Wednesday 5 November 2014

Against the Dictatorship of the Expert-ariat


Does democracy need to take a time-out in the face of existential threats such as antibiotic resistance and climate change?


Essay published in Jacobin, 5 November, 2014.
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Shortly after the Copenhagen UN climate talks in 2009 collapsed, James Lovelock, a godfather of modern environmentalism, was asked by Guardian reporter Leo Hickman what should be done in light of the failure. Lovelock issued a call for what can only be described as a climate dictatorship.

Rejecting the idea that a solution to climate change could be achieved in a modern democracy, Lovelock thundered that what was needed instead was “a more authoritative world” where there are “a few people with authority who you trust who are running it.”

“What’s the alternative to democracy? There isn’t one. But even the best democracies agree that when a major war approaches, democracy must be put on hold for the time being. I have a feeling that climate change may be an issue as severe as a war. It may be necessary to put democracy on hold for a while.”

This call for a sort of benevolent dictatorship of science is increasingly being made for a range of problems that we confront globally, from biodiversity loss to antibiotic resistance.

Antibiotic resistance has become such a danger to public health worldwide, and government action has been so indolent and inadequate, that a pair of leading scientists impatient with the situation have called for a new executive global body to assume control of the problem. They want an international organization similar to those currently tasked with navigating our species’ response to climate change — basically an Intergovernmental Panel on Climate Change (IPCC), but for bugs and drugs and with more executive oomph.

Given the magnitude of the danger — the “apocalyptic” scenario, according to Sally Davies, the UK’s chief medical officer, is that within twenty years we will completely run out of effective drugs against routine infections — it may seem a trivial, even irresponsible, exercise to fret over the democratic ramifications of such a move.

However, considering how often this kind of technocratic proposal is the default response to any new scientific problem of profound import, democrats do need to consider whether other approaches are more desirable.

“So far, the international response has been feeble,” wrote Jeremy Farrar, the director of the Wellcome Trust, the UK’s largest medical research charity, and Mark Woolhouse, University of Edinburgh professor of infectious disease epidemiology, in a tubthumping commentary published in the scientific journal Nature in May and presented at a press conference at the Royal Society (giving the proposal the imprimatur of the august scientific body).

The commentary took aim at the World Health Organization in particular, which in April issued its first ever report tracking antimicrobial resistance worldwide, finding “alarming levels” of bacterial resistance. “This serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country,” the authors warned.

Despite the acceleration of this universal risk, the UN body responded by simply calling for better surveillance. “The WHO missed the opportunity to provide leadership on what is urgently needed to really make a difference,” the authors wrote, acknowledging that surveillance is vital, but radically insufficient.

The growing threat from what are popularly termed “superbugs” is similar to that posed by climate change — they are “a natural process exacerbated by human activity and the actions of one country can have global ramifications,” according to a parallel statement put out by the two authors’ organizations.

They are not the only researchers or clinicians that have made the comparison between drug resistance and climate change. Last year, Davies described the situation as a more dangerous risk than terrorism, and a greater threat to humanity than global warming, telling the BBC, “If we don’t take action, then we may all be back in an almost nineteenth century environment where infections kill us as a result of routine operations.”

So many medical techniques and interventions introduced since the 1940s depend on a foundation of antimicrobial protection. The gains in life expectancy that humanity has experienced over this time depended on many things, but they would have been impossible without antibiotics. Prior to the development of antibiotics, bacterial infections were one of the most common causes of death.

We need to keep discovering new classes of antibiotics because over time, the bugs that are susceptible to the drugs are eradicated. Those with random mutations that make them resistant survive, reproduce, and eventually dominate. This is just evolution.

And yet for almost three decades, there has been a “discovery void.” No new class of antibiotics has been developed since the use of lipopeptides in 1987. The reason for this is straightforward: big pharmaceutical companies have refused to engage in research into new families of antibiotic because such drugs are not merely unprofitable, but are antithetical to capitalism’s operating principles. The less they are used, the more effective they are.

As these firms readily admit, it makes no sense for them to invest an estimated $870 million per drug approved by regulators on a product that people only use a handful of times in their life, compared to investing the same amount on the development of highly profitable drugs that patients have to take every day for the rest of their lives.

Some governments have begun to partially recognize this market failure. The European Commission has set aside €600 million for an “innovative medicines” program endearingly named “New Drugs 4 Bad Bugs.” But the scale of investment allotted by governments to this solution remains inadequate.

Hence Farrar and Woolhouse’s demand for the establishment of a global, scientific body that’s up to the challenge. The new intergovernmental organization would exist to marshal evidence on drug resistance and to encourage policy implementation. Working with national governments and international agencies tasked with implementing its recommendations, it would set strict targets to stem the loss of drug potency and speed up the development of new therapies.

An Intergovernmental Panel on Antimicrobial Resistance would be welcome if it allowed for greater coordination of information sharing, surveillance, and analysis.

But to whom would this scientific policy recommendation body report? What overarching structure would decide what is to be done and then implement those recommendations?

While distinct problems, one has to presume that like climate policy, it would require a copy of the IPCC’s twin, the conference of parties to the UN Framework Convention on Climate Change (UNFCCC). The IPCC was established in 1988 by the UN Environment Program and the World Meteorological Organization. Four years later, the IPCC played a key role in the creation of its diplomatic corollary, the UNFCCC, a quadrennial space for horse-trading between governments that all but collapsed in 2009 in Copenhagen and which has moved hardly at all since.

We as a species are once again confronted by a difficult issue, with worldwide political and economic implications, and without a global democratic body to address it. And the only option imaginable is a process of technocratic and diplomatic decision-making.

Drug resistance and climate change are hardly the only topics like this. As the IPCC itself proudly declares, the relationship between it and the UNFCCC has become a model for interaction between science and decision makers, and a range of efforts have been mounted in the years since their founding to construct similar assessment and policy processes for other global issues.

In 2012, under the aegis of the UN Environmental Program (UNEP), the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) was established, but in partnership with parties signatory to multiple UN conventions, including those covering biological diversity, endangered species, migratory species, plant genetic resources, and wetlands: an “IPCC for biodiversity.” And a similar structure is currently being set up to bring together experts and officials into a subsidiary body of the conference of parties to the UN Convention on Combating Drought and Desertification: an “IPCC for deserts and dustbowls.”

For some, even the IPCC/UNFCCC is excessively politicized (read: democratic). Johan Rockstrom, the head of the Stockholm Resilience Centre, and Will Steffen, director of the Australian National University Climate Change Institute are two of the world’s leading climate strategists, and are best known for their development with twenty-six other researchers of the Earth-system concept of “planetary boundaries,” a framework for understanding “a safe operating space for humanity” — not just as it relates to climate change, but ocean acidification, pollution, ozone depletion, and others.

Rockstrom and Steffen call for a “global referee” independent of elected governments to ensure humanity does not exceed these boundaries: “Ultimately, there will need to be an institution (or institutions) operating, with authority, above the level of individual countries to ensure that the planetary boundaries are respected. In effect, such an institution, acting on behalf of humanity as a whole.”

They suggest the creation of an Earth Atmospheric Trust, “which would treat the atmosphere as a global common property asset managed as a trust for the benefit of current and future generations.” But how would the governors of such a trust be picked? Elected by the people of the Earth, or appointed by technocrats?

To be clear: the concern is not over the international aggregation of expertise in a particular topic. Who could oppose such a necessary pooling of knowledge and intellectual resources? Rather, the worry is that we have not properly interrogated this particular IPCC/UNFCCC model nor adequately wrestled with how expertise is imbricated with anti-democratic global governance and its retreat from norms of public accountability, participation, and popular decision-making.

Not all those asking questions about the IPCC and UNFCCC’s democratic deficit are climate denialists. Indeed, it is precisely those concerned about the ramifications of anthropogenic global warming who should be most worried about the galloping tendency of elites to remove decision-making from direct democratic control and the realm of political contest.

For Harvard science and technology studies researcher Sheila Jasanoff, there are a number of pertinent questions: what is the demarcation line between scientific and political institutions? How do governments construct what she calls “public reason” — those forms of evidence and argument used in making state decisions accountable to citizens? Are these new structures apolitical in service of the general interest, or do they provide unacknowledged protections to particular groups whose interests are at odds with the rest of humanity?

Riffing on this idea, German sociologist Silke Beck and her colleaguesask in a recent paper on the structures of the IPCC and the IPBES that we at least explore “the full range of alternative institutional design options as opposed to implementing a one-size-fits-all model of expertise.”

“So far,” says Beck, whose research focuses on new forms of environmental and science governance, “no debate has ever taken place about the IPCC’s relationship to public policy and to its various global ‘publics’ or about its normative commitments in terms of accountability, political representation, and legitimacy.”

In the last two years, there have been talks among stakeholders on the future of the IPCC, but participants in these closed-door meetings are bound by strict confidentiality agreements, and journalists and researchers have been shut out.

In a parallel fashion, great swathes of legislative topic areas such as monetary policy, trade, intellectual property, fisheries, and agricultural subsidies that used to be debated openly in democratic chambers are now drafted, amended, and approved in backroom arenas.

It’s what sociologist Colin Crouch calls “post democracy”: while the pageantry of general elections proceeds, decision-making takes place not in legislative bodies, but in closed-door, treaty-based negotiations between government leaders or diplomats, advised by experts.

In the case of the European Union, the most advanced technocratic governance space in the world, we can add to the list of topics outside democratic debate: fiscal policy (that is, all spending decisions) and labour market regulation, those core policy areas that, apart from defense and policing, perhaps define most what it is to be a state.

Since the advent of the Eurozone crisis, the European institutions have successfully insulated economic decision-making from electorates and shifted it to the junta of experts of the European Commission, the Council of Ministers, the European Central Bank, the European Court of Justice, or even ad hoc self-selecting groups of key players in the European institutional mosaic.

The Eurozone catastrophe was so grave that the EU no longer had time for “political games” or “politicization,” as outgoing commission president José Manuel Barroso and council president Herman Van Rompuy repeatedly stressed. In other words, they no longer had time for democracy.

It’s a common sentiment among elites. The incoming commission chief and ex-head of the Eurogroup of nations using the single currency, Luxembourger Jean-Claude Juncker, notoriously said a few year ago: “Monetary policy is a serious issue. We should discuss this in secret, in the Eurogroup,” he told a meeting on economic governance organized by the European Movement, not realizing the meeting was open to journalists. “I’m ready to be insulted as being insufficiently democratic, but I want to be serious. I am for secret, dark debates.”

The IPCC/UNFCCC model, the EU, and similar post-democratic structures also operate on the basis of consensus among “stakeholders,” rather than majority rule through democratic popular mandate. In other words, policy-making has been globalized, but democracy has not.

Consensus delimits the range of policy options available to those that are amenable to all stakeholders, potentially excluding policy options that may actually solve the given problem if it threatens the interests of a particular stakeholder. The possibility of overruling or even eliminating a stakeholder is precluded by this form of decision-making. The policy window is thus highly circumscribed, and incremental change is favored over dynamism and innovation. Such policy lethargy is not desirable when it comes to existential threats.

The argument for democracy, then, is not just one of principle. The UNFCCC’s post-democratic, consensus-based structure is one of the reasons why climate negotiations are perennially stalled.

And so it would be with a comparable governance model for drug resistance. Farrar and Woolhouse explain that such a strategy is necessary because “the scientific and business worlds need incen­tives and a better regulatory environment to develop new drugs and approaches.”

The pharmaceutical companies are thus considered stakeholders to be welcomed at the table, operators that need to be incentivized to change their ways rather than the key structural obstacle to be overcome. Such incentives include tax credits or grants for priority antibiotic development, “transferable priority review vouchers” that expedite regulatory review for another product of the company’s choosing, advance-purchase commitments, and patent-life extensions.

The concept of advance market commitments — in essence, when a government guarantees a market for a successfully developed medicine — is promoted by the World Bank and free-market think-tanks like the Brookings Institution as a solution fills the gap left by market failures while leaving capital’s profits unchallenged.

The most elementary and cheapest solution would be the socialization of the pharmaceutical sector, permitting the democratic redirection of revenues from profitable therapies to subsidize R&D in unprofitable areas. Prior to privatization across the West, this cross-subsidization model permitted postal, rail, bus, and telecommunications services to be provided to remote regions, as revenues from the urban centers balanced things out in the interest of universal service.

But such a simple model is not merely off the table because it is politically unrealistic. It is off the table because the very structure of consensus-based intergovernmental and stakeholder decision-making does not allow such solutions to even be raised.

In a clarifying recent paper on the growing preference in some quarters for what he terms environmental authoritarianism, science and technology policy researcher Andy Stirling writes that “democracy is increasingly seen as a ‘failure,’ a ‘luxury,’ or even ‘an enemy of nature.’… So, knowledge itself is increasingly imprinted by the age-old preoccupations of incumbent power with rhetorics of control. It seems there is no alternative but compliance — or irrational denial and existential doom.”

On the contrary, Stirling argues, democratic struggle is the principal means by which sustainability is shaped in the first place — and we should view antibiotics as a precious resource to be carefully shepherded and sustained. “[C]oncentrated power and fallacies of control are more problems than solutions … among the greatest obstacles to [progressive social transformation], are ideologies of technocratic transition.”

A couple of thought experiments to underscore the point: first, French economist Thomas Piketty recently proposed a confiscatory global wealth tax as a solution to capitalism’s inherent tendency toward ever-greater inequality. It has to be global, he rightly says, in order to avoid inter-state competition to deliver the lowest tax rates.

But imagine if this policy were taken seriously for implementation. How could such a tax be imposed by any agency other than an elected, global government with a strong mandate to do so? A model based on the UNFCCC or EU structures would end up mired in years or decades of fruitless discussion, at best resulting in a highly watered down version that all stakeholders could agree to — much like the dismal, foundering effort to introduce a Tobin Tax across Europe.

A second thought experiment: If we discovered tomorrow that a large near-Earth asteroid were on a course for the planet and was due to obliterate human civilization in five year’s time, which would be your favored mechanism of developing a planetary defense system and mounting a mission to divert it?

A global, democratically elected government that could within weeks pick the best plan after receiving advice from experts and then rapidly direct resources to where efforts would be most efficient and likely to succeed?

Or a series of multilateral stakeholder talks debating for most of those five years who would bear the bulk of the cost (If you’re familiar with the “climate finance” debate, try “asteroid finance”); which country would get the most jobs from the project; which companies would win the contracts; how to share data, technology, and best practices; and which city would get to host the project secretariat?

About fifteen years ago, the global justice movement mounted a critique of this kind of extra-democratic decision-making, focusing on its incarnation in international institutions like the WTO, the World Bank, the IMF, and the G8, and in “investor rights” chapters and investor-to-state dispute settlement clauses in trade agreements that permit democratically approved legislation and regulations to be overturned by closed-door, unelected trade tribunals.

Similarly, the struggle today against EU-imposed austerity across southern Europe — often led by veterans of those millennial street battles — also involves a critique of the steady removal of ever larger sections of fiscal policy from the realm of democratic control.

But for the most part, this critique of post-democracy has amounted to little more than a demand for a return of national sovereignty. Globalization is neoliberal and undemocratic; therefore, we propose the small and local. European integration is austerian and technocratic; therefore, we propose a break-up of the EU.

Conversely, the recognition that existential threats such as drug resistance and climate change must be confronted at the global level often causes well-meaning, pragmatic people to embrace the creation of international, but post-democratic structures.

Yet there is a third option that is both better suited to the task and intrinsically preferable to the status quo: genuine transnational democracy, both at the continental and global level. This means an abandonment of polite but undemocratic stakeholder negotiation between bureaucrats, diplomats, and their experts, and the welcome return of robust ideological antagonism, of majority rule, and messy clashes of radically different ideas and programs, of what Stirling calls “open, unruly political struggle” — of democracy.

Existential threats are not just scientific, medical, or environmental problems. They are also social, political, and economic problems, and that is why democratic struggle is the solution that suits them best.

What precisely this could look like is beyond the scope of this essay. Perhaps a UN Parliament from which a global prime minister and cabinet were drawn, with similar models in Europe (meaning a dissolution of the unelected commission and indirectly elected council) and on other continents. The exact contours are not for me to describe anyway: if global governance is to be democratic, then by definition it has to be fought for and built by grassroots democratic movements. It cannot be an elite inspiration or construction.

But it is long past time that we set aside the idea that global government is a utopian — or dystopian — fantasy. It’s already happening, and we do need it desperately to deal with the global scale of problems we now face. Global government is here. We need to make it democratic.

Democracy is the Enlightenment sibling of science. It is no barrier to solving problems like antibiotic resistance and climate change. Rather, it is, as it has always been, humanity’s best hope.

Monday 18 August 2014

The Political Economy of Ebola

Published in Jacobin, 13 August, 2014. I was later interviewed about the essay on Democracy Now.

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The Onion, as ever, is on point with its “coverage” of the worst recorded outbreak of Ebola, and the first in West Africa, infecting some 1,779 people and killing at least 961. “Experts: Ebola Vaccine At Least 50 White People Away,” read the cheeky headline of the July 31 news brief.

Our shorthand explanation is that if the people infected with Ebola were white, the problem would be solved. But the market’s role in both drug companies’ refusal to invest in research and the conditions on the ground created by neoliberal policies that exacerbate and even encourage outbreaks goes unmentioned.

Racism is certainly a factor. Jeremy Farrar, an infectious disease specialist and the head of the Wellcome Trust, one of the largest medical research charities in the world, told the Toronto Star: “Imagine if you take a region of Canada, America, Europe, and you had 450 people dying of a viral hemorrhagic fever. It would just be unacceptable — and it’s unacceptable in West Africa.”

He noted how an experimental Canadian-developed Ebola vaccine had been provided on an emergency use basis to a German researcher in 2009 after a lab accident. “We moved heaven and earth to help a German lab technician. Why is it different because this is West Africa?”

But Ebola is a problem that is not being solved because there is almost no money to be made in solving it. It’s an unprofitable disease.

There have been around 2,400 people killed since Ebola was first identified in 1976. Major pharmaceutical companies know that the market for fighting Ebola is minute while the costs of developing treatment remain significant. On a purely quantitative basis, some might (perhaps rightly) warn against focusing too much on this one disease that kills far fewer than, for example, malaria (300,000 killed since the start of the Ebola outbreak) or tuberculosis (600,000).

Yet the economic constraints retarding progress in developing Ebola treatment also explain why drug companies are resisting developing treatment to those diseases as well as many others.

The last decade has actually seen a tremendous advance in research into therapies for Ebola, usually in the public sector or by small biotech companies with significant public funding, with a variety of treatment options on the table including nucleic-acid-based products, antibody therapies, and a number of candidate vaccines — five of which have successfully protected non-human primates from Ebola.

Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, has been telling everyone in the press who will listen to him in the last fortnight that an Ebola vaccine would be within spitting distance — if it weren’t for the corporate skinflints.

“We have been working on our own Ebola vaccine, but we never could get any buy-in from the companies,” he told USA Today.

“We have a candidate, we put it in monkeys and it looks good, but the incentive on the part of the pharmaceutical companies to develop a vaccine that treats little outbreaks every thirty or forty years — well, that’s not much incentive,” he told Scientific American.

Almost everyone familiar with the subject says that the know-how is there. It’s just that outbreaks are so rare and affect too few people for it to make development worthwhile — that is, profitable — for large pharmaceutical companies.

“These outbreaks affect the poorest communities on the planet. Although they do create incredible upheaval, they are relatively rare events,” Daniel Bausch, the director of the emerging infections department of Naval Medical Research Unit Six (NAMRU-6), a biomedical research laboratory in Lima, Peru, told Vox. “So if you look at the interest of pharmaceutical companies, there is not huge enthusiasm to take an Ebola drug through phase one, two, and three of a trial and make an Ebola vaccine that maybe a few tens of thousands or hundreds of thousands of people will use.”

John Ashton, president of the UK Faculty of Public Health, wrote a vituperative opinion piece in the Independent on Sunday decrying “the scandal of the unwillingness of the pharmaceutical industry to invest in research to produce treatments and vaccines, something they refuse to do because the numbers involved are, in their terms, so small and don’t justify the investment.

“This is the moral bankruptcy of capitalism acting in the absence of an ethical and social framework,” he concluded.

This situation is not unique to Ebola. For thirty years, the large pharmaceutical companies have refused to engage in research into new classes of antibiotics. Due to this “discovery void,” clinicians expect that within twenty years, we will have completely run out of effective drugs against routine infections. So many medical techniques and interventions introduced since the 1940s depend upon a foundation of antimicrobial protection. The gains in life expectancy that humanity has experienced over this time depended on many things, but would certainly not have been possible without antibiotics. Prior to their development, bacterial infections were one of the most common causes of death.

In April, the World Health Organization issued its first-ever reporttracking antimicrobial resistance worldwide, finding “alarming levels” of bacterial resistance. “This serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country,” the UN health body warned.

The reason for this is straightforward, as the companies themselves themselves admit: It simply makes no sense to pharmaceutical companies to invest an estimated $870 million (or $1.8 billion accounting for the cost of capital) per drug approved by regulators on a product that people only use a handful of times in their life when suffering from an infection, compared to investing the same amount on the development of highly profitable drugs for chronic diseases such as diabetes or cancer that patients have to take every day, often for the rest of their lives.

Every year in the US, according to the CDC, some two million people are infected with antibiotic-resistant bacteria. 23,000 die as a result.

We see an identical situation with vaccine development. People purchase asthma drugs or insulin, for example, for decades, while vaccinations usually require only one or two doses once in a lifetime. For decades now, so many pharmaceutical companies have abandoned not just vaccine research and development but production as well, that by 2003, the US began to experience shortages of most childhood vaccines. The situation is so dire that the CDC maintains a public website tracking current vaccine shortages and delays.

But at least with respect to Ebola, where the market refuses to provide, the defense department is comfortable intervening and setting aside free-market principles in the interests of national security.

Virologist Thomas Geisbert of the University of Texas Medical Branch at Galveston told Scientific American about his hope for the VSV vaccine, one of the most promising options against Ebola:


We’re trying to get the funds to do the human studies … but it really depends on financial support for the small companies that develop these vaccines. Human studies are expensive and require a lot of government dollars. With Ebola, there’s a small global market — there’s not a big incentive for a large pharmaceutical company to make an Ebola vaccine, so it’s going to require government funding.

William Sheridan, the medical director of BioCryst Pharmaceuticals, the developer of experimental anti-viral drug BCX4430, describes the financial predicament facing Ebola treatment research and development: “It just wouldn’t make the cut at a major company.”

But for a small company like his, the federal government has both backed research and promised to purchase stockpiles of anti-Ebola drugs as a preventative measure against bioterrorism. BCX4430 is also co-developed with the US Army Medical Research Institute for Infectious Diseases (USAMRIID). “There is a market, and the market is the US government,” he told NPR.

USAMRIID, along with Canada’s Public Health Agency, is also backing the development of ZMAPP, a serum of monoclonal antibiodies by a small San Diego-based biotech firm MAPP Biopharmaceutical, which was administered last week to two American doctors, Kent Brantly and Nancy Writebol, working with the evangelical Christian missionary group Samaritan’s Purse.

The pair had fallen ill in Liberia while taking care of patients infected with Ebola. Brantley’s condition had been rapidly deteriorating, and he had phoned his wife to give his farewells. Within an hour of Brantley receiving the experimental serum, his condition had reportedly reversed, with his breathing improving and rashes fading.

The following morning, he was able to shower on his own, and by the time of his arrival in the US after being evacuated from Liberia, he was able to climb down out of the ambulance without assistance. Writebol is now similarly “up and walking,” after her arrival in Atlanta from the Liberian capital.

We should be extremely cautious about drawing any conclusions from this development and claiming that the drug has cured the missionaries. We have a sample size of just two in this “clinical trial,” with no blinding or control groups. The drug had until now never been tested on humans for safety or efficacy. And as with any illness, a certain percentage of patients will recover on their own. We do not know whether ZMapp was the cause of the apparent recovery. Nonetheless, it is not unreasonable to state that this turn of events gives great hope.

Two of the ZMapp antibodies were originally identified and developed by researchers at the National Microbiology Laboratory in Winnipeg and at Defyrus, a Toronto-based “life sciences biodefense company,” with funding from the Canadian Safety and Security Program of Defence R&D Canada. The third antibody in the cocktail was produced by MappBio in collaboration with USAMRIID, the National Institutes of Health, and the Defense Threat Reduction Agency. The companies then partnered with Kentucky Bioprocessing in Owensboro, a protein production company that was bought earlier this year by the parent firm of RJ Reynolds Tobacco, to pharm the antibody-laden tobacco plants.

On hearing of the role of the Pentagon and Canada’s defense establishment, some have jumped to conspiracy theories. Indeed, ZMapp appears to be a perfect storm of popular nemeses: GMOs, Big Tobacco, the Pentagon, and injections that look a bit like vaccines!

But the Defense Department funding should not be viewed as nefarious. Rather, it is evidence of the superiority of the public sector as shepherd and driver of innovation.

However, not all unprofitable diseases are subjects of the colonels’ bioterror concern. And why should the private sector get to cherry pick the profitable conditions and leave the unprofitable ones for the public sector?

If, due to its profit-seeking imperative, the pharmaceutical industry is structurally incapable of producing those products that are required by society, and the public sector (in this case in the guise of the military) consistently has to fill in the gaps left by this market failure, then this sector should be nationalized, permitting the revenues from profitable treatments to subsidize the research, development, and production of unprofitable treatments.

In such a situation, we would no longer have to even argue whether the prevention of malaria, measles, or polio deserves greater priority; we could target both the big name and neglected diseases at the same time. There is no guarantee that turning on the tap of public funding will immediately produce a successful result, but at the moment, private pharmaceutical companies aren’t even trying.

This is precisely what is meant when socialists talk of capitalism being a fetter on the further development of the forces of production. Our concern here is not merely that the refusal of Big Pharma to engage in neglected tropical disease, vaccine, and antibiotic R&D is grotesquely immoral or unjust, but that the production of a potential cornucopia of new goods and services that could otherwise benefit our species and expand the realm of human freedom are blocked due to the free market’s lethargy and paucity of ambition.

Focusing on a vaccine or drugs is critical. But doing so without also paying attention to the deterioration of public health and general infrastructure across West Africa, and the wider economic conditions that contribute to the likelihood of outbreaks of zoonotic diseases like Ebola, is at best using a bucket to empty the water out of a leaky and sinking boat.

Phylogeographer and ecologist Rob Wallace has described well how neoliberal fallout has established the ideal conditions for the epidemic. Guinea, Liberia, and Sierra Leone are some of the poorest countries on the planet, ranking 178th, 174th, and 177th out of 187 countries in the UN’s Human Development Index.

Were such an outbreak to occur in northern European countries, for example, nations with some of the best health infrastructure in the world, the situation would more likely have been contained.

It is not merely the dearth of field hospitals, lack of appropriate hygiene practices in existing hospitals, absence of standard isolation units, and limited cadre of highly trained health professionals that are able to track down every person that may have been exposed and isolate them. Or that better supportive care is a crucial condition of better outcomes, whatever the treatment available. The spread of the disease has also been exacerbated by a withering away of basic governmental structures that would otherwise be able to more broadly restrict movement, to manage logistical difficulties, and to coordinate with other governments.

Epidemiologist and infectious diseases specialist Daniel Bausch, who worked on research assignments near the epicenter of the current outbreak, describes in a paper published in July in the Public Library of Science journal Neglected Tropical Diseases how he “witnessed this ‘de-development’ firsthand; on every trip back to Guinea, on every long drive from Conakry to the forest region, the infrastructure seemed to be further deteriorated — the once-paved road was worse, the public services less, the prices higher, the forest thinner.”

Wallace notes that here, as in many countries, a series of structural adjustment programs have been encouraged and enforced by Western governments and international financial institutions that require privatization and contraction of government services, removal of tariffs while Northern agribusiness remains subsidized, and an orientation toward crops for export at the expense of food self-sufficiency. All of this drives poverty and hunger, and, in turn, competition between food and export crops for capital, land, and agricultural inputs leads to an ever greater consolidation of land ownership, in particular by foreign companies, that limits access of small farmers to land.

Ebola is a zoonotic disease, meaning a disease spread from animals to humans (or vice versa). Some 61 percent of human infectionsthroughout history have been zoonotic, from influenza to cholera to HIV.

The single biggest factor driving growth in new zoonotic pathogens is increased contact between humans and wildlife, often by the expansion of human activity into wilderness. As neoliberal structural adjustment forces people off the land but without accompanying urban employment opportunities, Wallace points out, they plunge “deeper into the forest to expand the geographic as well as species range of hunted game and to find wood to make charcoal and deeper into mines to extract minerals, enhancing their risk of exposure to Ebola virus and other zoonotic pathogens in these remote corners.”

As Bausch puts it: “Biological and ecological factors may drive emergence of the virus from the forest, but clearly the sociopolitical landscape dictates where it goes from there — an isolated case or two or a large and sustained outbreak.”

These outcomes are the predictable result of unplanned, haphazard development in areas known to be the origin of zoonotic spillover, and without the sort of infrastructural support and egalitarian ethos that permitted, for example, the elimination of malaria from the American South after World War II by the CDC in one of its earliest missions.

Over these past few months, the worst Ebola outbreak in history has exposed the moral bankruptcy of our pharmaceutical development model. The fight for public health care in the United States and the allied fight against healthcare privatization elsewhere in the West has only ever been half the battle. The goal of such campaigns can only truly be met when a new campaign is mounted: to rebuild the international pharmaceutical industry as a public sector service as well as address wider neoliberal policies that indirectly undermine public health.

We could take inspiration from HIV/AIDS activist groups from the late 80s/early 90s like ACT UP and the Treatment Action Group, and, in the 2000s, South Africa’s Treatment Action Campaign, which combined direct action and civil disobedience against both companies and politicians with a scientifically rigorous understanding of their condition.

But this time, we need a larger, more comprehensive campaign covering not just one disease, but the panoply of market failures with respect to vaccine development, the antibiotic discovery void, neglected tropical diseases, and all neglected diseases of poverty. We need a science-based treatment activism that has the long-term, ambitious but achievable aim of the pharmaceutical industry’s democratic conquest.

We need a campaign to destroy the unprofitable diseases.


Thursday 17 July 2014

Cheerleading for Big Organic

Battling the merchants of doubt does not mean backing one set of multinationals over another.

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It's a shame.

Fair and Accuracy in Reporting has a proud and honourable history of exposing right-wing bias and corporate influence in the press. For almost three decades, the progressive media watchdog's magazine Extra! has been a useful guide to censorship, false balance, double standards, cheerleading for war, conflict of interest, and systemic bias in the American media landscape. I remember as a shouty teenager coming across the magazine roughly at the same time I discovered Noam Chomsky and other useful media critics. In recent days, for example, they've been invaluable in parsing American coverage of the ongoing war on Gaza.

So it's rather disappointing to see the magazine's July cover story, “The Attack on Organics”, take the side of a multi-billion-dollar industry that preys on ill-informed consumers, instead of defending the interests of working families struggling to make ends meet.

Authors Kari Hamerschlag and Stacy Malkan have spotted what they believe to be a growing trend of anti-organic food articles appearing in the press, alighting upon in particular a trio of features in the New York Post, the Washington Post and Slate, and hint that there is some secretive, orchestrated campaign by agribusiness moustache-twiddlers to discredit the sector.

The pair begin their 'exposé' with an attack on Naomi Schaefer Riley's short piece, “The tyranny of the organic mommy mafia”, which in a humorous fashion shines a light on the conspicuous consumption and class snobbery of Judgy McJudgerson parents raising their Cruella Deville eyebrows at what is and isn't in other children's lunchboxes:
Another mom, a class parent at a preschool in Westchester, told me she was being harassed by one of the other mothers to issue a new rule: Only organic snacks would be allowed in the classroom. 
A mom in Washington tells me that she was unable to participate in a number of nanny-share agreements she looked into because the other parents were so crazy about not having their children come into contact with anything non-organic. One mother she met was convinced her child’s ADD became worse when he was exposed to non-organic food. A stray Goldfish or Cheerio might set him off.
Let's be clear. Organic food is damn expensive. An all-organic grocery cart is going to increase your weekly food bill by 49%1. Even putting the Great Recession aside, the income of 90 percent of Americans have been stagnant since the 1980s. At the bottom end, the benefit formula of the US Supplemental Nutrition Assistance Program (formerly Food Stamps) assumes that recipient families will spend 30 percent of their net income on food. Is it realistic to demand this sort of increase in spending on food? Even if organic food were demonstrably safer and more nutritious than conventional food, the difficulty of affording it, and the haughtiness and condescension of those who can toward those who cannot, would not be issues that any self-styled progressive should dismiss.


The core of Malkan and Hamerschlag's criticism of Riley's very brief article is that she quotes Julie Gunlock, the author of From Cupcakes to Chemicals: How the Cultureof Alarmism Makes Us Afraid of Everything and How to Fight Back, but not on the basis of anything Gunlock says in the article per se, but on the basis of who she is. Gunlock is involved with the Independent Women's Forum, a conservative women's group that is funded by “right-wing foundations and other conservative interests including the Koch brothers”.

Of course one should be sceptical of anything funded by the Zaphod Beeblebrox of conservative sugar-daddies, but that scepticism can only be the starting point, not the conclusion of any analysis. We still have to do the hard analytical and evidentiary work of disproving a Koch-funded claim. It is not enough to shout: “Koch brothers!” and then be satisfied that your job here is done. It's a rhetorical shortcut permitting truth and non-truth to decided not on the basis of evidence or sound argument, but of the identity of who is making the argument. Underdogs speak truth; overlords lie. What a retreat from the left's historic championing of reason over fiat!

And Gunlock happens to make the very reasonable point (in paraphrase by Riley) that the understandable desire on the part of moms to feed their kids the best food they can, combined with the guilt that they aren't always being the best parent they can be, is a gift to the multinationals behind the organic industry that is expected to be worth almost $200 billion by the end of the decade - a gift that helps them get away with charging extortionate prices for staple food items. So she's a conservative making this argument. So what? Is the argument wrong?

Hamerschlag and Malkin wonder where on Earth journalists get the idea to write articles “attacking” organic agriculture. It couldn't possibly be because the reporters have looked into the issue and found the claims of the organic industry to be wanting. No, instead, they must be inspired by corporate propaganda. They note that the Riley article in the New York Post cited a report put out by Academics Review that criticised the “deceptive marketing practices” and “false and misleading” health and environmental claims of organic producers. But rather than challenging the points made in the Academics Review, they go after who is behind Academics Review:
Academics Review claims to be an independent “association of academic professors, researchers, teachers and credentialed authors” from around the world “committed to the unsurpassed value of the peer review in establishing sound science. 
However, recent articles on its website and Facebook page paint a picture of industry-biased, agenda-driven organization focused on discrediting public interest organizations, organic companies, media outlets and scientists who question the safety of GMOs and pesticides, or who tout the benefits of an organic diet.
A co-founder of the organisation, University of Illinois at Urbana-Champaign microbiologist Bruce Chassy, comes in for criticism because he “has received research grants from major food companies, and has conducted seminars for Monsanto, Genencor, Amgen, Connaught Labs and Transgene,” which are “companies with a large financial stake in pesticides and GMO technologies designed to boost pesticide sales”. Chassy is also on the advisory board of the American Council on Science and Health (ACSH), a non-profit some of whose “funders include agribusiness giants Syngenta and Bayer CropScience, as well as oil, food and cosmetics corporations that have a vested interest in getting consumers to stop worrying about the health effects of toxic chemical exposures."

A few things here. First off, as a Lefty, any time that I come across a non-profit that receives funding from corporations, my spidey-sense starts tingling. It immediately makes me dig deeper into the organisation, find out what else they've been up to and published. Since the advent of public relations in the 1920s, the general interest has been undermined by the 'merchants of doubt': phalanxes of ad men, lawyers, ex-journalists and even unscrupulous scientists who have been hired by companies to convince us that smoking is harmless, that cars don't need seatbelts, and that climate change is a myth. There have been thousands of examples of campaigns of what is known as “product defence” - strategies of corporate obfuscation, misleading advertising, 'astroturfing' (fake grassroots groups) and outright lies - mounted to protect products known to cause harm against government regulation or bans.

But suspicion alone is not enough. I still have to go out and prove that the corporate claim is wrong. It is not enough just to declare: “Corporate! Don't believe them!” If Monsanto said that the sky was blue, their long history of aggressive patent protection, legal intimidation and monopolistic market behaviour would still not make the sky green. It is not enough to suspect somebody of something, however reasonable that suspicion may be; you must then go on and prove that they are guilty.

And having read the Academics Review report, I cannot find anything that to my mind screams that this paper is the work of a product defence campaign. Rather, it appears to me that Academics Review is simply comprised of scientists and science-oriented individuals that are fed up with pseudoscience and mumbo-jumbo irrationally restricting the advance of human flourishing.

The ACSH however does appear to regularly tilt conservative, and indeed, my spidey-sense is positively screaming now, but again, Chassy's membership on its advisory board alone does not damn the entirety of the work of an otherwise unconnected organisation, Academics Review, still less this particular report.

Lastly on this point about taking money from The Man: That's what most people do. Unless we work in the public sector or for a charity or NGO, we take money from The Man every month in order to pay our rent, buy our food and raise our kids. And are we really saying that the only people who can be trusted on any topic are people who don't work in the private sector? 

Writing in Slate meanwhile, Melinda Wenner Mayer gets in trouble with the FAIR pair for beginning to get suspicious about the organic milk she's buying for her toddler when “it can be hard to consistently pay $7 for a pint of something he’ll go through in two days.” Yet again, to my Lefty mind, is doesn't seem that you have to be funded by a Kochian Orthrus to side with the sort of harried single dad working two jobs who takes his girls through the drive-through one evening for a couple of Big Macs that cost less than a head of cauliflower.

Mayer even says in her article, "Organic Schmorganic", that she remains convinced that organic has a role to play in our food system for environmental reasons, and that she still feels “we should care about the chemicals found in our food and household products”. (Myself, I feel this veers over into chemophobia a bit too much. All products are composed of chemicals. Indeed all matter is. Only energy, human ideas and a perfect vacuum could have a label declaring themselves to be chemical-free while not lying). It's just that Mayer went and did some research into whether organic food is healther, and found that meh, not so much.

She highlights a couple of mythbusting posts in Scientific American that describe how organic farmers use organic pesticides, herbicides and fungicides in volumes far exceeding the use of synthetic equivalents, volumes that are not recorded by the government. The difference between the two is that organic pesticides come from 'natural' sources and are only lightly processed, on the grounds that natural is safe and synthetic is not. (On this basis, I wonder why these foodies don't mix themselves an asbestos, mercury and rattlesnake-venom shake for breakfast every day. The ingredients are all natural.)

Mayer was troubled to find that organic pesticides can be bad for you as well, and, importantly, highlighted that dosage, i.e., the amount to which you are exposed over a particular period of time, not the mere presence of a substance, is what matters most. Glyphosate, a.k.a. Roundup, the Great Satan of synthetic pesticides according to the foodie brigade because it is produced by Monsanto, has an EPA recommended exposure limit of 0.1 milligrams per kilogram of body weight per day while Rotenone, an organic pesticide, has a EPA limit of 0.004 milligrams. As Mayer points out, glyphosate is 25 times less toxic by weight in comparison to Rotenone.

As a result of this fairly straightforward and useful explanation of the distinction between hazard and risk (potential for harm vs probability of harm, essentially), Mayer is denounced as a shill for agribusiness and the biotech industry, and her Sci Am author Christie Wilcox source before her. FAIR attacks Mayer's article as “based on spin”, and says that her article has been handily rebutted by the Organic Center, Civil Eats, and the Environmental Working Group.

Hamerschlag and Malkin suggest something of a conspiracy, that there has been a “proliferation of industry-associated scientists, websites and opinion pieces attacking organic agriculture and spinning their narratives about the safety of chemical-intensive GMO foods”. Meanwhile, they openly state that they have no problem with the “relatively small amount of money spent by the organic industry to support mission-aligned nonprofits”, as if these are not the same as the “lobbying and .. PR front groups or 'industry trade groups' [that] help spin a story”.

Just for fun, let's have a look at who some of these “mission-aligned” groups are. Let's employ the FAIR authors' own preferred analytical mode, pointing to the character of the people involved rather than confronting their argument.

The Organic Center website claims to “bring you the science behind organic”, but while it has science-y photos of people in labcoats and sitting at microscopes, it's actually an organic industry promotion group that is a subsidiary of the Organic Trade Association, the sector's trade lobby. Its board of trustees include the CEO of the Organic Trade Association; the vice-president of Garden of Life, “the leading supplement and nutrition brand sold in the Healthy Foods Channel”; the president of Horizon Organic, the largest supplier of organic dairy products in North America and a daughter company of Whitewave Foods, an organic multinational with a $3.3 billion market capitalization (as of 2013); a vice-president of Annie's Inc, which has a market cap of $744 million; a vice-president of Whole Foods (market cap: $14.4 bn); a vice-president of Jamba Juice, and a handful of other corporate bods. Amongst the Organic Center's recent bites of organic scienceyness is an article boosting the re-publication (without peer review) of disgraced French molecular biologist Gilles-Eric Seralini's study purporting to show that GMO maize causes tumours in rats, a study that was ultimately retracted after being denounced by six French academies of science for its unorthodox methodology.

Civil Eats meanwhile is a foodie news website, not a scientific journal, and the article in question was written by Kristin Wartman, a nutritionist (a title that is not subject to professional regulation; i.e., anyone can call themselves a nutritionist), not an expert in toxicology. And the Environmental Working Group is a green NGO that campaigns against nanotechnology, GMOs and synthetic pesticides. It is known for its annual 'Dirty Dozen' list of 'most pesticide-heavy' fruits and vegetables, an exercise in ranking whose methodology has been criticized in the Journal of Toxicology for “lacking scientific credibility”. The Office for Science and Society at Montreal's McGill University, a body dedicated to promoting critical thinking and improving the scientific literacy of the general public, was less charitable in its description of the EWG, saying bluntly: “This organization is dedicated to raising money through fear-mongering.”

Elsewhere, the FAIR authors cite articles appearing in such respected academic journals as the Huffington Post, and by the Organic Farming Research Foundation, which despite its name is actually a pressure group that according to its own description employs lobbyists in Washington in an effort to “Secure a substantial increase in government support for organic agriculture”. Oh, and in the Journal of Alternative and Complementary Medicine, a publication that anti-pseudoscience website Quackwatch includes on its list of “nonrecommended periodicals”.

And naturally, Kari Hamerschlag herself is a senior program manager at Friends of the Earth USA's Food and Technology Program, which has a long history of pro-organic lobbying, and previously worked for the same Environmental Working Group mentioned above, while Stacy Malkan has for years been an anti-GMO campaigner.

But of course, all I've done there in the last few paragraphs is essentially the same as what FAIR has done – guilt by association and ad hominem attack.

So to get to the truth on organics, how about we get away from making arguments based on the identity and associations of the individual making the argument? How about we start making arguments about organic food on the basis of evidence?

And this means accepting from the beginning the possibility of being wrong, and willing to change one's opinion in the face of new evidence. Whichever way the evidence shakes out. If it turns out that organic food is not better for the environment and healthier, then we have to be willing to accept that, and not just declare the researchers with such findings to be shills for 'Big Agra' - or for that matter the journalists that report on this issue. Equally, if it turns out that organic food is indeed better, we shouldn't shy away from saying that either simply because it's the favoured option of new-age crunchies.

The reality is that corporations do indeed engage in dodgy practices, and absolutely undertake campaigns of obfuscation and public relations to protect their products. And that goes for Big Organic as well. 

But the way we resolve this is not by picking one set of big businesses over another.

(Full disclosure: I did not receive any money from Monsatan or the Kochbeast for writing this article.)



1 Brown, C. and Sperow, M. (2005). Examining the Cost of an All-Organic Diet. Journal of Food Distribution Research 36(1), 20-26. http://ageconsearch.umn.edu/bitstream/26759/1/36010020.pdf