LETTERS FROM THE GLOBAL PROVINCE |
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GP 23 May 2007: Fixing Our Martinis and Our Health When Drinking Was Still Two-Fisted. Back in the 20th century, probably around 1975, the Harvard Club of New York started stinting on its martinis. It tinkered with the formula, and, by all reports, cut the size in half. The Harvard chaps had to call on their Yale Club friends for aid and comfort, repairing for the real thing to the Second Floor Bar on Vanderbilt where a drink was still a drink. The overseers of the Harvard Club had to back down, shamefaced. The drink that made the commute home on the New York Central bearable was restored. Harvard, it seems, has always had a perverse gremlin loose in all its courtyards, the Club long renowned for its ongoing labor problems, and the University most recently killing off its president for being politically incorrect (and, we hear, for being a poor fundraiser). It little mattered that he was doing some of the things Harvard desperately needs to do. During the American Century the martini was serious business. It was the elixir that made for powerful advertising. Today all the advertising shops have been turned into marketing giants headed by short people, and you cannot quite tell what the devil the ads made by committee are all about. Certainly not about substance. Somewhere in those ’70s, the bigger-than-life head of the best agency came down to see our offices. We were then housed in a refurbished firehouse, and our friend the chairman was an amateur fire department buff. After a look at the firehouse pole, we sped off to a nearby Japanese restaurant. Several martinis later, he stood up and recited the only speech he had ever given in Tokyo. Ah, he was late for his afternoon appointment, but was so inspired that we are sure he captured the day, firing up his colleagues to etch a missive with words that would be heard around the world. Once again, the Power of Martini Magic. Comes the Revolution. Well, the martini at the Yale Club is now puny and not worth a tinker’s dam. Effete, tense types sit around its over-decorated lounge and drink white wine, so it probably doesn’t matter anyway. Harvard has also probably gone over the same cliff. The menus feature the high-falutin’ ‘new cuisine,’ overpriced and emaciated. As one Yalie says, “It used to be a great club. Now it’s an average hotel.” There’s no hope for a Restoration—at the Yale Club or anywhere else. In yesteryear, we liked lots of rocks, lots of gin, onions (instead of olives), and a splash (one capful) of vermouth, just the way our fathers made martinis. That’s gone forever. So we are bent on coming up with something totally new—a martini of a different color. We are exploring gins. (We had been imbibing Magellan until the American distributor messed it up.) Our friend Phil has taken to Hendricks. We think the French are probably headed in the right direction with the inclusion of herbs and spices, packaged in handsomely designed bottles, but we have not found the perfect gin yet. Citadelle, for instance, has 19 spices. We suspect we will take to a Dutch gin. The people of Holland know a whole lot about gin, and even have a gin museum next door in Belgium. The one-time editor of Fortune has a jenever permanently sitting on ice. Then the question for us will be what infusion to use with it. For instance, we have just gotten a shipment of real wasabi root in from the Carolinas (not the pasty stuff that you get at the restaurants) and suspect it will play a part in our ultimate formulation. New vermouths are emerging and that will take a whole lot of exploration. Friend Bill G insists on Boissiere, and he has consumed enough Washington martinis to ward off all the infections spread by the noxious effusions of politicians and lobbyists. The right garnish has been invented, and you will find it on our sister site SpiceLines. What you want is Dan Field’s Pickled Green Cherry Tomatoes. A Votre Sante. Martinis need a top-to-bottom redo. About the same thing has to happen to healthcare. We’re not going to get back to craftsman-like doctors and dedicated nurses who honorably run the railroad and keep us out of the clutches of expensive specialists, hospitals, health plans and insurers, absurd federal bureaucrats, drug companies, and a host of other parasites we have not even named. It’s hard enough to get well, but it’s even harder to stay calm and avoid high blood pressure, with all of these maggots eager to suck you dry. We will have to try for something entirely new in healthcare. The ancien regime is long gone. As readers of the Global Province know, we regularly survey the sundry nostrums for the healthcare system coming from one quarter or another. We are not encouraged. First off, they’ve been mainly devised by people who are knee-deep in the muck, part of the healthcare directorate strewn along the path from Boston to Washington. They don’t have a vested interest in revolution. As Eldredge Cleaver said, you are either part of the solution or part of the problem. They’re part of the problem. As well, most of their proposals seek a restoration of healthcare as it was, rather than a revolution. They want an old-style martini, and dem days are gone forever. The proposals for reform mainly put the squeeze on patients, not on the whole vast chain of providers who are ratcheting up the costs without curing very much. Fairly good academic work demonstrates that about 1/3 of healthcare either does you no good or does you dirty. In economic terms, our healthcare system has vast friction costs that are draining us. What’s Wrong. From 30,000 feet you would be able to see the smog and realize that we are a very, very unhealthy society. It avails us little to fiddle with the healthcare system, if what we need to remedy is the society. And we, as all the advanced developed nations, are caught up in a demographic trap. We’re not creating that many babies, but we’re creating a whole lot of old people. They require an entirely different kind of care than our docs are rendering. ’Til we come to grips with age and the noxious habits of our society, we’re not going to get healthier. Off to the Fitness Club. A few years back, some wag calculated that the amount we add to our life by visiting the health club is exactly matched by the amount of time we spend doing our chin ups. That is, he thought, we gain little. There’s a bit of truth in this. Just the other morning we contemplated a lassie on the treadmill. A young gamine in her 20s, she was tightly packaged in $250 spandex. A bit of jewelry here and there. Mascara and mysterious scents from the Orient wrapped her in the aura of some Rita Hayworth movie. Clearly her makeup had consumed as much time in the doing as all the exercise she was to undertake. Back and forth she went on the treadmill, a can of Coca Cola in hand, smoothly consumed as her hand lilted it upwards in an effortless, ballet-like motion. Could any soft drink manufacturer pray for a prettier picture? She is one lovely emblem of our deadly sins: we’re running to stay alive but doing so many other things that will clip our wings and shorten up our lives. Preventive medicine, of a breadth and depth that have not been contemplated by our physicians, will be required to change a consumptive society to a lean society. All the stuff and nonsense we surround ourselves with is laying us low. Over-the-Hill Medicine. Atul Gawande’s “The Way We Age Now,” The NewYorker, April 30, 2007, pp. 50-59 struggles to deal with the fact that we’re growing older and need a different kind of medicine. The problems of old age are chronic, not events that doctors can deal with at one sitting. It calls for lots of geriatricians, but our perverse system is discouraging people from entering that specialty, though the potential patient population is countless. Gawande himself is a surgeon, and we suspect he has reflected more than once that his specialty is not related to our oldsters’ needs. We know of a host of seniors who should not have been operated on, but have been, simply because the surgeons were around to do some cutting. If Mencken were alive, we are certain he would wax sarcastic about the torrent of plastic surgery that has turned women atop society into ghouls. Daniel “Pat” Moynihan. The late and very original Senator from New York, Daniel Patrick Moynihan, had it right. When you have large intractable problems, don’t do anything and things may eventually straighten themselves out. Borrowing from our colonial history, he called for ‘salutary neglect.’ In terms of the healthcare mess, that means stopping our legislators and our academic gurus in their tracks, for just about everything they do makes the mess worse. Where you can, unwind the system, moving towards state and local solutions. At the local level, there is a hope that citizens can get control of things, and revolutionize healthcare. And make sure it begins to serve today’s rather than yesterday’s needs. In fact, most of the experiments that offer some hope are taking place at the local level, although, oddly enough, the Veterans Administration did reinvent itself during the Clinton administration. Out of Left Field. Here and there, at the margins, singular events are happening that are cause for hope. It’s this small stuff, almost out-of-view, under the radar screen, that might make us better. Out on the hustings, a little bit of health is rearing its head. Vaccines. William and Melissa Gates are trying to push vaccines around the world, funding immunizations with the vast loot in their foundation. As interesting in this regard is Darren E. Higgins, a professor of microbiology and molecular genetics at Harvard Medical School. As the New York Times, May 16, 2007, p. H5 remarks, he “wants to help your immune system in a hurry and on the cheap.” “Dr. Higgins is a co-founder of Genocea, a biotechnology start-up company working on a novel method of vaccine development. His goal is to find the quickest way to make inexpensive vaccines to fight numerous complex and aggressive viruses and bacteria.” Many of the pharmaceutical companies have exited the vaccine business, and those that remain are not innovation-driven, given the high costs of the business and low margins, as well as other associated risks. Now, with entrepreneurs trying new technologies, venture capital is coming into the game, and we can hope for a vaccine bulge. Taking some of the hit or miss out of vaccine development, Higgins and his colleagues are developing the protein blocks around which new vaccines can be built. Vaccines, we should point out, are one, though only one, component that will help rebuild public health programs which have eroded badly in almost every major country in the world. Retail Clinics. There’s an inclination to take medicine out of the ivory tower, the fancy offices, and the cost-laden hospitals and put it on the street. In “Health Conscious Employers,” we addressed the clinic offerings of Whole Health Management and Quad Graphics, and the inclination of a number of companies to provide do-your-own treatment for low-level complaints right on the job. Grace-Marie Turner, president of the Galen Institute, salutes the spread of retail clinics in “Customer Health Care,” Wall Street Journal, May 14, 2007, p. A17. As Turner notes, these clinics in some instances are providing care where people need it at a cost they can afford, especially for the uninsured, outside of the traditional healthcare system. As we have previously noted, Schools of Public Health around the country have done a rather poor job of dishing out health services to people on their doorsteps, so it seems to be up to private clinics to fill the vacuum. Bacteria Ain’t All Bad. Every medical researcher worth his salt, and wanting his grant money, is doing lots of genetic probing and seeing what he can find out with the expensive magnetic resonance machines the big-time medical equipment manufacturers are churning out. If you go into some medical centers these days, a few of the docs can’t wait to amortize the equipment by prescribing yet another scan. But time and again, we are discovering that old-fashioned bacteria have a lot to do with a complaint or its absence. For instance, it took an out-of-the-way Australian doctor named Barry Marshall to put to rest all the official medical superstitions about the cause of ulcers—stress, diet, and all the rest. He found that the pylori bacteria were the culprits. Now we are finding that neurologists are spending so much time on genetic codes and complex sequences that they may be missing the current best hope for dealing with a host of brain complaints. One Mary O’Brien, an oncologist at the Royal Marsden Hospital in London, thought she would see if she could wallop her patients’ lung cancer with Mycobacterium vaccae. She not only noticed that the inoculations helped the cancer but also gave her patients relief from depression. Seemingly, a two-for-one. Subsequent research at Bristol University on mice illuminated what was at work. In the mice, anyway, serotonin seems to be elevated by the introduction of the good—or at least harmless—bacteria. It is the magic ingredient that links together brain circuits, and has something to do with the relief of numerous brain conditions. The big-time researchers are pursuing genes, not bacteria. Nor are they looking at minerals and dietary matters, though it seems that those who ingest the right things put off or never get some neurological diseases that come with aging. The people of India, for instance, have low rates of Alzheimer’s, which some attribute to curcumin, a key ingredient of widely used tumeric. Given our epidemic rates of depression, we have some need to find simplistic things like bacteria and dietary substances that will help us deal with our heads today, although elegant genetic explanations may help us out with tomorrow. A New Cocktail. Well, we cannot restore the martini, but we can move on to a potion that is a bit more global. Maybe even with a dash of tumeric. P.S. Back in the ’70s the Times was a manageable, two-section paper, a lot more tightly written. It has always been a bit heavy handed, but back then it would occasionally try to capture the fun and vigor exhibited by the wonderful New York Herald Tribune, the memory of which was still alive with journalists who counted. Imagine our surprise when we read the top article on the first page of the second section one fine day. It was all about the flood of visitors—from the Harvard Club—to the Second Floor Bar. This was when a martini, Harvard, and Yale were still big news. This was a Tribune sort of article. P.P.S. There are still a whole host of physicians that are practitioners of a higher order. It’s a pleasure to visit with them. We remember an oncologist in Houston named Montague who could listen to a patient recite the whole course of an illness and then spit back the history without an error—a minute later. That’s how you can tell a doctor will not foul up. There’s an extremely fine surgeon in New York (so fine that he has recommended against surgeries that lesser doctors were stoutly urging) who has had to rebel against federal bureaucrats. They wanted to surround him and his staff with rules that would make them gigantically less productive. More than one physician has said to us when we ask how things are going, “Well, the practice is absolutely wonderful. But the business is dreadful.” P.P.P.S. We’re not only trying to turn off consumption and fat for our health. We are now trying to get to a ‘lean economy,’ as symbolized by the Toyota Lean Manufacturing System. Several of our efforts in this regard have cut into our muscle instead of our fat. The challenge is to use less resource to produce higher quality, but we often get a lot less when we take out a little. On a day to day basis, it’s very hard to add value and take away some ingredients. The tendency, rather, is to overdo things. We advise start-ups who demand a $25,000 Cadillac website rather than the $2500 Chevrolet that will get the job done. None of the new CIA-trained chefs can figure out how to make a simple meal. Immensely elegant, purposeful engineering is required. In business, as in personal life, so many luxuries have become necessities. Seemingly, every entrepreneur that has any pride must tool around in a BMW. P.P.P.P.S. Gourmet, June 2007, p. 81 takes a peek at gins and a look at tonics. For gin and tonics, it recommends No. 209 from San Francisco, Zuidam Dry from Holland, Gale Force from Massachusetts, Oregon’s Aviation, and Tanqueray Rangpur from Great Britain. Obviously, a Buy America campaign has gotten its claws into the editors. We like the name, anyway, of Fever-Tree tonic from Great Britain, and Q Tonic, a domestic, is mentioned as well. Decent tonics are hard to find, so these items are good news. We would hope Gourmet will get serious and come up with some real contenders. |
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