Of pigs, Babel and totalitarianism

Here is a weird thought: Our current food production is closer to the Soviet collectivization than to the free enterprise model. Outrageous? Not really.

I had avery interesting weekend. As some of you may know, I am finally going back to Odessa (no, not the one in Texas) after a 35-year hiatus -- we left when I was 13. Since I am only spending 3 days there, I have been doing a lot of soul-searching to figure out what I need to get out of the trip. Serendipity struck last Sunday, when in the midst of a gloomy morning I went online to search for something to do in the Valley, indoors, and came upon this. Now, although most of you probably have never heard of Babel, he was a very well known and respected author of the Soviet era. A Jew in peri-revolutionary Odessa, he was a master story teller, best known as the bard of the colorful life of the Moldavanka, a district of Odessa particularly rich in poverty and Jewish gangsters. My father was a great scholar of Babel, and I remember hearing his stories from a very young age. I also remember passing by his house in the streets of Odessa, with a modest plaque marking its historic lineage.

But Babel became personal for me when in 1996 my parents brought me a gift from their trip to our home town, a book of Babel's short stories with an inscription from my cousin's family. This inscription pointed me specifically to page 19 of the tome. As my eyes focused on the small print, and as I started to skim the text, I shortly came upon the following sentence: "None other than Dr. Zilberberg operated on him..." Yes, my great-grandfather was a fairly well respected surgeon in Odessa at the turn of the 20th century, and Babel in fact mentions him in several other of his works, including this autobiographical sketch. Unfortunately, most of what I know about that Dr. Zilberberg has been passed down through the idealized prism of the family lore. Yet I am thoroughly intrigued by the claims that his professional ethics forbade him from turning anyone away, and he cared for the rich Jewish ladies alongside the mafiosi of Moldavanka with the same level of professionalism. And for this, the legendary gang leader Mishka Japonchik, who incidentally is rumored to be related to me on my mother's side, but that is a story for a different time, is known to have afforded him protection from the rogue elements of his gang. The story is well told by my father in this essay, albeit in Russian.

But I digress. So I immediately got myself out the door to get to the program and sat, along with about 100 other attendees, riveted by Andrei's reading of his grandfather's work. After the intermission he read the story that features my great-grandfather, and of course in the Q&A I came out as the great-granddaughter of the great surgeon. Because of this I was invited to join a group of locals and Andrei for a memorable dinner. It was at this dinner that an insightful comment from the brilliant hostess clarified the mindset for my trip. And it was at this dinner that Andrei started to remind us about his grandfather's journalistic work about the collectivization movement in the nascent Soviet Union. It is at this dinner that I got a very clear picture of how our current food production is eerily totalitarian. Imagine if you will being a small farmer at the turn of the 20th century in Russia. You are by no means well off, and all you have is the land and what it gives you after hours and hours and hours of backbreaking loving tending. Imagine now that in comes a new regime, claiming to be for the workers and peasants, and now considers you a land-owner, a kulak, a member of the bourgeoisie, and takes away your farm (the term used is "raskulachit'" or de-kulakize) and puts it in the hands of the collective. Now the big whole owns your meager part and you are left with nothing.

Now let us think about what has transpired in the US over the last century. Let us look at the meat industry specifically. Its deplorable practices at the turn of the 20th century were chronicled brilliantly by Upton Sinclair, and I will only mention that, according to Eric Schlosser's writing, in 1917, 5 largest meatpacking companies owned 55% of the market. On the heels of Sinclair's book, and prompted by the appalling confirmation by the government investigation of Sinclair's claims, the government embarked on a regulatory voyage culminating in the 1920s with the anti-trust legislation, meant to ensure that no monopoly (or oligopoly) would control any market in our nation, thus precluding companies from getting big enough to control our free markets. Well the result of this was a sharp decline in the market share for each of the giants. Yet this was transient, and, as Schlosser points out on page 162, today the top 4 meatpacking giants control over 80% of the market. What happened? Well, we call it "deregulation." But is it really all that different from collectivization? Not that much -- it is still the few controlling the many, and the many going bankrupt and having no leverage to improve their lot. But, you say, it is not the government, but private interests that are at play, so this makes it all better, right? Well, are you sure about that? Who is pilling the strings of our congressional representatives? And these strings are only going to get stronger, thanks to Citizen's United decision from the Supremes. So, while the politicians are foaming at the mouth calling Obama a socialist and a communist, we are careening head first away from democracy and into that social structure we contemptuously call totalitarianism.

Simplistic? I don't think so. Think about it: a pig with lipstick on is still a pig.    

Dear Dr. Val

Dear Dr. Val,

I enjoy reading your blog and the contributions from many of the leading medical bloggers that appear on it. Occasionally, the spirit moves me to post a comment, but for the second time in just a few months my comment has not made it to your blog. Why? I also tweeted you to ask if there are technical difficulties peculiar to my comments, but I did not get a reply. Why?

I know that some bloggers have a policy about what comments get rejected. I know that I will not accept abusive, profane or overtly marketing comments on my blog. I am sure you have the same standards. So, why not accept mine? I read Dr. Novella's post with great interest yesterday, and got passionate enough to write a pretty lengthy response. I am grateful to you and to Dr. Novella for allowing me to think through some of the issues that I commented on. But I was hoping for a dialogue... How will we ever arrive at mutual understanding or even better individual understanding without a cogent dialogue?

I do understand that the blog belongs to you, and you must have many reasons not to accept all comments, and that is your right. Perhaps you never even saw it, perhaps you no longer follow my tweets and thus did not get my queries. That is all fine. If I cannot get my comment on your blog next to the corresponding post, I will put it here and hope that you will come for a visit. If you do, I will welcome your comments. So, here it is:

What a great post! Dr. Novella makes the point that there is no evidence for the superiority of consuming organically produced foods over the conventionally produced ones in terms of health benefits. To arrive at this conclusion he relies heavily on a recent systematic review supported by the UK Food Standards Agency, which examined 12 studies, 8 of them in humans, 6 of which were RCTs and the remaining 2 observational studies. Because the article is available by subscription only, I could not access the whole paper. However, knowing what conducting clinical trials entails, I doubt that the 6 experimental studies followed the subjects for all that long. Perhaps not long enough to detect the benefit? Would love Dr. Novella to comment on this.

Additionally, divorcing the potential direct health effects due to consumption of organic products from the effects of the production on the environment is a false dichotomy. The pesticides do not just stay on the skin of the produce, but get into our water supply; the antibiotics given to the animals in CAFOs do not just get into their meat, but also get into the water and produce resistant pathogens -- there is plenty of work from the Netherlands to support the connection between agribusiness practices and human pathogen resistance emergence. Also, look at the staggering findings by the USGS about the contaminants found widely in our water supply and in what amounts.

The monoculture model of conventional agribusiness also requires enormous amounts of petroleum for fertilizers and pesticides as well, a resource that is dwindling. And, perhaps most importantly, the impact of monoculture farming on the land itself is devastating, decimating arable lands and creating essentially sterile deserts which need centuries to recover.

Having said all this, the mass-produced organic food business is not much more environmentally friendly than the conventional agribusiness, relying on monocultures and artificial fertilizing and pesticide management, as Dr. Novella aptly points out. Additionally, because it is concentrated in places remote from where it is consumed, its carbon footprint is still enormous. The really sustainable way to farm and eat, environmentally and human health-wise, is returning to small local farming, with a short distance from farm to table and a self-perpetuating cycle of earth's nutrient consumption and repletion by a diverse biome, just like nature intended.

My final sentiment is that, as people involved in healthcare of our nation, we must care about social and environmental justice. While these issues may fall more comfortably under the rubric of Public Health, doctors and nurses and other personnel at the bedside need to develop a greater appreciation for the context in which disease develops. This context includes healthy and sustainable food production and other social and environmental concerns.