On a literary trip

The Guardian books blog has a fantastic short piece on fictional mind-bending drugs from literature, stretching from the nightmare-inducing hallucinogens of William Burroughs to Pan Galactic Gargle Blaster from Hitchhikers’ Guide to the Galaxy.

The most famous invented drug is probably soma in Aldous Huxley’s Brave New World. It was an integral part of the story because it was an integral part of the authorities’ control mechanism ‚Äì they were literally keeping the people doped up and happy. Sounds alright to me: a permanent state of blissed-out semi-catatonia. In fact, given my choice of fictional narcotics, soma would probably be first.

Nor would I mind sampling some melange/spice from Frank Herbert’s Dune (long life, heightened awareness and possible extrasensory properties, cool blue eyeballs); septus from Iain Banks’s Transition (the ability to flit between parallel worlds and inhabit others’ bodies); Dylar from Don DeLillo’s White Noise (no more fear of death); the various hallucinogens drunk with the old moloko in A Clockwork Orange (a nice quiet horrorshow starring Bog and all his angels); Can-D in Philip K Dick’s The Three Stigmata of Palmer Eldritch (allows you to participate in a group hallucination). I also quite like the sound of the Pan Galactic Gargle Blaster in Hitchhikers’ Guide to the Galaxy, described as “like having your brains smashed out by a slice of lemon wrapped round a large gold brick”. Well, it beats aspirin and sniffing exhaust pipes.

However, it misses out one of the most wonderful examples: the feathers from Jeff Noon’s Vurt and Pollen novels that produce shared hallucinations that are a cross between Jung’s collective unconscious and the internet.

Link to ‘Literature’s most mind-blowing drugs’.

A varied diet

A 1964 article from the Archives of Surgery discusses how to treat psychotic patients who may have ingested inedible objects.

It reports on one remarkable case where the following list of objects was found in one patient’s stomach. They also helpfully provided a photo of all the objects laid out on a table.

Nickels (173), Pennies (161), Quarters (3), Dimes (26), Military buttons (22), Insignia clasps (5), Nails (50), Staples (5), Screws (16), Metal bolt (1), Metal nuts (4), Overall buckles (19), Metal cap top with keys (8), Lock key (1), Crucifix (2), Bottle caps (2), Knife handle (1), Fork handle (1), Spoon handle (1), Complete fork (bent double) (1), Dessert spoon (1), Rifle shell (unexploded) (1), Pieces of lead (14), Brass ball (1), Pieces of brass (3), Pins and needles (27), Watch parts (22), Broken earring (1), Rings with chain (2), Pieces of wire (7), Nondescript pieces of metal (16), Empty cigarette package (with tinfoil) (1), Official War Department letter (wrapped in cellophane) (1), Piece of glass (1), Streetcar tokens (2), Several small packages of cancelled postage stamps wrapped in cellophane.

Rifle shell? Blimey.

The persistent eating of inedible objects is known as pica although rarely does it occur in such as spectacular fashion.

Link to PubMed entry for 1964 study.

Brain skulls on the front, splatters on the back

You wait ages for a neuroscience-themed dress to appear (and believe me, I have) and then two come along at once.

After my discovery of neuro streetwear for the female fashonista last week, comes a brain themed tutu dress for the riotgrrl neuroscientist.

The description is actually quite poetic:

Brain skulls on the front, splatters on front and back. Distressed style: Imagery has unique cracks, splatters, smears, asymmetry, fading. Adjustable halter straps tie behind your neck for customizable fit. Shredded cotton ruffles underneath tulle ruffles to prevent see-through look. All garment edges raw (hemless) for a deconstructed / shredded look. Shredded cotton bust ruffles.

I have no idea what ‘shredded cotton bust ruffles’ are but surely a great name for an all-girl indie band.

Link to Brianskull tutu dress.

One Hundred Years of Memory Loss

Image from Wikipedia. Click for sourceNeurology journal Brain has a fantastic article on the close parallels between the effects of semantic dementia, a degenerative brain disease that causes the loss of memory for the meaning of words and objects, and the novel A Hundred years of Solitude where a magical disease affects villagers’ memory for ‘the name and notion of things’.

The novel is by the Nobel-prize winning Colombian writer Gabriel García Márquez and is famous for founding the magical realism style of fiction where fantastical things seem to happen in an otherwise ordinary world.

What is interesting about One Hundred Years of Solitude is that while the memory loss closely resembles the effects of semantic dementia, it was written before the condition was recognised by neurology.

Unfortunately, the article isn’t available online but this an excerpt from the article which captures the main themes:

In One Hundred Years of Solitude, García Márquez created a literary depiction of collective semantic dementia before the syndrome was recognized in neurology. The memory plague section of the novel also provides an inspiring and human account of one town’s fight against “the quicksand of forgetfulness”.

Why does García Márquez envision a world in which people lose their ability to communicate the names of everyday things? He gives some insight into his use of magical realism in the opening lines of the novel, in which he describes the village of Macondo in its earliest days: “the world was so recent that many things lacked names, and in order to indicate them it was necessary to point”. With this description, García Márquez implies that the ability to assign a name to an everyday object is a defining human achievement that has developed over time. In this light, the insomnia plague forces Macondo villagers into a primitive state by robbing them of their ability to remember “the name and notion of things”.

Remarkably, García Márquez’s probing investigation of the power of words and everyday names leads him to a striking literary enactment of the clinical syndrome of SD [semantic dementia] and the problems faced by SD patients. His fictional characters, just like the SD patients discussed here, are acutely aware of the “infinite possibilities of a loss of memory”. Both patients and characters attempt to preserve semantic meaning in more permanent forms that are free from the devastating effects of a neurodegenerative process and a fantastical plague. As such, García Márquez achieves a masterful portrayal of SD not just in his description of the plague’s ravaging effects on semantic knowledge, but even more vividly in his account of the affected people’s ability to maintain hope through various coping strategies – to preserve their fragile self-identity in the pages of word lists and pocketbook diaries.

Link to PubMed entry for article.

Nine Legendary Hypochondriacs

ABC Radio National’s Late Night Live has a fascinating discussion with the author of a new book on nine famous hypochondriacs: James Boswell, Charlotte Bronte, Charles Darwin, Florence Nightingale, Alice James, Daniel Paul Schreber, Marcel Proust, Glenn Gould and Andy Warhol.

I’m not sure Daniel Paul Schreber is necessarily the best example of someone with hypochondria is he is famous for writing a personal account of being genuinely mentally ill and floridly psychotic. However, I’ve not read the book and the programme focuses on better known figures so I am open to being convinced (certainly his delusions included lots of beliefs about his body changing in curious ways).

Link to Late Night Live on hypochondria.

Bonuses generate more heat than light

The engaging behavioural economist Dan Ariely has just become a columnist for Wired UK and in his first article he describes how the promise of performance-related pay often backfires leading people to do more but perform worse.

To see the effect of bonuses on performance, Nina Mazar (assistant professor of marketing, Toronto University), Uri Gneezy (professor of economics and strategy, University of California, San Diego), George Loewenstein (professor of economics, Carnegie Mellon, Pennsylvania) and I conducted three experiments. In one we gave subjects tasks that demanded attention, memory, concentration and creativity. We asked them, for example, to assemble puzzles and to play memory games while throwing tennis balls at a target. We promised about a third of them one day’s pay if they performed well. Another third were promised two weeks’ pay. The last third could earn a full five months’ pay. (Before you ask where you can participate in our experiments, I should tell you that we ran this study in India, where the cost of living is relatively low.)

What happened? The low-and medium-bonus groups performed the same. The big-bonus group performed worst of all.

Link to ‘Bonuses boost activity, not quality’ in Wired UK.

Full disclosure: I’m a contributing editor to Wired UK. I have never received a bonus in my life, but if I do, I hope to spend it beautiful on women and fast cars, although, in reality, I will probably buy a laptop.

2010-02-05 Spike activity

Quick links from the past week in mind and brain news:

Sex addiction is a feminist victory, according to an article in Slate, apparently because it allows man shaming. Malevolence-based medicine rears its ugly head.

The BPS Research Digest covers research finding CBT-based self-help books might do more harm than good for people who worry a lot.

The public are asked for their opinion on the recent news that The Lancet retracts the Wakefield autism paper, by The Onion.

Neurophilosophy has an excellent piece on big news that the first evidence for navigation essential grid cells in the human brain.

Why does time fly by as you get older? NPR has a great segment that tackles the cognitive science of changing time perception with age.

Neuroskeptic has an excellent piece on a new fMRI scanning technique that manages 10 scans a second over a thin slice. If you’re not reading Neuroskeptic, you should be, it’s great.

Any Freemasonry in the family? The Independent has a piece on one man’s experience of trying gay ‘conversion’ ‘therapy’ in the UK.

The Economist looks to the February 10th release of the first draft of the new psychiatric manual, the DSM-V. Doesn’t mention that it is likely to unleash a bun-fight of biblical proportions.

Mind Hacks is a top 30 science blog according to The Times and a top 100 blog for psychology students according to News42. Shakira todavía no me ha llamado.

H+ Magazine covers the announcement that the next $10 million X Prize is for a brain-computer interface. I shall propose ‘fingers’ as my entry.

There’s a thought-provoking piece on whether racism is partly due to perceptual illusions over at The Vision Revolution.

Fora.tv has an excellent talk about the new book ‘The Harvard Psychedelic Club’ about how the psychedelic revolution emerged from the Harvard psychology department, based on the new book of the same name.

Reactive action is quicker action, according to research covered by Not Exactly Rocket Science.

Nature has an excellent short article on writer Jorge Luis Borges interest in neuroscience but it’s locked behind a paywall because this information can kill! It’s for your own good.

“We have buried Trials 15, 31, 56…” The Carlat Psychiatry Blog covers jaw-dropping evidence of drug companies Eli Lilly, AstraZeneca hiding evidence and lying about drug harm.

The Daily Mirror has a poor write-up but a genius headline over the recent internet and depression flap: “Does being inter the net bring you down loads?”

Is Telephony Making Us Stupid? Carl Zimmer’s The Loom covers Mark Twain’s article about the dangers of the telephone.

NPR has a good short piece on Haiti, imposing Western ideas about <a href="Mental Health Disaster Relief Not Always Clear Cut
http://www.npr.org/templates/story/story.php?storyId=122981850&ft=1&f=1001″>trauma and how some treatment can do more harm than good.

Teaching abstinence makes teens delay sex? Dr Petra presents the evidence behind the media hype.

The Washington Post reports that the US Defense Department starts an investigation into military mental health care after an exposé by Salon.

A new London exhibition on the history of the ‘Bedlam’ hospital and the development of mental health care in the UK is covered by The Guardian. Only runs until February 12th.

In the News is a fantastic forensic psychology blog.

The founder of the Baby Einstein sues the university for access to raw data for a study reporting that the DVDs actually slowed language development, reports Advances in the History of Psychology.

Eureka brain special and more fighting

The Times has just released its monthly science magazine, Eureka, with a special issue on the brain and all the articles freely available online.

There doesn’t seem to be a way to link to a whole issue, but inside you’ll find an excellent piece on the use of transcranial magnetic stimulation (TMS) to temporarily switch off bits of the working brain, a profile of neurosurgeon Huma Sethi, an article on commercial brain-computer interfaces, a remarkable piece on how old injuries can ‘return’ to affect phantom limbs as well as an exploration of the link between brain activity and sporting skill.

Probably my favourite is an article on how forensic science and criminology are increasingly using neuroscience, and there’s also an account of a writer’s experience of being brain scanned and a description of the Total Recall project which aims to digitally record everything about day-to-day life.

There’s also a piece by me, where I go to head-to-head with Baroness Susan Greenfield in the Fight Club section where we debate ‘Is screen culture damaging our children‚Äôs brains?’.

Greenfield goes for the usual “maybe.. perhaps… could it be?… tada! compulsive gambling and schizophrenia!” argument, so I hope I’m a little more evidence-based. Anyway, you can read for yourself.

I also debated exactly the same thing with psychologist Tracey Alloway live earlier today, and you can read the transcript here. It’s more in-depth but is less coherent and has typos and bad jokes.

Also don’t miss out on the fantastic downloadable brain poster, which is available online as a (big) jpg file.

I’m still reading through all the articles but the ones I’ve read so far have been excellent. A motherlode of neuroscience reading.

Time to think

Bioemphemera has found some wonderfully left-field brain illustrations by Dutch graphic designer Rhonald Blommestijn. The image on the left is a brain made out of clocks.

Blommestijn’s blog is full of strikingly surreal eye-candy that manages both to inspire a feeling of wide-eyed wonder and illustrate scientific themes.

They’re certainly very original takes on the subject and the neuroscience images are particularly vivid.

Link to Bioephemera on Blommestijn’s brain illustrations.
Link to Blommestijn’s blog.

On communicating through the coma-like state

A study just published in the New England Journal of Medicine reports on how a subset of patients diagnosed as being in a coma-like state can be trained to show specific brain activity to answer yes / no questions despite seeming to be unconscious and unresponsive.

Many news reports seem to suggest that researchers have found a way of ‘reaching inside coma’ with a brain scanner to communicate with patients but the findings are much more modest, only 5 out of 54 patients could reliably produce specific brain activity on command and only one was tested who could answer simple yes / no questions in this way.

Despite this, the study is still incredibly impressive and it indicates that some patients who seem unconscious may have a much richer inner life than we assume and it may be possible to communicate with some of them by measuring their brain activity.

The researchers put people in brain scanners and, in one condition, asked them to imagine standing still on a tennis court while swinging an arm to “hit the ball” back and forth to an imagined instructor, and in the other, to imagine navigating the streets of a familiar city or to imagine walking from room to room in their home. These were chosen because they show distinct patterns of brain activity on a scan.

This was tested both on healthy people, for a comparison of how activity should normally look, and in brain injured patients in a coma-like state.

Only 5 of the 54 patients responded with distinct brain activity, similar to the type found in all the healthy comparison participants, but in this subset, it indicated that they were likely following simple verbal commands.

This has been established before, but one criticism of these past studies was this this could just be an automatic response to the words in the command. We know that the brains of unconscious people respond briefly but automatically to words, even the person is not aware of hearing them.

The brain activity for the ‘tennis’ and ‘walking’ commands was much longer and more sustained than we might expect from the normal automatic response to words, so this was unlikely, but you might still argue that these are automatic, non-conscious responses.

To rule this out in one patient, the researchers asked six yes/ no questions about simple personal details and instructed the patient to imagine tennis for yes and walking for no.

Crucially, during the questions, the researchers prompted the patient with just the word “answer?”, meaning any different reactions that showed up couldn’t be just an automatic response to the word itself which was always the same.

Out of these six simple questions, the patient ‘responded’ correctly to 5, suggesting that they were genuinely understanding, considering and making a conscious response. This was in a patient who had no external signs of consciousness.

The scans for a couple of the questions are in the image above (click for a bigger version). You can see how different the responses are, but also how serious the brain damage is.

Importantly, these correct answers do not necessarily mean that the patient was completely mentally fine but ‘trapped’ their body. One common test used on definitely conscious patients after brain damage asks lots of these yes / no type questions (like “Do cinemas show films?” / “Are bottles edible?”) to test understanding.

Some patients can be fully conscious but their language so damaged that they can’t answer these questions, others can manage the less complex ones (the easiest are usually simple personal details) but not others, for the same reason.

All of the patients in coma-like states were clearly very brain damaged, so it could be that even the one who could make conscious responses might not have full understanding. On the flip side, it could also mean that some of the other patients may have been conscious but could not understand the task, and so did not show up on this test. You can see it’s a tricky area.

However, the discovery that it is possible to communicate, even in a simple terms, with a patient previously though to be in a coma is huge news and this research is likely to lead to further work trying to detect which patients are conscious and to develop methods to communicate with them.

Link to study summary in NEJM
Link to good write-up from New Scientist.

Neuro street wear

Herb is a hip Berlin fashion label who have a fantastic collection of women’s clothing with a subtle brain scan motif.

The label is the work of designer Angela Herb and there are actually two collections inspired by the MRI scan.

It’s definitely a street wear collection but the clothes have a wonderfully understated futuristic feel.

Unfortunately, it seems like clothes are exclusively sold through boutiques in Germany so you may have to contact the label directly if you want to get hold of something from outside the country.

We occasionally feature mind and brain t-shirts on Mind Hacks but rarely anything this stylish.

Link to Herb collection one.
Link to Herb collection two.

Death of a gladiator

Roman gladiators took part in one of the most brutal sports in history, many dying by traumatic brain injury during their matches. A medical study published in Forensic Science International examined the skulls of deceased fighters, discovered in a gladiator graveyard from Turkey, and reveals exactly how they died and even what weapons delivered the fatal brain injury.

The graveyard was discovered by archaeologists in 1993 but this study is the result of applying modern forensic medicine, which more typically attempts to discover the cause of death by looking at human remains after a crime, to the ancient bones.

Gladiator matches were not free for alls. Each gladiator had a certain attack and defence weapon combination, and these were matched between pairs of fighters so none had an unfair advantage. Men of equal, speed, strength and skill were also matched together to ensure a fair fight.

Since no point system existed, fighting was always pursued until a decisive outcome, which could be any of the following alternatives: defeat through death, defeat due to injury preventing further combat, defeat due to exhaustion, a win, with the bestowal of a palm branch or a laurel crown, or a draw, with both opponents being allowed to depart the Arena alive. This was the most unlikely case, since the superiority of one fighter had to be proved to enable the public to reach a verdict.

The final decision of the loser’s fate resided within the hands of the games‚Äô organizer. To this end he appealed to the mood of the plebs. Upon the cry of iugula (lance him through), it was expected of the vanquished that he would set an example of the greatness of manhood (exemplum virtutis) and would motionlessly receive the death thrust. The turning down of the thumb signified to the spectators, not that the gladiator should be put to death, but rather that the gladiator was dead.

After the final blow, arena servants carried the combatant on a stretcher into the carcass chamber and gave the twitching body a deathblow. It is not known exactly how this execution was performed. The executor, a costumed arena servant, associated with the Roman god of death “Dis Pater” or the Etruscan counterpart “Charun” carried a deadly hammer accompanying the gladiator on his last journey.

The first task of the investigators was to work out whether the damage to the skulls was due to an earlier blow the fighter survived, the death blow, or whether the bones had been damaged since the fighter was buried.

Living bone contains fluid-filled vessels, grease, and collagen fibres, which makes it more durable, flexible and, most importantly, it doesn’t splinter when broken. This allowed the research team to work out which skull fractures happened at the time of death. Furthermore, any sign of fracture healing shows that the gladiator survived the injury.

Once this had been established the researchers could start to match up the deadly fractures with the types of weapon they knew existed at the time.

Two examples of skulls are on the right, with the likely weapons that delivered the final blow illustrated in the white boxes underneath – one a hammer and the other a trident. These were identified by looking at the unique damage patterns caused by the impact of specific weapons.

Out of the 10 skulls with deadly fractures, the cause of death in 7 was a puncture wound from weapons such as a trident, javelin, pointed hammer or sword, and, interestingly, three were caused by being hit by the blunt force of a shield.

Deadly blows were either over the frontal area (above the eyes and forehead) or the parietal area (above and slightly behind the ears), whereas all the blows that the gladiators survived were at the front of the skull.

The researchers suggest that this is because death blows were usually given after the gladiator had been beaten and so were more likely to be from behind, whereas survivable blows were more likely to occur in training where less deadly weapons were used.

Link to PubMed entry for ‘Head injuries of Roman gladiators’.

The internet, depression and drinking a glass of water

Photo by Flickr user Hoggheff aka Hank Ashby aka Mr. Freshtags. Click for sourceA new study has made headlines around the world that claim that internet use is linked to depression despite better evidence from previous studies that there is no substantial link.

The study itself is a fairly straightforward online survey with the key finding that out of 1,319 people who completed the questionnaires, 18 were identified as ‘addicted’ by Kimberly Young’s Internet Addiction Questionnaire and these people were more likely to score highly on the BDI – a standard questionnaire to measure depression.

The study itself was well conducted although it is not a surprising finding because Young’s Internet Addiction Questionnaire (which you can read online here) asks lots of questions about emotional distress, so it’s hardly surprising that people who say they’re distressed on one questionnaire will say they’re distressed on the other.

I have criticised the concept of internet addiction on the basis that the whole concept doesn’t make sense, but research has also shown that these ‘diagnostic’ questionnaires are not particularly reliable, meaning they not a good guide even to what they claim they’re doing.

But perhaps the most important point, is that this study is just one in a long line of studies that have looked at whether internet use is linked to changes in mood.

Recently, a type of study called a meta-analysis was published that looked at all of these previous studies to see what the overall effect was – in essence, a mathematical aggregation of all the reported findings to get at the big picture.

This meta-analysis found that there was a statistically reliable link between internet use and depression, but one so small as to be insignificant. In fact, it found that internet was responsible for between 0.02% and 0.03% of total changes in mood (stats geeks: the variance was not reported directly but I calculated it from the r by the coefficient of determination).

In other words, internet use explains so little of a person’s depression that it’s irrelevant. It’s like knowing that hypothermia is a serious medical condition and that drinking a glass of water reliably lowers body temperature, but by such a small amount as to be medically unimportant.

Interestingly, I am quoted in some of the news stories about the study. Actually, I was contacted by a BBC journalist and some other stories have seemingly just nicked the quotes (often wrongly describing me as a psychiatrist).

What’s curious is that I sent the BBC journalist a link to the meta-analysis, even explained what it found and what a meta-analysis is, and included comments about why the study doesn’t change the general conclusion.

Instead of focusing on the existing evidence, I am quoted as being a naysayer. I have not been misquoted but the most important scientific point is omitted at the expense of presenting my words. This seems to be a common pattern where news stories often privilege opinion over data, when science privileges data over opinion.

In fact, the motto of the Royal Society, the world’s oldest scientific society, translates as “on the words on no-one”, but news stories often turn the hierarchy of evidence on its head, giving a skewed impression of the most fundamental way in which science works.

In this case, to suggest that science has established that internet use is strongly linked to depression when we know that it isn’t.

Link to PubMed entry for latest study.
Link to PubMed entry for meta-analysis.

Blue Brain Year One

Film-maker Noah Hutton has just released an excellent 15-minute documentary on the Blue Brain project that captures the team as they work and explains the goals of the ambitious attempt to simulate animal, and eventually, human scale neural networks on computer.

It’s an interesting look both inside the scientific mission and inside the mind of project leader Henry Markram, whom it must be said, is largely talking about the potential of the project rather than what it can do now.

It’s probably worth saying that Markram is not known for underselling his efforts, and some of his projections seem a little unrealistic.

At one point he mentions that the project could be used in hospital so doctors can simulate the effects of drugs on a digital brain to see if they’ll work before giving patients the real thing. Best of luck with that chaps.

It’s a great short piece, however, and apparently there are more to come in the future.

Link to Blue Brain: Year One.

Fight club debate on computers and kids’ brains

On Thursday, I shall be taking part in a live debate hosted by The Times Online entitled ‘Is screen culture damaging our children’s brains?’ where I will be debating psychologist Tracey Alloway who recently made headlines by suggesting Facebook ‘enhances intelligence’ but Twitter ‘diminishes it’.

It one of those online chat things but you are welcome to sign up and take part. It happens at 1pm UK time which turns out to be far-too-early-o’clock Colombian time so I may be in my dressing gown. Don’t let that put you off.

An article on the same topic will also be coming out on Thursday which should help set the scene and which I’ll link to when it appears.

Link to ‘Is screen culture damaging our children’s brains?’ debate.

Injecting heroin with a doctor

Slate has two articles on an innovative but controversial service in Vancouver, Canada, that provides injecting drug users with a place to safely inject drugs with clean equipment and medical staff on hand.

The project, ‘Insite’, is based on a ‘harm reduction‘ approach which is driven by the idea that users should be encouraged to take drugs in the safest way possible.

This is partly an admission that addiction treatment is not very successful on its own, but partly a public health measure in that injecting drug users have much higher rates of diseases such as HIV and hepatitis and are more likely to pass them on to other people.

It is also the case that one of the biggest dangers from injecting drugs is the actual practice of injecting, as unsanitary conditions, ad-hoc ‘cooking up’ and unpredictable street dope as become much more risky when the final product is injected into the bloodstream.

These services can be controversial in some places as they can be seen to be condoning drug use, although some countries are now going further and actually prescribing heroin to addicts.

One of the biggest impacts on society is not the fact that a tiny minority of people are damaging themselves with smack, but that they tend to commit crimes to feed their habit and support a violent criminal network of dealers.

Methadone is a heroin substitute that has been prescribed for years and we know that it can stabilise the lives of users and increase their chance of kicking the habit.

But it is often not what users want. It stops the withdrawals, as it’s another form of opioid drug, but it doesn’t feel the same and still has the danger of overdose. One common problem is known euphemistically in the medical literature ‘methadone diversion‘ where users sell their methadone to buy street drugs.

Several countries have trialled the prescription of heroin itself, with, it turns out, a great deal of success – including better health, a reduction in criminal activity and a higher chance of actually kicking the habit.

This may seem counter-intuitive, but one of the advantages of these projects is that the user is constantly in contact with health professionals who can provide addiction treatment.

The political and local opposition to harm reduction services is usually immense, however. Politicians want to be seen to be ‘tough on drugs’ and no-one, and I mean no-one, wants one of these clinics near where they live.

The Slate articles looks into the day-to-day running and talks to some of the clients of the Vancouver programme, and provides an insight into the challenges such services face. There’s also a gallery of photos that captures the project in action.

Link to Slate article ‘Welcome to Insite’.
Link to Slate article ‘Upstairs, Downstairs’.
Link to photos of the Insite project.