And furthermore, would you be willing to make the change if it meant making changes to the water supply?
From The Big Think
Adding trace amounts of lithium to the drinking water could limit suicides. Two studies, a recent one in Japan and an older one in Texas, have shown that this naturally occurring substance, used as a psychotropic drug to combat bipolar disorder, could have beneficial effects for society: Communities with higher than average amounts of lithium in their drinking water had significantly lower suicide rates than communities with lower levels. Regions of Texas with lower lithium concentrations had an average suicide rate of 14.2 per 100,000 people, whereas those areas with naturally higher lithium levels had a dramatically lower suicide rate of 8.7 per 100,000.
A gated version of the study is available here. There are other benefits beyond a reduction in suicides. From the Texas study:
[T]he homicide rates during the decade studied were consistently lower (by 30-50%) in the high- than the medium- or low-Li counties. The incidences of robbery, burglary, theft and the total crime rates were also lower in the high-Li counties, but the respective differences involving assault were statistically significant.
Drug use was also lower in the area with the highest natural occurring lithium concentrations.
One question I've never seen answered is: How much would it cost a low-lithium city to artificially boost their concentrations to the highest level? We have experience adding trace elements to the water supply (fluoride), so it can certainly be done.
I decided to do a very rough back-of-the-envelope type calculation to see what the cost per person in lithium is.
I am not a chemist, but my understanding is that a city that wanted to increase the elemental lithium in the water supply would use lithium carbonate (if I'm mistaken here, please let me know). The largest bulk price I could find for lithium carbonate is 50kg for $3842.82 (Source), which works out to $76.86/kg or 7.686 cents per gram. This should only be used as a rough estimate – the price may be lower (because a city would be buying in far larger quantities) or higher (because the city would need a grade with less impurities than the one quoted). But for a rough back-of-the envelope calculation, it works.
A city with no-to-little elemental lithium would need to add 70 micrograms/L of elemental lithium to the water supply. Since we're adding lithium carbonate (not pure lithium), we would need roughly 200 micrograms/L. (For reference, there are a million micrograms in a gram).
The average Canadian domestic user uses just over 100,000 L of water a year (Source). At 200 micrograms/L, we would need to add roughly 20 grams per person of lithium carbonate for a total cost of $1.53 per person, or $153,000 per 100,000 people.
The city of Toronto has 3.3 murders/100,000 people (Source). A 30% reduction in this rate would lower it by 1 murder per year per 100,000 people. If our rough back-of-the-envelope calculations are correct and the lithium carbonate method works like the Texas study suggests, $153,000 buys us one less murder. That does not take into account the reductions in rapes, suicides, drug use or thefts.
Will it work? I don't know. It seems like it would be worthy a pilot study or two. Although those levels of elemental lithium are believed to be safe, there may be side-effects we are not considering. There are ethical considerations as well, but it is hard to make a case that adding fluoride to the water supply is ethical but lithium is not – and we've been adding fluoride to drinking water for over half a century.
Edited to add: The Texas study grouped counties into four groups: High lithium (70-160 micrograms), Medium (15-60), Low (0-12) and Low excluding big cities (0-12). If we compare the first group to the fourth, high lithium counties have, per 100,000 population:
- 5 fewer murders
- 5 fewer suicides
- 22 fewer rapes
- 310 fewer burglaries
- 751 fewer thefts
(all of which are statistically significant at the 5% level). There may be a multitude of other factors causing this than lithium levels. There is no guarantee that artificially raising lithium levels to get a county to go from low-lithium to high-lithium would provide these results. But given a (very rough) cost of $153,000 per year, isn't it worth investigating?
Worthwhile Canadian Initiative 
$153k per life saved is really cheap. IIRC, government departments like Transport Canada have costs per life saved of a few millions. Most estimates from value of life studies are in the millions, IIRC. So it’s cheap by a whole order of magnitude.
Still, it gives me the heeby-jeebies as a policy proposal. I must reflect on why.
“Still, it gives me the heeby-jeebies as a policy proposal.”
Me too. Which is weird when you think about it, because my response to fluoride in the water supply is ‘meh’. Why is one okay but not the other?
Also, I agree it is really, really cheap. So much so that I kept checking my figures because I had assumed I made a mistake somewhere.
Does Toronto have a low murder rate already? Save the lithium for Detroit.
“Although those levels of elemental lithium are believed to be safe, there may be side-effects we are not considering.” This line undermines the whole premise. It’s bullshit science. Oh, wait. This is an economics site.
“Why is one okay but not the other?”
Fluoride, even to its detractors, isn’t accused of being a mind-altering drug. Lithium is.
http://en.wikipedia.org/wiki/Lithium_pharmacology
What you’re exploring here is more akin to adding very small amounts of [insert your drug of choice] to the water supply. I’d like to know what the large-scale effects of putting the population on a mood-altering substance like Lithium are, especially after the drugging ends (people leave the jurisdiction, or the program is ended for political reasons.)
“I’d like to know what the large-scale effects of putting the population on a mood-altering substance like Lithium are, especially after the drugging ends (people leave the jurisdiction, or the program is ended for political reasons.)”
That would be really interesting to see – what happens to someone who moves from a high-lithium county to a low-lithium one. Haven’t seen any studies like that.
If I’m not mistaken, you’re only talking about topping up the amount of lithium in the water in low-lithium cities to naturally occurring levels in other cities. Regardless of whether it’s a good or bad idea. that makes the experiment seem less rash, or frightening.
“If I’m not mistaken, you’re only talking about topping up the amount of lithium in the water in low-lithium cities to naturally occurring levels in other cities.”
Agreed. And even then, I think you’d want to start at something close to 70-80 micrograms/L (some counties in Texas had naturally occurring levels twice that). It’s more about eliminating a deficiency than ‘drugging the water’.
“If I’m not mistaken, you’re only talking about topping up the amount of lithium in the water in low-lithium cities to naturally occurring levels in other cities. Regardless of whether it’s a good or bad idea. that makes the experiment seem less rash, or frightening.”
_
The big question is should a municipal government have the authority to put psychotropic drugs in the water. Even if the policy is to keep levels within a naturally occurring range, do citizens trust their local gov’t enough to refrain from adding more around election time or scandal time? Also, it is hard enough to convince people to take lithium as a psycho tropic drug. I would expect that many of the people who are prescribed lithium would react very very negatively to a proposal of this type and refrain from drinking perfectly healthy tap water. “I knew the gov’t was putting mind control stuff in our water all along!”
Poor taste in topic chosen. And timing.
Can hardly wait for the mental health care professionals to weigh in.
You people are all wacked! All you’ve achieved is to make me realize that adding fluoride to the water was a terrible idea and a truly slippery slope. Take your lithium, fluoride and whatever else you want to consume, and add it to your own water. I’m good with that. But keep it the hell out of mine.
“Poor taste in topic chosen. And timing.
Can hardly wait for the mental health care professionals to weigh in.”
I have to disagree, this is exactly the right time to talk about this. I don’t know if this is the silver bullet that would have prevented the tragedy of the past weekend, but there should be a rational, non-partisan discussion of what can be done. Nothing should be kept from the table, so long as we can talk about this like adults.
Although I really like to know what health care professionals think about this. I’d add lawyers to that list too.
I wonder if it might be more difficult to get the same Texas results now that bottled water has become a more common source of drinking water.
I have to disagree, this is exactly the right time to talk about this…I’d add lawyers to that list too.
You mean the lawyers that don’t advocate a rush to judgement, but rather waiting to find out motive/and psychological testing? Yep. Me too.
“You people are all wacked! All you’ve achieved is to make me realize that adding fluoride to the water was a terrible idea and a truly slippery slope. Take your lithium, fluoride and whatever else you want to consume, and add it to your own water. I’m good with that. But keep it the hell out of mine.”
K: Do you advocate that municipal water systems remove naturally occurring lithium from the water supply?
It took me a minute or two to realise what “In poor taste” was on about.
Look. Not everything in the world revolves around US politics. The US is not (always) the centre of the universe. Not everything is about the latest US news. This is a Canadian blog. People get murdered in Canada too, you know. And in the rest of the world. And if we want to write about murder, and about policies that might reduce it, we will.
And if we want to write about murder, and about policies that might reduce it, we will.
Then be prepared to enter a debate over whether drugs or psychotherapy is the better means of treating depression. Or whether lithium has any effect on individuals suffering from schizophrenia. Go ask your colleagues in the other depts. if you are unsure.
Big difference between tooth enamel and brains.
I lived for a while during elementary school in a village that didn’t fluoridate its water. No matter. A nurse from the Public Health Unit came around to each class every week and gave everyone a paper cup with fluoride rinse in it. A two minute swish for everyone. It was the ritual when we came back from gym class as that was when the nurse put the cups at everyone’s desk.
Might I also add that chemically lithium is in the same group as sodium and potassium? They are all alkali metals.
I find this economically interesting because, in a way, it’s like Greg Mankiws “Height tax”. Standard analysis says a height tax is a good policy, so why don’t we want to implement it?
Standard CBA says (given the assumptions) it would be a good policy, because it easily meets the positive NPV test. From a consequentialist perspective, it’s good policy (given the assumptions). So why does it give me the heeby jeebies? Moreover, why do I find Andrew Coyne’s point (“If I’m not mistaken, you’re only talking about topping up the amount of lithium in the water in low-lithium cities to naturally occurring levels in other cities. Regardless of whether it’s a good or bad idea. that makes the experiment seem less rash, or frightening.”) so compelling? What Andrew Coyne says ought to be irrelevant. But it doesn’t feel irrelevant.
Maybe: one problem with CBA (Cost-Benefit Analysis) is the use of the Potential Pareto Improvement concept. Which ignores the existing endownment. And Andrew Coyne’s re-framing, so we think of it as restoring the level of lithium to its “natural” level, is somehow akin to restoring the endowment to its “proper/rightful/natural” level.
Lithium intoxication:
Lithium carbonate is a widely used and invaluable drug in the treatment and prevention of manic-depressive illness. However, this medication has a low therapeutic index and, therefore, many attendant side effects. Acute lithium carbonate intoxication affects predominantly the central nervous system and the renal system and is potentially lethal.
Well, it seems that veggies contain dietary lithium. Maybe we could start by just eating healthier diets?
There are savings to be had too. What’s the cost of a murder investigation, prosecution, defense (supposing it’s on the house), and incarceration? Also, what are the lost tax revenues due to one person being dead and another being jail? Not to mention lost productivity of family and friends of the victim and murderer due to the effects of the crime? It wouldn’t surprise me if it paid for itself, and then some.
In many ways the relevant comparison here is not fluoride but iodine.
Iodine deficiency causes cretinism http://en.wikipedia.org/wiki/Iodine_deficiency. Adding iodine to salt not only eliminates the most extreme effects of iodine deficiency, but also has been found to increase the average intelligence of populations – see the excellent work by Canada’s micronutrients initiative.
That’s to say nothing of other brain-boosting manipulations of our diet, e.g. the addition of folic acid to flour.
There’s also the addition of vitamin D to milk, addition of iron and vitamins to breakfast cereals, and (the latest) addition of omega-3 fatty acids to just about everything.
Robert: Ban DHMO!
Here’s where the math comes in handy.
If you drank 100L of water in a day, under my proposal you’d consume 20 milligrams of lithium carbonate. A dose of lithium carbonate given for depression starts at 300 mg. Source: http://www.rxlist.com/eskalith-drug.htm. So at worse you’d be consuming 1/15th of a therapeutic dose.
Of course, you’d have died of water toxicity several times over, as even 20L/24hr is lethal for almost anyone.
If you’re worried about acute toxicity in the water supply, the first thing you’d want to eliminate from the water supply is water.
But if we’re worried about high levels of lithium in the water supply, why is no one proposing that we remove high levels of naturally occurring lithium?
Let’s assume a person consumed 5L/day at 200mcg/day. That’s 1 milligram of lithium, daily. By comparison, the LD50 (intraperitoneal) for rates is 156mg per kilogram weight.
The patient in Mr. McClelland’s link was consuming 1500mg/day. While clearly the symptoms might have presented at, say, an order of magnitude less that’s still 150 times the amount a person consuming 5L a day from domestic supply at 200mcg/L.
I think it’s definitely worth a further look.
oops – typo crept in there. The LD50 refers to “rats” not “rates”
K: “Do you advocate that municipal water systems remove naturally occurring lithium from the water supply?”
Maybe. Does it occur naturally in the surface water which as a species we have adapted to consuming over the eons? If not (and there is generally negligible quantities of minerals in surface water), I would strongly prefer to get rid of it. Arsenic, copper, lead, even radon can naturally occur in toxic quantities in ground water. That doesn’t mean its a good idea to drink it.
I’m all for advocating scientifically determined public health policy. If that includes popping lithium pills, then so be it. But I do find the idea of making drug consumption compulsory offensive. I think it’s also dangerous. In the very unlikely event that the effects of the drug are extremely harmful (e.g. causes infertility after three generations) you’d better hope that there exists a sub-population somewhere that didn’t partake.
Determinant: “Might I also add that chemically lithium is in the same group as sodium and potassium? They are all alkali metals.”
Yup. And mercury is in the same group as zinc. Doesn’t make them biologically equivalent.
“Maybe. Does it occur naturally in the surface water which as a species we have adapted to consuming over the eons? ”
Yes, as well as in many different types of vegetables (specifically ones like cucumbers which are water heavy) and grains.
Oops that quote above was Mike, not K (me). I.e. it was supposed to read:
Mike: “K: Do you advocate that municipal water systems remove naturally occurring lithium from the water supply?”
“In many ways the relevant comparison here is not fluoride but iodine…”
_
But these are all products bought and sold in the market. I can buy non-iodized salt (Kosher and sea salts), and I can buy non-omega-3 eggs. If lithium is added to the municipal water supply my substitutes are very costly (move, invest in reverse osmosis, buy large quantities of bottled water, or drill a well).
JDUB – in Canada the only way to avoid taking in iodine through salt is to live on some kind of radical organic diet. No restaurant food. No baked goods (no bread or muffins or…). No prepared foods from breakfast cereal to salad dressing to…
Probably very healthy.
But honestly it would probably be easier to avoid taking in lithium through water.
Janice said: “I wonder if it might be more difficult to get the same Texas results now that bottled water has become a more common source of drinking water.”
Something tells me that bottled water consumptions is not high amongst the population of murderers. Not a lot of murders occur because Slim Jim drank Fat Tony’s Evian.
Mike: Thanks for the creepy post! It challenges implicit norms.
But I like the idea of my neurons better connecting. Will have to look for lithium supplements next time in the drugstore. Any thoughts on Lithium orotate relative to Lithium carbonate? See the wiki-page here.
Incidentally, do you think Lithium would reduce the violent crime rates in SW British Columbia?
westslope: “Mike: Thanks for the creepy post! It challenges implicit norms.”
It also challenges us economists to be consistent with what we say we believe. If I were true to what I say I believe, I would say “Sure, let’s do it!”, and I wouldn’t need any of the talk about iodine, and naturally occurring lithium to convince me. I wouldn’t have the heeby jeebies at all.
The content of lithium in surface water is about 0.01 parts per million, equivalent (by my calculation) to 3.8 micrograms per liter. The site I found claims similar levels for ground water. The kinds of concentrations you discuss (70 mcg/L or 0.18 ppm) are found in what they refer to as “mineral” water. Sounds to me like they have pretty funky water in Texas. And if there is significant lithium in some surface water, I don’t see any evidence of it. Where do you get your data?
How much lithium is there in cucumbers? And is it there because those cucumbers were watered with “mineral water”?
But hey, if you insist on an economic evaluation: might being zooed out on lithium (even a bit) have an adverse productive impact? Could make $1.53 look like a joke. And while we’re at it, if we’re looking for ROI, why don’t we put some speed in the water? Just a bit!
Anyways, my initial opinion had nothing to do with lithium specifically. My point is this: unless you are 100% certain that there are no adverse effects you are extremely ill advised to perform your experiment on all of humanity. And aside from that, I do have a philosophical problem with forced consumption of mind altering drugs as a condition of membership in society.
Frances: “But honestly it would probably be easier to avoid taking in lithium through water.”
I doubt it. What if it builds up in our crops and livestock? Honestly, how can you be so serene? Have you guys all started on your lithium regimen ahead of me?
did anyone consider that a certain amount of bi-polar disorder in a population may be as the result of an evolutionary beneficial selection? frances, you’ve talked about sociobiology here before…
Ritalin in the grade school fountains; Viagra in the faculty water bottles.
The Economist Party almost has a full platform.
brother… the strawman rhetoric debating team is out in full force…. or is that “I have trouble reading” debating team?
Nick: People are sensitive about water. Perhaps somewhat hyper-vigilant.
The municipality of White Rock sits on a protected piece of Pacific Ocean between Vancouver and Washington State. The municipality has chosen to not chlorinate the water which is a potentially risky, read costly strategy but perhaps makes sense from an aesthetic, health and operational cost perspective.
westslope: ” Any thoughts on Lithium orotate relative to Lithium carbonate? ”
Don’t know – that is way beyond my level of expertise.
“Incidentally, do you think Lithium would reduce the violent crime rates in SW British Columbia?”
Not sure, for a couple reasons: 1) Not convinced the lithium link isn’t just spurious correlation – it needs to be studied more and 2) Don’t know what the lithium concentrations are in drinking water in SW British Colubmia.
K: “Where do you get your data?”
Mostly the Texas and Japan studies. I do have a couple other studies in my office – maybe time for a follow-up report? Obviously I’m not a medical doctor – my interest in this area is for a book on behavioural econ I’m writing. Specifically, how imperceptible differences can alter our decisions.
“But hey, if you insist on an economic evaluation: might being zooed out on lithium (even a bit) have an adverse productive impact?”
Of course it might. That’s why we’d want to study it.
Keep in mind, though, we’re talking about increasing lithium levels to levels that already exist in other jurisdictions.
K: “My point is this: unless you are 100% certain that there are no adverse effects you are extremely ill advised to perform your experiment on all of humanity.”
Nobody is suggesting to “perform an experiment on all of humanity”. But consider the effect your standard would have on progress in other areas.
K: “I doubt it. What if it builds up in our crops and livestock? Honestly, how can you be so serene? Have you guys all started on your lithium regimen ahead of me?”
How do you know you haven’t already been consuming the levels of lithium that we’re discussing? Have you done a test to check? If not, why not? How can you be so serene?
I know this is a crass point to make on an economics blog, but have you considered the economics of the proposal?
On your proposal we’d need 20 grams of lithium carbonate, or roughly 7 grams of lithium proper, per person, per year to achieve the desired result. Assuming that most North Americans (let’s call it 250 million) live in “low” lithium/water areas (good god, I hope that’s the explanation for our American friends), that would require about 1750 metric tons of lithium a year to “treat” North America. In 2009, global Lithium production was 18,000 metric tons. In other words, it would take about 10% of the world’s output of lithium in 2009 to treat North Americans alone. To treat the world (and, lord knows, there are other chunks of the world who need lithium in the water far more desperately than North Americans), well, forget about it. I have no idea what the long-run supply elasticity of lithium is (though there are apparently abundant known reserves), but at least in the short-term a 10% (or greater, if other countries followed your proposal) bump in demand has to have some price impact.
And lithium, apart from its desirable properties of keeping Texans from killing one another is also a key component for, amongst other things, rechargeable batteries. Indeed, limited lithium production is already seen (in some quarters) as a constraint on the production of hybrid and electric cars, to say nothing of iphones and laptops (there is, I gather, a lithium-based ETF which is premised on the notion that the price of lithium will spike in the near future). Putting lithium in the water may make us less likely to kill and maim one another, all else being equal, but if the result is to price people out of the iphone and blackberry market, that would almost certainly have an equal (if not greater) offsetting effect (could you imagine actually having to talk to a teenager rather than text messaging them?).
Bob: That’s a really good point. And it’s one I hadn’t considered.
westslope: “The municipality of White Rock sits on a protected piece of Pacific Ocean between Vancouver and Washington State. The municipality has chosen to not chlorinate the water which is a potentially risky, read costly strategy but perhaps makes sense from an aesthetic, health and operational cost perspective.”
Given the practice of the cities of Vancouver and Victoria of dumping raw sewage into Georgia Strait, remind me not to drink the water next time I’m in White Rock.
I’m thinking that much the creep factor is due to lithium being associated with crazy people and mental dysfunction.
Bob: but the price of lithium should already reflect the value of those alternative uses. If Mike’s calculation is even roughly correct, the value of life is at least 10 times the cost of the lithium, so it would take a 10-fold increase in the price of lithium before we might reconsider adding it to the water supply. And even then, we would only re-consider at the margin. It would meet the CBA test in areas with high murder rates, but fail in areas with low murder rates. And if that means fewer iphones, laptops, battery-operated cars, and stuff like that, so be it.
K: “My point is this: unless you are 100% certain that there are no adverse effects you are extremely ill advised to perform your experiment on all of humanity.”
The funny think about life is that every day we’re conducting an experiment on all of humanity. We do things every day without being 100% certain of the implications of those things for the future of the world. Putting lithium in the water is no more (or less) an experiment that burning fossil fuels (or, for that matter, trying to control global warming) domesticating animals, or growing crops. Indeed, not putting lithium in the water is every bit as much an experiment as putting lithium in the water. Heck, even something as simply as my deciding to travel through Heathrow on my way to Scotland for a vacation may have life threatening implications for the world if I turn out to be patient zero for some wretched plague (because, hey, I can’t be 100% certain that I won’t be) and I infect travelers headed all over the globe.
“If Mike’s calculation is even roughly correct, the value of life is at least 10 times the cost of the lithium, so it would take a 10-fold increase in the price of lithium before we might reconsider adding it to the water supply.”
Fair point. Though, when I think about, the real question is what is the cost of lithium-ating the water supply versus the cost of our other “treatments” to control murders, rapes, robberies, suicides, etc (because, the reality is, we are already spending $1.53, and then some, trying to reduce murders). Given that we’re, as a society, currently willing to spend many hundreds (if not thousands) of dollars per person to reduce the number of murders, rapes, robberies, suicides, etc (without much success), to say nothing of the human costs thereof, the prospect of being able to treat those “ailments” at a cost of $1.53 a person (or even $153 a person) is a bargain. Sign me up. Better yet, sign up my neighbours, family members and co-workers.
Of course, you just know that, already, there are lithium conspiracy theorists out there citing this blog as evidence of a conspiracy of either the Masons, Barack Obama and the Trilateral commission or the CIA, large multinational corporations and the Davos group (depending on one’s political ideology) to put mind control drugs into the water supply to turn us all into subservient communists or servants of multinational corporations (again, depending on one’s political ideology). It’ll be referred to darkly as the “Canadian Initiative”.
The Precautionary Principle restated:
Keep all economists away from public policy health care issues.