These paradoxical developments arising in the clinic or in the lab should not be viewed as nuisances or obstacles impeding the path of medical progress. They should serve as intellectual challenges or warning signals that dare us to return and reappraise our preconceived notions about health, disease and human biology. Unraveling their rationale might be daunting, but the knowledge gained can be considerable.
Foie Gras et Fromage
Among the best known medical paradoxes is one relating to the dietary habits of our Gallic friends. In France, the national consumption of saturated fats exceeds standards established by the World Health Organization by as much as 50%.5 Foie gras et fromage (cheese) and leisurely meals that are pleasurably enhanced by liberal quantities of wine—slow cooking at its very best. Yet despite the high intake of dietary cholesterol and saturated fat, the death rates related to coronary heart disease are significantly reduced in France compared with other countries, such as the U.S., where fat consumption and alcohol ingestion are far less.6 Might these findings be due to the French love of food and its careful preparation in contrast to the more puritanical American view of food as a commodity to be consumed quickly and in large quantities?7
When it comes to life expectancy, diet may even trump the economic success of a nation. Consider the tiny country of Albania, whose gross domestic product ranks 96th in the world and life expectancy, 77.35 years, is just 17 months shy of the American average. Although its infant mortality rates are among the highest in Europe and the high cost of food requires them to spend three-quarters of their income on food, Albanians share the low rates of cardiovascular mortality observed in neighboring countries in the Mediterranean area.8
In our hemisphere, there is the mystery of the Cuban health paradox. This small island country whose economy produces about $6,000 in goods and services per person annually, a mere fraction of U.S. economic activity, lacks access to many commonly used drugs. Specialty medical care is scarce, and obesity rates are high and growing. Yet Cuba boasts a life expectancy that surpasses the U.S. by six months.9 Could this finding be explained by their diet, too, one that is rich in fresh produce, but low in saturated fats? Or might it be related to their accessibility to primary care services and high compliance rates of childhood vaccination?
Another puzzle: Why do immigrants live longer than their native-born neighbors? For decades, it has been observed that people with greater income or formal education enjoy better health and tend to live longer than their counterparts who have less money or schooling. Despite their reduced incomes and lower levels of formal education, immigrants to the U.S., Australia, Germany and Canada live longer than native residents.
