Leaked internal research shows Instagram knows how much it harms teens (and does nothing about it)

By | Addiction, Mental Illness, Teens | No Comments

We don’t let kids smoke, drink, gamble or take drugs, so why do we let them use Instagram?

At senate hearings last week, US Senator Edward J. Markey, said, “Facebook is just like Big Tobacco, pushing a product that they know is harmful to the health of young people, pushing it early, all so Facebook can make money … Instagram is that first childhood cigarette, aimed to get teens hooked early ”.  The Senator was talking about internal research conducted by Facebook on its subsidiary Instagram over the last three years.  The studies had been leaked by a whistle-blower and  former Facebook employee and they came to some stunning conclusions.

Some of the research concludes “We make body image issues worse for one in three teen girls,” and “Teens blame Instagram for increases in the rate of anxiety and depression. This reaction was unprompted and consistent across all groups.”  Other internal documents described children aged 10-12 as a valuable ‘untapped audience’ and even suggested they could appeal to younger children by ‘exploring playdates as a growth lever’.

Another leaked internal study of teens who struggle with their mental health, found that 35 percent of UK teenage girls felt Instagram made things worse and 13 percent of UK teenage girls felt their suicidal thoughts started on Instagram.   When the researchers asked teens how Instagram harmed their mental health they cited, “the pressure to conform to social stereotypes,” “pressure to match the money and body shapes of influencers” and “the need for validation – views , likes and followers.”

Other research not funded by Instagram has shown similar things for at least the last five years, but this is the first time it has been clear the company has known this. All the while it has made public statements to the contrary.  It smells a lot like Big Tobacco’s, public denials in the eighties while it sat on a mountain of internal evidence of harm.  It is no wonder the Senator drew the parallel.

Social media like Instagram destroys teen mental health because it is addictive. It is not accidentally addictive.  It is very much on purpose.  Or as Tristan Harris, a former in-house ethicist at Google puts it, “the largest supercomputers in the world are inside of two companies — Google and Facebook — and … we’re pointing them at people’s brains, at children.”

The purpose of all this computing power is to get more minutes of your attention.  Attention is gold. It can be sold for billions to an army of eager advertisers.  Every extra minute of a child’s attention mined by those super computers is money in the bank. To do it, the programmers use everything we know about how our reward system works.

We like to be liked by others, so we’re constantly scanning our peers for signs that we’re liked. We’ll actively seek out things we think will mean we’re liked more, and we’ll avoid things that might mean we’re liked less. We call this peer pressure, and it drives us to ensure our behaviour is consistent with that of the others in our group.

At the biochemical level peer pressure is driven by a hormone called oxytocin.  Oxytocin is our super reward for bonding with others. When we think people like us, oxytocin is released and it, in turn,  stimulates dopamine release, ensuring we desire the thing producing the oxytocin response.  Every time we gain a follower or something we post to social media collects a like, comment or view, we get a little bump in oxytocin.

In real life, we might receive a compliment or a smile every now and then, but there is no equivalent for receiving hundreds of ‘likes’ for everything we do or say.  Social media is a high speed simulator of stimulating social interaction and just like other high speed computer simulations like gambling, gaming and porn, it is intoxicating and powerfully addictive.

The reward pathway in women is significantly more sensitive to oxytocin than that in men. This means women are significantly more sensitive to social cues than men, and find social interaction more rewarding than men do. Because of the low GABA levels in adolescents, teenage girls have this sensitivity dialled up to ‘maximum’, making them desperate for the approval of others and extraordinarily vulnerable to technologies that exploit that need.

The brain adapts to addiction by temporarily rewiring into a dopamine adapted state. It makes addiction harder to break and simultaneously makes us anxious, depressed and prone to suicidal thoughts.  The teens in the Instagram research felt worse after using the app for the same reason a drug addict feels worse when they are not high.  Addiction is a powerful driver of anxiety and depression.  Addictive behaviour is stress relieving behaviour for the anxiety that addiction creates. It is a highly destructive vicious circle.

The latest leaked research makes it clear how sinister the social media giants are. They have known all of this, have done for a long time and don’t care. As Chamath Palihapitiya, Facebook’s former vice president for user growth, said in 2017, “the short-term, dopamine-driven feedback loops we’ve created are destroying how society works.”

We don’t let children buy cigarettes, alcohol or drugs. We don’t let them gamble and they are not legally allowed to access pornography. Hell, we even have confectionary-free checkouts in supermarkets.  We don’t want our kids to be exploited for profit by merchants of addiction. Big Social Media has demonstrated that it is more than happy to addict kids for profit regardless of the consequences.  It’s time we recognised there is very little to distinguish them from Big Tobacco. It’s time we revoked their right to operate. And its time they paid the price for the massive damage they are doing.

 

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Assaults have doubled to record levels since the start of the pandemic … and it’s just the start.

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Queensland experienced the largest number of assaults ever in August 2021 according to data published by the Queensland Police. Last month there were almost 4,000 assaults in the State. This is double the number which occurred in August 2019.  Similarly there were 37% more breaches of domestic violence orders in August 2021 when compared with August 2019. Blowouts like this do not happen in crime statistics. A bad year is a 10% increase. Something very, very odd is happening and the science says that COVID could be the culprit.

Studies in animals and humans tell us our mental stability is driven by dopamine signalling. Too many dopamine hits too often will lead to mental illness as certainly as night follows day. We are most familiar with this when the thing delivering the hit is a stimulant drug like cocaine or meth.  But we can also get those dopamine hits by experiencing stress.  Just as dopamine motivates us to chase rewards, it is also used to make us respond to danger.  Same system, same neurochemical, same result. We end up in an on-edge state either anticipating reward or danger.  Both pleasure and pain deliver the same dopamine surge.

The strength of that hit is significantly accelerated by uncertainty. Continuous exposure to addictive substances delivered on an uncertain schedule pushes us into a state of anxiety and depression.  And in exactly the same way, continuous exposure to uncertain danger does the same.  If our housing is not certain.  If our food is not certain.  If our job is not secure.  If we could catch a deadly disease just by going to the shops.  If we’re trying to work from home and home-school. If we don’t know if we will be in lock-down tomorrow, we are in a constant state of on-edge preparedness for danger.

Our brain turns uncertainty-boosted dopamine hits into a semi-permanent change to the brain biochemistry that helps us cope with our high-dopamine environment. Unfortunately, that coping mechanism comes at a cost – our mental health.

Dopamine-adapted brains are anxious. They overreact, are irritable, have low impulse control, have weak memory and make poor decisions without care for consequences.  If we allow that mental state to go on indefinitely, we place ourselves and others at mortal risk from self-harm, domestic violence, or suicide.  It is meant to be a temporary adjustment, not a permanent state.

One of the most studied areas of impulsivity is domestic violence. A long line of studies have established that about two-thirds of recorded instances of domestic violence are impulsive. We would therefore expect that anything likely to raise the level of impulsivity, such as stress or addiction, would also raise the level of domestic violence. The data makes it clear that the two are very closely related.

A major US study of over 23,000 demographically representative households found that women in more disadvantaged neighbourhoods were more than twice as likely to be a victim of domestic violence when compared to advantaged neighbourhoods. Digging a little deeper, the researchers found that the rate of violence jumps from 4.7 per cent when the male is always employed to 7.5 per cent when he experiences one period of unemployment. If a man from a disadvantaged neighbourhood has continuous unstable employment, the rate jumps to 15.6 per cent.

The higher the level of financial uncertainty, the higher the level of domestic violence.

Similar research in Australia based on 13,375 households revealed similar correlations between stress and violence. The Australian study found that the risk of family violence was three to four times as high in households suffering financial stress, jumping on average from around 4 per cent to nearly 15 per cent. This was after controlling for age, parental status and drug dependency.

The dopamine tolerant state induced by chronic stress will drive someone to seek addictive substances. Accessing Cocaine, Nicotine and Booze, Porn, Social Media and Gambling are all stress relieving behaviours. But they all make things worse. They temporarily reduce anxiety quickly and effectively, but because they also deliver a dopamine hit, they ultimately make the dopamine adapted brain even worse. Alcohol is often the first port of call to cope with stress.

Commonwealth Bank card spending data tells us that Australians spent between 30 and 45% more on alcohol in 2021 than they did in the same months in 2019.

It provides a temporary solution, but it also significantly reduces inhibition and impulse control and gives people a sense of invincibility. A community infused with high levels of drunkenness will be one in which violence and crime occur at significantly higher levels.  And in turn the stress created by random acts of violence in the community will increase the likelihood of it occurring more often. It is a vicious cycle that rapidly accelerates, as clearly demonstrated in the stats from QLD police.

The really bad news from those stats is that those crimes are seasonal.  The worst months for assaults are December, January, and February.  August 2021 may have set a record, but it is likely to be broken very soon.

COVID has created a wave of uncertainty that affects almost all of us, almost all of the time.  For as long as that uncertainty continues, these crime statistics will rapidly spiral into territory none of us has ever experienced.  Governments must recognise this urgently and plan to provide the financial and social certainty we all desperately need.  Because if they don’t the society we think we know will tear itself apart in a stressed, addicted and impulsive rage.

 

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China crushes the supply of online gaming ‘opium’ while Australia hands it out in schools

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China has just cut access to online gaming to a maximum of three hours a week. As far as the Chinese government is concerned, games are highly addictive ‘spiritual opium’ with devastating consequences for the mental health of an entire generation. Meanwhile Australian schools and universities are opening the equivalent of injecting rooms in their classrooms.

There is no doubt that gaming is addictive. The dopamine spikes created by the simulated danger in online games, cause addiction. Those dopamine ‘hits’ are just as addictive as the ones generated by chemical stimulants like opioids. And the consequences of that addiction are no less dire, with anxiety, depression, self-harm and even suicide featuring prominently on a very long list. The science is so clear that in mid 2018 the World Health Organisation (WHO) added gaming addiction to the list of diagnosable mental health conditions.

Shortly after the WHO declaration the China Internet Network Information Centre (CINIC) said more than 30 per cent of Chinese children were suffering from the disorder. Within a year the Chinese government implemented severe restrictions on gaming. Children were only permitted 90 minutes of gaming per day plus three hours on holidays.  It didn’t work. The CINIC now estimates that gaming addiction among children in China is rampant, with around 60% of children affected.

The latest move tightens the screws further. Now under 18s in China cannot play online games at all from Monday to Thursday and are allowed to play only between 8pm and 9pm on Friday, Saturday, Sunday and public holidays. Another new requirement is that every player has to be registered with a real name and the games must provide links to online anti-addiction services. Face recognition software is also being deployed into games to ensure compliance.

Data from CINIC showed China’s gaming industry produced revenue of US$43 billion in 2020, up 21 percent from the previous year.  An article published by the Chinese state owned newsagency said “No industry, no sport, can be allowed to develop in a way that will destroy a generation.” According to Tong Lihua, director of the Beijing Children’s Legal Aid and Research Center, the latest move is a response to the unchecked profit-seeking nature of a gaming industry that depends on the addiction of children.

China knows a thing or two about being the victim of addiction profiteering. In the late 18th century, the British East India Company solved a wee cash flow problem by shipping tonnes of Indian grown opium into southern China, where the habit of consuming it was taken up with gusto. By 1836, up to twelve million Chinese were opium addicts. When the Chinese government banned its use and destroyed the stockpiles of British merchants in 1839, the British Navy used their overwhelming military might to force the Chinese to become good customers of the British opium trade once again.

It wasn’t until Mao brutally eliminated the trade in the 1950s that China got its opium addiction under control. He knew that the primary cost of addiction was time. Time spent feeding the addiction was time not spent producing. It was a productivity cost that post-war China could not afford. Mao put ten million addicts in compulsory treatment, executed the dealers and ploughed over opium farms.

Today in Australia, we are now ploughing the over the ‘spiritual opium’ farms that are online gaming. We are fertilizing them.  Our high schools and universities are signing up to eSports leagues. To participate, a school establishes “teams” of competitive gamers who “train” for hours each week after school and compete in the online leagues. The players pay a nominal fee to be part of the season, just like a real sport but about a third of the cost.

The games are free to play and can be played all the time regardless of being in a “team”, so I suspect most of the players get in a lot more “training” than the hour or two they do at school. And probably use the need to “train” as an excuse for access to their devices at home.

The schools do it because it seems like sport, but is much cheaper to run, keeps the kids busy and there are great prizes for the schools and the students on offer. But they might as well be opening lunchtime pubs in their canteens. Addicting their students to gaming is no better than addicting them to booze and it certainly isn’t sport.

According to Roy Morgan data from December 2020, 5.5 million Aussies played video games in the past three months. And if there is one thing gamers like doing almost as much as playing, it’s watching people who are better than them play.  The audiences for eSports eclipse the audiences for real sports by extraordinary margins.  And where there is an eager audience, there’s money to be made.

PwC’s latest Australian Entertainment and Media Outlook says that total interactive gaming and esports revenues rose by 7.2% in 2020 to $3.41 billion in Australia, a number expected to grow by at least a quarter of a billion dollars a year through to 2025.  This is why, AFL clubs, with a capped local audience for their core game and desperate desire for growth, have driven the adoption of eSports in schools in the last five years.

There is a lot of money to be made from getting and keeping Australian kids addicted to gaming.  And the best bit, from the industry’s point of view is the collateral damage, the mental health tidal wave that follows the wave of addiction, is not their problem. New gamers are born every minute and schools are willing accomplices in feeding the production line.

These games are the very best, the most addictive, the most evolved, the gaming industry has to offer. Their purpose is to addict young minds, so that billions can be drained from their bank accounts and billions more can be drained from the accounts of sponsors who want access to the players and their fans. And our schools have signed up as part of the gaming industry sales force.

We don’t tolerate commercialisation of our schools. There are no Macca’s school canteens. There are no school footy teams with brewery sponsors.  So why on earth are we allowing companies whose entire purpose is to addict young minds open up shop in our schools?

eSport is addictive gaming, pure and simple, so don’t let your school fall for the marketing BS designed to turn your kids into a product for sale to the highest bidder.

China is not quite at the point of executing dealers and putting millions of kids into rehab centres, but their recent experience with mass addiction has meant they are quick to recognise the signs of a productivity and mental health catastrophe.  We would be wise not to ignore what they are doing and at the very least stop our schools and universities fanning the flames of the next profit driven addiction pandemic.

 

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How simple things done well can help reset our brain

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Dopamine is our go-juice. It motivates us to chase reward and to run from danger. Without it, we might notice the bar of chocolate but would be unable to muster the energy to pick it up.  We might see the car running the red light but lack the will to move out of the way.

Luckily, we come fitted out with a perfectly operational dopamine system. Arranging motivation for chasing rewarding things like food or sex or running from danger is not a problem.  If, however, we overstimulate dopamine we can change the way our brain is wired.  If we obtain rewards or encounter stressful situations too frequently our brain adapts by making us less sensitive to both risk and reward. This makes us simultaneously seek bigger rewards – something we call addiction – and overestimate risk – something we call anxiety.

We can overstimulate dopamine using chemicals, like cocaine, alcohol, nicotine, and sugar. Or we can do it using software like porn, social media and dating apps, that run high frequency simulations of rewarding experiences.

Chronic stress such as financial, job, or housing insecurity or health pandemics and lockdowns will achieve the same result.  And we can get there using software that simulates stress, like gambling and games.

Once our brain is rewired by reward or stress, we are at very high risk of developing serious addictions and mental illness, not to mention lacking impulse control and being more prone to violence.  Fortunately, there is a way to reset our brains.

Breaking an Addiction

Obviously the first step is to remove whatever it is that is overstimulating dopamine. For rewarding behaviours and substances, it means admitting we have a problem and consciously stopping. That is not easy. If it were they would not be addictive.

The research tells us that most of us will struggle to get past this hurdle the first time we try. But there is nothing to be lost in stopping again, and again, and again if necessary.  Failing to quit is not a character defect, it is biochemistry and every time we abstain for even a short time, we are making the mountain a little bit easier to climb the next time.

Something that the science says will significantly improve our odds of success is finding other people who are also quitting and meeting them weekly to talk about how we are going. It keeps us and them honest and motivated.  Every day away from addiction makes it much more likely we will break it.

Removing Stress

If the source of the overstimulation is stress, then we must work to reduce stress.  For some sources that is achieved introducing routine.  The less decisions we must make the less uncertainty we encounter and the less we engage the mechanism that creates decision anxiety.

There are many uncertain parts of our life over which we have no control.  We cannot control whether the government puts us in to a lockdown that endangers our job.  We cannot control whether our landlord will delay collection of the rent. But we can control smaller things. If for example you always know what you will have for dinner on Monday night, you have removed whole chains of decisions – when to shop, how to shop, how to pay for it and how to cook – from your life. It is by definition, boring. But routine and boredom is what we are aiming for when we seek to remove uncertainty from our lives.

Using a Dopamine patch

We know that for some people it is easier to break an addiction if something which delivers a lower dopamine hit is administered and then the dose lowered slowly over time.  This is the theory behind nicotine patches.  Deliver the nicotine/dopamine hit without the cigarette and lower the dose over time. That notion of low dose dopamine hits will help to rewire the brain’s addictive and stressed state.

The body sometimes attempts this sort of self-help solution on its own. Pain, hunger and lack of sleep all produce dopamine hits. We see those in real-life, in the form of self-harm, intentional starvation and insomnia. The body will apply those band-aids itself if we don’t get in front of the problem.

We can do this in many other ways which don’t need drugs, pain or exhaustion. We know that anything that requires us to focus delivers a dopamine hit.  So taking up a hobby, or a sport or learning to play an instrument or even meditating will all work as long as you can remain focused and live in the moment while you are doing it.

The key is focus.  To focus, our brain needs to increase dopamine levels. This becomes a ‘nicotine patch’ for bringing us down from the endless chase for hits from addictive behaviours or substance while simultaneously making those same hits from stress and uncertainty more tolerable. Haven’t you always wanted to learn the piano?

 

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Why COVID is turning us all into addicts

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Pre-covid, one in ten UK adults reported current symptoms of anxiety or depression.  The number was similar in Australia and the US.  By June 2020, the UK number had risen to one in five.  By Christmas in the US 42% of all US adults were reporting the symptoms.  There is no reason to believe Australia’s numbers will be any different when they are eventually published. The stress of covid and the lockdowns associated with it are driving mental illness to levels we have never measured or experienced before.

We also are starting to see similar increases in addiction and violent crime.  A third of households now report drinking daily to cope with anxiety and one in five report buying more alcohol than usual. The number of Australians gambling four or more times a week increased by 40% during 2020.  And according to crime data, assaults increased by 30% and domestic violence increased by 45%.

All of this is united by a single simple explanation that is based on the way our brain adapts to stress. The bad news is that this stress adaptation creates a self-perpetuating cycle that leads inevitably to addiction and mental illness. The good news is that we know this – and can stop it if we act quickly.

I live under a flight path.  Visitors often remark about aircraft noise which I stopped noticing long ago. They live in quiet streets where a jet flying over at a thousand feet would stand out like canine gonads. But I have ‘backgrounded’ it because it happens to me every 10 minutes. That ability to not notice things which are part of our normal environment is an important survival mechanic. We need to be able to do that so that when something unusual happens we do notice it amongst the noise.

We don’t just do this for sounds.  We do it for smell, colour, temperature, and pain to name just a few others. Critically we also do it for danger. If we live in a war zone, a stressful event like nearby gunfire will bother us a lot less than if we live in (say) Adelaide.  In the war zone we would be adapted to the background of frequent gunfire so that we would react only to the noises which put us in real, imminent danger.

This response helps us cope with the ever-present risk so we can still function.  If we responded to constant risk the way we respond to a once in a lifetime mortal threat, we’d be permanently frozen in fear.  Our biochemistry changes the calculation of risk so we can keep moving forward even in the most hair-raising circumstances.

We do the same thing for rewarding behaviour.  If rewards are rare, we keep a close eye out for them, but if we have unlimited access to reward, we get bored.  We need more and more stimulation to manage the same level of desire.  We create a new baseline for ‘normal’ levels of pleasure. Our brains background the good stuff just as efficiently as they do for the bad stuff.  This is not particularly surprising because we use the same biochemistry for both.

The trap is of course that since both pleasure and pain trigger the same biochemical adaptation, they act as gateways to each other.  People experiencing high levels of danger seek extraordinary levels of pleasure.  And people experiencing high levels of pleasure accept significantly greater levels of danger.

But there is a bigger price to pay than merely seeking pleasure and danger. Because our brains have moved the goalposts on what is normal, we will overestimate the potential reward on offer – we call this addiction – and do the same for potential risk – we call this anxiety.

This is why, in times of chronic disease uncertainty, chronic housing insecurity and chronic job insecurity, we are seeing rates of addiction and mental illness skyrocket.

Worse, the adaptation to stress puts our brain in a state of impaired impulse control.  We are more irritable, less able to make rational decisions and generally angrier and more impulsive. We might feel like punching the driver that just cut us off at the best of times, but when we are in this state we are much more likely to act on it. There is little wonder then that is exactly what we are seeing play out because of the stress associated with COVID and the government responses to it.

All hope is not lost, however. We can reset the brain wiring that holds us in a state of anxiety, addiction, and dangerous lack of self-control.   It is not easy, but it is possible to reset our tolerance levels for danger and reward and return us to non-addicted, non-anxious equilibrium.  Exactly how that is done is the subject of part two of this series.

 

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7 Paths to Mental Illness

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Stimulant drugs like opioids, cocaine, meth and alcohol are devastatingly effective pathways to addiction, but there are much more subtle everyday routes to the same destination, and they all start with overstimulation of dopamine.

Dopamine is a neurochemical that motivates us to take action and focuses our attention.  It makes us run towards pleasure and away from danger.  If, however we overstimulate dopamine our brain becomes semi-permanently rewired into a significantly more fragile state. In that state we overestimate both the probability of receiving rewards and the danger posed by threats.

The rewiring for extreme alertness helps us cope with the high dopamine environment, but it is only meant to be a temporary fix. When we hold ourselves in that overstimulated state for too long we will initially become clinically anxious and then, eventually, depressed.

We can do that by using chemicals that we know stimulate dopamine but many more of us are achieving the same result without consuming any of these.

Social media and dating apps stimulate oxytocin, our socialisation hormone which in turn gives us a hit of dopamine.  Porn follows a similar path with the assistance of testosterone. Gambling and danger simulating games like Fortnite get to the same destination by stimulating cortisol, the same hormone released when we are in real-life danger.  Chronic uncertainty caused by housing insecurity, job insecurity or, say, COVID has the same effect.  As does exposure to trauma, pain or violence.

All these starting points promote overstimulation of dopamine. Because both stress and addiction produce the same state, stress makes us easier to addict and addiction makes us more susceptible to stress. Our brain adapts by decreasing our sensitivity to dopamine by dialling up an epigenetic control called DelatFosB.  Unfortunately, that leaves our brain in a fragile state which makes us overestimate rewards (craving more dopamine) and risks (high anxiety about everything).  Even worse, any dopamine stimulating behaviour will temporarily provide relief but ultimately make the problem worse.  This is why addiction is so hard to break and anxiety is so hard to cure.

In between dopamine hits, the edgy state of our brain biochemistry leads us into low dopamine states we recognise as depression (a lack of motivation) and ADHD (a lack of focus).

It doesn’t matter (to our biochemistry) if the next dopamine hit comes from looking at Facebook, or playing Fortnite, or smoking a ciggy, or inhaling cocaine, or hitting the booze, or being evicted, or stress about COVID, or being a victim of violence, and of course any combination of these.

The affect is the same, the effects are cumulative and left unchecked, over time, will continue to drive the growing epidemic of anxiety, depression, and mental illness.

Excerpt from Brain Reset

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Introduction

If I were to call you an addict, I doubt you’d take it as a compliment. Addicts are nasty people. They steal, they cheat and lay unconscious in the gutter, oblivious to the world around them. Am I right? Yet, in the sense I will use that word in this book, you probably are an addict.

You probably wouldn’t be too keen on me describing you as having a mental illness either. But according to the latest statistics, if you are standing in a room with four other Australians, one of you currently has a mental illness such as anxiety or depression, and two and half of you will, at some point in your life. It is even worse for younger people. More than one in four people aged 16–24 currently suffer a mental disorder. Between 2005 and 2019, depression in the US in people under 25, the age group most easily addicted, increased by 73 per cent. One in eight US teens is depressed and twice that many suffer from anxiety. The Australian statistics are similar. Those numbers tell us that every family is in some way dealing with mental illness.

This is a book about how addiction, anxiety and depression are all part of the same spectrum. It is a book about mental health but it is not an attempt to explore the vast universe of mental illness; just a very important part of the equation. It is a detailed look at the way seesawing dopamine, caused by stress, uncertainty and addictive behaviours (smoking, drinking, gambling, screen use, eating sugar and many more) create imbalances in our brains. This in turn causes anxiety and depression. This matters a lot because it is rapidly creating an epidemic of mental illness the likes of which we have never before experienced. If we do not stop it, it will have disastrous consequences for each of us and our communities.

This is not to say that addiction or stress causes all mental illness. Like all human disease states, there is an underlying level. The power of sexual reproduction continuously recombining our DNA is that every one of us has a different propensity to any given disease to the person next to us. Some people can drink 50 cans of Coke a day and live to 127. Some people put on 400 kg merely by reading the word ‘Coke’ in the preceding sentence. We are all different. What we can say with confidence is certain factors take disease states from background noise into population-wide epidemics. That’s what sugar consumption did for type 2 diabetes when it went from a non-disease in the 70s to affecting one in ten of us now. And it is what addiction and stress is doing to our mental health.

I am not a doctor. I am a researcher. I write about evidence with the singular motivation of providing you (and me) with information that helps us make better choices about our health. I firmly believe that knowledge gives us the power to change our lives for the better. There are many very large, very rich companies making very good money out of keeping that knowledge from us and keeping us addicted.

Because I have no relevant qualifications, I really have to know my stuff. I am very aware that my lack of formal training in the area means anything I say is open to criticism. This is how it should be, but this important reality forces my research to be more thorough, my references more current and my conclusions more defensible. My outsider’s view allows me to connect silos of knowledge where the evidence says it is necessary. The only relevant skill I bring to the table is knowing nothing about the area. This means I can’t accept a fact until I see the evidence. I can’t operate on the basis of ‘this is what my lecturer told me’ or ‘this is what everyone knows to be true’. Everything you are about to read is referenced. You can read all of it in the original journals. It is all there for everyone to see, but nobody is laying it out for us ordinary people in a way that makes any sense.

I have researched sugar, education, seed oils, psychopathy and teenage addiction and, as disparate as they are, a common theme has consistently emerged. There is always someone who will try to profit from human vulnerability. It could be the private school network pressing parents’ status anxiety button. It could be the processed food industry adding sugar to everything to increase sales. Or it could be Facebook harvesting our need to be liked.

When it comes to your brain there are loads of people fighting for your neural real estate. There is a reason the processed food, alcohol, gambling, social media, tobacco and pharmaceutical industries account for the lion’s share of our business landscape – and they are just the legal addictions. And they don’t stop at addicting individuals either. They make sure our leaders are addicted to their money. Our governments believe they would struggle without the rivers of gold generated from taxing our addictions. For all the nice feel-good campaigns about mental health and addiction, there is a very strong financial undertow pulling all of us in the other direction.

Addiction is not just messy drunks, coke-heads or junkies. The biochemical reality is we can become addicted to many things that are much more subtle and that are so socially acceptable, we’d happily give them to a toddler. In 2009, an advertising campaign kicked off on the side of London buses that said, ‘Nice People Take Drugs’ in large bright red letters. The campaign was paid for by a charity campaigning for the decriminalisation of drugs. It was immediately banned and removed. The UK was not ready to hear that nice people are addicts too, and things have not changed much since then. Denial is one of the first signs of addiction. It is a reflexive defensive mechanism aimed at keeping the addiction alive and hidden from view. That’s worth remembering as we look at the nature of everyday addiction.

Addiction is a loss of self-control when presented with potential rewards. Our brains operate a biochemical reward system to make us get off our bottoms and do stuff that keeps us alive long enough to produce the next generation. Without it, we wouldn’t get out of bed, we wouldn’t eat even if food was put in front of us, we wouldn’t go to the trouble of meeting other people and we certainly wouldn’t bother with getting to know them well enough to have children with them. This same system keeps us safe from danger by providing us with the motivation to run away or stand and fight.

That reward system, however, can be broken. We can like things too much for our own good. This can happen if we do rewarding things at very high frequency, or use substances to mess with the biochemistry of dopamine, a key neurotransmitter responsible for messaging in our reward system. For most of the history of addiction, substances have been the only path to addiction. We discovered pretty early on that the alcohol produced by overripe fruit made us feel good. As the centuries passed, we added to the collection of stuff we knew would give us a buzz – tobacco leaves, tea leaves, coffee beans, kola nuts, opium poppies, coca plants and, of course, sugar.

I was addicted to sugar. I didn’t know I was addicted to sugar until I wasn’t. Had you asked me at the time, I would have denied it till the cows came home – and then bought a Coke instead of water because it was more ‘fun’. When I compare the way I felt about food before to the way I feel about it now, I definitely was. Sugar pushes exactly the same biochemical buttons in our reward system as cocaine, alcohol, nicotine and many others. Just because the cravings are less intense and it has stayed under the regulatory radar doesn’t mean the biochemistry is any different or it is not addictive.

When we consume one of these substances, we ratchet up our need for reward. The brain is not evolved to deal with this. It foolishly assumes our environment is largely free from anything that can mess with its biochemistry because until very recently in evolutionary terms, that was true. To make things even more dire, in the last decade, we have invented and deployed powerfully addictive software to every person on the planet. While this software doesn’t administer a substance that breaks our reward system, it manipulates our brains into doing it.

In just a decade, software that simulates the most common real-life rewards, like sex, gambling or the oxytocin-enhancing feeling of being liked, has become ubiquitous. Now addiction is not just for the adventurous few, it can be enjoyed in the bedroom, bathroom, on the bus, at work and school and during parliamentary question time. No one can have sex 100 times a day or meet real people 1000 times a day or place 500 bets a day, but with the high-speed simulations now available on every portable device, our pocket has become a seething cesspit of potential addiction. This is why the generation who have never known life without these devices will not know life without addiction.

In a similar way, our bodies and minds never evolved to be under extreme stress for long periods of time. We are fine with stress while we are running away from a woolly mammoth. We are not designed for the kind of persistent low-level stress created by constantly having $100 in our account when the rent is $500. Unfortunately, our brains save resources by using the reward system to handle chronic stress. This means that stress increases addiction and addiction increases stress and both flow through to anxiety and depression.

Addiction and stress are not the only ways to create anxiety and depression but they are now the dominant pathways for most of us. The good news is that knowing the enemy is the key to stopping it. Once we know exactly how our operating system works and how it can be manipulated, we can use that knowledge to give ourselves the edge.

Part of the reason I didn’t think I was addicted to sugar was that I didn’t think I was eating that much of it. Then I started reading food labels. I found out that just by eating a bowl of Sultana Bran and a glass of orange juice, I had consumed 20 teaspoons of sugar before I pushed back from the breakfast table. That was just the start. BBQ sauce can be half sugar, some yoghurt has more sugar than ice-cream and there is often more sugar in low-fat mayonnaise than Coke. Knowing how much I was eating, and reading the science of exactly how it addicted me to make sure I kept eating, was the key to me stopping. I am hoping this book can do the same for all of us, with the addictions we may not be aware we have.

Addiction is loss of control. It is not being able to say ‘no’ when offered just one chocolate. It is settling down to a quick look at your socials and then wondering what happened to the last three hours. It is having just one more game, then realising the night has disappeared. It’s putting on one more multi-bet because you are sure your luck has changed. We may not feel like rats in a cage being manipulated to press the lever for reward, but that is the subtle art of addiction. If you want to see if you really are exercising free will, just try to stop.

Anxiety and depression are a direct result of dopamine signalling. Too many dopamine hits too often will lead to mental illness as certainly as night follows day. We can get those dopamine hits by becoming addicted to substances or behaviours that deliver them or by living in a state of stress. Both of these processes are significantly accelerated by uncertainty. Uncertainty takes an interesting and rewarding experience and at least doubles the perceived excitement and the size of the consequent dopamine spike. Equally, when bad things may or may not happen, the uncertainty at leastdoubles the dopamine hit, to make sure we are on full alert. It is like a free supersized dopamine hit for no extra effort.

Either way, the reward system turns uncertainty-boosted dopamine hits into a semi-permanent change to the brain biochemistry that helps us cope with our high-dopamine environment. Unfortunately, that coping mechanism comes at a cost – our mental health. Dopamine-adapted brains are anxious and depressed and work much less well than brains that are not in this state. They are irritable, have no impulse control, have weak memory, make poor decisions and are able to contribute much less to our overall welfare. If we allow that mental state to go on indefinitely, we place ourselves and others at mortal risk, either from the addictions or from self-harm, domestic violence or suicide.

The key to undoing the damage done by addiction or stress or, usually, both is to reset the biochemical switch, ΔFosB (DeltaFosB). This controls how we react to a surge in dopamine generated by reward or danger and amplified by uncertainty. It would be really nice if we could just access the neurochemical program that runs our brains and flick the switch to reset DeltaFosB to normal. While that is possible, it is nowhere near that easy or quick. Unfortunately, there is no such thing as a free lunch in biochemistry. Resetting the switch flicked by years of addiction or stress takes a bit of effort. To do that, we need to delete addictive behaviours and substances, replace them with rewarding real-life experiences that are not addictive. We also need to remove as much stress and uncertainty from our lives as possible.

Once we know how our reward system works and how it is manipulated, we can regain control. We can push the profiteers out of the driver’s seat and own our destiny once more.

This is not a book about stopping pleasure. You will not be told all fun must end. Our reward system works perfectly well when it isn’t being messed with. We can enjoy life and do things that provide us with shots of dopamine without the risk of addiction, anxiety or depression. The catch is we need to do a system reset before we get to that point. This is a book about how to do that. I will guide you through what the science says about how to reduce and remove the substances and behaviours that drive addiction and how to increase the behaviours that recalibrate our reward system. The pay-off will inevitably be reductions in levels of anxiety and depression or avoiding them altogether.

You don’t need to be diagnosed with anxiety or depression to find value in these pages. A common pathway to diagnosable mental illness starts with insomnia, feeling low, feeling trapped, feeling like we are not living the life we want to lead (and can’t work out why) or worrying about things that never used to bother us. For many of us, our reward system has been broken for so long that we have no idea what life can look like on the other side. I didn’t know I was apathetic, moody and low on energy until I wasn’t on sugar. Life without addiction can take us to a new level. Suddenly, we can concentrate better, think through complex situations, set and reach goals and get more enjoyment out of life in general. Our moods will be less volatile, we’ll be more motivated, sleep better, lose weight and have better health overall.

There are also dramatic benefits for the higher functioning addict, one who feasts on a smorgasbord of smaller addictions but isn’t incapacitated by any single one. They will experience high of contentment, less reactivity, better focus on work and more connection with family and friends.

And it is not just you who will benefit. As a society, we are neck-deep in addiction for profit. Governments are as addicted to revenue from the addiction industries as we are to straight bourbon and unfiltered Camel cigarettes. If governments divest themselves and genuinely try to help, we will all benefit from living in a society where there is less violence, less addiction-driven death and less preventable disease. Our businesses will be more productive because of the massive reduction in mental health costs and our families will more robustly handle any stressors they encounter. The local leagues club will be a lot smaller but, then again, it won’t need to house so many pokies. And there won’t be as much money for pork-barrelling the local pollie into power, but there will be a lot more money for community services left over from our taxes because society will be relieved of the costs of addiction.

This is a book about mental health. It is about what we can do to decrease our levels of anxiety and depression and the many disease states that can cascade from them. It is a book about real science and practical outcomes. It is not a book about being nice to yourself or talking yourself out of depression or herbal gerbil knit your own pseudo-scientific counselling techniques. It is a book about neuroscience and hard, knowable, measurable outcomes.

What we know about how our brains work has advanced significantly in the last decade but so far very little of that knowledge has made it past the cover of a medical journal. Our society is struggling to contain a tidal wave of mental illness and addiction that disables families and dismantles communities. Worse, turning our teens and young adults into addicts robs them and our society of a future. Once the young have no vision beyond the next dopamine hit, human civilisation is in real peril. This is not hyperbole. There needs to be an honest desire to fix this. There needs to be an uncomfortable accounting for the true costs of generations burned at the altar of addiction for profit.

This is a book about what the evidence really says so that you can apply it, if you wish, in your own life. This book will not eradicate all mental illness alone, but if we listen to the science, we can remove the static and clear the white noise driven by corporate profiteering so resources can be freed to help those whose illness would exist even in a world free of addiction.

This book takes a good hard look at the science behind resetting our reward and punishment pathway and what that science implies about how we should behave. But it isn’t all science. At the end, you will find an actionable plan to help you to reduce your addictive behaviour and set you on a path towards understanding your mental health.

The solution is in your hands.

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The ACL epidemic is caused by sugar-water

By | Sugar | No Comments

Last week Gold Coast Suns co-captain Jarrod Witts collapsed with a season ending ACL injury. This week Carlton defender Caleb Marchbank suffered the same fate.  They are just the latest high-profile examples of the rapidly growing list of ligament injuries in the AFL and AFLW. Ironically, the science tells us the damage is being done by one of their sponsors’ products.

ACL injuries are not a problem exclusive to the AFL but they do keep very good stats on them. The average male professional AFL player will suffer an ACL injury after playing 1,428 hours of footy.  The average AFLW player will do her knee after just 133 hours. In general, women are up to 10 times more likely to injure an ACL than men because the wider female pelvis makes a knee collapse, or movement towards the other knee, more likely. ACLs in sports are not generally caused by contact with another player but by landing.

The dreaded ACL injury is a tear in the anterior cruciate ligament, one of the four ligaments that hold our knee together.  The ACL is inside the knee joint connecting the bottom of the thigh bone (the femur) to the top of the lower leg bone (the tibia).  It is attached to the tibia by a little spit of bone called the tibial spine.

ACL rates have been accelerating massively over the last few decades.  Between 2000 and 2015, the annual incidence of ACL’s requiring surgery increased by 43 per cent. In people under 25 they increased by 74 per cent.  The fastest growing group are children aged 5-14 where the rate of injury is growing at around 8 per cent a year.

Twenty five years ago kids didn’t tear their ACL, they broke the tibial spine.  Orthopaedics textbooks from the nineties warned doctors to look for tibial spine fractures because children don’t tear their ACLs.  In essence, they thought they were immune to ACL tears by virtue of being children. This was because in growing children the bones are not at full strength, but the ligaments are.  In a stressed situation, where the ACL is yanking on the tibial spine, the bone gave way before the ligament, hence the fracture.

Fortunately, there is good science that tells us why our ACLs are suddenly failing.  Sugar.

The massive increase in our consumption of sugar is responsible for us producing substandard ligaments and cartilage.  If we make knees out of rubbish material its little wonder that they are suddenly not up to the job.

A byproduct of human metabolism is that sugars can become randomly attached to proteins in a process called glycation. Glycation results in the formation of all sorts of unpredictable (and haphazard) molecules called AGE’s (Advanced Glycation End-products).

All sugars can form AGE’s but the fructose half of table sugar (sucrose) is ten times as likely to do so as glucose (the other half). AGE’s are dangerous because they bond easily (and randomly) to each other and to other proteins in a process called cross-linking. Cross-linking significantly degrades the quality of the protein.

Our bodies are used to garden variety (glucose-produced) AGE’s. And we are pretty good at breaking them down and disposing of them. But even so, over time they accumulate in our organs and tissues and we, well, age (the acronym AGE is very much on purpose).

Unfortunately the AGE’s made with fructose molecules are resistant to our disposal system. So not only they made at 10 times the rate, they hang around.

Long-lived proteins such as collagen, elastin (both used in ligaments), lens crystallins (used in the eyes) and cartilage are much more susceptible to the effects of AGEs because once we make a bad batch, they’re part of us for an awfully long time.

Collagen degraded by AGEs makes less elastic ligaments.  And substandard ligaments, rather like rubber bands left in the sun, tear much more easily. So it would seem that it is less than intelligent to be telling people who play sport to drink sugar that will significantly increase their chances of never playing sport again. That is, of course, unless you are the one selling the sugar-water.

Coca-cola sponsors the AFL and many other sports under the Powerade brand and Pepsi does the same for an array of sports under its Gatorade brand.  They are not doing this because they want to give money to professional sports. They are doing it so young players will see their heroes knocking back blue, green, yellow and pink sludge during and after games and come to the conclusion they need to do the same.  And it’s working, sport drinks are the one part of the sugar water industry doing well.  The global sports drink market is worth $30 billion and it is growing rapidly.

ACLs and other ligament and cartilage damage are now a standard part of sporting life because fructose is being consumed at unprecedented rates (ironically, particularly by those playing sport) and the group suffering the most explosive growth in injuries are those kids emulating their sporting icons.

ACL’s can be repaired (by transplanting other ligaments) but even a well repaired ACL is likely to have debilitating long term consequences.  A Swedish study for example found that half of all adult soccer players who tore their ACL had developed severe arthritis of the injured knee within 14 years. Apply that timeline to an 8 year old and it means they will spend most of their lives battling severe debilitation.  And that’s from an injury that 8 year olds are supposed to be ‘immune’ to.

Let’s stop paying professional sportspeople to suck down sugar. Let’s stop advertising sugar nonstop during broadcast sport. Most of all, let’s stop teaching our kids that sugar and sport go together. And then hopefully we can stop putting severely injured teenagers and their sporting idols in the back of ambulances every weekend.

 

Picture: Adelaide’s Taylor Walker was one of 15 AFL players to tear their ACL in 2013. (Joe Castro: AAP Image)

Don’t give kids sugar flavoured seed oil masquerading as Health Food

By | Big Fat Lies, Sugar, Vegetable Oils | No Comments

Do you have a fussy eater? Are your kids refusing to eat their greens?  Worry no more, you should just give them a chocolate milkshake instead. Well, that’s what the makers of PediaSure would have you believe.  But is filling a kid with flour, sugar and seed oil really a better alternative to telling a kid to eat their greens for dinner or risk getting them for breakfast?

The latest Television Commercial for PediaSure shows a ‘busy kid’ playing basketball, riding his bike and sucking down a ‘delicious PediaSure health shake’ to ‘help support immunity, growth and a healthy appetite.’  The ad was in high rotation on Sunday night prime-time telly. The packaging looks a little like an infant formula tin but was clearly being sold as something active kids should be inhaling by the bucket-load. So what is it?

Here’s the ingredient list for vanilla PediaSure:

Hydrolysed corn starch, sucrose, PROTEIN (milk protein concentrate, soy protein isolate), VEGETABLE OIL (canola oil, high oleic sunflower oil, sunflower oil, medium chain triglycerides (MCT) oil), maltodextrin, MINERALS (potassium citrate, sodium citrate, calcium phosphate tribasic, potassium chloride, magnesium chloride, potassium phosphate monobasic, calcium carbonate, potassium phosphate dibasic, sodium chloride, magnesium phosphate dibasic, ferrous sulfate, zinc sulfate, manganese sulfate, cupric sulfate, potassium iodide, chromium chloride, sodium selenite, sodium molybdate), oligofructose (FOS), EMULSIFIER (soy lecithin), flavoring, DHA from C. cohnii oil , choline chloride, VITAMINS (ascorbic acid, Vitamin E, niacinamide, calcium pantothenate, thiamin hydrochloride, pyridoxine hydrochloride, riboflavin, Vitamin A palmitate, folic acid, phylloquinone, biotin, Vitamin D3, cyanocobalamin), ascorbyl palmitate, taurine, myo-inositol, carnitine tartrate, Lactobacillus acidophilus, mixed tocopherols

As delicious as that explosion in a chemical factory sounds, it boils down to garbage. Here’s my translation of the ingredient list (in descending order by calories supplied)

  1. Seed oil (35% of the calories)
  2. Pre-digested corn flour (for volume and ‘creaminess’ – also used in cosmetics) (30%)
  3. Table sugar (20%)
  4. Protein extracted from milk and soy (12%)
  5. Multi-vitamin
  6. Man-made soluble fibre
  7. Emulsifier (so the oil doesn’t layer out)

Yes, that’s right, this swill can summarised as Seed oil, Corn Flour and protein extracts with a serious dose of sugar to make sure the ‘busy kid’ will actually swallow it. It has a very similar make-up to so-called Toddler formula, the completely unnecessary marketing extension to actual infant formula. It also looks pretty similar to the shakes being sold to the elderly.

The omega-6 fats which dominate the seed oils are implicated in (at least) osteoporosismale infertilityrheumatoid arthritisParkinson’s diseaseallergies, asthmamacular degenerationimpaired intelligence and cancer. And the sugar will put the kid on track to an even more spectacular array of chronic diseases including Type II Diabetes, Kidney Disease, Fatty Liver Disease, Heart Disease, Erectile Dysfunction and Alzheimer’s.

This is all part of powder-creep. Baby formula is a, sometimes, vital food for infants who cannot be breast fed. But manufacturers are legally prohibited from filling infant formula with sugar and the margins are thin. If the manufacturers want to grow their revenue, they need new tummies to fill. So, we can expect more and more ‘nutritional supplements’ that look and taste like a milkshake but spouting dubious medical sounding benefits.

The reality is that a child in Australia today has about as much risk of being clinically undernourished as I do of being elected Pope. Yes, there are an exceedingly small number of Australian kids who could be considered at risk and they probably already have the support of a medical diagnosis and supervision.  So, let’s stop pretending that flogging this sugar flavoured seed oil on prime time TV is anything other than a cynical attempt to sell cornflour at a massive markup.  If you really want a kid to be well nourished give them a glass of milk or an egg.  Both are almost perfect foods from a human nutritional perspective.

Corn flour, sugar and seed oil will not boost the average kid’s immune system or help them grow (well at least not vertically).  PediaSure is no more a health food than the similarly composed seed oil and sugar effluent sold as Up&Go.  It should be avoided with just as much diligence. And under no circumstances should it be given to children.

Will COVID-19 finally drive us to do something about poverty?

By | covid-19 | One Comment

SARS-CoV-2, the virus that causes COVID-19 is the third major outbreak of a dangerous beta-coronavirus.  We have known about beta-coronaviruses in the human population since the 1960s but have never been able to develop a vaccine.  The most likely scenarios are that the virus fizzles out like SARS or it simply becomes part of the normal ‘flu’ season.  The real concern is not COVID-19 but the next virus that tramples its well-worn path into the human viral landscape.

Beta-coronaviruses are descended from the bat gene pool, but some can directly or indirectly (via other mammals such as camels, mice, anteaters and cats) infect humans.

These viruses have been bothering humanity for at least a century, that we know of. The common cold is a beta-coronavirus (CoV OC43) that was first detected in 1965 and another common cold variant (CoV-HKU1) has been in widespread circulation in the population since at least 2005.  A 2016 study of 1208 patients with respiratory disease in Cleveland, Ohio for example showed that 18 had HKU1, 18 had OC43 and 7 had other less common cold variants (NL63 and 229E).  A similar study in Malaysia in the same year detected 26 OC43 and 22 HKU1 cases in a 2060 patient sample. A genetic study of OC43 and HKU1 suggest both share a common ancestor and have been in human circulation since the 1950s.

In late 2002, we discovered that beta-coronaviruses can be more dangerous than the common cold. A new variant, later christened SARS-CoV, the virus that causes SARS, was something very different.  Death from viral pneumonia was a real possibility. It became our first know coronavirus pandemic during its brief run over the northern winter of 2002-2003. It was limited to 8,096 cases resulting in 774 deaths, mostly in southeast Asia.

One of the earliest known cases was a chef in Shenzhen, near Guangzhou, Southern China. He regularly handled recently butchered wild game. His wife, two sisters, and seven hospital staff who had contact with the family were all diagnosed with SARS-CoV. From 16 November 2002 to 9 February 2003, a total of 305 cases were reported in mainland China, with more than a third of those cases involving health care workers.

The virus reached Hong Kong on 21 February 2003, when a Guangzhou doctor, infected by his patients, visited the city. Within a day, he’d infected 16 other people in the hotel he was staying in. Those people unwittingly carried the virus to 30 other countries over the following 6 months.

Subsequent analysis established that the likely natural reservoir for the virus was Chinese horseshoe bats.  SARS-CoV is a zoonotic virus, which means it is a virus that is transmitted between animals and people, but once established in the human population it is easily spread from person to person.

The incubation period was between 2 and 14 days and the average person with the disease would infect between 2 and 4 others. Unlike influenza viruses, which are most infectious in the first 2 days of illness, infection from symptomatic SARS patients usually occurred on or after the fifth day of onset of disease. That is in line with the rising viral load in nasal mucus which peaks at around day 10. Fever, chills, dry cough and muscle pain were the major symptoms. Infections in children were milder than those in adults. And SARS in pregnant women carried a significant risk of death.

The most important route of person-to-person spread was inhaling infectious airborne droplets or touching hard surfaces those droplets have landed on (and then touching the face, or food). The virus can survive on hard surfaces for up to 7 days but is easily inactivated by soap, alcohol or other common disinfectants. The virus lasted longer on disposable plastic hospital gowns than on cotton gowns. Cotton gowns were therefore preferred in hospital care settings. Subsequent tests also revealed that transmission risk from paper was very small.  Even where a page was sprayed with a significant viral load, viable virus particles could not be recovered after the paper dried.

By far the most likely place to become infected was in hospital. Hospital transmission was much more likely where nebulizers, suction, intubation, bronchoscopy, or cardiopulmonary resuscitation on SARS patients were used.  All those procedures generate large numbers of infectious droplets. Around half the Hong Kong SARS cases were acquired in hospitals.

The SARS pandemic eventually fizzled out, not because of anything we did to stop it but because it developed an, as yet unexplained, mutation which impaired its ability to spread.

Subsequent studies showed the virus infected between 13 and 40% of asymptomatic food animal handlers in southern China. It is likely the sustained exposure of the animal handlers to live and recently deceased infected animals was a perfect testing ground for mutations which could jump from animals to humans.  Handlers were constantly exposed to variants of coronaviruses, with one eventually breaking through by successfully developing the ability to infect humans.

Like other viruses such as influenza A or Ebola, SARS-CoV possessed the ability to evade the innate immune system, the part of our immune system that reacts instantly to a foreign pathogen. Our long-term immune response, the adaptive immune system is not fooled.  It begins manufacturing anti-bodies against SARS-COV at around day 7.  Manufacture plateaus at around 60 days but is maintained for over 12 months, probably conferring immunity against reinfection.

A decade after SARS-CoV wiped itself out, another lethal outbreak of a coronavirus was detected in Saudi Arabia.  MERS-CoV, the beta-coronavirus that causes MERS (Middle Eastern Respiratory Syndrome) has since infected around 2,500 people and caused around 750 deaths.  MERS was directly transmitted by camels which at some time in the distant past acquired it from bats.  MERS is significantly less transmissible than SARS, requiring lengthy, unprotected close contact with an infected person undergoing medical treatment.  It is still an active infection in the Middle East.

SARS-CoV-2 is the latest and by far the most virulent member of the family.  It appears to be almost identical to SARS-CoV except it has not, so far, acquired the self-limiting mutation which stopped SARS in its tracks.  We are now learning what SARS would have been like if that had not happened. So far it has infected 1.8 million people and directly or indirectly caused almost 110,000 premature deaths worldwide. This is between a third and a sixth of the number of influenza deaths each year.

Bats are a major reservoir of beta-coronaviruses, but they are not the only risk for zoonotic diseases.  COVID-19 is just the latest to join a list which includes Rabies, Ebola, bird flu, Hendra and over 200 others that we know have crossed from wild animals to humans.

The biggest driver of the explosion in zoonotic diseases is fast growing urban population in poverty-stricken parts of the world.  The human population growth results in the destruction of rainforest habitat, bringing large groups of humans into close contact with animals and the diseases they carry.  Feeding those populations is a significant problem and has accelerated the growth in informal markets which provide fresh meat to those people.  A lack of refrigeration often means the best way to transport and keep meat fresh is to keep the wild animal alive until it is sold and butchered on the spot.

A virus is significantly more likely to be transmitted from a recently deceased and butchered wild animal than from traditional farming and butchering methods.  Markets like these exist in China and throughout west and central Africa.  They are essential sources of food for hundreds of millions of the world’s poorest people.

The world will get through COVID-19 once the virus either wipes itself out, we develop herd immunity or (much less likely) we develop an effective vaccine.  But that is not the end of the problem.  The same things which created it, will create its successor.  And next time it could be something far worse.  It is pure random chance that COVID-19 is not a disease as deadly as Ebola (it kills half of those it infects) and as transmissible as measles (every infected person infects 12-18 others).

There is probably nothing we can do to totally eliminate that risk, but a significant step towards lowering it is to ensure the people reliant on so-called wet markets don’t need them anymore.  This means lifting them out of poverty and providing sufficient high-quality nutrition.  And we need to do it very quickly or prepare now for the human and economic destruction that will inevitably accompany the next zoonotic outbreak.

Photo by Nathalie van Vliet