He studied digestion and
the stomach and taught in the medical school at the University of Oklahoma. He
spent his summers on a farm in Pennsylvania, not far from Roseto although that,
of course, didn't mean much, since Roseto was so much in its own world that it
was possible to live in the next town and never know much about it. “One of the
times when we were up there for the summer this would have been in the late
nineteen fifties I was invited to give a talk at the local medical society,” Wolf
said years later in an interview. “After the talk was over, one of the local
doctors invited me to have a beer. And while we were having a drink, he said,
'You know, I've been practicing for seventeen years. I get patients from all
over, and I rarely find anyone from Roseto under the age of sixty-five with
heart disease.' ” Wolf was taken aback. This was the 1950s, years before the
advent of cholesterol-lowering drugs and aggressive measures to prevent heart disease.
Heart attacks were an epidemic in the United States. They were the leading
cause of death in men under the age of sixty-five. It was impossible to be a
doctor, common sense said, and not see heart disease.
Wolf decided to
investigate. He enlisted the support of some of his students and colleagues
from Oklahoma. They gathered together the death certificates from residents of
the town, going back as many years as they could. They analyzed physicians'
records. They took medical histories and constructed family genealogies. “We
got busy,” Wolf said. “We decided to do a preliminary study. We started in
nineteen sixty-one. The mayor said, 'All my sisters are going to help you/ He
had four sisters. He said, 'You can have the town council room/ I said, 'Where
are you going to have council meetings?' He said, 'Well, we'll postpone them
for a while the ladies would bring us lunch. We had little booths where we
could take blood, do EKGs. We were there for four weeks. Then I talked with the
authorities. They gave us the school for the summer. We invited the entire population
of Roseto to be tested.”
The results were
astonishing. In Roseto, virtually no one under fifty-five had died of a heart
attack or showed any signs of heart disease. For men over sixty-five, the death
rate from heart disease in Roseto was roughly half that of the United States as
a whole. The death rate from all causes in Roseto, in fact, was 30 to 35
percent lower than expected. Wolf brought in a friend of his, a sociologist
from Oklahoma named John
Bruhn, to help him. “I
hired medical students and sociology grad students as interviewers, and in
Roseto we went house to house and talked to every person aged twenty-one and
over,” Bruhn remembers. This happened more than fifty years ago, but Bruhn
still had a sense of amazement in his voice as he described what they found. “There
was no suicide, no alcoholism, no drug addiction, and very little crime. They didn't
have anyone on welfare. Then we looked at peptic ulcers. They didn't have any
of those either. These people were dying of old age. That's it.” Wolf's
profession had a name for a place like Roseto a place that lay outside everyday
experience, where the normal rules did not apply. Roseto was an outlier. Wolf's
first thought was that the Rosetans must have held on to some dietary practices
from the Old World that left them healthier than other Americans. But he
quickly realized that wasn't true. The Rosetans were cooking with lard instead
of with the much healthier olive oil they had used back in Italy. Pizza in
Italy was a thin crust with salt, oil, and perhaps some tomatoes, anchovies, or
onions. Pizza in Pennsylvania was bread dough plus sausage, pepperoni, salami,
ham, and sometimes eggs. Sweets such as biscotti and taralli used to be
reserved for Christmas and Easter; in Roseto they were eaten year-round. When
Wolf had dieticians analyze the typical Rosetan's eating habits, they found
that a whopping 41 percent of their calories came from fat. Nor was this a town
where people got up at dawn to do yoga and run a brisk six miles. The
Pennsylvanian Rosetans smoked heavily and many were struggling with obesity. If
diet and exercise didn't explain the findings, then what about genetics The Rosetans
were a close-knit group from the same region of Italy, and Wolf's next thought
was to wonder whether they were of a particularly hardy stock that protected
them from disease. So he tracked down relatives of the Rosetans who were living
in other parts of the United States to see if they shared the same remarkable
good health as their cousins in Pennsylvania. They didn't. He then looked at
the region where the Rosetans lived. Was it possible that there was something
about living in the foothills of eastern Pennsylvania that was good for their
healthThe two closest towns to Roseto were Bangor, which was just down the
hill, and
Nazareth, a few miles
away. These were both about the same size as Roseto, and both were populated
with the same kind of hardworking European immigrants.
Wolf combed through both
towns' medical records. For men over sixtyfive, the death rates from heart
disease in Nazareth and Bangor were three times that of Roseto. Another dead
end.
What Wolf began to
realize was that the secret of Roseto wasn't diet or exercise or genes or
location. It had to be Roseto itself. As Bruhn and Wolf walked around the town,
they figured out why. They looked at how the Rosetans visited one another,
stopping to chat in Italian on the street, say, or cooking for one another in
their backyards. They learned about the extended family clans that underlay the
town's social structure. They saw how many homes had three generations living
under one roof, and how much respect grandparents commanded. They went to mass
at Our Lady of Mount Carmel and saw the unifying and calming effect of the
church. They counted twenty-two separate civic organizations in a town of just
under two thousand people. They picked up on the particular egalitarian ethos
of the community, which discouraged the wealthy from flaunting their success
and helped the unsuccessful obscure their failures.
In transplanting the
paesani culture of southern Italy to the hills of eastern
Pennsylvania, the
Rosetans had created a powerful, protective social structure capable of
insulating them from the pressures of the modern world. The Rosetans were
healthy because of where they were /row, because of the world they had created
for themselves in their tiny little town in the hills. “I remember going to
Roseto for the first time, and you'd see three generational family meals, all
the bakeries, the people walking up and down the street, sitting on their
porches talking to each other, the blouse mills where the women worked during
the day, while the men worked in the slate quarries,” Bruhn said. “It was
magical.”
When Bruhn and Wolf
first presented their findings to the medical community, you can imagine the
kind of skepticism they faced. They went to conferences where their peers were
presenting long rows of data arrayed in complex charts and referring to this
kind of gene or that kind of physiological process, and they themselves were
talking instead about the mysterious and magical benefits of people stopping to
talk to one another on the street and of having three generations under one
roof. Living a long life, the conventional wisdom at the time said, depended to
a great extent on who we were that is, our genes. It depended on the decisions
we made on what we chose to eat, and how much we chose to exercise, and how
effectively we were treated by the medical system. No one was used to thinking
about health in terms of community.
Wolf and Bruhn had to
convince the medical establishment to think about health and heart attacks in
an entirely new way: they had to get them to realize that they wouldn't be able
to understand why someone was healthy if all they did was think about an
individual's personal choices or actions in isolation. They had to look beyond
the individual. They had to understand the culture he or she was a part of, and
who their friends and families were, and what town their families came from.
They had to appreciate the idea that the values of the world we inhabit and the
people we surround ourselves with have a profound effect on who we are.
In Outliers, I want to
do for our understanding of success what Stewart Wolf did for our understanding
of health.
To be Cont'd......
Posted By Adam Mahama Yunus
