Any good scientist is always seeking to answer questions, and willing to question answers.
But when urgent action is warranted to avoid calamity, and when enough established “truth” is in hand to steer the general course of that action- doubt for doubt’s sake is an enemy to the essential. Scholarship and procrastination do not share the same pedigree. The provocation for today’s tirade resides there, where these two roads diverge.
By any objective parameter, the earth- our home- is a hot mess. We have just passed through the hottest, global July in the history of meteorology; followed by the hottest, global August. We have borne witness during the same span to the highest recorded sea temperatures. We have made these passages together, dispensing carbon and plastics and pesticides along the way.
With all due respect to us, we are a pestilence.
To some extent- at least during this somewhat dismal span we can only hope is that singular darkness just before a new dawn- we can forgive ourselves that. We are a pestilence by virtue of inertia, initiated at the dawn of agriculture, accelerated by every “advance” since, notably the industrial revolution. We set out with very different intentions than soiling our nest, depleting aquifers, and obliterating the treasure of biodiversity. These are all just byproducts of human beings doing what human beings tend to do.
Our reckoning before agents in the Matrix- that we are a fever-inducing, planetary virus- is not far wrong.
We are a thinking virus, however, and that changes the scope of our license. Viruses can’t change their behavior to avoid killing their host. We, in principle at least, can.
So our singular indictment is not for parasitism; we are parasites by accident. It is for apathy. We are apathetic by choice. We are mostly fiddling as Earth burns…and floods, and howls, and desiccates, and thrashes, and dwindles.
Twice over recent weeks I’ve had correspondents reach out to share with me some version of a published claim by scientists challenging the link between carbon emissions and global warming. This, in turn, raises questions- so I was informed- about allocating resources to address this “alleged problem.” Enter the risk of calamitous fiddling.
The central tenet of this refutation seems to be that “atmospheric carbon dioxide is not the locus of the principal harm.” We are well past the point of credibly denying the effects of our abuses of the planet, so this contention shifts the focus to the relative importance of putative causes. My response may at first seem anti-intellectual, but I will gladly don my dunce cap and declare it just the same: who cares?
I can’t help but think of the many published papers by acolytes of Big Soda over the years, challenging the contributions of all those calories and all that sugar to plagues of modern epidemiology, notably obesity and diabetes. The standard approach has generally been to make the case that soda is not “the” cause of a given public health crisis, and thus shroud the potential merits of doing anything about it as one among the causes. Consider how easy it would be to “prove” that soda is not “the” cause of obesity: design a study that matches for total calories and added sugar, at low or high levels, but that varies the sources, soda in particular. The outcomes would be the same or nearly so in both groups, and thus the singular contribution of soda would be disproved.
Here as well, I offer up: who cares? We can no more convict soda as “the” cause of obesity or diabetes than we can convict any given snowflake in a lethal avalanche. The same amount of sugar and calories from other sources than soda would do the same harm. But take away soda, while also working to avoid replacing that sugar and those calories, and we are onto something. Elevate the quality of the diet overall, and a whole new world of promise opens before us.
So, too, for the health of the planet. Leaving aside the vast aggregation of evidence and expertise linking carbon emissions specifically and directly to our worsening environmental woes, there is quite simply nothing more to be gained for planetary health than for human health by attempts to isolate “the” cause of its decline. All of nutrition matters to human health, and no one food item explains the effects of overall diet quality. All of lifestyle matters to human health, and no one domain can substitute for all the others. All of our collective depredations matter to planetary health, and no one of them need account for the harms of all to know that each, and all, must be addressed.
One need not be an environmental scientist to recognize that we can’t do much about the indisputable elements of planetary decline- pollution of air and water; depletion of aquifers; deforestation; ecosystem destruction causing mass extinctions – without addressing the principal sources of carbon emissions, namely: how we manufacture and power just about everything; how we travel; how we produce, source, and distribute our food. We could take corrective actions “to” address carbon emissions, or we could address carbon emissions by taking such actions for any other good reason. Either way, and no matter what theory of causes you favor, we can’t engage in meaningful remedies without addressing carbon emissions.
Accordingly, with regard to the contrarian contention: who cares? A difference, to be a difference, must make a difference. If the introduction of doubt about “the” principal cause of climate disruption does not appreciably alter what we can or must do to save our planet, then it is a distinction that does not make a difference. It is an invitation not to enhanced means to better ends, but to procrastination and complacency. It translates loosely to: “we can muster doubts about what caused the fire, so let’s fiddle with those instead of putting it out…”
Note that it is almost always easy to find some scholarly (or seemingly so) paper refuting any given premise, no matter how reliably established. This is utterly insidious in the nutrition purview I call my own, and has bogged us down in circuitous, and calamitous meanderings for decades. Contrived and contorted theories that invite doubt and impose delay are readily made to sound erudite by cherry-picking source material. Where doubt is warranted and delay tolerable, endless rounds of questioning answers might be healthy. But where truths are settled- as, for instance, the reliable effects on us of gravity; or the reliable benefits of eating whole fruits and vegetables and legumes - challenges are apt to be either deluded or disingenuous, and perniciously dangerous. Iconoclasts don’t need to be right, or even reasonable, to garner a lot of attention.
Beware the scholarly patina so readily used to coat the contrarian view. Recall that there are, famously, three kinds of lies: lies, damned lies, and…statistics. Numbers can be made to lie by enlisting them in duplicity, willful or otherwise. I say this as someone who has written texts on biostatistics, and taught the subject to medical students at Yale for over a decade. I understand this particular brand of legerdemain quite well.
In my primary field- nutrition- numbers are made to lie all the time, sometimes by intention, sometimes by innocent ineptitude. The remedy is to look at the big picture- for sourcing evidence, synthesizing it, and applying it.
We might imagine that instead of this heavenly body we all inhabit, this column were instead about an individual human body in intensive care. Imagine that because of, say, septic shock, a particular course of treatment is required. Now, however, we hear from the nephrologist, or neurologist, or hepatologist, or some other organ-system-ologist, raising questions about the specific cause of some organ-specific impairment: it’s less the hypotension and more the hypercoagulability; no, it’s the hypoxemia; no, it’s the metabolic acidosis. We are invited to debate the matter. The problem? While we debate, the patient dies. Whatever the specific causal pathways affecting each organ, treating the sepsis to save the patient’s life is obviously essential, and urgently so. How best to administer targeted organ system support may be debated once the patient is no longer on the brink of death.
So, too, for carbon and climate, oceans and aquifers, rivers and rainforests. The evidence is overwhelmingly clear how and why carbon emissions are a problem. But if there were room for debate- so what? We are clearly destroying the natural balance of our world by many means, all involving our generation of carbon emissions, whatever the arguments about carbon and climate. What we need to do to fix carbon and climate, we need to do for other reasons as well; what we do to solve the general problem of planetary degradation solves the problem of carbon and climate. So why dither and debate the particulars when the general case calls out so urgently for action? No family ever appreciated the scholarly debate that played out while the patient was left to die.
On the off chance you wonder how this is my business, other than by lying awake at night and worrying what will be left of the planet for my kids when they are my age, my answer is: I am a health professional.
We have some hope of being healthy, vital people on a healthy, vital planet- or we have no hope of being healthy, vital people. Thus, planetary health is my business, and that of anyone else professing to defend health. One can no longer be a legitimate “health” professional in 2023 if not advocating routinely, and with passion, for the health of Earth. I am minding my business. A sustainably vital planet to call home is the business of us all.
Which brings us to flames, and fiddles.
The Roman Emperor Nero is notorious for “fiddling” while Rome burned; specifically, a conflagration of uncertain origin in 64 AD that consumed 70% of the city and left half the population homeless. The story of literal fiddling is assuredly apocryphal, while the figurative implications seem more valid. Whatever complacency Nero did or did not display during the fire, and however music on whatever instrument did or did not figure in it, he is rendered to us as a decadent, apathetic, inept despot. He has been weighed and measured by the judgment of history, and found gravely wanting.
In this era, the Anthropocene, we have met the blithe musicians, and they are us.
Of course, not everyone is fiddling; hence, my qualifying “mostly.” To those working tirelessly and fervently to fix what we have so badly broken: thank you! This isn’t about you. It is about the inadequacies of the collective “us,” and the gravity of doubt for doubt’s sake in a world on fire.
Regardless of any actual fiddling, Nero was compelled by the judgment of history to face the music. As we mostly fiddle while earth burns, we should expect no less.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and former President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.