Good Advice

Barack Obama. What a disappointment. I didn’t think he could do anything more to sadden me, but he has.

Last week he announced loan guarantees for the construction of nuclear power plants. In essence, this is a pre-emptive bailout for the Wall Street firms that finance construction of any nuclear power plant that goes belly up. According to the Congressional Budget Office, that chance is 50%. So taxpayers will pay Wall Street firms for half of all nuclear projects. This time, however, instead of mortgages, we’ll have real toxic assets on our hands.

Why does the government have to guarantee the financing of nuclear power? Because on strait financial grounds, Wall Street—the same people who took insane risks that blew up and created the Great Recession—won’t touch nuclear projects.

We’re reassured that nuclear power is a great alternative to reduce greenhouse gases. We’re assured that those radioactive fuel rods that are the toxic legacy of nuclear power plants will not be a problem because Mr. Obama is assembling a commission of experts to find the solution once and for all. These are, no doubt, the same experts who have been looking for that solution for over 60 years without success.

Joseph Mangano, executive director of the Radiation and Public Health Project, responded to the news by saying, “Adding new reactors will raise the chance for a catastrophic meltdown. It will also increase the amount of radioactive chemicals routinely emitted from reactors into the environment—and human bodies. New reactors will raise rates of cancer—which are already unacceptably high—especially to infants and children. Public policies affecting America’s energy future should reduce, rather than raise, hazards to our citizens.”

Why has Barack Obama embraced this dangerous technology? Something of an answer comes from a recent article in the Nation magazine by a former colleague and supporter. The article isn’t about nuclear power but about the many sad decisions Mr. Obama has made that are contrary to his mandate for “Change we can believe in”—a phrase that now seems tragically ironic. The author, Lawrence Lessig, argues that the fundamental problem is that Mr. Obama has surrounded himself with the clever but small minds of the Democratic Party establishment, the brain trust for the status quo. As we saw with the Wall Street bailout, these are not the minds and hearts to chart a bold course toward a sustainable future. In other words, Mr. Obama is getting bad advice. Those who remain enthusiasts no doubt feel that if these bad advisers were replaced, everything would be great. Of course, this idea ignores the obvious: Mr. Obama picked these guys with his eyes open.

It was one of the great existentialist philosophers, either Jean Paul Sartre or Albert Camus, who observed that people pre-select the answers they get by choosing the people they ask and what they ask them.

The lesson for the rest of us is quite clear: the answers you get depend on who you ask and what you ask them.

You could say that our book Too Much Medicine, Not Enough Health is about that very lesson. Certainly, Layna and I see a lot of it played out in our health education practice: the vexing practical problem of whose advise to take—particularly vexing in the age when we are saturated with information that we have to somehow turn into practical knowledge.

For example, your doctor prescribes a cholesterol-lowering drug. You hear us say there are real risks to following that advise and, besides, there are non-invasive ways to address the problem—if there’s a problem at all.

Significant cultural forces pressure us to believe that the best minds on health are found in the system that delivers medical treatment—that is, medical clinics, doctor’s offices, hospitals, and the like are where people get health. Having the people in that system as advisers, however well intentioned, leads to well-defined and well-known outcomes: the health care system as we know it is one in which the third leading cause of death after heart disease and cancer is medical mistakes.

It takes a great deal of courage to resist that system and its advice. Not an easy thing, courage. But getting good advice about the thing that is best for you, the thing that is life affirming—whether it’s taking nuclear power off the table or looking for health beyond the invasive overdiagnosis and overtreatment of the medical system—really starts with the question: “What kind of answer do you want?”