In a recent issue of the Journal of the American Medical Association, researchers reported the first systematic analysis of this database. The results are a cause for concern. What kind of concern depends, of course, on your point of view.

The researchers were concerned because most of the studies could not provide practitioners with what they called “high-quality evidence.” This is a problem because, for over two decades, there’s been a drumbeat for evidence-based medicine. Now it turns out that the evidence isn’t so great.

This study is not the only voice from within conventional medicine that has raised the flag of over-confidence in health and medical research.

Of course, it also turns out that conventional practitioners don’t much practice evidence-based medicine, at least not as envisioned by its promoters. Although practitioners pay attention to official guidelines and such, what they principally use as sources of knowledge includes the advise of colleagues, observing colleagues, information from sales representatives of drug companies and medical device manufacturers, and other forms of social knowledge.

One researcher calls the actual practice of evidence-based medicine a new ritual. Other researchers refer to it as marketing-based medicine, referring to the grip that commercial interests hold over research and publication in respectable journals—the place where the evidence of evidence-based medicine is to be found.

The take away message for these folks—trying desperately to maintain social order—is just keep up the good work and the evidence will get better and better.

I offer two other take away messages.

The first is that the clinical trial as the standard for knowledge of health and illness is a false idol. Clinical trials are privileged by a specific ideology of health and medicine—namely, that health effects (whether good or bad) are caused through a linear process that is reducible to specific biochemistry or physiology. In other words, clinical trials are incapable unraveling inherently complex health effects.

The second take away message is that this handwringing over the FDA database reinforces the ideology and institutions of science that count evidence to be valid only when it is of a particular kind. That ideology and those institutions are tightly coupled with specific technologies, which are inevitably manifested in commercial enterprises.

This coupling of science with commerce is obvious in virtually every study I read, where researchers hope that their new knowledge will lead to a better drug or medical device or procedure or what have you.

It’s also true that this coupling of science with commerce is characteristic of what is referred to as natural medicine and natural health. Instead of a better drug, it’s a better nutraceutical or better herb or better something that isn’t a pharmaceutical.

All of this technology for the healing arts should, of course, be common property not commercial property—because our health is common property resource—it is like the air we breathe.

A recent study suggests another approach. In this study, the prevalence of obesity and diabetes was found to be as much about neighborhood as genetics. A neighborhood is common property resource—it is like the air we breathe.

As I said before, what dominates now is science that’s about linear processes reduced to biochemistry and physiology. A good deal of ink is being spilled on how our genome determines all of that. Strange thing, though, is that with greater sophistication in examining the proteins our genes produce—proteins being the biochemicals that do the actual doing—there is great gene variation among peoples, variations that affect health. The variations are closely associated with place of origin.

Put simply, each body has a place that it’s made for. That’s not a reason to abandon finding things to cook up in the lab. It is a reason—a very good reason—to abandon our scientific devotion to an ideology that prevents us from understanding how where we live affects our health and, like where we live, is something we share in common—like the air we breathe.

They cite a wide range of illnesses to make their case: asthma, diabetes, obesity, autism, ADHD, developmental disabilities, and on and on. All of these are strongly associated with an equally wide range of environmental exposures: metal pollution (especially lead), endocrine disruptors, air pollution, poverty, and on and on. The researchers emphasize that the effect on health is not just an event that kids get over with some medicine and a little rest. These are conditions that keep on giving, often piling on as the child grows to adulthood on into old age when the chickens really come home to roost.

By making an investment that eliminates exposures, the cost of ensuing medical conditions as well as the non-medical cost of lifelong disability is eliminated. But this is not our current approach, which focuses on the gene for this and that and the other clinical measures of individual susceptibility to illness. “As Geoffrey Rose, a pioneer in the science of prevention, wrote provocatively, ‘If causes can be removed, susceptibility ceases to matter’.”

Prevention of this order focuses on changing the physical and social environment to which populations are exposed rather than clinical practices and technologies applied to individual patients. Although this approach makes perfect economic sense, it makes no financial sense—illustrating the common confusion between the two.

What I mean is that it’s common to talk about the economics of prevention as being about the costs of eliminating exposures versus the medical and other costs of living with a condition caused by those exposures. Actually, that’s finance. It’s about the money. And it’s money from a particular, commercial perspective: what is gained and lost in dollars.

The economics of prevention is about the value of what is gained and lost over a lifetime. Sometimes, it’s about what is gained and lost over many lifetimes. For example, recent research suggests that exposures during fetal development to common plasticizers and insecticides increase ovarian cancer rates over at least three generations—that is, the exposure makes it more likely that the exposed fetus will have ovarian cancer as an adult and that her daughters and granddaughters will also have more ovarian cancers.

The process of fracking brings economics and finance into even greater contrast. This last week the Obama Administration issued a rule that requires companies such as ExxonMobil to disclose the chemicals they use drilling for natural gas deposits. The chemicals include endocrine disruptors and other toxins. Once released, these chemicals are carried into the water table and water supply.

So now there’s a rule that these companies must tell us how they’re poisoning us. Originally, the Obama Administration proposed disclosure 30 days in advance of drilling—that is, before the toxin laden fluid is driven into the ground to fracture the rock and release natural gas. However, the final rule requires only that a company disclose what chemicals were used after the drilling is done—in other words, after the toxin-laden fluid has been injected into the ground.

“Lobbyists representing oil industry trade associations and individual major producers like ExxonMobil, XTO Energy, Apache, Samson Resources and Anadarko Petroleum met with officials of the Office of Management and Budget, who reworked the rule to address industry concerns about overlapping state regulations and the cost of compliance.”

That’s finance, not economics. It does not weigh the risk of incurring additional costs for compliance with the additional costs of, among other health effects, neurological damage, endocrine disruption, and cancer.

Instead of this horror show, the Canadian’s point processes that require manufacturers to demonstrate that a chemical is safe before they can use it. They point to repairing substandard housing. They point to a ban on cigarette advertising.

What’s odd about this and other studies that demonstrate the promise of population-based prevention is that it fails to sell the idea in some important way. Although inroads are made here and there, it is very much an effort that is swimming upstream against powerful currents illustrated by fracking.

The shift to population-based prevention, the shift to changing our physical and social environments in order to spare our children and grandchildren from the suffering to which we’ve condemned them will take another kind of environmental change—an environment, a political economy in which finance is not in command.

One of these critiques is a book titled Snake Oil Science: The Truth About Complementary and Alternative Medicine. Somehow I don’t think I need to spell out the book’s attitude for you. The first page describes a press conference held to launch the National Institutes of Health’s National Center for Complementary and Alternative Medicine. A group of alternative practitioners spoke passionately about their hopes for their modality of choice. “But there was no sense of conflict or rivalry. As each spoke, the other would nod in agreement.” The author found this “amusing.” He goes on to say that “[I] observed [it] numerous times during my own involvement in an NIH-funded center for complementary and alternative medicine.”

Here’s the odd thing. I thought being open-minded was a core value of the scientific method. I thought the purpose of the scientific method was to let the facts lead you to a better knowledge of how the world works. If someone has an unorthodox idea but he otherwise seems sane, why does he deserve to be ridiculed?

Because this book and others like it aren’t written for other scientists or for health practitioners. They’re written for you. They’re written to warn you off alternative health practices. In addition to setting the tone with scorn, these writers are also invariably alarmed by the growing use of alternative health practices.

By “practice” what I mean is the practical application of what you know. Where does what you know come from? It doesn’t fall from the sky. It comes from one of two places: you figure it out yourself from your own experience or someone tells you.

Those who wear the mantel of the scientific method describe it as inference of what causes and prevents illness based on careful observation—that is, figuring it out based on experience. Yet it’s not your experience. And you’re not figuring it out. It’s someone else’s experience in the practice of science and you’re being told what it means. That’s not a bad thing in itself—if you trust the someone who’s telling you.

This kind of authoritative voice that speaks for “science” has been culturally dominant for more than a century and has been speaking for at least 500 years. What that voice has been saying is that life as experienced by the individual human being does not exist in the absence of verified scientific knowledge—that is, what you experience isn’t real unless a scientist says it is.

The novelist Marilynn Robinson, in her recent book of essays Absence of Mind: The Dispelling of Inwardness from the Modern Myth of the Self, speaks to that exclusion. She calls the authoritative voice parascience. As her book’s title suggests, the delegitimated experience of the individual person is traditionally referred to as the mind. But in a better phrase, she refers to “the felt life”—that is, our sense of how things are.

That people are turning in ever-greater numbers to alternative health practices demonstrates, I think, that the felt life, our sense of how things are is very much alive. Parascience, however, is ascendant. So on the one hand, as Marilynn Robinson observes, those who speak authoritatively about the scientific method seem to be singing mostly to their choir. On the other hand, that choir defines what counts as science. And this fits very nicely into the power structure of our political economy.

In our book Too Much Medicine, Not Enough Health, we discuss a distinction made by the medical historian Robert Aronowitz in describing medical science and practice. On the one hand, specific disease is what medical practitioners diagnose and treat and what researchers study. On the other had, individual illness is the felt life of the person, his or her sense of how things are.

The dominant mode of medical and health science is interested only in the causes of specific diseases. It is inevitable that it would exclude alternative health practices because, so far, they’re the only science of individual illness—and health—available to us. They’re the only home for the felt life.

The marvel is that human beings are capable of selflessness, empathy, doing the right thing. We need more of those marvels. Of course, the Wildlife Conservation Society is not unique in this regard—yet another marvel. It is also not unique in getting itself into moral dilemmas.

Last year, the head of the organization in India was forced to resign because he participated in implementation of the Forest Rights Act—environmental legislation common to many developing countries where the traditional rights of tribal people to land are restored. International organizations such as the Wildlife Conservation Society oppose these laws because they believe that tribal peoples will not properly manage wild places.

The dilemma was: protect the wildlife or protect the tribal people. Some argued that it was a false dilemma, that in fact protecting tribal rights would also protect wildlife. However, although almost all moral dilemmas have questions of fact at their core, I want to bring to your attention how humans actually work out what to do—in particular, the critical role of the context in which moral dilemmas arise and are resolved.

In the last decade or so, both psychologists and neuroscientists have uncovered what goes on in our brain when we make moral decisions. A typical experiment consists of posing a moral dilemma to someone and identifying what areas of the brain light up when he or she decides what to do.

A classic moral dilemma used in these experiments is called the Trolley Problem.

A runaway trolley is headed toward a switch that you control. Along one track, five people are working. Along another, one person is working. You can’t stop the train, but only change which track the trolley runs along. If you throw the switch, the trolley kills the single worker, saving the other five. Do you throw the switch?

Nine out of ten people throw the switch. The brain area that lights is used for calculation. Essentially, those who throw the switch are making a utilitarian decision: one life for five.

But if the dilemma is changed, a different area of the brain lights up. This dilemma, again a classic, is called the Man on the Bridge Problem. The trolley is coming, there are five workers on the track, but instead of standing at a switch, you’re standing on a bridge over the track. Next to you is a large man who, if thrown in front of the trolley, would bring it to a stop before hitting the five workers. Do you throw the large man in front of the trolley?

This time nine out of ten people would NOT throw the man in front of the train, sacrificing the five to save the one. The brain area that lights up is used, not for calculation, but for emotion and empathy.

Those who chose to throw the switch justified their action with utilitarian reasoning: greatest good to the greatest number. Those who chose not to throw the large man from the bridge appealed to their gut feeling, their intuition: it just didn’t feel right.

Researchers frequently use this contrast to suggest that the intuitionists have made a moral choice of poor quality—in other words, the utilitarian credo of greatest good to the greatest number defines good moral choices. That bias is understandable—as Marx observed, utilitarianism is the philosophy of the market, which saturates the air we breathe. It also turns out to have some unsavory associations.

The people whose brains light up in resolving moral dilemmas with a utilitarian calculation are those prone to analytic thinking (such a philosophers and scientists) and men and people who score high for antisocial characteristics on tests for psychopathology and Machiavellianism.

But that information doesn’t answer the question of whether it’s right to throw the switch or the large man. Of course, it would be hard to suggest that it’s wrong to throw the switch at all. Or would it? What if the one worker who gets killed is your child? Faced with that kind of dilemma, the split is half and half, not nine out of ten who would throw the switch.

So context is critical. And so is your emotional distance from the subjects of your actions.

Consider the following dilemma. A scientific panel has decided that Teflon causes testicular and kidney cancer. You are an executive at DuPont, responsible for Teflon. Do you stop producing Teflon throwing hundreds of people out of work?

Or consider this dilemma. You are a public official. Before you is an application for construction of a cell tower. Most people want the better cellphone service that is promised. A small number of people fear for their health and the health of their children. Do you vote for or against the application?

The moral dilemma is not just about the possible outcomes. It’s also about how you create the context in which the dilemma is resolved and how you feel about the people who are affected.

This is an illustration of economic insanity masquerading as financial responsibility.

The economics are clear: lead toxicity causes biological damage with costs that include medical treatment and lost productivity not to mention the shear misery of neurological and other impairments. A recent study found that medical costs to children poisoned by lead amounted to a lifetime cost $6 million while lost productivity due to neurological impairment from lead came to $51 billion. So cutting efforts to prevent lead poisoning are economically stupid and cruel and insane.

So it looks like we’re thrown on the tender mercies of the marketplace in protecting ourselves. It’s the age of laissez faire prevention and laissez faire health care and buyer beware.

But wait!

Is it really true that when the government abandons us we’re helpless to prevent the ravages of rampant environmental poisoning by toxic products and production processes? Let’s start over.

There is no safe dose of lead. Any exposure is toxic. Lead’s principal effects are on the nervous system. The most vulnerable are children and fetuses, although adults are not spared. We absorb lead principally through our lungs and gut: from what we breath, eat, and drink.

Many public health sources will advice you to “avoid lead” without telling you exactly what that means. A well-known source is lead-based paint on older buildings. A less well-known source is the cords for electric appliances and such things as Christmas lights. Ho, ho, ho! Yet others include solder in copper water pipes, toys, antiques, PVC products, lipstick, and ordinary dust.

So exposure is pervasive. Does that mean you’re at risk?

Yes.

However, your liver has a lovely process for identifying and eliminating toxic metals such as lead—that is, until it’s overwhelmed. Then your body tries to tuck it away in places such as the intercellular space in your brain where it does considerable mischief. And if you’re a young body, lead gets caught up in the rapid turnover of growing tissues and wreaks other sorts of havoc.

How do you know whether your or your child’s body has been overwhelmed and is holding onto lead or other heavy metals? A hair analysis is a common, simple, non-invasive, and relatively reliable indicator.

No matter the test results, the first thing to do is avoid exposures. Unless you’re living next to a lead smelter, the greatest exposure is likely to be the buildings you work and live in and the furnishings that are in those buildings. But don’t forget personal items such as PVC-based products and personal care products.

Supporting your liver’s detoxification capacity is as important as avoiding exposures. That begins with a diet that has sulfur-containing amino acids. Protein from animal sources is by far the richest source. It also begins with a diet rich in anti-oxidants. And herbs such as milk thistle add additional support.

There is a variety of non-invasive methods that work to clear lead and other heavy metals. However, caution is required because pulling lead out of its hiding places in the body can make it available for reabsorption and renewed damage. For example, cilantro works well at pulling out lead, but you’ll need something such as chlorella to sweep it away so it isn’t reabsorbed.

The point here is not to provide you with a very sloppy tutorial on detoxification, but to emphasize that abandonment by the government does not mean that we are helpless in the face of toxic assaults. We can protect ourselves—and well beyond the small world of individual choice.

Recall that the place everybody starts is the elimination of exposures. That means mobilizing to take actions such as removing lead-using products from homes and offices. Government intervention and government money are potentially helpful but not necessary to do such things.

And government intervention also isn’t necessary to halt the production of lead-using products. It’s true that government, when it’s not an impediment to protection, can economize on coercing producers to act responsibly—among other reasons because government has the badges and guns. But we civilians have out own means of coercion.

Deficit hawks in both major political parties argue that public spending must be slashed in order to avoid burdening our children with our debt. In exchange, they’ll burden our children with lead poisoning. What it really means is that in exchange for saving the future trust funds for the children of the wealthy, the children of the poor, near poor, and soon to become poor will receive damaged health.

We aren’t helpless. At the small, medium, and large scale, we have the capacity to protect ourselves from the ravages of economically insane products and production practices.

The focus of attention was the occurrence of variations in the DNA sequence of specific genes present in some people with autism but absent from people without autism. These variations “are not inherited but occur spontaneously near or during conception.”

Doesn’t that sound as though some environmental assault has affected the germ tissue of the parents? Doesn’t that negate the notion that autism has a “strong genetic component?”

Of course, that’s not the question these researchers were asking. But even staying in the DNA ballpark, if the variant makes the child susceptible to the disorder and the variant isn’t inherited but caused at conception or during early development, shouldn’t they ask about the DNA of the parents?

And what goes begging is the obvious question: what in the parents’ environment would cause the difference in the gene’s DNA sequence?

If the purpose of this kind of research is to identify what can be done to prevent and treat autism, this exercise in DNA determinism seems a cruel half-step: identifying the artifact of an environmental assault without identifying the assailant itself.

This article sparked a discussion on the Collaborative on Health and Environment’s EMF listserv. Cindy Sage eloquently pointed out that the context for this research is that rates of autism are increasing, pointing to changes in our environment. She then goes on to describe the known effects of non-ionizing radiation on development before and after birth, with 42 citations.

Blake Levitt then commented that the practice of using ultrasound to examine a fetus might also be implicated because the technology has changed in the last decade. She too cites research that indicates ultrasound exposures damage developing tissues.

The DNA researchers, of course, did not take this research into account. Non-ionizing radiation from wireless technologies is not accepted as a respectable environmental exposure in most research. But even exposures that are more or less respectable—such as endocrine disrupting chemicals and nutrient imbalances and deficiencies—were not considered. The only thing that came close was the age of the parents—which suggested that older parents are at greater risk of having an autistic child.

Beyond speculations about which exposures affect the risk of autism there is the context in which the risk of exposure itself occurs. Acknowledging that some people will be more at risk than others in a given environment, what (and who) determines what’s in that environment?

For example, a recent study found that a mother’s metabolic condition (specifically, body mass and blood sugar control) affects the risk of autism and other neurological conditions for her child. The increase in the metabolic disruptions that we see as the so-called obesity and diabetes epidemics has been associated with the rise of obesogens (endocrine disrupting chemicals such as pesticides). Bisphenol A is such a chemical. The Food and Drug Administration is studying the use of BPA in food packaging. The process has been going on for over 4 years. The FDA has promised to make a decision about BPA soon.

So we have these elements to the story: DNA, developing tissues, mother’s health, environmental exposures, and political environment.

The causal chain for autism (or most other conditions for that matter) doesn’t start with DNA and cascade up through cells to tissues to organs to the person whose health is damaged. It is not a consequence of fate from a genetic curse. It is a consequence of a particular set of biological relationships—call it a system, call it an ecology—with DNA and politics as only two of the critical elements that make it a living whole that promotes or prevents metabolic damage or neurological damage or any of the other conditions that plague us.

The New York Times article reporting on these people, titled “Ecuadorean Villagers May Hold Secret to Longevity,” tells us that the gene that causes the growth hormone receptor defect is similar to one researchers have studied in animals such as roundworms. When the roundworm gene is removed, the worms live twice as long as they normally would. This has scientists and drug companies very excited.

This view, that there are genes for this and all of our other characteristics, genes that cause sickness and health, including genes for our mental and emotional life is deeply embedded in our culture and media. The metaphor is something like a string of biochemical dominoes, with a gene at the beginning and some health outcome at the end. Knock the gene over and—click, click, clickety-clack—you live a long time or you get cancer or you have a heart attack or you become a schizophrenic.

From what I’ve been reading lately, this idea of a “gene for” something or other has been more or less abandoned by scientists working in the field of genetics and genomics. One reason for this abandonment is that work has shifted from studying genes to studying DNA molecules and the part they play in recurring biochemical processes. In other words, DNA is just one of many chemicals involved with the recurring chemistry of life.

One of the many discoveries about how DNA works is that many, perhaps even most stretches of DNA associated with a gene occur in more than one place on the genome. This makes functional sense since demand for the protein that a stretch of DNA participates in creating can increase beyond the capacity of a single DNA span to accommodate. So copies exist to help. Each copy is likely to differ from the others. So it now becomes difficult to say exactly where the gene is located.

Instead of a line of dominoes with the gene as the ultimate cause, one scientist has suggested the metaphor of life as music with DNA molecules as one of the instruments in the orchestra. In this metaphor, the music that is life is created by the coordinated effort of all the players and their instruments. And don’t forget the venue: music is profoundly affected by the environment in which it’s played—for its acoustics, for its inspiration of the instrument players, for it’s inspiration of those experiencing the music.

The idea that genes work like the first domino is very attractive. It’s seems simple and direct. People like simple and direct solutions to problems. It gives us some comfort that the people in Ecuador who have Laron syndrome have a simple explanation for their condition that could enable them to live long lives, if they only stopped drinking and stopped acting carelessly. The idea is that in these people’s genes there is a way to extend our lives—and maybe even a way to prevent cancer and diabetes—all by striking the right domino.

The music metaphor seems much messier. If the music isn’t right, it might be an instrument that’s not in tune or an instrument that’s missing or too many instruments of one kind or a combination of instruments that isn’t right for the piece of music being played or too much from one section of the orchestra or maybe even something that’s wrong with the venue.

A few weeks ago, the Journal of Internal Medicine carried an article with the title “Factors Associated with Reaching 90 Years of Age.” The research had many flaws, but what it concluded was that, among a group of men born in 1913, how long a man’s father lived had nothing (statistically speaking) to do with how long the man born in 1913 lived. How long his mother lived had a little bit to do with how long he lived. On the other hand, what had the most significant effect hands down was whether the man smoked. There’s no doubt that DNA is involved in the biochemistry that shortens a smokers life. But do we really need to know what stretch of DNA is at work to know that we should toss smoking and other toxins out of the concert hall?

As I’m sure you know, the placebo effect is a beneficial outcome to health from the use of something that isn’t supposed to be biologically active. Since 1964, the FDA has required all new pharmaceuticals to be compared to a placebo. The regulatory hurdle is that new drugs must be statistically better.

In the late 1990s, a researcher at the pharmaceutical company Eli Lilly discovered a troubling trend. Using Lilly’s database of published and unpublished clinical trials he found that, over time, placebos were getting better compared to drugs: drugs that 10 years before were better than the placebo would now fail the FDA test and not make it to market. That list included Prozac.

The trend has continued: a significant number of drugs have not been taken to market because they failed in clinical trials. In case you’re worried, the drug companies aren’t standing still. More on that later. Right now, I want to talk about placebo research.

The word “placebo” comes from the Latin verb “to be pleasing.” A placebo is pleasing to the body because it elicits the innate capacity to heal. The effect was discovered during World War II in rationing morphine to wounded soldiers: a soldier was told he was getting morphine, injected with saline solution, and experienced pain relief as though he’d received the actual drug.

The doctor who made the discovery went on to advocate for the use of placebo controlled clinical trials in evaluating the effectiveness of drugs generally. His research along with drug disasters such as thalidomide led to the 1964 FDA rule requiring placebo controlled clinical trials.

After that, placebo research goes cold until the mid-1990s. These new researchers have asked how a placebo works. Originally, the effect was attributed to psychological peculiarities of specific test subjects. The consensus now hovers around how the placebo is administered. Through either conditioning or learning, a patient understands the placebo to be effective medicine and as a consequence a biological cascade ensues that calls forth the body’s own healing processes.

In the case of pain, for example, the brain region responsible for producing opioids increases in activity during a placebo response. One researcher says that the placebo effect results from the person’s narrative—that is, the story of which use of a placebo is part. This fact is illuminated by the plight of drug companies.

Many believe that drug companies got into trouble because 40 years ago the growth market was in psychiatric medications—that is, the murky goings on of the functional areas of the central nervous system most susceptible to the placebo effect. As the story of psychiatric meds became common knowledge, the placebo effect became more powerful because it became common knowledge that drugs benefited psychiatric conditions.

Since the increased efficacy of placebos boiled up, drug companies have embarked on systematically mining the statistics from their secret vaults. They’ve also hired virtually every mainstream placebo researcher to figure out ways to tease apart drug effects from placebo effects so that Big Pharma can combine therapies—in effect, use the placebo effect to develop and sell more drugs.

I hope you’re reassured that the drug companies will be OK so I can return to the idea that the placebo effect is a consequence of a narrative—in particular, the sufferer’s story and the biological effect that flows from this sense of self. Either consciously or unconsciously, my treatment story, placebo or not, is about whether I get better, survive, recover, return to life as I know it or I decline, return to a life of diminished capacity, die.

That story doesn’t fall from the sky. It’s certainly in my mind, but it’s my mind making sense of what’s going on around me. I’m a wounded soldier. A nurse gives me a shot of what she says is morphine. I’m in a story where nurses make me feel better and never lie and have morphine.

In other words, the placebo effect is intimately entwined with social relationships and material processes.

I invite you to consider the well-known relationship between social class and health outcomes. The harder your life, the less healthy you’re likely to be. It’s commonly agreed that the biological effect is mediated through the stress response. The story I experience is about things getting better or worse or never changing.

The placebo effect and the social determinants of health run along a continuum that is the biological effect of the story you experience of suffering and health. Surely we can put that knowledge to work toward a goal more noble than keeping the drug-besotted medical model in business.

As Alexander Cockburn wrote recently in The Nation, Japanese antinuclear activists are at the threshold of a remarkable event. “At the moment, only two out of fifty-four reactors in Japan are operating. There have been no blackouts because of power shortage. If the antinuclear forces manage to stop the restart of the remaining reactors—which has to be locally approved in each prefecture—all reactors will be shut down by May.”

This could have profound implications elsewhere. The nuclear industry inside Japan is fighting back and the nuclear industry worldwide is watching carefully.

Why exactly should we be concerned about the use of nuclear reactors?

I start with the conclusion of the National Academy of Science, an organization known to be friendly to the needs of government and progress (which means the advance of technology, which means the advance of industry). In 2005, after decades of foot dragging, the Academy concluded that there is no known safe dose of ionizing radiation.

To fans of nuclear energy, “no known safe dose” enables them to reassure us that the little itty-bitty doses we’ll receive from Fukushima and are still receiving from Chernobyl and Three Mile Island and all currently operating nuclear power plants are nothing to be concerned about. I say that any sane person would know that “no known safe dose” means “Get rid of that stuff.”

I think we’re all familiar with the dramatic health effects of radiation poisoning suffered by people in the immediate vicinity of a reactor accident. On the other hand, I don’t think most people are familiar with the less well known effects of what are called low dose, slow dose exposures to ionizing radiation that’s released by accidents and as a routine part of power plant operation.

Most of what we know is based on research conducted in the aftermath of Chernobyl, exposures that are still with us. The principle conclusion from this research is that exposures to ionizing radiation are bi-modal. That is, the effect of a low dose is not a simple fraction of a high dose. Instead, as the dose of ionizing radiation approaches zero, the effect does not but instead gets proportionately greater.

What are some of these greater than expected effects?

DNA damage (that is, genotoxicity), disruption or outright failure of DNA damage repair mechanisms, oxidative stress, increased physiological stress, suppression of the immune system (that is, greater susceptibility to infection and increased inflammation), hypersensitivity to new exposures to ionizing radiation (such as from diagnostic or therapeutic X-rays), susceptibility to leukemia and related diseases (which are cancers of the lymphatic system, which is part of the immune system), and neurological impairment.

This last one is quite interesting. Researchers observed increased cases of poor attention, memory loss, mental exhaustion, reduced mental ability, and, in 70% of cases, very high levels of anxiety. “Some patients could not even remember their phone numbers, or what they had just read in a newspaper.” The researchers emphasize that these conditions are not the result of stress but of actual damage to the central nervous system.

What sane person would want to put people at risk of such suffering?

I mention the details of low dose, slow dose exposures to ionizing radiation because a recent article in The Environmentalist by Cindy Sage draws a direct parallel between the effects of low dose ionizing radiation and low level exposures to non-ionizing radiation—that is, radiofrequency radiation from wireless technologies such as cell phone and extremely low frequency radiation from sources such as electric power lines.

The first parallel is that both ionizing and non-ionizing radiation are bi-modal: the effects at low exposure are much greater that would be expected from the effects at high exposures. Again, as the dose approaches zero, the effect does not but gets worse.

The second parallel is the actual symptoms suffered: DNA and DNA repair damage, oxidative and physiological stress, suppressed immunity, hypersensitivity to subsequent radiation exposures, and damage to the central nervous system with a variety of debilitating conditions.

And so I ask with respect to both low dose ionizing and non-ionizing radiation: what sane person would want to put themselves and other people, especially children, at risk of such suffering?

In the final episode of a spy thriller I watched recently, the section chief asks a spy, “What’s our status?” He replies, “Bad people are trying to kill us.” I’d say nice people, too, are trying to kill us because they’re insane.

The State of California’s Assembly is considering legislation that further promotes the mass vaccination of children. The current State law already requires the vaccination of every child who attends public school. However, parents can obtain an exemption on philosophical grounds. It’s not easy, but it’s possible.

The new legislation (Assembly Bill 2109), sponsored by the California Medical Association, would require parents to obtain written permission for an exemption from an MD. Naturopaths and chiropractors are excluded. This will undoubtedly herd even more children into being vaccinated.

The rationale for forced vaccination is herd immunity: an infectious disease will not spread if enough people in a population have developed immunity to it. The reason is fairly simple. There are three steps to the spread of an infectious disease: exposure, infection, and sickness.

You won’t get sick if you’re not exposed. Even if you’re exposed, you won’t get sick if you don’t get infected. And even if you’re infected, you won’t get sick if your immune system neutralizes the infection. So from the herd’s perspective, the spread of disease is prevented by minimizing exposures, preventing infection, and supporting a healthy immune system throughout the herd.

Here’s where I have a problem with this argument.

If someone is vaccinated, they are supposedly protected and so no longer at risk. If someone choses to take the risk of sickness by not being vaccinated, why is that anyone else’s business? So long as people are well-informed of the risks, why do you need anyone’s permission to opt out?

What makes sense of this is two curses that plague our culture. These twins have been with us in full force since the beginning of the last Century and show no signs of weakening.

The first curse is that a new technology is taken as a matter of faith to have only a good side—until it’s shown after a lot of suffering to have a bad side.

The second curse is the culture of expertise in which not only do experts have the institutional power to decide what is good for us, we happily go along.

Now let me say clearly that public health is rightly based on the principle that actions that one person takes that put others at risk involuntarily ought to be regulated. Although those actions should be regulated to the satisfaction of those at risk, what typically happens is they are regulated to the satisfaction of experts. Of course, that’s part of the culture of expertise.

The herd immunity rationale for vaccination falls apart because the risk of disease is entirely voluntary.

So this permission slip law makes no sense to me from a public health standpoint. However, it makes perfect sense from the standpoint of the political economy of conventional medicine. In addition to the culture of expertise that herds us into technological corrals, there are two other herding effects.

First, the physician Suzanne Humphreys argues that doctors are simply indoctrinated into the faith of vaccination, confusing the interventionist medical practice of vaccination with the promotion of biology immunity. Second, Mike Adams argues that the pharmaceutical industry and the Pentagon create immense pressure to promote vaccination through their influence on agencies such as the Institute of Medicine.

Of course, the crucial question is whether vaccination risks harm or is instead all sunny skies.

Here’s an example. The eradication of polio is supposed to demonstrate the triumph of vaccination. Yet there’s a diagnostic slight-of-hand going on. While poliomyelitis cases have declined, the number of cases of Acute Flaccid Paralysis has increased. This is an umbrella diagnosis for conditions of weakness that include polio as well as chronic fatigue syndrome, Guillain-Barré syndrome, and other conditions of muscular weakness and paralysis. As mass polio vaccinations have increased, the cases of Acute Flaccid Paralysis have also increased. Some think there’s a connection. They are ignored.

When the 20th Century opened a little over 100 years ago, the dominant cause of death was infectious disease. The gospel of technological progress tells us that it was vaccination and other medical miracles that stopped all that.

The truth is that it was sanitation, improved nutrition, and rising incomes that eliminated infectious disease as a primary killer, especially of children. But the medical herd holds rabidly to the myth that everyone should be vaccinated. If you disagree, you don’t count.