From Autism, Inside and Out, Steve Silberman’s review of Amy Harmon’s Byliner hit “Asperger Love”:
Anyone who has spent time with autistic people can tell you that they’re intensely concerned with how other people are feeling, to the point of being overwhelmed. But they often can’t piece those feelings together from the usual clues of facial expression, tone of voice, and body language. At the same time, however, autistics are often adept at reading each other’s emotional states from signs that would be opaque to their typical peers. There are moments in Harmon’s book when Jack and Kirsten seem to be doing that for one another. (This experience is so common that autistics refer to a second sense called “autdar” — inspired by gaydar — that enables them to spot a fellow Aspie in a room full of chatty neurotypicals.) Calling autistics mindblind may turn out to be as apt as calling those who doesn’t speak English deaf.
You simply must read this review, as well as the fine smart Harmon story that it reviews. Silberman, who wrote “The Geek Syndrome,” a pivotal early Wired feature on Aspies in Silicon Valley, is in top form here. He has produced a gorgeous essay on where we’ve been with autism, and where we need to go. Stay tuned for his upcoming book on the subject, which, to judge by his recent essays, will be a shimmeringly smart work.
via Download The Universe (a site that reviews e-books at least vaguely about science, and to which I’m a sometime (unpaid) contributor)
Prof. Steve Jones: ‘Nature or Nurture?’ from The Lost Lectures on Vimeo.
“The most dangerous words in genetics,” says geneticist Steve Jones, “are ‘the gene for.’
It’s just one pithy and wise insight in a talk stuffed with them — an essential warning against hubris, an appeal to humility, and a very funny 20-minute romp through smart genetic thinking. The talk, part of a “Lost Lecture” series in London, in which an unusual lecture site is announced at the last minute, draws on Mickey Mouse, obesity, testosterone and murder rates in Wales and Chicago, and bendy buses to serve up a humorous and necessary reminder that pretty much nothing is just genetics: genes respond to environmental stimuli, and their expression varies by environment. Nature and nurture aren’t in an argument; they’re in a conversation. You’re the outcome.
Thank you, Matt Yglesias, for cutting to the core of Stephen Brill’s huge Time magazine story on the profiteering orgy we call the U.S. healthcare system:
The framing device, which is clever-but-wrong, says we spend too much time debating who should pay for U.S. health care and not enough time debatingwhy the prices are so high.
The analytic core of the article shows that when it comes to hospital prices, who pays determines how high the price is. When an individual patient comes through the door of a hospital for treatment, he or she is subjected to wild price gouging. Insane markups are posted on everything from acetaminophen to advanced cancer drugs to blankets to routine procedures. Because these treatments are so profitable, internal systems within the hospital are geared toward prescribing lots of them. And even though most hospitals are organized as non-profits, most of them in fact turn large operating profits and their executives are well-paid….
I can see two reasonable policy conclusions to draw from this, neither of which Brill embraces. One is that Medicare should cover everyone, just as Canadian Medicare does. Taxes would be higher, but overall health care spending would be much lower since Universal Medicare could push the unit cost of services way down. The other would be to adopt all-payer rate setting rules—aka price controls—keeping the insurance market largely private, but simply pushing the prices down. Most European countries aren’t single payer, but do use price controls. Even Singapore, which is often touted by U.S. conservatives as a market-oriented forced-savings alternative to a universal health insurance system relies heavily on price controls to keep costs down.
For reasons I do not understand after having read the conclusion twice, Brill rejects both of these ideas in favor of meaningless tinkering around the edges. He wants to alter medical malpractice law, tax hospital operating profits, and try to mandate extra price transparency. That’s all fine, but it’s odd. His article could not be more clear about this—health care prices are high in America because, by law, we typically allow them to be high. When foreigners force prices to be lower, they get lower prices. When Americans force prices to be lower (via Medicare), we get lower prices. If we want lower prices through new legislation, the way to get them is to write laws mandating that the prices be lowered.
Yglesias has it right. The problem is both complex and simple: By following a philosophy of market-driven healthcare and commie-control paranoia, we’ve allowed the creation of a Byzantine bazaar of profiteering in which the market plays virtually no role. The market plays no role because the entire system is fixed so that even health insurance companies have little market leverage and individual consumers have virtually none. When you need care, you enter not a market but a con game in which you’re first a guarantor and source of profit, and second a patient. If you don’t believe me, read Brill’s account. It opens with the appalling but perfectly representative story of a man who made the mistake of developing cancer when he had a crap insurance plan even though the plan ate a fifth of his household income. The hospital told him it didn’t take such discount insurance, and would need most of his projected treatment cost — some $83,000 and more — up front.
Brill has more such stories, which are ripping perfectly responsible lives to pieces as we speak.
But well, OK, this guy had cancer. Chemo is expensive. Maybe the sharks don’t bite so aggressively on smaller prey?
Let’s experiment. What would happen if we throw, say, my 7-year-old daughter into the shark pool with something minor?
Actually we don’t need to toss her in, because she fell in last year. And small though she be, and minor as her problem was, the sharks are still ripping at us, even now, trying to extract more blood.
Here’s what happened. Last April, I took my two youngest kids to visit family in Houston. On the second day there, my 7-year-old daughter fell two feet from the snaking branch of a live-oak tree, landed awkwardly, and injured her foot. She could not walk and was in pain. While a sprain seemed most likely, she clearly needed an X-ray to rule out fracture. So I iced and talked nice, wrapped her ankle in an Ace, and drove her to the nearest urgent-care facility.
Thus I entered … what, a market? No way, no how. No search on Google Maps or Yelp would have yielded me prices for the care she would need; as Brill’s article notes, no such service could possibly give me prices, because the clinics and hospitals and urgent care places not only fail to declare their charges ahead of time but charge any two patients wildly different fees depending on God knows what. So no market there; no cost-value information available.
So I took her to the nearest urgent-care facility. I chose it not only because it was near, but because it was a satellite clinic run by the big hospital where my father trained long ago as a surgeon and often operated, where I and three of my siblings were born, where my siblings and I would later sometimes join my father for lunch in the unexpectedly good cafeteria, where my mother stayed in her penultimate hospital stay before her death. A friendly place. So I thought.
We entered, and to get past the first counter, of course, I had to surrender not just proof of ability to pay (a Blue Cross card) but a promise to make good on the charges, even though we didn’t know what the charges would be. Non-market sign number one.
We were the only customerspatients customers, and they took good care of her. Two kind, caring, competent people saw her, spending a total of about 20 minutes with us; a particularly sweet man, complimenting her on her good cheer and her one sandal, rolled her down the hall for a standard three-view X-ray of her foot (a $20 charge if Medicare pays for it); the examining doctor re-wrapped her ankle (handing my perfectly good Ace back to me); and they sized a pair of new crutches and sent us home.
The bill arrived a few weeks later.
It came to over $4,300.
* * *
When I stopped yelling (“Daddy,” my daughter said later, “you used a lot of car-repair language.”), I looked for what we were being charged for. Maybe they had her mixed up with an appendectomy, or, I don’t know, a multiple-victim car crash? I could find little clue. There was a line about X-rays, another about exam, and then about 20 lines that made no sense at all. Later, when the dunning calls started and I asked, barely restraining myself from using more car-repair language, for an itemized bill to replace the ledger of meaningless gibberish they had sent, I was told, “That’s the only bill we have.”
I told them, “You’re dreaming if you think I’ll pay this.”
Along with being incredibly greedy, this particular hospital has been incredibly incompetent. At first it repeatedly billed Blue Cross of Texas, even though my plan is administered by Blue Cross of Vermont, as is stated clearly right on the card they photocopied last April; that mistake alone took two months to recognize and correct. (They’d say, “Blue Cross says you have no policy.” I’d say, “But I do.” I didn’t think to ask which Blue Cross.) Once they got that right, they failed to send information to the right policy number and/or to provide information requested. Then Blue Cross of Vermont denied the charges because it was an out-of-state non-emergency visit; maybe they got the same opaque spreadsheet I had received, so had no idea what sort of visit it was? Who knows?
All along, meanwhile, they have been sending us dunning notices. Each notice accuses me of failing to respond to their prior notices — a lie meant to make me the bad guy. We’ve called several times and sent them corrective information and put them in touch with our insurers about five times. They call me every few weeks, and we have the same conversation that I had the last time with whomever called, because half the time they call me they say there’s no record of prior conversations.
This went on and on until finally, this January, 9 months after the visit, we contacted our actual insurer instead of its administrator (Blue Cross). Our insurer happens to be the State of Vermont. When we told the state what was going on, a beautiful thing happened. You know that joke about the guy who says “I’m from the government, and I’m here to help you.” Well, this guy was, and he was. This very nice man gave us his name and number and mailing address, and he told us If the hospital contacts you again, tell them that they are no longer to contact you; we are the insurer; we are the guarantor; they can deal with us.
Which I related to the hospital the very next time they called, gleefully, emphatically, but using no car-repair language.
Then the nice man did something even nicer. On a piece of State of Vermont letterhead he informed this hospital, citing state and national statute and regulations, that since this was an ER visit out of state for us, the hospital, as per cited laws and regulations, was entitled to collect only what it cost to stabilize the patient — and in fact only what it would cost to stabilize said patient in Vermont, not in whatever fantasy land the Hospital in question was operating in. He added (I especially like this part) that this was the one and only offer the hospital would receive, and that in accepting the payment offered in the letter the hospital agreed that neither the insurer nor the patient would be liable for any further charges.
I suspect the hospital will take this money, bringing a welcome end to this ludicrous non-market adventure, in which the hospital has spent about three times as much time trying to shake me down for its fantasy forty-three hundred than it did treating my daughter.
And why will it end with a payment of reasonable scale? Because I’m insured by an entity, the State of Vermont, that a) seeks to make sure my family gets good healthcare at reasonable cost, and b) has clout. It’s notable that only this achieved that goal. Only now does the hospital find itself billing a party that has the power to say, No: this is a fair payment. For years I was insured directly by Blue Cross of Vermont, and while BCV would ardently work to limit what it paid when my family incurred medical bills, it did not care a fig if a hospital or doctor went after us later, as they always often did, for the gap between Blue Cross’ compensation and their desires for profit.
You want a market-driven healthcare economy? You’ll get it when the payer has as much clout as the biller does. And as Yglesias notes, the name of that payer is government. Anything else, and walking into a hospital is like jumping into a shark tank covered in blood. Good luck negotiating.
Cited:
Stephen Brill, Bitter Pill: Why Medical Bills Are Killing Us | TIME.com
Matt Yglesias, Brill on health care: Steven Brill’s opus on hospital prices, at Slate.com
Jonah Lehrer was one of the first writers I befriended as I went into science writing. I did so before he published his first book. We became friends, blogged beside and often in response to one another first at ScienceBlogs and then here at Wired, and collaborated both at Scientific American’s Mind Matters, which I founded, and as co-contributors at Very Short Lists’s science channel. I considered him a good friend and an admirable colleague.
I at first defended him from charges of ‘self-plagiarism’ and was then dismayed when it was revealed his sins went far, far beyond plagiarism. I have hoped since then that at some point he would “reach out”, as the saying goes, to the many colleagues and editors and friends whom he betrayed with his systemic fraud. Like everyone who knows him, I’ve always wished him well. But there is a sense in which he stole work from us, and betrayed the trust for many who worked incredibly hard for him, and I’ve come to wish for an apology, not just to me, but to others he has betrayed. I have so far waited in vain. I feel as big a fool as did the fans of Lance Armstrong who long believed He Just Couldn’t Have Done It.
Today I learned that the Knight Foundation, which does so much to support good journalism, will give him a podium as a keynote speaker at a conference tomorrow. I tweeted the head of the event, one @ibarguen, that I hope he has some tough questions for Jonah. I have some myself I’d like to see answered. Here they are, as I tweeted them:
#3Qs4Jonah @jonahlehrer 1 Why did neither you nor Knight note, in your bio, that one of the books that made u famous was withdrawn? Cc @ibarguen
#3Qs4Jonah @jonahlehrer 2 Will you confess to anything that others haven’t already exposed or stand on the verge of exposing? Cc @ibarguen
#3Qs4Jonah @jonahlehrer 3 Why haven’t u apologized 4 yr fraud to the colleagues, friends, & editors whom u lied to & betrayed? Cc @ibarguen
And finally:
#3Qs4Jonah @jonahlehrer I ask as one who feels a friendship & trust & generosity were betrayed. I am truly sorry to feel compelled to do so.
I miss the Jonah I once knew, or thought I knew. I would love to come to know another that contains the best of him without the worst. But I feel I would fool myself badly, and betray his enormous potential, if I pretended he didn’t have a lot to answer for before he’s ushered back to podiums.
Corrections Tuesday 2/12/13: I originally wrote, in question 1 above, that “the books that made you famous” were withdrawn, as it was my memory, as I wrote this post a bit hurriedly last night amid some family healthcare tasks, that both Imagine and How We Decide were withdrawn by the publisher. In fact only Imagine was withdrawn last summer. It was withdrawn from sales by the publisher while it was on the bestseller list, doubtless at tremendous direct cost and the cost of lost sales, so that it could be factchecked. As of today it has not been returned to the market.
Also, I should probably also have asked, in my second question, why he had never confessed to anything that others hadn’t already exposed or stood on the verge of exposing, rather than using the future tense, which may imply that more fabrications or other misdeeds stood ready to be exposed — a question on which I’ll pass for now. However, see the paragraph above.
Later, during the talk, I tweeted a request that Jonah consider paying an independent fact-checker (or more than one) to fact- and source-check both Imagine and How We Decide and publish the results.
There are so many ways to go wrong in evolutionary psychology. Kate Clancy does us the tremendous favor of specifying how to do evo psych right. Invaluable reading. Here’s the pith:
For something to be an evolutionarily stable strategy it has to fit a few conditions:
You need clear evidence it is an adaption, which means it has to conform to the conditions from the previous section: being heritable, variable, and producing differential reproductive success.
You would also need evidence that what you’re seeing isn’t simply a correlated response from another, linked behavior being selected.
You would need to demonstrate that the behavior is at least equivalent to, if not resistant to, alternative strategies, in terms of its rate of success.
I laid out how hebephilia fails these tests in a post last year. The problem with demonstrating natural selection, and in particular evolutionarily stable strategies, is that the burden of evidence is incredibly high. Which means most stories that buttress bad evolutionary psychology work will ultimately lead to that study’s collapse, when we see the stories are made of thin air.
If you design your study really well, finding ways to anticipate and control for cultural bias, and still find a correlation, I’m quite happy for you! But chances are good you don’t have enough to contend what you’re seeing is an evolutionarily stable strategy. So hold the storytelling. Just for a little while.
I tried to get at some of this a while back in Enough With the ‘Slut Gene’ Already: Behaviors Ain’t Traits. Clancy does a broader, more thorough job here. Bookmark this one and come back to it when you need to hip-check some evo psych mojo that’s Just Wrong.
5 Ways to Make Progress in Evolutionary Psychology: Smash, Not Match, Stereotypes | Context and Variation, Scientific American Blog Network.
The real action starts at 6.55 into the vid. (Though the whole thing’s great.)
Military efforts often create some cool stuff that never gets used. Some you take one look at and know why. Others you wonder why you haven’t seen them IRL. This one, I’m thinking, would serve well up here in Vermont this time of year.
Hat-tip to my 11-year-old son, who told me, “You gotta see this!” And the music. Who knew?
The guy who jumps off the machine into the snow to show you how deep it goes: I’m thinking he has to be from this group:
On Tuesday, I posted here an excerpt of a longer transcript of an interview I did with author David Quammen recently about his writing. We covered the blessings of scissors and notebooks, the complexity of viruses and deadly diseases, the dangers of staring open-mouthed at bats, the nuances of narrative strategy, and that special moment when you suddenly realize you have army ants in your pants.
That curated, edited transcript was posted in full at The Open Notebook — but it represented only a about a third of the full interview. TON has now posted the video of the entire interview, which took place before a live audience at a TON event at the National Association of Science Writers meeting in Raleigh, North Carolina last October. You can view it here at Neuron Culture (that’s it above) — but it’s better over at TON, because a) you can watch it full screen, b) you’ll have handy links to lots of other TON goodness, and c) you can hit TON’s tip jar to express your appreciation. In that support you’ll be joining the esteemed folks at the Burroughs Wellcome Fund, who made a huge difference with a generous grant. .
In any case, enjoy the interview. Quammen is as riveting and smart live as he is on the page.
The wonderful shop-talk site for science writers, The Open Notebook, just published the first of two interviews I did recently with author David Quammen about how he researched and wrote his magnificent new book Spillover: Animal Infections and the Next Human Pandemic. This first installment covers how Quammen gathers the raw materials for his work; next week’s will look at how he turns that into sinuous, rich books such as Spillover and his iconicThe Song of the Dodo.
Here’s a bit from Part I, now up in full at The Open Notebook. A video will soon be posted there as well:
Dobbs: Spillover, as you put it at one point in the book, is about “the infernal aboriginal connectiveness between us and other kinds of hosts.” You show us how these connections can kill us. You show us some practical things, too, like when you look up at bats flying overheard, don’t open your mouth in amazement, because bats sometimes pee when they fly — and after you’ve read this book, we’ll know, for a deep fact, that you do not want a bat to pee in your mouth.
But we’re not going to talk about any of that. We’re going to talk about how you built this thing. Could you read the passage describing how you were drawn to write this book?
Quammen: The moment that started me on the road to this book, 12 years ago now, was when I heard about an outbreak of Ebola in a little village in northeastern Gabon, I was in the midst of a long, arduous hike across a forest — I was writing a National Geographic story about a researcher named Mike Fay, who was walking a survey transect all the way across Africa — when at a campfire one night in the middle of Central Africa, I met some fellows who started telling me about the time Ebola hit their village. Their village was a place called Mayibout 2; it was an outbreak I already knew about from the literature.
This one fellow in particular, Thony, started telling me what happened after some boys brought a chimp back from a hunting trip from the forest into the village, and people in the village butchered and ate the chimp — and quickly, within a couple of days, they started getting very sick. [He reads:]
They vomited; they suffered diarrhea. Some went down river by motorboat to the hospital at Makokou. But there wasn’t enough fuel to transport every sick person. Too many victims, not enough boat. Eleven people died at Makokou. Another eighteen died in the village, Mayibout 2.… To this day, no one in Mayibout 2 eats chimpanzee.
I asked about the boys who went hunting. Them, all the boys, they died, Thony said.… Had he ever before seen such a disease, an epidemic? “No,” Thony answered. “C’était la première fois.” Never.
How did they cook the chimp? I pried. In a normal African sauce, Thony said, as though that were a silly question. I imagined chimpanzee hocks in a peanut-y gravy with pili-pili, ladled over fufu.
Apart from the chimpanzee stew, one other stark detail lingered in my mind. It was something Thony had mentioned during our earlier conversation. Amid the chaos and horror in the village, Thony told me, he and Sophiano had seen something bizarre: a pile of thirteen dead gorillas lying nearby in the forest.
Thirteen gorillas? I hadn’t asked about dead wildlife. This was volunteered information. Of course, anecdotal testimony tends to be shimmery, inexact, sometimes utterly false even when it comes from eyewitnesses. To say thirteen dead gorillas might actually mean a dozen, or fifteen, or simply lots — too many for an anguished brain to count. People were dying. Memories blur. To say I saw them might mean exactly that, or possibly less. My friend saw them, he’s a close friend, I trust him like I trust my eyes. Or maybe I heard about it on pretty good authority. Thony’s testimony, it seemed to me, belonged in the first epistemological category: reliable, if not necessarily precise. I believed he saw these dead gorillas, roughly thirteen in a group if not a pile he may even have counted them. The image of thirteen gorilla carcasses strewn on the leaf litter was lurid but plausible. Subsequent evidence indicates that gorillas are highly susceptible to Ebola.
Scientific data are another matter, very different from anecdotal testimony. Scientific data don’t shimmer with poetic hyperbole and ambivalence. They are particulate, quantifiable, firm. Fastidiously gathered, rigorously sorted, they can reveal emergent meanings. That’s why Mike Fay was walking across Central Africa with his yellow notebooks: to search for big patterns that might emerge from small masses of data.
Dobbs: This passage speaks to the task we writers take on: We look for emergent patterns. But first we need the data. I want you to describe how that scene that you just read got from the field, where you observed it, back to your desk in Bozeman so you could use it in your book. First the nitty-gritty paper-and-pencil question: How do you take notes in the field?
Quammen: I am very, very old-fashioned and clumsy. I use those long reporter notebooks. This is what a troglodyte I am. The night before I go off on a trip, I take a scissors, I pull out about four of these things and I cut off the bottom inch and a half so this thing is only that long. You know why? Because it fits in a ziplock bag if I do that.
I do a lot of work from jungles, from tropical forests – and my sine qua non field equipment are a ballpoint pen and a chopped-off reporter’s notebook in a ziplock bag. If everything else is gone, if we are swimming across a black lake for our lives, or we are falling down a hillside in the mud, or whatever, I still have my ziplock bag with that one notebook and that ballpoint pen in there.
I know that a trip has been successful at the ten-day or the two- week or the three-week point traveling in Africa or whatever, I reach a point where my notebooks are more valuable to me than my passport. That’s the ideal point. And if you get near the end and you’re still a little bit more concerned about your passport than about your notebooks, it hasn’t been a very good trip….
The full interview has oodles more, so get on over to The Open Notebook for the rest. On Thursday, the site will post a video of the entire hour-long interview from which this text selection is drawn; next week, the second interview, on what happens back at the desk.
The Atlantic has done so many things well in its move online that I was among the many readers and journalists flabbergasted when it teamed with the Church of Scientology to repeat a mistake that had already been made more than two years ago, in almost exactly the same form, when Seed sold a blog spot to Pepsigate. Some of the Atlantic’s writers struck back fast and cleverly, posting nice reviews of Lawrence Wright’s new Scientology expose, for instance, so that those links ran right alongside the advertorial, which the magazine soon pulled. The Atlantic — they’re smarter than that, right? I suspect they are. But as they say in grammar school, someone made a bad decision and needs to think about what they’ve done.
Meanwhile, some watchers asked just what was so wrong about the advertorial anyway? It carried a sort of prominent yellow banner that said “Sponsor Content”; wasn’t that enough to declare it an advertisement?
Well, no. If the Church of Scientology wanted to run an ad, they’d buy an ad. But they wanted something more: They wanted some of the credibility that goes with being editorial content at the Atlantic. That’s the whole point of sponsored content or advertorials whose design mimics that of the magazine or occupies layouts that are, by design, meant to tell the reader that This Is The Magazine (or website): to pass as editorial content, or something very much like it, and thereby borrow — no, steal — some of the credibility that writers and editors have worked hard to grant that space.
Whoever made the call at the Atlantic should know this, as this was an almost exact repeat of the Pepsigate scandal at Seed. That affair drew a lot of attention in the journalistic blogosphere, but someone high up at the Atlantic clearly missed, dismissed, or forgot it. What I wrote about Pepsigate 27 months ago (3 months after fleeing Seed when the magazine sold a chair at the editorial table to Pepsi) applies perfectly to the Atlantic’s slip if you simply substitute Scientology advertorial for Pepsi blog:
[J]ournalism has long recognized that it’s vital to have clear distinctions between advertising and editorial, and the entire point of the Pepsi blogScientology advertorial was to blur those lines, and give a commercial message some of the dressings of editorial content. It let Pepsithe Church of Scientology buy a credibility that should be earned otherwise. In doing so, it threatened the credibility of the bloggers writers who established ScienceBlogsThe Atlantic’s reputation. In that sense it was a zero-sum game that created winners and losers: Pepsithe Church of Scientology bought the right to siphon credibility from SB’s bloggersThe Atlantic’s writers and editors. That’s what that giant slurping sound was.
And in this case the sound, audible all the way up here in Vermont, of Alexis Madrigal and James Fallows and company retching down in D.C. A publication’s editorial space has credibility because its writers write there from personal points of view rather than corporate or organizational perspectives, and — the vital element — their allegiance is first and foremost to their readers, not to their subjects, much less whatever outfit wants to pony up big to buy the space. The writers may (will) get stuff wrong. They may hold stinky or ill-formed opinions. But they write to communicate, not to sell.
That’s the fundamental promise of editorial space, and at a publication like the Atlantic, a writer earns the right to occupy that space through merit, not a sheaf of twenties slipped to the editor. (This is one reason that when a writer and an editor go to lunch, the editor, God bless her, always picks up the check.) That space and that credibility comes hard earned. And the particular design and layout conventions that magazines and website use to designate editorial space are meant to tell the reader: We find this writer, and what she wants to communicate, important enough to bear the expenses of bringing you her work; and this writer will try to inform or sway or entertain or move you, but she will not try to sell you something.
A banner at the top is not nearly enough to overturn all the conventions that make this announcement, for aside from the banner, everything else about the presentation is designed to tell the reader, The goods are in the ads; this here is a place in which a writer we trust will seek to have an intimate conversation with you. Editorial space, folks, is editorial space: It’s a sitting room, an intimate booth, a bedroom. It’s dishonest, and a huge betrayal of writers and readers, to turn it into a sales room.
Mosquito filling up. Photo courtesy State of Tennessee Department of Health
Note: This post first appeared at Slate this past December 28, where it came at the end of a fine series on Pandemics; it seeks to direct you to the best reading and tweeting about the bugs out to kill us. Other Pandemic series highlights included Carl Zimmer’s Koala pandemic genetics: Viruses have inserted themselves into the human genome 31 times, Tara Smith’s Origins of new diseases: Zoonotic pandemics come from bats, birds, monkeys, cows, and other animals, and our own Maryn McKenna’s Dengue fever in United States: Breakbone fever outbreaks Florida, Texas, and Hawaii.
My piece below, however, titled “Pandemic Porn,” was about finding yet more great writing on bad bugs.
Enjoy. And wash your hands.
Pandemic Porn
by David Dobbs
[first appeared at Slate.com.]
The germs have been busy. In the United States this year alone, we’ve lost people both to old enemies such as whooping cough and to relatively new spillovers from other animals, such ashantavirus and West Nile virus, which killed more than 240 Americans this year, a record. Diseases we’ve come to think of as utterly foreign, such as dengue fever, are spreading through the United States. Meanwhile, further afield but far too near, we’ve seen two separateEbola outbreaks; one of Marburg; alarming blips of Q fever; an unsettling and unsettled game of whack-a-mole in the Mideast with a new SARS-like coronavirus; and the news that because gonorrhea has now developed resistance to yet another antibiotic, we possess just one that still gives pause to this old intimate. If that drug stops working before we develop a better one, expect a steady drip of ugly cases.
More bad-bug news pops up almost weekly, and it stands to get worse for a while, maybe for decades. More bacterial strains will develop antibiotic resistance, and our continuing disruption of virus-rich and fungus-rich ecosystems worldwide will invite yet more pathogens to make us part of their life cycles. We will live increasingly in a world where you might die because a bat happened to sleep in a certain tree in Tanzania or a particular robin landed in your backyard.
Pandemic diseases hold an irresistible allure for both writers and readers, as they involve threats both universal and personal, deep scientific mysteries from cellular to ecosystem levels, and urgent scientific sleuthing with high stakes. If the subject sometimes lends itself to oversimplified and sensationalistic journalism, it has also inspired a bounty of writing that is riveting while being thoughtful, nuanced, and deeply informed. And this work comes in every form and length, from 140-character tweets to 600-page global tours.
Here I offer a guide to the best of this work. I’ve drawn from my own reading and from the suggestions of top infectious-disease writers (more on them shortly). We’ll start long, with books, and end, as we should, with tweeted expirations of germ-inflected wisdom.
Best Books
We face an embarrassment of riches here, and if it’s hard to know where to start, it’s easy to name a fivesome that will immerse you in the drama of pandemics both past and future while giving a fine understanding of the science.
Leading the way almost 20 years ago, and still absolutely trenchant today, is Laurie Garrett’sThe Coming Plague: Newly Emerging Diseases in a World Out of Balance, which vividly and judiciously reports the global forces creating a new infectious age. It remains essential reading, with astounding prescience.
Warm from the presses, meanwhile, comes David Quammen’s Spillover: Animal Infections and the Next Human Pandemic—one of the year’s best books of any kind. This rich, engrossing work entrances as much with its darting literary elegance and deep humanity as with its exquisitely measured, layered reveal of the global strands binding us to a world of beauty and death.
Equally riveting is Maryn McKenna’s way-too-close-to-home SuperBug: The Fatal Menace of MRSA. This bacterium (methicillin-resistant Staphylococcus aureus) is everywhere these days, including, perhaps, on your keyboard and almost certainly on your nose. As McKenna makes vivid, its spread and its increasing resistance to antibiotics can turn a routine cut or hospital visit into a deadly saga.
Finally, there are the classics Microbe Hunters, Paul de Kruif’s 1934 account of how the bug-hunters got started, and John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History, which makes scary reading anytime near flu season.
Longreads
“The First Alert,” from Maryn McKenna’s SuperBug, tells of a 13-year-old boy’s battle with MRSA. “Where Will the Next Pandemic Come From? And How Can We Stop It?,” in Popular Science, opens the puzzle box that David Quammen explores at more length in Spillover. In “The Hunt for the Origin of AIDS,” in the Atlantic, Jon Cohen sifts through AIDS-origin theories both well-founded and weird.
“The Flu Hunters,” a classic piece by Gretchen Reynolds in the New York Times Magazine, follows the hunt, far from over, to figure out how to prevent future flu pandemics on the scale of the one that killed 20 million to 50 million people in 1918. “Undead: The Rabies Virus Remains a Medical Mystery,” in Wired, an excerpt from the new book by Monica Murphy and Bill Wasik, Rabid, shows how bizarre this old affliction is; some of the comments are as unsettling as the story. Bruce Barcott‘s “Death at Yosemite,” in Outside, shows how zoonotic diseases such as the much more obscure hantavirus can pop up, suddenly and fatally, even in the most sublime settings.
Finally, “The Rise of Drug-Resistant Gonorrhea,” by Jerome Groopman at The New Yorker, has some unsettling news about the human pharynx. And his colleague Michael Specter, in “A Deadly Misdiagnosis,” shows how misguided attempts to fight tuberculosis—possibly the disease that most threatens us—may actually strengthen its hand. Don’t read this while you have a cough.
Breaking News and Analysis
Health and science sections of the New York Times, National Public Radio, and Reuters, as well as Science and Nature’s news departments, all cover infectious disease pretty well. If you read those, you’ll catch most of the big news, though it requires sieving out from other stories. (TheGuardian‘s infectious-disease news tag does the sieving for you.)
To build your own filters, you can perform specific author/subject-tag searches at those and other publications, then bookmark the self-updating results. I’ve included such searches in the following links for the New York Times‘ Denise Grady; Nature‘s Declan Butler and Brendan Maher; NBC’s Maggie Fox; Science‘s Jon Cohen and Martin Enserink; and the Canadian Press‘Helen Branswell. All of these journalists do top-flight work. Branswell’s reporting, alas, goes criminally overlooked in the United States (except by other health journalists). She focuses with particular intensity on swine, bird, and seasonal flu, navigating their changes, overlaps, and frightening uncertainties with particular grace and foresight; she is my go-to for flu.
Those folks will get you the main goods. Meanwhile, as with many deep but narrow topics in today’s media environment, the infectious-disease beat benefits greatly from a handful of blogs, including some written by journalists, that track back stories, side stories, and follow-ups with a detail and steadiness that mainstream media doesn’t allow. Two favorite blogs among bad-bug journalists are Humanosphere Health blog, kept by Tom Paulson, and the GuardianHealth Blog, written by health editor Sarah Boseley.
Finally, freelance journalist and blogger Maryn McKenna is unmatched in reporting and contextualizing infectious-disease news with stories that’ll scare the antibodies out of you. (She also possesses a disturbingly cool radio voice.) The easiest way to follow McKenna is at her blog,Superbug. (Disclosure: She and I both blog for Wired.) She repeatedly sees the big in the big stories, from new coronaviruses to the CIA’s lethally destructive fake-polio-vaccine boondogglein Pakistan, before almost anyone else does. For a sample, see her Slate piece on dengue fever.
Global Disease in 140
Finally, if you’ve dumped your RSS reader and newspaper home pages for Twitter, you’re in luck, for many of the writers named above use Twitter to link to, curate, and discuss both their own and others’ breaking coverage. Particularly sharp are Helen Branswell, Maryn McKenna,Laurie Garrett, Maggie Fox, David Quammen, Declan Butler, Brendan Maher, Jon Cohen, andMartin Enserink; and last but not least, Michael Coston, who blogs at Avian Flu Diary and tweets, indefatigably, as Fla_Medic.
