Steven Hayes’ new book, A Liberated Mind1 marks an inflection point in the evolution of consciousness.  Our mental abilities have enabled us to master the world through symbolic manipulations, which defined actions to be taken in the physical world. We have gone from being able to guide others in hunting to the symbolic analyses of the physical science that have achieved mastery over the physical world that would have been considered complete fantasy two hundred years ago. 

Yet at this point, few would argue that our mastery of the world is an unparalleled good. Indeed, our world is clearly more imperiled than it was fifty years ago. Authoritarian regimes are developing throughout the world.  The climate crisis is no longer something in the future.  Terrorism is widespread.  Economic inequality, a condition that harms people at virtually all levels of income, is at an all-time high. Daily doses of discrimination stress millions throughout the world.  Materialism pervades our societies, as stressed people seek to assuage their stress by accumulating more possessions. Nuclear weapons continue to proliferate and with it a growing danger that they will be used.

None of the things that enabled our takeover of the planet could have occurred without the mental capacities that we have evolved. But our mental skills have not enabled us to control the dangers that our “achievements” have produced.  In fact, our evolved capacity to use symbolic processes has directly contributed to our problems and, as currently used, stands in the way of our solving them.

Every one of the problems we face is the result of one or another ideology. It is easy to see this with respect to authoritarian regimes, terrorism, discrimination, and nuclear weapons. But it is equally the case for the economic inequality, materialism, and the climate crisis, each of which has been spurred by a set of beliefs that justified the policies and practices that have created inequality, promoted materialism or denied the reality of global warming.

The dangers to humans in terms of the magnitude and extent of harm that an antisocial ideology can do is far greater than it could have been two hundred years ago thanks to the success of the physical sciences in developing technologies, which although often providing enormous benefits, have the potential to harm human beings far beyond anything that could even have been conceived two hundred years ago.

If a Rip Van Winkle woke up fifty years from now and discovered that all of these threats had diminished to the level of an historic curiosity, what would that look like?  I submit that it would be because most people had somehow gotten much more mindful of the wellbeing of those around them and those still to come. It would mean they were more willing to forgo things that provided immediate benefit to them but produced longer-term harm for them or those around them.  It would mean that people were more willing to share and to sacrifice for others. And it would mean that the major institutions of our societies were organized to monitor the wellbeing of every person and implement policies that limited the ability of people and organizations to engage in practices that harmed others.

If such a vision seems incredible, I ask you to consider whether a similar vision of the wonders of modern science circa 1960 would have seemed equally unlikely to a person in 1860. (As Arthur Clarke observed, “Any sufficiently advanced technology is indistinguishable from magic.”) If I asked you to explain to that 1860 person how these wonders had occurred you would probably say that it was thanks to science. If you are not a behavioral scientist, you might be quite skeptical that the science of human behavior could produce a similar improvement in the behavior of humans. However, I submit that we already have the science to achieve such a seemingly miraculous change; we just haven’t made the benefits of our science widely available.

Psychological Flexibility

Hayes describes forty years of research that has delineated a new form of consciousness that is precisely what is needed to create societies that work for everyone—including those not yet born. He calls it psychological flexibility.   The main feature of this form of consciousness involves living a life in the pragmatic pursuit of a set of chosen values. 

The values aren’t prescribed by ideology or creed.  On the contrary, people who have developed this new form of consciousness are extraordinarily aware of the way in which beliefs, rules, dicta, theories, feelings, and all the other aspects of the content of our consciousness can influence our behavior in ways that may or may not be helpful.  They are acutely aware that there is a part of consciousness, sometimes called the transcendent self, that is not the contents of their mind, but the “I” that is observing all of what they think and feel. 

This is, of course, not an idea that behavioral scientists invented.  It is very much the way in which Buddhists have long thought.  However, research over the past forty years has elaborated on how this works and how to make it available to many people.

In the context of this perspective on the self and the mind’s content, people are encouraged to choose what they want their life to be about. They are encouraged to do this not on the basis of what other say they should do or on the basis of some creed or ideology, but rather to choose what they want to make their life about not only over the long term but in their day-to-day experience.

You might think that this leaves people open to embracing values consistent with one or more of the above-stated dangers to humanity. But as an empirical matter, that does not seem to happen. In the hundreds of studies of the impact of helping people to become more psychologically flexible, people choose prosocial values that involve contributing to the wellbeing of those around them and growing as a person.

Psychological flexibility involves more than just being clear about one’s values. Indeed, at least in the context of clinical work with people, the first step often involves getting people to develop a different relationship with their thoughts and feelings.  This is a matter of skill development.

One skill is defusion, a made-up word that connotes being able to step back from your thoughts and feelings rather than being fused with them in the sense that you see the world through them without evening noticing that they are your thoughts, not reality. In talks I give, I often ask for a show of hands of people who have had the experience of lying in bed, stressing about someone who is not lying next to them.  Every hand goes up. Without the ability to notice that you are having thoughts about the person, it is almost like they are there in bed with you.  But people can learn to look at their thoughts rather than through them thanks to meditation and other forms of experiential exercise.

Hayes describes a client whose problems included drug addiction and antisocial behavior. When asked what he most deeply wanted, he “loudly declared that the only thing important to him was not to be messed around with, explaining with a gesture that turned his hand into the shape of a pistol that he carried…everywhere he went…” However, after a simple exercise in which he repeated the word “loser” over and over again—as a means of defusing from it, he stood up and “said that his family had suffered terribly through his bouts with addiction and what he most wanted was to be a good dad to his small children.” Apparently, the repetition of “loser” diminished its meaning for him and allowed him to make contact with something that was important to him; having briefly separated from himself “being a loser” he could contact something important to him.

A second skill is acceptance.  In the world which most of us have grown up in, we naturally do what we can to avoid “negative” feelings.  However, this form of avoidance drives us to do things that are contrary to our long term wellbeing—drinking or taking drugs to damp down unpleasant thoughts and feelings; severing relations with loved ones who have harmed or criticized us; working incessantly in an effort to avoid anxiety or to prove that we are better than what our parents said about us. Acceptance involves being willing to have thoughts and feelings.  Metaphors that promote it encourage us to “hold our anxiety the way we would hold a delicate flower or a crying child.”

With these two skills, we become better able to have whatever thoughts and feelings we have and not be pushed around by them. If I am willing to feel sad or ashamed, I am less likely to need drugs or alcohol to avoid these feelings.  And in this context, I can take steps that may be painful, but that helps me move forward in life. Re-engaging with a difficult parent; going back to school even in the context of anxiety that we will fail.

It is in the context of these skills that people become better able to experience the transcend self. This is the idea that there is a part of us that is not the content of our mind, but the “I” that is observing all of our experience. It has been labeled the transcendent self because the Observer “I” goes across any and all content.  And there appears to be a larger sense in which it is transcendent.  The observer I can not only look at the mind’s content but can take the perspective of others. This is foundational for empathy and compassion. Research on this new form of consciousness shows that when people become better at defusing from and accepting their thoughts and feelings they become more compassionate toward themselves and toward others. 

The social psychologist Jonathon Haidt2 has argued that this form of transcendence is rooted in our evolved cooperative capacities and that it puts us in contact with the whole of humanity in a spiritual way that is deeply gratifying to those who experience it.  In any case, it appears that this new form of consciousness leads people to become more loving toward themselves and others.

Closely related to these skills is the skill of being in the present moment.  Being in the past or thinking about the future is of course useful.  But they are experiences our minds give us and they may obscure what is in the present moment.  Being in the moment makes us better able to contact how we can pursue what we most value. 

Finally, there is the skill of taking committed action. As people become clearer about their values and able to step back from what their minds tell them, they become better at acting in the services of their values. Doubts about our ability to take effective action are simply thoughts to be noticed.

Over the past forty years research on helping people to adopt psychological flexibility has helped people cope with or overcome problems as diverse cigarette smoking, epilepsy, anxiety, depression, obesity, substance use, and post-traumatic stress disorders.

Indeed, the work on psychological flexibility has transformed the way we think about “psychopathology.”  Traditionally, a segment of the population was considered to have mental, emotional, and behavioral disorders. The rest of us were “normal.”  But that way of thinking has eroded as it has become clear that the majority of us have a diagnosable “disorder” at some time in our lives and all of us have problems in living that cause anxiety, depression, and behavioral excesses.  Rather than thinking of a subset of people as “abnormal” the evidence shows that the root of our problem is the form of consciousness that we have evolved over the past 10,000 years.  Namely, we solve problems with our minds by thinking about what we experience and coming up with ways to deal with whatever problem is before us.  This has “worked” enormously well in enabling us to solve problems big and small—from where to find food or protect ourselves from predators, on up to how to build a nuclear weapon. 

But there are at least two problems with our “normal” form of consciousness. First, we have evolved an orientation that makes the avoidance of danger our top priority. An organism that didn’t, didn’t survive. We are constantly scanning the environment for dangers. But thanks to our ability to think about what happened before and what is likely to happen later, we can be in the presence of threatening stimuli that are only in our mind—lying in bed stressing about someone. From this perspective, the threats our mind gives us are problems to be solved. 

And that is the second problem.  Our consciousness is greatly oriented toward not having unpleasant thoughts and feelings.  You are lying in bed stressing about that person because you have so often solved a problem by thinking about it, coming up with a strategy, trying it, and succeeding.  And while this has worked enormously well for solving problems that are outside of you, the strategy is a trap when it comes to dealing with distressing thoughts and feelings.  There is a saying about thoughts and feelings among therapists who promote psychological flexibility: “If you don’t want it, you’ve got it!”  If you don’t want anxiety—if your highest priority is to not feel anxious—you will find yourself living in a world in which everything is about anxiety.  This will simply amplify the very thing you are seeking to avoid.

Consider how this form of consciousness is related to the problems I enumerated above. For example, young men develop patterns of anti-social behavior including not just delinquency, but hate groups and terrorism. Boys who are lacking in self-regulation and engage in annoying or aggressive behavior are often dealt with through punishment.  This not only does not work, it often leads to the escalations of aggressive and annoying behavior. That, in turn, leads to rejection by peers and teachers. This produces anger and distress—for the same reason that you lie in bed thinking about someone who has slighted you. The late Tom Dishion studied this process in depth. He found that by early adolescence, such socially rejected boys find other boys who are in the same boat.  The result is magic!  They suddenly have a friend who feels just as angry and resentful toward the people who have been rejecting.  Dishion observed the interactions of these boys and found that when they laughed at each other’s deviant talk, it predicted their arrest two years later.  Dishion was watching the socialization of anti-social behavior before his eyes.  He went on to point out that terrorism is often an endpoint in this development.  While we are accustomed to focusing on the ideology that appears to drive terrorist acts, the ideologies are diverse—white nationalism, jihadism, anti-Semitism.  The function of the ideology is to bring young men together in their hatred of those whom they feel have oppressed them. The process is in the service of their not feeling that they are “losers,” “wrong,” “worthless,” “inferior.”                                                                                      

         Research on psychological flexibility is only one facet of the spreading adoption of this kind of consciousness.  Other examples include

  • The work of the Dalai Lama
  • The kindness movement, which includes the work of Barbara Fredrickson and her colleagues on the value of kindness meditation3 and the writings of Doug Carnine4 on kindfulness.
  • The Prosocial Movement, which is promoting psychological flexibility in small groups worldwide.5
  • The Conscious Capitalism6 and B Corp movement which are promoting values in business that take into account the impact of business practices on employees, customers, suppliers, and the society as a whole, in addition to their impact on investors.
  • The work of Tim Kasser, 7-9 in documenting the harm that is associated with materialistic values and the benefits of more prosocial values.
  • The work Frederik Livheim of 29K, which is developing internet strategies to promote psychological flexibility.
  • The work of Peter and Susan Glaser in teaching the skills needed to build cooperation and openness to criticism in work organizations.10
  • The identification and dissemination of school-based programs that promote prosocial behavior. These include the PAX Good Behavior Game,11,12 Positive Action,13 and Positive Behavioral Intervention and Support,14 all of which encourage young people to adopt prosocial values and goals and engage in actions that are consistent with those values.  Each is being widely implemented in the U.S. and other countries. 

Although the evidence is quite limited at this point, I submit that a world run by psychologically flexible people would steadily diminish our most pressing problems. Why?  Because those people would tend to act in the service of a set of prosocial values that take into account the wellbeing of every person.

And even if this proves to not be the case, there is reason to believe that increasing the prevalence of psychological flexible people will be good for public health.  A recent study by Andrew Gloster and his colleagues in Switzerland15 showed that in a representative sample of the adult population, persons who were high in psychological flexibility were less likely than less flexible people to have psychological or health problems when they were exposed to stressors such as stressful life events, daily stress, or low levels of social support. They were better able to deal with these stressors, apparently because they did not try to avoid their feelings, but did take practical action to cope with their situation.

         If increasing the prevalence of this form of consciousness can contribute to human wellbeing the challenge remains of how this might be accomplished.  The primary means, thus far, has been a bottom-up strategy in which individuals are being reached through clinical interventions, schools, mass media, and popular books, such as Get Out of Your Mind and Into Your Life16

         There is, however, one bottom-up strategy that appears to be underused, at least when compared with how this strategy is promoting antisocial behavior. It is the use of social media. Andrew Marantz’s new book, Antisocial,17 documents the extent to which a network of fascists, white nationalists, anti-Semites, and Nazis have succeeded in getting a huge proportion of the population to like, follow, and share, their antisocial memes. Thanks to the fact that we no longer all attend to the same media, they have been able to do this in a way that has been invisible to the traditional gatekeepers in the mainstream media.  One reason for their success is that negative, emotionally evocative messages are more likely to be attended to than more positive prosocial messages.18 (The members of this network are the product of the kind of socialization of antisocial values and behaviors that I described above. Concerted efforts to prevent such socialization are needed and the school-based examples I cite above are proof that we can do so.19)

On the other hand, those who are promoting psychological flexibility are generally unaware of the potential of social media for promoting flexibility and the need to counter right-wing efforts to promote antisocial behavior and values.  We need to build a network of people on social media who are promoting psychological flexibility and the compassion and caring that comes with it.  

(As a first step in using social media…If you are at all favorable to the notion that greater promotion of psychological flexibility will evolve more nurturing societies, please like, share, and forward this essay, as well as all of the works that I cite here.)

         There are, in addition, top-down strategies that people who want to evolve psychologically flexible societies need to pay greater attention to.  Psychological inflexibility is made more likely by threatening social conditions and the related process of promoting materialism. People who are living in poverty, in unequal societies, or in social environments high in discrimination or other social stressors are more likely to develop antisocial behavior.20 To the extent that we can ameliorate these conditions through public policy, we will enable the spread of psychological flexibility.

At the same time, people living in stressful social conditions are more susceptible to the steady beat of marketing that tells them that material goods will make them happier. Countering such materialism is vital, if for no other reason than it is promoting unsustainable lifestyles.

Bottom-up and top-down strategies need to be integrated through reciprocal relationships.  We need to cultivate and expand networks of psychologically flexible people into a coalition of people and organizations that are not only trying to encourage this new form of consciousness among individuals but are advocating for the public policies that are needed to make social environments less stressful and more likely to nurture21 psychological flexibility.

Consider how this form of consciousness would affect wellbeing.  Imagine that more and more people are mindfully going through their day, acting in ways that are consistent with the compassionate values they have chosen.  Chosen not because someone pushed them to, but because, when they felt free to choose what they wanted their life to be about, they chose values like compassion and caring. 

What would this imply for economic inequality?  As the prevalence of psychologically flexible people increases, there will be greater support for policies that benefit all members of society. Wouldn’t more people support tax policies that reduce inequality?   Wouldn’t they become less materialistic?  In their compassion for children, wouldn’t they insist that more should be done to prevent climate change? Wouldn’t our governments become better at developing policies that anticipate the threats to wellbeing? 

If the principles of psychological flexibility were increasingly taught or promoted in our schools, our workplaces, our government agencies, and our civic engagement, we could move the public discussion away from divisive arguments and toward advocacy for policies in terms of their measurable impact on wellbeing.

Science has changed the world profoundly, but not necessarily for the better. The changes that physical science have wrought thus far outstrip the changes that the behavioral sciences have made to human existence.   For many years, the assumption, especially among physical scientists, was that a true science of human behavior was not possible.  But that belief is no longer tenable. Although it is not widely recognized research on human behavior over the past 100 years has resulted in a profound new understanding of human consciousness that has the potential to counter the many ways in which human wellbeing is threatened in this “modern” physical science era.  

Reference:

1. Hayes SC. A Liberated Mind: How to Pivot Toward What Matters. Penguin Publishing Group; 2019.

2. Haidt J. The Righteous Mind: Why Good People Are Divided By Politics and Religion.: New York: Pantheon Books; 2012.

3. Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM. Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of personality and social psychology. 2008;95(5):1045-1062.

4. Carnine D. How Love Wins: The Power of Mindful Kindness. Mindful Kindness Project; 2017.

5. Atkins PWB, Wilson DS, Ryan RM, Hayes SC. Prosocial: Using Evolutionary Science to Build Productive, Equitable, and Collaborative Groups. Context Press; 2019.

6. Mackey J, Sisodia R. Conscious Capitalism, With a New Preface by the Authors: Liberating the Heroic Spirit of Business. Boston, MA: Harvard Business School Publishing Corporation; 2014.

7. Kasser T. Cultural values and the well-being of future generations: A cross-national study. Journal of Cross-Cultural Psychology. 2011;42(2):206-215.

8. Kasser T. Materialistic values and goals. Annual review of psychology. 2016;67:489-514.

9. Kasser T. The High Price of Materialism. MIP Press; 2003.

10. Glaser SR, Glaser PA. Be Quiet, Be Heard: The Paradox of Persuasion. Eugene, OR: Communication Solutions Publishing; 2006.

11. Embry DD. The Good Behavior Game: A best practice candidate as a universal behavioral vaccine. Clinical Child and Family Psychology Review. 2002;5(4):273-297.

12. Jiang D, Santos R, Mayer T, Boyd L. Latent Transition Analysis for Program Evaluation with Multivariate Longitudinal Outcomes. 2016.

13. Beets MW, Flay BR, Vuchinich S, et al. Use of a social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii. Am J Public Health. 2009;99(8):1438-1445.

14. Horner RH, Sugai G. School-wide PBIS: An Example of Applied Behavior Analysis Implemented at a Scale of Social Importance. Behavior analysis in practice. 2015;8(1):80-85.

15. Gloster AT, Meyer AH, Lieb R. Psychological flexibility as a malleable public health target: Evidence from a representative sample. Journal of Contextual Behavioral Science. 2017;6(2):166-171.

16. Hayes SC, Smith S. Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy. New Harbinger Publications; 2005.

17. Marantz A. Antisocial: Online Extremists, Techno-Utopians, and the Hijacking of the American Conversation. United States of America: Viking; 2019.

18. Wylie C. Mind F*ck: Inside Cambridge Analytica’s Plot to Break the World. New York, NY: Random House; 2019.

19. Biglan A, Van Ryzin M, Moore K, Mauricci M, Mannon I. The Socialization of Boys and Men in the Modern Era: An Evolutionary Mismatch. Cambridge University Press. In press.

20. Biglan A. Rebooting Capitalism: Forging a Society that Works for Everyone. Values to Action; 2020.

21. Biglan A. The Nurture Effect: How the Science of Human Behavior Can Improve our Lives and Our World. Oakland, CA: New Harbinger; 2015.

I am probably older than you; born on June 6, 1944. This is a time of year that brings sad memories. Robert Kennedy, who after his brother’s assassination, had become a deeply caring person, died on my birthday in 1968. I was President of the Students for Robert Kennedy at the University of Illinois. I was heartbroken. Martin Luther King had been murdered two months earlier. Kennedy, who had bonded in compassion with farm workers in California, poor black people in the Mississippi delta, and South African black people in Soweto, seemed our last hope for bringing white and black people together to create a society that would advance everyone’s wellbeing. On the night that Dr. King was killed, he landed in Indianapolis to speak to a mostly black audience. He was advised against it, but he insisted on speaking. Here is what he said:

I have bad news for you, for all of our fellow citizens, and people who love peace all over the world, and that is that Martin Luther King was shot and killed tonight.

Martin Luther King dedicated his life to love and to justice for his fellow human beings, and he died because of that effort.

In this difficult day, in this difficult time for the United States, it is perhaps well to ask what kind of a nation we are and what direction we want to move in. For those of you who are black — considering the evidence there evidently is that there were white people who were responsible — you can be filled with bitterness, with hatred, and a desire for revenge. We can move in that direction as a country, in great polarization — black people amongst black, white people amongst white, filled with hatred toward one another.

Or we can make an effort, as Martin Luther King did, to understand and to comprehend, and to replace that violence, that stain of bloodshed that has spread across our land, with an effort to understand with compassion and love.

For those of you who are black and are tempted to be filled with hatred and distrust at the injustice of such an act, against all white people, I can only say that I feel in my own heart the same kind of feeling. I had a member of my family killed, but he was killed by a white man. But we have to make an effort in the United States, we have to make an effort to understand, to go beyond these rather difficult times.

My favorite poet was Aeschylus. He wrote: “In our sleep, pain which cannot forget falls drop by drop upon the heart until, in our own despair, against our will, comes wisdom through the awful grace of God.”

What we need in the United States is not division; what we need in the United States is not hatred; what we need in the United States is not violence or lawlessness; but love and wisdom, and compassion toward one another, and a feeling of justice toward those who still suffer within our country, whether they be white or they be black.

So I shall ask you tonight to return home, to say a prayer for the family of Martin Luther King, that’s true, but more importantly to say a prayer for our own country, which all of us love — a prayer for understanding and that compassion of which I spoke.

We can do well in this country. We will have difficult times; we’ve had difficult times in the past; we will have difficult times in the future. It is not the end of violence; it is not the end of lawlessness; it is not the end of disorder.

But the vast majority of white people and the vast majority of black people in this country want to live together, want to improve the quality of our life, and want justice for all human beings who abide in our land.

Let us dedicate ourselves to what the Greeks wrote so many years ago: to tame the savageness of man and make gentle the life of this world.

Let us dedicate ourselves to that, and say a prayer for our country and for our people.

America is in deeper peril than at any time in my life. We face the realistic possibility that our president will attempt to seize dictatorial control. When I set out to write something about the difficult situation we face as a nation, I hoped to say something that would contribute to bringing us together so that all of us would visibly speak for the nation we aspire to. But I think I can do no better than to give you what Robert Kennedy said at another dark point in our nation.

Speaking in South Africa, (also on June 6 [1966]), Kennedy emphasized the power of united action.

It is from numberless diverse acts of courage and belief that human history is shaped. Each time a man [sic] stands up for an ideal or acts to improve the lot of others or strikes out against injustice. He sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest wall of oppression and resistance.

May we all come together in love and compassion to ensure that black people have the safety, respect, and nurturance that every person has a right to.

Kevin Roose of the New York Times reported that Joe Biden has only 32,000 subscribers to his video platform, 300,000 fewer than Trump has. In a campaign in which the only way to reach people will be via TV and the Internet, this is a serious problem.

If you are desperate to defeat Trump, here are two simple things you can do that won’t cost you any money and won’t take much of your time.

Don’t follow and comment on things you disagree with. Research shows very clearly that arguing with people about their beliefs and attitudes will not only not persuade them, it will strengthen their beliefs.[1] However, that is not the main reason you should not bother arguing with posts you find on the internet that you disagree with. The main reason is that YOU ARE HELPING THEM!


All of the major social media platforms promote pieces on the basis of how much attention they get. They could care less whether you are praising or objecting to the piece. They just want to have as many eyes on content in their platform as possible and their research shows that controversial material gets more eyes.

Andrew Marantz’s eye-opening book about the antisocial actors on the internet has described how many right wing trolls are making a living by inciting controversy. They do and say things that are calculated to enrage progressives and when progressive fight back or counterattack, it guarantees more attention to the right wing attack. The right calls that “owning the libs.” It’s a sport. They love it when you become enraged.

Do like, follow, and share prosocial posts. Although it is smaller and less connected than the right wing social media netowork, there are plenty of progressives on the internet. If we can get them to stop paying attention to the trolls and instead build the network of people who support prosocial values and norms, we can move society in the right direction. When I suggested this to my wife, Georgia, she said that she couldn’t possibly have an influence by liking and sharing examples of prosocial values or behavior that she sees on the internet. So here is what I said in Rebooting Capitalism about how progressive individuals can make a difference. (Which I am happy to report she finds persuasive.)

Imagine that just a thousand people began to forward one thing a week to their connections. About 69 million Americans have Twitter accounts. According to the KickFactory blog, the average Twitter user has 707 followers. If a thousand people tweeted to their followers, we would reach more than 700,000 people. And if just 10% of those 700,000 retweeted, we would be reaching another 49,000,000 with retweets. Of course, my numbers don’t include the fact that many of those people would be reached more than once. But that is a good thing — repeated messages from multiple source is effective social influence.

Of course this is just Twitter. About 151 million American adults use Facebook. They average about 338 friends. Using the same assumptions as for Twitter, the first round of 1000 sharing a Facebook post would reach 338,000. If 10% of them shared an article or video, it would reach another 11,424,400. If five percent of them shared, we would reach another 193,072,360. It adds up.

I am not talking about simply liking and sharing what the Biden campaign puts out or only promoting political content you agree with. If you support Biden or other democrats, I am pretty sure it is because you want a society that seeks to nurture the wellbeing of every person. We can’t achieve such a society by simply winning the next election. We need to build a network of people and organizations that are promoting prosocial values in every sector of society. Any content that you find on the web or that you create that exemplifies kindness, caring, compassion, respect, or love is important.

Too often the Democratic party has tried to win elections by activating the most motivated, all the while ignoring the people who have turned away from our contentious politics in disgust. In 2016 only 55.7% of eligible voters voted. To some extent the party’s focus on getting out the vote of their base is understandable; they have limited resources and ordinarily it is very hard to influence people who seldom vote.

But these are not ordinary times. The rise of Trump, the looming catastrophe of climate change, and the Covid-19 epidemic call on us to get more involved in the direction of the world. And it turns out that you can contribute to the change we need, simply by like and sharing positive messages about the world you want.

Reference Cited

  1. Biglan, A., Rebooting Capitalism: How behavioral science can forge a society that works for everyone. 2020, Eugene, OR: Values to Action. https://valuestoaction.com/reboot/

This article is related to Anthony Biglan’s new book Rebooting Capitalism: Forging a Society that Works For Everyone.

Evolution has taken us where we didn’t want to go. Thanks to relentless and very effective advocacy for free-market thinking, every sector of society has been corrupted by the belief that individual and corporate pursuit of wealth will necessarily result in a benefit to society. Each of the industries that I have described in these essays has evolved practices that have been quite beneficial to the companies engaged in these practices, but quite harmful to society as a whole. Indeed in the case of climate change, we face unprecedented and catastrophic harm to humanity and most of the other species on the planet.

We must evolve a form of capitalism that minimizes harm and maximizes benefit. It is true that the pursuit of profit in the marketplace often selects innovations and efficiencies that are of great benefit. But as the evolution of the industries I have discussed shows, it can also do great harm.

The answer is not the total abandonment of capitalism. No plausible alternative has yet to be proposed. Rather the answer is to use the much more accurate framework of evolutionary theory to evolve a form of capitalism that only allows truly beneficial practices to be selected. In essence, we need to change the consequences that select practices so that only those practices that minimize harm and promote wellbeing survive.

As these essays have shown, companies will engage in whatever legal practices they can to preserve profitable practices, frequently with no regard to their impact on general wellbeing. And in the current era, these companies have enormous influence over lawmaking. In industry after industry, the laws are favorable to the industry. Gunmakers are shielded from liability for any of the features of their products that contribute to gun-related deaths. The RICCO statute that made it illegal for the tobacco companies to collude in obscuring the impact of their product on cancer and heart disease has no criminal or financial penalties for the companies or their executives, despite the millions of people killed by their product. The pharmaceutical industry pays fines for marketing opioids that result in hundreds of thousands of overdose deaths, but the fines are far less than the profits they make in marketing the opioids. The food industry markets foods that result in record levels of childhood obesity and then fight to prevent taxes on sugar-sweetened beverages. The financial industry steadily erodes laws that have prevented depressions and severe recessions and when its investment instruments cause a severe recession, they influence the government to bail them out and make sure that they continue to be minimally regulated. The fossil fuel industry creates a network of astroturf, advocacy, and pseudo-science organizations to prevent laws that would increase the price of their products.

In each of these industries, public health and citizen’s groups have arisen that are working to publicize the harm of the product and prevent further harm. But what is striking is how little these organizations have come together to address the generic features of the problem. In every case, measurable harm is occurring and the profits of the industry are the fundamental cause of both the harm and the efforts of the industry to prevent anything that would impinge on those profits.

Groups opposing the industry fight their battles in the context of widespread beliefs that government regulation is harmful and that the rights of those who are marketing the product and those being harmed by the product are in jeopardy. They get into arguments with the industry over whether the harm is real and are disadvantaged by these default assumptions.

The problem needs to be addressed not at the level of whether a particular industry may be doing harm, but at the level of how our society ensures the wellbeing of its members.

Here are a set of straightforward principles that are applicable to any industry:

  1. The harms and benefits of any industry can and should be assessed routinely. Economists are well able to assess the economic benefit of an industry’s practices to the companies, their investors, the consumers, and the public at large. At the same time, economists and the public health community are quite capable of assessing the harms of products to consumers, employees, investors, and the public at large.
  2. Whether the practices of an industry should be altered via regulation should be a function of our weighing the risks and benefits of the practices. Policies that required the routine analysis of risks and benefits would make it unnecessary to fight these battles one industry at a time.
  3. When the harm of a product outweighs its benefits, the remedies for addressing the harm must ensure that the cost to the industry is greater than its profits. Otherwise, the penalties will simply be the cost of doing business and harmful marketing will continue.

Of course, precisely where you set the bar in weighing harms and benefits will have to be worked out in a democratic process.

I realize that it will seem wildly unrealistic, to believe that policies such as these could be adopted. Currently, that is the case. However, in Rebooting Capitalism: How Behavioral Science Can Forge a Society that Works for Everyone, I lay out a strategic plan for how we can get there. The book provides a detailed roadmap for how this evolution can be accomplished. Every major sector of society has been corrupted by the singular focus on self-aggrandizing values. In business, healthcare, higher education, criminal justice, the media, and our political system, fundamental reform is needed. We must replace the values and beliefs promoted by free-market ideology, with a set of prosocial values that make the wellbeing of the society as a whole the ultimate criterion for individual, corporate, and governmental practices.

Rebooting Capitalism provides a detailed description of how we can create a movement to reform every sector of society. It begins by providing you with the psychological tools you need to cope with the current crisis and contribute to the changes that are needed. It then analyzes each of the major sectors of society in terms of how we can measure its impact on wellbeing, replace self-aggrandizing values with prosocial, nurturing values, and select practices that advance the wellbeing of every person. Go to ValuestoAction.com and join us on this vital journey!

Read the Full “Cultural Evolution of Social Pathologies” Series by Anthony Biglan:

  1. Introduction by David Sloan Wilson
  2. How Cigarette Marketing Killed 20 Million People
  3. The Right to Sell Arms
  4. How and Why the Food Industry Makes Americans Sick
  5. Big Pharma and the Death of Americans
  6. How Free-Market Ideology Resulted in the Great Recession
  7. The Fossil Fuel Industry: The Greatest Threat to Human Wellbeing
  8. The Crisis of Capitalism

This article is related to Anthony Biglan’s new book Rebooting Capitalism: Forging a Society that Works For Everyone.

Jerry Brodsky was a race track tout. After dropping out of graduate school he made his living betting on the horses at Portland Meadows, until, that is, the track burned down and he had to go back to psychology. One day, after the racetrack was rebuilt Jerry took me to the races. I had never been before. Over the course of five or so races, he taught me how to read a racing form, which gives the history of each horse’s finishes, the conditions of the track, and other data. By the sixth race, I was an expert. Jerry picked one horse, but I, with my new knowledge, picked another one. They were off! Jerry who is about six foot five and has a deep bass voice stands up and follows the horses with his binoculars. As they round the far turn, he startles me as he starts yelling loudly. His horse won.

I said, “Jerry, why didn’t you tell me you were that sure.” He said, “I did.” I said, “Yes, but if you had said it the way you were yelling at the end of the race, I would have listened!” That is where we stand with global climate change. They are rounding the far turn and we need to be yelling at the top of our lungs!

Our problem is that although humans are far better at dealing with distant threats to our wellbeing than any other species, compared to the dangers we face as a species, we are lousy at it.

If you feed a rat some food that makes him sick hours later, the rat will avoid that food the next time you offer it to him. Psychologists call this the bait-shy phenomenon. That is one of the very few examples of non-human organisms changing their behavior in light of distant consequences.

Humans, on the other hand, can plan ahead—including planning to avoid disaster. Consider engineering standards. According to Richard Lindeke, a professor of engineering at the University of Minnesota, Duluth, the U.S. Government has created more than 45,000 standards that guide engineers in their work. They provide the rules regarding the materials, procedures, products, and services that engineers need to comply with to build things.

If you are not an engineer, you take for granted that the bridge, elevator, airplane, train, or automobile you use will be safe. The standards have been shaped by the experience of engineers over many years to ensure that failure of the things they design and make will be exceedingly rare. In this sense, the standards are a form of planning ahead.

In the 1620s, when Sweden was still a war-like nation, King Gustavus Adolphus ordered the building of a warship to be used in Sweden’s war with Poland and Lithuania. On August 11, 1628, the Vasa sailed into the Stockholm Harbor on its maiden voyage. As soon as a moderate wind hit its sails, it listed, water flooded in through the lower gun ports, and it promptly sank. The sinking was due to the ship being too narrow, with too much weight on the upper decks. Shipbuilding was not an exact science in those days. But subsequent shipbuilders were careful to not build ships that were so top-heavy. In 1959 the ship was raised from the Stockholm harbor. It can now be viewed at the Vasa Museum.

Many of the standards that engineers have adopted were created because of disasters like the Vasa sinking. After an iceberg sunk the Titanic, they created doubled hulls that would be more likely to survive such a collision.1 Disasters persistently spur engineers to modify their standards. Earthquakes have driven repeated improvements in the design of buildings and lifeline systems such as electric grids so that they will withstand earthquakes.2 Similarly, floods, which account for 80% of declared disasters, prompted the construction of numerous dams, beginning in the 1930s. However, recently it has become clear that flooding can also be reduced and mitigated by not allowing natural barriers, such as coastal wetlands, to be destroyed. Hurricanes have prompted improvements in building design that allow them to withstand higher winds.

So while humans are able to learn from their mistakes, and plan a future that avoids the catastrophes of the past, our future planning is mostly shaped by our past catastrophes. This is what makes the ongoing climate change such a threat to human wellbeing. There is simply no precedent for humans dealing with such a slow-moving, worldwide disaster as we are facing.

The first step in preventing or preparing for any disaster is to develop as accurate predictions as we can of what is likely to happen.3 If you have been ignoring dire predictions about climate change either because it is hard to think about a problem that you don’t feel you can do anything about or because you have heard that the dangers are exaggerated, I ask you to hear me out. Although I am not a climate scientist, I am confident that I have the skills to evaluate the science and reliability of the scientists who have been making predictions.

The Growing Threat of Climate Change

The National Aeronautics and Space Administration (NASA) provides a clear and reliable summary of the ways in which our planet’s climate is changing.4 To begin with the average temperature on earth rose about one degree Fahrenheit during the 20th Century and effects on climate are already visible in the form of melting sea ice and glaciers, the rise in sea level, longer more intense heat waves, and more severe storms. The Intergovernmental Panel on Climate Change (IPCC) predicts a further temperature rise over the next century of 2.5 to 10 degrees Fahrenheit.

Figure 7.1 comes from NASA. It shows the level of CO2 in the earth’s atmosphere over the past 400,000 years. (The historical estimates come from an analysis of air bubbles trapped in ice.) As you can see, CO2 levels have been increasing dramatically over the past two hundred years. The level exceeded 400 parts per million in 2013 a level considered to be far above the level needed to prevent further climate change. The last time levels were this high, dinosaurs roamed the world and the ocean level was forty feet higher than it is today.5

The consensus among climate scientists is that the earth risks catastrophic climate change if the average temperature of the earth rises more than 3.6 Fahrenheit above its pre-industrial level.6 Here is what is happening and what will happen:

  • More and more severe storms. 2017 was a historic year for storms. In the Atlantic, we had ten storms of hurricane force in a row, a record. In terms of damage it was the costliest season on record, at more than $202 billion.7 The total energy of the storms in September of 2017 broke all records. A study by the National Oceanic and Atmospheric Administration estimated that over the next 100 years, the frequency of storms in the Atlantic will double.8
  • Rising sea level. According to the National Oceanic and Atmospheric Administration,9 sea level has risen 2.6 inches in just twenty years and the rate of increase is rising. The latest estimates for sea level in 2100 range from one foot to 8.2 feet. Nearly 40% of the U.S. population will be affected by rising seas and eight of the ten largest cities in the world are threatened with rising seas. Higher sea levels combined with stronger storms will result in storms unlike anything humans have ever experienced.
  • Species extinction. It has been estimated that about 1/6th of the species on the planet will become extinct due to climate change.
  • The Center for Climate and Energy Solutions reported that wildfires in the United States burned more than twice the area they did in 1970, due to less snow accumulation in mountains, drier summer weather, and hotter summers.

These are only some of the ways in which climate change will alter the human environment for the worse. In the usual way that you would expect from an American, I have focused on the U.S. But indeed the rest of the world will suffer enormously. Already we are seeing people in low lying areas having to move to higher ground. Many islands around the world are facing the fact that their citizens will have to move to other countries. Indonesia announced that it is moving its capital from Jakarta because by 2050 95% North Jakarta will be submerged.10

The Syrian civil war was precipitated by the long drought which drove farmers out of rural areas and into the cities. That led to hundreds of thousands of refugees pouring into Europe. That, in turn, is sowing discord and racism in Europe. Many more problems of this sort will occur as millions of people are forced to flee their homes due to climate change or the conflicts that it leads to.

Human societies have evolved under fairly stable climate conditions for thousands of years. We are rapidly approaching conditions unlike any since dinosaurs lived. It is not going to be pretty. I elaborate on the problem in Rebooting Capitalism, where I discuss what we can do about it.

The Role of the Fossil Fuel Industry in Climate Change

It would be hard to overstate the benefits that fossil fuels have provided to human wellbeing in the past 200 years. A huge proportion of the technological developments that have enabled millions of people around the world to escape from poverty are thanks to coal and oil-fired power. Without fossil fuels, we would not have railroads, airplanes, automobiles, or much of our electricity. But the evidence is clear that this boon to human wellbeing has brought with it an unprecedented increase in CO2 in the atmosphere and with it, climate change.

The evolution of the fossil fuel industry has been fairly simple. As technologies such as the steam engine, the internal combustion engine, the jet engine, and electricity generators were developed, coal, oil, and gas industries developed to provide the energy to run these engines. These energy providers have been some of the biggest and most lucrative industries over the past 200 years. Google estimated that the combined worth of all fossil fuel companies worldwide in early 2018 was $.4.6 trillion; Exxon Mobil was worth $425 billion making it the second only to Apple in size.

Like any modern corporation, fossil fuel companies have monitored the threats and opportunities for their business and taken steps to ensure the long-term profitability of their companies. Recent reporting by the Los Angeles Times disclosed that some of the oil companies had done their own research and confirmed that global warming was occurring and that it was the result of human-caused CO2 emissions. Indeed, Exxon concluded that the melting of ice in the Arctic was likely to make it possible to drill for oil in the arctic and the company began to plan for doing that.

Viewed from the standpoint of the harm that continued use of fossil fuels will do to the planet, the threat to these businesses is huge. The problem for these industries is one of “stranded assets.” Christophe McGlade and Paul Ekins11 who are at the Institute for Sustainable Resources at the University College of London have analyzed the fossil fuel reserves and their impact on warming. They estimate that in order to prevent the earth’s mean temperature from exceeding a 3.6 degrees Fahrenheit rise above preindustrial levels that climate scientists warn may cause irreversible and catastrophic damage to the planet, “a third of oil reserves, half of the gas reserves and over 80 percent of current coal reserves” would have to remain unused. This means that if you are a fossil fuel company that owns some of these reserves, the value of your assets become less if you are prevented from selling them. Bloomberg News estimated that the industry stands to lose $33 trillion if they are not allowed to sell the coal, oil, and gas they own.12

In other words, fossil fuel companies have a tremendous incentive to prevent policies that would keep them from selling their assets. We should not be surprised, therefore, that these companies have taken steps to prevent such an outcome. Here is a brief summary of what they have done to protect their investments.

The Union of Concerned Scientists (UCS) analyzed internal memos of the fossil fuel industry to assess whether the companies have been trying to keep the public from believing that climate change is happening and that it is due to human behavior. If you have read the last five essays on industries, your reaction will probably be, “Of course they have.”

And indeed, that is what the UCS analysis shows. The report enumerates seven ways in which the industry prevented effective action on climate change. Here is a brief summary.

The industry (ExxonMobil and the Koch Brothers among others) secretly funded an aerospace engineer, Wei-Hock Soon to do research on climate change at the Harvard-Smithsonian Center for Astrophysics. The research claimed to show that human emissions were not causing climate change. His research has been widely criticized. Soon did not disclose the sources of his funding. The Smithsonian agreed to not disclose that the research was funded by the fossil fuel industry.

The American Petroleum Institute (API), an industry group supported by the major oil companies developed a plan in 1998 to sow doubt about climate change. One document stated that “Victory will be achieved when average citizens ‘understand’ (recognize) uncertainties in climate science; recognition of uncertainties becomes part of ‘conventional wisdom’.” The plan included recruiting five scientists to become spokespeople for climate denial; their connection to the industry would, of course, be hidden. The industry also funded an organization called The Advancement of Sound Science Coalition. The API has distributed curriculum materials to schools that are designed to sow doubts about climate change. They also facilitated rallies in communities throughout the country that were designed to suggest that there was strong opposition to a carbon tax.

The Western States Petroleum Association, which is a lobbying organization for oil companies in the west created as many as 16 “astroturf” organizations to oppose California and Oregon’s efforts to reduce carbon emissions. An “astroturf” organization is one that pretends to be a grassroots organization but is actually created by an industry or political organization that knows that if it directly advocated on an issue, they would have much less influence than a group that seemed to be created by interested citizens. Among the organizations they created was Fed Up at the Pump, the California Drivers Alliance, Californians Against Higher Taxes, and Oregonians for Sound Fuel Policy.

The coal industry forged as many as 13 letters to congressional representatives that were purported to be from organizations such as the NAACP and the American Association of University Women. The letters claimed that these organizations opposed a bill that would have reduced the use of coal.

The coal industry also created a front group called the Information Council on the Environment. This group sponsored scientists and ran ad campaigns. The organization was attempting to “reposition global warming as theory (not fact)” and to “use a spokesman from the scientific community,” because “technical sources receive the highest overall credibility ratings.” An ad played on the Rush Limbaugh show stated:

Stop panicking! I’m here to tell you that the facts simply don’t jibe with the theory that catastrophic global warming is taking place. Try this fact on for size. Minneapolis has actually gotten colder. So has Albany, New York.13

The American Legislative Exchange Council (ALEC) is a conservative organization that focuses on creating model legislation for conservative policies. They bring together state and federal legislators from all over the country and provide them with model bills and the talking points and advocacy materials needed to help them get passage of the bills. ALEC has taken the position that “the debate will continue on the significance of natural and anthropogenic contributions” to climate change. The organization has been an effective conduit of fossil fuel industry misinformation about climate change to legislators around the country. This has been one of the most effective ways for the fossil fuel industry to influence policymaking. They have particularly focused on preventing legislation that would reduce carbon emissions. According to the UCS, sixty-five ALEC-sponsored bills were introduced into legislatures between 2013 and 2015.

Many of the oil companies have publicly acknowledged the role of carbon emissions in climate change in recent years. Yet at the same time, they continue to fund ALEC, which as Eric Schmidt, the CEO of Google put it, is “just literally lying.”

The UCS analysis of the fossil fuel industry’s disinformation efforts ends with a description of a 1995 document titled “Predicting Future Climate Change: A Primer,” which was written by fossil fuel company scientists. The document, which was intended for industry insiders only, stated: “the scientific basis for the Greenhouse Effect and the potential impact of human emissions of greenhouse gases such as CO on climate is well established and cannot be denied.”

Simply put the fossil fuel industry is investing heavily in efforts to prevent any actions that will curtail their ability to market fossil fuels profitably. Like the tobacco industry, they have realized that the credibility of their companies would be undermined if they continued to deny the facts. So many companies have acknowledged that climate change is real. But at the same time, they continue to fight any policies that would prevent carbon emissions. They do this through other organizations such as ALEC, the Information Council on the Environment, and Oregonians for Sound Fuel Policy.

Action Implications

Personal

  • Reduce your carbon footprint. Here are some sources for how you can do that”
  1. https://cotap.org/reduce-carbon-emissions/
  2. http://www.globalstewards.org/reduce-carbon-footprint.htm
  3. https://climatecare.org/50-ideas-for-shrinking-your-carbon-footprint/

Policies

  1. Support policies that increase the cost of fossil fuels, either through cap and trade procedures that slowly increase the cost of these fuels or through an outright increase in the tax on them. In Rebooting Capitalism, I elaborate on how these policies work.
  2. Support the Green New Deal. It is a carefully thought through a comprehensive approach to the problem.
  3. Demand more funding for behavioral science research on the problem. As I describe in Rebooting Capitalism, there is far to little behavioral science research being done on how to influence policy adoption and behavior change that would reduce Greenhouse Gas emissions.

Organizations

  1. You will find organizations working to prevent climate change at https://climatestore.com/take-action/get-involved/non-profit-organizations-working-on-climate-change. Find ones that you like, give to them, volunteer for them, and get your friends and family to do the same. It will be especially helpful if you work at the local level because every Middlesex village and farm needs to take action. The more communities that are actively involved in this the easier it will become to generate state and national action.

Read the Full “Cultural Evolution of Social Pathologies” Series by Anthony Biglan:

  1. Introduction by David Sloan Wilson
  2. How Cigarette Marketing Killed 20 Million People
  3. The Right to Sell Arms
  4. How and Why the Food Industry Makes Americans Sick
  5. Big Pharma and the Death of Americans
  6. How Free-Market Ideology Resulted in the Great Recession
  7. The Fossil Fuel Industry: The Greatest Threat to Human Wellbeing
  8. The Crisis of Capitalism

References:

  1. Lynch D, Marschall K. Titanic – An Illustrated History. 2nd ed. London, UK: Hodder & Stoughton; 1997.
  2. Cruz AM. Engineering contribution to the field of emergency management. Engineering in Natural Hazards n.d.; https://training.fema.gov/hiedu/docs/emt/engineering%20contribution.pdf. Accessed October 24, 2018.
  3. Biglan A, Barnes-Holmes Y. Acting in light of the future: How do future-oriented cultural practices evolve and how can we accelerate their evolution? Journal of Contextual Behavioral Science. 2015;4(3):184-195.
  4. NASA. How climate is changing. Effects n.d.; https://climate.nasa.gov/effects/. Accessed October 24, 2018.
  5. Freedman A. The last time CO2 was this high, humans didn’t exist. 2013; http://www.climatecentral.org/news/the-last-time-co2-was-this-high-humans-didnt-exist-15938. Accessed October 24, 2018.
  6. PBS. Why 2 degrees Celsius is climate change’s magic number. News Hour 2015; http://www.pbs.org/newshour/bb/why-2-degrees-celsius-is-climate-changes-magic-number/. Accessed October 24, 2018.
  7. McNoldy B, Klotzbach P, Samenow J. The Atlantic hurricane season from hell is finally over. Capital Weather Gang 2017; https://www.washingtonpost.com/news/capital-weather-gang/wp/2017/11/30/the-atlantic-hurricane-season-from-hell-is-finally-over/?utm_term=.518836188338. Accessed October 24, 2018.
  8. Bender MA, Knutson TR, Tuleya RE, et al. Modeled impact of anthropogenic warming on the frequency of intense Atlantic hurricanes. Science. 2010;327(5964):454.
  9. NOS. Is sea level rising?: Yes, sea level is rising at an increasing rate. n.d.; https://oceanservice.noaa.gov/facts/sealevel.html. Accessed October 24, 2018.
  10. Kennedy M. Indonesia Plans To Move Its Capital Out Of Jakarta, A City That’s Sinking. Asia 2019; https://www.npr.org/2019/04/29/718234878/indonesia-plans-to-move-its-capital-out-of-jakarta-a-city-thats-sinking. Accessed May 9, 2019.
  11. McGlade C, Ekins P. The geographical distribution of fossil fuels unused when limiting global warming to 2°C. Nature. 2015;517:187.
  12. Ryan J. Fossil fuel industry risks losing $33 trillion to climate change. Business 2016; https://www.bloomberg.com/news/articles/2016-07-11/fossil-fuel-industry-risks-losing-33-trillion-to-climate-change. Accessed October 24, 2018.
  13. Simmons Advertising Inc. Memorandoum to Rush Limbaugh Show. 1991; 1. Available at: https://research.greenpeaceusa.org/?a=view&d=2949. Accessed October 24, 2018.

This article is related to Anthony Biglan’s new book Rebooting Capitalism: Forging a Society that Works For Everyone.

Sometime in 2007, I read an article in the New York Times about how Wall Street banks were having collateralized debt obligations rated for their safety by one of three major rating houses, Standard & Poor’s, Moody’s, and Fitch. A collateralized debt obligation is an investment that consists of a set of loans or mortgages. More on that later. The article explained that the rating agencies were competing for the business of the banks, which paid them to rate the worthiness of the CDOs. The better the rating, of course, the more the banks could charge for the CDO.

I remember thinking, “Uh oh!” It was obvious to me, as it would be to anyone who understands the principles of reinforcement, that the agencies would be motivated to give high ratings to the CDOs; if they didn’t the bank would hire a different agency. And indeed, emails that came to light after the crash of 2008 showed that the rating agencies had indeed been motivated to give the banks what they wanted.

The Great Recession of 2008 cost the world economy trillions of dollars, threw millions of Americans into unemployment, and homelessness and contributed to 4750 suicides1 and 18,000 cancer deaths.2 It is a classic example of what happens when people are blind to the contingencies that influence people’s behavior. Of course, the rating agencies inflated their estimates of the values of the CDOs. They were being paid to provide a service to the banks that would help the banks to make a profit. They and the banks relied on the myth that the rating agencies are entirely objective in their estimation of the value of an investment instrument. Both the banks and the rating agencies profited handsomely from the widespread and erroneous belief that the rating agencies were wholly objective. If anyone in the regulatory community had understood (or been willing to admit) that people’s behavior is influenced by its consequences, this tragedy could have been prevented.

This was not the only failure to see harmful contingencies in the run-up to the crash of 2008. The first failure was the inability of regulators to see the danger of allowing banks and other lenders for home mortgages to bundle their loans into Collateralized Debt Obligations and sell them. Traditionally local banks loaned people money to buy houses. Because the bank stood to lose money if the mortgage was not paid off, the banks were scrupulous in assessing people’s ability to repay these loans. But when it became possible for banks to bundle these mortgages and sell them to Wall St bankers, the contingencies changed. Local banks now had an incentive to give mortgages. Because they could sell them, they did not need to worry as much about whether they would be paid off. Of course, Wall Street banks wouldn’t want to be holding mortgages for people who weren’t creditworthy. Ah, but if Wall Street could turn around and sell them in the form of collateralized debt obligations, they would be passing on the risk to buyers and would have the same motivation that the local banks had. And if the rating agencies gave these CDOs good ratings, there was money to be made and little risk to the Wall Street banks. After the crash, it was widely reported that people on Wall Street were saying, “I’ll be gone,” by the time the true worth of these CDOs became apparent.

In the 1920s, Charles Ponzi figured out a way to harness the madness of investment crowds with a scheme that came to be named for him. The key trick in a Ponzi Scheme is to pay high returns to the initial investors using money that later investors put in. Ponzi was able to maintain the scheme by sending reports of the high returns to the initial investors. The later investors are motivated to put their money in because of the returns they see the initial investors getting and the initial investors didn’t want to take their money out of such a seemingly lucrative investment.

A more recent Ponzi scheme was the one that Bernie Madoff carried off for many years.3 His Ponzi scheme came to light when the Great Recession hit and people began to withdraw money from his fund. Prosecutors estimated that the scheme led to losses of $64.8 billion. Although the scheme did not collapse until 2008, doubts were raised about Madoff’s investment firm as early as 2000. A Boston investment analyst, Harry Markopolos, looked at Madoff’s reported returns and concluded that they were too consistent to be believed. Madoff had had only 7 months in which he reported the fund losing money over a 174 month period. Markopolos took his concerns to the Securities and Exchange Commission, but they did nothing.

At the root of the Great Recession of 2008 was a Ponzi scheme run by the entire network of Wall Street banks. At the bottom of the bubble were people buying homes. Because it had become easy to get mortgages, more and more people began to do so. As in any market system, the more demand there was, the more prices of homes would go up. Many people realized that in this market, they could buy multiple homes and sell them a year or so later at a much higher price. This further increased the demand for houses, which further increased the price of homes.

This is nicely documented in Michael Lewis’ book, The Big Short, and the movie by the same name. I recommend both. Lewis tells the story of a few investors who realized that the housing market had become a bubble. The collateralized debt obligations—the financial instrument that bundled home mortgages to be sold by the Wall Street banks—consisted of sets of mortgages. By the time these CDOs got to Wall Street to be sold, very little attention was being paid to whether the mortgages inside them were as safe as mortgages used to be when local banks, granted them and held onto them. But when Steve Eisman became suspicious about the real worth of the CDOs he had his staff investigate each mortgage in some CDOs and discovered that many of the houses were unoccupied. They had been purchased by speculators who had been flipping the houses (selling at a higher price when their value went up) after a year or so and making money on them. Eisman and a few other investors decided to bet against these CDOs by buying credit default swaps that would pay off if a bond failed. When the crash came, Eisman made $400 million.

All of this may seem obvious even to someone who is not trained to study the contingencies that influence human behavior. But it was far from the view of the titans of the financial industry and those who were responsible for regulating their business practices. They are under the thrall of free-market economic theory. According to this theory, markets are self-correcting. There is an old joke about someone pointing out to an economist that there is a five-dollar bill on the ground. The economist replies that there couldn’t be because someone would have picked it up.

According to free-market theory, bubbles can’t happen because everyone in the market place is motivated to maximize their return on investment and that motivation will lead them to avoid transactions that would be harmful. A market in which everyone has all the information they need and everyone is free to act as they choose is known as an efficient market; everyone is maximizing their outcomes. The theory is founded on the assumption that players in the market always act rationally and that they have the information they need to maximize their outcomes. Both of these assumptions are contradicted by a wealth of evidence. But that evidence did not penetrate the financial and regulatory system in time to avoid the Great Recession.

Take the assumption of rational actors. Daniel Kahneman received the Nobel Prize in Economic Sciences in 2002 for his work showing that people are quite frequently far from rational actors. Among the biases of judgment that lead us to deviate from rational judgments is an optimism bias in which we wrongly believe that we will be more successful than other investors. Another is loss aversion, where people are more motivated to avoid the loss of a given amount of money than to gain that same amount of money.

Then there is the question of how much information market participants have. Economists have enumerated a number of ways that markets are not efficient, in the sense that they maximize buyers’ and sellers’ outcomes. The one that is most relevant here is an imbalance in information where the seller knows things that the buyer doesn’t know. Certainly, the buyers of CDOs, trusting that the rating agencies were accurately estimating the value of these investments did not have accurate information. The buyers of homes did not realize that the steady increase in housing prices was not sustainable, that it was a classic bubble, which would pop as soon as there was any downturn in prices.

Free-market theory is not entirely wrong. It lines up with an analysis of the effect of contingencies on behavior to some extent. For example, if a market participant has accurate information about the value of things they might buy or sell, they will tend to maximize their benefits. In this case, their behavior will be selected by consequences that are truly beneficial.

Indeed, if free-market theory were consistent with what we know about the contingencies of reinforcement, it would have predicted the debacle that occurred. Markets work to provide increasingly better goods and services because the actors who improve those goods and services are reinforced for doing so. It is the reinforcement for the actor that matters. What were the reinforcers for the people who ran the rating agencies? Getting business from the banks. They provided exactly the service that the banks needed. The banks got what they wanted, profits from the sale of CDOs. The home buyers got what they wanted, homes to live in or to flip. All of the actors in this tragedy were getting immediate reinforcement for the actions they took. They did exactly what behavioral scientists would have predicted.

Of course, the long-run consequences for many of the actors in this story were distinctly negative. Although many of the big banks made out just fine, millions lost jobs, houses, and, in some cases, their lives (due to suicide and heart attacks). In the absence of effective analyses of the long term consequences of our behavior, human behavior, like that of other organisms, will be selected and maintained by its immediate consequences.

The History of the Free-Market Illusion

The Great Recession was the culmination of a nearly forty-year evolution of free-market theorizing that led to the abandonment of the policies that had been put in place as a result of the Great Depression.

Let’s start this history lesson with the Great Depression. In 1929 the American stock market crashed. The crash was the result of the unsustainable run-up in the value of stocks—a classic bubble. At the time, there was virtually no regulation of the stock market. Requirements regarding the information to be given to prospective investors were minimal. The dictum Caveat emptor—let the buyer beware—was about all there was.

As stock prices rose and banks became more aggressive in marketing investments, it brought many people into the market who had never invested in stocks and who had very little understanding of investment. Among the factors that contributed to this situation was the increase in advertising largely as the result of the spread of radios; by 1930, 60% of households had radios.4

The situation was made more precarious because people could buy stocks on “margin.” They could put up only 10% of the price of the stock and pay off the rest when the price of the stock rose (which it did through most of the 20s.) However, by 1929, the economic expansion that had begun in 1920 ran out of steam. There were no more people who could enter the market and buy goods thus continuing the expansion. Stock prices began to level off or decline, which resulted in “margin calls”—the demand that those who bought on margin put up more money to cover their loans. That led to a panic in which people were forced to sell their stocks. By 1932 the market had lost 90% of its value. Thus, began the most prolonged depression in U.S. history. It did not fully end until the U.S. stepped up war production in 1939.

There were numerous Congressional investigations of what had happened. However, little progress had been made in coming up with ways to prevent what had happened from happening again.

That changed in 1933 when Ferdinand Pecora was appointed chief counsel to the Senate Banking and Commerce Committee. The story is told by Michael Perino, in his delightful book, The Hellhound of Wall Street.5

Pecora was an Italian lawyer who had gained some prominence for his skill in cross-examination as an Assistant District Attorney in Manhattan. I say he was Italian because in those days it was significant. There was still substantial discrimination against “Dagoes” a pejorative term that at the time was commonly used. He was an unlikely person to bring about significant reform of Wall Street banking practices. He only got the job as chief counsel three months before the Committee’s charter to hold hearings was going to expire.

Pecora subpoenaed Charles E. Mitchell the Chairman of the Board of City Bank to testify before the committee. At the time, the bank was the largest commercial bank in the country. The bank led the way in marketing investments to the middle class. They created a network of offices that assured inexperienced middle-class investors that they would provide the guidance needed to invest wisely. They marketed their services through extensive advertising, something that banks had seldom done.

Mitchell had testified earlier, but very little of note had resulted from that testimony. However, through careful analysis of the minutes of the board of directors meetings and skillful questioning, Pecora revealed how much the bank was reaping profits for its leadership at the cost to investors and the bank’s customers.

City Bank was a commercial bank. Commercial banks take deposits and make loans. This is different from an investment bank, which arranges the offering of stock for companies, facilitates mergers and reorganizations of companies. Goldman Sachs is a prominent example of an investment bank. At the turn of the 20th Century, commercial banks were prohibited from selling stock. However, between 1900 and the 1920s this prohibition had eroded. City Bank had created an affiliate, which it controlled, National City Company, which sold stock. At the time of the hearings, Hugh Baker was the President of National City Company. He also testified.

Pecora proved that the concerns about allowing commercial banks to sell stocks and bonds were well placed. Through its affiliate National City Company, City Bank was selling stock, including City Bank’s own stock, to the bank’s customers. The bank used every newly developed marketing method they could to sell their stocks and bonds. They had a large, nationwide team of salespeople, who had lists of bank customers to whom they could sell the stock. Tremendous pressure was put on them to increase sales. They got bonuses for meeting sales targets and had contests to see who could sell the most. That might sound positive, but employees also knew that they would be let go if they did not meet sales targets. Between 1927 and 1933, the number of people owning the bank’s stock went from 15,000 to 86,000.

Through massive advertising the bank presented itself as a secure, wise, and trusted financial advisor. It encouraged customers to use their savings, including bank deposits and government bonds, to buy the bank’s stock on margin. At that time, the margin was 10%.

Pecora zeroed in on the many ways in which the Mitchell and his fellow executives put their own interests ahead of the interests of customers and lower-level employees. First, there was the bonus system for top executives. Funds were put aside each year to pay for bonuses to top executives. Mitchell got 40% of the bank’s management funds and 30% of the National City Company bonus funds. Mitchell received more than $3.5 million from 1927 to 1929. The equivalent of $50 million in 2017.

When the crash of 1929 came in October, the bank lost a lot of money. However, the executives never returned any of the bonuses they got early in 1929. And they never disclosed their bonuses to stockholders, many of whom had been convinced to buy the banks stock as a better investment than government bonds. Second, the bank did not reveal the spread between what they paid for a bond and what they charged a customer. Gullible people who had no experience in investment were persuaded to trust that the bank had their interests at heart. Mitchell said that he saw no reason why the fact that the bank profited from the sale of securities was something that should be disclosed to their depositors.

Third, the bank did not disclose the risks that people were exposing themselves to in moving their money from savings or government bonds to the purchase of the bank’s stock. The bank’s stock quadrupled in price between 1926 and 1928 thanks largely to National City Company’s promotion of it. So it was easy to persuade them that it was a better investment than government bonds.

Fourth, when the stock crashed Mitchell and his fellow executives used company money to avoid losses. Two weeks after the crash, bank executives were in trouble because they had purchased the company’s stock on margin and they could not meet the margin calls. The bank lent the top 100 executives the money to pay the margin calls interest-free and never recovered much of that money. Thus the stockholder’s money was used to bail out the executives. At the same time, the bank took the savings of many of its customers who had put up those savings as collateral for the purchase of the bank’s stock, but had no money to put up to meet the margin call. When questioned about the discrepancy between the way that the bank’s executives and its customers were treated, Gordon Rentschler, the President of City Bank, justified taking customers’ saving by saying “It is the absolute rule of the bank to preserve its assets that are secured in any manner.”

The bank also failed to address the plight of lower-level employees who had been sold the banks’ stock on margin for $200 a share in December 1929. This sale which occurred after the crash was promoted to try to keep the price of the stock up. When the price of the shares sunk as low as $25, employees were forced to pay off the loans despite the stocks diminished values. The only way out for these employees was to resign their position. However, with unemployment at 25% and millions of people homeless and hungry, there were few employees willing to risk losing their job.

Pecora also got a stunning admission from Mitchell. Mitchell sold 18,300 shares of the Banks’ stock at the end of 1929 and bought it back in early 1930. He did this to create a loss for tax purposes. As a result, he paid no tax in 1929 and took home $1.1 million in salaries and bonuses. ($15,746,467 in today’s money.) This was tax evasion. (He had sold the stock to his wife).

The result of the first week of testimony by the City Bank officials was a chorus of outrage from the media, citizens, and politicians. The hearings were occurring at the height of bank failures all over America. At the time, the Federal Deposit Insurance Corporation did not exist. Thus, if a bank becomes insolvent and was unable to cover withdrawals from savings deposits, the depositor was simply out of luck. If you have seen It’s a Wonderful Life, you have witnessed a run on banks.

For the first time, millions of Americans learned how untrustworthy and selfish bankers could be. Over the weekend, both Charles Mitchell and Hugh Baker, the President of the National City Company resigned.

Pecora nonetheless continued the hearings. He called Hugh Baker, the National City president back to testify. He established that the bank did a brisk business in South American bonds. Pecora first established that for much of the 1920s the bank had evaluated Peruvian bonds as unsafe. However, after an improvement in the Peruvian economy and given the continued pressure from Mitchell to sell stocks and bonds, the company began to sell Peruvian bonds.

Pecora showed that despite the dismal evaluation over many years of the ability of the Peruvian government to pay back bonds, the prospectus for the bonds, which they quickly sold, made no mention of any risks of this investment. When he directly asked Baker if he could find any mention of the bad credit record of Peru, Baker replied, “No I do not see anything.” Instead, the ads for the bonds stated: “When you buy a bond recommended by National City Company, you may be sure that all the essential facts which justify the company’s own confidence in that investment are readily available to you.” According to Perino, the bank’s profit on the sales of the bonds was $100 million in today’s dollars.

Pecora also entered into the record the doubts of one of the company’s own South American experts to the effect that the Peruvian economy was unlikely to improve and that the political situation was uncertain and could possibly result in revolution. When asked if the public would have bought the bonds if that information had been provided to them, Baker admitted that he doubted that they would.

Finally, Pecora presented documents and elicited testimony from Ronald Byrnes, the former head of the foreign bond department at National City that showed that the company had marketed bonds for the Brazilian state of Mina Geraes. Here too the track record of the State in paying its debts was pathetic according to George Train who had urged the underwriting of the bond offering. He had written in company documents, “The laxness of the State authorities borders on the fantastic.”

National City said in its prospectus that the bonds were being issued for the purpose of increasing the “economic productivity of the State.” What the prospectus did not reveal was that under a Mina Geraes State law that National City lawyers had actually written, the bonds could be used to pay off existing debt. What debt? Half of the bond funds were going to be used to pay off existing loans from National City. The company was raising money from investors to escape default on earlier loans they had made to the state. The investors would have had to have read the law in Portuguese to learn that the funds raised could be used for this purpose.

Reforms Adopted in the 1930s

Ferdinand Pecora’s work for the Senate Banking and Commerce Committee was not the only thing that prompted reform of the financial system. The situation was dire in 1933. Banks were failing right and left. By the last week of the Pecora hearings, 20 states had made laws allowing restrictions on withdrawals or outright closing of banks to prevent bank failures. At the same time, there was 25% unemployment and people starving to death. Given the rage of the populous that was stirred up by the committee hearings, there was much more public pressure to make laws in reaction to the crisis than we saw in 2008.

The Committee continued to hold hearings after the Democrats took control of the Senate and President Roosevelt was inaugurated in March of 1933. Within that year major reforms were enacted. The first was the Truth in Securities Act, which required that the seller of securities provide accurate information about the risks of each investment. It made the sellers liable for false or misleading information.

The Banking Act of 1933, also known as Glass Stegall, prohibited commercial banks from also selling securities. It also created the Federal Deposit Insurance Corporation which established insurance for bank deposits up to $2500. It now insures deposits up to $250,000. This insurance has eliminated the risk of bank failures due to a panicked withdrawal from banks.

Finally, in 1934 the Securities Exchange Act created the Securities and Exchange Commission. It required all stock exchanges to register with the federal government. It regulated margin trading, which had contributed to the bubble in stocks in the 20s. It also prohibited insider trading, in which someone could use inside knowledge of what a company was about to do to buy stock in advance of its increase in value. Joseph P. Kennedy, JFK’s father became the first head of the SEC. He had made a fortune on Wall Street and knew all of the tricks. In an atmosphere in which capitalism seemed to be imperiled, he was happy to reform the system in the interest of saving it.

In 1996, Senator Daniel Patrick Moynihan6 published a figure showing the ups and downs of the Gross Domestic Product in the United States from 1890 to 1993. It is reproduced here.

The Gross Domestic Product is the total of all goods and services produced in the nation. Notice the extreme changes that occurred in GDP up until 1947. The Great Depression from 1929 until 1940 was by far the longest and deepest decline in GDP. The recession of 1949 was deep but lasted only 11 months. After that there five minor recessions. Moynihan used this chart to illustrate how much progress we had made in managing the economy. We reduced the length and depth of recessions due to the reforms initiated in the 1930s along with improvements in our ability to measure and forecast economic trends and the creation in 1947 of a policy to minimize both inflation and unemployment. The reforms of the 30’s reduced the risk of bubbles by preventing the kind of fraudulent promotion of securities that Pecora and the Banking and Commerce Committee revealed and the reforms prevented bank failures due to panicked withdrawal that deepened and prolonged recessions.

I used to use Moynihan’s chart in talks I gave and things I wrote7 about how we can improve the wellbeing of children and adolescents. I argued that the chart showed how, with careful data collection and good policy, we could manage the economy. I argued that in the same way, with careful monitoring of child and adolescent wellbeing and the widespread implementation of tested and effective policies we can prevent most of the child and adolescent problems that affect young people’s life prospects. (See The Nurture Effect for further details.)

But of course, that argument has unraveled since the Great Recession of 2008. That downturn was the deepest and prolonged since the Great Depression. It would seem to belie my claim that we can manage the economy.

But not so fast. The fact of the matter is that we wandered away from the policies and practices that were established in the 1930s and 40s that did succeed in minimizing recessions.

How Free-Market Thinking Undermined the Management of the Economy

Alan Greenspan was the Chairman of the Federal Reserve from 1987 to 2006. He was one of the most influential economists of the past fifty years, and a strong believer in free-market principles. In looking back on the crash of 2008 he said, “Those of us who have looked to the self-interest of lending institutions to protect shareholders’ equity, myself included, are in a state of shocked disbelief.”

Sebastian Mallaby has written a 700-page biography of Greenspan, The Man Who Knew.

Greenspan believed that it was impossible to predict bubbles and that the mess that they created could be cleaned up by lowering interest rates and bailing out the entity. Bailouts were contrary to what he originally believed, but when he found himself in positions of power as head of the Council of Economic Advisors and as Fed chair, as a practical matter, it was wiser to bail them out than to let a failure take down many other entities that had loaned to the failing company.

For example, in 1998 Long-Term Capital Management Trust collapsed when its investment practices proved to be far less smart than they had appeared to be. LTCM was a hedge fund that included two partners who had won the Nobel Prize in economics for their work on determining the value of derivatives. (Derivatives are investments whose value is derived from its relation to an underlying asset. A credit default swap is a derivative.) The LTCM leadership believed (and got many investors to believe) that they had refined the prediction of risks to the point where they could buy investments that others thought were too risky, but that their analysis indicated were not as risky as the market believed. They also sold insurance against the loss of value of financial instruments, based on their supposedly superior analysis of the risk. The flaw in their system was that it was based on an analysis of a short period in which markets did not fluctuate as much as they could. As a result, they were simply wrong about the risk of much of what they bought. When Russia defaulted on its bonds, they were in trouble. In 1998, they had lost $1.9 billion and 44% of their capital.

Greenspan understood the problem of “moral hazard.” If a bank or other investment organization made reckless investments but was bailed out by the government rather than being allowed to fail, then subsequent investors would be more comfortable in taking big risks. However, the collapse of LTCM posed a risk to all the other institutions that LTCM had borrowed from. Under the circumstances, Greenspan supported Peter Fisher of the New York Federal Reserve persuading the heads of sixteen banks to lend LTCM $4 billion to prevent its collapse.

Mallaby recounts a series of financial crashes during Greenspan’s time as Fed Chairman. In every case the government rescued the system by pouring money into to prevent bankruptcies.

The financial system has evolved in many ways since the reforms of the 1930s were enacted. Many new forms of investment have been invented, in particular derivatives. Globalization has meant that financial transactions are far more frequently international. High technology has changed the extent and speed with which transactions occur. The financial industry has grown and created a variety of organizations that did not exist in the 1930s. All of this has created huge challenges for regulation—even if the government and the leaders of the financial industry had agreed that regulation was necessary.

But virtually all of our leaders over the past thirty years have believed that regulation was not useful or not possible. Mallaby recounts how Greenspan had flirted with increasing regulation of some of the more questionable practices on Wall Street He had certainly been an opponent of regulation through much of his career, but some of what became apparent in the 90s and 2000s caused him concern. However, the Fed did not pursue it, partly because of its complexity. The Fed had regulatory responsibility for only certain sectors of the financial industry and various other federal agencies had responsibility for other sectors.

In the end, the system failed the American people. The basic problem is that risk-taking is reinforced when there are big profits to be made short term and little likelihood of negative consequences for taking those risks. Repeatedly the system has failed to regulate the riskiest practices but has bailed out the risk-takers when they got into trouble rather than allow a wider network of institutions to be pulled down.

In making the case for an alternative to free-market economic theory or to otherwise criticize current practices of capitalism, it is tempting to make the proponents of these views out to be unvarnished villains. But life is not that simple and I am convinced that the common tendency in public discussion to vilify and attack does not advance the goal of creating a more nurturing society. We will not punish our way into a more nurturing society.

Alan Greenspan is a case in point. Sebastian Mallaby’s biography of Greenspan convinces me that Greenspan is a kind, genial, and extraordinarily well-informed man. Greenspan’s distinctive quality as an economist was that he loved data. During the time in which he was coming of age, the field of economics made massive strides in the collection of data. Greenspan was one of the pioneers in this regard. He developed a consulting firm that provided very useful analyses of economic data to businesses that improved their forecasting, and thereby, the financial success of the companies that hired him.

However, if Greenspan had had a more accurate understanding of the contingencies that drive human behavior, he would not have been shocked by the crash of 2008. If we want our market systems to function for the good of everyone, we need to abandon the vague free-market theory that says that as long as government doesn’t interfere, market “forces” will ensure that everyone benefits from market transactions. Instead, we need to—and readily can—understand the contingencies affecting everyone’s behavior in a market system and assess the long term consequences of the system. We need to consider not only the consequence to the actors in the market but those who may be affected by transactions that they have no control over.

The Values of Wall Street

There is another aspect of the financial industry that needs to be examined—its values. Free-market ideology has encouraged people to believe that if they pursue their own wealth, they will necessarily benefit others. This has encouraged the development of a culture of self-aggrandizement that has ended up justifying egregious behavior. Some examples:

  • Wells Fargo’s creation of phony accounts without customers’ knowledge.8 The bank opened as many as 2.9 million accounts9 and issued 565,000 credit cards that customers did not request
  • Banker’s Trust created complicated derivatives that not even the CEO of the company understood. Mallaby described one derivative in which the investor made money so long as interest rates stayed within a certain range—if they went higher or lower—the investor lost money: “This sort of arrangement had no obvious risk-management purpose; it was a gamble, pure and simple. It was a gamble, moreover that the clients were almost bound to lose…” The Banker’s employees routinely referred to the “rip off factor.” According to Mallaby, one employee was recorded saying that selling these investments would be “a massive, huge, fucking, gravy train.”
  • Widespread unethical behavior. A 2015 report from the University of Notre Dame’s Mendoza College of Business, found that seven years after the Great Recession began, a huge proportion of people working in the financial industry in the U.S. and the U.K. believed that there was rampant unethical behavior in the industry. Forty-seven percent believed that their rivals were breaking the law or acting unethically. Twenty-seven percent believed that the industry did not put the interest of the client first. Sixteen percent said that their companies’ confidentiality policies prohibited them from reporting illegal behavior.
  • Criminal conduct. One way that a society deals with behavior that is harmful to others is by making it illegal and punishing such acts. However, very little of the type of egregious behavior on Wall Street is prosecuted.
    • Writing in The Atlantic in 2015, William Cohan described the reticence of justice department officials to prosecute Wall Street bankers. When he was Deputy Attorney General, Eric Holder wrote a memo warning that such prosecutions could cause corporate instability or collapse. In 2012, the head of the Justice Department’s criminal division, Lanny Breuer, said that “it was his duty to consider the health of the company, the industry, and the markets in deciding whether or not to file charges.”
    • The Wall Street Journal reported in 2016 that 156 prosecutions had occurred since 2008, but that few people had been convicted. They attributed this to the fact that many of the things people were accused of, although harmful to others, were not actually illegal.
    • Defenders of Wall Street will argue that the banks have paid huge penalties for their mistakes–$190 billion in fines and settlements. These are literally a cost of doing business; banks were often able to deduct these fines as a business expense.

Compensation

The contingencies on Wall Street promote egregious behavior in two ways. First, the huge bonuses that people get to create a competitive environment in which each person’s worth is measured by the size of their bonuses. This is not simply a matter of money affecting behavior, it is the creation of a social environment in which people are encouraged to measure their self-worth in terms of the money they make. The result is a culture where making money is the end-all and be-all.

As of 2015, the profits of the financial sector as a portion of the overall economy were twice what they had been for the last 70 years of the 20th Century. The average pay of people working in the financial sector is 3.6 times that of the average American worker.10 However, a study by Thomas Philippon of New York University suggests the United States financial industry has become less efficient over the last 130 years at channeling capital toward productive use. And this same phenomenon may be a major contributor to rising inequality.11

Finance from an Evolutionary Perspective

It may seem like the financial world is quite different from the tobacco, gun, food, and pharmaceutical industry. However, the principles of variation and selection are as relevant to finance as the other industries. The practices of banks and related financial institutions are selected by their impact on profits. And in the context of values that lionize material self-aggrandizement, there are no countervailing forces that would restrain these organizations from using every lever they have to maximize their gain even when it is costly to the rest of society.

We need to change the contingencies that have selected and maintain current practices—contingencies like astronomical salaries for the people at the top and a social system that admires the accumulation of great wealth and fails to chastise or punish those who achieve it at a cost to others. This is a matter of changing the laws and regulations that allow so many practices to simply be the cost of doing business, because even after the fines, the companies are making great profits and their leaders are getting rich. But we will not get very far in changing laws and regulations so long as wealth accumulation trumps every other value. Reform begins with a reform of our values.

Action Implications

Personal

  1. Save for retirement. The economic policy Institute reports that half of the people between 50 and 55 have $8000 or less save for retirement. One of the major reasons for this is that a large proportion of Americans don’t earn very much. But another is that people don’t establish the habit of saving money. The easiest way to save for retirement is to have a fixed amount taken out of your pay and automatically put into a retirement account.
  2. If it seems too good to be true, it probably is. I am not an investment advisor. But I do know that it is unlikely that an investment will make more than 10% tops. (Unless of course you are a member of the 1% and have access to investments that you and I would not have access to.) But it is important to realize that if you begin investing small amounts of money early on it does add up thanks to compounding. A rough rule of thumb is what I have been taught is the rule of 72. Whatever amount of money you have, if you divide the interest you get on your investment into 72, it will give you an estimate of how many years it will take to double. For example, an investment of $10,000 that makes 6% a year will take 12 years to double. Another 12 years and you’ll have $40,000.

Policy

  1. Support stronger regulation of the financial system. In Rebooting Capitalism, I describe how the leadership of the Democratic Party has been co-opted by Wall Street. Your efforts to support reform in this country should include a demand that the financial system be much more closely regulated. This would include criminal prosecution of wrongdoers that result in some jail time and the confiscation of all profits that resulted from the wrongdoing. Of course, many of the misdeeds of Wall Street are currently not illegal. Reform must begin by changing the contingencies for practices that have a high risk of causing financial calamity.

Organizations Working to Reform Financial Practices

Here is a website that lists numerous organizations working to improve economic justice. It includes groups working on anti-corporate domination, progress economic research, progressive taxation, consumer protection, and socially responsible business groups. http://www.startguide.org/orgs/orgs04.html


Read the Full “Cultural Evolution of Social Pathologies” Series by Anthony Biglan:

  1. Introduction by David Sloan Wilson
  2. How Cigarette Marketing Killed 20 Million People
  3. The Right to Sell Arms
  4. How and Why the Food Industry Makes Americans Sick
  5. Big Pharma and the Death of Americans
  6. How Free-Market Ideology Resulted in the Great Recession
  7. The Fossil Fuel Industry: The Greatest Threat to Human Wellbeing
  8. The Crisis of Capitalism

References:

  1. Reeves A, Stuckler D, McKee M, Gunnell D, Chang SS, Basu S. Increase in state suicide rates in the USA during economic recession. Lancet. 2012;380(9856):1813-1814.
  2. Maruthappu M, Watkins J, Noor AM, et al. Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990–2010: a longitudinal analysis. The Lancet. 2016;388(10045):684-695.
  3. Red Flags. In Wikipedia. n.d.; https://en.wikipedia.org/wiki/Madoff_investment_scandal#Red_flags. Accessed April 10, 2019.
  4. xroads. Radio in the 1920s. n.d.; http://xroads.virginia.edu/~ug00/3on1/radioshow/1920radio.htm. Accessed April 10, 2019.
  5. Perino M. The Hellhound of Wall Street: How Ferdinand Pecora’s Investigation of the Great Crash Forever Changed American Finance. New York, NK: The Penguin Press; 2010.
  6. Moynihan DP. Miles To Go: A Personal History of Social Policy. Boston: Harvard University Press; 1996.
  7. Biglan A, Brennan PA, Foster SL, Holder HD. Helping Adolescents at Risk: Prevention of Multiple Problem Behaviors. New York: Guilford; 2004.
  8. Corkery M. Wells Fargo Fined $185 Million for Fraudulently Opening Accounts. Business & Policy 2016; https://www.nytimes.com/2016/09/09/business/dealbook/wells-fargo-fined-for-years-of-harm-to-customers.html Accessed April 10, 2019.
  9. Brown J. Wells Fargo Has Found 1.4 Million More Phony Accounts, Somehow Still Has Customers. 2017; https://gizmodo.com/wells-fargo-has-found-1-4-million-more-phony-accounts-1798665893. Accessed April 10, 2019.
  10. Irwin N. Wall Street Is Back, Almost as Big as Ever. The Upshot 2015; https://www.nytimes.com/2015/05/19/upshot/wall-street-is-back-almost-as-big-as-ever.html. Accessed April 10, 2019.
  11. Turbeville W. Financialization & Equal Opportunity: Financialization is a major driver of growing inequality and undermines key sources of growth and job creation. 2015; http://www.demos.org/publication/financialization-equal-opportunity Accessed April 10, 2019.

This article is related to Anthony Biglan’s new book Rebooting Capitalism: Forging a Society that Works For Everyone.

When asked who owned the patent of the vaccine, Salk famously remarked, “There is no patent. Could you patent the sun?” Talk about selfless service to society!1

Of all the industries I am covering, the pharmaceutical industry might lay claim to being the industry with the largest net benefit to humans. Start with antibiotics. My older sister, Hekate, tells me that when I was an infant in 1945, I was hospitalized for pneumonia, and they feared I would die. My uncle Al, however, was a physician who was in the military. He was able to get the new wonder drug, penicillin. It may have saved my life.

Since the discovery of antibiotics, millions of lives have been saved. How many? I find claims that penicillin alone saved between eighty and two hundred million lives, but I cannot find any actual data. We do know that penicillin was the first drug that effectively treated pneumonia, strep throat, scarlet fever, diphtheria, syphilis, gonorrhea, meningitis, tonsillitis, and rheumatic fever.2 Certainly penicillin and the other antibiotics developed since then have made a huge difference in human wellbeing.3

Very significant progress has also been made in pharmaceutical treatments for cardiovascular disease. For example, a meta-analysis to assess the average impact of statins across multiple experimental evaluations of them showed that they lowered the risk of death by 19%.4 Similarly, a meta-analysis of evaluations of anti-hypertensive medications showed that they lower the rate of any cardiac event by 22% and the rate of strokes by 41%.5

In sum, there is no question that the pharmaceutical industry has been of great benefit to human wellbeing. However, the industry has also evolved some harmful practices. I review several of them and describe how they evolved. As you will see, this is another example of an evolutionary process that was driven by the profits they produced for the industry.

Harmful Consequences of Some Industry Practices

I will only present four examples of harmful practices, but they suffice to show how even an industry that is organized to produce much better health of American’s can evolve practices that reduce wellbeing.

The Opioid Epidemic

The number of people killed by opioid deaths is stunning. The Centers for Disease Control reports that between 1999 and 2016, more than 630,000 people died from a drug overdose involving prescription opioids or heroin.6 A New York Times investigation concluded that more than 59,000 people died of some form of drug overdose in 2016. That would make it the eighth leading cause of death.7

There are a number of reasons for this epidemic, including the loss of jobs among working class people and the instability of families, which I document in Rebooting Capitalism. However, a major cause was the shift toward aggressive treatment of pain with opioids. In testifying at a Senate Caucus on International Narcotics Control,8 Nora Volkow, the Director of the National Institute on Drug Abuse cited three factors leading to the opioid epidemic: “drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies.” She indicated that 76 million prescriptions for opioid pain killers were written in 1991, but by 2013, the rate had risen to nearly 207 million, which is two thirds of the U.S. population.

A thorough and I think balanced account of the history of the opioid epidemic was written by Chris Elkins. It can be found at the website of DrugRehab.com (https://www.drugrehab.com/opioid-epidemic/). He recounts how the U.S. has gone through several different periods of widespread use of opioids and other periods where their use was very limited. In the late 19th century opioid addiction was common. The extensive use of morphine during the Civil War contributed to high levels of addiction. Morphine was available without prescription at that time. In 1914, however, the Harrison Narcotics Act made opioids available only by prescription. What commenced was a period where physicians avoided prescribing them even for people who were dying of painful cancers.

In the 1980s, however, thinking about pain relief began to change. There was a report that people treated in hospitals with opioids seldom became addicted. Another concluded that for non-cancer pain patients, these medications could be safely prescribed with little risk of abuse. That study called for further research to assess long-term outcomes, but those studies were never done.9

In the 1990s, given the reports of the apparent safety of opioids and the increasing advocacy for better pain relief, the three pharmaceutical companies that made these narcotics– Purdue Pharma, Johnson & Johnson, and Endo Pharmaceuticals—began to aggressively market them for long-term use with patients with non-cancer related pain. The companies funded the creation of American Academy of Pain Management and the American Pain Society, the latter of which developed guidelines which advocated expanded use of these medications. The companies provided continuing education to physicians which encouraged prescribing these medications for pain.

Not only was there an effort to promote the prescription of these narcotics, there was a move to punish physicians for failure to adequately treat pain. Physicians with ties to the drug industry drafted rules that the Federation of State Medical Boards adopted, calling on state boards to punish physicians who failed to prescribe medication for pain. The Federation was at that time receiving funds from the drug companies.9

The dramatic rise in overdoses from opioids led to efforts to curtail prescribing. Wilson Compton and his colleagues10 reported that the rate of prescribing and the rate of overdose deaths due to opioids plateaued in states that were working to reduce the over-prescription of opioids. However, with millions of Americans addicted, it is not surprising that, as it became harder to get them, some turned to heroin. Compton et al. report that “914,000 people reported heroin use in 2014, a 145% increase since 2007” and that “mortality due to heroin overdose more than quintupled” between 2000 and 2014. They indicate that people who are already addicted to prescription opioids are particularly likely to begin to use heroin. They attribute the increasing use of heroin to the fact that it has become cheaper. It seems that the drug cartels are outselling the pharmaceutical companies.

The Treatment of Attention Deficit Hyperactivity Disorder (ADHD)

The U.S. has a higher rate of diagnosing and medicating ADHD than other countries. They are ten times greater in the United States than in the United Kingdom.11 There was a five-fold increase in the number of U.S. children being medicated with psychostimulants between the period 1988-1994 and 2007–2010.12 Young children (under age 5) are increasingly being medicated. The CDC raised concerns about overmedication of young children with psychostimulants; 75% of young children who have a diagnosis of ADHD are on medication, generally either Adderall and Ritalin.13 This is true despite the fact that the American Academy of Pediatrics recommends the use of behavior therapy rather than medication for young children who “have” ADHD. They point out that behavior therapy is effective and that the impact of given young children psychostimulants such as Adderall and Ritalin is unknown and could be harmful.

Sanford Newmark, the head of the pediatric integrative neurodevelopmental program at the University of California, San Francisco, says that the long-term effects of these drugs have not been well-studied. Side effects of these medications include poor appetite, sleeplessness, irritability and slowed growth.14

Research beginning in the 1970s showed that stimulant medication of children can impede their growth.15 However, additional studies have not replicated this effect.16

Although concerns have been raised that these medications could lead to drug abuse in adolescence, the research indicates that use of these medications is associated with a lower likelihood of drug abuse in adolescence and early adulthood.17

Despite evidence of the value of behavior therapy18 and omega 3 fatty acid supplements,19 for the treatment of ADHD, the dominant treatment for ADHD continues to be psychostimulants. The main reason seems to be that none of the alternative treatments are being promoted with anything like the skill and budget that the drug makers are spending on marketing and promotion.

Unlike most physical disorders—pneumonia, cancer, heart disease–there are not clear cut physiological processes that can be used to diagnose ADHD. ADHD is a behavioral disorder. If you look at the behaviors that are said to be diagnostic of ADHD, you can see why it has been easy to promote the prescribing of psycho-stimulants to young children. According to DSM 5 a child can be diagnosed as “having” ADHD if they are inattentive and/or hyperactive. Examples of inattention include:

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
  • Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
  • Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

If you have or have ever had a young child, it would be remarkable if you had not observed these behaviors.

Examples of the behaviors that count as symptoms of hyperactivity or impulsivity include:

  • Often fidgets with or taps hands or feet or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often unable to play or engage in leisure activities quietly.
  • Is often “on the go,” acting as if “driven by a motor”.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.

These are the behaviors that young children engage in. It should not be surprising that the youngest children in any given grade are more likely to be diagnosed as “having” ADHD and be put on medication.20. If you were a parent of a child who engaged in these behaviors “often” (how often is often?) and you believed that ADHD is a physiological condition, and you were highly motivated to be sure your child was treated for any illnesses they had, and you had been exposed to pharmaceutical advertising of ADHD medications, how likely would you be to allow your child to be put on medication if they exhibited many of these behaviors?

My reading of the research on the effects of psychostimulants does not lead me to conclude that the harm of these medications is proven. But their safety for young children has also not been proven. And, it is clear that the extensive prescribing of these medications is more a function of the marketing skill of the pharmaceutical industry than the harm to public health of hyperactive children.

I can remember sitting next to my son in a movie theater and being driven crazy by his constant movement. Sleeping with him was an adventure. Yet as a person familiar with behavior therapy and aware that the risk of hyperactivity for further problem development had only been found for children who were also aggressive,21 there is no way that I would have had him medicated. (He turned forty this year; he is a successful business man and a wonderful human being—and he does not fidget anymore.)

The Evolution of Resistant Strains of Bacteria

My mother was a nurse at the University of Rochester’s Strong Memorial Hospital in the early 1960s. At that time, there was a dramatic rise in a strain of staphylococcus aureus in hospitals that came to be called “hospital staph.” Patients admitted to the hospital often contracted the infection. Many died.

My mother was a good manager. They had put her in charge of the hospital ward for burn patients. One of the greatest dangers to the survival of burn patients is infection. My mother implemented a system for the ward, which involved sterile precautions for the treatment of burn patients. Whenever a staff member went into a patient’s room, they donned a protective gown, put on a mask so that the patient would be exposed to as few germs as possible. And so when the staph infections became a serious problem, they put those patients on my mother’s ward, because her staff were trained in sterile precautions. (The rooms were all singles and they were thoroughly fumigated after every patient.)

This was an early harbinger of what was to come. The principles of variation and selection are at the root of this story. If you have ever taken antibiotics, you know that your instructions were to take the entire course of antibiotics, even if your symptoms disappeared before you finished taking them. This is important because the germs the antibiotic is going after vary in how readily the antibiotic will kill them. In the first few days of taking the drug, the least-resistant bacteria are done in. When that happens, your symptoms may disappear. But if you stop taking the antibiotic then, the more resistant bacteria will remain and you will have selected that more resistant strain. Those remaining bacteria may multiply and may prove very difficult to kill.

I think what happened in hospitals is that whenever a patient got a staph infection, they used penicillin to treat it. I suspect they also got more lax about sterile precautions, because everyone knew they now had the miracle drug. As a result they selected this very resistant strain.

The problem of antibiotic resistant bacteria has grown. A report of the CDC in 201613 showed that about two million Americans are infected with antibiotic resistant bacteria each year and about 23,000 die as a result.

A study published in the Journal of the American Medical Association (JAMA) by the Centers for Disease Control and Prevention (CDC) concluded that about 30% of the antibiotics prescribed in the United States are unnecessary.13,22 The most common misuse is the prescription of antibiotics to treat virus infections of the respiratory system. Antibiotics simply don’t kill viruses. But their use in this way is contributing to the selection of resistant bacteria.

Another factor that contributes to the problem is the extensive use of antibiotics with livestock. They are used in three ways: (a) to treat infected livestock; (b) to prevent livestock from becoming infected; and (c) to accelerate their growth. Melinda Moyer, writing in Scientific American, describes visiting a 40 by 200 foot barn that held eleven hundred pigs. Having them in such close quarters is one reason that antibiotics are needed. In addition to the concern that these practices may be contributing to bacterial resistance, there is a concern that the antibiotics will remain in the livestock when they are consumed by humans.23

Recent research shows that resistance can spread more rapidly than was believed. Research in the Netherlands has shown that a resistant strain of Staphylococcus Aureus was being passed from pigs to humans.24 Moyer argued that: “In 2014 pharmaceutical companies sold nearly 21 million pounds of medically important antibiotics for use in food animals, more than three times the amount sold for use in people. Stripped of the power of protective drugs, today’s pedestrian health nuisances—ear infections, cuts, bronchitis—will become tomorrow’s potential death sentences.”

A third reason for the rise of antibiotic resistance is the manufacturing process for these drugs. An investigative report by SumofUs.org, a non-profit organizations working to “stop big corporations from behaving badly,” reported that the release of antibiotics into the environment through polluting practices of drug manufactures, careless disposal of antibiotics, and human and animal excretion of them have been overlooked as a source of bacteria resistance.

In order to control the uses of antibiotics with livestock, the Food and Drug Administration implemented regulations in January of 2017 requiring a prescription from a veterinarian. However, the pharmaceutical industry has expanded its marketing of antibiotics for animal use around the world, in places where regulations are lacking.25,26

The Rise of Anti-Depressive Medication

Twelve percent of American adults (29 million people) are taking anti-depressive medication.27 And according to the Director of the National Institute of Mental Health, 80% of these prescriptions are not written by psychiatrists and an unknown number of them are written for people who are not diagnosed as depressed.28

Irving Kirsch from the UK and five researchers from the U.S. did a meta-analysis of the results of all of the randomized trials that were submitted to the U.S. Food and Drug Administration to get approval for these drugs. The meta-analysis provides a statistical summary of the results across studies. They found that these anti-depressives had significant benefit only for people who were severely depressed.29 Moreover, they concluded that the reason that these trials show better outcomes for the severely depressed than for less depressed patients is not because the anti-depressive medication is more effective for severely depressed patients, but because the placebos do not have as much effect for these patients. In addition, it should be noted that two thirds of the people in these studies were not severely depressed. In other words, two thirds of the people prescribed these medications may be getting no benefit at all.

There is a risk of suicide and aggression in the treatment of children and adolescents with anti-depressive medication. The Nordic Cochrane Centre analyzed evidence regarding suicide and depression during anti-depressive drug therapy involving selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).30 They obtained the reports that the drug companies had submitted to the UK and the European authorities to obtain permission to prescribe these drugs. However, they reported that much of the information regarding possible harm to patients was missing from the reports. Nonetheless they found that the children and adolescents in these trials had more than double the rates of aggressive and suicidal behavior compared to those receiving placebos.

The brain hypothesis. A widely accepted theory of how anti-depressive medications work is that depression is due to low levels of serotonin in the brain. Serotonin is a neurotransmitter that is involved in the way that neurons stimulate other neurons. The first neuron releases serotonin. When the serotonin fills the space between neurons, it stimulates the next neuron to fire.

It is on the basis of this theory that depression has been considered to be due to a deficit in serotonin. The evidence has not supported this theory. People who are depressed do not have reliably lower levels of serotonin. Here is a summary of the evidence from a paper published by Lacasse and Leo in the journal PLOS Medicine.31

Regarding SSRIs, there is a growing body of medical literature casting doubt on the serotonin hypothesis, and this body is not reflected in the consumer advertisements. In particular, many SSRI advertisements continue to claim that the mechanism of action of SSRIs is that of correcting a chemical imbalance, such as a paroxetine advertisement, which states, “With continued treatment, Paxil can help restore the balance of serotonin…”

Yet […] there is no such thing as a scientifically established correct “balance” of serotonin. The take-home message for consumers viewing SSRI advertisements is probably that SSRIs work by normalizing neurotransmitters that have gone awry. This was a hopeful notion 30 years ago, but is not an accurate reflection of present-day scientific evidence.

The ultimate question is whether the widespread use of anti-depressive medication poses any risks to patients. Here is what I have been able to find on this question:

  • There is a small but significant increase in the risk of diabetes for people taking anti-depressive medication.32,33
  • There is evidence that tricyclic anti-depressive medication is associated with an increased risk of cardiovascular disease, but this was not the case for Selective Serotonin Reuptake Inhibitors.34
  • A meta-analysis of 12 randomized trials of the impact of tricyclic antidepressants for the treatment of depression for children and adolescents concluded: “Tricyclic antidepressants appear to be no more effective than placebo in the treatment of depression in children and adolescents.”35,36
  • Discontinuing SSRI medication results in withdrawal symptoms such as nausea, headache, fever, trembling, panic attacks and hallucinations, which motivate people to go back to taking them.37,38 A recent investigation by the New York Times found that the number of people who have been on anti-depressive medication for more than two years has soared.39 More than 15 million Americans have been on them for five or more years. The primary reason is that the symptoms they experience when they try to withdraw drive them back to taking the medication.

Pharma Business Practices

Now let’s look at the facts I just laid out from the standpoint of the business of pharmaceuticals. Like all other corporations, pharmaceutical companies are organized to make money. They will naturally do what they can to maximize their profits. The numerous advances that have been made in finding effective drugs are largely the result of the motivation of companies to find new drugs that will increase their revenues and profits.

Companies have an incentive to do whatever they can to maximize their profit. The issue here—and for all the other industries that I discuss—is which practices we will allow and which we will prevent. In all of the areas I just discussed—the opioid epidemic, ADHD, resistant bacteria, and the treatment of depression—the pharmaceutical industry has contributed clear benefits. Opioids are effective in reducing pain and under the right circumstances, can be administered without resulting in addiction. Some children with high rates of activity and related problem behaviors may benefit from psychostimulants. Antibiotics are unquestionably beneficial, and cases of severe depression appear to benefit from anti-depressive medication.

However some of the practices of the pharmaceutical industry—and a network of researchers, physicians, and health care organizations they work with—are contributing to the deleterious outcomes I described above. Let’s look at the evolution of these practices.

Expanding markets. One of the best ways to increase your revenues is to find new customers. In each of the cases I describe, the companies have extended the uses of their medications beyond uses that were initially found to benefit people. Opioid use has been encouraged for longer periods then are needed and for problems that could have been addressed with other pain killers or behavioral interventions. Parents who are troubled by their young children’s fidgety and annoying behavior and physicians who treat those children have been encouraged to diagnose the problem as ADHD and prescribe psychostimulants. The pharmaceutical industry has marketed antibiotics to accelerate animal growth and to treat infections that are not bacterial. And when restrictions were placed on their use with animals in the U.S. the companies expanded their marketing to less regulated countries. In the case of depression, the industry and its allies in psychiatry have loosened the criteria for depression by, for example, redefining bereavement as a form of depression40 that should be medicated. And despite the fact that the only clear evidence for the efficacy of anti-depressive medication is for people with severe depression, 12% of American adults (29 million people) are taking anti-depressive medication.

Each of these moves has been quite profitable. For example, whatever the facts regarding the “true” rate of ADHD, the benefits of medication, the alternatives to medication, and the availability of other treatments, the huge increase in medicating children for ADHD has been very profitable to some of the drug companies. The sales of stimulant drugs prescribed for ADHD increased from $1.7 billion to nearly $9 billion between 2002 and 2012.41

An investigation by the New York Times41 attributed the rise to an extensive and successful marketing campaign by the makers of these drugs, which encouraged parents to view common problems of young children’s behavior, such as being fidgety, forgetful, or getting poor grades as symptoms of ADHD.

Lobbying to prevent controls on drug prices. In 2003, Congress passed a law to subsidize drug costs for Medicare recipients. The drug companies got an amendment to the law that prohibited Medicare from negotiating with the companies for lower drug prices. Given the volume of drugs that Medicare is paying for under this law, don’t you think they would have some leverage to negotiate lower prices? But despite the money that the government might have saved, many legislators who are adamant about reducing government expenditures voted for this bill. And certainly many of the people who voted for this bill are also adamant about the importance of free markets where buyers and sellers can negotiate to maximize their benefit. But in this case, free market advocates made an exception for the pharmaceutical companies.

Drug companies spend huge amounts of money on lobbying and on funding legislators who vote for what the companies want. According to Eric Pianin,42 writing for The Fiscal Times the drug industry spent more than $1.9 billion on lobbying between 2003 and 2016.42 Similarly, the companies gave $147.5 million to congressional and presidential candidates and super PACS in this period. Pianin cites a Center for Responsive Politics report that the industry spent the equivalent of $468,108 per member of Congress in 2015 and in the first nine months of 2016.43

Corruption of research on drugs’ efficacy. Research on the impact of drugs is supposed to be done in a way that ensures that only medications with clear benefits are approved. One way this is done is through double-blind placebo controlled trials. These are experiments in which people are randomly assigned to get the medication or to get a “placebo” a substance that there is no reason to believe will benefit the patient. Randomization assures that the two groups are very similar. In this way we can have confidence that any difference between them is due to the medication given to the one group.

However, people’s reactions to a medication—especially one that is designed to affect a behavior such as hyperactivity or depression—may be affected if they believe they are getting an effective medication. And they might be affected by what their physician says about the impact of the medication. For this reason, neither the physician giving the drug nor the patient is told whether they are getting the actual drug or the placebo. Both are blind to the patient’s experimental condition.

In addition, research that will be submitted to the FDA for approval must be done with high levels of scrutiny. I was one of the investigators involved in testing the nicotine patch that was created to help smokers stop smoking. We had to keep extensive records of our contact with each patient. We did not know which ones got the nicotine patches and which got patches without nicotine. Our records were audited to be sure that they were accurately kept. In the case of that study, we found that the people who got the patch (along with counseling, which the placebo group also got) were more likely to succeed in quitting smoking.

Despite these safeguards, the process of assessing drugs has gotten corrupted. Perhaps the most outspoken critic of the pharmaceutical industry is Peter Gotzsche, a professor of Clinical Research Design and Analysis at the University of Copenhagen. His 2013 book is titled Deadly Medicines and Organized Crime: How big pharma has corrupted healthcare. To say that his criticism is inflammatory is to put it mildly. He has chapters titled, “Organized Crime, The Business Model of Big Pharma”; “Very Few Patients Benefit from the Drugs They Take”; and “Pushing Children into Suicide with Happy Pills.”44

And yet his credentials as a scientist are impressive. His biography in the book indicates that he has published more than 50 papers in the five most prominent medical journals (British Medical Journal, Lancet, Journal of the American Medical Association, Annals of Internal Medicine, and the New England Journal of Medicine). In a foreword to the book, written by the Deputy Editor of the Journal of the American Medical Association, Drummond Rennie states that he trusts Gotzsche “to have his facts right. My trust is based on solid evidence, and on my own experience of several decades struggling with the results of pharmaceutical company influence upon my clinical researcher colleagues, and upon the public. I trust Gotzsche because I know him to be correct when he writes about events of which I have independent knowledge.” Drummond goes on to point directly to the contingency that is at the root of the problem: “To me nothing will help unless we disconnect completely the performance and assessment of trials from the funding of trials.”

Gotszsche claims that most clinical trials have been corrupted by the fact that the pharmaceutical industry is paying for them and the industry has a conflict of interest; their profit depends on a positive outcome of the trial. And indeed, there is strong empirical evidence that the outcome of drug studies funded by the pharmaceutical industry are more likely to conclude that a drug works than are studies not funded by the industry.45

Gotszsche gives examples of biases in the reporting of trials for three drugs for cardiovascular disease in which the number of heart attacks that were reported to the FDA in these trials were less than those reported by “a central adjudication committee in the publications.”

He indicates that one of the ways that the industry protects itself is by having agreements with investigators they are paying to conduct the trials that the company owns the data or would have the right to approve any manuscripts written. In this way the companies can suppress evidence that is not in their interest. Moreover, in many cases, the company also had the right to stop a trial at any time, another way in which unhelpful evidence could be suppressed. In addition, many of the contracts between companies and universities are themselves kept confidential, making it harder to determine whether the companies have undue influence over what data become available to the public.

One example of the problems involved in this, concerns the impact of SSRIs on adolescent suicides. When a concern arouse about the possibility that these drugs might be causing some adolescents to commit suicide, the investigators who had conducted the trials were unable to get access to the data, because some of the companies refused to provide it.

Gotzsche provides the details of one of the SSRIs, Paxil, which was tested with children and adolescents by GlaxoSmithKline in 2001. The published study reported that the drug was effective and minimal side effects. However, the Attorney General of New York sued the company in 2004 concerning fraud in relation to concealing harms of Paxil. The company’s internal, unpublished report indicated that eight children taking the drug had become suicidal, a rate significantly higher than for children taking the placebo. The FDA demanded that the company review the data again; that revealed four additional cases of “self-injury, suicidal ideation, or suicide attempt.” An internal company document stated, “It would be commercially unacceptable to include a statement that efficacy had not been demonstrated, as this would undermine the profile of paroxetine [Paxil].”

Gotzsche goes on to say that despite evidence that Paxil and Zoloft could induce suicides in children and adolescents, five million prescriptions a year were written for these drugs between 1998 and 2001. He then goes on to describes seven people who committed suicide after being prescribed an SSRI. None of them were diagnosed as being severely depressed, the only subgroup whom these drugs have been shown to benefit.

Gotzsche reports that three makers of SSRIs submitted data to the FDA in which they included suicide attempts of people who were randomized to the control group, prior to the beginning of the trial, but did not do this for those assigned to the intervention group. This reduced the difference in suicide rates between the two groups, making it less likely that a significantly higher rate of suicide would be detected in the intervention group.

Violation of the law. The corruption in the pharmaceutical industry is borne out by the prosecutions of companies. One of the ways that a company can make money is to simply violate the law. One might think that such events would be rare among wealthy professionals who run these companies. However, this is not the case. Here are just a few examples.

  • In 2007, Purdue Pharma and three of its current or former executives pleaded guilty to criminal charges that they had misled doctors, patients, and regulators about the risk of addiction for the drug OxyContin.46 The company paid a $600 million fine and those three executives paid $34.5 million in fines. According to the New York Times, the company took in $2.8 billion in sales on the drug during the six year period when they were fraudulently marketing it. None of the executives served time in prison. More recently, states and counties in the U.S. have initiated numerous lawsuits against Purdue Pharma. At this writing none of them have been settled. However, according to the Times, discovery in these suits has shown that the Sackler family, which owns Purdue was doing everything it could to promote the over-prescription of opioids. Once the epidemic of overdose deaths began, they started marketing drugs to treat the problem!
  • That the drug company campaigns were misleading is shown by the fact that “The Food and Drug Administration has cited every major ADHD drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.”41 For example, Shire Pharmaceuticals was fined $56.5 million for claiming that Adderall would normalize children taking the drug and improve academic performance, and prevent unemployment and criminal behavior.
  • Gotzsche44 cited ten cases in which drug companies have been convicted of fraud. Here are five of them.
    • Pfizer paid $2.3 billion in 2009 for fraudulently promoting four of their drugs and paying bribes to health care providers to get them to prescribe these drugs
    • Novartis paid $423 million in 2010 for illegally marketing an epilepsy drug and five other drugs, making false claims about their efficacy, and paying kickbacks to health care providers.
    • Sanofi-Aventis paid $95 million for overcharging US and local health agencies.
    • GlaxoSmithKline paid $3 billion for illegally marketing a number of their drugs for off-label use. (“Off-label” means prescribing the drug for a malady that it was not evaluated for.) The case also involved obstruction of justice, lying to the FDA, paying kickbacks to doctors, failure to include safety data, allegations of Medicaid fraud, and withholding incriminating documents.
    • AstraZeneca paid $520 million for illegally marketing an anti-psychotic drug to children, the elderly, veterans, and inmates for uses that it was not approved for. The uses, for which there was no evidence of benefit, included aggression ADHD, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness. The company paid kickbacks to doctors and spend lavishly on resort vacations for prescribing the drug.

Promotion by and to doctors. Once drugs are approved for use, the drug companies use advertising and promotion techniques to sell them—both to the physicians and patients. One way they do this is by paying physicians to speak to other physicians about the benefits of drugs. Often the physicians have been involved in evaluating the drugs. However, until recently the financial relations between these physicians and drug companies were not disclosed. When it came out that 84% of physicians were receiving payments, meals, free drugs, and free travel from the pharmaceutical industry,47,48 Congress passed the Sunshine Act to require reporting of all such payments.

But the Sunshine Act does not seem to have curtailed these practices. ProPublica49 reports that physicians were paid $6.2 billion by the pharmaceutical industry between August 2013 and December 2015. A further analysis by ProPublica showed that doctors who get more payments from drug companies are more likely to prescribe brand-name medications, even when cheaper generics of the same drug are available.

One of the physicians who received payments from the companies and promoted increased prescribing of narcotics defended his actions saying that his association with the companies “would benefit my educational mission, they benefit in my research mission, and to some extent they can benefit my own pocketbook, without producing in me any tendency to engage in undue influence or misinformation.”9 So long as the general public remains blind to effects of consequences on human behavior, people can get away with making such claims.

Advertising. Then there is advertising directly to patients—even children. For example, Shire the maker of Adderall for ADHD subsidized 50,000 copies of a comic book about drugs for ADHD. According to the New York Times report it uses superheroes to tell children, “Medicines may make it easier to pay attention and control your behavior!”41

Direct advertising to consumers is one of the biggest ways that anti-depressive prescribing is encouraged. They are designed to get people to consider that they may be depressed and to ask for a specific anti-depressive medication by name. As noted above, there is no evidence that people with mild levels of depression benefit from it, but one study showed that when patients asked for an anti-depressive medication by name it was prescribed 55% of the time.50

The argument for direct marketing to consumers is that it will increase the likelihood that people who need treatment will get it. But given the huge number of adults on such medication in this U.S., it seems equally likely that many people who won’t benefit from these drugs will get on them and will remain on them throughout their lives because of the difficulty in withdrawing from them.

Disorder creep—the loosening diagnostic criteria. One of the other ways in which drugs are promoted is by finding new disorders or loosening the criteria for diagnosing existing disorders. The diagnosis of psychological disorders is a case in point. The dominant system for diagnosing psychological disorders in the United States is the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. Diagnoses are based on assessments of people’s behavior, not on the assessment of physiological processes. This is unlike the diagnosis of most physical illnesses, where there are measurable processes such as a bacterial infection, high levels of blood sugar, or occlusion of arteries.

The dominant view in psychiatry is that mental disorders are also due to clear biological conditions. However, the evidence does not support this view. There are not measurable physiological processes that can be used to diagnosis depression, ADHD, or schizophrenia. For example, the diagnostic criteria for depression are as follows:51

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2)52 loss of interest or pleasure.

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by other.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  4. Insomnia or hypersomnia nearly every day.
  5. Psychomotor agitation or retardation nearly every day.
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

I submit that these criteria leave an enormous amount of the judgment to the physician as to whether a person is depressed. As I noted above, 80% of prescriptions for the treatment of depression are written by physicians who are not psychiatrists and many of those prescriptions are not written for depression. We should not be surprised, therefore, that 29 million Americans are taking anti-depressive medication.

I mentioned another example of disorder creep above—the shift in how bereavement is dealt with. Whereas, sadness due to the loss of a loved one (bereavement) was not a basis for the diagnosis of depression, the latest version of the DSM has eliminated that exclusion.40 It has thus become more likely that a person who is experiencing prolonged sadness over the loss of a loved one will be diagnosed as depressed and will be put on anti-depressive medication.

When I was doing behavior therapy in the 1970s I would often do an intake with a client who was highly distressed and would meet diagnostic criteria for depression. I would ask them about what was happening in their life and they would typically describe numerous difficulties—job loss, separation or divorce, conflict with a loved one. I usually found myself saying to them, “If I had experienced what you have experienced, I would be depressed too.”

Yet, the DSM has been revised so that experiences such as loss of a loved one or a job, divorce or a serious disease are no longer mentioned as reasons for not diagnosing a person for depression.44 The result is more people being prescribed anti-depressive medication.

Consider what might be the practical effect of this practice? Keep in mind that there is no evidence that anti-depressive medication works for people who are not severely depressed. Might it not be better if, rather than telling a person that they have a disease, that we help them figure out how they can cope with the important things that have happened in their life? Might it be that in this process, we will help people develop new skills and experiences that will ultimately, enhance their lives?

It is in this context, that we should consider what alternatives are available for helping people who are depressed. Here are viable alternatives that do not carry the risks of anti-depressive medication.

  • Behavioral Activation. This involves helping people learn to monitor their mood and daily activities, and increase the number of pleasant activities and positive interactions with their environment. A meta-analysis of sixteen randomized trials showed that compared with control conditions, it had a large effect (effect size .87) in reducing symptoms of depression.53
  • Light Therapy. Some people become depressed during winter months when daylight is limited. A meta-analysis of studies testing the impact of treatment with bright lights or dawn simulation (a gradual increase in illumination before the person wakes) have effects on depression that are equivalent to those found in pharmacotherapy.54
  • Omega 3 supplements. There are at least three randomized trials showing that omega 3 fatty acid has beneficial effects in treating depression. One study showed effects with patients with recurrent major depression. A second showed benefits for treating children (6-12) with major depression. The third study showed effects on patients with bi-polar depression.55
  • Acceptance and Commitment Therapy (ACT). I have already described ACT in detail in The Nurture Effect. ACT can be considered a form of behavior therapy. Rather than encouraging people to do what they can to suppress depression and other negative moods, it encourages them to become more mindful and accepting of them and to act in the service of their goals and values.

In short, there are numerous viable alternatives for the treatment of depression. Unfortunately they are not being promoted the way that pharmacotherapy is being promoted and they are not subsidized by insurance to the extent that pharmacotherapy is.

The Culture of Money Making

The corruption in the pharmaceutical industry is encouraged by the culture of wealth accumulation. Free-market ideology has made the accumulation of wealth the central feature of the business culture in many, though certainly not all, sectors of business. The widespread belief that the pursuit of one’s own financial gain will benefit everyone has distorted the culture of business in many industries. If my pursuit of economic gain will benefit others, then there is no reason why I should hesitate to pursue that gain. Indeed, the more I make the more I must be doing for others.

If I am correct, then we should not be surprised to find that industry leaders are making great amounts of money. And if I am correct that this invisible hand theory is not supported by the evidence, we may also find that in many cases, the general wellbeing is not advanced by increases in stock prices or executive salaries.

Our first question, then is “Are the Salaries of CEOs of Pharmaceutical Companies high?” The answer is yes. According to USA Today56 the top 14 CEOs salaries’ ranged from $8.7 million to $47.5 million in 2015. Taking a longer time span, the CEO of Gilead Sciences made $863 million since the Affordable Care Act was passed.57

Because such a large proportion of CEO pay is in the form of stock options, CEOs have a strong incentive to increase the price of their stock. According to an analysis of CEO salaries of health care companies, which included pharmaceutical companies, there is a close relationship between CEO salaries and stock prices.57 Obviously one of the ways that companies can increase stock prices is by increasing the price of drugs. That has certainly happened. The average price of drugs in the U.S. rose 98.2% between 2011 and 2016.58 And there are numerous examples of huge increases in drug prices that are not justified by any benefit to consumers or the contribution that the company has made to better health. Consider the recent practices of increasing the price of drugs that have been around for many years.

  • In 2015, Martin Shkreli, the 32 year old founder of Turing Pharmaceuticals, acquired a 62 year old drug, Daraprim, which is used to treat life threatening parasitic infections. He then raised its price from $13.50 a tablet to $750. In response to criticism he said “This isn’t the greedy drug company trying to gouge patients, it is us trying to stay in business. It really doesn’t make sense to get any criticism for this.”59
  • The EpiPen is a drug that can save the life of someone going into anaphylactic shock due to an allergic reaction, such as to a bee sting. Mylan, the maker of the drug raised its price over a five year period from $164 to $608.60 The CEO of Mylan, Heather Bresch, was paid $18.9 million in 2015.56
  • Gilead Sciences, which had a profit margin of 63.7% in 2015 was charging $84,000 for a drug to treat Hepatitis C.
  • Marathon Pharmaceuticals got permission from the FDA to charge $89,000 for a drug that treats children with Duchenne muscular dystrophy. The drug costs between $1,000 and $2,000 in Canada and Europe.61

The increases in drug prices are not due to these companies trying to survive—as Martin Shkreli argued. They are not only surviving, they are thriving: The top 11 drug companies had profit margins ranging from 25.3% to 62.7%.56

The United States spends far more per capita on health care than other developed countries–an average of $9,086 per person, compared with $2,802 per person in the United Kingdom.62,63 Expenditures on drugs account for ten percent of health care costs.64,65 Thus, while other parts of the health care system are struggling to control or reduce health care costs, the pharmaceutical industry is escalating prices with little regard to its impact on patients or the health care system.

In short, there is plenty of evidence that pharmaceutical companies are maximizing their profits in ways that harm those who cannot pay for their drugs and those who are harmed by the drugs themselves.

Making Pharmaceutical Malfeasance Unprofitable

In all of these examples, there are groups of scientists, practitioners, and journalist who are trying to stop medication practices that are doing as much or more harm than good. But dealing with it at the level of whether one type of drug should be prescribed less than it is fails to get at the root contingencies that are driving each of these harmful practices—namely the failure of government to regulate the practices of pharmaceutical companies so that the harms that may occur are carefully assessed and documented and the practices of companies that increase harmful prescribing are stopped. The prosecution of pharmaceutical company executives is one contingency that might reduce this behavior. However, the fines levied on companies for bad behavior, are typically less than the profit the companies reap. Whenever that is the case, then fines for bad behavior are simply the “cost of doing business.”

This is where a clear understanding of the impact of consequences on human behavior and the actions of corporations needs to be a guiding principle in our regulation of business. As long as harmful practices result in profits to corporations and income to corporate leaders, harmful practices will continue. Public policy needs to be that when a company engages in harmful behavior, they forfeit all profits and then some. If a company fails to make a profit, investors will stop investing and the drop in stock prices and the risk of bankruptcy will modify the behavior of corporate leaders.

None of this is likely to happen in a system of government where the companies whose practices are to be regulated have so much political influence that government is prohibited from taking effective regulatory action—or the regulators are members of the network of corporations that they have no motivation to take regulatory action. I discus what we can about this in Rebooting Capitalism.

(There is some hope that the criminal behavior of pharmaceutical companies is beginning to be addressed. John Kapoor, the founder of founder of Insys Therapeutics was recently sentenced to more than five years in prison for the fraudulent marketing opioids by his company. Four other executives are also being sentenced to prison.)

In closing, I think I need to occasionally mention that I do not write any of this to generate anger or animosity toward the leaders of these companies. I simply don’t think that it is strategic to do that. This series as a whole is describing a complex web of beliefs, values, organizations, and practices that must change. The thing that is needed across all of the examples in these essays is an understanding of the financial and social contingencies that are involved in their behavior. I have in mind not only the money that flows to the companies but the social reinforcement that occurs in the network of people who run these companies, serve these companies by providing legal counsel, public relations advice, advocacy for both their specific practices and for the generic practices such as limited regulation that are being promoted for the benefit of all companies.

Action Implications

Personal

  • Make sure that medications that are prescribed for you are necessary and effective compared to alternative strategies.
    1. For pain try non-medicinal strategy such as behavior therapy before taking medications. Refuse opioids if other pain killers have been shown to be effective. If you do take opioids, take them for a short period of time.
    2. If your child is behaving in ways that are listed as “indicative” of ADHD, be skeptical. Are they younger than other kids in their class? Consider that all of these behaviors are common in children and that medication may stunt their growth (not kidding). Read the first half of The Nurture Effect and seek competent behavior therapy before considering medication.
    3. If you or a loved one feels they are depressed, explore behavior therapy before considering anti-depressive medication. Chapter 5 of The Nurture Effect 66 describes behavior therapy treatments. And here are some more books you may find helpful:
      1. Get Out Of Your Mind And Into Your Life.67
      2. The Mindfulness and Acceptance Workbook for Depression: Using Acceptance and Commitment Therapy to Move Through Depression and Create a Life Worth Living.68
  • The Happiness Trap69
  • If you have a cold, don’t take antibiotics unless your doctor can convince you that you have a bacterial infection. Don’t buy meat from livestock that had been raised on antibiotics.
  • Tell your friends what you learned about pharmaceuticals. Spreading the word about harmful corporate practices will help to change their practices.
  • Support candidates who will impose consequences for malfeasance that eliminate the companies’ profits for harmful practices.


Policies

  1. In the pharmaceutical business and every other business, we need to monitor the impact of corporate practices to identify any that produce more harm than benefit.
  2. When a practice is show to be harmful, the company engaging in it must be penalized to an extent that the company does not just pay a fine, but instead loses money.


Organizations

  1. PharmedOut (https://sites.google.com/georgetown.edu/pharmedout/about-us/history?authuser=0). PharmaOut’s mission is to investigate the influence of pharmaceutical industry marketing on the practice of medicine; foster access to unbiased information on drugs; and create and promote pharma-free continuing medical education to providers.
  2. Undark, https://undark.org, provides scientifically accurate evidence on not only on pharmaceuticals (https://undark.org/article/big-pharma-influences-clinical-practice-guidelines/), but on most other ways in which science can benefit society.

Read the Full “Cultural Evolution of Social Pathologies” Series by Anthony Biglan:

  1. Introduction by David Sloan Wilson
  2. How Cigarette Marketing Killed 20 Million People
  3. The Right to Sell Arms
  4. How and Why the Food Industry Makes Americans Sick
  5. Big Pharma and the Death of Americans
  6. How Free-Market Ideology Resulted in the Great Recession
  7. The Fossil Fuel Industry: The Greatest Threat to Human Wellbeing
  8. The Crisis of Capitalism

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When asked about President Trump’s insane idea to end social distancing in two weeks, Larry Kudlow, Trump’s Director of the National Economic Council, said “public health includes economic health.” I am not much of a fan of Kudlow’s thinking about the economy, but as a behavioral scientist, I have to admit that Kudlow is right; our economy has a huge impact on public health. However, I don’t think Kudlow was talking about the facts that came to mind for me.

About twenty percent of our children are being raised in poverty. Children raised in poverty are significantly more likely to die from cardiovascular disease in midlife. One reason is that living in poverty is stressful and stress promotes inflammatory processes that contribute to obesity, metabolic syndrome, and cardiovascular disease.1 Another is that poor children are more likely to live in high poverty neighborhoods that lack social cohesion2 and have schools with inadequate resources.

Then there is economic inequality. Thanks to fifty years of relentless free market advocacy by people like Kudlow, America has evolved the most economically unequal country of all developed nations. Since 1978, the top one tenth of one percent of the wealthiest in the U.S. have gone from having about 7% of all the wealth to having about 22%. Unequal countries have significantly poorer health, not just among the poorest, but among all but the very highest levels of wealth and income. Here too, the reason is stress. In unequal societies, people have more stressful interactions with people above and below them in the economic hierarchy.

There are many other ways that free market economics has harmed American’s health. For fifty years we have been told that government regulation is bad for the economy. As far back as the 1990s it was claimed that regulation costs the American economy more than a trillion dollars. And so thanks to effective opposition to regulating business, we have numerous industries that are engaging in highly profitable activities that harm public health. The tobacco industry accounts for more than 400,000 deaths per year.3 The gun industry contributes an average of about 35,000 deaths a year.4 The pharmaceutical industry’s marketing of opioids led to the more than 630,000 overdose deaths since 1996.5 The food industry markets high sugar and high fat foods to children with impunity, despite the fact that it has led to an epidemic of obesity that is, for the first time in a century, lowering the life expectancy of our children.6

Economics can also promote public health. But I doubt that Larry Kudlow had the benefits of taxing products when he said that public health includes the economy. There is solid evidence that taxing unhealthy products such as tobacco and alcohol will reduce youth use of these products and prevent addiction.7 Taxing sugar sweetened beverages also appears to reduce their consumption, although the evidence is not as good, because the sugar and beverage industries have so far limited the implementation of such taxes.

As you have undoubtedly heard, people with pre-existing medical conditions are more likely to die if they get infected. Thanks to a health care system that does little to prevent unhealthful behavior and an economic system that stresses millions of American’s we have a larger pool of people who have medical conditions that put them at greater risk if they get the Covid-19 virus. If we had an economic system that worked for everyone, we would have fewer people living in poverty, more people with health coverage, less stressful social relations, fewer companies marketing harmful products and a healthier and more resilient population.

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  3. Biglan A. How cigarette marketing killed 20 million people. The Evolution Institute. Social Pathologies Series Web site. https://evolution-institute.org/how-cigarette-marketing-killed-20-million-people/. Published 2020. Accessed March 12, 2020.
  4. Biglan A. The right to sell arms. The Evolution Institute. https://evolution-institute.org/the-right-to-sell-arms/. Published 2020. Accessed March 12, 2020.
  5. Biglan A. Big pharma and the death of Americans. The Evolution Institute. Social Pathologies Series Web site. https://evolution-institute.org/big-pharma-and-the-death-of-americans. Published 2020. Accessed March 12, 2020.
  6. Biglan A. How and why the food industry makes americans sick. The Evolution Institute. Social Pathologies Series Web site. https://evolution-institute.org/how-and-why-the-food-industry-makes-americans-sick. Published 2020. Accessed March 12, 2020.
  7. Pechmann C, Biglan A, Grube JW, Cody C. Transformative consumer research for addressing tobacco and alcohol consumption. Transformative consumer research for personal and collective well-being. 2012:353–390.

This article is related to Anthony Biglan’s new book Rebooting Capitalism: Forging a Society that Works For Everyone.

My son Michael is addicted to sugar. About three years ago he announced on Facebook that he would not be eating anything that had added sugar–no cookies, cakes, ice cream, even my coleslaw to which I always add a bit of sugar. He immediately lost 15 pounds.

Mike was not terribly overweight; about 210 at 6 foot 1 inch.

At the end of the year, he went back to eating things with sugar and quickly found that just a day of having some cookies and other sweets produced a craving that resulted in his eating incessantly and regaining much of the weight he had lost. So he made another public declaration and went back to not eating sugar.

I was vaguely aware of some evidence that sugar could have this effect, but I also thought that he could just put some limits on when he would eat sweets. Behaviorists call that “stimulus control.” Forty years following behavioral principles had allowed me to establish stimulus control over some of my behaviors. For example, I would engage in a behavior like overeating at a party, but not at other times. I got so I could click into gorging, but it would not carry over to other times and places. Similarly, I established the habit of writing first thing in the morning, and got so I could readily click into writing at that time.

But Mike found it difficult to control the behavior. Based on what I have learned about the addictive effects of heavy sugar consumption in childhood, I suspect that his problem resulted from the fact that he was exposed to a lot more sugar as a child than I was, when I was growing up in the 1950s. Yet Mike has established a form of stimulus control –his publicly stated intention to not consume sugar–for a year.

Anyway, my research on this topic has convinced me that Mike is right. The consumption of large amounts of sugar, especially when you are a child can establish a craving and dependence for sugar that is functionally the same as the craving for alcohol or other drugs.

So this essay is dedicate to Mike. Teasing each other over who is right is unfortunately a manly tradition in our family. So Mike you were right and I was wrong!

 


 

There is a large and growing literature on the problems with the American diet and the role the food industry has played in the problem. A recent analysis estimated that more than 500,000 Americans die each year due to unhealthful eating habits.1

I will only discuss the problems involved in children’s poor diet and obesity problems. That will be enough to illustrate how this industry’s practices have evolved as a result of market forces. There are other examples of how the industry has harmed health in the process of expanding its markets and profits, but one example will do. The story is fairly simple:

  1. Childhood obesity is a huge problem. (No pun intended.)
  2. Children’s diets are at fault.
  3. Their poor diets are the result of the products the food industry has created and marketed to children.
  4. The practices of the food industry are simply the result of the evolution of the industry. They were selected by their contribution to profits. They evolved increasingly effective ways to design foods that children will crave and to market them to children.
  5. As the harmful impact of the food industry on children became apparent to the public health community, the industry has evolved lobbying, public relations, and marketing techniques to prevent regulation of their business practices.

Obesity in America

America has an obesity problem and it has been getting worse for at least 25 years.2 In 1990, 15% of adults in Mississippi were obese and that was the highest rate in the country. By 2016, Mississippi’s obesity rate was 37% and every other state had seen a dramatic increase. Colorado, the state with the lowest rate in 1990 went from 6% obese to 22% in 2016. Across the nation, about 36% of people are obese.3

Increases in obesity among children has been especially dramatic. About one in five children are obese.4 In six states, more than 35% of children are obese or overweight. The lowest rate of obesity or overweight is in Utah, at 19%. The highest is in Tennessee at 37.7%.

Why should we care about obesity? Well, an obese child risks developing major diseases as an adult. They include diabetes, cardiovascular disease, some types of cancer, and kidney disease. An obese girl is more likely to have complications if she becomes pregnant. A child who is obese is also more likely to develop high blood pressure, osteoarthritis, and sleep apnea.5 Pediatricians are finding that obese young people are developing adult onset diabetes, something that was never before seen in children and adolescents.6 For the first time in history, public health officials are predicting that the younger generation will have a life span shorter than their parents.7

Children’s Diets

Why do we have an obesity epidemic? One of the major reasons is that the American diet has changed dramatically over the past fifty years. In particular our consumption of sugar has gone off the charts.

Stephan Guyenet, a neurobiologists has studied records of the production of sugar in the U.S. since 1822. His data show that our consumption of sugar climbed steadily from 6.3 pounds person in 1822 to 107.7 pounds in 1999.8 Think about this from an evolutionary perspective. I am pretty sure that the level of sugar consumption in 1822 was already way above the level that human consumed for the previous ten thousand years in which many of our genes were selected.

This is an example of what evolutionists call an evolutionary mismatch. We evolved to find sugar reinforcing, undoubtedly because the humans who found it reinforcing were likely to get good at finding and eating foods that were high in calories and were thus more likely to survive. However, few places in nature had large amounts of the stuff. That changed when we learned how to massively increase the production of sugar. Our current obesity epidemic is the result of the fact that we simply weren’t built to consume that much sugar.

In fact, the World Health Organization’s (WHO) recommends that ideally less than 5% of our caloric intake should come from added sugar.9 That’s about 6 teaspoons. Yet the most thorough study of American children’s intake of sugar shows that on average, about 16% of the calories come from added sugar.10

Children’s breakfast cereals contain forty percent more sugar than cereals popular with adults. They average more than two and half teaspoons per serving, well over twice the limit recommended by the World Health Organization.11 However the serving size that most cereals list on the box is less than most children consume at a meal. So even if a cereal seems to have a low level of sugar, your child is probably getting more of it than the nutrition label suggests.

In addition to there being more sugar in the foods we eat, the size of the portions we eat have increased. Selling bigger portions of a food is one way food manufacturers can sell you more of their product. Over the past 70 years the typical size of soft drink bottles has gone from six and a half ounces to 12 ounces, then 20 ounces, and then to 42 ounce bottles. By 2004, children were getting 11% of their calories from soft drinks. The number one calorie source for teens is sugary drinks!12

Designing, Manufacturing, and Marketing Foods That Harm Us

The development of the food industry is another evolutionary story. It involves the rise of corporations, the use of science and technology to produce products that will sell, and the evolution of marketing to maximize sales. It also involves the evolution of lobbying and public relations practices to prevent regulation of the industry.

The food industry did not set out to make us ill, that is simply a by-product of their efforts to compete successfully in the marketplace. The generic principle that explains the development of harmful marketing of any product is that market competition motivates companies to innovate in whatever ways work to improve their profits. In the case of the food industry, this has included extensive research on what makes foods irresistible and how the companies can market their products to as many people as possible.

Designing and Manufacturing Irresistible Food

If you are troubled by my referring to the food industry and the manufacture of foods, let me explain. The major corporations producing and marketing food in this country, carefully research the impact of different formulations of their products to identify the ways to make these foods as irresistible as possible.

Michael Moss, the Pulitzer prize winning investigative journalist has written about the precision with which the food industry has pinpointed what it takes to make you love a processed food. The key ingredients are salt, sugar, and fat. The best-selling foods are loaded with them.

Here are some examples of how the industry developed and manufactured foods that are far different from any food humans have eaten prior to the advent of the food industry.

The bliss point. Through careful and precise experimental research food technicians study what level of sugar is most preferred by the most people. They call this the bliss point. Most manufactured foods are made to have the level of sugar that tests have shown are going to be the most satisfying to the most people. The typically preferred level is not the highest you could possibly make it, but it is far higher than the amount of sugar that you will find in any natural food such as an apple, orange, or other fruits or vegetables. Oh and it turns out that the bliss point for sugar is higher for children than for adults. That is why there is so much sugar in cereals for children.

Convenience. Moss describes how over the past fifty years the food companies competed to make foods that could be prepared quickly with as little work as possible. He tells the story of General Foods which was trying to make a pudding that would take less than two hours to prepare. (This was at a time when women were beginning to work outside the home. Two hours of meal preparation might not have seemed that much of a problem when few women worked outside the home, but for the increasing number of women who did work outside the home, the convenience of quick meal preparation was huge.).

At the time, General Foods refused to use additives to make the pudding quicker to prepare. Until, that is, another company was about to market a pudding mix that was likely to capture the market for instant pudding. The company then told their chief chemist, Al Clausi, to find whatever additives he needed to make an instant pudding. He succeeded, General Foods captured the market in puddings, and the company’s restrictions on the use of additives became a thing of the past.

These are just two examples of the way in which the food industry has evolved its ability to design and manufacture foods that make it easy and irresistible to consume foods that aren’t good for you—but are good for the companies. Read Michael Moss’ book, Salt, Sugar Fat: How the Food Giants Hooked Us, to learn about how good the industry has become in designing food products that will sell.

Unhealthful Foods Are Being Marketed To Children

So if children are getting fat, is it the fault of the food industry? Like the tobacco industry, the food industry has put the blame on parents for not properly supervising their children’s eating habits. But that argument ignores how successfully the food industry has made it nearly impossible for parents to combat their children’s desires for fattening foods.

Public health researchers have been appropriately cautious in evaluating whether food marketing is a factor in childhood obesity. A report from the Institute of Medicine reviewed the evidence available in 2006 and concluded that the food industry’s marketing affects children’s food preferences and “likely” contributes to poor diets and obesity. However, the report said that there was insufficient evidence to conclude that marketing was affecting adolescents. At that time, only the marketing to children was indicted.

More evidence has accumulated however. A report from the Rudd Center for Food Policy and Obesity13 summarized the evidence. The industry spends $1.8 billion a year marketing to children and adolescents. Most of this is spent marketing food products that are high in fat, sugar, and salt and have little nutritional value—fast foods, high sugar cereals, sugar-sweetened beverages, candy, snacks, and deserts.

Only four tenths of one percent of the companies’ marketing is spent advertising fruits and vegetables. Children’s and teens’ exposure to ads has been increasing in recent years, with children seeing an average of 12.8 ads per day and teens seeing 16.2 per day. In addition to ads, product placement in movies and TV shows is quite common. One study found that for the 20 most popular movies between 1996 and 2005, 69% of them had at least one food or beverage shown and that a total of 1,180 brands were placed in these movies.14 And in recent years, companies are increasingly advertising in social media, which is expanding the companies’ ability to reach youth and may be more effective than TV ads.

If you are inclined to believe that companies are spending more and more on advertising because it works to get children to demand their products, you probably don’t work for a food company. But I can tell you from experience in U.S. vs. Philip Morris et al. that the companies will continue to claim that the problem of children eating too much fattening food is due to parents, not to their advertising.

The best way to address this argument is to see if food ads affect children, regardless of how vigilant their parents are. Such a study has been done. Rodrigo Uribe and Alejandra Fuentes-García14 in Chile randomly assigned 483 children between the ages of 9 and 15 to one of four conditions: (a) viewing ads for McDonald’s, (b) viewing a video of Richie Rich in which McDonald’s products were placed, (c) viewing both ads and the product placement, and (d) a control group which saw neither ads nor product placement. They found that both ads and product placement increased children’s awareness of and preference for McDonald’s over other fast food brands. Notice that in this study the degree of parental influences on children’s inclination to want to eat at McDonald’s was controlled for. That is, by randomly assigning kids to these conditions it made it very likely that there were just as many kids with vigilant parents in each condition.

Lobbying and Public Relations

Another practice companies have evolved over the past 150 years is the use of lobbying and public relations to protect the public image of the company, to ensure that they are not prohibited from engaging in profitable activities, and to give the company any advantage it can in the competition for customers. Here are two examples from the food industry.

Blaming fat and exonerating sugar. Cristin Kearns, Laura Schmidt, and Stan Glantz15 obtained and analyzed internal documents from the Sugar Research Foundation. They discovered that the foundation sponsored research on the causes of cardiovascular disease. A review paper that they funded was published in the New England Journal of Medicine. It emphasized the impact of fat consumption on cardiovascular disease, but downplayed the role of sugar. The foundation’s role in this research was not revealed.

As public understanding of the role of fat in heart disease grew, the food companies responded by offering low fat foods. However, since the public was not aware of the impact of sugar on heart disease, and given that sugar is highly reinforcing for human beings, the sugar content of our foods skyrocketed. So has our obesity and diabetes, both of which contribute to heart disease.

Facing up to the impact of sugar on health? Upton Sinclair once observed that it is difficult to get a man to understand something when his salary depends on his not understanding it. So too for whole industries.

Michael Moss begins Salt, Sugar, Fat with the story of the fateful day on which the industry almost faced up to the harm that their sugar-filled product marketing was doing to American’s health. Almost, but not quite.

On April 8, 1999 the heads of eleven of the largest food companies gathered in Minneapolis for a secret meeting to discuss the fact that obesity was becoming a major concern of Americans. With talk of a tax on sugar, the companies felt threatened. A few of these executives had been paying close attention to the obesity epidemic and the growing criticism of the food industry. They hoped that through this gathering the industry could honestly address the problem. Michael Mudd, vice-president of Kraft Foods made the first presentation, reviewing the extent of obesity and criticism of public health experts. He posed the question, “What’s driving the increase?” His answer was “Ubiquity of inexpensive, good-tasting, super-sized, energy dense foods.”16

Mudd and the executives he had been working with had developed a proposal for how the industry could address the problem. The companies would join together to get a better understanding of why Americans were overeating and to establish restrictions on how much salt, sugar, and fat they would put in their products. They would also promote physical activity through public service announcements.

When Mudd finished talking, Stephen Sanger, the CEO of General Mills stood up and essentially ended the meeting. He made it clear that his company would not alter its practices. He claimed that the industry had weathered other storms, such as the concerns about trans fats or the need for more fiber in the diet. The heads of the other companies didn’t say anything; they didn’t need to. The matter was closed.

If you are concerned about public health and don’t own stock in any of these companies, this story may make you angry. But it may be more productive to put yourself in the shoes of these executives. These men (apparently there were no women at the meeting) had all become very successful and very wealthy thanks to the years of successful product development and marketing. What psychological benefit would there be for them to believe that they were causing disease? Certainly there could be no financial benefit to facing up to the problem. Their salaries and wealth depended on not understanding that they were contributing to disease and death.

Lobbying. Rather than do what Mudd had proposed, the food industry has invested in lobbying to prevent laws and regulations that might impinge on its profits. The Center for Responsive Politics has a database on the lobbying done by companies. Across all companies, expenditures on lobbying have grown from $1.45 billion in 1998 to $3.37 billion in 2017.17 For the food industry, they report that, in 2017, 250 food companies or trade associations have lobbyists working for them on a total of 1,016 issues.18

Variation and Selection

The evolution of the food industry over the past hundred years illustrates the evolutionary principles of variation and selection. The industry experimented with various formulations of their products and various ways of marketing them. They kept the ones that increased sales and profits, and dropped the ones that didn’t work or didn’t work as well. Their practices were shaped by their consequences in the marketplace. This same process explains the evolution of all of the industries I am discussing.

The Evolution of the Food Industry Has Taken

Us Where We Didn’t Want to Go

I have given you just one example of the way that the food industry has evolved to market products that harm our health. We have an epidemic of childhood obesity that is shortening the lives of many of our young people.

The food companies did not set out to do this. They just set out to be profitable companies. The health of their customers was simply not a consequence that affected their profits. Their volume of sales was.

And if you are not much of a capitalist and think that the pursuit of profit is necessarily a bad thing, I ask you to consider abandoning your cell phone, automobile, television set, and the many other modern conveniences that you enjoy, all of which would not have been developed in the absence of the profits that motivated companies to innovate.

The problem is that capitalism, as it is currently practiced in the United States, has no system for assessing the risks of companies’ products and marketing practices. So long as our default assumption continues to be that we will all benefit if companies are free to pursue their profits with as little regulation as possible, we will have a food industry that continues to undermine our health.

Advocates for a healthier food system, such as Michael Pollan, Marion Nestle, and Michael Moss, are having an impact on the eating habits of many Americans. And we are beginning to see some regulatory actions that could reduce childhood obesity and prevent some cardiovascular disease.

However, advocates for healthful food are fighting a very difficult, uphill battle so long as most Americans’ basic belief is that limited government is essential, regulation is usually bad, and government efforts to protect our health will impinge on the rights of Americans to do as they please.

Action Implications

Personal

  1. Change your diet. Michael Pollan has summarized what we need to do to improve our health. He argues that over the past fifty years we have become obsessed with avoiding some nutrients (e.g., fat, sugar, and salt) and consuming others (e.g., omega 3, folic acid, fiber). He suggests that a simpler approach is to look at what humans ate before processed foods took over our lives. Here are two straightforward facts that I think capture what you need to do to protect your health and the health of your family:

    1. Fact 1. “Populations that eat a so-called Western diet – generally defined as a diet consisting of lots of processed foods and meat, lots of added fat and sugar, lots of refined grains, lots of everything except vegetables, fruits, and whole grains – invariably suffer from high rates of the so-called Western diseases: obesity, type 2 diabetes, cardiovascular disease, and cancer. Virtually all of the obesity and type 2 diabetes, 80 percent of the cardiovascular disease, and more than a third of all cancers can be linked to this diet. Four of the top ten killers in America are chronic diseases linked to this diet.
    2. Fact 2. “…there is no single ideal human diet but … the human omnivore is exquisitely adapted to a wide range of different foods and a variety of different diets. Except, that is, for one: the relatively new (in evolutionary terms) Western diet that most of us now are eating. What an extraordinary achievement for a civilization: to have developed the one diet that reliably makes its people sick!”
    3. Pollan goes on to cite a third fact: “People who get off the Western diet see dramatic improvements in their health.”
    4. The result is Pollan’s simple and straightforward advice: “Eat food. Not too much. Mostly plants.” For the details, go to: read his Food Rules: An Eater’s Manual, which you can get free with one google search. http://www.grubstreet.com/2018/03/ultimate-conversation-on-healthy-eating-and-nutrition.html

Policy

  1. Advocate for Better Policy. In looking for advocacy organizations that are focused on this problem, I was surprised to find that there do not seem to be many.
  2. Healthy Food America (http://www.healthyfoodamerica.org/) seems well organized to advance the cause. They have an extensive set of materials to support getting taxes placed on sugar-sweetened beverages. There are also centers such as the Rudd Center at the University of Connecticut (http://www.uconnruddcenter.org/), which is doing research on the industry and food policy and providing resources to anyone who is concerned about the problem. You can support these organizations and use their information to educate others about the extent of the problem.


Organizations and Resources

  1. Center for Science in the Public Interest (CSPI, see https://cspinet.org/) is probably the biggest player in this field.
  2. Marion Nestle (see https://www.foodpolitics.com/about/) is in this area as well.
  3. Environmental Working Group (https://www.ewg.org/)
  4. Food Tank (https://foodtank.com/)
  5. Healthy Food America (http://www.healthyfoodamerica.org/) – focus on sugary drinks.
  6. Food and Water Watch (https://www.foodandwaterwatch.org/)
  7. Institute for Agriculture and Trade Policy (https://www.iatp.org)
  8. Center for Food Safety (https://www.centerforfoodsafety.org/)
  9. National Sustainable Agriculture Coalition (http://sustainableagriculture.net/)

Read the Full “Cultural Evolution of Social Pathologies” Series by Anthony Biglan:

  1. Introduction by David Sloan Wilson
  2. How Cigarette Marketing Killed 20 Million People
  3. The Right to Sell Arms
  4. How and Why the Food Industry Makes Americans Sick
  5. Big Pharma and the Death of Americans
  6. How Free-Market Ideology Resulted in the Great Recession
  7. The Fossil Fuel Industry: The Greatest Threat to Human Wellbeing
  8. The Crisis of Capitalism

References:

  1. U. S. Burden of Disease Collaborators, Mokdad AH, Ballestros K, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319(14):1444-1472.
  2. The State of Obesity. Adult Obesity in the United States. The State of Obesity 2017; https://stateofobesity.org/adult-obesity/. Accessed July 8, 2018.
  3. U.S. Department of Health and Human Services. Adult Obesity Facts. 2018; https://www.cdc.gov/obesity/data/adult.html. Accessed November 1, 2018.
  4. U.S. Department of Health and Human Services. Childhood Obesity Facts. 2018; https://www.cdc.gov/healthyschools/obesity/facts.htm. Accessed November 1, 2018.
  5. U.S. Department of Health and Human Services. Health risks of being overweight. Health Information n.d; https://www.niddk.nih.gov/health-information/weight-management/health-risks-overweight. Accessed November 1, 2018.
  6. Pulgaron ER, Delamater AM. Obesity and type 2 diabetes in children: epidemiology and treatment. Current diabetes reports. 2014;14(8):508-508.
  7. Olshansky SJ, Passaro DJ, Hershow RC, et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. New England Journal of Medicine. 2005;352(11):1138-1145.
  8. Guyenet S. By 2606, the US diet will be 100 percent sugar. 2012; http://wholehealthsource.blogspot.com/2012/02/by-2606-us-diet-will-be-100-percent.html. Accessed November 1, 2018.
  9. WHO. WHO calls on countries to reduce sugars intake among adults and children. 2015; https://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/. Accessed November 1, 2018.
  10. Ervin RB, Kit BK, Carroll MD, Ogden CL. Consumption of added sugar among U.S. children and adolescents, 2005-2008. NCHS data brief. 2012(87):1-8.
  11. EWG. Children’s cereals: Cereals contain far more sugar than experts recommend. 2014; https://www.ewg.org/research/childrens-cereals-sugar-pound/cereals-contain-far-more-sugar-experts-recommend. Accessed November 1, 2018.
  12. Department of Nutrition at Harvard School of Public Health. Sugary drinks and obesity fact sheet. 2012; https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/. Accessed November 1, 2018.
  13. Harris JL, Heard A, Schwartz MB. Older but still vulnerable: All children need protection from unhealthy food marking. Rudd Brief. 2014:1-14. http://www.uconnruddcenter.org/files/Pdfs/Protecting_Older_Children_3_14.pdf. Accessed March 5, 2019.
  14. Uribe R, Fuentes-Garcia A. The effects of TV unhealthy food brand placement on children. Its separate and joint effect with advertising. Appetite. 2015;91:165-172.
  15. Kearns CE, Schmidt LA, Glantz SA. Sugar industry and coronary heart disease research: A historical analysis of internal industry documents. JAMA Internal Medicine. 2016;176(11):1680-1685.
  16. Moss M. Salt, sugar, fat: How the food giants hooked us. New York, NY: Random House; 2013.
  17. The Center fro Responsive Politics. Lobbying Database. n.d.; https://www.opensecrets.org/lobby/. Accessed November 1, 2018.
  18. The Center fro Responsive Politics. Food industry: Issue profile, 2018. 2018; https://www.opensecrets.org/lobby/issuesum.php?id=FOO. Accessed November 1, 2018.

Ok, I admit it. My generation has done a lousy job of making the world safer for your generation. We allowed the political system to be taken over by the very wealthy, which hollowed out the middle class and decimated hundreds of communities. We failed to prevent climate change, which has become a slowly moving catastrophe. We have allowed the federal government to fall into the hands of incompetents. So maybe you don’t owe us anything.

But was there just maybe one grandmother who cared for you when you were sick? A grandpa that always approved of what you did or protected you when a bully picked on you? if so, maybe you would take this opportunity to do something for the grandparents of the world.

You see even though the Coronavirus is not going to kill many people your age, it is going to kill about 10% of people in their seventies and 18% of those in their eighties.

Here is what is happening In Italy, because they did not get healthy people to isolate themselves early on. The hospitals are overflowing with more people than they can treat. The sickest need respirators to help them breathe, but they don’t have enough. Overworked and increasingly sickened health care workers are having to decide who will get ventilator and who will be left to die. The death rate from the virus is higher in Italy than in other places because they didn’t slow the infection rate.

The countries that have taken the most aggressive steps in encouraging social isolation have been the most successful in slowing the rate of infections and avoiding what Italy is experiencing. In the U.S. much progress has been made in the past week with the cancellation of most large public gatherings.

However, it appears that many young adults are oblivious. In Miami, thousands of young adults are partying on the beaches even though the city called a state of emergency. In New York, young adults are lining up to get into bars. We can be sure that many of them will be infected. Few of them will die. But, they will ensure that the ERs in their communities are overwhelmed and that more older people and those with infirmities will die.

I suspect that most of the people doing these dangerous things have no idea what harm they are doing. Certainly the news stories have not made clear what the problem is. Even experts appearing on CNN this morning, did not indicate that everyone should be isolating themselves.

So here’s hoping that despite any disgust you may feel about my generation as a whole that you feel some warmth for a Grandma or Grandpa and that in their honor you will stay at home and isolate yourself as much as possible.