The Human Cost of Losing Bees

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I'm Leiff Nasser. and today we're resurfacing a quite provocative episode we originally reported in twenty fourteen sounds like a long time ago until you start listening and you start to realize how many parallels there are between twenty fourteen And this moment right now, outrageous health carere costs, war in the Middle East, climate change in every one of these cases specifics that they're referring to have changed overall picture remains depressingly the same Honestly, since it came out, like I still think about these stories. I still remember them all the time, especially the last one I would say this episode is one of my all time top ten radio lab episodes I hope you feel the same way, whether you are hearing it for the first time or hearing it for the tenth time Here he goes worth wait, you're l thing I' listening to radio lab Radio from Bain WNY. Th Y. You ready? Yes. feelingm full worth. I'm feeling full of value. Well, in that spirit, I'm Jad Abom Moran. I'm Robert Kroowich. This is radio Labin today. Three very different stories that try to put a dollar value. A million's okay. onene million dollars. Seven dollars. ten thousand dollars. Yeah, I would say five bucks. One things This seem priceless. priceless. Priceless. priceless Is it really? Okay, so start at the top. So bring on the pressure. So to tell All right, we're gonna to start the show with a story from our producer, Molly Webster. I we might actually want to rename Molly Wonster becausecause she recently got herself to some serious numeric sizing. Actually it didn't start as a wonky thing. It started actually with some medical journals. So that was that was interesting because it was some of the most poetic writing I've seen out of doctors ever One journal article said like, what would one more month mean to a thirty seven year old mother who has four children Or what would one more month mean if you are a sixty seven year old who's about to go traveling around the world? People were just kind of like drifting these questions out there whereere they were All these questions seemed to circle around The seemingly simple story of the pricing of a drug cer And the story, if you really want to tell it from the beginning, it begins with this guy named Leonard. Leonard Salz, I'm a medical oncologist at Memorial Sloan Kettering Cancer Center. whichich is here in New York, and it's one of the largest cancer centers in the country. mean We have seventeen doctors here who treat colon cancer just for colon cancer. They treat a very large number of patients. It's a huge hospital And one of the things Leonard's been noticing in the last, I don't know, decade is cancer drug prices have just gone through the roof. I mean, we have drugs out there that are many hundreds of dollars per pill Yeah. Oh, just wait Let's see, whereere doess this start? It starts It's june in twenty twelve. Leonard Salt is at a conference and at this conference is a pharmaceutical company called Santay And they give a presentation about a new drug that they have. A drug called ZLTrap. andZalTrap is a drug that Without getting into the science, too much targets the blood supply to the tumor. It cuts off the blood supply, which means the tumor can't grow.'s scientific hypothesis. So this new drug is presented and they like present the data and they showed That the survival difference between the people who got Zaltrap and the people who didn't was one point four months or forty two days. In other words, if you take this drug, you could get forty two more days of life on average, which means you could get three more days, you could get no days, you could get forty two or you could live another three years.ty two forty two days Yeah Please, I could show you some graphs that have been put up at meetings that show survival curves calculated out to two decimal places in terms of months So I'm looking at this.ot tenth of a hundredth of a month. a hundredth a month. That's a little over seven hours. prettyty amusing actually Why would you why would you It's pseudo precision. Pseudorecision. At any rate. Anyways, after the conference, the FDA approves the drug and basically, once the FDA approves a drug Public insurance has to take it, and then the private insurance companies just follow suit, which means you get prescribeed the drug and people pay for it. And what does the drug cost? That's the thing. It costs U roughly thirty thousand four ree month course. So So Leonard is like, wow, that is expensive. And there was already another drug on the market did the same thing and it cost half as much To put that in context, this is just one drug that's eleven thousand dollars a month. A normal cancer patient might take dozens of drugs. There are anti nausea medicines that are sometimes used that are in the range of ninety do to one hundred dollars a tablet and you take a tablet once a day for three days. One needs growth factors to help support the white blood cell count, which you sometimes need in chemo. Those can be five thousand dollars every two to three weeks. If you need antibiotics to treat infections, those aren't cheap. and then you need a pharmacist to prepare it. They're labor intensive tubing and equipment and needles to give it. You need trained nurses to administer it. you need doctors to take care of the patients. And don't forget there's a cost for a CAT scan or MRI. and then of course someone's got to pay for the real estate, the heat and the lights. None of those prices are figured into it Okay, I'm just giving you the cost of the drug So Leonard calls up one of his colleagues. My name is Peter Bach. I'm a physician at Memorial Slan Kettering. Peter is the number cruncher of the group. He does the statistical analysis of, I don't know the cost of care. And Leen grabbed him and ran him through all the data. And we walked through the out of pocket expenses for Medicare beneficiaries Medicare beneficiaries, if they don't have additional insurance twenty cents of every dollar they pay out of pocket. And that number sort of hit him because he realized for Medicare patients, they'd be paying something like two thousand dollars out of pocket every month For just this druudge. twenty thousand two hundred, if I remember the number correctly. For a lot of Medicare patients, that's all of their money Never mind, other drugs That's when I thought we should go public with it. Memorial Stone Kettering They decide to boycott this drug that is that a I mean, I'm just stopping you because when you guys made that decision was that that feels like a big deal. It did feel like a big deal and it felt like a big enough deal that we decided to write the op ed piece in the New York Times. They write an op ed in the Times that basically says, look, this is crazy. eleven thousand dollars a month for a drug that maybe gives you forty two more days of life. Is that worth it And a little less than a month after the opD piece came out, the company that makes Saltrap. They went to individual doctor' offices, sent representatives and said, we're offering a fifty percent discount price in half just like that Nationwide or like just in this area. Nationwide. It was sort of incredible We reached out to Santafi to talk about the price of ZalTrap, and they declined to comment. But in a statement that they released when this whole ZalLTrap thing happened, they said that they incur so many costs for researching and developing and bringing a drug to market that that is what their pricing is based on. Leonard doesn't disagree. We need these companies They're the ones developing the drugs. Which aren't easy to develop. I mean, Leonard gave us just one example. If we talk about colon cancer. He says for years, there was only one drug on the market called fiveFU. FiveFU was patented in August of nineteen fifty seven. It was from nineteen fifty seven Until nineteen ninety six that a second drug came along. That's how long it takes to develop a good drug? Or in that interim, there were over seventy drugs that were tried and failed. like I don't give it enough credit because that just astounded me. It's very, very hard. And that, according to Leonard, is one of the reasons why prices are just gonna to keep going up Sooner or later this system is going to fall apart. And at what point does society say H, there isn't an infinite number of dollars that we can commit to our health carere system? It's funny because I had this interesting reaction to the word society 'use of a sudden I thought, like why is N not in like a, you know, crazy death panel way, but I thought, why Why is society involved in my conversation with my doctor about if I want to take this drug that may give me another month and a half of life. Why is society involved becausecause you're not paying Unless you have hidden resources I'm aware of, probably couldn't afford ten to fifteen thousand dollars a month in drug bills. Someone else has to pay that Obviously, he says, it's your insurance. I mean, say you're part of a policy that has one thousand members. Let's say that the premium for that is one hundred dollars So we had a hundred dollars, thousand people, we got ourselves one hundred thousand dollars. Okaykay? So we now have one hundred thousand dollars. to take care of that thousand people. for that month. whatever amount of time, if now one person comes up with a healthcare cost. let's say it's for a month that is a hundred thousand dollars in that month Everybody else is in trouble There's no money left So They write this up ed saying like prices are too high and the drugs are not that great. And sort of the next like notable wave is There was there's this journal called Blood, which is really big to anybody that works in a community has like called blood. Yeah. How did we not know about this when we made the Blood show? Oh, I knew I just kept it in here. Anyhow. So yes, there's a journal called Bood, which is basically like the journal for anybody that works in a field that has to do with blood And what happens is like a hundred doctors get together and they c signign an editorial, which basically says, We totally agree with everything you guys are saying, but we have an even bigger issue You know, with ZLtrap, you're talking about an expensive drug that maybe doesn't really do that much. It's kind of easy, even though it had never been done before, to say, we're not going to use this. What all of these doctors in the blood editorial are saying, what do you do when you have a really expensive drug But it's really, really good It's like a drug you actually want to take Is that like a one day in the future we will face this kind of question? No, that is like a now today question the most important new medicine approved this year. Everyone I talked to pointed me to this new drug called Sovaldi. It's known as Svald.vald. many in the medical community are calling the new medication a blockbuster. Svaldi came on the market last December. That's december twenty thirteen. That's correct. This is Bruce Bruce Mole. I'm the editor of Commonwealth Magazine He's written about Svald, and here's the basic story, right It is a drug that treats hepatitis C, which is caused by a virus. And the disease itself goes to work on your liver. inflames it. It scars it. It can cause liver cancer, cirrhosis, it can be fatal. And for the longest time, the treatments that they had just really weren't that great or they just had Wretched side effects But along comes Svaldi and it's one pill twelve weeks. You take it with some other antiviral meds, it is a super simple treatment option. And the side effects are very minimal. Like this it was like kind of like the saavior drug And so a lot of doctors start to prescribe it. In the first half of twenty fourteen, seventy thousand people in the country in the United States were treated and it had a ninety five percent rate of cure in other words The virus was eradicated. That's very big But In fitting with our story. This drug costs a thousand dollars a pill. For like one one pill that I take one a day. whichich as you can imagine, it angered a lot of people with Heepi. In total, it costs eighty four thousand dollars. And if you think about the fact that In twenty fourteen, we know at least seventy thousand people got this drug. Then you're starting to talk about serious money. Wait, I want I just want to say that that I just timesed out seventy thousand times eighty four thousand. and I got something with seven zeros in it. It's five, eight eight and then there's seven zeros is five billion dollars? Yes. ye The big question is how states will pay for what could be upwards of. And so we have a situation where states are basically having to ration. Yeah.ay in Massachusetts, most of the insurers currently are requiring some liver damage before you can take the drug Similar restrictions are happening in other states, Florida, it's happening in Oregon, Illinois. The doctor says the only option may be to wait until you're even sicker. And then there's Arizona out of the entire state Public insurance only approves one hundred and eighty people for treatment W just one hundred and eighty? Just one hundred and eighty. Now, when I talk to a representative of the company that makes the drug, Greg Alton, exxecutive vice president for cororporate and Medical affairs for Gillant Sciences. He says you gotta keep in mind, this is not a chronic care situation. This is a cure. Here you're actually curing a person of a disease. We're talking about twelve weeks of therapy od That's it, and you're done and you'veured somebody. So he says, this is a one time deal. This is like one time eighty four thousand dollars And then you're done. Think about all the years you'll live without having an illness. then you'll see. Over a twenty year period, the savings that will accrue to the system by having a patient cured of hepatitis C. He also said it's important to understand that every hepatitis C sufferer is not going to hit the system At the same time, so all of the cost is spread out, right which is totally true, but I think there's like this bigger picture here And Bruce points it out too. It's sort of like a precursor of what could come because these companies are developing drugs all the time. What if if you could get a drug, but it was very expensive to treat diabetes? And then you're talking tens of millions of people. An enormous segment of the population. Even if just a fraction of them want a drug that's a thousand dollars per day prractically our entire US budget? What do you do in that case? A drug comes along like that and throws everything out of whack This is the part where I really sort of got hooked in where it's like, how do you answer this question? Is it that You know, at a certain point, you just draw a line and you say beyond this point We're not paying Beyond what point? Exactly. I mean, that's the hard part How good does a treatment have to be for you to say, this is worth the price that it's been set at? I don't think we rejected it out of hand, but I don't think I got into this a bit with Leonard eith. In the case of Zaltrap, they said, all right, forty two days, that much money. we're not going to do it. But would it have been different if it was fifty days? a hundred, is that enough? I'm sure you want to be talking in years, but I guess the question is, like what would be is there a magic line for you? Um If I this is a I can't personally determine it for everybody. I wouldn't presume to try. But ultimately as a society going to have to reach an understanding of what that cut point is because we can't afford not to. And the question that sort of bubbles out of this conversation is what is one more year or one more month or one more day of life worth to us? Are we willing to pay a thousand dollars for an extra day of life? Well, what about one hundred thousand dollars for an extra day of life? You know, peopleople like to say, yeah, so what's the value of a human life And the answer is, boy, that's a complicated question but a really important one because nobody thinks it's infinite He said that and I was like, Okaykay, it's not zero and it's not infinite. Is there an answer like in the middle? And so I started looking around I don't know. I guess I was wondering has anyone actually thought about this? And so I started looking around and what I realized was that the World Health Organization actually I mean, I guess they almost have a number, but it's a number per country. They have the recommendation that countries spend going to get gobly cookie but just bear with me. The countries spend one to three times the GDP which is like the gross domestic product per individuals. So take the entire ball of money that is in a country and divide it per individual. Divided by the individuals. and then you spend one to three times that on one more good year of life. And what would that be for us? So for the US, that's about fifty to one hundred fifty thousand. Interesting. And that does that have any teeth? that recommend? It legally doesn't have any teeth, but it has teeth in the sense that Doctors in the US are actually going to start using this WHO number to evaluate medical treatments for cardiology They said they were going to do this in a paper and it was kind of very quiet, very subtle In other countries, this conversation is very loud actually. It happens at the government level. They're also passing out surveys where they're asking Citizens, what is your limit on how much you want to spend on one more good year of life. Have they done that here As far as I know, no Why not because Because the last time we tried to talk about cost in medicine, it ended up in the whole death panel Death panel. Death panels or so called death panels thing and I don't know, I just wandered right into the mess of it. Hey, Times square. If I actually tried to go out and ask this question in a very basic way. How would people respond? Excuse me, can I ask you a question? What is a year of life worth Wow, what a question. That's deeep. Can I think about it? And That's a tough one, but I was really surprised at how seriously people took the question. Man What is a year of life worth? That was the first thing I noticed. Then the next thing was No one could answer the question until I had answered like a million questions of theirs. Am I gonna die tomorrow Yes. Where do I get that year? So I get it at the beginning in the middle or the end? How would I spend that year of life? Good It would be a good year of life. A good year of life depends. Is this like a pie in the sky kind of answer? They wanted to know, would they be emotionally happy? alone with friends or family? Where did they get the money? Ifould they borrow the money, they have to pay the money back. Were they dying? Was it an emergency? A other people also trying to get money at the same time? because then there'd be like a rush on the money in America? Oh, interesting Did you actually ever end up getting numumbers? I did get numbers, but they were at least ten thousand dollars. fifteen thousand dollars. thirteenQarter million, seven dollars All over the place. Yeah, I would say five bucks. ten million dollars forty four thousand dollars. Interesting. One woman said ten million do. tenen million dollars for a year It's irresponsible. Well, you asking me about my personal choice? T million dollars. Not about a public policy question. Why do you have any way of parsing all this No. I really, I honestly don't. I think my biggest takeaway was like no one punched me, which which makes me feel as if people are ready not ready but willing to engage in this conversation But I also realized I kept talking about things and I just wanted to be in the room with patients. L I just wanted patients in the room with me because it was like we were all having this conversation that Eventually, we'll all be patients, I guess. but we were also having this conversation around group of people that weren't ever present, like they're not at conferences or not in research articles And so that was when I started talking to patients. Ah, well I guuess what is forty two days What does forty two days mean in the sense of Is that something that you'd pay fifty thousand dollars for if you were I mean, of course you would. that it's like No I almost I can't even ask the question, but I don't know. Well, know, I think it's a good question. I think ethically it would be to the good of patients and doctors to have this conversation. This is Susan, Susan Gubar, writer of the Living withith Cancer blog for the New York Times. Back in two thousand eight, Susan went to the doctor. She hadn't been feeling well for a while. They thought it was some sort of bowel issue, but then the doctor walked into the room and said she had advanced stage ovarian cancer Most ovarian cancers are diagnosed at a late stage. It's it's basically Incurable It can be handled, it can be managed, it can be kept at bay and longer periods of time now we hope. But you're given a diagnosis of three to five years That is you go from having unlimited time in your mind to three to five years in like a doctor's visit Yeah, it it's a big shock. You sort of enter a zone Well, you're not quite aware of what you're doing That day, the day she was diagnosed, she was told pack a bag, get in a car and drive to Indianapolis. You need surgery now. So I went the next day to Indianapolis and the day after that, I had the debulking surgery, which takes out the ovaries and the uterus and the fallopian tubes and the spleen and sometimes the cervix and sometimes the appendix, and holy Simes the bowel. Are you serious Yeah, it's called the mother of all surgeries. And then just like that She was doing multiple rounds of chemo. Chemicals that are used They destroy or quick growing cells So, for example, you have no hair, no eyebrows, no eyelash is that? you know. you also can I got terrible sores in my mouth. I have no idea why, but I know this happens to other people. But yeah, the other thing is this extreme fatigue And Susan, who writes for a living couldn't even read. I would look at a page and think, had I turned a page? Chemotherapy it really is toxic to the spirit To the heart, to the mind just the normal aspects of life feel polluted Have you ever had to think about cost? I was never informed of the cost of any drug or any procedure I was given, which really makes me think about how masked these costs are. Would you want to be thinking about cost while you're going through it? or is it better to just say here are your treatment options? These are statistical outcomes beces like one and then we'll deal with it on the other side I think there's a kind of Unspoken agreements among everyone that the insurance company or Medicare is going to pay And if it's the government, that means that our grandchildren are going to end up paying for all of this money. So yes, I guess to answer your question, I think it would be healthier to know what these things cost. On the other hand, I have to say as a patient I was so traumatized, I'm not sure I could have taken that information in I was thinking about your what is worth What's it worth? title and I was thinking that um, The American individualistic, optimistic, response would be, well, whatever it takes Whatever it takes. lifeife is worth it, whatever it takes But whatever it takes will not cure my cancer So I think this question changes when you have incurable cancer. It becomes a different question, which is when is enough enough I rememember when she said that win is enough enough. I was just I don't know that we are ready to say there's one magic line. Thrown back to this conversation that I had had with Leonard Saltz, where he was saying that we have to look at everything in terms of value You need to think deeply about the kind of life you want to live. It's not just about how many days, it's about what kind of days. So if you told me that there was something that gave us seventy two survival benefit, but it makes people feel nauseous for most of the time. Is that worth it? When we're trying to draw this line as a society, before we figure out what we're willing to pay, we have to think about what we are paying for. Yeah, I don't think we know what for Susan you know six years ago, she decided that she was going to get chemotherapy because In part, it would be more time with her daughters. Yeah. and suddenly It's worth it. But I think we're changed by the treatment too For now, Susan's cancer is Basically under control because she's on this new drug For two years and now a month. And I am counting. I've been alive without a recurrence, without the cancer growing by taking these pills every day And I take them at home. They're not infused in the hospital through my veins. They're just pills And it's made lastess few years remarkably Normal like, the new normal. Yeah But when these drugs stop working and I've been told they will stop working, I'm not sure I would want to go back to chemotherapy But I suspect I don't know until I get there from Molly Webster And now for the thanks for that piece. we want to thank Stephen Hall and we want to mention Susan Gubar's book It's called Memoir of a Dbuked Woman. And thanks also to dor. Atul Gwande for all his help and his latest book. Which is really I really thought it was wonderful. It's called Being Mortal. Yeah. And thanks also to Nickki Haynes and to Glen Blumquist. 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More at Viking dot comot Th two and He hey, I'm Jad A Bbom Rod. I'm Robert Kroowwich. This is radio Ain today. Well, we're still on the subject of worth, but this is a totally different take. Yeah. and this comes from our producer, Matt Kilty Next, a slightly different story about worth A story that rather than being about how much we value our own lives is about How much we value someone else's? Right. And it starts with Buzzfeed writer Gregory Johnson. So okay, maybe you should start with what has now become sort of the infamous wedding wedding drone strike? Is that? Was that sort of where it started for you? Yes, so this strike happens in a very rugged part of Yemen. there are no paved roads, no electricity, there's no running water. It's Thursday morning. decemember twelfth, twenty thirteen. and early that morning in a small village. A group of guys, roughly fifty to sixty people, including a soon to be married man. I into a bunch of cars and they started driving. This is the convoy the wedding convouroy. In the lead car of this convoy this man His name is Abdullah Mohammad Al Tayisi. We spoke to him through an interpreter in Yemen. Abdullah told me It was his neighbor who was the groom to be married that day. And so they were all driving up to the bride's village Abdullah said they got there little before noon, ate lunch, recited wedding poems. After lunch, they grabbed the bride and just a few of her bridal attendants, a few females. And they start driving back to the groom's village for the actual wedding ceremony Abulla said that ever since they'd left that morning through lunch all day long, they heard this. This sort of metallic whirring, this metallic thumping overhead. No one in the convoy could see it, but they knew what it was. a drone. some sound hearing all the day. It's nothing new for people in rural parts of Yemen by this point. They don't think anything of it. It's common to hear those sounds. Yeah. It's usually heard there So Keep driving. Basically if you can imagine it, they're sort of winding through these waddies, these desert mountainous places The road is is mountainous. They're all strung out on this rutted out little dirt track eleven cars single file. Finally, they reached this little clearing top of this cliff where they all slowed down and started to bunch together. Because apparently onene of the cars that got in a flat. Some guys got out, fixed it, got back in their cars. and right at that moment, the sound shifts somehow And then The missiles start. of them In quick succession. The shrapnel is just flying everywhere. in a blink It's. People are trying to figure out what has happened, all the screaming, there's fires that are burning. in Abdullah His car was torn up. He had trapned in his face. twow wounds in his face. one in Yamin In the right hand, left thigh, one in the back And he says that once he saw there was smoke His first thought was, whereere's my son He was looking for his son. His son was there? Yeah, a young man who had been a few cars back from him. The fourth car on Cb and he was married with two boys and one daughter. Abdulla said he could move, so he got out of his car and stumbled back toward the fourth car I get on the stair for be to find his son? Yeah he said he found him just next to the car Before yesT He died It's canot with uo yeah Nom. No, he didn't talk to him. just he looked at him and just passed away So it turns out that there are twelve dead And typically what happens in Yemen is that as soon as someone is killed, they're buried very, very shortly thereafter What happens here is something different The people in the convoy take the bodies of the dead And they take them back to Rada. this big town ne where the drone strike occurred. There's a video I have. That's what you're hearing where you see some men take these twelve dead bodies And they line them up in the street on this bright blue tarp and they sort of wrap them in these cheap blankets. And so there's this huge crowd that just gathers around to stare at these dead bodies who are laid out in the street. and at a certain point. this very tiny very leathery old Yemeni who's sort of Holding on to the back of a pickup with one arm. He stands over the dead. sort of swaying over the bodies and just lecturing the crowd on what happened. He's just screaming at them and so you can hear his voice start to go hoarse And he's screaming an American drone killed these. It was a massacre. These people are on their way to a wedding. Why did this happen? Why were they killed Why did they target this convoy Well, according to the US government, they had received intel that on that day, in this convoy was an Qaeda operative named Shoki Albadani, who apparently had been planning attacks against the U. S.. That's why they took the shot. And in fact, they say that he was wounded in this in this wedding convoy strike. And do we have any reason to Believe that? I have no reason to believe it. Greg spent weeks in Yemen, talked to survivors of the drone strike, Taled to people who were there. No one knows this guy. And Greg says the guy isn't really a member of either the tribes that were involved in the wedding. And so to him, it makes no sense that he would be there. To him, this was a terrible mistake really got me interested in Craig's reporting. which you can read on buzzfed. com highly recommend it is that he goes really deep into the question of like, the US. did Because the question is like What do you do in this case How do you repair something like this? When you have two totally different cultures with two different traditions How do you find a way? Try to make this right. It can't can you? No. I mean, historically, do soldiers have an obligation to repair damage they do No, there's no obligation, but what's happened is we've actually created an obligation for ourselves. And Americans have? Yeah, yeah, this has a really long history. a history that's meang legally? Yeah, ye, yeah, a leegal history. Really. And there's a great law professor at Yale. What's his name? His last name is is Witt. It's John Witt. That's me. We ended up tracking down John Witt Hi, Jad, how are you? To talk about how the US first started to try to right the wrongs in war. So what is the foundation story of all this? That starts with General Pershing in World War one nineteen America is called to ar. The Great warar ramps up, so we start shipping young men. Thousands of them and millions more to follow. Over to Europe spepecifically France, and in charge of these men was a man named John J. Commander of American forces on the Western Front. Sern man, handsome mustache, a bit of a maverick. General Peron's nickname was Blackjack And when he first arrives in France with his troops, General Blikejack Pershing, he's got this problem, which is that he has Jeeps. Built in America by our men. So World War O is the first war in which the US. is shipping a lot of automobiles, more than one hundred thousand for the soldiers to drive cars, trucks, Jeeps. And Jeeps are really great. They get his men from one place to another. P? end to I don't know what I say, but they also run into French farmers chickens and cows. children, sometimes just the farmers themselves Were these random collisions or were there no roads? I'm going to bet there was some of everything. Sometimes it was probably just ordinary car accidents and sometimes no doubt a little French wine was involved. So this is Persine's problem He's trying to run a war. Overseas. And it wasn't any good for him to have grumpy civilians at his rear. And so Pershing has an idea which she actually borrows from the Brits. And that is He will use cash, money to write our wrongs Well And so he goes to Congress and begs for a statute. And Congress obliges really quickly. There's no sign this is a controversial thing. But it was a genuinely new thing because for the first time, in the history of war, as far as we could tell You had a state compensating individuals Usually it's state to state, here you have state to individuals. And so the US government starts systematically paying money for the loss of a non American life in war. How much?eez, I don't know. It's actually surprisingly hard to find documentation mentioning specific amounts whatever the amounts were It seems to have worked. Perschy wrote in his biography that the swift imprompt settlement of claims had a great effect people. So it seemed to work really well. And this I mean, is the idea here that like this is what we would do with the drone strike victims we talked about, that wed pay them money? Well, it's actually it's a It's a bit trickier than that because the thing that Pershing got in World War I It came with a catch. and that is that there's a combat exclusion. In case you just walked in, that's Gregory Johnson. And what he means is that this law, basically what it says is that will'll pay your claims if it didn't happen on the field of battle and it wasn't a combat situation If it was combat and it was on the field of battle, then H luck So if U. S. soldiers were driving to a fight and they ran their car into somebody and they damaged that car or killed that person, those people would not be able to get compensation, whereas if the U.S soldiers were driving to a bar and got in an accident, they would be able to get compensation Problem is Once we get into these counter inssurgency wars, civilians are suddenly in the middle of the fray. Charges have been made that troops killed as many as five hundred and sixty seven South Vietnamese civilians during a sweep. This is in a way the story of modern warfare. Air raid sirens are beginning to sound over Baghdad. President Karzai says he's delivering his final warning to the US a U S. airstrike accidentally killed more than a dozen mothers and children. By the time we get to Afghanistan and Iraq, the fighting is happening in cities. so there's no difference really between the battlefield and where people live. And so the line between what's combat related and what's not combat related It starts to get Burry. And so in two thousand three in Iraq, what happened was there were actually people lining up you know there were civilian military operations centers, people started lining up outside of these saying My family has been harmed, I want help people do you remember? if I had to guess it was, you know Maybe around eighty people or so. That's a ton of people. Yeah That's John Try. He was a military lawyer in Iraq in two thousand three. And before him, Marla Kenan. I'm managing director of Center for Civilians in Conlict. So when they came with a complaint, what sort is it like you ran over my chicken or you knocked out my window? No, no, no, no. much more serious. I mean, I think of cluster bombs during the Sock and awe campaign. One of the The types of bombs that we were using or the air Force was using were what they call cluster munitions. Basically, John says air Force planes would fly over these targets and drop hundreds and hundreds of these tiny little bombs smaller than a coke can. And a lot of them would land in maybe a parking lot or a field, and they wouldn't explode. So on a number of occasions, you'd have mostly it was kids, rights See it And they didn't know any better. It would just run over and kick it. and then that's when it would explode Right, huh I had a lot of those close to a dozen. And so That was a That was a difficult one because well combat because the air Force dropped it because they were you know, bombing the city. R. But at the same time, days, weeks, even months have gone by and this thing is just sitting in the ground Couldn't we say it's not combat? And this was a real question that John had to ask his boss and then his boss asked his boss. They eventually sent the question up to the Army Claims Service, and they said, no, it's combat meaneaning they're not going to pay. Basically like we are in an armed conflict and this was an unfortunate incident, but an incident that happened during a lawful combat operation and therefore We're sorry And that's basically it. So I said no to a lot of people. And so like in World War one, with General Pershing, military officers, they started lobbying their bosses for an expanded system so they could start making more payments. And eventually the military does expand it. In fact, I talked to one of the military's top lawyers. Brigadier General Richard C. Gross, I go by Rich. I'm the legal counsel to the chairman of the Joint Chiefs of staff. And he told me that around two thousand six, paying out these kinds of condolence payments actually became sort of a key part of military strategy. Absolutely. Even had its own acronym. MaS, MAA WS. it's money as a weapons system, which, you know, I'm not sure that itle resonates with everybody, but's interesting phrase for sure. Yeah, exactly. But it's the idea that money can be used to win hearts and minds that help bring the population over. And it just got me wondering How much money? makes a good weapon Well I haven't like the U.S military hasn't given me access to a database or anything like that. But through FOIAas and interviews, I've seen different numbers. Marla says that in two thousand six, the ACLU filed a FOIA request and eventually got their hands on hundreds of claims files And in those files, what you see are a bunch of different numbers. But one that comes up again and again, two thousand five hundred dollars. twenty thousand five hundredars by and large Now, someone like John could have paid more, but that meant they'd have to run the claim up the chain of command. Exactly. So it was almost like there were these ceilings. twenty thousand five hundred for a life fifteen hundred for property damage. and then eventually the property damage amount got raised to two five hundred as well And like that That didn't make any sense to me that somebody could get so much for a Toyota Corolla, but you weren't you were just going to get the same amount for a lost life. Like I can't get over, I mean twenty thousand five hundred seems like just such a nominal amount and the practicality of that money of like if you were to kill someone who is the breadwinner of a family that twenty thousand five hundred dollars would not be able to support this family in any way Right. But we're not actually trying to pay full compensation, right? Like we're not trying to say, we think if this twenty year old man had lived to be the average age in Afghanistan, then he, you know that it would have been sixty thousand eight hundred and forty three dollars, R right? Like that's not the thing. do you ever, you know, we had people who were killed here in an attack. The federal government is one step closer to cutting its first checks to families of those killed and injured on september eleventh. And those people have been compensated. The levels of compensation to the New York victims is pretty The range of payments for a death claim ranged anywhere from two hundred fifty thousand dollars to just under seven million dollars. Did you notice that? I do. Um I do But it is to a large degree comparing apples and oranges. That's general Gross again, because you're talking about a legal system where a country is paying their own victims versus condolences in an area where there's no legal obligation to make those payments in the first place. So that's a very different type of monetary payment? Well, yes and no. Eesssentially it's a person's life And yeah, I mean I think there's an argument to be made that empathy in the number that you come up with in the amount that pay for someone's life. I totally get what you're saying. The twenty five hundred dollars I think it's any amount of money. If I told you ten, would you feel better about it? I' feel a little bit better. You wouldn? I think so.. What does it get you though? In the end, ten thousand dollars doesn't buy anything more back than what you lost. I don't know what ten doesn't gets you exactly in Afghanistan Asumption is that it gets you a lot more than two thousand five hundred But does that really help you? Is that really what you want? Was the money unimportant to you really? It sounds like the money's really I'm not a victim, so I don't know that I can answer that to me if it happened. And at this point, Marla told us a story about how before she got into this line of work, I had several friends who were journalists. One of those friends was a man named Chris Hondros. Yeah, he's a photojournalist. He was a photojournalist. And back in twenty eleven, Chris was on a assignment in Libya, moving with a rebel group when they were fired upon Chris was killed. Yeahah U And Mela says when she found out that happened? I wanted someone to explain to me why that happened I mean I just wanted to explain I didn't you know, like I knew his family wasn't going to get any money. I knew that these guys that shot a rocket propller needed him weren't going to care No one was going to explain. But I wanted that the money then becomes occasion for you say like Not just I'm sorry, but here's what happened. It's the here's what happened part I think it's the token that's given with the apology and with the explanation But it's the apology and the explanation Yeah, that's why we call it amends, making amends One of the things that is true of money damages Generally is there there are desperate efforts to find some common language between the Party paying and the victim. some Esperanto for communicating the meaning of what's happened in a language that the other side knows matters. And that's how John Witt puts it. becausecause we see it everywhere, we look. We see not just apologies, sometimes not apologies at all, but we see the almighty dollar, which is both distressing, and also we know it's meaningful But the problem is In order for that esperanta to work, it has to say the same meaning to both sides. whichich for John Tracey lawyer. wasn't really about the money at all, or not just about the money It was this much about the envelope that the money was in or that there was a real person there to hand it to them. I wasn't the one who raided their house. I wasn't the one who their daughter, but Most of them you know, just wanted to look at somebody who's in a uniform and say You really messed with my life and that opportunity is exactly what Abdullah al Tayisi We'll never get. His son was killed by a drone he never saw, operated by a man he'll never meet on behalf of a country that still doesn't admit it was a mistake And so the money he got from your hat Which in the end he says was the equivalent of thirty thousand US dollars, way more than anyone got in Iraq or Afghanistan Still, All he can do without anything else to go on. is just compare am mount. he can accept that only if if if if he gives, you know, the like the payment equal to those, you know like in America. How you can perate someone who who lost his son, for example, killed? If the payment was if the payment was equal. Yeah Producer, Matthew Big thanks to Gregory Johnson, writer at large for Buzzfeed, who started us off on this adventure when he brought us the initial story. And also thanks to Buzzfeed editor Steve Candell, and to Shahib Bal Masawa for helping Matt organize that interview in Yemen when the country's going through an awful lot of tumult and he was able to get interviews that we didn't think he could get. Yeah, absolutely. 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I'm Rbert Pll. This is Radio Lab. And so far, we've been talking the value of our lives. And then the value of other people's lives. Next up Value of. All it Okay everything We think. And by everything, of course, we mean. The value of nature. That's Carl Zimmer, science writer, regular blower of minds. So we thinkink of ecosystems as just kind of sitting there. but actually they're doing things. If they weren't doing them for us, we would have to pay to do them artificially. For example, cotton farms in South Texas. So you know, the farmers are doing their thing like this guy. James Parker. Planting their cotton, they're collecting it. I farmed about I don't know, usually five to six, seven hundred acres of cotton, so say two thousand bales. They're doing what farmers do. I spend a lot of time on a tractor and Cck your water every morning every evening. Meanwhile, They have all this extra help In the air? Yes. They have bats. How many bats are out there? you really don't know. Flying all around. The bats eat the equalent of two thirds of their own weight in insects every night. Wow. They eat all night long, all kind of bugs. A whole bunch of pests that would otherwise be eating the cotton. Now, a few years ago, a guy named John Westfall did a calculation justust to see how this arrangement was working out. He came out to my farm and did a study He had some college girls that worked for him and those girls were out there all hours of the night listening to what the bats were saying. and eachach year, the farmers collectively, they make about four or five million dollars off of them farms. Question was, how much of this was because of the bats? you know bats are natural pesticides. You know, the more they're eating, the less I' got to spray. And here's what the scientists figured out. Out of four to five million dollars, it was around seven hundred thousand dollars that you could ascribe to the bats. It's just beautiful. Wow I mean, it does make me think that if you're those farmers You should be compensating the bets somehow. Yeah. well yeah. It does give you a glimpse at It kind of scale of value, economic value that nature has that we generally just totally ignore. But we talked to a guy who didn't ignore it. My name is Robert Costanza. In fact, he took this way of thinking to the absolute limit. Yes. So the question was, what's the value of all of these ecosystem services globally? All the services on Eth. know it's bugs, eating leaves, worms turning the soil, beetles chewing tree stumps, coral leaves, protecting cities, during storms, everything. We tried to synthesize all of the studies that had been done around the country and the world Like like that bat study, except they didn't just look at cotton farms, they looked at tropical forests, rivers and lakes, coral rees, coastal wetlands, inland wetlands, the ocean, woodlands, temperate forest, you know, it goes on and on. Grasslands. This must be some Excel spreadsheet. It's kind of the Excel spreadsheet from hell. It can get tricky. So Costanza and his colleagues took all these different studies, summed them together, did a whole bunch of math and came up with a number which in today's dollars is one hundred and forty two point seven. trillion dollars per year of services That's more than all of the ghost national products of the world That's how valuable the services of nature are Let me ask you, like I get the way this would work with a bat. like the bat's eating the bugs, but like how do you do it with like, with like a like a field or something, likeike do you just walk through and you're like, o, that's twenty bucks for services, that's fifty. Like how do you even figure out what the services are? Well they they came up with a list So The list kind of depends on the ecosystem you're talking about, because different ecosystems provide different services. For example, a salt marsh And we are in the water now. We're in the water What, a salt marsh is it like the Florida wetlands bit salty? I suddenly don't know what a salt marsh is. Salt marshes are wetlands that are on the coast. Got it. Yep, we're standing in about a foot of water here. We're quickly approaching high tide. We sent one of our producers, Simon Adler to a nearby salt marsh. Partially to Hazen. Your boots are much more waterrof. Yeah. But really to talk to this guy. My name is Adam Welchell and I'm the director of science for the Nature Conservancy here in Connecticut. And Adam gave Simon a kind of inventory of someome of the services provided by coastal salt marshes a stream of goods and services have provided over time. One of the things it does is it takes water that's coming in from inland and it's laden with all sorts of pollutants, all sorts of bad stuff. The salt marsh will trap that water so the pollutants settle. And then very often the marsh grass will suck up that water into the roots and Clean it up. Yep. So you could ask very simply, how much would you have to spend? to keep your water an second. Well there is one other study Adam Welschill said that scientists inew England have already figured that out. For flood control, water supply protection, pollution control, It's roughly about thirty one dollars twenty two cents. hector per year. Then you gott to add the value of all the plants that feed the fish that end up on our dinner plate. three hundred and thirty eight dollars annually per acre. Then they're the bird watchatchers that buy lattes to support the local economy. hundred. ninety dollars per hector and then there's habitat provisioning. The list goes on and on and on and on. You do get kind of obsessed with it. start like you start becoming an accountant and writing down numbers just furiously. And it gets you to think about nature in a different way than you had before There's this galling element though or this aspect. L when I first came across the at this point, our producer Tim Howard jumped into the interview and you'll also hear our producer Sn Wheeler in just a second. I do feel like in an example like the salt marsh, which cleans water, that's all reliant on people being there that need the water. So if you didn't have people there, does that salt marsh cease to have any value? But Tim, haven't you ever had a conversation with somebody who just doesn't get Like if you make the aesthetic argument, which is that nature should be preserved for his own sake There's a whole category of humanity that just doesn't respond to that argument. this becomes a way to talk across the aisle, But it does still feel like it demotes something of infinite value to something of a paid leave val It can't really be infinite value. I mean, like a mother's love. You don't think your mother's love is priceless. I mean, you know, okay. T tootally accept that there is this sort of priceless aspect of nature if you are in the government in a very poor country You have some tough choices to make If somebody comes to you and says, o, you've got these lovely mangroves. Now it turns out that this sort of setting where the mangroves are is the perfect place for shrimp aquaculture. Be shrimp farms need lots of seawater, so it makes sense to put them by the sea. We're going to put in these farms, we're going to grow shrimp. You are going to get millions and millions of dollars in tax revenue. If you're thinking about the welfare of all the people in your country manyany of whom are starving that might be a really powerful argument. Now into that kind of a discussion, you can bring in the fact that these mangroves are sitting there very quietly doing all sorts of incredibly valuable things. In fact, they've done these kind of calculations, and in some cases The services that mangroves provide are four times more valuable than what you could get out with shrimp. So it's stupid. It's just stupid in a very basic sense. wantonly replace lots of mangroves with shrimp aquaculture. Is that a hypothetical situation? No, that's a That's what we' asked. This is Glen Marie Lang. She's an environmental economist for the World Bank. and she says very often she finds herself in exactly this kind of conversation. Particularly, you know, I work for the World Bank O primary clients are governments Philippines, Vietnam. And when you're talking to a minister of finance and saying, you know what? I know jobs are jobs, but you need those marshes. They have value. They'll say, Well, yeah, that's true, but that means I'm going to have to reduce the money that I put into the education budget. So you've got to really make a strong argument about the benefits That's really where the rubber hits the road. Well, I mean, that's it. Here's the counter argument. It comes from Doug McCauuly and a collegeist at the University of California, Santa Barbara. The real danger is that we actually succeed that we convince people that nature is valuable because it makes money. And then we're We're really in trouble in the many instances where it doesn't make us money. What do you do in a situation? he says where, say a bunch of rivers are running dry and they're e depreciating in value. You know, by the same logic that you train me to think with, we should go out and liquidate these natural assets. That makes me feel really uncomfortable. He says it's just kind of a weird way to think about nature. We had a proposal here in the state of California to make gay marriage legal and economists had to look at this legislation and said This is expected to generate hundred sixty three million dollars annually for the state of California Well, it's good to know that. I appreciate having that information in front of me. However, when I'm making a decision on this legislation, and I would say that when many legislators, voters, average citizens are considering the issues at hand, they're not thinking about whether they're going to make one hundred sixty million dollars to the state. They're thinking about a different set of values. On the other hand, I want to say, and this is based on my experience working in developing countries When you don't. value on these services. Bically they don't get counted. They get implicitly assigned a value of zero, according to Glenn Marie Lang And as we were debating this and going back and forth and back and forth bumped into a story about what happens when all of these value of nature ideas are let loose into a world of fruits and trees and human uncertainty Terrible of the bees. We heard this first from writer JB McKinnon, who says the story begins. In Mao County in Central China. Rural area, fairly remote. Lush green mountains filled with apple orchards And apple orcharding was the main business. And according to JB, in the nineteen nineties, the wild bees of Mao County slowly started to disappear And there's a few different reasons given for that. It could have been the destruction of the habitat that the bees nested in, the heavy honey harvesting that wasn't leaving enough food for the bees. But the prevailing theory is actually an economic Because in the nineteen nineties, as China was shifting to a market based economy, apple producers were under pressure to produce more apples. So they started spraying pesticide Probably it was a constellation of all of those things and a few others endnd result is the bees stopped buzzing in Mao County. Which if you are an apple farmer That's a disaster. As bees travel from flower to flower in search of nectar, they're dusted with pollen, which is the means by which flowers engage in sexual intercourse. So if you don't have the bees making the birds and the bees on the blossoms, then you don't get fertile flowers. to turn into fruit. And obviously, if you're a fruit farmer and you have no fruit to sell, you have no income So what do you do? You're an apple farmer and you don't have bees, then you need to find some other way to pollinate the flowers And I guess they concluded, well we'll have to do that ourselves by hand In Mandarin Chinese, we say Zhengong Chfen. so basically that means a manual pollination This is Harold Tibaot. I'm a correspondent in China for the French newspaper Lem Mon. A couple of years ago, he heard about the apple farmers in Mao County. so he flies to Chengdu and he and a friend hop in a car and we drive for like five or six hours until we reach this village, Nanchin. Tiny little village. only a few houses and then we took a small rod and between the field and we actually saw that there were lots of farmers in the trees, like on the apple trees straddling up on these often thin and spindly branches, men and women that I've seen in photos in any case. Harold and his friend took pictures and if you look at those pictures, you'll see the farmers holding little brush, little pollen brush that they'd constructed using things chopsticks and chicken feathers and cigarette filters and they'd have a little bottle filled with pollen. and then what they do brush into the bottle and they paint a flower blossom. pollen, they dip their brush back into the pollen and they paint the next flower blossom again and then they dip the brush back in again and they paint again and then they dip again and they paint to make sure that all of the blossoms that they could possibly fertilize would be fertilized so that they would go on to produce fruit. We're talking hundreds and hundreds of flowers per tree. It was very strange to see a humans doing the job of the bees. God, what a pain in the ass that sounds like. Yeah the image of this of these Chinese orchardists standing up in these spindly trees traveled around the world through environmental circles and it The message that it seemed to send was that you know, this is what happens. if you if you lose biodiversity, you end up standing in the trees