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Medical Anthropologist Dr. Paul Farmer

Farmer is an infectious disease specialist and a recipient of the MacArthur "genius" grant for his work treating tuberculosis in Haiti. He is the subject of the new book Mountains Beyond Mountains, by Pulitzer Prize-winning author Tracy Kidder.

21:40

Other segments from the episode on September 25, 2003

Fresh Air with Terry Gross, September 25, 2003: Interview with Dr. Paul Farmer; Commentary on Money Records; Interview with Isaac Mizrahi; Review of the new fall TV season.

Transcript

DATE September 25, 2003 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Paul Farmer discusses his work as an infectious
disease specialist
BARBARA BOGAEV, host:

This is FRESH AIR. I'm Barbara Bogaev, in for Terry Gross.

Can one person really change the world? Dr. Paul Farmer is making the case
that all of us have that potential. Farmer is a professor of medicine at
Harvard Medical School and he chairs the Department of Social Medicine and
Health Inequalities at Brigham and Women's Hospital in Boston. He won a
MacArthur Genius Award for creating a public health system in Cange, Haiti, in
the midst of a squatter settlement devastated by poverty and disease.

Through his foundation, Partners in Health, he and his colleagues are
providing not only basic medical care to nearly a million Haitians, they've
also built schools and water sanitation systems, and accomplished things many
have claimed were impossible in impoverished communities, like successfully
treating drug-resistant strains of tuberculosis and reducing the incidence of
HIV.

Working with governmental agencies and international organizations like the
WHO, Farmer has pursued similar programs in Peru, Russia and in Boston,
Massachusetts. He's the subject of a new book, "Mountains Beyond Mountains,"
by Tracy Kidder.

Farmer first came to Haiti when he was 23 after studying for a degree in
medical anthropology. I asked him what he saw there that made him want to
start his own rural hospital.

Dr. PAUL FARMER (Harvard Medical School): If you go to a hospital and you
need--say, for example, you have obstructed labor--that is, you're at your due
date--you're pregnant, you're at your due date, and the baby doesn't come out.
And if you have $700, you can have a Caesarian section, and if you don't have
$700, you don't receive appropriate medical care. And I had seen this happen
in a couple of the clinics and facilities, hospitals that I'd visited in
Haiti. And I thought it would be intolerable to work in those conditions.

And, you know, illness after illness--I mention obstructed labor because that
was something that hit me early on. You know, it hadn't occurred to me really
at the age of 23 or 24 that, you know, your social standing would determine
whether or not you survived pregnancy.

BOGAEV: So could you describe for us then the scope of the medical services
that the complex provides that's funded by your charity group, Partners in
Health?

Dr. FARMER: Well, you know, it's actually a very ambitious endeavor now.
There's 104 beds, there are two operating rooms, there's a dental clinic, an
ophthalmology clinic, a women's health clinic, we have an HIV and TB clinic,
probably the first AIDS treatment program in a really poor country, all in one
very concentrated campus. I suppose it's utopian or maybe impossible to have
a Brigham and Women's Hospital in the middle of a squatter settlement in
central Haiti, but it's a pretty good, you know, dream to aspire to. And so
that was the goal. But, of course, you start with an idea like that, and soon
you find out that the children that you're taking good care of for their
complex diseases, they're also not in school, or you see the thousandth case
of typhoid and you know that that's because people don't have clean drinking
water, or you see a whole family living in a very tiny hut, all with
tuberculosis and realize that, of course, not only do they not have access to
care for tuberculosis, they also don't have adequate housing.

So it sort of opens a Pandora's box. Once you start doing a good job taking
care of sick people, which is what a doctor or nurse does, and become involved
in their lives and visit them at home, you discover that they're not just
sick, they're facing what seem to some to be insuperable problems. I
personally don't believe they're insuperable problems, and neither do my many
co-workers and colleagues in Haiti, most of whom are Haitian. We believe
they're problems that can be addressed with the right kind of conviction and
resources.

BOGAEV: So what kind of money does it take to make this work, and do you
charge patients for treatment?

Dr. FARMER: It takes very little money to make this sort of thing work.
Just to give a specific example, there was finally a study of how much it cost
to take care of a patient with tuberculosis in the city of Chicago, and this
is just regular tuberculosis, because, you know, we've worked with very
complicated forms of tuberculosis that are difficult and expensive to treat.
But if you added up hospitalization costs in special kind of rooms that TB
patients go into in a US hospital and the care provided by doctors and nurses
and the public health department, they came up with a figure of $68,000 per
patient per cure.

And we provide excellent care for tuberculosis in rural Haiti with
community-based care in which a community health worker visits the patient
every day. And we have cure rates that are even better than many posted in
American cities, and we can do that for under $200. So I think that it
doesn't cost a lot to do a good job.

BOGAEV: How is that possible, though? How do you keep costs down?

Dr. FARMER: Well, for one thing, we rely on community health workers to do
the everyday work, and that's what we did when we decided--when we became the
first clinic in Haiti to decide, well, many are arguing that it's not
cost-effective or even possible to treat AIDS in a country this poor. And we
had already decided that we weren't going to listen to that sort of logic
because our mandate is to remediate inequalities of access to care; that is,
to take care of the destitute sick. So we already had a mandate that we
worked hard to develop.

So when AIDS came along to rural Haiti, we felt impelled to try and introduce
the same standard of care or maybe even better than what you'd get in Boston.
And the way it became possible is because we had already learned from our
experience at delivering prenatal care or tuberculosis care to use community
health workers. And, you know, community health workers are not volunteers,
but the labor costs in Haiti are very low, and there's enormous interest among
villagers to become trained as community health workers or village health
workers, and that's one of the reasons that, A, our costs are low, and B, our
outcomes are excellent. That is, these people do a very good job delivering
care.

BOGAEV: Well, I want to talk about some of the other changes you've made in
your program or improvements you made in your program that other hospitals
don't pursue or other international medical projects don't pursue. And one of
them is you travel to see patients when they don't come in for treatment, your
aid workers at the hospital, and also when you travel to Haiti, you also do
this. And you'll travel hours walking into the mountains to track patients
down to make sure that they get their treatment, and this is a rule at your
hospital. Why?

Dr. FARMER: Well, we had this traumatic experience in 1988, which is 15
years ago, and we had--the clinic had been founded three years earlier. And
we don't pay for tuberculosis medications. The Haitian government, the
Ministry of Health, provides us these medications. And so, as in most
countries, in principle, and we thought in our own clinic, that TB care,
tuberculosis care, was free. Well, in 1988, three people from right around
the clinic died of tuberculosis, and that was a very traumatic experience for
me, for the--at that time, we had only one doctor--and for the community
health workers on whom we relied. And there were several nurses at the time.
And we got together and said, `What happened here? How could we lose three
otherwise healthy young people, parents with kids? How could we lose them to
this eminently treatable disease?'

And it was interesting, there were all these discrepant theories as to what
had happened. And some people--and it was really mostly the
professionals--they tended to blame the patients, and they brought up this
whole idea of, you know, they believe in voodoo and they're superstitious, and
that's why they die of tuberculosis, even though they have free care. But the
community health workers who shared the social conditions of the patients who
died, they didn't agree, by and large. They said, `No, these are the poorest
patients who died.'

And when we started looking harder that year at our so-called free TB
treatment program, we found all kinds of hidden costs. For example, we found
that it cost money to get to the clinic if you were too sick to walk. And
even if you could walk, you know, for three hours, you're not doing something
else. If you're a peasant farmer, you're not planting, you're not hoeing.
But for people who couldn't walk, they had to pay to borrow a donkey. And
then we found that--you know, at that time, we were using a drug called
streptomyacin. It's not used as widely anymore. It's a good TB drug, but you
have to give it as an injection, and we found out that they were paying people
to give them the injection in the village.

And so what we did is we just eradicated every single barrier to free care,
and then we felt we could have an honest conversation, but only after we made
the care really free to the patient could we have an honest discussion as to
why these people died. And so I have to say, you know, since that time, since
we overhauled the project, we haven't lost patients to tuberculosis.

BOGAEV: Why do you, though, do that kind of work? Why are you doing hands-on
work in the clinic now and visiting patients in faraway regions? I would
think your time is very short. You have this huge project that you help
administer and fund-raise for.

Dr. FARMER: Well, I do it because I like it. It's my favorite part of the
work, the clinical work and visiting patients in their homes. Really, they're
not homes, they're huts. And as you said, we get some of our best ideas by
walking the long way and thinking about what patients must be going through.
If I could give you one example, I remember the day distinctly that I ran into
a patient who had a child on her arm, and the child, I think, was about three.
And she had come from the clinic. And I offered, because she looked so--the
woman had looked sick herself, and the child was sick, and she had not been
seen at the clinic; she'd brought her kid there. And I said, `Can I help you
carry the baby?' And you know, she threw me this look, first of all,
incredulous and then grateful. And after--and it was a three-hour hike to her
home village. And after a half an hour of carrying the three-year-old, who
was a malnourished child, my arm started to hurt. And after an hour of
carrying that child, my arm was really killing me.

And so, you know, being not sick, I did make it all the way to that village,
the rest of the way, with the kid on my arm. And I sat down, and I was
fanning myself with a piece of paper I had, and I said to her, `Well, you
know, my arm hurts from carrying that child, carrying your baby. Doesn't it
hurt your arm?' And she said, `If I go to your clinic with one of my children,
one of my infants, my arm hurts for weeks afterwards.' And you know, it had
never occurred to me before. I had never thought about it. And I can think
about all these things I learned from--you know, and the way to these
villagers are, obviously, very far away from the fund-raising or the
international conferences or the, you know, work that is regarded as really
important by some, but I think you do learn things by sticking close to the
patient and their condition.

BOGAEV: I'm talking with Dr. Paul Farmer. He's the founding director of the
charity organization Partners In Health, which supports medical services in
Haiti, also projects in Peru, in Russia and in Boston, Massachusetts. Farmer
is a professor of medicine at Harvard Medical School. He's the subject of a
new book by Tracy Kidder called "Mountains Beyond Mountains."

We're going to take a break now. Then we'll talk some more. This is FRESH
AIR.

(Soundbite of music)

BOGAEV: If you're just joining us, my guest is Dr. Paul Farmer. He is the
founding director of the charity organization Partners In Health, which funds
medical clinics and medical services in Haiti, Peru, Russia, also here in the
US in Boston. Farmer is profiled in a new book, "Mountains Beyond Mountains,"
by Tracy Kidder.

Part of the problem in fighting many of these epidemics, AIDS, also TB, is
that the drugs are very expensive. You've had some success getting drug
companies to lower the price of drugs in order to implement your project. How
do you do that? It sounds impossible.

Dr. FARMER: Well, you know, there's all sorts of different tricks, I might
say. And some of it is cajoling, and sometimes it's working with individuals
within these big companies who are sympathetic to the cause. Sometimes it's
working with generic manufacturers in other countries. But the fact remains
that, as, I think it was the Indian minister of health who once said in
reference to AIDS drugs, `If you could drop the prices by 80 percent, it
suggests that there was something wrong with the initial price setting to
start with,' and I think that's true. You know, these are--the TB drugs had
been off patent for years. There's no reason that they should have cost that
much, and we proved that you could drop the drug prices by 95 percent with
most of them.

BOGAEV: Well, you were working on this project before you were able to
negotiate lower prices for these drugs, and there is a story that Tracy Kidder
tells in the book about you in which you--and it involves you and a colleague
borrowing drugs from the hospital that you work in in Boston. Can you tell me
about that?

Dr. FARMER: What, are you trying to get me fired?

BOGAEV: Well, $92,000 worth of drugs?

Dr. FARMER: Well, we just borrowed it. No, the colleague that you're
talking about is Jim Kim, and we were, you know, working in a hospital, you
know, that had these drugs on hand but didn't have the patients. The patients
were in Peru. And so we were borrowing the drugs.

BOGAEV: Yeah. How did that work? Did you have friends in the pharmacy...

Dr. FARMER: Well, yes, we did...

BOGAEV: ...and they would stock your briefcase?

Dr. FARMER: ...and we promised to pay back the pharmacy. I'm not sure we
had a very clear strategy at the time, but you know, when the president of the
hospital, he asked about this, and then also his successor did, too. Our
biggest supporter, a man named Tom White, came and bailed us out and paid off
our debts to the pharmacy.

And you know, again, the thing that makes me uncomfortable about this story is
that it does make it sound like extraordinary measures are required to stop an
epidemic of drug-resistant tuberculosis, when, in fact, I think what's
required is political will. I mean, why should, you know, one of these drugs,
a gram, which is a day's supply, cost $29 at the Brigham and Women's Hospital,
and, you know, you could find it for $8 in Paris, made, you know, by the same
company? So, you know, of course, we tried buying it in Paris. There were
enough patients, and this is a disease that takes a long time to treat. Our
patients were poor. They weren't going to be able to pay for these drugs, and
we were trying to find ways of making sure that they never missed a dose, and
they didn't miss a dose.

BOGAEV: I want to ask you about some of the arguments that are offered
against offering medical aid and international support for large-scale
projects that combat infectious diseases, and one of them is that cultural
differences will make it problematic to properly treat patients, and that was
part of the bias against funding drug treatment to HIV patients in Africa.
How does religion or cultural mores enter into the work that you do? And I'm
thinking many Haitians believe in voodoo or sorcery and seek other treatments
for disease.

Dr. FARMER: Well, you know, this is one of those instances in which it was
really helpful not to have training in anthropology, to have a doctoral degree
in anthropology, but to be able to say, `That's not true, and I'm also an
anthropologist.' Because, really, the arguments that cultural beliefs or
religious beliefs will serve as barriers to effective care are--see, this is
perhaps not a very scholarly term, but they're just bogus. There's no
evidence, really, to show that that's what the barrier to care is. And,
frankly, I really don't believe that that is why we can't treat AIDS in
Africa. I believe that we can't treat AIDS in Africa because powerful people,
decision makers, still don't have the political will that we need in order to
move even community health--to pay community health workers. We don't need
big infrastructures to treat AIDS or tuberculosis, for that matter, or
drug-resistant malaria. What we need are the medicines and the community
health workers, and make sure that the community health workers are paid at
least a modest stipend so that they can do this job and not another job, such
as planting corn or millet for their family to eat.

BOGAEV: Is it possible to have political will at the level it would require
to be effective to institute these changes?

Dr. FARMER: Well, you know, hope springs eternal, but that means Washington,
Tokyo, Paris, Munich, Geneva--I think the political will we need is in the
rich countries and in--I mean, for example, this is pretty dull stuff, but the
international financial institutions like the World Bank. I mean, the World
Bank is the leading funder of TB control, and what they decide--what kind of
TB gets treated, how it's done--that lays down the law for most of these poor
countries. So that's where the political will needs to be summoned.

BOGAEV: There's something very interesting, a quote in the book. You say
you've organized your life "around areas of moral clarity." Can you talk about
what you mean by moral clarity?

Dr. FARMER: Well, first of all, you know, there's a lot of things in a book
like that that you wish you'd never said. You know, that...

BOGAEV: I'm sure I'll hit on every one.

Dr. FARMER: That's the hard thing. Yeah. I think so. I mean, again, when
you spend--the way the author of that book works is he just hangs around and
hangs around with you so long that you basically tell him anything he wants to
hear.

And so, you know, when you talk about areas of moral clarity, I don't know,
maybe it sounds a little sophomoric, but I feel that when you're a physician
or, again, a nurse and you know the answer to a problem, a patient's problem,
that it's a good thing to act and save lives or prevent suffering. And so in
some ways, maybe that's a cop-out answer. That is, people who are trained as
healers who are around the sick, they should have plenty of areas of moral
clarity. But as you point out, things are very complicated in the doing, and
you know, the devil's in the details. We made errors along the way, and we're
going to make errors, I'm sure, in the future, but it seems like if you could
have more successes than make errors in a world so fraught with problems and
riven by social inequality that you might be on the right track. And I don't
know if I'd push it much farther than that, because then it'll sound like
I've, you know, happened on some great solutions and know the answers to lots
of problems that I don't know the answers to.

BOGAEV: Well, it's a real honor to talk with you, Dr. Paul Farmer. Thank
you for talking with me.

Dr. FARMER: Well, thank you, Barbara. It's been a real privilege to be on
the show.

BOGAEV: Dr. Paul Farmer is the founding director of Partners In Health and
the head of the department of social medicine and health inequalities at
Brigham and Women's Hospital in Boston. He's the subject of Tracy Kidder's
new book, "Mountains Beyond Mountains."

I'm Barbara Bogaev, and this is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Profile: Money Records remembered as the most successful imitation
Motown of the 1960s
BARBARA BOGAEV, host:

This is FRESH AIR. I'm Barbara Bogaev.

As the black record industry saw Motown getting more and more successful in
the '60s, veterans of the business asked why Detroit should have all the luck.
Of all the imitation Motowns that sprung up in that decade, probably none was
as successful as Money, a label that was also the last gasp of one LA's most
colorful record stores, Dolphins of Hollywood. Now rock historian Ed Ward
tells us the story of Money Records.

(Soundbite of music)

ED WARD reporting:

Money Records was the last gasp of one of LA's most famous record empires.
The Dolphin Records Group had been in existence since the late '40s, an
outgrowth of the Dolphins of Hollywood Record Stores owned by John and Ruth
Dolphins, far from Hollywood in what is today South Central LA. The Dolphins
had used the name Money before; they had a bewildering number of labels. But
it was revived in 1964, six years after John Dolphin had been shot to death by
a songwriter who said he owed him money.

The man behind the new Money Records was the deejay who played records in the
window of the Dolphins Record Stores, Al "A.C." Scott, who also managed the
stores and had a show on KGFJ. Scott knew the local scene well enough that he
wanted to start the label with a proven winner. So when Don Julian walked
into the office with some reels of tape, he took notice. Julian had led a
local group, Don Julian and the Meadowlarks, for many years, and they'd always
done well. Now, Julian told Scott, he'd just been to his sister's house, and
her teen-age kids were doing a new dance. So he'd recorded a song about it
and called his group The Larks.

(Soundbite of song)

THE LARKS: (Singing) Girl, hey, what's that you're doin'? Girl, girl, what's
that you're doin'? You've got to show me the steps to it. Come on, gonna
learn how to do it. Doin' the jerk. Hey, do the jerk, girl. Come on and
work. Hey, do the jerk. Girl...

WARD: The song got to nine on the soul charts and seven on the pop charts and
started a craze. Over 60 more `jerk' songs came out over the next year, and
Julian wound up running a record label called Jerk, which was, of course, a
division of Money.

A.C. Scott was in business, so the next thing was to find an artist who could
be developed into a star. Twenty-one-year-old Betty Champion from Shreveport,
Shreveport, Louisiana, was the one. She changed her name to Bettye Swann,
thinking Champion brought up unfeminine images of boxers. And, best of all,
she wrote her own material.

(Soundbite of "Don't Wait Too Long")

Ms. BETTYE SWANN: (Singing) Good things come to those who wait, but don't
wait too long. Good things come to those who wait, but don't wait too long
because love is just a merry-go-round. Before you know it, your love will be
gone. Now let me tell you a story...

WARD: Her first record, "Don't Wait Too Long," was a mild soul hit that sold
well locally, but it was the follow-up that made her reputation and even
broke onto the pop charts.

(Soundbite of "Make Me Yours")

Ms. SWANN: (Singing) I'd never had a love to call my own. I was about to
give up, and then you came along. Just to have your tender ways thrills me
for days and days. I don't care what nobody says, I'm with you for always.
Now that I've found you I wanna stick around. So make me yours, make me
yours.

WARD: "Make Me Yours" hit the top of the soul charts. And now, with three
hits under his belt, Scott started signing up more and more acts. Bobby
Angel was one of them.

Mr. BOBBY ANGEL (Singer): (Singing) I keep on hearing you call my name, even
when I'm asleep. And every time my telephone rings, my heart just skips a
beat because, I, baby, I'm in love with you, baby. It just got to be that
way. Oh, darlin', I...

WARD: Angel was one example of the problems Money faced. He sang a bit like
James Brown, and yet the backing track sounded a bit like Motown--not a good
mix. In fact, for a while, Money had a big M on their label that looked a lot
like the one Motown used. And particularly on the records produced by Arthur
Wright, the sound was a lot like Motown's, putting a vibraphone right up front
or using that metronomic tambourine.

Unidentified Man: (Singing) Good things come to those who wait, but don't
wait too long. Good things come to those who wait, babe, but don't wait too
long, because love is just a merry-go-round. Before you know it, you're love
will be gone.

WARD: The not-quite-Motown sound made Money legendary among British fans of
what they called northern soul. But like much of northern soul, it sounds
fairly derivative to Americans who to got to hear a lot more of this kind of
music than the BBC ever played.

Still, there was one artist that Money signed who would later become a legend.

Mr. TED HAWKINS (Singer): (Singing) Hey. Hey, hey. Baby, baby. Baby,
what's wrong? Baby, ooh, baby, come back where you belong. I'm so sad and
disappointed. I don't know what to do. Listen to me, brother, and listen
well, 'cause the same thing could happen to you. I had a woman, sweet and
kind. She gave me everything. I woke up this morning and felt beside me,
there was nothing but the mattress and springs. Baby, baby...

WARD: Ted Hawkins was rediscovered in the late '80s living on the beach in
Venice, California. And he still had his amazing Sam Cooke-sound-alike
voice. He'd been in and out of prisons and hospitals before he cut "Baby" in
1966, and he never really changed. But in 1994, he was able to cut an album
for Geffen that made him a star for a brief moment before he died.

The rest of Money's stable never really did too well. And although there's a
Larks album from 1974, the label was pretty much history by the end of the
'60s. Bettye Swann went on recording till the end of the '70s, and Don Julian
and The Larks were still playing in 1998 when Julian died. Today, Money and,
indeed, all of the Dolphins of Hollywood empire are all but forgotten, except
by those crazy British soul fans.

BOGAEV: Ed Ward lives in Berlin.

Coming up, classic Hollywood films through the eyes of a fashion designer.
This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Designer Isaac Mizrahi discusses Hollywood films
which influenced his career
BARBARA BOGAEV, host:

Monday nights in October, the cable network Turner Classic Movies is
presenting a special series, "Style in Motion," featuring conversations about
fashion and film with such designers as Kate and Andy Spade, Badgley Mischka,
Michael Kors and my guest, Isaac Mizrahi.

Mizrahi says films like "Roberta," "The Women," "Darling" and "Blow-Up"
ruined him for life, that nothing today can compare to the elegance of those
pictures, the romance and panache.

Here's a scene from the 1935 film "Roberta," about a Paris fashion house. In
this scene, Fred Astaire and Ginger Rogers are trying to lure Irene Dunne back
to Roberta's Salon after she quits. Fred Astaire is showing Dunne some
designs he thinks Roberta's should put out.

(Soundbite of "Roberta")

Ms. IRENE DUNNE ("Stephanie"): But this is like the mode two seasons back.

Mr. FRED ASTAIRE ("Huckleberry `Huck' Haines"): I know, but I liked them
better then.

Ms. DUNNE: But nobody will buy them. Well, you'd be laughed out of Paris if
you did a thing like that. The trend is away from such styles.

Mr. ASTAIRE: I'm not interested in the trend.

Ms. DUNNE: But you've got to be. You don't understand. You're giving a
fashion show next week. Every couturier in Europe is going to be watching.
You can't afford to show models like those.

Ms. GINGER ROGERS ("Schwarenka" aka "Lizzie Gatz"): Well, of course you
cannot. Stephanie is right.

Mr. ASTAIRE: What does it matter, as long as they're pretty?

Ms. DUNNE: But clothes must be more than pretty. Look. The trouble with
that is it sits in the wrong places.

Ms. ROGERS: Such a pity. The famous Roberta to go second-rate.

Ms. DUNNE: Roberta's will never go second-rate.

BOGAEV: Isaac Mizrahi, welcome back to FRESH AIR.

Mr. ISAAC MIZRAHI (Fashion Designer): Oh, such a pleasure to be here.

BOGAEV: I want to start by talking about the film "Roberta." It's a Fred
Astaire-Ginger Rogers movie.

Mr. MIZRAHI: Right.

BOGAEV: What I always noticed about their films, the clothes look so perfect
when they're dancing. You know, all satin and the high-waisted...

Mr. MIZRAHI: Mm-hmm. Right.

BOGAEV: ...wide-legged pants and skirts on Ginger Rogers; they flow so
beautifully. And Fred Astaire's tails on his tux always swing just right.

Mr. MIZRAHI: Match just right. Yeah.

BOGAEV: Is that why this film is on your list?

Mr. MIZRAHI: Well, yes, of course, that's one of the reasons it's on my
list. But it happens to be about a fashion house in Paris. The movie is
like, you know, sort of a tale about an old lady who surprisingly dies and
leaves this whole sort of couturier to Irene Dunne, actually. You know, it's
just the tale of a couturier in Paris, which is why, you know, for me, when I
was approached by Turner to do this little festival of pictures about clothes,
I decided that they would actually literally be stories about fashion, you
know? Whereas I probably could have thought of millions of pictures that I
really loved the clothes in or that clothes were sort of mentioned in or
something, but these are my actual favorite movies about fashion.

BOGAEV: So everyone is just covered in yards and yards of fur. I mean,
that's the first thing you notice.

Mr. MIZRAHI: Yards and yards of fur and satin and jewels. And, you know,
honestly, I have to say the clothes aren't by anyone particularly famous. I
don't think they're Adrien--I know they're not Adrien. I know they're not,
you know, someone who went on to do, like, fabulous--like, I don't think
they're Walter Plunkett or any of those great designers. But to me, they're a
little bit, like, sort of unrestrained, if you know what I mean. They're a
little vulgar.

BOGAEV: Yeah, everyone looks a little over the top.

Mr. MIZRAHI: They're overstated, I would say.

BOGAEV: Well, I wanted to go to this idea of the '30s art deco extravagance.
I wonder if you wish, in some part of you, for those days back. I know your
clothes had featured fur and a certain kind of extravagance.

Mr. MIZRAHI: Right.

BOGAEV: I mean, it's such a way of reveling in luxury and textures and that
kind of forbidden fruit.

Mr. MIZRAHI: Right. I have to say, I don't really look back and wish for any
particular thing, but I will say I look back and I wish that one could be as
earnest as that, you know? Today you sort of--well, for the past, like,
let's say, 20 years or even 30 years, you really can't be all that earnest
with beauty. You know what I mean?

BOGAEV: What does that mean, to be earnest with beauty as a designer?

Mr. MIZRAHI: You know, in other words, there always has to be some little
bit of irony that throws it off, you know. Like something--you know, today,
if you make a dress that's all that beautiful, maybe it has to be slightly
wrinkled. Do you know what I mean? It has to be like--it has to look like
it's coming from a thrift store, you know? It can't really be...

BOGAEV: Like, you're just not trying that hard.

Mr. MIZRAHI: Yeah. Yeah. Yeah, honestly. Otherwise, if I gave you the
dress, right, and I said, `Barbara, you know, wear this,' you'd put it on and
you wouldn't be able to. You just couldn't walk out of the house in something
that gorgeous. Do you know what I mean? You'd have to somehow mess it up.
Like, you'd have to mess up your hair or wear it with sneakers or something.
You know? I mean, there has to be some kind of irony today.

I mean, you stand in front of the mirror--I know you do, Barbara. Don't lie
to me, OK? I know you stand there and you look perfect...

BOGAEV: In my fur and my ball gown and satin.

Mr. MIZRAHI: Seriously. No, you look beautiful, and you say, `Oh, that's a
little too beautiful, I have to do something to this, like, put a bandanna on
or something.' Right?

BOGAEV: Oh, God forbid. Yeah.

Mr. MIZRAHI: Well, I think everybody knows what I mean. You know, it's like
in the 1950s, you wore, like, crinolines and heels and full makeup and crazy
hairdos, and it was all so incredibly courtly. You know, it was so put
together. And today, if you can do something like that...

BOGAEV: Right, and unapologetic.

Mr. MIZRAHI: Right. It was unapologetic, just earnest.

BOGAEV: Do you look to films for inspiration?

Mr. MIZRAHI: Well, yes. I mean, the answer to that question, of course, is
yes, but to sort of really state what goes on, I don't look to films for
inspiration. They sort of find me or something. That's what happens, you
know?

BOGAEV: So what do you look for? Are you looking for that tiny spark of
inspiration, like the shape of a sleeve or the drape of a coat or trouser...

Mr. MIZRAHI: Well...

BOGAEV: ...or is it something as ineffable as style with a capital "S"?

Mr. MIZRAHI: It's both. And in fact, you know, the point is that you don't
really look. There was once I was doing a collection and I was having
problems with skirts in general, right?

BOGAEV: What was the problem?

Mr. MIZRAHI: Oh, the problem was they just weren't looking good, I couldn't
figure out what the hell length to make them. You know, it just wasn't
working at a certain particular time, and I happened to be watching a series
of pictures with Katharine Hepburn, right? And I noticed that mostly she wore
trousers and looked great in trousers, right? So what I did was instead of
trying to figure out skirts, I did trousers in place of skirts, you know? So
I did, like, ball gowns but with trousers. You know, somehow I managed to do
that. It sort of pushed the envelope. And that year, it turned out,
everybody was having problems with skirts. I wasn't the only one. So it was
like a big pants year, you know?

BOGAEV: Uh-huh.

Mr. MIZRAHI: I mean, that sounds retarded, but I'm serious. That's what
happens.

BOGAEV: Did people buy them?

Mr. MIZRAHI: Yeah. You know, people bought them. Yes, they did.

BOGAEV: Another film you chose to talk about for the series is "The Women."
I love this movie.

Mr. MIZRAHI: Oh.

BOGAEV: I have to say, though, that the script is so outstanding, it almost
overshadows the visuals in my memory.

Mr. MIZRAHI: Oh, yes.

BOGAEV: You know, there are all amazing actresses...

Mr. MIZRAHI: Well, you know, thank heaven...

BOGAEV: ...like Joan Crawford and Norma Shearer and Rosalind Russell and Mary
Boland, and they all talk so fast that you have to concentrate really hard on
the dialogue...

Mr. MIZRAHI: Yeah.

BOGAEV: ...and I have hardly any brain cells left to notice what they're
wearing.

Mr. MIZRAHI: Or, you know, like me, you see it, you know, 50 times and you
memorize the dialogue and then, you know, it's easy to just take a little nap
through part of it and just look at the clothes.

BOGAEV: What are your favorite dresses or outfits from this film?

Mr. MIZRAHI: Oh, there are so many, I have to say. You know, the period is
probably my favorite all-time period for fashion, which is the late
1930s--1938 and 1939--because it has all of the glamor and polish of the 1930s
and it's getting even more structured, you know? Like, there's a shoulder
that's starting to become a bit more prominent like a leg-o'-mutton sleeve.
You know what that is?

BOGAEV: No. What is it?

Mr. MIZRAHI: A leg-o'-mutton sleeve? Sort of like a little puffy sleeve,
right? Hats were so, like, sort of incredibly silly and prevalent and
architectural. They were starting to become really aggressive by the middle
of the '40s, but here they're just beginning to sprout, you know? Let's see.
Some of my favorite dresses in this picture. You know, it's Norma Shearer who
has this amazing sort of black dress that is this big ball gown thing, and it
looks almost like a Singer Sargent painting of Madame X or something, you
know. It's very bare on top, but it's very, very sort of classical, and you
know, it's the high road of bare. You know, it's just her shoulders are bare,
and the rest of her is very covered, and it has a beautiful little hat that
goes with it.

Now OK, I don't know about you, but the idea of an evening dress with an
evening hat just makes me swoon. Where was I? You know, there's a fantastic
sort of a sequin dress that Joan Crawford has at the end, just sensational
dress and this big sort of chinchilla cape that she puts on top of it that's
just the ultimate luxury.

BOGAEV: Are there any things that you notice watching these films that are on
their way back? I'm thinking of gloves.

Mr. MIZRAHI: Well, actually, now that you mention it, gloves are coming back,
aren't they? That's so true. Gloves and, I think, hats in a certain way.

BOGAEV: Although I have a theory about hats...

Mr. MIZRAHI: What is it?

BOGAEV: ...that women don't go to the hairdresser the way they did in the
'50s or the '40s, and so you can't be walking around in a hat and having hat
hair.

Mr. MIZRAHI: No, you're absolutely right about that, about, like, you know,
what are the hats in the women if not for the coifs under the hats, but in a
lot of instances, you are covering your hair, so it...

BOGAEV: So it does fit in the 21st century.

Mr. MIZRAHI: That's right. That's right. That's right.

BOGAEV: Are there any other things that caught your eye that you think are
making a comeback?

Mr. MIZRAHI: Well, you know, what's come back is everything. You know, you
can't really say what isn't anymore. You know, it's just like every period
it's become such a pastiche of the 1930s and the 1960s and 1970s. It's really
like there isn't anything that isn't right anymore. What's wrong is the way
you put it together, you know? The degree of irony, the degree of sort of,
you know, humor that you use when you put these things together, that's what
changes. That's what looks wrong or right, do you know? It's true. And
every women knows what the hell I'm talking about, I think, you know? It
isn't what you're wearing; it's how you're wearing it now.

BOGAEV: It's been a lot of fun talking with you. Thank you.

Mr. MIZRAHI: Thank you. It's a lot of fun being here. Thank you.

BOGAEV: Fashion designer Isaac Mizrahi. He's one of six designers featured
on a special series "Style in Motion," airing Monday nights in October on
Turner Classic Movies.

Coming up, we preview the new TV season. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Upcoming TV programs
BARBARA BOGAEV, host:

After months of summer reruns and reality shows, broadcast network television
is now midway through its official fall premiere week. TV critic David
Bianculli is sad to report that, for the most part, he doesn't think it was
worth the wait.

DAVID BIANCULLI reporting:

Every fall, the networks turn out about 40 new shows hoping to strike a nerve,
launch a hit and preserve or change their own prime-time standings. This
fall, 20 of those shows already have premiered. Eight more will be introduced
tonight through Sunday, and the rest will dribble out in October and November.

I've seen all of them, including the ones that won't show up until the World
Series is over, and there's not one must-see show in the bunch--not one.
That's bad. Just a few seasons ago at this time, I was able to rave about the
excitement and vision of new shows called "24" and "Alias."

Last year, there was "Boomtown." This year, the show I'm most enthused about
is the new Joe Pantoliano show called "The Handler," which basically is a
cross between "Mission Impossible" and "Wiseguy." Entertaining? Yes.
Groundbreaking? No.

At all the networks, the approach to series development this season has been
to play it safe. There are police procedural shows and family sitcoms and new
series spun off of old TV shows and movies. There's even a "Tarzan" update on
The WB, which is very funny. Unfortunately, it's not supposed to be.
Exemplifying this conservative approach this year is NBC, which tonight
launches its 10th and final season of "Friends." This is the network's last
chance to introduce a new show that could someday follow in that show's
footsteps and keep NBC's Thursday lineup from slipping significantly in the
ratings race.

So what does it do? It takes a British sitcom called "Coupling" and recasts
the show using pretty much the same scripts. I like the British version,
shown here on BBC America, but the first two episodes of the Americanized
"Coupling" are oddly flat. Some jokes are overplayed. Others, some of the
best ones, are cut out entirely.

Both versions of "Coupling," a show about six attractive young people who hang
out together, have been accused by most TV critics of copying "Friends."
Actually, that's not fair. What "Coupling" really tries to copy is
"Seinfeld," especially in the way the characters find their own ways to define
things. Here's a scene from the original British pilot of "Coupling" in which
one guy suggests an unflattering term for a persistent ex-girlfriend.

(Soundbite from "Coupling")

JEFF: Steve, do you know what I call this kind of woman, you know, the type
you can't get rid of?

STEVE: Is this going to be really tasteless? Am I going to be ashamed to be
your friend?

JEFF: There's a technical term. It's just a harmless expression.

STEVE: All right. Hit me.

JEFF: Unflushable.

STEVE: Turn around, Jeff. Walk away.

JEFF: You know, because they keep bobbing around.

STEVE: Go, Jeff! Go! Go!

BIANCULLI: I'd let you listen to the American version of that same scene, but
it doesn't exist. NBC cut it, just as they cut a lot of the other memorable
or subtle lines from the original shows. All that's left are two good
performances from Rena Sofer and Lindsay Price, and that may not be enough.

In the CBS drama series "The Handler," Joe Pantoliano's performance is enough.
He plays the head of an undercover FBI squad. In this scene, which opens the
series, he's trying to force a young woman into his car during a driving
rainstorm. It turns out, she's a new FBI trainee and he's trying to teach her
what to expect and avoid on the street.

(Soundbite from "The Handler")

Mr. JOE PANTOLIANO: Look, you think you can just sell on my corner and my
customers because you want to?

Unidentified Actress #1: I didn't see any signs that said you own this street.

Mr. PANTOLIANO: You weren't looking close enough.

Unidentified Actress #1: You got a map in your car?

Mr. PANTOLIANO: What?

Unidentified Actress #1: Why don't you just show me what part of the city you
don't own, and I'll go sell over.

Mr. PANTOLIANO: Maybe get in the car, I'll give you a ride and show you
myself.

Unidentified Actress #1: Why don't you just cut me some dope, and I can stay
where I am, and we can both be happy?

What?

Mr. PANTOLIANO: No. No. You can't do that. No. That's entrapment.
You've got to get him to make the suggestion. Let him come to you. The
attitude was good. I like that. You're not a pushover and you didn't get in
the car. That's important. And, listen, what you did, getting sexy with
me...

Unidentified Actress #1: Yeah?

Mr. PANTOLIANO: ...don't do it unless you plan on going all the way with it.

BIANCULLI: He's good enough to watch and support that show, and the rest of
the cast is intriguing, too. "The Handler" is worth sampling.

So, in the next few days, are "Joan of Arcadia" on CBS, Rob Lowe's new series,
"The Lyon's Den" on NBC and "Karen Sisco" on ABC, but there's not a "24" or an
"Alias" in the bunch, and that's a bit frustrating. What's not frustrating is
that those shows have survived and are coming back: "Alias" this Sunday, "24"
not until the end of October. If we can't get excited about any of the new
shows, at least we can be happy that so many wonderful old ones made the cut
for another year.

"The West Wing," which returned last night without series creator Aaron Sorkin
at the helm, will take a few episodes to resolve last season's major
cliffhanger in which Martin Sheen's President Bartlet stepped down after his
daughter was kidnapped by international terrorists. John Goodman as the
Republican speaker of the House is now in charge at the Oval Office, and his
performance effectively shatters the show's complacency and status quo.

As for "The Practice," which returns Sunday, half of its cast was fired in
order to save the show, but the series has plenty of star power anyway. It's
hired James Spader to play a lawyer joining the firm in the first episode, and
beginning in the second show, producer David E. Kelley has written a
multi-episode guest role for Sharon Stone. She plays Sheila, a lawyer
dismissed from her job because she claims to hear the voice of God, which
ironically is the premise of one of CBS' new shows "Joan of Arcadia."

Adam Arkin plays the boss at the law firm who let her go and defends his
actions in court, but when it's Sheila's time to give opening remarks, she
addresses the jury directly--very directly.

(Soundbite from "The Practice")

Ms. SHARON STONE ("Sheila"): Imagine being considered insane for endeavoring
to communicate with God. I've been so ostracized by my firm these days. God
was the only one who talked to me. You talk to him, Margaret, every night,
and though you think she's a he, that's OK. And, Ward, I know you don't
believe in her, but when your wife survived cancer, you were heard to mutter,
`Thank God.'

Mr. ADAM ARKIN (Unidentified Character): What is going on here?

Ms. STONE: I'm giving my opening remarks, and I'd appreciate being allowed to
finish. And this is fraud.

Mr. ARKIN: Objection!

Ms. STONE: Agnostic, Mitchell. Shame.

Unidentified Actress #2: Ms. Carlisle, chambers, now!

Ms. STONE: Just as well. Shirley has to pee.

BIANCULLI: "The Practice" very quickly becomes The Spader and Stone Show and
makes the series worth watching again for the first time in years. When
you're a TV fan, patience is a virtue. That's why, less than one week into
this new season, I'm already telling myself, `Wait till next year.'

BOGAEV: David Bianculli is TV critic for The New York Daily News.

(Credits)

BOGAEV: For Terry Gross, I'm Barbara Bogaev.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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