The Pill That Promises Everything Except the Part That Matters

You know how a pocketknife works. Blade, bottle opener, that little screwdriver nobody uses but everybody's glad is there. Each thing does its one job. You don't expect the bottle opener to fix your fence.

I've been thinking about that pocketknife because of something I read about tadalafil, which is the chemical name for Cialis, which is the thing from those commercials where attractive couples hold hands in matching bathtubs outdoors, which has always raised more questions for me than the commercial intended. Anyway. The drug started life as a heart medication, didn't quite work out that way, found its more famous purpose, and now the researchers are circling back to ask whether it might be good for the heart after all. Like a man who left town at twenty and comes back at sixty-five wondering if the old hardware store is still there.

It is. But the man behind the counter retired.

The studies are real and the numbers are striking. Men who took low-dose tadalafil showed substantially lower rates of dying from heart trouble, lower rates of dementia, lower rates of just about everything you'd rather avoid. A panel of experts has since said the drug might be appropriate for certain men at higher cardiovascular risk. The online clinics, naturally, have moved faster than the panels. They're already selling it as a longevity pill, a subscription to a longer life, which is a tidy pitch if you don't think about it too hard.

I thought about it too hard. That's my problem.

Here's what I keep snagging on. These studies are what the researchers call observational, meaning they watched what happened to people who were already taking the drug. They didn't set up two groups and run a controlled experiment. Which is a little like noticing that people who own pickup trucks seem to have more dogs. Could be true. Probably is true, in my experience. But buying a truck on Friday won't get you a Labrador by Monday. The relationship is real and the explanation is more complicated than it looks.

Pastor Holmgren had a cousin who started taking something for his joints. Just a supplement, nothing alarming. Within six months he'd added three more things and was drinking apple cider vinegar every morning for his digestion. Felt great, he said. Also started sending the pastor articles about things I won't repeat here. Now, I'm not saying the supplement caused the other business. But Pastor Holmgren, who preaches forgiveness and holds grudges about euchre, would point at his cousin and say: a man who believes one thing without evidence is liable to believe a second thing without evidence, and pretty soon you've got a pantry full of things you can't account for.

He's not wrong.

What I wonder, when I read about the men who took tadalafil and fared better than the men who didn't, is whether those men were also the kind of men who went to the doctor when something felt off. Who had someone in their lives, a partner, a friend, a daughter who said, hey, maybe get that looked at. Because that's not a small thing. That's actually a considerable thing. That's the part of health that doesn't come in a bottle, the part where somebody notices you and you notice them back.

Aunt Vi, who is currently in a dispute with the county over whether her mailbox qualifies as historically significant (it does not, it is a standard rural mailbox with a waving flag decal, but Vi has chosen her hill and she is prepared to occupy it indefinitely with a lawn chair and a thermos), Aunt Vi's position on pills is uncomplicated. If you need them, take them. If you don't, find something else to occupy your mind. She has no patience for what she calls solutions in search of problems. And while Vi's track record of being wrong is, to hear her tell it, essentially unblemished since the late seventies, I think she's got something here.

Because the thing being sold online isn't really the pill. It's the idea that you can skip the steps. That longevity is a subscription service, a transaction, something you can handle from your phone between meetings. And I understand the appeal. I do. Time is short and doctors are busy and the form you have to fill out before you can talk to a nurse is four pages long and asks you things you don't know the answer to.

But the people I've known who made it into their eighties and nineties, still sharp, still curious, still capable of being genuinely surprised by something, they didn't get there by optimizing. They got there because they had somewhere to be and someone expecting them. They got there because they were part of a place that needed them to show up, and they did, and eventually the place returned the favor.

Big Earl at the grain elevator was like that. Showed up for his neighbors for forty years, fixed fences, lent tools, drove people to appointments without being asked. When his body started failing him, the neighborhood came back around. Brought food. Sat on his porch. Listened to stories he'd told before and acted like they hadn't heard them. That's not a wellness strategy. That's just people, being people, to each other.

You can't put that in a capsule. Believe me, people have tried.

So if your doctor looks at your situation and says this medication makes sense for you, then take it. I'm not a doctor and I don't pretend otherwise. But while you're at it, call somebody. Show up somewhere you're expected. Be the person who notices when a neighbor goes quiet.

That's the part of a long life they haven't figured out how to market. Which might be why it still works.

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