Don’t tear down statues

Pervez Hoodbhoy in The Dawn

WINSTON Churchill was a terrible man. He authorised use of chemical weapons against Afghans and Kurds, called China “a barbaric nation”, spoke of the “great hordes of Islam” and wrote of Indians as “a beastly people with a beastly religion”. When informed of mass deaths in the 1943 Bengal famine, he simply asked: “So is Gandhi dead yet?” Those nostalgic for the Raj love him, as do white supremacists. Zionists adore him for what he told the Palestine Royal Commission in 1937:

“I do not agree that the dog in a manger has the final right to the manger even though he may have lain there for a very long time. I do not admit for instance, that a great wrong has been done to the Red Indians of America or the black people of Australia. I do not admit that a wrong has been done to these people by the fact that a stronger race, a higher-grade race, a more worldly wise race to put it that way, has come in and taken their place.”

Unsurprisingly, Churchill’s statue is iconic for leftists and progressives around the world. Galvanised by the killing of George Floyd, they want not just this statue gone but all historical monuments associated with oppression, slavery, and bigotry to be eliminated from public view. Thoroughly decent people are roaring: pull them down!

But stop! This is terribly dangerous. Step back and reflect upon the consequences.

I’ve dwelt on Churchill here because he is a metaphor for countless racist, supremacist leaders who led wars of conquest and plundered treasures. From Alexander the Great to Chandragupta Maurya, and Mohammed bin Qasim to Napoleon Bonaparte, ambitious conquerors subjugated weaker peoples on various pretexts. So shouldn’t we eliminate hurtful memories?

Let’s begin by bulldozing the pyramids of ancient Egypt. They are symbols of extreme oppression and the word ‘pharaoh’ is synonymous with cruelty. Thousands of slaves toiling in the scorching desert sun built tombs for the pharaoh king. When he died his retainers were obliged to collectively commit suicide and be buried in the same pyramid, ready to serve when he awakes in the after-life. Morally, the pyramids ought to be levelled.

And what to make of Babri mosque? For Hindu zealots it was the symbol of cultural oppression by Muslim invaders. In 1992 with bare hands and pick-axes a maddened crowd tore apart a five-centuries-old structure built by Emperor Babar, allegedly on the very site where Lord Ram was born. India has never recovered from that.

More Muslim heritage lies in the cross hairs. ‘Babar ki auladain’ (sons of Babur) is the pejorative name given to about two dozen or so Indian cities. In time Ahmadabad, Karimnagar, Jamalpur, Faridpur, Hajipur, Moradabad, and Secunderabad might disappear from the map of India and emerge reincarnated with Hindu names.

Where will the madness stop? Should the Taj Mahal also be torn down because it marks the extraordinary success of invaders? Of course, the Taj is a horrific example of the abuse of man by man much as the magnificent cathedrals of Europe are. Resources to build monuments were forcibly extracted from toiling peasants. The Taj is just the whim of a ruthless monarch mourning his favourite wife.

But look at the Taj in the moonlight and you see something even more enchanting than an architectural jewel. One can almost feel the soft emanations from the side-by-side graves of two star-crossed lovers. Life is surely complex, filled with nuances. My vote: preserve and protect the Taj.

Pakistan’s cultural vandalism exceeds India’s. Hindu heritage sites in Pakistan have all but vanished, and Buddhist statues and artifacts wilfully plundered and destroyed. Hardly a tear was shed in Pakistan when the Taliban blew up the 2,000-year old Buddhas in Afghanistan’s Bamiyan province.

Deemed as corrupting Hindu influences, the celebration of cultural events such as Baisakhi and Basant, as well as kite flying, have been gradually forbidden or abandoned in recent decades. Even ‘Hindu trees’ like banyan, neem, and pipal have been punished — far fewer can be seen today in comparison to earlier times. I cannot forget the smouldering remains of a 200-year-old graceful banyan in the posh E-7 area of Islamabad, destroyed by students from a nearby madressah as a Hindu symbol.

I urge my iconoclastic liberal/left friends in the West to learn from Pakistan-India. In seeking purification by removing distasteful symbols of the past they risk cultural and aesthetic desertification. Pictures of pre-Partition Karachi and Lahore tell us how visually rich and architecturally beautiful they once were — and how cultural purification reduced them to boring blandness.

Eliminating symbols does nothing of substance. There was mass euphoria when crowds of Iraqis, helped by US marines with a 50-ton armoured vehicle, toppled a massive Saddam Hussein statue located exactly where the ousted tyrant had destroyed an older monument. But this was no new dawn for the people of Iraq. On the contrary, a decade of bitter Shia-Sunni sectarian warfare ensued.

Those who seek to efface history’s markers are merely self-righteous. Those seeking a pure, authentic past untainted by sin are chasing a phantom — it doesn’t exist. In my last Dawn op-ed (‘Dangerous delusions’) I wrote of the psychedelic substance being dished out to Pakistan’s masses every evening in the form of Ertugrul Ghazi and of the dangerous hallucinations it is inducing.

Spaceship Earth hurtles towards an uncertain future with a crew that’s terribly sick, more mentally and psychologically than physically. The doctors on board must record the history of various quarrelling groups professionally and clinically, all without emotion or embellishment. The naïve notion of heroes and villains must be dumped; history has actors only.

Let Churchill stay. That fat, cigar-smoking, racist Englishman cannot hurt anyone now that worms have eaten away his flesh. Instead, let’s get serious. The starting point must be the realisation that widow burning, slavery, and genocide are as much part of the human condition as are great acts of generosity and compassion. Every civilisation is the legacy of wars, conquests, and brutality. Even the cleverest surgery cannot cut out these bitter legacies without killing the patient.

Waking up to the realities of racism in the UK

Gary Younge in The FT 

Every now and then much of Britain discovers racism in much the same way that teenagers discover sex. The general awareness that it is out there collides with the urgent desire to find out where. People talk about it endlessly and carelessly, unsure of what to say or think or whether they are doing it right. They have lots of questions but, even if they did know whom to ask, they would be too crippled by embarrassment to reveal their ignorance. Everyone has an opinion but only a few have any experience. The interest never goes away, though its intensity wanes as they explore other things. 

The trouble is not everyone gets to move on. Black people, and other minorities, do not have the luxury of a passing interest in racism. It is their lived reality. A YouGov poll of black, Asian and minority ethnic Britons surveyed over the past two weeks reveals the extent to which prejudice and discrimination is embedded in society. 

It found that two-thirds of black Britons have had a racial slur directly used against them or had people make assumptions about their behaviour based on their race. Three-quarters have been asked where they’re “really from”. (When I once told a man I was born in Hitchin, he asked, “Well where were you from before then?”). 

More than half say their career development has been affected because of their race, or that they have had people make assumptions about their skills based on their race; 70 per cent believe the Metropolitan police is institutionally racist; and the proportion of black people who have been racially abused in the workplace (half) is almost the same proportion as those who have been abused in the street. 

Little wonder then that two-thirds of black people polled think there is still a “great deal” of racism nowadays. This is not a substantial difference from the three-quarters who say they think there was a great deal around 30 years ago.  

As the public gaze shifts from the Black Lives Matter protests, these experiences will endure. They may be tempered by greater sensitivity; but heightened consciousness alone will not fix what ails us. The roots are too deep, the institutions too inflexible, the opportunism too prevalent and the cynicism too ingrained to trust the changes we need to goodwill and greater understanding alone. 

I applaud the proliferation of reading lists around issues of race and the spike in sales for the work of black authors — people could and should be better informed. But we did not read our way into this and we won’t read our way out. The racism we are dealing with isn’t a question of a few bad apples but a contaminated barrel. It’s a systemic problem and will require a systemic solution. 

This is a crucial moment. The nature of the protests thus far has been primarily symbolic — targeting statues and embassies, taking a knee and raising a fist. That ought not to be dismissed. Symbols should not be disregarded as insubstantial. They denote social value and signify intent. But they should not be mistaken for substance either, lest this moment descend into a noxious cocktail of posturing and piety.  

Concrete demands do exist. All Black Lives UK, for example, has called for the scrapping of section 60, which gives the police the right to stop and search, and the abolition of the Met police’s gangs’ matrix, an intelligence tool that targets suspected gang members. It also wants measures to address health disparities, particularly relating to black women and mental health, and the implementation of reviews that already exist, including the Lammy Review (on racial disparities in the criminal justice system), the Timpson Review (on school exclusions), and the McGregor-Smith review (race in the workplace). 

But the only demand that has cut through has been the push for the education system to more accurately reflect our colonial past and diversity. The poll finds this has the support of 81 per cent of black people — the same percentage that approved of removing a statue of the slave trader Edward Colston in Bristol. (Far from wishing to “photo shop” our cultural landscape, as the prime minister claims, they want their kids to learn more about it. They just don’t want the villains put on a pedestal.) 

This is great, as far as it goes but, given the size of the constituency that has been galvanised in the past few weeks and the awareness that’s been raised, it doesn’t go nearly far enough.  

 The solemn declarations of intent and solidarity that flooded from corporations and governments will leave us drowned in a sea of racial-sensitivity training unless they are followed up by the kind of thoroughgoing change and investment that seeks to genuinely tackle inequalities in everything from housing and education to recruitment, retention and promotion. That costs money and takes guts; it means challenging power and redistributing resources; it requires reckoning with the past and taking on vested interests. 

“When people call for diversity and link it to justice and equality, that's fine,” the black radical Angela Davis once told me. “But there’s a model of diversity as the difference that makes no difference, the change that brings about no change.” 

The governing body of Oxford university’s Oriel College did not resolve to take down its statue of Cecil Rhodes because they suddenly realised that he was a colonial bigot. They did so because it had become more of a liability to keep it up than to take it down. Similarly, it was not new information about police killings that prompted the National Football League in America to change its position on taking a knee. They did that because the pressure was too great to resist. We have to keep that pressure up, albeit in different ways. 

 “If there is no struggle there is no progress,” argued the American abolitionist, Frederick Douglass. “Power concedes nothing without a demand. It never did and it never will.”  

Economics for Non Economists 1: What is a free market economy?

by Girish Menon

Suma, you have asked a really fundamental question and I will try to answer it in two parts viz;

-         What is a market economy?

And

-         What does free mean in the context of free market economy?

So let’s start with the first aspect – What is a market economy?

The activity of buying or selling a good is called a market transaction or a market activity. Thus a market is a set of arrangements where goods are exchanged for money.

Today most countries in the world adopt the market model for the production and consumption of goods and services. They believe in the Adam Smith quote, ‘It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.’

Google Dictionary defines self interest (own interest) as ‘one's personal interest or advantage, especially when pursued without regard for others.’ Some economics texts assume that the self interest of a goods producer is to earn profits whereas the self interest of a consumer is to maximise her happiness by paying for goods she requires.

Adam Smith’s theory expects citizens in an economy to be both producers and consumers of goods. As a producer you are expected to generate a profit from your toils. You, as a consumer, are expected to use the profits to buy other goods to live your life.

Based on the above logic, market theory predicts that if all the citizens of an economy are left to pursue their self interest then it will result in the automatic production of all goods and services that citizens require in order to be happy.

Though Adam Smith preferred the word ‘invisible hand’, I have used the term automatic. Google dictionary defines automatic as ‘working by itself with little or no direct human control’. In other words producers make and sell goods which they think will be demanded and hope to profit from it. There is no authority other than their anticipation of consumer needs that guide their decision to produce and sell goods. Similarly, consumers pay for a good because they think it will make them happier and there is nobody telling them what to buy and consume.

Thus, a market economy would be an economy where the production and consumption of all/most goods and services is determined by the self interest of its producers and consumers. This system is also known as capitalism.

 ----

So, what is a free market economy?

These days it’s not only the UK, USA etc. but many other countries who call themselves free market economies. But are they truly free market economies where the production and consumption of all goods are determined automatically with its citizens unabashedly following their self interest?

I notice that you seem to be shaking your head. Especially in this Covid climate you will have noticed the role that the UK government has played in your life and the way it has affected your pursuit of self interest and happiness. So what I will now do is list the conditions necessary for Adam Smith’s theory of the invisible hand to work:

1. There are many buyers for a good in the market and no buyer is large enough to get a discount on the price.
2. There are many small sellers of a good in the market and no seller is large enough to set its own price.
3. The goods produced and consumed are identical or homogeneous. In other words a consumer cannot recognise the producer of the good.
4. There must be freedom of entry to the market – or no barriers that prevent a potential producer from entering the market.
5. There must be freedom of exit from a market – if a producer wishes to quit a market then s/he should be able to do so freely and without any sunk costs.
6. There must be perfect knowledge. Producers must have full knowledge of the technologies used by its rivals and consumer preferences. Consumers must be aware of the short and long term benefits and costs from consuming a good.
7. The factors of production must be mobile. It means that the land, workers, machines used for producing a good should be easily redeployed to producing any other good when demand changes,
8. There must be no transport costs.
9. There must be independence in decision making. No external forces affect the decision making ability of producers and sellers.
10. No externalities. The act of production and consumption based on self interest should not result in benefits or costs to third parties.

I am sure that after you have read the above conditions you will agree that neither the UK economy nor for that matter the Indian economy is anywhere close to being a free market economy. I don't think there is a single economy in the whole world that satisfies most of the conditions of a free market.

I will now let Ha Joon Chang have the final word on free markets:

“The free market (economy) does not exist. Every market has some rules and boundaries (by governments) that restrict freedom of choice. A market looks free only because we so unconditionally accept its underlying restrictions that we fail to see them. How ‘free’ a market is cannot be objectively defined. It is a political definition. The usual claim by free market economists that they are trying to defend the market from politically motivated interference by the government is false. Government is always involved and those free-marketeers are as politically motivated as anyone. Overcoming the myth that there is such a thing as an objectively defined ‘free market’ is the first step towards understanding capitalism.’

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• When I presented this article to Suma she said, 'Girish, you have not understood my question. I meant where can I find the free goods that should by definition be there in a free market?' 

60 is the new 80 thanks to Corona

 Patti Waldmeir in The FT

“Better be safe than sorry.” I have never believed that. 

I have lived my first 65 years often turning a blind eye to risk. I lived in China for eight years, enduring some of the worst industrial pollution on earth, despite having asthma. I risked damaging the lungs of my then small children by raising them in a place where their school often locked them in air-purified classrooms to protect them from the smog. 

Before that, I lived for 20 years in Africa, refusing to boil water in areas where it needed boiling, eating bushmeat at roadside stalls — not to mention the escapades that I got up to as a young woman in the pre-Aids era. 

But now, as I peer over the precipice into life as a senior citizen, coronavirus has finally introduced me to the concept of risk. Part of it is the whole “60 is the new 80” paradigm that the pandemic has forced on us — but most of it is that, whether I like it or not, I fit squarely in the category of “at risk” for severe illness or death if I catch Covid-19. 

I have diabetes, asthma and am finishing my 65th year. I don’t live in a nursing home, a jail, a monastery or a convent (as does one close friend with Covid-19), but according to the US Centers for Disease Control and Prevention (CDC), I still qualify as high risk because of my underlying conditions and age. 

So what do I — and people like me, I am far from alone — do now that the world is reopening without us? I’ve got some big decisions to make in the next few days. My youngest child is moving back to our flat outside Chicago after a month living elsewhere: does one of us need to be locked in the bedroom? Do I have to eat on the balcony for two weeks? 

There is no shortage of people, not least President Donald Trump, telling me that all this is simple: vulnerable people should just stay home. But what if they live with other people? What if those people have jobs? And what about our dogs? Our two old mutts are overdue for a rabies shot because the vet was only seeing emergencies. Is it safe for me to take them in now? Can my kids go to the dentist, and then come home to live at close quarters with me? 

I asked several medical experts these questions, and they all offered versions of “we haven’t got a clue”. Robert Gabbay, incoming chief scientific and medical officer of the American Diabetes Association, was the most helpful: “Individuals with diabetes are all in the higher-risk category but even within that category, those who are older and with co-morbidities are at more risk — and control of blood glucose seems to matter. 

“You are probably somewhere in the middle” of the high-risk category, he decided. My diabetes is well controlled and I don’t have many other illnesses. “But your age is a factor,” he added. Up to now, I’ve thought I was in the “60 is the new 40 crowd”: now I know there is no such crowd. 

The head of the Illinois Department of Public Health underlined this at the weekend when she gave her personal list of Covid dos and don’ts, including don’t visit a parent who is over 65 with pre-existing conditions for at least a year, or until there is a cure. Dr Ngozi Ezike also said she would not attend a wedding or a dinner party for a year and would avoid indoor restaurants for three months to a year — despite the fact that Chicago’s indoor restaurants reopen on Friday. 

I turned to the CDC, which initially said it would issue new guidance for “at risk” people last week, but didn’t. This would be the same CDC that I trusted when it said not to wear a mask — though 1.3 billion people in China were masking up. Today China, which is 100 times larger by population than my home state of Illinois, has less than three-quarters as many total pandemic deaths. (Yes, I know China has been accused of undercounting cases, but so has the US.) Masks aren’t the only reason; but they are enough of a reason to erode my trust in what the CDC thinks I should do now. 

It doesn’t help that the CDC website lists “moderate to severe asthma” as one of the primary risk factors for poor coronavirus outcomes — while the American Academy of Allergy Asthma and Immunology says “there are no published data to support this determination”, adding that there is “no evidence” that those with asthma are more at risk. Who’s right? 

I need to know: this weekend is the one-year anniversary of the death of my eldest sibling. I’ve chosen not to make the trip to visit his grave in Michigan. Next month, I turn 65, and I want to spend that day with my 89-year-old father: should we rent a camper van, so we don’t infect his household? I thought about a porta potty for the journey, since public toilets are apparently a coronavirus hotspot. When I started searching for “female urination devices” online, I knew it was time to ditch this new “better safe than sorry” persona I’ve assumed under lockdown. 

Maybe it’s time to remind myself of a fact that I once knew: that life is a risky business, and there is only so much I can do about that. I’ll die when it’s my time — probably not a day before or after, coronavirus or no coronavirus.

Britain's persistent racism cannot simply be explained by its imperial history

It played its part, but empire does not explain all of Britain’s record of elitism, exploitation and discrimination writes David Edgerton in The Guardian


 

Enoch Powell electioneering in his Wolverhampton constituency, 1970. Photograph: Leonard Burt/Getty Images


The question of empire has become central to discussions of Britain’s national past. Some see residual imperialism as the prime element in a deficient, delusional, racist culture. Others think emphasising the dark underside of empire is an attempt to erase British history. The problem is that although long historical tradition sanctions criticism of imperialism, national history has proved far more resistant.

Talk of empire is now omnipresent, but it was previously written out of history. In the 1940s the unashamed imperialist Winston Churchill didn’t offer an imperial history of the second world war, or even a national one, but an Anglo-American, cold-war version of events in his six-volume work, The Second World War. Subsequently, what’s striking about postwar historiography is the lack of imperialist histories and the absence of condemnation for nationalist and anti-imperial forces. At most there were sotto voce claims that the British empire should have done a deal with Adolf Hitler in 1940 to keep itself alive.

More importantly, national histories ignored empire altogether. The reason is easy to find: after the war, a new nation arose that wanted to tell a national, not imperial, history of itself. This story was about the dawn of the welfare state, the Labour party and the National Health Service. This country’s ancestry lay in the industrial 19th century, but it only became a true nation in 1940, during the Battle of Britain and the blitz.

Putting the empire in its proper historical place is hugely important for understanding the sheer scale of slavery, the racialised nature of the imperial project, and how this project shaped the Conservative party into the 1950s. For much of the elite, the UK was seen as a part of something far bigger: the empire. This is why we have an Imperial War Museum and an Imperial College, and why the head of the army was called the chief of the imperial general staff. Britain’s second world war, as it was understood at the time, involved the whole British empire (and many, many allies). In 1940, no one in authority could say “Britain stood alone”. If anything was alone, it was the entire empire.

It’s also important to remember the important role anti-imperialism played for radical liberals and socialists. Radical liberals in 19th-century Britain criticised imperialism as the cause of unnecessary wars, and for sustaining a useless elite. More recently, the British centre-left has cited imperialism as the cause of war, militarism, nuclear weapons, economic decline, the failure to join the common market in the 1950s, and the failure to adapt to it since. For some historians, the demons and ghosts of empire are the spectres driving contemporary racism and Brexit, too. The UK, according to these critics, seems perpetually trapped in an Edwardian imperial mindset.

Blaming empire is a deep-seated reflex that feels reassuringly progressive. But it has also been a way to avoid confronting things that lie a little closer to home. It has long been easier, and less morally and intellectually contentious, to castigate the actions of the British state and elite in faraway colonies than confront their actions at home. Far too many ills of past and present are lazily laid at this door.

To make empire the dominant story in British history is to misunderstand the nature of Britain, its elite and its exploitative power, and its persistent racism. The racism of Oswald Mosley and Enoch Powell, for all its roots in the past, was a self-consciously post-imperial nationalist one. Imperialism reluctantly granted British Caribbean people UK citizenship. These rights were stripped away by nationalists, right down to Theresa May – this was the essence of the Windrush scandal. People voted for Brexit not because they were imperialists, but because they were nostalgic for a national Britain. They were certainly not voting for the return to free immigration from the old imperial territories. The history that seems to matter most to Brexiteers is a particular account of the second world war, one that is decidedly nationalist.

Empire has only ever been part of the British story, but it can never stand for the whole. Even at its peak, it represented only a fraction of Britain’s relations with the rest of the world, not least in war, but also in trade. From the late 19th century onwards, the Caribbean empire was tiny in terms of trade and population compared with Canada and Australia. In population numbers, India accounted for four-fifths of the entire empire, but trade with India was significantly less important than trade with the dominions. And the history of migration to and from the UK stretches wider than the empire, too – with people flowing into and out of the country to the US and from Europe. Britain’s global history, in other words, is not the same as its imperial history.

If we want to look for great silences in our history, empire is hardly the only one. There has been a glaring hole where the history of British capitalism and the British capitalist class should be; in its place are overwrought stories of decline and of imperial finance. The neglect of the British working class is particularly stunning. Giants of (anti-imperialist) postwar history such as EP Thompson and Eric Hobsbawm made this their field, and inspired countless others in a historical endeavour that peaked in the 1970s, but has since decayed even more rapidly than the industrial working class. Around 1900, Britain’s industrial proletariat was one of the three largest in the world, comparable to those of the US and Germany. The British working class alone accounted for roughly 30% of the population of the entire empire outside India, and a far higher proportion of those producing for capitalist markets.

There are many aspects of British history – many dark sides, too – other than imperialism. We should not admit the framing of the debate about history as a question of a dark imperial history sullying a bright national story. To do so would be to ignore a more difficult truth: all our national history needs rethinking.

Why you should go animal-free: 18 arguments for eating meat debunked

Unpalatable as it may be for those wedded to producing and eating meat, the environmental and health evidence for a plant-based diet is clear writes Damian Carrington in The Guardian

Whether you are concerned about your health, the environment or animal welfare, scientific evidence is piling up that meat-free diets are best. Millions of people in wealthy nations are already cutting back on animal products.

Of course livestock farmers and meat lovers are unsurprisingly fighting back and it can get confusing. Are avocados really worse than beef? What about bee-massacring almond production?

The coronavirus pandemic has added another ingredient to that mix. The rampant destruction of the natural world is seen as the root cause of diseases leaping into humans and is largely driven by farming expansion. The world’s top biodiversity scientists say even more deadly pandemics will follow unless the ecological devastation is rapidly halted.

Food is also a vital part of our culture, while the affordability of food is an issue of social justice. So there isn’t a single perfect diet. But the evidence is clear: whichever healthy and sustainable diet you choose, it is going to have much less red meat and dairy than today’s standard western diets, and quite possibly none. That’s for two basic reasons.

First, the over-consumption of meat is causing an epidemic of disease, with about $285bn spent every year around the world treating illness caused by eating red meat alone. Second, eating plants is simply a far more efficient use of the planet’s stretched resources than feeding the plants to animals and then eating them. The global livestock herd and the grain it consumes takes up 83% of global farmland, but produces just 18% of food calories.

So what about all those arguments in favour of meat-eating and against vegan diets? Let’s start with the big beef about red meat.

Meaty matters

Claim: Grass-fed beef is low carbon

This is true only when compared to intensively-reared beef linked to forest destruction. The UK’s National Farmers Union says UK beef has only half the emissions compared to the world average. But a lot of research shows grass-fed beef uses more land and produces more – or at best similar – emissions because grain is easier for cows to digest and intensively reared cows live shorter lives. Both factors mean less methane. Either way, the emissions from even the best beef are still many times that from beans and pulses.

There’s more. If all the world’s pasture lands were returned to natural vegetation, it would remove greenhouse gases equivalent to about 8 bn tonnes of carbon dioxide per year from the atmosphere, according to Joseph Poore at Oxford University. That’s about 15% of the world’s total greenhouse gas emissions. Only a small fraction of that pasture land would be needed to grow food crops to replace the lost beef. So overall, if tackling the climate crisis is your thing, then beef is not.

Claim: Cattle are actually neutral for climate, because methane is relatively short-lived greenhouse gas

FacebookTwitterPinterest Cattle graze in a pasture against a backdrop of wind turbines which are part of the 155 turbine Smoky Hill Wind Farm near Vesper, Kan. Photograph: Charlie Riedel/AP

Methane is a very powerful greenhouse gas and ruminants produce a lot of it. But it only remains in the atmosphere for a relatively short time: half is broken down in nine years. This leads some to argue that maintaining the global cattle herd at current levels – about 1 billion animals – is not heating the planet. The burping cows are just replacing the methane that breaks down as time goes by.

But this is simply “creative accounting”, according to Pete Smith at the University of Aberdeen and Andrew Balmford at the University of Cambridge. We shouldn’t argue that cattle farmers can continue to pollute just because they have done so in the past, they say: “We need to do more than just stand still.” In fact, the short-lived nature of methane actually makes reducing livestock numbers a “particularly attractive target”, given that we desperately need to cut greenhouse gas emissions as soon as possible to avoid the worst impacts of the climate crisis.

In any case, just focusing on methane doesn’t make the rampant deforestation by cattle ranchers in South America go away. Even if you ignore methane completely, says Poore, animal products still produce more CO2 than plants. Even one proponent of the methane claim says: “I agree that intensive livestock farming is unsustainable.”

Claim: In many places the only thing you can grow is grass for cattle and sheep

NFU president, Minette Batters, says: “Sixty-five percent of British land is only suitable for grazing livestock and we have the right climate to produce high-quality red meat and dairy.”

“But if everybody were to make the argument that ‘our pastures are the best and should be used for grazing’, then there would be no way to limit global warming,” says Marco Springmann at the University of Oxford. His work shows that a transition to a predominantly plant-based flexitarian diet would free up both pasture and cropland.

The pasture could instead be used to grow trees and lock up carbon, provide land for rewilding and the restoration of nature, and growing bio-energy crops to displace fossil fuels. The crops no longer being fed to animals could instead become food for people, increasing a nation’s self-sufficiency in grains.

FacebookTwitterPinterest The Wild Ken Hill project on the Norfolk coast, which is turning around 1,000 acres of marginal farmland and woodland back over to nature. Photograph: Graeme Lyons/Wild Ken Hill/PA

Claim: Grazing cattle help store carbon from the atmosphere in the soil

This is true. The problem is that even in the very best cases, this carbon storage offsets only 20%-60% of the total emissions from grazing cattle. “In other words, grazing livestock – even in a best-case scenario – are net contributors to the climate problem, as are all livestock,” says Tara Garnett, also at the University of Oxford.

Furthermore, research shows this carbon storage reaches its limit in a few decades, while the problem of methane emissions continue. The stored carbon is also vulnerable - a change in land use or even a drought can see it released again. Proponents of “holistic grazing” to trap carbon are also criticised for unrealistic extrapolation of local results to global levels.

Claim: There is much more wildlife in pasture than in monoculture cropland

That is probably true but misses the real point. A huge driver of the global wildlife crisis is the past and continuing destruction of natural habitat to create pasture for livestock. Herbivores do have an important role in ecosystems, but the high density of farmed herds means pasture is worse for wildlife than natural land. Eating less meat means less destruction of wild places and cutting meat significantly would also free up pasture and cropland that could be returned to nature. Furthermore, a third of all cropland is used to grow animal feed.

Claim: We need animals to convert feed into protein humans can eat

There is no lack of protein, despite the claims. In rich nations, people commonly eat 30-50% more protein than they need. All protein needs can easily be met from plant-based sources, such as beans, lentils, nuts and whole grains.

But animals can play a role in some parts of Africa and Asia where, in India for example, waste from grain production can feed cattle that produce milk. In the rest of the world, where much of cropland that could be used to feed people is actually used to feed animals, a cut in meat eating is still needed for agriculture to be sustainable.
“What about … ?”

Claim: What about soya milk and tofu that is destroying the Amazon?

It’s not. Well over 96% of soy from the Amazon region is fed to cows, pigs and chickens eaten around the world, according to data from the UN Food and Agriculture Organization, says Poore. Furthermore, 97% of Brazilian soy is genetically modified, which is banned for human consumption in many countries and is rarely used to make tofu and soya milk in any case.

Soya milk also has much smaller emissions and land and water use than cow’s milk. If you are worried about the Amazon, not eating meat remains your best bet.

Claim: Almond milk production is massacring bees and turning land into desert

Some almond production may well cause environmental problems. But that is because rising demand has driven rapid intensification in specific places, like California, which could be addressed with proper regulation. It is nothing to do with what almonds need to grow. Traditional almond production in Southern Europe uses no irrigation at all. It is also perhaps worth noting that the bees that die in California are not wild, but raised by farmers like six-legged livestock.

Like soya milk, almond milk still has lower carbon emissions and land and water use than cow’s milk. But if you are still worried, there are plenty of alternatives, with oat milk usually coming out with the lowest environmental footprint.

Claim: Avocados are causing droughts in places 

Again, the problem here is the rapid growth of production in specific regions that lack prudent controls on water use, like Peru and Chile. Avocados generate three times less emissions than chicken, four times less than pork, and 20 times less than beef.

If you are still worried about avocados, you can of course choose not to eat them. But it’s not a reason to eat meat instead, which has a much bigger water and deforestation footprint.

The market is likely to solve the problem, as the high demand from consumers for avocados and almonds incentivises farmers elsewhere to grow the crops, thereby alleviating the pressure on current production hotspots.

Claim: Quinoa boom is harming poor farmers in Peru and Bolivia

Quinoa is an amazing food and has seen a boom. But the idea that this took food from the mouths of poor farmers is wrong. “The claim that rising quinoa prices were hurting those who had traditionally produced and consumed it is patently false,” said researchers who studied the issue.

Quinoa was never a staple food, representing just a few percent of the food budget for these people. The quinoa boom has had no effect on their nutrition. The boom also significantly boosted the farmers’ income.

There is an issue with falling soil quality, as the land is worked harder. But quinoa is now planted in China, India and Nepal, as well as in the US and Canada, easing the burden. The researchers are more worried now about the loss of income for South American farmers as the quinoa supply rises and the price falls.

Claim: What about palm oil destroying rainforests and orangutans?

Palm oil plantations have indeed led to terrible deforestation. But that is an issue for everybody, not only vegans: it’s in about half of all products on supermarket shelves, both food and toiletries. The International Union for the Conservation of Nature argues that choosing sustainably produced palm oil is actually positive, because other oil crops take up more land.

But Poore says: “We are abandoning millions of acres a year of oilseed land around the world, including rapeseed and sunflower fields in the former Soviet regions, and traditional olive plantations.” Making better use of this land would be preferable to using palm oil, he says.
Healthy questions

Claim: Vegans don’t get enough B12, making them stupid
A vegan diet is generally very healthy, but doctors have warned about the potential lack of B12, an important vitamin for brain function that is found in meat, eggs and cows’ milk. This is easily remedied by taking a supplement.

However, a closer look reveals some surprises. B12 is made by bacteria in soil and the guts of animals, and free-range livestock ingest the B12 as they graze and peck the ground. But most livestock are not free-range, and pesticides and antibiotics widely used on farms kill the B12-producing bugs. The result is that most B12 supplements - 90% according to one source – are fed to livestock, not people.

So there’s a choice here between taking a B12 supplement yourself, or eating an animal that has been given the supplement. Algae are a plant-based source of B12, although the degree of bio-availability is not settled yet. It is also worth noting that a significant number of non-vegans are B12 deficient, especially older people. Among vegans the figure is only about 10%.

Claim: Plant-based alternatives to meat are really unhealthy 

The rapid rise of the plant-based burger has prompted some to criticise them as ultra-processed junk food. A plant-based burger could be unhealthier if the salt levels are very high, says Springmann, but it is most likely to still be healthier than a meat burger when all nutritional factors are considered, particularly fibre. Furthermore, replacing a beef burger with a plant-based alternative is certain to be less damaging to the environment.

There is certainly a strong argument to be made that overall we eat far too much processed food, but that applies just as much to meat eaters as to vegetarians and vegans. And given that most people are unlikely to give up their burgers and sausages any time, the plant-based options are a useful alternative.
‘Catching out’ vegans

Claim: Fruit and vegetables aren’t vegan because they rely on animal manure as fertiliser

Most vegans would say it’s just silly to say fruit and veg are animal products and plenty are produced without animal dung. In any case there is no reason for horticulture to rely on manure at all. Synthetic fertiliser is easily made from the nitrogen in the air and there is plenty of organic fertiliser available if we chose to use it more widely in the form of human faeces. Over application of fertiliser does cause water pollution problems in many parts of the world. But that applies to both synthetic fertiliser and manure and results from bad management.

Claim: Vegan diets kill millions of insects

Piers Morgan is among those railing against “hypocrite” vegans because commercially kept bees die while pollinating almonds and avocados and combine harvesters “create mass murder of bugs” and small mammals while bringing in the grain harvest. But almost everyone eats these foods, not just vegans.

It is true that insects are in a terrible decline across the planet. But the biggest drivers of this are the destruction of wild habitat, largely for meat production, and widespread pesticide use. If it is insects that you are really worried about, then eating a plant-based organic diet is the option to choose.

Claim: Telling people to eat less meat and dairy is denying vital nutrition to the world’s poorest

A “planetary health diet” published by scientists to meet both global health and environmental needs was criticised by journalist Joanna Blythman: “When ideologues living in affluent countries pressurise poor countries to eschew animal foods and go plant-based, they are displaying crass insensitivity, and a colonial White Saviour mindset.”

In fact, says Springmann, who was part of the team behind the planetary health diet, it would improve nutritional intake in all regions, including poorer regions where starchy foods currently dominate diets. The big cuts in meat and dairy are needed in rich nations. In other parts of the world, many healthy, traditional diets are already low in animal products.
On the road

Claim: Transport emissions mean that eating plants from all over the world is much worse than local meat and dairy

“‘Eating local’ is a recommendation you hear often [but] is one of the most misguided pieces of advice,” says Hannah Ritchie, at the University of Oxford. “Greenhouse gas emissions from transportation make up a very small amount of the emissions from food and what you eat is far more important than where your food traveled from.”

Beef and lamb have many times the carbon footprint of most other foods, she says. So whether the meat is produced locally or shipped from the other side of the world, plants will still have much lower carbon footprints. Transport emissions for beef are about 0.5% of the total and for lamb it’s 2%.

The reason for this is that almost all food transported long distances is carried by ships, which can accommodate huge loads and are therefore fairly efficient. For example, the shipping emissions for avocados crossing the Atlantic are about 8% of their total footprint. Air freight does of course result in high emissions, but very little food is transported this way; it accounts for just 0.16% of food miles.

Claim: All the farmers who raise livestock would be unemployed if the world went meat-free

Livestock farming is massively subsidised with taxpayers money around the world – unlike vegetables and fruit. That money could be used to support more sustainable foods such as beans and nuts instead, and to pay for other valuable services, such as capturing carbon in woodlands and wetlands, restoring wildlife, cleaning water and reducing flood risks. Shouldn’t your taxes be used to provide public goods rather than harms?

So, food is complicated. But however much we might wish to continue farming and eating as we do today, the evidence is crystal clear that consuming less meat and more plants is very good for both our health and the planet. The fact that some plant crops have problems is not a reason to eat meat instead.

In the end, you will choose what you eat. If you want to eat healthily and sustainably, you don’t have to stop eating meat and dairy altogether. The planetary health diet allows for a beef burger, some fish and an egg each week, and a glass of milk or some cheese each day.

Food writer Michael Pollan foreshadowed the planetary health diet in 2008 with a simple seven-word rule: “Eat food. Not too much. Mostly plants.” But if you want to have the maximum impact on fighting the climate and wildlife crisis, then it is going to be all plants.

Another Medical and Wall Street "Success Story"! The story of Subsys and Insys

Hannah Kuchler, Shaunagh Connaire, Nick Verbitsky, Annie Wong, Rebecca Blandon and Tom Jennings in The FT


Deborah Fuller had just heard the sentences that were the closest she would get to justice. 

In March 2016, her daughter Sarah died from an overdose of drugs that included Subsys: a tiny yet potent spray containing fentanyl, an opioid 50 to 100 times stronger than morphine. The day before her death, mother and daughter had chatted about her upcoming wedding. Sarah had already bought a garter. Deborah was planning to sew her veil. 

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The next morning, Sarah’s fiancé found her dead, keeled over on her face. “It was not a vision I would wish on anyone. We had to have her cremated because there was no way they could have made it so that she was recognisable,” Deborah recalls in an interview. 

The former nursing assistant had first become addicted to opioids when she was prescribed them for fibromyalgia and neck and back injuries. After she recovered from the addiction, she visited a new doctor. With an Insys sales representative in the room, she was put back on opioids including Subsys — and within 20 days, her dose of the spray was tripled. Admitted to hospital for hyper-sedation, physicians recommended she stop using the spray — but her doctor continued to prescribe it. 

Now, four years later, executives from Insys, the maker of Subsys, had become the first pharmaceutical bosses to be handed prison time for their role in America’s opioid epidemic. Clutching her speech, the 62-year-old mother from New Jersey stood outside the court in Boston this January and accused John Kapoor, the Insys founder, and his colleagues of a “greed and fraud” that took Sarah away when she was just 32. “They are no different from mobsters,” she said. 

Seven of the Insys executives and employees on trial were found guilty of masterminding and participating in a scheme to bribe doctors to prescribe the drug. Kapoor was sentenced to five and a half years on charges that included racketeering conspiracy. Michael Babich, Insys’ former chief executive, and Alec Burlakoff, former vice-president of sales, co-operated with prosecutors and received two and a half, and 26 months, respectively. 

Fuller calls the sentences “a disgrace”, believing they should have been far longer. But she hopes the sheer fact of people going to prison will deter other drugmakers, which may have previously accepted fines as a cost of doing business. “Normally, they just get a slap on the wrist and have to pay a penalty, which was easily made up by selling more opioids,” she says. “At least now, they’ll have to think, maybe they’ll go to jail for this.” 

---Also Watch

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The opioid epidemic has shaped America. There have been 750,000 overdose deaths since the crisis began in 1999, according to the Centers for Disease Control and Prevention, and about two-thirds involved an opioid. Fuller’s family is one of many still suffering from losing a loved one. 

Many people hooked on illegal opioids start on painkillers prescribed by doctors. At first, marketers convinced some physicians that opioids were not as addictive as previously thought. But in some regions, the abuse became brazen. One town in West Virginia had 3,200 residents, but was receiving enough opioids for them to take 6,500 pills each over 10 years. 

In a joint investigation between the FT and the PBS series Frontline, we spoke to several former employees about life inside Insys, including Burlakoff, the former vice-president of sales, who we questioned under prosecutors’ supervision. We also interviewed prosecutors, short sellers and the reporters who exposed the scheme. 

Insys was a flagrant flouter of the rules. Founded in 2002, it started clinical trials for its under-the-tongue fentanyl spray in 2007. Subsys won regulatory approval in 2012, more than a decade into the opioid crisis, when overdose deaths were already rising and after other pharma companies had been fined for mismarketing opioids. 

The company used tactics familiar in the US pharmaceutical industry — but took them across the line into illegality. Many drugmakers pay speakers’ fees to doctors, with the understanding that they will recommend their product to peers at educational events — but Insys made it clear that they expected more prescriptions in return for their money. Sometimes it abandoned the pretence of such events completely. 

Subsys was approved for “breakthrough” bursts of pain in cancer patients already tolerant to opioids, yet the majority of prescriptions were for patients, like Fuller, who did not even have cancer. It is legal and common for doctors in the US to prescribe drugs “off label” or for uses they are not approved for. But it is illegal for pharmaceutical companies to market their medicines for these other uses. 

Jerry Avorn, who heads the division of pharmacoepidemiology at Brigham and Women’s Hospital in Boston, believes it was mostly the marketing to doctors that made Subsys “lethal”. “The Insys example is the extreme . . . ‘mass shooter’ version of what happens when you create a culture that does not pay enough attention to what’s true and what isn’t about drugs, and where you allow uncontrolled marketing,” he says. “What made it so dangerous was people getting behind it and seeing it as a ticket to riches.” 

The pharmaceutical industry has a history of paying settlements in the billions of dollars. But even as evidence of investigations began to emerge, analysts played down the risks, sometimes citing companies that had previously only received fines, and investors bid up the stock. 

Across the US, counties and states are now suing pharmaceutical companies, desperate to recoup the cost of treating and policing those hooked on their drugs. Many of the defendants have teamed up to offer $48bn to settle these suits — but so far, many states are holding out for more. After all, according to the Council of Economic Advisers, the crisis cost the country $2.5tn from 2015 to 2018. 

“Most people involved in making opioids, distributing them and financing the companies turned a blind eye as at first there were thousands of deaths, then tens of thousands, and then hundreds of thousands of deaths. These are the kind of numbers we usually associate with genocides and civil wars — in the richest country in the history of human civilisation,” says Anand Giridharadas, author of Winners Take All, a critique of how elites make their money. “There’s now a mountain of evidence about all the people who had warning signs who ignored them.” 

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At the end of 2013, Insys chief executive Michael Babich was lauded on CNBC. The stock was the best performing initial public offering of the year — up by more than 400 per cent at its peak — and sales had risen almost sevenfold year-on-year. The TV anchor served up a softball: “Tell us what it is about Insys that has investors so excited?” 

Wearing a tightly buttoned gingham shirt, Babich showed off the Subsys spray, smaller than an asthma inhaler. He blinked rapidly as he trotted out the official line: the product is designed for cancer patients suffering from “breakthrough” bursts of pain. 

Wall Street was captivated by the numbers coming out of the small Arizona-based company — and downplayed risks it could not quantify. The Wall Street Journal praised Babich that year as “the right kind of insider trader” for legally buying more stock to show his conviction in Insys. Insys founder, John Kapoor, originally from India, cast himself as an immigrant success story, telling Forbes: “This is the country you can do it in. Nowhere else.” 

David Amsellem, a softly spoken analyst at Piper Sandler with decades of experience covering pharmaceuticals, recommended buying Insys in 2014. Speaking in a conference room above New York’s Park Avenue, he described how he and fellow analysts were impressed that sales were taking off, when most small biotech companies spend years investing in R&D before selling anything. “Insys was a rare breed as a company that had a product that was on the market,” he says. “In other words, it wasn’t just a hope and a dream.”

For Stephanie Yon, however, Insys was a nightmare. That December when Babich was promoting the fentanyl spray on TV, the Michigan mother of three started seeing Dr Gavin Awerbuch, seeking treatment for pain from a car crash the month before. Yon did not have cancer. She had not taken opioids before. Subsys came with a “black-box warning” that it could cause respiratory depression and death. Yet Awerbuch prescribed her a plethora of opioids, including Subsys. Then, he increased her dose rapidly. The 38-year-old died on March 14 2014, just three months after the initial prescription, with lethal levels of fentanyl in her body. 

Brian McKeen, the lawyer for Yon’s family, says no one could have mistaken the drug as safe. “It doesn’t happen because of a lack of scientific knowledge, or a lack of warning. It happens because of doctors disregarding patient safety and putting their own financial interest first,” he says. 

Unbeknown to Yon, her doctor had such a close relationship to Insys that the company’s management would advise sales reps across the US to get their own Awerbuch. He was the top prescriber of Subsys in the country, helping fuel sales that rose 276 per cent year-on-year in the first quarter of 2014. In return, his pockets jangled with so-called “speakers’ fees”: in 18 months, he was paid $138,000, ostensibly for educating other medical professionals about the drug. The local press reported that much was spent on his vast collection of ancient coins. 

At the trial last year, Awerbuch described searching his files for new patients to write Subsys prescriptions for. “It got to the point — and this was a complete lack of judgment on my part, but I started prescribing Subsys to patients who really didn’t need such a potent medicine,” he said. “I probably went against my Hippocratic oath and did prescribe medicine that could potentially harm patients.” 

He liked the money and the Insys reps, who made him feel like they were his friends. Many were hired for their beauty — Burlakoff says he knew that “sex sells” — and few had deep experience in pharmaceuticals. “Honestly, they had beautiful sales reps, and I liked the attention I was getting,” Awerbuch testified. Two months after Yon died, he was arrested. He pled guilty and was sentenced to 32 months in prison and forced to pay restitution and fines of $4.1m. 

“When you have a prescriber who can say, ‘I was bribed,’ that’s an important moment,” says Nat Yeager, who prosecuted the Insys executives. But inside the company, Burlakoff claims, no one cared. In fact, the sales representative who courted Awerbuch was promoted. Asked about the case on an earnings call, Babich insisted: “In no way, shape or form was there any allegations against Insys” [sic]. 

Amsellem, the Piper Sandler analyst, says Insys leaders were “very, very clear” that the doctors who were arrested were just “bad actors”. “Basically, I had to take management’s word for it. And there’s always going to be that element of trust,” he says. “You want to believe that management teams are going to be honest.” 

The stock carried on rising. 

Giridharadas says Wall Street funded the opioid crisis, just like it speculated its way into causing the financial crisis. “The system is set up to tell corporations to make as much money as possible by cutting every possible societal corner,” he says. “It is a sector of our society that is consistently working in advocating against the life, liberty and pursuit of happiness of the American people.” 

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A year later, Insys sales representatives were revelling in their success. Sales in the first quarter of 2015 soared more than 70 per cent year-on-year, and the stock was climbing towards its peak that July, at almost six times the IPO price. At a national sales conference in Arizona, reps showed off a video that was later to become an exhibit at trial. Parodying a hit by hip-hop artist A$AP Rocky, the sales reps rapped: “I love titration. Yeah, that’s not a problem. I got new patients, and I got a lot of ’em.” 

The lines referred to the tactics used by sales reps of pressuring doctors to escalate patient doses of Subsys — known as titration. Higher doses fetched higher prices, and so the reps pocketed fatter commissions. In the video, a man in a giant Subsys costume dances with the rappers. At the end, Burlakoff comes out from under the costume. The audience laughed and clapped, one former sales representative told the FT and PBS Frontline. They had no idea that it would be “a piece of evidence in court in four or five years’ time,” he says. 

Our team interviewed Burlakoff last summer, before he was sentenced, under the supervision of the prosecutors at a studio in Boston. Wearing the smart suit of the salesman he once was, he was extremely talkative. Just as he had decided to “co-operate like nobody’s business” with the prosecutors, he was eager to recount how Insys devised its scheme. “I didn’t think about the patients, the people suffering, the addiction,” he admits. “I imagined that I was selling a widget.” 

He described how he was in awe of the billionaire Kapoor and set about creating a team that would recruit doctors who, nine times out of 10, were not oncologists. “It all comes down to targeting. You gotta find their hot button. Whatever makes them tick. And it sounds ruthless and it is ruthless that we would target someone that is in distress in an effort to take advantage of them,” he says. Sometimes the target was wooed more literally. “Sex with a doctor or chartering a private jet and taking a couple of doctors to, say, Cancún, Mexico. It’s been done,” he says. 

The criminal conspiracy went right to the top. While many pharmaceutical companies pay speakers’ fees to doctors, they don’t officially expect them to prescribe more of their drug. Kapoor insisted on a clear return on investment. “Dr Kapoor doesn’t lose. He made that very clear. He did not want to lose a penny,” Burlakoff recalls. Insys sales representatives were instructed to deliver at least a 2:1 return. “The only way that I knew how to do it, to get that guarantee, is to bribe doctors.” 

This clarity was to prove the company’s downfall. Prosecutors discovered a spreadsheet — which they dubbed a “smoking gun” — that showed calculations of the return Insys was getting from its investment in speakers’ fees. Insys also deceived insurers so they would pay for prescriptions. The company created an internal reimbursement centre, giving staff carefully worded scripts known as “The Spiel” that would convince insurers to pay up, often by implying — or even claiming — that a patient had cancer when they did not. 

Fred Wyshak, one of the prosecutors, said in an interview: “Kapoor decided that, ‘If I’m paying doctors to speak, I’m also paying them to write [prescriptions].’ And philosophically, that’s not supposed to be the way it works. I’m not saying that’s not the reality in the pharmaceutical industry, and as I think Burlakoff described it, that’s the dirty little secret in the pharmaceutical industry, but nobody ever discusses it.” 

Wyshak had built his career prosecuting the mafia. He used similar tactics to turn witnesses and unearth evidence to prosecute Insys leadership. Kapoor was the ultimate target. “The executives at Insys displayed an arrogance that you find in organised crime groups,” he says. “They thought that they were above the law.” 

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Short sellers, who search for stocks they think will fall and profit if they do, were also digging into Insys. They believed that Wall Street was missing warning signs. Jim Carruthers, who runs his firm Sophos Capital from Silicon Valley, became suspicious because there were so few doctors prescribing so much Subsys. Carruthers had shorted healthcare companies before and began to piece together public data including which doctors Insys was paying, available under transparency laws, and the numbers of overdoses related to the drug. He also hired a private investigator, who visited a top prescriber in Alabama, describing it as the “epitome of a pill mill”. 

“We thought this was all information that when it came out into the public market, that would change the investors’ perception of the value of the stock,” Carruthers says. His “aha moment” came when his firm approached someone who used to work for Insys competitor Cephalon. It turned out the employee also used to work for Insys. “When we asked him why he left that name off his résumé he told us, ‘Because these guys are all going to get arrested. They’re all going to go to prison,’” he says. 

Carruthers built his short position and sent tips to journalists. In April 2015, Roddy Boyd, a hedge-fund analyst-turned-investigative reporter in North Carolina, published an exposé, “Insys Therapeutics and the New ‘Killing It’” on his non-profit site, called The Southern Investigative Reporting Foundation at the time. The stock fell almost 10 per cent. Within weeks, though, it had recovered. Carruthers says the “greed” went beyond the top of Insys, down to its investors. “There were people on Wall Street who were intent on keeping this stock price up and, I believe, ignoring some of the more obvious indications that this was an unsustainable, potentially fraudulent business model,” he says. 

Amsellem says the first reports of investigations into Insys were met with a “collective shrug”. “There had been a whole host of investigations of other companies, companies that are industry leaders and big fines that were paid. And none of these companies were put into bankruptcy,” he says. 

When David Steinberg, an analyst at Jefferies, initiated coverage of the stock as a “buy” in late 2014, he acknowledged the investigations could bring “more negative headlines”. “As we are not privy to the facts, we are not in a position to render a conclusion. That said, we’re pretty sure that the worst case outcome for Insys is some sort of fine,” he wrote. The fact that investors assumed investigations could be settled for a fine was understandable. There was no precedent for pharmaceutical executives being sent to jail. Purdue Pharma, owned by certain members of the Sackler family, had settled a 2007 misbranding case of its opioid OxyContin for $600m. Cephalon, which also sold a fast-acting fentanyl product Actiq and had previously employed Burlakoff, settled investigations into its marketing practices in 2008 for $425m. 

“If Cephalon executives had gone to jail for the way they promoted Actiq, for actions they took that promoted a loss of life, then maybe we wouldn’t have had a Subsys,” says Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management. 

In late 2015, more heavy prescribers of Subsys were arrested and the company began to suspect federal agents were pursuing executives. And yet, in 2016, five out of the six analysts covering the stock still had “buy” or “outperform” ratings on it. Some analysts kept buy ratings on Insys until shortly before it went bankrupt in 2019, according to Sinan Gokkaya, an associate professor of finance at Ohio University. “Short sellers have an incentive to push down the price so they can get involved in negative investigations,” he says. “If I’m an analyst, I don’t have much to gain from a negative stock price.” 

In May 2017, Amsellem became the second to downgrade Insys, rating it “neutral”. He did not rate it as “underweight” until March 2018, five months after Kapoor had been arrested and charged. Amsellem says he wanted to keep his focus on “data and information”. By 2018, investigations had made doctors more cautious about prescribing any fast-acting fentanyl drug. Subsys sales were lower than they had been at the initial public offering in 2013. 

“I don’t regret not downgrading it earlier,” he explains. “I think that to make decisions on stocks you have to be methodical . . . You don’t want to be knee-jerk. Does that mean that sometimes you might get things wrong? Yes. I get things wrong all the time in terms of stockpicking.” 

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If you google “Subsys”, you will find, perhaps surprisingly, that the tiny fentanyl spray is still on the market in the US. After executives were convicted and Insys was ordered to pay $225m to the US government, the company filed for Chapter 11 bankruptcy in June 2019. Subsys was sold to Wyoming-based BTcP Pharma, in return for paying a proportion of sales to creditors. Several state attorney-generals objected. The Maryland attorney-general argued there were “ample red flags” about the new owner. “Patients became addicted to Subsys through Insys’ misconduct and their addiction has not been treated; the court should ensure, in approving any sale, that Subsys will not fall into the hands of those who would further exploit that addiction through intentional conduct or negligence,” the objection read. “Further harm should not emerge from this bankruptcy.” The sale was approved after BTcP promised to only market it for cancer patients. BTcP’s parent company did not respond to a request for comment. 

Insys was an extraordinary case of explicit bribery to prescribe a potent opioid — and an unusual example of government agencies rallying together to prosecute executives. But it also exposed flaws in how the US regulates drugs. The system makes it hard to catch bad actors — whether individuals or entire companies — before they devastate lives. 

Chris McGreal, author of American Overdose, says it took the FDA 20 years to improve its monitoring of whether a drug is addictive. “One of the strongest and most constant criticisms of the FDA during this epidemic is that it’s taken a very narrow view of the grounds on which it approves a drug,” he explains. “They don’t want to know the answer to the question, is this drug addictive and therefore dangerous? Will it kill patients?” 

Since Subsys came on the market in 2012, the regulator has put new warnings on the boxes of opioids and required companies to do studies into misuse and overdose after approval. It has requested that one opioid — Opana ER, made by Endo Pharmaceuticals — be removed from the market because of patterns of abuse, but also approved Dsuvia, by AcelRx Pharmaceuticals, another fast-acting opioid, despite strong criticism. 

Yet off-label prescription is still rife. Sometimes it makes sense to give doctors discretion, but it can also be dangerous: concerns have been raised about the effects of anti-psychotics prescribed for dementia, which ended up increasing death rates, and antidepressants that raise the risk of suicide in children and adolescents. 

Aaron Kesselheim, a professor at Harvard Medical School, believes the FDA needs to invest more in monitoring drugs after they have approved them. He fears recent court cases have given pharma companies more — not less — latitude in how they market drugs off-label. “Things are moving in the wrong direction,” he says. 

The Physician Payment Sunshine Act of 2010 put data on doctors taking dollars online. But it would take an enterprising patient to discover it — and decipher what it might mean for their care. And transparency has not stopped many doctors from taking the money. A 2019 paper in the journal Addiction analysed data from more than 800,000 physicians and found those who received money from opioid makers tend to prescribe substantially larger quantities of opioids. 

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The US is now consumed by another public health disaster. Yet the coronavirus pandemic could end up exacerbating the opioid epidemic. A report from the Well Being Trust, a foundation focused on mental health, predicted “deaths of despair” from suicide, drug and alcohol abuse, could rise because of Covid-19, leading to another 75,000 deaths. Lawsuits against other opioid makers have been delayed by lockdowns. There are civil suits against much larger companies including Johnson & Johnson and Teva, as well as distributors and pharmacies. Attorney-generals are pursuing certain members of the Sackler family in relation to Purdue Pharma, but those cases are on hold as part of the bankruptcy process. There are also signs of a criminal investigation, with opioid manufacturers being hit with subpoenas. The companies and members of the Sackler family all deny any wrongdoing. 

Wall Street analysts do now say that litigation risks are affecting their ratings. But they still view the potential fines as a financial calculation. As news has trickled out about possible settlements, they have tried to look for bright sides. One wrote that the deal would likely be less than the $248bn the tobacco industry settled for in 1998, because there have been fewer deaths from prescription opioids than there were from smoking. Another called possible fines “manageable” for J&J, which is the world’s largest healthcare company. 

Meanwhile families such as the Fullers live with their loss every day. Deborah says the end of the year is always a slog: Sarah is missing from Thanksgiving, then her birthday, then Christmas. “We haven’t decorated for Christmas in some time,” she says. “Within a very short period of time, there are all these family-oriented holidays, when one fourth of our family is not here any more.” She hopes the Insys case will be a warning to other drugmakers — but she also believes the broader system needs to change. It should be far harder to prescribe medications off-label, especially dangerous opioids, she says. Doctors should be cautious about taking money from pharmaceutical companies, and, if they do, they should be forced to declare it “in a frame in big letters in their office”. 

“They take an oath not to hurt anybody,” she says. “When your patients are dying . . . that goes beyond hurting.”