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Author gets 'Physical' in Mayo exam

'Physical: An American Checkup'

By James McManus.

255 pp. Farrar, Straus &; Giroux. $24.

By Pamela Paul

For the New York Times

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James McManus's new book has an imposing title, weighty subject material and huge potential. It aims to convey baby boomers' inevitable reckoning with their own mortality, grapple with the frustrations of seeing stem-cell research stymied by abortion politics, document the bifurcation of the American health care system along class lines and describe the startling realization by the Big Mac-chomping, gin-swilling, nicotine-addled boomers that the chickens must come home to roost soon now as they start to hit 60.

This is fascinating material, ripe for exploration, and McManus is a terrific writer -- sharp-eyed and sharp-tongued, and lots of fun to read -- even when dwelling on grisly topics like colonoscopies and eye-trauma surgery. Fans of "Positively Fifth Street," McManus's memoir about his foray into the world of high-stakes poker, will no doubt be eager to hang out again with Good Jim and, especially, Bad Jim.

All begins well -- a bit too well, health-wise, considering the book's subject. Like "Positively Fifth Street," "Physical" arose from an assignment for Harper's Magazine. This time, instead of covering the World Series of Poker, McManus was shipped off to the Mayo Clinic to endure the privilege of the Executive Health Program, a regimen that consists of a souped-up physical exam during which patients are ferried from specialist to specialist for a series of diagnostic examinations.

He uses this experience -- billed at $8,484.25, on Harper's dime -- not only for its comic potential, but also as a meditation on his generation's looming decline. Not that his health is particularly poor, which would probably have made for a more interesting story, though his personal habits could stand improvement and his genetic cards look grim.

Even as McManus's body is poked and prodded, he ruminates on the history of the Mayo Clinic and the rise of concierge or boutique medicine, in which top-tier medical services are offered to those who can pay steep fees and participating doctors opt out of the traditional health care system. As an "honorary queer French Jewish Massachutanian," McManus makes no effort to hide his disgust with luxury health care and its colluding partner, the pharmaceutical industry. To those who can't afford miracle medicines like AIDS cocktails and synthetic insulin, McManus writes, "drug companies should give them away, having built that cost into prices the rest of us pay."

After leaving the Mayo Clinic, McManus decides he clearly needs "to do a serious cost-benefit analysis of my pleasures -- come up with a calculus of their ramifications for my health and actuarial span: how much fun I want to have versus how long I want to live."

But he doesn't.

Instead, he writes movingly about the health of his family, including his adult daughter Bridget's fight against juvenile diabetes and his daughter Grace's eye, which gets punctured at a birthday party (a scene that will send waves of nausea through any parent's body). But he also veers into the mundane details of the whole family's physical lives.

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Next we jump to a discourse on the history of tobacco and another on stem-cell research. Just one more chapter, I told myself, and he'll contract a grave disease or take up the South Beach diet. Not only does he do neither, but he never follows up on the Mayo doctors' recommendations or revisits the clinic.

The book doesn't push forward or come full circle, but reads like a scattershot collection of essays, strung together by some absorbing anecdotes and a few persuasive, yet disjointed arguments. While entertaining and intermittently informative, it is not so much a waste of time as a lost opportunity.

Pamela Paul is the author, most recently, of "Pornified: How Pornography Is Transforming Our Lives, Our Relationships and Our Families."

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