'We're Broke': Empty Bank Accounts, Empty Meaning?

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How 'Italian Food' Became A Global Sensation

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Italian food is now popular around the world. My guest, John Mariani, points
out that it wasn't long ago that Italian food just about everywhere outside of
Italy was regarded as little more than macaroni with red sauce, chicken
parmigiana, pizza, and cheap wine.

Before World War II, only a handful of major cities around the world had any
Italian restaurants at all. Mariani is the author of the new book "How Italian
Food Conquered the World," which is in part about how immigrants to America
created the Italian-American style of cooking that became so popular.

Mariani is also the author of "America Eats Out" and "The Dictionary of
American Food and Drink." He's the food and travel correspondent for Esquire
magazine and the wine columnist for Bloomberg News.

John Mariani, welcome to FRESH AIR. The Italian food that really caught on
first in America - you point out it wasn't really Italian food, it was more
Italian-American food. So what was the food that first caught on?

Mr. JOHN MARIANI (Author): Well, it was clearly the immigrants from the
southern part of Italy. Eighty-five percent of the immigrants who came to the
United States between 1880 and 1920, five million of them, 85 percent were from
the south - Naples, Sicily, Abruzzo, where my people came from, Campania - and
these were very, very poor people, who believe me, had never been to nor owned
a restaurant nor probably so much as a grocery store.

And back in the old country they were spending 75 percent of their income on
food, and that was a meager income. And when they got to the United States,
they found they were spending only 25 percent of their income, and there was
food available every day.

Out of this came the so-called Italian-American cooking, which was based very
much on Italian products, but they weren't the same as Italian products over
there because they just couldn't get them at that point. They did ship in their
own cans of tomatoes. But curiously enough, the tomato came from America and
went to Italy. But this kind of cuisine started out with pizza and a little
pasta and some Italian salads, and it was only within the Italian communities
in the United States, mostly New York, Boston, Providence, some in New Orleans.
The Sicilians went to New Orleans.

And it grew in popularity because it was a very lovable, comforting and at that
point very inexpensive cuisine. So that after World War II, when the Italians
were starving again, until their recovery kicked in, the rest of the world
started to catch on to Italian-American food rather than the regional foods of
Italy, which were very, very different from one another.

So that a Tuscan was not eating the food that a Sicilian was eating, and a
Sicilian was not eating the food that somebody from Rome was eating. They were
very different - 20 different regions with distinct cuisines. So it took
Italian-American cuisine to actually conquer the world.

GROSS: So getting back to Italian-American cuisine, so we're talking pizza,
pasta, marinara sauce. This was based on home cooking. It wasn't really based
on restaurant cooking, because as you pointed out, the Italian-Americans who
were first selling this kind of food in restaurants and pizza places didn't
likely ever go to a restaurant in Italy.

Mr. MARIANI: The only likelihood that they had ever been to something, a
facsimile of a restaurant, would have been a pizzeria, because those did begin
in Naples after 1860. And the pizza margherita, as we know it, which is the
typical - prototypical tomato, mozzarella and basil, was actually concocted on
a specific week in 1881 when the Queen consort of the New Italy came to Naples
and there was a competition among the pizza makers and he put together, very
cannily, a pizza that had the colors of the new Italian flag, red tomato, white
mozzarella, green basil. So the Italians - well, let's say the Neapolitans, at
least, had familiarity with pizza, because that was a street food, that was a
snack food when they might have had an extra couple of lira to spend.

GROSS: Can I interrupt you for a second? So it - this was named after Queen
Margaret, who was making the visit?

Mr. MARIANI: Yes, yes, Margherita. So when those people came to America, one of
the first things that appeared in New York that is completely identifiable is
the pizzeria, which in 1905, the first one - it's still there, open on Spring
Street in Greenwich Village, it's called G. Lombardi's. And then they
proliferated, and then there were Italian grocery stores where you can an
Italian sandwich. But it grew and grew in popularity throughout the 1920s and
'30s. It was cheap food, just as Jewish-American food was cheap food. Chinese-
American food was cheap food.

And it got its foothold early on. Also, as I said, five million of those
Italians came over, so that's a lot of Italians to spread the word.

GROSS: So if Italian restaurants early on in the history of Italian-American
food in the U.S. were based more on home cooking than on what restaurant
cooking was in Italy, how similar was what you'd eat in a restaurant to what an
Italian family would actually eat at home? Because like if you went to an
Italian restaurant back then, you'd probably get a really big plate of pasta,
and then probably a fairly big portion of meat, maybe a big dessert.

I mean, Italian food when I was growing up was always seen in my neighborhood
as very fattening food. Now Italian food is considered really healthy,
Mediterranean cuisine, but you know, the cheeses and the pastas and the big
desserts were not seen as healthy food.

Mr. MARIANI: Well, they weren't seen by most people as healthy food because
they probably ate too much of it at those very little restaurants in
trattorias. At home, as you say, that's where it was all taking place, because
the abundance of American ingredients in every market changed radically the
position of the Italian woman, especially the southern Italian woman.

Because back in the old country, her job was solely to get some food on the
table, whatever it was. And in the North it was almost every single day, three
times a day, polenta. In the south they might get pasta just a couple of times
a week, a few vegetables.

When the immigrants came to the United States, they could afford to buy pretty
much anything they wanted, so that the shift of the Italian housewife went from
just getting food on the table at a subsistence level to becoming the best cook
on the block. And part of that was the abundance. Part of that was that we can
have 10 meatballs if we want. We can a pizza that's 12 inches across rather
than six inches across.

And this was translated into the restaurants, as you said, too much food, too
much sauce, too much abundance, which Americans being big eaters just dove into
for so many years. And it was not particularly healthy food, and it was not
particularly the best of ingredients necessarily either.

It was only in the 1990s that the so-called Mediterranean diet came along,
which I detail in my book, where the whole food pyramid that we all learned
about in high school was just upended so that the proteins were now at the tip
top, meaning the smallest amount you should eat, and the beans and the grains
and the pastas and the olive oils were all on the broad bottom, which is what -
most of what we should eat. That was a very big departure from how Italian food
was viewed before that.

GROSS: If you're just joining us, my guest is John Mariani, who writes about
food, has written several books about food. His new book is called "How Italian
Food Conquered the World."

Now, you talk about how after World War II, when, you know, processed food,
canned food became really popular - there was all this like new food technology
- that Chef Boyardee became like a really famous brand, and you tell the story
of Chef Boyardee. I'd like you to tell the story.

Mr. MARIANI: Well, he was an Italian immigrant, grew up in the Midwest and had
some restaurants. And during World War II, because pasta, let's - we'll say
spaghetti - was such a cheap dish, and canning was the only way to get American
GIs and servicemen fed, that he made a small fortune in the ration business
during World War II. This also allowed those hundreds and hundreds of thousands
of GIs and Air Force kids and Navy kids to get a taste of Italian food that
kids who didn't grow up in the eastern cities probably had never really tasted
before.

So after the war he marketed it and very, very successfully so, sold millions
upon millions of cans. And I remember asking my mother for it growing up in the
1950s, and of course she arched an eye, and said, well, if you must. And I
remember tasting it for the first time. It was just this overcooked canned
spaghetti in a sweet tomato sauce, and I was just appalled at how bad it was.

But that very night that I tried it for the first time, there were millions of
American kids eating that thing. Still do.

(Soundbite of laughter)

GROSS: Yeah. And also, I think like in the '50s and '60s, dishes like chicken
cacciatore were really popular. It's funny the way Italian food has gone in and
out of fashion, like do you see chicken cacciatore on a lot of menus now?

Mr. MARIANI: You do now, and you see - I see more eggplant parmigiano, eggplant
parm, if you will, on some of the toniest of Italian restaurants, and it's
really, really good. And this is - and the reason it's really, really good is
that in the past it was made with the cheapest possible ingredients. By the
past I mean before the 1970s and early '80s.

Italian cooks and chefs had absolutely no access to what we now take for
granted, which is to say extra virgin olive oil. Nobody ever heard of extra
virgin olive oil. Nobody outside of the city of Modena, where it was used as a
Christmas gift, was balsamic vinegar known to anybody. Funghi porcini, true
prosciutto, which was kept out by the pork producers of America for so long,
parmigiano reggiano, all of these things, and of course the ultra-expensive
white truffles. These were ingredients that were not available in any way,
shape, or form, to Italian cooks, however expensive their restaurants where.

So they had to use white mushrooms instead of funghi porcini, and they had to
use poor quality olive oil, and not - no imported pasta. So they were at a
disadvantage to really show off how delicious the food could be.

GROSS: So how did olive oil become a staple, not only of Italian cooking but of
cooking?

Mr. MARIANI: Well, you're absolutely right about that. The French, who once
completely eschewed olive oil, unless they were in the deep south of France
along the Riviera, if you open the typical French cookbook in the 1980s, you
would barely see olive oil mentioned at all. Today, pick up a French cookbook,
and I would say that at least 60 to 70 percent of the recipes are using olive
oil.

And this happened again...

GROSS: And sometimes instead of butter, right?

Mr. MARIANI: Oh, absolutely. I mean, you speak to a chef like Alain Ducasse,
Roger Verge, all of these famous French chefs, and they extol the virtues of
olive oil for its taste, not for its health benefits.

But what really happened with olive oil that made it so fashionable was that
the International Olive Oil Commission in the 1980s was one of the major
promoters and funders of that Mediterranean diet idea. And it coincided with
the so-called slow foods movement which grew very rapidly out of Turin, that
artisanal products and smaller producers make the best food, which seems very
logical to most Europeans. But to the rest of the world, or least to Americans,
we didn't know about that. We really didn't know.

Most Americans idea of parmesan cheese was out of that little green canister
that Kraft Foods made. So olive oil now, you can't go into any supermarket
anywhere without finding half a dozen olive oils, and they're all extra virgin
olive oil.

GROSS: My guest is John Mariani. His new book is called, "How Italian Food
Conquered the World." We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is John Mariani. He writes about
food. He writes a column for Esquire. He writes a column for Bloomberg News.
He's written several books. His new book is called "How Italian Food Conquered
the World."

Now, there's a lot of American chefs who aren't Italian, but who love Italian
food, and who either specialize in it or serve it as part of their menu. Do you
think Americans who aren't Italian-American have changed Italian food?

Mr. MARIANI: Yeah. The most salient example of that is a guy named Michael
White. He's this big luggy Wisconsin Midwestern kid who fell in love with
cooking and told his mother and father, I want to go to Italy to study food.
And, of course, this is more than 10 years ago, they said, you've got to be
crazy.

Well, he did, and he learned the right way, and he came back. And by working at
some of the finest Italian restaurants in New York and Chicago, like Spiaggia
in Chicago and San Domenico in New York, he learned this refined Italian
cuisine, and he's opened a series of restaurants which I now consider among the
best Italian restaurants in the United States, one of which is Marea. Marea, M-
A-R-E-A, is on Central Park South.

And there, like Paul Bartolotta in Las Vegas, he is doing a kind of seafood,
Italian seafood, which you will only find on the Italian Riviera made as well
as he does.

Now, the interesting thing is being not an Italian-American, but an American
kid, he puts his spin on everything. So his latest restaurant is called Ai
Fiori, but there's a lot of French and global techniques in there. So he's not
so staid, as many, many, many Italian restaurants in the old country are staid
and never get out of their comfort zone. Guys like Michael White are not only
leading the charge, but believe me, those are the chefs that the Japanese and
the people in New Delhi, and the people in Shanghai are all looking to and
often hiring to come over and either consult on their restaurants or to open a
restaurant, a Michael White restaurant in Shanghai or New Delhi.

Just as some years ago Wolfgang Puck who pioneered the so-called gourmet pizza,
now has outposts all over the world.

GROSS: And he's not Italian, right?

Mr. MARIANI: No. He's an Austrian kid. He's an Austrian-born, Southern
California chef. He came there in the '70s, cooked strictly nouvelle French
cuisine. And then when he opened Spago, because he didn't have much money, he
said, well, I just want this to be a really good pizzeria, but I want it to be
the kind of pizzas that you could get in Naples, rather than an Italian-
American, or at least the American pizzas.

And in addition, he struck really gold when he came up with the so-called
Jewish pizza, which was with smoked salmon, caviar, and sour cream on top.

GROSS: I have to say those kinds of pizzas make no sense to me.

(Soundbite of laughter)

GROSS: I think I'm kind of a traditionalist in that respect. But...

Mr. MARIANI: Oh, me too.

GROSS: Like I don't understand like pineapple on pizza and things like that.
Can you explain it?

Mr. MARIANI: Well, that is very typically American corporate. Which is to say
that Wolfgang Puck comes along, or Alice Waters up in Chez Panisse, and they
make a few interesting pizzas that go a little beyond the outside of the usual
circle, and they add ingredients that are unusual, but that's their
interpretation.

What happens then is something like California Pizza Kitchen gets hold of it,
and says, let's have 35 different pizzas. Let's put anything we want. Let's put
barbecued chicken on top. Let's, as you say, call it a Hawaiian pizza and put
pineapple. And I think at a certain point a pizza stops being a pizza, or at
least stops being a good pizza or anything like a good pizza.

GROSS: You give some recipes in your book, and one of the recipes is for
marinara sauce. What's your favorite recipe for a simple-to-make marinara?

Mr. MARIANI: This will be my easiest and quickest answer.

(Soundbite of laughter)

GROSS: Okay.

Mr. MARIANI: You take a pot, you put in three or four cloves of garlic, brown
them in olive oil, take them out, pour in a can of tomatoes, which have been
peeled. Cook that for about 20 minutes to 30 minutes. Mush them up if you like.
Salt, pepper, a couple of sprigs of basil, and that's it.

I mean, many times people - there's a story in the book that I tell, and it was
going to be the subtitle of the book called "Stretching the Sauce," and my
mother was a very good cook. I brought five or six friends home from college,
just walked in the door, and said, hi Mom. And she had finished dinner, and she
was oh, sit down, sit down, I'll make you something. And I said, well, no,
don't go to any trouble. And she said, no, no, I'll just stretch the sauce.

Well, that sauce only took 20 minutes to make, and for her it was, again, to
show off her prowess as a wonderful Italian-American chef. But that is what a
marinara sauce is, and curiously enough, you won't even find the name marinara
in the Oxford Companion to Italian Food.

It's not something they use in Italy. This was an Italian-American word
creation for the so-called red sauce that - there's an interesting quote in the
book from Martin Scorsese about how the red sauce - the marinara sauce became a
religion. And on Sundays, every Italian housewife, sometimes grandma, was
either making a very, very long-cooked meat sauce which could take three, four
hours or more, or the marinara sauce which took 15, 20 minutes.

GROSS: Now, correct me if I’m wrong. Your grandparents were both - your
grandmothers were both from Italy?

Mr. MARIANI: Yeah. My mother's side of the family was from Campania, south of
Naples, and my father's side was from Abruzzo, which is east of Rome, in a
little Adriatic town called Vasto, which I've seen pictures of in 1905 when
they came over. You would have emigrated too.

(Soundbite of laughter)

Mr. MARIANI: Now, it's a quite - now, it's quite a fashionable resort for the
Germans and the Austrians who just come right down the coast. But it was not a
nice place to be back then. It was poverty stricken as all of these southern
Italian towns were.

There's a quote in the book from Booker T. Washington, a former slave who
became one of Americas great educators, and he wrote a book called, "The Man
Farthest Down." And he visits Italy, this is in the 1880s, 1890s, and he saw
12-year-old children, 10-year-old children working in coalmines. And he said,
the American Negro of the South is not the man farthest down. I have seen the
man farthest down, and who are much worse off than the American Negro.

These were people who had to get out of town, and one of the great options was
America.

GROSS: So sometimes I ask musicians to redeem a song - to take a song they love
but that other people think of as square or corny or sentimental, and they're
often criticized for loving the song. I'm going to ask you to redeem a food, to
take a food that is mighty unpopular, but you think is really quite good.

Mr. MARIANI: I think, and I'm seeing more of it, that tripe, which is cow's
stomach, and it has to be cleaned by the butcher, and it's snowy white and
looks like a bathing cap, and it can be very, very chewy. But when it is stewed
in the Italian manner with tomatoes and onions and chili peppers and parmigiano
cheese, it is one of the best dishes in the world, and I'm seeing it more and
more and more on menus, and I couldn't be happier.

GROSS: But do a lot of butchers sell it?

Mr. MARIANI: No. It's - you really have to go to a specialty butcher. You're
not going to find tripe in the A&P.

GROSS: Right. Okay.

(Soundbite of laughter)

GROSS: Okay. Well, John Mariani, thank you so much for talking with us.

Mr. MARIANI: It's been a great, great pleasure. Thank you so much for having
me.

GROSS: John Mariani is the author of "How Italian Food Conquered the World."
You can read and excerpt on our website, freshair.npr.org. Mariani is also the
food and travel correspondent for Esquire magazine.

I'm Terry Gross, and this is FRESH AIR.
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Cyro Baptista: Sounds From Everywhere, Evoking Home

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Brazilian percussionist Cyro Baptista has played with everyone from Paul Simon
to Herbie Hancock to Yo-Yo Ma. On his new CD, Baptista and his band interpret
the music of composer and saxophonist John Zorn.

Music critic Milo Miles has a review of "Caym" on Zorn's label, Tzadik.

(Soundbite of music)

MILO MILES: Back in the heyday of world-music fusions in the 1980s, tradition-
minded players and fans worried that too much mixing of styles would result in
a dreaded generic worldbeat that was a bit of everything and a lot of nothing.
The neo-traditionalist movements that countered runaway fusions were worthy
attempts to keep old styles alive in specific regions and languages. And,
eventually, the idea of huge crossover hits in world music faded away.

But the ideal of blending diverse styles never went away. And one of the most
enduring proponents is percussionist and bandleader Cyro Baptista. He's from
Brazil, but his real native land is the recording studio and on stage. Baptista
is a regular collaborator with John Zorn and, like Zorn, you never quite know
what his records are going to sound like.

Indeed, "Caym," Baptista's latest project with his group Banquet of the
Spirits, uses a dozen themes written by Zorn as starting points. But all the
tracks take off in unpredictable, though satisfying, directions.

(Soundbite of music)

MILES: On the first cuts, Baptista and Banquet of the Spirits evoke and play
around with the sounds and textures of North African gnawa music, and even the
horn-driven clamor of Morocco's Jajouka musicians. But just when you think
"Caym" is settling into a pan-Middle East mode, the album swerves into a
delightful evocation of Indonesian gamelan.

(Soundbite of music)

MILES: Most impressive is that all this variety comes from just a quartet.
Producer and arranger Shanir Ezra Blumenkranz plays oud and the gimbri African
lute, as well as bass. Tim Keiper does drums and percussion, as well as the
ngoni guitar from Mali, and Brian Marsella excels on piano, harpsichord and
pump organ. Leader Baptista plays a slew of instruments that throb and rattle,
including some of his own invention. Everybody does some affable chanting from
time to time.

But, more than virtuosity, it's the harmonious, positive spirit of "Caym" that
makes it a fine introduction to Baptista's way of performing. The session ends
with a number called "Phaleg," featuring Marsella wailing on the pump-organ in
a workout that's both witty and eerie, a sort of Phantom of the International
Opera.

(Soundbite of song, "Phaleg")

MILES: The strong group unity and interaction helps "Caym" avoid the typical
downfalls of eclectic world-music albums: fancy, empty playing and superficial
dabs of exotic styles. Instead, you feel like you're listening to a captivating
travelogue, told by a group of nomads who are at home everywhere.

GROSS: Milo Miles lives in Boston. He reviewed "Caym" on the Tzadik label.

Coming up, a physician who has witnessed the spread of obesity and diabetes in
the Arctic and South Pacific.

This is FRESH AIR.
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How Western Diets Are Making The World Sick

TERRY GROSS, host:

My guest, Canadian physician Kevin Patterson, has witnessed the spread of
diabetes in the Arctic and on islands in the South Pacific. He attributes this
to obesity caused by an increasing reliance on processed foods and increasingly
sedentary lifestyles, as traditional lifestyles disappear. Patterson lives in
British Columbia on Salt Spring Island. But for the past 16 years, he spent
part of each year practicing medicine in the Arctic along the Hudson Bay. His
novel "Consumption" is based on his experiences in the Arctic. He's also
treated soldiers in Afghanistan, working as an internist and intensive care
doctor at the Canadian Combat Surgical Hospital in Kandahar. He co-edited
"Outside the Wire: The War in Afghanistan in the Words of its Participants,"
which was published in 2008.

Kevin Patterson, welcome to FRESH AIR. I want to start with an image that made
a big impression on me. You write about how when you were a doctor in
Afghanistan at the Canadian Combat Surgical Hospital in Kandahar, that you
treated Afghan soldiers, police and civilians, and that the insides of their
bodies were really different from the bodies you were used to seeing in Canada
and in the Arctic. Would you describe the differences?

Dr. KEVIN PATTERSON (Physician, Author): Typical Afghan civilians and soldiers
would have been 140 pounds or so as adults. And when we operated on them, you
know, what we were aware of so dramatically was almost the absence of any fat
or adipose tissue, or just trace amounts around the - underneath the skin. But
when, of course, when we operated on Americans or Canadians or Europeans, the -
what was normal was to have most of the organs encased in fat. And this is an
observation that has been made many times in lots of different places other
than war, but it had a kind of visceral - if you'll forgive the pun - potency
to it when you could see it directly there.

GROSS: You know, I have to say, I think often about how a body looks when it's
fat from the outside. I've never really thought - you know, not being a doctor
or not seeing surgeries, I've never really thought about how it looks different
inside. So you actually see fat inside, surrounding the organs?

Dr. PATTERSON: Yeah, absolutely. And more importantly, the visceral fat, the
fat that, in the abdomen, that encases the organs is very metabolically active
and is part of what has driven the epidemic of diabetes over the last 40 years
in the developed world.

And what's driven it, of course, is this rise in obesity, especially the
accumulation of abdominal fat. And that fat, as I said earlier, is
metabolically and endocrinologically active. It induces changes in our
receptors that cells have to insulin. Basically, it makes them numb to the
effect of insulin.

And for a long time, the body can compensate for that by secreting larger
amounts than normal of insulin in an effort to keep the blood sugar levels
normal. But over time, that numbness becomes too profound to be overcome by
higher-than-normal insulin levels, and then the pancreas begins to fail. It
can't secrete as much insulin as it had been, and this is when we develop
diabetes.

GROSS: After reading your article about working in Afghanistan, I got the
impression you were surprised that you never had to give insulin to Afghans.

Dr. PATTERSON: Mm, yeah. That's true. I do a lot of critical care here in
Canada, and this is normal when people are very sick and stressed by infections
or extensive surgery. We often have to give insulin even to non-diabetics in
order to keep their blood sugar something like normal. When the blood sugar
gets too high, it impairs the body's ability to fight off infection.

Among the Afghans who were critically ill, this was never necessary. And again,
it has to do with the fact that they were - you know, their body fat
percentages were a third or a quarter of what North Americans typically are.
Presently, you know, about a quarter or 30 percent of North Americans are
obese, and this representation rises quickly as people get older, which is the
people who make up most of our patients in a North American intensive care
unit. So this is a very common, almost normal problem for us.

GROSS: I don't want anyone to think that we're holding up the people from
Afghanistan as models of health. The average age of death in Afghanistan is 39.

Dr. PATTERSON: Yeah. Exactly. The - it's interesting. We - there's an idea
called the epidemiologic transition that describes how people get sick as a
function of where their society is historically and culturally. And it begins
with this idea of a hunter-gatherer society, and that's stage one. The Inuit,
with whom I work in the Canadian Arctic, lived like that, certainly until the
late 1960s. Their principal problems were starvation and predation and other
situations.

That changes in the Middle East with the Mesopotamians civilizations and the
advent of agriculture. And then people are still - have fairly precarious life
spans in terms of average age being about 35, 40. But their principal problem
becomes infectious diseases from the crowding. Starvation's still an issue.
Stage three happens with the Industrial Revolution, where really, there's
enough to eat, but industrial problems, malignancies, pollution start to bear
on it. Stage four is with the advent of antibiotics, and some North Americans
went through that in the 50s and 60s. And that's when, really, when life's
expectancy starts to take off.

Viewed on this idea that Afghans are pretty clearly still in stage two, where
they've got a subsistence agriculture existence and their life expectancy
reflects what other cultures have had in living that existence.

GROSS: Now, you work part-time in the Arctic treating Inuit people, native
people. Your novel, "Consumption," is about a doctor in the Arctic. I imagine
some of it is based on what you experience and observed. The doctor in your
novel comments on how the diseases and injuries he treats have changed since
the time he arrived there. And he says: I don't see the head injuries and the
dog maulings that I used to. Now they all waddle in to see me, and together, we
talk about how we might control our diabetes better.

So what changed as the diabetes level increased? What's behind it?

Dr. PATTERSON: Well, acculturation. The traditional Inuit culture of relentless
motion and a traditional diet - consisting mostly of caribou but also Arctic
char and whale and seal - that's been abandoned over this period of time for
Kentucky Fried Chicken and processed food and living a life very similar to
ours, spending an awful lot of it in front of a glowing screen.

GROSS: So whale is very fatty food. I mean, whale, it's blubber. It's whale
fat, right?

Dr. PATTERSON: Mm-hmm.

GROSS: So what's the difference between whale fat and, you know, fried chicken
or French fries?

Dr. PATTERSON: Well, I think the big thing is that your body will forgive you
for eating almost anything if you move enough. And if the way you get your
whale is by being out on a boat in the ocean working very, very hard to stick a
harpoon in a beluga whale, then you won't get large.

The other thing, too, is that historically, carbohydrates were almost not a
part of the Inuit diet. They'd get some when they ate the berries that were
available for a few weeks in the fall, and that would be about it. Now our diet
is so full of simple carbohydrates that they're not adapted to, and we're not
adapted to, either. And that's one of the big drivers of the rise of obesity
worldwide.

GROSS: You've written about how much cheaper it is in the Arctic to eat
processed food than it is to eat fresh food, in part because fresh food has to
be shipped in a refrigerated truck or train or whatever, plane, in order to get
there. And that's pretty expensive compared to, what, like, processed food that
can be packaged, and you could take a long time to ship it, and it still be
edible.

Dr. PATTERSON: Yeah. It's all flown in. There's no roads or rail access to any
of those communities.

GROSS: Oh.

Dr. PATTERSON: So a four-liter jug of milk can cost you 10 or $11. But, you
know, this - and part of the point in my writing has been to draw the parallels
between the experience of the Inuit and southern North Americans. There's a
very clear parallel between that and the inner city. In poorer neighborhoods,
in North American cities, fresh food, healthy food is either not available or
extremely expensive compared to - on a calorie-per-calorie basis - compared to
fast food available on every street corner.

And so something about the way we've structured the economics of food
privileges the least healthy food available to us. You know, we subsidize the
high fructose corn syrup products and make fresh beans and broccoli, much more
expensive again on a calorie-per-calorie basis.

GROSS: Are there fast food restaurants in the tundra now?

Dr. PATTERSON: It's amazing to think about it, but yeah, there are. There are
fried chicken outlets and burger joints in Rankin, in the little community I
work in, mostly. And they're just stacked. The people love that food.

GROSS: So what do you do when you're in the Arctic, when you're working there
and you don't want to have a fast-food, high-fructose-corn-syrup, lots-of-fat
kind of diet?

Dr. PATTERSON: It's really difficult, you know? The fresh food and milk is all
flown in, and is very expensive. And so it's easy to understand why people eat
so much of the highly processed, packaged food. But really, the answer for the
Inuit, I think, is to preserve some of the hunting tradition and continue to
eat caribou and fish. There's a public health effort to do just that. They call
it country food, and there's an effort to make Arctic char and caribou
available to families where there aren't hunters, and to encourage those
hunters who are still active to attempt to harvest as much food as they can for
the community.

It's difficult, though, because salty, sweet food appeals to the human palate,
and people crave it for reasons that have to do with food that we're designed
to crave, going back 50,000 years.

GROSS: The rise of diabetes in the Canadian Arctic must be a very expensive
prospect for the Canadian health care system, especially if more and more
people need dialysis.

Dr. PATTERSON: Absolutely. The fact is is that no country in the world has the
resources to continue to treat diabetics the way that they're being treated now
if the prevalence rates increase at the rate that they're increasing for much
longer. I worked in Saipan, which is in the Marianas Islands in the Western
Pacific. It's an American possession. And there, the dialysis population was
increasing at about 18 percent a year, all as a consequence of diabetes and
acculturation - exactly the same process that's going on with the Inuit.

You know, when you look at the curves, it's just clear how unsustainable it is.
In 20 or 30 years, everybody on that little island will either be a dialysis
patient or a dialysis nurse, unless something fundamental is done about the
rise in diabetes. And so change will be forced upon us. It's going to happen.
It would just be - it would be nice to do it in a considerate fashion earlier,
rather than waiting for the crisis that's coming our way. And that's no less
true in Canada and no less true in Samoa and Hawaii, and even in Omaha and
Toronto. You know, we all have exactly the same problem when we plot out those
curves.

GROSS: Dr. Patterson, thank you so much for talking with us.

Dr. PATTERSON: Oh, you're welcome.

GROSS: Dr. Kevin Patterson practices medicine in British Columbia and the
Arctic. His novel, "Consumption," is based on his experiences in the Arctic.
You can read an excerpt on our website: freshair.npr.org.

Coming up, linguist Geoff Nunberg considers the increasing use of the question
we're broke.

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'We're Broke': Empty Bank Accounts, Empty Meaning?

TERRY GROSS, host:

We're broke. That's an expression we've been hearing a lot lately, including
from legislators, mayors and governors.

Our linguist Geoff Nunberg has been thinking about what that homey expression
conveys.

GEOFF NUNBERG: The word economics comes from oikos, the Greek word for home,
and originally referred to the art of household management. It hasn't meant
that for some centuries, of course. But people are still drawn to describing
the affairs of government in homey terms. Take we're broke, which Republicans
have made their mantra to justify cuts in government programs and services,
none so insistently as John Boehner, who has been pleading the B word for
years, long before the B word was cool.

That claim that we're broke drives some people into a lather. A recent New York
Times editorial called it obfuscating nonsense. No states are going to go
bankrupt, it said, and a country with a big deficit is no more broke than a
family with a college loan. E.J. Dionne called it a phony metaphor. And a
recent Bloomberg article observed that you can't call a country broke when
investors all over the world are lining up to lend it money for less than a one
percent return.

In response, though, a spokesman for Boehner said that a family is broke if
they keep spending more than they're making. And who's to say that sort of
definition is wrong? It isn't as if broke is a precise term, like insolvent.

And Republicans aren't the only ones who have found the word a handy label for
government deficits. The New York Times' editorial qualms haven't deterred the
paper from running headlines like "California, Almost Broke." And even Jon
Stewart said not long ago that the country is broke, though he laid the blame
on the extension of the Bush tax cuts.

On the other hand, if the definition of broke is so loose, why go there in the
first place? The Times called the word a scare tactic. And broke can raise
specters of bailiffs and bread lines, and seems to come up a lot in the
scenarios of imminent financial catastrophe in ads for vendors of gold coins
and bullion.

But broke can convey things other than fear. It comes from an old use of break
to mean impoverish, and suggests an abiding association between destitution and
destruction, the same connection that gives us wiped out and busted, not to
mention the -rupt of bankrupt, which came from the Italian for broken bank. The
Victorians said all to smash, or more politely, ruined, which could suggest
financial, moral or social degradation, or sometimes all three together - as
when a character in Thackeray's "Vanity Fair" says: A countess living at an inn
is a ruined woman.

In fact, broke and its synonyms can convey those same overtones of shame and
disgrace, which is why we say somebody who's gone broke is financially
embarrassed. You can be born poor, but nobody's born broke. It's a calamity
that happens to you through ill fortune or improvidence. But one way or the
other, broke implies helplessness. As Ray Charles put it in "I'm Busted": There
ain't a thing I can do. It brings to mind the little "Monopoly" man on the
bankruptcy Chance card, with his pockets turned out and his palms and shoulders
raised in a plaintive shrug. That's what can make we're broke a self-absolving
way of closing down a discussion, whether it comes from a parent or a
politician. What part of we're broke do you not understand?

Well, okay, since I asked, it's the first part, actually. I get where broke is
going, but I have some trouble with that we. In my experience, people work more
sleight of hand with that little pronoun than with any other word in the
American political lexicon. Who exactly is the we on whom all that helplessness
and humiliation have been visited? Well, who could it be but the American
people, or the people of New Jersey, Wisconsin or wherever?

But if that's right, the statement's puzzling. It isn't as if the whole country
is beggared or the American economy has collapsed. There's still a lot of money
around in the aggregate, even if it's not spread around evenly and there are
places where the floorboards show through.

That's where the pronoun gets tricky. We doesn't always mean you and I and the
others. Thanks to the semantic operation called metonymy, the word can jump
from one thing to something else that's connected with it. When I say we're
parked out back, I don't mean me and my wife. I mean our car. And when the
president of the pep club shakes the tin where the cookie money's kept and says
we're almost broke, she doesn't mean the members are all out of money, just the
club's coffers.

And that's pretty much what John Boehner and Jon Stewart mean when they say
we're broke. Call it stealth metonymy. We're not broke, no more than we're
parked out back. It's just the cookie fund. And that isn't the helpless,
mortifying kind of broke that can descend on a family with nowhere to turn. We
either get some people to kick in a few more bucks, or we can spend the rest of
the school year eating saltines. But whether it's the pep club or the federal
government, that's a question of politics - not household management. And while
you could describe the situation by saying we're broke, that doesn't really
move the conversation along very much. The problem's with the pronoun. Things
would just be clearer if we were left out of it.

GROSS: Geoff Nunberg is a linguist who teaches at the School of Information at
the University of California at Berkley.

You can find links to all the clips and articles he referred to on our website,
freshair.npr.org, where you can also download podcasts of our show.
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