Industry-sponsored research: this week’s collection

Every time I collect five, I’m posting studies sponsored by food companies or trade associations that show benefits of the sponsor’s products.

I would love to be able to post industry-sponsored studies with results contrary to the sponsor’s interest, but I’m just not finding any.  If you run across some, please send.

Here’s this week’s batch, with comments on the last two:

Probiotic supplementation prevents high-fat, overfeeding-induced insulin resistance in human subjects. Carl J. Hulston, Amelia A. Churnside and Michelle C. Venables British Journal of Nutrition (2015), 113, 596–602 doi:10.1017/S0007114514004097.

  • Conclusion: These results suggest that probiotic supplementation may be useful in the prevention of diet-induced metabolic diseases such as type 2 diabetes.
  • Sponsor: The present study…was financially supported by industry funds. The cost of consumables for the study was covered by an educational grant from Yakult UK Limited.

Dairy Foods and Dairy Proteins in the Management of Type 2 Diabetes: A   Systematic Review of the Clinical Evidence.   Gonca Pasin and Kevin B Comerford.    Adv Nutr 2015; 6:245-259. doi:10.3945/an.114.007690.

  • Conclusion: Given cultured dairy products’ long history of safe use, and whey protein’s overall efficacy in clinical studies so far, these dairy products appear to have great potential to assist with the management of T2DM in millions of people worldwide, in an inexpensive and easily implementable manner.
  • Sponsor: California Dairy Research Foundation. G Pasin is the executive director of the California Dairy Research Foundation. KB Comerford is a paid consultant for the California Dairy Research Foundation.

One Egg per Day Improves Inflammation when Compared to an Oatmeal-Based Breakfast without Increasing Other Cardiometabolic Risk Factors in Diabetic Patients.  Martha Nydia Ballesteros , Fabrizio Valenzuela, Alma E. Robles, Elizabeth Artalejo, David Aguilar, Catherine J. Andersen, Herlindo Valdez  and Maria Luz Fernandez.   Nutrients20157(5), 3449-3463; doi:10.3390/nu7053449

  • Conclusions:  When compared to an oatmeal breakfast, one egg per day did not result in changes in plasma glucose, our primary end point…[and other markers] indicating that eggs can be consumed without any detrimental changes in lipoprotein or glucose metabolism in this population. The most interesting finding, however, was that eggs—possibly due to their content of highly bioavailable lutein and zeaxanthin—reduced inflammation in diabetic subjects when compared to oatmeal intake.
  • Sponsor: Egg Nutrition Center

The Acute Electrocortical and Blood Pressure Effects of Chocolate.  M. Montopoli, L. C. Stevens, C. Smith, G. Montopoli, S. Passino, S, Brown, L. Camou, K. Carson, S. Maaske, K. Knights, W. Gibson, J. Wu.  NeuroRegulation 2015;2(1):3-28.  doi: 10.15540/nr.2.1.3.

  • Conclusions: This is the first known study to investigate acute EEG effects of consuming chocolate and suggests a potential attention-enhancing effect… there is clearly the possibility of an application of this combination of L-theanine and cacao in the treatment of hypertension.
  • Sponsor: “Chocolate products for this study were provided by a generous grant in supplies from The Hershey Company…Grateful appreciation is expressed to Dr. Debra Miller and to the staff at The Hershey Company for their guidance and support throughout this project and for their careful review of this manuscript prior to submission.”

Comment: I learned about this study from FoodNavigator, which deserves highest praise for this headline: “Step aside energy drinks: Chocolate has a stimulating effect on human brains, says Hershey-backed study.”  Bravo!

Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials.   Cholesterol Treatment Trialists’ (CTT) Collaboration.  Lancet 2015:385:1397-1405.

  • Conclusion: “In men and women at an equivalent risk of cardiovascular disease, statin therapy is of similar effectiveness for the prevention of major vascular events.”
  • Conflicts reported: The CTT Collaboration reports funding by various British and Australian research councils and foundations, “and not by the pharmaceutical industry.” But, it says, most of trials covered by its analysis were supported by the drug industry, and numerous members of the CTT report fees, grants, consultancies, or honoraria from various companies making cholesterol-lowering drugs.

Note:  drug companies have a vested interest in promoting drug, rather than dietary, approaches to LDL-lowering.

Comment: Conflicts of interest do not necessarily mean that the results of the study were manipulated or wrong.  They do mean that the methods and results require more than the usual level of scrutiny.  Sponsored studies almost invariably produce results consistent with the sponsor’s economic or marketing interests.

It’s likely that some industry-sponsored studies produce conclusions contrary to the sponsor’s interest.  If you know of any, please send.

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How Contact Lenses Change the Eye’s Microbiome

Turns out you can’t just put a piece of plastic in your eye every day and expect everything to stay the same. New research shows that wearing contact lenses could significantly change the bacteria of the eye’s surface, making it more susceptible to infection.

Scientists from New York University’s School of Medicine presented this work Sunday at the American Society for Microbiology’s annual meeting. The study has been submitted, and the researchers are waiting to hear back on publication. They analyzed swabs from nine contact-wearers and 11 non-wearers to determine the number and type of bacterial species that lived on the surface of their eyes—the eye’s microbiome. The researchers also analyzed the bacteria on the skin just below the eye.

“It’s not like all contact-lens wearers get more infections, it’s simply that a different type of bacteria has colonized and is living on the surface of their eyes,” says Lisa Park, a study co-author and clinical associate professor in the NYU School of Medicine’s department of opthamology. “It’s shifted a little bit. And the question then is: Does that predispose them then to getting certain types of infections?”

Infections often come when people don’t take proper care of their lenses—sleeping in them overnight, or not cleaning them well or often enough. According to one 2010 study, while 86 percent of contact-wearers thought they did a good job caring for their lenses, only 32 percent showed “good compliance.” Forty-four percent did average, and 24 percent were “noncompliant.”


Big Food owns pet food companies?

A twitter follower, @davelove1 asks:

@marionnestle what do you think about big food companies buying pet food brands?

His question referred to an article in the Washington Post titled theMcDonaldization of pet foods.

The New York Times also covered the buying of pet food brands by Big Food companies, in this case, the purchase by Smucker’s of Big Heart Pet Brands, “the company once known as Del Monte.”

That rang a bell.

In my book with Malden Nesheim about the pet food industry, Feed Your Pet Right, we used Del Monte as an example of the buying and selling of pet food brands.

That was 2009.  Now we need to add new boxes for Big Heart and for Smuckers.

Del Monte isn’t the only Big Food company to own pet food brands:

  • Nestlé (no relation) owns Purina PetCare, with a long list of brands.
  • Mars (yes, the chocolate company) has a Petcare division
  • Procter & Gamble used to own Iams but sold it to Mars in 2014 for nearly $3 billion

The one other big brand is Hills.  It is owned by Colgate Palmolive.

Of course Big Food companies want to own pet food brands; they are hugely profitable.

  • The ingredients are cheap byproducts of human food production that would otherwise go to waste.
  • They can be sold at shockingly high prices, especially when marketed with health claims.

Our book gives generic recipes for making your own complete and balanced pet foods.  Enjoy!

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Don’t Let Them See Your Tampons

The key word is “discreet,” apparently.

“Tampax Compak has a smooth plastic applicator that is half the length of a usual Tampax Cardboard applicator, making it twice as discreet to carry.”

“New! Neat! Discreet!” proclaims an 80s-tastic ad for Playtex Portables.

“The original o.b. tampon … was revolutionary in the world of tampons and played to women’s need for discreet yet reliable protection.”

Tampax Compak is apparently so discreet, according to one old commercial, that a teacher mistakes it for a piece of candy, and asks his student to bring it to the front of the class when he catches her passing it to a friend.

You would think once he held it and felt the hard plastic applicator within the wrapper he would figure it out—tampons and candy bars don’t really have similar tactile sensations. But no. “I hope you brought enough for everyone,” he says, sternly.

“Enough for the girls,” the girl replies, laughing. All the boys in the class look around, confused. This is beyond their simple understanding.


The Tampon: A History

In some sense, they can be forgiven. It’s entirely possible these wide-eyed naïfs have never seen a tampon in the wild, given the sometimes painstaking efforts women make to conceal them (the same efforts that products like Tampax Compak are created to facilitate). You can just palm it, or there’s the ole tampon-up-the-sleeve trick. In sleeveless weather, one can tuck it under the bra strap, or in the waistband. Anywhere tuckable, really. Or just bring your whole purse to the bathroom.

My friend Mallory, a project manager for a digital agency in Nashville, used some creative strategies to carry tampons at her old job. Her office was situated at the end of a long hallway, meaning she had to walk past everyone else to get to the bathroom.

“I would make sure I took care of things in the morning and then always have to remember to take my purse with me to lunch,” she says. “And then one day I was in a bind, I had already gotten up to get coffee and then get water and then I came back to my desk and I realized I hadn’t changed my tampon. It feels too awkward to get up from my desk in the middle of the day and walk out with my purse and then walk back in five minutes later. Then I look at my coffee mug, it was empty. So I stuck a tampon in an empty travel coffee mug and walked to the bathroom. And that was my plan.”


Weekend reading: Food Ethics for Everyone

I was pleased to be asked to blurb this one:

From Field to Fork makes it clear that every food choice has ethical implications and that sorting out these implications from the science and politics of food is anything but simple.   The ethical issues discussed in this book are fascinatingly complex and deserve the serious debates they are sure to stimulate.  If ever a book provided food for thought, it’s this one.


Should It Be Illegal for Supermarkets to Waste Food?

In 2010, U.S. supermarkets and grocery stores threw out 43 billion pounds, or $46.7 billion worth, of food, according to the U.S. Department of Agriculture (USDA). But if Arash Derambarsh had his way, that number would be zero. His goals are ambitious, but then again the municipal councilor from Courbevoie, France did manage to get a law passed in France last week that would accomplish just that.

The law bans supermarkets in France from discarding or destroying unsold food. According to Salon’s Lindsay Abrams, the law mandates that all unsold but edible food should be donated to charities for immediate distribution to the poor. Food that is unsafe to eat is to be donated to farms for agricultural purposes. Supermarkets that exceed a certain square footage are required to sign contacts with charities by July 2016; penalties for failing to do so include fines of up to roughly $81,600 or two years in prison. The legislation is one of the world’s first attempts to address the twin problems of food waste and hunger in this manner.


Food Waste: A $100 Billion Problem

The momentum for the law’s adoption came from a petition that Derambarsh launched on four months ago. On the petition site, Derambarsh explains, “On the one hand, [we have] a middle class that has more and more economic problems. … [O]n the other hand, every supermarket throws away every day more than 20 kg of food. This is unthinkable with the current economic crisis!” The appeal quickly gathered support, with over 210,000 people signing it and several French celebrities endorsing the cause.

Derambarsh told The Guardian that he first tried to tackle the problem himself by distributing unsold food from his local supermarket in Courbevoie. “Every day we’d help around 100 people. Half would be single mothers with several children, pensioners, or public workers on low salaries, the other half would be those living on the streets or in shelters.” Derambarsh told me by phone that he did all this on the street outside the supermarket after it closed for the night—an experience that inspired him to turn his campaign into national law.

Now Derambarsh is hoping to globalize his movement. He said he plans to return to within the next week with a call for an international law that mirrors the new French legislation. In coordination with the advocacy group ONE, he plans to present the issue to the European Union, United Nations, the G-20 forum of major economies, and the upcoming UN climate-change conference in Paris known as COP 21.

Any campaign to reduce food waste is likely to resonate in a world where as much as half of all food produced is never eaten. The problem stems from multiple inefficiencies and weaknesses along the supply chain, and it manifests itself differently in different regions; in developing countries, over 40 percent of waste occurs before the supermarket, while in industrialized countries over 40 percent occurs in the supermarket or the home. As the Natural Resources Defense Council (NRDC) points out, leaving food uneaten not only squanders valuable resources, but also endangers the environment due to the methane that the leftover food emits in landfills.

About one in seven Americans lack reliable access to food, and an extra 15 percent in saved food could feed over 25 million people.
At the core of Derambarsh’s campaign, however, is the human cost: Food that is tossed out is a meal that a hungry person will never be able to enjoy. The UN’s Food and Agriculture Organization reported on Wednesday that the number of undernourished people in the world had dropped considerably over the past 25 years despite global population growth. Even so, that leaves 795 million people without enough food to eat. For reference, about one in seven Americans lack reliable access to food, and an extra 15 percent in saved food could feed over 25 million Americans, according to the NRDC. The retail sector in the United States accounts for approximately 10 percent of the available food supply, suggesting that a law similar to the one just passed in France could make a difference in reducing U.S. food insecurity.

Still, a solution for France may not be appropriate for other countries. Across the channel in the United Kingdom, for instance, the retail sector accounts for only 1.7 percent of total food waste, according to the British charity WRAP, far below France’s 11 percent. This low percentage is at least in part due to a concerted effort by retailers, rather than the government, to develop more sustainable supply chains. British waste-reduction measures aren’t necessarily helping feed the poor, though—of the 250,000 tons of waste that U.K. supermarkets produce, less than 40,000 tons is redistributed to people.

The situation in the United States is also distinct. For one thing, the United States already has a rather robust public-private donation system in place. Feeding America, the nation’s largest hunger-relief organization, reports that it provides food to 46.5 million people per year, or roughly the number of food-insecure people in the United States. Moreover, hidden costs may mean that a law mandating food donations could do more harm than good, according to Elise Golan, the director for sustainable development at USDA. “The logistics of getting safe, wholesome, edible food from anywhere to people that can use it is really difficult,” she said. “If you’re having to set up a really expensive system to recover marginal amounts of food, that’s not good for anybody.”

The United States also has a legal framework in place that encourages food donations. Beyond tax incentives, there is also the Good Samaritan Food Donation Act, which ensures that donors are not liable for harm done by donated food as long as it was given in good faith. France lacks such a safeguard for retailers, which has made supermarkets hesitant to donate foods near their expiration dates and, in more extreme cases, to pour bleach over discarded food in an effort to dissuade dumpster divers. Gaëtan Lassale, head of institutional relations and advocacy at the French Federation of Food Banks, explained to L’Express that “we regret [the practice], but it’s the only way for supermarkets to avoid being implicated in case someone gets sick after having eaten something out of their trash.” Bleaching discarded food has been explicitly banned under the new French law.

Derambarsh, for his part, doesn’t seem bothered by questions about the applicability of his campaign beyond France. When I asked about the small percentage of food waste that retailers contribute, he responded, “I don’t want to talk about the percentages. I will talk only about what I see in reality—the reality that all of the supermarkets throw out 40 kilos of food [each night]. I don’t care if it’s 1 percent or 10 percent. … My only problem is that these 40 kilos will not go to the garbage, but [instead] will go to the plates of poor people.”


What’s up with the Trade Promotion Authority act?

what’s going on with the Trade Promotion Authority act (TPA) has lots of people worried. The bill, known as “fast track,” allows President Obama to make trade agreements that Congress can approve or reject, but cannot change.

The Senate passed the TPA. It now goes to the House.

USDA Secretary Tom Vilsack issued a congratulatory statement:

Today the Senate helped move America closer to securing responsible agreements that open markets for America’s farmers, ranchers and agribusiness and create jobs and improve wages across the country…Our farmers and ranchers face exorbitant tariffs and others barriers in important foreign markets, and if we do not act to maintain and gain market share in these places, our competitors will.

On the other hand, 2009 labor, environmental, family farm, consumer, faith, Internet freedom and other organizations oppose the TPA. They say “Fast Track is rigged to give special rights to corporations at the expense of workers and consumers.”

TPP rally Maryland

In an article in the American Journal of Public Health last year, tobacco researchers explained the problem:

International trade agreements relocate decisions about tobacco control policy to venues where there is little opportunity for public scrutiny, participation, and debate…“Fast-track authority,” in which Congress cedes ongoing oversight authority to the President, further distances the public from the debate.

As I explained in previous posts on the Trans Pacific Partnership (TPP) and the Transatlantic Trade and Investment Partnership (T-TIP), trade agreements:

Are conducted in secrecy
View safety regulations and matters such as country-of-origin labeling (see yesterday’s post) as trade barriers
Allow multinational corporations to sue governments for passing laws that might affect corporate profits
I’ll be trying to keep up with what’s going on with trade agreements. Stay tuned.

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What Good Is Thinking About Death?

In the heart of every parent lives the tightly coiled nightmare that his child will die. It might spring at logical times—when a toddler runs into the street, say—or it might sneak up in quieter moments. The fear is a helpful evolutionary motivation for parents to protect their children, but it’s haunting nonetheless.

The ancient Stoic philosopher Epictetus advised parents to indulge that fear. “What harm is it, just when you are kissing your little child, to say: Tomorrow you will die?” he wrote in his Discourses.

Some might say Epictetus was an asshole. William Irvine thinks he was on to something.

“The Stoics had the insight that the prospect of death can actually make our lives much happier than they would otherwise be,” he says. “You’re supposed to allow yourself to have a flickering thought that someday you’re going to die, and someday the people you love are going to die. I’ve tried it, and it’s incredibly powerful. Well, I am a 21st-century practicing Stoic.”

He’s a little late to the party. Stoicism as a school of philosophy rose to prominence in the 3rd century B.C. in Greece, then migrated to the Roman Empire, and hung around there through the reign of emperor Marcus Aurelius, who died in 180 A.D. “That Stoicism has seen better days is obvious,” Irvine, a professor of philosophy at Wright State University, writes in his book A Guide to the Good Life: The Ancient Art of Stoic Joy. He stumbled across the philosophy when researching a book on Zen Buddhism—“I thought I wanted to be a Zen Buddhist,” he says, “but Stoicism just had a much more rational approach.”

Though the word “stoic” in modern parlance is associated with a lack of feeling, in his book, Irvine argues that the philosophy offers a recipe for happiness, in part by thinking about bad things that might happen to you. The big one, obviously, is death—both yours and that of people you love.

“We can do it on a daily basis, simply by imagining how things can be worse than they are,” he says. “Then when they aren’t that way, isn’t that just wonderful? Isn’t it simply wonderful that I get another day to get this right?”

For Irvine and the Stoics, thoughts of death inspire gratitude. For many others, thinking about The End inspires fear or anxiety. In fact, the latter may be the natural human condition.

* * *

“We are different from other animals in that we are uniquely aware of our own mortality,” says Ken Vail, an assistant professor of psychology at Cleveland State University. “Certainly other animals recognize they can die—if a cheetah chases an impala, or chases us, both us and the impala are going to run away. We recognize that as an immediate threat of mortality. But the impala doesn’t sit in the safety of its office aware of the fact that it will eventually die. And we do.”

This is the price we pay for the nice things consciousness has given us—self-reflection, art, engineering, long-term planning, cooking our food and adding spices to it instead of just chomping raw meat straight off the bones of another animal, etc. We’re all going to die and we all know it.

But we’re not always actively thinking about it. When people are reminded of death, they employ a variety of strategies to cope—not all of which are as well-adjusted as Stoic gratitude. That many kinds of human behavior stem from a fear of death is the basis of one of the most prominent theories in modern social psychology—terror-management theory.

It’s the hope of symbolic immortality that calms the frightened rabbits of death-fearing hearts—the idea that people are a part of something that will last longer than they do.
Terror-management theory exists because one day, some 30-odd years ago, Sheldon Solomon was perusing the library at Skidmore College, where he’s a professor of psychology, and he happened to pick up The Birth and Death of Meaning, by Ernest Becker. “This is nothing to be proud of, but the cover is white with green splotches on it, and I was like ‘Ooh, what an interesting color,’” Solomon says. “Then I liked that it was a short book with big print. Again, nothing to be proud of, but true. And that’s why I reached for it.”

Once he opened the book, though, Solomon was taken by its central question—Why do people do what they do?—and how it was presented, without “turgid academic jargon,” he says. Becker offered an answer to that question: People do a lot of the things that they do to quell their fear of death. So Solomon and two of his friends from grad school, Jeff Greenberg and Tom Pyszczynski, set out to test that idea empirically.

* * *

The only antidote to death is immortality. And so, terror-management theory holds, when faced with the idea of death, people turn to things they believe will give them immortality, literal or otherwise. The hope of true immortality can be found in religion’s promises of heaven or reincarnation, or in some of science’s more dubious life-extension promises (Just freeze your dead body! They’ll wake it up later!).

More often though, it’s the hope of symbolic immortality that calms the frightened rabbits of death-fearing hearts—the idea that people are a part of something that will last longer than they do. Their culture, their country, their family, their work. When thinking of death, people cling more intensely to the institutions they’re a part of, and the worldviews they hold.

What that actually means in terms of behavior, is trickier. The research shows that what people do when they’re feeling aware of their mortality depends on the person, the situation she’s in, and whether she’s focusing on death or it’s just in the back of her mind. (The TMT literature, which details a wide range of effects, is now fairly substantial. A 2010 metareview found 238 TMT studies, and this page on the University of Missouri website lists nearly 600, though it doesn’t seem to have been updated since 2012).

When death is in the front of your mind—when you pass by a cemetery, when someone you know is sick (or when, in a lab, a researcher has just asked you about it)—the tendency, according to TMT, is to want to push those thoughts away. You might suppress the thoughts, distract yourself with something else, or comfort yourself with the idea that your death is a long way away, and anyway, you’re definitely going to go to the gym tomorrow.

A couple of studies have shown that conscious thoughts of death do increase health intentions, for exercise and medical screenings, though whether people actually follow through on those intentions is unclear. Promising yourself you’ll eat better may just be a strategy to get death off your mind.

When death is on people’s conscious minds, “they can wield logic to deal with it,” Vail says. “This would be similar to your mom saying, ‘Put on your seatbelt, you don’t want to die.’ So you think about that and recognize, yes, she’s right, you don’t want to bite it on the way to the grocery store, so you put on your seatbelt.”

According to Solomon, even young children use versions of these same strategies. His new book, written with Greenberg and Pyszczynski, The Worm at the Core: On the Role of Death in Life, cites the story of 5-year-old Richard, from a series of interviews the psychologist Sylvia Anthony conducted in the 60s and 70s:

“He swam up and down in his bath [and] he played with the possibility of never dying: ‘I don’t want to be dead, ever; I don’t want to die.’ … After his mother told 5-year-old Richard that he wouldn’t die for a long time, the little boy smiled and said, ‘That’s all right. I’ve been worried, and now I can get happy.’ Then he said he would like to dream about ‘going shopping and buying things.’”
Classic distraction move, Richard. Though at times, our own coping mechanisms may not be much more sophisticated. “Americans are arguably the best in the world at burying existential anxieties under a mound of French fries and a trip to Walmart to save a nickel on a lemon and a flamethrower,” Solomon says.

But shopping excursions can only distract you so much. Even once you stop actively thinking about it, death is still prominent in your nonconscious mind. “One metaphor is the file drawer,” Vail says. “You pull out a file and read it, then you get distracted, now you’re thinking about dinner. You put [the file] back in the drawer, you pull out dinner, now you’re looking it dinner, but whatever you were thinking about previously is now on the top of the file. It’s the closest thing to your conscious awareness.”

This is when, the research shows, people’s attitudes and behaviors are most affected—when you’ve recently been reminded of death, but it’s moved to the back of your mind.

Unfortunately, a lot of what death brings out when it’s sitting at the top of the file drawer is not humanity’s most sterling qualities. If people feel motivated to uphold their own cultures and worldviews in the face of death, it stands to reason that they might be less friendly toward other worldviews and the people who hold them.

“Americans are the best in the world at burying existential anxieties under a mound of French fries and a trip to Walmart to save a nickel on a lemon and a flamethrower.”
The very first terror-management study involved “22 municipal-court judges in Tucson, Arizona,” according to The Worm at the Core. The judges were tasked with setting bail for alleged prostitutes, but first they were asked to take a survey. Some of them just answered personality questions, but some were also asked two questions about death: “Please briefly describe the emotions that the thought of your own death arouses in you,” and “Jot down, as specifically as you can, what you think will happen to you as you physically die, and once you are physically dead.” The standard bail at the time was $50, set by judges who didn’t take the survey. The ones who did take the survey set the bail an average of nine times higher.

“The results showed that the judges who thought about their own mortality reacted by trying to do the right thing as prescribed by their culture,” the book reads. “Accordingly, they upheld the law more vigorously than their colleagues who were not reminded of death.”

But, Solomon says, the researchers later repeated that study with students, and found that only those who thought prostitution was “morally reprehensible” opted to set a harsher bail. The logic goes that those students wanted to uphold their values, and punish transgressors. Since then, more studies have shown this tendency: When mortality’s on their minds, people prefer others in their (cultural/racial/national/religious) group to those outside it. This dynamic has manifested in silly ways—in one study liberals were more likely to make conservatives eat a gross hot sauce after a death reminder and vice versa—and in more serious ones—reminders of mortality have been shown to make people more likely to stereotype others.

While wanting to promote your own worldviews can mean putting others’ down, that isn’t the only way people seek to feel like part of something greater than themselves—searching for that symbolic immortality. Looming mortality can also lead people to help others, donate to charity, and want to invest in caring families and relationships. (And studies have backed up that people do these things when reminded of death.)

These reactions have also been observed outside the lab, after the terrorist attacks of September 11, 2001, when death was likely top of mind for many Americans for quite a while. Comparisons of survey answers before and two months after 9/11 found increases in kindness, love, hope, spirituality, gratitude, leadership, and teamwork, which persisted (though to a slightly lesser degree) 10 months after the attacks. But Solomon, Greenberg, and Pyszczynski point out in their book that there was also a lot of fear and derogation by Americans of the “other” after 9/11, specifically Muslim and Arab others.

“It’s not the case that awareness of mortality and the ensuing terror-management process is an inherently negative one that causes prejudice and closed-mindedness and hostility but instead it appears to be simply rather a neutral process,” Vail says. “It’s one that motivates people to indiscriminately uphold and defend their cultural worldviews.”

How you manage your terror, then, depends on what’s already important to you—and that’s what you’ll turn to when confronted with mortality. In one study, empathetic people were more likely to forgive transgressions after a death reminder; in another, fundamentalist religious people were more compassionate after thinking of their own mortality—but only when compassionate values were framed in a religious context, such as excerpts from the Bible or Koran.

* * *

Terror-management theory contends that there’s something different about our fear of death, compared to other fears. Every other threat is survivable, after all. And in research, thinking about death has produced just as strong of an effect whether the alternative was something neutral, or another threat like rejection or pain. So a fear of death is not just like a fear of rejection, except more.

Except Steven Heine, a professor of psychology at the University of British Columbia, doesn’t think death is necessarily such a unique threat. In 2006, he and fellow researchers Travis Proulx and Kathleen Vohs developed the Meaning Maintenance Model, which says yes, thinking about death can inspire these attitudes and behaviors, but for a different reason. Death, according to their theory, is a threat to the way we understand the world, similar to uncertainty, being rejected by a friend, or even—Heine’s example—finding a red queen of spades in a deck of cards. All these things interrupt what Heine calls “meaning frameworks—understandings of how the world works. When we think about the fact that we’re going to die, it calls all of those assumptions into question. All these things I’m trying to do, I won’t be able to succeed, my relationships will be severed, the way I think I fit into the world, ultimately I no longer will. This is bothersome.”

But perhaps not more bothersome than other threats to meaning. Heine says Meaning Maintenance Model studies have found that thinking about death does not have a noticeably larger effect on people’s attitudes and behaviors than, say, watching a surreal movie. A metareview of TMT studies also notes that the effects of thinking about death are less significant when compared with thinking about something else that threatens someone’s sense of meaning.

Thoughts of death still lead people to uphold their worldviews according to this theory, but it’s because, when faced with an idea as confounding as one’s own mortality, people turn to the other things in their lives that still make sense to them. While the two theories have a lot in common, Heine says MMM can explain one thing that TMT cannot: suicide.

“TMT would argue that while we want to have a sense of meaning as a way of keeping away thoughts of death, one of the key motivators of suicide is feeling that your life isn’t very meaningful, wanting death when you feel like you don’t have sufficient meaning in your life,” he says. ”

The thing that makes death different, Heine says, is that it’s not solvable. With other meaning threats, you can try to fix the problem, or adjust your worldview to accommodate the new information. “The fact that we’re going to die is a problem that we can never fully resolve throughout our lives,” he says.

But maybe that’s for the best.

* * *

“I know we’re supposed to be super afraid of death. But it’s good, isn’t it?” asks Laura King, curator’s professor of psychological sciences at the University of Missouri, Columbia. “If life never ended, think about it, right? Isn’t that like every vampire story or sci-fi movie? If you live too long, after a while, you just lose it. Life no longer has any meaning, because it’s commonplace.”

King did a study in 2009 that offers an alternative, economical perspective on death and meaning. She showed that after reminders of death, people valued life more highly—and conversely, reading a passage that placed a high monetary value on the human body increased people’s number of death thoughts. This is the scarcity principle, plain and simple—the less you have of something, the more you value it.

But “most of us don’t live like we’re aware that life is a finite commodity,” King says. She describes an exercise she has her students do, in which they write down their life goals, and then write what they’d do if they only had three weeks to live. “Then you say, ‘Why aren’t you doing those things?’ They say, ‘Get real, hello, we have a future to plan for.’”

“Everybody always says life is too short, but it’s really long. It’s really, really long.”
“Live every day as though it’s your last” is nice but profoundly unhelpful advice, when you know that today is probably not your last day. I’m not sure what I’d do if I was going to die tomorrow—round up all my loved ones and fly them to Paris? Or maybe just throw them a really nice dinner party, the kind where everyone ends up sprawled out on couches, overstuffed and warm from the wine.

Either way, I can’t do that today. I have to go to work.

“Everybody always says life is too short,” King says, “but it’s really long. It’s really, really long.”

Once people’s days truly are numbered, their priorities do seem to shift. According to research done on socioemotional selectivity theory, older people are more present-oriented than younger people, and are more selective in who they spend time with, sticking mostly with family and old, close friends. Other studies have shown them to also be more forgiving, and to care more for others, and less about enhancing themselves.

This all fits in well with Irvine’s Stoic philosophy. Rather than pulling curtains over the darkness on the other side of the window, you stare straight into it, so when you turn away you’re thankful for the light.

Irvine gives the mundane example of buying a lawn mower. “As I’m doing it, I have the realization that this is conceivably the last lawn mower I will ever buy,” he says. “I don’t like mowing the lawn, don’t get me wrong, but I’ve only got X number of times it’s going to happen. Some day, this moment, right now, is going to count as the good old days.”

* * *

Unfortunately, Western culture isn’t exactly death-friendly. Death is kept largely out of sight, out of mind, the details left to hospitals and funeral parlors. Though most Americans say they want to die at home, few actually do—only about 25 percent, according to the Centers for Disease Control and Prevention. Most other people die in hospitals, nursing homes, or other facilities.

Death Is Having a Moment

This is why, in 2011, the mortician Caitlin Doughty founded The Order of the Good Death, a self-described “group of funeral industry professionals, academics, and artists exploring ways to prepare a death-phobic culture for inevitable mortality.” She’s also written a book about working in a crematory, Smoke Gets in Your Eyes, and hosts the “Ask a Mortician” webseries.

“Death doesn’t go away just because we hide it,” Doughty wrote to me in an email. “Hiding life’s truths doesn’t mean they disappear. It means they are forced into darker parts of our consciousness … Death is the most natural thing in the world, and treating it as deviant isn’t doing our culture any favors … We don’t control nature. We aren’t higher-ranking than nature.”

This is terror management writ large, a culture that pushes death away as best it can. Even though, ultimately, it can’t.

More people are coming around to Doughty’s way of thinking. “Death salons” and “death cafes,” where people gather to talk about their mortality have sprung up across the U.S., and many doctors, like the Being Mortal author Atul Gawande, are working to advance the conversation around end-of-life care, getting patients involved in planning for their deaths.

But the research shows the effects of thinking about death aren’t all grace and gratitude —so would bringing death out into the open ultimately help or hurt humanity?

“At first, thinking about death regularly made me move up and down and way up and way down the emotional spectrum,” Doughty writes. “But over time thinking about death moves you closer to magnanimity. You realize that you will have to give your body, your atoms and molecules, back to the universe when you’re done with them.”

She also points out that TMT studies are isolated instances, and don’t look at what happens when people think about death regularly, over time.

Maybe the key, then, is being deliberate. Not letting thoughts of death sneak up on you, but actively engaging with them, even if it’s hard. In one 2010 study, people who were more mindful were less defensive of their worldviews after being reminded of death, suggesting that “mindfulness can potentially disrupt some of these kinds of processes that go into terror management,” says Vail, the Cleveland State University psychologist.

Solomon, too, is hopeful. “I like to think there comes a moment where sustained efforts to come to terms with death pay off.” Vail suggests that freeing oneself from the psychological reactions to death might get rid of the good effects along with the bad, but Solomon’s willing to take the trade. “If you look at the problems that currently befall humanity—we can’t get along with each other, we’re pissing on the environment, [there’s] rampant economic instability by virtue of mindless conspicuous consumption—they’re all malignant manifestations of death anxiety running amok.”

It’s probably not possible to erase all fear of death—animals have a drive to survive, and we are animals, even with all that consciousness. Even if being mindful about death means getting rid of the good along with the bad consequences of death anxiety, people can be generous and love each other without being scared into it.

“Death destroys a man, but the idea of death saves him,” E.M. Forster once wrote. I don’t know if there’s really any salvation, but if we accept death, maybe we can just live.

What’s up with Country-of-Origin Labeling (COOL)?

The attack on Country-of-Origin-Labeling (COOL) is a good example of why international trade agreements require close scrutiny.

In my book What to Eat, I had this to say about COOL (among other things):

In 2002, Congress passed a law requiring Country of Origin Labeling (the apt acronym is COOL) that was to take effect in 2004. Later, under pressure from the food industry, Congress postponed the deadline until the end of September 2006…In America, food industry opposition to COOL is just about universal. The industry complains that tracking the origin of foods is difficult, but also would prefer that you not know how far food has traveled before it gets to you. The Grocery Manufacturers of America, an especially vigilant trade advocacy group, called the 2002 bill “a nasty, snarly beast of a bill,” but even stronger opposition came from the meat industry. Its lobbyists argued that COOL would be “extraordinarily costly with no discernible benefit,” but their real objection was that meat producers would have to track where animals and products come from—another sensible idea that they have long resisted.

Nevertheless, COOL was supposed to go into effect for meat in 2008 and finally did so in 2014. In the meantime, Canada and Mexico went to the World Trade Organization to argue that COOL unfairly discriminated against meat produced in those countries.

The Hagstrom Report lists Canada’s threatened trade retaliation (if the U.S. keeps COOL, Canada will raise tariffs on these products).

The WTO agrees that Canada and Mexico have the right to do this.

Now the House has introduced a bill to repeal COOL. The House Agriculture Committee voted for the repeal.

So much for consumers’ interest in knowing where foods come from.

I’ll be posting more about trade agreements this week and next. Stay tuned.

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Doctors’ Secret Language for Assisted Suicide

SAN FRANCISCO—Physician-assisted suicide is illegal in all but five states. But that doesn’t mean it doesn’t happen in the rest. Sick patients sometimes ask for help in hastening their deaths, and some doctors will hint, vaguely, how to do it.

This leads to bizarre, veiled conversations between medical professionals and overwhelmed families. Doctors and nurses want to help but also want to avoid prosecution, so they speak carefully, parsing their words. Family members, in the midst of one of the most confusing and emotional times of their lives, are left to interpret euphemisms.

That’s what still frustrates Hope Arnold. She says throughout the 10 months her husband J.D. Falk was being treated for stomach cancer in 2011, no one would talk straight with them.

“All the nurses, all the doctors,” says Arnold. “everybody we ever interacted with, no one said, ‘You’re dying.’”

Until finally, one doctor did. And that’s when Falk, who was just 35, started to plan. He summoned his extended family. And Hope made arrangements for him to come home on hospice.

“All the nurses, all the doctors, everybody we ever interacted with, no one said, ‘You’re dying.’”
The day her husband was discharged from the hospital, Arnold was dropping off some paperwork when she bumped into one of his doctors.

“He hugged me and asked me how I was holding up,” she says. “And then he handed me a bottle of liquid morphine. He said, ‘You might need it.’ ”

Arnold says she handed the bottle back. She told the doctor the hospice was going to bring a machine that would administer Falk’s pain medication automatically.

“And he looked at me,” she says, “and he held my gaze for a second. And he put it back in my hand and he said, ‘You might need it.’”

She slipped the vial into her purse.

“When I got home, it hit me like a ton of bricks,” Arnold remembers. “And I said to J.D., ‘I think he may have given this to me so I can give you an overdose.’ And he said, ‘Maybe.’ And then we didn’t talk about it anymore.”

Over the next couple days, Falk deteriorated quickly. Arnold says the hospice nurse offered another euphemism: “He said, ‘He’s showing signs of imminence.’”

Hope and J.D. Falk on their wedding day
(Photo courtesy Kelly Dunsford)
Arnold worried that Falk was in a lot of pain. But she couldn’t tell. She was afraid that if she asked, it would betray the thoughts she was having about that extra vial of morphine.

“I couldn’t ask the nurse that,” Arnold says. “I couldn’t ask anybody anything.”

If Arnold could have asked the Stanford medical ethicist David Magnus, he could have explained what assisted suicide is—and what it isn’t. It is legal for people to take or give large doses of narcotics to relieve pain, even if a known side effect is that it may hasten death.

“The difference really has to do with intent,” Magnus says. “And that’s a tricky thing because it has to do with what’s going on in the mind.”

In the end, Arnold didn’t do anything with the extra vial of morphine, and her husband died within days of coming home on hospice.

“J.D. never told me, ‘I do want you to give me too much morphine,’” she says. “Actually, I don’t know whether or not he wanted that. That’s not the point. The point was nobody could talk about it.”

People don’t talk about it, but it happens. Just over 3 percent of U.S. doctors said they have written a prescription for life-ending medication, according to an anonymous survey published in The New England Journal of Medicine in 1998. Almost 5 percent of doctors reported giving a patient a lethal injection.

Other studies suggest oncologists, and doctors on the West Coast, are more likely to be asked for life-ending medication, or euthanasia, in which the doctor administers the lethal dose.

“Those practices are undercover. They are covert,” says Barbara Coombs Lee, the president of Compassion and Choices, an advocacy group. “To the degree that patients are part of the decision-making, it is by winks and nods.”

Coombs Lee’s organization helped tell the story of Brittany Maynard, a 29-year-old woman who moved from California to Oregon to be able to end her life legally after she was diagnosed with a brain tumor. Now the organization is backing legislation in California to make it legal for doctors to prescribe lethal medication to terminally ill patients who request it.

Coombs Lee’s group guides dying patients on current law.

“We talk with people about how they might broach the subject with their physicians,” she says, “and quite frankly, how to play the wink-and-nod game in a way that doesn’t jeopardize their physician.”

At one point, he threatened to shoot himself. A nurse dropped hints that there was a different way.
It’s a game one San Francisco woman is all too familiar with. (Her name is withheld at her request to protect her privacy.) She lived in San Francisco during the 1980s and watched one friend after another die of AIDS.

“The guys would have fungus everywhere,” she recounts. “Horrible diarrheas, emaciation. It looked like concentration-camp pictures.”

A lot of her friends begged for lethal drugs to end their suffering, and she and the other caregivers figured out which doctors were willing to help. The caregivers coached each other on how to speak to the doctors in code.

“We would tell each other, ‘This is the doctor,’” she says. “‘They’re going to tell you how much is too much to give, and then they’re going to give you too much.’”

Though she witnessed many deaths hastened in this way, she says she never administered the drugs herself. Her time would come 20 years later when her husband was dying of throat cancer.

Some of his symptoms were brutal.

“It was like a horror movie,” she says, recalling the tumors all over his neck. They would fill with blood, she says, and sometimes burst.

“I remember standing there with syringes in my hand. Just standing there, with my hands shaking.”
“There’d be blood on the walls, on the mirror, everywhere,” she recounts, “And he’d be panicking.”

They were warned his death might be ugly. He might choke. He might have a seizure. More than anything, she says, he was afraid of dying in a hospital, hooked up to machines, powerless.

“He made me swear not to let anybody hospitalize him. He made me swear not to let his family swoop in and take him away.”

At one point, he threatened to shoot himself to avoid that. A nurse dropped hints that there was a different way.

“I remember being told, here’s how much pain meds you can give,” she says, “but beyond this, he’ll probably stop breathing.”

Her husband made it clear to her that this was the way he wanted to go. Several times, she says, he reviewed the instructions with her.

Months later, he slipped into a coma. When the nurse said he looked like he was a day, maybe hours, away from dying, it seemed like another hint.


From Doctor to Patient to Assisted-Suicide Advocate

“And I remember standing there with syringes in my hand. Just standing there, with my hands shaking,” she says. She remembers thinking, “Okay, what goes with what?’ And I was all alone. And that was about the most alone I’ve ever felt. That I couldn’t tell anybody else.”

She injected the drugs. Then she crawled into bed with him and held him and talked to him for the next six hours.

“And he literally died in my arms. I was holding him when he stopped breathing. And it was really peaceful. He just sort of drifted away.”

For years, she had nightmares about holding the syringes, but today she is confident that she did the right thing. Her husband’s death was calm and peaceful and exactly what he’d asked for. But she resents that she was the one who had to do it, that she had no help and no real guidance from a medical professional.

“I don’t regret it, but I wouldn’t wish it on anybody else. It’s not fair. It’s not right,” she says. “It’s not like choosing to die doesn’t happen. We just make it be sneaky and we put it on the wrong people.”

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