The Health Habits of ‘Mad Men’ (and Women)

By  //  April 7, 2013

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Health & Life Style Choices

Mad Men’s self-indulgent anti-hero, Don Draper, with his ubiquitous cigarette. ( images)

THE SIXTH SEASON of the very popular Emmy and Golden Globe award winning dramatic television series, Mad Men, is in full swing on AMC starting tonight.

Set in 1960s New York City, the stylized, steamy and provocative ongoing story-line follows the lives of the ruthlessly competitive men and women of a Madison Avenue advertising agency, Sterling Cooper, an ego-driven world where key players make ad copy and ideas a sometimes unethical and often perverse art.

The focal points of the series are Don Draper, initially the creative director at Sterling Cooper and later a founding partner of the newly created firm Sterling Cooper Draper Pryce, and the people in his life, both in and out of the office.

Mad Men has received critical acclaim, particularly for its historical authenticity and visual style, which regularly depicts the changing moods, social mores and pernicious health habits of 1960s America.

Unhealthy Life Style

One of the most striking differences between that era and today is our dramatically changed outlook and behavior related to life-style and health.

Because of today’s much better educated and more aware populace, the mortality rates from many diseases related to self-destructive habits, such as smoking and heavy habitual drinking, every-day staples in the lives of the “Mad Men and Women,” are down.

Pregnant or not, Don Draper’s troubled wife, Betty, smokes and drinks her way into the 5th year of Mad Men.

The lives of the Mad Men company have never, in any episode that I can recall over the 4-year run of the program, been encumbered with anything remotely related to exercise or fitness, and an acute heart attack or two has not been a deterrent to ongoing heavy indulgence in tobacco, booze and cholesterol-laden cuisine.

My 27-year old daughter, who will be completing her masters degree as a physician assistant this summer, has followed the series closely.

She was initially appalled by the chain smoking, which is an integral part of almost every character, and especially disconcerted by the behavior and habits of Draper’s troubled wife, Betty, who smoked constantly and drank regularly, including during her pregnancy in an age of ignorance related to the risks of smoking and alcohol to the unborn.

Having lived through that era with parents who smoked, both of whom had lung cancer, I took the opportunity to impart to my daughter a candid history lesson of the the life and times before cigarette pack and booze bottle health warnings.

What’s Changed Since The Days of Mad Men

Healthcare spending now at $2.6 trillion annually. (Shutterstock image)

Cost: In 1960 the annual per capita annual healthcare expenditure was $147. It was $8,402 in 2010. The total healthcare expenditure was $27 billion in 1960, ballooning up to $2.6 trillion in 2010.

Healthcare spending as a percentage of U.S. gross domestic product was 5.2% in 1960 and 17.9% in 2010.

Healthcare Provider Profile: Women made up less than 8% of the med school graduates and even less in the active physician workforce in 1960.  Today, ~50% of med school graduates are women and they comprise ~30% of the active physician workforce.

The allied health “physician extenders,” who are so vital to today’s practice patterns and healthcare services did not exist in 1960.  In the mid-60s, training programs for both physician assistants (PA) and advanced registered nurse practitioners (ARNP) were established in response to physician shortages.

Today there are over 70,000 PAs and 100,000 ARNPs serving in a myriad of capacities to extend the availability of needed professional health resources in the U.S.

Medicare:  Medicare was not in existence in 1960. Since its enactment in 1965, spending on Medicare has grown steadily, as measured in absolute dollars, as a share of the federal budget, and as a share of the gross domestic product.

Growing astronomically from it’s first year in 1966 from $3 billion to $524 billion in 2010, expenditures represented 15 percent of all federal outlays and 3.7% of the gross domestic product.

Population: Life expectancy in 1960 was 69.8 years, and in the most recent preliminary data available for 2010 it is 78.7 years.  The chain smoking, habitual drinking and destructive behaviors surely took their toll on the Mad Men.

In 1960, 17 million people were 65 or older.  Now there are over 40 million in that age range.

Chronic Disease:  As expected, there has been a marked decrease in deaths related to heart disease and stroke since 1960–68% in heart disease, and 78% in stroke; with a more modest ~10% decrease in deaths due to cancer and diabetes.

The cancer survival rate has increased appreciably since the 60s, with statistics showing a >32% increase in cancer survival across the board since the mid-70s.

The bad news centers around the prevalence of obesity and diabetes.  13% of the 1960 population was obese, with that statistic unfortunately now up to over 35% and representing one of the most critical healthcare problems facing us today.

The burden of today’s diabetic management is reflected in the >500% increase in diabetes since the 1960s, when 1.3% of Americans carried the diagnosis, as compared to 7.4% today.

Life-StyleIn the mid-60s over 42% of the population smoked cigarettes, a pack of which cost between a quarter and 35 cents, and anyone of any age could purchase a pack right over the counter or out of a vending machine.  That rate is now down to 20%, but unfortunately the progressive decrease in smoking seen over the past 10 years has started to plateau especially among teens.

Work, play or at home, alcohol plays a prominent role in Mad Men, which depicts a world of liquor-stocked offices, 4-martini lunches and alcohol-soaked dinners.

A recent report by the U.S. Surgeon General found that young people who have a greater number of peers who smoke are more likely to start smoking themselves, and exposure to actors in movies and on television lighting up increases the likelihood that a young person will begin to smoke.

Alcohol consumption in America peaked between 1975 and 1985, but is now at the same level as the mid 60s at 8-9 liters per capita annually.  In the 60s, bad behavior resulting from heavy drinking could be considered “macho” and even romantic, rather than an addictive disease. One reviewer called Draper’s on screen boozing a “sobering tale of drunken excess,” depicting a man struggling with his addiction to alcohol.

We’ve come a long way since the early 60s when running for fitness was very rare and exercise was not a priority or an activity considered key to good health.

Of course today we have an excellent understanding of the value of exercise, however only 40% of the adult population exercise on a regular basis and only one quarter have done so for five or more years –  38% of females, 43% of males, 29% of those 65 years and over exercise or play sports regularly.

“Baby Boomers” Usher In a Healthier Outlook But Sheer Numbers Challenge the System

There is some irony in the fact that, as a surgeon who treated that “Greatest Generation” depicted by Draper and his cronies for mostly preventable severe conditions, such as lung cancer and ischemic peripheral vascular disease, I made a living on their misfortune and  life-style indiscretions.

The healthcare industry’s new focus on the “whole” individual, a patient-centered home, and helping to facilitate a life-style that embraces health and wellbeing is far-removed from healthcare in the Mad Men era.

Despite a healthier life style, as the first wave of Baby Boomers reaches retirement age, predictions for the nation’s health care system have been nothing short of apocalyptic.

However the predictions are not necessarily based on a high incidence and severity of specific preventable chronic diseases like we saw in the last four decades of the 20th century, but more on the surge in demand for increasingly costly global medical care straining our resources to a degree that future generations will face permanently higher inflation, higher taxes – or both.

The best advice I can give my daughter as she ventures out into the healthcare workforce 52 years removed from the Mad Men era is to maintain a laser focus on meeting the individual needs of and instilling the importance of healthy choices in each and every one of her patients.