Basis Magazine

Making Sense of a Complicated World Spring 2018 | Volume 09

How Friends Become Closer Tips and tricks to maintaining relationships in a busy world

Strength in Numbers

Why sharing your salary with your coworkers benefits you

It’s Lit!

How film finally started to light black skin

THE SUGAR CONSPIRACY How did the world’s top nutrition scientists get it so wrong for so long?

$ 9.99US $10.99CAN

7

44070 83261

0

CONTENTS 11

Culture Why Government Websites Suck How Film Started to Light Black Skin Why Kids Fight Monsters in Stories

23

Science Uncomplicating Health Just What the Doctor Prescribed?

The Flu Shot

35

Money Strength in Numbers You’re Hired!

Avoiding the Sunk Cost Fallacy The Cost of Hop

ON THE COVER:

‘‘ The Sugar Conspiracy”

55

p. 56

Body The Sugar Conspiracy How to Find a Good Doctor Getting Health Care When Uninsured

81

Mind The Smartphone Generation Who Cares About Climate Change?

How Friends Become Closer

EDITOR’S NOTE It’s hard to look after yourself and the people around you. Why isn’t it easier to figure out what’s good for you and what’s not? Why are the experts always contradicting each other? What are we supposed to believe?

We have the world at our fingertips, and somehow we’re all still clueless.

But you don’t have to be lost in all the noise. Be wary and curious and open-minded. Don't be afraid to ask questions. Don’t settle.

Every day, I encourage you look at the world around you and ask, “Why?” The world can be so much more. You can receive so much more from it, and you can give so much more back.

Kelly Ou Editor-in-Chief

6

BASIS

THE POWER TO QUESTION IS THE BASIS OF ALL HUMAN PROGRESS. — INDIRA GANDHI

7

Editor-in-Chief Kelly Ou Deputy Editor Vivian Zhang Managing Editor Ruth Johnson Creative Director Sharon Grewal Associate Creative Director Megan Reed Body Editor Akshay Bakshi Mind Editor Chris Barker Money Editor Lowell Bander Culture Editor Lauren Francis Science Editor Sam Hooper Head of Research York Zhang Research Editors Aman Agarwal, Jimmy Yang Production Editor Chi Pham Senior Editors Mary Kang Associate Editors Chang Liu, Julien Brundrett Staff Writers Victor Ho, Yoni Anderson, Alyssa Cable, A.J. Jackson, Mariah Gladden, Summer Wang, Kelly Ellis, Mae Lee, Jennifer Nguyen Designers Garima Lunawat, Frank Chen Contributing Writers Alex Zhang, Roger Xu, Paul Witcher, Teryn Leuthold, Marc Finn, Cindy Wang, Hannah Imson

DID YOU KNOW? A standard cup of brewed coffee has more caffeine than a single shot of espresso. Though ounce per ounce, espresso has more caffeine, since brewed coffee is served in larger volumes, a coffee drinker will end up consuming more caffeine over the course of a drink. Keep in mind that the amount of caffeine in a standard cup of joe also varies significantly depending on coffee type, grind time, water temperature, etc.

PHOTOGRAPHY BY ANNIE SPRATT

8

BASIS

9

10

BASIS

CULTURE

“As citizens, it can be hard to understand why our local governments are so slow to innovate. In my experience, I found that it has less to do with technical ability and skill and more to do with an environment of complacency. Innovation requires risk, and that’s a potential headache most governments want to avoid.”

Tom Cochran ‘‘Why Government Websites Suck So Much” p. 18

12 It’s Lit!

How Film Finally Started to Light Black Skin Nadia Latif

16 What’s So Great About Kids Fighting Monsters?

How ‘‘It” Stands Out Steven Jones

18 Why Government Websites Suck So Much And What Can We Do About It? Tom Cochran

19 Recommendations

11

It’s Lit! How film finally started to light black skin

By Nadia Latif

12

BASIS

Insecure, an HBO series currently in its terrific second season, has been garnering attention since its pilot for its refreshing look at the lives of a small group of black women in Los Angeles. Broadcast in the same slot as its precursor Girls, which showed women as their “real” messy selves, and before that Sex and the City, a fantasia of skipping around New York in Manolos, Insecure sits somewhere between the two.

Its storylines are all too real, but it looks stylish and glamorous.

Previous incarnations of black characters on television have mainly been overlit sitcoms or overly gloomy slices of realism.

Insecure is neither — and its actors look like bonafide movie stars.

There is a growing amount of chatter tackling questions of representation on-screen — which reached a tipping point with the #OscarsSoWhite scandal and has been followed by a triumph for diversity with this past year’s Emmy haul for people of color. But the conversation about the aesthetics of representation — what people of color actually look like on screen — is rarely addressed. Chronically bad lighting for black actors has been a problem ever since black actors first appeared on screen (and before that, to the era of blackface and minstrelry). All too frequently, a beautiful dark-skinned actor is transformed into an ashy spectre because filmmakers fail to tailor their practice to making that actor look as good as everyone else.

“I don’t appreciate seeing black folks that are unlit,” 13th director Ava DuVernay said recently. “If there’s a dark brother, and

if he’s in a frame with a lighter-skinned person, you don’t automatically light for the lighter-skinned person and just leave him in shadow.”

But things seem to be changing, thanks to the likes of Insecure’s director of photography, Ava Berkofsky, who recently shared some tricks and tactics cinematographers can use to achieve on-screen black magic.

Of these, the oldest trick in the book is the importance of moisturizing the actors’ skin to give the lighting the most bounce (this was particularly important to Spike Lee when working in black and white on She’s Gotta Have It).

It’s about quality, not quantity. It’s about the universe of blackness appearing in all its different glorious ways.

In addition, Berkofsky said that since all of Insecure’s actors take light differently, rather than putting light directly on them, she uses reflection instead. Similar to the use of moisturizer, this adds a bit of shine.

“Rather than pound someone’s face with light, have the light reflect off them,” she said. “I always use a white or [canvas-like] muslin, so instead of adding more light, the skin can reflect it.”

Berkofsky also emphasized the value of a filter called a polarizer. “People use them when shooting glass, or cars, or any surface that intensely reflects light. The filter affects how much reflection a surface has.

The same principal works with skin, and this can be a highly effective way to shape the reflected light on an actor’s face.”

The tech Berkofsky uses is expensive, but she has a tip dark-skinned folks can use to improve their club selfies using just their phones. “Stand close to a soft light source and turn three quarters to the light, so that it’s not filling in everything the same way. Kind of like a Rembrandt painting.”

Lighting should be used to sculpt, rather than bleach, an actor’s skin, a technique championed by Charles Mills in Boyz n the Hood in his night-time exterior shots. Although many directors lament the shift from shooting on film to digital cameras, one of the advantages is that one can digitally recreate the effects of shooting on extinct Fuji, Kodak or Agfa film stocks, which were particularly good for capturing the richness of black skin. Color palette is key, whether in the production design or the post-production grade — drawing Culture

13

We have moved beyond the betterment of lighter skin tones and are technically able to equally represent all skin tones — the only thing holding us back is filmmakers themselves. a rainbow of colors from the actors’ skin itself to create something more vibrant and less concerned with being “real”.

After all, the original title for Moonlight was In Moonlight Black Boys Appear Blue.

As the cinematographer, Berkofsky wants every scene in Insecure to look like a painting, stating that the secret to making television resemble film is providing different levels of light to the scene. “[In sitcoms], everything is the same level of brightness. That’s what I’m trying to avoid,” she said. “The trick is keeping [light] off the walls. If you keep it off the walls, you can expose for the faces and it still has a cinematic look.”

Berkofsky has put herself firmly in the ranks of a new generation of cinematographers who are finally giving black skin 14

BASIS

the treatment it always deserved. They include Dion Beebe (Collateral), Rachel Morrison (Fruitvale Station), Matthew Libatique (Straight Outta Compton), James Laxton (Moonlight) and Sean Bobbitt (12 Years a Slave). But the DOP on everyone’s lips has to be Bradford Young, responsible for the look of Pariah, Middle of Nowhere and Selma, and the first black man ever to be nominated for a cinematography Oscar. Young credits closely studying the work of those who came before him — including Arthur Jafa, Ernest Dickerson and Malik Sayeed.

Indeed, all of these cinematographers, including Young, trained at Howard University under Haile Gerima, who stressed the importance of accessing the vast referential universe of black art and

culture. Young says: “[at Howard] the question of representation was always first and foremost. When bias is built into the negative, how does that affect the way we see people of color on screen? . . . There’s always an inherent bias sitting over us.

We’ve just got to climb through it and survive, and that’s what’s embodied in the cinematography.”

This inherent bias is very real, and embedded within every technical aspect of making movies. Isaac Julien, director of Looking for Langston and Frantz Fanon (about to be re-released in a 2k remaster), says “the politics of lighting are summed up in that all technologies that are produced are non-neutral.” “Shirley cards” used by filmmakers to calibrate skin tones and light, only featured Caucasian models until well into the 70s (and only changed because of complaints from photographers trying to advertise chocolate or wood furniture).

Another professor at Howard, Montré Aza Missouri, teaches her students that the sensors used in light meters have been calibrated for white skin. Rather than resorting to tricks, they need to manage the built-in bias of their instruments, in this case opening their cameras’ apertures to allow more light through the lens.

“The question of representation was always first and foremost.

When bias is built into the negative, how does that affect the way we see people of color on screen?”

The technology of cinema has sadly always centered on the idea that its rightful subjects are white. There is no corner of cinema that is not dominated by white privilege. But in this new age of technology, at least the tools of cinematography have become equal to the imaginations of filmmakers. We have moved beyond the betterment of lighter skin tones and are technically able to equally represent all skin tones — the only thing holding us back is filmmakers themselves. And ever so slowly, things might be pushing forward.

When I watch Moonlight, Mudbound, Dope or Insecure, it’s not simply about black skin just appearing on screen. It’s about quality, not quantity. It’s about the universe of blackness appearing in all its different glorious ways. It’s about moving past the light-skinned straight-haired blackness of the past, to embrace the dark skin and natural hair of our future.

Let’s decolonize and moisturize. This is a blackness that has always been here, but has been forced to hide in the shadowy corners of film because, at best, no one knew what to do with it, or, at worst, they deemed it unworthy. It’s about making that blackness look beautiful and aspirational. That is the real defiance of black skin on screen. p

Culture

15

PHOTOGRAPH BY BROOKE PALMER

What’s so great about kids fighting

MONSTERS?

BY STEVEN JONES

The new adaptation of Stephen King‘s classic novel It has quickly become one of the most successful horror movies of all time. But why has it fared so much better than other recent King adaptations like The Dark Tower and The Mist? Horror author Grady Hendrix says one reason might be that it focuses on the universal childhood fear of monsters.

“Kids fighting monsters has a real primal hold on our imagination,” Hendrix 16

BASIS

said. “Going back to fairy tales, it’s been a really resonant trope.”

But it’s not just any kids that we want to see fight monsters. Whether it’s Stranger Things, The Lost Boys, or Monster Squad, these stories gain much of their power from taking nerdy kids who know and care about monsters and making their daydreams a reality.

“This goes back to Mark Petrie in Salem’s Lot,” Hendrix says, “who is the kid

“ Even in twenty below, my parents were like, ‘Here’s a snowsuit, go outside. I don’t want to see you until sunset.’ So it’s completely plausible that they would go off for hours at a time and nobody would think it was odd.”

who is so in tune with pop culture and much freedom as possible, and be able to alienated from everyone else, but that pop try as many things as possible, and expericulture has served as like boot camp to ment with as many things as possible.’ And allow him to accept the idea of vampires, then in the early ’80s there was this whole and as soon as they appear he is dropped thing — and it really appeared in ’79 and and locked and ready to rock and roll.” ’80 — ‘Your kids are in danger. Moonies Fantasy author Erin Lindsey notes that want to abduct them from a shopping mall, many of these tales are set in the ’80s, and they’re going to be on the back of a milk that this may be because it was easier for carton, they’re going to be molested at kids to have adventures back then. “Even their daycare center, Satanists are going to in twenty below, my parents were like, give them stickers of Mickey Mouse that ‘Here’s a snowsuit, go outside. I don’t want have LSD on them.’ And so it’s weird that to see you until sunset,’” she says. “So it’s everyone’s fetishizing this idea of ’80s kids completely plausible that they would go fighting monsters, but maybe that’s when off for hours at a time and nobody would everyone feels like the monsters appear.’” think it was odd.”

Horror author John Langan thinks it’s Grady Hendrix on It: still possible to tell stories about mod“It is a big, messy, sprawling, undisciplined ern-day kids battling monsters, but that novel, but I also think it’s pretty genius. it probably requires more work to justify There’s these kids in Derry who defeated how the heroes could break free of their Pennywise in the ’50s, and they’ve all overprotective parents. grown up and forgotten it. So when they “I think you would have to acknowledge remember their childhoods, they rememthat those kids might very well be the lucky ber these beautiful, bucolic, nostalgic ones,” he says. “They might have plenty images of the ’50s, and it’s up to Mike of friends who are like, ‘Nope, my mom Hanlon, who’s the one black kid, to call says I’m not going out there.’” them up and say, ‘Not so fast. You’re not We asked Grady Hendrix, Erin Lindsey, remembering that era right. It was a time and John Langan for their thoughts on of horror, and danger, and we almost all horror movies. Here are some highlights died, and it was cruel, and mean, and from the discussion. sadistic.’ And I don’t think it’s a mistake that this is a book about a bunch of white John Langan on Stephen King and kids who grow up to glorify their past, Peter Straub: and a black kid who calls them up and “Pennywise, to an extent, is a psychic says, ‘Uh-uh, remember how it really was.’” mirror who reflects back at you that which you fear the most. And since Pennywise Erin Lindsey on women in horror: is so caught up in your mental energy, “What I think is equal parts interesting you can turn that to your own advantage. and frustrating as a woman in this stuff, Straub actually does something like that is that even in the modern incarnations in Ghost Story — the monster, the manitou we don’t seem to be able to get away figure in Ghost Story, is another kind of from this sense that the woman is often a mirror, another kind of reflector. And struggling with her sexuality and how that there’s a young guy — actually he’s a high plays into it. So even in Stranger Things, for school student, so he’s a little older than example, the older sister, in one of the the kids in It — but he figures out that if earlier episodes, is having sex with her this thing has gotten in his head, that he boyfriend — or on the cusp of having sex can turn that to his advantage and use with her boyfriend — when something bad that to actually harm the monster. It never happens to one of her friends, and so she’s occurred to me before that maybe King in a sense punished, and her impetus as a got the idea from Straub, but it’s entirely character going through it is that she feels possible in this case that he did.” very guilty that this thing happened to her friend because her friend was waiting for Grady Hendrix on the ’80s: her to make out with her boyfriend. And “In the ’60s and ’70s you really had this Buffy also has a lot of paroxysms of angst loosey-goosey approach to parenting. through the series about the relationParents were like, ‘Kids should have as ships that she has and all that. And that’s

not a criticism of them in a standalone sense — these are all perfectly acceptable narrative arcs. I would just like to see a narrative that doesn’t rely on that trope of the woman feeling guilty or being punished for her sexual expression.” p

Why aren’t Amber alerts issued for all missing children?

Amber Alerts are only used in the most serious cases that meet the Amber criteria. Overuse of Amber Alert could result in the public becoming desensitized to Alerts when they are issued.

The following criteria must be met to initiate an Amber Alert: Law enforcement confirms the child is under 18 years of age.

Law enforcement believes the abduction poses a credible threat of immediate danger or serious bodily harm or death to the child.

There is sufficient descriptive information about the child, the suspect, and/or the circumstances surrounding the abduction to believe that activation of the alert will help locate the child.

A law enforcement agency determines the child is not a runaway and has not been abducted as a result of a family abduction, unless the investigation determines the child is in immediate danger of serious bodily harm or death.

Culture

17

Why Government Websites Suck So Much

By Tom Cochran

O

ur interactions with government websites are often memorable for all the wrong reasons. Whether you’re trying to change your official address or applying for a local permit, you’re likely to see conflicting information, struggle through non-responsive design, or need a law degree to understand the five-paragraph disclaimer below a simple log-in form.

In a world where industry giants like Facebook run hundreds of user experience tests daily, why are our government websites so far behind the curve? I witnessed this problem first hand at the U.S. Department of State and while running the White House’s digital technology initiatives under Obama.

I discovered that while change does not happen overnight in these large bureaucracies, it is possible. And we, as frustrated citizens, should be demanding it.

The Trump administration is focused on upgrading a crumbling public infrastructure, proposing to invest $1 trillion over 10 years.

Though not crumbling, our government’s digital infrastructure is weak and inferior.

The systems through which we receive government services should be deemed as critical as our roads and bridges.

We must remember that our government is here to serve the people. Military jets should not fall out of the sky, filing taxes should not fail, and you should get your social security benefits on time. Using internet services quickly and easily should be no different.

Government websites exist to provide citizens with essential services and information, yet more often than not, it is difficult to find voter registration information or the form to pay your parking ticket.

As citizens, it can be hard to understand why our local governments are so slow to innovate. In my experience, I found that it has less to do with technical ability and skill and more to do with an environment of complacency. Innovation requires risk, and that’s a potential headache most governments want to avoid.

In contrast to agile, private-sector companies, the public sector does not face any pressure from competition. When it comes time to renew your license, there is only one place for you to do that: and, unfortunately 18

BASIS

for Americans, that’s the DMV. With no competitive forces, government agencies do not have to innovate or take bold risks when it comes to digital.

It is our right and our responsibility to hold our government accountable. In today’s digital-first world, that means expecting government websites to be easy-to-use, accessible to all, up-to-date, and intuitive.

From finding health insurance options to scheduling a road test, if someone cannot easily access information, the government is failing its constituency.

Understanding the best technology for the job is a smart first step toward change.

Over the last few years, I have worked with public-sector digital teams to invest in opensource technology solutions. While running

technology for Obama’s WhiteHouse.gov, open-source solutions enabled our team to deliver projects on budget and up to 75% faster than alternative proprietary-software options. More than anything, open-source technology allows governments to utilize a large ecosystem of developers, enhancing innovation and collaboration while driving down the cost to taxpayers.

Unfortunately, not every leader in the public sector understands what’s at stake.

Transforming outdated government websites needs more than legislation to spur innovation; they’ll require market pressure to push governments to improve service delivery, and this pressure should come from a groundswell of demands voiced by citizens like you and me. We cannot allow ourselves to fall into

complacency of crappy government portals, accepting the status quo as immutable. The government can change if, collectively, we demand more.

Change is possible, and for some governments, it’s already underway. In Arkansas, for example, government leaders sought a better way to become citizen-centric. Consequently, they became the first state to launch a digital government assistant, Gov2Go. The assistant allows Arkansans to receive personalized notifications from the state and keep track of important deadlines such as voter registration, property-tax payments, vehicle-registration renewals, and more. The state of New York, the province of Ontario, and the city of Boston are other governments listening to the demands of their constituents.

In our time-pressed society, we’re unlikely to waste hours (or even three minutes) on websites that lack the information we seek.

If this rule applies in our professional and personal lives, it should absolutely be true for our interactions with the government.

Now, more than ever before, digital leaders working in government, on both a local and national scale, need to challenge the status quo and embrace the shift toward citizen-first digital experiences. At the same time, citizens need to recognize when their government is not providing them with adequate access to crucial resources and services — and make the choice to do something about it.

You can be part of transforming the government experience by demanding more. You are funding these agencies with your tax money; you have the right and the responsibility to push for better service delivery. Become civically engaged and contact your elected leaders. Tell them to look at standout examples of the public sector focusing on a citizen-first digital transformation.

When the City of Boston embarked on its digital transformation, one of the team’s guiding principles was for the new site to “act as a helpful human.” Choosing to bring public-sector websites into today’s digital-first age is choosing to humanize government and, ultimately, better serve its citizens. This is the perspective of the future — one that all public-sector leaders should aspire to and all citizens should demand. p

Still Curious?

Amusing Ourselves to Death: Public Discourse in the Age of Show Business Neil Postman

Television has conditioned us to tolerate visually entertaining material measured out in spoonfuls of time; Neil Postman alerts us to the real and present dangers of this state of affairs and offers compelling suggestions as to how to withstand the media onslaught. Before we hand over politics, education, religion, and journalism to the show business demands of the television age, we must recognize the ways in which the media shape our lives and the ways we can, in turn, shape them to serve out highest goals.

BOOK

SOCIOLOGY

MEDIA

V for Vendetta Alan Moore and David Lloyd

A powerful story about loss of freedom and individuality, V for Vendetta takes place in a totalitarian England following a devastating war that changed the face of the planet. In a world without political freedom, personal freedom and precious little faith in anything comes a mysterious man in a white porcelain mask who fights political oppressors through terrorism and seemingly absurd acts. It’s a gripping tale of the blurred lines between ideological good and evil.

GRAPHIC NOVEL

FILM

POLITICS

Moonlight A look at three defining chapters in the life of Chiron, a young black man growing up in Miami. His epic journey to manhood is guided by the kindness, support and love of the community that helps raise him as he experiences the ecstasy, pain, and beauty of falling in love, while grappling with his own sexuality.

FILM

SEXUALITY

SONOS is on a mission to bring music listening back to the home.

Sonos is the wireless Home Sound System that fills as many rooms as you want with great-sounding music, movies and TV. Play whatever you’re craving, from the bedroom to the kitchen, streaming via wifi.

Clear, true sound married with sleek, modern design, Sonos brings a contemporary touch to any room.

20

BASIS

We’re giving you a behind-the-scenes glimpse at what Janelle Monae enjoys listening to in her New York City loft.

Visit sonos.com to listen to Janelle Monae’s At Home playlist.

SCIENCE

“But rather than producing any outright cures for chronic disease, decades of basic science research seem to have yielded a different kind of truth — that the human body is an incredibly, devilishly complex system. The deeper we dig, the more convoluted becomes the pathophysiology of chronic disease. What has become clear is that these chronic diseases — high blood pressure, diabetes, cardiovascular disease — are manifestations of aberrant metabolisms, rather than a lone faulty switch buried somewhere within our cells.”

Clayton Dalton ‘‘Uncomplicating Health” p. 24

24 Uncomplicating Health Are Treatments for Chronic Disease Too Crude?

Clayton Dalton

26 Just What the Doctor Prescribed?

The Truth About Generic vs.

Brand-Name Medications Beth Levine

28 The Flu Shot

The Myths, the Facts and Why Doctors Recommend It Nicole Spect

30 Tips

5 Things You Didn’t Know You Could Do With Your Kindle

31 Recommendations

Science

23

Uncomplicating Health There is nothing inevitable or natural about chronic disease.

BY CLAYTON DALTON

I

n the 1830s, British settlers in New Zealand imported European rabbits for food and sport. With no native predators, the rabbits soon took over. Accounts from the period describe thousands of hectares run through with burrows, and huge tracts of arable land destroyed by overgrazing.

In a desperate bid to stem the scourge, New Zealanders brought in a natural predator of the rabbit — ferrets. Without native predators to pick them off, the new imports did well. But they also played a prominent role in the decline of several endangered bird species, including the kiwi, the weka, and the kakapo. It’s a familiar parable (Mark Twain even riffed on it) about unintended consequences, and the danger of applying reductionist logic to a world that is characterized by extraordinary interdependence and complexity.

As a physician, I can’t help but be reminded of ferrets in New Zealand as I write prescriptions for drugs we use to manage chronic disease. Hydrochlorothiazide for high blood pressure. Sulfonylureas, a class of medication used to treat Type 2 diabetes. Statins for heart disease.

Don’t get me wrong, these drugs work.

They absolutely save lives. But the human body is a precisely interdependent system, and these drugs are like sledgehammers.

The ferrets did kill rabbits, but they were such an indelicate intervention that they wrought their own special havoc on the native ecosystem. The kakapo might never again be seen on the New Zealand mainland. How much collateral damage are we inflicting on the human ecosystem with our powerful medicines?

Perhaps more than we think.

Hydrochlorothiazide, a widespread treatment for high blood pressure, increases haemoglobin A1C and impairs glucose tolerance. These are indices of insulin resistance, which is associated with diabetes, obesity, cardiovascular disease

24

BASIS

and dementia. Hydrochlorothiazide raises LDL cholesterol and triglycerides, and lowers HDL cholesterol — a pattern known to confer increased risk of cardiovascular disease.

Sulfonylureas have been shown to increase the risk of cardiovascular disease as well.

And statins, some of the most widely prescribed drugs in the United States, have been found to impair glucose tolerance and increase the risk of diabetes.

While there is no doubt that the collective benefit of these medications currently outweighs their adverse effects, it’s remarkable that many of the drugs we give to treat chronic disease can actually increase the risk of those selfsame diseases. It speaks to the intricacy of human biology, and to the crudity of even our most advanced pharmaceuticals. Twain would have loved the irony.

The hope of academic medicine is that research — especially in molecular biology and pharmaceuticals — will save us. As we zero in on the elusive, primordial mechanisms of disease, we can design ever more precise pharmaceuticals, or even cures.

But rather than producing any outright cures for chronic disease, decades of basic science research seem to have yielded a different kind of truth — that the human body is an incredibly, devilishly complex system. The deeper we dig, the more convoluted becomes the pathophysiology of chronic disease. What has become clear is that these chronic diseases — high blood pressure, diabetes, cardiovascular disease — are manifestations of aberrant metabolisms, rather than a lone faulty switch buried somewhere within our cells.

There seem to be no silver bullets.

Causation at the molecular level, deep inside the body, appears to be beyond our current reach. But what about pushing against the ultimate cause — not within us, but in the outside world? Are we fated to follow the New Zealanders’ folly, causing damage with every effort to treat? Or, can we learn what external forces have made us so chronically ill, and push back there?

Perhaps we can. It turns out that traditional cultures across the globe, from hunter-gatherers to pastoralists to horticulturists, have shown little evidence of chronic disease. It isn’t because they don’t live long enough — recent analysis has found a common lifespan of up to 78 years among hunter-gatherers, once the bottlenecks of high mortality in infancy and young adulthood are bypassed. We can’t blame genes, since many of these groups appear to be more genetically susceptible to chronic disease than those of European descent.

Evidence suggests it is how they live.

Though traditional cultures span an immensely diverse gamut of lifestyles, they share a common denominator defined by the absence of modern banes: absence of processed food, absence of sedentary lifestyle, and likely absence of chronic stressors.

Indeed, evidence suggests that lack of chronic disease in these groups flows from how they live, how they move, and how

Nutrition Facts Why Does the FDA Recommend 2,000 Calories Per Day?

they eat. Diet looks to be an especially powerful driver — adoption of a Western diet, rich in processed foods, has mirrored the development of chronic disease worldwide, and prospective studies with healthy and diabetic subjects have documented the powerful influence of food on health.

Physical exercise, long touted as merely a means to calorie disposal, turns out to have complex endocrine and metabolic effects on insulin signaling, stress response, sleep, mental health, and even neuronal function in the brain. What the science seems to say is that an ancestral way of life aligns the machinery of our metabolisms toward good health.

Thus it appears that our bodies aren’t, after all, destined for chronic disease as they age — rather, it is the environment we’ve put them in that should bear most of the blame.

But isn’t this obvious? Yes, physicians and public health researchers have long acknowledged the influence of environmental elements on health, but we remain beholden to a paradigm that places first priority on mastery of molecular mechanisms. The sophistication of our sciences is a triumph, and technological progress must no doubt continue. But we know enough about the environmental determinants of health to act, even if we don’t fully understand the mechanisms.

Our ship is sinking, and the current approach is akin to bailing with a thimble.

If we are to stem the rising tide of chronic disease, we must alter the elements of our environment that promote chronic disease.

With the global price tag of chronic disease projected to rise to $30 trillion by 2030, we simply can’t afford not to. p

The FDA wanted consumers to be able to compare the amounts of saturated fat and sodium to the maximum amounts recommended for a day’s intake — the Daily Values. Because the allowable limits would vary according to the number of calories consumed, the FDA needed benchmarks for average calorie consumption, even though calorie requirements vary according to body size and other individual concerns.

From USDA food consumption surveys of that era, the FDA knew that women typically reported consuming 1,600 to 2,200 calories a day, men 2,000 to 3,000, and children 1,800 to 2,500. The FDA proposed using a single standard of daily calorie intake — 2,350 calories per day, based on USDA survey data. The agency requested public comments on this proposal and on alternative figures: 2,000, 2,300, and 2,400.

Despite the fact that 2,350 calories is below the average requirements for both men or women obtained from doubly labeled water experiments, most of the people who responded to the comments judged the proposed benchmark high. Nutrition educators worried that it would encourage overconsumption, be irrelevant to women who consume fewer calories, and permit overstatement of acceptable levels of “eat less” nutrients such as saturated fat and sodium.

Instead, they proposed 2,000 calories as: Consistent with widely used food plans Close to calorie requirements for post-menopausal women, the demographic most prone to weight gain A reasonably rounded-down value from 2,350 calories asier to use than 2,350 and, therefore, a better tool E for nutrition education Whether a rounding down of nearly 20 percent is reasonable or not, the FDA ultimately viewed these arguments as persuasive. It agreed that 2,000 calories per day would likely make it clear that people needed to tailor dietary recommendations to their own diets.

It addressed the adjustment problem by requiring the percent Daily Value footnote on food labels for diets of 2,000 and 2,500 calories per day, the range of average values reported in dietary intake surveys.

Science

25

The Truth About Generic vs. Brand-Name Medications

By Beth Levine ILLUSTRATION BY MARK AIRS

I

n a recent University of Cincinnati study published in Neurology, subjects with Parkinson’s Disease were given shots of two supposedly similar medications. They were told that the first was more expensive, and the second was similar in effectiveness but, because of differences in manufacturing, was much cheaper. The overall result was that patients’ motor skills after the first shot were improved 28% compared to the second shot. The one fact that the patients weren’t told: Both shots were actually just saline solution. Study authors believe patients got better because they had very high expectations, which translated into health benefits.

There’s been a lot of debate about the use of generic vs. brand name drugs. Are

26

BASIS

generics really as effective? It pays to be informed since, according to the FDA, “nearly 8 in 10 prescriptions filled in the United States are for generic drugs. The use of generic drugs is expected to grow over the next few years as a number of popular drugs come off patent.”

What is the difference between generics and brand names? Is there a time when one is preferable over the other? We spoke with C. Michael White, Pharm.D., Professor and Head, Department of Pharmacy Practice, University of Connecticut, to get an explanation: Q: Why are brand names so much more expensive than generics?

A: Unlike the generic manufacturer, the original pharmaceutical company has to pay for more than just the actual pro-

duction of that medication. The Tufts Center for the Study of Drug Development estimates that the cost to develop and win marketing approval for a new drug is $2.6 billion. It also pays for the research and development for medications that failed in trials and can’t be brought to market. According to the IMS Institute for Healthcare Informatics, generics have saved Americans one trillion dollars in health care savings over the past decade — a current rate of more than one billion dollars in savings every other day.

Q: What happens when a brand name goes generic?

A: At the end of an approximately seven-year period of exclusivity, the FDA allows one specific generic to be the first to market. That generic is given a

period of time of exclusivity for about six months. At the end of that time period, any manufacturer that can prove that it can achieve the same drug concentrations in the blood that the brand name does can make a generic. Manufacturers of generics aren’t required to do studies in people to prove safety. It is assumed that if they can achieve same blood concentration, they will achieve same results.

Q: Do generics have to have the same recipe, effect, and side effects?

A: The generics have to have the number of milligrams of drug that is included on the label in the pills. That will not vary. In addition, the pill needs to get you within 10 percent above or below the blood concentrations achieved with the brand for the FDA to approve the generic, and in reality, they only usually vary by 3-4 percent in one direction or another. So yes, they are very similar in terms of the active ingredient. It is possible that one generic will get you a 3 percent lower concentration than the brand and another can get you a concentration that is 3 percent above the brand and therefore the two generics can be 6% different from each other. Most people will never notice a difference.

According to the FDA, generic drugs do not need to contain the same inactive ingredients as the brand name product.

Inactive ingredients are those that have nothing to do with the therapeutic action of the drug; binding materials, dyes, preservatives, and flavoring agents. That’s why sometimes a pill you have been taking will suddenly look different. It usually means a different manufacturer has made that pill than the one you had before. Also, given individual variations, a person can have an allergic reaction to an inactive ingredient in one generic and not another.

Q: Is this true for over-the-counter, as well as prescription meds?

A: Yes. The FDA has very strict criteria, so over-the-counter store brands must achieve very similar blood concentrations as name brands. Most people don’t notice a difference. I strongly recommend that patients start out on generic medications or switch to generic medications if they’re available, since they almost always work as well and can save people a lot of money.

Why throw away money to get a brand name when the generic will give you what you need for a fraction of the cost?

Generics have saved Americans one trillion dollars in health care savings over the past decade — a current rate of more than one billion dollars in savings every other day.

Q: So, will you always achieve the same effect with a generic as with a brand name?

A: Keep in mind that there is a lot of diversity among people. When they do the blood concentration studies, they do them in “average” people, but because the inactive ingredients and process of manufacturing are different, they can’t assure that everyone will achieve same blood concentrations. For example, if you have a shorter colon or disease that makes food pass through your intestines faster or slower, that might make a difference.

Other people are just very sensitive to small changes in blood concentrations and notice a difference.

Q: Are there other instances when you should opt for a brand name?

A: NTI (narrow therapeutic index) drugs can be tricky because the blood concentrations you need to achieve a therapeutic dose and the concentrations that will cause harm are very close together. Small changes in concentrations can lead to ineffective or toxic responses. Medications for seizures, heart arrhythmias, thyroid hormone, warfarin (blood thinner), and lithium are all NTIs. With these, you need to talk to your physician about switching to generic, make sure you understand the risks and rewards, and that you are more closely monitored for the first couple of weeks afterwards.

Of these NTI drugs, patients with anti-epilepsy drugs are a unique group that do equally well when started on brand or generic drugs but during the couple of weeks after switching from brand to generic or generic to brand, they are more likely to have complications. Epileptic patients should not be routinely changing between forms of the drug for this reason.

Some patients will tolerate a brand name medication but when they switch

medications, they simply don’t do as well.

The reason may be that that while the blood concentrations of the brand name medication are very similar, what the tablets are made out of can vary. So while the average patient does as well, not everyone will. If you are that outlier, you are better off on the branded medication or another generic. I usually recommend trying two generic versions before giving up and moving back to a brand name drug because again, the costs are much cheaper.

There’s been a lot of consolidation in the generic manufacturing industry (companies merging with other companies, leaving less competition in the field).

In very rare cases, we are left with only one generic manufacturer, so the generic is more expensive than the brand name.

Supply and demand also happens in generic drugs and it’s all what the market will bear. Insurance companies may stipulate that you get a lower co-pay with generic than with a brand name even if brand name is less expensive. Patients with very expensive generics should ask their pharmacists if brand name medications are actually cheaper and if they are, switch back to the brand.

Q: Is it dangerous to your health to switch back and forth?

A: Most people taking almost all drugs would not notice a perceptible difference in efficacy or safety when switching between brands and generics or between generics, except in the case of NTIs, which are trickier. If you are on a NTI drug, talk with your doctors about the risks and rewards of switching. For all the other drugs, if you switch and you have mild symptoms, there is a chance that those things will resolve and you should stay the course. If it’s more than a mild inconvenience, then you need to let your doctor know right away. p Science

27

The Flu Shot

The Myths, The Facts And Why Doctors Recommend It

By Nicole Spector

ILLUSTRATION BY MATT HUYNH

U

nlike Halloween or Thanksgiving, we can’t consult our calendars to know exactly when it will hit, but we know it’s coming: the flu. Doctors and pharmacies are advertising the annual flu vaccine, prompting many to ask, “Should I get the flu shot?”

You needn’t read too far to know that the overwhelming consensus of the medical community is a resounding yes.

But other questions abound: What is in this vaccine? Why should I get it every single year? If I get the vaccine can I still get the flu? Can the shot give me the flu?

With so many viruses circulating, it’s a yearly challenge for scientists to predict which three or four will prove to be the season’s most prevalent flu viruses.

It’s isn’t unreasonable to have questions when a stranger in a lab coat asks you to sign a waiver and then comes at you with a needle. And many of us have had experiences that warrant skepticism about the flu vaccine, myself included. Last year I got the flu shot and then three months later, 28

BASIS

I went to the doctor with a sore throat and fever and what did he tell me I had?

The flu. Why did I even bother getting the vaccine?

I brought these questions to a few doctors, including Dr. Michael Chang, a pediatric infectious disease specialist with Children’s Memorial Hermann Hospital in Houston, Texas, who generously took an hour to go through it all with me, though not without noting that it would take many more hours to really explain this “fascinating virus,” and the vaccines engineered to fight it.

The flu is more than one virus — and so is the vaccine. We call it the flu like

there’s only one, but every year the flu is different, and is not singular — there are different types of flu viruses. The reason we call it the flu instead of being more specific is because each of the viruses function more or less the same, and because they pop up like clockwork every year in a seasonal epidemic.

“Every winter we know that a flu epidemic will spread around the globe, with maybe three or four strains of the virus [proving to be] the most predominant,” says Dr. Chang, adding that a flu virus typically enters the body through the eyes, nose and mouth. From there it targets the lungs, which is where things can get really bad.

“The flu will cause all the usual upper respiratory symptoms, but it can also cause viral pneumonia or viral lower respiratory infection which can be more serious, and if you have a particularly severe flu infection, other organs in the body can be affected,” says Chang.

With so many viruses circulating, it’s a yearly challenge for scientists to predict which few will prove to be the season’s most prevalent and potent flu viruses.

“Predicting what the predominant strains of the flu will be each winter is done through a lot of surveillance around the world,” says Chang. “We look at all the cases of flu that happen around the world to try to predict each season in advance.”

Once they pinpoint the strains that appear to be the epidemic ones, scientists grow the vaccines either in chicken eggs, or in specialized bacteria. Then they inactivate the virus; “essentially they kill it and chop it up,” explains Chang, adding that this is not the only way to engineer a flu vaccine but is currently the most common. These dead flu parts get packaged with other ingredients needed to make a vaccine (a concoction of proteins, fats, and antigens).

It is impossible for the vaccine to give you the flu. The fact that the viruses in the

vaccine are dead is a critical point: a dead virus cannot infect you. It just can’t.

“A lot of times people will say they or their children got the flu from the vaccine, and that is just not possible,” notes Chang.

“That said, some people do feel bad after: muscle aches, low grade fever, achy arm [where they had the injection]. I always tell patients that this is good in the sense that it means your immune system is having a response, which is what we want.”

What you don’t want is an allergic reaction — but these are exceedingly rare.

“After getting the vaccine, if there’s any difficulty breathing, swelling of face or tongue, or blockage of airways, that is a severe allergic reaction,” says Chang.

Patients should also keep an eye on their temperature. A fever of around 101 degrees is common. A Tylenol should help reduce this and other symptoms, but if you’re still ill or getting worse after 48 hours, or if the site of injection is swelling tremendously to the point where you cannot move it — go to the doctor.

Chang notes that even if you’re among the lucky few who feel totally fine after the flu shot with no soreness or low fever, this does not mean your immune system didn’t respond or that the flu vaccine didn’t work.

When do I get the shot and how long does it last? Let’s say you get the flu shot

and two days later you get the flu. You didn’t get sick because of the vaccine (because again, dead viruses are noninfectious), but it does reveal a loophole: the vaccine takes two to three weeks to have full effect. This is why doctors recommend getting it as soon as it’s available.

If you get the vaccine at the beginning of October, you should be covered

through the duration of the flu season, which can start as early as mid-fall, and end as late as early spring. How long the vaccine lives in your system depends on your immune system, but for the general patient it’s between six months and a year.

“The vaccine is not that long-lived in part because the viruses that cause the flu are very smart and keep changing to infect us,” says Dr. Megha Tewari, a family medicine doctor at Memorial Hermann Medical Group. “This is why I tell my patients to get the flu shot every year.”

The goal of the vaccine is not necessarily to prevent flu. Optimally, the flu vaccine

will prevent you from getting the flu, but that’s actually secondary to the primary goals of the vaccine which are to prevent epidemic and to reduce the cases of severe flu infection.

“At its most effective, the flu shot would prevent you from getting the flu, but really when you look at studies, the purpose of the vaccine is to reduce the number of severe flu illnesses that require going to the hospital,” says Chang. “In other words if you get the flu vaccine, the real goal is even if you do get the flu that you are not as sick as you would be if you had not gotten the vaccine.”

Another purpose of the flu vaccine: not everyone can get it, so it’s important that people who can receive it do so that “we build herd immunity,” says Dr. Tewari.

“A lot of patients who have immunological diseases, or an organ transplant, have cancer or other conditions may not be strong enough to get a flu vaccine,” Tewari adds. “But if those around them are vaccinated, we develop a herd immunity, so that hopefully the few people who can’t get the vaccine will not get infected.”

The vast majority of people over the age of six months should get a flu shot, and both Dr. Chang and Dr. Tewari insist that there are very few exceptions. Even if you have an egg allergy (remember that flu vaccines are often cultivated in eggs) your doctor can recommend an alternate type of vaccine if needed.

What if I'm pregnant? Just last week

there was a study published suggesting that the flu vaccine could be associated with early-term miscarriage in some

pregnant women. But this finding is far from conclusive, and doctors still advise pregnant women to get the flu shot.

“Let’s be clear: this study does not suggest the flu vaccine can cause an increased risk of miscarriage,” says Dr. Sherry Ross an OB/GYN at Providence Saint John’s Health Center. “The flu is more likely to cause serious illness in pregnancy compared to those women who are not pregnant [because] in pregnancy there are changes in the immune system, heart and lung function that make pregnant women more prone to severe illness from the flu which can lead to hospitalization or even death. Other problems as a result of the flu include dehydration, miscarriage and pre-term labor.”

Furthermore, a flu shot helps protect newborns from getting the flu.

“Babies can’t get the flu vaccine until thy are six months, so by getting the vaccine herself, the mom will make the antibodies and pass it onto the baby, protecting them from severe flu for the first months of their lives,” says Dr. Chang.

Still, it is totally understandable to be concerned, so if you are pregnant and have questions, talk to your OB/GYN. And if you’re a parent who is unsure if your six month old is really ready for the flu vaccine, pay a visit to your pediatrician.

“If anything, it’s a good excuse for a well baby visit,” adds Chang, who admits that as a pediatrician he holds some bias when recommending that parents take their little ones to the pediatrician for their flu shots, but says he doesn’t see any problem with having them administered at your local pharmacy.

Children, like elderly people, are more susceptible to developing severe flu. This is in part because they’re ultra exposed in schools and daycare facilities (and you know, they may not have the best hand hygiene), but also because their immune systems haven’t been toughened up.

“Children have had less experience with flu, whereas adults have more antibody from previous infections,” says Dr. James D. Cherry, a distinguished research professor at the David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital. p

Science

29

5 Things You Didn’t Know You Could Do With Your Amazon Kindle Jordan McMahon You’d be forgiven for thinking your Amazon Kindle is just a tiny slate only fit for reading, but your humble e-reader has some hard-to-find, little-known tricks up its sleeve. Here are the best Kindle features you don’t know about.

1. Play Apps And Games Is your mind feeling a bit mushy after reading too much Kierkegaard? Take a break and download some games so you can kill some time with Scrabble, Sudoku, or rack your brain trying to complete the latest New York Times crossword.

2. Get Free Library Books Avid bookworms might notice a big chunk of their budget going towards their reading habits. If you want to cut back on your spending, there’s a good chance you can nab free e-books from your local library.

3. Take A Screenshot Some people like to tear their favorite pages out of a book to hang onto. Why ruin all those perfectly good books? When you find a passage that resonates with you, just tap two opposite corners of the screen and your Kindle will take a screenshot of the page. When you want to look at all your screenshots, plug your Kindle into a computer via USB and they’ll all be there.

30

BASIS

4. Extract Your Highlights If you’re reading a book for research, you’ll want to keep track of critical passages and quotes. If it’s a paper book, you’d use a highlighter or plastic sticky tabs. On a Kindle, you can use the touchscreen to highlight text but referring to them later can be a hassle. Protip: you can export everything you’ve selected. Your Kindle creates a .txt file of all your highlights, complete with citations, that you can access from any computer via USB. 5. Loan Books To A Friend Just suggesting a book to a pal probably won’t get them to read it. Instead of pestering them every week to see if they’ve finally gotten around to it, just send it over to them with Amazon’s 14-day loan policy. Once they see it show up on their Kindle, they might feel guilty enough to sink their eyes into your latest obsession.

Still Curious?

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer Shannon Brownlee

In this gripping, eye-opening book, award-winning journalist Shannon Brownlee takes readers inside the hospital to dismantle some of our most venerated myths about American medicine.

Brownlee dissects what she calls “the medical-industrial complex” and lays bare the backward economic incentives embedded in our system, revealing a stunning portrait of the care we now receive.

BOOK

HEALTHCARE

Deadly Choices: How the Anti-Vaccine Movement Threatens Us All Paul A. Offit

There’s a silent, dangerous war going on out there. On one side are parents, bombarded with stories about the dangers of vaccines, now wary of immunizing their sons and daughters. On the other side are doctors, scared to send kids out of their offices vulnerable to illnesses like whooping cough and measles — the diseases of their grandparents. In Deadly Choices, infectious disease expert Paul Offit relates the shocking story of anti-vaccine America — its origins, leaders, influences, and impact.

BOOK

MEDICINE

Food, Inc. Robert Kenner

Mammoth corporations have taken over all aspects of the food chain in the United States, from the farms where our food is grown to the chain restaurants and supermarkets where it’s sold.

Narrated by author and activist Eric Schlosser, the film features interviews with average Americans about their dietary habits, commentary from food experts like Michael Pollan and unsettling footage shot inside large-scale animal processing plants.

FILM

FOOD

32

BASIS

34

BASIS

MONEY

“Evaluating a job offer is not always straightforward — especially since you may not have the luxury of comparing it to others. ‘Step back and think expansively about your objectives,’ advises Jeff Weiss, president of Lesley University and author of the HBR Guide to Negotiating. ‘Think about the offer in terms of your development, your quality of life, and the variety of the work you want to do.’ No job offer will be perfect, so a big part of the evaluation requires you to ‘think about the trade-offs you are willing to make.’”

Rebecca Knight ‘‘You're Hired!” p. 42

36 Strength in Numbers

How Telling Your Coworkers How Much You Get Paid Benefits You Jonathan Timm

42 You’re Hired!

How to Evaluate, Accept, Reject, or Negotiate a Job Offer Rebecca Knight

46 Avoiding the Sunk Cost Fallacy How You Work Against Your Best Interests and What to Do About It Mariana Lin

48 The Cost of Hop

Here’s How a Six-Pack of Craft Beer Ends Up Costing $12 Joe Satran

51 Recommendations

35

36

BASIS

ILLUSTRATIONS BY JOSH PATTERSON

00 $5 0 00 0,6 $2 $3 $ 00 20 , 8 $4 5,0 0 $ 00 ,

0 $ 4 0 2 50 ,5 00 ,00 62 0 $ , 0 0 0 0 4 10 $ 0 St $ 00 5, 17 in ren 23 $ 0 $1 0 ,00 $ gt ,40 3 0 9 5, $ 0 0 h 0 , 0 $ 0 $ N 6 0 $5 0 8 u 00 74 4, $ ,00 mb $ ,0 0 0 7 $8 00 2 0 er 56 9, $ ,00 $4 $ ,0 $ 0 $ 0 2 0 6 2 0 Last fall, I became a barista in a small, “socially responsible” coffee company. A few months later, I got a temporary paralegal position at one of the world’s biggest multinational, corporate law firms.

The two companies had little in common, but both told me one thing: Don’t talk to your coworkers about your pay.

At the law firm, this warning was conveyed to me during my salary negotiation. After I had worked for three months through a temp agency, the firm offered me a spot on their payroll. Given the size and success of the firm, the starting salary seemed fairly low.

The HR manager tried to convince me that the offer was competitive. She told me that she couldn’t offer more because it would be unfair to other paralegals. She Why You Should Tell said that if we did not agree to a salary day, then she would have to suspend Your Coworkers How that me because I would be working past the Much You Get Paid allowed temp phase. I insisted that she look into a higher offer and she agreed that we could meet again later. Before I JONATHAN TIMM left, she had something to add.

“Make sure you don’t talk about your salary with anyone,” she said sweetly, as if she was giving advice to her own son.

“It causes conflict and people can be let go for doing it.”

It wasn’t all that surprising to hear this from a corporate HR manager. What was surprising was the déjà vu.

Just three months earlier, some of my coworkers at the coffee shop told me that our bosses, who worked in the office on salaries, and even the owner, got a higher cut of the tips than we did. One barista told me that when she complained about it, the managers reduced her hours.

When you make minimum wage and have to fight for more than 30 hours per week, tips are pretty important, so I sat down with my managers to discuss the controversy. That’s when they told me not to talk about it with the other baristas. The owner “hates it when people talk about money,” my manager added, and “would fire people for it if he could.” I sulked back to the espresso machine, making my lattes at half speed and failing to do side work.

In both workplaces, my bosses were breaking the law.

Under the National Labor Relations Act of 1935 (NLRA), all workers have the right to engage “concerted activity for mutual

38

BASIS

aid or protection” and “organize a union to negotiate with [their] employer concerning [their] wages, hours, and other terms and conditions of employment.” In six states, including my home state of Illinois, the law even more explicitly protects the rights of workers to discuss their pay.

This is true whether the employers make their threats verbally or on paper and whether the consequences are firing or merely some sort of cold shoulder from management. My managers at the coffee shop seemed to understand that they weren't allowed to fire me solely for talking about pay, but they may not have known that it is also illegal to discourage employees from discussing their pay with each other. As NYU law professor Cynthia Estlund explained to NPR, the law “means that you and your co-workers get to talk together about things that matter to you at work.” Even a nudge from the boss saying ‘we don’t do that around here’ . . . is also unlawful under the National Labor Relations Act,” Estlund added.

And yet, gag rules thrive in workplaces across the country. In a report updated this year, the Institute for Women’s Policy Research found that about half of American employees in all sectors are either explicitly prohibited or strongly

“ The problem isn’t so much that the remedies are inadequate,” Becker says, “but that so few workers know their rights.”

discouraged from discussing pay with their for wrongful termination, back-pay, and/ coworkers. In the private sector, the numor “informational remedies” such as “the ber is higher, at 61 percent. posting of a notice by the employer promThis is why President Obama recently ising to not violate the law.” signed two executive actions addressing At the same time, ignorance of the workplace transparency and accountability. law can just as easily fuel gag rules. Craig One prohibits federal contractors from Becker, general counsel for the AFL-CIO, retaliating against employees who discuss used to serve on the National Labor their pay with one another. The other Relations Board. He told me that workers requires contractors to provide compenwho called the NLRB rarely were aware sation data on their employees, including that their employer’s pay secrecy policy race and sex. But while these actions was unlawful. protect workers at federally contracted “The problem isn’t so much that the employers, they do not affect others. remedies are inadequate,” Becker said, The bill that would cover the rest of “but that so few workers know their workers is the Paycheck Fairness Act. rights.” He says that even among those The law would strengthen penalties to workers who are aware of the NLRA, employers who retaliate against workers for many think that it protects unions but discussing pay and require employers to no one else. Now overseeing organizers provide a justification for wage differentials. at the AFL-CIO, Becker has found that These reforms are necessary to address before organizers even begin helping this widespread, illegal problem that the workers, they have to educate employees law has failed to address for decades. Gag on this very basic law. “Workers call us up rules violate a fundamental labor right and saying they’re unhappy and they want to allow for discriminatory pay schemes. organize,” Becker explains, “and when Given their illegality, why are gag organizers look at the employee manual, rules so common? One answer is that the sure enough, they find a policy saying that NLRA is toothless and employers know workers aren’t allowed to discuss their pay.” it. When employees file complaints, the Gag rules, then, are policies that flourNational Labor Relations Board’s “remeish when employers know the law and dies” are slaps on the wrist: reinstatement their employees do not.

But why do employers do this in the first place? Many employers say that if workers talk to each other about pay, then tension is sure to follow. It’s understandable: If you found out that your coworker made more than you for doing the same work, then you’d probably be upset.

A study by economists David Card, Enrico Moretti, and Emmanuel Saez from Berkeley and Alexandre Mas from Princeton supports that prediction. To study the relationship between pay transparency, turnover, and workplace satisfaction, they selected a group of employees in the University of California system and showed them a website that lists the salaries of all UC employees. They found that employees who were paid above the median were unaffected by using the website, while those who were paid lower became less satisfied with their work and more likely to start job hunting. This result suggests, according to the authors, that employers have an incentive to keep pay under wraps.

The limitation of this research is that it doesn’t tell us much about whether those employees’ dissatisfaction was a bad thing.

While it’s possible that those employees were getting a fair wage and just felt belittled by their comparative pay, it’s also possible that they were getting stiffed.

Money

39

Do gag rules directly cause wage discrimination? That’s unknown, but they undoubtedly open the door to it.

And many workers are, in fact, getting stiffed — especially women and people of color. Recall the story of Lilly Ledbetter, the inspiration of the Lilly Ledbetter Act, which gives workers a longer period of time to file pay discrimination suits against their employer. Ledbetter was told that she would be fired if she talked about pay with her coworkers, but after nearly three decades of work with Goodyear, someone finally slipped her a note saying that she was underpaid.

Ledbetter’s case shows how pay secrecy can cause the pay gap between men and women, a gap that widens between men and women of color. More than 50 years after the Equal Pay Act, study after study show that women are still paid less than men for the same work. Some have argued that the pay gap is effectively a myth, attributing it to women’s career choices rather than workplace discrimination. But, as the National Women’s Law Center has repeatedly pointed out, this “ignores the fact that ‘women’s’ jobs often pay less precisely because women do them, because women’s work is devalued, and that women are paid less even when they work in the same occupations as men.”

40

BASIS

Even when you look at industries dominated by one sex or the other, the pay gap exists in both.

Ariane Hegewisch is the study director at the Institute for Women’s Policy Research and the author of several reports on pay secrecy and wage discrimination.

One of the reasons she sees behind the pay gap is that, five decades after the Civil Rights Act outlawed discrimination on the basis of sex, old-fashioned workplace beliefs still justify sexist pay distribution.

For example, in one case, in which a group of women sued Walmart for sexist discrimination in pay and promotions, women testified that their managers said men “are working as the heads of their households, while women are just working for the sake of working,” even though women are now the sole or primary breadwinners in around 40 percent of American households.

Others have explained the pay gap by showing that women are less likely to ask for raises. True as this is, the solution isn’t as simple as telling women to speak up.

Several experiments by Hannah Bowles of Harvard and Linda Babcock and Lei Lai of Carnegie Mellon University have

shown that employers are more likely to penalize women than men for negotiating. This suggests that women bite their tongues to avoid being called “pushy” or “bossy,” words with particularly negative connotations for women.

We don’t know whether gag rules directly cause wage discrimination, but they undoubtedly open the door to it.

Employers who keep pay secret are free to set pay scales on arbitrary bases or fail to give well-deserved raises because of social norms. “When you don't have transparency and accountability,” Hegewisch told me, “employers react to these pressures and biases and women tend to lose out.”

Of course, one of the time-tested mechanisms of preventing wage discrimination, unionization, has been in steady decline for decades. Jake Rosenfeld, associate professor of sociology at the University of Washington, has studied unions and is now researching the relationship between pay secrecy and wage discrimination. He told me that although there is not enough data to draw a direct causal line between pay secrecy and unfair wages, we do know that in the public sector, where wage transparency is far more common, pay tends

to be more equal and benefits are more evenly distributed.

But in both the public and the private sector, union decline has shifted the balance of power toward employers in a way that allows employers to keep wages secret and pay their workers unfairly. “Removing a key source of collective power in the vast majority of workplaces opens up space for employers to institute new wage setting practices, and pay secrecy is one of them,” Rosenfeld says. “It’s much harder to keep the books closed when you have a union arguing left and right to open them up.”

Republican lawmakers have blocked the Paycheck Fairness Act three times, claiming that it would just increase lawsuits against employers. They’ve also argued that forcing firms to share their compensation practices would hurt business. But according to Hegewisch, there’s no evidence that lawsuits have increased in states where pay transparency laws have been strengthened, and firms already share compensation information through human resources services like WorldatWork.

If the law did change, we would still face one of the biggest barriers to pay transparency: workplace culture. Even the

most confident among us can melt into awkward, self-conscious messes when we have to negotiate our salaries, and asking a coworker about pay seems akin to asking about their sex life. Private companies are showing that opening up the books completely can work, while the public sector has done that for decades, yet many still fear that talking about pay would destroy our workplace collegiality.

On the day my bosses at the coffee shop told me not to talk tips, my morale hit bottom. An organization I once trusted was telling me not to ask basic questions about my compensation. Even if pay secrecy comes with good intentions, this is its unintended effect: It tells workers that their bosses have something to hide, or that they don’t have the right to get a second opinion on whether they are being treated fairly. As Craig Becker told me, “Workers can only improve their situation when they can understand their working conditions.” Deciding whether a pay scale is fair cannot be left up to the employer alone. p

Money

41

HIRED

42

BASIS ILLUSTRATIONS BY AXEL PFAENDER

How to Evaluate, Accept, Reject, or Negotiate a Job Offer

By Rebecca Knight

C

ongratulations! You got the job.

Now for the hard part: deciding whether to accept it or not. How should you assess the salary as well as the other perks? Which publicly available information should you rely on? How should you try to get a better deal? And what’s the best way to decline an offer if it’s not the right job for you?

What the experts say When an employer extends a job offer to you, they have, in essence, “fallen in love with you,” says John Lees, career strategist and author of The Success Code. “They have psychologically committed to you, and it is a critical moment.” According to Lees, “you have more leverage” to shape your job description and improve your salary and benefits package “right after you are made an offer than you do in your first two years of employment.”

Still, evaluating a job offer is not always straightforward — especially since you may not have the luxury of comparing it to others. “Step back and think expansively about your objectives,” advises Jeff Weiss, president of Lesley University and author of the HBR Guide to Negotiating.

“Think about the offer in terms of your development, your quality of life, and the variety of the work you want to do.”

No job offer will be perfect, so a big part of the evaluation requires you to “think about the trade-offs you are willing to make.” Here are some ideas to help you figure out if the job is right for you.

Shift your mindset First, you must recognize that receiving an offer represents a “new and different phase” of the job search process, says Lees. “The purpose of the interview is to get the offer,” he says. The next stage is about weighing that offer and then negotiating with your new employer.

“Pause, you are starting a new chapter.”

Bear in mind that even though the job is yours if you want it, you must “continue to be enthusiastic” in your dealings with your prospective manager, says Lees. “By sounding critical or suspicious or by questioning something about the offer, you are sending a negative signal,” he says.

“It sounds as if you’re uncertain that you want job.” That may indeed be the case, but it’s not the message you want to send to your would-be manager. “Employers need to feel that you are committed.”

Be methodical Next, you need to think about what matters to you in both your professional and private life and then “assess the offer” against these metrics, says Weiss. “People tend to focus on the dollars, but it is useful to ask, “What is of value to me?” After all, money is only one component of career satisfaction. “Very often it comes down to, ‘I would rather make X amount of money and be excited to go to work in the morning, than make X plus 10% and hate my job,’” he says. Below are the most important components to take into account as you assess the offer.

Ask yourself, “Is this a place where I will be happy? Where I will be challenged? And where I will thrive?”

Money

43

DREAM JOB Salary. Even when the money on offer is enough to live on, you need to figure out if it’s an amount worthy of your knowledge and skills and whether it’s in line with the local market. Look at the financial package on the whole. The key question, says Weiss, is “What is someone with my competencies and experience in this role and in this city paid?” Databases and job search websites, such as Glassdoor, Indeed, Ladders, and Salary.com are a good starting point, but Lees recommends talking to recruiters and headhunters and others in the industry. “Find anyone who knows the sector and the range,” he says.

As part of your detective work, you must also devise “a good argument for why you are in the top 10-15% of that range.” But usually there is only so much wiggle room.

“You must have a backup plan if there is no flexibility on money in terms of what other areas you want to push back on.”

Job content. It’s also important to think about whether you will “derive job satisfaction,” from the offer that’s on the table, says Lees. To answer this question, you need to know the “kinds of activities you want to be involved in and the skills you want to use” as a professional. Ask yourself questions like “Do I want to lead a big team, supervise only a few others, or have zero management duties? Do I want to be in front of clients? Do I crave autonomy? Do I want lots of international travel — or no travel at all? What kinds of projects do I want to be engaged in? And what kinds of professional tasks do I want no part of ?” Then see how well the offer matches up against the responsibilities you’re being asked to take on. “Also, look at what you will be doing, what success looks like, and what benchmarks you’ll be judged against,” he says. Having a deep understanding of what’s expected of you is critical for deciding whether you do indeed want the job, he adds. Think hard about whether the “the job is achievable and whether you feel you are going to be able to hit the targets set out.” If the answers are no, it may be that the role is ill-conceived or not for you.

44

BASIS

Cultural fit. You must “do your due diligence,” on the organization and its people to make a sound judgment on whether you will enjoy working there, notes Weiss. Ask yourself, “Is this a place where I will be happy? Where I will be challenged? And where I will thrive?” To answer that, Lees recommends “working the phones, reaching out to your contacts and LinkedIn network,” and asking questions. “What is the organization like? How long do people stay? Find out what happened to the last person who did the job.” You will not be able to negotiate or change the organization’s culture, of course, but it is helpful to know beforehand what you’re getting into.

It might make sense to do a trial run at the company during the evaluation stage.

“Say, ‘I really want to learn more about this organization. Can I spend a few hours with the team?’ That’ll give you a sense of what your colleagues are like, what it would be like to work there, and where the bodies are buried.”

Flexibility, vacation, and perks.

For many employees, vacation time and the ability to work flexible hours are an increasingly valuable perk. While health benefits are typically standard issue, additional paid time off may be negotiable. If flexibility is not an explicit component of the job offer, you can broach the topic in the negotiation stage, says Weiss. But bear in mind that “things like that are much easier to raise when you’ve made yourself invaluable,” and have been working in the job for a certain period of time. That said, it’s important during the evaluation stage to find out whether current employees are afforded such benefits. Get a feel for how a request for flexibility might be received by senior management. “If you are a perfect match for the job and it’s a tight market, you have a lot of leverage,” says Lees. But if the market is more fluid, you may have little leeway.

Other options. “You must also assess your walk-away alternatives,” says Weiss.

Even if you don’t necessarily have other job offers in hand, you need to consider other possibilities. “Think about the offer

in terms of the cost and benefit of starting the job search process all over again, of staying in your current job, or of waiting to see what other offers materialize later down the road,” he says. If nothing more, this exercise is useful in helping you realize that you have options.

Devise your plan “Once you’ve determined the most important elements of the offer that you would like to change, decide which cards you’re going to play and the sequence of how you will play them,” says Lees. Formulating your negotiation strategy requires creativity, says Weiss. If you’re dealing with an intermediary — an HR administrator or a recruiter, for instance — remember to “not only make requests, but also arm that person with questions, information, and ideas.” Come at it from the “perspective of joint problem-solving.” He suggests saying something like, “The salary you’re offering is great, but I would want to keep developing in this role. I can imagine some possibilities that might make this job more appealing such as having access to a mentoring program, a rotation program, or an educational allowance. Would any of these be possible?’”

Be tough but cheerful The rest is “classic negotiation,” says Lees. “You want to maximize the cost of the things you are prepared to accept and minimize the things you’re asking for.”

Demonstrate that you’ve undertaken a thoughtful evaluation. For instance, you might say, “I am quite happy with the role and responsibilities, but I would like to work from home one day per week.”

Seek to come across as a “tough but cheerful negotiator,” he says. “Go into the deal-making with your eyes open,” he adds.

“You can’t negotiate everything, and once you’ve agreed on something you can’t go back on it,” he says. Adds Weiss: “It’s not what you ask for; it’s how you ask for it.

Be well-prepared, respectful, and constructive. You want to be seen as someone they want to work with.”

Say no (politely) if it’s not right Ideally there will be some give and take in these negotiations, but if “you keep coming up against a ‘no’ for everything you ask for, that demonstrates inflexibility” on the part of your prospective employer, and that “could well be a management style you don’t want to live with,” says Lees. Heed red flags. “Pay attention to your internal monitoring system,” he says. “If due diligence tells you that you should not take the job, listen.” Besides, there’s no shame in declining a job offer if it’s not the right fit. “As long as you turn it down politely with one or two good reasons — it will not stretch you enough or you want to work in a different sector — you shouldn’t feel bad about it,” he says. And yet, you should “always leave the door open,” says Weiss. “The people you are dealing with are your potential customers, potential advisors, and perhaps even your future employers. Be respectful.”

Principles to remember Do • Think about what you want out of your job and use that as a framework to determine the elements of the offer you would like to alter.

• Be selective about what you want to push back on.

• Employ classic negotiation techniques by maximizing the cost of the things you are prepared to accept and minimizing the things you seek.

Don’t • Be critical or suspicious when questioning something about the offer.

• Neglect to consider your walkaway alternatives.

• Ignore red flags. If your instincts and due diligence tells you that you should not take the job, listen. p

Money

45

Financial Advice: Avoiding The Sunk Cost Fallacy

By Mariana Lin ILLUSTRATION BY FRANCESCO BONGIORNI

P

icture this: It’s the evening of the your favorite band’s concert. You bought the tickets months ago, saving up and looking forward to it. But you’ve had the worst week, and you’re exhausted. Nothing would make you happier than hot chocolate and pajamas, not even screaming at the top of your lungs in a decked out music venue.

But you should go, anyway, right?

Because otherwise you’d be “wasting all of that money?”

Think again. Economically speaking, you shouldn’t go. Welcome to “sunk costs.”

based on future utility or payoff. For example, a woman goes out and spends $300 on a dress. She tries it on again at home but it doesn’t fit; plus, she looks awful in it! She may be reluctant to get rid of it because she may think, ‘Oh my god, I put all this money into it!’ But it doesn't matter; she’s just honoring the sunk cost.”

More often than not, people will waste money (and time) in order to justify costs they’ve already spent — it’s like throwing good money after bad. It applies to not only financial decisions, but professional and relational ones as well.

People are bad at cutting losses “Sunk costs” is the economic principle that what you’ve spent is already gone. In other words, you could have spent $200 and had an unpleasant evening, or you could have spent $200 and had a great evening. Either way, you’ve already spent the $200.

Robert Leahy, a psychiatrist as well as Director of the American Institute for Cognitive Therapy in New York, says, “A model of good decision-making is always

Know when to bail One of the smartest moves we can make for our money and time is to know when to cut our losses. The irony of a sunk cost is that the more we have put into it, the harder it is to abandon it.

The first key is to recognize a sunk cost. Leahy advises, “Ask yourself, am I staying with this relationship or at this job, computer, house or this piece of clothing because I’ve already put money into it?

46

BASIS

That’s sunk. That’s all down the drain. If I had never made this commitment, would I go out and get it now? If the answer is no, then you probably should try to get rid of it as soon as possible.”

According to Leahy, it’s also important to know when to bail because of missed opportunities. “If I stick with this commitment to this past relationship, car, or house, am I losing out on other opportunities?” says Leahy. Your money and time can be better spent on new experiences you may not be as open to when you’re still hanging on to old things.

The principle of sunk costs isn’t about living a life without commitment or follow-through. There are things we may not feel like doing in the moment but that we know, deep down, are good for our wellbeing (exercise and healthy habits are just one example, and all worthwhile relationships require hard work).

But it is about getting in touch with what we truly want now, not what we think we’ve been wanting all along. It’s about spotting our own patterns in honoring

Go Through Your Closet (And Also Your House)

sunk costs and making better decisions in the future. Clearing the sunk cost “baggage” (financial and otherwise) from our lives will make room for better things. Because sometimes walking away is the wisest decision we can make.

Walk Out If The Movie is Bad

Your ticket is already a sunk cost. Do something fulfilling with those two hours: take a walk or enjoy a book over a cup of tea.

Do a sunk cost inventory of your life Don’t Read Those Magazines If You’re Not Enjoying Them Take some time to look back on the past year and assess where some of your biggest The subscription is already a sunk cost. If “sunk costs” went, in terms of finances, your time is better spent on a hobby, do time, and energy. that instead. And make a note to yourself Humans aren’t rational by nature, and not to renew. that’s why so many businesses rely on subscription or pre-paid models, so that we Consider Selling A Flagging Stock feel “invested” and force ourselves to par. . . and declaring your losses — the end of take of their product or services. Be savvy the year is usually the best time to do this to this. Here are some places to start: (talk to your accountant).

Donate or sell expensive items you no longer use — their purchase is a sunk cost, and holding onto them just because they were expensive may make you feel less guilty, but is not the best decision for you.

Don’t Like It? Leave It On Your Plate

Don’t finish a dish that you’ve ordered in a restaurant if you don't like it just because you’ve spent money on it. Those are just wasted calories that would be better spent on consuming something you like.

End A Relationship If It’s Really Not Going Anywhere

That goes for friendships and romantic relationships. The time you spent is already a sunk cost. You’ve probably learned valuable things, so don’t see it as wasted time. Not every relationship is meant to move forward. p

Money

47

By Joe Satran

I

I’ve said it before and I’ll say it again: There’s never been a better time to be a beer drinker in America. The skillful innovation of American craft brewers over the past decade has pushed beer in delicious new directions. It wouldn’t be hard to argue that the craft beer renaissance is the most exciting development in the country’s culinary world right now.

But this explosion in quality comes at a price. Literally. With few exceptions, prices for good craft beer are far higher than for mainstream macrobrews from brewing conglomerates such as MillerCoors and Anheuser-Busch. A six-pack of beer from breweries like Dogfish Head, Ballast Point or Cigar City almost always costs more than $10 — and routinely exceeds the $15 48

BASIS

mark. You could easily get a 12-pack of Bud Light for that much.

Part of the price differential is due to pure marketing. Like vendors of designer clothing, acclaimed craft breweries can charge more because their customers expect to pay more for luxury goods. I spoke with more than a dozen people involved at all levels of the craft beer world to get a sense of the industry’s cost structure, and as it turns out, craft brewers incur far higher costs than mainstream brewers. Once you learn about all the work and material that goes into each sixpack, $12 starts to seem like a bargain.

To give you a sense of what all these various expenses actually mean, I’ll take you through the life cycle of a craft

beer — from grain to glass — explaining, at each step, what’s involved.

R

Raw Ingredients Most beers contain four basic raw ingredients: water, malt, hops and yeast.

Beer brewing uses a great deal of water. About five gallons are required to produce one gallon of beer. And though water access has become a problem for some growing craft breweries on the West Coast, even in dry Southern California, water remains so cheap that it’s not a serious concern for most breweries when it comes to pricing. So we’ll leave that out of the equation.

The other three ingredients cost real money. Let’s take them one at a time.

Malt When it comes to malted grain — the source of the sugars that become the alcohol that makes beer what it is — macrobreweries have three key advantages over craft breweries. Their huge size lets them demand lower prices from malt suppliers. They mix corn or rice — far cheaper than the traditional barley — into their beer. And compared with craft breweries, they generally produce beers that are lower in alcohol, which require significantly less malt per barrel of beer.

Craft breweries are also likely to use small amounts of specialty malts to add special flavors to the final product.

According to Bob Hansen, an executive at specialty malt powerhouse Briess, a medium-sized craft brewer can expect to pay 40 cents to 50 cents per pound for malt, while a macrobrewer will pay closer to 22 cents a pound. And while a macrobrewer uses about 40 pounds of malt to make a barrel of low-alcohol beer, a craft brewer might use 70 pounds to 100 pounds of malt to make a barrel of IPA or stout.

That means that a six-pack of craft beer contains about 65 cents of malt, while a six-pack of macrobrew contains about 16 cents of malt.

All told, a typical six-pack of craft beer contains 53 cents worth of hops, while a six-pack of macrobrew contains maybe 5 cents. And, of course, the sky’s the limit on the craft beer side. A su­per-hoppy double IPA with ultra-premium hops could include more than $1 worth of hops.

A

cited a rule of thumb for labor costs that says it takes about 20 hours of work to make a batch of beer, regardless of the size. The going rate for a ground-level brewer at a non-union brewery is about $12 an hour, meaning it costs $200 in labor to make a batch. Assuming the 30-barrel batches that are standard at relatively small breweries, that means 15 cents of labor goes into a typical six-pack of craft beer.

Packaging — whether in cans or bottles — is surprisingly expensive. Even buying in bulk, a glass bottle with a beer label affixed to it can cost as much as 20 cents, and the cardboard container that holds a six-pack costs a few more cents.

So packaging can add as much as $1.50 to the cost of a six-pack. Packaging is often one of the single-biggest expenses a brewery incurs. That amount drops significantly when a brewery is selling beer by the half-barrel to restaurants, but it’s still considerable.

Some high-end beers undergo barrel-aging for six months to a year before being bottled. A brewery has to buy a barrel, usually from a bourbon distiller, for about $100, for this process. In addition, it takes up valuable time and space in the brewery, which is hard to quantify. Let’s assume barrel aging adds about $1 to the dfew beers undergo barrel-aging, we won’t include this cost in our main analysis.

Finally, buying equipment and renting space for a commercial-scale brewery costs a ton of money — at least several hundred thousand dollars, and often in excess of $1 million. And there are ongoing

B

A six-pack of craft beer contains about 65 cents of malt, while a sixpack of macrobrew contains about 16 cents of malt.

Hops Hops are the herbacious plants that contribute much of the distinctive flavor to great beer, especially the hoppy IPAs that are the bestselling category in the craft beer world. They’re best known for adding bitterness to beer, but there are hundreds of varieties of hops, each of which contributes its own flavor to beer. Certain hop varieties have become extremely sought after by craft brewers in recent years, driving prices to record levels. Though most hops cost $4 to $6 a pound, some specialty types cost as much as $20 a pound.

Macrobrews contain almost no hops; that’s why they taste more “drinkable” and not as bitter. A macrobrewer might add a pound of cheap — say, $3 a pound — hops to a barrel of beer.

Meanwhile, a craft brewer could easily put four or five pounds of $7-a-pound hops into a barrel of hoppy IPA.

Yeast Another category that ranges wildly in price. Very large brewers — and some craft brewers — cultivate their own yeast, and rarely spend significant money on it. So let’s call a macrobrewer’s yeast cost nil.

But most others regularly buy fresh batches of yeast from the two companies that produce it for the beer market: San Diego’s White Labs and Oregon’s Wyeast.

Overnighting a batch of yeast large enough to brew a 30-barrel batch of beer is extremely expensive — around $800.

Most brewers try to reuse the yeast as many times as possible, often around four times, which would imply a per-six-pack cost for yeast of 13 cents. It’s less than malt or hops, but still significant.

It should be noted that a few breweries — including acclaimed Toppling Goliath brewery in Decorah, Iowa — insist on buying fresh yeast every time they brew beer. Clark Lewey, the owner of Toppling Goliath, said the increased quality and consistency more than justifies 50 cent-per-six-pack cost of fresh yeast.

Additional Ingredients Some specialty beers made by craft brewers include additional ingredients as supplemental flavorings. Coffee beans, for example, make regular appearances in certain stouts, and spices like grains of paradise and chipotle peppers can add zest to various beers. In some cases, this can add as much as a couple dollars to the cost of a six-pack. The range here is too big to include in our normal analysis, especially because most beers don’t include anything besides the big four, but it can be a major factor in the price of some beers.

Brewing, Aging and Packaging Once all the raw ingredients get to a brewery, the beer-making can begin. That requires labor. Several people I spoke with

Money

49

costs — promotional events, advertising, R&D — that are not included in the small amount of labor mentioned above.

Basic microeconomics tells us that it’s unwise to explicitly account for these past expenses, called sunk costs, when pricing a product, but the owner of the brewery eventually has to recoup that investment, not to mention make a living. To do that, breweries typically add a healthy markup to costs before selling the beer to a distributor — around 50 percent of gross costs, leading to a margin of 33 percent.

Assuming raw ingredient costs of $1.31, labor costs of 15 cents and packaging costs of $1.50, the brewer’s margin ends up adding about 91 cents to the final cost of the six-pack.

States vary wildly in the amount they levy, from 62 cents a barrel in Wyoming to $33 in Alaska. The median, though, is $6.20, which is what we’ll use for the purpose of our analysis.

Federal and state excise taxes add about 23 cents to the price of a six-pack.

D

S

Shipping A brewery that mostly sells its beer in-state, or in a relatively tight group of states, won’t incur much in the way of shipping costs. But prominent craft breweries are increasingly distributed across the country.

You can now find beer from lots of San Diego and Portland breweries in New York City, for example. And trucking beer thousands of miles costs a lot of money.

Andreas Martin, a transportation broker specializing in the beer industry, said shipping costs vary significantly by season.

Refrigerated trucks out of California are far more expensive in the summer, when vegetable producers in the Central Valley and Salinas Vally are competing for them.

Martin said that, depending on the time of year and the type of truck, it costs $5,000 to $7,000 to send a truck across the country. A truck generally carries 18 pallets of goods, and you could fit around 80 cases of beer onto one pallet. That translates into shipping costs of 67 cents for each sixpack trucked across the country.

Distribution Thanks to a web of laws created in the wake of Prohibition, almost all beer sold in America must pass through a distributor before it reaches a consumer. Beer distributors are in charge of a wide variety of tasks: They help market beers to restaurants and shops, they teach retailers the proper way to serve beer, and they bring beer from their warehouses to retail locations. They’re generally accountable for any loss along the supply chain — theft, broken bottles and so forth — which might account for about 5 percent of the total.

For these services — and thanks to their legally-mandated monopoly, they generally mark beer up drastically — 50 percent is actually quite normal. All the costs we’ve discussed so far mean that a distributor might buy a six-pack from a brewer for $4.75. The distributor’s markup, plus the cost of the lost product, adds $2.73 to the price of a six-pack.

R

E

Excise Taxes The federal government and each state government levy excise taxes on alcoholic products, and beer is no exception. Federal excise tax is the rare cost that’s actually lower for small breweries than large ones.

Washington charges breweries $7 per barrel for the first 60,000 barrels a brewery sells. After that — and for all breweries that sell more than 2 million barrels a year — the federal tax is $18 a barrel.

50

BASIS

Retail A typical retailer, then, would buy a sixpack of craft beer for about $7.48 from a distributor. The retailers I spoke with for this article said that, for sought-after craft beers, there’s relatively little wiggle room on pricing at this stage, even for large companies. But as anyone who’s comparison-shopped beer within a given city can attest, they have broad discretion on how much they will charge the consumer. A run-of-the-mill bottle shop is likely to mark up beer by around the same amount as the brewery and the distributor — that is, 50 percent, or $3.75 on a $7.48 six-pack.

Once you add the 7 percent sales tax, approximately the national median, you get almost exactly $12 a six-pack. p

Still Curious?

I Will Teach You to Be Rich Ramit Sethi

At last, for a generation that's materially ambitious yet financially clueless comes I Will Teach You To Be Rich, Ramit Sethi’s 6-week personal finance program for 20-to-35-year-olds. A completely practical approach delivered with a nonjudgmental style that makes readers want to do what Sethi says, it is based around the four pillars of personal finance — banking, saving, budgeting, and investing — and the wealth-building ideas of personal entrepreneurship.

BOOK

PERSONAL FINANCE

So Good They Can't Ignore You Cal Newport

With a title taken from the comedian Steve Martin, who once said his advice for aspiring entertainers was to “be so good they can’t ignore you,” Cal Newport’s clearly written manifesto is mandatory reading for anyone fretting about what to do with their life, or frustrated by their current job situation and eager to find a fresh new way to take control of their livelihood. He provides an evidence-based blueprint for creating work you love.

So Good They Can’t Ignore You will change the way you think about your career, happiness, and the crafting of a remarkable life.

BOOK

SELF-HELP

CAREER DEVELOPMENT

Thinking, Fast and Slow Daniel Kahneman

Engaging the reader in a lively conversation about how we think, Kahneman reveals where we can and cannot trust our intuitions and how we can tap into the benefits of slow thinking.

He offers practical and enlightening insights into how choices are made in both our business and our personal lives ― and how we can use different techniques to guard against the mental glitches that often get us into trouble. Thinking, Fast and Slow will transform the way you think about thinking.

BOOK

PSYCHOLOGY

ECONOMICS

52

BASIS

BODY

“By opening the gates of publishing to all, the internet has flattened hierarchies everywhere they exist. We no longer live in a world in which elites of accredited experts are able to dominate conversations about complex or contested matters.

Politicians cannot rely on the aura of office to persuade, newspapers struggle to assert the superior integrity of their stories. It is not clear that this change is, overall, a boon for the public realm. But in areas where experts have a track record of getting it wrong, it is hard to see how it could be worse.”

I an Leslie

‘‘ The Sugar Conspiracy” p. 56

56 The Sugar Conspiracy

How Did the World’s Top Nutrition Scientists Get It Wrong for So Long?

Ian Leslie

72 How to Find a Good Doctor Christy Rakoczy

74 How to Get Medical Care When You’re Uninsured Tisha Tolar

76 Recipes

3-Ingredient Banana Cookies

77 Recommendations

55

Hiciae. Ne EJEdeRIHRE KHRKWEHWEd Odd OIJE WEOIWHWKWmqui sdolut endi dit THE am lid ss ulpa pedissim nes etjadsrwisjr kjrfn SUGAR ks emqsue nobisti orionseque sWER WEOIJWLWIEWE WOW EJ WEd d CONSPIRACY ls fD Dunt vendi que podlor est auta si voloritsaddt aE nusam rese laboreperis E maximus daepdit velit, incia cus. Sed quas olorio.

Tus que laboratecum sfrweffwed d BY et archtem ent quas estrumquisti id quiam inist IAN qu d date culliss equiasped que et adis alitasp eriosti sam aut re et exeribearumtem quid ullabod dr LESLIE ut quium. voluptios escient eniasit emporro blaD borae rempori atquaer ecuptatumet accullaccus ulparum quis aboris senim conss pa sum facculparusm sqD uo veliquis dolds ded e orectorum PHOTOGRAPH BY TOA HEFTIBA

56

BASIS

Robert Lustig is a pediatric endocrinologist at the University of California who specializes in the treatment of childhood obesity. A 90-minute talk he gave in 2009, titled Sugar: The Bitter Truth, has now been viewed more than six million times on YouTube. In it, Lustig argues forcefully that fructose, a form of sugar ubiquitous in modern diets, is a “poison” culpable for America’s obesity epidemic.

A year before the video was posted, Lustig gave a similar talk to a conference of biochemists in Adelaide, Australia. Afterwards, a scientist in the audience approached him. Surely, the man said, you’ve read Yudkin. Lustig shook his head. John Yudkin, said the scientist, was a British professor of nutrition who had sounded the alarm on sugar back in 1972, in a book called Pure, White, and Deadly.

“If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” wrote Yudkin, “that material would promptly be banned.”

The book did well, but Yudkin paid a high price for it. Prominent nutritionists combined with the food industry to destroy his reputation, and his career never recovered.

He died, in 1995, a disappointed and largely forgotten man.

Perhaps Yudkin intended a friendly warning. Lustig was certainly putting his academic reputation at risk when he embarked on a high-profile campaign against sugar. But, unlike Yudkin, Lustig is backed by a prevailing wind. We read almost every week of new research into the deleterious effects of sugar. In the U.S., the latest edition of the government’s official dietary guidelines includes a cap on sugar consumption. In the U.K., the chancellor George Osborne announced a new tax on sugary drinks. Sugar has become dietary enemy number one.

This represents a dramatic shift in priority. For at least the last three decades, the dietary arch-villain has been saturated fat.

When Yudkin was conducting his research into the effects of sugar, in the 1960s, a new nutritional orthodoxy was in the process of asserting itself. Its central tenet was that a healthy diet is a low-fat diet.

Yudkin led a diminishing band of dissenters who believed that sugar, not fat, was the more likely cause of maladies such as 57

obesity, heart disease and diabetes. But by the time he wrote his book, the commanding heights of the field had been seized by proponents of the fat hypothesis. Yudkin found himself fighting a rearguard action, and he was defeated.

Not just defeated, in fact, but buried. When Lustig returned to California, he searched for Pure, White and Deadly in bookstores and online, to no avail.

Eventually, he tracked down a copy after submitting a request to his university library. On reading Yudkin’s introduction, he felt a shock of recognition.

“Holy crap,” Lustig thought. “This guy got there 35 years before me.”

I

n 1980, after long consultation with some of America’s most senior nutrition scientists, the U.S. government issued its first Dietary Guidelines. The guidelines shaped the diets of hundreds of millions of people. Doctors base their advice on them, food companies develop products to comply with them. Their influence extends beyond the U.S. In 1983, the U.K. government issued advice that closely followed the American example.

The most prominent recommendation of both governments was to cut back on saturated fats and cholesterol (this was the first time that the public had been advised to eat less of something, rather than enough of everything). Consumers dutifully obeyed. We replaced steak and sausages with pasta and rice, butter with margarine and vegetable oils, eggs with muesli, and milk with low-fat milk or orange juice. But instead of becoming healthier, we grew fatter and sicker.

Look at a graph of postwar obesity rates and it becomes clear that something changed after 1980. In the U.S., the line rises very gradually until, in the early 1980s, it takes off like an airplane. Just 12% of Americans were obese in 1950, 15% in 1980, 35% by 2000. In the U.K., the line is flat for decades until the mid-1980s, at which point it also turns towards the sky.

Only 6% of Britons were obese in 1980.

In the next 20 years that figure more than tripled. Today, two thirds of Britons are 58

BASIS

either obese or overweight, making it the fattest country in the EU. Type 2 diabetes, closely related to obesity, has risen in tandem in both countries.

At best, we can conclude that the official guidelines did not achieve their objective; at worst, they led to a decadeslong health catastrophe. Naturally, then, a search for culprits ensued. Scientists are conventionally apolitical figures, but these days, nutrition researchers write editorials and books that resemble liberal activist tracts, fizzing with righteous denunciations of “big sugar” and fast food. Nobody could have predicted, it is said, how the food manufacturers would respond to the injunction against fat — selling us low-fat yogurts bulked up with sugar, and cakes infused with liver-corroding trans fats.

Nutrition scientists are angry with the press for distorting their findings, politicians for failing to heed them, and the rest of us for overeating and under-exercising.

In short, everyone — business, media, politicians, consumers — is to blame. Everyone, that is, except scientists.

But it was not impossible to foresee that the vilification of fat might be an error. Energy from food comes to us in three forms: fat, carbohydrate, and protein.

Since the proportion of energy we get from protein tends to stay stable, whatever our diet, a low-fat diet effectively means a high-carbohydrate diet. The most versatile and palatable carbohydrate is sugar, which John Yudkin had already circled in red. In 1974, the U.K. medical journal, the Lancet, sounded a warning about the possible consequences of recommending reductions in dietary fat: “The cure should not be worse than the disease.”

Still, it would be reasonable to assume that Yudkin lost this argument simply because, by 1980, more evidence had accumulated against fat than against sugar.

After all, that’s how science works, isn’t it?

I

f, as seems increasingly likely, the nutritional advice on which we have relied for 40 years was profoundly flawed, this is not a mistake that can be laid at the door of corporate ogres. Nor can it

be passed off as innocuous scientific error.

What happened to John Yudkin belies that interpretation. It suggests instead that this is something the scientists did to themselves — and, consequently, to us.

We tend to think of heretics as contrarians, individuals with a compulsion to flout conventional wisdom. But sometimes a heretic is simply a mainstream thinker who stays facing the same way while everyone around him turns 180 degrees.

When, in 1957, John Yudkin first floated his hypothesis that sugar was a hazard to public health, it was taken seriously, as was its proponent. By the time Yudkin retired, 14 years later, both theory and author had been marginalized and derided. Only now is Yudkin’s work being returned, posthumously, to the scientific mainstream.

These sharp fluctuations in Yudkin’s stock have had little to do with the scientific method, and a lot to do with the unscientific way in which the field of nutrition has conducted itself over the years.

This story, which has begun to emerge in the past decade, has been brought to public attention largely by skeptical outsiders rather than eminent nutritionists. In her painstakingly researched book, The Big Fat Surprise, the journalist Nina Teicholz traces the history of the proposition that saturated fats cause heart disease, and reveals the remarkable extent to which its progress from controversial theory to accepted truth was driven, not by new evidence, but by the influence of a few powerful personalities, one in particular.

Teicholz’s book also describes how an establishment of senior nutrition scientists, at once insecure about its medical authority and vigilant for threats to it, consistently exaggerated the case for lowfat diets, while turning its guns on those who offered evidence or argument to the contrary. John Yudkin was only its first and most eminent victim.

Today, as nutritionists struggle to comprehend a health disaster they did not predict and may have precipitated, the field is undergoing a painful period of reevaluation. It is edging away from prohibitions on cholesterol and fat, and hardening its

We replaced steak and sausages with pasta and rice, butter with margarine, eggs with muesli. But instead of becoming healthier, we grew fatter and sicker.

Body

59

warnings on sugar, without going so far as to perform a reverse turn. But its senior members still retain a collective instinct to malign those who challenge its tattered conventional wisdom too loudly, as Teicholz is now discovering.

T

o understand how we arrived at this point, we need to go back almost to the beginning of modern nutrition science. On September 23, 1955, President Dwight Eisenhower suffered a heart attack.

Rather than pretend it hadn’t happened, Eisenhower insisted on making details of his illness public. The next day, his chief physician, Dr. Paul Dudley White, gave a press conference at which he instructed Americans on how to avoid heart disease: stop smoking, and cut down on fat and cholesterol. In a follow-up article, White cited the research of a nutritionist at the University of Minnesota, Ancel Keys.

Heart disease, which had been a relative rarity in the 1920s, was now felling middle-aged men at a frightening rate, and Americans were casting around for cause and cure. Ancel Keys provided an answer: the “diet-heart hypothesis” (for simplicity’s sake, I am calling it the “fat hypothesis”). This is the idea, now familiar, that an excess of saturated fats in the diet, from red meat, cheese, butter, and eggs, raises cholesterol, which congeals on the inside of coronary arteries, causing them to harden and narrow, until the flow of blood is staunched and the heart seizes up.

Ancel Keys was brilliant, charismatic, and combative. A friendly colleague at the University of Minnesota described him as, “direct to the point of bluntness, critical to the point of skewering”; others were less charitable. He exuded conviction at a time when confidence was most welcome. The president, the physician and the scientist formed a reassuring chain of male authority, and the notion that fatty foods were unhealthy started to take hold with doctors, and the public. (Eisenhower himself cut saturated fats and cholesterol from his diet altogether, right up until his death, in 1969, from heart disease.)

Many scientists remained skeptical.

The most prominent doubter was John Yudkin, then the U.K.’s leading nutritionist. When Yudkin looked at the data on heart disease, he was struck by its correlation with the consumption of sugar, not fat. He carried out a series of laboratory

60

BASIS

PHOTOGRAPH BY BROOKE LARK

Sugar — a pure carbohydrate, with all fiber and nutrition stripped out — has been part of western diets for just 300 years; in evolutionary terms, it is as if we have, just this second, taken our first dose of it. experiments on animals and humans, and built a department of nutrition science observed, as others had before him, that with an international reputation. sugar is processed in the liver, where it Ancel Keys was intensely aware that turns to fat, before entering the bloodstream. Yudkin’s sugar hypothesis posed an alterHe noted, too, that while humans have native to his own. If Yudkin published a always been carnivorous, carbohydrates paper, Keys would excoriate it, and him. only became a major component of their He called Yudkin’s theory “a mountain diet 10,000 years ago, with the advent of nonsense”, and accused him of issuing of mass agriculture. Sugar — a pure “propaganda” for the meat and dairy carbohydrate, with all fiber and nutrition industries. “Yudkin and his commercial stripped out — has been part of western backers are not deterred by the facts,” he diets for just 300 years; in evolutionary said. “They continue to sing the same terms, it is as if we have, just this second, discredited tune.” Yudkin never responded taken our first dose of it. Saturated fats, in kind. He was a mild-mannered man, by contrast, are so intimately bound up unskilled in the art of political combat. with our evolution that they are abunThat made him vulnerable to attack, dantly present in breast milk. To Yudkin’s and not just from Keys. The British Sugar thinking, it seemed more likely to be the Bureau dismissed Yudkin’s claims about recent innovation, rather than the prehissugar as “emotional assertions”; the World toric staple, making us sick.

Sugar Research Organization called his John Yudkin was born in 1910, in the book “science fiction”. In his prose, Yudkin East End of London. His parents were is fastidiously precise and undemonstrative, Russian Jews who settled in England after just as he was in person. Only occasionally fleeing the pogroms of 1905. Yudkin’s does he hint at how it must have felt to father died when he was six, and his have his life’s work besmirched, as when mother brought up her five sons in poverty. he asks the reader, “Can you wonder that By way of a scholarship to a local gramone sometimes becomes quite despondent mar school in Hackney, Yudkin made it about whether it is worthwhile trying to do to Cambridge. He studied biochemistry scientific research in matters of health?” and physiology, before taking up medicine.

Throughout the 1960s, Keys accumuAfter serving in the Royal Army Medical lated institutional power. He secured places Corps during the second world war, for himself and his allies on the boards of Yudkin was made a professor at Queen the most influential bodies in American Elizabeth College in London, where he healthcare, including the American Heart Body

61

PHOTOGRAPH BY KEILA HOETZEL

Association and the National Institutes of Health. From these strongholds, they directed funds to like-minded researchers, and issued authoritative advice to the nation. “People should know the facts,” Keys told Time magazine. “Then if they want to eat themselves to death, let them.”

This apparent certainty was unwarranted: even some supporters of the fat hypothesis admitted that the evidence for it was still inconclusive. But Keys held a trump card. From 1958 to 1964, he and his fellow researchers gathered data on the diets, lifestyles and health of 12,770 middle-aged men, in Italy, Greece, Yugoslavia, Finland, Netherlands, Japan, and the U.S. The Seven Countries Study was finally published as a 211-page monograph in 1970. It showed a correlation between intake of saturated fats and deaths from heart disease, just as Keys had predicted.

The scientific debate swung decisively behind the fat hypothesis.

Keys was the original big data guy (a contemporary remarked: “Every time you question this man Keys, he says, ‘I’ve got 5,000 cases. How many do you have?’). Despite its monumental stature, however, the Seven Countries Study, which was the basis for a cascade of subsequent papers by its original authors, was a rickety construction. There was no objective basis for the countries chosen by Keys, and it is hard to avoid the conclusion that he picked only those he suspected would support his hypothesis. After all, it is quite something to choose seven nations in Europe and leave out France and what was then West Germany, but then, Keys already knew that the French and Germans had relatively low rates of heart disease, despite living on a diet rich in saturated fats.

The study’s biggest limitation was inherent to its method. Epidemiological research involves the collection of data on people’s behavior and health, and a search for patterns. Originally developed to study infection, Keys and his successors adapted it to the study of chronic diseases, which, unlike most infections, take decades to develop, and are entangled with hundreds of dietary and lifestyle factors, effectively impossible to separate.

To reliably identify causes, as opposed to correlations, a higher standard of evidence is required: the controlled trial. In its simplest form: recruit a group of sub62

jects, and assign half of them a diet for, say, 15 years. At the end of the trial, assess the health of those in the intervention group, versus the control group. This method is also problematic: it is virtually impossible to supervise the diets of large groups of people. But a properly conducted trial is the only way to conclude with any confidence that X is responsible for Y. Although Keys had shown a correlation between heart disease and saturated fat, he had not excluded the possibility that heart disease was being caused by something else. Years later, the Seven Countries study’s lead Italian researcher, Alessandro Menotti, went back to the data, and found that the food that correlated most closely with deaths from heart disease was not saturated fat, but sugar.

By then it was too late. The Seven Countries study had become canonical, and the fat hypothesis was enshrined in official advice. The congressional committee responsible for the original Dietary Guidelines was chaired by Senator George McGovern. It took most of its evidence from America’s nutritional elite: men from a handful of prestigious universities, most of whom knew or worked with each other, all of whom agreed that fat was the problem — an assumption that McGovern and his fellow senators never seriously questioned. Only occasionally were they asked to reconsider. In 1973, John Yudkin was called from London to testify before the committee, and presented his alternative theory of heart disease.

A bemused McGovern asked Yudkin if he was really suggesting that a high fat intake was not a problem, and that cholesterol presented no danger.

“I believe in both of those things,” replied Yudkin.

“That is exactly the opposite of what my doctor told me,” said McGovern.

I

n a 2015 paper titled Does Science Advance One Funeral at a Time?, scholars at the National Bureau of Economic Research sought an empirical basis for a remark made by the physicist Max Planck: “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

The researchers identified more than 12,000 “elite” scientists from dif-

It was not difficult to persuade the public that if we eat fat, we will be fat. The scientific rationale was also pleasingly simple . . . but simple does not mean right, of course.

63

64

BASIS

If ever there was a case that an information democracy is preferable to an information oligarchy, then this is it. ferent fields. The criteria for elite status included funding, number of publications, and whether they were members of the National Academies of Science or the Institute of Medicine. Searching obituaries, the team found 452 who died before retirement. They then looked to see what happened to the fields from which these celebrated scientists had unexpectedly departed, by analyzing publishing patterns.

What they found confirmed the truth of Planck’s maxim. Junior researchers who had worked closely with the elite scientists, authoring papers with them, published less. At the same time, there was a marked increase in papers by newcomers to the field, who were less likely to cite the work of the deceased eminence. The articles by these newcomers were substantive and influential, attracting a high number of citations, moving the whole field along.

A scientist is part of what the Polish philosopher of science Ludwik Fleck called a “thought collective”: a group of people exchanging ideas in a mutually comprehensible idiom. The group, suggested Fleck, inevitably develops a mind of its own, as the individuals in it converge on a way of communicating, thinking and feeling.

This makes scientific inquiry prone to the eternal rules of human social life: deference to the charismatic, herding towards majority opinion, punishment for deviance, and intense discomfort with admitting to error. Of course, such tendencies are precisely what the scientific method was invented to correct for, and over the long

run, it does a good job of it. In the long run, however, we’re all dead, quite possibly sooner than we would be if we hadn’t been following a diet based on poor advice.

I

n a series of densely argued articles and books, including Why We Get Fat (2010), the science writer Gary Taubes has assembled a critique of contemporary nutrition science, powerful enough to compel the field to listen. One of his contributions has been to uncover a body of research conducted by German and Austrian scientists before the second world war, which had been overlooked by the Americans who reinvented the field in the 1950s. The Europeans were practicing physicians and experts in the metabolic system. The Americans were more likely to be epidemiologists, laboring in relative ignorance of biochemistry and endocrinology (the study of hormones). This led to some of the foundational mistakes of modern nutrition.

The rise and slow fall of cholesterol’s infamy is a case in point. After it was discovered inside the arteries of men who had suffered heart attacks, public health officials, advised by scientists, put eggs, whose yolks are rich in cholesterol, on the danger list. But it is a biological error to confuse what a person puts in their mouth with what it becomes after it is swallowed.

The human body, far from being a passive vessel for whatever we choose to fill it with, is a busy chemical plant, transforming and redistributing the energy it receives. Its

governing principle is homeostasis, or the maintenance of energy equilibrium (when exercise heats us up, sweat cools us down).

Cholesterol, present in all of our cells, is created by the liver. Biochemists had long known that the more cholesterol you eat, the less your liver produces.

Unsurprisingly, then, repeated attempts to prove a correlation between dietary cholesterol and blood cholesterol failed.

For the vast majority of people, eating two or three, or 25 eggs a day, does not significantly raise cholesterol levels. One of the most nutrient-dense, versatile and delicious foods we have was needlessly stigmatized. The health authorities have spent the last few years slowly backing away from this mistake, presumably in the hope that if no sudden movements are made, nobody will notice. In a sense, they have succeeded: a survey carried out in 2014 by Credit Suisse found that 54% of U.S. doctors believe that dietary cholesterol raises blood cholesterol.

To his credit, Ancel Keys realized early on that dietary cholesterol was not a problem. But in order to sustain his assertion that cholesterol causes heart attacks, he needed to identify an agent that raises its levels in the blood — he landed on saturated fats. In the 30 years after Eisenhower’s heart attack, trial after trial failed to conclusively bear out the association he claimed to have identified in the Seven Countries study.

The nutritional establishment wasn’t greatly discomfited by the absence of definitive proof, but by 1993 it found that it couldn’t evade another criticism: while a low-fat diet had been recommended to women, it had never been tested on them (a fact that is astonishing only if you are not a nutrition scientist). The National Heart, Lung and Blood Institute decided to go all in, commissioning the largest controlled trial of diets ever undertaken.

As well as addressing the other half of the population, the Women’s Health Initiative was expected to obliterate any lingering doubts about the ill-effects of fat.

It did nothing of the sort. At the end of the trial, it was found that women on the low-fat diet were no less likely than the control group to contract cancer or heart disease. This caused much consternation.

The study’s principal researcher, unwilling to accept the implications of his own findings, remarked: “We are scratching Body

65

Researchers interested in the effects of sugar and complex carbohydrates on obesity only had to look at what had happened to the most senior nutritionist in the U.K. to see that pursuing such a line of inquiry was a terrible career move.

66

BASIS

our heads over some of these results.” A Keys, which implied that since Krauss’s consensus quickly formed that the study findings contradicted every national and — meticulously planned, lavishly funded, international dietary recommendation, overseen by impressively credentialed they must be flawed. The circular logic is researchers — must have been so flawed symptomatic of a field with an unusually as to be meaningless. The field moved on, high propensity for ignoring evidence that or rather did not. does not fit its conventional wisdom.

In 2008, researchers from Oxford Gary Taubes is a physicist by backUniversity undertook a Europe-wide ground. “In physics,” he told me, “You study of the causes of heart disease. Its look for the anomalous result. Then you data shows an inverse correlation between have something to explain. In nutrition, saturated fat and heart disease, across the the game is to confirm what you and continent. France, the country with the your predecessors have always believed.” highest intake of saturated fat, has the As one nutritionist explained to Nina lowest rate of heart disease; Ukraine, the Teicholz, with delicate understatement: country with the lowest intake of saturated “Scientists believe that saturated fat is fat, has the highest. When the British obebad for you, and there is a good deal of sity researcher Zoë Harcombe performed reluctance toward accepting evidence to an analysis of the data on cholesterol the contrary.” levels for 192 countries around the world, she found that lower cholesterol correlated hen obesity started to become with higher rates of death from heart disease. recognized as a problem in western In the last 10 years, a theory that had societies, it too was blamed on satsomehow held up unsupported for nearly urated fats. It was not difficult to persuade half a century has been rejected by several the public that if we eat fat, we will be fat comprehensive evidence reviews, even as (this is a trick of the language: we call an it staggers on, zombie-like, in our dietary overweight person “fat”; we don’t describe guidelines and medical advice. a person with a muscular body as “proThe U.N.’s Food and Agriculture teiny”). The scientific rationale was also Organization, in a 2008 analysis of all pleasingly simple: a gram of fat has twice studies of the low-fat diet, found “no as many calories as a gram of protein or probable or convincing evidence” that a carbohydrate, and we can all grasp the high level of dietary fat causes heart disidea that if a person takes in more calories than she expends in physical activity, the ease or cancer. Another landmark review, surplus ends up as fat. published in 2010, in the American Simple does not mean right, of course.

Society for Nutrition, and authored by, It’s difficult to square this theory with the among others, Ronald Krauss, a highly dramatic rise in obesity since 1980, or respected researcher and physician at the with much other evidence. In America, University of California, stated “there is no significant evidence for concluding that average calorific intake increased by just a sixth over that period. In the U.K., it dietary saturated fat is associated with an actually fell. There has been no commenincreased risk of CHD or CVD [coronary heart disease and cardiovascular disease]”. surate decline in physical activity, in either country — in the U.K., exercise levels have Many nutritionists refused to accept increased over the last 20 years. Obesity these conclusions. The journal that pubis a problem in some of the poorest parts lished Krauss’s review, wary of outrage of the world, even among communities among its readers, prefaced it with a rebutin which food is scarce. Controlled trials tal by a former right-hand man of Ancel

W

have repeatedly failed to show that people lose weight on low-fat or low-calorie diets, over the long-term.

Those pre-war European researchers would have regarded the idea that obesity results from “excess calories” as laughably simplistic. Biochemists and endocrinologists are more likely to think of obesity as a hormonal disorder, triggered by the kinds of foods we started eating a lot more of when we cut back on fat: easily digestible starches and sugars. In his new book, Always Hungry, David Ludwig, an endocrinologist and professor of pediatrics at Harvard Medical School, calls this the “Insulin-Carbohydrate” model of obesity.

According to this model, an excess of refined carbohydrates interferes with the self-balancing equilibrium of the metabolic system.

Far from being a static dumping ground for excess calories, fat tissue operates as a reserve energy supply for the body. Its calories are called upon when glucose is low — that is, between meals, or during fasts and famines. Fat takes instruction from insulin, the hormone responsible for regulating blood sugar. Refined carbohydrates break down into glucose in the blood, prompting the pancreas to produce insulin. When insulin levels rise, fat tissue gets a signal to suck energy out of the blood, and to stop releasing it. So when insulin stays high for unnaturally long, a person gains weight, gets hungrier, and feels fatigued. Then we blame them for it.

But, as Gary Taubes puts it, obese people are not fat because they are overeating and sedentary — they are overeating and sedentary because they are fat.

Ludwig makes clear, as Taubes does, that this is not a new theory — John Yudkin would have recognized it — but an old one that has been galvanized by new evidence. What he does not mention is the role that supporters of the fat hypothesis have played, historically, in demolishing the credibility of those who proposed it.

PHOTOGRAPH BY IAN DOOLEY

67

PHOTOGRAPH BY JOANNA KOSINSKA

I

n 1972, the same year Yudkin pub­ lished Pure, White and Deadly, a Cornell-trained cardiologist called Robert Atkins published Dr. Atkins’ Diet Revolution. Their arguments shared the premise that carbohydrates are more dangerous to our health than fat, but they differed in particulars. Yudkin focused on the evils of one carb in particular, and didn’t explicitly recommend a high-fat diet.

Atkins argued that a high-fat, low-carb diet was the only viable route to weight loss.

Perhaps the most important difference between the two books was tone. Yudkin’s was cool, polite and reasonable, which reflected his temperament, and the fact that he saw himself as a scientist first and a clinician second. Atkins, resolutely a practitioner rather than an academic, was unbound by gentlemanly conventions. He declared himself furious that he had been “duped” by medical scientists.

Unsurprisingly, this attack enraged the nutritional establishment, which hit back hard. Atkins was labeled a fraud, and his diet a “fad”. It was a successful campaign: even today, Atkins’s name brings with it the odor of quackery.

A “fad” implies something new-fangled. But low-carb, high-fat diets had been popular for well over a century before Atkins, and were, until the 1960s, a method of weight loss endorsed by mainstream 68

BASIS

science. By the start of the 1970s, that had changed. Researchers interested in the effects of sugar and complex carbohydrates on obesity only had to look at what had happened to the most senior nutritionist in the U.K. to see that pursuing such a line of inquiry was a terrible career move.

John Yudkin’s scientific reputation had been sunk. He was uninvited from international conferences on nutrition. Research journals refused his papers. He was talked about by fellow scientists as an eccentric, a lone obsessive. Eventually, he became a scare story. Sheldon Reiser, one of the few researchers to continue working on the effects of refined carbohydrates and sugar through the 1970s, told Gary Taubes in 2011: “Yudkin was so discredited. He was ridiculed, in a way. And anybody else who said something bad about sucrose [sugar], they’d say, ‘He’s just like Yudkin.’”

If Yudkin was ridiculed, Atkins was a hate figure. Only in the last few years has it become acceptable to study the effects of Atkins-type diets. In 2014, in a trial funded by the U.S. National Institutes of Health, 150 people were assigned a diet for one year which limited either the amount of fat or carbs they could eat, but not the calories. By the end of the year, the people on the low-carb, high fat diet had lost about 8 pounds more on average than the low-fat group. They were also

If you are seeking to protect your authority, why draw attention to evidence that seems to contradict the assertions on which that authority is founded?

more likely to lose weight from fat tissue; scientific integrity of the process”. The the low-fat group lost some weight too, scientists reacted angrily, accusing the polbut it came from the muscles. The NIH iticians of being in thrall to the meat and study is the latest of more than 50 similar dairy industries (given how many of the studies, which together suggest that lowscientists depend on research funding from carb diets are better than low-fat diets for food and pharmaceutical companies, this achieving weight loss and controlling type might be characterized as audacious).

2 diabetes. As a body of evidence, it is far Some scientists agree with the polfrom conclusive, but it is as consistent as iticians. David McCarron, a research any in the literature. associate at the Department of Nutrition The 2015 edition of the U.S. Dietary at the University of California-Davis said, Guidelines (they’re revised every five “There’s a lot of stuff in the guidelines years) makes no reference to any of this that was right 40 years ago but that has new research, because the scientists who been disproved. Unfortunately, sometimes, advised the committee — the most eminent the scientific community doesn’t like to and well-connected nutritionists in the backtrack.” Steven Nissen, chairman of country — neglected to include a discussion cardiovascular medicine at the Cleveland of it in their report. It is a gaping omisClinic, was blunter, calling the new guidesion, inexplicable in scientific terms, but lines “an evidence-free zone”. entirely explicable in terms of the politics The congressional review has come of nutrition science. If you are seeking to about partly because of Nina Teicholz. protect your authority, why draw attenSince her book was published, in 2014, tion to evidence that seems to contradict Teicholz has become an advocate for the assertions on which that authority is better dietary guidelines. She is on the founded? Allow a thread like that to be board of the Nutrition Coalition, a body pulled, and a great unraveling might begin. funded by the philanthropists John and It may already have done. Last Laura Arnold, the stated purpose of which December, the scientists responsible for is to help ensure that nutrition policy is the report received a humiliating rebuke grounded in good science. from Congress, which passed a measure In September last year she wrote an proposing a review of the way the advice article for the BMJ (formerly the British informing the guidelines is compiled.

Medical Journal), which makes the case for It referred to “questions . . . about the the inadequacy of the scientific advice that

underpins the Dietary Guidelines. The response of the nutrition establishment was ferocious: 173 scientists — some of whom were on the advisory panel, and many of whose work had been critiqued in Teicholz’s book — signed a letter to the BMJ, demanding it retract the piece.

Publishing a rejoinder to an article is one thing; requesting its erasure is another, conventionally reserved for cases involving fraudulent data. As a consultant oncologist for the NHS, Santhanam Sundar, pointed out in a response to the letter on the BMJ website: “Scientific discussion helps to advance science. Calls for retraction, particularly from those in eminent positions, are unscientific and frankly disturbing.”

The letter lists “11 errors”, which on close reading turn out to range from the trivial to the entirely specious. I spoke to several of the scientists who signed the letter. They were happy to condemn the article in general terms, but when I asked them to name just one of the supposed errors in it, not one of them was able to.

One admitted he had not read it. Another told me she had signed the letter because the BMJ should not have published an article that was not peer reviewed (it was peer reviewed). Meir Stampfer, a Harvard epidemiologist, asserted that Teicholz’s work is “riddled with errors”, while declining to discuss them with me.

Body

69

Reticent as they were to discuss the substance of the piece, the scientists were noticeably keener to comment on its author. I was frequently and insistently reminded that Teicholz is a journalist, not a scientist, and that she had a book to sell, as if this settled the argument. David Katz, of Yale, author of four diet books, one of the members of the advisory panel, and an indefatigable defender of the orthodoxies, told me that Teicholz’s work “reeks of conflict of interest” without specifying what those conflicts were.

Dr. Katz does not pretend that his field has been right on everything — he admitted to changing his own mind, for example, on dietary cholesterol. But he returned again and again to the subject of Teicholz’s character. “Nina is shockingly unprofessional . . . I’ve been in rooms filled with the who’s who of nutrition and I have never seen such unanimous revulsion as when Miss Teicholz’s name comes up. She is an animal unlike anything I’ve ever seen before.” Despite requests, he cited no examples of her unprofessional behavior. (Note that the vitriol poured over Teicholz is rarely dispensed to Gary Taubes, though they make fundamentally similar arguments.)

In March this year, Teicholz was invited to participate in a panel discussion on nutrition science at the National Food Policy conference, in Washington D.C., only to be promptly disinvited, after her fellow panelists made it clear that they would refuse to share a platform with her. The organizers replaced her with the CEO of the Alliance for Potato Research and Education.

O

ne of the scientists who called for the retraction of Teicholz’s BMJ article, who requested that our conversation be off the record, complained that the rise of social media has created a “problem of authority” for nutrition science. “Any voice, however mad, can gain ground,” he told me.

70

BASIS

By opening the gates of publishing to all, the internet has flattened hierarchies everywhere they exist.

It is a familiar complaint. By opening them to do to Robert Lustig or Nina the gates of publishing to all, the internet Teicholz what they once did to John has flattened hierarchies everywhere they Yudkin. Harder, too, to deflect or smother exist. We no longer live in a world in the charge that the promotion of low-fat which elites of accredited experts are able diets was a 40-year fad, with disastrous to dominate conversations about complex outcomes, conceived of, authorized, and or contested matters. Politicians cannot policed by nutritionists. rely on the aura of office to persuade, Professor John Yudkin retired from newspapers struggle to assert the superior his post at Queen Elizabeth College in integrity of their stories. It is not clear 1971, to write Pure, White and Deadly. The that this change is, overall, a boon for the college reneged on a promise to allow public realm. But in areas where experts him to continue to use its research facilihave a track record of getting it wrong, it ties. It hired a fully committed supporter is hard to see how it could be worse. If of the fat hypothesis to replace him, ever there was a case that an information and it was no longer deemed politic to democracy, even a very messy one, is pref- have a prominent opponent of it on erable to an information oligarchy, then the premises. The man who had built the history of nutrition advice is it. the college’s nutrition department from In the past, we only had two sources scratch was forced to ask a solicitor to of nutritional authority: our doctor and intervene. Eventually, a small room in a government officials. It was a system that separate building was found for Yudkin.

When I asked Lustig why he was worked well as long as the doctors and offithe first researcher in years to focus cials were informed by good science. But on the dangers of sugar, he answered: what happens if that cannot be relied on?

“John Yudkin.

They took him down so The nutritional establishment has severely — so severely — that nobody proved itself, over the years, skilled at ad wanted to attempt it on their own.” p hominem takedowns, but it is harder for

71

72

BASIS

How to Find a Good Doctor

By Christy Rakoczy

1. Decide what doctor you need We all need a different kind of doctor at different times of our lives. If you have special medical needs, you might even need a specialist, or at the very least, a primary care physician who has experience with your needs. Even still, speaking with Dr. Pamela F. Gallin, The New York Times notes that your best starting place might be a primary care physician: “Do you have special medical needs, such as cardiac or rheumatology problems, or do you just need routine checkups? Do you have diabetes? Does your lifestyle put you in a certain category of risk?”

While some internists have additional training in cardiology or rheumatology, primary care physicians also have a network of trusted specialists for referrals.

You want to find a doctor that suits your medical needs, and who has dealt with your issues before. If you’re completely stuck on who to go to, a primary care physician is a good starting point because they can refer you to a specialist.

2. Use smart tools to choose the best doctor Start by asking your friends and family (and any doctors you have and like) for the names of their favorite docs. This method may seem unscientific, but in one recent survey, doctors ranked getting a recommendation from family or friends as the

most valuable way for you to choose a good physician. There is a caveat, however.

Friends who have had only annual checkups don’t have as good a sense of their doctors’ medical competence, so see if you can ask someone who’s had health trouble or concerns. If they felt well-served by that doctor, they may be a better bet.

If you can’t get a personal recommendation, consider searching physician directories online. Zocdoc is a great resource for finding in-network doctors in your area, particularly if you need a last-minute appointment. In addition to being able to search by zip code and health insurance plan, you can see who has an opening the soonest and how well others have reviewed their services. As with the recommendations from people you know, keep in mind that opinions from others may be a good gauge of a doctor’s bedside manner (which is indeed important), but not necessarily a way to measure her medical ability.

In your health insurance plan, you should also have access to a list of doctors who accept your insurance. From there, you can narrow it down by specialty, then cross-reference that list with other databases. Whereas personal recommendations may be out-of-network, choosing directly from this list may help you avoid researching a great doctor and finding out they don’t take your insurance.

3. Find an in-network doctor — and always double check with insurers Once you’ve found a doctor that fits your criteria, call both the doctor’s office and your insurer to make sure the physician actually takes your insurance.

Provider directories are not always up-to-date on whether a particular doctor participates in a plan or not. Conversely, a doctor may tell you they participate in your plan, while your provider has no record of that. You need to make sure both the doctor and the provider agree that they are in-network. Otherwise you may get stuck with a large bill with no way to fight it.

If you call your insurer and get verification of coverage, ask for the name and ID number of the representative you spoke with and ask to be sent confirmation of coverage in writing in case you get denied after the fact.

4. Research the doctor’s credentials and read up on reviews Next it’s time to do a background check to make sure the physician is board certified. The American Board of Medical Specialties certifies doctors who earn medical degrees from qualifying schools, complete accredited residency training, pass examinations by the board and obtain licensure from the medical board in their state. Certification Matters allows you to conduct a search to see if your doctor has board certification. You can also call 1-866-ASK-ABMS. Make sure you know the difference between MDs and other types of degrees.

Credentials are one thing, but reviews can tell you more about a doctor’s people skills. AngiesList.com, HealthGrades.com and RateMDs.com are three websites recommended by Consumer Reports to find ratings and reviews.

Lastly, find out if your doctor has faced disciplinary action or has been sued for malpractice, both of which can be red flags of serious problems. The Federation of State Medical Boards lists local medical boards, which you can contact to find out if a doctor has had disciplinary action taken against them.

5. Check that you really get along You can find out some key details about a prospective doctor just by calling their office. Are the doctor and staff are nice and professional? How long is the usual wait time for an appointment? When you go to visit, is the office clean? Is everything organized and run smoothly?

Once you’re finally face-to-face with the M.D., do a gut check. Do you feel comfortable? Your health will benefit if you do: A recent study in the Journal of the American Board of Family Medicine found that patients who had empathetic, engaged physicians felt more supported and were better able to take charge of their own well-being.

Bring three questions about your health issues, big or small, to your first appointment. As the doctor answers your queries, think to yourself: Do they explain things well? Do they consult with me and give me time to ask follow-up questions? A doctor who does these things — and makes you feel comfortable — just might be your perfect match. p Body

73

Do some digging to find out if you’re eligible for any sort of coverage. You may qualify for coverage from your state, county, or through another organization. If you don’t qualify for any of those, your health care options will depend on things like your location, income, ailment, and immigration status.

74

BASIS

How to Get Medical Care When You’re Uninsured

By Tisha Tolar ILLUSTRATION BY BENEDETTO CRISTOFANI

W

ith more and more people who can’t afford medical insurance not qualifying for state or federal assistance, many will skip medical treatment to save money. Your health isn’t something you should compromise on, however, so here are some places you can check out when you need medical help but don’t have the insurance to cover it:

A Regular Primary Care Doctor When you call the doctor’s office, don’t let the question of insurance coverage discourage you; you can still see a family physician without insurance and still be able to afford it. Approach your doctor about a reduction in rates for services if you’re willing to pay cash; many doctors will be happy to work with you because they’ll likely get more money in a faster time period than when having to deal with insurance or Medicare. Sometimes just taking the initiative to ask is all you need.

Community Clinics Finding a community clinic nearby is beneficial if you have low income. Many of these clinics provide free or low-cost treatment, and the cost is usually determined on an income-based sliding scale.

Community clinics typically offer services for prenatal care, vaccines, primary care, and assistance with finding a specialist when needed for ailments such as mental health, substance abuse and HIV/AIDS. Urgent Care Urgent care centers are becoming more popular, and they’re usually comparable in price to a regular cash doctor visit.

These facilities are preferable to emergency rooms in non-emergency situations, because their fees are much lower, the wait

is usually much shorter, and the staff is generally able to be more attentive.

This is important: if you find yourself in need of care, and you lack insurance, steer clear of the hospital emergency room unless you feel your condition is life threatening or that it somehow truly calls for an emergency room setting. Often, urgent care centers have much of the same equipment as an emergency room, but since each office varies, it is recommended that you call ahead to ensure they can treat you when you arrive.

Planned Parenthood Because Planned Parenthood centers often receive state funding and public donations, the fees for services may be even lower than normal, but you’ll typically be charged what you can afford, based on your income. Women can receive family planning services, plus other treatment and testing for STD’s, pap tests, breast exams, and birth control for little or no cost. Men are also welcome at Planned Parenthood to make sure their reproductive and overall health is on track. Be sure to call first to discuss your finances if you do not have insurance. You’ll be able to get a ball park figure for how much it will cost prior to going to your appointment.

Walk-in Clinics Because of its convenience, walk-in clinics are preferred by travelers, locals and those who are under-insured and uninsured.

Typically staffed with certified practitioners, these convenient clinics are usually tucked away in the back corner of a pharmacy or inside a grocery store.

Often, these clinics are equipped to treat strep throat and UTIs and might also perform routine labs, and provide com-

mon vaccines like flu and hepatitis. Often, the costs associated with a walk-in clinic can be half the cost of a regular doctor visit for those who are paying cash.

Health Screenings Keep an eye out for free or low-cost health screenings in your area. Many community groups, civic organizations, and local hospitals will offer regular free clinics for specific screenings of disease such as cancer, diabetes, high blood pressure, and other conditions. Usually, screenings are done by the facility in an attempt to raise awareness and catch diseases early on, raising the likelihood of a successful treatment. Though facilities might not advertise these events, you can call each facility from time to time for a schedule.

Medical Tourism For more expensive procedures or treatments, you may consider traveling outside your country of residence to seek medical care. There are risks to going abroad to get medical treatment, so do your research, but with limited access to health care and rising costs, medical tourism is something that millions of people do each year. If you need a specific treatment plan, you should involve your doctor in the U.S. to make sure you’re able to plan out everything you need. If you don’t have a connection in another country, there are associations dedicated to facilitating medical tourism, and there are a couple of hospitals who have made their name treating foreigners, like Bunrumgrad Hospital in Thailand. p

Body

75

No Sugar Added Three-Ingredient Banana Cookies RECIPE

YIELD: 12 INGREDIENTS • 2 small ripe bananas • ⅓ cup almond flour • ⅓ cup shredded unsweetened coconut METHOD 1. Preheat oven to 180 C/350 F. 2. Peel the bananas and cut them into 1" pieces.

3. Put the bananas in a food processor with the rest of the ingredients and blitz until smooth.

4. Cover a baking tray with parchment paper and form little balls with the dough; press them into cookies.

5. Bake for 10-12 minutes.

TIPS • If you only have large bananas, just add a little almond flour.

• If you don’t have a food processor, put the ingredients together in a bowl and mash it with a fork.

MIX-IN IDEAS While the few ingredients used in these recipes are part of their charm, here are a few favorite mix-ins to make it even more awesome.

• Peanut butter • Honey • Cinnamon • Mint • Chocolate • Berries • Instant coffee • Nuts

76

BASIS

Still Curious?

Overdiagnosed: Making People Sick in the Pursuit of Health H. Gilbert Welch, Lisa M. Schwartz, Steven Woloshin

A complex web of factors has created the phenomenon of overdiagnosis: the media promotes fear of disease and the myth that early, aggressive treatment is always best; to avoid lawsuits, doctors leave no test undone; and profits are being made from screenings, medical procedures, and pharmaceuticals. Revealing the social, medical, and economic ramifications of a healthcare system that overtreats patients, Dr. H. Gilbert Welch makes a call for change that would save us pain, worry, and money.

BOOK

HEALTH

HEALTHCARE

How Not To Die Michael Greger, Gene Stone

The vast majority of premature deaths can be prevented through simple changes in diet and lifestyle. In How Not to Die, Dr. Michael Greger, an internationally-renowned nutrition expert and physician, examines the fifteen top causes of premature death in America — heart disease, cancer, diabetes, Parkinson’s, high blood pressure, and more — and explains how nutritional and lifestyle interventions can sometimes trump prescription pills and other pharmaceutical and surgical approaches, freeing us to live healthier lives.

BOOK

NUTRITION

The Obesity Code: Unlocking the Secrets of Weight Loss Jason Fung

The Obesity Code addresses the history, causes, and treatments of obesity and today’s rising obesity rates. By understanding it through scientific and social study, obesity becomes less of a blanket term for metabolic complications and a more tangible problem with real, though not widely practiced, solutions.

BOOK

NUTRITION

Ad

MIND

“Which problems facing the modern world do you really, truly care about the most, as measured by how emotionally exercised you get, and how willing you are to take action? Somewhere near the top, for me, is the man who illegally parks his dark blue van outside my apartment building almost every week; he reliably renders me furious, and I never fail to make an online complaint. A little lower down the list comes the decision by my fellow Brits to leave the European Union; and below that, terrorist atrocities: appalling as they are, they’re so incomprehensible that my main response is bafflement.

Below all these comes climate change.”

Oliver Burkeman ‘‘Who Cares About Climate Change?” p. 91

82 Have Smartphones Destroyed a Generation?

Post-Millennials Are on the Brink of a Mental-Health Crisis Jean M. Twenge

91 Who Cares About Climate Change?

Why Climate Change is Hard to Think About Oliver Burkeman

94 How Friends Become Closer A Few Strategies for Developing Deep Friendships in a Busy World Julie Beck

97 Recommendations

81

Have Smartphones Destroyed a Generation?

More comfortable online than out partying, post-Millennials are safer, physically, than adolescents have ever been.

But they’re on the brink of a mental-health crisis.

By Jean M. Twenge ILLUSTRATIONS BY YUKAI DU

O

ne day last summer, around noon, I called Athena, a 13-year-old who lives in Houston, Texas. She answered her phone sounding as if she’d just woken up. We chatted about her favorite songs and TV shows, and I asked her what she likes to do with her friends. “We go to the mall,” she said.

“Do your parents drop you off?,” I asked, recalling my own middle-school days, in the 1980s, when I’d enjoy a few parent-free hours shopping with my friends. “No — I go with my family,” she replied. “We’ll go with my mom and brothers and walk a little behind them. I just have to tell my mom where we’re going. I have to check in every hour or every 30 minutes.”

Those mall trips are infrequent — about once a month. More often, Athena and her friends spend time together on their phones, unchaperoned. Unlike the teens of my generation, who might have spent an evening tying up the family landline with gossip, they talk on Snapchat, the smartphone app that allows users to send pictures and videos that quickly disappear. They make sure to keep up their Snapstreaks, which show how many 82

BASIS

days in a row they have Snapchatted with each other. Sometimes they save screenshots of particularly ridiculous pictures of friends.

“It’s good blackmail,” Athena said. She told me she’d spent most of the summer hanging out alone in her room with her phone.

That’s just the way her generation is, she said. “We didn’t have a choice to know any life without iPads or iPhones. I think we like our phones more than we like actual people.”

I’ve been researching generational differences for 25 years.

Typically, the characteristics that come to define a generation appear gradually, and along a continuum. Beliefs and behaviors that were already rising simply continue to do so. Millennials, for instance, are a highly individualistic generation, but individualism had been increasing since the Baby Boomers turned on, tuned in, and dropped out. I had grown accustomed to line graphs of trends that looked like modest hills and valleys. Then I began studying Athena’s generation.

Around 2012, I noticed abrupt shifts in teen behaviors and emotional states. The gentle slopes of the line graphs became

The allure of independence, so powerful to previous generations, holds less sway over today’s teens.

steep mountains and sheer cliffs, and many of the distinctive characteristics of the Millennial generation began to disappear.

In all my analyses of generational data — some reaching back to the 1930s — I had never seen anything like it.

At first I presumed these might be blips, but the trends persisted, across several years and a series of national surveys. The changes weren’t just in degree, but in kind. The biggest difference between the Millennials and their predecessors was in how they viewed the world; teens today differ from the Millennials not just in their views but in how they spend their time. The experiences they have every day are radically different from those of the generation that came of age just a few years before them.

What happened in 2012 to cause such dramatic shifts in behavior? It was after the Great Recession, which officially lasted from 2007 to 2009 and had a starker effect on Millennials trying to find a place in a sputtering economy. But it was exactly the moment when the proportion of Americans who owned a smartphone surpassed 50 percent.

Mind

83

The arrival of the smartphone has radically changed every aspect of teenagers’ lives, from the nature of their social interactions to their mental health.

84

BASIS

The more I pored over yearly surveys of teen attitudes and behaviors, and the more I talked with young people like Athena, the clearer it became that theirs is a generation shaped by the smartphone and by the concomitant rise of social media. I call them iGen. Born between 1995 and 2012, members of this generation are growing up with smartphones, have an Instagram account before they start high school, and do not remember a time before the internet. The Millennials grew up with the web as well, but it wasn’t ever-present in their lives, at hand at all times, day and night. A 2017 survey of more than 5,000 American teens found that three out of four owned an iPhone.

The advent of the smartphone and its cousin the tablet was followed quickly by hand-wringing about the deleterious effects of “screen time.” But the impact of these devices has not been fully appreciated, and it goes far beyond the usual concerns about curtailed attention spans. The arrival of the smartphone has radically changed every aspect of teenagers’ lives, from the nature of their social interactions to

their mental health. These changes have affected young people in every corner of the nation and in every type of household.

The trends appear among teens poor and rich; of every ethnic background; in cities, suburbs, and small towns. Where there are cell towers, there are teens living their lives on their smartphone.

To those of us who fondly recall a more analog adolescence, this may seem foreign and troubling. The aim of generational study, however, is not to succumb to nostalgia for the way things used to be; it’s to understand how they are now.

Some generational changes are positive, some are negative, and many are both.

More comfortable in their bedrooms than in a car or at a party, today’s teens are physically safer than teens have ever been.

They’re markedly less likely to get into a car accident and, having less of a taste for alcohol than their predecessors, are less susceptible to drinking’s attendant ills.

Psychologically, however, they are more vulnerable than Millennials were: Rates of teen depression and suicide have skyrocketed since 2011. It’s not an exaggeration

to describe iGen as being on the brink of the worst mental-health crisis in decades. Much of this deterioration can be traced to their phones.

Even when a seismic event — a war, a technological leap, a free concert in the mud — plays an outsize role in shaping a group of young people, no single factor ever defines a generation. Parenting styles continue to change, as do school curricula and culture, and these things matter.

But the twin rise of the smartphone and social media has caused an earthquake of a magnitude we’ve not seen in a very long time, if ever. There is compelling evidence that the devices we’ve placed in young people’s hands are having profound effects on their lives — and making them seriously unhappy.

In the early 1970s, the photographer Bill Yates shot a series of portraits at the Sweetheart Roller Skating Rink in Tampa, Florida. In one, a shirtless teen stands with a large bottle of peppermint schnapps stuck in the waistband of his jeans. In another, a boy who looks no older than 12 poses with a cigarette in his mouth. The rink was a place where kids could get away from their parents and inhabit a world of their own, a world where they could drink, smoke, and make out in the backs of their cars. In stark black-and-white, the adolescent Boomers gaze at Yates’s camera with the self-confidence born of making your own choices — even if, perhaps especially

if, your parents wouldn’t think they were the right ones.

Fifteen years later, during my own teenage years as a member of Generation X, smoking had lost some of its romance, but independence was definitely still in.

My friends and I plotted to get our driver’s license as soon as we could, making DMV appointments for the day we turned 16 and using our newfound freedom to escape the confines of our suburban neighborhood. Asked by our parents, “When will you be home?,” we replied, “When do I have to be?”

But the allure of independence, so powerful to previous generations, holds less sway over today’s teens, who are less likely to leave the house without their parents. The shift is stunning: 12th-graders in 2015 were going out less often than eighth-graders did as recently as 2009.

Today’s teens are also less likely to date. Only about 56 percent of highschool seniors in 2015 went out on dates; for Boomers and Gen Xers, the number was about 85 percent.

This decline in dating tracks with a decline in sexual activity. The drop is the sharpest for ninth-graders, among whom the number of sexually active teens has been cut by almost 40 percent since 1991.

The average teen now has had sex for the Mind

85

first time by the spring of 11th grade, a full year later than the average Gen Xer. Fewer teens having sex has contributed to what many see as one of the most positive youth trends in recent years: The teen birth rate hit an all-time low in 2016, down 67 percent since its modern peak, in 1991.

Even driving, a symbol of adolescent freedom inscribed in American popular culture, from Rebel Without a Cause to Ferris Bueller’s Day Off, has lost its appeal for today’s teens. Nearly all Boomer highschool students had their driver’s license by the spring of their senior year; more than one in four teens today still lack one at the end of high school. For some, Mom and Dad are such good chauffeurs that there’s no urgent need to drive. Teens described getting their license as something to be nagged into by their parents — a notion that would have been unthinkable to previous generations.

Independence isn’t free — you need money in your pocket to pay for gas, or for that bottle of schnapps. In earlier eras, kids worked in great numbers, eager to finance their freedom or prodded by their parents to learn the value of a dollar. But iGen teens aren’t working (or managing their 86

BASIS

own money) as much. In the late 1970s, 77 percent of high-school seniors worked for pay during the school year; by the mid2010s, only 55 percent did. The number of eighth-graders who work for pay has been cut in half. These declines accelerated during the Great Recession, but teen employment has not bounced back, even though job availability has.

Of course, putting off the responsibilities of adulthood is not an iGen innovation.

Gen Xers, in the 1990s, were the first to postpone the traditional markers of adulthood. Young Gen Xers were just about as likely to drive, drink alcohol, and date as young Boomers had been, and more likely to have sex and get pregnant as teens. But as they left their teenage years behind, Gen Xers married and started careers later than their Boomer predecessors had.

Gen X managed to stretch adolescence beyond all previous limits: Its members started becoming adults earlier and finished becoming adults later. Beginning with Millennials and continuing with iGen, adolescence is contracting again — but only because its onset is being delayed.

Across a range of behaviors — such as drinking, dating, and spending time unsupervised — 18-year-olds now act more like

Why are today’s teens waiting longer to take on both the responsibilities and the pleasures of adulthood?

15-year-olds used to, and 15-year-olds act more like 13-year-olds. Childhood now stretches well into high school.

Why are today’s teens waiting longer to take on both the responsibilities and the pleasures of adulthood? Shifts in the economy, and parenting, certainly play a role. In an information economy that rewards higher education more than early work history, parents may be inclined to encourage their kids to stay home and study rather than to get a part-time job. Teens, in turn, seem to be content with this homebody arrangement — not because they’re so studious, but because their social life is lived on their phone.

They don’t need to leave home to spend time with their friends.

If today’s teens were a generation of grinds, we’d see that in the data. But eighth-, 10th-, and 12th-graders in the 2010s actually spend less time on homework than Gen X teens did in the early 1990s. (Although high school seniors headed for four-year colleges spend about the same amount of time on homework as their predecessors did.) The time that seniors spend on activities like student clubs and sports and exercise has changed little in recent years. Combined with the

decline in working for pay, this means iGen teens have more leisure time than Gen X teens did, not less.

So what are they doing with all that time? They are on their phone, in their room, alone and often distressed.

One of the ironies of iGen life is that despite spending far more time under the same roof as their parents, today’s teens can hardly be said to be closer to them than their predecessors were. “I’ve seen my friends with their families — they don’t talk to them,” Athena told me. “They just say ‘Okay, okay, whatever’ while they’re on their phones. They don’t pay attention to their family.” Like her peers, Athena is an expert at tuning out her parents so she can focus on her phone. She spent much of her summer keeping up with friends, but nearly all of it was over text or Snapchat.

“I’ve been on my phone more than I’ve been with actual people,” she said.

In this, too, she is typical. The number of teens who get together with their friends nearly every day dropped by more than 40 percent from 2000 to 2015; the decline has been especially steep recently.

It’s not only a matter of fewer kids partying; fewer kids are spending time simply hanging out. The roller rink, the basket-

ball court, the town pool, the local necking spot — they’ve all been replaced by virtual spaces accessed through apps and the web.

You might expect that teens spend so much time in these new spaces because it makes them happy, but most data suggest that it does not. The Monitoring the Future survey, funded by the National Institute on Drug Abuse and designed to be nationally representative, has asked 12th-graders more than 1,000 questions every year since 1975 and queried eighthand 10th-graders since 1991. The survey asks teens how happy they are and also how much of their leisure time they spend on various activities, including non-screen activities such as in-person social interaction and exercise, and, in recent years, screen activities such as using social media, texting, and browsing the web. The results show that teens who spend more time than average on screen activities are more likely to be unhappy, and those who spend more time than average on non-screen activities are more likely to be happy.

All screen activities are linked to less happiness, and all non-screen activities are linked to more happiness. Eighthgraders who spend 10 or more hours a week on social media are 56 percent more likely to say they’re unhappy than those who devote less time to social media. And those who spend six to nine hours a week on social media are still 47 percent more likely to say they are unhappy than those who use social media even less. The oppoMind

87

As teens have started spending less time together, they have become less likely to kill one another, and more likely to kill themselves.

site is true of in-person interactions. Those who spend an above-average amount of time with their friends in person are 20 percent less likely to say they’re unhappy than those who hang out for a below-average amount of time.

If you were going to give advice for a happy adolescence based on this survey, it would be straightforward: Put down the phone, turn off the laptop, and do 88

BASIS

something — anything — that does not involve a screen. Of course, these analyses don’t unequivocally prove that screen time causes unhappiness; it’s possible that unhappy teens spend more time online.

But recent research suggests that screen time, in particular social-media use, does indeed cause unhappiness. One study asked college students with a Facebook page to complete short surveys on their phone over the course of two weeks.

They’d get a text message with a link five times a day, and report on their mood and how much they’d used Facebook. The more they’d used Facebook, the unhappier they felt, but feeling unhappy did not subsequently lead to more Facebook use.

Social-networking sites like Facebook promise to connect us to friends. But the portrait of iGen teens emerging from the data is one of a lonely, dislocated generation. Teens who visit social-networking sites every day but see their friends in person less frequently are the most likely to agree with the statements “A lot of times I feel lonely,” “I often feel left out of things,” and “I often wish I had more good friends.” At the generational level, when teens spend more time on smartphones and less time on in-person social interactions, loneliness is more common.

So is depression. Once again, the effect of screen activities is unmistakable: The more time teens spend looking at screens, the more likely they are to report symptoms of depression. Eighth-graders who are heavy users of social media increase their risk of depression by 27 percent, while those who play sports, go to religious services, or even do homework more than the average teen cut their risk significantly.

Teens who spend three hours a day or more on electronic devices are 35 percent more likely to have a risk factor for suicide, such as making a suicide plan.

(That’s much more than the risk related to, say, watching TV.) One piece of data that indirectly but stunningly captures kids’ growing isolation, for good and for bad: Since 2007, the homicide rate among teens has declined, but the suicide rate has increased. As teens have started spending less time together, they have become less likely to kill one another, and more likely to kill themselves. In 2011, for the first time in 24 years, the teen suicide rate was higher than the teen homicide rate.

Depression and suicide have many causes; too much technology is clearly not the only one. The teen suicide rate was even higher in the 1990s, long before smartphones existed. Then again, about

four times as many Americans now take burning. Her phone had overheated and antidepressants, which are often effective melted into the sheets. National news in treating severe depression, the type most outlets picked up the story, stoking readers’ strongly linked to suicide. fears that their cellphone might spontaWhat’s the connection between smartneously combust. To me, however, the phones and the apparent psychological flaming cellphone wasn’t the only surprisdistress this generation is experiencing? For ing aspect of the story. Why, I wondered, all their power to link kids day and night, would anyone sleep with her phone beside social media also exacerbate the age-old her in bed? It’s not as though you can teen concern about being left out. Today’s surf the web while you’re sleeping. And teens may go to fewer parties and spend who could slumber deeply inches from a less time together in person, but when they buzzing phone? do congregate, they document their hangCurious, I asked my undergraduate stuouts relentlessly — on Snapchat, Instagram, dents at San Diego State University what Facebook. Those not invited are keenly they do with their phone while they sleep. aware of it. Accordingly, the number of Their answers were a profile in obsession. teens who feel left out has reached all-time Nearly all slept with their phone, putting highs across age groups. Like the increase it under their pillow, on the mattress, or in loneliness, the upswing in feeling left out at the very least within arm’s reach of has been swift and significant. the bed. They checked social media right This trend has been especially steep before they went to sleep, and reached for among girls. Forty-eight percent more girls their phone as soon as they woke up in the said they often felt left out in 2015 than morning (they had to — all of them used in 2010, compared with 27 percent more it as their alarm clock). Their phone was boys. Girls use social media more often, the last thing they saw before they went giving them more opportunities to feel to sleep and the first thing they saw when excluded when they see their friends getthey woke up. Some used the language of ting together without them. Social media addiction. “I know I shouldn’t, but I just levy a psychic tax on the teen doing the can’t help it,” one said about looking at posting as well, as she anxiously awaits the her phone while in bed. Others saw their affirmation of comments and likes. phone as an extension of their body — or Girls have also borne the brunt of even like a lover: “Having my phone closer the rise in depressive symptoms among to me while I’m sleeping is a comfort.” today’s teens. Boys’ depressive symptoms It may be a comfort, but the smartincreased by 21 percent from 2012 to phone is cutting into teens’ sleep: Many 2015, while girls’ increased by 50 pernow sleep less than seven hours most cent — more than twice as much. The rise nights. Sleep experts say that teens should in suicide, too, is more pronounced among get about nine hours of sleep a night; a girls. Although the rate increased for both teen who is getting less than seven hours sexes, three times as many 12-to-14-yeara night is significantly sleep deprived. 57 old girls killed themselves in 2015 as in percent more teens were sleep deprived in 2007, compared with twice as many boys.

2015 than in 1991. In just the four years The suicide rate is still higher for boys, in from 2012 to 2015, 22 percent more teens part because they use more lethal methods, failed to get seven hours of sleep. but girls are beginning to close the gap.

The increase is suspiciously timed, once These more dire consequences for again starting around when most teens got teenage girls could also be rooted in the a smartphone. Two national surveys show fact that they’re more likely to experience that teens who spend three or more hours cyberbullying. Boys tend to bully one a day on electronic devices are 28 percent another physically, while girls are more more likely to get less than seven hours likely to do so by undermining a victim’s of sleep than those who spend fewer than social status or relationships. Social media three hours, and teens who visit social-megive middle- and high-school girls a dia sites every day are 19 percent more platform on which to carry out the style likely to be sleep deprived. A meta-analysis of aggression they favor, ostracizing and of studies on electronic-device use among excluding other girls around the clock. children found similar results: Children In July 2014, a 13-year-old girl in North who use a media device right before bed Texas woke to the smell of something are more likely to sleep less than they

Their phone was the last thing they saw before they went to sleep and the first thing they saw when they woke up.

should, more likely to sleep poorly, and more than twice as likely to be sleepy during the day.

Sleep deprivation is linked to a myriad of issues, including compromised thinking and reasoning, susceptibility to illness, weight gain, and high blood pressure. It also affects mood: People who don’t sleep enough are prone to depression and anxiety. Again, it’s difficult to trace the precise paths of causation. Smartphones could be causing lack of sleep, which leads to depression, or the phones could be causing depression, which leads to lack of sleep. Or some other factor could be causing both depression and sleep deprivation to rise. But the smartphone, its blue light glowing in the dark, is likely playing a nefarious role.

The correlations between depression and smartphone use are strong enough to suggest that more parents should be telling their kids to put down their phone. As the technology writer Nick Bilton has reported, it’s a policy some Silicon Valley executives follow. Even Steve Jobs limited his kids’ use of the devices he brought into the world.

What’s at stake isn’t just how kids experience adolescence. The constant presence of smartphones is likely to affect them well into adulthood. Among people who suffer an episode of depression, at least half become depressed again later in life.

Mind

89

Adolescence is a key time for developing social skills; as teens spend less time with their friends face-to-face, they have fewer opportunities to practice them. In the next decade, we may see more adults who know just the right emoji for a situation, but not the right facial expression.

Restricting technology might be an unrealistic demand to impose on a generation of kids so accustomed to being wired at all times. My three daughters were born in 2006, 2009, and 2012. They’re not yet old enough to display the traits of iGen teens, but I have already witnessed firsthand just how ingrained new media are in their young lives. I’ve observed my toddler, barely old enough to walk, confidently swiping her way through an iPad. I’ve experienced my 6-year-old asking for her own cellphone. I’ve overheard my 9-yearold discussing the latest app to sweep the fourth grade. Prying the phone out of our kids’ hands will be difficult, even more so than the quixotic efforts of my parents’ generation to get their kids to turn off MTV and get some fresh air. But more seems to be at stake in urging teens to use their phone responsibly, and there are benefits to be gained even if all we instill in our children is the importance of moderation. Significant effects on both mental health and sleep time appear after two or more hours a day on electronic devices.

90

BASIS

What’s at stake isn’t just how kids experience adolescence. The constant presence of smartphones is likely to affect them well into adulthood.

The average teen spends about two and a half hours a day on electronic devices.

Some mild boundary-setting could keep kids from falling into harmful habits.

In my conversations with teens, I saw hopeful signs that kids themselves are beginning to link some of their troubles to their ever-present phone. Athena told me that when she does spend time with her friends in person, they are often looking at their device instead of at her. “I’m trying to talk to them about something, and they don’t actually look at my face,” she said.

“They’re looking at their phone, or they’re looking at their Apple Watch.” “What does that feel like, when you’re trying to talk to somebody face-to-face and they’re not looking at you?,” I asked. “It kind of hurts,” she said. “It hurts. I know my parents’ generation didn’t do that. I could be talking about something super important to me, and they wouldn’t even be listening.”

Once, she told me, she was hanging out with a friend who was texting her boyfriend. “I was trying to talk to her about my family, and what was going on, and she was like, ‘Uh-huh, yeah, whatever.’ So I took her phone out of her hands and I threw it at my wall.”

I couldn’t help laughing. “You play volleyball,” I said. “Do you have a pretty good arm?” “Yep,” she replied. p

Who Cares About Climate Change?

By Oliver Burkeman ILLUSTRATIONS BY YUKO SHIMIZU

H

ere’s a question you shouldn’t ask yourself unless you’re prepared for an unsettling answer: which problems facing the modern world do you really, truly care about the most, as measured by how emotionally exercised you get, and how willing you are to take action? Somewhere near the top, for me, is the man who illegally parks his dark blue van outside my apartment building almost every week; he reliably renders me furious, and I never fail to make an online complaint. A little lower down the list comes the recent decision by my fellow Brits to leave the EU; and below that, terrorist atrocities: appalling as they are, they’re so incomprehensible that my main response is bafflement. Below all these comes climate change. Apart from brief flashes of sadness at what’s happening to the planet, and my complicity in it,

the shameful reality is that it generally just isn’t a regular cause of motivating emotion.

This probably makes me a bad person, but I’m not a stupid one: I can see that my priorities, judged by the vehemence of my emotions, are precisely upside-down.

Like many other people, I’m a walking embodiment of Sayre’s Law, coined by the American political scientist Wallace Sayre: when it comes to political disputes (and, he might have added, other societal challenges) intensity of feeling is inversely proportional to what’s at stake. We tend to care most about what matters least, and vice versa — a very human flaw, perhaps, but one that may yet bring about our destruction. The problem of humanity’s impact on our natural habitat feels too complex to understand; too big for any individual to make a difference; and potentially so catastrophic as to be painful 91

to contemplate. No wonder it’s more modernity’s most pressing problems are appealing to pursue my vendetta against frequently among the least interesting — Blue Van Guy instead. in part because they involve not exciting This predilection for focusing our individual human dramas, which seize our energies on precisely the wrong things is attention and evoke empathy, but comnothing new: in his famous letter “On the plex interconnected systems and endless Shortness of Life”, the Stoic philosopher quantities of data. The global financial Seneca bemoaned his fellow Romans’ meltdown of 2007-8 was of little interest tendency to fill their lives with pointless to anyone other than specialists, or those busywork, rather than using their short worst affected, until it began to involve TV span of time more meaningfully. (Which images of homeowners forced from their meant, Seneca argued, using it to do dwellings, or fired bankers carrying out philosophy.) What’s different about climate boxes of their belongings on to Wall Street. change, psychologically speaking, is the There are, of course, dramatic human way it triggers an unprecedented comstories unfolding right now as a consebination of our in-built self-sabotaging quence of the climate crisis — but they impulses. As recent research in behavioral tend either to be happening far away, or economics has shown, we’re largely unable difficult to attribute definitively to global to make small sacrifices now to avert major warming. (Those displaced by flooding losses later on — and we’re much more and fires in the US, for example, rarely troubled by threats we can mentally picget described as climate refugees.) The ture (a terrorist planting a bomb, a thief conspiratorial thinking of climate denial, with a gun) than those that are harder to by contrast, positively teems with gripping visualize (the systemic ramifications of a tales of evil scientists scheming in backone-degree rise in global temperatures, say). rooms. These stories may be false — but Besides, when we do take some selfless you can’t claim they’re not compelling. action, such as donating to an environmen- They are testaments to what the literary tal charity, we become immediately prone scholar Jonathan Gottschall, author of to ‘moral licensing’, the phenomenon The Storytelling Animal, has called “the whereby the warm inner glow of having vast, witchy power of story in human life”. done the right thing provides an excuse Stories compel us, whether or not they’re for doing something that cancels out the true; facts may not, even though they are. benefits, such as eating more meat, or Or maybe the feeling of boredom is turning up the air conditioning. Some of better explained psychoanalytically, as a these cognitive biases have evolutionary defense against emotions we daren’t make justifications: in early human communiconscious — a numbing but easier alternaties, for example, easy-to-picture dangers tive to confronting the horror we’re helping probably did pose the greatest threat. to perpetrate? Either way, it’s natural Now, though, they’ve become a serious enough for climate campaigners to want impediment to our safety — one that to shock people out of their listlessness Daniel Kahneman, the doyen of cognitive with graphic imagery and dire warnings. bias researchers, has said he’s personally But as a widely reported study showed pessimistic we’ll ever manage to surmount. in 2011 — and subsequent research has Yet perhaps the most interesting and confirmed — such messages can easily troubling psychological feature of climate backfire. The more alarming they are, the change, ironically enough, is how boring it more likely audiences are to discount them is to so many of us. The filmmaker Randy because of the challenge they pose to the Olson has called this “the great unmen‘just world bias’, the widely held, if usually tionable” of the environmental movement, unarticulated, assumption that life is and at first glance it makes little sense: such generally safe, predictable, and fair. When a severe, planet-wide threat might well confronted with evidence that contradicts terrify us into paralysis, but you’d hardly a deeply-held belief, we’re frighteningly expect it to seem dull. The truth is that skilled at dismissing the evidence, rather

92

than changing the belief. And even if they don’t backfire, they risk working too well, inducing a sense of helplessness. That despair can then serve as a defense mechanism: if there’s no point in caring about the climate, nor can there be any ethical obligation to do so.

It would be absurd to propose any simple remedy for this predicament. (Who said the existence of a problem entails the existence of a solution anyway?) Personally, I’ve found both solace and motivation in the work of Derrick Jensen, a co-founder of the environmental movement Deep Green Resistance. Jensen keeps fighting in the face of despair, he has written, because he’s “in love. With salmon, with trees out-

side my window, with baby lampreys living in sandy streambottoms . . . and if you love, you act to defend your beloved. Of course results matter to you, but they don’t determine whether or not you make the effort.”

Though it risks sounding sentimental, thinking in terms of love is actually highly clarifying. Instinctively, we understand what it entails: most of us would condemn a parent who stopped caring for a child simply because the experience was often tedious, or inconvenient, or scary, or because success couldn’t be guaranteed. If we claim to love the planet, why should things be any different? “If my love doesn’t cause me to protect what I love,” as Jensen puts it, “it’s not love.”

The climate crisis may sometimes bore me, or strike me as hopeless, or fail to make me as viscerally angry as it should (or as Blue Van Guy does). But so what?

Virtually everyone knows the experience of investing time and energy in caring for those you love, regardless of whether, in that very moment, you happen to feel like it. You don’t usually do it for some future payoff, or even for the warm inner glow.

On the contrary, it’s self-justifying. You do it because it’s what needs to be done. p

Mind

93

How Friends Become

By Julie Beck

ILLUSTRATIONS BY MARK CONLAN

CLOSER

Strategies to cultivate deep friendships in a busy world.

94

BASIS

F

“

riendships don’t just happen,” says William Rawlins, a professor of interpersonal communication at Ohio University. “They don’t drop from the sky.”

Like any relationship, friendships take effort and work. But they’re often the last to receive that effort after people expend their energy on work, family, and romance.

And as I’ve written before, as time goes on, friendships often face more hurdles to intimacy than other close relationships. As people hurtle toward the peak busyness of middle age, friends — who are usually a lower priority than partners, parents, and children — tend to fall by the wayside.

Our increasingly mobile world also strains friendship. In one study that longitudinally followed best-friend pairs, people moved 5.8 times on average, over 19 years. But it’s not just that people move frequently in the modern era — they also cover more ground than they ever have, historically. The epidemiologist David Bradley once looked at the “lifetime track” of four generations of his family. “Lifetime track” is a term zoologists use to describe the entire sum of an animal’s movements from birth to death. Bradley found that his great-grandfather’s entire life took place “in a square of only 40 kilometers.”

His grandfather’s lifetime track was about 400 square kilometers; his father’s was about 4000 square kilometers, and his own extended all over the world, for a 40,000-kilometer square.

“Thus in four generations the range of linear traveling has increased by a factor of 1000 and the area within which movement takes place has increased by a factor of 1 million,” Bradley wrote. “The experienced described here is not atypical.” This was in 1989 — one imagines that between then and 2017 the average roaming range of humans has only grown.

This matters because when people move, their families may come with them, but they leave their friends behind. And even though extended, remote social networks are more accessible than ever for anyone with an internet connection, proximity still makes a difference. Moving is associated with shallower relationships, and people who move frequently are more willing to dispose of their friends, perhaps because they get used to losing them.

At the same time, there’s been a growing interest in exploring the complex dynamics of friendship. As people

get married later, and the ranks of single women rise, more and more books and television shows have been exploring friendship dynamics.

But even if someone wants to make friends a high priority in their life, unlike with romantic relationships, for friendships there are fewer cultural scripts to follow to do the work of befriending someone, or making a friendship closer.

“The opportunities for friendship come with how people’s lives are organized,” Rawlins says. “When I talk to students, I say ‘Pay close attention to the habits you’re forming, because before you know it, you have organized your life in a way that doesn’t allow for the kind of friends that you would like to have.’”

Ryan Hubbard, who lives in Adelaide, Australia and works in “design for social innovation,” started a research project called Kitestring to try to figure out how people organize their lives to prioritize friendship, and some of the more specific ways that friendships get deeper. Later, they hope to use what they learn to fuel some sort of business or nonprofit venture aimed at better facilitating friendships.

Kitestring recently put out a report of its findings from around 20 in-depth

“ Take the risk to express to someone that you’d like to do something with them outside of situations where you’re required to spend time together.”

interviews, and 50 smaller interviews.

While it’s not an academic study by any means — their methodology was closer to what companies do for market research — they came up with several interesting insights.

The first was that the more points of connection you have with someone, the stronger the friendship will be. “We think of friendship as a singular connection, but it’s a structure,” Hubbard says. A friend who you see in only one context — the office, for example — is likely to be a less close friend than someone who you see in many contexts, and connect with over many different things, rather than a single shared interest.

The second takeaway was actually borrowed from existing research on romantic relationships. The psychologist John Gottman came up with the concept of “bids” in the 1990s. “Bids” are small requests for connection — anything from a smile, to attempting to start a conversation, to inviting your partner on a trip with your family. The more partners respond to each other’s bids by “turning toward” them — engaging and offering the requested connection — the stronger their relationship. The more they “turned away” from the bids, the more likely they were to get divorced, Gottman found.

In the interviews Kitestring did, Hubbard found that bids also deepened friendships, and could set off “a cycle of increasing vulnerability and trust.”

Kelci Harris, a postdoctoral fellow at the University of Toronto who studies friendship, says that bids seem “probably equally viable for friendship” as they do for romance and marriage. She thinks that’s a promising avenue for research — taking concepts from romantic relationships and seeing if they work for friendship as well.

But as far as getting that cycle going, “it does take some push from someone,” she says. “I think a lot of people, myself included, can sometimes get stuck. Like ‘They haven’t called me, so I’m not going to call them.’ If you want to talk to your friend, you should just call them. You don’t have to play chicken about who’s going to take the first step.”

Rawlins, however, doesn’t care much for the bid concept. “I don’t think of friendships in economic terms,” he says.

“I don’t think about ‘investing’ in friends.

Mind

95

I see friendship as an ongoing conversation. A way of literally coauthoring the story of our relationship.”

“Repotting” friendships can make them closer, as you might repot a succulent that has outgrown its terracotta cup.

Another metaphor Rawlins doesn’t like is Kitestring’s third takeaway — the idea of putting friendships in “containers,” where friendships are easier to maintain if you create some kind of regular practice in which to hold them — a weekly dinner, or a monthly book club.

“I think friendships are more dynamic than to be placed in a container,” Rawlins says. “But I like the notion of rituals.”

One interesting way Hubbard uses the container metaphor is this concept of “repotting” friendships to make them closer, as you might repot a succulent that has outgrown its terracotta cup. “You’ve got a friend at work, and you see them every day, but the pot that plant is in at work is quite small,” Hubbard says. “It’s going to reach the size of the pot, and that’s it. If you want it to be a bigger, deeper friendship, you need to repot it to a bigger context. You might need to bring them to your house. Or invite them to meet your family — that’s an even bigger pot.”

Regardless of the chosen metaphor, Rawlins has some similar advice. He recommends “taking the risk to express to someone that you’d like to do something with them outside of situations where you’re required to spend time together.”

Obviously you have to build up to it; it probably wouldn’t be advisable to try to start a strict weekly dinner date with a brand-new friend. Hubbard uses the terms “intention” and “air” — “intention” being earnest efforts to connect with someone, and “air” being the breathing room you give the relationship. “If you have a lot of

96

BASIS

trust in a relationship, it can bear more intention, and if you don’t have as much trust, you need more air,” he says.

A lot of things about modern life make it easy for the air in a friendship to overtake the intention. “I think the times we live in are really an obstruction to friendship, and it needs to be said out loud,” Rawlins says. “We are living in very very divisive times where the tenor of discourse in public places sets the tone for conversation and it works its way down very quickly to dyadic relationships.”

He also expressed a considerable concern about the “proliferating technological illusion of connection.”

“We live in a time where people are getting messages to multi-task, to be doing several things at once, to in many ways not actually be where they are,” he says.

Harris disagrees, noting that social media can allow for a “constant chain of communication, wherever you are in the world,” with your closest friends. They both have a point: Technology can make friendships shallower, but it can also make them stronger, depending on how intentionally you use it.

I honestly lost track of the number of times I heard the word “intentionality” while reporting this piece. All it really means, Harris says, is putting effort into a relationship. And the fact of that effort is probably more important than the exact form it takes.

In a study that Harris did, the quality of the time that friends spent together — specifically their self-reported depth of conversation, and the amount of self-disclosure — was linked to higher friendship satisfaction.

And you have to be realistic about your friends’ other responsibilities. Sometimes life is so busy that people may not be able to keep friendship from falling to the bottom of their priority list, much as they may desire otherwise.

“Part of the genius of friendship is that people respect and encourage each other to make their life the best it can be,” Rawlins says. “How do you do that in a way that respects the contingencies of each other’s lives while also trying to build in, if not a regular practice, the expectation that we’re going to see each other? It can be a challenging needle to thread.” p

Still Curious?

Merchants of Doubt Naomi Oreskes and Erik Conway

Naomi Oreskes and Erik Conway, two prominent science historians, present their account of how a group of top scientists ran campaigns in order to confuse the public over the validity of scientific discoveries on issues such as global warming, the dangers of smoking and acid rain. In this book, the authors reveal the actions of this scientific community and how they have prevented the understanding of some of the most important global issues.

BOOK

FILM

POLITICS

SCIENCE

This Changes Everything: Capitalism vs. The Climate Naomi Klein

Forget everything you think you know about global warming.

The really inconvenient truth is that it’s not about carbon — it’s about capitalism. The convenient truth is that we can seize this existential crisis to transform our failed economic system and build something radically better. Naomi Klein, author of the global bestsellers The Shock Doctrine and No Logo, tackles the most profound threat humanity has ever faced: the war our economic model is waging against life on earth.

BOOK

FILM

POLITICS

ENVIRONMENT

How to Win Friends & Influence People Dale Carnegie

Dale Carnegie’s rock-solid, time-tested advice has carried countless people up the ladder of success in their business and personal lives. One of the most groundbreaking and timeless bestsellers of all time, How to Win Friends & Influence People will teach you how to make people like you, how to win people to your way of thinking, how to change people without arousing resentment, and so much more. You can go after the job you want, and get it. You can take the job you have, and improve it. You can take any situation, and make it work for you!

BOOK

COMMUNICATION