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  • Posted July 1st, 2018

    ‘Homegrown well-being’ and alternatives to corporate drug companies: interview with GP Simon Lennane

    ‘Homegrown well-being’ and alternatives to corporate drug companies: interview with GP Simon Lennane

    Another of our interviews, first posted on NonCorporate.org, with people working on providing alternatives to multinational corporations – this time in the health sector. Simon’s position is that the way we’ve organised society, especially the stressful nature of work and modern life generally, but specifically the breakdown of communities and the support networks they provide, has resulted in an epidemic of depression, and treatments are usually based on pharmacological models of distress that tend to be treated with corporate drugs, rather than by addressing the systems we live under. But he’s optimistic that we can turn this around.

    Are you talking about mental or physical well-being?

    Both. The two are inseperable. We have had to mend the damage caused by the idea, starting with Descartes, that the mental and the physical somehow reside in different realms. I might see a patient with chest pain, but it’s anxiety that caused the chest pain in the first place. Trying to work out if something is ‘physical’ or ‘mental’ is surprisingly unhelpful in a consultation, so we try to look at the whole person in terms of well-being, rather than focusing on one aspect of health.

    I think that ‘well-being’ is the best umbrella term, because as soon as you start talking about mental health, you lose some people, because they don’t see themselves as having a mental health problem.

    What’s the problem as you see it?

    I don’t think we’re looking closely enough at the causes, or focusing enough on preventative medicine. In health we often use the analogy of a river, with drowning people floating by. Of course we have to fish the people out of the river and save them, but it would be absurd to keep doing that without looking upstream to see why there are lots of drowning people in the river in the first place, and try to prevent them from falling in.

    Is depression becoming more prevalent?

    Depression diagnoses have gone up about 100-fold since the 1950s. Of course, this doesn’t mean that there’s more depression – it could just mean that we diagnose it more. Before the development of the first antidepressants, only major depression was recognised, but having effective treatments means doctors pay more attention to symptoms.

    Depression can be diagnosed with symptoms of low mood lasting as little as 2 weeks. A low mood after the loss of a loved one is normal, and the concern is that reaching for antidepressants is to medicalise life. A much more useful definition is around resilience – to see if people going through a bad time have the ability to pull themsleves out of it.

    Essentially, people are diagnosed as depressed if symptoms respond well to antidepressants, whereas it used to be that responses to life problems weren’t described in terms of mental health. So for example, if someone loses their job, or is bereaved, they might go to the doctor with the assumption that they are depressed, whereas their condition could also be seen as normal sadness due to a negative life event. Both patient and doctor may subconciously frame the problem in terms of a mental disorder, whereas previous generations might have just talked with friends and family, and experienced the sadness until it went away or until circumstances changed.

    Mental health problems carry much less of a stigma than previously – which is a good thing, but can very easily put people on a path towards taking medicines when talking to people might have been a better path.

    Do antidepressants work?

    Yes, although we don’t know how much is due to the placebo effect. SSRIs comprise one of the main families of antidepressants, (including Prozac) but we don’t actually know how they work. The evidence for the ‘serotonin hypothesis’ is actually pretty scanty, partly as it’s a very difficult thing to prove. Although these drugs, ‘Selective Serotonin Reuptake Inhibitors’, are designed to make the neurotrasmitter serotonin more available in the brain, we don’t actually know if this is why people get better.

    I don’t mean to ignore talking therapies – these do help, and for some provide a drug free alternative, but NHS waits are long and you need to be motivated to engage with therapy. The NHS has invested in Cognitive Behavioural Therapy (CBT), but this doesn’t suit everyone and other therapies are much harder to access.

    I’m hugely concerned about jobcentres pushing people towards CBT however, especially when threats of sanctions are used. The move towards defining joblessness as a mental illness is worrying, and therapy at the behest of the state draws parallels with the misuse of psychiatry in Russia under Stalin, when disagreement with the ruling party was defined as a mental illness. Therapy must always be something people enter into voluntarily.

    Jobcentres taking inspiration from Stalin?

    Other drugs work for depression too – antipsychotics such as quetiapine also lift mood, and many people self medicate with cannabis, for example. The common factor seems to be taking the mind to a slightly different place – a bit like taking a holiday. It’s getting out of your normal rut, and seeing the world from a different perspective, that seems to be beneficial in terms of depression. If you can move someone sideways so that they can see their life and their problems from a different place – that’s a powerful therapeutic tool. It can get people ‘unstuck’ from their usual thinking. This may be what antidepressants are doing, and this may be why they work, rather than any effect they’re having on serotonin.

    And strong, supportive communities work too – see below. Antidepressants can definitely work, and in some cases they’re life-saving. But a lot of people come in, talk over their problems with a doctor, leave with a prescription, don’t take the tablets, but get better anyway. Maybe a diagnosis and a prescription create a little badge for them, that encourages people close to them to look after them a bit better.

    So instead of disparaging antidepressants, I’d like to step back and try to work out why there are drowning people floating by, and focus a bit more on preventative measures.

    What do you think are the causes of depression?

    I think it has a lot to do with people feeling disconnected from power – from having no control, no power to intervene in the things going on around them. This seems to be a strong factor in terms of people’s resilience. The current febrile and polarised political climate is not helping either. Depression is a reaction to this feeling of helplessness, by taking the position ‘you can’t hurt me any more – I’m hurt enough already’. At some level there can be a passivity or even a feeling of victimhood, and a narrative gets framed around that. Moving forward from this means finding an alternative narrative that celebrates and encourages enablement.

    How did we get here?

    The distancing of families and loss of community ties has had a lot to do with it – social media and TV can’t replace real live people in communities. There are fewer opportunities for local interaction. As a GP, I’m sometimes the only person a patient has talked to for weeks, and possibly the only person to have touched them for years.

    Humans are social animals. This can’t replace real people and real communities.

    When a spouse dies, some older people haven’t built up a local community that they can turn to, may not have family members nearby because they’ve moved away, and are looking at a very lonely and vulnerable old age. This isn’t meant to be a call for a reactionary ‘family values’ approach, just a reflection of the fact that we need to respond to changing patterns in society and encourage groups, which often can act as surrogate families.

    Pfizer brought out a questionnaire called the PHQ9, which looks at the ‘biological features’ of depression, like poor sleep, low mood, loss of enjoyment, poor concentration etc. In order to standardise care for depression, it was incorporated into the GP contract. This left practices financially penalised if GPs didn’t do a PHQ9 for people with depression, and therefore it became inculcated into clinical practice. People with a high PHQ9 score tend to respond well to drugs – and remember that this is something devised by a drug company and pushed into clinical practice by the government. This helps to medicalise depression – i.e. if you meet these criteria, you’re depressed, and here are some drugs.

    Is there pressure from drug companies to prescribe drugs?

    Huge pressure – yes. In the States it’s worse, with direct consumer advertising of drugs and the medicalisation of distress, rather than looking for less-profitable alternatives. It used to be the case that opiates were only prescribed for severe pain, for example with cancer; but now opiate pain-killers are more frequently prescribed for musculoskeletal pain. We clearly need to try and reduce pain, and treating acute (recent onset) pain helps prevent loss of function and the development of ongoing pain symptoms. However, strong opiates bring a signifciant risk of addiction and / or overdose, and sure enough, opiate addiction is becoming a big problem. This may be because opiates also help anxiety, and this is actually the condition that the drugs are inadvertently treating.

    In the UK, prescription medicines can’t be advertised directly to the public – only to doctors. There are ways around this for drug companies though – they can operate via charities, for example. Take prostate cancer – it is counterintuitive, but there’s very little evidence of survival benefit from looking for prostate cancer if you don’t have the symptoms; but people are regularly exposed to the idea it is responsible to ‘get yourself checked’, promoted by some prostate cancer charities. If you follow the funding of these charities, you’ll often find drug companies not far behind. Injections for prostate cancer cost around £1,000 per year. This represents significant income for drug companies, as, because we don’t know at diagnosis whether prostate cancer will actually shorten life of this patient, everyone gets treated.

    There is a statistical fallacy called ‘lead time bias’ which makes survival rates look better by screening asymptomatic individuals. Supposing treatment for a condition makes no difference, the date on a death certificate will be the same, whenever it is diagnosed. If you screen for prostate cancer in someone without symptoms, the patient is usually incredibly grateful that something has been ‘picked up early’, but you may not be extending their life. Making a diagnosis earlier means the apparent length of time this patient ‘survives’ cancer is longer. Starting the clock earlier makes it look like survival rates have improved, but all that has happened is we are making someone into a ‘cancer patient’ earlier.

    Drug companies don’t have to do much ‘pushing’ these days however, when people have got used to the idea of antidepressants, and believe that there’s a ‘pill for every ill’.

    Another example is dementia. Only around half of people with dementia have been diagnosed as such, and Cameron introduced government targets for dementia diagnosis. You could see this as the government trying to do something to help people with dementia, but the target is only about numbers diagnosed – it doesn’t measure the experience of people with dementia, the availability of respite care, whether people can die in the place they choose, or any of the things that actually matter to people with dementia. This may be less about wanting to help people with dementia, and more about government being successfully pressured by drug companies to increase numbers, because dementia drugs are expensive to develop and a ready market helps offset costs. The health secretary meets with drug companies a lot more often than he meets with doctors. We could do much better as a society in looking after people with dementia, but making communities more responsive to needs is probably a more helpful way of achieving this.

    The same is happening with tech companies by the way – a lot of the newly announced investment in the NHS will go on technology of uncertain benefit, rather than on much cheaper preventative care. Health care is in thrall to whizzy, expensive, high tech medicine, hence the huge spend on hospitals rather than primary care, which is a much more cost effective way to provide care. While politicians receive donations and sinecures from the corporate sector, and as long as there exists a massive corporate lobbying industry, these things will continue.

    Industry funded research is another way care provision can be biased. The Seroxat / Paroxetine saga is a case in point. GlaxoSmithKline suppressed negative results of research into its use with children, and an internal document read “It would be commercially unacceptable to include a statement that efficacy [in children] had not been demonstrated, as this would undermine the profile of paroxetine”. They were fined, but no-one went to jail. There have been, and continue to be, plenty of other corporate offenders too.

    This pressure from drug companies has made health care much more expensive for fewer lives saved. Cost-effectiveness is best served by preventative measures, but they are sidelined in favour of expensive corporate products. The government produced the Cancer Drugs Fund in 2011 to fund expensive cancer treatments not deemed cost-effective by the National Institute for Health & Care Excellence. The most cost effective thing I can do as a GP to save a year of someone’s life is to invest in services to help stopping smoking – it costs around £700 to save one year of someone’s life (actually, one QALY, a ‘quality adjusted life year’, an attempt to recognise that survival and quality of life may not be the same thing). Doing the same thing using statins to lower cholesterol costs up to £20,000, and some cancer drugs costs nearer £100,000 for a year of life. Far more life-years can be saved for the same amount of money by encouarging smoking cessation, but the money gets spent on cancer drugs. When even the Daily Telegraph says ‘This mechanism for diverting taxpayers’ money to enhance, to little or no purpose, the profits of Big Pharma might be more aptly named the Drug Company Fund’ you know that it’s really all about corporate bungs.

    £700 to save a year of life via services to help stop smoking, versus £100,000 for an extra year of life via anti-cancer drugs.

    Is ‘insanity’ just a sane response to an insane world?

    I mentioned this concept to a patient recently, and she had what doctors describe as the ‘flash’, a moment of insight. She understood that maybe the problem wasn’t with her but in the society around her. When she came in, her attitude was ‘I can’t cope – I need to change’, and when she left, her attitude was more ‘no wonder I can’t cope – I need to help change society’.

    [NB: the seminal book on this subject is ‘The Sane Society’ by Erich Fromm.]

    How can we change direction?

    We can realise how much strong communities can be a preventative factor when it comes to depression, and a strong restorative factor when people are unwell. So if someone has supportive friends and family nearby, and a job that allows them to take time off and come back to work slowly, they might be able to avoid antidepressants. The NHS is doing the best it can to help people get well again, but there’s not enough happening to strengthen communities to stop people getting ill in the first place.

    The trick is to build community for everyone.

    Doctors can think about de-medicalising some forms of depression, anxiety etc. I often suggest people join some of the community activities we have locally – like the ‘men’s shed’, or poetry or flower-arranging or yoga or gardening, before I’ll think about antidepressants. Often the problem is loneliness – which requires people, not pills. The exercise from getting an allotment will help high blood pressure and raised cholesterol just as much as tablets.

    ‘Social prescribing’ is the term used for this kind of approach, and it’s on the up. I think it will slowly become more available – it’s being supported by local commissioning groups, and it’s extremely cost-effective in NHS terms, after all, because being part of a community doesn’t cost the NHS anything, and it not only helps people with mental health issues, it makes those issues less likely in future.

    Allotments: just as effective as tablets for high blood pressure and raised cholesterol.

    Doctors like it too – the only thing that’s stopping them getting more involved is lack of time. Some places like Bromley-by-Bow are doing great things, and it is spreading across the country. It’s not some sort of new, magic answer – I was suggesting people recovering from illness spend time volunteering in charity shops rather than launching straight back into work, a long time before I’d heard the phrase social prescribing. It’s often just common sense.

    What can individuals do?

    I mentioned above that it’s seeing things from a different perspective that is really useful in overcoming depresssion. But it’s not only drugs that can give people this different perspective – other people are good at that too. So just sitting down with someone and having a coffee and a chat might be just as effective as antidepressants, without the potential side-effects. And of course it’s free, and it helps to build community – plus it’s usually by putting things into words that people actually get to understand how they’re feeling.

    People who are most at risk are those who don’t have anyone they can have these kinds of conversations with, or worse, are surrounded by people who might frame their symptoms in negative terms. If people around you are telling you that your situation is awful and hopeless, it will be more difficult to pull yourself out of it. In some ways, the old attitude of ‘plenty more fish in the sea’ or ‘look on the bright side’, delivered in a loving way, is not that far from what talking therapies like CBT provide, in a much more long-winded way!

    The view from evolutionary psychology is that when thinking about yourself, the ‘pull yourself together’ attitude is protective, in that it can prevent you from slipping into depression. It’s not a helpful narrative for people who already have depression though, because if you could snap out of it, you would. It’s important to remember that depression isn’t your fault, and if you beat yourself up when you’re unwell, it’s not going to make you any better. You have to forgive yourself, because as long as you see it as your fault, it reinforces the blame, making it very hard to move forward.

    If you’re suffering from mental health issues yourself, then work out what it is that keeps you well (for me, it’s gardening, for example), and then find a local group that will allow you to do it with other people. Of course your job might not be helping. I spoke to someone recently, working in a call centre for the kind of company that sends fliers to people telling them they might have won £10,000, and to call a premium rate number to check. He was profoundly depressed, and although it was a difficult subject to broach, in the end he realised that his job was making him ill. Believing in what you do for a living is enormously beneficial for mental health.

    In terms of building community, then people can join or start groups focusing on an area of personal interest – whether it’s singing, art, poetry, sport, DIY, gardening or whatever, you can be sure that there will be other people locally who are interested in it too. Anything that brings people together is good.

    Seeing things from a different perspective can be really helpful in fighting off depression. Talking to people helps to do this – plus it builds community (but doesn’t provide profits for drug corporations).

    Are you optimistic?

    I am, because there’s been a huge change in attitudes, perhaps especially in the UK. It’s not about having a stiff upper lip any more – we’re all encouraged to talk about our feelings. I believe that social prescribing will become more prevalent, and allow us to sidestep corporations more easily.

    At the moment, if the only response doctors have is antidepressants, then any distress starts to look like depression. If we have other ways of addressing issues, we can offer an alternative to medication. Basic antidepressants aren’t expensive, but lack of community might mean mild problems become worse, and for major symptoms, the drugs become much more expensive.

    There are a growing number of organisations providing community care – for example, Orchard Origins in Herefordshire, who take people with mental health difficulties and they go out and prune old orchards. They maintain orchards, and make cider in the autumn. It works. There are hundreds of suitable activities that can have the same effect, depending on personal interest. Having a range of options seems to be the important factor – a sense of shared purpose is what makes a group & ultimately helps build communities.

    I hope that in 10 years time, antidepressants will only represent a small percentage of the options available for treating depression or anxiety. Drug companies will continue the search for profits, but we’ll have to deal with that as well.

    Is the problem systemic, rather than just in the health sector?

    Yes – it’s the corporatisation of everything, although of course I’m looking at it from a health perspective. For me, Huxley’s ‘Brave New World’ provides a useful warning, where everyone ends up taking ‘soma’, because it allows you to put up with a crappy society. It’s the same message historically peddled by the church, and more recently the National Lottery – put up with a bad situation now & things will get better one day. Don’t make a fuss and aim to go to heaven / win the lottery / marry a rich footballer. In the meantime, it’s a very potent way to discourage attempts at change.

    At the moment, we have a situation where close to 50% of teenage girls in the UK will self-harm to some extent. I can’t see any way to avoid the conclusion that there’s something wrong with a system in which that happens. I don’t believe that this would happen at such scale in a healthy system.

    What can we do about that?

    PSHE (personal, social and health education) classes in schools are important in building resilience; and actually, resilience is a bit of a buzzword at the moment. It basically means being able to cope with bad stuff – but how about not subjecting people to these stressors in the first place? So focusing on resilience might distract us from looking at the cracks in our society, and how we might change it.

    Talking of young people, possibly the most important thing they need is a support system – and maybe a resurrection of the old idea of apprenticeships – mentoring by adults outside the immediate family help to teach them how to become adults. An adult role model that a young person can look up to is extremely helpful in producing healthy young adults and a healthy society.

    Building community is vitally important. I think the NonCorporate position is right – that multinational corporations take wealth out of communities, and prefer people to live in nuclear families so that each unit has to buy all the kit they need to operate properly. Sharing things and doing things for each other within communities doesn’t suit corporations, whose existence is predicated on a need to make as much money as possible, competing with other corporations for market share.

    So I think that the current crop of community land trusts, community energy and community-supported agriculture schemes, and all the other new kinds of institutions that build community are really important. NonCorporate.org is a useful tool to help people disengage with the corporate world and to help these new institutions to flourish.

    The views expressed in our blog are those of the author and not necessarily lowimpact.org's


    • 1Annie Leymarie July 1st, 2018

      I am astonished that Dr Lennane rightly stresses the need to focus more on preventative medicine without mentioning the number one factor that will reduce or eliminate the majority of health problems (whilst playing a big part in helping to heal the rest of life on Earth): a shift in diet. Various studies have shown that together with moderate exercise (as well as stopping smoking and, where relevant, some stress-reducing practices), the adoption of whole food plant-based diets would cut by 80% the prevalence of non-communicable diseases such as cardiovascular problems, many cancers, diabetes and excess weight, Alzheimer, etc – thus the majority of the health burden.

      I am attending today a conference in London convened by a blood cancer specialist (haematologist), Dr Shireen Kassam, with Professor Kim Williams as guest speaker on “Taking the die out of diet”. Kim Williams is a highly respected cardiologist, immediate past President of the American College of Cardiologists. I would love Dr Lennane, who like other physicians probably never had any tuition on nutrition, to look at the data that Prof Williams presents here: https://www.pbs.org/video/dr-kim-williams-taking-the-die-out-of-diet-qew3sn/.

      This shows how home-grown well-being is indeed in our hands, or rather first and foremost on our plates.

    • 2Simon Lennane July 1st, 2018

      Thanks Annie. I actually spent a year studying vegetarian nutrition as part of my degree, but it was a long time ago now, and the research will have moved on greatly (80% seems amazing to me), but you’re right that medics typically get little training in nutrition. I will have a look at the link thanks. It’s hard to cover such a wide topic in a small space, and I’ve also left out the role of exercise, libraries, mindfulness, and all sorts of other therapeutic options. Thanks for comments, Simon

    • 3llinos July 1st, 2018

      Well I agree with both of you, as a psychoanalytically trained person who runs an organic farm. But you’re talking about two sides of the corporate problem; it’s the “food” purveyed by the corporate system, in its expensive plastic packets with all the vitamins taken out, that doesn’t sustain health or wellbeing. This has been known since the time of Doris Grant for one; and is of course the basis of the organic farming movement.More reason to get an allotment and make a start growing your own.

    • 4Simon Lennane July 1st, 2018

      It’s interesting to wonder how much is due to the nutritional quality of the food, & how much to the love & effort that goes into self grown food. Allotments are good for exercise, but the companionship, and the connectedness – for example, eating fruit in season – are likely to be important.

    • 5Annie Leymarie July 3rd, 2018

      Hello Simon

      I have seen the 80% figure in a number of papers, such as a very recent one on ‘lifestyle medicine’ written by 21 physicians. Here is an extract from their introduction:

      “We describe the practice of lifestyle medicine and its powerful effect on the modern instigators of premature disability and death. We address the economic benefits of prevention-based lifestyle medicine and its effect on our health care system: A system on the verge of bankruptcy. We recommend vital changes to a disastrous course. We believe that lifestyle medicine should become the primary approach to the management of chronic conditions and, more importantly, their prevention. For future generations, for our own health, and for the Hippocratic Oath we swore to uphold (“First do no harm”), the medical community must take action. It is our hope that the information presented will inspire our colleagues to pursue lifestyle medicine research and incorporate such practices into their daily care of patients. The time to make this change is now.

      (…) Chronic diseases are presently the leading cause of morbidity and mortality and are responsible for most of our health care expenditure. Most of these chronic conditions are preventable and are the result of an unhealthy lifestyle. MORE THAN 80% OF CHRONIC CONDITIONS COULD BE AVOIDED THROUGH THE ADOPTION OF HEALTHY LIFESTYLE RECOMMENDATIONS. Eighty percent of the population wants to live in a better state of health but do not know how to pursue it. Minimal information is given by health care practitioners on how to implement an effective, long-term plan to achieve health. The ongoing acceptance and adoption of a healthy lifestyle remains our greatest challenge. An aggressive analysis is needed to review the impact of lifestyle on our health”.


      The 80% reduction is based on the adoption of whole food plant-based diets, moderate exercise, no smoking and minimal alcohol consumption + stress-reducing practices where relevant. Another recent analysis has shown that just avoiding meat consumption (not other animal proteins and no other lifestyle changes) would cut early deaths by at least 30% (https://www.telegraph.co.uk/science/2018/04/26/third-early-deaths-could-prevented-everyone-giving-meat-harvard/?WT.mc_id=tmg_share_tw).

      In addition there are of course all the environmental arguments in favour of plant-based diets. Thus the 20,514 scientists who so far have signed the recent ‘Warning to Humanity’ (among the 5% most read papers https://oxfordjournals.altmetric.com/details/28854048#score) urge us to promote mostly plant-based diets. And of course as a bonus there are the billions of animal lives that can potentially be saved directly.

      I fully agree with what you wrote – I volunteered for many years in the first UK ‘Transition Town’ (in Totnes) where community food growing is a key activity and doctors in the local surgery prescribe community food growing sessions instead of anti-depressants to some patients. But it seems to me particularly important to educate the public (and experts!) on the well-evidenced nutritional and environmental advantages of whole food plant-based diets. Many studies have shown that both for our health and planetary health it is much more important to choose plant food than to choose local food – though of course choosing both is best!

    • 6Dave Darby July 4th, 2018


      ‘to promote mostly plant-based diets’ – I’m with you.

      But the article is about depression, rather than meat-eating or any other particular aspect of modern life that might (or might not) be damaging to health. You know I agree with you that we eat too much meat in the West, but you’re not going to persuade me that my level of meat-eating (i.e. around once a fortnight) is dangerous. It’s a question of risk assessment – and getting in a car, smoking, drinking too much, or just crossing the road, are all much more dangerous. There’ll be plenty more articles to debate the pros and cons of meat-eating.

      And when we do, the three main points I’ll keep coming back to are:

      1. ‘as a bonus there are the billions of animal lives that can potentially be saved directly’ – you can’t stop billions of animals being killed (much more cruelly than by humans) unless you want to stop nature, which I assume you don’t.

      2. Meat production keeps smallholdings alive. It’s much more difficult to make a living producing plant food only – and a waste of resources (cf sheep and chickens under orchard trees, fertilising them, removing pests, providing additional meat and eggs from the same land, and keeping weeds down, rather than having to mow). And moving to a system of food production by organic, independent smallholdings is the best we can do for ecology and democracy in terms of food production.

      3. ‘Many studies have shown that both for our health and planetary health it is much more important to choose plant food than to choose local food – though of course choosing both is best!’ – really contentious. It’s all about scale – choosing the large and distant rather than small and local will benefit multinational corporations and industrial agriculture, and therefore shore up a damaging economic system. Scientific studies focus on physical rather than political realities (ever tried to talk politics with a scientist?). I know you know this though.

    • 7Annie Leymarie July 4th, 2018

      Hello Dave,

      Good to read you and I look forward to more debate opportunities! I confess that I had rather rushed my initial response to the main post, having read mostly the headline, but the first thing Simon says is that mental and physical wellbeing are inseparable so I feel my points still hold. Now briefly onto yours: Yes of course it’s about risk assessment! Indeed eating meat once a fortnight is far less harmful than 30 times, but there is still an average impact higher than that of plant-base-food, both for human and planetary health (and I contend that the two are inseparable, with depression possibly inevitable if we close our eyes to the harm we knowingly inflict around us, whilst aware that it could easily be avoided). You compare meat eating with smoking: well one ciggie a fortnight won’t harm a smoker much but no cigarette at all will harm her even less. Prof Walter Willett from Harvard, the most cited health expert in the world, has said it many times: little meat is better than much meat and no meat at all is better still! He has co-authored a number of recent studies which confirm his point, such as one showing how every incremental intake of animal protein shortens our lives, and every incremental intake of plant protein prolongs them (http://archinte.jamanetwork.com/article.aspx?articleid=2540540).

      Indeed the comparison with tobacco is often used by other health experts who recommend whole food plant-base diets. On Sunday in London prof Kim Williams confirmed that not so long ago many medics smoked and some promoted tobacco. It took more than 7000 published studies demonstrating tobacco’s harm for any authority anywhere to issue a warning about it! The difference with tobacco is that our meat-eating habits don’t just harm us but also the climate, air, water, biodiversity, wildlife, farm animals, etc.

      Your other points:

      1. I can’t stop billions of animals being killed in nature (and I disagree about the blanket statement of ‘much more cruelly’), but I can resist murdering you even if our opinions clash, for instance (and we’re both ‘nature’). ‘Nature’ does all kinds of things that are not relevant to my choice of behaviour. It kills millions of humans through malaria and tuberculosis, for instance, but that’s no justification for killing many more millions.

      2. Undoubtedly it is still a small minority of farmers who not only practice veganic agriculture but also, to prove the validity of their choice, are able to invite many scientists on their land to gather evidence, as well as promote their work and teach others, as Iain Tolhurst does, having been a successful and passionate stockfree grower for over 40 years. Still, there are plenty of other examples and advice on the Vegan Organic Network site, on the Grow Green site (https://www.vegansociety.com/take-action/campaigns/grow-green and elsewhere. In fact it has been shown many times that animal manure, unlike compost or green manure, can often bring more problems than benefits. George Monbiot has documented the terrible impacts of manure from dairy farming on our waterways (and 80% of the EU’s beef comes from the dairy herd) and the problem is of course worldwide (http://www.onegreenplanet.org/environment/how-factory-farm-run-off-threatens-marine-life/). Sadly the majority of subsidies go directly or indirectly to livestock farming (as the €17.7 million currently going to the promotion of sheep farming, for instance). And we could still keep some animals on smallholdings without killing and eating them. We need more imagination! Our carnivorous pets also have a very big eco footprint. So we could have fewer of these and share some others. Instead of keeping sheep that we kill every year and are thus forever fast-growing juveniles emitting masses of methane and destroying all the vegetation around them, plus needing dogs for herding, we could perhaps keep in our orchards some pet donkeys or miniature poneys (non-ruminants) who could live two decades or more and act as community or family pets. We could equally keep slug-eating ducks for the love of them, without killing them! We could get more people to learn and practice scything instead of attending the gym, etc, etc.

      3. The planet is on fire and unless we do right now everything we can to cool it, none of our other problems will matter long because we will be gone, together with most life as we know it. The UK currently imports 80% of its fresh vegetables and 40% of its fruit. Within the EU we are the country with the highest rate of obesity (and high up on the ranking worldwide); excess weight is linked to the consumption of junk and sweet food but also very much – if not mostly – to meat and dairy. So yes to small and local farms but until we can produce locally the plant-food that is best for us and the planet, it is far better overall to choose imported veg, fruit, grains pulses and nuts than local meat and dairy. The recent meta-analysis of the scientific evidence on food’s impacts, which strongly confirms that “Avoiding meat and dairy products is the single biggest way to reduce your environmental impact on the planet” also confirms that “The greatest changes in the effect of a person’s diet on the planet comes from choosing certain kinds of food over others” (i.e. plant-based over animal-sourced, rather than local over distant). (https://www.theguardian.com/environment/2018/may/31/avoiding-meat-and-dairy-is-single-biggest-way-to-reduce-your-impact-on-earth?CMP=fb_gu).

    • 8Dave Darby July 5th, 2018

      Hi Annie – I promise to look into this a lot more in future articles, but this article isn’t the place to get into an arms race with links to contradictory studies – we know where that can lead! There are just as many studies I could link to that show opposite results to the ones you’ve posted, and it takes time to sift and to check their validity. Ultimately, studies aside, you’re opposed to any human killing any animal, under any circumstances, and I respect that – in fact there may come a time when humans look back on killing animals in the same way that we look back on slavery now.

      But I also know that you can’t possibly be against bears or weasels or killer whales killing animals, so philosophically, it doesn’t sit right with me. Also, trying to persuade smallholders that they keep animals as pets rather than a much-needed source of income wouldn’t go down too well I don’t think. Not at this time in history – we need smallholders to have every advantage they can over industrial agriculture.

      But as this article is about health, I’m with Michael Pollan – ‘eat food; not too much; mostly plants’, and then not worry about the occasional bacon sandwich, few beers, or even a ciggie if I feel like it.

    • 9Annie Leymarie July 5th, 2018

      Hi Dave, When in the past I have backed my opinions here, under relevant posts, with well-established scientific facts you already responded that you would look into it later. You decided that it was more appropriate to look at ethics first, and afterwards at facts onto wish ethics is based. I disagreed, but this is your site! The announced posts never materialised and here I am just responding to your comment. My very first comment some months ago was in response to the cattle farmer and LowImpact.org adviser who was recommending on your site that more meat should be consumed in the UK.

      Please do post relevant studies! Let’s agree to only look at peer-reviewed ones with no conflicts of interests. I am not trying to tell you or anyone else what to do. What you choose to eat, drink or smoke is not really the point, though I would prefer you doing it with full knowledge of any potential harm to yourself and others. But this is an educational site! Currently anyone can choose to smoke or not, and how much, but some regulations have finally been put in place. It’s taken many years of battle from some stubborn health experts and others for information to be relayed on the risks involved, including to others from passive smoking, and including the NHS costs involved.

      Similarly it is a fact that the vast majority of people are currently misinformed about the health and environmental impacts of their diet. Simon confirmed here that most medics get very little or no tuition in nutrition, even though food is the number one factor influencing our health and thus influencing the biggest public expenditure – without even considering the climate and other environmnental costs.

      Let’s look at facts coming through my mailbox today: First a short video confirming that grass-fed livestock harms the climate, in the vast majority of circumstances: https://www.youtube.com/watch?v=nub7pToY3jU (from a large international team of scientists who have examined 300 studies and much else over several years – having to push against the misinformation spread by some livestock farmers).

      In my inbox also is the latest ‘AHDB Beef and Lamb’ newsletter (AHDB = Agriculture and Horticulture Development Board), telling me that an additional €10 million have been granted by the EU to promote sheep farming, because consumers are turning away; and that the UK has agreed a target of 37% reduction of its greenhouse gas emission by 2030, but that there are no obligations set for farmers. Indeed the AHDB site shows that climate change is in theory part of their research remit but that there is currently no research project underway neither for cattle nor for sheep farming.

      Simon has mentioned the heavy pressure and misinformation from Big Pharma that weighs onto medicine. There is equally big pressure from the livestock industry to avoid or distort inconvenient facts. It takes some bright and courageous voices such as that from George Monbiot to fight such misinformation (and George also spends a lot of his time promoting the kind of community activities that Simon suggest to fight depression and loneliness). On Tuesday I will be listening to him and the wonderful Mark Cocker explain why sheep and cattle are wrecking our uplands and we should be rewilding them instead (https://www.intelligencesquared.com/events/the-battle-for-the-countryside-britain-should-rewild-its-uplands/).

      You write that I am “opposed to any human killing any animal, under any circumstances”. I have never written such a thing! In fact I clearly wrote here in the past that I have no problem with the killing of malaria mosquitoes, as just one example. I am opposed to any unnecessary harm – and in the case of our consumption of animal-based food, I point out the many ways this is harming our health, the climate, the wider environment and human justice, as well as the animals themselves. Show me cases where harming or killing is justified and I’ll happily consider them. I am broadly in favour of euthanasia, thus the killing of some humans and animals, for instance (and had both my beloved dogs killed at age 19, as well as two cats). There are parts of the world where the adoption of a fully plant-based diet would be impossible and I fully accept that.

      I also understand that under the present circumstances it is not easy for smallholders to do things differently – but this is largely because of cultural pressures – thus my interest in at least establishing correct facts on sites such as LowImpact.org. Things are changing very fast, as more and more people discover for themselves the benefits or reducing or avoiding the consumption of animal-sourced food. Stories about livestock farmers switching to horticulture and not looking back now abound. Companies selling plant-based food tend to do extremely well. Whereas dairy farmers struggle and get increasingly depressed to the point of scapegoating badgers or anything else they can think of, companies such as Good Hemp in Devon, selling plant-based ‘milk’, are flourishing. Or Homedods, selling quinoa and pulses – now at last grown in the UK to feed humans rather than livestock, also doing very well. With good advice, starting with correct facts, smallholders could be on the right side of history and greatly benefit!

    • 10Dave Darby July 5th, 2018

      Yes, sorry, been too busy launching https://www.noncorporate.org/. It’s taken a year of my life.

      And yes – peer-reviewed studies only, no vested interests. But the last spat between you and Rob would have taken a month of full-time work to compare the studies. It was just too much. And (very important) – I’m not interested in research into the current meat industry. We’re clearly against that. I’m interested how damaging is an agriculture with far fewer animals, all on mixed organic smallholdings (I’m also in favour of rewilding the uplands, but with humans using the forests – for example charcoal production, green woodworking, timber, firewood, running pigs, and wild food, including hunting and fishing). Again, I’d be interested to see research on the impact of those activities. (sorry, I meant that you were against keeping livestock for food, not mosquitoes or euthenasia).

      I’ll post our policy on meat production soon (you already know what it is), but if you / other vegans and Rob / other meat-eaters post links to hundreds of studies each, the same thing will happen – stalemate. All I can do is state our policy, but not carve it in stone. I’m happy to have the debate here, and to interview smallholders of both persuasions. We’re now a workers’ co-op of 3 workers and 4 associate advisors. If we’re persuaded by an argument, we’ll change our policy.

    • 11Annie Leymarie July 5th, 2018

      Very briefly (am off camping for a short week): well done for noncorporate.org! My passion for the topic of diet is fueled by the fact that whichever way one looks at it, the evidence that we’re better of without animal-based source is overwhelming. You say you’re “interested in how damaging is an agriculture with far fewer animals”, so it seems you’re adopting from the start a biased viewpoint? My own viewpoint, assuming you meant ‘farmed animals’, is that this would be very healing, not damaging – for a range of reasons. Rob never posted hundreds of studies. I did, to present the overwhelming evidence I’m talking about. Even if you have (relatively) free-running pigs in the woods animal protein will still be bad news healthwise for whoever eats it. Studies have shown that wild meat fares no differently on many grounds. The introduction of the pigs, then their killing, will also affect the ecosystem. And of course it’s completely out of question to have 7.6 billion people living from hunting and fishing. In fact we will very soon be running out of fish other than farmed fish who are plagued by disease, highly inefficient in their use of resources and also responsible for tons of methane. The romantic notion that we can all go back to some kind of modern stone age or idyllic indigenous relationship with animals that we both revere and kill is lovely nonsense. Hunting is also responsible for a large part of the annihilation of wildlife worldwide. You write that you’re ‘interested to see research’ but when I post some you tend to respond that you have no time to look at it. I sympathise with the busyness but I am also seeing something else happening here…

      I’ll leave it here, but will quote some extracts from a video I have just watched, on an angle I tend not to insist too much on (you call me a vegan, I tend to call myself someone on a whole food plant-based diet, putting my focus more on climate change and other environmental impacts as well as health rather than animal suffering – but of course it’s huge). Philip Wollen, interviewed here, is in my opinion full of wisdom:

      “There are now 7.5 billion of us on Earth – and we torture and kill 2 billion loving, sentient animals every week, we stab and suffocate 1 billion ocean animals every 8 hours. If we were killed at the same rate, we would be wiped out in one weekend. It really is a crime of unimaginable proportions and I won’t have a part in it.

      When we suffer, we suffer as equals. In its capacity to suffer, a dog is a pig is a bear is a boy. I think there is no such thing as ‘humane slaughter’. Anyone who tells you that we can slaughter an animal humanely is either a liar, a fool or a profiteer. The industry is inherently cruel, one cannot avoid it! People are not doing this deliberately for a particular pleasure – it’s just that the job requires it. I no longer believe in animal welfare – I believe in animal rights.

      Ahimsa (non-violence to any living being) is in my judgment the most beautiful word ever written at any time, in any country, in human history. I think it is beautiful not because it describes our politics, our diet, our lifestyle or our whims but because it describes our character: it says we reject violence wherever and whenever it occurs.

      The meat and dairy industry is in my judgment the greatest scam ever inflicted on humanity and the animal kingdom. It has no place in a civilised society. It is also the biggest social justice issue. By 2048 all our fish are going to be dead, in part poisoned by the animal-industrial complex, and there seems to be no sign that we have hit the top of the curve – the growth rate continues.

      Unfortunately governments and industry really don’t care if the car goes into a ditch, as long as they get to drive. This kind of short termism, regardless of the long term costs, could be the undoing of civilisation. There are many people who argue, and so do I, that unless something radical is done, and soon, this will be our final century. Much better minds than I have expressed this sentiment and have done so much more eloquently and elegantly, but that reality is true.

      Yet I am hopeful that we have in our heart the capacity for compassion and the capacity for change – and if not, what are we?”


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