thought feeling itself

The English Surgeon is a documentary about a neurosurgeon from England and his attempts to help a neurosurgeon in Kyiv, Ukraine. The Ukrainian is running a private practice and he's doing it in a way that the government does not like very much - performing risky operations, recycling equipment from England. The film depicts a faulty medical system that is controlled by a government bent on saving money. It's focus on a few individual patients and the general conditions of this clinic paints these two neurosurgeons as heroes. I would definitely recommend watching this film, but here is an interesting article if you are uncertain about committing the necessary two hours.

I'd like to share a few lines that really caught my attention.

• The film begins with the English surgeon saying this: "It is difficult to know when one is being reckless and when one is being wise, when one is being brave and one is being a coward." He said this in the context of the risks a surgeon chooses to take as well as the risks they were taking by battling the Ukrainian system, but it certainly applies to many areas of life.

• Here is another thought-provoker: "Everyone is equal. Everyone will get a consultation. The crowd should decide who gets to go first." This is what the surgeon said to quiet the mob of people waiting for a second opinion after being told their tumors were inoperable. But here, in the land of the equality and freedom, I have never seen such a system in place. It seems that we do not have enough confidence in our fellows, nor in ourselves, to handle such situations in a calm and polite manner.

• Recently I've been trying to pay more attention to subtle techniques used in film, journalism, and literature. I hope to offer you more examples in the future. These two neurosurgeons are not ones that people are inclined to criticize and the film does, appropriately I believe, show them in a very positive yet human light. But if you watch this film, look for what I am about to describe while they are in the marketplace. The two surgeons have gone to buy common drill bits, which they will be sterilizing and using to drill through a man's skull. It is crowded as many people shuffle from one booth to the next, carrying their goods and bartering. The camera pans through the crowd and stops on a ragged-looking woman picking through a few coins in the palm of her hand. A minute later, as the doctors purchase the drill bits, the camera zooms in on the Ukrainian physician's well-endowed wallet. I am slightly puzzled by this because in every other sense he is shown as a modest, self-sacrificing man. Perhaps the director's aim was to show that this man is still comparable to the doctors of Europe and America in some ways, or maybe he wanted to ensure the viewer that this is not a saint, just another man with personal interests as well as good intentions and good acts.

             How do you interpret it?

• One last, marvelous, captivating line. The two surgeons perform brain surgery on a young man, removing a large tumor from a completely exposed brain while the man is awake. As we see the brain pulsating, slimy, like a living organism in and of itself, the English surgeon says, "That is thought feeling itself." And that, my friends, is one of the great puzzles of life!

soda and cigarettes

In the Seven Year Itch the main character, Mr. Sherman, sends his wife and son away to Maine for the summer. He is initially determined to obey the doctor's orders to quit drinking and smoking and to eat healthily. He locks away his cigarettes and eats dinner at an outrageous vegetarian restaurant. He goes home and removes a bottle of soda from the fridge. He reads the back of the label: "Carbonated water, citric acid, corn syrup, artificial raspberry flavoring, vegetable colors and preservative." Then he asks himself, "Why is this stuff better for you than a little scotch and a twist of lemon? I'd really like to know." Of course, it's obvious to us that it is in fact much worse to drink the soda. What I find interesting is that this must have been obvious to the 1955 audience as well.

There is a lie that I have been telling myself for some time now as a means of explaining how our tolerance of preservatives and artificial flavorings developed. It is the same story that we often hear regarding cigarettes. They didn't know any better. I reasoned that we must excuse ignorance, and that the food industry was out of control before we realized that these things could be so bad for us. But clearly that is not the case. In 1955, although he still got milk delivered to his apartment door every morning,  simple Mr. Sherman knew that drinking corn syrup and preservatives was unhealthy and his doctor told him to quit smoking.

Then how did we get to where we are today? Well, clearly health is not the biggest concern in these matters. I think it is reasonable to argue that media plays a huge role*. Although Mr. Sherman was the protagonist, he was just a nice guy, a bit of a schlump. The real star in this film is clearly Marilyn Monroe. She is oblivious to any reason that one should quit smoking. And she eats potato chips with champagne. Today we don't see the glamorous cigarette adds that were common in the 1950s, fewer Americans smoke, and fewer Americans die from diseases associated with smoking, like stroke and heart attack. But it certainly took a while to get to this point, and it is still a problem. How long will it take for better eating habits to become the norm?

I'm actually very optimistic about this. I think change will come sooner rather than later because it is necessary. I certainly see it in my peers (okay, so maybe they are all medical students, but still). I also see how many people are drawn to farmer's markets and  and preparing their own meals. There is even a movement for specialty ingredient foods - chocolates, wines, gelato. Even if these are not the healthiest items, the call for natural whole ingredients is promising, and it proves that Americans are willing to pay for quality, not just quantity.

I recently began reading In Defense of Food: An Eater's Manifesto by Michael Pollan. He argues that America's nutritional problems have been complicated by the rise of what has been called Nutritionism. Nutritionism is the idea that we can calculate what we should eat and follow those numbers in our diet and be perfectly healthy. But that has lead to catastrophes like Liebig's Extractum Carnis, the idea that multi-vitamins would solve all our problems, or that simply cutting back on fats or carbs would solve all our problems. This idea forced me to think a bit more, because I am very interested in understanding more about nutrition - what different foods can offer us, how different nutrients work together as our body attempts to metabolize them, etc. But the more I thought about it the more I came to understand that when we try to apply a formula to each meal we can no longer enjoy our food. It becomes like a pill we have to take or a temptation we must resist.

When I was in high school I paid no attention to the nutrition information on packages and I definitely could not tell you what percentage of my calories came from fats or if there was too much sodium in my diet. First, I want to clarify that understanding these things are essential for people that are already overweight or have Diabetes or Hypertension or are at risk for heart disease. Second, I do think that for most of the population we can totally forget about these numbers and follow our instincts when it comes to eating well. Michael Pollan's manifesto is this: "Eat Food. Not too much. Mostly plants." So, basically, avoid artificial anything, be mindful and don't eat past the point that you are full, and listen to your mother - eat all your vegetables.

It is likely that I will have more to say about nutrition in the coming months, as I read more of this book, but I'm curious to hear what you think. Should we rely on our gut to tell us what to eat? Or do we need science to guide us?

*So does the government - according to Pollan, as recently as 2004 the Bush State Department was enlisted in a campaign to recommend that Congress threaten to cut WHO funding unless they agreed to raise their daily recommendation of calories from added sugars from 10% to 25%, the official U.S. recommendation at the time. I believe that has been changed, adding to my optimism.