On Vegetarianism, Morality, and Science: A Counter Reply

EVELYN B. PLUHAR

Department of Philosophy The Pennsylvania State University Fayette Campus Uniontown, PA 15401, USA

A b s t r a c t I recently took issue with Kathryn George's contention that vegetarianism cannot be a moral obligation for most human beings, even assuming that Tom Regan's stringent thesis about the equal inherent value of humans and many sentient nonhumans is correct. I argued that both Regan and George are incorrect in claiming that his view would permit moral agents to kill and eat innocent, non-threat: ening rights holders. An "unequal rights view," by contrast, would permit such actions if a moral agent's health or life is at stake. I then argued that current nutritional research does not support Professor George's claim that some wealthy adult males (and many fewer wealthy women) are the only persons whose health does not require the consumption of nonhuman animals and their products. In her 1992 response to my critique, George did not address my moral argu- mentation. She concentrated her entire paper on a wholesale rejection of my discussion of nutrition. Although she now takes a somewhat more moderate position on who can safely contemplate strict vegetari- anism, she still believes that most people are not in a position to fol- low such a diet. In my counter-reply, I argue that her rejection is based upon numerous distortions, omissions, and false charges offal- lacy. She even devotes a substantial section of her paper to criticizing me for saying the opposite of what I actually wrote. As I did in my earlier paper, I cite current research, including George's own pre- ferred source on the topic of vegetarianism, to support my view. I con- clude that Professor George has still not shown that for most human beings it .is dangerous to follow a diet that omits nonhuman animals and their products. Moral agents who take the rights of humans and nonhumans seriously will find vegetarianism well worth considering.

K e y w o r d s : human and nonhuman animal rights, omnivorous diets, nutritional safety, vegetarianism, veganism.

I n t r o d u c t i o n

Recently, I took issue with philosopher Kathryn P. George's contention that vegetarianism cannot be a moral obligation for most human beings, even if Tom

Journal of Agricultural and Environmental Ethics, 1993, 6(2), 185-213

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Regan, in his The Case forAnimal Rights, is correct in holding that humans and many nonhumans are equally inherently valuable, thus all possessing a right to life. She has argued (1) that Regan's rights view permits the killing and eating of rights-holding sentient nonhumans if not doing so would make one worse off, and (2) that abstention from consuming nonhuman animals and their products would seriously endanger most of the world's population (George, 1990). I argued (Pluhar, 1992) that she, as well as Regan himself, was incorrect in hold- ing that his "equal rights" view would sanction the killing and eating of inno- cent others, be they human or nonhuman. Among views that accord moral rights to sentient nonhuman animals, only an "unequal rights" view, assigning more moral weight to beings with complex mental lives than to simpler sentient beings, would have this consequence; this view also implies that certain inno- cent humans may permissibly be sacrificed for the sake of other humans. Moreover, I argued that current nutritional research does not support George's contention that a vegetarian diet, including one that excludes all nonhuman animal products, is dangerous for most humans.

George has now replied to my defense of vegetarianism (George, 1992). She has nothing to say about the first major part of my article, in which I argue that she is mistaken about the moral implications of Regan's rights view. She focus- es exclusively upon my discussion of her claim that most humans need some meat and animal products to maintain health. Apparently, she finds no merit in a single word that I say on this subject, claiming that "each of Pluhar's claims is suspect or incorrect" (p. 217). I am said to have "violated the canons of fair rea- soning," to have reasoned throughout in a "specious" manner (p. 217). I am even compared to "a believer who searches through Scripture" (p. 218), blind to all but my own doctrinaire view. In short, George portrays me as a zealot who is guilty of "abusing" science to promote my warped position, self-righteously con- demning as "immoral" any poor starving people who eat nonhuman animals in order to stay alive.

These are sweeping charges indeed, and to each of them I plead "not guilty." As I shall show, George's response is peppered with false charges of fallacy, replete with omissions and distortions of what I have said. "Distortion" is some- times too mild a word: one of her lengthy criticisms goes completely awry because she attributes to me a claim that I actually contradict in the passage in question. I hasten to add that I have never made any claim of infallibility; as a typical philosopher devoted to reason and truth, I am grateful for legitimate cor- rection. One of George's specific charges turns out to be correct: I did misde- scribe part of one study on AIDS patients. I apologize for this, but my error in no way obviates my overall case (as we shall see, the rest of her comments about my discussion of that study are unjustified). I too have consulted a nutri- tional expert at my university; that expert was greatly startled by the inaccura- cy of George's interpretation of my text. In what follows, however, I am not merely concerned to set the record straight about my article. I am above all arguing that George has still not shown that for most human beings it is

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dangerous to follow a diet free of nonhuman animals. In my counter-reply, I shall first address general issues about George's and my positions and their implica- tions for overall diet safety. I shall then respond to her so-called "detailed indict- ment" of my earlier discussion of nutritional research. Consideration of these specific issues will further buttress the case for vegetarianism.

1. General Issues: A Compar i son of Pos i t i ons and the ir Impl ica t ions

la. The Moral Context Readers should bear in mind that George's original article and my response to it are set in a particular moral context. She and I accept the view that it is prima facie wrong to harm or kill humans or sentient nonhumans who do not threaten us. The question is when this general obligation may rightly be overridden by another obligation. As I have argued, the "unequal rights" view 1 would permit the killing of innocent others whose mental lives are less complex than those of moral agents in cases where health or life is at stake. However, one must remember that in this view, there must be no reasonable alternative to such a course of action, and the beings who are to be sacrificed should be treated respectfully and humanely. It follows from the unequal rights view that one should refrain from harming or killing sentient nonhumans for their flesh or their products when one can avoid doing so without making oneself dangerously worse off. Thus, followers of the unequal rights view must ask, as I said in my critique of George, whether "an animal-free diet puts one at serious risk in com- parison to an omnivorous diet" (Pluhar, 1992, p. 197). In weighing such risks, one must also inquire into conditions that would lower one's chances of being made worse off. The issue, then, involves weighing comparative risks, risks that cannot be reduced o1" acceptably minimized by the taking of other measures.

lb. George's Claim of Misrepresentation George claims that I misrepresent her position by accusing her of advocating a "meat-centered" diet (George, 1992, pp. 218, 222); allegedly, I go on to infer that since such a diet is known to be dangerous, a diet free of nonhuman animal products is "without risk" (George, 1992, p. 222). In effect, she is accusing me of engaging in a combination of the "straw person" and "false dilemma" fallacies. George is wrong on both counts. I am careful throughout my paper to point out that she advocates minimal use of nonhuman flesh. The very paragraph of my article where I use the phrase that she quotes, "a meat-centered diet," is con- cluded by a lengthy passage explicitly pointing out that this is not George's posi- tion (Pluhar, 1992, p. 200-201). 2 In a related false charge of misrepresentation, George accuses me of "distorting facts" by giving only "passing mention" to information indicating that moderate consumption of nonhuman animal protein (48 grams daily) is not related to calcium excretion; she then announces that the modest omnivorous diet she advocates can thus not be accused of promoting

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osteoporosis (George, 1992, p. 222). I pointed this out myself, explicitly and at length (Pluhar, 1992, p. 201); any reader relying on George's response would conclude that I had said nothing, damning her view by implication. Besides omitting what I did say, George attributes reasoning to me that I never engaged in. She believes she is disputing what I have said when she claims, quite cor- rectly, that "[h]owever, even if eating too much meat is a health risk, this does not show that eating no meat and/or animal products is without risk" (George, 1992, p. 222). She is mistaken: readers will look in vain for any passage in which I conclude that vegetarian diets must be free of risk since meat-centered diets are dangerous. Such absurd reasoning is not to be found in my article. The issue is one of comparative risks between a balanced vegetarian diet, including a strict vegetarian (vegan) diet, and a balanced omnivorous diet. Unbalanced diets of either sort are brought in only where doing so is relevant.

lc. My Use of Review Articles One of George's most fundamental objections concerns my alleged failure to con- sult general reviews of the literature: "Pluhar does not cite such comprehensive reviews, or if she does, she takes from them only what will suit the argument she wishes to make" (George, 1992, p. 224). 8 George then lists citations that she finds tangential or incomplete. Once again, I plead "not guilty." I used two com- pr, ehensive reviews of vegetarianism, the 1988 "Position Paper of the American Dietetic Association on Vegetarian Diets" (ADA Reports, 1988) and Johanna Dwyer's "Nutritional Consequences of Vegetarianism" (Dwyer, 1991). In addi- tion, I used a number of articles that reviewed literature on a specific subject, as well as reports of individual studies. Now, George speaks very highly of Dwyer, especially recommending her "excellent" 1991 review (George, 1992: 222). I agree that this review is very informative. However, George's specific list of occasions on which I cite Dwyer is incomplete: she omits mention of two important general citations. She does not mention the Dwyer quote given in my article that "[M]alnutrition due to poor dietary planning or secondary to disease is largely avoidable or preventable, and is not a necessary concomitant of vege- tarian diets" (Pluhar, 1992, pp. 203-204; Dwyer, 1991, p. 73), 4 nor does she men- tion the fact that I cite (without quoting) Dwyer's general conclusion (Pluhar, 1992, p. 208; Dwyer, 1991, p. 86), which is once again supportive of planned vegetarian diets. Could George have omitted these references from her list of my citations because they do not support the arguments she wishes to make? An even more striking omission concerns my extensive use of the American Dietetic Association's review of the literature on vegetarianism. As I said in my original article, both of these reports, which do indeed support my general posi- tion, are especially convincing because they come from respected sources not known for radical views about nutrition. Yet, George makes not a single mention of the comprehensive ADA report or my frequent citation of it, falsely accusing me of ignoring review articles. This is especially ironic given tha t the ADA report was wri t ten by Suzanne Hava]a and Johanna Dwyer! 5

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ld. The Moderation of George's General Position A comparison of George's original article and her response to me indicate that she has actually moderated her 1990 view, making it more consistent with Dwyer's 1991 recommendations (and Dwyer's 1988 ones, although I do not know if George read them). In the article to which I responded, George claimed that seven classes of humans (infants and children, pregnant and lactating women, older women and some older men, the poor, the undereducated, allergic and ill persons, and persons whose genetic makeups clash with vegetarianism) "would be adversely affected nutritionally by strict vegetarian diets" (George, 1990, p. 175; my italics). After discussing her reasons for believing that such diets are unsafe for such individuals, George concludes that individuals falling into these seven groups have no duty 6 to cease eating nonhuman animals or their products (this is in line with what I have called the "unequal" rights view). Who would have such a duty? Almost no one:

If you are an adult male, non-allergic, healthy, well-educated, middle or upper class individual or a young adult non-allergic, healthy, well-educat- ed, middle or upper class female unable to bear children, then you may be reasonably assured by the scientific evidence on nutrition that you do not need to eat meat (George, 1990, p. 179).

George's 1990 view that her seven groups of vulnerable people (which includes everyone except the very privileged and small group of people she describes above) need to consume some meat and dairy products to maintain health is not consistent with the 1991 Dwyer review which George finds to be "excellent" (nor is it compatible with Dwyer's 1988 co-authored article). She accordingly modi- fies her view, although she does not point this out herself. Concerning diet, George now claims that:

These [vegetarian and vegan] diets are safe for the groups in question [i.e., the seven vulnerable groups] when the diets are well-planned. But "well- planned" requires access to a high level of education, health monitoring, and supplementation - - something which is unavailable t o . . . the majori- ty of the world's population (George, 1992, p. 218; italics mine).

She repeats this on her page 224 after quoting Dwyer's remarks on how vegan diets for the very young, the old, the ill, and pregnant and breast-feeding women should be planned. I can only view this moderation of George's original position as progress. Although she still believes that most people cannot have a duty to be vegetarians, thinking that well-off people in highly industrialized societies are the only ones in a position to plan such a diet, George at least now acknowledges that, in addition to some affluent males and young, healthy, well- off females with good educations who cannot have children, appropriately positioned women of child-bearing age, infants, children, the elderly, and the ill or recovering can safely be strict vegetarians.

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le. George's Moderated Position and Dwyer's Position: Dietary Supplements There is still disagreement, of course, between George's moderated position and mine: there is also disagreement between her current position and Dwyer's. I will highlight this by quoting the passage from Dwyer that George quotes in support of her (moderated) position:

For those who wish to progress to a vegan diet that includes no animal foods whatsoever, additional care in dietary planning is needed. In addi- tion to iron and zinc, unplanned vegan diets are often low in kilocalories, calcium, and are always low in vitamin B12 and vitamin D unless supple- mentary sources of these vitamins are provided, since plant foods contain no known sources of these vitamins. The assistance of a registered dieti- cian is helpful, since a good deal of skill in planning and familiarity with unconventional food sources is needed by omnivores who wish to alter their dietary intakes in this way. Certainly, if the individual in question is an infant, child, pregnant or lactating woman, over 65 years of age~ recovering from an illness, or a chronic sufferer of a disease, dietetic consultation is highly advisable in order to incorporate these additional considerations into dietary planning and to avoid or circumvent adverse nutritional conse- quences. Several good articles are available to guide counseling efforts for vulnerable groups (Dwyer, 1991, pp. 82-83; my italics).

One of the major reasons for George's claim that only the affluent can safely adopt a strict vegetarian diet is her belief that extensive vitamin and mineral supplementation would be required. If this were true, vegans would have to be in a position to afford the supplements as well as the medical and nutritional advice needed to avoid bad interactions, toxicity due to excessive doses, and deficiencies. However, the above quotation from Dwyer and the discussion that precedes and follows it do not support George's claim that "a wide array of sup- plementation" is called for in a planned strict vegetarian diet. George seems to be assuming that the whole list of vitamin and mineral deficiencies Dwyer lists as possible consequences in unplanned vegan diets would have to be overcome by supplements in a planned vegan diet. In general, with the possible exception of vitamin D, and the certain need for vitamin B12 in the diets of vegans living in relatively affluent nations, vegans can get the needed vitamins and minerals without supplementation or fortification. For example, George claims that "veg- ans are advised by nutritionists to fortify their foods with calcium or take pill- form supplements: (George, 1990, p. 224), but Dwyer, for one, by no means insists upon this. She mentions a number of excellent plant sources of calcium in addition to the usual supplements. Further, recent research supports the excellence of these sources. Researchers R. Heaney and C. Weaver have shown that high-calcium vegetable greens like kale, which is representative of the group tha t includes broccoli, collard, turnip, and mustard greens, provide calcium in an even more (albeit marginally) absorbable form than does a compa- rable serving of milk (Heaney and Weaver, 1990). Dwyer also does not claim that vegetarians are required to take iron supplements. 7 Vegetarians can also

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obtain enough zinc from plant sources, especially from cereal products. Dwyer states that "[a]lthough phytates and dietary fiber inhibit zinc absorption, zinc nurtr i ture is usually satisfactory in this country, even among vegetarians" (Dwyer, 1991, p. 69; see also Kelsay, 1988). People in developing nations with access to sufficient quantities of cereals would also have a good source of this mine ra l (see d iscuss ion of T. Colin Campbel l ' s China s tudy below for confirmation).

Vegans who cannot get enough exposure to sunshine in order for Vitamin D to be made in their skins will need to eat foods fortified with vitamin D or take a supplement. As Dwyer herself points out, however, vitamin D deficiency is a problem for a great many omnivores too, especially those living in the northern hemisphere, post-menopausal women, babies, very young children, invalids, and others who are little exposed to the sun (Dwyer, 1991, p. 68). Note that most of George's high risk groups are included here. Industrial nations began fortifying staples with vitamin D because of serious deficiencies - - and complications such as rickets - - among their omnivorous populations. In fact, US nutrition writer Jane Brody lists "fortified milk" as the best food source of vitamin D, followed by egg yolk, liver, tuna, salmon, and cod liver oil (Brody, 1982, p. 159). Certainly, vegans with inadequate sun exposure are more susceptible to vitamin D deficien- cy than omnivores, given this list, but they are far from being the only ones who should be concerned about getting enough of it. Products other than milk can be fortified: in the United Kingdom, this is already being done with margarine. In countries or areas where it is currently impossible for some to obtain enough vita- min D without recourse to nonhuman animal products, those individuals will risk their health by adopting strict vegetarian (as opposed to ovo-vegetarian) diets: as I said in my original article, if a sufficient variety of food is unavailable, the unequal rights view gives its blessing to such a course of action, provided that no better, more humane alternative is an option.

The only supplement or fortification that is needed in the diet of a strict vege- tarian (in an industrialized country) but that lacto-vegetarians and omnivores need not worry about getting is vitamin B12. I have said enough about this in my original article (Pluhar, 1992, p. 204). For once, and only in this one respect, vegans in an industrialized country are at a disadvantage compared with veg- ans in poorer societies: the former's food is produced so hygienically that the bacteria-generated vitamin is not present in or on plants (Herbert, 1988, p. 854). Good sources fortified with this vitamin, such as cereals, are widely avail- able in more affluent countries: one need not be well-off to purchase them. Therefore, George's claim that a vegan diet in comparison to an omnivorous one calls for a "wide array of supplementation" is not justified.

lf. Education, Health Monitoring, and Medical Care for Vegetarians and Omnivores George cites Dwyer in support of her claim that vegans must have access to registered dieticians, health monitoring and medical care, and a high level of

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education. For George's claim to have force in the context of this argument, it must be the case that omnivores need far less of these good things than do veg- ans. But Dwyer's words do not support such a contention. George fails to men- tion that Dwyer's discussion of ways to ensure health and balance in vegan diets occurs in a section entitled "Dietary Advice and Practical Principles for Counseling" that also discusses omnivorous diets. Dwyer points out the need for "detailed dietary guidelines" that can guard against both the deficiencies and the excesses of a diet that can rely too heavily on nonhuman animal fat; she goes on to give detailed advice to omnivores (Dwyer, 1991, pp. 80-81). Dwyer recognizes that nutritional education and advice are crucially important for omnivores as well as vegetarians (of course, the purpose of her 1991 review is to examine vegetarianism; the fact that she devotes less space to discussion of omnivorous diets is hardly surprising). With Havala in their co-authored 1988 review of vegetarianism, she notes that:

It should be recognized that both vegetarian and nonvegetarian diets have the potential to be either beneficial or detrimental to health. Sound nutri- tion planning may result in risk reduction and control of some diseases and conditions by dietary measures, whereas poorly planned or haphazard diets increase the likelihood of diet-related disorders of deficiency or excess" (ADA Reports, 1988, p. 351).

No comparison of omnivorous and vegetarian diets detrimental to the latter is made in Havala and Dwyer's report: quite the contrary. The authors go on to add that many choose a vegetarian diet for its "possible health benefits," as well as for ecological and ethical reasons, noting that "[i]t may be easier, as well as more acceptable, for some individuals to meet the Dietary Guidelines for Americans by following a vegetarian diet rather than a nonvegetarian diet" (ADA Reports, 1988, p. 351). s Havala and Dwyer also do not imply that vegetar- ians need more careful health supervision than omnivores. Instead, they say that "[a]dditionally, both vegetarian s and nonvegetarians must obtain adequate health monitoring throughout the life cycle" (p. 354). Those who cannot get such monitoring - - and I agree with George that, tragically, there are many who can- not - - need both information to aid them and reformed government policies on health care: that applies just as much to omnivores as to vegetarians. 9 In fact, such information should be part of routine health care. Countries that already have or are moving to implement universal health care rightly focus on disease prevention: in view of the major role that diet plays in disease, health-care pro- fessionals ought to be well-trained in nutrition and in methods of communicat- ing their knowledge.

Direct consultation with a registered dietician is not the only way to get good advice about diet. Indeed, (and I do not, of course, offer this as a scientific random sample), no one of my acquaintance, vegetarian or omnivore, seeks such consultation. This is a mat te r of public education, and nutri t ional experts should indeed be leaders in this, through widely promoted dietary guidelines,

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food labels, and the like. One need not have a college degree to understand the basic elements of good nutrition, including good vegetarian nutrition. (I recently read an excellent small book on nutrition for first-grade children.) As I have said before, George's own carefully calibrated version of omnivorism, allowing "only enough [animal products] to ensure adequate nutrition and health, with a reasonable margin for safety," (George, 1990: 178) calls for just as much educa- tion as does any vegetarian diet (Pluhar, 1992, p. 208).

In my original article, I spoke enough about the inappropriate role that poli- tics play in blocking the dissemination of such badly needed information. The poor, the elderly, and the disadvantaged are especially vulnerable to bad diets. As I said in my original article, underprivileged persons in affluent countries are suffering from badly balanced meat-heavy diets. They would benefit from a voluntarily adopted balanced vegetarian diet as well as from George's modest omnivorous diet. Either diet is achievable for them, with the same amount of societal good will and resources. I am arguing that current evidence about vege- tar ian diet safety, in conjunction with the unequal rights view, supports the vegetarian option. Most of the suffering caused to nonhuman animals used for food is due to the eating habits of both advantaged and disadvantaged inhabi- tants in well-off countries. I f George's option were taken by people in affluent countries, both human and nonhuman suffering would be reduced, but the lat- ter would be diminished to a much higher degree by the adoption of vegetarian- ism. (The diets of people in impoverished countries are discussed below.)

We have now examined all but one of George's reasons for contending that only the wealthy dare consider vegetarianism. That final reason is her claim that a wide variety of food is needed for vegan diets. For this claim to be rele- vant, the variety called for must, once again, be significantly greater than the variety required by a healthy omnivorous diet. Dwyer too speaks of "unconven- tional food sources" that omnivores who become strict vegetarians will have to rely upon (Dwyer, 1991, p. 82). This is a rather odd claim for Dwyer to make. People who regard Big Macs, Twinkies, and pork rinds as food staples might find whole grains, vegetables, legumes, and fruits "unconventional" (these are the "new four food groups" p romoted by the Phys ic i an ' s C o m m i t t e e for Responsible Medicine, mentioned in my earlier article), but these foods are assuredly available and affordable in many countries. 1~ On my visits back to the poorest regions of Appalachia, where I was born, I encounter in every mar- ket abundant quantities of each of these food groups, at prices far lower than those for meat.

This variety of foods is familiar to many people in poorer countries. In fact, the most inexpensive, tasty, and healthful vegetarian recipes come from coun- tries such as Mexico, India, China, Lebanon, etc. George, however, does not th ink we can t rus t such t radi t ional fare to provide adequa te nut r i t ion to vulnerable groups of people, such as mothers and children. She cites P. Soysa's 1987 article in World Reaiew of Nutrition and Dietetics as support for her view that traditional dietary patterns are at least partly motivated by men's desire to

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subjugate and weaken women and children by depriving them of meat (George, 1992, p. 230). Space limitations prevent me from fully addressing this topic, but some things must be said. Some feminists, while agreeing that food is often used as a political weapon by men in the West as well as the East who associate meat with power and virility, nevertheless see vegetarianism as an essential component of feminism, to be embraced as a healthful, sane alternative to the eating of flesh. 11 The traditional dishes referred to above are in fact nutritious. This is not to say that they are perfect, or that they can be eaten in abundance by everyone in areas where they are traditional. There are indeed regions of the world where not all of these products can be obtained, as I pointed out in my article. Vitamin D fortification is also needed for those individuals who cannot get appropriate sunshine exposure: omnivores who do not include in their diets certain fish products, eggs, or liver have the same problem. However, for ecolog- ical and political reasons, these same regions frequently also do not offer the variety of foods that are needed for a healthy omnivorous diet (the tragedies in parts of Somalia and the former Yugoslavia provide extreme examples of this). What does an omnivorous diet require? Meat or legumes, dairy products, grains, fruits and vegetables. Of this wide variety of foods, meat tends to be the scarcest and the most expensive. If the requirement for a "wide variety" of foods were to disqualify a diet from consideration, omnivorous diets woul~ be disqualified along with vegetarian ones.

I think that affluent countries should help poorer countries to remedy such dietary deficiencies. After all, the agricultural and economic practices of the affluent few have contributed mightily to the poverty of the many (Durning and Brough, 1991: Worldwatch Paper #103). "Help" does not necessarily require us to encourage such countries to produce or import more meat, however. A greater quantity of the foods constitutive of a healthy vegetarian diet can be encouraged instead, along with attention to vitamin D fortification. Moreover, as I argued in my original article, there can also be no objection to humanely, respectfully obtained dairy products and eggs, 12 consumed in amounts compatible with health (see Section 2a). One can provide such help without "preaching" vegetari- anism. People in these countries eat little meat anyway; they are not the ones responsible for the suffering and slaughter of billions of factory-farmed animals. In some respects, we could learn more from them about vegetarian diets than they can from us. We should focus our reform efforts on ourselves: doing so will free resources that will help us rectify problems we have helped to cause else- where. (For more discussion of this rechanneling of resources, see the conclud- ing section of this article.)

George has not shown, then, that vegan diets call for more medical care, health monitoring, education, or food variety (with the exception of a B12 source in industrialized nations, and a vitamin D source if sunlight exposure is not an option, a recommendation also appropriate for omnivores in George's risk groups) than does the healthy omnivorous diet advocated by her. It is not the case that only the rich, privileged few can safely adopt a vegan diet. In view of

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the way that nonhuman animals raised for their flesh, eggs, or dairy products are now treated, particularly in affluent nations, and given the moral context of this discussion about omnivorism and vegetarianism, the choice for moral agents who accept that moral context is clear. If nonhuman animals who do not threaten us haveprima facie rights not to be harmed or killed, as George claims to believe, and if we can avoid so treating them without seriously risking our health, the unequal rights view calls for the vegetarian alternative.

2. Specific Issues and False Charges of Fallacy

Now I shall turn to George's false charges of fallacious reasoning and to her spe- cific distortions of my views. Consideration of these issues will further clarify the debate between us. In some instances, I shall introduce new evidence to shed light on our clashing claims. All these considerations lend additional force to the already strong case for vegetarianism.

2a. Osteoporosis Risk for Omnivores and for" Strict Vegetarians First, let us consider the issue of osteoporosis risk for omnivores and strict vege- tarians. Now, as earlier, George thinks that dairy products are the calcium sources that females should consume to lessen their risk of acquiring this crip- pling disease. As I have noted above, I never expressed any "monolithic principle against milk" (George, 1992, p. 223), as she claims. In the part of my paper - - wholly ignored by her - - that concerned moral theory, I write that it is possible to obtain dairy products without exacting harm and death from nonhu- man animals and their offspring. I have a sister4n Tennessee who does exactly this on her small farm (her chickens also lead the good life). As I have said, however, few of us in highly industr ia l ized nat ions have access to such humanely obtained dairy products. If we have no such access, and can do with- out such products without endangering ourselves or those for whom we are responsible, the unequal rights view enjoins us to find another source of calci- urn. The evidence from nutritional research shows that this can be done with- out risking osteoporosis. As I did in my earlier paper, let me quote once again from the comprehensive review on vegetar ianism (also wholly ignored by George) writ ten by Havala and Dwyer on behalf of the American Dietetic Association: "Calcium deficiency in vegetarians is rare, and there is little evi- dence to show that low intakes of calcium give rise to major health problems among the vegetarian population" (ADA Reports, 1988, p. 354). 13 Vegetarians appear to store their calcium more efficiently. Zemel's work, which I discussed, shows that strict vegetarians on soybased diets were able to maintain calcium balance with only 457 mg of daily dietary calcium (the RDA promulgated for the general population in omnivorous industrialized nations is nearly twice this amount) (Zemel, 1988, p. 880).

George thinks that in my discussion of a meeting of the American Society for Bone and Mineral Research I am trying to show that calcium supplements are

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nutritionally better than dairy products. She claims that I interpret the meet- ing's message as if it were an at tack on the view that calcium should be obtained from dairy products, when - - she says - - it is actually an attack on the use of calcium supplements (George, 1992, p. 219). In fact, however, George's claim misinterprets both the message of the conference and my discussion of it. Readers who read the latter will see that I take the conference to support the view that neither calcium supplementation nor large daily amounts (1000-1500 mg) of calc ium from food sources are needed for adults . These leading researchers in osteoporosis are disputing the National Institute of Health's rec- ommendation that Americans need to take in these large amounts of calcium, in whatever form (Science, 1986). Their discussion is general, as is only logical: the recommendation is not about the specific form in which calcium can be included in the diet. The researchers quote studies that examine women who get their calcium from food, from supplements, or from both: the conference participants conclude that the need for such large amounts of calcium in adults has not been established. It would hardly be relevant for them to mention the food calcium studies if supplements were their only concern. Yes, one researcher, Riggs, whom I quoted on this head, still advises his female patients to get 1000 mg through dairy products instead of supplements, because of the other nutritional benefits, the cheapness of this source, and its presumed safety; thus he finds the recommendations to be not harmful (just not demonstrated to be helpful) (Science, 1986, p. 519-20). Mazess reaches a different conclusion, disagreeing with the NIH recommendation of 1000-1500 mg of-calcium (from whatever source). Mazess is paraphrased by the Science reporter as holding that % high calcium intake can lead to kidney stones in susceptible people and that calcium supplements cut off vitamin D" (520). According to George, this obviously means that he is talking only about supplements, and she claims that I "inappropriate- ly" claim that he is saying that consuming large amounts of dairy products can cause kidney stones (George, 1992, p. 219). I instead took his tin'st remark about kidney stones, in line with the general discussion of the conference itself, to be a general one that would include calcium from dairy products. The following source should clear up this ambiguity: The New Handbook of Health and Preventive Medicine (Prometheus Books, 1990), discusses causes of kidney stones on p. 215. The authors list, in this order, "genetic predisposition to high concentrations of calcium, oxalate, or uric acid in the urine; excessive intake of vitamin D, milk, calcium antacids..." (italics mine). Thus my statement clear- ly was not "inappropriate."

George also suggests wrongly that I ignore many factors involved in osteo- porosis, such as race, bone frame size, level of exercise, and lack of estrogen in post-menopausal women (George, 1992, p. 220). On the contrary, I refer to all of these factors (Pluhar, 1992, pp. 200 and 211, note 7). I go on to cite literature showing that, even given these factors and adjusting for them, osteoporosis is strongly correlated with high consumption of dairy products and nonhuman animal protein. The countries with the highest rates of osteoporosis are those

Vegetarianism, Morality, and Sc ience- A Counter Reply 197

countries in which calcium, at the "RDA" level or the higher level recommended by the NIH, is derived largely from dairy products rich in animal protein. George has little to say about Zemel's research on the relationship between high con- sumption of nonhuman animal protein and the loss of calcium from the body, other than to say (as I did) that she does not advocate such high consumption, and she rejects D. M. Hegsted's contention that osteoporosis is more prevalent in countries with higher consumption of dairy products (Hegsted, 1986) by citing studies t ha t allegedly contradict the da ta in his review article. However, Nordin's studies of Indian women, as George points out in a footnote, were done on women with bones damaged by vitamin D deficiency; damage due to this deft- ciency and damage resulting from osteoporosis cannot be disentangled (George, 1992, p. 231, note 2). (See my discussion above about vitamin D deficiencies in omnivores and vegetarians, especially in poor countries where foods are not forti- fied with the vitamin.) 14 In any case, most Indians are lacto-vegetarians; the remainder eat both meat and dairy products. Hence these studies constitute no indictment of veganism. George also cites a classic Yugoslavian study which shows that the inhabitants living in one district of that country and having half the calcium intake of the inhabitants living in another district had lesser aver- age bone width and more fractures (Matkovic, 1979). However, as Riggs points out in one of the sources I cited in my original article, "[t]hese differences were apparent in young adult bone and did not become larger with aging, suggesting that the main effect of calcium intake was during bone growth" (Riggs, 1987, p. 979; my italics). Following the scientific evidence, I stated in my article that dietary calcium in some form does appear to be needed for bone development during childhood and adolescence (Pluhar, 1992, pp. 199 and 211, note 6). Hegsted, now Emer i tus Professor of Nutr i t ion at Ha rva rd Univers i ty and formerly human nutrition administrator for the US Department of Agriculture, also does not dispute this claim: the question concerns how much is needed and what sources of the mineral are adequate. Moreover, compared to countries with high per-capita rates of nonhuman animal protein and calcium intake, subjects in the low-calcium Yugoslavian district still had relatively low fracture rates, as is shown by yet another recent review article (Abeloe, 1992). I shall now briefly discuss this new article, to shed more light on this complex issue.

Abeloe considered every peer-reviewed geographic study on hip fracture rates that included age-specified data: 34 of 37 studies, inclu~ng the Matkovic study, met his criteria for inclusion. He explains that hip fracture rates are examined so frequently by researchers because they are "the most devasta t ing of the osteoporosis-associated fractures" (Abeloe, 1992, p. 14). After careful statistical analysis, Abeloe and his colleagues state that their results are consistent with Hegsted's (Abeloe, 1992, p. 15). They relate the level of calcium intake as well as the level of nonhuman animal protein consumption to the reported fracture rates, making the necessary adjustments. Their charts plainly show "a strong, positive association" between high calcium and nonhuman animal protein intake and the rate of hip fractures (Abeloe, 1992, p. 16). Note that, while it is

198 Evelyn B. Pluhar

true that blacks with their relatively larger bone frames are less susceptible to osteoporosis than are whites, American blacks had ten times the fracture rate of South African blacks, and seven times the amount of nonhuman animal protein in the i r diets (Abeloe, 1992, p. 15). 15 Abeloe and his col leagues t r ied to distinguish dietary calcium consumption from nonhuman animal protein con- sumption, but found themselves largely unable to do so, since the two are themselves highly correlated (Abeloe, 1992, p. 16). 16 This result is exactly what one would expect if the subjects got most of their calcium from dairy products. In line with sources I cited earlier, as well as much corroborative research, the authors of this study hypothesize that there is a "biologically plausible" causal link between bone loss and the ingestion of ever larger amounts of nonhuman an imal protein. The researchers note tha t there is evidence tha t calcium excretion is precipitated by increased acidity. They compare omnivorous, ovo- lacto-vegetarian, and vegan diets (matched for total protein) in terms of acidity, observing tha t on this scale vegan diets r ank lowest and omnivorous diets highest. "Omnivore diets," they write, "can induce a more negative calcium balance than less-acidogenic vegetarian diets matched for total protein" (Abeloe, 19921 17). I will quote their concluding paragraph in full:

In conclusion, many epidemiologic, human metabolic, and animal studies have produced results consistent with the metabolic acid-osteoporosis hypothesis. Though our findings do not necessarily imply a causal rela- tionship, the strength of the association does lend additional weight to the hypothesis. We conclude that further study of the endogenous acid-osteo- porosis hypothesis is warranted. Given the epidemic of osteoporotic frac- t u r e s in the West and the poss ib i l i ty of dietary prevention or new adjunctive therapies, such study may be of considerable practical value (Abeloe, 1992: 17; my italics).

Neither in my original paper nor here do I make the illogical leap, attributed to me by George, of reasoning that since meat-centered diets are a likely cause of osteoporosis, plant-based diets pose no such risk. Instead, I cite evidence for the claim that vegan diets do not predispose one to osteoporosis. Nor do I accuse George of advocating a dangerous meat-centered diet: of course she does not, as I repeatedly noted in my article. The whole discussion concerning the correla- tion between significant consumption of nonhuman animal protein, including the protein obtained from dairy products, and osteoporosis is relevant as fol- lows: people in Western countries are told to get from 800 to 1500 mg of calcium daily, preferably from dairy products, as a help in protecting themselves from osteoporosis. George, in line with this thinking, holds that the lack of dairy products in the vegan diet is a serious risk factor for osteoporosis. Her con- tention is not supported by these data: quite the contrary. Plant sources appar- ently can provide sufficient calcium for the growth and development of bones; thus strict vegetarianism is not a good casting choice for a major villain in this piece.

Vegetarianism, Morality, and Science- A Counter Reply 199

2b. Lactose and Risks of Ovarian Cancer and Senile Cataracts I now turn to two of George's most serious charges about my discussion of dairy products. In the course of that lengthy discussion, I said the following:

Dairy products are also implicated in the formation of cataracts (Simoons, 1982) and, more seriously yet, the incidence of the usually fatal disease of ovarian cancer (Cramer, 1989). It is far from clear that a diet containing dairy products is less risky than one that omits them (Pluhar, 1992: 199).

I returned to this topic once more at the end of this section of my article, con- cluding that:

. . . George has not shown that a strict vegetarian diet puts one more at risk than her version of a healthier omnivorous diet. Considering dairy products' troubling role in increased rates of heart disease, cataracts, and ovarian cancer, strict vegetarianism not only does not make one worse off in this regard: it may actually be an advantage (Pluhar, 1992, p. 201).

In her response to me, George claims that (1) I badly misconstrue the article on ovarian cancer and (2) I attribute to the author of the cataract study a con- clusion that actually contradicts the conclusion he drew (George, 1992, pp. 221- 222). Let us take each of her charges in turn.

George claims that Cramer's ovarian cancer study shows that only women with a genetic inability to adequately break down galactose (a product of lac- tose, found in dairy products) would be at possible risk of getting ovarian cancer from eating high lactose dairy products, especially yogurt and cottage cheese (George, 1992, p. 221). Thus, she reasons, ! am as wrong as one can be in saying that the study suggests that high consumption of dairy products could cause women in general to get this usually fatal cancer. Readers who check Cramer's article will find, however, that he and his colleagues do not draw George's limit- ed conclusion. They conclude that:

If our findings are confirmed, however, avoidance of lactose-rich food by adults may be a way of primary prevention of ovarian cancer, particularly in those women with low transferase activity (Cramer, 1989, p. 70).

Since, in this study, women who already had ovarian cancer were compared with a control group of healthy women, George argues that one would need to look for a relationship between women eating high-lactose products and the incidence of ovarian cancer in order to draw the conclusion which I (and Cramer et a id drew. However, the authors state in this very article that "[w]orld-wide, ovarian cancer risk is strongly correlated with !actase persistence [the contin- ued ability, as aging progresses, to digest lactose] and per capita milk consump- tion" (Cramer, 1989, p. 70). Yes, as the authors say, more detailed studies are needed before a direct causal link can be established; but, as I said, to date the evidence is "troubling."

200 Evelyn B. Pluhar

George is also quite mistaken in her interpretation of what I have said about Simoons' senile cataract study. Remember that I said dairy product consump- tion was "implicated" in the formation of cataracts. George correctly reports Simoons as saying that the evidence reviewed by him "does not demonstrate" his hypothesis that even moderate milk consumption contributes to cataract forma- tion. But, as George acknowledges, Simoons immediately goes on to say that the evidence is sufficient to war ran t fur ther investigation of tha t hypothesis (Simoons, 1982, p. 263). George infers that when I said that dairy products "are implicated" in the formation of cataracts, I said "the opposite" of what Simoons concluded; she thus claims that I am confusing an hypothesis with a fact (George, 1922, p. 222). I find this a very bewildering accusation. Apparently she takes "is implicated in" to be equivalent to "has been demonstrated to be a cause of." That is oobviously not how I used the term; if that were what I meant, I would hardly have gone on in my very next sentence to say, so mildly, that given this evidence "[i]t is far from clear that a diet containing dairy products is less risky than one that omits them." I also would not have used the subsequent cautious language, speaking about a merely "troubling role" for dairy products in cataract formation, ovarian cancer development, etc., or said that, given this evidence, strict vegetarianism "may" be an advantageous diet - - all of which is very much in line with Simoons' conclusion. Furthermore, I do not know how "is implicated in" could at all plausibly be construed in George's strong sense of "has been demonstrated to be a cause of." The phrase, commonly used in crimi- nal justice, means "is involved in" or "is suspected of being responsible for." (By the way, I checked with colleagues in the natural and social sciences on this, and they likewise saw no contradiction at all between my words and Simoons'.) So much, then, for George's charge that I "confuse a hypothesis with a fact."

2c. Vegetarianism and Lower Levels of Blood Pressure George makes a similar charge when she disputes my statement that Carter's study of pregnant vegan women on "the farm" shows that these women "are sig- nificantly less prone to pregnancy-induced high blood pressure than [are] omnivorous women" (George, 1992, p. 228). She objects that factors other than a vegan diet could be responsible for the women's blood pressure status (George, 1992, p. 228). Apparently, she is once again taking me to be claiming a causal connection that is not supported by the evidence. Here again she is doubly mis- taken.

First , my s t a t emen t above is no th ing more than a descr ipt ion of the researchers' findings. They state that the virtual absence of pregnancy-induced high blood pressure in the vegan women (of 775 pregnant women, only one had the disease of preeclampsia) is "an extremely low incidence in comparison to any other sample taken anywhere in the U.S." (Carter, 1987, p. 696). Why this should be so is another issue. My statement is a description, not a causal claim; thus, George's mentioned "other factors" are compatible with what [ have said. Second, there is evidence that a strict vegetarian diet contributes to lower blood

Vegetarianism, Morality, and Science ~ A Counter Reply 201

pressure (note that I do not claim and have never claimed that no other factors could contribute). Many studies have shown that vegetarians, especially vegans, are less likely to suffer from hyper tension than the omnivorous general population. Havala and Dwyer speculate about both dietary and lifestyle factors that could explain this (ADA Reports, 1988, p. 353). Dwyer, in 1991, said it is not clear which factors are involved (Dwyer, 1991, p. 72). However, in attempts to sort out some of the lifestyle factors (e.g., greater attention to physical exer- cise, abs ten t ion from subs tances such as coffee, tobacco, and alcohol), researchers have compared omnivorous Mormons and ovo-lacto-vegetarian Seventh Day Adventists; both groups tend to shun caffeine, tobacco, and alco- hol. The vege ta r i ans in these studies had lower blood pressure than the omnivores (Rouse, 1983, pp. 8, 9). 17 (This is cited in a source I used in my original article.) One wonders what differences might have been found if vegans, who do not consume any nonhuman animal fat, could have been brought into the comparison. In fact, a way to bring in vegans while controlling for different lifestyle factors has also been made, as is noted by another source that I cited (Zemel, 1988, p. 883). Studies have been done in which the same individuals had their diets changed from either omnivorous or strict vegetarian to strict vegetarian or omnivorous, then back again: blood pressures were con- sistently lower during times when the subjects were on a strict vegetarian diet. ls Several plausible, mutually compatible hypotheses have been advanced to show how the vegan diet itself could contribute to lower blood pressure: see, e.g., Carter on arachidonic acid, and Zemel on the relationships between protein, calcium, and sodium in strict vegetarian diets (Carter, 1987; Zemel, 1988, pp. 882-3).

2d. Strict Vegetarianism and AIDS One of George's charges that distresses me most concerns my mention of a study on AIDS patients. Since George originally claimed that it was dangerous for ill people not to eat nonhumans or their products, I discussed a number of studies that dispute her contention (Pluhar, 1992, p. 207). One of 11 serious dis- eases that I mentioned was AIDS. Here is what I said:

Even patients with AIDS-caused Kaposi's sarcoma have improved their conditions by switching to a strict vegetarian diet, in comparison to those who do not (Levy, 1985). (Of course, no one could responsibly claim that such a diet would cure a terminal disease.)

From my list of studies concerning 11 diseases, George picks out the AIDS study to discuss. She accuses me of misdescribing the study and of giving AIDS patients "false hopes" that encourage them to stop medical treatment (George, 1992, p. 230). She quotes what I say above, minus the last sentence. In my response, let me point out a mistake I did make, then defend myself against her claim that I have given AIDS victims "false hopes" that encourage them to replace medical treatment with a vegan diet.

202 Evelyn B. Pluhar

George is correct in pointing out that I should not have said these patients "switched" to a vegan diet. Levy does not indicate whether they had been veg- ans before this very serious stage of their disease. George does not say so, but this could affect the results as follows. Epidemiological studies indicate that vegetarians are less susceptible to cancer than are omnivores (Malter, 1989, p. 271). In inves t iga t ing this phenomenon, Malter and her fellow German researchers note that many factors, from diet to lifestyle, may he responsible for this, al though they state that dietary factors alone "may be sufficient" to explain the lessened cancer risk (Malter, 1989, p. 272). 19 They did a controlled study to focus on the NK ("natural killer") cell production of vegetarians as opposed to omnivores. They found that their vegetarian subjects (they do not specify the type of vegetarianism) had stronger immune systems than their omnivorous subjects, concluding that "[t]his is in line with the idea that the reduced cancer risk of vegetarians is possibly partially related to the better nat- ural defense system they seem to have" (Malter, 1989, p. 278). These subjects were presumably all healthy (we are not told otherwise). Now, if the vegan AIDS patients under discussion had been vegan before contracting the disease, they might have had stronger immune systems in the beginning (for dietary reasons, lifestyle reasons, or both) than other AIDS victims. This could have skewed the results, helping to explain why most of the men were still working and "surviving at least as well" as Kaposi sarcoma patients who were getting conventional treatment. (The fact that the men studied had not chosen conven- tional treatment, other than radiation therapy in some cases, makes their con- ditions especially remarkable. Had they chosen conventional treatment, they might very well have had even more impressive survival rates. Note, however, that in my quoted sentence above I did not mention their lack of treatment.) By contrast, for non-vegetarians whose immune systems have already been com- promised, there may be no benefit in such a dietary change. Considering Dwyer's view that the chronically ill can safely adopt a vegan diet (Dwyer, 1991, pp. 82-3), however, it is unlikely that such a diet (properly balanced, of course, as I repeatedly stressed in my article) would harm them. Thus my incorrect "switching" terminology, for which I do apologize, cannot fairly be construed as life-endangering.

George, however, muses that if a vegan diet is "incidental or even harmful" to the survival of the vegan AIDS patients, "wouldn't it be a shamd if some AIDS patient were to read Pluhar's remarks and think it would improve his/her condition to forgo other treatment and become a vegan instead?" I defy the reader to find anything in "Pluhar's remarks," quoted above, that encourages AIDS patients to "forego other treatment and become a vegan instead"! In my brief sentence about the study, I did not even mention, let alone advocate, the lack of conventional treat- ment (remember too that several of the men had radiation therapy). Moreover, for George to quote me and then to accuse my quote of giving "false hopes" to AIDS patients, while expressly leaving out my very next sentence warning that a vegan diet cannot cure a terminal disease, is, quite frankly, unbelievable.

Vegetarianism, Morality, and Science- A Counter Reply 203

2e. "The China Project" and Allegedly Sweeping Claims George also accuses me of making "sweeping claims" based on sources that report no data. The only example she gives are my alleged claims that "there is apparent- ly no osteoporosis in China and no iron deficiency" (George, 1992, p. 229). As any- one can see who goes back to check what I actually said, however, I made no such claims. I said that osteoporosis is apparently "rare" in China (Pluhar, 1992, p. 199), and my second claim was about T. Colin Campbell's sample 2~ of 6500 Chinese sub- jects, not about all Chinese inhabitants (Pluhar, 1992, p. 201). It is George, not I, who is guilty of making sweeping claims here. Moreover, the claims I make are supported by data, data that are summarized on the releVant topics in sources I used and fully detailed elsewhere. Let us take each topic in turn.

My claim on the rarity (not absence) of osteoporosis in China, Iike Campbell's claim about the lack of iron deficiency in his Chinese subjects, is based on the immense study he did in conjunction with Chinese colleagues. New York Times nutrition writer Jane Brody is one of many who discusses these claims (I did not cite her article in my earlier article; it is consistent with Varkonyi's article but far more detailed). Let me quote her on the subject of osteoporosis:

Most Chinese consume no dairy products and instead get all their calcium from vegetables. While the Chinese consume only half the calcium Americans do, osteoporosis is uncommon in China despite an average life expectancy of about 70 years, just five few years less than the American average (Brody, 1990: C14). 2i

On the issue of iron, Brody writes that Campbell has shown that average Chinese adults, who get most of their iron from plants (93%) and eat at least three times the amount of allegedly mineral-binding fiber that Americans eat, do not suffer from iron deficiency; thus, "[t]he study also showed that consumption of meat is not needed to prevent iron-deficiency anemia" (Brody, 1990, C14).

Because of the unprecedented scope and representative nature of Campbell's study, Brody does not hesitate to generalize from this study to conclusions about the Chinese people. George thinks Campbell could hardly be in a position to make generalizations about China on the basis of his supposedly limited sample, but that is because she misunderstands the conditions under which the study was done. The parameters of the study are described in the research news report in Science (Roberts, 1988) which I cited in my article, and which George says she has read. She thinks the study was done on Chinese vegetarians, and in a "localized area"; neither is the case, as Science (and I) both made clear. Campbell surveyed 12,000 people in 65 counties across the entire country, two villages in each county, for a total of 130 sites. He then gathered more data on 350 items, taking blood and urine samples from 6500 men and women. A 1990 follow-up article in Science finds the study, which has been expanded even further, to be extremely impressive (Moffat, 1990). A 920 page book reporting all the data, including thousands of correlations, was published by Cornell University Press in 1990 (Campbell, 1990). Moreover, Campbell has published two articles in 1990 and one in 1992 that analyze parts of

204 Evelyn B. P luhar

the data (Campbell et al., 1990 a, b; 1992). Public policy proposals are being made to the Chinese government on the basis of the data gathered. Much analysis remains to be done, but it simply is not true to suggest, as George does, that the data have not been published, or that they have not been discussed in scientific journals (George, 1992, p. 229). (I did not cite the book and articles in my earlier critique of George's piece, but any library check will unearth them.) Campbell's findings are consistent with all the other sources I quoted on these issues.

2f. Vegetarianism and Iron Deficiency

It is hard for me to choose, but I think that George's most serious distortions of what I have written occur in her discussion of my alleged views about iron deficiency. First, she takes the portion of my article that addresses the iron status of v e g a n s as it was in the beginning of their commune at "The Farm" in Summertown, Tenessee (see Pluhar, 1992, p. 203) to be a slanderous attack on the medical research team that did the early 1971 checkups of the children and women. George spends two pages castigating me for supposedly claiming that a biased medical team "found" iron-deficiency anemia in the 44 children when in fact none of them was actually clinically anemic (George, 1992, pp. 226-227). In truth, however, as readers can see for themselves if they check (Pluhar 1992, p. 203), I accepted the medical team's claim that 8% of the 44 children were anemic! 22 So convinced is George that I am some sort of vegetarian fanatic that she is blind- ed to my actual words, "seeing" the contradictory of what I have written. "Thus, Pluhar's attack is specious," George concludes, after heatedly defending the med- ical team's diagnosis of iron-deficiency anemia in three of the 44 children (George, 1992, p. 227). No, indeed, it is not my reasoning that can be said to be "specious"

here. George further "violates the canons of fair reasoning" (to use the phrase she

wrongly uses against me) in claiming that "Professor Pluhar wonders whether we should care about iron deficiency, given that many women even in wealthy nations are anemic" (George, 1992, p. 228). Her claim is flagrantly false. I never made or

implied any such statement. George seems to think that my not listing the symp- toms and terrible consequences of iron deficiency anemia, especially in its extreme forms, means that I do not think this deficiency is important. This is nonsense. I am at a loss to understand how anyone could read my article and come away with such a notion. My pointing out that omnivores as well as vegetarians must battle against iron deficiency (Pluhar, 1992, pp. 201-203) is hardly tantamount to declar- ing iron deficiency an insignificant problem. Of course iron deficiency must be fought, and I said so.

Research shows that vegetarians can do this quite successfully. To summarize what I said in my article: iron deficiency expert Nevil Scrimshaw's own food tables show that many ordinary plant sources compare very favorably with similar por- tions of meat sources (other than steaks and organ meats) in providing absorbable

iron to the body (Scrimshaw, 1991, p. 48; Pluhar, 1992, p. 202). Campbell's China study also shows that plant sources evidently supply sufficient iron, even in a diet

Vegetarianism, Morality, and Sc ience- A Counter Reply 205

extremely high in fiber; see also Kelsay's 1988 study, cited by me (Pluhar, 1992, p. 201). I agree with George (I never said otherwise) that people in developing countries are especially vulnerable to iron deficiency, with their greater blood losses from disease, parasitism, and uterine bleeding. They need to replace more lost iron than do most people in industrialized nations. Scrimshaw, as I also reported does not try to solve the problem by suggesting that people in these coun- tries should be enabled to eat more organ meats: instead he urges UNICEF and WHO to work harder at eradicating parasitic infestations and diseases like malar- ia, to help provide iron supplements to vulnerable groups (remember too that omni- vores in vulnerable groups are routinely given the same advice, even in affluent countries); he also says fortification of a staple food might be considered (note that in the US, bread and cereals are often thus fortified). Encouraging the greater con- sumption of legumes, grains, and ascorbic-acid-rich food sources would be very helpful as well.

George claims that those of us who are more fortunate should try to enrich the diets and fight the diseases that contribute to anemia in developing countries instead of trying to solve the problem by pushing iron pills (George, 1992, p. 229). I quite agree. However, she then ends her long discussion of my supposed errors about iron deficiency by proclaiming that "[w]hat does seem clear is that we have little business telling them that they are immoral if they can consume a bit of ani- mal protein to enhance their diets" (George, 1992, p. 229). Her clear implication is that I have taken such an attitude. This is false. I am not a vegetarian version of Carrie Nation, wielding my rhetorical axe against meat-eating sinners, as anyone who has read my earlier article should know. "Immoral" actions are deliberate vio- lations, by omission or commission, of moral obligations one knows oneself to have, when alternative courses of action that would not violate an equal or even greater moral obligation are available and known to one. Moral agents who are unaware of the view (accepted by George in her 1990 article) that sentient nonhumans as well as humans are rights-holders hardly qualify as "immoral" when they kill to eat a sentient nonhuman. Also not blameworthy would be those moral agents who quite sincerely and non-culpably reject this rights view. Many people fall into one or both categories. Never do I refer to poor, uneducated, or disadvantaged omnivores in developing or industrialized nations as "immoral!" Moreover, those who accept the unequal rights view, as I think George plainly does, would also not act in a blame- worthy way if they killed a nonhuman animal in order to maintain the health or lives of themselves or other humans for whom they care. Instead of condemning human omnivores as "immoral," I repeatedly use language like the following: "Are most of us tragically compelled to violate the rights of others in order to sustain ourselves?" (Pluhar, 1992, p. 197; italics added). As I made abundantly clear in my article, the people who really behave immorally on the issue of diet are those who deliberately promote unhealthy diets and inadequate food supplies; those who obstruct efforts to inform others about safe diets or to help supply them with healthy food sources are also blameworthy. (I do not of course accuse George of any such "immorality.")

206 Evelyn B. Pluhar

3. Conflicts of Interest, Vegetarianism, and Omnivorism: Concluding Remarks

The preceding topic leads naturally to the last part of my discussion. I turn now to George's final false claim, made at the end of her article, that I deny that there are any conflicts of interest between humans in vulnerable groups and "food animals," as she calls them (George, 1992, p. 230). In fact, however, I do not deny that there are any such conflicts of interest. In the last section of my article I state that some humans would endanger their health by becoming veg- ans (Pluhar, 1992, pp. 209-210). This most prominently includes humans who live in areas where an adequate and varied supply of plant sources is not avail- able. Thus, my overall conclusion at the end of that final section is qualified: "In conclusion, morality and human health are in general not at tragic odds. If sen- tient nonhuman animals do indeed have aprima facie right to life, a large num- ber of humans are in a position to recognize and honor such a right" (Pluhar, 1992, p. 210; italics added).

Ironically, George herself appears to be ignoring very real conflicts of interest that now exist between humans and the sentient nonhumans they regard as food resources. Apart from the conflict she perceives between many humans ' health and nonhumans! lives, George seems to see few interest clashes. After reiterating her view that humans in the vulnerable groups need nonhuman ani- mal products, she defends omnivorism by stating that "[t]he plain fact is that humans and food animals have co-evolved and they serve one another as species" (George, 1992, p. 230; my italics). This is a very surprising statement. For example, surely domestic turkeys, who cannot fly, can hardly be said to have "evolved" into that condition over the millennia. Although George says "[o]ur bodies have changed with their bodies," evolutionary processes have not and cannot alter us at anything like the pace at which we have altered nonhumans (quite literally to suit our tastes). The term "co-evolution" implies that the par- ties involved have mutually, gradually, developed and adapted: it hardly describes the reality of nonhuman animal husbandry. Even more inaccurate is the claim that humans and the nonhuman animals we raise for food "serve one another as species." Annually, billions of sentient nonhumans suffer for the human animals they "serve." Factory-farmed nonhuman animals, who are the majority of sentient nonhumans consumed, have largely miserable , brief lives (Mason and Singer, 1990). Yes, we "serve" them too: at dinner! Conditions can be greatly improved, of course: omnivorous Swedes are in the process of doing this by phasing out factory farming over a 10-year period. But what they and some others are doing is not representative of current conditions. I find George's above remarks about the mutually beneficial relationship between humans and these other sentient beings, stated as a "plain fact" rather than as an ideal to be pursued, especially surprising because she has spoken quite diffently in the past. In her 1992 paper, the only suggestion that all may not be as it should in our relationship with "food animals" is her unspecified claim at the end that a

Vegetarianism, Morality, and Science - - A Counter Reply 207

"better and more humane world" is desirable (George, 1992, p. 231). The degree of inhumanity involved in current meat production methods receives no mention.

As I have already said, humans suffer from these practices too. Our diets are in conflict with many interests, including our own. Current patterns of omnivo- rous consumption contribute very significantly to the lack of sufficient food in many parts of the world, as well as to severe ecological damage (Durning and Brough, Worldwatch Paper 103, 1991). George speaks to this in her original article (see George, 1990, pp. 178-179). She believes that these problems could be alleviated by an omnivorous diet containing far less meat than is currently consumed in affluent countries (112 kilograms per person per year in the US, according to the Worldwatch Institute). 2a As we have seen, this is the sort of diet she thinks the majority of people in the world ought to have. However, given our current population, it may not be possible to feed humanity even a very modest omnivorous diet. Researchers at Brown University's Alan Shawn Feinstein World Hunger Program have calculated what primary food resources are needed to feed current numbers of humans. Their projections were publi- cized in 1992 (Cohen, 1992, p. 117). I have verified the reported projections in a telephone conversation with Dr. Robert Chen, the World Hunger Program researcher who made the calculations. As I write, at the end of 1992, 5.5 billion humans exist. The World Hunger Program estimates that, at present levels of food production, and even assuming an equal distribution of food, our planet could sustain no more than the number that currently exists, 5.5 billion people - - i f all of them are lacto-vegetarians! Consider that this figure takes into account the fact that millions of tons of grains and legumes now fed to nonhu- man animals that we eat (rather than employ for dairy purposes) would he diverted to humans, giving us more total protein than is now available for our species: 24 still, there would be barely enough food for us. 25 By contrast, given these same base conditions, the Brown researchers estimate that the planet could sustain a population of only 3.7 billion omnivores getting 15% of their calories from nonhuman animal products, including eggs. This is quite a modest omnivorous diet, now followed by many in Latin America. According to the World Hunger Project, if the world's population got an average of 25% of their calories from nonhuman animals instead, as many Westerners do, only 2.8 billion h u m a n s could be sus ta ined. These are s t unn ing figures. I f the Brown researchers are correct, then, unless we can somehow respectfully and humanely reduce our numbers or manage to vastly increase food production in an ecologically responsible way, even an omnivorous diet t ha t is more modest than the diet pursued by many people in Latin America is incompatible with the survival of large numbers of humans. Now, that is a conflict of interest.

In short, the lives of billions of rights holders of all species depend upon the decisions that we moral agents make about our diets. Science, ethical theory, and good reasoning are needed to help us make those decisions. On this, at least, Kathryn George and I agree. 2s

208 Evelyn B. Pluhar

N o t e s

1. Regan, the most prominent defender of rights for certain nonhumans, cannot consis- tently accept this view, but George can. I do not endorse it myself, for the reasons given in my 1992 article. 2. George also objects to my saying that she advocates the "liberal use of dairy products," but this is not equivalent to the claim she thinks I am making, namely that she supports consuming far more of these products than she thinks necessary. The Recommended Daily Allowance (RDA) for calcium is 800 mg for the general population and nearly twice that for adolescents, pregnant or breast-feeding women, and women during and after menopause. George thinks dairy products should be used to fulfill the calcium require- ment: thus, depending on one's status, the RDA on her view would call for (roughly) three to five 8-ounce glasses of milk or the equivalent in other dairy products every day, In call- ing this a recommenda t ion for "l iberal use of dairy products," I mean t only tha t a "substantial" amount of these products is being recommended, not an amount that would be "excessive" in her eyes. As I said in my critique (to mention but one of several such descriptions of George's position), "she holds that meat and dairy products should be eaten only if they are required for human health, and then never to excess" (Pluhar, 1992: 208). 3. She also objects to my not citing nutrition textbooks. She wrongly assumes I have not read such sources. The problem with textbooks, however, is that they tend to be more dated than articles, even review articles: the research upon which they are based is years older than the publication date of the text (the Whitney text George cites was published in 1987). This lack of currency is not problematic in many cases, but it can be damaging in a discussion of vegetarianism, particularly its strict form, since so many early studies were done on people (often very small numbers of people) who followed very unbalanced diets. The warnings against a vegan diet for children, for example, even in the 1986 The New Laurel's Kitchen, a combination vegetarian cookbook and nutrition text cited by George in her 1992 article (I did not cite this edition in my critique of her, contrary to her claim), are based on such studies. The 10-year Farm study (O'Connell, 1989) of hundreds of healthy vegan children who follow, with their parents, a sensible diet, is not discussed by such sources, although I trust it soon will be. 4. Dwyer goes on to warn of the dangers of unplanned vegetarian diets. I fully agree that diets should not be haphazard, and I stressed this repeatedly in my response to George. As we shall see shortly, Dwyer herself notes that any unplanned diet, including an omniv- orous one, poses health risks. 5. Dwyer cites the 1988 position paper she co-authored, without any expression of second thoughts or disclaimers, in her 1991 review. 6. Strictly speaking, only those who are moral agents can have duties or moral obliga- tions. Infants and children have no such obligations. In her 1992 article, George takes me to be saying that they are morally obligated to be vegetarians (George, 1992, p. 225). I did not claim this. As I make clear in that section of my article (pp. 205-206), parents or guardians are the ones who are responsible for the ethical decisions involved. 7. Her recommendations are on p. 65: plant sources, especially those low in substances that might inhibit absorption, taken in conjunction with plant sources rich in ascorbic acid (vitamin C). She adds that muscle foods are helpful (not an option for a vegetarian), but does not suggest that they are essential. Also helpful are sources rich in the amino acid cysteine. She says the lat ter include milk and eggs, but grains also provide a rich source of cysteine. See Nevil Scrimshaw's list of common plant sources with the percent- ages of absorbable iron each portion provides, sources that compare favorably with eggs and meat (except for cholesterol- and sa tura ted fat-laden steaks and organ meats) (Scrimshaw, 1992, p. 48; see also Pluhar, 1992, p. 202). Campbell's China study (see my discussion below) as well as Kelsay (1988) indicate that fears about inhibiting effects on

Vegetarianism, Morality, and Science - - A Counter Reply 209

iron absorption in plant sources are more theoretical than practical. A vegan diet is com- patible with adequate iron status. 8. Nutritional research published in 1992 gives us another example of a vital nutrient that vegetarians may get more easily than many omnivores. The absence from pregnant women's diets of sufficient folic acid, found in leafy green vegetables, citrus fruits or juices, and beans, is linked to severe birth defects such as spina bifida. The US Food and Drug Administration is seriously considering recommending that baked goods be fortified with this vitamin to ensure adequate consumption because largely omnivorous US women typically get only half the dosage that they should ("Health and Science: Fortified Bread," Time, December 7, 1992, p. 30). Vegans eating unbalanced diets could have the same problem, of course: in the early days of "The Farm," a vegan community I extensively dis- cussed in my earlier article, folic acid deficiency was thought to be a "possibility," although this was not established (Carter, 1987; see George's discussion of this on her p. 227). 9. Here is just one example of information needed by omnivores (and lacto-vegetarians) who contemplate parenthood. Skim milk should not be given to infants; in addition, the American Academy of Pediatrics' Committee on Nutrition recommended in 1992 that infants under 1 year of age be given no whole cow's milk either. Bad effects of cow's milk given to infants include impaired iron status (American Academy of Pediatrics, 1992). Moreover, there is frightening new evidence that cow's milk could trigger juvenile dia- betes in genetically susceptible young children (Karjalainen, 1992). Vegans, of course, need good advice about their children's diets too, as I repeatedly stressed in my article. 10. I also find odd Dwyer's claim that much "skill" is needed in planning a diet consisting of such elements. It used to be thought that much planning is needed because of the alleged need to complement proteins in every meal. Dwyer, however, is well aware that this is a myth: she and Havala deny the need for such "precise planning" in their 1988 article (ADA Reports, 1988, p. 351). Whole grains, green and yellow vegetables, legumes and fruit over the course of a day will give you a balanced diet (brief exposure to sunshine or a fortified source of vitamin D, and a fortified source or supplement of B 12, is also need- ed, as discussed). Could Dwyer mean that preparing such "unconventional" food sources requires a lot of skill? But this is not true. If someone with as little time and as little culi- nary skill as myself can produce appetizing, well-balanced fare, there is hope for anyone. What one really needs are good recipes, and there are many such recipes, readily available in popular bookstores. 11. See, e.g., Carol Adams, The Sexual Politics of Meat: A Feminist-vegetarian Critical Theory (New York: Continuum Publishing Co., 1991). 12. Such treatment is compatible with a principle central to many Eastern religions: "Ahimsa" proscribes violence against other sentient beings. This principle is, alas, widely flouted in dealings with one's fellow humans as well as one's fellow nonhumans, as Gandhi (himself a murder victim) frequently pointed out. See Steven Rosen, Food for the Spirit: Vegetarianism and the World Religions (New York: Bala Books, 1987), Chapter Five. 13. This is puzzling to nutritionists because a plant-based diet is high in phytic acid, oxal- ic acid, and fiber, all factors that "may," as Dwyer states, inhibit calcium absorption (1991, p. 68). Havala and Dwyer note that "this effect may not be significant" (1988, p. 354). In her Single-authored review, Dwyer cites diet (lack of excessive protein) and lifestyle factors for vegans that could counterbalance an inhibiting effect. Moreover, as we saw above, low-oxalate vegetable greens like kale (broccoli, collard, turnip and mustard greens also belong in this group) have been shown to provide calcium in an even more absorbable form than is provided by milk. Finally, the literature I cited in my earlier arti- cle, confirmed by a yet more recent review article (Abeloe, 1992), strongly suggests that lack of excessive nonhuman animal protein may well be extremely helpful in maintaining healthy bones.

210 Evelyn B. Pluhar

14. Life is extremely hard for a great many people in India, but especially hard for women, and much needs to be done to alleviate this. As I am sure George recognizes, this includes but also transcends dietary factors. Clearly, some more reliable way to obtain vit- amin D than exposure to the sun, which presumes that one can get out of the house with- out being almost entirely covered, is needed. As I have said, this is a matter of education and health policy, and it can be done compatibly with vegetarianism. I repeat that I have never advocated forcing vegetarianism on individuals, let alone individuals who do not have the means to meet basic nutritional requirements. 15. George points out that Nordin's (1966) study cites Africans who believe that the low rates of osteoporosis in their countries would change for the worse if the inhabitants lived longer. However, all the comparative data above are age-adjusted. 16. It is interesting, however, that the data show that the two Yugoslavian districts dis- cussed by Matkovic are both low on the overall fracture scale, although one is indeed twice as high as the other: note that the total amount of dietary nonhuman-animal pro- tein for inhabitants in both districts was the same (27.5 g daily) - - quite low compared with the countries with higher fracture rates. (Abeloe, 1992, pp. 15, 16). Apparently the diets in these regions were rather divergent. These fracture rate comparisons support the h y p o t h e s i s t h a t h i g h e r n o n h u m a n a n i m a l p ro t e in c o n s u m p t i o n c o n t r i b u t e s to osteoporosis. 17. Dwyer cites one study that did not find a difference in the blood pressures of white ovo-lacto vegetarians and white omnivores in the US (see her reference #89 on p. 90). She does not mention the Mormon-Seventh Day Adventist studies, which attempted to sepa- rate the lifestyle from the dietary factors: as we see, these did find a difference. She also does not cite Rouse's controlled study of omnivores who were given an ovo-lacto vegetari- an diet, then returned to their old diets (Rouse, 1983; see note 18 below). These studies are compatible with the many other studies that have found vegetarians to have lower blood pressure than omnivores. (I must add that my vegetar ian acquaintances and I would be regarded as "untypical" by Dwyer: we all drink coffee, enjoy a glass of wine, and exercise in quite varying degrees. No one has high blood pressure. In saying this, my point is not to advocate an unhealthy life-style.) 18. Rouse did the same type of study, switching his 59 volunteers from omnivorous to ovo- lacto-vegetarian diets, then back again. Blood pressure drops were significant during the vegetarian phase of the study; a control group of omnivores who did not change diets had no changes in blood pressure readings (Rouse, 1983). I have also examined the studies involving vegan diets. The first, which began with 21 macrobiotic vegetarian volunteers, found tha t both plasma cholesterol and blood pressure rose significantly dur ing the omnivorous portion of the study (Sacks, 1981). The vegetarian and omnivorous diets were calibrated such that the only difference involved the addition or subtraction of meat; no other lifestyle factors varied during the study. There was concern that increased anxiety felt by the vegans as they added meat to their diets might have accounted for the differ- ence, but Sacks and his colleagues report that their statistical methods showed no signifi- cant correlation between mood change and blood pressure level (Sacks, 1981, p. 643). A subsequent study (Burstyn, 1982) avoided the anxiety issue altogether by beginning with 24 omnivorous volunteers. Their blood pressures went down during the 6-week portion of the study in which they ate (mostly) strict vegetarian diets (probably to better ensure compliance, they were allowed to eat one weekly meal containing meat during this time). The differences were not large, perhaps in part becaue of the meat the subjects were still allowed to eat during the 6 weeks. However, as Burstyn points out, these results are important given that differences in blood pressure between omnivores and vegetarians become greater as individuals age (Burstyn, 1982, p. 30). Their blood pressures returned to "normal" within 6 weeks of returning to their old diets. 19. Researchers have recently identified a substance in broccoli, brussels sprouts, and kale that causes human cells to produce enzymes that fight cancer cells (Science News,

Vegetarianism, Morality, and Science ~ A Counter Reply 211

1992). Omnivores can eat these fine vegetables too, pace ex-President George Bush, but vegetarians tend to eat more of them. 20. Associate Professor of Nutrition Barbara Deskins, University of Pittsburgh, who wrote the newspaper article I mentioned here, quotes Campbell himself as saying that none of his data analyzed thus far indicate iron deficiencies in his subjects (Deskins, 1991, F6). 21. George cites an English abstract in the May 1990 issue of a Chinese journal by a Chinese researcher (H. Zhu) who claims, she says, that he found varying degrees of osteo- porosis in his sample of 2041 Chinese; data on the incidence of the disease were said to be unavailable (George, 1992, p. 229). I do not doubt her word that this study has been done, but I have been unable to find this source. I have also checked for English articles by the author since 1990: none on the subject of osteoporosis can be found. My check of Science, Science News, and Scientific American from 1990 to the time at which I am writing (December 1992) has uncovered discussion of only one May 1990 report of a Chinese study with implications for osteoporosis in that country: Campbell's. Since Campbell's data were published in their entirety in June 1990, although specific findings were discussed before then, Zhu was probably unacquainted with those data. From the description George gives of Zhu's abstract, it is not clear that his data conflict with Campbells'. Campbell found osteoporosis, albeit rarely, in his very large sample. 22. I also accepted the team's report that "none" of the women examined in 1971 were anemic (Carter, p. 694; Pluhar, p. 203). I do indeed question the researchers' claim that hematocrit values below 32% automatically indicate anemia. Obviously, however, since we are not told how far below 32% the hematocrit values of 8% of the children fell, one cannot say that the three (I assume the actual number is "3" rather than "3.52!") children were not anemic. That is why I accepted the medical team's anemia diagnoses. 23. See Durning and Brough (1991, p. 10); their comparison of the meat (including beef, pork, mutton, lamb, and poultry) consumed on the average in various countries is illumi- nating. If all the meat currently produced were equally distributed across the world pop- ulation, every person would have 32 kilograms annually (p. 11). 24. See Francis Lappd's discussion of domestic farm animals as "protein factories in reverse" (Lappd, 1990, 70 tD. George cites Lappd's discussion on p. 138 of her 1990 article. See also Worldwatch (1991) and Mason and Singer, Chapter Five. The livestock industry objects to these protein-reversal figures; see all three sources above for refutation of that industry's arguments. 25. In our telephone conversation, Dr. Chen noted that the supply would be augmented to some extent if some livestock grazing areas could be converted to crop lands: this would be one way to increase present levels of production. 26. I wish to express my thanks to three of my colleagues at Penn State, each of whom was kind enough to lend me a pair of critical eyes: Dr. Gene M. Thomas (Biology), Dr. Nancy J. Treat (Health and Human Services, Women's Studies), and Dr. Werner S. Pluhar (Philosophy).

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