Giving advice is usually a thankless business. I have always been mindful of the unconsciously profound summation given by a six-year-old when she was asked to identify Socrates. “Socrates,” she stated, “was a really old Greek guy who went around giving people good advice. They poisoned him.”

But here goes: We do not need government intervention to improve our health, and, by extension, the quality of our lots in life.

This essay is about the rewards, physical and emotional, of marathon running and a proposed trajectory of circumstances that may yet promise self-improvement — not as the byproduct of government programs and demographics and statistics and insurance, but rather of personal responsibility and commitment.

Sunday, May 2, 2010, was an anomaly: a Sunday of record heat and humidity in Long Branch, NJ, ironically following a colder and wetter than usual spring.

It was the day of the Marathon and Half Marathon. At 6 a.m., as the 10,000+ runners assembled by the Atlantic Ocean for the 9 a.m. start, it was 58 degrees and windy. Cold. The runners discussed the usual: performance and training, planned pacing, new shoes, old injuries, renewed acquaintances. Bruce Springsteen reasserted from deafening loudspeakers that he was born in the U.S.A.

Forecast high temperatures led race management to warn about overly ambitious pacing as well as adequate hydration stops. The advice felt wrong for the seaside chill. As it turned out, the warnings were understated.

At 9 a.m. and the race start it was cool until the first turn off the ocean. Within the first mile, the temperature rose to the 70s and within an hour to the 80s.

Before the first 10 kilometers were run, the walking wounded, the cramped and overheated and, soon, the heat exhausted, were intermixed with those survivors who, largely, went on to finish. Everybody, all the competitors, all the helpful spectators and townspeople, first responders and marathon workers and organizers, pulled together to reduce the burden of less than wonderful conditions, to forge a successful outing and experience.

A marathon, so it is said, is a microcosm of life. Look at “the pack”: all races, sexes, ages — as diverse a selection as exists, sharing the love of fitness as a unifying singularity, 10,000 plus runners, facing certifiably unfavorable running conditions, and, notably, with fewer than 10 runners as competitors with any real chance at a medal.

So why does one do this?

It is not about placing that motivates, but rather the ability to set and achieve a big athletic goal with one’s own sweat and effort, not vicariously through a television or movie, not by mandate or some variation of political correctness or for diversity sensitivity training.

Whether the goal has any purpose is irrelevant so long as it has meaning.

This was Mark Twain’s definition of play: any activity that has meaning but no purpose. And while we adults may not lend much importance to our play, the pursuit of personal excellence by physical means and self-discipline may be the only remaining arena of control over our individual lives left to us in this era of political posturing, self-aggrandizement, distorted polemics, healthcare reform, consumer skepticism, and product liability. Big government is not the grand motivator of personal fitness.

It seems that we have evolved into generation after generation of affluent and indifferent adult delinquents, self-indulgent, obese, in a state of mental, moral and physical torpor. It is hardly strange to observe these traits in a culture that has not yet learned how to replace its antique religious imperatives with something beyond hedonism and consumerism despite its attempts to do so. What Ten Commandments?

Yet perhaps even for those in whom the prop of religion has been removed, some reassessment of the concepts of discipline, of personal responsibility, of honor for a code, and honest self-achievement can be regained, by seeing the example in sports and fitness. So what motivated this story?

At the half-way point, it felt like I was running in a fur coat. I was tiring and felt that lunacy of the moment, when I paralleled an Asian runner with a most unusual stride. He had a U.S. Marine tattoo on his left deltoid, he was very sweaty, very fit, and running on one-and-a-half legs.

His left gastrocnemius was scarred and quartered. I confabulated a story as we ran together about the IED in Iraq that removed the bulk of his leg.

I might have been tiring and uninspired before I saw him, but when I saw that he was still pursuing his goal and going strong despite the conditions … well, there was no doubt about why marathoning is a good thing. That’s why I am writing this story.

Sport is a motive for action. In sport, George Sheehan liked to remind us, one is not only expected to do one’s best, but to dare failure in the attempt.

We do not do this in our daily lives. We do not expose our frailties in despairing endeavor. Or in public.

In sport, it is seen constantly. Not for the health of it, not for the medals, not for the prize … just for that moment of Pyrrhic victory and inner bliss that setting a goal, pursuing, and finally achieving it sanctifies our lives.

So what if we get healthier as a byproduct?

Sport is a motive for action. Few other activities can deliver us from our physical and moral inertia.

Miracles and health are not the product of government policy, of insurance plans, of wishes or of prayers; they are the product of hard work.

If this world is an arena for soul-making, sport is one of the better ways to engage in this enterprise. Little else will help us evolve into the self we ought to be.

This is beyond health and healthcare — this is the perfection of the biology that one was given to steward through our individual existences.

It is not a government responsibility.

Thank you, Marine. And God bless all the runners, winners all.

Jeffrey Hall Dobken is an assistant clinical professor of pediatric immunology and allergy, and certified bioethicist at Weill Cornell School of Medicine in New York City.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.