...University of B.C. psychiatrist Dr. Joseph Noone, who deals daily with extremely agitated patients, told the commission there is no such medical term as "excited delirium." It's a term used by police officers to describe someone who is in an agitated and violent state, usually cocaine-induced, and who exhibits abnormal strength and excessive body heat. "It's basically an excuse for everything that happens and an excuse to blame it on the person who dies and not on the person [arresting him]," he said. "It provides a convenient post-mortem explanation for in-custody deaths where physical and mechanical restraints and conducted-energy weapons were employed." [LINK]
Remember - it was Taser that sent out brochures to every medical examiner and coroner in the land promoting 'Excited Delirium' as an explanation for taser-associated deaths.
Remember - Taser's own lawyer Michael Brave has registered the domain name ExcitedDelirium.com [no dash] and redirected all traffic to IPICD, a tiny privately-held company (pretending to be an 'Institute...') with multiple ties to Taser.
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Well, that's what happens when you have a psychiatrist opining about pathology. The concept of excited delirium has actually been around since the mid-19th century (where it was called "Bell's mania").
However, the reason that pathologists use the term "excited delirium" is because we describe it as a syndrome, not a disease. A syndrome is merely a collection of signs and symptoms that occur together without a specific indication of etiology (cause).
Let me use SIDS as an example. "Sudden Infant Death Syndrome (SIDS)" is a description of the death of an infant in the absence of otherwise diagnostic findings at autopsy or investigation of the scene or history. There is no such thing as the "disease" of SIDS -- it is instead the end point of a number of different things. As different diagnostic criteria are discovered, the deaths are removed from the classification of SIDS and moved to the new classification. Thus, in my jurisdiction, for instance, with the recognition of prone position as a risk factor for sudden death, I no longer classify such cases as SIDS, but instead "Sudden unexpected infant death in the presence of prone position." One of the interesting things about this is that people who don't understand this classification issue point to the great "success" in the drop in the number of SIDS deaths and don't recognize that while there has been some success, a lot of it is merely the result of reclassifying the deaths.
Similarly, "excited delirium" describes a particular constellation of signs, symptoms, and findings. It does not imply a specific cause (such as sympathomimetic poisoning with something like methamphetamine). The syndrome was first described in the 19th century as a psychiatric condition (while your psychiatrist expert may not recognize "excited delirium" he would acknowledge "agitated delirium"). In fact, of the last three cases I investigated of this, two had no drugs on board. One was in diabetic ketoacidosis and the other had no anatomic findings other than increasing delirium and sudden death. Neither had been TASED in proximity to death.
Thus, your psychiatrist is wrong. He is wrong that it is not recognized in the medical profession. A MEDLINE search reveals 34 articles in the peer-reviewed literature on it. The fact that psychiatrists use a slightly different term does not mean that other specialties cannot use terms that are more appropriate for their specialties.
There is a post on this blog imagining a maker of military flame-throwers blaming Spontaneous Human Combustion for the burnt humans. You should review it to compare it the relationship between Taser and E-D.
There is another post on this blog where the state of mid-19th century medical science was revealed by revisiting the ridiculous medical term 'Hysteria' (remember that?). So claiming that E-D has been around for many years is nothing to boast about and has nothing to do with the main point.
The Nobel Prize-winning physicist Richard Feynman made a very clear distinction between 'naming' and 'knowing'. Your post makes it clear that 'Excited Delirium' is simply a place-holder name to mark the spot where expert knowledge ends.
In that sense, it is extremely misleading when E-D is mentioned as a CAUSE of death (as it has been many times). It would be more honest to sometimes report 'Cause of Death: Don't know.'
Many taser critics feel that Taser has grasped at E-D as a convenient excuse for mysterious deaths.
But E-D is not exclusive to taser incidents, and nobody claimed that it was. That's a strawman argument of your own construction.
It is not a coincedence that the domain name ExcitedDelirium.com (no dash) is owned by Taser's lawyer Mr. Brave and he has redirected it to an organization with multiples ties to Taser.
Our criticisms of E-D are not directed at the history of the science of pathology. The criticism relates to Taser's massive PR effort using E-D. They sent brouchures to every coroner and medical examiner they could find. And they have sued coroners to change their findings. They invite coroners to conferences.
It's all in the blog.
But thanks for your comment. It is nicely written and it's a perfectly fair part of the debate.
"In that sense, it is extremely misleading when E-D is mentioned as a CAUSE of death (as it has been many times). It would be more honest to sometimes report 'Cause of Death: Don't know.'"
No, it's no more misleading to call Excited Delirium a cause of death than it is to call SIDS a cause of death (or AIDS a cause of death before we knew what caused AIDS), or for that matter sudden arrhythmic cardiac death -- which can be observed and for specific cases there is often not a known specific etiology.
You contradict yourself in your claim that noting the long history of excited delirium is irrelevant. It refutes your claim that it is not recognized in the medical profession or the medical literature. You can't have it both ways. You can't claim that excited delirium isn't real because it's not recognized, and then say that it's irrelevant that it is recognized when it is shown to be.
"The criticism relates to Taser's massive PR effort using E-D."
I think you need to realize that your complaint that TASER is making much of excited delirium does not imply that excited delirium does not exist. That some group may mistate the implications of a diagnosis does not invalidate that diagnosis.
In fact, I believe that TASER is implying the wrong things about excited delirium in conferences such as the IPICD. They are conflating excited delirium with "sympathomimetic poisoning syndrome with malignant hyperthermia." In the coming years, this conflation will cause some problems, particularly with the work that looks at serotonin receptors and excited delirium.
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