"When evil walks into a room, it is not wearing horns and a tail"

I was listening to a podcast of Krista Tippett On Being this past weekend while hiking. She was having a conversation with Darius Rejali, an Iranian-born American scholar who studies and writes about torture. His most memorable line was: "When evil walks into a room, it is not wearing horns and a tail". He said that one does not have to read Hannah Arendt to understand the banality of evil.

Yet for me, reading Eichmann in Jerusalem did produce the very epiphany evoked by the book's subtitle: A report on the Banality of Evil. More than any other previous experience, Arendt's narrative wove for me the convincing tale demonstrating how easily one can slide into evil. The journey is incremental and, by virtue of this, insidious. The travel companions also matter -- they must be people whom one respects and emulates, and, the logic becomes that, if they are acting in a certain way, it must then be OK for one to act similarly. She illustrates these ideas by recounting the testimony of Eichmann, a petty clerk, a follower essentially, who ascended in the Nazi bureaucracy to the level of orchestrating a massive genocide. The story is one of almost witless and blind compliance with the higher-ups, all people commanding Eichmann's respect and admiration. The thesis is so spooky that it demands constant self-examination to assure avoiding the barely noticeable descent into evil.

Similarly, Rejali described people who are hired to perpetrate torture not as psychopaths, passionate about hurting others, but more as methodical disciplinarians, careful not to inflict too much damage, lest the victim expire prior to giving the wanted information. So, essentially, they are just "doing their jobs". Just as marketers who sell us cigarettes are doing their jobs. I am sure that they do not perceive themselves as evil -- they have families, children, they have their faith, they play golf and eat Chinese food, just like the rest of us. They drive their children to soccer games and sit on school committees and boards of charitable organizations. Yet, what they do at work is follow orders and money and sell certain death.

And how much other evil gets perpetrated by regular people? What about climate change deniers? Because they do not have unequivocal proof that humans are catalyzing an environmental catastrophe, they feel justified in prioritizing the economy over the facts. They do not understand that observational science does not provide proof beyond the shadow of the doubt, and we indeed need to heed the circumstantial evidence before us. Yet, since respected politicians deny any possibility of an impending man-made environmental disaster, citizen deniers feel justified in their willful ignorance.

Am I stretching this concept too much? I do not think so. Nicholas Christakis and colleagues have been showing the importance of networks to our health, and it is not a stretch to imagine that networks may be critical to the health of other common concerns. These include the environment, and may even include our vast and growing economic disparities, which are no longer merely causing illness and inconvenience, but are responsible for killing our children.

So, next time we cavalierly dismiss others' concerns about shared resources, next time we turn our heads away from socially and economically inconvenient realities, let us inspect methodically the possibility that this very banality of evil may be working to insinuate itself into who we are. Because an ounce of prevention is still worth a pound of cure.  

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.