Docs Pushing More Hard Drugs on Kids

At Time, Maia Szalavitz tells of some really, really bad medicine:

The new study, published in the Archives of General Psychiatry, found that in 2005-09 nearly two thirds of all antipsychotic prescriptions for youth were written for ADHD and other disruptive behavior disorders; these conditions accounted for 34% of all antipsychotic prescriptions for teens. Yet there is little data supporting the safety or efficacy of the drugs for those conditions. The drugs’ effect on children’s brain development is also not known, but their side effect profile is clear: aytpical antipsychotics are known to cause weight gain and diabetes, side effects to which children seem particularly prone.

“As the actual evidence base that would support [such off-label prescriptions of antipsychotics] is scant to non-existent, and the evidence of permeating undue influence of pharma on prescribing practices in psychiatry is abundant, one is led to the conclusion that this is another example of irrational prescribing that can be traced to both the overt and tacit influence of [drug companies] on practitioners,” says Dr. Bruce Perry, a senior fellow at the ChildTrauma Academy. [Full disclosure: Perry and I have co-authored two books.]

Antipsychotics are enormously powerful drugs, and we’ve very little knowledge about what they might do to the growing brain. That anyone would prescribe them for ADHD beggars the imagination. That the rate should go up recently, when critiques of overdiagnosis and overprescription have skyrocketed, is just stunning.

And there’s more. You should definitely read the whole thing — short, important, and sickening — over at Time: Antipsychotic Prescriptions in Children Have Skyrocketed


What’s It Like To Be Schizophrenic?

From “I Should Be Included in the Census,” by Amy Johnson.

This is the catch-22, the double bind. Schizophrenia happens to 1% of the population. We speak our own language. We speak a language you do not understand. We are defenseless and rendered helpless because we, me, and the world can’t understand each other. The more I try to speak, the less you understand me. This is why we stop trying to communicate. It’s like quicksand. It’s an inevitable and slow death. Not being able to communicate my basic feelings, not identifying with another human being, and feeling completely alone in my experience are killing me.

I sit at home alone, and I physically hurt from just loneliness. I curl up in the fetal position and hold my head. I stare at the wall and barely breathe. That’s my loneliness. My loneliness is dead silence. It is pitch black. It stretches on and one endlessly. I am not trying to be poetic. I am not trying to dream up a new and dramatic way to express loneliness. My true experience is exactly as I  have described. I am not embellishing; I’m not adding to the facts. My emotions, the facts, I tell with objetivism. You think I am being dramatic, building fluff when there isn’t any. I think I am telling a normal experience because I talk calmly and normally about my emotions. I watch you get angry and snap at me as I talk, and I have no idea what’s made you so mad. You stomp off and never speak to me again. I am left feeling like a heel, like yesterday’s garbage. I felt like you spit on me and I have no idea I could  have possibly done to warrant such indignities.

Little is more maddening, more annihilating, than complete social isolation.

Please read the rest via PDF. Kudos to Schizophrenia Bulletin for running this, and JonesNev, a new and already powerful presence on Twitter, for drawing my attention to it.


Cited:  Johnson, Amy. 2012. “I Should Be Included in the Census.” Schizophrenia Bulletin 38 (2) (March): 207–8. doi:10.1093/schbul/sbq170.

Photo by watersoluble. Some rights reserved

“Medicine is Broken”: Ben Goldacre’s Bad Pharma


Eight days a week. Photo by Robbie1, via flickr. Some rights reserved.

From the muckraker troublemaker Dr. Ben Goldacre, of Bad Science fame:

Medicine is broken. We like to imagine that it’s based on evidence and the results of fair tests. In reality, those tests are often profoundly flawed. We like to imagine that doctors are familiar with the research literature surrounding a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by industry. We like to imagine that regulators let only effective drugs onto the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients.

All these problems have been protected from public scrutiny because they’re too complex to capture in a sound bite. But Dr. Ben Goldacre shows that the true scale of this murderous disaster fully reveals itself only when the details are untangled. He believes we should all be able to understand precisely how data manipulation works and how research misconduct on a global scale affects us. In his own words, “the tricks and distortions documented in these pages are beautiful, intricate, and fascinating in their details.” With Goldacre’s characteristic flair and a forensic attention to detail, Bad Pharma reveals a shockingly broken system and calls for something to be done. This is the pharmaceutical industry as it has never been seen before.

Somebody’s writing some good jacket copy, and I suspect that Ben Goldacre has written a very good book. Out Sept 27 in the UK, Jan 13 in the US.

Photo by Robbie1, via flickr. Some rights reserved.

Mikhail Baryshnikov & The Art of Action Amid Quiet

Alec Wilkinson went to see Misha in a play last night:

There were two startling moments, both involving Baryshnikov. One came at the end of the play, when his character, who has died on the Metro while reading a newspaper, returns to life. From the putting on of his military overcoat, he derives a dance, featuring the coat’s red lining, which he uses as a matador’s cape to dance as a bullfighter. The movements are compact and precise, and I am not equipped to say if they represent a refinement of the grand technique of his heyday, but I can say that they were compelling.

The other moment occurred earlier in the play during a set piece in the restaurant in which Baryshnakov’s overcoat and hat kept falling from the pegs where he had settled them. They have fallen twice, and he has walked slowly over to them and hung them up again. They fall a third time, and in exasperation, he does a quick, foot-stamping dance—nearly a jig—which ends with a flourish of his arms. It had the compression, the succinctness of form and force, that the gesture of an older dancer can sometimes have. I had the feeling that I had seen something magnificent that had happened only there and nowhere else.

via Mikhail Baryshnikov’s Play, “In Paris” : The New Yorker.

On the Lack of Science Books by Women

Writer Jo Marchant, author of Decoding the Heavens, ponders the lack of prominent science books by women. I was wondering on the same when earlier today I refreshed my memory of great science books I’d read.

This isn’t for a lack of women writing about science. When I took a course in science communication at Imperial College more than a decade ago, we often used to wonder why so many of us (around 25 in a class of 30) were female. I’ve since worked at both New Scientist and Nature, where the gender balance of writers and editors is very equal. Women are well represented at the annual awards of the Association of British Science Writers.

So are these talented women choosing not to write books? Do they find it harder to get book deals? Are their books taken less seriously when they’re published? Do science writers tend to move on to books later in their careers, when women’s professional goals have often had to take second place to childcare?

Similar questions are being posed in every field where women are under-represented at the highest levels, but with books so crucial for bringing science to a popular audience, I think it’s important to ask them here too.

Get the rest at Why are so few popular science books written by women? 

Oracles, Big Answers, & Pop Sci’s Neglect of Mystery

Georges Simenon

Ta-Nahesi Coates, pondering the downfall of Jonah Lehrer, writes:

[W]e now live in a world where counter-intuitive bullshitting is valorized, where the pose of argument is more important than the actual pursuit of truth, where clever answers take precedence over profound questions. We have no patience for mystery. We want the deciphering of gods. We want oracles. And we want them right now.

I’m not here to either pile onto or defend Jonah. But Coates here nails a huge problem in much writing about science that stands aside from any question of shortcuts or fabrication*: a pressure from writers, readers, editors, and the entire bookselling and meme-making and talk-fest machine to have the answers. And not just answers, but Big New Answers To Vexing Eternal Questions.

Science, of course, is rarely like that — rarely indeed. A fortunate scientist, a truly important scientist, is one whose work is foundational or heavily influential for a decade. A few researchers do work that proves indispensable for 25 to 50 years. An extremely select number do work that remains foundation or impetus for a century. And no one, not even Newton, Darwin, or Einstein, have their work go a hundred years without significant revision.

Yet from our writers and speakers we howl for final answers — how we do this, the key to that, everything you wanted to know about this other thing. And the book industry relentlessly presses for writers and agents to offer those things, and in a flash. As Coates says, right now.

The sad part is that that’s not even the good stuff. It tastes good going down, but it doesn’t ride with you. I was thinking about this over the last month as I read —  slowly, savoring every scene, every sentence, every bit of nuance, detail, caveat, wrinkle, and complication — an advance copy of David Quammen’s Spillover, which will be published this October. Spillover is about how human epidemics rise from diseases that spill over from the animal kingdom. Think HIV, SARS, bird flu, and other nasties. The book is riveting, terrifying, and inspiring, and it matches and possibly excels Quammen’s Song of the Dodo, which I consider one of the best science books of the 20th century.

Spillover by David Quammen

I’ll write more later about Spillover when it’s published. For now, though, pertinent to Coates’ observation, it’s enough to note that  Spillover generates its delicious deep power partly because Quammen doesn’t try, with every chapter or anecdote, to resolve a mystery or question. He constantly sheds light — which, lo and behold, reveals more boxes and doors and caves holding darkness. He is true to the real state of progress, the ‘growing island’ model: the more we expand our knowledge, the bigger is the border between what we know and what we don’t understand. He embraces constantly the mystery of where these diseases come from and how they spill into and spread through humanity. He mines the perplexity of the scientists trying to crack these mysteries in a way that reminds me of the way Georges Simenon mines the confusion of his French detective Jules Maigret. Maigret usually gets his man (or woman). Yet he’s mystified all the way through almost every novel, and the stories draw meaning at least as much from Maigret’s mystification as from the arrests at the end. When it’s over we see that Maigret has solved one mystery — whodunnit? — but remains confounded by the deeper, far more important questions of human nature, cause, chance, and epistemology.

Likewise Quammen in Spillover. Likewise all the science books with long legs: Song of the Dodo; The Immortal Life of Henrietta Lacks; The Eighth Day of Creation; Love at Goon Park; The Voyage of the Beagle;  Primo Levi’s The Periodic Table;  The Making of the Atomic Bomb; even, in its infinite weirdness, and despite sometimes the intentions of its author, The Double Helix.

We need more of this.

*Changes: About an hour after posting, I added underlined phrase in 3d paragraph, lest anyone think this post seeks to brush aside or excuse issues of fabrication etc. The problems I’m writing of here exist alongside and independent of any problems of journalistic misconduct and don’t cause such, nor should they serve as an excuse for journalistic misconduct. They have their own bad effects, as noted.

Photo of Simenon via Wikipedia

Happy Birthday, Jerry Garcia

For Steve Silberman and Richard Ober.

Garcia would have been 70 today, had he withstood the ravages he himself and the times inflicted on him. I’ve never been a huge Dead fan, but the sweetest of their music, such as this version of Peggy-O, is sweet indeed. As the person who posted it at YouTube said, “This one is all Jerry, frail yet strong and full of emotion. In my opinion, the solo alone is possibly one of the most poetic of Jerry’s later years.”

Hat-tip to Open Culture, which has lots more Dead goodies through its Free Grateful Dead Concert Archive.

Batman Returns: How Culture Shapes Muddle Into Madness

Let’s try this door again.

What does it mean to say a culture shapes the expression of mental dysfunction? I bungled that question a few days ago in “Batman Movies Don’t Kill, But They’re Friendly to the Concept,” my post about Batman movies and James Holmes. Even friends who got what I was getting at told me I hadn’t really made the case well. Heeding that top item on my daily to-do list — “Do better” — I’ll try to improve on it here. I’ll draw on two brilliant pieces of writing that I hope will make this gin clear.

In the original piece I deliberately referred to “certain unhinged or deeply a-moral people.” I left this vague for good reason: Mental health diagnoses are to a great extent social constructs. Their framing and use not only identify traits or behaviors that most observers in a given culture would agree on, but categorize a person in a way that can push that person further out of society and culture. Indeed, such diagnoses explicitly seek to identify what is different  about the person — what sets them aside, and to some extent, outside, the rest of society. Good diagnosticians do this because, at least in theory, it can help caretakers help the person. But the resulting sense of alienation can exacerbate the person’s problems.

In the case of schizophrenia, for example (and I mean example, since as of this writing we have no reliable diagnosis or description of Holmes’s mental state), the very diagnosis can push a person almost instantly into alienation. But it’s not that way in every society. In his splendid Crazy Like Us: The Globalization of the American Psyche, Ethan Watters describes research demonstrating that the course of schizophrenia, as well as the actions of those who have it, depends enormously on culture.

Janis Hunter Jenkins and Robert John Barrett, two of the premier researchers in the field, describe the general state of affairs.

“In sum, what we know about culture and schizophrenia is… [that] culture is critical in nearly every aspect of schizophrenic illness experience: the identification, definition and meaning of the illness during the primordial, acute, and residual phases; the timing and type of onset; symptom formation in terms of content, form, and constellation; clinical diagnosis; gender and ethnic differences; the personal experience of schizophrenic illness; social response, support, and stigma; and perhaps most important, the course and outcome with respect to symptomatology, work, and social functioning.”

By “course and outcome,” Jenkins and Barrett are referring to that most perplexing finding in the epidemiology on the disease: people with schizophrenia in developing countries appear to do better over time than those living in industrialized nations.

A large World Health Organization study [huge PDF download], for instance, found that “Whereas 40 percent of schizophrenics in industrialized nations were judged over time to be ‘severely impaired,’ only 24 percent of patients in the poorer countries ended up similarly disabled.’ Their symptoms also differed, in the texture, intensity, and subject matter to their hallucinations or paranoia, for instance. And most crucially, in many cases their mental states did not disrupt their connections to family and society.

Watters, curious about all this, went to Zanzibar to see how all this worked. He learned that there, schizophrenia was seen partly as an especially intense inhabitation of spirits — bad mojo of the sort everyone had, as it were. This led people to see psychotic episodes  less as complete breaks from reality than a passing phenomena, somewhat as we might view, say, a friend or coworker’s intermittent memory lapses.

For instance, in one household Watters came to know well, a woman with schizophrenia, Kimwana,

was allowed to drift back and forth from illness to relative health without much monitoring or comment by the rest of the family. Periods of troubled behavior were not greeted with expressions of concern or alarm, and neither were times of wellness celebrated. As such, Kimwana felt little pressure to self-identify as someone with a permanent mental illness.

This was rooted partly in the idea of spirit possession already mentioned, and partly to an accepting fatalism in the brand of Sunni that the family practiced. Allah, they believed, would not burden any one person with more than she could carry. So they carried on, in acceptance rather than panic. As a result, this delusional, hallucinating, sometimes disoriented young woman passed into and out of her more disoriented mental states while still keeping her basic place in family, village, and work life, rather than being cast aside. Almost certainly as a result, she did not feel alienated, and her hallucinations did not include the sort of out-to-get-me kind that mark paranoid schizophrenics in the West.

This, writes Watters in enormous understatement, “stood in contrast with the diagnosis of schizophrenia as [used] in the West. There the diagnosis carries the assumption of a chronic condition, one that often comes to define a person.”

Can we find an example? Someone whose situation was sufficiently relevant to both Kimwana and James Holmes that it can highlight the sort of cultural effect I refer to? Yes we can.


The afternoon after Holmes shot up the theater in Aurora, and three days before I posted my assertion that culture can shape the expression of mental distress, an extraordinary young woman who goes by the pen name N described an experience that eerily parallels the one that Holmes seems to have experienced. Her story powerfully illustrates how the West’s definition of and reaction to schizophrenia shapes its course, outcome, and expression. Please, if you care a whit about what happened in Colorado, about madness, about culture, read this:

I suspect it would strike most people as ‘mad,’ particularly perhaps, to those who know me, to identify any sort of kinship, any common bond, with James Holmes, the “Batman shooter,” mass killer, and “psychotic son of a bitch,” as Colorado Congressman Ed Perlmutter has put it.  After all, I cry even over the deaths of the small birds my cats carry in from the deck.

And yet school shootings, or acts of extreme violence in which the perpetrator is or recently was a college student, have punctuated my life in strange & powerful ways.  I was diagnosed with schizophrenia just a month after Steven Kazmierczak (quickly identified as “schizoaffective”) shot six people to death on the campus of NIU, just an hour north of Chicago.  Undoubtedly primed by this shooting, wary, uncertain, without enough time to think, my doctoral adviser suspended my graduate assistantship, banned me from the university, and alerted all faculty, graduate students and staff to forward all emails to her and, under no circumstances, respond. It was not until a few weeks had passed that I learned—from the Dean of Students—that she had been operating under the assumption that it had been my plan or intention to bomb one of the buildings on campus.  She never apologized.

Why? Because the adviser had concluded that _N _, as she calls herself, was schizophrenic, and that this made her dangerous — a Kazmierczak waiting to happen. The effect was profound and immediate. The diagnosis didn’t just marginalize this young woman a bit. It promptly cast her full out of the world that meant everything to her. She writes

Although [the adviser’s] (clearly illegal) decision was reversed within a week, it set in motion a chain of events that were to forever change my life, perhaps as profoundly as the “diagnosis” of schizophrenia itself.  Friends—my doctoral cohort, as is often the case, were a close and tight-knit group—abandoned me overnight.  Students and faculty passed me in the halls, staring ahead blankly as if I were an undergraduate they had never seen and would never see again.  Parties were announced, talked about, and I was never invited.  Never again.

As if the psychosis were not enough, I developed an entirely expectable paranoia about my classmates and former adviser (and other involved faculty).  I studied their schedules and timed my entrances and exits from the department with obsessive precision, forced to “hide” in bathrooms and side rooms only on a handful of occasions.  I no longer attended departmental events (a fact that, with so many others, would eventually be held against me).  I did not, could not, finish any of the papers from courses I had been taking, and the themes of those last lectures—the relationship between the work of Winnicott and Melanie Klein, Lacan’s reading of Antigone—followed me like hungry ghosts for years.

For a while I struggled through classes, overwhelmed, perhaps in equal measure, by delusions and this new and unprecedented isolation.  Voices took the places of both professors and friends.  Following a hospitalization (and consequent withdrawal from a semester’s worth of classes), I descended into a state of the most stunning dysfunction, unable (or simply unmotivated) even to walk from my bed to the bathroom.  I could not read, I could not write—words rearranged themselves on the page, and my own thoughts became so hard to follow that I simply could not make it to the end of a sentence; suspended linguistically, suspended in life.

Then, in a harrowing annual review, she is expelled, without any warning she could discern, from her doctorate program; not given time off or compassionately offered help and room to regroup. Expelled, cast out, shunned, made irrelevant in the world that meant the most to her.

I only remember bits and pieces” of this review, she relates;

within five minutes, perhaps less, I had to bite down hard, dig my nails into my forearms, to keep back the tears.  First, the decision: we are dismissing you, in fact you may not, even as an unfunded student, enroll in any further classes.  From a professor I had, until that point, trusted completely: “the decision strikes the committee as simple—you clearly do not have your act together and we have no reason to believe you ever will.”  Another professor: “you are a burden on the instructors.”  And then some additional reasons, faculty talking more to each other than me: “look at all the withdrawals;” “she hasn’t attended a departmental lecture in almost two years;” “unambiguously uninvolved in the life of the department.”  Someone (I’m not looking at them) interjects: “perhaps allowing her just one more term….?”  Another “…keeping in mind that if we do this she will immediately lose all her health coverage…”  Then: “Absolutely not, but we can discuss the reasons after she leaves.”  Clearly she will not succeedNow or ever.<

Me: Everything I have ever been told was a lie.  My one way out—of poverty, desperation, madness—was never more than an illusion. And then disbelief.  And then, how will I ever explain this to anyone, to family, to old mentors? And then betrayal.  No language this time, no thoughts; crying, crying for hours. Alcohol, unconsciousness, unbidden dreams.  Even there: repeating their words, over and over and over again. Isolation so intense, there is no way I will ever bridge itI am lost. Days go by, weeks.

Isolation so intense, there is no way I will ever bridge it.

This differs in deeply existential ways from Kimwana’s experience. _N_ is not taken in or tolerated. She is, as one commenter at the post noted, ostracized in a way that was “a living death.”

She responded by fantasizing about inflicting horrid damage on herself and/or her academic mentor.

I fixated on a single vision, me, sometimes hanging, sometimes with gun in hand and a pool of blood on the floor, outside ‘her’ [i.e., her former advisor’s] office…. Suicide, yes, obviously, but also something more: revenge.

Her obsessions and fantasies did not run to mass murder. But others who had committed mass murder in similar circumstances, such as Kazmierczak and Jared Loughner, who was much in the news then, were much on her mind. Her confusion and disorientation and anxiety — her schizophrenia — rose from complex sources. But her anger rose in large part from an alienation that came hand-in-glove with our society’s definition of what she experienced — to the mere application of the word schizophrenia. And her ideas about expressing that anger rose directly from models of action brought to her from the media — models that expressed, in their violence and their repetitive, replicative nature, each bloody rampage imitating others, deep and multiple strains of our culture.

I hope this makes more clear that “culture shapes the expression of mental dysfunction.” We see in Kimwana’s experience how a different culture shaped what we all agree is schizophrenia in such a way that both its experience and expression take forms that looks foreign to us. And in N’s story, we see first a medical and social culture that profoundly shaped the experience of her disoriented mind by giving it a label that cast her aside — and then see our larger culture steer the expression of her resulting anguish toward visions that would seem foreign to Kimwana but horribly familiar to Loughner or Holmes. This is what I tried to get at in my post about Holmes, his SWAT-gear mass-shooting fantasy-turned-reality, and culture.

I’m not claiming this is The Whole Answer (though many commenters virtually insisted on seeing it that way before). This is not something we’re going to figure out by finding The Primary Cause, or insisting we must choose A, B, or C. Madness is an endlessly complex phenomenon and experience; mass murder is a stark but enormously complex act. It is, pardon the language, insane to think we can explain their intersection with math resembling a x b = c.

We need, as anthropologist Daniel Lende said in his own extraordinary, wider-ranging post about Aurora, to “expand our moral imaginations.” His post and N’s — the most thoughtful, risky, fully engaged, and truly provocative responses I’ve read, provocative in the best sense of the term, that of provoking new thought rather than reactive argument — make a good place to start.


Batman Movies Don’t Kill. But They’re Friendly to the Concept. Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters

maeror meror (in mourning) « Ruminations on Madness, by _N_

Inside the Minds of Mass Killers, by Daniel Lende

Many thanks to Lende, _N_, Watters, those commenters who actually tried to understand what I was getting at, and to Maggie Koerth-Baker and the commenters at BoingBoing for a rich discussion of the topic there, which provoked my thinking further and generated an earlier version of some of the material above.

Exit-door photo by jennlynndesign, used by permission. Some rights reserved. Other photos by David Dobbs.

Are We Slaves to Gadgets, or Work?

Alexis Madrigal, over at AtlanticTech, favors the latter answer:

Another day, another New York Times story about technology addiction. It’s almost like they are trying to win a Pulitzer Prize or something by pandering to the preformed opinions of journalists like themselves about the evils of modern communication.

The problem, Madrigal notes, is that our work culture, rather than the devices, that provide much of the propulsion behind our compulsion:

I’ve got no problem with trying to figure out how devices or social networks should fit into one’s life, or even in recognizing that some of them have addictive feedback mechanisms as features, not bugs. But for crying out loud, some of these New York Times gadget addiction pieces need to recognize the role that The Great Speedup in the American workplace plays in keeping people tethered to their devices….

To elide that one of the reasons we spend so many hours in front of our screens is that we have to misses the key point about our relationship with modern technology. The upper middle class (i.e. the NYT reader) is WORKING MORE HOURS and having to stay more connected TO WORK than ever before. This is a problem with the way we approach labor, not our devices. Our devices enabled employers to make their employees work 24/7, but it is our strange American political and cultural systems that have allowed them to do so.

I found this so during my year in London, which ended, alas, a year ago next week. An American friend happened to move there shortly before I did, he to edit a major magazine. All his reporters and editors used smartphones. But they all took long vacations, and unlike here in the U.S., where editors and reporters tend to stay connected and caretake stories they have in the pipeline, my friend’s staff “were GONE,” he said, when they took a vacation. “They don’t leave me their numbers,” he said, “and it’s understood they won’t answer email. It’s bad form to call unless it’s a real emergency.” He rather liked this when he took his own. Though he was the top editor, he would actually go a couple days without checking email — first time in years — and would leave the phone on a table in his hotel room or cottage instead of toting it around. 

Another editor I talked to there, a Brit fairly high up at a major UK popular magazine, had spent a decade as an editor at glossy mags in NY, doing quite well, but moved back to Britain, he said, “so I could have some hope of spending time with my family. I supposedly got vacation in New York, but it was considered poor form to actually take it. I’d get this look. I got tired of my time with my family consisting of waving to them as they went off to board a plane or a train.”

It’s the nature of culture that we’re not aware of how saturating its influence is. (A point I tried to make yesterday in another context.) But it matters — and I think Americans in particular, both blessed and cursed with a big-country isolation that grants security but encourages insularity, are apt to miss it.

Get  the whole Alexis mojo at Are We Addicted to Gadgets or Indentured to Work?

Photo by bengrey, by permission, AttributionShare Alike Some rights reserved

Whooping Cough Runs Amok in Washington — A Very Scary Graph

As I’ve been pushing my own legislators here in Vermont to close the big fat public health pothole called the ‘philosophical exemption,’ I often ask them to pay attention to the pertussis outbreak in Washington State. So I hope they’ll take note of Phil Plait’s update over at Bad Astronomy:

This is one of the scariest graphs I’ve seen in a long time.

This plot, from the CDC, shows probable and confirmed cases of pertussis – whooping cough – in the state of Washington from 2011 through June 2012. Last year’s numbers are the short, light-blue-grey rectangles, and this year’s are the dark blue. The plot is by week, so you can see the 2011 numbers slowly growing across the year; then this year’s numbers suddenly taking a huge leap upward. They are reporting the new rate as 13 times larger than last year. Note that 83% of these cases have been confirmed as being pertussis, while 17% are probable. The drop in recent weeks is due to a lag in complete reporting of cases.

Got that? There are 13 times as many people – more than 2500 in total so far – getting pertussis right now as there were last year at this time in Washington.

Some of this increase may be attributable to the pertussis bacterium growing a resistance to the vaccine and booster. However, it’s curious that Washington state has seen such a large jump; the incidence of pertussis overall in that state is nine times higher than the national average.

The really scary part is the possibility that this year’s graph (the tall bars) will rise through the season in the same way last year’s graph (the shorter gray bars) did as the year progressed. It’s vital to note that this is a 13-fold jump from last year. What does this tell us? When our vaccination levels drop enough to allow outbreaks, we won’t necessarily get the slow-motion, gentle warning we’d ideally want. Epidemics don’t work that way; they’re not polite, and in many cases, certain factors can line up to create a tipping point beyond which the numbers balloon. The graph above shows how fast things can get ugly.

You should read the whole thing at Bad Astronomy — a must-read generally. But in case you don’t go, DO heed Plait’s take-home:

Pertussis is a terrible, terrible disease. It puts infants at grave risk of dying, and eight infants so far this year have been killed by pertussis in the US. Even if it doesn’t kill them, it’s a horrible thing to put them through.

Vaccines save lives. Talk to your board-certified doctor and find out if you need one, or a booster.I did, and my whole family is up-to-date with their vaccinations. I refuse to be a part of spreading a disease that can kill anyone, let alone babies, and I refuse to be silent about it.

See: Washington pertussis outbreak is very, very bad

and some of Phil’s other links:

– Not vaccinated? No kisses!

– Whooping cough outbreak in Boulder

– Pertussis can kill, and you can help stop it

– Pertussis and measles are coming back