Tag Archives: health

Mr. Throat and Me

(RICOWde/Getty)

Arnold Thomas Fanning | Banshee | Spring 2017 | 17 minutes (4,695 words)

I love to smoke.

I think it’s important to state that right at the beginning so there can be no equivocation about what follows, in case there is any doubt.

Smoking is one of the greatest pleasures in my life, if not the greatest. It subsumes me, and consumes me. I have been smoking, on and off, for over twenty years and it has at times reached levels of obsession that even I know are unsustainable. Over and over I vaguely register that the time has come to quit. But it takes a long time for me to actually follow up on this idea and act: smoking takes precedence over stopping smoking.

I simply love it too much.

Last thing at night before I go to sleep I am thinking of all the cigarettes to be smoked the next day. The prospect cheers me. On waking, before showering, before coffee, before eating, I put on my dressing gown, go downstairs, stand outside, and light up the first cigarette of the morning. It is the harshest of the day, the smoke rough and burning on the throat after eight hours without, and harsh on an empty stomach too. Then I drink some juice and brew some coffee. I eat cereal while the coffee is brewing and then it is ready to pour: just in time for the second cigarette of the day, arguably the most enjoyable.

This is more smooth, the coffee on the palate a buffer for the smoke, and is smoked at a more leisurely pace, sitting outside this time on the step with my cup. These two cigarettes are the most physiologically necessary of the day: to get some nicotine into the system after the depletion of sleep, to get the equilibrium going.

Conversely the last cigarette of the day is smoked almost regretfully because for the following eight hours or so there will be no more, and there is a vague anxiety that I won’t make it through the night without. It is smoked after everything else is done with: the evening meal, TV, reading in bed, bathroom ablutions, everything except brushing my teeth. In dressing gown again I stand outside, as late as possible and shaking with cold, and suck in the day’s final smoke. Usually I follow with a second cigarette to be sure I won’t be craving one before I go to sleep; sometimes I have a third for the same reason. Only then do I brush my teeth, a small sop to freshness, and go to bed, anticipating already the first cigarette of the next day in the morning.

This routine — cigarettes as soon as I rise, cigarettes last thing before I succumb to sleep — means that for all of my waking hours I reek of cigarette smoke, not only my breath, but my clothing, my hair, and my skin as well. I am a walking, waking, fug of smoke. No doubt I reek of cigarettes in my sleep too.

The sensations that come from smoking: the first cigarette of the day, there is a definite head rush, a clear hit of a high, a spinning lightness. The next one is merely a settling of accounts, a restoration of normality and getting comfortable. Later, if there have been notable gaps between smokes, there is the relaxing cigarette that takes the edge off of absence. Then there are the cigarettes taken after breakfast, lunch, and dinner, the smoke burning off and replacing the flavors of food in the mouth, cleansing the palate. Cigarettes with beer, refreshing and frivolous; with wine, studied and reflective; with green tea, delicate and palatable. There are many sensations that come with smoking, and I love every one.

There are images on the back of the cigarette packs that try to dissuade me from smoking. There is the one of the wrinkled apple (signifying the wrinkled skin a smoker gets if they don’t quit), the one of the drooping cigarette ash (impotence), the one of a bared gummy mouth (tooth loss), and several more. But none of these have the same effect on me as does the image of Mr Throat.

Mr Throat is the name I give to the man whose photograph appears as a health warning on many of the cigarette packs I smoke from. His image is accompanied by the message, bold and chilling in its simplicity: ‘Smoking can cause a slow and painful death.’ As if to demonstrate the truth of this, there is the picture of Mr Throat, which is truly stomach-turning.

A young(ish) man, age indeterminate, photographed from the bridge of the nose down almost to his clavicle, mouth shut in seeming determination, has a tumor growing on his throat. And what a tumor. The size of a deflated football, it is the color of raw chopped liver, and bulges, shapeless, under his chin, covering his Adam’s apple, spreading each side as far as his ears and down over his neck. Above the tumor Mr Throat is mostly expressionless, apart from that grimly set mouth, although it is hard to determine his expression given the absence of eyes from the portrait. He has a florid but wispy mustache, and has made a half-hearted attempt to nurture a goatee; truth be told Mr Throat does not have a very strong facial hair growth.

Mr Throat’s appearance is nauseating, shocking, and terrifying to the smoker. No one wants to end up like this. But that is what will happen to us, the health warning implies, if we continue to smoke: we, too, will look like a monster. Mr Throat is there to tell us, in earnest, that smoking can cause a slow and painful death, and he delivers that message well.

Nonetheless I continue to smoke, and go on loving it.

Brands are important, and only some will do for me. It has to be either Lucky Strike Silver (‘It’s Toasted!’) or Camel Lights, the ones in the blue pack. These are both a mid-strength (6mg) cigarette. Anything milder has no effect on me, no kick at the back of the throat, no nicotine rush; anything stronger is nauseating and too strong to inhale deeply. Occasionally I find Gauloises Bleu which are a nice change. While travelling I sometimes come across the brand I smoked while living in the States, American Spirit Yellow, a good alternative to Luckies (and supposedly free of ‘additives’).

But I still keep coming back to my two favorite brands: Camel and Lucky Strike. I smoke the 6mg level exclusively, feel it is just right. The only times I smoke other brands is during those brief, periodic episodes of attempting to ‘quit’ in my twenty-odd-year smoking career, during which I inevitably bum cigarettes off strangers incessantly so as to feed the habit that my attempt at ‘quitting’ has only put on temporary hold. At these times my choice of brand is at the whim of the smoker I bum from: I may end up with a Major (un-inhalable due to the strength), a Marlboro (unpleasant taste), a Silk Cut (not strong enough), or worse of all, a Kent Menthol (simply nauseating).

Inevitably I get back to buying my own brand again and I joyfully open and smoke from a pack of Camel Lights or Lucky Strike Silver once more. Back, finally, to my own brand and strength. It is one thing that could be said in my favor: I am nothing if not loyal.

I never quite get to the stage of being a chain smoker, but do I smoke my cigarettes in couplets, one cigarette followed by another, before leaving an interval until the next one (which is actually two); which makes me a chain smoker of sorts. The intervals last anywhere from thirty to sixty minutes depending on what I am doing. Sometimes they last a bit more, on occasions when it is unavoidable. Frequently, however, they last less. I am going through a lot of cigarettes every day, needing them more often.

So it is I begin to dread going to the cinema to see long movies, one of those occasions when the gap between cigarettes is longer than strictly bearable. Any movie over ninety minutes is a real strain to get through. I sit through it growing increasingly anxious as I wait for it to end, for the moment I can smoke again. Then, as soon as the film is over, as soon as the credits roll, I am up and out of my seat, out the door, and outside, grasping at a cigarette and smoking. I often leave whatever cinema-going companion I am with to come find me. It occurs to me that roughly speaking I now need a cigarette every thirty minutes, minimum, or I grow agitated.

I meet an American girl at a busy bar. She is nice. We have a lot in common. We click. She says, See you in a bit, and goes to the bathroom.

I go for a smoke, resolved to talk to her on my return. When I come back, she is standing by the bar waiting to order and I go join her.

When I speak, leaning in close so she can hear me over the bar noise, she visibly recoils.

Do you smoke? she asks, startled, as if she has never heard of such behavior in an adult: she has caught my smoky breath, and ends the conversation.

The encounter has led nowhere; she has no interest in hanging out with a smoker. Needless to say I don’t bother asking for her number.

It is imperative never to run out, never to be in a position where I have no cigarettes on me or in the house. To this end I always make sure I have two packs about me at all times. One pack is the previous day’s leftovers: the final cigarettes remaining from a pack of twenty begun the preceding day which I use to begin the day’s smoking, and rapidly finish. Then I open a fresh pack which I bought the previous day and start that. Thus for a brief period I have only one pack on me; the imperative takes over now and I make sure as soon as possible to buy pack two. Buying this second pack gives me a sense of security. I continue to smoke pack one, getting through perhaps sixteen or seventeen (I have already consumed two or three from the previous day’s pack two). I have thus two or three left over for the following morning, plus the fresh unopened second pack to start once I have got through them.

The system ensures I always intake a minimum of twenty cigarettes a day; but also means that if, for example, I am out late, or get up very early, that pack two can be opened earlier and begun ahead of schedule, though still leaving some aside for morning consumption. On these days consumption goes up to twenty-five or thirty cigarettes, and always, always, the imperative to have two packs on me is fulfilled and justified. It means, in practice, that every day I need to monitor consumption levels closely, stop somewhere and make a purchase, and thus reassure myself that stocks are good and I do indeed have enough, because the thought of running out fills me with dread. I obsessively stroke pack two unopened in my pocket to calm myself at these moments of anxiety.

I can’t help wondering, as I’m handed a pack in the newsagent and am unable to avoid seeing the image on the health warning: Who is Mr Throat really? Does he have his own story, biography, experience, somewhere? In the past, or even now, living or in the memories of those living? How did he go from being an individual, a man, to being an image, dehumanized, on a pack of cigarettes, used as a health warning, merely a function? Did he consent to that photograph being taken and distributed or was it taken as part of some health screening program, or test, and then used at other times, in other contexts, without his knowledge? Is he actually alive in that photograph, or is this an image of a corpse? Is Mr Throat alive today?

These are the thoughts that go through my mind every time I am unlucky enough to see the nauseating image of Mr Throat. Then I try and forget him again.

I go to a country wedding, pocketing two packs of cigarettes as usual. I idly wonder, as I get dressed and prepare to board the hired coach that will take me to the wedding venue, would three packs be better; but in my wedding outfit I don’t have enough spare pockets to carry more than two, so it will have to suffice.

The reception is held out in a remote rustic estate in the countryside; there are no shops nearby, nor vending machines within. My two packs will have to get me through the night. It is a long night and inevitably I run out. What follows is an orgy of begging for cigarettes fueled by increasing panic as I realize I will be on this estate, out, awake, away from any source of buying cigarettes, for several more hours and I will, in no way possible, make it through this without smoking.

Other smokers have now realized the same thing: the coaches back to town won’t arrive until dawn. There is now a finite and unrenewable quantity of cigarettes available to smokers on the estate and they are being rapidly consumed. Rationing begins, and it becomes harder and harder to bum a smoke. More and more smokers refuse me, waving their packs at me and demonstrating they only have two or three forlorn cigarettes left to get them through the rest of the night. I begin to feel a sense of utter fear as the anticipation of withdrawal symptoms kicks in.

Finally dawn breaks over the misty fields of the estate and I am able to catch the coach and return to the hotel in the regional town where I am staying. There the hotel bar is open for breakfast, and selling cigarettes also; sweet oblivion overcomes me as I open my own pack at last and can smoke my own cigarettes, in control of my nicotine intake once again.

There have been – there actually continue to be – intermittent attempts to quit for good even as my career as a smoker progresses. In the course of the two-plus decades of being a smoker, these attempts have resulted in me quitting for periods ranging from a few hours to a few years. Always they have ended in the same way: me bumming cigarettes off strangers to satisfy cravings, on the streets or outside pub entrances:

— Excuse me, spare a cigarette?

Followed by the humiliating refusal:

— Sorry bud, it’s my last one.

— Sorry, I don’t have any more on me.

— No.

Sometimes no verbal reply at all, just a physical brushing off, even more humiliating in its casual brusqueness.

Then, the occasional hit:

— Spare a cigarette?

Followed by:

A barely perceptible eyeroll, a silent acquiescence, the slow drawing out and offering of the pack (inevitably followed by my slight disappointment that the brand is not one of my favorites, tempered by the relief that at least I am getting a hit), the giving of the light, then my furtive walking away from the bummee, inhaling the cigarette with glee, perhaps the first one I’ve managed to acquire in an hour if the bumming hitherto has gone badly; but, a successful bumming at last, after several humiliating failures.

Eventually it is this constant recurring humiliation — of asking and being rejected or patronizingly given to — that gets to me and drives me back to buying my own cigarettes. And so, once again, I quit quitting. I give in. I go and buy a pack of cigarettes, my own brand again, my own supply. And that is that: I am a smoker once again.

I conjure up a life for Mr Throat. He has the air of someone used to the wide open spaces, the prairies, the high plains about him, but he seems too winsome, not rugged enough, to be from the American West. He is Canadian, I conclude. He is a bit of a dandy too, evidenced by that attempt to grow that florid mustache, the wispy goatee. I think of him as a dreamer and a schemer and an optimist (look at the determined set of that mouth), and that all his dreams have become derailed by this gigantic carbuncle growing on his throat. He wanted a future and now thanks to his smoking his future has been cruelly curtailed.

In this he is a warning to me.

In this, he could be me.

It isn’t always the experience of bumming that brings me back to the smokes.

I start to smoke again, and in earnest, so as to deal with the effects of emotional turmoil: periods of stress, or distress, or duress. To deal with a low mood brought on by relationship breakups, job loss or change, bereavement, sickness, sheer having-a-bad-dayness. Indeed the only reason smoking began as a serious component in my life at all was to ‘deal’ with the ‘stress’ of completing my Master’s thesis.

Sitting in the café of the University Arts Department, I admit to a group of fellow postgraduate students that I am getting increasingly anxious about all the work I have yet to do, when one woman in the group opens up her handbag, takes out a pack of Marlboro Red and offers me one.

— You should really try one of these. They really help me with the stress.

I take one, light it, and inhale. Get the rush in my head, the euphoric feeling, and yes, for a moment I get the sense that my anxiety has abated. I thank the woman, go buy a pack of my own, and in that moment become a smoker.

If I had only known the history of smoking that early cigarette would kick off, maybe I’d have considered another form of relaxation.

Since then cigarettes have always been my fallback curative of choice when going through hard times: buy a pack, rip it open, light up, smoke whatever feelings I am experiencing away in a rush of nicotine, let it calm the nerves (even as I know, rationally, that nicotine is a stimulant and is doing the exact opposite of relaxing me). Feel a momentary twinge of regret that I have, once more, failed to quit and returned to being a smoker. Then feel a sense of what can only be called homecoming: a sense of this is where I belong, and how.

During one particularly heavy day of smoking, during which I manage to consume two full packs and make serious dent on a third, resulting in me feeling seriously nauseous and wired, I take stock of my life, my situation, my future. I can’t help conjuring up the image of Mr Throat, and make a resolution: yes, it is time to try to quit for good again.

So I sign up for a series of one-to-one smoking cessation counselling sessions, held once a week in a local health center. These are basically therapy for smokers, and give me the opportunity to let off steam and talk a lot about smoking. This I enjoy doing so I continue to go to the sessions for a long time. Throughout this period I keep smoking between sessions however.

Then, amazingly, I actually manage to stop. This is mainly guilt-driven quitting: I can’t bear seeing my smoking cessation officer week after week and admitting to him I am still a smoker. There is no use denying it: he makes me blow into a tube every week that shows the nicotine levels in my blood.

I quit through the simple expedient of wearing two nicotine patches at all times, as well as pulling on a nicotine inhaler any time I have a craving. I struggle through the week without actually smoking with this method (apart from the occasional bummed cigarette which in my mind doesn’t count, as they are smoked in times of dire emergency withdrawal symptoms).

Then the London Olympic Games begin.

I’ve been anticipating them for years, and sit down to watch them on TV eagerly that weekend. But there are a lot of gaps in the action: pundits chatting as the athletes stand around in tracksuits apparently doing nothing. Then there is finally a brief burst of activity followed by another gap, another period of waiting.

It is during one of these gaps that I grow impatient, and this impatience leads to restlessness that develops into a growing agitation, an agitation I know can only be relieved by nicotine, and not the kind that is delivered by patches or an inhaler, but by smoke. So immediately after a fleeting heat on the TV, I skip the commentary, don shoes and jacket, and head for the local newsagent, there to buy a pack of cigarettes which I smoke with relish and appreciation.

Somehow, perversely, the sight of the most physically fit men and women on the planet has driven me back to the unhealthiest pastime legally available.

I have lasted all of four days, and return to my next smoking cessation session a smoker once more. Sure enough, when I blow in the tube my smoking cessation officer proffers me, the nicotine levels in my blood are sky high.

Every time I toy with a pack of cigarettes, idly looking at the health warnings (or avoiding looking at them if it is Mr Throat), the same questions go through my mind: when did this all start, this health warning thing, the slogans, the photographs? Who picks the particular images, how and why? Where do the images come from – was the guy with the gummy teeth happy to be photographed, for example? And should I try and actually understand more about my nicotine addiction so as to help my attempts to deal with it?

These are the thoughts that pop into my mind as I rip off the cellophane from a fresh pack of twenty, pull out the tinfoil, take out a cigarette, light up and smoke. Again and again and again.

Friends assure me that hypnotherapy is the way to really quit smoking. I locate a hypnotherapist in the city center and make an appointment. Just before going into his office, I smoke my last cigarette and throw the rest of the pack, half-full, rather optimistically into a bin outside.

The hypnotherapist – bearded, swarthy, otherwise unremarkable in appearance – sits behind and just to one side of me as I sit back in a divan. He urges me to close my eyes, relax, and just listen. Then he begins to speak, his voice a low but clear mumble, the words quickly falling into a repetitive pattern:

– You are going to stop smoking, Arnold, you no longer need to smoke, Arnold, when you wake up you will not want to smoke, Arnold, you have no need to smoke, Arnold, cigarettes have no control over you, Arnold, you are going to stop smoking, Arnold, when you wake up you will not want to smoke, Arnold, you have no need to smoke, Arnold, cigarettes have no control over you, Arnold, you are going to stop smoking, Arnold, you no longer need to smoke, Arnold, when you wake up you will not want to smoke, Arnold—

On and on and on in a low monotonous hum until —

Hang on.

‘When you wake up?’

Am I meant to be asleep for this? But I am wide awake, fully conscious, aware of every word.

It occurs to me that this is not working.

Sure enough I leave the hypnotherapy clinic and walk not ten meters before I stop, turn into a newsagent, buy a pack of cigarettes, rip it open ravenously, and smoke. The hypnotherapist’s words come back to me: obviously they have not sunk in.

I have lasted less than an hour and a half without a cigarette.

The hypnotherapist phones me to follow up on our session, and when I explain it didn’t work he offers me a free second consultation.

I return to the office. I sit, I relax, I close my eyes, and I listen once again as he rumbles on, telling me, assuring me, but failing to persuade me, that I will no longer want to smoke. As soon as I leave I again go into the newsagents and buy a pack of cigarettes. The failed exercise in hypnotherapy has cost me €350 and a dent in my pride: obviously I am not hypnotherapy material.

I buy and read two books on quitting smoking; I return to the one-to-one smoking cessation sessions; I try a program of nicotine patches, gum, pills, spray, inhaler. I try cold turkey.

Nothing works.

I still smoke.

I still love it.

Then, one day, all the pieces for quitting actually fall in place.

There is a day, for example, that it really gets to me: I get a pack with Mr Throat and realize I am sick of seeing the grotesque lurid bulge jumping out at me from the back of a pack every time I reach for a smoke. I realize not only am I afraid of this fate I seem destined for — to develop a painful and incurable throat disease — but I am also weary.

Weary of the constant fear of running out of cigarettes, weary of going outdoors into the cold for a smoke, weary of leaving conversations and company behind when I do so, weary of people being repulsed by my smoker’s breath, weary of the expense, weary of the shortness of breath I am developing, weary of the increasing nausea that accompanies my habit, weary overall of the fact that cigarettes control me now: they control my routine, my very life at this stage. I realize, genuinely, that I have had enough of all this.

I resolve to quit.

For keeps this time.

And I do. But this is a story of smoking, not quitting, so suffice it to say here that the weeks go by, and then the months, and then the years, without a smoke.

I don’t remember my last cigarette now, although at the time it was loaded with significance and I thought I would remember it forever. Perhaps I can’t remember it because there have been so many ‘Last Cigarettes’ in my past and they have always been followed, sometimes after a gap of many years, by yet another cigarette. Maybe I don’t remember because deep down I didn’t really believe that this was going to be the last cigarette.

But nonetheless I do know how that last cigarette would have been.

It would have been a morning cigarette, sitting in the garden with a coffee, my favourite combination. I would have already consumed two or three cigarettes from the pack, the leftovers from the previous day. And then I would have rattled the box, looked down, and seen it: The Last Cigarette.

I would have picked it out reverently, with appreciation and relish, and I would have acknowledged to myself how much I enjoy smoking. Then I would have lit it, inhaled deeply, and smoked it with as much attention as possible, slowly, and fully present to its pleasures. Finally, regretfully, and with loaded significance, I would have finished the smoke and stubbed it out.

And so I would have left that part of my life behind.

For good, it can only be hoped. But I know that I will always have a love of smoking, that cigarettes are my weakness, and that deep down, no matter how many years pass, I will always struggle with that addiction.

The fact remains: I currently do not smoke: but I am, and always will be, a smoker.

Because I love to smoke.

***

This essay was published in the fourth issue of Banshee. Co-edited by three writers in three Irish cities, this biannual print journal is a vocal part of Ireland’s thriving literary culture and print renaissance. 

Taking Up Smoking at the End of the World

John Sherman | Longreads | September 2017 | 9 minutes (2,250 words)

 

I started smoking this year. In Berlin, where I lived before recently returning to New York, almost everyone seems to smoke, almost everywhere, almost all the time. It’s like a 1970s game show, but in German and with better hair.

It wasn’t the ubiquity of smoking that sold me as much as the opportunity to become excellent at rolling cigarettes — a simple task that is wildly impressive when done well. The most practiced rollers can assemble a factory-grade filtered cigarette in about ten seconds, packing it casually against a thumbnail while your own attempt looks like a slightly crumpled, pregnant snake, leaking tobacco from both ends.

I’ve watched Berliners roll cigarettes walking, standing up in a moving subway car, and even once while biking through traffic on Karl-Marx-Straße. A German friend claimed her father could roll a cigarette inside his pants pocket, which, bullshit or not, puts the bar for trick-rolling higher than I can even imagine.

Aside from being a cheap way to smoke — about €5 for a bag of decent rolling tobacco, plus €1 each for filters and rolling paper — it’s an excellent sideline for fidgeters, people like me who can’t help but curl straw wrappers into intricate fiddleheads, or peel the label off their beer bottle to fold origami fortune tellers. Cigarette rolling is a mini-craft project unto itself, repeatable and perfectible. I probably enjoy rolling cigarettes even more than I enjoy smoking them.

***

I don’t mean to be flip about the health hazards of smoking, which are illustrated in full color on every side of every tobacco product I’ve ever purchased, and rattled off by every serious smoker I’ve ever talked to about it. I was born in America in 1989; the only thing I know about smoking is that it’s bad for me.

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The Case for Believing Women Who Are In Pain

If there’s only one important takeaway from the backlash to Gwyneth Paltrow’s Goop, it’s that women seek alternative medicine — and therefore the “wellness” movement — because traditional doctors have never taken them seriously.

As Annaliese Griffin pointed out for Quartz, the American healthcare system, while undeniably terrible for nearly everyone, damages women to an extreme. Their “experience of pain is routinely minimized by health practitioners,” resulting in longer wait times, misdiagnoses and even an increased chance of death from things as common as heart attacks.

When Maxwell Williams learned a female friend of his was incapable of having sex without feeling excruciating pain but struggled to find a doctor who would take her pain seriously, he decided to investigate what was really causing the stabbing sensation that doctors kept telling his friend was all in her head. (Never mind that the head is part of the body, indeed controls all of the body, so it makes little sense to discount it.)

For his piece for GOOD Magazine, Williams spoke with about a dozen women who shared his friend’s experience, including one whose marriage unraveled because of it, and he learned of vulvodynia, a Latin medical term that roughly translates to “vulva pain.” The condition plagues far more than the dozen women he spoke with — as much as 16 percent of the female population, or 14 million women, markedly more than those who experience endometriosis or breast cancer. So why don’t we know about it? And why are treatment options so scarce?

“If you were a woman and you were asked, ‘In your last sexual encounter or your last series of sexual encounters, did you experience pain?’ what would you think the answer would be?” he says. “It’s a little over a third. That’s a freaking epidemic. One third of women in our environment are having pain during sex. That’s an unnecessary, bothersome, distressing issue. We need a lot more effort in understanding it.”

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The American Dental Refugees of Mexico’s ‘Molar City’

Visitors from the United States walk past a dental office in downtown Los Algodones in February, 2017. (Guillermo Arias /AFP/Getty Images)

A mouthful of healthy teeth has become a luxury in America, and the divide between rich teeth and poor teeth has become a stark symbol of inequality. Poor dental care can be both humiliating and life-threatening, and those who wait in lines for hours at free clinics in tents or local stadiums are often given the chance to fix one thing, and little else.

Los Algodones, Mexico — tucked into the sharp corner where California and Arizona meet at the border near Yuma — has 600 dentists among its 6,000 residents, giving it the nickname “Molar City.” As Republican senators cobble together a plan to repeal Obamacare behind closed doors, little has been done to address the dental crisis currently unfolding in the United States, where 114 million Americans don’t have dental insurance.

Dental insurance has only been commonplace for about thirty years in America. As a 34 year old, I remember trips to the dentist in the mid-1980s as intense and frequent. Fluoride was a cure-all at the time; I was given extra-fluoridated chewables on top of our already-fluoridated town water supply, which left my teeth strong but streaked with white stains. When I lost my four adult front teeth in a playground accident at ten, I didn’t get porcelain veneers until I was 18. They cost $1000 each, so we had to save.

In Los Algodones, porcelain metal crowns that can cost $1500 in the states are just $180 each — one patient got fourteen in a single go. “We’re helping the United States take care of the people they are not able to,” the mayor of Los Algodones told Buzzfeed in their recent profile of the city.  And many of those people the US is unable to take care of just put the new president in office.

Jennifer Ure smiles sheepishly through the numbing agent as we stand on the sidewalk outside her dentist’s office. She’s just had her first round of surgery to replace three crowns on the right side of her mouth and is speaking with a lisp. The crown would have cost $600 back home in Ashland, Oregon; here, it’s $190. Her sister, Dana Gross, is here, too. Both are retired, both lack dental insurance, and both have been coming to Molar City for years.

“I’m on Medicare, and I can’t afford dental insurance,” Ure says as she starts to choke up. “I just can’t afford to pay.”

Both sisters warn that to get quality care in Molar City, you have to get recommendations from people you know and trust.

“You really need to do your research,” Ure, 61, tells me. “You can get some who don’t know what they’re doing, which happened to me.” Her first procedure here seven years ago didn’t go well — the implants a dentist put in fell apart soon after Ure returned to the US.

Ure, like most of the Americans I spoke with in Molar City, voted for Trump. The president’s dark warnings of Mexican rapists and gangsters coming into the US haven’t deterred his supporters from coming to Mexico for dental care.

Of course, that’s not to say the Mexicans providing care don’t see the irony.

David Gil, the manager of TLC Dental, says he’s become Facebook friends with many of the patients, and “everything is Trump, Trump, Trump.” But so far, he hasn’t seen a drop-off in customers who support the president — and he hasn’t had any problems with visiting Americans. “I think when it comes to racism, people hide it … [but] why else would you vote for him?”

“I think it’s a little bit odd, but we can’t judge them on how they voted, so we just try to respect them,” says Margo Carilla, who works as a translator for a dentist in town.

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A Tale of Two Americas Through the Lens of Health Care

(Christopher Furlong / Getty Images)

Two articles published by the Washington Post and the New York Times this weekend focused on extremely different versions of the U.S. healthcare system: The Post feature— part of a series on “Disabled America,” which focuses on rural populations receiving federal disability checks — bears the dateline of Pemiscot County, Missouri, a place where the dwindling population has an unemployment rate of eight percent. The Times’ feature is part of the series “The Velvet Rope Economy,” which focuses on “how growing disparities in wealth are leading to privileged treatment of the rich.” Nelson Schwartz reports from San Francisco, currently the second-most densely populated major city after New York, with the third-highest median household income. Known for being plagued by homelessness, the poverty rate is 12 percent, lower than the national average, and the unemployment rate is 2.6 percent.

In the Post, Terence McCoy reports on a multi-generational family on disability that struggles to make ends meet in “a county of endless farmland, where the poverty rate is more than twice the national figure, life expectancy is seven years shorter than the national average and the disability rate is nearly three times what it is nationally.”

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RAWR! What’s Happening to Me? The Truth is Out There (About Menopause)

Gillian Anderson and Jennifer Nadel
Anderson and Nadel. Photo: AP Images

In this conversation at Lenny, Gillian Anderson and Jennifer Nadel reflect on the maddening and sometimes little-known symptoms of perimenopause and menopause. The goal? To get more women talking about the flow and ebb of the female reproductive cycle and how it affects them, their work, their partners, and their families.

Gillian Anderson: Perimenopause, as I understand it, is a period of time that can last anywhere from a few years to even a decade before one’s period actually stops, before one actually goes into menopause proper. What happens is, over time our levels of estrogen start to deplete, and as a result we develop symptoms like anxiety, depression, mood swings, hot flashes, night sweats, fatigue, and find it harder and harder to cope with the normal routines of our lives.

Jennifer Nadel: Memory loss was a huge one for me. I thought that I was getting dementia. I would just go into my brain to try and pull a few facts off the shelf. I’d be halfway through a sentence and I simply couldn’t find them. And when that happens on a regular basis, it can get scary. You can stop wanting to engage in an argument or put your point across because you might forget what it is halfway through. I found myself becoming silent. I was losing my voice through fear of not being able to deliver in the way that I’d taken for granted all my life. Now I make myself speak, and if I forget or can’t locate the stats to back up my point, I tell the truth: “Sorry, it’s my menopause brain.” And when I own it out loud, the fear gets less, and I find other women start admitting it too.

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The Race to the Bottom of the Sugar Bowl

brown and white sugar cubes
Photo by minjungkim (CC BY-ND 2.0)

Beth Kowitt, in Fortune, explores food manufacturers’ race to find a sugar stand-in that ticks all the boxes: cheap, “natural” (i.e., plant-based), and actually tastes like sugar. Amid the science, stevia leaves, and sucralose, she takes a step back: if sugar is such a health hazard, why don’t we just… eat less sugar?

There seems to be an obvious solution to all of this that would be much easier for everyone: Why not just eat less sugar? “As we move away from sugar, we are facing this dilemma that nothing tastes like sugar,” says consultant Woo. We know, after all, that our expectations are not set by nature. In the U.S. products tend to be sweeter than in Europe. For example, a liter-size bottle of American Dr ­Pepper has 108 grams of sugar, vs. about 73 grams for the U.K. equivalent. Why not just drop the threshold in the U.S. market too?

Several of the big food and beverage manufacturers have pursued this path, vowing to cut sugar in their products. Coca-Cola says it has already reduced it in more than 200 of its sodas. For its part, PepsiCo has committed that by 2025, at least two-thirds of its volume will have 100 calories or fewer per 12 ounces. (A can of Pepsi has 150 calories, for example.) General Mills has begun slashing sugar in its cereals and yogurt. Nestlé and Dr Pepper Snapple have made pledges of their own.

The challenge stems in large part from what the rest of the market is doing. “They’re afraid that consumers will taste 20% lower sweetness and go to a competitor,” says DuBois. Paul Bakus, Nestlé’s president of corporate affairs, told me that the company has to walk a narrow line between being nutritionally superior to the rest of the market and not sacrificing taste. “We want to reduce sugar where possible as long as we don’t put ourselves at a competitive disadvantage,” he says. “How do you compete if your competitors aren’t following the process or rules or guidelines?”

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Everything in Moderation, Including Moderation

I’ve been drinking more beer in the last three months than I have in the last fifteen years. Meaning, I’ve been drinking beer at all. I gave it up because it made me sluggish, but I’ve fallen back in love with beer’s flavor. Is this an unhealthy development?

In his 2014 Pacific Standard article “The Truth We Won’t Admit: Drinking Is Healthy,” Stanton Peele not only argues that moderate alcohol consumption protects you from cardiovascular disease and helps you live longer, he treats abstinence itself as an undeniable risk factor in heart disease and shortened life spans. “Well-informed Americans,” he says, “think that abstinence is better for them.” The reason: “…Americans’ addiction-phobia, which causes them to interpret any daily drinking as addictive.” A psychologist and addiction specialist by trade, he cites studies that show the positive effects moderate and even “excessive” drinking have on health and longevity. Peele traces this deep-seated cultural issue back to the temperance movement on through modern health care, where the U.S. public health establishment’s standard treatment of alcohol’s cardiovascular benefits is a resounding, systematic silence.

I read this the other night while pouring myself a pint. Maybe I should explore my motives for resuming drinking in case I’m unconsciously reaching for some delicious way to manage the increasing stress in my life. But in terms of volume consumed, there’s no issue. When I drink, I drink one beer. Too much alcohol disrupts my sleep, so I keep it between three and five beers a week. Most people laugh. Five a week? How about five a night! 

According to the Mayo Clinic, my weekly three-to-five fall within the moderate range, which the CDC lists as up to two drinks a day for a man, one for a women, with a drink defined as 12 ounces of beer and 5 ounces of wine. “When it comes to drinking alcohol,” the Mayo says, “the key is doing so only in moderation.” Peele encourages moderate consumption, as does Aaron E. Carroll’s recent The New York Times piece “Drink to Your Health (in Moderation), the Science Says,” which offers stats about how people who don’t drink have a higher death rate than those who drink moderately.

With so many articles giving conflicting information about the pros and cons of contentious foods ─ coffee is good for you, coffee is bad for you; dark chocolate helps your heart, too much fat harms it ─ it’s hard to figure out moderation. 

Moderation lies the core of American dietary thinking. “Everything in moderation,” goes the old line, meaning don’t binge, and don’t abstain, but do take it easy on the bad stuff. Between the two poles of asceticism and indulgence, moderation is about never giving up or fully giving in. It’s a reasonable approach: walk the rational temperate middle road to health. Moderation works well for those of us who want to limit something for physical or ethical reasons, like meat, dairy or dessert, but not abandon it entirely. Life without chocolate is no life at all, but you don’t want to suffer from too much of a good thing, despite what Mae West said. Another example, I’m a weekday vegetarian. I abstain from animal flesh Monday through Friday, and I indulge on Saturday and Sunday. The reason: I object to factory farming on ethical grounds, but I can’t afford to buy only small farm, humanely raised meat. But by abstaining five out of seven days I balance my values with my financial inability to fully live by them, and also accommodate my taste for certain foods, since I do love pork. The result: moderate intake of animal fats and cholesterol; more regular intake of vegetables, legumes and fruits; greatly reduced participation in an unethical farming system; and only moderate guilt about not being able to skirt that system entirely. This approach loosely fits within the Aristotelian idea of the golden mean, and maybe in Confucius’s Doctrine of the Mean.

If I wonder whether I should worry about my sudden return to beer, Peele says it’s because this sort of worried thinking is part of our distinctly American problem. As a nation, we’re ambivalent about alcohol. We see it as poison that’s healthy to avoid, yet we drink it at games and parties and dinner. So we binge, sober up, and wrestle with our urges and guilt, when more of us should be sipping responsibly like so many Europeans. Peele acknowledges that it’s moderate consumption which science has found to have the most health benefits. But in order to reap those benefits, Americans need to get over the idea that daily moderate drinking ─ meaning, a drink or two at night ─ is somehow unhealthy, or a sign of a mounting problem, and the health community needs to stop telling the public that seven drinks a week for women is healthy, but ten is excessive. Peele distinguishes himself from the standard “everything in moderation” ideology in favor of Oscar Wilde’s quip about “Everything in moderation, including moderation because, he says, “the evidence that abstinence from alcohol is a cause of heart disease and early death is irrefutable.” Alcohol’s “benefits are greatest if you drink moderately. But even drinking more than is ‘perfectly’ recommended, without displaying clinical symptoms of problem drinking or alcohol dependence (and these are not subtle), is generally better for you than drinking nothing.”

He isn’t talking about just drinking a few beers. He’s saying drink to live. I love it when science tells me what I want to hear.

***

Additional Reading:

“Drink to Your Health (in Moderation), the Science Says” (Aaron E. Carroll, The New York Times, Dec. 21, 2015)
“The Truth We Won’t Admit: Drinking Is Healthy” (Stanton Peele, Pacific Standard, Aug. 12, 2014)

The Mysteries and Truths of Illness: A Reading List

Photo: NVinacco

In her essay “This Imaginary Half-Nothing: Time” (#10 on this list), poet Anne Boyer quotes another poet, John Donne: “We study health, and we deliberate upon our meats, and drink, and air, and exercises, and we hew, and we polish every stone that goes to that building; and so our health is a long and a regular work.” What happens when that long work is disrupted, when an irregularity appears? What if the irregularity is chronic, terminal, fatal? Here, I’ve collected 10 stories about authors reckoning with illnesses—some without cause or cure. Read more…

The Debate Over Alternative Medicine

Photo by Pixabay

The Laidlers’ story is a microcosm of the changing debate over so-called alternative medicine and its cousin, integrative medicine. In 2007, Americans spent $2.9 billion on homeopathic medicine, a treatment based on the belief that minuscule amounts of what causes symptoms in a healthy person will alleviate symptoms in someone who is ill. From nutritional supplements to energy healing to acupuncture, treatments outside the medical mainstream are big business. But the vast majority of scientists find much of alternative medicine highly problematic.

The supposed mechanisms of energy healing, homeopathy, and acupuncture are unscientific and violate basic laws of physics and chemistry. Other alternative treatments, including many nutritional supplements, are unproven, unregulated, and occasionally dangerous. This month, the fight came to a very public head when a group of doctors sent an open letter to Columbia University, demanding the school remove Dr. Mehmet Oz, who has used his syndicated TV show to promote integrative medicine, including nutritional regimens, homeopathy, and reiki—a form of energy healing that claims to use “universal life force energy” to “detoxify the body” and “increase the vibrational frequency on physical, mental, emotional and spiritual levels.” But at the same time, integrative medicine has pushed such techniques into the mainstream.

Alan Levinovitz, writing in Wired about the fight over alternative medicine, and Jim Laidler, a man who first turned to alternative medicine after both of his sons were diagnosed with autism.

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