Legend tells of an Athenian named Pheidippides who, in 490 B.C., ran from the battlefield at Marathon to Athens, telling of the victory over the Persians. Proclaiming the news that Athens would be spared pillage and fire, the Athenian dropped dead. The story is a myth.

But the marathon, like most things worth doing, does offer both risks and rewards. Because it gives a chance to go beyond usual boundaries, with a greater than casual chance of failure, the distance both attracts as well as intimidates.

In fact, the marathon has become athletic pop culture — and it reinforces something of incredible importance and value in this, the 21st century and the Age of American Healthcare Reform.

It matters little whether one supports or opposes the politics that are attempting to transform healthcare in America. What is clear is that all of us will have to learn how to care for ourselves as a primary personal responsibility.

Medicine as a profession as well as the medical care we have been programmed to expect is now changing — for good or for bad remains to be seen. With little doubt, however, the profession of Medicine will not continue to provide us with the “care” we have known or come to expect.

The primacy of self-motivated, self-reliant, and self-actuated personal health choices and responsibility needs a George Sheehan reincarnation.

Yes, it is time to revisit the philosophy of fitness espoused by George Sheehan, M.D., the guru of running in the 1970s. “Health is a stage you pass through on the way to getting racing fit,” Sheehan said. What does this mean for us now?

Let’s look at the 2010 New York City Marathon.

This year’s race had 45,000+ athletes selected from 124,000+ applicants, 44,829 finishers. Nobody died.

The media treated the television audience with the now-customary visual carpet of humanity moving through the city’s five boroughs from the start at the Verrazano Narrows Bridge in Staten Island to Central Park in Manhattan. Viewers were told that ideal running conditions prevailed. Lead runners were highlighted and viewers were treated to selected human-interest cameos, including a rescued Chilean miner.

For me, the New York City Marathon started at 3 a.m. It was 34°F, windy, and damp, as I started my journey to Ft. Wadsworth on Staten Island. By 6:45, wearing multiple layers of soon-to-be discarded clothing and oversized black garbage bags, two hoods and a baseball cap, and two pair of gloves, I’d found my way to my “corral” for the “blue start, second wave” at 10:10 A.M., 30 minutes+ after the “first wave” had started.

Complicated, complex, well-organized, but professionally accomplished as expected in an event that has grown more spectacular, more expensive, more international, and more commercialized than any comparable marathon.

This was my 10th N.Y.C. Marathon, but there was a twist: My nine previous events were run in the 1970s and ’80s, my penultimate effort in 1989, 21 years ago. That particular Marathon Sunday became my daughter’s birthday, and, as such, rightfully eclipsed any other consideration. Oh, there have been many other marathons and ultramarathons, but coming back to N.Y. this way felt Gladiatorial: entering an arena of strangers for a public spectacle.

I am older, of course, so performance no longer was the goal. The Finish became the endpoint but this marathon renewed yet again the value of fitness, discipline, and goal setting — reinforcing that one’s health is a byproduct of lifestyle choice.

No one plunges into a marathon without a lot of thought and preparation. Not successfully, anyway. Almost any reasonably healthy individual can, with rather modest training and persistence, survive a marathon; even, say, the survivor of a mining disaster. As Nicholas Fox, an Australian journalist, comments, “it is a rare thing in our everyday life to see a man commit himself, expose his frailties, prostrate himself, in despairing endeavor. Yet in sport it is seen constantly.”

George Sheehan reminds us that “in the pursuit of excellence we runners do something that upsets some observers. We tend to reset goals. Runners are never satisfied; we are always in process.”

For Sheehan, the constant perfection of self, the constant striving for physical and mental perfection through physical fitness was the only individually controlled means left to find true happiness, contentment, and balance. And, perhaps, the only means reserved to each individual to control his own health and destiny. “We use ourselves to the utmost, calling on all the primitive virtues and fundamental gifts of man.”

The process of health requires performance, not for longevity, but to achieve our own personal maximum. It is through this means that we can achieve and maintain the balance that defines proactive health. Or as Sheehan put it: “People of all ages, of both sexes, in sickness and in health, have taken to the roads and athletic clubs … to recondition their bodies to maximum use.”

This is not about longevity nor denying death’s inevitability, but living the life one is given to steward through the agency of one’s own choices and discipline.

New York is indeed a pageant on Marathon Sunday. The Chilean miner, Edison Pena, finished his marathon in 5 hours and 40 minutes. There were 44,000+ others, some blind, many multiply impaired … but the singularly unforgettable image for me was that of an Iraqi war vet with a facial/head injury that took one eye and robbed him of upper body mobility. He sat in a wheelchair and kicked himself backward as his means of propulsion. Remarkable.

My finish was an unremarkable 5 hours and 20 minutes … okay for an Antediluvian runner.

It will happen again.

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.