Medicine

Ask a surgeon why the gallbladder came out, and the answer arrives fast, almost cheerful: you don’t really need it. That’s true in the narrow sense that a person can live, eat, and digest fat well enough without one. It’s also one of the most quietly revealing sentences in modern medicine. Cholecystectomy — removal of the gallbladder — is now among the most common abdominal operations performed in the country doing the most of them, and the organ is coming out almost always because of gallstones that track, closely, with obesity and insulin resistance. Nobody is treating a design flaw in the gallbladder. They are treating the downstream damage of a metabolic environment the organ was never built to survive, and calling the removal a fix rather than a receipt. …

“Ask your doctor if it’s right for you.” Anyone who has watched American television knows the sentence by heart. It sounds like caution, but read it slowly and it’s a script: here is a feeling you may not have noticed, here is a product that addresses it, and here is a professional whose role in the transaction is to ratify or veto a decision you have already half-made. The ad doesn’t sell a drug. It sells a diagnosis and rents a doctor’s authority to close the deal. …

The body in front of the doctor is easy to measure. Weight goes on a scale. Height goes on a chart. Divide one by the square of the other and you have a number — a BMI — that gets entered into a database and flagged if it falls outside a range established in the 1830s by a Belgian astronomer named Adolphe Quetelet who was studying the statistical distribution of soldiers, not the metabolic health of individuals. Quetelet called his formula the Indice de Corpulence. He did not intend it as a clinical tool. He was doing population statistics. …