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Either we are suckers, or we think health sucks

David L. Katz, MD
Policy
July 7, 2013
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Ralph Cramden was the quintessential sucker. I suppose only people of a certain age — my age, for instance — will remember Ralph. If you have fewer gray hairs than that, perhaps you will remember the next incarnation of Ralph, Fred Flintstone. The Honeymooners character, brought indelibly to life by Jackie Gleason, was the inspiration for Fred, just as Ralph’s long-suffering wife, Alice, was the inspiration for Wilma.

Fred Flintstone, too, was a quintessential sucker. Ralph and Fred can teach us all something about health, wealth, and wisdom — or more specifically, neglect of the first, reverence for the second, and inconsistent application of the third.

Before proceeding, two quick caveats. First, and inevitably, I am likely preaching to the choir. Those who read my rants are apt to be those least in need of them. Assuming that, perhaps you will find someone in need, roll this up, and smack them in the head with it.

Second, our behavior with regard to health and wealth isn’t actually crazy, though crazy it may seem. It is a new phenomenon that the fundamentals of healthful living — eating wholesome food, being active, and such — are skill dependent. Throughout most of human history, such behaviors were the only option. As for money, it is really just a surrogate for food; that’s why we talk about making dough, winning bread, and bringing home the bacon. Our apparent reverence for wealth may really just be a displaced reverence for security, and the capacity to fill an empty belly.

Now back to our regularly-scheduled programming.

Jackie Gleason made Ralph Cramden loveable. But Ralph was, objectively, a sucker, if not an outright idiot. More often than not, Ralph dragged his goofy best friend, Ed Norton, into boondoggles, most of them of the get-rich-quick variety. We looked on and laughed as Ralph played the sucker, again and again — believing in yet another get-rich-quick scheme. Norton would get cajoled into the role of accomplice. Alice would knowingly roll her eyes.

And now we come to it: When it comes to health, we are a society of Ralph Cramdens and Fred Flintstones. This suggests something a little disturbing: Either we are suckers, or we think health sucks. Either way, I am rolling my eyes.

My disillusionment is to some extent inspired, paradoxically, by my very gratifying online following. And thanks for that, by the way. I am proud, and honored, to be reaching lots of people — and I hope being of some use to some of you some of the time.

But the same exposure is a window into the world of how many people follow whom. And by and large, we health types just don’t hold a candle to the wealth types. Talk about money, and the whole world listens. People with a reputation for having money stick to them wind up having the most people stick to them, and their every word, as well — online, as elsewhere. I am not complaining about this — just observing.

And the nature of the talk about money is different, too. When it comes to money, get-there-quick schemes are the stuff of vintage sitcoms. When it comes to weight loss, or health — get-there-quick schemes are the stuff of very current bestselling books, and mesmerizing infomercials. They are fodder for national morning shows just about every morning.

Mainstream media handle wealth and health very differently. There are hours of programming each day devoted to money management. Some of this is just drama, of course, but mostly, these involve serious people talking about serious alternatives for investing, saving, and cultivating those hard-earned dollars. Almost none of the serious programming is about a magical formula for making millions in mere days. If we treated wealth like health, that’s exactly what it would be.

In contrast, successful medical programming doesn’t tend to be about groups of experts discussing the various legitimate approaches to a given condition. It tends, overwhelmingly, to feature the health equivalents of getting-rich-quick.

There are, of course, exceptions. My friend Dr. Oz certainly has great influence. But even here, the public’s disrespect for health is on display. What people seem to favor when it comes to health is the very thing we all laugh at and dismiss when it comes to wealth: the quick fix. I get lots of emails from people who watch The Dr. Oz Show (especially when I’m on it) hoping they can learn about the one quick, easy, effortless thing that will produce great health in spite of it all. I haven’t had any emails from Ralph Cramden or Fred Flintstone yet, but I keep expecting one.

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I recognize the risk here. I may sound as if I’m whining. I may seem to be saying: “You people aren’t paying enough attention to me!” But honestly, I’m doing fine. This isn’t about me, any more than it’s about Rodney Dangerfield. Rodney and I share this space with folks way above our pay grade.

What do I mean? Well, name five famous movie stars. Easy, right? Name five prominent politicians. No problem. Name five superstar athletes. Piece of cake. Name five really rich people. A child could do it.

Now, name five Nobel laureates in medicine. Take your time. Chew on it. Oh forget it — name two. Oh, never mind — just Google it.

See what I mean? We’re just not that into health — until it’s time to try and put Humpty Dumpty back together again. And then, it’s not health that sucks after all — it’s the disappointing performance of the King’s men and horses. We can put satellites into orbit, put people on the moon, and beam messages through cyberspace — but we can’t, even in 2013, unscramble an egg.

Perhaps we are all just suckers. But in other matters, we seem quite sensible, and rational. We take good care of our money. If we are suckers, we are suckers selectively. We seem to turn off our common sense only when our lives are on the line. We are patient, and diligent, and wise about wealthy, but healthy — not so much.

We could manage our weight and our health with at least as great and reliable a ROI as we can get by managing our money. We could, if we chose to use what we know, eliminate 80 percent of our lifetime risk of chronic disease. The grim landscape of modern epidemiology is not for want of knowing — it’s for want of doing. It’s about cultural priorities. If we treated wealth like health, most of us would passively anticipate bankruptcy at midlife as a rite of passage, and then deal with the consequences. Heart disease and diabetes are more preventable than bankruptcy — but millions upon millions get them anyway. That’s a little odd.

So, I guess health sucks — at least in comparison to life’s other priorities. That’s the implication of how we treat it most of the time. But when health is gone, and you or someone you love is lying on a gurney sucking wind, suddenly health doesn’t suck. But then, of course, it’s too late.

My hope is that for you and those you love, today is not that day. My hope is that for you, it’s not too late.

You see, Ralph and Fred never did get rich, quickly or otherwise. I’ve seen enough patients in dire straits over 20 years to know that health eventually is a priority for everyone, even if only after it’s gone. My wealthiest patients would give their last dollar to get back the health they lost.

My advice? End the honeymoon with get-healthy-quick nonsense. Laugh at Ralph and Fred, but take health seriously. As with wealth, it’s a lifelong commitment and thoughtful investing that really pays over time. Suck it up, and deal with it.

David L. Katz is the founding director, Yale-Griffin Prevention Research Center. 

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