Showing posts with label Wall Street Journal. Show all posts
Showing posts with label Wall Street Journal. Show all posts

Tuesday, February 28, 2023

The Many Excuses for Ignoring Science – Where Did SARS-CoV-2 Originate?

 


The COVID origins story started off with a bang last weekend.  Woody Harrelson gave the monologue on Saturday Night Live comparing pharmaceutical companies to drug cartels and COVID vaccinations to illicit drugs. He was conveniently able to ignore the fact that these vaccinations have saved an estimated 20 million lives and could have saved more if vaccination goals were met. By way of contrast there are about 30,000 drug related homicides in Mexico every year, several thousand per year in the US, and tens of thousands dead from overdosing on illicit drugs. A stark contrast to the way this monologue was presented. There was plenty of commentary on the monologue – mostly focused on Harrelson’s antivaxx stance in the past including a post that he had to remove at one point. Elon Musk enthusiastically supported the monologue – but didn’t say if it was for the comedic or scientific genius. Harvey Levin praised producer Lorne Michaels for not censoring Harrelson, but didn't comment on editing for comedic content. Nobody recited the simple facts listed above.

The monologue was followed Sunday by a more detailed story without much more scientific credibility in the Wall Street Journal (1).  The authors of that story discuss a 5-page report by the Department of Energy stating the opinion that a lab leak was the likely cause of the pandemic but that theory was given a ‘low confidence’ rating.  They describe the DOE as having many relevant scientists.  Other than controversial headings and fueling partisan debate – what good is a low confidence theory?  The FBI has the same theory with “moderate confidence.” They explain that the US has an 18 agency intelligence community implying that there is adequate expertise there for these low to moderate confidence lab-leak theories. Is this the same intelligence community that was confident that there were weapons of mass destruction in Iraq and who seemed vaguely aware of Chinese balloons invading US air space?  They might have better things to do than speculate about pandemic virus origins and rate those speculations.  Protecting US infrastructure against cyberattacks and criminal activity would seem to be at the top of that list.

I would like to see that 5 page report at this point – to see if there is any reference to a recent consensus statement from the virology community on the origins of SARS-CoV-2 (2).  The full text of that report is available online.  If you read that report a few points jump out at you.  First – these are the professionals with the most expertise in viral genetics and evolution. It is their full-time job and they do active research in the area.  Second – beyond claiming expertise virologists have been very successful at reducing the disease burden through their efforts.  They get results. Third – while emphasizing neutrality they point out that the zoonosis hypothesis (wild origin) has the most supporting data and that there is “no compelling data” to support either a lab leak or intentional contamination hypothesis. Fourth they point out that “gain-of-function” is an inexact term but within the field it also means modification for therapeutic purposes.  The term has been used by some politicians to suggest “nefarious” activity. Fifth – they review the extensive oversight of their research.  They conclude that millions of people are alive today because of their research and that there is adequate oversight. All of that clearly stated before the start of Congressional hearings on these issues.

 There is pre-existing research on viral origins from other groups and wild origin is the most likely scenario (3, 11, 12).

In an interesting twist of events the celebrity gossip show TMZ (10:34 to 18 minute mark) ran with the story.  They started out with the Harrelson monologue followed by Harvey Levin’s characterization that the lab leak theory “blossomed” with the Wall Street journal article.  To their credit they brought on Michael Worobey an evolutionary virologist with a previous description of the wild origins of SARS-CoV-2 in Science (4).  Dr. Worobey pointed out that he wrote a letter in 2021 that the ‘lab leak’ hypothesis had to be taken seriously, but since then then there has been “really strong scientific evidence” of a wild origin of the virus and no real scientific evidence of a lab leak.  Just from a probability standpoint he pointed out that all of the cases were in the area of the Wuhan market, there were animals present that carried coronaviruses, and there is really no other explanation for that degree of localization in a city of 12 million people. He also pointed out the severe social media backlash that he received as a result of following the evidence but encouraged a systematic approach to the research.  He suggested taking the DOE report with a “grain of salt”.

A final comment on the DOE report was made on the public radio show All Things Considered.  Michael Osterholm from CIDRAP was interviewed (5).  He describes himself as being agnostic towards the lab leak versus zoonoses but clearly sees the preponderance of data supporting the wild origin.  He goes on to suggest that people want certainty when a high degree of certainty is not possible and that has led to definitive headlines (about lab leak for example) when hard evidence is lacking. He adds the following characterization and challenges the DOE to present their data:

“…. again, there is a very different type of theater being played out here. It's not one that's based on science.”

He also describes a very plausible scenario of a new virus occurring in the Caribbean and how that could be spun into a ‘lab leak’ from the CDC in Atlanta.

Expect a lot of political demagoguery on the issue with Congressional hearings in the months to follow. Unless there is any data as good as the references I have posted - keep an open mind.  In a postmodern world – people with no or vague expertise make unfounded claims about scientific evidence.  The strongest evidence by far is with the experts and scientists listed in this essay. And that is a wild origin of the virus – just like previous coronaviruses. Anyone suggesting otherwise needs to show up with some data and not excuse making or political theater.

 

George Dawson, MD, DFAPA

 

References:

1:  Gordon MR, Strobel WP. DOE Says Lab Leak Is Likely Origin of Covid-19 ---New intelligence about China outbreak spurs assessment; finding is given 'low confidence'.  Wall Street Journal.  Wall Street Journal.  February 27, 2023.

2:  Goodrum F, Lowen AC, Lakdawala S, Alwine J, Casadevall A, Imperiale MJ, Atwood W, Avgousti D, Baines J, Banfield B, Banks L, Bhaduri-McIntosh S, Bhattacharya D, Blanco-Melo D, Bloom D, Boon A, Boulant S, Brandt C, Broadbent A, Brooke C, Cameron C, Campos S, Caposio P, Chan G, Cliffe A, Coffin J, Collins K, Damania B, Daugherty M, Debbink K, DeCaprio J, Dermody T, Dikeakos J, DiMaio D, Dinglasan R, Duprex WP, Dutch R, Elde N, Emerman M, Enquist L, Fane B, Fernandez-Sesma A, Flenniken M, Frappier L, Frieman M, Frueh K, Gack M, Gaglia M, Gallagher T, Galloway D, García-Sastre A, Geballe A, Glaunsinger B, Goff S, Greninger A, Hancock M, Harris E, Heaton N, Heise M, Heldwein E, Hogue B, Horner S, Hutchinson E, Hyser J, Jackson W, Kalejta R, Kamil J, Karst S, Kirchhoff F, Knipe D, Kowalik T, Lagunoff M, Laimins L, Langlois R, Lauring A, Lee B, Leib D, Liu SL, Longnecker R, Lopez C, Luftig M, Lund J, Manicassamy B, McFadden G, McIntosh M, Mehle A, Miller WA, Mohr I, Moody C, Moorman N, Moscona A, Mounce B, Munger J, Münger K, Murphy E, Naghavi M, Nelson J, Neufeldt C, Nikolich J, O'Connor C, Ono A, Orenstein W, Ornelles D, Ou JH, Parker J, Parrish C, Pekosz A, Pellett P, Pfeiffer J, Plemper R, Polyak S, Purdy J, Pyeon D, Quinones-Mateu M, Renne R, Rice C, Schoggins J, Roller R, Russell C, Sandri-Goldin R, Sapp M, Schang L, Schmid S, Schultz-Cherry S, Semler B, Shenk T, Silvestri G, Simon V, Smith G, Smith J, Spindler K, Stanifer M, Subbarao K, Sundquist W, Suthar M, Sutton T, Tai A, Tarakanova V, tenOever B, Tibbetts S, Tompkins S, Toth Z, van Doorslaer K, Vignuzzi M, Wallace N, Walsh D, Weekes M, Weinberg J, Weitzman M, Weller S, Whelan S, White E, Williams B, Wobus C, Wong S, Yurochko A. Virology under the Microscope-a Call for Rational Discourse. mSphere. 2023 Jan 26:e0003423. doi: 10.1128/msphere.00034-23. Epub ahead of print. PMID: 36700653.

3:  Garry RF. The evidence remains clear: SARS-CoV-2 emerged via the wildlife trade. Proc Natl Acad Sci U S A. 2022 Nov 22;119(47):e2214427119. doi: 10.1073/pnas.2214427119. Epub 2022 Nov 10. PMID: 36355862; PMCID: PMC9704731.

4:  Worobey M. Dissecting the early COVID-19 cases in Wuhan. Science. 2021 Dec 3;374(6572):1202-1204. doi: 10.1126/science.abm4454. Epub 2021 Nov 18. PMID: 34793199. (see also the map of SARS-CoV-2 origins)

5:  Contreras G, Brown A, Shapiro A, How an infectious disease expert interprets conflicting reports on COVID-19's origins.  All Things Considered.  February 27, 2023.

https://www.npr.org/2023/02/27/1159821909/how-an-infectious-disease-expert-assessed-how-covid-19-started

6:  Worobey M, Levy JI, Malpica Serrano L, Crits-Christoph A, Pekar JE, Goldstein SA, Rasmussen AL, Kraemer MUG, Newman C, Koopmans MPG, Suchard MA, Wertheim JO, Lemey P, Robertson DL, Garry RF, Holmes EC, Rambaut A, Andersen KG. The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic. Science. 2022 Aug 26;377(6609):951-959. doi: 10.1126/science.abp8715. Epub 2022 Jul 26. PMID: 35881010; PMCID: PMC9348750.

7:  Pekar JE, Magee A, Parker E, Moshiri N, Izhikevich K, Havens JL, Gangavarapu K, Malpica Serrano LM, Crits-Christoph A, Matteson NL, Zeller M, Levy JI, Wang JC, Hughes S, Lee J, Park H, Park MS, Ching Zi Yan K, Lin RTP, Mat Isa MN, Noor YM, Vasylyeva TI, Garry RF, Holmes EC, Rambaut A, Suchard MA, Andersen KG, Worobey M, Wertheim JO. The molecular epidemiology of multiple zoonotic origins of SARS-CoV-2. Science. 2022 Aug 26;377(6609):960-966. doi: 10.1126/science.abp8337. Epub 2022 Jul 26. PMID: 35881005; PMCID: PMC9348752.

8:  Bloom JD, Chan YA, Baric RS, Bjorkman PJ, Cobey S, Deverman BE, Fisman DN, Gupta R, Iwasaki A, Lipsitch M, Medzhitov R, Neher RA, Nielsen R, Patterson N, Stearns T, van Nimwegen E, Worobey M, Relman DA. Investigate the origins of COVID-19. Science. 2021 May 14;372(6543):694. doi: 10.1126/science.abj0016. PMID: 33986172; PMCID: PMC9520851.

This is an important reference form May of 2021 signed by Dr. Worobey suggesting that a more thorough investigation of the origins of the SARS-CoV-2 virus needs to be done.  Per the above assay and several references - he has concluded that the virus originated in the wild rather than lab leak since this letter. I think this letter also addresses the censorship comments.  Clearly the suggestion by this group that the lab leak had to be reinvestigated illustrates there was no censorship on the science side. 

9:  Chait J.  The Surprisingly Contrarian Case Against Lying About Science.  The Intelligencer.  February 28, 2023  https://nymag.com/intelligencer/2023/02/lab-leak-hypothesis-lying-about-science-is-bad-for-liberals.html 

10: Garry RF. SARS-CoV-2 furin cleavage site was not engineered. Proc Natl Acad Sci U S A. 2022 Oct 4;119(40):e2211107119. doi: 10.1073/pnas.2211107119. Epub 2022 Sep 29. PMID: 36173950; PMCID: PMC9546612. 

11:  Pekar JE, Magee A, Parker E, Moshiri N, Izhikevich K, Havens JL, Gangavarapu K, Malpica Serrano LM, Crits-Christoph A, Matteson NL, Zeller M, Levy JI, Wang JC, Hughes S, Lee J, Park H, Park MS, Ching Zi Yan K, Lin RTP, Mat Isa MN, Noor YM, Vasylyeva TI, Garry RF, Holmes EC, Rambaut A, Suchard MA, Andersen KG, Worobey M, Wertheim JO. The molecular epidemiology of multiple zoonotic origins of SARS-CoV-2. Science. 2022 Aug 26;377(6609):960-966. doi: 10.1126/science.abp8337. Epub 2022 Jul 26. PMID: 35881005; PMCID: PMC9348752.

12:  Worobey M, Levy JI, Malpica Serrano L, Crits-Christoph A, Pekar JE, Goldstein SA, Rasmussen AL, Kraemer MUG, Newman C, Koopmans MPG, Suchard MA, Wertheim JO, Lemey P, Robertson DL, Garry RF, Holmes EC, Rambaut A, Andersen KG. The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic. Science. 2022 Aug 26;377(6609):951-959. doi: 10.1126/science.abp8715. Epub 2022 Jul 26. PMID: 35881010; PMCID: PMC9348750.

13:  Wu Y, Zhao S. Furin cleavage sites naturally occur in coronaviruses. Stem Cell Res. 2020 Dec 9;50:102115. doi: 10.1016/j.scr.2020.102115. Epub ahead of print. PMID: 33340798; PMCID: PMC7836551.

14:  Xiao, X., Newman, C., Buesching, C.D. et al. Animal sales from Wuhan wet markets immediately prior to the COVID-19 pandemic. Sci Rep 11, 11898 (2021). https://doi.org/10.1038/s41598-021-91470-2

15:  Lenharo M, Wolf L. US COVID origins hearing renews debate over lab-leak hypothesis. Nature. 2023 Mar 9. doi: 10.1038/d41586-023-00701-1. Epub ahead of print. PMID: 36890328.

"Michael Worobey, an evolutionary biologist at the University of Arizona, Tucson, who has studied genetic evidence from the early days of the pandemic, told Nature that he found the proceedings “shockingly unscientific” and that they do not bode well for the overall investigation. “Not one of those witnesses had any scientific record of investigating and publishing peer-reviewed research on the origins of this virus in quality journals,” he said."

16:  Cohen J.  Science takes a backset to politics in first House hearing on origin of COVID-19 pandemic.  Science.  March 8, 2023.  doi: 10.1126/science.adh5155

Very useful essay that points out little science is occurring and the intelligence is very sketchy.

17:  Rutledge PE. Trump, COVID-19, and the War on Expertise. The American Review of Public Administration. 2020 Aug;50(6-7):505-11.

This is a good reference to keep in mind because it points out that President Trump and his administration actively promoted the lab leak theory of the pandemic dating back as far as May 2020.  All of the pundits decrying censorship of the lab leak hypothesis should ask themselves how censorship is possible when the theory is being actively promoted by the Executive Branch. 

18:  Maxmen A. Wuhan market was epicentre of pandemic's start, studies suggest. Nature. 2022 Mar;603(7899):15-16. doi: 10.1038/d41586-022-00584-8. PMID: 35228730.

This study links to three preprints describing the origin of the virus in the wild with spillover to humans.  As far as I can tell these preprints became the 2 papers listed below as well as reference 12 above:

19:  Pekar JE, Magee A, Parker E, Moshiri N, Izhikevich K, Havens JL, Gangavarapu K, Malpica Serrano LM, Crits-Christoph A, Matteson NL, Zeller M, Levy JI, Wang JC, Hughes S, Lee J, Park H, Park MS, Ching Zi Yan K, Lin RTP, Mat Isa MN, Noor YM, Vasylyeva TI, Garry RF, Holmes EC, Rambaut A, Suchard MA, Andersen KG, Worobey M, Wertheim JO. The molecular epidemiology of multiple zoonotic origins of SARS-CoV-2. Science. 2022 Aug 26;377(6609):960-966. doi: 10.1126/science.abp8337. Epub 2022 Jul 26. PMID: 35881005; PMCID: PMC9348752.

20:  Mueller B.  W.H.O. Accuses China of Withholding Data on Pandemic’s Origins.  New York Times March 17, 2023.

21:  Cohen J. Anywhere but here. Science. 2022 Aug 19;377(6608):805-809. doi: 10.1126/science.ade4235. Epub 2022 Aug 18. PMID: 35981032.

22:  Cohen J.  Chinese researchers release genomic data that could help clarify origin of COVID-19 pandemic.  Science 2023 March 29; doi:10.1126/science.adi0330.


Supplementary 1:

The director of the FBI came out in the media today (02/28/2023) and reiterated that the FBI has concluded the virus most likely originated as a lab leak but provided no additional data. As far as I know at this point the FBI and DOE data has not been released to the public.

Supplementary 2:

How is science ignored?  I realize after reading the post it contains historical information but nothing explicit about how science is ignored.  Here is the short list:

1:  Science is a process of serial approximations to reality or more to the point - an empirically acceptable model of reality.  Politics, journalism, and entertainment clearly are not. As a result the scientifically informed realize this is often series of hypothetical steps and missteps until a widely agreed upon model is accepted in the scientific community.  That contrasts sharply with a long series of provocative headlines and opinion pieces.  

2:  Science deals with probability statements - politics, journalism, and entertainment exists largely on the plane of dichotomous thinking.

3:  The probabilities on the probability statements can be adjusted in either direction.  As is the case in the Dr. Worobey references above - his probability of a "lab leak or nefarious activity" hypothesis was adjusted drastically downward over time as the probability of a wild origin was adjusted upward to the point where it became most likely.  This adjustment of probabilities is often seen as a "mistake" or "lie" by the nonscientific community. Within the scientific community it can be difficult to change your mind.  Neither of those considerations invalidates the process. 

4:  There are still scientific standards that acknowledge expertise and peer review. Although peer review is criticized by authors it has resulted in conventions that probably limit grand pronouncements like a newspaper headline.  The evidence should be in the 'limitations' section of any scientific paper.  In the postmodern world expertise is seen as relative by those in many nonscientific endeavors - to the point that anyone who can Google is considered an expert. This is also the predominate social media method of operation. 

5:  The legal/political model of ascertaining the truth or reality is highly flawed - and the evidence is obvious in studies of racial profiling, unjustified violent encounters with law enforcement, wrongful convictions, unequal treatment based on economic considerations, fallible eyewitness testimony, and highly flawed interrogations. Focusing only on coronavirus - the interrogations of Dr. Fauci by Sen. Paul is an additional example. And yet - this is the process that is going to be used by the government to decide on the origins of the virus.  Unless the DOE or the FBI have concrete scientific proof - it will be an exercise in rhetoric.

6:  If not science what? Typical analyses presented in the media can occur at several levels that cut science out of the mix. Anytime you hear an analysis by a group of journalists, politicians, regulators, administrators or consultants who lack the requisite expertise to analyze the problem take a close look at that final product. Ask yourself if there is anyone with scientific expertise who should have looked at it.  Be very skeptical of analyses that are not disclosed because they are proprietary or classified.


Supplementary 3 (Updates):

Update 03/02/2023:  As expected the COVID origins appearance of controversy was still whipping up the media today.  TMZ continued with their fractured analysis – continuing to focus on the FBI and DOE reports as a game changer and not mentioning at all what the evolutionary virologist Michael Worobey told them yesterday.  They played a brief John Stewart tape and suggest that he was now “vindicated” for suggesting early in the pandemic that this was probably a lab leak. Harvey Levin pointed out that Stewart was not crowing about being correct in the brief clip that they played and how could he? How can a guy who knows nothing about epidemiology or pandemic viruses and has no information about what transpired in Wuhan suggest there was a lab leak?  The excerpt that I saw had Stewart talking about the need to have both sides represented.  TMZ did touch on the most important aspect of this debate and that was rhetoric and how President Trump’s racist polarizing rhetoric led to conflation of the viral origin hypothesis with racism and that created significant backlash from the left. But we are still dealing with a non-scientific argument and ignoring Dr. Worobey. Harvey Levin seems stuck on these events as primarily a free speech issue.  To me that is obviously not a problem given the degree of bullshit and demagoguery that occurred around this issue.  There was probably no more “free speech” exercised at any other time in the history of the country. Watching TMZ the last two days just illustrates that they can avoid science as rigorously as anyone else – even after talking to a top scientist in the field. As some level the free speech argument just becomes a rationalization.

New York Times political columnist Jonathan Chait wrote a piece in the Intelligencer entitled “The Surprisingly Contrarian Case Against Lying About Science”.  He claims the DOE analysis has weight because there is a division there that is supposed to assess bioweapons threats. To me that just deepens the nonscience of it all. From a rhetorical standpoint we have gone from an appeal to emotion to an appeal to authority.  He goes on to analyze the rhetoric starting with the need to shift blame away from the Trump administration and their “mishandling of the epidemic.”  He is the first journalist I have seen who writes about how China unleashing the virus on their own people (one suggestion) is absurd.  I would add even considering the coronavirus as a bioweapon is equally absurd. In his analysis of Peter Hotez Tweets he gets it wrong.  Dr. Hotez characterizes the antiscience aggression of certain elements of the media and Congress as: “The best defense is a good offense”.  Chait’s response is:

 “I’m neither a professor, a doctor, nor a Ph.D., but I know enough to state confidently that the ethos of the scientific method is not “the best defense is a good offense.”

What about the ethos of journalism and politics? I am confident that is what Hotez is referring to.  He ultimately makes the argument that the left is not skilled enough to parse the anti-science rhetoric of the right and as a result lump legitimate scientific discussion with anti-science crankery and this is not a good thing. He concludes that ideology cannot be used to settle scientific debate. Some good points and some bad points. I will add it is pretty obvious to anyone who knows a thing about science that real scientific debates cannot be settled in the media and every scientist I know has had bad experiences with the media because they are trying to tell the story they want to tell.  My classic example was television interviews that I was asked to give around the Christmas holiday when I was a young psychiatrist. I knew the reporter was trying to sell the story that there were more suicides at Christmas and no matter what I said there would be that suggestion. I finally just told them – no more interviews. After all – in this case what is the more provocative headline ‘COVID is a bioweapon leaked or intentionally released’ or ‘COVID is a coronavirus that jumped from animal populations to humans like all human coronaviruses before it – including the 4 normally circulating coronaviruses that are considered common cold viruses.”  Rhetoric is a very strong component here and if the press wanted to really be useful, they might point out that on a timeline basis.  The arguments are largely rhetorical rather than scientific and factual.  All the press would have to say about the science is that it is not settled and digress a little into how scientific decisions are made. But I have never seen that happen.     

Update 03/03/2023:  The following document reviews some of the history of the controversy and points out that there really is no definitive proof of the viral origins at this point.  In the last few paragraphs the scientists who see zoonoses/spillover as the most plausible scenario are looking for falsifying data but have not found it.

Robertson L.  Still No Determination on COVID-19 Origin.  FactCheck.org 03/02/2023: https://www.factcheck.org/2023/03/scicheck-still-no-determination-on-covid-19-origin/

Update 03/06/2023:  TMZ was at it again today.  They put up a weekend poll on the origins of COVID and posted 2 possibilities -  wet market or lab leak.  The vote went like this:

wet market - 12%

lab leak - 88%

Harvey Levin's analysis was that this showed censoring the lab leak hypothesis at the outset was the problem.  This analysis is incorrect at two levels. First, there are endless headlines from 2021 where Republicans like Senator Rand Paul accused Dr. Fauci of lying about gain-of-function and labs leaks.  The demonized Dr. Fauci about this to the point that he started getting threats and needed protection for himself and his family. The same sequence of events happened to many public health officials who became objects of right wing scorn.  Secondly - I don't know what you expect when you are hyping unscientific proclamations about lab leak for the past week. Let's not pretend the media is a disinterested party here. TMZ chose the story about "censorship" when there was none and chose to suggest that was a better explanation for why two government agencies were suggesting a lab leak over the expert they interviewed last week. Just another clear example of the title of this post. 


Supplementary 4:

House Committee on Oversight - COVID origins:

Here is the web site - not the current references to Fox News and the New York Post - both obviously the farthest information from science:

https://oversight.house.gov/landing/covid-origins/


Graphics Credit:

Eduardo Colon, MD photo is much appreciated.

 

Thursday, May 19, 2022

Racism and gun violence both exist in an overtly gun extremist society: They cannot be explained away by mental illness.




I suppose I should have not been very shocked that a Wall Street Journal editorial this morning (1) chose to double down on both gun rights and the myth that racism is not a problem and had nothing to do with the recent mass shooting – while scapegoating both mental illness and the rationed system of mental health care that we have in this country.  For good measure he added another conservative agenda item - that there was also blame for the public health officials like Dr. Fauci for mismanaging the pandemic.  This post is to straighten all of that out.

Let me preface these remarks by saying that I have no information about the most recent mass shooting other than what is reported in the media.  The author of the editorial does not seem to either. What I do have is 22 years of experience in acute care psychiatry and involuntary care. That’s right – for 22 years I was one of the guys you would have to see if you were admitted to my hospital on a legal hold for behavior that involved threatening or harming other people or yourself.  That included all kinds of violence - homicide, suicide attempts and severe self injury, and violent confrontations/shoot outs with the police.  I had to evaluate the situation with the considerable assistance from my colleagues and decide if that person could be released or needed to be held for further assessment and treatment. People (including psychiatrists) like to summarize that situation by saying: “Nobody can predict future dangerousness” and that is certainly true. But we do pretty well in the short term (hours to days).  We also do well coming up with a plan to prevent future violence.

The details about the most recent mass shooting are still being reported at this time, but so far include interviews with the families of the victims, police reports, videos, and excerpts from a manifesto written by the perpetrator.  According to reports that manifesto discussed Replacement Theory as a potential motive for the mass shooting.  Replacement Theory is a white nationalist, far right ideology that claims non-whites are a threat to the white majority in several countries including the US. A corollary is that the Democrats are trying to get aligned with more non-white voters to develop more political power. This is the rationale currently given in the media for the actions of the mass shooter who scouted neighborhoods and said very explicitly in documents that his intent was to murder as many black people as possible. He had no difficulty obtaining firearms legally – even though he was detained and sent for an emergency evaluation a little less than a year earlier for stating “murder-suicide” in response to an online question about what he planned to do upon retirement.  Those details and his response talking about how he got out of it and continued to plan to kill people are at this link.  

As a psychiatrist and member of the American Psychiatric Association, I can’t speculate on the diagnosis of anyone who I have not personally assessed and if I did do an assessment – I would need a release from the person to discuss any details.  The editorialist is under no constraints speculating that “signals were missed” and that “psychotic young males whose outlet is killing” is not the object of his column.  Instead, he makes the claim that he is really concerned about the post pandemic mental illness and addiction trends in this country. He is apparently not consulting the correct sources about what has happened in this country in terms of mental health care before the pandemic.

I will start with his anchor point in the 1970s.  At about that time Len Stein, MD and coworkers invented Assertive Community Treatment and a number of additional innovative approaches that were focused on keeping people with severe mental illnesses in their own homes.  Dr. Stein was one of my mentors and in seminars he would show what Wisconsin state hospital wards used to look like. About a hundred patients in one large room with their cots edge-to-edge and all wearing hospital pajamas. By the time I was working with him in the 1980s, those folks were living independently supported by case management teams and psychiatrists. Dr. Stein and his colleagues also ran a community mental health center that included crisis intervention services and outreach. That model of community mental health and crisis intervention is still practiced and has been covered in the New England Journal of Medicine.  Psychiatric residents are still trained in community mental health settings and many prefer to practice there.  Counties are not as enthusiastic and have shut down many if not most community mental health centers.

Community psychiatry is an obvious 50-year-old solution but it has to be funded. The same is true of affordable housing.  In some cases that housing needs to be supervised and also a sober environment. Both community psychiatry and affordable housing are casualties of business rationing that can only occur with the full cooperation of both state and federal governments. The current system costs about a trillion dollars in overhead that is directed to Wall Street profits and unnecessary meddling by middle managers. The only people who “sweep mental health under the rug” are large healthcare organizations and state bureaucrats who disproportionately ration it.  The "science of mental health" is not difficult at all.  Being forced to do it for free is difficult.

The 1980s were a critical time in establishing the managed care industry and taking all healthcare out of the purview of physicians.  While rationing psychiatric resources was being ramped up, services to treat alcoholism and addiction were essentially demolished. Suddenly you could not longer get detoxification services at most hospitals.  People were sent to social detox units run by counties where there was no medical coverage.  The thinking was that if a person developed medical complications like seizures or delirium tremens they could always be sent back to the hospital. The biggest risk was continued substance use and immediate relapse. Residential and outpatient treatment facilities never materialized.  Inadequate funding was a significant problem.  The managed care industry played a role in that case as well with absurd expectations and limits on treatment.  It is no accident that treatment for substance use disorders basically became non-existent.  None of the disproportionate rationing of mental health or substance abuse treatment is new.  It has been like this for 30 years because it is the government endorsed model of care.  

Overall, this editorial is a smokescreen over the proximate issues of guns and racism.  The author trivializes this as political rhetoric when in fact the rhetoric has all been pro-guns and pro-white supremacy.  It is the only rational explanation for turning the United States into an armed camp that has progressively increased the likelihood of gun violence. We are not talking about a pandemic precipitated phenomenon.  The gun violence has been multi-year and the pro-gun party has “doubled down” on it to make it more likely.  As far as politics go – now that we know how a partisan Supreme Court works – the Heller decision and the resulting liberalization of gun ownership should not come as a surprise.  On the issue of hate crimes, I can’t really think of anything more relevant in a case based on the public disclosures.  This was a specific crime directed at black Americans intentionally perpetrated in a neighborhood that was scouted ahead of time for that ethnicity. Brushing that aside to claim that this is a response to an embarrassing record on mental illness, when there is no evidence that is a factor is disingenuous.

American history including other recent mass shootings tells us that racism can be a causative factor.  What is never addressed is the omnipresent gun culture in the USA.  People with an apparent need for military weapons and handguns and politicians willing to give them unlimited access to carrying them in public, carrying them without permits, and stand your ground laws - encouraging violent confrontations with firearms.  All fueled by one party and their affiliated special interests.

Disingenuous discourse and misinformation is what we typically see these days. If you want the facts about what needs to be there in terms of a functional mental health system (and I know there are absolutely no business people and very few politicians that do) – ask a psychiatrist. If you want to know about what gun control needs to be in effect rather than claiming that psychiatrists are not preventing gun violence from people with no mental illness – you can also ask me.

I could put all of those details on a 4” x 6” card and it would work. 

But there is certainly nobody on the right or at the WSJ who wants to know that either.

 

George Dawson, MD, DFAPA

 

References:

1:  Daniel Henninger. The Next Pandemic: Mental Illness.  Wall Street Journal. May 18, 2022.


Graphics Credit:  Eduardo Colon, MD