Jacob M. Appel is a bioethicist and fiction writer. He holds a B.A. and an M.A. from Brown University, an M.A. and an M.Phil. from Columbia University, an M.D. from Columbia University's College of Physicians and Surgeons, an M.F.A. in creative writing from New York University, and a J.D. from Harvard Law School. He has most recently taught at Brown University in Providence, Rhode Island, and at the Gotham Writers Workshop in New York City. He publishes in the field of bioethics and contributes to such publications as the Journal of Clinical Ethics, the Journal of Law, Medicine & Ethics, and the Bulletin of the History of Medicine. His essays have appeared in The New York Times, The New York Daily News, The Chicago Tribune, and other publications.
Appel has also published short fiction in more than one hundred literary journals. His short story, Shell Game With Organs, won the Boston Review Short Fiction Contest in 1998. His story about two census takers, "Counting," was shortlisted for the O. Henry Award in 2001. Other stories received "special mention" for the Pushcart Prize in 2006 and 2007.
He is admitted to the practice of law in New York State and Rhode Island, and is a licensed New York City sightseeing guide.
Appel contributed a Dangerous Idea to Big Think's "Month of Thinking Dangerously," advocating that we add trace amounts of lithium to our drinking water to help reduce the suicide rate.
Appel is a Big Think Delphi Fellow.
Question: Why should we drug our drinking water?
Jacob Appel: I think when you ask questions about whether or not any pharmaceutical or any products be added to the drinking water, you’re really asking two sets of questions. One is: should any product that might be beneficial be added to the drinking water? And secondly, should the specific product be added. The first question I think can be dismissed fairly easily. People who oppose adding enhancement to the drinking water in the way people opposed adding fluoride to the drinking water half a century ago rely on the false premise of naturalism—that because something occurs naturally it must be better.
Now many things that occur naturally are better, but that correlational, not causational. Pain is natural, anesthetics are synthetic. Most people would prefer anesthesia to pain. By the same logic, there are many things that naturally occur in the drinking water that are beneficial in some parts of the country that don’t cover other parts of the country. One of those items happens to be lithium. People who oppose adding lithium to the drinking water in trace amounts don’t go around advocating to strain the lithium from the drinking water in the areas where it does exist.
The specifics of lithium are rather interesting and I should add, I am not the first person to propose this idea. Peter Kramer floated this idea in the New York Times over a year ago, the Brown University psychiatrist, the author of "Listening to Prozac." In areas where lithium in trace amounts is in the drinking water, there seems to be a lower level of suicidality and in the Texas counties that we’re studying, there’s actually a lower crime rate. The same studies were repeated in Japan, a completely different cultural milieu and they had the same result.
I should add that we are not talking about adding therapeutic levels of lithium to the drinking water. It’s worth noting that if you wanted to get a therapeutic level than the trace amounts that currently exist in the area where there is already lithium, you would have to drink several Olympic size swimming pools every minute to reach that level of concern. That level of therapeutics. So the reality is, these are very low levels and there’s no reason to think they are not safe in the areas they already exist, so why not give everybody that benefit?
Question: Is lithium the drug different from lithium the element?
Jacob Appel: Actually it is the element. It’s the ionic form of the element. Unlike many pharmaceuticals, which are complex compounds synthesized in laboratories, lithium is simply an ion that occurs naturally in the environment. I am not a geologist, I don’t know exactly the process by which the lithium leaches into the water, but it does. And I think it is also worth noting that the mechanism by which the lithium works in the body is probably very different in the treatment of diseases like bipolar disorder, or mood disorders, mania than it is in the much lower levels where it seems to prevent suicidality.
And the theory is that very low or trace amounts of lithium enhance connectivity between neurons. And doing that over the course of a lifetime, a lifetime exposure makes the brain more healthy.
Question: Why stop at lithium? Are there other enhancements that we should add to the water?
Jacob Appel: Well I think the first thing to point out is fluoride, which is widely available in the United States, the Surgeon General has determined that it is possibly the most cost effective health intervention in the history of the United States. That has saved hundreds of dollars, if not thousands of dollars per person in dental care over the course of lifetimes. And it’s the reason why Americans tend to have very good teeth. And if you go abroad to some countries people tend not to have as good teeth with the same other dental hygiene care. Because our fluoride protects our teeth and there is no evidence that that fluoride—no credible evidence—does any damage. So this has been an experiment that has been tried.
I think the other most interesting area to look at would be in basic nutrients added to the drinking water to protect specific populations. A good example might be alcoholics who are at risk of certain neurogenic disorders, for example, from lack of thiamin and adding a trace amount of thiamin to the drinking water. I could be done relatively cost effectively. It might prevent alcoholics from developing what’s called Wernicke-Korsakoff Syndrome. The other benefit of this would be every emergency room that treats alcoholics wouldn’t instantly have to treat them with thiamin because they would know these people are exposed to thiamin. Not that different from adding Vitamin A to rice.
Recorded on August 28, 2010
Interviewed by Max Miller
The objections to all of these phenomena are really not what people say they are.