The Water is Coming, and Venice, New York, and Miami are Waiting….and Waiting

The seas are rising, slowly at the moment, but the rise will accelerate.  How fast and how far can only be estimated, and not with a great degree of agreement between the estimators.  Only a few feet of increase will be catastrophic for many island nations and for sea coasts where land is only a few feet above current sea level.  For the poor, life will be tragic, but simple.  The poor will have no choice but to move on and hope they can find a home somewhere else.  The wealthy will face a more complex situation.  They have too much invested in their coastal infrastructure to be able to walk away from it.  The wealthy will inevitably face the need to expend enormous amounts of capital on protecting their assets from rising waters.  Jeff Goodell summarizes the current state of knowledge about sea level rise in his book The Water Will Come: Rising Seas, Sinking Cities, and the Remaking of the Civilized World.  He also visits locations that are most likely to be affected to learn what might be being done in preparation.  We will discuss his findings with respect to three wealthy cities.

Sea level rise is dominated by two sources.  If the Greenland ice fields should all melt the oceans are expected to rise about 20 feet.  If all the ice carried by Antarctica should melt, the oceans would rise by an additional 200 feet.  Clearly, humans are playing a dangerous game by meddling with the climate.  Such drastic changes are expected to take many centuries….or not.  No one really knows.

“’We just don’t know what the upper boundary is for how fast this can happen.’  Richard Alley, a geologist at Penn State University who probably understands ice sheet dynamics better than anyone, told me.  ‘We are dealing with an event that no human has ever witnessed before.  We have no analogue for this’.”

Scientists generally limit any predictions to the end of the current century.  Estimates of how high the seas will rise by 2100 are highly uncertain, but there is a definite tend toward greater numbers for possible sea level increases.  The last official estimate by the Intergovernmental Panel on Climate Change (IPCC) came out in 2013 predicting a maximum anticipated rise of about 3 feet 2 inches.  Since the data available for that estimate was used, scientists observed an anomalously high ice melt event in Greenland and surprising ice sheet breakups in Antarctica that have raised concerns that the 2013 estimate may be way too conservative.  Unofficial estimates now range from about 3 feet up to as much as 15 feet.  Goodall claims that 145 million people live on land that will be submerged by a 3-foot rise.  A 6-foot rise would be much more disruptive.

So, given that introduction, are many cities planning for significantly higher sea levels?  Of course not.  Goodell tells us that the seas rose by a mere six inches in the past century, and half of that was due to thermal expansion of the warming oceans.  While six inches is significant in some places, the wealthy cities were not likely to have been greatly affected.  But there are other effects to consider, overuse of water resources can cause groundwater loss that leads to a region sinking relative to the rising sea.  That is one of the reasons Venice has seen a dramatic increase in the number of flooding events in recent years.  New York City is also falling relative to the ocean level.  Goodell explains that phenomenon as a rebound from an uplift caused by the massive weight over North America during the last ice age.  The ice compressed the earth underneath causing a bulging upward of the uncovered areas.  New York is gradually lowering to a former level.

Goodell chose to devote chapters to the conditions in Venice, New York City, and Miami, because those cities already have critical issues with sea level even before the coming rise has become significant.  Flooding is frequent in both Miami and Venice when tides are particularly high.  New York City suffered considerably from the storm surge from Hurricane Sandy.  Surely cities already contending with major ocean-related issues will recognize the need to plan for the time when their current problems are extended to include a several foot increase in sea level?  We shall see.

Venice’s official concerns with the sea arise not from the recent rise in flooding events, but with a massive storm from over fifty years ago.  Venice is built in a lagoon with a passage to the open sea.

“On November 4, 1966, gale-force winds in the Adriatic Sea pushed a wall of water into the lagoon.  Venetians awoke to find their city under five or six feet of water.  Electricity was cut, heating-oil tanks swamped, ground floors submerged.  Strong winds kept the water in the city for the entire day.  When it finally retreated, it left the city full of broken furniture, wet garbage, dead animals, and raw sewage.  Miraculously, no one died.”

Clearly such an event was intolerable and must be prevented from happening again.  A number of solutions were considered before finally selecting one for funding (the MOSE barrier).  The idea was to put floatable barriers at each of the three inlets to the lagoon.  When not needed, the barriers would be filled with water and sink to the bottom.  When needed, air would be pumped in and they would rise and form a barrier.  That is way too simple a description for a very complex engineering problem, but that is basically what happens—or what is supposed to happen.  At the time of Goodell’s writing it was hoped to become operational in 2018.  As of yet, it has not happened.

There is a lesson to be learned from Venice’s experience.  Efforts to contend with the sea are complex, difficult to implement, and enormously expensive.  Even without conflicts over its need, becoming operational can take a very long time.

“After the 1966 flood, it took more than fifty years to settle on a plan to protect the city, then get it approved, funded, designed, and partially built.”

When the MOSE barrier was designed, sea level rise was not a high priority.  The device is thought to be able to handle only a 1-2 foot rise in sea level.  If seas rise by more than 2 feet, then water will begin to pour into Venice’s lagoon from other directions as well and the only way to protect the city will involve a wall completely surrounding it.  It is not clear that anyone has estimated how long it would take to build such a wall and how much it would cost.

New York City’s moment of truth when its relationship with the ocean changed forever, analogous to Venice after the 1966 flood, was Hurricane Sandy in 2012.

“Hurricane Sandy, which hit New York City in October 2012, flooding more than 88,000 buildings in the city, killing 44 people, and causing over $19 billion in damages and lost economic activity, was a transformative event.  It did not just reveal how vulnerable a rich, modern city like New York is to a powerful storm, but it also gave a preview of what the city may face in the coming century.”

New York, like many cities, chose to increase its area by building on landfills.  This guarantees that these areas will be at risk to storm surges and sea level rise immediately.  The most damaged areas after Sandy were in the landfill areas.  Sandy, now six years ago, is not the worst threat that the city can expect to encounter.  Meteorologists have long predicted that global warming will bring more intense storms to ride on top of the rising seas, and New York is particularly vulnerable.

“Finally, New York City is a sea-level-rise hotspot.  Because of changes in ocean dynamics, as well as the ground beneath the city is sinking as the continent recovers from the last ice age, seas are now rising about 50 percent faster in the New York area than the global average.”

New York City is moving much faster than Venice did to arrive at a solution.

“In 2018, the city planned to break ground on what’s called the East Side Coastal Resiliency Project, a ten-foot high steel-and-concrete-reinforced berm that will run about two miles from East Twenty-Fifth Street don to the Manhattan Bridge.  The project, which is budgeted at $760 million but will surely cost far more before it’s completed, is the first part of a larger barrier system, known informally as the Big U, that someday may loop around the bottom of Lower Manhattan….There are plans in the works to build other walls and barriers in the Rockaways and on Staten Island, as well as across the river in Hoboken.  But the Big U in Lower Manhattan is the headliner, not just because it cost billions to construct (rough estimates start at $3 billion and rise fast), but because Lower Manhattan is the most valuable chunk of real estate on the planet, as well as the economic engine for the entire region—if it can’t be protected then New York City is in deep trouble.”

What is built into the plan is the notion that the richest regions will be protected because one can’t protect the entire 520-mile city coastline.  The very act of protecting some areas is likely to direct waters preferentially at the unprotected areas.  It may be unavoidable, but even in the wealthy US, the poor are likely to bear the brunt of the pain.

New York City leapt into action and has created a plan of sorts.  That is to be applauded.  But the plan is to protect part of itself from another Hurricane Sandy.  When Goodell asked why the plan didn’t include protection from about five feet of additional sea level rise, he was told: “Because the cost goes up exponentially.”

So, the city moved much faster than Venice, but the net result is the same: protect from the threat that we know, not the bigger one that we don’t yet know.

Miami, and much of South Florida are among the most threatened places on Earth with respect to sea-level rise. 

“More than three-quarters of the population of Florida lives on the coast, where virtually every house, road, office tower, condo building, electrical line, water line, and sewer pipe is vulnerable to storm surges and high tides.  As the seas rise in the coming years, the vast majority of that infrastructure will have to be rebuilt or removed.  According to a report by the Risky Business Project, a group cofounded by billionaires Michael Bloomberg, Tom Steyer, and Henry Paulson, between $15 billion and $23 billion worth of Florida real estate will likely be underwater by 2050; by 2100 the value of the drowned property could go as high as $680 billion.”

And while New York can conjure up images of sea walls that will one day protect it, Miami has no such option.  It is built on porous limestone which water can easily penetrate.  Any wall would quickly see water levels equalized on each side.  South Florida must also worry, for the same reason, that salty sea water will penetrate sources of underground fresh water and destroy them.  Such occurrences have already happened, and they will become more frequent as sea level continues to rise.  Miami already experiences regular flooding episodes, not unlike those in Venice.  It is already common to view sea water bubbling up out of storm drains and flooding streets and landscaping whenever there is a high tide.  Everyone knows that this will only get worse.

Miami has only two options, it can elevate the city, or it can decide to live on the water not next to it.  Do either of these options make any sense?  Who will produce the studies, issue the calls for innovative proposals?  There is no one.  New York is a city of structures with high market value and high intrinsic value.  Miami is a city with structures of high market value and near zero intrinsic value.

“There are few corporate headquarters in South Florida, no manufacturing to speak of, no entertainment industry (except sports and porn).  Even the illegal drug market, which powered the Miami economy in the 1970s and 1980s, has declined.  The core business of Miami is real estate and tourism.  It is an empire of property and pleasure.”

Are a hundred thousand condo owners going to band together and form a political movement that will demand active countermeasures be taken to protect their property?  Will a bold political leader arise and demand increases in taxes so that plans can be formulated and implemented?  In Florida?

Goodell tells us that Miami is stymied by the fact that no one feels they own any of the coming risk.  The main reason for buying real estate in Miami is to turn a profit and move on.  Property owners have nothing to gain by raising issues that threaten their property’s value; rather, their concern is in understanding the issues sufficiently that they can cash in and leave before it is too late.

“….most condo owners keep their units for about four or five years—as long as they can get their money out, who cares what becomes of the place in twenty years?”

Miami, and much of South Florida seems doomed to a watery fate.  The rich will leave in an orderly fashion, but those who can’t take their property with them will have to leave it behind.  Like the Oakies of old they will possess what they can carry away.

Goodell is probably more optimistic about humans being able to deal with rising tides than this summary might indicate.  On the other hand, he did provide this interesting comparison.

“We’re not so different from the proverbial frog that boils to death in a pot of slowly warming water.”

The interested reader might find the following articles informative:

Climate Change: The Water Will Come by Jeff Goodell

Global Warming and the Resurrection of Dormant Diseases

Putting Climate Change in Perspective

Ground Zero for Sea-Level Rise: South Florida

Global Warming and the Holocaust’s Warning: It Can Happen Again

Geoengineering, Volcanoes, and Climate Change Experiments

Climate Change: The Water Will Come by Jeff Goodell

Global warming will bring the rise of sea level as melting ice pours into the oceans.  Sea level rise, as well as most other climate change impacts, is often projected to become significant in the distant future.  This detracts from the urgency of the issue and allows deferral of action to an undetermined future time.  However, climate change is already upon us and changes in sea level are already causing problems.  If we are ever to successfully adapt to coming conditions, we must begin now when changes are relatively mild rather than wait until they become catastrophic.  That is the message Jeff Goodell presents in his book The Water Will Come: Rising Seas, Sinking Cities, and the Remaking of the Civilized World.

“….if you live on a coast, what matters more than the height the seas rise is the rate at which they rise.  If the water rises slowly, it’s not such a big deal.  People will have time to elevate roads and buildings and build sea walls.  Or move away.  It is likely to be disruptive, but manageable.”

“Unfortunately, Mother Nature is not always so docile.  In the past, the seas have risen in dramatic pulses that coincide with the sudden collapse of ice sheets.  After the end of the last ice age, there is evidence that the water rose about thirteen feet in a single century.  If that were to occur again, it would be a catastrophe for coastal cities around the world, causing hundreds of millions of people to flee from the coastlines and submerging trillions of dollars of real estate and infrastructure.”

The options available will, of course, depend on the wealth of the affected country, and, as usual, the poor will suffer the most.

“Globally, about 145 million people live three feet or less above the current sea level.  As the waters rise, millions of these people will be displaced, many of them in poor countries, creating generations of climate refugees that will make today’s Syrian war refugee crisis look like a high school drama production.”

What do we know about the rate of sea level rise?  Not much, as it turns out.  What we know for sure is how much water is currently captured in Greenland and Antarctica.

“Antarctica is about seven times bigger than Greenland and contains much more ice.  If the whole continent were to melt (a scenario that would likely take thousands of years), it would raise the Earth’s sea levels by about two hundred feet.  If all of Greenland were to go (a scenario that would take significantly less time), it would raise sea levels about twenty-two feet….Right now melting from Greenland contributes roughly twice as much to current sea-level rise as Antarctica—but that may change in coming decades.”

The situation in Antarctica is particularly complex.  Melting from warmer air is not the main issue.  Rather it is melting from below caused by warmer waters.  The ice sheets extend beyond the land mass and terminate in the sea.  Warming waters could cause these extended ice regions to fracture and break off.  That could trigger instability of the thick ice masses behind causing much more rapid sea rise than expected from a simple melting process.

Even predicting melt rates from a warming atmosphere is fraught with uncertainty.

“In the past twenty years, the Arctic has warmed by more than three degrees Fahrenheit, roughly twice as fast as the global average.  As the ice melts, the region’s albedo, or reflectivity, changes.  Clean, fresh snow is one of the most reflective substances known in nature, reflecting away more than 90 percent of the sunlight that hits it.  But as the ice softens, its structure alters, lowering the reflectivity and absorbing more heat.  As it melts away, more water and more land are exposed, both of which are darker, and both of which absorb still more heat.  This in turns melts more ice, creating a feedback loop that can accelerate quickly.”

Scientists feel most comfortable trying to predict sea level rise out to the end of the current century using their best physical models and incorporating various scenarios for greenhouse gas production.  But they do not feel much confidence in the accuracy of their predictions.

“’We just don’t know what the upper boundary is for how fast this can happen.’  Richard Alley, a geologist at Penn State University who probably understands ice sheet dynamics better than anyone, told me.  ‘We are dealing with an event that no human has ever witnessed before.  We have no analogue for this’.”

Estimates of how high the seas will rise by 2100 are highly uncertain, but there is a definite tend toward higher sea levels.  The last official estimate by the Intergovernmental Panel on Climate Change (IPCC) came out in 2013 predicting a maximum anticipated rise of about 3 feet 2 inches.  Since the data available for that estimate was used, scientists observed an anomalously high ice melt event in Greenland and surprising ice sheet breakups in Antarctica that have raised concerns that the 2013 estimate may be way too conservative.  Unofficial estimates now range from about 3 feet up to as much as 15 feet.  Recall Goodall’s statement that 145 million people live on land that will be submerged by a 3-foot rise.  A 6-foot rise would be much more disruptive.

Much of Goodell’s book deals with interactions with cities and states threatened by rising sea levels.  Many people agree that the seas are rising and will continue to do so.  However, the ones that are planning to protect their cities are those that have already suffered damage from rampaging waters via storm surges such as New York City and Venice, Italy.  These polities have gained permission to invest the resources to protect themselves from future similar surges because it has become clear that the events could occur again.  Building additional protection for future sea rise seems to be a too far off a concern to justify the additional expense. 

Goodell was often presented with this this perspective: “Who cares?  I’ll be dead by then.”  Well, somebody should care.  The year 2100 is within the life span of the very young.  A 30-year-old might expect to live until 2075-2080.  If any of these estimates of sea-level rise are accurate the world will become a much different place during their lifetime.

“….we are not wired to make decisions about barely perceptible threats that gradually accelerate over time.  We’re not so different from the proverbial frog that boils to death in a pot of slowly warming water.”

Goodell provides a final thought.

“The real x-factor here is not the vagaries of climate science, but the complexity of human psychology.  At what point will we take dramatic action to cut carbon dioxide pollution?  Will we spend billions on adaptive infrastructure to prepare cities for rising waters—or will we do nothing until it is too late?  Will we welcome people who flee submerged coastlines and sinking islands—or will we imprison them?”

The interested reader might find the following articles informative:

Global Warming and the Resurrection of Dormant Diseases

Putting Climate Change in Perspective

Ground Zero for Sea-Level Rise: South Florida

Global Warming and the Holocaust’s Warning: It Can Happen Again

Geoengineering, Volcanoes, and Climate Change Experiments

Yet Another Crazy Gun Law in the United States

In 2004, Congress passed the Law Enforcement Officers Safety Act (LEOSA).  This act, given its title, tried to codify a special privilege for law enforcement officers of nearly all varieties to have concealed-carry firearm permission anywhere in the United States, regardless of local law or local police practice.  This privilege was also extended to retired officers provided they fulfilled certain yearly certification requirements.  From Wikipedia:

“The Law Enforcement Officers Safety Act (LEOSA) is a United States federal law, enacted in 2004, that allows two classes of persons—the ‘qualified law enforcement officer’ and the ‘qualified retired or separated law enforcement officer’—to carry a concealed firearm in any jurisdiction in the United States, regardless of state or local laws, with certain exceptions.”

This right to concealed-carry was available to federal officers, but not to state and local officers.  LEOSA was intended to fix that, and to extend the right to certain retired officers.  The legislation was pushed by police organizations and lobbied against by police administrators who feared loss of control and the chaos that might ensue when local police interacted with unknown gun carriers whose legality could not verified.

The legislation seemed to assume that officers would be carrying their firearms around and would be able to leap into action whenever a crime was encountered.  One goal of the law was to protect officers from liability for whatever followed from their actions. The following quote from the House version of the bill that was ultimately passed into law suggests that the recent 9/11 terrorism attack weighed heavily on the legislators.

“LEAA [Law Enforcement Alliance of America] argues that this legislation will ‘allow tens of thousands of additionally equipped, trained and certified law enforcement officers to continually serve and protect our communities regardless of jurisdiction or duty status at no cost to taxpayers.’ FOP [Fraternal Order of Police] contends that this legislation will help its members to protect citizens in the wake of a terrorist attack and that it is even more necessary since September 11, 2001.”

 Explicit in this law is the assumption that every law enforcement officer is an exemplary citizen who will always know what to do in any situation encountered.  Given recent history, many people might consider that concept to be rather naïve.  It would be interesting to know the statistics associated with off-duty officers using their weapons, but that is a discussion for another time.

The reason the term “crazy” was used with respect to this law was not to criticize the use of weapons by off-duty policemen and policewomen.  That may be efficient in terms of law enforcement.  Rather, the goal was to point out that any good intention can be perverted and produce unintended consequences.

Think not of current urban law enforcement, but rather of rural regions with low population density.  Few people means few police officers and a lot of ground to over.  One recalls the old westerns where a sole sheriff deputizes a bunch of local residents to go out and apprehend a horse thief or cattle rustler.  Apparently, there is a modern version of this where law enforcement agencies extend the status of “deputy” or an equivalent title to lightly trained individuals who spend a little time working at law enforcement.  These part-time or weekend officers can also gain the right to concealed-carry throughout the nation.  In this context, the law invites abuse.

From Wikipedia, a qualified enforcement officer under LEOSA is one who is authorized to carry a gun by a law enforcement agency and…

“….is authorized by law to engage in or supervise the prevention, detection, investigation, or prosecution of, or the incarceration of any person for, any violation of law, and [sic?] has statutory powers of arrest, or apprehension under section 807(b) of title 10, United States Code (article 7(b) of the Uniform Code of Military Justice); This includes state and public college/university police officers.”

Zachary R. Mider produced an article for Bloomberg Businessweek that looked into the practice of gaining concealed-carry authorization by establishing a limited association with a police agency: Robert Mercer’s Secret Adventure as a New Mexico Cop.  Yes, the person referred to is the same Robert Mercer, billionaire, famous, or infamous, for his support of Donald Trump’s election campaign and various other extreme right-wing activities.

Lake Arthur is a small town with a population of 433.  It has a police department with one full-time employee, Police Chief William Norwood.  Norwood chose to encourage the use of “reserve officers” in order to have company on his long drives through the area he patrols, or to have “backup” as he refers to them.

“Norwood formed the reserve program in 2005, not long after he joined the department. With the nearest backup a half-hour or more away, he didn’t like the idea of patrolling solo, so he turned to a couple of Army buddies for volunteer help. The program expanded by word of mouth. At one point a few years ago, there were almost 150 reserve officers—that’d be a ratio of one to every 2.9 residents—and Norwood, who prefers patrolling to paperwork, acknowledged he wasn’t giving the program the oversight it needed. In 2016 a reserve captain took over administrative duties, tightened up policies, and cut the number of reservists almost in half. Last year, Norwood stopped accepting new members altogether. But even this smaller force is enough to provide him with a visiting reservist or two on any given day, free of charge.”

And who are these people who flock to Lake Arthur at considerable personal expense to perform police duties for a few days per year?

“Norwood and three part-timers are buttressed by 84 reserve officers, most of whom live hundreds or even thousands of miles away. There are Lake Arthur reservists in San Diego and Virginia Beach. Several are among the most elite soldiers on Earth—former U.S. Navy SEALs. Many are high-dollar bodyguards or firearms instructors, and almost all of them are serious gun enthusiasts. On that count, Mercer fits right in. He once built a personal pistol range in his basement. Through a company he co-owns, Centre Firearms Co., he has a vast collection of machine guns and other weapons of war, as well as a factory in South Carolina that makes assault-style rifles.”

Norwood insists that none of these “reserve officers” receives special treatment.  Therefore, each are willing to go on patrol at least six days each year, paying for their own travel, lodging and food, a firearm, and body armor.  It seems there are a number of people who are willing to spend a lot of money and time to obtain what money alone can’t buy: concealed-carry privilege anywhere in the United States.  They don’t fit the image of solid-citizen police officers who carry their guns hoping, in their spare time, to intercede in the fight against crime.

“Norwood refused to discuss Mercer or any other individual reservist but said that if a person simply wanted concealed-carry rights, volunteering for his squad wouldn’t be worth the trouble: Department rules require 96 hours of patrol work and 20 hours of training a year. He added that while reservists are encouraged to carry their weapons off-duty for protection, they’re not allowed to use their concealed-carry privileges for outside work. (Later, after I showed Norwood the LinkedIn accounts of two men who seemed to be doing just that—security contractors touting their ability to carry guns anywhere—the men faced ‘severe’ disciplinary action, a department spokesman said.)”

How common are situations like that in Lake Arthur?

“Since the law took effect, a few police and sheriff’s departments around the country have been rumored to hand out badges to buddies or in exchange for cash. The gun community calls them ‘badge factories.’ Questions about whether Lake Arthur was such a place swirled last year on a popular gun chat room, after a noted firearms expert from North Carolina who was also a reservist got drunk and accidentally shot his brother-in-law in the leg. (Norwood quickly stripped him of his badge.)”

The Law Enforcement Officers Safety Act may have been sold as an attempt to free full-time officers to counter crime and criminals 24/7 while protecting them from liability for their off-duty actions, but from todays perspective it appears as just another ploy to put more guns on the street.  This seems an opening stage to the marketing of the concept that if every “good guy” carried a gun the “bad guys” wouldn’t dare commit a crime. 

What is always forgotten, or ignored, is the fact that a considerable fraction of injuries and deaths from guns are attributed to accidents and suicides.  And those activities are proportional to the number of guns in play.  The harm from putting more guns in circulation exceeds any crime fighting benefit that might accrue.

The interested reader might find the following article informative:

Guns, Armed Citizens, Crime, and Massacres

Antidepressant Drugs versus Placebos

Irving Kirsch is well-known psychology professor who specializes in what is referred to as response expectancy theory.  The basis for this line of research is the perfectly reasonable assumption that what people experience in a given situation is influenced by what expectations they have.  Such considerations are very important in clinical tests of medications where comparisons are made between the responses of patients who are provided either the drug under study or an inert substance, a placebo.  Patients are not told which type of pill they receive.  Often, patients receiving a placebo will claim to have benefited from it.  This is referred to as a “placebo effect.”

Placebo effects are particularly important with psychotropic drugs used in addressing mental illnesses.  There are few if any physical markers for mental illness other than observable behaviors or experiences reported by the patient.  There are no blood tests to analyze, no tumors to measure, and no way to be certain that drug effectiveness is not mostly or entirely a placebo effect.  What are available are clinical tests, usually provided by the pharmaceutical company trying to market the drug under investigation.  The dirty reality of medical science is that these studies are notoriously easy to game in order to produce desired results.  One must be careful in evaluating them.  A researcher named John Ioannidis published an analysis of a collection of some of the best-known, and most widely-accepted clinical studies and concluded that most of them had systematic errors, improper uses of statistical analyses, or researcher bias associated with them, and were thus of suspect validity.  A number of the clinical results could not be reproduced by subsequent studies.  David H. Freedman was motivated by Ioannidis’s work to produce the article Lies, Damned Lies, and Medical Science for The Atlantic in 2010. 

Kirsch became famous and controversial for his studies of the placebo effect with respect to antidepressant drugs.  In 2008, he published an analysis of clinical tests studying the effectiveness of several antidepressant drugs.  This is not a trivial exercise because drug companies rarely publish anything but favorable results.  Nevertheless, they are supposed to provide a complete suite of studies to regulatory agencies like the FDA.  Kirsch gathered as much of the data as he could and concluded that the drugs, while statistically better than a placebo, did not have an effect large enough to be considered clinically significant.  In other words, they didn’t work as advertised. The media outlets picked up on this and proclaimed that “antidepressants don’t work.”

A new analysis was recently published in Lancet (February, 2018): Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis.  The main author on this work was Andrea Cipriani.  This effort analyzed data on more drugs and a much larger sample size of participants.  The published results reached the general public with media claims such as “It’s official, antidepressants work,” and “Study proves antidepressants work.”  The problem with these claims is that the new study actually shows that by one measure, antidepressants are slightly less effective than Kirsch claimed when they were deemed to be useless by the press.  What is going on?

A writer for Discover magazine who goes by the name “Neuroskeptic” provides some insight in About That New Antidepressant Study. 

“The truth is that while the Lancet paper is a nice piece of work, it tells us very little that we didn’t already know, and it has a number of limitations. The media reaction to the paper is frankly bananas, as we’ll see below.”

“Here’s why the new study doesn’t tell us much new. The authors, Andrea Cipriani et al., conducted a meta-analysis of 522 clinical trials looking at 21 antidepressants in adults. They conclude that “all antidepressants were more effective than placebo”, but the benefits compared to placebo were “mostly modest”. Using the Standardized Mean Difference (SMD) measure of effect size, Cipriani et al. found an effect of 0.30, on a scale where 0.2 is considered ‘small’ and 0.5 ‘medium’.”

“The thing is, ‘effective but only modestly’ has been the established view on antidepressants for at least 10 years.”

The author also points out that Kirsch’s negative study actually assigned a slightly greater effectiveness to the drugs, making the public response to the new study rather ridiculous.

“Cipriani et al.’s estimate of the benefit of antidepressants is also very similar to the estimate found in the notorious Kirsch et al.  ‘antidepressants don’t work’ paper! Almost exactly a decade ago, Irving Kirsch et al. found the effect of antidepressants over placebo to be SMD=0.32, a finding which was, inaccurately, greeted by headlines such as ‘Anti-depressants “no better than dummy pills”’.”

Neuroskeptic provides this conclusion.

“Overall, there’s no big surprises here. The new paper confirms what we already knew about antidepressants, and the media confirmed what we knew about the media.”

Neuroskeptic also raised an extremely serious issue that remains unresolved: antidepressant drugs could owe their limited effectiveness entirely to the placebo effect.

“Another caveat is that a meta-analysis is only as good as the data that goes into it, and one concern that hangs over pretty much all antidepressant trials is the issue of unblinding….. According to some people, all of the benefits of antidepressants might just be a placebo effect, driven by people who feel side-effects and then assume that the drug must be working, making them happier. I don’t subscribe to this view but there is very little good evidence either way.”

Given this state of affairs, what does a practicing psychiatrist do?  Daniel J. Carlat provides his view in Unhinged: The Trouble with Psychiatry - A Doctor's Revelations about a Profession in Crisis.

“If you ask any psychiatrist in clinical practice, including me, whether antidepressants work for their patients, you will hear an unambiguous ‘yes.’  We see people getting better all the time.  True, much of this response is undoubtedly due to the placebo effect, but it would be deceptive for me to prescribe a sugar pill to my patients while telling them that it is a real medication.  So I am stuck with prescribing active psychotropic drugs in order to activate the placebo, with the main disadvantage being that such drugs have far more side effects.”

Carlat also provides some interesting insight into the dangers inherent in assuming clinical trials are providing valid information.

“Companies have found by experience that if they want to be sure their drug outperforms a placebo, they have to be very picky about which patients are allowed into the study.  They want patients with ‘pure’ depression, unblemished by messy problems, alcohol use, anxiety problems, or bipolar disorder.  Furthermore, because of reasonable worries about the safety of patients who might be assigned to a sugar pill, these studies exclude patients with suicidal thoughts.  Other common exclusion criteria include an active medical illness, depression that is too mild, or conversely, depression that has lasted too long.”

Carlat wondered whether any of his own patients would have been allowed to participate in one of these studies.

“Mark Zimmerman, a psychiatrist at Brown University had this same thought and decided to test it.  He identified 346 depressed patients who had shown up for treatment at Rhode Island Hospital’s department of psychiatry.  Then he pretended that each one was applying for a spot in a typical antidepressant research study, and applied each of the many exclusion criteria commonly used.  Only twenty-nine out of the 346 patients, or 8.3 percent, would have gained entry into this exclusive club.  The only Ivy League college that matches this is Harvard, which had a 7.1 percent admission rate in 2008.”

This leads to this conclusion from Carlat.

“The bottom line is that antidepressant research studies are not generalizable to real patients, meaning that few of their results, whether positive or negative, are reliable indicators of what would happen to your mood on antidepressants.”

Yep—lies, damned lies, and medical science.