The Craven Greed Department: another installment

A while ago we posted on some circulars we'd been sent advertising companies who would help write grants for NIH and grantsmanship the system.  This was preying on faculty who felt fearful for their careers if they didn't haul in the bucks.  Gaming the system may be part of life (we teach our students how to do it, after all), and it's very crass if not dishonorable.  But in the past, universities had offices or faculty members had colleagues who would help them.

Companies cashing in prey like vultures, however.  Where do the fees come from?  It would be immoral to spend money on this year's grant to get help writing next year's, because grant funds are supposed to strictly to the proposed research.  Departments are very unlikely to shell out for their faculty members to buy the service, and if they do it may come from grant overhead, and again would be immoral if not illegal.

Another installment, this time by a once-reputable company
Today, everyone subscribing to Nature got, stuck onto the issue's cover, an advertisement for Macmillan Science Communications (MSC--Macmillan publishes Nature), selling services to help you write your next paper and target it to journals you tell them you want to hit.

As the snapshot from their web site shows, the minimal service costs $625 for a brief bit of reaction from MSC, and $1250 for actual help on a paper, if the paper is less than 1500 words (a length that, by the way, is basically a comment, not generally a real paper); for longer papers, of course, the tab goes up by an unspecified amount.

From: http://msc.macmillan.com/en/editing

You might think of these as bargain charges, and of course one would expect Macmillan to be livid at our portrayal of their noble cause.  But we can remember how, in the good old days, your colleague down the hall would help. If English was not your native language, you would get help with your grammar and the like.  We ourselves have done that countless times (if only we'd known we should have been charging such fees!).

OK, you're in a hyper-competitive system and you're scared that you'll not get tenure if you don't get your paper in the highest impact journal, so you'll pay through the proverbial proboscis.  We wonder if the noble MSC ever will tell you your paper is too trivial or minimal to make it to a good journal, or if they'll just charge you and wish you good luck. They don't, we presume, guarantee acceptance.

So who pays?  Like the grant-writing scams of a couple of years ago, will it be from your current grant?  Will your Chair provide the funds?  How many papers' worth will be covered?  Are you too embarrassed to ask for help, lest your weaknesses be exposed?  Or, is it more likely that MSC is knowingly preying on your fears and knowing that you'll pay it out of pocket?

One might argue that MSC is just tapping into, and exploiting in a benign sense, a ready market, and that they are in that sense doing a service, even a good thing.  If so, it's a very sorry reflection of the state of affairs.  Why, even if MSC is a crassly capitalistic company, this is downright Marxian! How could that be, you ask?

We churn out more labor--in this case, PhDs--than we can employ, and let them linger on the edge until or if we need them.  We churn them out because they generate the work of our labs and enable us to bring in the profits (grants, patents) in which they really don't share.  That they are unemployed doesn't mean we don't keep training more, because of the industrial growth-is-everything model.  So some of these urchins have to find other jobs, and in this case it appears that some find jobs with MSC, preying on the insecurities and fears of those who do cling onto or hope to get jobs in the system, by promising that if they (the surplus scientists) edit the terrorized workers' work the latter can hope to keep their jobs.  Of course, given that we are training surplus labor, that's an illusion.  So we think it's a cruelty in many ways to exploit this situation.

The idea that anything any greedy person wants to gouge others for is all right is a symptom, we think, of an honorless society.  If getting cribs to do your paper-writing, or (we've posted on this before) to 'help' you get grants, is doing a needed service, or a service that the trade will bear, is a legitimate thing to do, then it shows how sorry our society's behavior is to provide the clientel in the first place.

Faculty members should not be hired as sales agents, but for their insight and talents.  Faculty  members should by that stage be able to write papers and grants, to know where to target them and how to write them.  One should not need cribs and commercial services to do what one has presumably been prepared to do while in graduate school and postdoctoral positions.  But if for proper reasons, such as English-language issues or lack of enough experience, they can't do their own work, then their colleagues should not be unwilling to help.

Wes Jackson on why perennials and why not annuals

Jim Wood wrote last week in defense of traditional agriculture.  He was reacting to something he heard Wes Jackson, director of The Land Institute, say in an interview with Mark Bittman on the New York Times site, and that was that "agriculture is the worst mistake in the history of the human race."  Jared Diamond may be responsible for this idea gaining traction as it was the title of an article he wrote for Discover Magazine in 1987.

Fertilizer being applied to a corn field; Wikimedia Commons

Jim noticed that the idea was perpetuated on the Land Institute's website, and it got his hackles up because, as an anthropologist, he believes that most traditional agriculture isn't all bad.  Of course, yesterday's post by archeology graduate student Reed Goodman points out that depending on what is 'traditional' agriculture has had serious consequences before today's industrialized, fossil-fuel-based version that Wes is referring to.

The Land Institute is a forward-thinking, some might say radical hot-shot on the sustainable ag horizon.  They have been working for 37 years now to perennialize grain, for many important ecological and economic reasons. We blogged about The Land recently, but of course Wes Jackson describes their work much better, and more fully than we can. He is passionate because he wants to motivate people to undertake fundamental change, and that is difficult to achieve.

Indeed, Wes emailed us a reply to Jim's blog post, explaining what he thinks is wrong with modern agriculture, and why perennializing grains will eliminate some of the worst ecological effects of today's reliance on annual crops, monocrops at that.  He has kindly agreed that we post his comments here.

Wes Jackson

First off, I am not an anthropologist. I have spent little time in undeveloped countries. I have visited a few farms in Mexico, rural Chile and Argentina and also Tunisia. I am not doubting the observations of Professor Wood with his vast “on the ground” experience with subsistence farmers. There is little to disagree with on any of the “bullet points” and wondering if perhaps he is not aware that we are mostly plant breeders (perennializing the major crops and domesticating some promising wild species) and ecologists at work to put them in mixes that mimic something close to the vegetative structure of a prairie.

I am attaching a.) my preface and prologue of New Roots for Agriculture, 1980 and b.) Chapter 6 of my 2012 book Consulting the Genius of the Place. [Please email me, avbuchanan at gmail, if you would like copies of either of these.]

1.     The Land Institute is not suggesting that we go back to gathering and hunting. Too much water has gone through the turbines for that to happen.

2.     We do not criticize farmers of any variety. We are all locked into a system in which there is little opportunity for life outside it.

3.     We are saying that annual grain monocultures represent a kind of “hardware” around which we have historically built several versions of software. Some have been sustainable and have stood the test of time, but most acreage with annual hardware erodes.

4.     Most of nature’s land based ecosystems tend to feature perennials grown in mixtures. There soil capital accumulates. Grain agriculture features annuals which tend to be grown in monocultures.

5.     Here and there and now and then (sometimes for long periods) are examples where the ecological capital has been sustained, for whatever reason. It depends.

6.     We can now come up with herbaceous perennial seed producing polycultures, something humanity could not do until the present. Here is the reason. Essentially all annuals tend to self, i.e. accept their own pollen and therefore the genetic load does not build up. Also, a desirable mutation, such as shatter resistance, can be quickly fixed in the population. This makes the first step to domestication easy. Perennials are likely to have a huge genetic load. Early agriculturists would have been quickly discouraged at getting high yield as they did with the annuals through crossing. There would have been lots of aborted embryos. Also they would have had to wait a long time for a desirable trait, such as shatter resistance, to become fixed. In our time, given our computational power and knowledge not available then, we can overcome the problem of our agricultural ancestors.

7.     I am not an anthropologist and have spent little time in undeveloped countries. I have visited farms in Mexico, rural Chile, Argentina and Tunisia. I am not doubting the observations of Professor Wood with his vast experience “on the ground” visiting subsistence farmers and liking them. Seems I have been influenced by others who have studied the history of earth abuse through agriculture. To name a few: Dr. Walter C. Lowdermilk, Plato and Aristotle, Curtis N. Runnels, Paul B. Seers and many others.

8.     The United Nations says we are losing some 30 million agriculture acres per year due to agricultural land degradation. Also, one study shows that for 1700-2000 the globe lost slightly less than 1 billion acres of ag land due to degradation of some form.

Here are a few points we believe we can defend as to why we should be optimistic about the potential of perennial grain mixtures.

1.     Production: “In most parts of the world, human activities, and agriculture in particular, have resulted in decreases in net primary productivity from the levels that likely existed prior to human management. (Chris Field, 2001, Science)

2.     More Efficient:  Perennials have greater access to resources over a longer growing season.

3.     Time-tested: Diverse, perennial plant communities have been successful micro-managers of landscapes for millions of years.

4.     Reallocation Potential: Perennials have “excess capacity” that can be reallocated to grain production.

5.     Sustained yield: Perennial grains have the advantage over annuals in terms of sustained yield on marginal landscapes.

6.     The revolutionary transformation of wild species into crops has been done before (with annuals).

7.     The Millennium Ecosystem Assessment (MEA) report said: Production (of food) at the expense of conservation (of the wild biodiversity) OR conservation at the expense of production. The either-or assumption can be replaced with “conservation as a consequence of production” with perennial polycultures.

In addition to the greenhouse problem being addressed with perennial grains, there are two other realities which Natural Systems Agriculture addresses:

1.     Agriculture is the “largest threat to biodiversity and ecosystem function of any single human activity.” (MEA)

2.     Humans are poor micro-managers of complex, dynamic processes taking place across large landscapes. Diverse perennial systems are elegant micro-managers of nutrients and water.

And more succinctly: 

I do not criticize grain farmers who have been forced to come up with software to do the best with the “hardware” with which they have been stuck for 10 millennia. Several small scale enterprises have come up with software (agronomic methods) to make do, depending on where they are and the history of their culture. With the new hardware (perennials on the horizon), now ecology can enter the picture in a robust way for the first time. What has to run ahead of everything else on the global scale is an historical reality. On a large scale annual agriculture destroys the ecological capital behind our food supply. It has done so long before the industrial era because annual systems are poor micromanagers of nutrients and water.

 Summing up?
A lively discussion about how things were, are, and ought to be is a salubrious thing for the social media.  In this case, the differences of views expressed reflect different perspectives and time scales and the like, not different assessments of the issues that Wes has devoted so much attention and creative work to.  And Jim Wood, like many anthropologists, is interested in other aspects of agriculture.

The more these discussions can be aired, and the more widely, the more likely it could be that these serious issues are addressed.

Here be Dragons: climate change and a lesson from the past

          Recently, Richard Alley, a Nobel Prize winner for his work with the Intergovernmental Panel on Climate Change, as well as Evan Pugh Professor of Geosciences at Penn State, told the Anthropology Department here a tired tale of human-driven global warming and how it will be our end (or our children’s children’s end, and then only if they live in the tropics). I’m a graduate student in Archaeology in the Department, working on land use and sustainability issues, and so I was particularly interested in what he had to say. 

          Alley provided good evidence that carbon dioxide is intimately linked to rising temperatures, as it has always been. Throughout different periods of history, changes in earth’s orbit caused heat spikes, in turn ramping up atmospheric levels of CO2. This resulted in a feedback effect, where increasing carbon dioxide spun the temperature dial in the direction of HOT. Of late, humans have opportunistically contributed to atmospheric CO2 through the burning of fossil fuels, causing uncharacteristic warming in our interglacial period and, undoubtedly, unnecessary extremes in weather. This has become a fairly well known and accepted argument across the board, and the data are only getting stronger.
          But the noteworthy bit, to me, was Alley’s generous display of humility. One of the world’s leading scientists on abrupt climate change, he began his talk with the moralizing concession that science can only know so much. In other words, he acknowledged that the story of climate change is and will remain, to some degree, unknowable. And that might be the scariest part. To bring the point home, he produced a slide of the Hunt-Lenox Globe. Dating to the early 16th century, the Hunt-Lenox is a beautiful, copper sphere, one of two historical maps with the Latin phrase HIC SVNT DRACONES, or “here be dragons.” He then posed a simple but earnest question: if people prepared for dragons in the past, if only out of fear, then why don’t we, here and now, prepare for ours, especially when we are, in terms of global warming, on firmer (though, dare I say, soon-to-be-submerged) ground?

Hunt-Lenox Globe
http://www.swiftek.net/?page=dragons

          These weren't scare tactics; Alley was being realistic. Based upon their theoretical constructs, scientists have long observed anthropogenic climate change. He pointed out that even Navy Admiral Samuel J. Locklear III, US Chief of Pacific Forces, was recently quoted in the Boston Globe as stating that melting polar ice is leading to rapid rises in sea level, posing a top threat to national security. When it comes to climate, the question is no longer if, but when and to what extent.

          Good science on climate change favors words like risk over certainty, because science deals in probability, not truth. Unfortunately, the public doesn’t like the former. This might seem odd, given that we equip our automobiles with seat-belts and airbags, our airplanes with flotation devices, and our dress shirts with that extra little button on the inside, just in case, all in the name of risk. Why, then, shouldn’t we prepare for the increased risk that attends a warming planet? The answer, I tend to believe, is that people are waiting to see direct correlations for the nearing of another Permian Extinction, where warming will be the de facto source of death and destruction. But that’s not how this works, not this time, at least. What will happen instead, and what we’re already beginning to see, is a correlation between rising temperatures and lower crop yields (at a time when one out of every eight people are suffering from chronic undernutrition), increased water usage (at a time when water scarcity effects one out of every five people), mounting violence (hello, Arab Spring), and rising seas (goodbye, Florida). There’s another problem, as well: the age-old belief that technology and innovation will be our savior. Here, archaeology presents a cautionary tale.
          Just as earth’s climate is dynamic by nature, people are naturally shortsighted in their maximization of resources, and understandably so. We prepare for what we know. Indeed, humans switched from hunting and gathering to farming some 12,000 years ago, in large part to optimize production, as agriculture provided a more consistent food supply. Famine and drought were ever-present possibilities, as they remain today, and so early farmers developed technologies, slowly over time, to increase and store their yields. Early agriculture’s shortsighted innovations had, from time to time, localized consequences, to be sure, but they remained just that: local. And that’s a fundamental difference from today.
          It was not until populations grew large enough, and technologies effective enough, that people had long-term impacts—through shortsighted decision-making—on the surrounding landscape. Maximization and stability are opposing strategies, but this becomes obvious only after certain thresholds are crossed. Particularly with the rise of state economies, individual or community interests became absorbed into fewer and fewer maximizing strategies. As humans invested ever more in their environments, and as economies of scale developed around the extraction of particular resources, institutions developed and the very fabric of a community became locked-in, part of a path-dependent, adaptational response. While this was economically and socially advantageous in the short-term, it meant decreased resilience over the long-term. With the introduction of a crisis, large, interdependent societies were faced with few options but to innovate. Often, they failed to do so, and this is why the rise and fall of empires is the stuff of legend.
          In some ways, it’s useful to think of history as a cycle of challenge and response. This is not to suggest that certain societies at certain times faltered because of a lack of creativity – to the contrary, in fact. But in terms of innovation and the environment, every technological response trades knowns for unknowns. Moreover, technological innovation is directed toward common challenges, meaning that a group’s technological advancements are designed to face common threats, meanwhile disregarding and therefore becoming more vulnerable to unsuspected but (potentially major) dilemmas. As societies and their technologies build in complexity, complex unknowns also build, inviting far-reaching and often unforeseeable consequences.
          Global warming is as much an environmental challenge as it is a social challenge. It would be an extreme myopia to believe that technological advances will save us in the future. When looked at from the perspective of the past, a people’s ability to successfully innovate is never guaranteed. A brief review of the archaeological record shows that, time and again, technological advances failed to outpace advancing interdependency and the coalescence of maximizing strategies. We now live in an era of globalization and unprecedented vulnerability, subsumed, willingly or not, under a stratagem of cheap oil maximization. The ineluctable switch to natural gas and methane hydrate, instead of the necessary and unconditional move to renewables, is further proof that technology is touted over reality, over science.
          Environmental catastrophes have never been wholly avoidable. But in the past, they were limited in extent, largely because societies were more decentralized, comprised of fewer people, and significantly, the sole reapers of what they sowed (pun intended). With the introduction of fossil fuels and the global market, we've exchanged local resilience and stability for worldwide maximization and fragility, as well as the universal responsibility of, as Richard Alley made clear, an unpredictable climate. And all with an Ozymandian arrogance. This is not to suggest that innovation is inherently evil, but to say that technology, in the modern sense, might not be able to slay the dragon.

To statin or not to statin, that is the question....or is it?

Last week we all heard about the new recommendations concerning predicting and preventing heart disease.  An online calculator was going to be used to predict risk, based on past experience of a study cohort, and if we were found to be at risk, we'd be advised to start taking statins.  Based on various risk factors -- BMI, whether we smoke, etc., -- the calculator would advise our doctor if our risk of heart disease was greater than 7.5%, and if so, that would trigger the writing of the prescription.  Estimates were that this was going to lead to 1/3 or more of American adults taking statins for the rest of their life.

We had various reasons to question this recommendation, as we wrote then, and that was even before new issues have come home to roost.  As reported in the NY Times yesterday (and in The Lancet today), experts are now showing that the calculator is way over-estimating risk, which would mean millions more people on statins than the generous new guidelines themselves would recommend.    Some leading cardiologists are calling for a halt to implementation of the new guidelines until the calculator issues get sorted. 

But apparently this shouldn't have come as a surprise to the cardiac community -- two Harvard cardiologists, authors of the Lancet paper, warned a year ago that the calculator overestimates risk.  The problem seems to stem from the use of old data to do the estimations. Ten or more years ago more people smoked, and developed cardiovascular disease earlier than they do now.  Risk estimates on that background now overestimate the effect of factors such as blood pressure and cholesterol because additional background factors, also a component of risk, have changed.  That is, there are confounding variables that affect risk, whose frequency in the population have change, but the calculator doesn't take this into account.  

Or at least that's probably the problem.  It may be even more fundamental than that.  Decades ago, a very well-known cardiovascular disease epidemiologist, Reuel Stallones, used to say that heart disease rates had both risen and fallen in the 20th century for reasons that were not understood.  Diet, exercise, smoking, cholesterol, none of the obvious risk factors explained either the rise or the fall, and it's still true.

However, the risk calculator problem raises another truly fundamental issue that pertains to this sort of risk prediction in general, not just to heart disease.  We have several times noted that one essential flaw in the whole concept of risk estimation based on the kinds of studies that are done, is that risk is estimated retrospectively, from a study sample's past experiences, but what we want are prospective risks: yours and mine for the future, not the past.  But future experiences, mainly here involving lifestyle environmental factors, are inherently unpredictable (In case you missed it, that's inherently unpredictable).

The critique of the new recommendations, in an unusual way, showed just this problem.  Risks were estimated for the new calculator from past data, but used to estimate risks subsequently.  However, since lifestyle risk has changed (less smoking, for example) our ultimate experiences can't be adequately predicted from risks based on the earlier experiences of the cohort used to estimate risk.  Whatever would lead properly cognizant epidemiologists to think that things would be different for the real future?

Indeed, this shows the stubbornness of our clinging to kinds of statistical association mechanisms, the belief in big-science, the haste, and so on that plagues much of what is afoot these days.  To a great extent, we do what we know how to do, the problems are very challenging and often risks are small in absolute value so that, with our approach, we do look to very large studies.  But we also stick with this rather than slowing down, taking a deep breath, and really re-evaluating what we face.  This is the issue we often write about: the need for a deep change in our scientific concepts or methodology, not just keeping the research factory humming.

Plus, we already know a better way to prevent heart disease, and that is lifestyle choices, exercise, not smoking, eating more vegetables than fats and meats.  Statins are largely generic drugs now, but they are still an expensive way to prevent illness -- people without disease become patients (see Jim Wood's August post on how he became sick), they are in the medical system, requiring not only drugs for life but testing and follow-up testing and so on.  And, statins aren't benign drugs; they do have side effects, including muscle pain, liver damage, diabetes.  The industry's credibility is at stake now with this calculator issue, but there are other reasons to question their word about going on statins.  

Change from the bottom up

We've been on a bit of a sustainable agriculture kick lately.  We've blogged about The Land Institute's work on perennializing grains and grasses, Matt Liebman's work on crop rotation and conservation planting, the implications of this year's World Food Prize being awarded to high tech ag, more realistic economic models, and so on.  These all address the Big Picture, the idea being that current technology-oriented agricultural practices, and economic models that treat natural resources as unlimited are not sustainable in the long run.  Or even the medium run, and that there are changes that can, and must, be made to slow climate change and the economic impact of continuing on the path we're on.

But we can't all perennialize grain.  Yep, think global, act local.  As long as our politicians aren't going to take climate change seriously enough to enact significant controls (cap carbon!), and as long as biotech money is in the pockets of those politicians, the only significant change is going to happen if we the people make it happen.  (If you missed Russell Brand on revolution last week, here he is, forcefully saying much the same thing.  It will inspire either your activism or your scorn.)

Eat Local
But, this isn't new.  The number of farmers' markets in the US, and elsewhere, has been growing for decades, CSAs (farms doing community supported agriculture) as well, colleges are seeing higher demand for degrees in agriculture.  Granted, many of these graduates are snapped up by the biotech industry, but many of them are interested in the local food movement and are growing food and starting CSAs and selling at their local farmers' market.

Ken and I had the opportunity recently to meet a number of people working on issues to do with sensible agriculture, food security and climate change in their local communities. Among them were Tracy Sides, who just won a million dollars from the city of St Paul, Minnesota to rehabilitate an old warehouse and turn it into a food hub.  She is calling this the "Urban Oasis", a centralized facility that will process produce, meat and fish from local farmers for sale in an onsite café and to local schools, hospitals and restaurants, and more.  The University of Minnesota announcement of this U of M alum initiative describes it this way:

The Urban Oasis, or food hub, would be the focal point for local produce, fish, and meat, and would combine a food processing operation with a kitchen, a classroom, a café, and an events center. And it would help transform an abandoned, graffiti-littered building in the Bruce Vento Nature Sanctuary—on St. Paul’s East Side between I-94 and the Mississippi River—east of the burgeoning Lowertown area and practically in Sides’ own backyard. 

Cassi Johnson in Minnesota works to improve community health by teaching about the connection between good food and good health.  She has been doing similar work for a decade.  Kim Bayer is one of the organizers of the Washtenaw Food Hub in Ann Arbor, Michigan.  She has a long history as a community organizer, and is founder and president of the Great Lakes CSA Coalition, which promotes CSA farms and wellness rebates from insurers.  She is also involved with her local Slow Food chapter as well as other food-related community organizations and issues.

Terra Brockman is a 4th generation farmer in Illinois, a speaker, and founder of The Land Connection, an educational nonprofit that connects farmers and would-be farmers with land, teaches sustainable farming practices, and educates consumers about sensible food choices.  She is a founding member of The Edible Economy Project, an Illinois food hub this time, with the aim of expanding markets for local farmers as well as expanding local food access for consumers.  She is also the author of a beautiful book, The Seasons of Henry's Farm, about her brother's thriving CSA farm.  It may be Henry's farm, but it takes a multigenerational family, and more, to make it work.

Farmers' Market, Bridgehamton, NY; Wikipedia

Jason Bradford is the founding director of Farmland LP in Corvallis, Oregon, an organization that has bought thousands of acres of farmland in Oregon and California, with the goal of connecting farmers with affordable land farmed with sustainable practices.  Mary Berry is executive director of the Berry Center in Kentucky which she established in 2011 to carry on the work of her grandfather John Berry, her uncle John Berry Jr, and her father, Wendel Berry.  The Center "was established to continue the Berry family's work in culture and agriculture by working on issues of farmer education, consumer education, land use, agricultural policy and urban/rural connectedness."

Kelly Hauser currently works with the international NGO One Acre Fund to bring sustainable agriculture techniques and small-scale economic practices to small farmers in Burundi.  Karen Lehman has been working on food system issues for thirty years, and is currently director of Fresh Taste, an organization dedicated to relocalizing Chicago's food system and addressing issues of equitable access to good food.  Julia Olmstead, an outreach specialist with University of Wisconsin Cooperative Extension, works with Wisconsin farmers to improve agricultural water systems to improve water quality and make them more resistant to climate change.

Ricardo Salvador, senior scientist and director of the Food and Environment Program at the Union of Concerned Scientists, works with scientists, politicians, economists and the public on developing a healthy food system based on sustainable farming practices.  He was the first professor to teach a sustainable ag course at a land-grant university, in 1989, and he hasn't stopped teaching and writing about the issues.

This work does not go unremarked.  Alan Guebert for one, who grew up on a farm and now writes about agriculture issues, is bringing the message to students, farmers, people on the ground as well as politicians making the decisions about things like whether corn-based ethanol is a good investment, or the kind of farming this year's Farm Bill should support. Bob Jensen, a professor in the School of Journalism at the University of Texas at Austin, is passionately interested in sustainable ag and climate change issues, and writes prolifically about them and about activism itself.

These people all have friends, and their friends have friends, and they in turn have friends; it starts to look like a movement. 

Universal statins: scam....or just honest good luck for Pharma...or what?

The American Heart Association and American College of Cardiology issued new guidelines on Tuesday for reducing risk of heart disease and stroke (the first of five explanations of these new recommendations is offered here).  If you've got a 7.5% risk of heart disease or higher, as measured by their risk calculator (downloadable here), they recommend you go on statins.  This means, according to the panel, that 70 million Americans should now be considering taking these drugs.  This is perhaps 70% more than the number who now take them, and would put at least one third of all adults in the US on this drug.  For life. 

These recommendations have caused quite a ruckus, but perhaps for the wrong reasons. Before Tuesday, people were put on these drugs to lower their LDL cholesterol levels beyond a given threshold, but, confusingly to many, that threshold which we had supposed was a well-established rock-solid risk factor, has now been eliminated!  Before Tuesday, the indication for going on statins was high LDL, but the indications have now been broadened to include other risk factors such as diabetes and obesity.  So, people now taking statins wonder if they should continue, and others wonder if they need to start.  Some doctors commenting on these changes hasten to add that the most important protection against heart disease is a healthy lifestyle -- don't smoke, exercise, lose weight -- but if these can't be accomplished, statins are recommended (see Dr Harlan Krumholz on "The Newshour" on PBS, e.g.).

Wikipedia

But the new recommendation seems strange. First, a word about statins, drugs designed to control circulating lipids (fats), which confer heart-disease risks. They inhibit an enzyme called 'HMG-CoA reductase' which is expressed in liver cells as they produce cholesterol from raw ingredients and secret it into the blood stream.  Lower enzyme activity, lower circulating lipids.  But in fact, there is evidence that for some reason statins target inflammation in irritated arteries and veins, which may be what reduces risk of heart disease rather than any effect on cholesterol, so there is mystery even in the supposed reason for their supposed effectiveness.


Now, according to John Abramson and Rita Redberg in an editorial in the Thursday New York Times, statins aren't actually effective at preventing heart disease.

Statins are effective for people with known heart disease. But for people who have less than a 20 percent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail even to reduce the risk of serious illness — as shown in a recent BMJ article co-written by one of us. That article shows that, based on the same data the new guidelines rely on, 140 people in this risk group would need to be treated with statins in order to prevent a single heart attack or stroke, without any overall reduction in death or serious illness.

If the recommendation is not based on evidence that everyone can agree is reliable then, where is it coming from? Partly, we think, it's a reflection of our belief that we're immortal, partly a general belief in the benefits of drug intervention.... and partly it's a reflection of the fact that some of the recommendation-makers have a vested interest in statins.

The first reason, our belief in immortality, is cultural, and of course very natural.  Few of us, even apparently those with strong religious belief in life hereafter, want to test out that belief.  Heart disease is the number 1 killer in the US and most of us don't want to die of it.

The second reason is more problematic. The most reliable way to lower heart disease risk is through diet, exercise and not smoking.  Indeed, lean, fit, non-smoking individuals whose only risk factor is high LDL are generally at low risk of heart disease.  Until this week, the purpose of statins was to lower LDL cholesterol, but that doesn't reliably lower risk of heart disease. So, are statins a good replacement for life-style?  The answer is No.

But what about the vested interest issues?  As Abramson and Redberg say:

The process by which these latest guidelines were developed gives rise to further skepticism. The group that wrote the recommendations was not sufficiently free of conflicts of interest; several of the experts on the panel have recent or current financial ties to drug makers. In addition, both the American Heart Association and the American College of Cardiology, while nonprofit entities, are heavily supported by drug companies. 

This kind of conflict of interest means that one must be highly suspicious.  One might argue that industry reps are the most knowledgeable about the benefits of their product.  If you want to know how to cure a toothache, ask a dentist, after all.  But how are we to judge the motive behind the recommendations?  Corporate-sponsored research is notoriously biased toward findings favoring their sponsor.  This doesn't mean the bias is intentional, but the evidence suggests that often it is.  At least, the corporate-sponsored research the corporate sponsors tell us about is that which favors their product, since they aren't in fact required to report all their results, and often don't.  (This is why Ben Goldacre, physician, writer and epidemiologist, started the AllTrials campaign to require that all clinical trials be registered, and all results be reported, positive and negative.)  So, when the science isn't convincing, and vested interests are involved in decision-making, it's not unreasonable to be suspicious.

Contingency and context
In addition, the related roles of context and contingency are fundamental and important to understand here.  Risk of heart disease is based on the context--genomic and environmental exposures affect the levels of statins and their consequences.  The risk in an individual is contingent on his/her situation at present, and that can change.  This seems so hard for the established system to understand!

Statins have side effects.  Risk of statin-related disease is estimated in the context of current culture.  If that culture changes, then the risks will change and by all that we know, they'll change dramatically.  If the major contexts change--better diets and so on, things we know a lot about--then the overall risk of heart disease will change.  Models can only do so well at estimating the interaction among the various factors (as the above quote suggests).  If people live healthier lives and if physicians actually pay attention to risk calculations, many may be able to go off their statins, or not start on them, as a result.

But how many will actually risk going off?  Will they keep taking, or their physicians not dare to recommend stopping, for various subjective, inertial, or even emotional reasons?  Will drug companies recommend cessation if, say, body weight goes below some value?  Will they fully advertise the fact that if other factors are favorable, to stop buying their product?  What does history--including their history--suggest to you?

And 10 years from now, how accurate will the predictions have been on which lifelong medications are now being recommended?  Will results be contingent, for example, on the current recommendations themselves?   For example, if you're on statins, will you be more likely to take that second helping of fries, feeling protected by the drug?  The Times Op-Ed puts it this way:

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease. According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.

These are not secret or new issues by any means, but they tend to be overlooked or minimized by a system that tries to be 'objective' based on current data.  The Op-Ed is written by respectable authors, but they are also known skeptics of the over-medicating problem, with its built-in conflicts of interest as we noted above.  So is their skepticism itself a disqualifying issue--does it mean they bias their views in a similar way to having Pharma-supported people on the panel that made the new recommendations?

Clearly, the issues are complex as so many issues related to late-onset disease are.  After all, you don't get a heart attack even at a young age like 40, unless you live to be 40.

Like second-hand smoke?  The real beneficiaries
Smokers get all sorts of diseases, because of the direct effects of the ugly weed.  But those who live in the same house also get diseases, indirectly, courtesy of their smoking cohabitant.  We have just the opposite story here.  The vendors of statins will get filthy rich as a direct result of their recommendations, whether or not they actually prevent heart disease.  And if they do, some other people--maybe the same people--will get even richer as an indirect result of the same recommendations!

If we don't die of heart disease or its associated diseases, we may live longer but that means more of us will get the slower, nastier, very expensive lingering ailments of old age.  The surgeons, retirement homes, cancer and dementia drug-makers will rake it in big-time!

We've written a few times about the subtle, surreptitious problem of competing causes, and this is another manifestation of the problem.  It's largely unavoidable that if you survive the quick-hitting earlier causes of death, you'll last and linger in service to the slower causes.  They're even more expensive.

We would not credit (nor blame) the statin-promoters for the diabolical scheming that would be involved in salivating over the indirect benefits of statin use.  That takes more perception and a longer view than most people, even scientists, usually have.  It is clear that most drug companies, not to mention the scientific research community itself, as we often write, are in for the quick kill, so to speak.

Agriculture: the worst mistake in the history of the human race???

A few words in defense of farming

By Jim Wood

I’m feeling a bit defensive. You see, I study traditional, subsistence-oriented farming – that is, farming in the absence of fossil fuels, commercial inputs, mechanization, seed from outside the local area, anything other than organic fertilizers, easy access to markets, extensive government meddling, etc. etc. etc. I’ve devoted much of my professional life to the topic. I’ve hung out with traditional farmers in several parts of the world, tropical and temperate, talked with old men who as young adults handled plows pulled by oxen (and not because they were hippies), discussed with young men how to judge soil quality by taste, seen mind-boggling arrays of local crop varieties, gotten to know cattle, pigs, sheep (and sheep dogs), water buffalo, and countless chickens. I really like a lot of the farmers I’ve met (okay, some are jerks, but that’s true of everyone). I think they’re really smart and mostly pretty solicitous about their own environments. They have to be if they and their families are going to survive. Yet most of my colleagues in anthropology firmly believe that, to quote the title of an all-too-often-cited article by Jared Diamond, agriculture was “the worst mistake in the history of the human race.”

Nineteenth-Century Persian Drawings of Rice and Wheat Cultivation
(Oriental and Indian Office Collections, British Library, London)

This strange idea is being spread rapidly by introductory anthropology textbooks. And the evidence mounts every day that it’s becoming widespread among the American public. (See how many books lauding the “paleodiet” are listed on amazon.com.) The last straw, I have to admit, landed on my metaphorical back as a result of reading the excellent post that Anne Buchanan recently put up on the MT about the Land Institute and its director, Wes Jackson. I respect both tremendously (all three if you throw in Anne). But Anne’s post inspired me to check out the Institute’s website, where I was immediately confronted with the following statement: “At the Land Institute, we believe that a solution to the 10,000 year old problem of agriculture – soil loss and degradation, environmental destruction, and high energy use – is not only necessary, but possible.” The 10,000 year old problem of agriculture? You mean going back to the early Neolithic in the Near East?? Are you talking about the worst mistake in human history???

Is there anyone out there other than me who’s willing to say something nice about traditional farming?

Let me take the charges leveled by the Land Institute’s website in reverse order. High energy use? The very antithesis of traditional farming. Traditional farming regimes of all forms, even the most intensive, are very low energy-input systems by our standards, and almost all energy (other than solar) is biological – i.e. human or animal labor (plus a bit of wind and water power). Such system are also, admittedly, low energy-output systems, which is why they support comparatively small populations. But – and here’s the critical point – various studies have estimated that overall energy efficiency (the ratio of energy output to input) is something like 3-5 times higher in traditional farming than in modern industrialized agriculture. To lump the two together is just plain wrong. And it’s by no means clear that hunter-gatherers are any more energy efficient, although they probably do have lower inputs on average.

How about soil loss/degradation and environmental destruction? Can these happen under traditional farming? Yes, of course – just as they can happen under hunting-and-gathering, as when hunters burn wide swathes of the landscape to scare out game. No one can look at the record of soil salinization caused by traditional irrigation methods in some parts of the world, or the deforestation sometimes associated with shifting cultivation, and deny the fact. But degradation and destruction are not the inevitable consequences of farming. The agricultural geographers Piers Blaikie and Harold Brookfield have pointed out that it’s a matter of balance:

net environmental degradation =

(natural degradation + human damage) – (natural regeneration + restorative management)

At any one time, the condition of the land is a dynamic equilibrium among these forces. Traditional farmers have devised countless ways to ameliorate and repair environmental degradation, but there’s no doubt that such farmers are capable of damaging the environment, at least locally, and sometimes incapable of putting things right again. Thus, the question is not whether environmental degradation or soil loss occurs under traditional farming – they most certainly do – but whether processes of regeneration, natural or human, can keep up with it. History and ethnography suggest that mostly they can, especially if you focus on small-scale, politically and economically autonomous, self-subsistent farming systems rather than big state-organized ones (see the case of soil salinization, mostly the result of large-scale irrigation).

Leveling padi surface with buffalo, Na Savang Village, northern Laos (© Shinsuke Tomita) 

The literature on traditional farming is filled with examples of practices that minimize or repair environmental damage. A short and incomplete list of examples might include long fallows, multicropping, crop rotations, terracing to stop erosion, use of nitrogen-fixing legumes as both food crops and green manures, and transplanting of other nitrogen-fixing plants such as water ferns of the genus Azolla in irrigated rice fields or casuarina and alder trees in long fallows. Manures of many kinds are generously applied: green manures, animal dung where available, human waste (euphemistically called “night soil”), crushed limestone, old roof thatching, straw bedding for livestock (a rich source of nitrogen from urine), food scraps, pot ash (whence potash and potassium), even seaweed in some areas. The only pesticides and herbicides used are human hands and hoes. Technical analysis has shown repeatedly that such measures can maintain soil quality – and local biodiversity – indefinitely if not stressed by growing population or outside interference. There are even areas, such as the western islands of Ireland, the Sibenik Archipelago off the coast of Croatia, and parts of the rocky highlands of Ethiopia, where generations of traditional farmers have created soil where only stone once existed.

To borrow some recent jargon from ecology, traditional farmers are “niche constructors” or “environmental engineers” – that is, creatures that actively transform environments to their own benefit and often to the benefit of many other species. So are beavers and termites and earthworms and all sorts of animals. Environmental engineering, whether by humans or other species, by definition transforms the local ecosystem but does not necessarily degrade it. In fact, traditional farms (like beaver ponds) have been shown to increase wild plant and animal diversity compared to surrounding natural habitats. Come to think of it, we wouldn’t call a beaver pond “unnatural” so why do we carefully distinguish a traditional farm from nature?

Michael Pollan, in his book In Defense of Food, does a nice job of pointing out that most of the environmental (and health) problems we associate with farming are really concomitants of industrial farming and are therefore very recent. A convenient start date might be 1909, when Fritz Haber first publicly demonstrated his method for fixing atmospheric nitrogen as ammonia for use in commercial fertilizer. (Vaclav Smil has called this “the single most important technical invention of the twentieth century” because “the single most important change affecting the world’s population – its expansion from 1.6 billion people in 1900 to today’s 6 [now 7+] billion – would not have been possible without the [industrial] synthesis of ammonia.”) To place Haber’s demonstration on a human time scale, I note that it occurred during my own father’s infancy.

Niche construction, Indonesia

I should note that environmental degradation is not the only sin pinned on traditional farmers. Here’s the longer rap sheet on farming, according to many, many anthropologists:

· The advent of farming led to a narrowing of dietary breadth, an over-reliance on high-carbohydrate seeds, a reduction in dietary protein, and a general lowering of nutritional status, as evidenced by archaeologically-recovered skeletons of early farmers that show the pathological signs of a poor diet.

· Traditional farmers are infamously subject to food shortages and occasional famines, often accompanied by elevated death rates.

· Farming led to larger populations and a more sedentary form of settlement, both of which led to unhygienic conditions and thereby exacerbated ill-health and mortality from infectious diseases.

· The domestication of livestock exposed early farmers to a variety of zoönotic (animal-borne) infections, further worsening health.

· Farming led eventually to social and political inequality, making life more difficult for a large fraction of humanity.

In my opinion, it’s a bum rap. Here’s why:

· Almost all the traditional farmers that I know of maintain a wide dietary breadth, either by planting a huge variety of secondary crops or by continuing to hunt and gather wild forest products (or, most often, by doing both). In addition, re-study of hunter-gatherer groups (for example, the !Kung) has actually shown them to have comparatively high prevalences of under-nutrition, not appreciably or consistently lower than those of farmers. And as my colleagues and I have long argued (e.g., here, "The Osteological Paradox"), the skeletal evidence on past health and nutrition is much more equivocal and difficult to interpret than many people think.

· The only empirical work done to date on the frequency and severity of food shortages and famines indicates that hunter-gatherers are at least as vulnerable to them as agriculturalists. In fact, the greater ability of sedentary farmers to store and protect food in bulk may actually buffer them more effectively against such environmentally-induced catastrophes.

· The “crowd diseases” that require large populations to persist (e.g. measles, smallpox, influenza) actually require populations that are several orders of magnitude larger than those of traditional farming communities. And pathogens that depend on poor local hygiene for reliable transmission, e.g. helminthes (worms), are actually quite common among modern hunter-gatherers. Besides, owing to the problem of competing causes of death (discussed frequently on this website by Ken Weiss), there is no simple linear relationship between the number of pathogenic agents present in a population and the mortality rate of that population. So even if agriculture increased the number of infectious diseases present in the local community (which is far from certain), that would not necessarily have worsened health and survival at the population level. Finally, a big unanswered question: If early farming was so damned injurious to human health, how did the farming population grow in the first place? Special pleading that fertility must have increased won’t cut it: the fertility rates of modern-day traditional farmers do not differ consistently from those of ethnographically-attested hunter-gatherers.

· Recent DNA evidence suggests that important diseases that probably did originate in animals that eventually became our domesticates (e.g. TB from bovids) actually jumped to humans several millennia before the origin of animal domestication. In addition, modern hunter-gatherers are exposed to a wide variety of zoönoses, many of them quite nasty. HIV and Ebola virus, anyone?

· Farming led to social and political inequality? Yeah, well, maybe – but only after several thousand years! Plenty of comparatively egalitarian farming communities survived well into the twentieth century and have been described by ethnographers. At most, agriculture is necessary but not sufficient for the development of significant sociopolitical inequality.

The fact that most traditional farmers – including even intensive wet-rice cultivators in Southeast Asia – continue to hunt and gather successfully in the surrounding forests is, I think, important. It means that they retain the technology, skills, and local knowledge needed to exploit wild resources. In light of that fact, one has to wonder: if farming is such an obviously rotten way of life, why is there next to no evidence of farmers reverting to full-time hunting-and-gathering? Did farming make people stupid?

I am in no way suggesting that traditional farming communities are paradise on earth. They are not. Traditional farmers work hard, are materially poor, suffer higher mortality rates than we do, especially among the very young – and they do indeed need to weather the occasional food shortage or outright famine. I’m just suggesting that hunter-gatherers were not in notably better shape. Perhaps it’s time to explore the possible advantages of agriculture compared to hunting-and-gathering, the very advantages that led people all over the world to adopt it.