I am sitting in the comfort of a rustling train as it bumpingly floats its way through the winter-white Nova Scotia countryside,  heading back home after four days of work in a rural part of a neighbouring province.

I am reading yesterday’s Globe and Mail.  The lead editorial headlines: “Those who read well at 15 succeed”.  And, the story is about a Canadian study reported by the OECD that young people who can read well at age 15 tend to do well in life and that young people who can not, do not.  It also reports the truly amazing finding (here I am being fascitious) that those youth who study do better than those who do not!

What insights! What revelations! What a surprise!  Teenagers who read well and study hard do well?  This is news?

Well, the news here is that reading ability is a good proxy measure for many problems.  We have known for a long time that the inability to read at grade level in grade three is predicitive of poor educational, social and vocational outcomes.  Seems that is also the case at age 15.  Reading is a complex skill.  Reading difficulties can be the result of psychosocial adversity, mental disorder, learning disability, or combinations of many factors.  Whatever the reason, reading ability is a “marker” that can be used to identify young people who may need help in sorting out what the problem is and then they can be given  personal assistance in addressing the problem so that they can become successsful.

So why are we not doing this?  Why are we not assessing reading levels in grade three and at age 15 in every single school in this country and using that assessment to identify young people and develop personal interventions that can help them be as good as they can be?  Why are we wasting large amounts of money on building self-esteem and other similar programs when the issue is not self-esteem?  Why are so hesitant to put our money and our efforts into those areas that are likely to bring the best results, particulary for those who need it?

From what I have seen, one reason may be that it is difficult and costly to provide the assessment and intervention services that young people who are having difficulty need.  So it is easier and perhaps cheaper to provide programs for the many that do very little, than interventions for the minority that may do a lot.

There is also a highly discriminatory ideology at play – not manifest but latent.  We do not want to “label” those who need help so we do not identify them and we do not provide them with what they need for success.  You see, “labelling” would hurt their self-esteem and would thus be unfair.  Instead we shunt them aside in favour of “helping” everyone (including mostly those who do not need any extra help).  This of course is more “fair” to those who need help as it denies them what they really need and sets them solidly on the road to poor outcomes. “Oh well, at least they were not labeled and their self-esteem did not suffer as a result”.

Is this fair?   Is this the right thing to do?  Not in my book.

–Stan

FINALLY, the Lancet (one of the world’s top medical journals) has retracted their publication of one of the most misleading articles in the history of modern medical  science – the now totally discredited piece on the relationship between autism and the MMR vaccine http://www.cbc.ca/health/story/2010/02/02/autism-mmr-lancet-wakefield.htmlt.

What took them so long?  It seems that the Lancet editors where the last in the world to know that the article was basic bunkum.  And why did they even print it?

If you can find me another article that uses the same low level of scientific evidence and flawed thinking that the Lancet has published in the last decade as this one used I will buy you a chocolate cookie. (Only one cookie per customer, just in case).  I for one have no idea about what the answer to either of those questions is.  But the fallout has been substantial.  It seems that large numbers of children died because they were not vaccinated.  And to what end?  Because a researcher (who it seems was in the employ of lawyers making lots of money suing vaccine manufacturers) published such poor science and because a learned journal did the publishing?

So what is a possible lesson here?   Although there are many, one most certainly is that one swallow does not a summer make.  That is, scientific knowledge is not built on one study, but on many, conducted by different and independent investigators, using best methods and techniques and scrutinized by peer review.  Is there the possibility that some studies will show one thing and others will show another?  For sure. Science is nasty, brutish and long.  Remember the word attributed to Mark Twain: “be careful reading a medical text book.  You may die of misprint”.

–Stan

Recent reports from the BBC highlight the complexities of helping people with psychotic illnesses – specifically schizophrenia, live symptom free and positive lives. 

The first story “NHS ‘failed’ over cannibal killer” presents an all too common media response to the extremely rare and thus somehow newsworthy bizarre homicide involving a person suffering from a mental disorder and the problems encountered in better understanding and assisting such individuals from people working within the mental health system.  While better training and more careful assessment procedures are in and of themselves important, it is hard to see what such news stories accomplish – except to perpetuate the stigma against people living with a mental illness and those who treat them.

The other story “Embracing the dark voices within” describes the approach (one that is unencumbered by evidence) of a person described as psychologist Rufus May.  What I can glean from this story is that the so called treatment involves getting in touch with your psychosis (voices) in the absence of medication.  Oh dear – here we go again.  This is nothing new and we have seen the chaos and destruction of lives and families that such idiotic ideologies have created in the past.  Those of us old enough to remember the psychoanalytic schools of living through the psychosis or the negative impacts of community circles or the strange world views expressed by the popular “philosopher” R.D. Laing in his books: Bird of Paradise and Politics of Experience or the sad “treatment” described in the novel “I Never Promised You A Rose Garden” shudder when we see history repeating itself.

Schizophrenia is a highly complex and disabling brain disorder often striking in the teen years.  We have good evidence on how to provide treatment – evidence based on solid science and many years of improvements and the integration of biological, psychological, social, vocational and civic engagement strategies to promote recovery.  Regressing into the darkness of the uninformed past is not news – just as the rare and bizarre homicide is not news.  Neither serves the better understanding of mental illness and its optimal treatment. 

I would really like to see some stories about how young people have coped with and overcome their disability.  I would really like to see some stories about how families have struggled with the adversities wrought by the illness – and have come out on top.  I would really like to see some stories about the human relationship between care providers and those living with the illness – the relationships that have gone on for years and have provided the basis for recovery and success.  Now, who can we find to write those stories for the BBC?

-Stan