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Easter Island and the Allure of “Lost Civilizations”

2026-01-26 20:06:02

2026-01-26T11:00:00.000Z

Finding out what actually happened in the deep past can be a slog, so when ancient history is packaged as mystery—spine-tingling but solvable—it’s hard to resist. Who doesn’t want to know how a lost civilization got lost, or where it might be hiding? The trouble is that what gets touted as a lost civilization often turns out to have been there all along. The people who can’t or won’t see the continuity in front of them have typically been European adventurers or armchair archeologists, busy spinning dismissive theories about the cultures of non-Europeans. The idea that the Pyramids of Egypt are so awesome they could only have been built by aliens is now a meme-able joke, fodder for Reddit debunkers and cheesy History Channel shows.

Still, the fancy persists, implanted like a microchip, ever since Erich von Däniken’s 1968 best-seller, “Chariots of the Gods,” begat the hugely popular 1973 television special “In Search of Ancient Astronauts.” Von Däniken argued that extraterrestrials must have visited Earth to lend a hand with various prehistoric undertakings—the Pyramids, the massive stone carvings of Easter Island, the Nazca Lines. What may have begun as trippy speculation fed on a darker premise: that the present-day peoples of Africa, Polynesia, or Latin America were simply not impressive enough to have had ancestors capable of such feats. (Stonehenge was the rare European site to make an appearance among von Däniken’s confounding examples.)

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The belief that Indigenous monuments must have been made by outsiders has, in more respectable guises, long shaped Western accounts of Indigenous cultural achievement. It continues to do so. The Pyramids of Egypt and the statues of Easter Island are extraordinary, and before modern archeological methods it was often hard to see how such works could have been produced without metal tools or machinery. That conundrum, however, slid easily into a failure of imagination and, specifically, an inability to credit the capacities of people who were not white. Nineteenth-century European explorers concluded that the stone ruins of Great Zimbabwe, now thought to have been built by the Shona between roughly 1100 and 1450 C.E., must be the work of Phoenicians or Babylonians or intrepid explorers from another far-flung place or, basically, anyone but the Africans who actually lived there. The pre-Columbian mound complexes scattered across North America met a similar fate. Their builders were variously imagined as giants, a vanquished white race of some kind, or members of the lost tribes of Israel—the last a notion promoted by Josiah Priest, a nineteenth-century pamphleteer with an animus against Native Americans, cited by Andrew Jackson to justify the Indian Removal Act, and taken up, in recent years, by Tucker Carlson.

In “Island at the Edge of the World: The Forgotten History of Easter Island ” (Mariner), a crisp, confident, and convincing new account of the place and its chroniclers, the British archeologist Mike Pitts calls these theories of lost European civilizations and alien drop-ins “demonstrable claptrap.” Yet a much more reputable but equally insulting theory about Easter Island has remained influential, even dominant, Pitts argues. In this version of events, Easter Island is a cautionary tale of a population that destroyed itself, its island paradise, and whatever mysterious civilization had created its thousand or so stone monuments, or moai. (A Dutch captain who landed there on, yes, Easter gave it the name many Westerners still know it by. Rapa Nui is the Polynesian name for the island; Pitts follows the convention of using “Rapanui” for its Indigenous inhabitants.)

Two angels looking at God with bangs.
“I don’t think God getting bangs is a good sign.”
Cartoon by Sofia Warren

Europeans who arrived in the late nineteenth century on this speck of land in the vast eastern Pacific encountered a very small local population in whom they saw little of interest or value. By contrast, the statues—hewn from volcanic stone, with beetle brows, long ski-slope noses, down-turned mouths, and distant gazes, once upright and now toppled or partly buried—earned their respect. They were blocky, minimalist, stylized, enormous, and strikingly different from the representational statues of people and gods the Europeans knew from home.

It was common in these late-nineteenth-century accounts, Pitts writes, to describe Rapa Nui’s inhabitants as “born cannibals,” and to wonder who could have carved the stone figures. Perhaps a cataclysm—an earthquake, a volcanic eruption—had driven those people away. The dearth of trees on the island implied to some that the inhabitants had cut them down to make clubs and shields.

In 1868, when the British naval frigate H.M.S. Topaze stopped at Easter Island to assess its usefulness to the Empire, the captain instructed his men to find a statue that they could bring home. With the assistance of islanders, they dug out an approximately eight-foot figure—one of the smaller, more portable moai, whose head had been spotted protruding from the ground—and hauled it back to the British Museum, where it stands to this day. The statue, known to the islanders as Hoa Hakananai’a, caused a sensation and, Pitts suggests, helped set off a new round of fervid conjecture about Rapa Nui. (Chile, Germany, and the United States soon dispatched ships to collect statues of their own.)

Martin Farquhar Tupper, a poet and an antiquarian favored by Queen Victoria, argued that Rapa Nui was the remnant of a lost continent whose people had perished. The spiritualist Madame Blavatsky saw the statues as evidence of a vanished race of giants who’d fled a mythical continent called Lemuria just before it sunk into the sea. Rapa Nui, Pitts writes, was subjected to “the full fantasy treatment,” based on a cluster of false premises: that the stone was too hard to carve with simple tools; that the island and its inhabitants were incapable of the civilization implied by the monuments; and that the real creators must have come from elsewhere—South America, Mexico, “Lemuria,” or beyond—and then disappeared. Running through it all was a strong note of judgment. The trees were gone because the islanders had cut them down to make war, and their world had been ruined, as Pitts writes, “because they had worshipped the wrong gods and reached above their station.”

Horses and people in a field
Katherine Routledge and a Rapanui man measure the stone foundations of a hare paenga, or canoe-shaped house, on the slopes of Poike, Easter Island, during the Mana Expedition, 1913–16.Photograph from Royal Geographical Society / Getty

When a serious archeological expedition finally took place on Rapa Nui, in 1913-15, its leaders, the British husband-and-wife team Katherine and William Scoresby Routledge, concluded that the islanders they’d met were indeed the descendants of those who had carved the statues. Yet much of their work—Katherine’s in particular—was later lost or ignored. Pitts, who edited British Archaeology for many years and has written books on Stonehenge and the search for Richard III’s remains, first visited Rapa Nui three decades ago and has taken an interest in it ever since. He seems to see a kindred spirit in Katherine, whose legacy, he believes, might have reshaped the island’s existing narrative had it not been cut short in a notably harsh way.

In 1913, Katherine Routledge set out for Easter Island. She was from a wealthy Quaker family in the North of England, and formally trained in modern history. (She had studied at Oxford but received her degree from Trinity College Dublin, in 1895, because Oxford did not then grant diplomas to women.) By the time of the expedition, she was in her late forties and had already carried out archeological field work in East Africa with her husband, Scoresby Routledge, an anthropologist in the gentleman-explorer mold. The impetus for Rapa Nui came from Thomas Athol Joyce, an ethnographer at the British Museum who’d urged the Routledges to go while elderly islanders who remembered the old ways were still alive. Katherine read everything she could about the place, and the couple secured support from the Royal Geographical Society and commissioned a two-masted, ninety-one-foot wooden schooner for an archeological and ethnological survey designed to collect “scientific facts in relation” to the “inhabitants and their arts.”

In the course of sixteen months, from 1914 to 1915, the Routledges and their crew crisscrossed the island on horseback, worked closely with an influential islander named Tepano Ramo a Veriamo, and produced a pioneering survey of Rapa Nui’s topography and monuments. But the oral histories Katherine conducted, interviewing elderly islanders, with Tepano translating, may have been more valuable still. Her informants told her, for example, about funeral practices—about how they wrapped bodies and carried them aloft to the base of coastal plinths. Pitts thinks that Katherine came to understand not only the island’s physical layout but its “psychogeography”: what certain places meant to the people who lived there.

She also formed a bond with a Rapanui prophetess named Angata, the leader of an uprising against the sheep-ranching operation then dominating the island, which took place during the Routledges’ stay. Scoresby dismissed Angata as a “mad woman” and her followers as “ruffians.” Katherine saw a “charming, frail old lady,” with expressive eyes, at the center of a movement that could not be reduced to livestock raiding. As the only woman on the expedition, and as someone who had long chafed at the limits imposed on her in Edwardian England, Katherine may have been predisposed to sympathy. When she thanked Angata for a gift of poultry and potatoes, Angata replied that no thanks were needed; the food, she said, came from God.

However impressive the Routledges’ research, it was no match for the seductive notion of a populace living among the ruins of a once mighty civilization whose origins were a puzzle and whose downfall was an object lesson. That idea was spooky and poignant and metaphorically potent. In particular, the Routledges’ research was no match for the narrative skills and indefatigable energy of the swashbuckling Norwegian explorer Thor Heyerdahl.

In the nineteen-fifties and sixties, Heyerdahl became an international celebrity largely on the basis of his fascination with Easter Island and his eagerness to prove his theories about it, at great personal risk. Heyerdahl, whom Pitts describes as “a charismatic expedition leader, and a driven writer and self-publicist untroubled by historical nuance,” shared the common supposition that the moai could not have been made by ancestors of the present-day islanders. His particular spin was that the moai’s true creators were people who had travelled from the Americas. Pacific peoples weren’t known to be strong on massive visages and the like, popular opinion suggested at the time, whereas groups like the Inca, the Olmec, and the Toltec were. But Heyerdahl had further theories about where these ingenious Americans had come from originally. He took the “patronizing premise” that the Rapanui were not up to the task, Pitts writes, “and bolted on explicit racism.” And so Heyerdahl recast the island’s earliest settlers as members of a Caucasian race who had migrated from what is now Iraq or Turkey to the Americas and then across the Pacific, and who were tall, fair, blue-eyed, and bearded—not unlike Heyerdahl himself, as Pitts wryly observes.

In 1947, to demonstrate that a pre-Columbian voyage from South America to Polynesia was at least possible, Heyerdahl and a crew of five set off from Peru on a forty-square-foot balsa-wood raft he named the Kon-Tiki. After a hundred and one days and some forty-three hundred miles drifting through shark-infested waters, they landed on a reef near Tahiti. The journey showed that such a crossing could be done—which did not, of course, mean that it had been. Still, it was a daring thing to have pulled off, and it yielded a best-selling book, an Oscar-winning 1950 documentary, and fuel for America’s postwar tiki-bar craze.

Heyerdahl’s ideas have been disputed by many scholars working on Rapa Nui, but they found a large and receptive audience, in part because they aligned with some of the conventional wisdom about Rapa Nui’s culture and its supposed violent rupture with its past. In 1994, the island received the Hollywood treatment in a film co-produced by Kevin Costner, not long after “Dances with Wolves.” In “Rapa-Nui,” bare chests, male and female, gleam in firelight, and internecine warfare—a love triangle gone apocalyptic—tears the island apart. Far more seriously, Easter Island became the exemplary case study in Jared Diamond’s 2005 book, “Collapse: How Societies Choose to Fail or Survive.” Diamond called it “the clearest example of a society that destroyed itself by overexploiting its own resources”—through deforestation, soil exhaustion, and overfishing—turning it into a worst-case metaphor for our collective future. The “ecocide” narrative, with Easter Island as its emblem, was eagerly taken up by politicians and podcasters, liberals and conservatives alike. New evidence from pollen analysis indicated that the island had once been home to tall palm trees, possibly even a primeval palm forest. In his writings and lectures, Diamond posed a chilling question: “What did the Easter Islander who cut down the last tree”—like the Once-ler in “The Lorax”—“say while he was doing it?”

The story Pitts tells—drawing on new archeological findings, a fresh reading of eighteenth-century visitors’ accounts, and a reconsideration of Katherine Routledge’s neglected work—is quite different. It will no doubt be contested; Rapa Nui studies is a notably argumentative field, perhaps because so little can be definitively proved in the absence of early written records. All the same, Pitts’s account reflects a broader shift in the consensus, one that many readers will find persuasive, as this one did. He begins from a premise now widely shared: that Rapa Nui was settled in around 1200 by Polynesians who’d sailed in dugout canoes across uncharted reaches of the Pacific from another island. It was an extraordinary journey, but one that requires no transoceanic, or extraterrestrial, embellishment. The settlers spoke a Polynesian language, practiced Polynesian customs, and left descendants who continue to. Genetic studies of ancient and modern Rapanui confirm their Polynesian origins while also suggesting limited contact with South America, likely the result of later voyages rather than founding migration.

The island that the settlers discovered was probably less lush and hospitable than the one they had left. Much of it was open and grassy and studded with rocks, its soil fragile. It had coral reefs but not at sea level, rough surf, and no permanent freshwater streams. Still, the Rapanui made a go of it. Within a few generations, they began carving moai from volcanic stone and mounting them on plinths. Far from self-destructive, the Rapanui proved remarkably resilient.

When Europeans first arrived—a Dutch West India Company ship in 1722, a Spanish expedition from Peru in 1770, a British voyage under James Cook in 1774, and a French one in 1786—they encountered a population that appeared stable and well organized. Visitors noted agricultural practices that included crop rotation and other methods of soil renewal, carried out with what the French captain Jean-François de La Pérouse called “a great deal of intelligence.” The islanders kept chickens and grew taro, yams, sugarcane, sweet potatoes, and bananas.

They also described the statues as depicting distinguished ancestors, and interacted with them—lighting fires in front of them, dancing around them, or sitting before them with bowed heads. None of the eighteenth-century visitors “made a cultural distinction between living islanders and the statues,” Pitts writes. “They took it for granted that the statues were made by the people they met, and had meaning for them.” Population estimates varied, but Pitts places the likely number at around five thousand. (That’s high when compared with other scholars’ approximations, but several thousand seems like a safe assumption.)

Cowboy with two arrows in his chest talking to cowboy with one arrow in his chest.
“How can you possibly know how I feel?”
Cartoon by Edward Steed

These eighteenth-century European accounts have been underused, Pitts thinks, in part because they were hardly systematic or scientific, and also because some were thought to be lost in a shipwreck and others were scattered and difficult to consult. Today, there’s a range of archeological and genetic work that tends to support their basic observations while countering, or at least complicating, the familiar ecocide narrative. A 2024 genomic study tracking the island’s population over roughly four centuries found no sign of the sharp demographic collapse that is supposed to have occurred around 1600. Research by the American archeologists Carl Lipo and Terry Hunt, among others, suggests that the islanders continued to prosper, and to build stone platforms for their statues, well beyond that date.

The evidence for environmental ruin, too, turns out to be less stark than advertised. The landscape of Rapa Nui probably never incorporated the sort of primeval forest of palm trees imagined in popular accounts, Pitts writes, but was more mixed, and scrubbier, with no one species of charismatic megaflora dominating. And, besides, it seems unfair to single out the Rapanui for cutting down their trees when, as Pitts notes, forest loss is a nearly ubiquitous consequence of human settlement. Medieval Europeans, to take one example, cleared enormous stretches of woodland—up to seventy per cent in parts of France and England by the fourteenth century—for farming, fuel, and timber. Later archeological research, including forensic examination of skeletal remains, has turned up no evidence for cannibalism or for a particularly bellicose society on Rapa Nui.

Something cataclysmic did happen to the Rapanui, but it was no great mystery, or shouldn’t be. In the eighteen-sixties, an Irish entrepreneur named Joseph Charles Byrne proposed a solution to a growing problem facing the Peruvian economy. Plantations producing sugar, the red dye cochineal, and cotton, along with guano operations on coastal islands, needed labor, and the tightening constraints on slavery were making it harder to secure. Byrne suggested looking west, to Polynesia, where, he claimed, workers could be obtained cheaply. So began a round of slaving raids in Polynesia. Rapa Nui was especially attractive because of its relative proximity to South America. “Some 1,500 islanders were taken or killed,” Pitts writes, “as the rest of the community hid in coastal caves and cowered inland.” Byrne skirted formal bans on slavery by having captives sign work contracts—in Spanish, which they could not read—and selling the contracts rather than the people themselves. The slaving raids became a public-relations problem, anyway. They drew criticism in Chilean and Peruvian newspapers, and the French Ambassador in Lima made a fuss. The trade was halted, and ships carrying Polynesian laborers were ordered back.

By then, the damage was done. Some captives had come down with smallpox during an epidemic in Lima and carried it home, spreading it to others. After the crossings and the returns, according to Pitts, more than six thousand Polynesians died, with the Rapanui suffering the heaviest losses. By the late nineteenth century, Rapa Nui’s population had fallen to a hundred and ten people, only twenty-six of them women.

Statues on a horizon
Moai statues facing the sea at Ahu Akivi, in Rapa Nui National Park.Photograph from De Agostini / Getty

Even so, the island drew outsiders seeking to save souls or make their fortune. First came Catholic missionaries from Europe, who found willing converts among a population still reeling from catastrophe. Then came Chile, which had a navy and a long coastline and was looking for a toehold in the Pacific; in 1888, it annexed Rapa Nui. (The island remains a Chilean province. In the Chilean Presidential elections that brought a law-and-order conservative to power last month, it voted for a leftist woman.) Then came the Chilean branch of Williamson, Balfour, a global firm founded by two Scotsmen with interests in everything from flour mills to railroads and oil fields in Chile and Peru. It alighted on Rapa Nui as the site for a sheep-farming enterprise. From the late nineteenth century to the nineteen-fifties, the island functioned, in effect, as a company state where, as Pitts observes, the sheep got better treatment than the people, with the pastures as well watered as a golf course. The population slowly recovered, but most of the land was given over to grazing, and the remaining Rapanui were confined to a walled settlement. As a result, “generations of gardens, houses and monuments lay abandoned and inaccessible,” Pitts writes, and the practices that sustained historical memory were badly disrupted. Knowledge of the statues grew tenuous among survivors of the raids and their descendants.

After the Routledges returned to England, they gave lectures about and published their findings; Katherine wrote a well-received book about their expedition. She also retained reams of notes, interviews, transcripts, genealogies, and sketches, evidently intending to write up further studies. By the late nineteen-twenties, however, her marriage was foundering, and her mental health was in decline. In 1927, the couple agreed to separate. Living in a grand house overlooking Hyde Park, Katherine packed up Scoresby’s belongings, sent them to a warehouse, changed the locks, and left for Syria and Palestine.

When she returned, she withdrew almost entirely, barricading herself in her seventeen-room house. In 1929, Scoresby’s and Katherine’s siblings had her committed to a psychiatric hospital, where she would remain until her death, seven years later. She was diagnosed with “mania,” believed by her doctors to be hereditary (one of her brothers had spent his life in an asylum after attacking his wife), aggravated, according to the diagnosis, by her “spiritualism.” Katherine appears to have suffered from paranoia and, at times, auditory hallucinations—though not, it seems, during her years in the Pacific. She needed help. Even so, the outcome was undeniably sad: a woman whose life had been defined by travel, research, and writing was cut off from all three. In a 2003 biography of Katherine, “Among Stone Giants,” the archeologist Jo Anne van Tilburg writes that “there is no evidence she ever saw Scoresby again.” For long stretches, she was denied access to books and bridled against the monotony and regulation of institutional life. When she was granted limited freedom to pursue her interests, such as walking in the garden, she exceeded the agreed-on terms and told her doctors she had done so “on principle.”

Even worse, perhaps, the wishes Katherine had set out in her will—that her notes, manuscripts, sketches, and photographs be edited, published, and deposited in a public archive, under the supervision of Thomas Athol Joyce, at the British Museum, or some suitable substitute—were never carried out, even though she had left the means to pay for this work. Scoresby, living in Cyprus and in poor health, showed little interest, and after his death, in 1939, no one else took responsibility. The fact that Katherine had been institutionalized may have tainted her scholarly reputation.

But she is not quite the neglected figure Pitts suggests—there is van Tilburg’s biography, for one thing, and she is regularly cited among a cohort of formidable women archeologists of the early twentieth century. If her papers had been collected and published, they might not have overturned entrenched ideas about Rapa Nui as forcefully as Pitts hopes. He’s surely exaggerating when he writes, “It seemed to me that had Katherine Routledge’s research become fully public,” those reigning narratives “would never have been born.” After all, his whole book makes a strong case for their tenacious utility. Still, it’s a shame that the papers were not available to the archeologists and anthropologists who came looking for them later. And it’s satisfying to see her taken so seriously, by a writer whose indignation on her behalf nearly matches his impatience with the persistent misreading of the island itself.

Rapa Nui continues to generate serious research questions. One that has long absorbed archeologists concerns the movement of the moai: how statues weighing several tons were transported from the quarry where they were carved to their platforms. Some scholars favor a method preserved in Rapanui oral tradition in which the figures were kept upright and made to “walk,” rocked forward with ropes. Heyerdahl demonstrated the technique’s feasibility in the nineteen-eighties, and more recently Carl Lipo and Terry Hunt have done the same, though others still argue for sledges or rollers. The island, in other words, still inspires genuine wonder, which is something quite different from the manufactured mystery of a lost civilization. The real question we should be asking now, as Pitts suggests, is how a people forced to cope with an inauspicious habitat, enslavement, and exploitation managed to survive at all. ♦

Briefly Noted Book Reviews

2026-01-26 20:06:02

2026-01-26T11:00:00.000Z
A book cover

Departure(s), by Julian Barnes (Knopf). Though subtitled “A Novel,” Barnes’s twenty-seventh book defies categorization, incorporating memoir, fiction, and philosophy. The narrator—also a writer named Julian—opens with a meditation on memory, before clambering through the recesses of his mind to retrieve the story of friends he unsuccessfully set up in the sixties and again decades later. In recounting their romance(s), Julian realizes that he had been confusing fiction and life, believing that he “could gently direct them towards the ends” he desired. He makes peace, too, with the end of his own story. More than anything, this book, published the day after Barnes’s eightieth birthday, is a letter to his readers—a thank-you, and a goodbye.

A book cover

Jean, by Madeleine Dunnigan (Norton). An English boarding school for troubled boys is the backdrop of this quiet yet accomplished début novel, set in 1976. Jean, one of the school’s teen-age charges, is the child of a single mother—a Jewish woman who was sent away from Berlin as a child, during the Second World War. Though something of an outcast, Jean finds snatches of intense companionship with another boy, with whom he has secret lakeside trysts at night, and whose fondness for Jean waxes and wanes, often depending on whether they are alone. While the novel stages Jean’s experience of being “driven uncontrollably” by desire, it also examines the weight of his and his family’s history—and the imperfect self-awareness of a young person carrying great pain.

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A book cover

Just Watch Me, by Lior Torenberg (Avid Reader). Dell, the narrator of this tragicomic novel, lives in a tiny apartment that used to be a walk-in closet. She also has a sister who’s in a coma. When Dell loses her job at a smoothie shop, after throwing a jar of almond butter at a customer, she decides to start live-streaming, asking viewers to fund her sister’s life support. Soon, Dell discovers she has a knack for streaming, owing to her snarky charisma and willingness to take shocking dares. But she begins to receive messages from an anonymous viewer, who threatens to expose a hidden truth about her. Unfolding over a week, the book is both a reflection on the nature of vulnerability and a pointed commentary on internet culture.

A book cover

Volga Blues, by Marzio G. Mian (Norton). In this travelogue of the Volga River—“Russia’s epicenter of culture, faith, and identity”—an undercover journalist grapples with contemporary Russia. Between the river’s source, entrusted to an order of Orthodox nuns, and its southern delta, where caviar bound for the Kremlin is harvested, the author journeys through a defiant country transformed by war, sanctions, and reinvigorated patriotism. Braiding snapshots of the present with history, Mian depicts a country haunted by threats to its national integrity, where people have come to believe that “questioning their leaders . . . creates social conflict and exposes the country to foreign occupation”—a tension that, he argues, has arisen in Western democracies as well.

“Infinite Jest” Has Turned Thirty. Have We Forgotten How to Read It?

2026-01-26 20:06:02

2026-01-26T11:00:00.000Z

A few stanzas from the end of Chaucer’s long poem “Troilus and Criseyde,” the author interrupts his story to indulge in a bit of reception anxiety. “Go, litel book,” he bids the manuscript that’s soon to be out of his hands. “That thou be understonde I god beseche!” Had Chaucer stuck around to witness the ensuing six hundred-plus years of literary discourse—and the past few decades in particular—he might have concluded that, when it comes to being understonde, the litel books aren’t the ones you have to worry about. It’s the big ones that’ll get you.

David Foster Wallace’s “Infinite Jest,” a book whose notorious bigness comprises both physical size and reputational heft, turns thirty in February. The occasion is a moment to ask how a novel that mourns addiction and venerates humility and patience became a glib cultural punch line—a byword for literary arrogance, a totem of masculine pretentiousness, a red flag if spotted on the shelves of a prospective partner, and reading matter routinely subjected to the word “performative” in its most damning sense. At a thousand and seventy-nine pages, “Infinite Jest” has become a one-liner.

Last year, an article in the Guardian explored the risks of so-called performative reading under the title “Is it OK to read Infinite Jest in public?” For the Guardian writer, the question was a rare refutation of Betteridge’s law, the journalistic adage stating that any headline ending in a question mark can be answered with a no. Here the answer was a nervous and tentative yes. Mostly, though, the piece drew on and perpetuated the archetype of the noxious “Infinite Jest” bro which has solidified in the quick-drying cement of social media. In 2020, the “Jest” bro hit the big screen in Emerald Fennell’s heavy-handed “Promising Young Woman,” in which a D.F.W. fanboy tells Carey Mulligan’s character that she has to read “Consider the Lobster,” one of the author’s essay collections. Moments later, the fanboy is revealed to be a sexual predator. In this way, “would-be rapist” is added to the already toxic mélange of incel, mansplainer, and poser that constitutes the putative “Infinite Jest” reader. Has anyone met these guys? Not the female journalist in the Guardian: ostentatiously wielding her copy of Wallace’s novel in Washington Square Park, she waits “to be caught in the act, secretly filmed for a TikTok ridiculing my performance.” The only interaction she has is with a polite Gen X dude on the bench beside her, who asks how she’s doing with the book. Her bench mate is, she surmises, the “type of guy who might consider David Foster Wallace a modern-day saint.”

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Wallace, whose mental health was fragile for most of his life, died, by suicide, in 2008, at the age of forty-six. Painfully aware of his shortcomings, Wallace would have been horrified by his own subsequent beatification. Such treatment would instead have given him—to enlist a phrase from “Infinite Jest”—a case of “the howling fantods.” (The phrase conveys something like “the heebie-jeebies,” albeit on a greater order of psychological magnitude.) Death casts an ennobling sheen on any writer, but especially on one who, to use another “Infinite Jest”-ism, eliminated his own map—a coinage that tells us something about Wallace’s aversion to treacly solemnity, even the trace amount present in the euphemism “took his own life.” In the years following Wallace’s death, this aura of saintliness likely derived from the combination of his moral seriousness as a fiction writer—his attunement to the heroism of private suffering and emotional endurance—and the fact of his premature end. In other words, it came to seem unbearable that his characters, many of them fellow addicts and overthinkers, prevail in a way their author could not. Now, however, the appellation “Saint Dave” tends to be used only mockingly, and not just on park benches.

In 2023, the writer Patricia Lockwood chafed at Wallace’s supposed sainthood in a long piece for the London Review of Books. The essay, in its ambivalence, did things other than chafe; Lockwood’s Technicolor mind, much like her subject’s, tends to move quaquaversally, to use a word that perhaps only a sesquipedalian math nerd who modelled his thousand-page novel on a particular fractal (the Sierpiński gasket) would tolerate. Nonetheless, the following lines are representative of Lockwood’s general attitude: “What were the noughties? A time when everyone went to see the Blue Man Group for a while. Men read David Foster Wallace. Men also put hot sauce on their balls.”

Men! But Wallace, alert to the sexism of his forebears and eager to demonstrate his own feminism, once sounded a lot like Lockwood. First, “Infinite Jest” made Wallace the most famous young writer in America. Then it began a mighty, self-sustaining Newton’s cradle of acclaim and backlash, a momentum transfer that hasn’t stopped since. When the novel appeared, in 1996, it was more than a best-seller; it was a phenomenon, a widespread, must-read accessory and experience. A year and a half after “Infinite Jest” came out, Wallace, perhaps with a tinge of his own reception anxiety, reviewed a lesser John Updike novel, “Toward the End of Time,” for the New York Observer. His review seemed a prescient (if covert) attempt to head off the very criticisms that would later confront his own work. Wallace began by dismissing the book’s author, along with Norman Mailer and Philip Roth, as “The Great Male Narcissists.” But his sickest burn—the real hot sauce to the balls—was reserved for Updike, whom Wallace, invoking a friend’s verdict, characterized as “a penis with a thesaurus.” Here was a clear case of the pot calling the kettle atramentous. You don’t need a penis to read “Infinite Jest,” but you might need a dictionary.

Beyond the novel’s fondness for five-dollar words, what is it like to read? Perhaps the greatest disjunction between the book’s reputation and its contents lies in the notion that it’s a pretentious slog no one could honestly enjoy. I first read the novel in 2008, before D. T. Max’s 2012 biography and, later, Mary Karr’s 2018 tweets detailed Wallace’s upsetting and potentially criminal treatment of Karr, once his romantic partner. Fiction is so often the gold extracted from the dross of a damaged life. As Rivka Galchen wrote in her review of Max’s book, “The co-founder of A.A., Bill W., is a guru of sobriety precisely because sobriety was so difficult for him.” Wallace, by implication, was concerned with patience, steadfastness, and tranquillity precisely because these virtues often eluded him in life.

Encountering the novel in my twenties, I was unaware that I was committing a form of gender treason; I knew only that little or nothing I’d read had come close in terms of sheer pleasure. The book had more brio, heart, and humor than I thought possible on the page. It was bizarrely grotesque and howlingly sad; it was sweet, silly, and vertiginously clever. It was also, by virtue of its relentlessly entertaining scenes and the high-low virtuosity of its language, a work that enacted its own theme of addiction. When I finished, I experienced withdrawal: Where to go after “Infinite Jest”? It was, in short, a supposedly unfun thing I would do again, and did.

The novel takes place in a future America, specifically Boston and its environs, and is mainly concerned with two institutions as its zones of action. The first is the Enfield Tennis Academy, where athletically gifted boys and girls (but mainly boys) are drilled in physical and mental preparation for what’s known as The Show, a stab at professional tennis. The second, just down the hill, is the Ennet House Drug and Alcohol Recovery House, where men and women (but mainly men) reckon with their substance abuse. Ambition and addiction, the two traits these institutions respectively represent, share a fat slice of their Venn diagram—an overlap that might be labelled “how to live with yourself.” The self-torturing helices of thought twisting inside the young minds on the courts are no less fraught than the recursive neuroses tormenting the addicts down the hill. Among the former cohort is Hal Incandenza, a star student, teen-age tennis prodigy, secret marijuana addict, and Hamlet manqué. His father, James, an experimental filmmaker and the school’s founder, has killed himself via a MacGyvered microwave oven. Hal was the one who found him, or what was left of him. Hal’s mother, Avril, is having an affair with Charles Tavis, who is either her half or adoptive brother, and has summarily replaced Hal’s father as headmaster of the academy. Much, in other words, is rotten in the state of the Enfield Tennis Academy, or E.T.A. (This most prolix of writers can never resist an abbreviation.)

Hal’s voice begins the novel. As he responds to the authority figures questioning him about his recent “subnormal” test scores, they react with horror: the eloquence of Hal’s internal monologue is at odds with his ability to actually speak. Rather than producing words, he’s emitting “subanimalistic noises and sounds.” Soon, he’s gurneyed off to an emergency room. A notable oddity is the way in which Hal’s first-person narration is abandoned after seventeen pages until close to the end, even though he remains one of the book’s central characters. Why? The novel’s very Gen X diagnosis of the character offers a clue: “One of the really American things about Hal, probably, is the way he despises what it is he’s really lonely for: this hideous internal self, incontinent of sentiment and need, that pules and writhes just under the hip empty mask, anhedonia.” Wallace, once a regionally ranked junior tennis player in his home state of Illinois, later considered a career in academia. One of his undergraduate thesis advisers has said, “I thought of David as a very talented young philosopher with a writing hobby, and did not realize that he was instead one of the most talented fiction writers of his generation who had a philosophy hobby.” Hal, in his academic brilliance, tennis talent, and acute anxiety, is the character who most resembles his creator. To grant him ongoing first-person status would be to privilege the book’s most autobiographical consciousness. And Wallace is not much interested in himself. In “Infinite Jest,” he’s going for the least solipsistic rendering of humanity he can pull off, via more than a hundred borrowed selves.

This enormous cast of characters is diverse mostly in terms of the variegated peculiarity of inner lives. As for “diversity” in the sense of gender parity and racial representation: not so much. The two main female characters, Avril Incandenza and Joelle van Dyne, both happen to be gorgeous. When it comes to the novel’s handful of Black characters, some of whom speak in a cartoonish version of Ebonics, perhaps the most tactful thing to be said is something like: It was a different time. And yet from this horde of fretting, feeling, interfacing selves a truth emerges: that loneliness is a universal problem experienced by each person in a unique way. The novel also suggests—mumblingly, without making eye contact, not wanting to be corny about it—that one’s own self becomes a little less hideous the more one attends to other selves. Not all of whom are entirely hideous.

In the weight room of E.T.A., for example, you’ll find Lyle, who maintains a permanent levitating lotus pose, and who lives (in a literal, biological way) off the sweat of others. The most important thing about Lyle, though, is that he’s a guru to anxious students: “Like all good listeners, he has a way of attending that is at once intense and assuasive: the supplicant feels both nakedly revealed and sheltered, somehow, from all possible judgment. It’s like he’s working as hard as you. You both of you, briefly, feel unalone.”

To feel unalone is pretty much what all the novel’s characters, not just tragic Hal, yearn for. Despite the solace Lyle dispenses, however, he’s more curio than hero. If the latter distinction goes to anyone, it’s to Don Gately, the large-hearted, as well as simply large (“the size of a young dinosaur”), addict who stealthily overtakes Hal as the book’s most prominent character. Don becomes a resident staffer at Ennet House, where he meets his fellow-addicts’ demands and offenses with implacable stoicism. His struggle to stay sober involves accepting that the bromides of A.A. (“It works if you work it”; “One day at a time”; and so on)—what Don calls “the limpest kind of dickless pap”—do actually work. In fact, “it starts to turn out that the vapider the AA cliché, the sharper the canines of the real truth it covers.”

“Infinite Jest” also involves a Pynchonesque subplot, which is certainly silly and sometimes funny, concerning an organization of wheelchair-bound Quebecois separatists, Les Assassins des Fauteuils Rollents. These militants are seeking a master copy of James Incandenza’s final film, “Infinite Jest,” also known as “the Entertainment,” which is a work so enthralling that anyone who views it becomes catatonic and eventually dies from starvation or dehydration. One of Wallace’s driving anxieties, a black thread running through this novel, was that television addiction (including his own) was inducing brain rot, social atomization, and spiritual death. In light of our mass smartphone and social-media addictions, a TV habit seems almost benign. Oh, honey, I find myself murmuring to the David Foster Wallace of 1996. Had he only known.

In the world of the novel, Boston is recognizably Bostonian but belongs to a U.S. that has subsumed Canada and Mexico to form a superstate by the name of the Organization of North American Nations, or O.N.A.N. The acronym may serve as a satirical indictment of a thanatotic American culture of bottomless self-gratification, but it’s also a joke about jerking off. The blend of brainy and base is typical Wallace. Here is a guy anxious to assure you that he may have produced a Dostoyevskian work of profligate genius, but he’s also just a regular dumbass like you.

Onanism, albeit of the metaphorical kind, is the very charge Wallace levies against Updike in that review from 1997. Blasting Updike and his fellow-“phallocrats” for their self-absorption, Wallace scoffs, in particular, at the character of Ben Turnbull, who narrates “Toward the End of Time.” Turnbull has undergone surgery for prostate cancer, which would be a sympathetic predicament if not for the fact that his entire hideous self seems to reside in his genitals and their gratification. He is facing what Wallace calls “the prospect of dying without once having loved something more than yourself.” In other words, a sort of onanism of the soul afflicts him. What might Wallace, or Updike, for that matter, have made of gooning, the subculture of isolated men masturbating to online pornography for hours or days at a time? For a writer to inhabit the souls of more than a hundred other people is surely the opposite of onanistic, as it is for a reader to do so, whether behind the locked door of a bedroom or among strangers on a park bench. The gentle paradox here, one Wallace was intimately in touch with, is that reading fiction is a form of self-gratification, done alone, that allows a person to feel unalone. And, unlike gooning, or freebasing, reading is the rare instance of an addiction that, as a rule, harms no one and may even sharpen your mind.

Despite this, a pseudo-Freudian emphasis on length and girth still haunts discussions of “Infinite Jest,” and, with it, an implication of the masturbatory—as if big novels were the exclusive preserve of arrogant males (“phallocrats”) whose self-conferred genius permits them to indulge in long-windedness. George Eliot, whose “Middlemarch” runs to more than nine hundred pages in its longest editions, would like a word. As, no doubt, would plenty of living women novelists. (Eleanor Catton, for example, whose “The Luminaries” runs to 848 pages, or Lucy Ellmann, whose “Ducks, Newburyport,” comes in at 1,040.) Late last year, I returned to Wallace’s masterpiece not from some built-in, media-friendly calendar for upcoming literary anniversaries but because two other long novels, both by women, had reminded me of the work. Tess Gunty’s “The Rabbit Hutch” and Alexis Wright’s “Praiseworthy” seemed, through the scope of their ensemble casts and their granular attention to the distinctive suffering of their characters, to pick up where Wallace left off. Just as Don DeLillo’s influence on a generation of women novelists (Rachel Kushner, Zadie Smith, Jennifer Egan, and Dana Spiotta among them) has been underacknowledged, perhaps so, too, has Wallace’s.

Thirty years on, “Infinite Jest” and its author seem poised to undergo not just a reëvaluation but something of a cultural feminization, too. The new, anniversary edition of “Infinite Jest” comes with a foreword from Michelle Zauner, the thirty-six-year-old, queer Korean American front woman of the indie-pop band Japanese Breakfast and the author of the hit memoir “Crying in H Mart”: a person worlds away from the maligned stereotype of the D.F.W. fan. Recently, the writer Hannah Smart (Instagram handle @howlingfantod) wrote in the Los Angeles Review of Books about diagramming a nine-hundred-word sentence from Wallace’s short story “Mister Squishy.” Parsing Wallace’s clauses, Smart reflected, has taught her “to distinguish between data and knowledge, to approach all inputs with not just narrative but also linguistic skepticism.” More than this, Smart’s project, an ongoing one, seems to have transcended the grammatical and become devotional. Wallace’s syntax, she believes, reveals a koanistic truth: “the future is eternal, while the present is momentary.”

The ephemeral present includes, of course, a writer’s reputation. If that writer is hailed as a once-in-a-generation voice, the reputation will undergo transmutations. Like Wallace, George Eliot had sainthood foisted on her, although in her case it was within her lifetime: readers wrote to her seeking advice on how to live. Her image as a figure of moral uplift was cemented with the publication of such works as “Wise, Witty and Tender Sayings in Prose and Verse” (1871), a florilegium of instructive or consoling lines mostly wrested from the fictive surroundings that had loaned them their vitality and moral torque. (That image, in turn, cemented the contempt that a subsequent generation had for her.) Much like “inspirational quotes” littering Instagram, the collection seemed to be a TL;DR cheat sheet for those unwilling to tackle “Middlemarch,” which had been published around the same time. In this way, the volume shows a curious similarity to Wallace’s “This Is Water,” the 2009 vade mecum that came, posthumously, out of a 2005 commencement speech he gave at Kenyon College. In this encomium to mindfulness, Wallace tells a tale of two fish swimming along, oblivious of the fact of water, the medium of their own existence. The words “this is water”—since tattooed on many a wrist—offer themselves as a mantra of consciousness and compassion. An earlier instantiation can be found, however, in “Infinite Jest.” Midway through the novel, Don Gately is chatting with some sober bikers when one of them, a man who goes by the cheery name of Bob Death, asks whether Don’s heard the one about the fish. Another biker supplies a lewd and sexist joke. Not that one, Bob says:

He leans in more toward Gately and shouts that the one he was talking about was: This wise old whiskery fish swims up to three young fish and goes, ‘Morning, boys, how’s the water?’ and swims away; and the three young fish watch him swim away and look at each other and go, ‘What the fuck is water?’ and swim away. The young biker leans back and smiles at Gately and gives an affable shrug and blatts away, a halter top’s tits mashed against his back.

We understand Don to be one of the bewildered young fish, although, owing to Mr. Death in the unlikely role of sage, perhaps a young fish now coming to terms with the water in which he swims, learning to pay attention to what merits attention. Wallace’s piscine material is much more successful in this rambunctious, dynamic, take-it-or-leave-it novelistic form than in his fish-out-of-water public performance, years later, before the class of 2005. Wallace gave a commencement speech for the ages, but homily was not his métier. His great novel proposed that the compulsive, addictive character of America, not least its addiction to entertainment, could best be resisted through the engaged reading of fiction. Here is a book about addiction that offers itself as a kind of counter-addiction, an example of the compounding value of sustained attention. The infamous length of “Infinite Jest” is, in this sense, a central feature of its ethic: not bigness as brag but duration as discipline. In a distractible age, Wallace made an argument for the long novel that is won simply by being heard. ♦

Did a Celebrated Researcher Obscure a Baby’s Poisoning?

2026-01-26 20:06:02

2026-01-26T11:00:00.000Z

On April 18, 2005, a Canadian woman named Rani Jamieson gave birth to a healthy boy. It was an unremarkable pregnancy but a painful delivery; a doctor had to use surgical scissors to make room for her son’s head. Afterward, the doctor prescribed her Tylenol No. 3, which combines the mild opioid codeine with acetaminophen.

Rani’s newborn son weighed almost eight pounds and had perfect neonatal scores. “He seemed very—like an old soul,” she told a Canadian news outlet. She and her husband, Douglas, named him Tariq. He was their only child.

The hospital gave Rani two tablets of Tylenol-3 in the morning and two at night. But she found that the pills made her drowsy, so, on the third day of Tariq’s life, she cut her intake to one pill at a time. She and Tariq were discharged from the hospital and went home. Rani, who was thirty-two, had been preparing for motherhood for a long time. “Anytime I read an article about something you shouldn’t do, or they’re not sure—that went on my list of things not to do,” she said.

In the next week, Tariq developed normally and surpassed his birth weight. But, at around 6:30 A.M. on April 29th, he stopped eating. Later that morning, Rani brought him in for a routine pediatric visit. The doctor noted that he was somnolent, but was generally unconcerned. Until that morning, Tariq had been feeding “on average, every three hours,” according to his parents, and the pediatrician noted that he had been producing about five wet diapers per day. Another doctor later reported that Tariq had “appeared to be thriving.”

That night, Douglas called the Ontario health ministry’s telehealth service. He said that Tariq had been sleeping for most of the past twenty hours, and that his skin was fluctuating in color. An ambulance was dispatched to the Jamiesons’ home, in an affluent neighborhood of Toronto. But, according to the Jamiesons, “a minute or two” before it arrived Tariq stopped breathing.

The E.M.S. team performed C.P.R. on Tariq, using just two fingertips on his tiny sternum and small puffs of air to inflate his strawberry-size lungs. For forty minutes, they tried to resuscitate him—on the kitchen counter, in the ambulance, and at the Hospital for Sick Children, one of the best pediatric hospitals in the world. But Tariq’s body was already cold, and his skin was mottled. Shortly after midnight, he was pronounced dead.

Fourteen hours later, Tariq was brought to his autopsy swaddled in his blue blanket, with an identification tag fixed around his right ankle. The coroner found no anatomical cause of death—no brain bleed, no congenital defects, no reason that an otherwise healthy boy had suddenly died. Nor did two Toronto police detectives sent to the Jamieson residence notice anything awry. Tariq’s parents were “just absolutely devastated and in a severe state of shock—the mother, especially,” one of the detectives told me recently. A blood sample, taken before or during the postmortem examination, was sent to a forensic-toxicology lab. When the results came back, twelve weeks later, they showed that Tariq Jamieson had died of codeine-and-morphine poisoning.

Opioids kill by suppressing the drive to breathe. They bind to receptors in the brain stem, altering the neurons that maintain patterns of respiration. Carbon dioxide builds up in the bloodstream, hypoxia sets in, and circulation falters. Brain damage follows, then death.

The coroner’s office asked one of Canada’s leading pediatricians and toxicologists, Gideon (Gidi) Koren, to examine Tariq’s file. For the past two decades, Koren had been running a program at the Hospital for Sick Children called Motherisk, which provided guidance for pregnant women and new mothers about drugs and breast-feeding. He was widely considered to be among the most capable research scientists in the field. Koren met with Rani’s physician and quickly ruled out foul play. “There was no evidence of psychiatric issues,” he later wrote. Instead, Koren interpreted the toxicology report as a scientific revelation: if mothers with a certain genetic predisposition took even a mild dose of codeine, the amount of morphine that ended up in their breast milk could kill their children.

A dose of codeine brings relief from pain only when the liver metabolizes a fraction of it into morphine. But the exact proportion that is converted into morphine can vary. Most people have two copies of the gene that carries out the conversion. Koren invited Rani to be tested, and discovered that she had three.

The concentration of morphine in Tariq’s blood was measured at seventy nanograms per millilitre. “If you have levels above twenty, you stop breathing,” Koren later said. Six months after Tariq’s death, Koren obtained a sample of Rani’s breast milk, which she had kept in her freezer. His lab measured its morphine concentration at eighty-seven nanograms per millilitre. Koren was stunned. “The level was several fold higher than ever described in the literature,” he noted. “This was the first time in history that a baby was reported dying from breast milk.”

Koren had long studied the transmission of opioids into breast milk. But he had never identified a mortal risk. Now, along with a few colleagues—including the deputy chief coroner of Ontario, James Cairns—he published his findings in The Lancet, one of the world’s top medical journals. Some women, like Rani, have a genetic predisposition to convert codeine into morphine faster and in higher quantities than the rest of the general population. Therefore, the authors concluded, “codeine cannot be considered as a safe drug for all infants during breastfeeding.”

The implications were terrifying. Millions of women—up to forty per cent of breast-feeding mothers in North America, according to Koren and his colleagues—might be prescribed codeine for postpartum pain, and yet almost none were being tested to see if they, like Rani, had more than the usual number of codeine-metabolizing genes. The risk was unevenly distributed across the population, according to ethnic background. Mothers from Finland have a one in a hundred chance of being so-called ultra-rapid metabolizers, according to Koren’s paper. But in Ethiopia the odds can rise to almost one in three.

Two birds look through window at woman sleeping in bed.
“What an amazing nest.”
Cartoon by Amy Hwang

Few academic-journal articles have had so abrupt an effect on the daily practice of medicine. Prior to its publication, the American Academy of Pediatrics had listed codeine as generally compatible with breast-feeding. “After we published it in Lancet, the F.D.A.—the Food and Drug Administration—said, ‘This is enough for us to change labelling,’ ” Koren said. Canadian and European health regulators soon followed suit. Doctors started prescribing other opioids for postpartum pain, such as hydromorphone and oxycodone, whose metabolic pathways are more predictable and less subject to genetic variations.

The Jamiesons’ identities were not revealed in Koren’s article. But they went public on April 30, 2007—exactly two years after Tariq’s death—filing a class-action lawsuit against Johnson & Johnson and a subsidiary, the manufacturer of Tylenol-3, on behalf of “all persons in Canada” who had ingested the products of the drug through breast milk. “This terrible tragedy should never have occurred, and I am determined to see that this does not happen to other children,” Rani said. “What can they give me? Can they give me my son back? I want other people not to have their children die or be damaged.”

The Jamiesons went on to have three more children—all boys, who grew up in the shadow of the brother they never met. “You’re consumed with a certain sadness that’s always there,” Rani told a reporter, seven years after Tariq’s death. Two decades later, she still finds April the most difficult month: “It’s always there.”

Koren continued to sound the alarm about codeine for years. “He was always on a plane somewhere, and always had a million spinning plates—meetings, talks, conferences,” David Juurlink, a Canadian clinical toxicologist and a colleague of Koren’s at the Hospital for Sick Children, told me. Koren published more papers about the Jamieson case, and his Motherisk program provided data for studies of patients who had been prescribed codeine for postpartum pain. His ability to distill complex scientific processes into clear public-health messaging made him a regular commentator in the press. “It’s quite common not to know why a baby dies,” Koren said, in an interview for Canadian television. “I am quite sure that quite a few of those were codeine in breast milk. But no one checked. You don’t check, you do not find.”

Juurlink first met Koren in the late nineties, when he was a resident in clinical pharmacology. Koren, who had been practicing medicine in Canada since 1982, was leading rounds. “When you were with Gidi, you really felt like you were in the presence of someone who wasn’t just an expert—in the truest sense of the word—but was also a kind, good-natured, thoughtful, and intellectually agile man,” Juurlink recalled. “He was very avuncular. It was really one of the highlights of my training, learning from him.” Koren was revered by colleagues, and he had almost six hundred publications in scientific journals.

By 2010, Juurlink was a widely respected pharmacologist and toxicologist in his own right, specializing in medication safety and opioids. He had positions at two top medical institutions in Toronto, including the Ontario Poison Centre, which is run out of the Hospital for Sick Children. He had also published many academic papers, including several with Koren. But he had found the experience to be somewhat disappointing: the first time they published together as “co-authors,” Juurlink wrote the paper and sent it to Koren but received no guidance or revisions in reply. “His only feedback to me was to please credit that he was getting financial backing from the Canadian Institutes of Health Research,” Juurlink recalled.

That June, Juurlink was invited to deliver the keynote lecture at a toxicology conference in Scotland. After the lecture, he joined Nick Bateman—then the director of the Scottish branch of the U.K.’s National Poisons Information Service—for a candlelit dinner at an old Edinburgh establishment called the Witchery. Bateman ordered haggis and wine. Eventually, he blurted out, “David, what the hell is going on with Koren and this baby that died from breast milk?”

“What?”

“It’s clearly nonsense,” Bateman said. “Why can’t everybody see it?”

Bateman told Juurlink that when he first read the Lancet report he’d thought, This can’t be true. “The science on metabolism—codeine to morphine—was beautiful,” Bateman said. But the numbers were off. Ultra-rapid metabolizers are generally exposed to around fifty per cent more morphine than the average person. And yet, though Rani had been taking only a fraction of her prescribed dose, Tariq had died with a concentration of morphine in his blood which was more than fifty times higher than the midpoint of the expected range.

Bateman and two colleagues at the Royal Infirmary of Edinburgh had looked deeper into the scientific literature and found that, within months of the Lancet report, Koren and his colleagues had published very similar papers in two practitioners’ journals—Canadian Family Physician and Canadian Pharmacists Journal—neither of which Juurlink had seen. They contained minor errors, and also a key fact that had been omitted in The Lancet: Tariq’s blood didn’t just have morphine in it—it also contained acetaminophen, the dominant component of Tylenol-3.

Acetaminophen appears in breast milk only at very low concentrations. At Rani’s intake of Tylenol-3, Tariq ought to have been consuming less than a milligram of acetaminophen per day—around half a per cent of what an infant of his size might receive as a standard treatment for pain. But the forensic-toxicology laboratory’s measurements showed that his acetaminophen concentration was in the range of what you’d expect to find in a baby’s bloodstream soon after he’d been administered a standard dose. “There is no way in the world that could have come from breast milk,” Bateman insisted to Juurlink.

“I am not aware of any cases in the U.K., or elsewhere in the world, where breast-feeding by women who were on either morphine or codeine—which has been in use for more than a hundred years—has caused death,” Bateman said. “I am familiar with patients whose babies have died after a caregiver gave the opiate directly.”

Juurlink listened in silence. The candles flickered. Bateman took a sip of wine, then leaned across the table and said, “David, whatever the intention, that baby was poisoned.”

David Juurlink grew up in New Glasgow, a small town in Nova Scotia. His parents operated a local diner, the West Side Drive-In, where they served burgers, fries, milkshakes, and fish and chips, seven days a week, from nine o’clock in the morning until ten o’clock at night. “People would just sit in their cars and eat, and then they would dump all of their detritus in the parking lot,” Juurlink told me. “My job, at 10 P.M. every school night—and sometimes also on weekends—was to go over and sweep that up, and put it in garbage bags. And then I’d go to bed, and go to school the next day.”

One day, Juurlink, who played the drums, was practicing at the home of his best friend, a bass player. “He had an older sister who I always thought was kind of cute,” he recalled. She told him that she had started working as a pharmacist. “I became aware of this profession called ‘pharmacy,’ which I’d never really thought of before,” he said.

He asked his chemistry teacher about it, but “he said, ‘Well, David, you need an average of at least eighty for that,’ ” Juurlink recalled. For the next two years, he studied obsessively, even after late-night shifts at the diner, and he ended up graduating first in his class.

Juurlink attended Dalhousie University, in Halifax, about two hours away. During summer breaks, he worked at three different pharmacies in New Glasgow. One day, a woman came in and asked for two hundred pills of Tylenol No. 1—a weak opioid whose generic form is still sold over the counter in Canadian pharmacies. A couple of days later, he saw her at a different pharmacy, asking for the same. “She clearly had an addiction to codeine, and she was visiting multiple pharmacies to avoid detection,” he said. It was the late eighties, and this was his first brush with the coming opioid crisis.

Tylenol-1 had 7.5 milligrams of codeine; addicts might take four pills to approximate the relief that they’d get from a single prescription pill of Tylenol-3. Juurlink was troubled by what seemed like an obvious hypocrisy: people could walk in and buy codeine without a prescription, but the pharmacy’s stock of morphine was kept in a safe. As he studied pharmacokinetics—how drugs move through the body—he came to believe that codeine is an inherently irrational drug.

When codeine was first isolated from the opium poppy, in 1832, scientists understood that it was chemically related to morphine but believed that the two drugs worked through different mechanisms. Codeine was marketed as a gentler alternative to morphine, particularly for cough suppression. Scientists didn’t understand until well into the twentieth century that codeine primarily works because the liver metabolizes it into morphine. But the perception of the two drugs as distinct—one mild, one serious—was entrenched in medical practice, in pharmaceutical regulations, in prescription guidelines, and in law.

Juurlink eventually attended medical school, after which he chose to specialize in clinical pharmacology and toxicology, the study of drugs and poisons. “I just fell in love with toxicology,” he said. “What attracted me? It’s that patients are often critically ill but salvageable. You can help prevent them from dying. But there is a real art to their management, because often they’ve not just taken one pill—they’ve taken something like eight different pills, and there’s an interplay between those pills. And it’s not just what those pills are doing to the patient but what they might do if we don’t address this right now.”

Before his visit to Scotland, Juurlink had never questioned Koren’s findings. He had even used the Lancet paper to teach medical students how individual genetic variations can pose unexpected risks in the use of certain drugs. But, if Bateman was right, the implications went far beyond the revelation of a possible crime. The opioid crisis was taking off in North America. With codeine now considered unsafe for breast-feeding, millions of new mothers were being prescribed stronger, more addictive opioids instead.

Bateman had detailed his concerns about Tariq’s death in a letter he’d sent to The Lancet in 2007. Koren, using arguments from the Jamiesons’ lawyer, had tried to block its publication by insinuating both that it was defamatory and that Bateman was a paid shill for the manufacturer of Tylenol-3. (A different subsidiary of Johnson & Johnson had named Bateman on an unrestricted educational grant that it awarded to the University of Edinburgh, where he was a professor at the time.) “We know the family and we are convinced that this will cause them harm!” Koren wrote to his editor at The Lancet. “It is one thing to philosophize in a journal, it is another thing to knowingly injure a grieving family.”

Koren wrote that Bateman’s critique was “frivilous and based on errors”; Bateman revised and resubmitted. When his letter finally ran, in August, 2008, it did so alongside a derisive rebuttal from Koren and his team. “Nicholas Bateman and colleagues’ comments seem to stem from fundamental flaws in their understanding of perinatal toxicology,” they wrote. They went on to attribute the high concentration of acetaminophen in Tariq’s blood to “postmortem redistribution”—the phenomenon of drugs migrating through the body after death, potentially skewing toxicological results—then cited a study that did not support their conclusion.

Back in Toronto, Juurlink searched the scientific literature for clues. His specialty was complex drug interactions and poisonings in adults—not breast-feeding, or infants—and it had never occurred to him that Koren could be so wrong, so publicly, about a matter that was so consequential, and so squarely within his longtime professional focus. And yet, the more closely Juurlink studied the issue, the less confidence he had in Koren’s interpretation.

According to Koren, the concentration of morphine in Rani’s breast-milk sample, at eighty-seven nanograms per millilitre, was “10-20 fold higher than previous published reports.” But Juurlink found a case report from 1990 that documented a breast-feeding mother producing a milk sample whose concentration was fifteen per cent higher than Rani’s—and that was after the woman’s morphine dosage had been tapered by ninety per cent. Even when she was taking the previous, higher dose, the infant suffered no ill effects. Koren ought to have known about this case report—he was listed as its second author.

In another case, involving intravenous doses of morphine given to new mothers after surgery, the concentration of morphine in one woman’s breast milk reached a level almost six times that of Rani’s sample. But, since newborns don’t take in much breast milk during a feeding, the authors concluded that “the amount of morphine transferred by nursing is, even at the peak concentration of 500 ng/ml milk, small and will hardly cause respiratory depression or drowsiness in the child.” The math was simple: a newborn who drank a hundred millilitres of milk from that mother—higher than average for a single feeding—would consume a twentieth of a milligram of morphine. According to the infant-dosing guidelines at the Hospital for Sick Children, that is less than five per cent of a single therapeutic oral dose for a four-kilogram baby in pain—nowhere near a toxic dose.

Museum security guard gives directions to visitor.
“If you see the fat naked lady bathing with the swan, you’ve gone too far.”
Cartoon by Robert Leighton

And yet the opioids in Tariq’s blood had killed him. Was such a high concentration of morphine even possible through breast-feeding alone? A 2009 study, led by the German scientist Stefan Willmann, set out to answer this question by modelling what he and his colleagues referred to as the “pharmacokinetic worst-case scenario.” They assessed that the mother’s ultra-rapid-metabolizer status was not necessarily as relevant as Koren had believed. Instead, the most important thing was the ability of the infant to process morphine in its liver and kidneys, and to eliminate the drug through urine. “In a neonate that can efficiently eliminate morphine, it is impossible to observe such an extreme accumulation of morphine in plasma as was seen in the case of the Toronto newborn,” Willmann wrote.

On an infant’s first day of life, its stomach is about the size of a cherry. At three days, it is the size of a walnut; at one week, an apricot; at two weeks—a milestone that Tariq never reached—it is roughly the size of an egg. Setting aside the matter of elimination, Juurlink calculated that the morphine concentration reflected in Rani’s breast-milk sample simply could not explain the amount of morphine in Tariq’s blood: he would have had to ingest several times his body weight in a single feeding.

In the fall of 2010, Juurlink reached out to the chief coroner of Ontario, Andrew McCallum, with detailed concerns. They had met fifteen years earlier, when McCallum was one of Juurlink’s supervisors during a rotation in emergency medicine. Now McCallum invited him to review the coroner’s case files, which were not public, and to prepare a confidential report. “I was a little bit fearful, because Koren was not only a colleague—he was, at least notionally, the world’s expert,” Juurlink recalled.

The files arrived—hundreds of pages of medical data, a smattering of clues. Nothing in the documents suggested the kind of kidney or liver dysfunction that would significantly impair morphine elimination. But Juurlink found critical details in the toxicology report which had never made it into any of the published literature. Tariq’s blood didn’t contain just morphine and acetaminophen; it also had codeine, at a concentration of three hundred nanograms per millilitre, more than a hundred times higher than one might expect to see from the consumption of breast milk produced by a mother on Rani’s dose.

Juurlink kept reading. Tariq’s last reported substantial feeding had taken place eighteen hours before his death. The 911 call log noted that he had been sleeping the whole day, and the Jamiesons’ lawsuit described “his lack of feeding that day.” But the postmortem examination revealed that Tariq’s stomach—which had no abnormalities or obstructions—contained two millilitres of “white curdled material.” Forensic testing on his gastric contents, using two independent analytical methods, detected codeine but not morphine. Such tests are best performed with larger samples. But these results, along with the sheer magnitude of drugs in his blood, suggested direct administration.

A twelve-day-old infant cannot crawl. It cannot grab, and it cannot put something into its own mouth. “It also cannot swallow a Tylenol-3 pill,” Juurlink told me. “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”

For the next year, Juurlink worked on his report to McCallum with great care and precision, expecting that he would someday have to present it in court. Rani’s ultra-rapid-metabolizer status “cannot explain the death of the child,” he wrote. Soon after he submitted it, in November, 2011, he was summoned to a meeting at the coroner’s office. He presented his opinion to McCallum and two forensic toxicologists who had worked on the case. As the meeting drew to a close, McCallum announced that the next step would be to send it to Koren, for review and response.

A couple of weeks later, Juurlink ran into Koren at a Starbucks in the lower level of the Hospital for Sick Children. “He was adding some milk to his coffee, and he just looked at me, and I will never forget the glare,” Juurlink recalled. “It was a look that could kill. I don’t think he and I ever spoke after that.”

Juurlink never heard back from the coroner’s office. Koren and his team kept publishing on codeine, repeating their warning that the drug, if taken by new mothers, could pass through breast milk at levels that might kill infants. There was almost no real pharmacokinetic data to back up this assertion, only extrapolation and anecdotes. For one paper, scientists working with Koren called up seventy-two women who had been breast-feeding while taking prescription codeine, months or years earlier, and asked whether they remembered their children being drowsy or having difficulty breast-feeding. (Many newborns nap after feeding.) They reported that nearly a quarter of these infants showed signs of “central nervous system depression.”

If there were genuine signals in the literature, they were indistinguishable from the noise. Only one of Koren’s cases stood out as “extremely compelling,” Juurlink told me, for the clarity and quantity of its medical data. “A one-week-old boy was seen in the emergency department with a two-day history of poor feeding and increasing lethargy,” Koren and a colleague named Michael Rieder wrote, in Paediatrics & Child Health, the journal of the Canadian Paediatric Society. His breathing was slow and shallow. “This baby had the classical combination of lethargy and bradypnea associated with opiate overdose,” Koren and Rieder reported. They referred to him as Baby Boy Blue.

Baby Boy Blue’s urine test was positive for opiates; subsequent analysis revealed that his blood-morphine concentration was fifty-five nanograms (mistakenly referred to as “micrograms” in the paper) per millilitre—not as high as Tariq Jamieson’s but potentially lethal nonetheless. Doctors administered naloxone—which displaces opioids from the receptors in the central nervous system—and he quickly recovered.

According to Koren and Rieder, “further questioning” revealed that the mother had been prescribed “an acetaminophen-codeine product” for postpartum pain. “She reported taking one or two pain tablets three or four times a day, and noted excellent pain relief but also drowsiness and constipation,” they wrote—just like Rani. Genetic testing confirmed that she was an ultra-rapid metabolizer. As with Rani, they continued, this woman’s genetics exposed her baby to “very high concentrations of morphine” each time she breast-fed.

Juurlink struggled to make sense of the case. The morphine concentration was implausibly high, and yet the fact that naloxone had worked was strong evidence that Koren’s interpretation was correct: Baby Boy Blue had consumed toxic levels of opiates.

Years after publication, Juurlink shared a taxi with Rieder, Koren’s co-author on the paper, while they were attending a professional meeting in Ottawa. By then, Juurlink had been studying the death of Tariq Jamieson for a decade, and had found no other credible case of an infant dying from breast-feeding. The only data point in the scientific literature that had shaken his theory of the case was the near-death of Baby Boy Blue. He asked Rieder about the case.

“Oh, we made it up,” Rieder replied.

Juurlink was speechless; he regarded Rieder as an “esteemed colleague,” as he later put it, “and someone I consider a friend.” But every detail was fiction. Koren and Rieder had even invented Baby Boy Blue’s siblings, a five-year-old sister, who was born in Sri Lanka, and a three-year-old brother, who was “born in Canada by caesarean section because of failure to progress.” The morphine concentration was implausibly high because it was fabricated. No life was jeopardized; no life was saved.

Koren, who has been ill in recent years, could not be reached for comment. But, according to an e-mail that Rieder sent Juurlink years later, the case was created as “a cautionary tale,” for teaching purposes. No such disclaimer appeared in print. Meanwhile, the paper has been cited in at least one court case and in a doctoral thesis. “Pathologists and forensic toxicologists have come to accept the idea of ‘death by breast milk’ based upon terribly sloppy work that began in Gidi’s lab,” Juurlink wrote to Rieder. “Experts and the courts are being misled by this belief. Unfortunately, your case work contributes to that misconception.” Rieder said that the paper would “likely” be updated with a disclaimer in 2024, some fourteen years after it was published. But this has not happened.

Gideon Koren was born in Tel Aviv in 1947, shortly before the establishment of the Israeli state. He served as a medic and a flight surgeon in the Israel Defense Forces, then studied at the Sackler School of Medicine, at Tel Aviv University. After a residency in pediatrics, he moved to Canada to train in pediatric pharmacology and toxicology. In 1985, he established the Motherisk program. “Every year, scores of new medications enter the market, and few of them have safety data concerning fetal exposure during pregnancy,” he later wrote. “There is a serious knowledge gap as to which medications are safe for the unborn baby and which should be avoided.” Motherisk was “Gidi’s baby,” Rieder later told reporters. “It was totally shoestring at first”—just Koren, plus a staffer answering the phone. But, in time, Koren raised millions of dollars for the program, and it grew, as he put it, “to conduct large-scale laboratory and clinical research, and to translate this new knowledge into counselling.”

Koren was an amateur folk musician, and he held weekly performances in the hospital wards. “How many people do you know who are outstanding scientists, outstanding clinicians, and set up a theatre for children?” an immunologist at the hospital once said. But, in private, Koren could be aggressive and vituperative—a competitive colleague who sought to destroy the reputations and careers of those who crossed him. In the late nineties, he sent five anonymous hate-mail letters that were directed at colleagues who had come to believe, during a series of clinical trials, that a drug he was researching and advocating for was neither safe nor effective. “How did you ever get yourself in the middle of this group of pigs?” he wrote to one of them. “Or did you think that their shit won’t touch you?” The letters were filled with spelling and grammar mistakes, and also with bizarre phrases, which, to those who knew Koren well, instantly identified him as the author. (In one letter, he told a colleague that he was tired of “your mesanthropy and a British version of a foul air baloon,” and signed off as “your appaulled colleagues,” with a stamp showing the face of a clown.) When hospital officials confronted Koren about the letters, he vociferously denied any involvement. The recipients spent hundreds of thousands of dollars on private detectives and expert analysis. In 1999, they matched saliva on the envelopes to a sample of Koren’s DNA.

At that point, Koren confessed. “It defies belief that an individual of Dr. Koren’s professed character and integrity could author such vicious diatribes against his colleagues,” a disciplinary committee reported. “It was only when confronted with irrefutable scientific evidence of his guilt did he admit that he was the perpetrator.”

The prospect of Koren’s dismissal threatened to upend the Motherisk program. “The day we heard the news about the letters, top scientists came into this office and cried. We cried,” a hospital assistant told the Globe and Mail at the time. “He is irreplaceable.” The hospital’s leadership, after an expensive investigation, settled on a fine of thirty-five thousand dollars and a five-month suspension from the hospital, three of them paid.

Koren returned to work stripped of two titles and of a chair that had been endowed in his name. But he remained the director of Motherisk, and soon the scandal was behind him. Research and operational grants poured in; Motherisk’s clinical laboratory expanded its operations, and its counselling center grew to seventy-five staff members, answering an average of two hundred inquiries a day. Motherisk also served as a kind of clearing house, with extremely similar articles based on its research findings running in multiple medical journals. Koren sat on the editorial boards of numerous publications and held several academic appointments.

“Everybody thought he was the best in the world,” Bateman, the Scottish toxicologist, told me. “I did, too!” But the impression wasn’t necessarily shared by those who worked closely with him. One of Koren’s former trainees, Shinya Ito, told me that, from his experience working with Koren, “I learned what I shouldn’t do.” He added, “Gidi was sloppy with details. That was my impression, even as a trainee.”

Koren’s résumé eventually grew to a hundred and forty-seven pages, and he was credited as an author on at least a dozen medical books and some two thousand academic-journal articles. (A 2018 analysis by Nature flagged Koren, among others, as “hyperprolific,” noting that some years he had pumped out an average of at least one new paper every five days. “I perceive myself as an individual who is highly committed to scientific discovery,” Koren wrote in response. “I do not feel I have to apologize for my high productivity.”) Koren spoke at conferences all over the world, and testified as an expert witness in Toronto courtrooms. He also received some of Canada’s top medical and research awards. “It feels great when your country says to you, through its highest research authority, ‘You have changed the lives of many Canadian women and their families,’ ” he said.

In late 2014, Juurlink picked up a copy of the Toronto Star from his porch and saw Koren’s name on the front page. For the past fifteen years, the Motherisk laboratory had been paid by the Canadian child-protection authorities to test strands of hair for drugs and alcohol. At least twenty-five thousand people, across the country, had been tested by Motherisk, earning millions of dollars for the lab. The results of the tests were used in eight criminal prosecutions and thousands of child-protection cases; Koren personally testified in a criminal proceeding that resulted in the removal of a child from his mother. “However, Dr. Koren has never had any formal training in forensic toxicology or any experience in a forensic toxicology laboratory,” an independent investigation that was commissioned by the government of Ontario found. “It is clear that he did not understand basic elements of forensic toxicology.”

In fact, no one at Motherisk’s lab had any proper forensic training. The entire enterprise “fell woefully short of internationally recognized forensic standards,” the investigator, a retired judge named Susan Lang, wrote. The lab had no standard operating procedures, no clear chain of custody, and poor recordkeeping. Worse, Koren’s team relied on preliminary screening tests, designed only to quickly assess whether a sample is negative, and thus merits no further testing, or is “preliminarily positive,” and thus requires an entirely different test to confirm and quantify the presence of a drug. Koren’s team didn’t do the follow-up tests; it presented preliminary positives as precisely quantified results—a practice that was “simply unheard of in forensic toxicology laboratories,” Lang wrote. Meanwhile, laboratory personnel “made repeated interpretation errors” when reporting to the authorities. Koren testified, on the basis of these spurious tests, that a toddler must have been ingesting substantial quantities of cocaine for about fourteen months. The child’s mother went to prison.

The Motherisk lab was shut down, and Koren returned to Israel. In his absence, the regulatory body for medical doctors in Ontario carried out an investigation into whether he had “engaged in professional misconduct or was incompetent.” In 2019, as part of a deal to end the investigation, Koren surrendered his Canadian medical license and “agreed never to apply or reapply for registration as a physician in Ontario.”

Man and woman dressed exactly alike and sitting across from each other at restaurant table.
“It’s crazy how much we have in common now that I’ve hijacked your entire personality.”
Cartoon by Will McPhail

The Motherisk scandal threw the Canadian child-protection system into chaos. “The testing was imposed on people who were among the poorest and most vulnerable members of our society, with scant regard for due process or their rights to privacy and bodily integrity,” a follow-up commission reported. Many of the children in these cases had been removed from their parents and put into foster care or formally adopted—a process that is practically impossible to reverse. They lived with new families, and in many cases had done so for years. Some biological parents no longer knew where their children were. Two additional years of investigation and a review of nearly thirteen hundred cases resulted in only four instances of children being reunited with their biological parents.

In early 2015, Juurlink contacted the coroner’s office to ask about the status of the inquiry into Tariq Jamieson’s death. Three years had passed since his run-in with Koren at Starbucks, and he had heard nothing. McCallum had left the role of chief coroner, and it was now held by Dirk Huyer, a widely respected practitioner who had investigated some five thousand deaths since 1992. The office Huyer inherited had spent much of the previous decade in turmoil: an unrelated scandal had culminated in James Cairns—who had been the chair of the Paediatric Death Review Committee and had co-authored the Lancet paper with Koren—surrendering his medical license and promising never to practice again.

Juurlink’s own son had been born two and half months after Tariq. “Watching him ride his bike for the first time, and watching him win a basketball tournament, and watching him go off to school—it’s one of the reasons I’ve been pursuing this with such tenacity,” Juurlink said. As we spoke, he began crying. “This baby didn’t get that opportunity, because somebody gave him Tylenol-3.”

Huyer sent a couple of “perfunctory replies,” as Juurlink put it, but otherwise seemed reluctant to engage. “Things continue to be evaluated,” he wrote. Months later, Huyer visited Juurlink at his office. He said that Koren had reviewed Juurlink’s report from 2011 and one of his former Ph.D. students, Parvaz Madadi, had issued a rebuttal. Although Huyer no longer trusted Koren, Madadi was now a forensic toxicologist associated with Huyer’s office, and he considered her rebuttal plausible, detailed, and beyond his scope of expertise. “We’ve got these duelling expert opinions—the original interpretation and yours,” Huyer told Juurlink. “What are we supposed to do with that?” Juurlink urged him to seek the opinions of other experts but he declined, indicating that the matter was closed.

At that point, Juurlink informed Huyer that he would someday go public with Tariq’s blood-codeine concentration. In response, Huyer warned that the contents of a coroner’s file are not a matter of public record; only he, as chief coroner, could legally authorize the disclosure of unpublished details. And he didn’t. Juurlink was incensed. “The motto of your office is ‘We speak for the dead to protect the living,’ and that’s exactly what you’re not doing here,” he said. But Huyer insisted that, absent some form of “clear and cogent” proof, such as a confession by the perpetrator, his office could only consider changing the manner of death from “accident” to “undetermined,” a step that it has not taken.

“We’re death investigators, and we frankly rely on information that comes to us,” Huyer told me, last fall. “There are scientists involved who are far more skilled and have an expertise that would be beyond ours.”

I asked him which scientists he considered to have the best understanding of the material.

“I don’t know,” he said. “It is outside of our specific expertise, so we have not decided who would be more expert or less expert.”

But the forensic toxicologists who had been assigned to the case had expressed concerns from the outset that Tariq had been administered codeine. There was a difference of opinion within the death-investigation team, and the toxicologists’ interpretation was sidelined. Soon afterward, Koren and Cairns took the story to the scientific press, presenting their version as an uncontested medical revelation.

I contacted Rani this past June, seeking clarity into what had happened to Tariq. “Just to warn you, dealing properly with this case will involve a great deal of in-depth research into the science related to my son’s death,” she replied by e-mail. “If you are willing to invest the time needed to do that, then I would be very happy to assist you over the next few months.”

In the following weeks, Rani provided me with a handful of primary-source documents, including Tariq’s postmortem examination and toxicology report. “It is important for me to keep Tariq’s memory alive and in the public eye to help prevent possible death and harm of other newborn babies in the same or similar way,” she wrote.

In July, Rani sent me a copy of Koren’s original draft of the Lancet paper, in order, she said, to demonstrate that there was never an attempt to conceal Tariq’s blood-codeine level, which Juurlink had treated as a kind of smoking gun. She was right: the codeine and acetaminophen levels were present. The draft was twelve pages long, including references, and The Lancet had asked Koren to shorten it to a page. It is unclear why, during that process, Koren removed the codeine and acetaminophen readings. But, shortly after publication, he promoted his young graduate student Parvaz Madadi as a new expert on opioids in breast milk.

Madadi was listed as the lead author of the two Canadian practitioners’ journal articles—her first bylines in academic journals. But, when I reached out to her this fall, she told me that she had not written either paper. I sent her Koren’s original Lancet draft, where she was also listed as an author. She was perplexed, then horrified. “Not only have I never seen this manuscript—I had no reason to be on it, since I did not contribute to the original death investigation in any way,” she told me.

When Tariq died, in April, 2005, Madadi was an undergraduate at the University of Western Ontario, some two hundred kilometres from Toronto. She began studying under Koren five months later, when, as a master’s student in her early twenties, she initiated a laboratory project to develop a reliable assay for drugs in breast milk. The project was launched in response to the Lancet case report, but she had never seen Tariq’s postmortem documents.

After a year of research, Madadi said, she was “unable to develop a reliable assay.” Koren offered her what seemed at the time like a promising path forward, inviting her to pursue clinical research with the Motherisk program. He also offered to name her as the lead author of the articles in the Canadian practitioners’ journals, although she had not contributed to them at all. “It’s a really nice thing he did for me!” she wrote to her parents, her sister, and her boyfriend.

From that day forward, “Gidi dragged me to the forefront of the scientific discourse,” Madadi told me. He tasked her with working on his response to Nick Bateman for publication in The Lancet, and steered her to produce more articles on codeine and breast milk, effectively creating a body of academic literature that cited and supported his initial interpretation of Tariq’s death. “I felt, and still feel, like there are real signals in the literature to support the notion that codeine can cause sedation in breast-fed infants,” she told me. “But all my assumptions about death stemmed from the Lancet case report, which said, This is a phenomenon that happens.”

Madadi learned of Tariq’s blood-codeine concentration in 2013, when she was working on the rebuttal to Juurlink’s interpretation for the chief coroner. But she didn’t grasp its significance. Soon afterward, she left Koren’s department and started working as a forensic toxicologist associated with the office of the chief coroner, where she came to understand how poorly Koren’s laboratory had been run. “Looking back at it now, with everything I have learned, I cannot reconcile the codeine level with Gidi’s interpretation,” she told me. “That number is too high.”

I asked Madadi whether she was aware that Tariq had died with “white curdled material” containing codeine in his stomach, many hours after his last substantial feeding.

She froze. Then she said, “Are you kidding?”

In 2019, the Hospital for Sick Children lost control of Motherisk’s web domain after the subscription lapsed. It now redirects to a website that promotes the use of cannabis during pregnancy.

By then, reporters at the Toronto Star had carried out a review of Koren’s published works and found that more than four hundred of his writings appeared to contain failures to disclose funding from drug companies; unretracted assertions based on his laboratory’s discredited record of testing hair; and other malpractices and lies. In response, the Hospital for Sick Children announced that it would conduct a “systematic examination” of Koren’s academic-publishing record.

At that point, Juurlink wrote to David Naylor, the former dean of medicine and president of the University of Toronto, who was serving as the interim president and C.E.O. of the Hospital for Sick Children. He asked to discuss the death of Tariq Jamieson, then went grocery shopping. Naylor called back soon afterward, and for the next hour Juurlink paced in the canned-fruit aisle, describing his belief that Koren had essentially generated an entire branch of neonatal toxicology based on a sloppy misreading of a single death.

Juurlink’s phone call hardly came as a surprise to Naylor. He and senior members of the hospital’s faculty had been “screening endless manuscripts,” as he put it, and devising strategies for requesting retractions of Koren’s most egregious works. “We actually had a term for it—we called it ‘Korening,’ ” he told me.

“Gidi had a tendency to just submit papers without the co-authors being advised or consulted, and let the peer-review process handle all the shitty nitty-gritty, you know?” a person who worked with the Motherisk program for several years told me. “Rather than sit back and be, like, ‘Let’s make sure, before we go forward with this paper, that we have all our ducks in a row.’ ”

Naylor informed Huyer, the chief coroner, that, as part of the hospital’s review of Koren’s publishing record, Juurlink would write a comprehensive reassessment of the Lancet paper and the two papers that had appeared in the Canadian practitioners’ journals. “Juurlink is one of the straightest and smartest faculty members I’ve dealt with in a long career, and this case has been a real passion of his for a long time,” Naylor told me. “No one knew this material better than him.” Naylor also emphasized the importance of disclosing Tariq’s full toxicology results. “It was imperative that those data points be allowed for public release by Juurlink in his publications, so that there could be a proper analysis of the science,” Naylor said. Huyer relented, and Juurlink and one of his doctoral students, Jonathan Zipursky, went to work.

They conducted a study of some hundred and seventy thousand new mothers, to see if infants of women who were prescribed opioids shortly after birth were at an increased risk of harm. What they found, instead, was that many women who are prescribed opioids postpartum appear to avoid breast-feeding, in order to “protect” their children—and thereby deprive them of immunological and other benefits. “The number of infants affected by this globally is now easily in the millions,” Juurlink told me. In May, 2020, they published their review, titled “The Implausibility of Neonatal Opioid Toxicity from Breastfeeding,” in the journal Clinical Pharmacology & Therapeutics. The key finding was that Tariq’s codeine concentration “obviously cannot be explained by maternal genotype, and suggests that conversion of codeine to morphine in the neonate . . . rather than the mother, explains the elevated morphine concentration detected postmortem.”

Soon after the paper was published, the editors of the two Canadian practitioners’ journals initiated an independent review process. Between 1995 and 2015, both publications—which have a combined circulation of some eighty thousand Canadian family doctors and pharmacists—regularly ran columns from the Motherisk team without subjecting them to peer review. “We are also widely read online outside Canada by family physicians and other primary-health-care clinicians, so our potential impact on clinician prescribing behaviors and on patients is significant,” Nicholas Pimlott, the editor of Canadian Family Physician, told me. When the independent reviews came in, the journals issued a joint retraction, citing “clear evidence” that Koren’s findings were “unreliable.”

Woman talking to detective in his office.
“It all started with a mysterious call from an unknown number, and now that I’m saying it out loud I think it was just spam.”
Cartoon by Ellis Rosen

Rani said that Juurlink and Zipursky’s analysis was “baseless speculation” that omitted “any information that would cause people to doubt their claims.” When I asked her what she meant, she forwarded me a sixty-five-hundred-word e-mail that she had sent to the editors of the two practitioners’ journals, criticizing their retraction. Her complaints were extremely detailed and highlighted some genuine challenges in postmortem toxicology. But they mostly centered on her belief that the relatively scant toxicological literature on opioids and breast-feeding did not apply to her son. She also pointed to case reports in the medical literature which attribute infants’ symptoms to opioids in breast milk, but these generally rely on inference and lack substantive data. Nothing in her response amounted to evidence that would challenge Juurlink’s conclusion. (Douglas Jamieson did not engage with me.)

I have spent the past year searching for ways in which Juurlink might be wrong or overstating the strength of the toxicological evidence. But I have come up short. It is true that newborns are unusually sensitive to opioids; their systems are still developing. But this vulnerability is the reason that opioid dosing in newborns is so carefully calibrated and closely monitored in clinical settings—where the amounts administered directly are still orders of magnitude greater than what is transferred through breast milk. Any accumulation from the trace amounts in breast milk would be gradual, with symptoms becoming evident well before catastrophe. And though the effects of postmortem redistribution can become a “toxicological nightmare” in some forensic circumstances, as one journal article put it, Tariq’s blood sample is not one of those circumstances.

“Medicine is full of exceptions to the rules that physicians and scientists set in their various paradigms,” Naylor told me. “And human biology is unpredictable. However, in this instance, the overwhelming balance of probabilities would favor the interpretation that Dave Juurlink and his collaborators have proposed.”

Shinya Ito—who replaced Koren as the head of clinical pharmacology and toxicology at the Hospital for Sick Children in 2000, and has been publishing scientific research on drug safety and breast-feeding for more than thirty years—agreed. Rani’s ultra-rapid-metabolizer status was a red herring. Leading European and American experts with whom I shared the raw postmortem and toxicological data told me much the same. “The amount of morphine in milk, even if it’s unusual, is still not enough—period,” Ito said. “There is a missing piece, the bigger exposure, which must have come from direct administration. By whom? Nobody knows.”

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue,” Richard Horton, the editor of The Lancet for the past thirty years, wrote in the journal, in 2015. “In their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Or they retrofit hypotheses to fit their data. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours.”

In 2020, Juurlink, Zipursky, Naylor, and several other experts—including Nick Bateman, the Scottish toxicologist; Thomas Hale, one of the world’s leading scientific authorities on breast milk; and Ronald Cohn, who had replaced Naylor as president and C.E.O. at the Hospital for Sick Children—wrote to The Lancet, asking the journal to retract Koren’s paper. “For more than a decade now, Koren either knew or ought to have known that his original interpretation of the case was flawed yet he took no corrective action,” the letter read. “He instead continued to publish work citing this case as foundational to consideration of the risks of opioid use while breastfeeding.”

The journal referred the request back to the Hospital for Sick Children, which established an internal research-integrity review. Since Cohn had signed the letter asking for retraction, the lead inquirer did not report to him.

What followed was an exercise in obfuscation through institutional review. There was no meaningful effort to assess whether Juurlink’s analysis disproved Koren’s; instead, the reviewers narrowed the scope of their inquiry to the matter of whether Koren’s team had demonstrated such a “lack of rigour” that retraction was unavoidable. “Is it a good paper?” Stephen Scherer, the hospital’s head of research, who oversaw the investigation, later said to Juurlink. “You know—it’s an n of one and a lot of hand-waving. But the four authors on the paper stick by it.”

Koren sent the review team a bizarre eight-page document, which contained factual errors, non sequiturs, multiple font sizes, and what appeared to be copied-and-pasted correspondence with Rani. The hospital’s research-integrity office chalked it up to a scientific dispute. The editors of the Canadian practitioners’ journals offered to provide The Lancet with the unambiguous findings of their own review, but The Lancet declined. An independent expert I contacted told me that, some years ago, The Lancet had asked him to weigh in on the subject—then ignored his advice to retract. Koren’s case report remains on the journal’s website, with no notes or corrections appended, and serves as the core basis for regulatory guidance on the subject of breast-feeding and codeine all over the world.

“The fact that the paper still exists means that medical students, pharmacy students, and, presumably, genetics students are being taught this as if it’s a real thing, and it has implications,” Juurlink told Scherer. “The scientific record now has this entire branch of pediatric pharmacology that has been made up out of whole cloth.” Koren’s Lancet article “is still used in a lot of textbooks,” the independent expert said. “Doctors who are less trained in this specific topic still perceive this case to be relevant.”

Soon after Naylor’s interim leadership came to an end, the internal review of Koren’s works was terminated. “The hospital decided that it was simply indigestible—that they would be forever at it,” Naylor told me. (The hospital disputes this.) Most journals resisted retraction, “even when strong arguments had been presented to get these papers out of the literature,” he said. “I was certainly disappointed. An enormous amount of work had been done, and the net result was a damp squib.”

Recently, Parvaz Madadi has undergone a painful process of revisiting her past work and memories. “This case report is misleading,” she said. “And the original submission was not done carefully or in good faith.” She added that she had no confidence in the measurement of Rani’s breast-milk sample, because it had been handled by Koren’s lab. Last week, she submitted a request to The Lancet to retract the original paper, along with her co-bylined response to Nick Bateman. At the core of her letter is a new allegation: that Koren falsified toxicological data.

Last month, Madadi scoured her archives and discovered an unpublished letter that Koren had submitted to The Lancet—without her knowledge but with her name as a co-signatory—in his initial attempt to suppress Bateman’s critique. On the second page, he misrepresented the contents of Tariq’s stomach. A toxicological screening of the “white curdled material” had detected codeine but not morphine. But Koren had claimed that the gastric contents “exhibited high morphine” levels—with no mention of codeine—“ruling out administration of Tylenol-3 to the baby.”

“Gidi was thinking about direct administration, and he created a scenario that would confuse or negate that explanation,” Madadi said. “He deliberated on this issue, and he lied.”

Tariq Jamieson was alive for only twelve days. But the circumstances of his death have cast a shadow over the scientific literature, top medical institutions, and the Jamieson family for more than two decades. After I contacted Huyer, the chief coroner, this fall, he began looking into the origins of the death investigation; during that process, he discovered that the full set of documents has gone missing.

In the decades since Koren’s first warnings concerning codeine and breast milk, public-health authorities and patient-advocacy services have issued guidance to new mothers that ranges from scientifically incoherent to potentially dangerous. A clinical report published by the American Academy of Pediatrics in 2013 cites the Lancet case as a reason to avoid prescribing codeine to breast-feeding mothers but notes that morphine—its metabolite—“appears to be tolerated by the breastfeeding infant.” The same guidelines also recommend the use of hydromorphone, which is about forty times more potent than codeine and can be highly addictive. Meanwhile, the U.K.’s National Health Service categorically warns against taking codeine while breast-feeding but allows for the use of fentanyl.

The notion that opioids can pass through breast milk in sufficient quantities to kill a child has also seeped into American courtrooms. Koren’s interpretation of Tariq Jamieson’s death has essentially served as a legal defense in at least two other cases that Juurlink believes most likely involved direct administration. During a review of other scientific literature, this summer, he discovered fourteen more, in Europe. “Who knows how many other babies have died at the hand of a caregiver and had it attributed to breast milk?” he said. “I don’t know the answer to that. But it’s not zero.” ♦

Nancy Kerrigan Persisted

2026-01-26 20:06:02

2026-01-26T11:00:00.000Z

Nancy Kerrigan doesn’t plan to attend the Winter Olympics in Italy next month. But she’s excited to watch the U.S. figure-skating contenders on TV. “It’s pretty expensive to go,” she said recently, in a coffee shop in Bellport, on Long Island. “I probably wouldn’t even be able to get a ticket.” Nonetheless, her presence will be felt: the white sheer-sleeved skating dress, designed by Vera Wang, that she wore when she won the bronze medal, in 1992—two years before the leg-bashing linked to her rival Tonya Harding—will be on display.

Kerrigan, still plainspoken and high-cheekboned at fifty-six, had travelled from her home in Massachusetts to headline and host the Gateway Playhouse’s annual “Holiday Spectacular on Ice.” “Everybody’s so welcoming here,” she said, as her sneakers crunched on the snowy sidewalk. “The other day, the local protesters for peace invited me to join them for coffee. Not to be political, but who could argue with peace?”

Kerrigan has her causes. She is transparent about fertility issues, having undergone six miscarriages, and she has raised funds for the vision-impaired, to honor her blind mother. “She couldn’t see much, but she knew when I fell,” she said. She also served as an executive producer for a documentary on eating disorders in sports, called “Why Don’t You Lose 5 Pounds?” But her biggest cause seems to be keeping figure-skating shows from melting away like glaciers. “There just aren’t the opportunities for young skaters like there used to be,” she said. “Not every skater gets to the Olympics.”

And most of the ones who did have left the ice. Sarah Hughes became a lawyer. Sasha Cohen went into finance. Michelle Kwan got into politics and became the Ambassador to Belize under President Biden. Harding got into boxing, worked odd jobs, and then made some celebrity appearances after Margot Robbie portrayed her hardscrabble life in the 2017 bio-pic “I, Tonya.”

Kerrigan no longer has contracts with Campbell’s, Seiko, Old Navy, or Revlon. (She lost other deals decades ago; it may not have helped that she was caught on a hot mike calling her role in a Disney World parade “dumb.”) But she still skates in shows. She and her husband-manager, Jerry Solomon, have paid the bills with choreography, book deals, creating “Halloween on Ice,” and making television appearances—e.g., on Fox Sports,“Dancing with the Stars,” and a Kardashian Christmas special. She refutes, with a gutsy laugh, an internet report putting her net worth at ten million dollars. “I raised three kids, and that’s expensive,” she said.

Inside the historic theatre’s lobby, she greeted the staff warmly, then signed copies of “Stronger Than She Thinks,” a children’s picture book she co-wrote, about a persistent little skater named Nancy. The five-hundred-seat house had sold out. “I just hope the audience is energetic,” she said. “Last night, a gentleman in the front row was asleep. I guess he felt relaxed.” On the way to her shared dressing room, she looked at the stage set—a wintry city park with a skating pond of ice, which was kept frozen by chilled glycol circulating underneath. Two stagehands were smoothing the surface with bladed scrapers. Kerrigan’s father, a welder, drove a Zamboni to pay for her predawn practice time as a kid. (He died in 2010, following an altercation with one of her brothers.) The stage was minuscule compared with most rinks. “I’m used to it,” she said. “Although the ice is a little hilly.”

During the show, Kerrigan shared the crowded stage with fourteen skaters and singers. Dressed as a cowgirl and a bathrobed mother, and then in a progression of little skating dresses, she had the audience in raptures. She pulled off an axel, a mazurka, and other moves with grace, although she warns people not to expect to see her do the old Olympic tricks. Afterward, in the wings, she hugged the youngest skaters, kissed a pug, and fist-pumped the cast like a big sister. In the lobby, she greeted a crowd of happy fans. Many older admirers told her that she hadn’t changed. She smiled a Snow White smile for a long series of selfies, telling one wiggly little boy at her side to hold still and stand up straight.

Walking back in the silvery moonlight to a nearby Victorian house where she was staying, she recalled falling during a Gateway show in 2023 and breaking her arm. “My name was on all the signs and posters, so I went on and I did my best,” she said. A herniated disk flares up sometimes, too, but she keeps doing her shows. “As athletes, we’re expected to be in pain and work through it,” she said. “That’s what we do.” ♦

How to Woo with Words Alone

2026-01-26 20:06:02

2026-01-26T11:00:00.000Z

No one wants to write these days. Kids send voice notes. Boomers blast out Bitmoji. A.I. is depressingly inescapable. So, when Philip Leif Bjerknes, a marketer and former Craigslist dater, designed a text-based, photo-free dating app, he knew that some prospective users might need help expressing themselves. Machine-generated slop would undermine his whole endeavor, which he’d decided to call Oh Hi. “The last thing a date wants is someone who can’t be bothered,” Bjerknes, who met his current girlfriend speed dating, said. “It’s literally called a personal. Like, if it’s not personal, you’ve sort of lost the plot.”

One recent week night, Bjerknes, who had a few days’ stubble and wore Buddy Holly glasses, teamed up with Katie English, a friend and copywriter who also works on Oh Hi, to co-host a free personals-writing workshop. At Clem’s, a classic corner dive in Williamsburg, Bjerknes would offer participants dating advice while they waited for their turn to sit at the bar with English, who would translate their conversation into solicitous slivers of text. English, whose thick gray-brown hair swooped over her head, was game. “I’ve always just kind of loved to take anybody’s writing and punch it up, clean it up, make it simple,” she said.

Up first: Kate, a bespectacled fortysomething publicist with a short bob, from Cobble Hill. As a divorced mother, she was looking for something casual, consistent, and not too energy-intensive. English dutifully typed notes. It was important that her suitor be patient in wine shops, Kate said, and that he find at least half the things she said cute. “And thinks it’s cool that I rarely brush my hair,” she added.

“As someone with curly hair,” English said, “I don’t think you’re supposed to.”

Kate sipped her cocktail. “I feel so pretentious,” she said. “Is this supposed to be about me or them?”

“Both,” English told her. She looked up from her screen and asked for a headline. “ ‘Curly divorcée seeking silver fox’?” Kate suggested. “But I think that’s too much about hair.”

At a nearby table, Laura, a therapist in a blue denim jacket, who wore her hair in an updo, told Bjerknes that she was newly single. “Tragically?” he asked.

She laughed. “Sort of,” she said. Her Hinge forays had been largely fruitless. “I do, like, five thousand hobbies,” she said—boxing, guitar lessons, sign-language class. But meet-cutes had been elusive. “People aren’t super open to that,” she lamented. “I guess they could just want to learn a skill.”

She brought a can of Narragansett and a publishing-house tote to the bar and sat beside English. “I want someone who’s earnest about dating and doesn’t treat it like Candy Crush, and also is not a nihilist,” she said. “I’m an appropriately hopeful person, so I need another appropriately hopeful person.” They discussed the need for brows both high and low: the Criterion Collection, but also Bravo binges. Social causes were important, too. The war in Gaza and celebrity conservatorship: both nos.

English tapped her keyboard and read aloud, “Looking for pro-Palestine, free-Britney hottie.”

Laura frantically tapped her arm. “That’s it!” she said.

Next came a neat-haired, lightly goateed attorney in search of a companion for late dinners—“like, Spain-late,” he said—and dancing.

After his turn, English let out a sigh, exhausted by all the extemporaneous scribing. “I feel like a rapper,” she said. Up walked a thirty-one-year-old government worker in a green Hawaiian shirt and a dark hoodie.

“Feel good?” English asked.

“I’ve never felt good in my life,” he told her.

Writing gives him awful anxiety, he explained. Dating apps had been their own disaster; he said he once had an account hacked and found himself transformed into a woman from Arkansas. He told English he was looking for a “certified yapper” who shared his love of sweets and boba. A hammer thrower, as in the spin-and-fling track-and-field event, would be nice, too.

He tried self-description. “Wanna be with someone who looks sad all the time but makes jokes?” he offered. “People say I look like Eeyore.” He backed off that idea, and several others. Citing casual cultural interests risked being exposed as a poseur. Mentioning his love of thighs could overpromise on his libido.

“Super-specific will bring in super-specific responses,” English said.

The government worker looked contemplative. “My perfect date, there’s no flies around,” he began. “We both turn into spirits, and we merge into each other. We possess the people on ‘S.N.L.’ and we force everyone in the audience to listen to our bad improv.”

English lit up. “Now you’re painting something very clear!” she said.

“You told me to,” he said. ♦