Sunday, March 3, 2019

Sunday Reading

It’s About The Climate — Benjamin Wallace-Wells interviews Gov. Jay Inslee (D-WA) who wants to be the climate change president.

Last week, Jay Inslee, the Democratic governor of Washington, was in Washington, D.C., for a meeting of the National Governors Association, but he had additional business to conduct. Inslee, who is sixty-eight, was widely understood to be on the verge of announcing a campaign for the Democratic nomination for President. Earlier in the day, he told me, once we’d settled into a conference room at the downtown Embassy Suites, he had met with Barack Obama. The timing created a slightly ridiculous situation, in which Inslee would not formally acknowledge his candidacy but kept hinting at it heavily—mentioning, for example, that he might be in Iowa soon and raising his eyebrows meaningfully. A week later, on Friday morning, he announced that he was running.

Inslee, who is tall and athletic, has an eager and direct manner: his thoughts emerge in lists (“No. 4 is . . .”) and his mind moves toward details. And though he has not been a single-issue governor, the case for his Presidential candidacy rests on his decades-long interest in political solutions to climate change. The thought of Iowa made Inslee turn not to county dinners but to wind turbines. Had I heard there was a new generation of turbines coming? “They’re humongous,” he said, with appreciation. “Three hundred feet long.” He mentioned an alternative-energy entrepreneur he had recently met, a man named Wayne Rogers, who had made a fortune by turning decommissioned dams into hydropower stations. Now, Inslee said, he was working on a high-speed-train venture.

For all the obvious majesty of the subject, environmental politics has always had a slightly airless quality. Al Gore’s documentary “An Inconvenient Truth,” which, for years, was the central document of climate-change activism, is essentially a PowerPoint presentation. For a while, the public discussion of climate change seemed defined, in part, by Gore’s personality—his tendency toward abstraction but also his assurance with his own expertise. Such emphasis was placed on the distinction between Democrats, who were said to be on the side of the scientists, and Republicans, who were said to be opposed, that it came as a surprise when, last October, the Intergovernmental Panel on Climate Change released a report indicating that the scientists had somewhat underestimated just how bad the consequences of global warming would be. The discussion, Inslee said, focussed so much on the consequences of two degrees Celsius of warming that “it shut off discussion of ‘What if we get to four or five?’ ” Now scientists believe that we are on track, without further action, for four degrees of warming by century’s end.

Inslee has been in politics for a quarter century but has never become a national figure. As one of his aides, reached on the West Coast, put it, “he’s not a show horse,” and it took a moment to conceive of the unpretentious governor as a Presidential candidate. On the other hand, there are credible public-opinion polls in which Democratic voters in the early-primary states of New Hampshire, Iowa, Nevada, and South Carolina say that they care more about climate change and health care than any other issues. Inslee’s approach to climate policy, he told me, is “can-do, optimistic—it’s in my nature.” But in Washington, D.C., that approach, reminiscent of Gore, has, for the moment at least, been displaced by the millennial left’s, which is bleaker in tone and more transformative in program. For many years environmentalism has been shaped by technocratic liberalism’s trust in scientific expertise, and faith in the possibility of a global consensus. Now there is an unexpected situation. The climate is in crisis and liberalism is under pressure, at the same time.

Inslee grew up in the Seattle area, where his mother was a Sears-Roebuck clerk and his father was a high-school basketball coach who became the athletic director of the city’s public schools. After Inslee graduated from the Willamette University College of Law, he and his wife, Trudi, moved to the small town of Selah, near Yakima, where he practiced law and worked as a prosecutor, and they raised, as he often says, “three feral boys.” Inslee won a seat in the state legislature, in 1988, and Congress, in 1992—just in time to vote for the assault-weapons ban and lose his seat in the Gingrich revolution of 1994. Inslee and his family moved to the more progressive suburbs of Seattle, and soon he returned to Congress, where he served from 1999 to 2012, co-writing a book, “Apollo’s Fire,” about the potential of green energy.

Inslee, who became governor in 2013, tends toward the pragmatic, the longtime aide told me: “His instinct is to take the win when it is there.” He oversaw an increase in the minimum wage, extensions of family- and sick-leave policy, and the strengthening of environmental regulation and green investment, making Washington State more progressive by increments. Twice in the past three years, he has tried to persuade the state to adopt a relatively modest tax on carbon, once through the legislature and once by referendum; both efforts failed. In 2017, Inslee joined Andrew Cuomo, of New York, and Jerry Brown, of California, to create the U.S. Climate Alliance, a coalition of states that have pledged to adhere to the provisions of the Paris climate accord, even if the Trump Administration did not. Inslee argued that this was important, pointing out that the twenty-one states now in the Climate Alliance would form the third-largest economy in the world, were they to secede from the United States. “Which I am not advocating,” he said, grinning. “Yet.”

Inslee’s view is that the new urgency about climate policy was created by the “visual drama” of real events in people’s lives and on local news. “The reason is Paradise, California, burned down,” he said. “And Houston flooded with unprecedented rain and Miami is underwater and Iowa farmers can’t get their crops in because of precipitation events and Oprah’s house has been swamped by mudslides.” This past November, Inslee drove through Paradise, where the Camp Fire had killed at least eighty-five people. It was dark and silent. “We drove for an hour through a town that wasn’t there anymore, that had burned right to the foundations,” he said. You could look at the town and see the elements of a chemical equation: power lines were kindling; trees were incinerated; houses were reduced to ash. It had been a year of historic fires across the West, in hot and dry conditions intensified by the changing climate, and the Camp Fire was the worst in California’s history. “This is basically a race,” Inslee said. “That’s all it is. Who’s going to win, us or climate change?”

I asked Inslee whether Democrats might have adopted a more urgent tone earlier. After all, humans have done more to warm the planet since his first election to Congress than in all the years before. Inslee said that they had. He and Trudi, his wife, had recently discovered a brochure from his first congressional campaign, in a conservative part of Washington State, in 1992, that emphasized reducing carbon pollution. The crisis had turned out to be deeper than scientists realized even a decade ago, he said, but that’s “hardly our fault.” He thought a bit more. “I think we could have taken Ralph Nader out on a ship before he could file for President. And set the ship adrift. And allowed him to be fed and healthy before the filing deadline. That would have been the most significant thing where we missed our opportunity. I mean, really! You think about how different the world could have been for three hundred and fifty votes that Ralph Nader took out of Al Gore’s pocket. Every time I think about that it just drives me nuts.”

The momentous Presidential election of 2000 had other consequences, too, among them an era of extreme partisan polarization that has transformed most of American politics but especially the pragmatic center-left. By the end of the Bush era, Democrats were pushing cap-and-trade as a policy solution to carbon emissions, in part because it had support from moderate Republicans. But after John McCain backed away from the program, in the 2008 Presidential race, it lost its bipartisan veneer, and the next year, having already expended their political capital on the economic stimulus and the Affordable Care Act, Obama’s Democrats could not muster the support to pass a cap-and-trade bill on their own. The liberals had worked to make their policies pragmatic, but, when they lost the possibility of Republican coöperation, this approach seemed not mature but naïve. In the course of Inslee’s career, the defining Democratic tone has grown more prophetic: Bill Clinton, and then Gore, and then Obama, and then Elizabeth Warren, and then (after a brief return to Clintonism) Bernie Sanders, and then Alexandria Ocasio-Cortez.

Inslee praised the young climate activists who have coalesced around the Green New Deal for their energy and their emphasis on communities, often poor and of color, that are on the front lines of climate change. It was true, Inslee said, and it also might broaden the coalition. But he still seemed to envision that the movement would soon be turned over to the adults. “They’ve raised the ambition level. They’ve married this to environmental justice. Now it’s my job and others’ to put policy behind it.” He was sounding more pugilistic. On Monday, a few days after we met in Washington, D.C., Inslee announced that he supported abolishing the Senate filibuster. “I believe that the world is now moving at a pace that does not accommodate sort of antebellum traditions,” he said. It was also a signal, though he did not explicitly say it, that he was no longer sure that on the deepest issues consensus was possible.

Back in January, Inslee told NBC News that he is no longer pushing carbon pricing. “To actually get carbon savings, you have to jack the price up so high that it becomes politically untenable,” he said. Fair enough. (An especially clumsy effort to impose carbon taxes, last year, sparked the gilets jaunes protests still consuming French politics.) If not carbon pricing, I asked Inslee, then what?

“I’m not running for President yet,” he said, which was technically true, but he went on to describe the plan he envisioned laying out shortly. It would be ambitious “to the scale of what we need to achieve.” It would create jobs; it would also emphasize the experience of front-line communities. There was no silver bullet, he explained; it was more like “silver buckshot.” Carbon pricing, through cap-and-trade or a tax, might be a theoretically elegant mechanism, but, Inslee said, the money to invest in green industries and technologies could come from anywhere, including a reversal of the Trump tax cuts. “It’s just money,” he said. He mentioned new forms of topsoil that could capture carbon, Swiss and German sequestration innovations, and the progress already made in electric cars and trucks. “I could give you twenty-four policies right now,” he said, which made me notice, fleetingly, the exactness of that number.

Republicans have lately taken to deriding the Green New Deal as gassy and fantastical. They have forgotten about the liberals, who will soon be arriving with their tax offsets and their staggered phase-in calendars and their twenty-four-point plans. “The scale of this is appropriate to think about,” Inslee said, with relish. “We do have to build an economy that is not based in fossil fuels. It has to be the organizing principle of the federal government. We don’t like to use conflict or war as a metaphor, but it requires the mobilization of our system like we’ve experienced in times of war.” It made no sense, he said, for Democratic Presidential candidates to insist that we were in an existential crisis and then make addressing it their fourth priority. “A President needs to say, ‘We will create a mandate through the campaign, and I will invest my political capital to get this done,’ ” Inslee said. “This is not an easy lift.” Perhaps he envisioned the Presidential-primary debate stage as the place where he might make that case to voters; it seems, equally, the place where he might impress that urgency onto his fellow-candidates.

Inslee, sitting across a conference table from me at the Embassy Suites, was now fully in campaign mode. He mentioned the transcontinental railroad, and the mission to the moon, with an intensity that suggested that he really meant to rescue the conviction that Americans are an especially brave and competent people. “This is my grand theory of climate change,” Inslee said. “It is not about scientific literacy. It is about optimism versus pessimism, confidence versus fear. Climate denialism is based on fear that we can’t solve the problem, so just ignore it. Fear that we’re not smart enough to develop a new technology. And we’re promoting the opposite view, which is yes, we can solve this.”

Steps To Treating Dementia — Paula Span in The New York Times.

Donna Kaye Hill realized that her 80-year-old mother was faltering cognitively when her phone suddenly stopped working. When Ms. Hill called the phone company, “they told me she hadn’t paid her bill in three months.”

Finding other alarming evidence of memory gaps, she took her mother, Katie, to a memory clinic. A geriatrician there diagnosed dementia and recommended two prescription drugs and a dietary supplement, a form of vitamin E.

Katie Hill dutifully took vitamin E capsules, along with a host of other medications, until she died four years later. As she declined, her daughter didn’t think the vitamin, or the two prescription medications, was making much difference.

“But if it doesn’t hurt, if there’s a chance it helps even a tiny bit, why not?” she reasoned. Ms. Hill, 62, a retired public employee in Danville, Va., takes fish oil capsules daily herself, hoping they’ll help ward off the disease that killed her mother.

The elder Ms. Hill was unusual only in that a doctor had recommended the supplement; most older Americans are taking them without medical guidance. The Food and Drug Administration estimates that 80 percent of older adults rely on dietary supplements, many purporting to prevent or treat Alzheimer’s and other forms of dementia.

Last month, the F.D.A. cracked down on this burgeoning market, sending warning letters or advisories to 17 companies selling about 60 supplements with names like Cogni-Flex and Mind Ignite.

The warnings pointed out that the companies had touted these products as working like Alzheimer’s drugs, “but naturally and without side effects.” Or as “clinically shown to help diseases of the brain, such as Alzheimer’s.” The pills, oils and capsules were said to treat other diseases, too, from stroke to erectile dysfunction.

Claiming that these products were intended for “the cure, mitigation, treatment or prevention of disease” meant that they were drugs, the agency’s letters said.

And since they were drugs the F.D.A. had never reviewed or approved for safety and effectiveness, the companies now must submit applications for approval or stop making such claims. Over the past five years, the agency has taken action against 40 other products making Alzheimer’s claims.

The supplements’ appeal is understandable. A growing older population with longer life spans means more people with dementia, though in population-based studies in this and other Western countries, its prevalence has fallen.

More of us have seen the devastation up close and would do almost anything to evade it. But so far, the news about drugs and supplements has been discouraging.

Although scientists have learned much more about dementia, the research literature and large pharmaceutical trials have mostly served to tell worried Americans about the many substances that don’t appear to prevent, treat or slow dementia.

Vitamins, various antioxidants, concoctions derived from animals and plants — “we see plenty of ads on TV, but we have no evidence that any of these things are preventive,” said Dr. Steven DeKosky, a neurologist and deputy director of the McKnight Brain Institute at the University of Florida.

Dr. DeKosky led a federally supported study of Ginkgo biloba extract, for instance, following more than 3,000 people for seven years to see if it reduced dementia. It didn’t.

“No effects at all,” he said. “But look on the shelves. Many companies still sell ginkgo — if there’s really any in there, because supplements don’t always have the contents they say they have.”

Moreover, “some of these supplements are biologically active and can cause toxicity when you take other drugs,” said Dr. DeKosky. Supplements can be costly, too.

But there are other ways people can reduce their risk of dementia. Two prestigious panels, reviewing many prevention studies, recently came up with several recommendations.

The more conservative report, from the National Academies of Sciences, Engineering and Medicine in 2017, relied primarily on large randomized clinical trials.

There aren’t many of those, so the panel endorsed just three interventions “supported by encouraging but inconclusive evidence,” to prevent, delay or slow cognitive decline.

The three:

  • Increased physical activity;

  • Blood pressure management for people with hypertension, particularly in midlife;

  • And cognitive training.

That last recommendation doesn’t necessarily refer to commercial online brain games, said Dr. Kristine Yaffe, a neuropsychiatrist and epidemiologist at the University of California, San Francisco, who served on the panel.

“It’s really the concept of being mentally active,” she said. “Find something you enjoy where you’re learning something new, challenging and stimulating your brain.”

Though the evidence to date doesn’t establish which mental workouts have the greatest impact or how often people should engage in them, “they’re not expensive and they don’t cause side effects,” Dr. Yaffe pointed out.

The blood pressure recommendation got a boost in January with the latest findings from the Sprint trial, a multisite study stopped early in 2015 when intensive treatment of hypertension (a systolic blood pressure goal of less than 120, compared to the standard 140) was shown to reduce cardiovascular events and deaths.

The investigators continued the trial, however, with 9,361 participants who had hypertension (average age: 68) and completed follow-up cognitive assessments.

Their results, published in JAMA, showed the intensive treatment group less likely to develop dementia than those in standard treatment, though not by a statistically significant margin. Intensive treatment did, however, significantly reduce participants’ risk of mild cognitive impairment, a frequent precursor to dementia.

“To me, it was one of the most exciting findings to come along in years,” said Dr. Yaffe, who noted in an accompanying editorial that this was the first large trial to demonstrate an effective strategy for preventing age-related cognitive impairment.

“The same things we recommend for heart health turn out to be important for cognition,” she told me. “It’s a blossoming field.”

The Lancet Commission on Dementia Prevention, Intervention and Care also recommended hypertension treatment for the middle-aged, along with exercise, social engagement and smoking cessation, as well as management of obesity, diabetes, hearing loss and depression. Such steps could prevent or delay a third of dementia cases, the commission estimated.

When Dr. Yaffe gives talks on dementia prevention, she also mentions good sleep hygiene and urges listeners to protect themselves against brain injuries.

It’s important advice, but disappointingly undramatic. Where’s the magic bullet? Don’t we already know to stay physically and mentally active, maintain a normal weight, treat high blood pressure and so on?

Moreover, “it’s not foolproof,” Dr. Yaffe acknowledged. In the lottery of dementia, “there’s a role for genetics. There’s a role for bad luck.”

Still, she added, “The concept is important. You can do something about this. You can lower your risk.”

That’s why the most helpful approach Donna Kaye Hill uses to protect herself from dementia probably isn’t taking fish oil.

It includes using medication to control her blood pressure. And reading biographies and mysteries and joining a book group with friends. And taking a four- or five-mile walk, five days a week, with a yellow Labrador named Annie.

Doonesbury — Speak up!

One bark on “Sunday Reading

  1. Re: dementia preventia. All through her 80’s my mother walked four miles a day at a good clip. She played bridge like a pro. She kept friends close through faithful correspondence until they died on her. She was a devoted Episcopalian so she paid her dues to God. But she began to lose her ability to bathe and dress herself when she turned 90 causing my sister to find a care center near her and helped Mom move. By the time Mom was 92+ she lost her ability to speak. . . aphasia. She died at age 96. Moral: there’s no answer to declining mental acuity, no pills, no diet, no amount of exercise. Pay me now or pay me later.

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