Worth

22 May 2026 · 1 h 12 min · 31 chapters

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In short

“Worth” explores how to assign prices to things that feel priceless, focusing on healthcare drug pricing, the ethics of rationing, and the monetary value of repairing harm after war; it also briefly expands to nature’s economic value.

Guests and backgrounds

  1. Dr. Leonard Saltz (Memorial Sloan Kettering oncologist) and Dr. Peter Bach (cost/statistics physician) discuss cancer drug pricing.
  2. Bruce Moll (Commonwealth Magazine editor; wrote about hepatitis C drug Sovaldi).
  3. Gregory Johnson (BuzzFeed writer; reported on a Yemen wedding drone strike).
  4. John Witt (Yale law professor; studies war compensation/amends).
  5. Marla Keenan (Center for Civilians in Conflict; works on civilian harm).
  6. Brig. Gen. Richard C. Gross (Joint Chiefs legal counsel; discusses condolence payments).
  7. Susan Gubar (NYT cancer memoir writer; ovarian cancer patient).
  8. Carl Zimmer (science writer; discusses ecosystem/nature value).
  9. Carl Zimmer appears with examples about bats and cotton farms.

Key claims

  • Zaltrap’s survival benefit (~42 days) contrasted with ~$30,000 for a 3-month course; public backlash and a 50% discount.
  • Sovaldi cures hepatitis C but costs ~$1,000 per pill (~$84,000 for 12 weeks), leading states to restrict access.
  • Society lacks a clear “magic line” for what extra life is worth; WHO cost-effectiveness guidance is debated.
  • After drone strikes, the U.S. has a legal/strategic tradition of condolence payments (“money as a weapon system”), but amounts can be token compared to loss.
  • Nature provides measurable economic services (e.g., bats reducing insect damage).

Notable examples

  • Zaltrap (Sanofi) and the 42-day survival framing; Medicare out-of-pocket estimates.
  • Hepatitis C rationing: Massachusetts liver-damage requirements; Arizona public insurance approving ~180 people.
  • Yemen wedding convoy drone strike (Dec 12, 2013) killing 12; dispute over claimed Al-Qaeda presence.
  • World War I precedent (General Pershing) and later Iraq/Afghanistan compensation limits (e.g., commonly cited ~$2,500 ceilings).
  • Cotton farms in South Texas: bats as “natural pesticides,” estimated ~$700,000 of value attributed to bat predation.

Written by AI. May contain mistakes. Listen to the episode to check what was said.

Chapters

Tap a time to open that second in VO

Introduction to the Episode: Worth

1:02 to 1:54

The hosts set the stage for a thought-provoking episode on value.

“And today we're resurfacing a quite provocative episode we originally reported in 2014.”

Setting the Scene for the Stories

1:54 to 2:41

The hosts introduce the concept of valuing seemingly priceless things.

“three very different stories that try to put a dollar value.”

The Story of Leonard Saltz and Drug Prices

2:41 to 4:03

Discussion begins on the high costs of cancer drugs and their implications.

“All right, we're going to start the show with a story from our producer, Molly Webster.”

Zaltrap and the Cost of Life

4:03 to 8:23

Leonard Saltz shares insights into the pricing of the cancer drug Zaltrap.

“I mean, we have drugs out there that are many hundreds of dollars per pill.”

Societal Impacts of Drug Pricing

8:23 to 9:40

Exploration of how society influences healthcare decisions and costs.

“We reached out to Santa Fe to talk about the price of Zaltrap and they declined to comment.”

Blood Journal Doctors and Ethical Dilemmas

9:40 to 11:46

Doctors discuss the ethical implications of expensive yet effective drugs.

“Unless you have hidden resources I'm aware of, probably couldn't afford$10 ,000 to$15 ,000 a month in drug bills.”

Sovaldi: A Blockbuster Drug's Price Tag

11:46 to 14:00

The introduction of Sovaldi and the financial burden it creates.

“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?”

The Cost of Curing Hepatitis C

14:00 to 19:09

Discussion about the high costs and implications of curing hepatitis C.

“Wait, I just want to say that I just timesed out 70 ,000 times 84 ,000.”

Valuing Life: What's a Year Worth?

19:10 to 21:54

Exploration of how much society values an additional year of life and the complexities surrounding it.

“wow, what a question that's deep, can I think about it?”

Patient Perspectives on Life and Cost

21:55 to 27:49

Susan Gubar shares her journey with cancer and the emotional toll of treatment costs.

“Ah well 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.”
Show all 31 chapters

Acknowledgements and Thanks

28:19 to 28:46

The producers express gratitude to contributors and resources used in the episode.

“producer Molly Webster and now for the thank yous for that piece we want to thank Stephen Hall and we want to mention Susan Gubar's book called Memoir of a Debulked Woman And thanks also to Dr.”

Podcast Teaser

29:37 to 30:03

Introduction to the topic of the episode relating to worth.

“Every story from Shortwave NPR Science Podcast starts with a question.”

Introduction of the Story

30:04 to 30:24

Hosts introduce a different perspective on worth through a wedding drone strike story.

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

The Wedding Drone Strike

30:25 to 36:30

A detailed recount of the events surrounding a deadly drone attack during a wedding in Yemen.

“And it starts with BuzzFeed writer Gregory Johnson.”

Questioning U.S. Responsibility

36:31 to 40:06

Exploration of the U.S. government's rationale and the complexities of compensating victims of war.

“is that he goes really deep into the question of like what the U.S.”

Historical Context of War Compensation

40:07 to 42:00

Discussion on the history of U.S. compensation practices in warfare starting from World War I.

“And that is that there's a combat exclusion.”

The Impact of Cluster Bombs

42:00 to 43:30

Learn about the devastating effects of cluster bombs used during warfare.

“So when they came with a complaint, what sort, is it like you ran over my chicken or you knocked out my window?”

Military Payments and Compensation

43:30 to 45:28

Explore the complexities of military condolence payments and their implications.

“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.”

The Value of Money in Tragedy

45:28 to 48:26

Discuss how monetary compensation is perceived in the context of loss and tragedy.

“that$2 ,500 would not be able to support this family in any way.”

Cultural Perspectives on Compensation

48:26 to 50:39

Understand different cultural views on compensation for loss and the significance of payment amounts.

“But it's the apology and the explanation that matter to you.”

Cultural Perspectives on Compensation

51:44 to 52:33

Understand different cultural views on compensation for loss and the significance of payment amounts.

“Did you know that some cat foods contain so much carbohydrate filler that they're closer to a granola bar than a prey animal?”

The Value of Ecosystems

52:46 to 56:00

Examine how ecosystems provide essential services and their economic implications.

“At NPR, we are here for your right to be curious about the world around you.”

Valuing Nature's Services

56:00 to 56:52

Explore the value of nature's services, quantified at $142.7 trillion annually.

“We tried to synthesize all of the studies that had been done around the country and the world.”

Understanding Salt Marshes

56:52 to 57:49

Learn about the ecological importance of salt marshes for water purification.

“The bat's eating the bugs, but how do you do it with a field or something?”

Economic Value of Ecosystem Services

57:49 to 59:13

Discover the financial benefits provided by coastal salt marshes.

“My name is Adam Welchel, and I'm the director of science for the Nature Conservancy here in Connecticut.”

Nature vs. Economic Value

59:13 to 1:00:23

Discuss the dilemma of assigning economic value to nature and its implications.

“There's this galling element, though, or this aspect.”

The Shrimp Aquaculture Dilemma

1:00:23 to 1:02:15

Examine the conflict between environmental preservation and economic development.

“Now, it turns out that this sort of setting where the mangroves are is the perfect place for shrimp aquaculture.”

The Parable of the Bees

1:02:15 to 1:09:03

Learn about the surprising relationship between bees and apple production.

“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?”

The Unforeseen Consequences of Economics

1:09:03 to 1:10:02

Explore how economic valuation can misrepresent nature's true worth.

“So let me find my notes about the wages exactly.”

The Unpredictable Value of Bees

1:10:02 to 1:12:28

Explore the fluctuating economic value of bees and the impact of human valuation.

“because they worry about the pesticides that the farmers have used.”

Biological Diversity as Imagination

1:12:28 to 1:13:17

Consider biodiversity as a source of creativity that enriches human thought.

“The best I was able to do thinking about this.”
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Transcript

Automatic transcript. May contain errors.

0:00Robert Krulwich:Jad Abumrad

0:30Robert Krulwich:Big news! Radiolab is headed to the Tribeca Festival podcast stage for a special live show in NYC. We'll be headlining the podcast program with this one-night-only live show at the festival's 25th anniversary. Come out on June 9th. I think I can safely promise that it will be sweeter than anything you have ever seen or heard. Tickets are available now at TribecaFilm.com slash audio. That's TribecaFilm.com slash audio. Hey, this is Radiolab. I'm Latif Nasser. And today we're resurfacing a quite provocative episode we originally reported in 2014. Now, that sounds like a long time ago until you start listening and you start to realize how many parallels there are between 2014 and this moment right now.

1:21Robert Krulwich:Outrageous healthcare costs, war in the Middle East, climate change. In every one of these cases, the specifics that they're referring to have changed, but the overall picture remains depressingly the same. Honestly, since it came out, I still think about these stories. I still remember them all the time, especially the last one. I would say this episode is one of my all-time top 10 Radiolab episodes. I hope you feel the same way, whether you are hearing it for the first time or hearing it for the 10th time. Here it goes. Worth. Wait, you're listening. Okay. All right. Okay. All right. You're listening to Radiolab.

2:04Robert Krulwich:Radiolab. From WNYC.

2:10Robert Krulwich:Rewind. Are you ready? Yes. Feeling full of worth? I'm feeling full of value. Well, in that spirit, I'm Jed Abumrad. I'm Robert Krulowicz. This is Radiolab, and today... three very different stories that try to put a dollar value. One million is okay. One million dollars. Seven dollars. Ten thousand dollars. Yeah, I would say five bucks. On things that seem... Priceless. Priceless. Priceless. Priceless. Is it really?

2:39Robert Krulwich:Okay, so start at the top. Bring on the pressure. So tell... All right, we're going to start the show with a story from our producer, Molly Webster. I don't remember any of it. Who we might actually want to rename Molly Wongster because she recently got herself some serious numericizing. Actually, it didn't start as a wonky thing. It started actually with some medical journals. 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?

3:22People were just kind of like drifting these questions out there.

3:26Robert Krulwich:All these questions seem to circle around a seemingly simple story of the pricing of a drug, a cancer drug. And the story, if you really want to tell it from the beginning, it begins with this guy named Leonard. Leonard Saltz. I'm a medical oncologist at Memorial Sloan Kettering Cancer Center. Which is here in New York, and it's one of the largest cancer centers in the country. I mean, we have 17 doctors here who treat colon cancer. Just for colon cancer. We treat a very large number of patients. It's a huge hospital, and one of the things Leonard's been noticing in the last, I don't know, decade, is cancer drug prices have just gone through the roof.

4:03Robert Krulwich:I mean, we have drugs out there that are many hundreds of dollars per pill. Really? Yeah. Oh, just wait. Let's see. Where does this start? It starts, it's June in 2012. 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. A drug called Zaltrap. And Zaltrap is a drug that, without getting into the science too much, targets the blood supply to the tumor. It cuts off the blood supply, which means the tumor can't grow. That's the scientific hypothesis. So this new drug is presented, and they present the data.

4:40And they showed that the survival difference between the people who got Zaltrap and the people who didn't was 1.4 months or 42 days. 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. 42.

5:01Robert Krulwich:42 days. Down to the fine grain. 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 the – That's like not a tenth of a month. A hundredth of a month. A hundredth of a month. That's a little over seven hours. What? Pretty amusing actually. Why would you – It's pseudoprecision. Pseudoprecision. Anyways, after the conference, the FDA approves the drug. And basically, once the FDA approves the 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.

5:41Robert Krulwich:And what does the drug cost? That's the thing. It costs roughly$30 ,000 for a three-month course. Wow. 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. There are anti-nausea medicines that are sometimes used that are in the range of$90 to$100 a tablet. 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.

6:20Robert Krulwich: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 then, of course, someone's got to pay for the real estate, the heat and the lights. None of those prices are figured into it. Okay, I'm just giving you the cost of the drug. So Leonard calls up one of his colleagues.

6:53Robert Krulwich:My name is Peter Bach. I'm a physician at Memorial Sloan Kettering. 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. 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. 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. It's$2 ,200 if I remember the number correctly.

7:27For a lot of Medicare patients.

7:28Robert Krulwich:That's all of their money. Never mind other drugs. That's when I thought we should go public with it. Memorial Stone Kettering, they decide to boycott this drug.

7:42Robert Krulwich:Now, is that... I mean, I'm just stopping you because when you guys made that decision, was that that feels like a big deal. It did feel like a big deal, and it felt like a big enough deal that we decided to write the op-ed piece in the New York Times. They write an op-ed in the Times that basically says, look, this is crazy,$11 ,000 a month for a drug that maybe gives you 42 more days of life? Is that worth it? And a little less than a month after the op-ed piece came out. The company that makes Saltrapp. They went to individual doctors' offices, sent representatives, and said, we are offering a 50 % discount they cut the price in half just like that?

8:20Robert Krulwich:Yep. Nationwide or like just in this area? Nationwide. It was sort of incredible.

8:29We reached out to Santa Fe 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.

8:48Robert Krulwich:We need these companies. They're the ones developing the drugs. Which aren't easy to develop. I mean, Leonard gave us just one example. If we talk about colon cancer... He says for years, there was only one drug on the market called 5FU. 5FU was patented in August of 1957. It was from 1957 until 1996 that a second drug came along. That's how long it takes to develop a good drug, or... Or in that interim, there were over 70 drugs that were tried and failed. I feel like I don't give it enough credit because that just astounded me. It's very, very hard. And that, according to Leonard, is one of the reasons why prices are just going to keep going up.

9:27Robert Krulwich:But sooner or later, this system is going to fall apart. And at what point does society say there isn't an infinite number of dollars that we can commit to our health care system? It's funny because I had this interesting reaction to the word society because all of a sudden I thought like why is – not like a crazy death panel way, but I thought why is society involved in my conversation with my doctor about if I want to take this drug that may give me another month and a half of life? Why is society involved? 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.

10:15Robert Krulwich:Someone else has to pay that. Obviously, he says, it's your insurance. I mean, say you're part of a policy that has 1 ,000 members. Let's say that the premium for that is$100. So we got$100 ,000, 1 ,000 people, we got ourselves$100 ,000. Okay? So we now have$100 ,000 to take care of that 1 ,000 people. For that month. For whatever amount of time. If now one person comes up with a health care 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. 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 um there was this there's this journal called blood which is really big to anybody that works in a community it's a journal called blood yeah how did we not know about this when we made the blood show oh i knew just kept it in here anyhow um so yes there's a journal called Blood, which is basically like the journal for anybody that works in a field that has to do with blood.

11:26And 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 going to use this. What all of these doctors in the blood editorial are saying, what do you do when you have a really expensive drug, but it's really, really good? It's like a drug you actually want to take.

11:58Robert Krulwich:Is that like a one day in the future we will face this kind of question? No, that is like a now, today question. The most important new medicine approved this year. Everyone I talked to pointed me to this new drug. Sovaldi. It's known as Sovaldi. Sovaldi. Many in the medical community are calling the new medication... A blockbuster. Sovaldi came on the market last December. So that's December 2013. That's correct. This is Bruce. Bruce Moll. I'm the editor of Commonwealth Magazine. He's written about Sovaldi, and here's the basic story, right? It is a drug that treats... Hepatitis C. Which is caused by a virus.

12:38Robert Krulwich:And the disease itself goes to work on your liver. It inflames it. It scars it. It can cause liver cancer. cirrhosis, it can be fatal, and for the longest time the treatments that they had just really weren't that great or they just had wretched side effects. But along comes Sovaldi and it's one pill 12 weeks. You take it with some other antiviral meds, it is a super simple treatment option. And the side effects are very minimal. Like this, it was like kind of like the savior drug. And so a lot of doctors start to prescribe it. In the first half of 2014, 70 ,000 people in the country, in the United States, were treated.

13:18Robert Krulwich:And it had a 95 % rate of cure. In other words, the virus was eradicated. That's very big. But, in fitting with our story... This drug costs$1 ,000 a pill. Whoa. For like one pill that I take... One a day. Drop the price! Drop the price! 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. Then you're starting to talk about serious money. Wait, I just want to say that I just timesed out 70 ,000 times 84 ,000. And I got something with seven zeros in it. It's 5-8-8 and then there's seven zeros, which is like$5 billion?

14:16Robert Krulwich:Yes. Yeah. The big question is how states will pay for what could be upwards of... And so we have a situation where states are basically having to ration. Yeah. Say in Massachusetts... Most of the insurers currently are requiring some liver damage before you can take the drug. Similar restrictions are happening in other states. It's Florida, it's happening in Oregon, Illinois. The doctor says the only option may be to wait until you're even sicker. And then there's Arizona. Out of the entire state, public insurance only approves 180 people for treatment. What, just 180? Just 180. Now, when I talk to a representative of the company that makes the drug...

14:57Robert Krulwich:Greg Alton, Executive Vice President for Corporate and Medical Affairs for Gilead Sciences. He says, you got to keep in mind, this is not a chronic care situation. This is a... Cure. Here you're actually curing a person of a disease. We're talking about 12 weeks of therapy, period. That's it. And you're done and you've cured somebody. 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. Over a 20-year period, the savings that will accrue to the system by having a patient cured of hepatitis C.

15:30He 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.

15:46Robert Krulwich:It's sort of like a precursor of what could come because these companies are developing drugs all the time. What if you could get a drug, but it was very expensive to treat diabetes? And then you're talking tens of millions of people. An enormous segment of the population. Even if just a fraction of them want a drug that's$1 ,000 per day? That's practically our entire U.S. budget? What do you do in that case? A drug comes along like that and throws everything out of whack.

16:19This 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?

16:32Robert Krulwich:But beyond what point? 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? I don't think we reject it out of hand, but I don't think it is. 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 going to do it. But would it have been different if it was 50 days? or 100? Is that enough? 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?

17:06Robert Krulwich: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. And the question that sort of bubbles out of this conversation is, what is one more year or one more month or one more day of life worth to us? Are we willing to pay$1 ,000 for an extra day of life? Well, what about$100 ,000 for an extra day of life? 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.

17:49He 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 countries spend, it's going to get gobbledygooky, but just bear with me, that countries spend one to three times the GDP per capita, which is like the gross domestic product per individual.

18:25Robert Krulwich:So take the entire fat ball of money that is in a country and divide it per individual? Divide it by the individuals, and then you spend one to three times that on one more good year of life. And what would that be for us? So for the U.S., that's about$50 ,000 to$150 ,000. Interesting. Does that have any teeth, that recommendation? It legally doesn't have any teeth, but it has teeth in the sense that doctors in the U.S. are actually going to start using this WHO number to evaluate medical treatments for cardiology. They said they were going to do this in a paper, and it was kind of very quiet, very subtle.

19:03But in other countries, this conversation is very loud, actually. It happens at the government level. they're also passing out surveys where they're asking citizens what is your limit on how much you want to spend on one more good year of life have they done that here as far as i know no why not because because the last time we tried to talk about cost in medicine it ended up in the whole death panels death panels death panels or so-called death panels thing and I don't know, I just wondered into the mess of it hey Times Square if I actually tried to go out and ask this question in a very basic way how would people respond?

19:49excuse me, can I ask you a question? what is a year of life worth? wow, what a question

19:57Robert Krulwich:that's deep, can I think about it? that's a tough one I was really surprised at how seriously people took the question Man, what is a year of life worth? That was the first thing I noticed. Then the next thing was, no one could answer the question until I had answered like a million questions of theirs. Am I going to die tomorrow? Yes. Where do I get that year? Do I get it at the beginning, the middle, or the end? How would I spend that year of life? Good. It would be a good year of life. A good year of life depends. Is this like a pie-in-the-sky kind of answer? They wanted to know, would they be emotionally happy, alone, with friends or family?

20:30Where 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.

20:42Robert Krulwich:Oh, interesting. Did you actually ever end up getting numbers? I did get numbers, but they were... At least$10 ,000. $15 ,000. $13? Quarter million. $7. All over the place. Yeah, I would say$5. $10 million. $44 ,000. Interesting. One woman said$10 million. $10 million for a year? It's irresponsible. Well, you're asking me about my personal choice. $10 million? Not about a public policy question. Do you have any way of parsing all this? No. I really, I honestly don't. Like, I think my biggest takeaway was, like, no one punched me, which makes me feel as if people are ready, not ready, but willing to engage in this conversation.

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21:28but 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. Ah well 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.

22:10That it's like, I almost can't even ask the question, but I don't know. Well, I know.

22:15Robert Krulwich:I think it's a good question. I think ethically, it would be to the good of patients and doctors to have this conversation. This is Susan. Susan Gubar, writer of the Living With Cancer blog for the New York Times. 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 advanced stage ovarian cancer. Most ovarian cancers are diagnosed at a late stage. And it's basically incurable. It can be handled. It can be managed. that it can be kept at bay and for longer periods of time now, we hope.

22:57But you're given a diagnosis of three to five years. Wow, that is, you go from having unlimited time in your mind to three to five years in, like, a doctor's visit.

23:08Robert Krulwich:Yeah, it's a big shock. You sort of enter a zone where you're not quite aware of what you're doing. That day, the day she was diagnosed, she was told, pack a bag, get in a car, and drive to Indianapolis. You need surgery now. So I went the next day to Indianapolis, and the day after that I had the debulking surgery, which takes out the ovaries and the uterus and the fallopian tubes and the spleen and sometimes the cervix and sometimes the appendix and sometimes the bowel. Are you serious? Yeah, it's called the mother of all surgeries. And then, just like that, she was doing multiple rounds of chemo.

23:51Chemicals that are used, they destroy all quick-growing cells. So, for example, you have no hair, no eyebrows, no eyelashes, that you know.

24:01Robert Krulwich:You also can, I got terrible sores in my mouth. I have no idea why, but I know this happens to other people. But yeah, the other thing is this extreme fatigue. And Susan, who writes for a living, couldn't even read. I would look at a page and think, had I turned a page? Chemotherapy, it really is toxic to the spirit, to the heart, to the mind. Just the normal aspects of life feel polluted.

24:33Have you ever had to think about cost?

24:36Robert Krulwich:I was never informed of the cost of any drug or any procedure I was given, which really makes me think about how masked these costs are. Would you want to be thinking about cost while you're going through it, or is it better to just say, here are your treatment options, these are statistical outcomes, like pick one, and then we'll deal with it on the other side? I think there's a kind of unspoken agreement among everyone that the insurance company or Medicare is going to pay. And if it's the government, that means our grandchildren are going to end up paying for all of this money. So, yes, I guess to answer your question, I think it would be healthier to know what these things cost.

25:22On 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.

25:49Robert Krulwich: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?

26:07I remember when she said that, when is enough enough? I was just...

26:11Robert Krulwich:I don't know that we are ready to say there's one magic line. Thrown back to this conversation that I had with Leonard Saltz, where he was saying that... We have to look at everything in terms of value. You need to think deeply about the kind of life you want to live. It's not just about how many days. It's about what kind of days. So if you told me that there was something that gave 72-day survival benefit, but it makes people feel nauseous for most of the time, is that worth it? When we're trying to draw this line as a society, before we figure out what we're willing to pay, we have to think about what we are paying for.

26:49Yeah, I don't think we know what we're willing to pay. For Susan, you know, six years ago she decided that she was going to get chemotherapy because, in part, it would be more time with her daughters. Yeah. And suddenly it's worth it. Yeah. But I think we're changed by the treatment too. For now, Susan's cancer is basically under control because she's on this new drug. For two years and now a month, and I am counting. I've been alive without a recurrence, without the cancer growing by taking these pills every day. And I take them at home. They're not infused in the hospital through my veins.

27:33Robert Krulwich:They're just pills. And it's made the last few years remarkably normal-like, the new normal. 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

28:19Robert Krulwich:producer Molly Webster and now for the thank yous for that piece we want to thank Stephen Hall and we want to mention Susan Gubar's book called Memoir of a Debulked Woman And thanks also to Dr. Atul Gawande for all his help and his latest book. Which is really, I really thought it was wonderful. It's called Being Mortal. Yeah. And thanks also to Nikki Haynes. And to Glenn Blumquist. Radiolab will continue in a moment.

28:46Robert Krulwich:Radiolab is supported by AT &T. Summer is great for many reasons. The best reason, our plans we made finally making it out of the group chat. Because there's more time to fit everyone in. Whatever you've got in store this summer, capturing those memories is a must. And AT &T has your summer essential in the iPhone 17 Pro. Its center stage front camera auto adjusts the frame to fit everyone into group selfies. You don't even have to turn your phone. No awkward cropping or asking strangers to take it. Just the perfect group selfie every time. And AT &T makes sharing those moments with everyone easy because you got to share the pic or it didn't happen, right?

29:20Robert Krulwich:Right now at AT &T, ask how you can get an iPhone 17 Pro on them with eligible. Trade-in requires eligible plan. Terms and restrictions apply. subject to change, visit AT &T.com slash iPhone or visit an AT &T store for details. Every story from Shortwave NPR Science Podcast starts with a question. Like, why do we have nightmares? How does AI affect my energy bill? At NPR, we are here for your right to be curious about the world around you. Follow Shortwave wherever you get your podcasts, because the more you ask, the more interesting the world gets.

30:03Robert Krulwich:3, 2, 1. Hey, I'm Jad Abumran. I'm Robert Krolwich. This is Radiolab, and today... Well, we're still on the subject of worth, but this is a totally different take. Yeah, and this comes from our producer, Matt Keelty. 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. Right. And it starts with BuzzFeed writer Gregory Johnson. So, okay, maybe you should start with what has now become sort of the infamous wedding drone strike. Right. Was that sort of where it started for you? 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.

30:43Robert Krulwich:It's Thursday morning. December 12, 2013. Early that morning in a small village. A group of guys, roughly 50 to 60 people. Including a soon-to-be-married man, pile into a bunch of cars and they start driving. This is the convoy, the wedding convoy. Now, in the lead car of this convoy was this man. His name is Abdullah Mohammed Al-Taisi. 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.

31:26Robert Krulwich:After lunch, they grab the bride. And just a few of her bridal attendants, a few females. And they start driving back to the groom's village for the actual wedding ceremony. Now, Abdullah said that ever since they'd left that morning, through lunch, all day long, they heard this humming. This sort of metallic whirring, this metallic thumping overhead. No one in the convoy could see it, but they knew what it was. A drone.

31:56Robert Krulwich:hearing all the day. It's nothing new for people in rural parts of Yemen by this point. They don't think anything of it. It's common to hear those sounds. Yeah, it's usually heard there. So, they keep driving. Basically, if you can imagine it, they're sort of winding through these wadis, these desert, mountainous places. Yeah, the road, he said, is mountainous. They're all strung out on this rutted out little dirt track. Eleven cars, single file. Finally, they reach this little clearing. 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.

32:36Robert Krulwich:Some guys got out, fixed it, got back in their cars. Then right at that moment... The sound shifts. Somehow. And then... The missiles start. Four of them. In quick succession. The shrapnel is just flying everywhere. In a blink, it's over. People are trying to figure out what has happened, all the screaming. There's fires that are burning. And Abdullah.

33:07Robert Krulwich:His car was torn up. He had shrapnel in his face. Two wounds in his face, one in Yamin or Al-Yasargan. In the right hand, left thigh, one in the back. And he says that once he saw there was smoke, his first thought was, where's my son? He was looking for his son. His son was there? Yeah, a young man who'd been a few cars back from him. He had the fourth car on the convoy. And he was married with two boys and one daughter. Abdullah said he could move, so he got out of his car and stumbled back toward the fourth car. To find his son. Yeah, he said he found him just next to the car. before just he died.

34:00Robert Krulwich:No, he didn't talk to him. Just he looked at him and just passed away.

34:11Robert Krulwich: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 Reda. This big town where the drone strike occurred. There's a video I have. That's what you're hearing, where you see some men take these 12 dead bodies. And they line them up in the street on this bright blue tarp, and they sort of wrap them in these cheap blankets. And so there's this huge crowd that just gathers around to stare at these dead bodies who are laid out in the street.

34:55Robert Krulwich:And at a certain point... This very tiny, very leathery old Yemeni who's sort of holding on to the back of a pickup with one arm. He stands over the dead. Sort of swaying over the bodies and just lecturing the crowd on what happened. He's just screaming at them and so... You can hear his voice. start to go hoarse. And he's screaming, an American drone killed these. It was a massacre. These people are on their way to a wedding. Why did this happen? Why were they killed?

35:41Robert Krulwich:Why did they target this convoy? Well, according to the U.S. government, They had received intel that on that day in this convoy was an Al-Qaeda operative. Named Shauki al-Badhani. Who apparently had been planning attacks against the U.S. That's why they took the shot. And in fact, they say that he was wounded in this wedding convoy strike. And do we have any reason to believe that? I have no reason to believe it. Greg spent weeks in Yemen, talked to survivors of the drone strike. Talked to people who were there. No one knows this guy. And Greg says the guy isn't really a member of either of the tribes that were involved in the wedding.

36:20Robert Krulwich:And so to him, it makes no sense that he would be there. 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? Can you? I mean, historically, do soldiers have an obligation to repair the damage they do? No, there's no obligation.

37:03Robert Krulwich:But what's happened is we've actually created an obligation for ourselves. Americans have? Yeah, yeah. This has a really long history, a history that's rooted. You mean legally? Yeah, yeah, yeah. A legal history. Really? And there's a great law professor at Yale. What's his name? His last name is Witt. It's John Witt. That's me. We ended up tracking down John Witt. Hi, Jed. How are you? To talk about how the U.S. first started to try to right their wrongs in war. So what is the foundation story of all this? That starts with General Pershing in World War I. So, 1917. America is called to art. The Great War ramps up, so we start shipping young men...

37:47Robert Krulwich:Thousands of men, millions more to follow. ...over to Europe. We'll be over, we're coming over. Specifically, France. And in charge of these men was a man named John Jay. Pershing is the commander of American forces on the Western Front. Stern man, handsome mustache, bit of a maverick. General Pershing's nickname was Blackjack. When he first arrives in France with his troops, General Blackjack Pershing. He's got this problem, which is that he has Jeeps. Built in America, shipped to France, and manned by our men. So World War I is the first war in which the U.S. is shipping a lot of automobiles.

38:23Robert Krulwich:More than 100 ,000. For the soldiers to drive. Cars, trucks, Jeeps. And Jeeps are really great. They get his men from one place to another. From Paris to Amiens to, I don't know, Massey. But they also run into French farmers' chickens and cows' children, sometimes just the farmers themselves. Were these random collisions? Or were there no roads? I'm going to bet there was some of everything. Sometimes it was probably just ordinary car accidents, and sometimes, no doubt, a little French wine was involved. So this is Pershing's problem. He's trying to run a war overseas. And it wasn't any good for him to have grumpy civilians at his rear.

39:00Robert Krulwich:And so Pershing has an idea, which he actually borrows from the Brits. And that is, he will use cash money to right our wrongs. Well, and so he goes to Congress and begs for a statute. And Congress obliges really quickly. There's no sign this is a controversial thing. But it was a genuinely new thing because for the first time in the history of war, as far as we could tell, you had a state compensating individuals. Usually it's state to state. Here you have state to individuals. And so the U.S. government starts systematically paying money for the loss of a non-American life in war. How much? Geez, I don't know.

39:35Robert Krulwich:It's actually surprisingly hard to find documentation mentioning specific amounts. But whatever the amounts were, it seems to have worked. We're going to swear our debt to you. Pershing wrote in his biography that the swift and prompt settlement of claims had a great effect upon the people. So it seemed to work really well. 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? 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. And that is that there's a combat exclusion.

40:13Robert Krulwich:In case you just walked in, that's Gregory Johnson. 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. So if US soldiers were driving to a fight and they ran their car into somebody and they damaged that car or killed that person, those people would not be able to get compensation. Whereas if the U.S. soldiers were driving to a bar and got in an accident, they would be able to get compensation. But the problem is, once we get into these counterinsurgency wars.

40:52Robert Krulwich:Civilians are suddenly in the middle of the fray. Charges have been made that troops killed as many as 567 South Vietnamese civilians during a sweep. This is in a way the story of modern warfare. Air raid sirens are beginning to sound over Baghdad. President Karzai says he's delivering his final warning to the U.S. after a U.S. airstrike accidentally killed more than a dozen mothers and children. By the time we get to Afghanistan and Iraq, the fighting is happening in cities. So there's no difference really between the battlefield and where people live. And so the line between what's combat related and what's not combat related, it starts to get blurry.

41:29Robert Krulwich: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. How many people do you remember? If I had to guess, it was, you know, maybe around 80 people or so. That's a ton of people. Yeah. That's John Tracy. He was a military lawyer in Iraq in 2003. And before him, Marla Keenan. I'm managing director of Center for Civilians in Conflict. So when they came with a complaint, what sort, is it like you ran over my chicken or you knocked out my window?

42:06Robert Krulwich:No, no, no, no. Much more serious. 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. Basically, John says Air Force planes would fly over these targets and drop hundreds and hundreds of these tiny little bombs, smaller than a Coke can. And a lot of them would land in maybe a parking lot or a field, and they wouldn't explode. So on a number of occasions, you'd have, mostly it was kids, right? Because the kids would see it and... They didn't know any better. It would just run over and kick it.

42:39Robert Krulwich:And then that's when it would explode. That's when it would detonate. Right. I had a lot of those, close to a dozen. And so that was a difficult one because, well, it's combat because the Air Force dropped it because they were, you know, bombing the city. Right. But at the same time, days, weeks, even months have gone by and this thing is just sitting in the ground. Couldn't we say it's not combat? And this was a real question that John had to ask his boss and then his boss asked his boss. They eventually sent the question up to the Army Claim Service and they said, no, it's combat. Meaning they're not going to pay.

43:18Robert Krulwich:Basically like we are in an armed conflict and this was an unfortunate incident, but an incident that happened during a lawful combat operation and therefore we're sorry. And that's basically it. So I said no to a lot of people. And so like in World War 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. Brigadier General Richard C. Gross. I go by Rich. I'm the legal counsel to the chairman of the Joint Chiefs of Staff.

43:52Robert Krulwich:And he told me that around 2006, paying out these kinds of condolence payments actually became sort of a key part of military strategy. Absolutely. Even had its own acronym. MAWS, M-A-A-W-S. It's Money as a Weapon System, which, you know, I'm not sure that title resonates with everybody. Interesting phrase for sure. Yeah, exactly. But it's the idea that money can be used to win hearts and minds that help bring the population over. And it just got me wondering how much money makes a good weapon. Well, I haven't, like the U.S. military hasn't given me access to a database or anything like that. But through FOIAs and interviews, I've seen different numbers.

44:36Robert Krulwich: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,$2 ,500. $2 ,500 by and large. Now, someone like John could have paid more, but that meant they'd have to run the claim up the chain of command. Exactly. So it was almost like there were these ceilings. $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 didn't make any sense to me, that somebody could get so much for a Toyota Corolla, but you were just going to get the same amount for a lost life.

45:18Robert Krulwich: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 breadwinner of a family, that$2 ,500 would not be able to support this family in any way. Right. But we're not actually trying to pay full compensation, right? Like we're not trying to say we think if this 20-year-old man had lived to be the average age in Afghanistan, then he – that it would have been$60 ,843, right? Like that's not the thing. Do you ever – we had people who were killed here in an attack. The federal government is one step closer to cutting its first checks to families of those killed and injured on September 11th.

46:03Robert Krulwich:And those people have been compensated. The levels of compensation to the New York victims is pretty high. The range of payments for a death claim ranged anywhere from$250 ,000 to just under$7 million. Do you notice that? I do. I do. It is to a large degree comparing apples and oranges. That's general gross again. Because you're talking about a legal system. Where a country is paying their own victims. Versus condolences in an area where there's no legal obligation to make those payments in the first place. So that's a very different type of monetary payment. Well, yes and no. Essentially, it's a person's life.

46:51Robert Krulwich:And I mean, I think there's an argument to be made that there's an empathy in the number that you come up with and the amount that you pay for someone's life. 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? I'd feel a little bit better. You would? I think so. What does it get you, though? In the end,$10 ,000 doesn't buy anything more back than what you lost. 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. But does that really help you? Is that really what you want?

47:24Robert Krulwich:Is the money unimportant to you, really? It sounds like the money is really... I'm not a victim, so I don't know that I can answer that. But to me, if it happened... And at this point, Marla told us a story about how before she got into this line of work... I had several friends who were journalists. One of those friends was a man named Chris Hondros. Yeah, he's a photojournalist. He was a photojournalist. And back in 2011, Chris was on assignment in Libya moving with a rebel group when they were fired upon and Chris was killed. Yeah. And Marla says when she found out that happened... I wanted someone to explain to me why that happened.

47:58Robert Krulwich:I mean, I just wanted someone to explain. I didn't, you know, like, I knew his family wasn't going to get any money. I knew that these guys that shot a rocket, propelled, grenaded him weren't going to care. No one was going to explain. But I wanted that. And the money then becomes an occasion for you to say, like, not just I'm sorry, but here's what happened. It's the here's what happened part. I think it's the token that's given with the apology and with the explanation. But it's the apology and the explanation that matter to you. Yeah, that's why we call it amends, making amends.

48:46Robert Krulwich:One of the things that is true of money damages generally is there are desperate effort to find some common language between the party paying and the victim. Some Esperanto for communicating the meaning of what's happened in a language that the other side knows matters. That's how John Witt puts it. 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. 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.

49:36Robert Krulwich: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. 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. And that opportunity is exactly what Abdullah Al-Taisi will never get.

50:05Robert Krulwich: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,

50:18Robert Krulwich:which in the end he says was the equivalent of 30 ,000 U.S. dollars, way more than anyone got in Iraq or Afghanistan. Still, all he can do, without anything else to go on, is just compare amounts.

50:34Robert Krulwich:in America, we didn't say that. They were disappointed and said, okay. He can accept that only if he gets the payment equal to those, you know, like in America. How can you say someone who lost his son, for example, killed? If the payment was equal. Yeah.

51:20Producer Matthew Kielty.

51:23Robert Krulwich:Big thanks to Gregory Johnson, writer-at-large for BuzzFeed, who started us off on this adventure when he brought us the initial story. Also thanks to BuzzFeed editor Steve Kandel. And to Sha 'ib 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. Yeah, absolutely. Thank you to him. Coming up.

51:48Robert Krulwich:That's next.

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53:12Robert Krulwich:Okay, now it's my left ear. Hello, Zorin. How are you? Good. How are you doing? I'm good. Hey, I'm Chad Abumrad. I'm Robert Krolwitz. This is Radiolab, and so far we've been talking about the value of our lives. And then the value of other people's lives. Next up. The value of... Everything. All of it. Everything. Everything. And by everything, of course, we mean... The value of nature. That's Carl Zimmer, science writer, regular blower of minds. 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.

53:53Robert Krulwich:For example, cotton farms in South Texas. So, you know, the farmers are doing their thing. Like this guy. James Parker. Planting their cotton, they're collecting it. I farmed about, I don't know, usually five to six, seven hundred acres of cotton, so say 2 ,000 bales. They're doing what farmers do. I spend a lot of time on a tractor, and you have to check your water every morning, every evening. Meanwhile, they have all this extra help in the air. Yes. They have bats. How many bats are out there, you really don't know. Flying all around. The bats eat the equivalent of two-thirds of their own weight in insects every night.

54:33Wow.

54:34Robert Krulwich:They eat all night long. All kind of bugs. A whole bunch of pests that would otherwise be eating the cotton. Now, a few years ago, a guy named John Westfall did a calculation. Just to see how this arrangement was working out. He came out to my farm and did a study. He had some college girls that worked for him, and those girls were out there all hours of the night listening to what the bats were saying. Each year, the farmers, collectively, they make about$4 or$5 million off of these farms. The question was, how much of this was because of the bats? Because, you know, bats are natural pesticides.

55:08Robert Krulwich:You know, the more they're eating, the less I got to spray. And here's what the scientists figured out. Out of$4 to$5 million, it was around$700 ,000 that you could ascribe to the bats. It's just beautiful. Wow. I mean, it does make me think that if you're those farmers, you should be compensating the bats somehow. 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. But we talked to a guy who didn't ignore it. My name is Robert Costanza. In fact, he took this way of thinking to the absolute limit. Yes.

55:49Robert Krulwich:So the question was, what's the value of all of these ecosystem services globally? All the services on Earth. You know, it's bugs eating leaves. Worms turning the soil. Beetles chewing tree stumps. Coral weaves protecting cities during storms. Everything. We tried to synthesize all of the studies that had been done around the country and the world. Like that bat study, except they didn't just look at cotton farms, they looked at. Tropical forests. Rivers and lakes. Coral reefs. Coastal wetlands. Inland wetlands. The ocean, woodlands, temperate forests. You know, it goes on and on. Grasslands. This must be some Excel spreadsheet.

56:20Robert Krulwich:It's kind of the Excel spreadsheet from hell. It can get tricky. So Costanza and his colleagues took all these different studies, summed them together, did a whole bunch of math, and came up with a number. Which in today's dollars is$142.7 trillion per year of services. that's more than all of the gross national products of the world. That's how valuable the services of nature are. Let me ask you, I get the way this would work with a bat. The bat's eating the bugs, but how do you do it with a field or something? Do you just walk through and you're like, oh, that's$20 of services, that's$50. How do you even figure out what the services are?

57:07Robert Krulwich: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. And we are in the water. Yes, we're in the water. What is it? Wait, so a salt marsh, is it like the Florida wetlands, but salty? I suddenly don't know what a salt marsh is. Salt marshes are wetlands that are on the coast. Yep, we're standing in about a foot of water here. We're quickly approaching high tide. We sent one of our producers, Simon Adler, to a nearby salt marsh. Parsley to haze him. Your boots are much more waterproof.

57:47Robert Krulwich:But really, to talk to this guy. My name is Adam Welchel, and I'm the director of science for the Nature Conservancy here in Connecticut. And Adam gave Simon a kind of inventory. Some of the services provided by coastal salt marshes, it's a stream of goods and services that's been provided over time. One of the things it 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. 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. And clean it up.

58:22Robert Krulwich:Yep. So you could ask very simply. How much would you have to spend to keep your water that clean? One second. Well, there is one other study I want to... Adam Welchel said that scientists in New England have already figured that out. For flood control, water supply protection, pollution control, it's roughly about$31.22 per hectare per year. Then you've got to add the value of all the plants that feed the fish that end up on our dinner plates. $338 annually per acre. Then there are the bird watchers that buy lattes that support the local economy. $490 per hectare. And then there's habitat provisioning.

58:58Robert Krulwich:The list goes on and on and on and on. You do get kind of obsessed with it. You start becoming an accountant and writing down numbers just furiously. And it gets you to think about nature in a different way than you had before. There's this galling element, though, or this aspect. Like when I first came across the— At this point, our producer Tim Howard jumped into the interview, and you'll also hear our producer Soren Wheeler in just a second. I do feel like in an example like the salt marsh, which cleans water, that's all reliant on people being there that need the water. So if you didn't have people there, does that salt marsh cease to have any value?

59:35Robert Krulwich:But Tim, haven't you ever had a conversation with somebody who just doesn't get, like if you make the aesthetic argument, which is that nature should be preserved for 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. But it does still feel like it demotes something of infinite value to something of a piddly value. It can't really be infinite value. I mean, what does that mean? Like a mother's love. You don't think your mother's love is priceless? I mean, you know. Okay. I totally accept that there is this sort of priceless aspect of nature.

1:00:12Robert Krulwich: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. Because shrimp farms need lots of seawater, so it makes sense to put them by the sea. We're going to put in these farms. We're going to grow shrimp. You are going to get millions and millions of dollars in tax revenue. If you're thinking about the welfare of all the people in your country, many of whom are starving, that might be a really powerful argument.

1:00:49Robert Krulwich: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. Is that a hypothetical situation? No. That's a conversation you have. That's what we're asked. This is Glenn Marie Lang. She's an environmental economist for the World Bank.

1:01:29Robert Krulwich:And she says very often she finds herself in exactly this kind of conversation. Particularly, you know, I work for the World Bank. So our primary clients are our governments. Philippines, Vietnam. And when you're talking to a minister of finance and saying, you know what? I know jobs are jobs, but you need those marshes. They have value. They'll say, well, yeah, that's true, but that means I'm going to have to reduce the money that I put into the education budget. So you've got to really make a strong argument about the benefits. That's really where the rubber hits the road. Here's the counter argument.

1:02:04Robert Krulwich:It comes from Doug McCauley, an ecologist at the University of California, Santa Barbara. The real danger is that we actually succeed, that we convince people that nature is valuable because it makes money. And then we're really in trouble in the many instances where it doesn't make us money. What do you do in a situation, he says, where, say, a bunch of rivers are running dry and they're, quote, depreciating in value? You know, by the same logic that you train me to think with, we should go out and liquidate these natural assets. That makes me feel really uncomfortable. He says it's just kind of a weird way to think about nature.

1:02:34Robert Krulwich: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 going to make$160 million for the state. They're thinking about a different set of values. On the other hand, I want to say, and this is based on my experience working in developing countries, that when you don't put a value on these services, basically they don't get counted.

1:03:21Robert Krulwich:They get implicitly assigned a value of zero, according to Glenn Marie Lang. And as we were debating this and going back and forth and back and forth, 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. The parable of the bees. We heard this first from writer J.B. McKinnon, who says the story begins... In Mao County in central China, rural area, fairly remote. Lush green mountains filled with apple orchards. And apple orcharding was the main business. And according to J.B., in the 1990s... The wild bees of Mao County slowly started to disappear.

1:04:05Robert Krulwich:There's a few different reasons given for that. It could have been the destruction of the habitat that the bees nested in, the heavy honey harvesting that wasn't leaving enough food for the bees. But the prevailing theory is actually an economic 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. Probably it was a constellation of all of those things and a few others. End result is the bees stopped buzzing in Mau County. Which, if you are an apple farmer, that's a disaster. As bees travel from flower to flower in search of nectar, they're dusted with pollen, which is the means by which flowers engage in sexual intercourse.

1:04:50Robert Krulwich:So if you don't have the bees making the birds and the bees on the blossoms, then you don't get fertile flowers to turn into fruit. And obviously, if you're a fruit farmer and you have no fruit to sell, you have no income. So what do you do? If you're an apple farmer and you don't have bees, then you need to find some other way to pollinate the flowers. And I guess they concluded, well, we'll have to do that ourselves by hand. In Mandarin Chinese, we say, So basically, that means a manual pollination. This is Harold Thibault. I'm a correspondent in China for the French newspaper Le Monde. A couple of years ago, he heard about the apple farmers in Mao County.

1:05:33Robert Krulwich:So he flies to Chengdu and he and a friend hop in a car. We drive for like five or six hours until we reach this village, Nanshin. Tiny little village. Like only a few houses. And then we took a small road between the fields. And we actually saw that there were lots of farmers in the trees, like on the apple trees. straddling up on these often thin and spindly branches, men and women that I've seen in photos in any case. Harold and his friend took pictures, and if you look at those pictures, you'll see the farmers holding a little brush. This little pollen brush that they'd constructed using things like chopsticks and chicken feathers and cigarette filters.

1:06:15Robert Krulwich:And they'd have a little bottle filled with pollen, and then what they do, they dip the brush into the bottle and they paint a flower blossom with the pollen, and they dip their brush back into the pollen and they paint the next flower blossom again and they dip the brush back in again and they paint again and they dip again and they paint. To make sure that all of the blossoms that they could possibly fertilize would be fertilized so that they would go on to produce fruit. We're talking hundreds and hundreds of flowers per tree. It was very strange to see humans doing the job of the bees. God, what a pain in the ass that sounds like.

1:06:48Robert Krulwich:The image 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 lose biodiversity. You end up standing in the trees doing the job that the bees used to do on the wing. For free. For free. Those people are just like human bees. But then this guy enters the story. This is Yin Sun Chen. Yeah, human bees. 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 Mount County.

1:07:29Robert Krulwich:But what he discovered, weirdly, was that the trees were producing more apples than ever. More production. More production. This can be confirmed. There are more production for hemp pollination apple trees than a bee pollination apple tree. Humans are more efficient. Really? You mean the people were doing it better than the bees had been doing it? Yes. A lot better. Fruit production went up 30%. That's what the farmers told Yin Sun Chen, which is kind of... Amazing. The only word I remember, amazing. Because I think hemp pollination can pollinate more thoroughly. They can pollinate every flower.

1:08:08Robert Krulwich:And bees don't pollinate every flower? Bees are a little bit, you know, they're a little bit uneven when it comes to pollinating. You're so polite. They don't like it if it's cold. They don't like it if it's damp. They don't like it if it's windy. In all those cases, bees often decide to stay indoors and just take the day off. But you send people out there and tell them to pollinate every damn blossom, and they're going to 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.

1:08:42Robert Krulwich:So here you had this whole story that was supposed to be about how important the bees are, this whole parable of biodiversity. And it turns out maybe the lesson's just the opposite, that actually we don't need bees, and maybe we never did. If we only measure things economically, then we might conclude 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. Right. So let me find my notes about the wages exactly. But there's one more chapter to the story. Harold Thibault told us that when he visited Nanchen...

1:09:19Robert Krulwich:I talked with one farmer. His name is Zheng Zegao. He's 38. And he said, in his opinion, the hand pollination might disappear in a few years. Apparently, as China's economy has continued to grow, workers have started demanding better pay. 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 end pollination anymore. That's what a lot of farmers say. Now they're likely thinking, damn, we need those bees back. Right, yeah. Problem is... There are no bees in those villages anymore. One farmer told Harold, beekeepers in other parts of China aren't going to bring their bees to this area because they worry about the pesticides that the farmers have used.

1:10:05Robert Krulwich:As for when wild bees might come back? Well, for this, we have no idea. It's very hard to make a prediction. If you ask the farmers, they're like, what budget is all? I don't know.

1:10:19Robert Krulwich: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 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. The bees go from being worth a lot to being worth nothing to being worth everything, all within a few years. 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 going to be wrong. That's why you can always be dumb. No, no, no. I want to argue the other side for a second.

1:10:57Robert Krulwich: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. You know, there have been estimates that the value of the pollination that comes from wild bees is$190 billion. 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. But remember, bees are valued at zero only until humans get valued more than bees go down and bees go up. I get it. You have to have a lot of numbers in your head.

1:11:27Robert Krulwich: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. Here's the loss. Yeah, here's the loss. Well, then that actually gives the whole precautionary don't thing some teeth. Except for this, that if you go businessy on nature and you're wrong. There are irreversibilities. That's how environmental economist Glenn Marie Lang puts it.

1:12:00This 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.

1:12:14Robert Krulwich: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? The best I was able to do thinking about this. Writer J.B. McKinnon again. Was when it struck me 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 a pool of imagination and creativity from which we as humans are able to draw.

1:13:07Robert Krulwich:And that when we draw down on that pool of creativity and imagination, we deeply impoverish ourselves. In a sense, we are doing harm to our own ability to think and to dream.

1:13:40Robert Krulwich:J.B. McKinnon's book is called The Once and Future World. He's written many, but this one is my fave. Deep thanks to Carl Zimmer, who's reporting in The New York Times on this topic, is really what got us launched into this whole thing. And what got us through this whole thing is Simon Adler, whose production assistance was invaluable. That was him. Freezing his ass off in the marsh. I talked so long, he nearly died. His toes fell off, I think. Anyway, thank you, Simon. Thank you, Simon. And thank you guys for listening. I'm Jad Abumrad. I'm Robert Prolich. We'll see you next time. Hi, I'm Gabby.

1:14:14Robert Krulwich:I'm from the Bay Area, California, and here are the staff credits. Radiolab is hosted by Lulu Miller and Latif Nasser. Soran Wheeler is our executive editor. Sarah Sandback is our executive director. Our managing editor is Pat Walters. Dylan Keefe is our director of sound design. Our staff includes Jeremy Bloom, W. Harry Fortuna, David Gable, Maria Paz Gutierrez, Sindhu Nainasambandan, Matt Kielty, Mona Mudgauker, Annie McEwan, Alex Neeson, Sarah Kari, Natalia Ramirez, Rebecca Rand, Anissa Vitsa, Arian Wack, Molly Webster, and Jessica Young, with help from Gabby Santis. Our fact checkers are Diane Kelly, Emily Krieger, Natalie Middleton, Anjali Mercado, and Sophie Semayi.

1:15:07Robert Krulwich:Hi, I'm Aubrey calling from Salt Lake City, Utah. Leadership support for Radiolab's science programming is provided by the Simons Foundation and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.

1:15:32Robert Krulwich:WNYC's journalism and storytelling is heard by millions of passionate listeners. Sponsors of our programming gain our listeners' attention and their respect. Learn about how your organization can support WNYC and WNYC Studios at sponsorship.wnyc.org.

From the publisher

This episode makes three earnest, possibly foolhardy, attempts to put a price on the priceless. We figure out the dollar value for an accidental death, another day of life, and the work of bats and bees as we try to keep our careful calculations from falling apart in the face of the realities of life, and love, and loss. 

In this story you’ll hear references to some of the issues that were on our minds when it first came out in 2014: wars in the middle east, drug costs and health care practices. Even as the exact shapes of these issues have evolved over the past dozen years, we feel the underlying questions are relevant and timeless: What is life worth? What about the earth?

EPISODE CREDITS: 
Reported by - Molly Webster, Simon Adler, Tim Howard, and Matt Kielty
with help from - Shahib Al-Masawa 
Produced by - Matt Kielty, Tim Howard
Fact-checking by - Michelle Soraka

EPISODE CITATIONS:

Books - 

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Leadership support for Radiolab’s science programming is provided by the Simons Foundation and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.


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