritin. Even more convenient for pill-poppers, there is now talk of a service that allows people to order prescriptions by phone or e-mail from physicians in cyberspace who will never see them personally.
But perhaps something else is involved in this physical expression of the citizenry's concern for health. Perhaps this reveals people neither feel cared-for well by current medical practice nor that any elements in the system can and will respond to patients' concerns for what are, after all, their only lives. It is almost as if there is in commercial practice and in public communication some reflection of turbulent private fear of mortality confronted without skilled and caring communal help. The response even in the Congress, which permitted managed care to develop in the first place, suggests that there is inadequate care, and what care there is is perceived to be mismanaged.
And there is a flood of media medical attention to a cavalcade of medical issues. For example, October was Breast Cancer Awareness Month, and there were countless stories of "survivors" who are?actually?people who were unfortunately sick and had fortunately effective treatment and are now well. Major newspapers run costly advertisements, even whole sections, supporting celebrity-leavened campaigns against this disease or that, while endless charity events collect $1000 per plate of expensive protein in pursuit of funds to challenge illness. And in an extraordinary contribution to Saturday night highlife, Channel 13 in New York announced several weeks ago Stories of Lupus: "A documentary on the effects of the disease on men and women in eight cities leads off five hours of documentaries on endometriosis, osteoporosis, diabetes, heart disease, and lung cancer."
Something's up. It appears large numbers of people turn to self- medication?there are more "nutriceuticals" bought in the USA than pharmaceuticals; 46 percent of the U.S. population takes one or more herbal or similar remedies, such as St. John's wort (whatever the side effects?this neo-panacea causes extension and disruption of the normal effects of anesthesia). Countless individuals self-administer a cocktail of substances conferring putative immortality, ranging from vitamins to oat bran to cranberry juice to black tea (or is it green?) to no carbohydrates to no protein to no sugar to no salt to a great deal or none of Whatever. Like marbles on a tippy table, consumers with their ears cocked to this week's announcements of experts flow from butter to margarine back to butter to Olestra to canola oil to no oil to foamy soups to a diet exclusively of tofu by the dumpster. People making dinner parties have to be alert to the danger of serving perilous sacrilegious food to guests?some of whom may actually accompany their acceptance of the invitation with the list of substances they will not eat lest they die right there at the table, after the plump rumpsteak with flowing Roquefort sauce.
A man newly arrived from Malaysia was planning his first American dinner party and wondered if he could serve chicken livers with fried rice. Chicken livers?those cholesterol pellets! He received immediate and stern food-taboo advice, and his social career was rescued in the nick of time. He would have become notorious as the neighborhood artery poisoner, and perhaps would have had to register with the authorities. Guests would have scorned him out on the way home and smiled gracefully at the ineptitude of this immigrant and his food folly. To guard against just such dire dining emergencies, some advanced specialists in committed self-medication will bring their own food in humble plastic containers purchased from Rite Aid (aisle six, housewares): "Don't fuss, I'll be fine, it's no bother, just warm it please. Not in the microwave if you don't mind. You know, the real oven."
Americans have now sustained for years an extermination model of food. The concept is food kills us, not keeps us alive and healthy. And this is true, to the extent we overeat like swine, eat the wrong things from restaurant plates half a square yard big, and more of us grow more obese by the meal. As part of normal education, neither boys nor girls learn how to cook, and hence as adults are increasingly unable to feed themselves with even minimal skill. It appears only some 16 percent of the food Americans eat they prepare for themselves from fresh ingredients. This means that the great bulk of their consumption is of foods prepared by marketing specialists who know all too well the commercial advantages of using generously those all-time favorites salt, sugar and lots of animal fat. This is a gross medical insult, since our cardiovascular systems evolved before we learned about 10,000 years ago how to make butter and cheese and consume caged animals with up to 38 percent animal fat (instead of athletic ones, such as venison and wildfowl, with three percent).
This is part of the reason that cardiovascular disease is the most costly one that afflicts elderly people. Over time, the body can't handle the volume of fat it is expected to push through the bloodstream, which is why millions of people take the statins and other drugs that mitigate the effects of diet. Which also of course explains the national obsession with diets in magazines (sold at checkout counters of course) and nonstop television hucksters in pastel leotards promising bellies as flat as pool tables if you just buy their systems and their mechanisms.
And this is to say nothing about the Next Big Thing in the extermination model of food department: the campaign against so-called genetically modified food. This was one understandable consequence of the mad cow scare in Europe, but it has been generalized politically, especially in France and Germany?and with special muddle in England, where political hostility to American symbols such as McDonald's (which no one is compelled to patronize?it's a choice) has been successfully merged with concern about new seeds that are genetically manipulated and the foods they generate. Of course, all of agricultural development has depended on manipulation of the original stock of nature. As anyone who has studied traditional agriculture in poor countries can attest, traditional ways of growing things may be highly costly in terms of labor and the environment. Slash and burn agriculture comes to mind, in which huge tracts of land are willfully burned (creating vast air pollution) to create conditions for new agriculture or eradicate the side-products of old.
Even dreaded pesticides permit farmers to grow crops that can survive without deploying the natural carcinogens plants themselves produce to defend themselves against their enemies. The fact is that Nature did not set up its grocery list solely to provide human beings with cheap and tasty food. Centuries of skillful agricultural experiment and experience have enabled fewer farmers to feed more consumers with more good food than any time in history. For nearly all people obsessing about their bodies and their food, just eating less would be more healthful than eating differently.
This is not to say that there are no virtues in organic and ecologically adroit agriculture, or that there isn't a direct esthetic benefit in fruits and vegetables grown in charming and familiar environments. While there has as yet been no substantial evidence of harmfulness of the now-suspect foods, it is understandable if people trust meadows more than factories. Nevertheless, it is also necessary to ask if the current turmoil about food is another element in a troubled relationship people have to their own health and the systems that are supposed to provide it.
And a poignant thought that may underlie this also comes to mind: Since science and technology are so capable of controlling so much, how come people still die? What's going wrong?