Transcript

WORTH FINAL WEB TRANSCRIPT

[RADIOLAB INTRO]

JAD ABUMRAD: Are you ready?

ROBERT KRULWICH: Yes.

JAD: Feeling -- feeling ...

ROBERT: I'm feeling ...

JAD: Full of worth?

ROBERT: I'm feeling full of value.

JAD: Well, in that spirit, I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich.

JAD: This is Radiolab. And today ...

ROBERT: Three very different stories that try to put a dollar value.

MAN: Mugen is okay. $1,000,000.

MAN: $7.

MAN: $10,000.

WOMAN: Yeah, I would say five bucks.

ROBERT: On things ...

JAD: That seem ...

MAN: Priceless.

MAN: Priceless.

MAN: Priceless.

WOMAN: Priceless.

WOMAN: Is it really?

JAD: Okay, so start at the top. So ...

MOLLY WEBSTER: Bring on the pressure.

JAD: All right, we're gonna start the show with a story from our producer Molly Webster.

MOLLY: I don't remember any of it.

JAD: Who we might actually want to rename Molly Wonkster, because she recently got herself into some serious numericizing. Actually, it didn't start as a wonky thing. It started actually with some medical journals.

MOLLY: Yeah, that was -- so 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 37-year-old mother who has four children? Or what would one more month mean if you are a 67-year-old who's about to go traveling around the world." People were just kind of like drifting these questions out there, where they were ...

JAD: All these questions seemed to circle around a seemingly simple story of the pricing of a drug. A cancer drug.

MOLLY: And the story if you really want to tell it from the beginning, it begins with this guy named Leonard.

LEONARD SALTZ: Leonard Saltz, I'm a medical oncologist at Memorial Sloan-Kettering Cancer Center.

MOLLY: Which is here in New York, and it's one of the largest cancer centers in the country.

LEONARD SALTZ: We have 17 doctors here who treat colon cancer.

MOLLY: Just for colon cancer?

LEONARD SALTZ: We treat a very large number of patients.

MOLLY: 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.

LEONARD SALTZ: I mean, we have drugs out there that are many hundreds of dollars per pill.

JAD: Really?

MOLLY: Yeah. Oh, just wait. Let's see, where does this start? It starts -- it's June in 2012.

JAD: Mm-hmm.

MOLLY: Leonard Saltz is at a conference, and at this conference is a pharmaceutical company called Sanofi. And they give a presentation about a new drug that they have.

LEONARD SALTZ: A drug called Zaltrap. And Zaltrap is a drug that, without getting into the science too much, targets the blood supply to the tumor.

MOLLY: It cuts off the blood supply which means the tumor can't grow.

LEONARD SALTZ: That's -- that's the scientific hypothesis.

MOLLY: So this new drug is presented and they, like, present the data.

LEONARD SALTZ: And they showed that the survival difference ...

MOLLY: Between the people who got Zaltrap and the people who didn't.

LEONARD SALTZ: Was 1.4 months or 42 days.

MOLLY: In other words, if you take this drug, you could get 42 more days of life on average, which means you could get three more days, you could get no days, you could get 42 or you could live another three years.

MOLLY: 42.

LEONARD SALTZ: 42 days.

MOLLY: Down to the -- down to the fine grain.

LEONARD SALTZ: Yeah. Oh, 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 ...

MOLLY: So that's, like, not a tenth of a month ...

LEONARD SALTZ: A hundredth of a month. A hundredth of a month. That's a little over seven hours.

MOLLY: What?

LEONARD SALTZ: Pretty amusing, actually.

MOLLY: Wait. Why would you -- why would you ...?

LEONARD SALTZ: It's pseudo-precision.

MOLLY: Pseudo-precision.

LEONARD SALTZ: At any rate ...

MOLLY: 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 prescribed the drug and people pay for it.

JAD: And what does the drug cost?

MOLLY: That's the thing.

LEONARD SALTZ: It costs ...

MOLLY: Roughly ...

LEONARD SALTZ: $30,000 for a three-month course.

MOLLY: Wow!

LEONARD SALTZ: So ...

MOLLY: So Leonard's 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 $11,000 a month. A normal cancer patient might take dozens of drugs.

LEONARD SALTZ: There are anti-nausea medicines that are sometimes used that are in the range of $90-100 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 $5,000 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. You need 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 -- 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.

MOLLY: So Leonard calls up one of his colleagues.

PETER BACH: My name is Peter Bach. I'm a physician at Memorial Sloan-Kettering.

MOLLY: Peter is the number-cruncher of the group. He does the statistical analysis of, I don't know, the cost of care and Len grabbed him and ran him through all the data.

PETER BACH: And we walked through the out-of-pocket expenses for Medicare beneficiaries. Medicare beneficiaries, if they don't have additional insurance, 20 cents of every dollar they pay out of pocket.

MOLLY: And that number sort of hit him, because he realized for Medicare patients, they'd be paying something like $2,000 out of pocket every month for just this drug.

PETER BACH: It was $2,200 if I remember the number correctly.

MOLLY: For a lot of Medicare patients ...

PETER BACH: That's all of their money. Never mind other drugs That's when I thought we should go public with it.

MOLLY: Memorial Sloan-Kettering, they decide to boycott this drug.

LEONARD SALTZ: Now that ...

MOLLY: Is that -- I mean, I'm just stopping you because when you guys made that decision was that -- that feels like a big deal.

LEONARD SALTZ: 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.

MOLLY: They write an op-ed in the Times that basically says, "Look, this is crazy. $11,000 a month for a drug that maybe gives you 42 more days of life?"

LEONARD SALTZ: Is that worth it? And a little less than a month after the op-ed piece came out ...

MOLLY: The company that makes Zaltrap ...

LEONARD SALTZ: They went to individual doctor's offices, sent representatives and said, "We are offering a 50 percent discount.

JAD: They cut the price in half just like that?

LEONARD SALTZ: Yep.

MOLLY: Nationwide? Or, like, just in this area?

LEONARD SALTZ: Nationwide.

PETER BACH: It was sort of incredible.

MOLLY: We reached out to Sanofi to talk about the price of Zaltrap and they declined to comment. But in a statement that they released when this whole Zaltrap 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.

LEONARD SALTZ: We need these companies. They're the ones developing the drugs.

MOLLY: Which aren't easy to develop. I mean, Leonard gave us just one example.

LEONARD SALTZ: If we talk about colon cancer ...

MOLLY: He says for years, there was only one drug on the market, called 5FU.

LEONARD SALTZ: 5FU was patented in August of 1957. It was from 1957 until 1996 that a second drug came along.

MOLLY: That's how long it takes to develop a good drug? Or ...

LEONARD SALTZ: In that interim there were over 70 drugs that were tried and failed.

MOLLY: I feel like I don't give it enough credit, because that just astounded me.

LEONARD SALTZ: It's very, very hard.

MOLLY: And that, according to Leonard, is one of the reasons why prices are just gonna keep going up.

LEONARD SALTZ: But sooner or later, this system is going to fall apart. And at what point does society say, "Hmm, there isn't an infinite number of dollars that we can commit to our healthcare system."

MOLLY: It's funny, because I had this interesting reaction to the word "society," because all of a sudden I thought, like, why is -- 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?

LEONARD SALTZ: Why is society involved? Because you're not paying unless you have hidden resources I'm aware of, probably couldn't afford $10,000 to $15,000 a month in drug bills. Someone else has to pay that.

MOLLY: Obviously, he says, it's your insurance. I mean, say you're part of a policy that has 1,000 members.

LEONARD SALTZ: Let's say that the premium for that is $100. So we had $100, thousand people. We got ourselves $100,000, okay? So we now have $100,000 to take care of that thousand people.

MOLLY: For that month.

LEONARD SALTZ: For whatever amount of time. If now one person comes up with a healthcare cost -- let's say it's for a month -- that is $100,000 in that month, everybody else is in trouble. There's no money left.

MOLLY: So they write this op-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 this -- there's this journal called Blood which is really big to anybody that works in a community that has, like ...

JAD: It's a journal called Blood?

MOLLY: Yeah.

JAD: How did we not know about this when we made The Blood Show?

MOLLY: Oh, I knew. Just kept it in here.

JAD: [laughs] Anyhow.

MOLLY: So yes, there's a journal called Blood, which is basically like the -- 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 co-sign an editorial which basically says, "We totally agree with everything you guys are saying, but we have an even bigger issue." You know, with Zaltrap 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 gonna 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.

JAD: Is that like a -- like a one day in the future we will face this kind of question?

MOLLY: No. That is like a now today question.

[CLIP: The most important new medicine approved this year ...]

MOLLY: Everyone I talked to pointed me to this new drug.

[NEWS CLIP: Called Sovaldi.]

[NEWS CLIP: It's known as Sovaldi.]

[NEWS CLIP: Sovaldi.]

[NEWS CLIP: What many in the medical community are calling the new medication.]

[NEWS CLIP: The blockbuster.]

BRUCE MOHL: Sovaldi came on the market last December.

MOLLY: So that's December, 2013.

BRUCE MOHL: That's correct.

MOLLY: This is Bruce.

BRUCE MOHL: Bruce Mohl. I'm the editor of Commonwealth Magazine.

MOLLY: He's written about Sovaldi and here's the basic story, right? It is a drug that treats ...

BRUCE MOHL: Hepatitis C.

MOLLY: Which is caused by a virus.

BRUCE MOHL: And the disease itself goes to work on your liver. It inflames it. It scars it.

MOLLY: 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 Sovaldi, and it's one pill, 12 weeks. You take it with some other antiviral meds. It is a super simple treatment option.

BRUCE MOHL: And the side effects are very minimal.

MOLLY: Like, this -- it was, like, kind of like the savior drug. And so a lot of doctors start to prescribe it.

BRUCE MOHL: In the first half of 2014, 70,000 people in the country, in the United States were treated. And it had a 95 percent rate of cure. In other words ...

MOLLY: Holy cow. That's big!

BRUCE MOHL: ... the virus was eradicated. That's very big.

MOLLY: But, in fitting with our story ...

BRUCE MOHL: This drug costs $1,000 a pill.

MOLLY: Whoa! For like, one -- one pill that I take ...

BRUCE MOHL: One a day.

[PROTESTERS: Drop the price! Drop the price! Drop the price!]

MOLLY: Which as you can imagine, it angered a lot of people with hep C. In total, it costs $84,000. And if you think about the fact that in 2014, we know at least 70,000 people got this drug ...

BRUCE MOHL: Then you're starting to talk about serious money.

MOLLY: Wait, I want to -- I just want to say that I -- I just times-ed out 70,000 times 84,000, and I got something with seven zeros in it. It's 588 and then there's seven zeros, which is, like, $5-billion?

BRUCE MOHL: Yes. Yeah.

[NEWS CLIP: The big question is how states will pay for what could be upwards of ...]

MOLLY: And so we have a situation where states are basically having to ration.

BRUCE MOHL: Yeah.

MOLLY: Say, in Massachusetts ...

BRUCE MOHL: Most of the insurers currently are requiring some liver damage before you can take the drug.

MOLLY: Similar restrictions are happening in other states. Florida. It's happening in Oregon. Illinois.

[NEWS CLIP: The doctor says the only option may be to wait until your even sicker.]

MOLLY: And then there's Arizona. Out of the entire state, public insurance only approves 180 people for treatment.

JAD: Just 180?

MOLLY: Just 180. Now when I talked to a representative of the company that makes the drug ...

GREGG ALTON: Gregg Alton. Executive Vice President for Corporate and Medical Affairs for Gilead Sciences.

MOLLY: He says you got to keep in mind, this is not a chronic care situation. This is a ...

GREGG ALTON: Cure. Here you're actually curing a person of a disease. We're talking about 12 weeks of therapy, period. That's it. And you're done and you've cured somebody.

MOLLY: So he says this is a one-time deal. This is like one time, $84,000 and then you're done. Think about all the years you'll live without having an illness. Then you'll see ...

GREGG ALTON: Over a 20-year period, the savings that will accrue to the system by having a patient cured of hepatitis C.

MOLLY: 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.

BRUCE MOHL: 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?

MOLLY: And then you're talking tens of millions of people.

BRUCE MOHL: An enormous segment of the population.

MOLLY: Even if just a fraction of them want a drug that's $1,000 per day, that's practically our entire U.S. budget.

BRUCE MOHL: What do you do in that case? A drug comes along like that and throws everything out of whack.

MOLLY: 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."

JAD: But beyond what point?

MOLLY: Exactly. I mean, that's the hard part. Like, how good does a treatment have to be for you to say this is worth the price that it's been set at?

LEONARD SALTZ: I don't think we reject it out of hand, but I don't think ...

MOLLY: I got into this a bit with Leonard. In the case of Zaltrap they said, "All right. 42 days, that much money. We're not gonna do it." But would it have been different if it was 50 days or a hundred? Is that enough?

MOLLY: I'm sure you want to be talking in years, but I guess the question is like, what would be a -- is there a magic line for you?

LEONARD SALTZ: If I -- this is a -- I can't personally determine it for everybody. I wouldn't presume to try. But ultimately as a society, we're going to have to reach an understanding of what that cut point is because we can't afford not to.

MOLLY: 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?

BRUCE MOHL: Are we willing to pay $1,000 for an extra day of life? Well, what about $100,000 for an extra day of life?

LEONARD SALTZ: You know, people 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.

MOLLY: He said that and I was like okay, 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 -- that countries spend, it's gonna get gobbly-gooky, but just bear with me.

JAD: Yeah.

MOLLY: That countries spend one to three times the GDP per capita, which is like the gross domestic product per individual.

JAD: So take the entire fat ball of money that is in a country and divide it per individual?

MOLLY: Divide it by the individuals, and then you spend one to three times that on one more good year of life.

JAD: And what would that be for us?

MOLLY: So for the U.S., that's about $50,000 to $150,000.

JAD: Interesting. And does that -- does that have any teeth? That recommendation?

MOLLY: It legally doesn't have any teeth, but it has teeth in the sense that doctors in the U.S. are actually gonna start using this WHO number to evaluate medical treatments for cardiology. They said they were gonna do this in a paper, and it was kind of very quiet, very subtle. But 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?

JAD: Have they done that here ever?

MOLLY: As far as I know, no.

JAD: Why not?

MOLLY: Because -- because the last time we tried to talk about cost in medicine, it ended up in the whole ...

[NEWS CLIP: Death panels.]

[NEWS CLIP: Death panels.]

[NEWS CLIP: Death panels, or so-called death panels.]

MOLLY: ... thing. And I don't know, I just wondered ...

MOLLY: All right into the mess of it. Hey, Times Square.

MOLLY: If I actually tried to go out and ask this question in a very basic way, how would people respond?

MOLLY: Excuse me, can I ask you a question? What is a year of life worth?

WOMAN: Wow, what a question.

MAN: That's deep. Can I think about it?

WOMAN: That's a tough one, but ...

MOLLY: I was really surprised at how seriously people took the question.

MAN: Man, what is a year of life worth?

MOLLY: 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.

MAN: Am I gonna die tomorrow?

MOLLY: Yes.

MAN: Where do I get that year? Do I get it at the beginning, the middle, or the end?

MAN: How would I spend that year of life?

MOLLY: Good. It would be a good year of life.

MAN: A good year of life depends ...

WOMAN: Is this like a pie-in-the-sky kind of answer?

MOLLY: They wanted to know would they be emotionally happy? Alone? With friends or family? Where did they get the money? Could they borrow the money? Did they have to pay the money back? Were they dying? Was it an emergency? Were other people also trying to get money at the same time, because then there'd be, like, a rush on the money in America.

JAD: Oh, interesting. Did you actually ever end up getting numbers?

MOLLY: I did get numbers, but they were ...

MAN: At least ...

MAN: $10,000.

MAN: $15,000.

WOMAN: $13.

MAN: Quarter million?

MAN: $7.

MOLLY: All over the place.

WOMAN: Yeah, I would say five bucks.

WOMAN: $10-million.

MAN: Oh, $44,000.

MOLLY: Interesting. One woman said $10-million.

MAN: $10-million for a year? It's irresponsible.

WOMAN: Well, you're asking me about my personal choice?

MAN: $10-million?

WOMAN: Not about a public policy question.

JAD: Well, do you have any way of parsing all this?

MOLLY: No, I really -- I honestly don't. Like, 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. Like 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, like, a 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.

SUSAN GUBAR: Ah, well.

MOLLY: I guess, what is 42 days? What does 42 days mean in the sense of, is that something that you'd pay $50,000 for if you were -- I mean, of course you would. That -- it's like ...

SUSAN GUBAR: Now, I think ...

MOLLY: I almost can't even ask the question, but I don't know.

SUSAN GUBAR: Well, I -- no, I think it's a good question. I think ethically it would be to the good of patients and doctors to have this conversation.

MOLLY: This is Susan.

SUSAN GUBAR: Susan Gubar, writer of the Living With Cancer blog for the New York Times.

MOLLY: Back in 2008, 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 ...

SUSAN GUBAR: Advanced stage ovarian cancer. Most ovarian cancers are diagnosed at a late stage, and it's -- it's basically incurable. It can be handled, it can be managed, it can be kept at bay, and for longer periods of time now, we hope. But you're given a diagnosis of three to five years.

MOLLY: Wow. That is -- you go from having unlimited time in your mind to three to five years in, like, a doctor's visit.

SUSAN GUBAR: Yeah. It's -- it's a big shock. You sort of enter a zone where you're not quite aware of what you're doing.

MOLLY: 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.

SUSAN GUBAR: 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 ...

MOLLY: Holy shit!

SUSAN GUBAR: Sometimes the bowel.

MOLLY: Are you serious?

SUSAN GUBAR: Yeah, it's called the mother of all surgeries.

MOLLY: And then, just like that, she was doing multiple rounds of chemo.

SUSAN GUBAR: Chemicals that are used they destroy all quick growing cells. So for example, you have no hair, no eyebrows, no eyelashes. 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.

MOLLY: And Susan, who writes for a living couldn't even read.

SUSAN GUBAR: 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.

MOLLY: Have you ever had to think about cost?

SUSAN GUBAR: 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.

MOLLY: 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. Like, pick one and then we'll deal with it on the other side."

SUSAN GUBAR: I think there's a kind of unspoken agreement among everyone that the insurance company or Medicare is gonna pay. And if it's the government that means that our grandchildren are gonna 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 it's worth? What's it worth title. And I was thinking that the American individualistic optimistic response would be well, whatever it takes. Whatever it takes. Life 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?

MOLLY: I remember when she said that. "When is enough enough?" I was just ...

LEONARD SALTZ: I don't know that we are ready to say there's one magic line.

MOLLY: ... thrown back to this conversation that I'd had with Leonard Saltz, where he was saying that ...

LEONARD SALTZ: We have to look at everything in terms of value.

MOLLY: 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 day.

LEONARD SALTZ: So if you told me that there was something that gave a 72-day survival benefit, but it makes people feel nauseous for most of the time, is that worth it?

MOLLY: 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.

SUSAN GUBAR: Yeah, I don't think we know what ...

MOLLY: For Susan, you know, six years ago she decided that she was gonna get chemotherapy because in part it would be more time with her daughters.

SUSAN GUBAR: Yeah.

MOLLY: And suddenly it's worth it.

SUSAN GUBAR: Yeah, but I think we're changed by the treatment too.

MOLLY: For now, Susan's cancer is basically under control because she's on this new drug.

SUSAN GUBAR: For two -- two years and now a month, and I am counting.

MOLLY: Okay.

SUSAN GUBAR: 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 the last few years remarkably normal-like. The new normal.

MOLLY: Yeah.

SUSAN GUBAR: 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.

JAD: Producer Molly Webster.

ROBERT: And now for the thank-yous for that piece. We want to thank Stephen Hall and just want to mention Susan Gubar's book called Memoir of A Debulked Woman.

JAD: And thanks also to Dr. Atul Gawande for all his help and his latest book.

ROBERT: Which is really -- I really thought it was wonderful. It's called Being Mortal.

JAD: Yeah. And thanks also to Nikki Haines.

ROBERT: And to Glenn Blumquist.

JAD: Radiolab will continue in a moment.

[ANSWERING MACHINE: You have two new messages. Message one.]

[SUSAN GUBAR: Hi, this is Susan Gubar.]

[BRUCE MOHL: Hi, this is Bruce Mohl.]

[SUSAN GUBAR: Attempting to read what you sent to me.]

[BRUCE MOHL: Here goes. Radiolab is supported in part by the Alfred P. Sloan Foundation.]

[SUSAN GUBAR: Enhancing public understanding of science and technology in the modern world.]

[BRUCE MOHL: More information about Sloan at www.sloan.org.]

[SUSAN GUBAR: Radiolab is produced by WNYC.]

[BRUCE MOHL: And distributed by NPR.]

[ANSWERING MACHINE: End of message.]

JAD: Three, two, one. Hey, I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich.

JAD: This is Radiolab. And today ...

ROBERT: Well, we're still on the subject of worth, but this is a totally different take.

JAD: Yeah, and this is comes from our producer Matt Kielty.

MATT KIELTY: So 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.

GREGORY JOHNSEN: Right.

MATT: And it starts with BuzzFeed writer Gregory Johnsen.

JAD: So, okay, maybe you should start with what has now become sort of the infamous wedding -- wedding drone strike. Is that ...

GREGORY JOHNSEN: Right.

JAD: Was that sort of where it started for you?

GREGORY JOHNSEN: Yeah. So this strike happens in a very rugged part of Yemen where there are no paved roads, no electricity. There's no running water.

MATT: It's Thursday morning.

GREGORY JOHNSEN: December 12, 2013. And ...

MATT: Early that morning, in a small village ...

GREGORY JOHNSEN: .. a group of guys, roughly 50 to 60 people.

MATT: Including a soon-to-be-married man, pile into a bunch of cars and they started driving.

GREGORY JOHNSEN: This is the convoy. The wedding convoy.

MATT: Now in the lead car of this convoy was this man.

[ABDULLAH MOHAMMED AL-TISI: speaking Arabic]

MATT: His name is Abdullah Mohammed al-Tisi. We spoke to him through an interpreter in Yemen. And 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 a little before noon, ate lunch, recited wedding poems.

GREGORY JOHNSEN: After lunch ...

MATT: They grabbed the bride ...

GREGORY JOHNSEN: And just a few of her bridal attendants, a few females.

MATT: And they start driving back to the groom's village for the actual wedding ceremony. Now Abdullah said that ever since they'd left that morning, through lunch, all day long, they heard this humming.

GREGORY JOHNSEN: This sort of metallic whirring, this metallic thumping overhead.

MATT: No one in the convoy could see it, but they knew what it was. A drone.

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: Some sound we'd been hearing all day.

GREGORY JOHNSEN: It's nothing new for people in rural parts of Yemen. By this point, they don't think anything of it.

MATT: It's common to hear those sounds.

ABDULLAH MOHAMMED AL-TISI: Yeah, it's usually heard there.

MATT: So they keep driving.

GREGORY JOHNSEN: Basically if you can imagine it, they're sort of winding through these wadis, these desert mountainous places.

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: The road, he said is mountainous.

GREGORY JOHNSEN: They're all strung out on this rutted-out little dirt track.

MATT: 11 cars, single-file.

GREGORY JOHNSEN: Finally they reach this little clearing.

MATT: Up near the top of this cliff where they all slowed down and started to bunch together because apparently one of the cars had gotten a flat. Some guys got out, fixed it, got back in their cars. And right at that moment ...

GREGORY JOHNSEN: The sound shifts somehow, and then the missiles start.

MATT: Four of them ...

GREGORY JOHNSEN: In quick succession. The shrapnel is just flying everywhere.

MATT: In a blink it's over.

GREGORY JOHNSEN: People are trying to figure out what has happened. All the screaming. There's fires that are burning.

MATT: And Abdullah his car was torn up. He had shrapnel in his face.

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: Two ones in his face. One in the right hand, left thigh. One on -- in the back.

GREGORY JOHNSEN: And he says that once he saw there was smoke, his first thought was, "Where's my son?"

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: He was -- he was looking for his son.

MATT: His son was there?

GREGORY JOHNSEN: Yeah. A young man who'd been a few cars back from them.

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: The fourth car on the convey. And he was married with two boys and one daughter.

GREGORY JOHNSEN: Abdullah said he could move, so he got out of his car and stumbled back toward the fourth car to find his son.

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: Yeah, he said he found him just next to the car. Before just he died. No, he didn't talk to him. Just he looked at him and just passed away.

GREGORY JOHNSEN: So it turns out that there are 12 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 Radaa.

MATT: This big town near where the drone strike occurred.

GREGORY JOHNSEN: There's a video I have ...

MATT: That's what you're hearing. Where you see some men take these 12 dead bodies ...

GREGORY JOHNSEN: 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.

MATT: And at a certain point ...

GREGORY JOHNSEN: This very tiny, very leathery old Yemeni who's sort of holding onto the back of a pickup with one arm.

MATT: He stands over the dead.

GREGORY JOHNSEN: 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?"

JAD: Why did they target this -- this convoy?

MATT: Well, according to the US government they had received intel that on that day in this convoy was an Al-Qaeda operative ...

GREGORY JOHNSEN: Named Shawqi al-Badani.

MATT: Who apparently had been planning attacks against the US.

GREGORY JOHNSEN: That's why they took the shot. And in fact, they say that he was wounded in this -- in this wedding convoy strike.

ROBERT: And do we have any reason to believe that?

GREGORY JOHNSEN: I have no reason to believe it.

MATT: Greg spent weeks in Yemen, talked to survivors of the drone strike.

GREGORY JOHNSEN: Talked to people who were there. No one knows this guy.

MATT: Greg says the guy isn't really a member of either of the tribes that were involved in the wedding. And so to him ...

GREGORY JOHNSEN: It makes no sense that he would be there.

MATT: To him, this was a terrible mistake. But what really got me interested in Greg's reporting, which you can read on Buzzfeed.com, highly recommend it, is that he goes really deep into the question of like, what the U.S. did next. 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 to try to make this right?

JAD: I don't think you can, can you?

ROBERT: No.

JAD: I mean, historically do soldiers have an obligation to repair the damage they do?

MATT: No, there's no obligation. But what's happened is we've actually created an obligation for ourselves.

ROBERT: Hmm. Americans have?

MATT: Yeah. Yeah. This has a really long history. A history that's ...

JAD: You mean a legal -- legally?

MATT: Yeah, yeah, yeah. A legal history.

ROBERT: Really?

GREGORY JOHNSEN: And there's a -- there's a great law professor at Yale.

JAD: What's His name?

GREGORY JOHNSEN: His last name is Witt. It's John Witt.

JOHN WITT: That's me.

MATT: We ended up tracking down John Witt.

JOHN WITT: Hi, Jad. How are you?

MATT: To talk about how the US first started to try to right the wrongs in war.

ROBERT: So what is the foundation story of all this?

JOHN WITT: That starts with General Pershing and World War I.

MATT: So, 1917 ...

[NEWS CLIP: America is called to arms.]

MATT: The Great War ramps up. So we start shipping young men ...

[NEWS CLIP: Thousands of them. And millions more to follow.]

MATT: Over to Europe, specifically France. And in charge of these men was a man named John J. ...

[NEWS CLIP: Pershing!]

JOHN WITT: Commander of American forces on the Western Front.

MATT: Stern man, handsome mustache. Bit of a maverick.

JOHN WITT: General Pershing's nickname was Blackjack. And ...

MATT: When he first arrives in France with his troops, General Blackjack Pershing ...

JOHN WITT: He's got this problem, which is that he has Jeeps.

[NEWS CLIP: Built in America, shipped to France, and manned by our men.]

GREGORY JOHNSEN: So World War I is the first war in which the U.S. is shipping a lot of automobiles.

JOHN WITT: More than 100,000.

MATT: For the soldiers to drive. Cars, trucks, Jeeps.

JOHN WITT: And Jeeps are really great. They get his men from one place to another.

MATT: From Paris to Orléans to, I don't know, Marseilles.

JOHN WITT: But they also run into French farmers' chickens and cows. Children. Sometimes just the farmers themselves.

MATT: Were these random collisions or were there no roads?

JOHN WITT: I'm gonna bet there was some of everything. Sometimes it was probably just ordinary car accidents, and sometimes no doubt a little French wine was involved.

MATT: So this is Pershing's problem. He's trying to run a war overseas ...

JOHN WITT: And it wasn't any good for him to have grumpy civilians at his rear.

MATT: And so Pershing has an idea, which he actually borrows from the Brits. And that is he will use ...

JOHN WITT: Cash.

MATT: Money to right our wrongs.

JOHN WITT: 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.

MATT: 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 U.S. government starts systematically paying money for the loss of a non-American life in war.

JAD: How much?

JOHN WITT: Jeez, I don't know.

MATT: It's actually surprisingly hard to find documentation mentioning specific amounts. But whatever the amounts were, it seems to have worked. Pershing wrote in his biography that these swift and prompt settlement of claims had a great effect upon the people. So it seemed to work really well.

JAD: And is this -- I mean, is the idea here that, like, this is what we would do with the drone strike victims we talked about? That we'd pay them money?

MATT: Well, it's actually -- it's a bit trickier than that, because the thing that Pershing got in World War I, it came with a catch.

GREGORY JOHNSEN: And that is that there's a combat exclusion.

MATT: In case you just walked in, that's Gregory Johnsen. And what he means is that this law, basically what it said is that we'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 tough luck. That's just war.

GREGORY JOHNSEN: So if U.S. soldiers were driving to a fight and they ran their car into somebody and they damage that car, 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.

MATT: But the problem is, once we get into these counterinsurgency wars.

JOHN WITT: Civilians are suddenly in the middle of the fray.

[NEWS CLIP: Charges have been made that troops killed as many as 567 South Vietnamese civilians during a sweep ...]

MATT: This is in a way the story of modern warfare.

[NEWS CLIP: Air raid sirens are beginning to sound over Baghdad.]

[NEWS CLIP: President Karzai says he's delivering his final warning to the U.S. after a U.S. airstrike accidentally killed more than a dozen mothers and children.]

MATT: 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 blurry.

MARLA KEENAN: And so in 2003 in Iraq, what happened was there were actually people lining up. You know, there were civilian military operation centers, people started lining up outside of these saying, "My family has been harmed. I want help."

MATT: How many people? Do you remember?

JOHN TRACY: If I had to guess it was, you know, maybe around 80 people or so.

MATT: That's a ton of people.

JOHN TRACY: Yeah.

MATT: That's John Tracy. He was a military lawyer in Iraq in 2003, and before him Marla Keenan.

MARLA KEENAN: I'm Managing Director of Center for Civilians in Conflict.

ROBERT: So when they came with a complaint, what sort? Is it like, "You ran over my chicken, or you knocked out my window?"

MARLA KEENAN: No. No, no, no. much more serious.

JOHN TRACY: I mean, I think of cluster bombs. During the Shock and Awe campaign one of the types of bombs that we were using, or the Air Force was using, were what they call cluster munitions.

MATT: Basically John says, Air Force planes would fly over these targets and drop hundreds and hundreds of these tiny little ...

JOHN TRACY: ... bombs. Smaller than a Coke can.

MATT: And a lot of them would land in maybe a parking lot or a field. And they wouldn't explode.

JOHN TRACY: So on a number of occasions you'd have -- mostly it was kids, right? Because the kids would see it and ...

MATT: They didn't know any better.

JOHN TRACY: ... they would just run over and kick it, and then that's when it would explode.

MATT: That's when it would detonate.

JOHN TRACY: Right.

MATT: Huh.

JOHN TRACY: I had a lot of those. Close to a dozen. And so that was a -- that was a difficult one because well, it's combat because the Air Force dropped it because they were, you know, bombing the city.

MATT: Right.

JOHN TRACY: 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?

MATT: And this was a real question that John had to ask his boss. And then his boss asked his boss.

JOHN TRACY: They eventually sent the question up to the Army Claim Service, and they said, "No. It's combat."

MATT: Meaning they're not gonna pay.

MARLA KEENAN: 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.

JOHN TRACY: So I said no to a lot of people.

MATT: And so like in World War I 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.

RICHARD GROSS: Brigadier General Richard C. Gross. I go by Rich. I'm the legal counsel to the Chairman of the Joint Chiefs of Staff.

MATT: And he told me that around 2006, paying out these kinds of condolence payments actually became sort of a key part of military strategy.

RICHARD GROSS: Absolutely.

MATT: Even had its own acronym.

RICHARD GROSS: MAAWS. M-A-A-W-S. It's Money As A Weapons System which, you know, I'm not sure that title resonates with everybody, but ...

MATT: Interesting phrase, for sure.

RICHARD GROSS: Yeah, exactly. But it's the idea that money can be used to -- to win hearts and minds that help bring the population over.

MATT: And it just got me wondering how much money makes a good weapon?

MARLA KEENAN: Well, I haven't -- like, the U.S. military hasn't given me access to a database or anything like that, but through FOIAs and interviews I've seen different numbers.

MATT: Marla says that in 2006, 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 ...

MARLA KEENAN: $2,500.

JOHN TRACY: $2,500 by and large.

MATT: Now someone like John could have paid more, but that meant they'd have to run the claim up the chain of command.

JOHN TRACY: Exactly.

MATT: So it was almost like there were these ceilings.

JOHN TRACY: $2,500 for a life. $1,500 for property damage. And then eventually, the property damage amount got raised to $2,500 as well. And 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 gonna get the same amount for a lost life.

MATT: Like, I can't get over -- I mean, $2,500 seems like just such a nominal amount. And the practicality of that money of, like, if you were to kill someone who is the -- the breadwinner of a family, that $2,500 would not be able to support this family in any way.

MARLA KEENAN: Right. But we're not actually trying to pay full compensation, right? Like, we're not trying to say, "We think if this 20-year-old man had lived to be the average age in Afghanistan, that he -- you know, that it would have been $60,843, right? Like, that's not the thing.

ROBERT: Do you ever -- you know, we had people who were killed here in an attack.

[NEWS CLIP: The federal government is one step closer to cutting its first checks to families of those killed and injured on September 11th.]

ROBERT: And those people have been compensated.

MARLA KEENAN: Mm-hmm.

ROBERT: The levels of compensation to the New York victims is pretty high.

[NEWS CLIP: The range of payments for a death claim ranged anywhere from $250,000 to just under $7-million.]

ROBERT: Do you notice that?

MARLA KEENAN: I do. I do. But ...

RICHARD GROSS: It is to a large degree comparing apples and oranges.

MATT: That's General Gross again.

RICHARD GROSS: Because you're talking about a legal system ...

MARLA KEENAN: Where a country is paying their own victims ...

RICHARD GROSS: Versus condolences in an area where there's no legal obligation to make those payments in the first place.

MARLA KEENAN: So that's a very different type of monetary payment.

MATT: Well, yes, and no. Essentially, it's a person's life. And ...

MARLA KEENAN: Yeah.

MATT: I mean, I think there's an argument to be made that there's an empathy in the number that you come up with, in the amount that you pay for someone's life.

MARLA KEENAN: I totally get what you're saying. The $2,500, I think it's any amount of money. If I told you $10,000, would you feel better about it?

MATT: I'd feel a little bit better.

MARLA KEENAN: You would?

MATT: I think so. $10,000?

MARLA KEENAN: What does it get you, though? In the end, $10,000 doesn't buy anything more back than what you lost.

MATT: I don't know what $10,000 gets you exactly in Afghanistan, but my assumption is that it gets you a lot more than $2,500.

MARLA KEENAN: But does that really help you? Is that really what you want?

ROBERT: Is the money unimportant to you, really? It sounds like the money's really ...

MARLA KEENAN: I'm not a victim, so I don't know that I can answer that. To me, if it happened ...

MATT: And at this point, Marla told us a story about how before she got into this line of work ...

MARLA KEENAN: I had several friends who are journalists.

MATT: One of those friends was a man named Chris Hondros.

MARLA KEENAN: Yeah, he's a photojournalist. He was a photojournalist.

MATT: And back in 2011, Chris was on assignment in Libya, moving with a rebel group when they were fired upon. And Chris was killed.

MARLA KEENAN: Yeah.

MATT: And Marla says when she found out that happened ...

MARLA KEENAN: I wanted someone to explain to me why that happened. I mean, I just wanted someone to explain. I didn't -- you know, like, I knew his family wasn't gonna get any money. I knew that these guys that shot a rocket-propelled grenade at him weren't gonna care. No one was gonna explain. But I wanted that.

ROBERT: And the money then becomes an occasion for you say like, not just, "I'm sorry," but, "Here's what happened?" It's the "here's what happened" part?

MARLA KEENAN: I think it's the token that's given with the apology and with the explanation.

ROBERT: But it's the apology and the explanation that matter to you.

MARLA KEENAN: Yeah, that's why we call it amends. Making amends.

JOHN WITT: One of the things that is true of money damages generally, is they're -- they're our desperate effort to find some common language between the party paying and the -- and the victim. Some Esperanto for communicating the meaning of what's happened in a language that the other side knows matters.

MATT: That's how John Witt puts it.

JOHN WITT: Because 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.

MATT: But the problem is, in order for that Esperanto to work, it has to say the same meaning to both sides. Which for John Tracy wasn't really about the money at all. Or not just about the money. It was as much about the envelope that the money was in. Or that there was a real person there to hand it to them.

JOHN TRACY: I wasn't the one who raided their house. I wasn't the one who killed their daughter, but most of them they -- you know, just wanted to look at somebody who's in a uniform and say you really messed with my life.

MATT: And that opportunity is exactly what Abdullah Al-Tisi will 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, which in the end he says was the equivalent of $30,000 U.S., way more than anyone got in Iraq or Afghanistan. Still, all he can do without anything else to go on is just compare amounts.

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: Oh, he can accept that only if -- if he gets, you know, the payment equal to those, you know -- to like in America. How you compensate someone who lost his son, for example. Killed.

MATT: If the payment was -- if the payment was equal.

ABDULLAH MOHAMMED AL-TISI'S INTERPRETER: Yeah.

JAD: Producer Matthew Kielty.

ROBERT: Big thanks to Gregory Johnsen, writer-at-large for BuzzFeed who started us off on this adventure when he brought us the initial story.

JAD: And also thanks to BuzzFeed editor Steve Kandell.

ROBERT: And to Shahib Al-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.

JAD: Yeah, absolutely. Thank you to him. Coming up? Bzzzzz ...

ROBERT: Bzzzzz ...

JAD: That's next.

[ANSWERING MACHINE: Start of message.]

[GREGORY JOHNSEN: Hi, this is Gregory Johnsen.]

[MARLA KEENAN: Hey, this is Marla Keenan.]

[JOHN WITT: Hi, this is John Witt.]

[JOHN TRACY: This is Jonathan Tracy.]

[GREGORY JOHNSEN: Radiolab is supported in part ...]

[MARLA KEENAN: ... by the Alfred P. Sloan Foundation.]

[JOHN WITT: Enhancing public understanding of science and technology in the modern world.]

[GREGORY JOHNSEN: More information about Sloan at www.sloan.org]

[ANSWERING MACHINE: End of message.]

CARL ZIMMER: Okay, now it's my left ear. Hello, Soren how are you?

SOREN WHEELER: Good. How you doing?

CARL ZIMMER: I'm good.

JAD: Hey, I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich.

JAD: This is Radiolab. And so far, we've been talking about the value of our lives ...

ROBERT: And then the value of other people's lives.

JAD: Next up? The value of ...

ROBERT: Everything.

JAD: All of it.

ROBERT: Everything.

JAD: Ev-ery-thing. And by everything, of course we mean ...

CARL ZIMMER: The value of nature.

JAD: That's Carl Zimmer. Science writer, regular blower of minds.

CARL ZIMMER: So we think 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.

JAD: Hmm.

CARL ZIMMER: So you know, the farmers are doing their thing.

JAD: Like this guy.

JAMES PARKER: James Parker.

CARL ZIMMER: Planting their cotton. They're collecting it.

JAMES PARKER: I farm about, I don't know, usually five to six, seven hundred acres of cotton. So say 2,000 bales.

CARL ZIMMER: They're doing what farmers do.

JAMES PARKER: I spend a lot of time on a tractor. And you have to check your water every morning, every evening.

CARL ZIMMER: Meanwhile, they have all this extra help in the air.

JAMES PARKER: Yes.

CARL ZIMMER: They have bats.

JAMES PARKER: How many bats are out there? You really don't know.

CARL ZIMMER: Flying all around. The bats eat the equivalent of two-thirds of their own weight in insects every night.

JAD: Wow.

JAMES PARKER: They eat all night long, all kind of bugs.

CARL ZIMMER: A whole bunch of pests that would otherwise be eating the cotton.

ROBERT: Now, a few years ago ...

JAMES PARKER: A guy named John Westfall ...

CARL ZIMMER: Did a calculation.

ROBERT: Just to see how this arrangement was working out.

JAMES PARKER: 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 ...

CARL ZIMMER: Each year the farmers collectively, they make about $4- or $5-million off of these farms.

ROBERT: The question was, how much of this was because of the bats? Because, you know, bats are natural pesticides.

JAMES PARKER: You know, the more they're eating the less I got to spray.

ROBERT: And here's what the scientists figured out.

CARL ZIMMER: Out of $4- to $5-million, it was around $700,000 that you could ascribe to the bats.

JAMES PARKER: It's just beautiful.

JAD: Wow! I mean, it does make me think that if you're those farmers, you should be compensating the bats somehow.

JAMES PARKER: [laughs]

CARL ZIMMER: Yeah. Well, yeah. It does give you a glimpse at the kind of scale of value, economic value that nature has that we generally just totally ignore.

JAD: But we talked to a guy who didn't ignore it.

ROBERT COSTANZA: My name is Robert Costanza.

ROBERT: In fact, he took this way of thinking to the absolute limit.

ROBERT COSTANZA: Yes. So the question was, what's the value of all of these ecosystem services globally?

CARL ZIMMER: All the services on earth.

JAD: Yeah, it's bugs eating leaves.

ROBERT: Worms turning the soil.

JAD: Beetles chewing tree stumps.

ROBERT: Coral reefs protecting cities during storms.

JAD: Everything.

ROBERT COSTANZA: We tried to synthesize all of the studies that had been done around the country and the world.

JAD: Like that bat study, except they didn't just look at cotton farms, they looked at ...

CARL ZIMMER: Tropical forests, rivers and lakes, coral reefs, coastal wetlands, inland wetlands, the ocean, woodlands, temperate forests ...

ROBERT COSTANZA: You know, it goes on and on.

CARL ZIMMER: ... grasslands ...

JAD: This must be some Excel spreadsheet.

CARL ZIMMER: It's kind of the Excel spreadsheet from hell.

ROBERT COSTANZA: It can get tricky.

ROBERT: 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.

CARL ZIMMER: Which in today's dollars is $142.7-trillion per year of services. That's more than all of the gross national products of the world. And that's how valuable the services of nature are.

JAD: Yeah. Let me ask you, like I get -- I get the way this would work with a bat. Like, the bats eating the bugs. But like, how do you do it with, like -- with, like, a -- like, a field or something? Like, do you just walk through and you're like, "Oh, that's 20 bucks of services. That's 50." Like, how do you even figure out what the services are?

CARL ZIMMER: Well, 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.

SIMON ADLER: And we are in the water now.

ADAM WHELCHEL: We're in the water.

JAD: What is it? Wait, a salt marsh is it like the Florida Wetlands but salty? I suddenly don't know what a salt marsh is.

CARL ZIMMER: Salt marshes are wetlands that are on the coast.

JAD: Got it.

ADAM WHELCHEL: Yep. We're standing in about a foot of water here. We are quickly approaching high tide.

ROBERT: We sent one of our producers, Simon Adler, to a nearby salt marsh.

JAD: Partially to haze him.

SIMON: Your boots are much more waterproof than mine.

ADAM WHELCHEL: Yeah, yeah.

ROBERT: But really, to talk to this guy.

ADAM WHELCHEL: My name is Adam Whelchel, and I'm the Director of Science for The Nature Conservancy here in Connecticut.

ROBERT: And Adam gave Simon a kind of inventory of ...

ADAM WHELCHEL: Some of the services provided by coastal salt marshes. It's a stream of goods and services that have been provided over time.

SIMON: One of the things that does is it takes water that's coming in from inland and that's laden with all sorts of pollutants, all sorts of bad stuff.

JAD: The salt marsh will trap that water so that the pollutants settle, and then very often the marsh grass will suck up that water into the roots ...

SIMON: And clean it up.

ADAM WHELCHEL: Yup.

ROBERT: So you could ask, very simply ...

SIMON: How much would you have to spend to keep your water that clean?

ADAM WHELCHEL: Well, there is one other study ...

JAD: Adam Whelchel said that scientists in New England have already figured that out.

ADAM WHELCHEL: For flood control, water supply protection, pollution control, it's roughly about $31.22 per hectare per year.

ROBERT: Then you got to add the value of all the plants that feed the fish that end up on our dinner plates.

ADAM WHELCHEL: $338 annually per acre.

JAD: Then there are the birdwatchers that buy lattes that support the local economy.

ADAM WHELCHEL: $490 per hectare.

JAD: And then there's habitat provisioning.

ROBERT: The list goes on and on and on and on.

SIMON: You do get kind of obsessed with it. You 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.

TIM HOWARD: There's this galling element though, or this aspect. Like, when I first came across ...

JAD: At this point, our producer Tim Howard jumped into the interview. And you'll also hear our producer Soren Wheeler in just a second.

TIM: 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?

JAD: 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 -- should be preserved for its 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.

TIM: But it does still feel like demotes something of infinite value to something of a piddly value.

SOREN: Well, it can't really be infinite value. I mean ...

TIM: Well, like a mother's love. You don't think your mother's love is priceless? I mean -- you know?

SIMON: Okay, I totally accept that there is this sort of priceless aspect of nature. But 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, okay, 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.

JAD: Because shrimp farms need lots of sea water, so it makes sense to put them by the sea.

SIMON: We're gonna put in these farms, we're gonna grow shrimp. You are gonna get millions and millions of dollars in tax revenue. If you're thinking about the -- the welfare of all the people in your country, many 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 to wantonly replace lots of mangroves with shrimp aquaculture.

JAD: Is that a hypothetical situation?

GLENN-MARIE LANGE: No, no. That's what we're asked.

ROBERT: This is Glenn-Marie Lange. She's an environmental economist for the World Bank. and she says very often she finds herself in exactly this kind of conversation.

GLENN-MARIE LANGE: Particularly, you know, I work for the World Bank, so our primary clients are governments.

JAD: Philippines, Vietnam.

GLENN-MARIE LANGE: And when you're talking to a Minister of Finance and saying, "You know what? You really should ...

JAD: I know jobs are jobs, but you need those marshes. They have value.

GLENN-MARIE LANGE: They'll say, "Well yeah, that's true. But that means I'm gonna 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.

DOUG MCCAULEY: Well, I mean, that's it ...

ROBERT: Here's the counter-argument. It comes from Doug McCauley, an ecologist at the University of California, Santa Barbara.

DOUG MCCAULEY: 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.

JAD: What do you do in a situation he says where, say, a bunch of rivers are running dry, and they're quote "depreciating in value?"

DOUG MCCAULEY: You know, by the same logic that you trained me to think with, we should go out and liquidate these natural assets. That makes me feel really uncomfortable.

ROBERT: He says it's just kind of a weird way to think about nature.

DOUG MCCAULEY: We had a proposal here in the state of California to make gay marriage legal. And economists had a look at this legislation and said, "This is expected to generate $163-million 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 gonna make a $160-million for the state. They're thinking about a different set of values.

GLENN-MARIE LANGE: On the other hand, I want to say -- and this is based on my experience working in developing countries, that when you don't put a value on these services, basically they don't get counted.

JAD: They get implicitly assigned a value of zero, according to Glenn-Marie Lange. And as we were debating this and going back and forth and back and forth, we 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.

J.B. MACKINNON: The parable of the bees ...

ROBERT: We heard this first from writer J.B. MacKinnon, who says the story begins ...

J.B. MACKINNON: In Mao County in central China. Rural area, fairly remote.

ROBERT: Lush green mountains filled with apple orchards.

J.B. MACKINNON: And apple orcharding was the main business.

ROBERT: And according to J.B., in the 1990s ...

J.B. MACKINNON: The wild bees of Mao County slowly started to disappear. And there was 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.

ROBERT: But the prevailing theory is actually an economic one, because in the 1990s as China was shifting to a market-based economy, apple producers were under pressure to produce more apples. So they started spraying pesticide.

J.B. MACKINNON: Probably it was a constellation of all of those things and a few others. End result is, the bees stopped buzzing in Mao County.

ROBERT: Which if you are an apple farmer, that's a disaster.

J.B. MACKINNON: As bees travel from flower to flower and search of nectar, they are -- 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 -- then you don't get fertile flowers to turn into -- to turn into fruit.

ROBERT: And obviously, if you're a fruit farmer and you have no fruit to sell, you have no income.

JAD: So what do you do?

J.B. MACKINNON: 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.

HAROLD THIBAULT: In Mandarin Chinese, we say Réngōng shòufěn. So it basically that means a manual pollination.

ROBERT: This is Harold Thibault.

HAROLD THIBAULT: I'm a correspondent in China for the French newspaper Le Monde.

ROBERT: 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 the car, and ...

HAROLD THIBAULT: We drive for like five or six hours until we reach this village Nanshin.

ROBERT: Tiny little village.

HAROLD THIBAULT: It's like only a few houses. And then we took a smaller road in between the fields. And we actually saw that there were lots of farmers in the -- in the trees, like on the apple trees.

J.B. MACKINNON: Straddling up on these often thin and spindly branches, men and women that I've seen in photos in any case.

ROBERT: Harold and his friend took pictures, and if you look at those pictures, you'll see the farmers holding a little brush.

J.B. MACKINNON: This little pollen brush that they'd constructed using things like chopsticks and chicken feathers and cigarette filters.

ROBERT: And they'd have a little bottle filled with pollen. And then what they'd do, they'd dip the brush into the bottle and they'd paint a flower blossom with the pollen. They dip their brush back into the pollen and they'd paint the next flower blossom again. And they'd dip the brush back in again and they'd paint again and they'd dip again and they'd paint again ...

J.B. MACKINNON: To make sure that -- that all of the blossoms that they could possibly fertilize would be fertilized so that they would go on to produce fruit.

ROBERT: We're talking hundreds and hundreds of flowers per tree.

HAROLD THIBAULT: It was very strange to see humans doing the job of the bees.

JAD: God, what a pain in the ass that sounds like.

J.B. MACKINNON: Yeah, the image of this -- of these Chinese orchardists standing up in these spindly trees traveled around the world through environmental circles. And 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 doing the job that the bees used to do on the wing.

ROBERT: For free.

J.B. MACKINNON: For free.

YUNZHONG CHEN: Those people were just like human bees.

JAD: But then this guy enters the story. This is Yunzhong Chen.

YUNZHONG CHEN: Yeah, human bees.

JAD: Four years ago, he traveled to Mao County to do a sort of economic analysis of just how much the loss of the bees was hurting the farmers of Mao County. But what he discovered weirdly was that the trees were producing more apples than ever.

YUNZHONG CHEN: More production, more production. This can be confirmed. There are more production for hand-pollination apple trees than bee-pollination apple trees. Humans are more efficient.

JAD: Really?

ROBERT: You mean that people were doing it better than the bees had been doing it?

YUNZHONG CHEN: Yes.

JAD: A lot better.

J.B. MACKINNON: Fruit production went up 30 percent.

ROBERT: That's what the farmers told Yunzhong Chen, which is kind of ...

YUNZHONG CHEN: Amazing. The only word I remember. Amazing. Because I think hand pollination can pollinate more thoroughly. They can pollinate every flower.

JAD: And bees don't pollinate every flower?

J.B. MACKINNON: Bees are a little bit -- you know, they're a little bit uneven when it comes to pollinating.

ROBERT: [laughs] You're so polite!

J.B. MACKINNON: They don't like it if its cold. They don't like it if it's damp. They don't like it if it's windy.

ROBERT: In all those cases, bees often decide to stay indoors and just take the day off.

J.B. MACKINNON: But send people out there and tell them to pollinate every damn blossom and they're gonna do it. And there was the additional benefit of the people that you paid, they'd go to the bar, they'd buy groceries, they'd spend those earnings in their local communities in a way that obviously bees never did.

JAD: So here you had this whole story that was supposed to be about how important the bees are. You know, this whole parable of biodiversity.

ROBERT: And it turns out maybe the lesson's just the opposite, that actually we don't need bees. And maybe we never did.

J.B. MACKINNON: If we only measure things economically, then we might conclude that -- that some species or some ecological processes just aren't necessary in certain places. Or that we might even do better to take care of those processes ourselves.

HAROLD THIBAULT: Right. So let me find my notes about the wages exactly.

JAD: But there's one more chapter to this story. Harold Thibault told us that when he visited Nanchen ...

HAROLD THIBAULT: I talked with one farmer. His name is Zhang Zago. He's 38. And he said in his opinion, the hand pollination might disappear in a few years.

ROBERT: Apparently, as China's economy has continued to grow, workers have started demanding better pay.

HAROLD THIBAULT: The wages are getting so high for the workers that the farmers have to employ to help them. Basically, it's not efficient economically to do the hand pollination anymore. That's what's a lot of farmers say.

JAD: Now they're likely thinking, "Damn! We need those bees back!"

HAROLD THIBAULT: Right. Yeah.

ROBERT: Problem is ...

HAROLD THIBAULT: There are no bees there in those villages anymore.

ROBERT: One farmer told Harold beekeepers in other parts of China aren't gonna bring their bees to this area because they worry about the pesticides that the farmers have used. And as for when wild bees might come back?

HAROLD THIBAULT: Well, for this we have no idea. It's very hard to make a prediction. If you ask the farmers, they're like we'll put it out. I don't know.

ROBERT: Here's where that story leaves me. It leaves me thinking that economics is just not a good way to go. Putting a value, even a -- even a precise and thoughtful value on a bee or on a pound of pesticide, you do it and you think you're smart. But then the value changes and the bees go from being worth a lot to being worth nothing to be worth everything all within a few years. This -- this is what markets do. They swing back, forth. And we pretend that we can predict, but we never can. So you can't put a value on -- because you're always gonna be wrong. That's why economics is a dumb ...

JAD: Well, no, no, no. I'm gonna argue the other side for a second. Nowhere in this story did someone walk into the middle of the proceedings and say, "You know what? The bees do have value, here's the number." In fact, you know what? Carl, when we were talking to him told us ...

CARL ZIMMER: You know, there have been estimates that the value of the pollination that comes from wild bees is $190-billion.

JAD: So that's globally, right? But still, there was nobody in the room giving that kind of number. So the bees were inherently valued at zero.

ROBERT: But remember, bees are valued at zero only until humans get valued more, then bees go down, bees go up. You have to have a lot of numbers in your head.

JAD: I get it. I get it. But here's what I like about this idea, is that when you put a number on a bee or a bat or a marsh, it's like an attempt to force a kind of long-term thinking. You can't just say, "Don't do that." I mean, that's the thing that, like, conservationists say. "Don't, don't, don't." But if you say, "Don't do that because here's the value."

ROBERT: "Here's the loss."

JAD: Yeah, here's the loss. Well, then that actually gives the whole precautionary don't thing some teeth.

ROBERT: Except for this. That if you go business-y on nature and you're wrong ...

GLENN-MARIE LANGE: There are irreversibilities.

ROBERT: That's how environmental economist Glenn-Marie Lange puts it.

GLENN-MARIE LANGE: This is one of the differences between nature ecosystems and what we produce. You smash your car? Hey, someone can build a new one. If you lose the bees, many instances you cannot bring them back.

JAD: So the question we got to is, is there another way to think about the value of nature? I mean, a way that's not economic and therefore short-sighted and all about us, but also not simply about the aesthetics and the beauty, because that can be sort of limiting too. Is there another way?

J.B. MACKINNON: The best I was able to do thinking about this ...

ROBERT: Writer J.B. MacKinnon again.

J.B. MACKINNON: Was when it struck me that -- that in a way, all of this diversity that's out there, all this biological diversity, all these wonderful and amazing and alien things that other species can do is like an extension of our own brains. There's so much imagination out there that we simply could not come up with on our own, that we can think of it as -- as a pool of imagination and creativity from which we as humans are able to draw. And that when we draw down on that -- on that pool of creativity and imagination, we deeply impoverish ourselves. You know, in a sense we are -- we are doing harm to our own ability to think and to dream.

ROBERT: J.B. MacKinnon's book is called The Once and Future World. He's written many, but this one is my fave.

JAD: Deep thanks to Carl Zimmer, whose reporting in the New York Times on this topic is really what got us launched into this whole thing.

ROBERT: And what got us through this whole thing is Simon Adler, whose production assistance was invaluable. That was him ...

JAD: Freezing his ass off in the marsh.

ROBERT: I talked so long he nearly died. His toes fell off, I think. Anyway, thank you, Simon.

JAD: Thank you, Simon. And thank you guys for listening. I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich.

JAD: We'll see you next time.

ANSWERING MACHINE: Start of message.]

[CARL ZIMMER: Hi. This is Carl Zimmer.]

[ROBERT COSTANZA: Hi, this is Robert Costanza.]

[HAROLD THIBAULT: Hi, Radiolab. This is Harold, the China correspondent for Le Monde, based in Shanghai.]

[GLENN-MARIE LANGE: Hi. This is Glenn-Marie Lange.]

[ADAM WHELCHEL: Hi, my name's Adam Whelchel. I'm calling in to read some credits.]

[HAROLD THIBAULT: So here we go.]

[CARL ZIMMER: Radiolab is produced by Jad Abumrad.]

[GLENN-MARIE LANGE: Our staff includes Ellen Horne ...]

[ADAM WHELCHEL: Soren Wheeler ...]

[GLENN-MARIE LANGE: Brenna Farrell ...]

[CARL ZIMMER: Molly Webster, Malissa O'Donnell, Dylan Keefe ...]

[ROBERT COSTANZA: Jamie York ...]

[GLENN-MARIE LANGE: Andy Mills ...]

[CARL ZIMMER: Kelsey Padgett ...]

[ADAM WHELCHEL: And Matt Kielty.]

[ROBERT COSTANZA: With help from Arianne Wack ...]

[ADAM WHELCHEL: Simon Alder -- Adler. Simon Adler.]

[GLENN-MARIE LANGE: Reem Abdou and Clare Toeniskoetter.]

[CARL ZIMMER: This episode was fact-checked by Michelle Soraka.]

[ADAM WHELCHEL: Special thanks to Rich -- oh, my goodness. Rich Di Meglio ...]

[HAROLD THIBAULT: Glenn Blumquist ...]

[GLENN-MARIE LANGE: Lily Sullivan ...]

[ROBERT COSTANZA: Shahib Al-Masawa ...]

[GLENN-MARIE LANGE: Grace Volckhausen ...]

[CARL ZIMMER: John Kim ...]

[GLENN-MARIE LANGE: Yara Al Moussawi ...]

[CARL ZIMMER: And Reprieve for expertise in Yemen.]

[ADAM WHELCHEL: Well, that's my best shot. Thank you. Bye.]

[ANSWERING MACHINE: End of message.]







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