The New World of Legal Highs

Posted on November 13, 2013 by Carl Zimmer

Uncontrolled Substances: How The Chemical Underground is Going Mainstream. By Mike Power. Matter, Kindle Single, $.99.

Reviewed by Maia Szalavitz

I've been reading and writing about drugs and addiction for over a quarter century (yikes!) so I'm somewhat curmudgeonly in this area: what's news to many isn't likely to be so to me, and even the most egregious errors can only enrage you a certain number of times before you develop, unfortunately, at least some degree of tolerance.

But Mike Power's new Matter ebook, Uncontrolled Substances, is different.

Power avoids both the clichés and the errors, delivering a compelling story about a genuinely new development in the drugs world: the advent of so-called "legal highs." These are new synthetic substances similar to illegal drugs that are sold over-the-counter at head shops and convenience stories, often winkingly labeled as apparently innocuous products like "bath salts" or "plant food."

Often never even tested first on animals, the drugs are typically manufactured in Chinese factories and distributed globally via the internet. They range from marijuana-like products to those aimed at mimicking psychedelics or stimulants.

Power takes us into the story in several ways: by describing the difficulties faced by E.R. doctors dealing with overdoses and bad reactions to the substances, by telling the stories of key chemists, and by seeking to have a Chinese company produce a sample of a stimulant once taken legally by the Beatles, John F. Kennedy, Frank Sinatra and Marilyn Monroe that was pulled from the market in 1971. Power weaves these elements together seamlessly, while describing the difficulties that the new substances present to public health and regulators.

Synthetic drugs reveal a fundamental flaw in the foundation of the current international drug control regime, which is its irrationality. It is impossible to make a scientific case for a system that makes cigarettes and alcohol legal for recreational use, some opioids legal in some places for pain relief, and marijuana completely illegal. This means there are no objective criteria in existing law for determining which of the new drugs should be legal and which should not be.

Regulators have tried to address the problem by banning "chemical analogues" of illegal drugs, but this, again, runs into science: drugs that are structurally similar can have very different effects, and drugs that are completely dissimilar structurally can be pharmacologically alike. Simply banning every new drug as it appears also runs into issues with pharma: prohibit willy-nilly and you may unwittingly be blocking cures for cancer, Alzheimer's or depression.

As Power notes, even the hardliners at the United Nations Office of Drug Control Policy admitted in their World Drug Report this year that the system is "floundering" in its attempts to deal with the problem: one in 12 adults worldwide has at least tried one of the drugs.

Uncontrolled Substances offers a fascinating introduction to the issue–but it may, like many drugs, leave you craving more. In this case, however, I highly recommend it!

[Disclosure: I am writing a forthcoming ebook for Matter, with a different editor]

Maia Szalavitz is a neuroscience journalist for TIME.com and other publications. She is author, most recently of Born for Love: Why Empathy is Essential—and Endangered , with Bruce Perry, M.D. Ph.D. Her next book, Unbroken Brain, will examine addiction as a developmental disorder.

Snowfallization

Posted on October 24, 2013 by Carl Zimmer

Review of "Sea Change," by Steve Ringman and Craig Welch, Seattle Times. Web site.

Review of "The Course of Their Lives," by Mark Johnson and Rick Wood, Milwaukee Journal-Sentinel. Web site.

Last year on Download the Universe, Veronique Greenwood wrote a review of a story about an avalanche. Journalists write about avalanches fairly regularly, but this piece, called "Snowfall" was different. It was a one-man-band of text, video, maps, and unfolding photos. The story attracted millions of readers and earned scads of awards, including a Pulitzer. And it has ushered in an era of big, ambitious online packages of newspaper reporting. Not surprisingly, science offers some of the best stories for the Snowfall approach.

One recent example is "Sea Change," published last month by the Seattle Times. Photographer Steve Ringman and reporter Craig Welch tackled the immense but little-known disaster that is ocean acidification. The carbon dioxide we pump into the atmosphere doesn't just warm the atmosphere. It also lowers the pH of sea water, making the chemistry of the ocean dangerous for some species. Oyster companies are already feeling the effects of the dropping pH, and if we continue to acidify the oceans at our current rate, the ecological effects could be tremendous.

Here's a nine-minute video from the project:

The package Ringman and Welch have created has three main text stories. It starts with an overview of acidification research, which is followed by two close-ups on fisheries that are being affected–namely, oysters and crabs. (Both are economically important to the Seattle Times's local readers.) Welch reports the stories in the classic mode of environmental journalism, mixing together in-person reporting in far-flung locations with explanations of the research that revealed the scale of the problem. The photos are impressive, the videos are well made, and the visualizations–which try to convey how big the phenomenon of ocean acidification is–are fairly successful.

If you've already read "Snowfall," the presentation of "Sea Change" doesn't feel like a bolt out of the blue. But that just shows how much our expectations have shifted. Just look back seven years to a similar series called "Altered Oceans" from the Los Angeles Times, to see what I mean. The authors, Kenneth Weiss and Usha Lee McFarling, won a Pulitzer for their efforts, which were even more ambitious than "Sea Change." Rather than focus on one way we're ravaging the oceans, they set out to create a picture of all of them, from pollution to climate change.

Although it came out in 2006, the "Altered Oceans" package of stories holds up well today. But the packaging is showing its age. The fancy front page takes you to five stories that are nothing but text. There are also animations and photos, but they're squirreled away in slow-loading pages. After looking at one of these pages, I discovered there was no way to find my way back to the front page again. Seven years of programming advances made "Snowfall" possible–and now raise our expectations for such ambitious online pieces. (Welch recently discussed the making of "Sea Change" with the Columbia Journalism Review.)

From the mountaintops of "Avalanche" and the open oceans of "Sea Change," we take a claustrophobic trip indoors with "The Course of Their Lives." It's a four-part series from the Milwaukee Journal-Sentinel about medical students dissecting the cadavers of people who donated their bodies to science. There's no news here, no warning of an impending disaster. Instead, reporter Mark Johnson and photographer Rick Wood faithfully follow students through a remarkable experience–getting to take apart another human being, down to the brain and guts. Wood and Johnson both bring an emotional sensitivity to the project that makes reading it a deeply moving, human experience.

While I would heartily recommend "The Course of Their Lives," I would also point out some shortcomings. I don't want to belittle the piece by talking about them; they're worth talking about as a way to ponder the kinds of decisions that newspapers make when they create Snowfall-esque stories about science.

Some of the bells and whistles attached to "The Course of Their Lives" don't add much. The videos are mostly of talking heads, who sometimes speak stiltedly. Distilling people's words down in compelling written prose remains a superior technology to a video camera that's simply switched on.

I was also underwhelmed by the interactive anatomical diagrams that went along with the stories. They're meant to illustrate the lessons that the students learned about the cadavers, organ by organ. But who actually needs to see lungs light up on a diagram of a body to know what lungs are? The powers of visualization, both online and in apps, are spectacular. (My favorite anatomical example remains this ebook about Leonardo Da Vinci's anatomical sketchbooks.) But there's no point in using those powers simply to check off a box in a to-do list. It's another lesson that we should respect the technology of prose.

Ironically, the prose itself in "The Course of Their Lives" also felt a bit antiquated. American newspaper journalism long ago settled on a certain style. The paragraphs became short, and the sentences shorter. The words needed to be plain and serviceable. There were perfectly good reasons for this approach–but a lot of them had to do with the physical properties of printed newspapers. Stories couldn't be made of densely packed paragraphs, for example, because editors would need the freedom to cut off sections of stories at the last minute to make them fit their available space.

These were good reasons, but they had some odd consequences. Along with their standard fare of short news pieces, newspapers would also prepare a few massive, long-form pieces–Pulitzer-bait, essentially–but these pieces often retained the staccato structure of short news stories. In these sprawling pieces, that style read strangely. And once New Journalism's masters like Tom Wolfe and Gay Talese turned magazine features into a new art form, the adherence to the old style in newspapers became even more peculiar.

Today, as newspapers and magazines shift online, that style has grown even more out of date. If you read stories from publications that got their start online, such as the Atavist, you never find the staccato style of old newspaper stories. There's no need to adhere to it.

Thus "Sea Change" and "The Course of Our Lives" serve as illustrations of journalism in transition–created by people trying to figure out how to bring the best of the old world of newspapers and leave the rest behind.

(Photos: Top-Steve Ringman, Bottom-Rick Wood)

Zimmer author photo square Carl Zimmer writes the "Matter" column for the New York Times and is the author of 13 books, including Evolution: Making Sense of Life.

Autism, Inside and Out

Posted on April 2, 2013 by admin

Asperger
Love: Searching for Romance When You're Not Wired to Connect by Amy Harmon. A New York Times/Byliner Original. Available for Kindle, iPad, Kobo, and Nook, $2.99.

And Straight On Till Morning: Essays on Autism Acceptance, edited by Julia Bascom. Published by the Autistic Self-Advocacy Network. Available for Kindle, $2.99.

Reviewed by Steve Silberman

In the early 1990s, a mother told a conference of autism
professionals that the upside of having a teenager on the spectrum at home is that
they will never want to do the things that often get kids in trouble. There will
be no need for awkward conversations about sex, because people with autism are
either uninterested in or incapable of intimacy. Parents won't have to worry
about a late-night knock on the door from the local sheriff, because autistic teens
have no desire to party. If these generalizations now seem naïve, offensive, or
some combination of the two, this mother had a lot of company in her assumptions.
The notion that people on the spectrum are disinclined to seek connection with
others is embedded in the very word autism,
which is derived from the Greek word for self, autos.

One of the world's leading
authorities on the subject, psychologist Tony Attwood, devotes only a handful
of pages in his Complete Guide to
Asperger's Syndrome to sexuality and relationships. Specifically, there are
two references to "lack of desire," four to pornography, two to
exploitation by predators, and two to celibacy. Casting a further chilling
effect on the notion of romance, Atwood cautions potential suitors that people on
the spectrum may find a friendly touch on the arm "unpleasant and even
difficult to tolerate, let alone enjoy" because of sensory sensitivity,
and compares embracing an autistic partner to "hugging a piece of
wood." This is the historical backdrop that looms — albeit invisibly to
most readers — behind the publication of a new ebook by Pulitzer prize-winning
New York Times reporter Amy Harmon, Asperger Love: Searching for Romance When
You're Not Wired to Connect.

Continue reading “Autism, Inside and Out” →

A Few Pounds of Microbes, Only Ounces of Insight

Posted on March 1, 2013 by Carl Zimmer

Honor Thy Symbionts, by Jeff Leach. Kindle

Guest review by Kevin Bonham

In 2003, the Human Genome Project–an effort to sequence every gene in a human being–was completed. The success, announced to great fanfare, was supposed to herald a new era in health care. Unfortunately, the promises of personalized medicine, in which treatments are tied to a person's genetic sequence, have not yet come to fruition. A few of the reasons for this are obvious (at least in hindsight). Knowing the location and sequence of a gene is one thing, knowing what it does is quite another. And understanding the role that a gene or gene variant plays in a disease, especially when many afflictions are influenced by tens or hundreds of genes, is even harder.

Complicating matters further is the re-emerging realization that genes are not destiny, and now many new "-omics" projects are beginning to gain attention. From the transcriptome (what genes are actually expressed), to the proteome (proteins and protein modification), to the epigenome (modifications of the DNA that regulate gene expression), more and more researchers are attempting large-scale analysis of entire biological systems and trying to extract meaningful information from enormous data sets. In his new ebook, Honor Thy Symbionts, Jeff Leach aims to tackle what is, in my opinion, the most fascinating of these new -omics revolutions: The Human Microbiome Project.

I desperately wanted to like Leach's book. Even though I've repeatedly heard the refrains, "There are 10 times more bacteria cells in your body than human cells," and "There are 100 times more bacterial genes in your gut than there are human genes," and "Bacteria account for 5 to 10 percent of your body mass," these facts never cease to amaze me. And I've been to enough microbiome-related research talks to know that the microscopic bugs that live in our guts can have profound impacts on our health–from metabolic disorders and type-II diabetes to multiple sclerosis and inflammatory bowel disease. The microbiome deserves a book-length discussion, but Honor Thy Symbionts falls short.

Problems

Problem 1 (I think this is the underlying reason for all of this book's problems): It's not a book, it's a collection of "essays" that are really just blog posts.

In fact, you can go to Leach's website and read almost all of the "chapters" for free on his blog. As I read his alleged book on my Kindle, it was abundantly clear that Leach simply did a large-scale copy-paste, without much additional effort. Spelling and grammatical errors abound, and phrases like "In a series of blog posts starting with this one[…]" only serve to call attention to the fact that I paid three dollars to download something I could just as easily have read on the Internet for free. In one chapter, the text refers to a graph that apparently didn't make it in the migration to Kindle. And since each chapter is really just a blog post, there's no cohesive narrative to tie the book together. Even the unifying "theme" of the microbiome is misleading, since several of the chapters don't even mention microbes.

Problem 2: A lot of the science is overstated.

Throughout this book, I had the same feeling of professional scientific unease I get when reading Malcolm Gladwell, without the benefit of Gladwell's ability to spin a narrative. For instance:

Though improved hygiene has many benefits, scrubbing soil from our bodies and food has thrown our immune system into an over reactive tailspin and is responsible for the skyrocketing increase in allergies and autoimmune disease.

There are several lines of evidence suggesting that hygiene may increase the risk for many inflammatory disorders, but there are plenty of other factors that may play a role, and a marginal increase in risk is a far cry from an "over reactive tailspin."

In another case, Leach describes compelling research suggesting that fiber intake can alter the levels of certain types of microbes. But then he leaps to a prescription how many grams of fiber we should eat each day (an amount significantly higher than current nutritional guidelines).

And in yet another case, Leach spends several pages discussing research on the protein consumption of spider monkeys. Based on this study, he draws conclusions about everything from human diets to agribusiness, sociology and the economics of poverty and health, finally concluding the chapter by pointing out that

This all assumes, of course, that the protein leverage theory plays any role in all of this. Maybe it doesn’t.

At least he admits the ambiguity this time. But then why all the self-assured conclusions? At times I wanted to pull my hair out.

Further complicating this scientific over-reach is Leach's failure to cite the research he's referring to. There's an extensive collection of references at the back of the book, but no link within the text to the reference itself. This seems to be another symptom of copy-pasting from a blog post. The blog posts have web links, but they were apparently were stripped out when the conversion was made.

Problem 3: Inconsistency of style and complexity.

Leach jumps back and forth from lofty rhetoric:

It is at this interface between the terra firma of our evolutionary past and the enhanced material standard of living[…]

to colloquialisms that border on inanity. Sometimes he makes the jump within a single sentence:

In just a few thousand centuries, our kind has gone from nesting in trees, to making stone tools and digging roots, to kindling fires, to subduing flora and fauna, to erecting massive cities, and finally to downloading Angry Birds over 1 billion times (and counting).

Leach routinely throws in random and unnecessary digs at creationists. At one he point calls health-care workers who recommend baby formula "predatory." I found the constant movement between grandiosity and link-bait trolling to be jarring.

Leach also routinely mixes lay-accessible and jargon-laden writing. I know what 16S ribosomal RNA and shotgun pyrosequencing (misspelled as prosequencing) are, but I doubt the target audience of this book will. In some cases, the jargon is useful and adequately explained, but in others it just seems like Leach is trying to show off.

Redeeming Qualities

Despite these glaring problems, I don't think Leach should be written off entirely. A lot of the science he talks about is interesting and important. Our obsession with cleanliness probably does play some role in the increased prevalence of allergies and autoimmunity, even if it's not the only cause. People probably should be eating more fiber, even if we can't make a specific grams/day recommendation. The cheap cost of corn and expense of protein probably explains at least a portion of the paradoxical association of poverty and obesity, even if we can't draw a straight line between spider monkey diets and our own. And the main thesis of this book, that our dietary decisions need to be increasingly informed by our emerging understanding microbiome, is almost certainly correct.

Strangely, Leach himself makes much the same point in the introduction to this book.

While researchers are cautious and right not to oversell the microbiome (much work is still needed to confirm causation for many ailments), the direct or indirect implication of microbes in a staggering number of ailments and diseases of the modern world, reinforces that we are on the cusp of a paradigm shift from the orthodox notions of health and disease.

It's a shame that the author failed to exercise some of that caution himself.

Final Verdict

There are too many problems for me to recommend this book. Prepare an enormous grain of salt and head over to Leach's blog instead. You'll get most of the same material, including web links to the relevant research so you can fact check any claims that seem overwrought. Meanwhile, I will anxiously await a book that tackles the microbiome and does justice to this amazing new field of research.

10.27.1KevinBonham16 Kevin Bonham is a graduate student studying the immune system at Harvard University. He blogs about microbes and the immune system at We, Beasties on the Scienceblogs network.

The Elusive Psychology of Mass Murder

Posted on February 20, 2013 by Carl Zimmer

The Mind of a Madman: Norway's Struggle to Understand Anders Breivik. By Richard Orange. Kindle Single, $1.99.

Review by Maia Szalavitz

Following Aurora and Sandy Hook— and the concerns that have not surprisingly arisen over the questions of violence, guns and mental illness— I was eager to
read journalist Richard Orange’s

Mind of a Madman: Norway’s Struggle to Understand Anders Breivik
.

The book ably and lucidly details the story of the trial of the man who carried out the world’s deadliest mass shooting by a single individual. It’s full
of twists and turns, with Orange expertly doling out the suspense as to whether the killer will ultimately be declared sane or not. But it lacks the
context and analysis I’d hoped to find in an account of an event in which psychiatry faces off against what can only be called evil.

Orange, a foreign correspondent for the UK’s Daily Telegraph, covered Breivik’s trial after the Norwegian right wing ideologue killed 8 people in bomb
attacks on government buildings in Oslo, then gunned down 69 people, mostly teens, who were attending a political youth camp in July 2011.

Breivik claimed he committed the attacks to “save” Norway from Islam, multiculturalism, “cultural Marxism” and feminism. Initially, a psychiatric report by
two of the country’s leading experts claimed that he had paranoid schizophrenia.

Their evidence for this diagnosis was his apparently false claims about being connected to a larger terrorist network, his self-bestowed medals and
handmade military “uniform” and his belief that he had the right to kill for his ideas. These were seen as “delusions,” which occurred after a period of
social withdrawal before the attacks and his rants were said to contain “neologisms” or made-up words, additional evidence of disordered thinking.

According to the initial report, these factors were apparently enough to qualify Breivik for a diagnosis of schizophrenia under the ICD 10, which is the
international medical diagnostic manual and is similar in its psychiatric classifications to the DSM.

“His political world exists just to have a world to be psychotic in,” one of authors of the report testified.

But after the report was leaked, experts on the far right argued that Breivik’s “neologisms” were actually common terms used by others with similar views,
making the diagnosis controversial. The ICD criteria apparently require that schizophrenic beliefs be “culturally inappropriate,” and the fact that the
other far right groups he saw as his peers had similar views called that into question.

Breivik was surprisingly insightful about this paradox: “What I think is that [they] could not believe that a normal person could do such a thing. A
person who does something so terrible cannot be normal. He must be sick.”

After widespread outrage, a second report was ordered. This time, a new group of professionals determined that Breivik had not been psychotic
while carrying out the attacks. The second report accepted that his ideology and resulting actions, while clearly despicable, were not in and of themselves
evidence of psychosis.

But there was still disagreement among the experts who testified as to what Breivik’s diagnosis— and everyone agreed that there should be one— actually
was. Breivik had been diagnosed with an autism spectrum disorder as a child because of his “pedantic” ways and obsessive compulsive behavior, so one
psychiatrist suggested that this led to his “lack of empathy.”

However, a psychologist disagreed with the accuracy of that diagnosis, testifying that during an evaluation, Breivik was “polite and friendly and seemed
empathetic.” One of Brievik’s childhood friends had called him “one of the most sociable people” that he knew.

Other psychiatrists argued that Brievik’s real problem was a personality disorder— either narcissistic personality disorder or antisocial personality
disorder, probably well into psychopathy— or some toxic combination of the two, along with his racist ideology.

Mind of a Madman,
however, does not provide readers enough context to draw conclusions about Breivik's true state of mind. It does not include the ICD diagnostic criteria or give any background information
about conditions like personality disorders, schizophrenia and Asperger’s. As a result, it’s very difficult to weigh the battling
reports and conflicting testimony. The book doesn’t mention that autism
spectrum disorders are not linked with violence, nor does it explore the
controversy over the link between schizophrenia and violence. It also fails to examine the question of empathy itself. This quality is critical to several of the diagnoses and seems to have been misunderstood by some of those who testified, incorrectly claiming that autistic people always lack empathy.

While this probably reflects a newspaper journalist’s attempt to be “objective” and simply detail the (most certainly compelling) story of the trial, it
left me frustrated. Underneath this story is a tale of the ongoing problems with our current system of psychiatric diagnosis and the lack of objective
measures available to characterize mental illness. There’s also a story about why some diagnoses— like schizophrenia— are seen as mitigating, while others—
like personality disorders— are seen as aggravating. And of what brain science suggests about moral responsibility.

Moreover, there’s also an untold story of a country which is not bent on vengeance even after such an unimaginable crime, a country that would have
accepted either an insanity verdict or the one that came down, which found Breivik morally responsible and sentenced him to 21 years, a sentence that can
and likely will be extended if he is still found dangerous at that time.

Of course, a short ebook may not be the place for such depth, but some basic facts about diagnosis and the controversies it evokes would have been
extremely useful. There’s certainly room for greater exploration of the Breivik case in light of these distressingly frequent events— and especially for an
examination of the role of culture, psychiatric ideas and varying legal systems so that we can become better at preventing or dealing with them.

Maia Szalavitz is a neuroscience journalist for TIME.com and the author of five books, most recently Born for Love: Why Empathy is Essential—and Endangered, with Bruce Perry, M.D. Ph.D.