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THE NEW YORK TIMES INTERNATIONAL EDITION THURSDAY, AUGUST 8, 2019 | 9
If you think that the United States-
China trade dispute is going to be easily
resolved, you’re not paying attention.
It’s so much deeper than you think —
and so much more dangerous.
If President Trump and President Xi
Jinping don’t find a way to defuse it
soon, we’re going to get where we’re
going — fracturing the globalization
system that has brought the world more
peace and prosperity over the last 70
years than at any other time in history.
And what we’ll be birthing in its place is
a digital Berlin Wall and a two-internet,
two-technology world: one dominated
by China and the other by the United
States.
This will be a much more unstable
and less prosperous world.
How did we get here? Two things
converged: The character of U.S.-China
trade changed — it went “deep,” and
both President Xi and President Trump
overplayed their hands and freaked
each other out.
What do I mean that trade went
“deep”? For the first three decades,
U.S.-China trade could be summarized
as America bought T-shirts, tennis
shoes and toys from China, and China
bought soybeans and Boeing jetliners
from America. And as long as that was
the case, we did not care whether the
Chinese government was communist,
capitalist, authoritarian, libertarian or
vegetarian.
But over the last decade, China has
become a more middle-income country
and a technology powerhouse. And it
unveiled a plan, “Made in China 2025.”
This was Xi’s plan to abandon selling
T-shirts, tennis shoes and toys and to
instead make and sell to the world the
same high-tech tools that America and
Europe sell — smartphones, artificial
intelligence systems, 5G infrastructure,
electric cars and robots.
I welcome China as a competitor in
these areas. It will speed up innovation
and drive down prices. But these are all
what I think of as “deep technologies”
— they literally get embedded into
your house, your infrastructure, your
factory and your community. And
unlike dumb toys, they are all dual use.
That is, they can potentially be used by
China to tap into our society for intelli-
gence or malicious purposes. And once
they are embedded, they are hard to
remove.
When you are trading deep technolo-
gies, “trust” matters like never before.
We cannot sell to each other, and buy
from each other, these deep technolo-
gies, at scale, without higher levels of
trust and shared values. That is why
Trump has banned Huawei, China’s 5G
manufacturer, from working in Amer-
ica.
Another reason we’re having this
trade war is that both Xi and Trump
have overreached.
More and more American companies
complained in recent years that their
access to the China market was being
constricted, while their Chinese com-
petitors were gaining scale and power
inside of China’s protected market and
then competing with these United
States companies globally. (See
Huawei.)
Someone had to call that game. And
that was what Trump did, and he was
right to do it. But he did it in an incredi-
bly foolish way!
As this column has argued, Trump
should have signed the Trans-Pacific
Partnership free trade agreement,
which would have aligned all the major
Pacific economies — except China —
around United States trade values,
norms, interests and standards, and
lowered thousands of tariffs on Ameri-
can products. Instead, Trump tore up
the TPP.
Then Trump should have lined up all
the European Union countries, which
have the same trade problems with
China as we do, on our side. Instead,
Trump hit them with tariffs on steel and
other goods, just as he did China.
Then Trump should have told Xi that
we and our Pacific and European part-
ners wanted to negotiate with him “in
secret” on a new trade regime and no
one would lose face. But in that secret
negotiation, it would be “the world’s
trade standards and values versus
China’s.”
Instead, Trump went it alone — and
made it America versus China alone. If
everything is “America first,” why
should anyone help us?
But Xi is also to blame. He has fright-
ened his neighbors by seizing islands in
the South China Sea against interna-
tional law. He has frightened the West
by announcing plans to dominate every
new technology industry by 2025, while
retaining the same trade restrictions of
the last 30 years, when China sold us
only T-shirts, toys and tennis shoes.
Is there a way out? If I were Trump,
I’d postpone the latest 10 percent tariff
on $300 billion in Chinese exports in
return for China’s walking back its
latest blows to American agriculture,
and then offer the Chinese an approach
that Jim McGregor, the chairman of
APCO China, suggests.
“The old trade regime was based on
the idea that America was a rich coun-
try and China was a poor country and
therefore China was entitled to certain
advantages and tolerance of its misbe-
havior,” explains McGregor. “We should
say to the Chinese: ‘You now are our
economic equal.’ Give them that dignity.
And tell them we want to restart these
negotiations on the basis of total reci-
procity. We should both have the same
rules of access to each other’s econo-
mies.”
If somebody has a better idea, put it
out there, because if both sides don’t
find a better way, the world as we’ve
known it is going to change. You may
not have loved what we had, but you
really won’t like what we’ll get.
ERIN SCHAFF/THE NEW YORK TIMES
The trade
war is
heading in
a dangerous
direction for
the whole
world.
Making America and China poor again
President Trump
and President Xi
Jinping of China
in June at the
Group of 20
summit in Japan.
Thomas L. Friedman
For much of history, there were three
great threats to human survival: infec-
tions, injuries and starvation. By strik-
ing early and often, all three prevented
us from fulfilling the most important
reason for our existence: reproduction.
Humans, therefore, evolved mecha-
nisms to stave off these life-limiters.
These days most of us die of heart
disease. The reason our species finds
itself in the ever-constricting clutches of
atherosclerosis — the insidious buildup
of cholesterol-filled plaques in blood
vessels leading to heart attacks and
stroke — might be that human evolution
inadvertently led us into its laby-
rinthine lair. If that is true, is it possible
for us find our way out?
While it’s hard to recreate ancient
human life and find a causative link, the
Tsimane, a remote people living in the
Bolivian rain forest, provide a sneak
peek. The Tsimane, who have minimal
atherosclerosis, are under relentless
assault by infectious organisms. An-
cient humans predating the Tsimane
were under even greater siege. The only
human beings who could survive were
those with a vigilant immune system,
always on the lookout for foreign invad-
ers.
In response to infections, the immune
system unleashes a powerful response
called inflammation. In extreme forms,
such as after catching the flu, inflamma-
tion can set the body ablaze and is our
best means to keep us sterile and free of
infection. Inflammation also plays an
important role when someone gets hurt
and the barrier between the body and
the world outside is breached. Inflam-
matory cells unleash a cascade that
results in blood clots forming to quickly
plug nicks and cuts. As species have
evolved, they have also developed
stronger mechanisms of clot formation.
After the institution of better public
hygiene, our great guardian, inflamma-
tion, no longer busy with outsiders,
turned its menacing guns inward. In-
flammation is responsible for every
important step in the story of athero-
sclerosis, from its birth as fatty streaks
in the lining of the blood vessels, to the
dramatic eruption of cholesterol-laden
plaques in blood vessels supplying the
heart, brain and legs, that activate our
clotting cascade, leading to blockages
that cause heart attacks, strokes and
blood-choked limbs needing amputa-
tion.
The third threat to ancient human
survival, starvation, existed because of
the long intervals that could occur
between generous meals. The brain
only feeds on sugar, specifically glu-
cose, and therefore it was necessary to
maintain glucose in the blood to nourish
the brain during thrifty times. And what
hormone lowers glucose levels in the
blood? Insulin. Therefore, it is hypothe-
sized inconclusively that genes that
reduced the effectiveness of insulin
were positively selected, raising the
glucose levels in the body and now
contributing to the pandemic of diabe-
tes. It is also controversially theorized
that high cholesterol levels, one of the
most important risk factors for athero-
sclerosis, could have conferred a longer
life in prior generations because of a
theoretical protective function against
infections. These days, however, the
lower the cholesterol, the better.
Evolution has a hand in another
important driver of heart disease —
obesity. Not only did we develop mecha-
nisms to store nutrition to prepare for
the inevitable famine around the corner,
obesity actually conferred another
advantage — it overcharged inflamma-
tion. Not only does inflammation cause
atherosclerosis, it also accelerates the
development of other risk factors for
heart disease such as diabetes and high
blood pressure.
Evolution may have affected African-
Americans even more adversely, as
they are very prone to high blood pres-
sure from salt consumption. Natives of
Africa had very little salt in their diets
and risked losing most of it in their
sweat. There is evidence that those that
held onto salt in the body were pos-
itively selected through evolution. Salt
intake in modern societies is several-
fold that of what we had consumed for
thousands of years. Mechanisms devel-
oped to hold onto a previously rare
nutrient might be contributing to high
blood pressure at a time when salt is
ubiquitous. Hypertension, in fact, is
much more common in black Ameri-
cans compared to both white Americans
and foreign-born blacks in the United
States.
How can we have a chance at revers-
ing these evolutionary mechanisms?
Anti-inflammatory drugs repurposed
from other conditions such as rheuma-
toid arthritis have shown mixed results
in treating atherosclerosis. Greater
benefits could be achieved from anti-
inflammatory therapies specifically
designed to treat atherosclerosis.
Perhaps the most important evolu-
tionary mechanisms behind the emer-
gence of atherosclerosis is that protec-
tion from our ancient adversaries —
infection, injury and starvation — now
allows us to live long enough to gain
prolonged deadly exposure from our
modern lifestyles. “Because we adapted
so well to these other threats, we now
live long enough to be exposed to risk
that we haven’t had time to genetically
accommodate to,” said Dr. Clyde Yancy,
a professor at Northwestern University
and Chief of Cardiology at Northwest-
ern Memorial Hospital in Chicago. “Is it
possible that lifestyle changes can
overcome the inclinations we have
developed?”
We need to stop testing ourselves
with lifestyles and diets that put our
body’s defenses at odds with our well-
being. Atherosclerosis has always been
around, even in the blood vessels of one
of the oldest mummified humans, Ötzi
the Iceman, who was found in a block of
ice from 5,300 years ago. Yet, the reason
atherosclerosis rarely killed was be-
cause our lifestyles were not at odds
with our biology. Recent dramatic re-
ductions in heart disease are proof that
through lifestyle improvements and
medical therapy, we can exert real
agency over our fitness, and that we are
not beholden to our genetic biology.
While the DASH and Mediterranean
diets have the best evidence for heart
health, the problem seems to be not too
much of either fat, salt, sugar or meat in
our diets, but too much of everything.
The density of calories available to us
coupled with the minimal effort re-
quired to obtain them is a toxic recipe.
The solution is not to live like the
Tsimane or crumble in nihilism. The
solution is to transform our lifestyles so
that we can come up to speed with
evolutionary mechanisms set in motion
millenniums ago. Heart disease is still a
new disease, and if we respect our
evolution, adapt accordingly and follow
medical advice, we can revert it to a
speck in the history of mankind.
It’s still a new
disease, and
we can adapt
accordingly.
Evolution gave us heart disease. We’re not stuck with it.
ILLUSTRATION BY FRANCIS BEN; PHOTOGRAPHS FROM METROPOLITAN MUSEUM OF ART, AND WELLCOME IMAGES
HAIDER WARRAICH is joining the faculty of
Brigham and Women’s Hospital, the
Boston VA and Harvard Medical School
in the fall. He is the author of the new
book: “State of the Heart: Exploring
the History, Science and Future of
Cardiac Disease.”
Haider Warraich
Opinion
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