Autism’s False Prophets

Salon has a good discussion of a new book on the culture and pseudoscience of vaccination scares by a paediatrician who received death threats after his public debunking of the overblown dangers.

The book is Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure and the paediatrician is Paul Offit, who examine both the claims and culture of the anti-vaccination lobby who are currently obsessed with autism.

This hasn’t always been the case though. As Ben Goldacre has noted, the US lobby seems to be concerned with thimerosal while the UK lobby believe the same thing about MMR, whereas previous unsupported scares have focused on hepatitis B jabs and multiple sclerosis.

In fact, as a BBC Radio 4 programme documented, a vaccination scare happened as the first ever vaccine for small pox appeared.

It’s a timely article, note least because yet another study has recently been published showing MMR vaccination was unrelated to autism. This is one of many many others, and an excellent article by Respectful Insolence rounds up the past evidence but also notes this latest study is particularly poignant as the first author is someone who has previously supported the scare.

Link to Salon article.
Link to more info on book Autism’s False Prophets.
Link to Respectful Insolence summary article.

A history of the history of madness

Madness and Civilization was a hugely influential book by the French post-modernist philosopher Michel Foucault and is often cited as a key ‘anti-psychiatry’ text owing to its claim that the modern concept of madness was an Enlightenment idea developed to allow the confinement of people that others in society found unacceptable.

What I wasn’t aware of is that Madness and Civilization is actually a cut-down translation of the original French text where most of the references to source material remained untranslated.

A full translation, renamed with its correct title History of Madness, was released last year and was given a damning review in The Times by medical historian Andrew Scull who derided Foucault’s “isolation from the world of facts and scholarship”.

Actually, Foucault’s major claim that 17th Europe undertook the “great confinement” of the mad through the building of asylums has been debunked before. The much-missed medical historian Roy Porter pointed out that France was the only country in Europe to centralise its administration of services for the ‘pauper madman’ while other countries didn’t typically have any legislation in place until the 19th century.

I was also interested in Scull’s debunking of the myth that visitors could pay to view the patients of London’s ‘Bedlam‘ Hospital:

Foucault alleges, for example, that the 1815–16 House of Commons inquiry into the state of England’s madhouses revealed that Bedlam (Bethlem) placed its inmates on public display every Sunday, and charged a penny a time for the privilege of viewing them to some 96,000 sightseers a year. In reality, the reports of the inquiry contain no such claims. This is not surprising: public visitation (which had not been confined to Sundays in any event) had been banned by Bethlem Royal Hospital’s governors in 1770, and even before then the tales of a fixed admission fee turn out to be apocryphal.

I looked this up in Russell’s Scenes From Bedlam (ISBN 1873853394) that confirms the ban on visitation in 1770, but does make reference to paying visitors, although it gives the impression that the arrangement was much more ad-hoc than is commonly assumed and casts doubt on the huge figures Foucault quotes.

Unfortunately, it doesn’t reference any historical documents on the matter, and neither does any other book I have, so I’ll have to do further investigation.

However, this is just one point among many where Scull notes that with the benefit of the fully translated version, we can see that Foucault’s research is just not up to scratch and doesn’t support his major historical claims.

But it’s probably worth saying that Foucault’s other major idea, that madness is not a fixed entity but is defined as much socially and politically as in medical terms is still as valid today. Particularly in an era where we are increasingly medicalising what we previously considered unfortunate but non-medical problems and stresses.

Link to Times article ‘The fictions of Foucault’s scholarship’.

On the sweltering summers of the soul

September’s New York Review of Books has an extended piece by Oliver Sacks where he reviews Hurry Down Sunshine, a memoir of a parent’s experience of seeing their daughter spiral into mania and psychosis.

In typical Sacks style it is more than just a book review, as it takes us through the history of manic-depression and discusses its the various literary treatments over the years.

I always thought manic-depression was a much better name for what is now diagnosed as bipolar disorder, precisely for the reason Sacks states in his review – that ‘bipolar’ suggests a kind of emotional see-saw, where you’re either up or down, where in reality, mixed emotional states occur in a significant minority of people with mood disorders.

Only one thing about the article made me roll my eyes (OK, two if you count the minor quibble that psychologist Kay Redfield Jamison is misdescribed as a psychiatrist).

Sacks says that “Mania is a biological condition that feels like a psychological one” and suggests it is due to “chemical imbalance in the brain”.

Of course, mania is both a biological and psychological condition (as we think with our brains, how could it not be?) and the references to a ‘chemical imbalance’ is a misleading oversimplification.

Otherwise, it’s as clear and engaging a piece as you’d expect from one of our best writers on the mind, brain and human condition.

Link to Sacks’ NYRB review ‘A Summer of Madness’ (via MeFi).
Link to more information on Hurry Down Sunshine.

It’s all gone scare shaped

The Guardian is currently running a series of extracts from Ben Goldacre’s new book, Bad Science. The first two are witty, acerbic and address how implausible vaccine scare stories get picked up by a scandal hungry media, and how pharmaceutical companies attempt to persuade us that every discomfort is a medical disorder.

Actually, I’m still waiting for the copy I’ve ordered to arrive so haven’t seen the whole thing yet, but if you’re a fan of the Bad Science column then the extracts suggest that the book will be just as insightful.

Times have changed. The pharmaceutical industry is in trouble: the golden age of medicine has creaked to a halt, the low-hanging fruit of medical research has all been harvested, and the industry is rapidly running out of new drugs. Fifty “novel molecular entities” a year were registered in the 1990s, but now it’s down to 20, and many of those are just copies of other companies’ products, changed only enough to justify a new patent. So the story of “disease mongering” goes like this: because they cannot find new treatments for the diseases we already have, the pill companies have instead had to invent new diseases for the treatments they already have.

Recent favourites include social anxiety disorder (a new use for SSRI antidepressant drugs), female sexual dysfunction (a new use for Viagra in women), the widening diagnostic boundaries of “restless leg syndrome”, and of course “night eating syndrome” (another attempt to sell SSRI medication, bordering on self-parody) to name just a few: all problems, in a very real sense, but perhaps not necessarily the stuff of pills, and perhaps not all best viewed in reductionist biomedical terms. In fact, you might consider that reframing intelligence, loss of libido, shyness and tiredness as medical pill problems is a crass, exploitative, and frankly disempowering act.

Night eating syndrome? No wonder those Goths look so pale.

Link to ‘The media‚Äôs MMR hoax’.
Link to ‘The Medicalisation of Everyday Life’.
Link to book details.

Book review: Sight Unseen

sightunseen.jpg

I cannot recommend strongly enough Goodale & Milner’s book on vision ‘Sight Unseen’. The title refers to the idea they pursue throughout the book that our everyday conception of vision is thoroughly misleading. Rather than vision just being ‘what we experience’, it is, in fact, a collection of specific eye-behaviour links (‘visuomotor functions’) of which our conscious perception of the world is only an evolutionary-recent addition. Goodale & Milner have spent their careers investigating this area and base their narrative around a selection of seminal experiments and case-studies of patients with selective brain injuries. Almost no background knowledge is assumed yet the book takes the reader into the intricacies of the psychology of vision. The triumph of the book is that it gives a flavour of how research proceeds while also managing to provide an intuition-shaking overview of the whole topic. I will never think about seeing in the same way again. This is a rare book which is accessible but will also be of interest to those working in the field. If you have any interest in how a research field develops or in the psychology of vision then you should read it.

Goodale, M. & Milner, D. (2004). Sight Unseen: An Exploration of Conscious and Unconscious Vision. Oxford: Oxford University Press

(Full disclosure: I did not get asked to do this review, nor did I receive payment or a free book. I did it because I liked the book. I am actively engaged in research in this area)