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Story Publication logo November 1, 2017

Health, Wealth, and Wine


As part of France's national plan against Lyme, 2,000 "Beware of Ticks" signs will be placed at forest entrances. This one stands across from some vineyards in the northeastern town of Kintzheim. Image by David Scales. France, 2017.

Despite having fewer yearly cases than Massachusetts, France is the first country to release a...

Image by David Scales. France, 2017.
Image by David Scales. France, 2017.

In the basement of Strasbourg Hospital there is a wine cellar. As a physician who often treats alcohol withdrawal, the juxtaposition of wine and hospitals struck me as unusual. In Massachusetts, at least, we can’t prescribe alcohol to inpatients. Instead, we use benzodiazepines to prevent possibly life-threatening seizures.

That’s a far cry from Strasbourg where, in the 18th century, hospital patients were rationed two liters of wine a day. Centuries ago, land could be given to the hospital as payment or appreciation, making it the largest wine producer in the region.

A wine cellar has been on the hospital grounds since 1395, and still contains a 1472 vintage thought to be the oldest wine in a barrel in the world (it has only been tasted three times, most recently when the Nazis were expelled from Strasbourg in World War II).

I stumbled across the wine cellar on my way to interviews at a new Lyme and tick-borne disease clinic and the National Reference Center for Borrelia research.

Today, nearby vineyards age their wine in the cellar's large, 100-200 year-old oak casks. A tiny percentage of the approximately 150,000 bottles of wine aged here yearly are given to the Hospices to be sold in their shop. The revenue is still used to buy medical equipment.

To my surprise, Strasbourg isn’t the only French hospital with a wine connection. The Hospices de Baune in Burgundy probably has the most famous charitable wine auction in France.

The tradition continues elsewhere too. Not far away in Germany, the Bürgerspital estate has sold wine to support charitable services including housing senior citizens since the 1300s. For over 400 years, the nearby Juliusspital also used the proceeds from wine sales for health services, now supporting palliative care for elderly patients.

My other job is at one of the last public hospitals in Massachusetts. Like many hospitals, we've run frequent deficits and had to think creatively how to fill the gap. Maybe a wine cellar is the way to go.
Image by David Scales. France, 2017.
Image by David Scales. France, 2017.

Foraging for mushrooms, coming home with ticks

“I always find them after foraging for mushrooms,” Joseph Koehly tells me when I ask if he’s run into ticks in the nearby forest.

I had stepped into his vineyard in Kintzheim, in the Alsace region of northeast France, after searching for one of the 30 “Beware of Ticks” signs that the government had been putting up in the region as part of the National Plan to combat Lyme. Alsace has the second highest incidence of Lyme disease in the country, so I found a sign where the village vineyards meet the forested mountains and the landscape is dotted with castles.

Koehly knows when to search for mushrooms because of the rosebushes that are planted at the end of a row of vines. Roses are more susceptible to mildew and other fungus, so provide a warning when he needs to add copper sulfate to prevent the vines from getting fungus.

But that also means it’s autumn and time to forage for wild mushrooms out in the forest. He won’t tell me where – his spots are secret – but it’s a favorite pastime and comes with the reward of a scrumptious mushroom omelet. He knows which ones are safe, but if he’s ever in doubt he can take them to the local pharmacist who can say which are poisonous.

Fall is also the time when adult ticks are most active. He’s never had Lyme, but he’s always on the lookout after a hike off the trails.

Mushrooms might explain an epidemiological mystery, says Benoit Jaulhac, the Director of the National Borrelia Center (named after the bacteria that causes Lyme). In the U.S., Lyme disease is most common in kids under 15 and adults over 60. Adults between those ages don’t seem to have as much Lyme, and we don’t know why. Some scientists think middle-aged people are hiking less and therefore less exposed. Others think it might be an immunological phenomenon. Since the kids and elderly have the weakest immune systems, they show up more often with the disease.

In France, the number of cases starts to rise in adults much earlier, in age groups in their 40s. Jaulhac hasn’t done a study, but thinks the French love for off-trail walks through the woods to find wild mushrooms might lead to this earlier uptick in Lyme cases.

Koehly fits right in this age group. I ask when else he might be going into the forest off the trails.

“You’ll have to ask my wife,” he says with a belly laugh.


navy halftone illustration of a female doctor with her arms crossed


Health Inequities

Health Inequities

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