Setting an exercise example.(GUEST EDITORIAL)

American medicine has allowed itself to become lost. Our $1.8 trillion annual outlay for health care nets us a 37th place world ranking in composite health outcomes. Other industrialized countries (such as Norway, which ranks first) spend far less per person per year, order far fewer tests, use far fewer pharmaceuticals, and do far fewer procedures--and yet have lower morbidity and mortality.

This trend has come into clearer focus during the past year, a year that has not been kind to the pharmaceutical industry. Recent months have brought revelations about unexpected severe side effects in many classes of drugs, including cyclooxygenase-2 inhibitors, traditional NSAIDs, bisphosphonates, and statins. Such concerns do not stop me from giving prescriptions to patients, but I have become much more thorough in discussing risks and benefits when considering whether to introduce a drug.

Like my fellow physicians, I have dished out tens of thousands of prescriptions, and I would never claim that this has done no good. But I feel that I must do more than pass out pills if I am ever to have a profound effect on my patients' health and longevity. And unless I have the gumption to live the life that I would recommend to them, my words carry no weight. If you want to talk the talk, you must walk the walk.

My patients in our rural community have all seen me running on the roads and trails. In the last 2 years, I have taken up ultradistance running, and this last year I ran my second 50-mile race--a race that began in a blizzard--in 10 hours 45 minutes. When not running, I partake of the abundant Maine white water as kayaker and canoeist.

But I have not been able to convince my colleagues that they need to exercise every day. The lives of physicians are increasingly hectic: 30-patient office days, nights on call, stacks of charts, paperwork, dictations, and hospital rounding. Physicians have come to exemplify the exact opposite of what I would try, health ...