On the ethics of eating.

On the ethics of eating.

Every living thing needs energy.  But our world is finite.  Energy has to come from somewhere.

Luckily, there’s a lot of potential energy out there in the universe.  For instance, mass can be converted into energy.  Our sun showers us with energy drawn from the cascade of nuclear explosions that transpire in its core. A tiny difference in mass between merging hydrogen atoms and the resultant helium atom allows our sun to shine.

Our sun radiates about 10^26 joules per second (which is 100,000 times more than the combined yearly energy usage from everyone on Earth), but only a fraction of that reaches our planet.  Photons radiate outward from our sun in all directions, so our planet intercepts only a small sliver of the beam.  Everything living here is fueled by those photons.

When living things use the sun’s energy, we create order – a tree converts disordered air into rigid trunk, a mouse converts a pile of seeds into more mouse, a human might convert mud and straw into a house.  As we create order, we give off heat.  Warming the air, we radiate infrared photons.  That’s what night vision goggles are designed to see.  The net effect is that the Earth absorbs high-energy photons that were traveling in a straight beam outward from the sun … and we convert those photons into a larger number of low-energy photons that fly off every which way.

We the living are chaos machines.  We make the universe messier.  Indeed, that’s the only way anything can live.  According to the Second Law of Thermodynamics, the only processes that are sufficiently probable so as to occur are those that make the world more random.

We’re lucky that the universe started out as such a bland, orderly place – otherwise we might not even be able to tell “before” from “later,” let alone extract enough energy to live.

Dog!

The earliest living things took energy from the sun indirectly – they used heat, and so they were fueled by each photon’s delivery of warmth to the Earth.  (Please allow me this little hedge – although it’s true that the earliest life was fueled only by warmth, that warmth might not have come from the sun.  Even today, some thermophilic bacteria live in deep sea vents and bask in the energy that leaks from our Earth’s molten core.  The earliest life might have lived in similar nooks far from the surface of the Earth.  But early life that resided near the surface of the seas seems more likely. Complicated chemical reactions were necessary to form molecules like RNA.  Nucleic acids were probably first found in shallow, murky pools pulsed with lightning or ultraviolet radiation.)

Over time, life changed.  Organisms create copies of themselves through chemical processes that have imperfect fidelity, after all.  Each copy is slightly different than the original.  Most differences make an organism worse than its forebears, but, sometimes, through sheer chance, an organism might be better at surviving or at creating new copies of itself.

When that happens, the new version will become more common. 

Over many, many generations, this process can make organisms very different from their forebears.  When a genome is copied prior to cell division, sometimes the polymerase will slip up and duplicate a stretch of code.  These duplication events are incredibly important for evolution – usually, the instructions for proteins can’t drift too far because any change might eliminate essential functions for that cell.  If there’s a second copy, though, the duplicate can mutate and eventually gain some new function.

About two billion years ago, some organisms developed a rudimentary form of photosynthesis.  They could turn sunlight into self!  The energy from our sun’s photons was used to combine carbon dioxide and water into sugar. And sugar can be used to store energy, and to build new types of structures.

Photosynthesis also releases oxygen as a biproduct.  From the perspective of the organisms living then, photosynthesis poisoned the entire atmosphere – a sudden rise in our atmosphere’s oxygen concentration caused many species to go extinct.  But we humans never could have come about without all that oxygen.

Perhaps that’s a small consolation, given that major corporations are currently poisoning our atmosphere with carbon dioxide.  Huge numbers of species might go extinct – including, possibly, ourselves – but something else would have a chance to live here after we have passed.

In addition to poisoning the atmosphere, photosynthesis introduced a new form of competition.  Warmth spreads diffusely – on the early Earth, it was often sheer chance whether one organism would have an advantage over any other.  If you can photosynthesize, though, you want to be the highest organism around.  If you’re closer to the sun, you get the first chance to nab incoming photons.

That’s the evolutionary pressure that induced plants to evolve.  Plants combined sugars into rigid structures so that they could grow upwards.  Height helps when your main goal in life is to snatch sunlight.

Animation by At09kg on Wikipedia.

Nothing can live without curtailing the chances of other living things.  Whenever a plant absorbs a photon, it reduces the energy available for other plants growing below.

Plants created the soil by trapping dirt and dust, and soil lets them store water for later use.  But there is only so much desalinated water.  Roots reach outward: “I drink your milkshake!”, each could exclaim.

For a heterotroph, the brutality of our world is even more clear.  Our kind – including amoebas, fungi, and all animals – can only survive by eating others.  We are carbon recyclers.  Sugar and protein refurbishers.  We take the molecular machines made by photosynthesizing organisms … chop them apart … and use the pieces to create ourselves.

Some heterotrophs are saprophages – eaters of the dead.  But most survive only by destroying the lives of others.

For the earliest heterotrophs, to eat was to kill.  But, why worry?  Why, after all, is life special?  Each photosynthesizing organism was already churning through our universe’s finite quantity of order in its attempt to grow.  They took in material from their environment and rearranged it.  So did the heterotrophs – they ingested and rearranged. Like all living things, they consumed order and excreted chaos.

The heterotrophs were extinguishing life, but life is just a pattern that repeats itself.  A living thing is a metabolic machine that self-copies.  From a thermodynamic perspective, only the energetics of the process distinguish life from a crystal.  Both are patterns that grow, but when a crystal grows, it makes matter more stable than its environment – life makes matter less stable as it’s incorporated into the pattern.

Your ability to read this essay is a legacy of the heterotrophs’ more violent descendants.  The earliest multicellular heterotrophs were filter feeders – they passively consumed whatever came near.

But then, between 500 and 600 million years ago, animals began to hunt and kill.  They would actively seek life to extinguish.  To do this, they needed to think – neurons first arose among these hunters.

Not coincidentally, this is also the time that animals first developed hard shells, sharp spines, armored plates – defenses to stop others from eating them.

The rigid molecules that allow plants to grow tall, like cellulose, are hard to digest.  So the earliest hunters probably began by killing other animals.

With every meal, you join the long legacy of animals that survived only by extinguishing the lives of others.  With every thought, you draw upon the legacy of our forebear’s ruthless hunt.

Even if you’re vegan, your meals kill.  Like us, plants have goals.  It’s a matter of controversy whether they can perceive – perhaps they don’t know that they have goals – but plants will constantly strive to grow, to collect sunlight and water while they can, and many will actively resist being eaten.

But it makes no sense to value the world if you don’t value yourself.  Maybe you feel sad that you can’t photosynthesize … maybe you’d search out a patch of barren, rocky ground so that you’d absorb only photons that would otherwise be “wasted” … but, in this lifetime, you have to eat.  Otherwise you’d die.  And I personally think that any moral philosophy that advocates suicide is untenable.  That’s a major flaw with utilitarianism – rigid devotion to the idea of maximizing happiness for all would suggest that you, as another organism that’s taking up space, constantly killing, and sapping our universe’s limited supply of order, simply shouldn’t be here.

At its illogical extreme, utilitarianism suggests that either you conquer the world (if you’re the best at feeling happy) or kill yourself (if you’re not).

We humans are descended from carnivores.  Our ancestors were able to maintain such large brains only by cooking and eating meat.  Our bodies lack an herbivore’s compliment of enzymes that would allow us to convert grass and leaves into the full compliment of proteins that we need.

And we owe the very existence of our brains to the hunts carried out by even more ancient ancestors.  If they hadn’t killed, we couldn’t think.

Just because we were blessed by a legacy of violence, though, doesn’t mean we have to perpetuate that violence.  We can benefit from past harms and resolve to harm less in the present and future.

Writing was first developed by professional scribes.  Scientific progress was the province of wealthy artisans.  None of the progress of our culture would have been possible if huge numbers of people weren’t oppressed – food that those people grew was taken from them and distributed by kings to a small number of privileged scribes, artisans, philosophers, and layabouts. 

When humans lived as hunters and gatherers, their societies were generally equitable.  People might die young from bacterial infections, dehydration, or starvation, but their lives were probably much better than the lives of the earliest farmers.  After we discovered agriculture, our diets became less varied and our lives less interesting.  Plus, it’s easier to oppress a land-bound farmer than a nomadic hunter.  Stationary people paid tribute to self-appointed kings.

This misery befell the vast majority of our world’s population, and persisted for thousands of years.  But the world we have now couldn’t have come about any other way.  It’s horrific, but, for humans to reach our current technologies, we needed oppression.  Food was taken from those who toiled and given to those who hadn’t. 

Mostly those others created nothing of value … but some of them made writing, and mathematics, and rocket ships.

Although the development of writing required oppression, it’s wrong to oppress people now.  It was wrong then, too … but we can’t go back and fix things.

Although the origin of your brain required violence, I likewise think we ought to minimize the violence we enact today.  We can’t help all the animals who were hurt in the long journey that made our world the place it is now.  And we can’t stop killing – there’s no other way for heterotrophs like us to live.

To be vegan, though, is to reckon with those costs.  To feel a sense of wonder at all the world pays for us to be here.  And, in gratitude, to refrain from asking that it pay more than we need.

On medical spending.

On medical spending.

Trepanation_-_feldbuch-der_wundartzneyBack when doctors were curing headaches by drilling holes through people’s skulls, or slapping on a few leeches to drain out the bad blood when sick patients came stumbling through the door, medical spending wasn’t a big deal.  There weren’t any serious political considerations attached.  If you were wealthy, you might visit a doctor and get yourself killed.  If you were poor, you’d probably go without medical care.  You’d live or die according to the virulence of your disease and the quality of your diet.  Maybe you’d buy a small amulet representing one of the healing saints, or pay a witch to bury herbs in an auspicious location near your house.

I haven’t done an extensive review of the historical data, but to the best of my knowledge no ancient kingdoms were bankrupted trying to provide leeches to all their sick citizens.

Now, though, the situation is different.  Medical care is better.  Doctors know enough that patients receiving care fare significantly better than those left untreated.

There are dramatic economic consequences of improved medical care, though.  Leeches and bloodletting and trapanation were ineffectual, but they were cheap.  Modern medical care actually saves people’s lives, but it comes at a huge cost.  In the United States, health care spending is about a fifth of the total economy, and rising.

US_health_costs_GDP

Albrecht_Dürer_-_Death_and_the_Lansquenet_(NGA_1943.3.3611)Death is scary.  For people who started learning philosophy with Camus (which is not something I’d recommend — this can result in an excessively bleak world view and is probably appropriate only for incurable depressives), inescapable death seems to be the major quandary in our attempt to ascribe meaning to life.

The fear of death fuels medical spending.  Also our spending on biomedical research.  Medical care is pretty great currently, especially if you’re comparing statins and anti-retrovirals and insulin to leeches.  But people still die.  We haven’t reached the singularity yet (thank goodness).

Leeching-largeBiomedical research spending makes the population as a whole sicker, though.  Most research innovations — and certainly the most lucrative ones — are for managing chronic conditions, not curing them.  People who would’ve died — how many leeches do we prescribe for atrial fibrillation? — survive instead, lowering our population’s average health.  And raises average age, since those first few maladies aren’t killing people as often.

It’s not so difficult to imagine that, if these biomedical research trends continue, people might survive until a hundred and fifty, maybe two hundred years old … and health care spending will rise until it’s a third of the U.S. economy, or fifty percent, or more.

That could doom the country.

But the real tragedy, to my mind, is the way that health care money is being spent.

9781250044631I think a passage from Damon Tweedy’s Black Man in a White Coat gives an elegant summary of the problem.  The whole book is great — I’d highly recommend it to anyone who cares about either racial inequality or the U.S. medical industry.  Tweedy’s writing is so compassionate, always looking to describe the best in people even when his narrative compels him to shown them at their worst.

The passage I want to quote appears just after Tweedy describes a preventable medical tragedy brought on by poor lifestyle choices.  Tweedy grabs a hasty meal with some of his colleagues and is still mulling over what more could’ve been done to help the patient.  Ironically, this leads to a conversation about counseling patients to eat better, but Tweedy and the other doctors are scarfing extremely unhealthful meals.

It really is a great book — big-hearted and earnest, with Tweedy always clear-eyed about his own failings.  His descriptions of his own struggles with poor lifestyle choices really dramatize his efforts to address other black men’s unhealthy lifestyles.

(Oh, and, I fixed a minor typographical error in the following quote without marking it — I always think  sic erat scriptum sounds snarky, and Tweedy’s book was good enough that I’d feel like a total jerk if I made him look bad for what was probably someone else’s mistake.)

pizza
Medical doctors should know better than to eat hospiteria (hospital cafeteria) pizza.

I asked them their thoughts on counseling patients about nutrition and exercise.

“That’s the responsibility of his outpatient primary care doctor,” he said.  “We’re here to deal with the life-and-death stuff.”

This focus on biomedical treatment over preventative care is not limited to Duke or similar schools.  Indeed, outpatient primary care physicians — the doctors that Mike felt bore the responsibility for counseling patients on diet and exercise — are often no more inclined than other doctors to have this discussion, even for diseases where these interventions are vital.  There are many barriers, among them money (dietary counseling is reimbursed poorly compared to medical procedures), time (physicians often see patients every ten or fifteen minutes), and the sense that nutrition talk is better left to dieticians, and that doctors should focus on their expertise (prescribing medications, interpreting tests, and performing procedures).  In addition, experience has made many doctors cynical about patient behavior and the likelihood for change.

The tragedy of U.S. health care spending isn’t just that we shovel too much money into it, which limits what we can spend on other, more important causes, but also that we pour huge sums of money into end-stage therapies that don’t increase quality of life nearly as much as cheaper, earlier interventions.

My father-in-law’s treatment is a great example.  By the end of his life, the federal government was spending hundreds of thousands on his care.  Medication for cholesterol and diabetes, high-tech surgery to replace arteries & restore nervous function in his hands after they’d been numbed by diabetic neuropathy, installing an internal defibrillator once his heart began to fail…

Those treatments helped.  Sure.  They kept him alive longer.  He was incredibly happy after the hand surgery — for months he’d been unable to play guitar because he couldn’t feel anything and could barely exert enough pressure to fret the strings, and after that surgery he could play again, invited everyone he knew for another potluck & jam session.

When K dropped her father off after that surgery, she realized our government’s medical spending on him was actually helping dozens of people — all his neighbors were outside waiting to greet him, and once he could use his hands well enough to cook again he resumed baking loaf after loaf of sourdough bread to give to them.

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I couldn’t find an image of any breads that look quite as dense as the whole-wheat loaves Mike used to bake for everyone, but David Jackmanson‘s seems close.

At the same time, our government could’ve brought K’s father — and everyone he helped — more joy by helping him earlier.  They spent nothing on him until his untreated conditions left him too disabled to work.  Only then, and even more so after he reached sixty-five, could he get help.

It’s crummy knowing that he would’ve been happier, and would’ve been able to give more back to his community, if he’d been helped earlier.  His childhood was rotten, but nothing was spent to overcome the scars left from hostile parenting.  Our government didn’t help him get counseling after a traumatic event in his early adulthood, either, and that was the root of so many of his later problems.  A few thousand spent to help him then could’ve kept him from becoming indigent. A few thousand spent on psychiatric counseling then would’ve staved off the need for the hundreds of thousands in medical care that were provided later.

This bizarre state of spending priorities is reflected very clearly in our federal budget.  For instance, there’s no money set aside for universal pre-K education.  This would only cost on the order of $10 billion dollars, though, whereas we spend something like $500 billion on health care for the elderly.  But if our goal is to produce good health, childhood education accomplishes much more than surgery and pharmaceuticals for the elderly.

As Tweedy wrote, simply teaching people to eat better would obviate the need for a significant percentage of our medical spending.  Maybe we’d need to spend some money subsidizing real food so that a better diet was within more people’s reach, but, still… that’s much cheaper than the life-and-death medical care that Tweedy was trained to provide.

After an education worth some hundred thousand dollars, after two decades of hard work & studying on his part, Tweedy served as part of a care team working arduous thirty-hour shifts … all to save people who might’ve stayed away from the hospital entirely if they’d been eating vegetables.