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Walter M. Bortz II, M.D. Headshot

Dare to Be 100: The Last Well Person

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This is the title of an article written by a Tennessee physician, Clifton Meador, published in the New England Journal of Medicine in 1994. In it he told the story of a fictional 53-year-old professor of algebra at a small Midwest college who goes through an extensive series of medical examinations, and nothing was found. He was "the last well person." This reminds me of a Victor Borge skit that told of his uncle who became depressed because he discovered a treatment for which there was no disease.

This article at first glance almost seems whimsical, but even a moment's reflection reveals the profundity of its ultimate message.

Meador's perspective faults the medical industrial complex (MIC) for its encouragement of sickness -- after all, that is how it makes money, by repairing people, surgery and drugs.

To gain more immediate access to people's anxieties, their underlying hypochondiasis, "The Last Well Person" takes aim at all the innuendos and commercial strategies that the MIC uses to gain access. The response of the young doctor when he or she is asked to define a healthy person replies "a healthy person is one who has not been fully worked up" is prescient, always another test to be done another treatment to be given.

All of this streams from the simple fact that no one of us is emotionally or intellectually strong enough to withstand constant intensive self-scrutiny. The magnifying mirror reveals many imperfections that the medical system is eager to take care of

The whole array of pre-diagnoses, pre-cancer, pre-hypertension, pre-dementia feeds into this pattern. I have personally participated in this labeling frenzy. I wrote a book "Diabetes Danger" that is actually not about having diabetes but about not getting diabetes in the first place. In it I coined the new term "pre-pre-diabetes" to classify those millions of people who do not yet qualify for the specific diagnosis of diabetes or pre-diabetes (fasting blood sugar over 100, or a two-hour after eating blood sugar over 140). There are 150 million Americans who are overweight or obese. There are 200 million Americans who are physically inactive who are primed to become first pre-diabetic and then frankly diabetic. They all have pre-pre-diabetes.


My issuance of a blinking yellow or red light is certainly not intended to promote a doctor's visit or a pill or even worse surgery. It is intended to inform. But when does health information overstep into medicalization?

This is the precise critique given by editorials in recent British Medical Journals about the World Health Organization's use of the word "complete" well-being in its reach for world health standards. Insisting on the qualifier "complete" leads to the notion that we are all sick or trying to become sick.

This is what "The Last Well Person" essay was all about.

It teaches that semantics matter a lot.

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