Outliers - By Gladwell, Malcolm Page 0,1

and English, and the next town over was overwhelmingly German, which meant—given the fractious relationships between the English and Germans and Italians in those years—that Roseto stayed strictly for Rosetans. If you had wandered up and down the streets of Roseto in Pennsylvania in the first few decades after 1900, you would have heard only Italian, and not just any Italian but the precise southern Foggian dialect spoken back in the Italian Roseto. Roseto, Pennsylvania, was its own tiny, self- sufficient world—all but unknown by the society around it—and it might well have remained so but for a man named Stewart Wolf.

Wolf was a physician. He studied digestion and the stomach and taught in the medical school at the University of Oklahoma. He spent his summers on a farm in Pennsylvania, not far from Roseto—although that, of course, didn't mean much, since Roseto was so much in its own world that it was possible to live in the next town and never know much about it. "One of the times when we were up there for the summer—this would have been in the late nineteen fifties—I was invited to give a talk at the local medical society," Wolf said years later in an interview. "After the talk was over, one of the local doctors invited me to have a beer. And while we were having a drink, he said, 'You know, I've been practicing for seventeen years. I get patients from all over, and I rarely find anyone from Roseto under the age of sixty-five with heart disease.' "

Wolf was taken aback. This was the 1950s, years before the advent of cholesterol-lowering drugs and aggressive measures to prevent heart disease. Heart attacks were an epidemic in the United States. They were the leading cause of death in men under the age of sixty-five. It was impossible to be a doctor, common sense said, and not see heart disease.

Wolf decided to investigate. He enlisted the support of some of his students and colleagues from Oklahoma. They gathered together the death certificates from residents of the town, going back as many years as they could. They analyzed physicians' records. They took medical histories and constructed family genealogies. "We got busy," Wolf said. "We decided to do a preliminary study. We started in nineteen sixty-one. The mayor said, 'All my sisters are going to help you/ He had four sisters. He said, 'You can have the town council room/ I said, 'Where are you going to have council meetings?' He said, 'Well, we'll postpone them for a while/ The ladies would bring us lunch. We had little booths where we could take blood, do EKGs. We were there for four weeks. Then I talked with the authorities. They gave us the school for the summer. We invited the entire population of Roseto to be tested."

The results were astonishing. In Roseto, virtually no one under fifty-five had died of a heart attack or showed any signs of heart disease. For men over sixty-five, the death rate from heart disease in Roseto was roughly half that of the United States as a whole. The death rate from all causes in Roseto, in fact, was 30 to 35 percent lower than expected.

Wolf brought in a friend of his, a sociologist from Oklahoma named John Bruhn, to help him. "I hired medical students and sociology grad students as interviewers, and in Roseto we went house to house and talked to every person aged twenty-one and over," Bruhn remembers. This happened more than fifty years ago, but Bruhn still had a sense of amazement in his voice as he described what they found. "There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn't have anyone on welfare. Then we looked at peptic ulcers. They didn't have any of those either. These people were dying of old age. That's it."

Wolf's profession had a name for a place like Roseto—a place that lay outside everyday experience, where the normal rules did not apply. Roseto was an outlier.

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On to some dietary practices from the Old World that left them healthier than other Americans. But he quickly realized that wasn't true. The Rosetans were cooking with lard instead of with the much healthier olive oil they had used back in Italy. Pizza in Italy was a thin crust with salt, oil, and perhaps some tomatoes, anchovies, or onions. Pizza in Pennsylvania was bread dough plus sausage, pepperoni, salami, ham, and sometimes eggs. Sweets such as biscotti and