Archive for the ‘News-Maybe-Worthy’ Category

The War on Autism

Sunday, November 2nd, 2014

In the 1980’s, President Ronald Reagan declared a ‘War on Drugs‘. The Global War on Terrorism was pronounced after 09/11/01. Early in this century, Bush 2 joined the war on HIV/Aids. This week, Obama named an Ebola Czar.

For some time now, the U.S. has only had an acting Surgeon General (Rear Admiral Boris Lushniak), because the nominee, Dr. Vivek Murthy, had the temerity to say that, “Guns are a health care issue.”

Is it any wonder that ASD has taken a backseat to other matters in our healthcare system?

More than forty years ago, Surgeon General C. Everett Koop challenged the tobacco industry juggernaut that assaulted the population of 20th century earth. He raised numerous warnings (including the dangers of second-hand smoke), and even changed the paradigms for advertising and labeling the product. In spite of some unpopular conservative views, especially regarding abortion, Dr. K was still considered America’s Doctor.

What does ‘declaring war’ mean?
It implies urgency. Somehow, more resources appear; including funding, infrastructure, media, etc. Priorities change. For ASD, a medical condition, personnel and materials would become focused on research to elucidate etiology, test treatments and evaluate prevention.

The ‘enemy’ is put on notice that the entire weight of the U.S. government is behind an effort to solve the problem. It worked when we landed a man on the moon, figured out the HIV epidemic, and Bin Laden. Autism is trickier because, like terrorism, it’s difficult to identify the opposition.

A ‘Czar’ is usually named. The Big Kahuna avoids Senate confirmation. Hopes are raised. There would be a commander to unify the disparate autism organizations.

How would the appointment of an Autism Czar help?
There would be instant recognition, finally, that there is an epidemic. Apparently, “ASD now affecting 1/42 males,” does not sound dire enough.

A true understanding of the costs should enlighten the prudent potentate about the enormous savings produced by early diagnosis and effective intervention.

There would be a respected leader to delegate resources to the areas of most need. This individual also has ultimate responsibility for education, caring for older patients, and the most affected.

More medical specialists would get involved in the search for answers. Gastroenterologists, dermatologists, immunologists, child neurologists, and pediatricians would find increased incentives to join the autism battle.

Research leading to effective medications would speed up. The major complaint by drug manufacturers is that it costs >$ 1B to develop any new drug. Perhaps, as in other crusades, the ASD maven could cut through the red tape to get things moving.

Vaccination research would take a new direction. Increased resources should include the formulation of controlled, prospective, randomized, double-blind studies about the various components of the present childhood immunization schedule, dose and timing. This would go a long way to clearing up the many lingering concerns in this area.

Unification would provide a national infrastructure for tackling the situation. The evaluation of genetic, environmental, bacteriological, nutritional, and other important disciplines by the Boss and Joint Chiefs of Autism Medicine may be the best way to gain ground on the enemy.

The Czar would be responsible for making a difference in the autism epidemic.

There is no ‘War on Autism’.
But patients, families and practitioners – those who live and fight in the trenches – could certainly benefit from some reinforcements.

Five Steps to Improving Vaccination Compliance

Saturday, October 4th, 2014

In a recent Wall Street Journal editorial, “The Anti-Vaccination Epidemic”, Dr. Paul I-never-met-a-vaccine-I-didn’t-like Offit whined about the ignorant public, The Wakefield Effect, “fringe” doctors, foolish families and the “inaccurate” media. The subtitle, Whooping cough, mumps and measles are making an alarming comeback, thanks to seriously misguided parents, sums up the position of Dr. He-ain’t-Jonas-Salk.

The mainstream approach to the childhood vaccination-autism controversy is that there is no blame on the part of the ‘experts’ or the doctors who follow the pharmaceutical industry’s dogma. The logic that says,”If you knew how bad those diseases were, you would believe,” doesn’t work on me. I have lived through many previous epidemics.

The major problem is trust. Confidence in the government is at an all-time low. More than half of the population doesn’t trust the FDA. That bureaucracy can’t manage to stop antibiotics in our food, even when there is evidence of negative effects.

The CDC has similar problems. The current whistle-blower incident, involving questionable data inclusion/exclusion affecting an association with MMR and autism in African-American males, hardly discourages vaccine skeptics. Furthermore, the present viral epidemics appear to reinforce public fear about the competence of that prestigious organization. It was media scrutiny that prompted investigators to secure the living quarters of the Texas ebola patient!

How to Improve Vaccine Compliance:

1. It is difficult to believe that an agency has ‘learned from its mistakes’ when they don’t even own up to them. There have been problems in the past. A neurologic illness has been related to some vaccines, and the Swine Flu ‘epidemics’ were debacles. Public trust would best be furthered by declaring, “We understand what happened and those issues are behind us,” if it’s true. If it isn’t, caution is warranted.

2. Pediatricians need to give better advice. Often, the doctor who professes vaccine safety also missed the child’s ASD diagnosis. Parents are not “bad”, “ignorant”, or misinformed. They simply don’t agree, and professionals should be armed with the facts, not paternalistic warnings.

3. Doctors need to listen. A previous sibling or relative with autism is cause for concern. Fevers or illness that followed other vaccinations should be highlighted in the chart, not dismissed. Co-morbidities, such as eczema or asthma need to be controlled, before adding to the immunologic load.

4. Research that challenges the norm warrants evaluation, not immediate dismissal. Instead of proclaiming the autism-vaccination question a dead issue, confidence would be elevated by experts who calmly declare, “That study deserves further attention.”

5. A practitioner’s willingness to agree to an individual family’s reasonable request to adjust the number and frequency of ‘shots’ will be met with more, not less, compliance. Furthermore, kicking an insubordinate family out of the practice is neither ethical nor helpful.

The present strategy of threats and intimidation is not working to decrease the number of families who either choose an alternative schedule, or the risky position of total noncompliance.

Further understanding and kindness is the best prescription for a more successful approach.

Early Intervention Reverses Autism

Sunday, September 21st, 2014

reverse autism2More than occasional skepticism has been voiced about my lead essay, “Reversing Autism“. However, because of recent research, the major media sites, at least, seem to have picked up on this paradigm.

CBS news asked, “Could early intervention reverse autism?” NBC news announced, “Treating Infants for Autism May Eliminate Symptoms.” U.S. News and World Report: “Spotting, Treating Autism Symptoms in Infancy May Prevent Delays,” and USA Today was the most optimistic, by reporting “Study: Autism signs in babies can be erased.”

What was the study?
Researchers from the University of California, Davis MIND Institute provided intervention to seven ‘symptomatic’ infants (5 male, 7-15 months) and results were compared with 3 control groups:
1. High-risk infants who were younger siblings of an ASD child, but never developed it.
2. Low-risk infants who were younger sibs of a neuro-typical child.
3. High-risk infants who were younger sibs and diagnosed with ASD by 3 years.

What was the intervention?
Twelve ~1-hour sessions were provided. In the first one, 5-6 measurable objectives were developed. Afterwards, parents were instructed on skills to address those concerns. “… Therapists also provided parents with specific interventions for other delays, which were individualized for each child to address weaknesses identified during the curriculum assessment…”

What was the result?
U.C Davis’ Dr. Sally Rogers, et.al. reported that, “Most of the children in the study, six out of seven, caught up in all of their learning skills and their language by the time they were 2 to 3… Most children with ASD are barely even getting diagnosed by then.

Conclusions:
I was a bit disappointed that no medical problems were noted in any of the children. Perhaps it will be addressed in future research. Furthermore, the child who did not improve might have had an undiagnosed physical ailment, which would have made the intervention more effective.

In many cases, autism is something that can be reversed. That is simply the way that I perceive the condition. ASD seems to present as some sort of injury; before, or up to three years after birth, from which a child may recover. As in any physical insult, there can be complete, partial, functional, little or no improvement. Also, it may take months or years to achieve significant gains. The earlier the condition is treated, the higher the chance of recovery.

Pediatricians, neurologists, geneticists, psychiatrists, psychologists, gastroenterologists, dermatologists, immunologists, family practitioners – are you listening?

MAPS Fall ’14 Conference

Saturday, September 13th, 2014

Twice a year, doctors who are interested in understanding and treating children with complicated developmental issues, convene under the direction of the Medical Academy of Pediatric Special Needs. This is our opportunity to stay up-to-date about the latest protocols, and to speak with specialists from all over the world.

In addition to introducing the biomedical approach to professionals and providing a venue for the spouse and kids, the program includes ‘advanced’ tracks. The highlights of those lectures will be reviewed.

Day 1
Dr. Anju Usman – Down Syndrome
“What does that have to do with autism?” Learning about one neurologic childhood condition helps elucidate normal vs. abnormal structure and function. Besides, there are more than a few patients who suffer from both.

The ever-changing basic science of the brain was reviewed. A medical workup is similar; requiring genetic, metabolic, immune, and gastrointestinal evaluation. Conversely, having discovered treatment for the mitochondrial issues in ASD has successfully addressed various problems for Trisomy 21 patients, as well.

Dr. Giuseppina Feingold – Cerebral Palsy and Seizures
Again, understanding seizure activity in a condition where it is not uncommon, helps our understanding about convulsions in ASD. The lecturer, a pediatrician who practices alternative medicine in a very conventional setting, described her experience with her own child, who has CP.
A thorough review on the use of HBOT for CP was presented.

Dr. Mukherjee (New Dehli) and Dr. Marois (Quebec) followed with their research and positive experience managing CP with HBOT. Somehow, their findings have been misunderstood and misrepresented by the conventional medical community, for variety of reasons.

Dr. Kenneth Stoller reviewed his clinical knowledge and experience with Fetal Alcohol Syndrome. He has successfully treated patients with HBOT and Oxytocin, and has published that research.

Case presentations and discussions – sharing our medical experiences – finished out the day. The 2000 pound gorilla in the room? (hint – it has something to do with autism). Data is lacking.

Day 2
Very exciting! This day’s lecturers are rockstars, as far as researching, teaching, publishing and treating the group of conditions that present as a post-inflammatory encephalopathy. It is rare to be among such experts, so freely discussing their findings and opinions.

The moderator, Dr. Nancy O’Hara described her extensive experience treating patients with these disorders, including her own son. Details are provided about an accurate description, differential diagnosis (“What else could it be?”), laboratory ‘workup’, treatment options (including an additional lecture covering nutritional support) and outcome.

Dr. Tanya Murphy presented a fascinating talk about the overlap between antimicrobials and psychotropic medications. Specifically, certain antibiotics can also have neuropsychiatric effects. Conversely, psychotropic drugs have effects on the inflammatory system. This finding helps explain why the disparate group of medications that we use may have similar effects.

The inventor of the term, Dr. Sue Swedo, a Director at the NIMH, presented the latest about PANDAS. She described the areas in the brain where tics and OCD behaviors lie, and how this manifests as a condition for doctors to investigate, with treatment guidelines.

Professor Madeleine Cunningham, a researcher for over 35 years, gave an elegant presentation that documented the presence of autoantibodies in certain patients’ blood and the CSF, offering evidence that those chemicals signal (or are blocked from) neuronal cells. This work helps our understanding of many of the movement disorders, from Tourette’s to PANDAS.

Case presentations and videos completed the afternoon. The take home message was that doctors should stop asking the question, “Do you believe in PANDAS?”

Day 3
Inflammation

Dr. Rodney Dietert conveyed his understanding regarding the complexity of the functional immune system, and the relationship to non-communicable chronic disease. “The tie that binds,” according to the Chief of Immunology at Cornell.
He presented with the passion and knowledge that only a man who has spent his lifetime in this research could bring.

Harvard celiac researcher, Dr. Alessio Fasano, presented Intestinal Permeability, Antigen Trafficking and Inflammation. The subtitle, “The gut is not like Las Vegas, what happens in the gut does not stay in the gut,” tells the whole story.

Canadian naturopathic physician, Dr. Zayd Ratansi spoke about HBOT and Inflammation. There were lots of associations with medical conditions such as wounds, pain, trauma, cystitis and CP. The only slide about ASD and HBOT slide was Dr. Rossignol’s controversial multi-center report.

Dr. Russell Blaylock, a neurosurgeon, researcher and author, spoke about Immunocytotoxicity in CNS Disorders, elucidating how inflammation is handled in the brain.
He explained why/how systemic disturbances activate the CNS immune system. In turn, ASD patients with inflammation, perhaps elsewhere, have behavioral signs and symptoms. Comments were offered about the risks of the present vaccine schedule on the developing brain.

Although I can’t report that there was a great deal of specific day-to-day information, there was a lot of food for thought, networking, and the knowledge that there an increasing number of serious professionals working on your kids’ difficulties.

GcMAF Autism Treatment Update

Monday, August 25th, 2014

Earlier in this century, it was reported that 1) Some cancer patients demonstrated an elevated level of an enzyme, called nagalase, and 2) When patients have been given a purified blood product, GcMAF, which acts as sort of an antidote, there have been reports that treatments were successful in some medical conditions.

Because of elevated levels of nagalase in children with ASD, it was suggested that the same treatment could be helpful to address inflammation in autism, as well.

So, for the past couple of years, The Child Development Center has been treating a small number of patients with a protocol, slightly modified for this pediatric practice. The first blog, explaining the therapy, appears here. Six months ago, I reported on our initial experience.

My conclusions at that time were: improvements were generally seen in children older than 5 years, females appeared to respond better, some showed dramatic improvements in speech and cognition, and most parents were satisfied enough to re-order the product. In the past 6 months, there have been more patients and additional experience, particularly learning about lower dosing and altering dosage depending on signs and symptoms. Most recently, there is a new, ‘improved’ version of GcMAF to evaluate.

Side effects, while not severe, are variable, from slight rashes and fevers to increased aggression, especially in the first month. The product is well tolerated.

What is GcMAF? Macrophage Activating Factor is a purified human protein. It arrives as ~1/2 tsp of a clear liquid that requires immediate refrigeration. Macrophages are cells that play a role in cleanup, immunity, muscle regeneration, and wound healing. With such capabilities, it is not difficult to imagine that some types of autism could be addressed by boosting the activity, especially if there is interference from another substance (nagalase).

GOleic, the newest preparation, is GcMAF attached to a native oil. According to the manufacturer, “oleic acid is found naturally both in the human body and in olive oil; it is the first thing GcMAF looks for once it enters the body. In the laboratory it is many times more powerful than standard GcMAF…”.

The company representative stated that, “There is a reported increase in positive results to 25% from 15%.” This may not seem like much, but it represents improvement in a population that was previously stuck at a level of autism demonstrating very-little-to-no improvement for years.

Some of the claims made on the GcMAF.eu website require additional scrutiny. The only documented ASD experience, so far, is an anecdotal report on 2000+ patients, that asserts “15% have their autism eradicated.” That is not my observation. The implication of unknown viruses as a major cause of autism has not been borne out in conventional literature.

How much does it cost? The new preparation is now available in a sublingual form, which is preferable to the subcutaneous (injection) route, for most families. “GOleic’s price is €450  plus €60 shipping. It arrives in either a vial, (treat as GcMAF) or a dropper bottle…” Given once or twice a week, there are enough doses so parents can assess response and decide whether to re-order.

Conclusion:
Protocols that assess the immune system and nutritional integrity, plus optimize gastrointestinal function, have proven quite effective in the majority of younger patients. When continued treatment does not result in communication or behavioral abatement, parents seek more assistance. The conventional medical advice is to get even more therapy (often, not covered by insurance) or prescribe harmful medications, such as risperdal and prozac.

To date, GcMAF therapy is no panacea. However, treatment appears safe and has provided some advancements in cognition and communication, especially in patients who have not seen similar improvements in years.

The jury is still out. Experienced parents have been through the cycle of hope-hype-disappointment of previous clinical trials. Autism is a huge hurdle, and GcMAF represents a possible useful piece in the treatment puzzle.

The Law, Antibiotics and Autism

Sunday, August 3rd, 2014

The Case:
A U.S. court ruled that the FDA is correct to continue to allow the administration of antibiotics to feed animals – even if they aren’t sick.
Argued: February 8, 2013 Decided: July 24, 2014

The Judges:
Robert Katzmann, Chief Judge, (has top notch credentials, and wrote the minority opinion.)
Gerard Lynch, Circuit Judge, (wrote 2-1 majority opinion). More about him later.
Katherine Forrest, District Judge, (a really rich, “celebrated litigatrix“).

The plaintiffs:
Natural Resources Defense Council – “One of the nation’s most powerful environmental groups… A credible and forceful advocate for stringent environmental protection.”
Center for Science in the Public Interest - Founded by 3 “scientists, CSPI carved out a niche as the organized voice… on nutrition, food safety, health and other issues… to educate the public, advocate government policies that are consistent with scientific evidence on health and environmental issues, and counter industry’s powerful influence on public opinion and public policies.”
Food Animal Concerns Trust – “Mission… is to improve the welfare of farm animals; address public health problems such as the safety of meat, milk, and eggs; broaden opportunities for family farmers; and reduce environmental pollution.”
Public Citizen, Inc. – “… serves as the people’s voice in the nation’s capital… To ensure that all citizens are represented in the halls of power.”
Union of Concerned Scientists – “puts rigorous, independent science to work to solve our planet’s most pressing problems. Joining with citizens across the country, we combine technical analysis and effective advocacy to create innovative, practical solutions for a healthy, safe, and sustainable future.”

The defendants:
Margaret Hamburg, commissioner of FDA. She is a Harvard-trained medical doctor, and appears to be a strong consumer advocate.
Bernadette Dunham, Director – Center for Veterinary Medicine. She was a clinician, professor, and has served as an advisor to several veterinary panels.
Kathleen Sebelius, Secretary of HHS, who took heat for the Obamacare Website debacle.

The Issue:
A lower court had decided that the FDA should have hearings about antibiotic use in animal feed. This challenge, brought by the FDA, was that they didn’t need to review the issue.

The Ruling:
The FDA won.
Rather than considering antibiotics in the feed as a public health hazard, Judge Lynch (good name) focused his ruling on “… a syntactically awkward variation that leaves the intended sequence ambiguous.” The Catch 22 is whether the drug can be withdrawn if it is thought to be unsafe, but it can’t be declared so until there is a hearing, which the FDA is not required to do.
The explanation contains 10 pages that document scientists’ concern about antibiotics in the animal feed. It is followed by 55 pages that explain why the ruling by the previous court was incorrect. “In an ideal world, Congress would have written a statute that clearly selects between one of these two possible readings. But as the statutory language is ambiguous, we must do our best to determine which of these two meanings Congress intended to convey.”

Discussion:
I asked former Florida Assistant Attorney General, Mr. Hugh Keough , about this case. “The dissent was by the Chief Judge of the District… Interesting discussion about antibiotics especially after all I’ve read from you about over prescription of antibiotics…”

“Indeed, the FDA has consistently reaffirmed that using low doses of antibiotics on healthy livestock to promote growth could accelerate the development of antibiotic‐resistant bacteria, causing “a mounting public health problem of global significance.”

The “decision allows the FDA to openly declare that a particular animal drug is unsafe, but then refuse to withdraw approval of that drug. It also gives the agency discretion to effectively ignore a public petition asking it to withdraw approval from an unsafe drug.” (Dissent).
Mr. Keough exclaimed, “17 Years ago the World Health Organization recommended ceasing! Uh, is it time to go vegetarian?”

Conclusions:
The plaintiff’s issue was the emergence of resistant strains of bacteria. However, there may be profound, as-yet undiscovered effects. Somehow, can’t the FDA see it’s way to erring on the side of caution?

In 1999, the Journal of Pediatrics, published a study documenting, “Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the behavioral problems of the non-verbal autistic patients.” If you don’t think that autism is an epidemic, and you don’t consider that childhood development could be affected by the overuse of antibiotics, then you wouldn’t ever know whether antibiotics in our food is a threat.

 Given this decision, it’s going to be a while until any change is made in this area.

 Don’t allow your doctor to prescribe antibiotics for every little illness, and don’t beg for them, either.

 Take strong probiotics – lots of colonies, with varied strains.

 Try to eat as ‘organic’ as possible (given that they are telling us the truth about ‘organic’).

 If we want better oversight, we should let our government know.

Autism – The Money Issue

Sunday, July 13th, 2014

While ‘expertscontinue to debate about the autism epidemic, parents are paying the price.

This week, the Journal of the American Medical Association published a study from the US and UK that documented a cost of (US$)1.4 million over a lifetime, if there was no intellectual disability. That’s seventeen thousand extra per child per year – 1/2  of the US median income. Add another 1 million dollars if mental problems persisted (46% in one study).’

Of course, I’m preaching to the choir here. Families are well aware of the financial burdens. The problem seems to be that the medical profession is clueless. Parents are told to get therapies that are very expensive, and even if they are ‘covered’ by insurance, the co-pays can be prohibitive. And, if the child fails to meet intellectual milestones? More therapy.

In 1987, Dr. Louvaas reported, “Follow-up data from an intensive, long-term experimental treatment group (n = 19) showed that 47% achieved normal intellectual and educational functioning, with normal-range IQ scores and successful first grade performance in public schools. Another 40% were mildly retarded and assigned to special classes for the language delayed, and only 10% were profoundly retarded and assigned to classes for the autistic/retarded. In contrast, only 2% of the control-group children (n = 40) achieved normal educational and intellectual functioning; 45% were mildly retarded and placed in language-delayed classes, and 53% were severely retarded and placed in autistic/retarded classes.

In 2010, Dr. Grenpeesheh, “… completed a study which found that 6 out of 14 severely autistic children who obtained treatment by CARD had fully recovered.That’s 43%. 

Regardless of the exact diagnosis, the reasons for increasing numbers, and questions about ‘recovery’, the lifetime costs of caring for more than half of the patients with ASD are considerable.

The commentary in that aforementioned issue of JAMA was entitled Autism – Moving Toward an Innovation and Investment Mindset. The Drexel University professors wrote, “…We wish to reflect further on the conceptual and measurement advances needed to reach a point where we can meaningfully link investments in services to life course outcomes…”

This is an indication that conventional medicine will be forced into evaluating the epidemic from the financial side, even as science fails to provide data supporting flawed theories. “… This accomplishment is especially remarkable given the challenge presented by a profound lack of infrastructure for routinely monitoring costs and outcomes in people with autism spectrum disorders.”

An important finding in the study was that the second highest cost of autism was lost productivity to family members who must care for an affected patient. That means that earlier diagnosis, with prevention of long-term disability, and the amelioration of intellectual disabilities, will have the greatest effect on decreasing costs.

I am not qualified to offer financial planning advice. There are experts on that side of the equation. Given the present state of our understanding about the cause(s) and useful autism treatment(s), such assistance in assuring your child’s future may prove valuable.

Protocols provided by MAPS physicians are certain to impact these tremendous expenses. At The Child Development Center, we have been very successful at achieving neuro-typical educational status by 1st to 3rd grade in the majority of infants and toddlers. That is a tall statement to make, and it is not offered lightly. Biomedical protocols involve a great deal of work by the families and counseling by the staff. Traditional therapies, such as behavioral, physical, occupational, and speech are a necessary accompaniment to assure improvement.

As noted in the editorial, “We need to recognize innovations that are already occurring in community settings and establish ways to learn from them about what works for whom. Accumulating practice-based evidence will require mutually beneficial partnerships between researchers and community health care… This approach would foster active learning from experience.

As in other medical conditions, such as hypertension-arteriosclerosis-heart disease or the HIV epidemic, a sizable cost savings may be the initial driving force to accurate diagnosis and effective treatment. If that is the impetus resulting in better medical care for autism, that’s OK, as well.

It’s Not the Asperger’s Syndrome

Sunday, June 1st, 2014

Let’s face it; anyone who goes on a shooting rampage has some mental illness. Often, it seems there was a history of family turmoil, few friends, bullying, and lack of empathy. That does not define Asperger’s Syndrome, which is a developmental disorder.

Recent sensational violent acts by young men could be due to a number of conditions, including:
∗ ADHD with feelings of inferiority because of poor performance
∗ Schizophrenia
∗ Personality disorder
∗ Watching violent video games
∗ Oppositional Behavioral Disorder
∗ Acute or transient reactive psychosis
∗ Reactive Attachment Disorder
∗ Subject to abuse
∗ Temporary insanity
In deranged individuals, such as the Connecticut and California shooters, psychiatrists would probably entertain even more possibilities.

There is no precise manner to define Asperger’s Syndrome after someone expires. The conditions that explain impulsive conduct are inaccurate, at best. Psychiatric diagnoses need to be assessed in real-time by documentation of signs and symptoms. Regarding the recent carnage, family members (and their lawyer) reportedly claimed that Elliot Roger was “on the spectrum,” and suffered a long history of mental difficulties.

How about focusing on the histories of mental illness
with easy access to firearms?

The Autism Epidemic that has blighted the child development landscape of the 21st century is a mystery, with vague descriptors and the recent inclusion of many other developmental problems, including Asperger’s and PDD-NOS. The public is left to wonder, “Why so many killing sprees?” The media is quick to supply an answer, “Perhaps it is those autistic (Asperger’s) kids!”

I have examined scores of patients who fit criteria for the disorder. Effective communication is difficult; some are depressed, some understand and address their challenges, and others who say, “That is the way that I am.”

Key traits include early developmental delays, an unusual affect, restricted interests, decreased eye contact and sensory issues. They are usually very standoffish individuals who feel uncomfortable outside of their usual environment.

There is not a great deal of published information about the association between violence and Asperger’s syndrome. In one study, 31 of 37 of the patients (85%) had a possible or probable comorbid psychiatric disorder.

A 2010 follow-up paper concluded, “The mean percentage of registered convictions was similar to that in the general male population of Austria over the studied time period. A qualitative assessment of offence types in Asperger’s former patients suggests that the nature of offences does not differ from that in the general population. In this original cohort of Asperger’s patients, convictions were no more common than in the general male population.

We should be very skeptical about media pundits’ experience, statements and motives. Sensational reporting is unfair and irresponsible because it assigns to Asperger’s patients a stigma that they do not deserve. There are many more examples of productive individuals than violent criminals committing heinous acts due to their autism diagnosis.

Just because Asperger’s Syndrome is the “diagnosis du jour,” it doesn’t mean that there is a shred of proof that affected individuals commit brutal crimes or that they are any more prone to such violence than those who are not so classified.

International Meeting for Autism Research 2014

Sunday, May 18th, 2014

My medical lifetime has experienced several epidemics. Although such problems are devastating to families, we learn a great deal of general science by uncovering the secrets of each new disorder. Think of Legionnaire’s disease (bacteria), the Norwalk virus, helicobacter (stomach ulcers), etc. Regarding the conditions that now fall under an autism diagnosis, these are exciting times for study and discovery.

At this conference there were 1800 attendees from all over the world, and nearly 1000 research papers. It has been great watching this organization grow; bringing advances to the science of autism spectrum disorders.

What I Liked:
This years Advocate Award went to Peter Bell. He is a true contributor to autism. More than simply offer an acceptance speech, he did a great job of expressing to this diverse, but research-oriented group, his “Top 10 List” for audience understanding. That included finding causes and treatments, environmental associations, lifetime services, and recognizing patients’ humanity, with the urgency that a only parent could feel and express.

Then, there were the short conversations with the presenters. I spoke with a pediatric neurologist who presented his work on Vitamin B12 and folic acid. Another was a social worker, whose study concluded that the new DSM 5.0 would result in fewer diagnosed cases. I couldn’t agree less, so I was able to discuss it.

At lunchtime, I sat with a distinguished, rather humble, retiring psychologist from a prominent New York clinic who said, “maybe 5% of our patients report G-I problems.” I took the opportunity to offer, “Gee, that is awfully low. I would sure like to test those patients with my protocol.”

I spoke with a young researcher whose paper detailed the changes in the neuron-type cells of the intestines, which is work that will elucidate gut alterations that might explain various autistic features.

There are so many young and promising minds. Just as HIV research enriched our knowledge of DNA, RNA and viral-human interaction, autism is enhancing scientific understanding of the development and function of the brain.

What I Didn’t Like:
There were few papers and presentations about environmental and epigenetic effects leading to the epidemic. For that matter, there was little discussion about the presence of an epidemic, though I suppose that would have been preaching to the choir.

Also, I think that there needs to be more work on how co-morbidities play into ASD. As a clinician, I find that problems, such as those in the G-I system, sensory difficulties, sleep disorders and anxiety, need to be studied as the very fabric of the condition.

Finally, this is not so much of a complaint, as a fact of life, but there is so much to read and learn in just a few days. There just never seemed to be enough time.

Best Thing at the Meeting:
Dr. Fred Volkmar, Yale autism expert, got a Lifetime Achievement award. He is an energetic and fascinating teacher who noted how few treatment studies are yielding success, especially compared to the explosion in the volume of research. Dr. V actually expressed his frustration that much of the work is not actually getting to the parents and the children.

This famous professor expressed an understanding of how parents seek Internet answers in the absence of viable medical alternatives, which is such a rare point of view in the academic world.

Conclusion:
The knowledge and information that ripples from this scientific meeting and the people who continue this work will make a difference. Perhaps not one particular study or that trial, but by their dedication to becoming part of the solution, parents can be assured that you have champions on your side.

You can access the research abstracts here.

Autism Wars II: The Wakefield Effect

Tuesday, May 13th, 2014

This month, Pediatrics published a paper indicating that there was, in fact, a “greater prevalence of GI symptoms among children with ASD compared with control children.” 
OK, so far.
Not really groundbreaking information, but it did appear in a mainstream, well-respected, scientific journal.

Somehow, the authors felt compelled to include an opinion that the medical profession has been delayed in studying this gut-autism association. The Discussion section includes, “Previous controversy surrounding the MMR vaccine and proposed causal link between ASD and infection of the GI tract probably deterred investigators from dedicating resources to examine GI functioning in this population while fostering uncertainty in the ASD community regarding the validity of this line of inquiry.
Not OK.
Investigators are not prevented from pursuing certain lines of thinking. In fact, there are several follow-up studies challenging the original postulation. That’s science, right?

Shortly thereafter, Forbes autism blogger, Emily Willingham, followed with a piece actually naming the culprit. She tattled that it was the nefarious Dr. Andrew Wakefield. He is the British pediatric-surgeon-gastroenterologist-fallen-from-grace who has been accused of concocting the measles-vaccine-autism association in order to gain riches and international fame. Thanks, Em, otherwise we wouldn’t have known who they meant.
Really not OK.
The science writer penned another less-than-illuminating piece. She posited her somewhat unconventional point of view that anxiety is the cause of many G-I disturbances, rather than the other way ’round. What has that got to do with “Blame Wakefield For Missed Autism-Gut Connection”? Has that delayed ‘Dr.’ W’s research, as well?

Yikes.
Can we get some facts straight here?

Fact: The title of the original article in question was, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
It began as a series of case reports, which has been totally blown out of proportion. Some of the patients had an autism diagnosis, assigned by other specialists.

Fact: The conclusion of that paper, We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”
Does that sound like science or sedition?

Fact: Dr. Leo Kanner, father of modern child psychiatry and inventor of the “autism” classification in the 1940’s, first reported on 11 patients, 8 of whom had G-I signs and symptoms. He called the problem a psychiatric disorder. That delayed correct diagnosis and treatment for about 50 years (and continues to slow the process because of the ASD inclusion in the Diagnostic and Statistical Manual of Mental Disorders).
Anyone angry about that?

Fact: Bruno Bettelheim helped prolong the ‘Refrigerator mom’ theory throughout the 60’s and beyond.
With a thick Austrian accent and faked credentials, he appeared on talk shows and became famous with that stupidity, not infamous.

The Wakefield Effect
Why is there such an emotional connection with this condition? It’s the Wakefield Effect. Because of this debacle, anything having to do with autism that is not sanctioned by the mainstream is considered an aberration; including special diets, yeast in the G-I system, vitamins, and toxins in the environment. Regarding certain establishment fixtures, such as vaccination, anyone who pursues a course of action other than the teachings of the Church (Big Pharma+ Conventional Medicine) is to be expelled from the religion and sent packing to other ports of call. With the availability of the Internet and Social Media, innuendo turns into truth.

I have met Dr. W and heard him speak several times. He is good-looking, articulate, charismatic, and tells a compelling tale. He probably could have continued his research, and even received funding, if he had followed his original work with more humility and sense of uncertainty. If this was a hoax or part of some grander plan, it has certainly failed as he (and his work) falls into obscurity.

Rather than discuss biology, genetics, objective research strategies and prospective trials that could assure safety and effectiveness, the public is fed dogma and discord. The wrong line of reasoning is being followed and now appears in more diverse venues, including popular, financial and even scientific publications.

Perhaps it is less interesting and more complicated, but the best antidote to the Wakefield Effect is for medicine to drop this non-issue and move on. The media wants controversy, but parents want answers.

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