Tuesday Reads

reading.outsideGood Morning!!

As the record-breaking heat wave continues in the West, firefighters in Arizona continue to fight the wildfires that killed 19 of their compatriots last night. NBC News reports:

Firefighters battling the Arizona blaze that killed 19 elite colleagues faced a tough task on Tuesday amid an excessive heat warning issued by the National Weather Service. Gusting winds of up to 20 mph threatened to fan the flames near Yarnell, Arizona, and officials were wary about propane tanks known to be in the town of 700 people. The dead firefighters’ colleagues continued to battle the raging blaze that by 9:30 p.m. local time Monday (11:30 p.m. ET) was zero percent contained. More firefighters are expected to join the 500-strong group. As the community began to mourn the loss of the men decribed as “heroes” by President Barack Obama, medical examiners were due to begin carrying out autopsies in the wake of the area’s “largest mass-casualty event in memory.”

The names of the men killed are:

Anthony Rose, 23; Eric Marsh, 43; Robert Caldwell, 23; Clayton Whitted , 28; Scott Norris, 28; Dustin Deford, 24; Sean Misner, 26; Garret Zuppiger, 27; Travis Carter, 31; Grant McKee, 21; Travis Turbyfill, 27; Jesse Steed, 36; Wade Parker, 22; Joe Thurston, 32; William Warneke, 25; and John Percin, 24; Kevin Woyjeck, 21; Chris MacKenzie, 30; and Andrew Ashcraft, 29.

From the Wall Street Journal: Sudden Turn in Flames Doomed Firefighters.

The men, aged between 21 and 43, were members of the Granite Mountain Interagency Hotshot Crew who endured grueling training together before being dispatched to battle wildfires nationwide. Based in Prescott, only 34 miles away from Yarnell, they knew the terrain. But late Sunday afternoon, the firefighters radioed from their positions on the ground that they were in trouble. A short time later, a helicopter pilot reported to the Arizona State Forestry’s dispatch center in Phoenix that firefighters were attempting to shelter themselves west of Yarnell under fire-shelter covers, a heat-resistant specialty fabric made of aluminum foil, woven silica, and fiberglass—their last line of defense. Smoky conditions and heat made it difficult to check on the firefighters. “It felt like forever,” said Carrie Dennett, state fire-prevention officer for Arizona State Forestry. What rescuers eventually found was that the men had been caught in a “burn over,” a sudden change in the direction of the fire that overtook them faster than they could get out of the way, according to a spokesman with the Prescott Fire Department.

Heartbreaking.

Edward Snowden’s search for a country that will grant him asylum continues.

This morning the list of countries he had applied to increased to 21, but so far none has offered to shelter him, according to CBS News. Snowden withdrew his request to Russia after Vladimir Putin said Snowden would have to stop leaking information designed to hurt the U.S.

CBS News correspondent Elizabeth Palmer reports that behind the scenes, the U.S. and Russia have been talking non-stop about how to resolve the Snowden conundrum. President Putin is between a rock and a hard place, explains Palmer; he won’t expel Snowden into U.S. custody, but he hopes to limit the damage to U.S.-Russian relations. With Snowden’s withdrawal of the asylum request to Russia, Palmer says, you could almost hear a sign of relief from the Kremlin. Poland rejected Snowden’s asylum request on Tuesday, and officials in Germany, Norway, Austria, Spain and Switzerland said that he could not apply for asylum from abroad. Many European countries require an asylum request to be made on their soil. Later Tuesday, India’s External Affairs Ministry said it had carefully examined Snowden’s request and decided to turn it down. Ministry spokesman Syed Akbaruddin told reporters the government had “concluded that we see no reason to accede to that request.” Venezuelan President Nicolas Maduro, coincidentally wrapping up a long-planned visit to Moscow, said Tuesday that his government had not yet received an official asylum request from Snowden, but that it would be considered if and when received.

The massive protests continue in Egypt.

From The Washington Post: Egypt protesters step up pressures with president facing military deadline and internal rifts.

CAIRO — With a military deadline for intervention ticking down, protesters seeking the ouster of Egypt’s Islamist president sought Tuesday to push the embattled leader further toward the edge with another massive display of people power. Meanwhile, Mohammed Morsi faced fissures from within after a stunning surge of street rage reminiscent of Egypt’s Arab Spring revolution in 2011 that cleared the way for Morsi’s long-suppressed Muslim Brotherhood to win the first open elections in decades. Three government spokesmen were the latest to quit as part of high-level defections that underscored his increasing isolation and fallout from the ultimatum from Egypt’s powerful armed forces to either find a political solution by Wednesday or the generals would seek their own way to end the political chaos. The Cabinet, led by the Morsi-backed Prime Minister Hesham Qandil, was scheduled to meet later Tuesday. But the defense and interior ministers were expected to boycott in a sign of support for the military’s warnings. The police, which are under control of the Interior Ministry, have stood on the sidelines of the protests, refusing even to protect the offices of the Muslim Brotherhood that have been attacked and ransacked.

President Obama weighed in on the Egyptian situation yesterday. From Bloomberg Businessweek:

President Barack Obama told Mursi in a telephone call yesterday that the U.S. “is committed to the democratic process in Egypt and does not support any single party or group,” according to a White House statement. Obama encouraged Mursi “to take steps to show that he is responsive” to the concerns of demonstrators, stressing “that democracy is about more than elections, it is also about ensuring that the voices of all Egyptians are heard and represented by their government.” During the conversation, Obama “underscored his deep concern about violence” and sexual assaults during the demonstrations and urged Mursi “to make clear to his supporters that all forms of violence are unacceptable,” according to the statement.

In other news,

There’s an interesting article in the Wall Street Journal by Samuel T. Wilkinson on the connection between marijuana and schizophrenia. Years ago the boyfriend of one of my closest friends developed schizophrenia after years of heavy daily pot-smoking. At the time I suspected that there was a connection. He probably had a genetic tendency toward the disease that might not have manifested without the marijuana use. Wilkinson writes:

Recent legislation has permitted the recreational use of marijuana in Colorado and Washington state. Those who support legalization often tout the lack of serious medical consequences associated with the drug. Most of us know people who used marijuana in high school or college and seem to have suffered no significant medical consequences. As the medical and scientific literature continues to accumulate, however, it is becoming clearer that the claim that marijuana is medically harmless is false. There is a significant and consistent relationship between marijuana use and the development of schizophrenia and related disorders. Schizophrenia is considered by psychiatrists to be the most devastating of mental illnesses. Patients who suffer from it often experience auditory or visual hallucinations, severe social withdrawal and cognitive impairment. Many require frequent and prolonged hospitalization in psychiatric wards. Schizophrenia affects almost three million Americans—more than six times the number of people with multiple sclerosis, two and a half times the number of people with Parkinson’s disease, and more than twice the number of people with HIV/AIDS. Less than one-third of patients with schizophrenia can hold a steady job or live independently. A large portion (about one-third) of homeless people in the U.S. suffer from the disease. Though they receive little attention in the legalization debate, the scientific studies showing an association between marijuana use and schizophrenia and other disorders are alarming. A 2004 article in the highly respected British Journal of Psychiatry reviewed four large studies, all of which showed a significant and consistent association between consumption of marijuana (mostly during teenage years or early 20s) and the later development of schizophrenia. The review concluded that marijuana is a “causal component,” among others, in the development of schizophrenia and other psychotic disorders.

I hope everyone will read this article. I don’t think anything is going to stop the legalization of marijuana at this point, but we need to be aware of the dangers of this drug to young people. Schizophrenia is a very serious illness that develops in early adulthood, usually before age 35. It is partly genetic but is usually triggered by some kind of environmental stress. Marijuana use appears to be one possible trigger. A high percentage of people with schizophrenia end up committing suicide.

A large 5-year World Health Organization study consisting of the follow-up of 1056 patients exhibiting psychotic symptoms found the most common cause of death in those with schizophrenia was suicide (Sartorius et al, 1986). In their review of the subject Caldwell and Gottesman (1990) found that 9-13% of patients with schizophrenia eventually commit suicide. At least 20-40% make suicide attempts (Meltzer & Fatemi, 1995) and 1-2% go on to complete in their attempt within the next 12 months (Meltzer & Okayli 1995). Therefore, suicide in schizophrenia has long been a major area of concern and research efforts.

In Denmark, Mortensen and Juel (1993) used the national case register to retrospectively examine mortality in a sample of 9156 patients following their first admission with schizophrenia, and reported 50% of males and 35% of females went on to commit suicide during the 17-year study period, with the relative risk of suicide increasing by 56% over this time. This suggests that the current level of risk is not stable, and is certainly not improving. The devastation that suicide brings for relatives, as well as the immense personal suffering the victim endures, must surely make this one of the most pressing issues for psychiatry to address. Carers and professionals are often left with feelings of profound ineffectualness and guilt in the face of suicide, and so it is vital for clinicians to feel confident in their understanding of risk assessment and management in this particularly vulnerable group.

My friend never recovered significantly; and the last I heard, he continued to have delusions and cognitive distortions. I doubt if he stayed on anti-psychotic medications–that wasn’t his style. He was employed at times and managed to stay in touch with some friends. But he was a completely different person than before he developed the disease. Before, he was a talented musician and earned a living playing in an Irish folk group. He was gregarious and had a many friends. For those of us who knew him, it was as if that person died and someone else took his place.

I’ll end there and turn the floor over to you. What are you reading and blogging about today?