Monday, April 23, 2007

But we have to do something!

I always find a little shiver of fear going down my spine whenever I hear someone - especially someone in elected office - say the words, "We have to do something about [X]!"

In my experience, those words have been the prelude to innumerable disasters, debacles and misadventures. The problem is that the urge to action is rarely accompanied by any planning or investigation. What we end up with when we rush to "do something!" is the equivalent of "Ready. Fire! Aim."

In other words, we miss the mark. In fact, we're lucky if we don't hurt somebody in the process.

Over the past several years, I have heard a number of parents with autistic children say, "We can't wait for scientific studies, we have to do something for our children!" While I can completely sympathize with them, I continue to urge caution. Doing something is only better than doing nothing if "something" isn't harmful.

Why do I bring this up, you might ask?

In February, a study was published that showed - for the first time - that treatment with DMSA (a chelating agent) can improve the intellectual functioning of lead-poisoned rats. This was a big deal because human studies (on children poisoned by lead-containing paint) had failed to show any improvement in behavioral or neuropsychological development.

Unfortunately, the study also showed that treating rats who were not lead-poisoned decreased their cognitive abilities. Permanently.

Now, people who are treating their children with DMSA for mercury poisoning would be right to be concerned about these findings, especially if they are relying on doubtful laboratory tests to determine that their children are "mercury poisoned". And those folks who are treating their autistic children with DMPS have no reason to smirk. There is currently no known mechanism to explain these cognitive impairments, so DMPS could be just as bad...or worse.

I hadn't planned to 'blog about this study - too many unanswered questions - but then I got an disturbing piece of news. It seems that a proposed autism-chelation study is being held up while the researchers test the DMSA for lead and mercury. I'm still trying to get confirmation of this, but it seems important enough for parents to know right now.

DMSA and DMPS are absolutely wizard at binding to lead, mercury, cadmium, arsenic and other "heavy metals". It's what they do. As a result, they will grab onto and carry along any lead, mercury, cadmium... that they come in contact with during their synthesis and subsequent handling. Given the ubiquitous nature of lead, mercury and arsenic, it is not improbably that these chelating agents could come in contact with - and grab onto - some in their progress from synthesis to final user.

Might this be the reason that so many parents using chelation report that the mercury is "...pouring out..." of their children? If you're pouring it in, you would hope that it would pour out.

I must emphasize that I have not yet confirmed that the proposed chelation study is being held while they test the DMSA for lead and mercury, but I feel that it is important for people who are doing chelation with DMSA (or DMPS) to get the news.

I'll keep you posted as I know more.


Saturday, April 21, 2007

Theories of Everything

Physics, that most pure of pure sciences, has been pursuing the "Theory of Everything" - a theory that will explain the four fundamental forces and their interactions - for some time now. Nobel Prize aspirants hope to connect the electromagnetic, strong nuclear and weak nuclear forces with gravity in a Grand Unified Theory. They've managed to connect the electromagnetic and weak forces into the "electroweak" force, but the other two forces obstinately refuse to join the game. For now.

Chemistry, which is sometimes referred to as "applied physics" (usually by physicists), has quantum chemistry, which is a close approach to a "theory of everything" in that field.

Biology (which snide chemists refer to as "applied rudimentary chemistry") has yet to develop anything even remotely resembling a "theory of everything". This is due to the immense complexity of the systems involved (so say the biologists) or the immense simplicity of the biologists involved (so say the chemists and physicists), take your pick.

However, I have noticed that at least one small segment of the biological sciences seems to be developing a "theory of everything". In fact, it seems to have developed several.

I refer, of course, to the field of autism "alternative" research.

The Grandmother of Grand Unified Theories of Autism

The first truly successful (in the sense of "popular" rather than "accurate") candidate for the "Grand Unified Theory of Autism" has to be the "mercury-causes-autism" hypothesis, first published (in Medical Hypotheses) by Bernard et al in April 2001. This hypothesis asserted that autism and mercury poisoning were one and the same, based on the use of similar words (in English) to describe certain features of both disorders.

Despite the fact that none of the authors had actually seen, let alone diagnosed a person with actual mercury poisoning, this hypothesis resonated with the zeitgeist of the community of parents with autistic children and resulted in massive popular support. Its scientific support has been less massive, unfortunately, and it stands in peril of fading to a mere cult phenomenon.

As a "theory of everything" in autism, the mercury hypothesis has met most of the requisite criteria. It is flexible enough to "explain" the features of autism, even as the definition of autism continues to change. In part, this is due to the protean nature of mercury poisoning, which has a wide variety of symptoms and signs.

However, a large part of the credit goes to the flexibility of the people applying the mercury-causes-autism hypothesis, who are willing to overlook significant ways in which autism differs from mercury poisoning. It is this willingness to suspend critical thinking, more than any inherent validity of the hypothesis, that accounts for its continued survival despite its lack of supporting data and the vast amounts of direct and indirect data refuting it.

With only a vague and easily disputed connection between signs and symptoms of autism and mercury poisoning and a few unrelated (and some might say also trivial and obvious) studies to support it, the mercury-causes-autism hypothesis is in trouble. The few studies that have been held up in support of the hypothesis, on closer examination, do not support it.

Some of these studies merely confirm what is already known (trivial), e.g. that mercury is neurotoxic. Others have shown that mercury can cause other types of disorders, e.g. autoimmunity, without connecting that to autism. In the end, most of the studies used to support the hypothesis are of three basic types:

[1] The study fails to show a connection to autism - i.e. mercury causes X, X is a bad thing, but no indication that either X causes autism or that X is part of autism, with X being a sign or symptom.

Example: Hornig, et al, "Neurotoxic effects of postnatal thimerosal are mouse strain dependent". This study demonstrated that mouse strains that were known to be prone to develop autoimmune disorders were more likely than other strains (which were not prone to develop autoimmune disorders) to develop autoimmune disorders after exposure to thimerosal. This is the trivial part of the study.

They then go on to posit that a variety of behavioral responses of the mice - decreased movement and decreased reaction to novelty - were signs of mouse autism. This is more than a bit of a stretch, as there are several alternative explanations, including the simple explanation that the mice were not feeling well, having developed autoimmune disorders.

[2] The study shows association without data supporting causation - i.e. the sudy shows that X is found in children with autism, but fails to show that X might cause autism. X might be caused by autism or simply be a co-traveler.

Example: James, et al, "Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism", which demonstrates signs of increased oxidative stress in autistic children without showing that the oxidative stress led to autism or what the cause might be. Significantly, when they corrected the signs of oxidative stress with betaine and folinic acid, the children remained autistic.

[3] The study proposes mechanisms that are either unsupported by the data and/or are contrary to known physiology

Examples: Kern, et al, "Sulfhydryl-reactive metals in autism", and Holmes, et al, "Reduced levels of mercury in first baby haircuts of autistic children". Both of these studies found reduced levels of mercury in the hair of autistic children and both propose - without providing a single citation or shred of data to support the proposal - that autistic children excrete less mercury into their hair.

This is contrary to decades of research into hair physiology, and so should have been accompanied by at least a paragraph of explanation. However, neither group of authors have found it necessary to provide support for their astounding claim that hair excretes mercury. Until they can, both studies are merely sources for scientific amusement.

The mercury-causes-autism hypothesis also has no explanation for the continued rise in autism numbers (from data sources that its proponents used to establish the "autism epidemic" in the first place) despite falling mercury exposure (both in vaccines and from the environment) and so its supporters have resorted to circular reasoning.

Despite having failed to establish that mercury causes autism, the proponents have boldly claimed that trace amounts of mercury remaining in vaccines, along with environmental mercury (which has been dropping since the 1960's), are sustaining the rise in autism.

This, of course, completely negates their earlier assertions that it was the rise in vaccination - and exposure to thimerosal - that caused the rise in autism, since the mercury exposure to children born after 2000 has been less than that of children born before 1980 (before the onset of the "autism epidemic").

What they have done - or tried to do - is say that the continued rise of autism (in USDE and California CDDS numbers) supports the mercury-causes-autism hypothesis because of the continued exposure to mercury - this continued exposure being proven by the continued rise in autism. And so, even though it took mercury exposures far in excess of what children are presently receiving to start the "autism epidemic", it takes only trace amounts to sustain it. Anyone want to go around again?

Another tactic used in support of the mercury-causes-autism hypothesis is to claim that chelation "cures" (or treats, if you like) autism. This supposedly establishes that mercury is the cause of autism, although it conveniently overlooks the fact that the chelating agents - if they do work - have effects beyond removing mercury.

Even more fundamentally, the proponents of the modified mercury-causes-autism-because-chelation-cures-autism have failed to support their claim that chelation has an effect on autism that is greater than placebo. Until this is established, they have no argument. They are trying to "prove" one unproven statement with another unproven statement.

Other "Theories of Everything" in Autism

Other "theories of everything" have arisen in the field of "alternative" autism research since the rise of the mercury-causes-autism hypothesis, although none have generated as much press or excitement. What these lesser hypotheses share with the mercury-causes-autism hypothesis is an emphasis on anecdote, unrelated (to autism) studies and hype.

Some of the current contenders for the "theory of everything" are:

[1] Nitric Oxide - since this is a widespread inter- and intra-cellular signalling molecule, it is not surpising that it is found in association with a variety of disease states. It is also not surprising that it is affected in a variety of conditions, both normal and pathological. This is roughly equivalent to saying that calcium is associated with autism, since calcium fluxes are critical in release of many neurotransmitters, including those thought to be important in autism.

Unless nitric oxide can be shown to either cause or treat autism, it remains just an interesting footnote. Considering the amount of hype that nitric oxide has in the "alternative" medicine and "nutraceutical" fields, it is no surprise that it has found its way into "alternative" autism therapy.

[2] Allergens (especially latex) - what could be more ubiquitous than latex? It's in car tyres, surgical gloves and a myriad of medical, industrial and household products. Latex allergies are on the rise - probably due to increased exposure, although this can be debated - and so is autism. Coincidence? Almost certainly, but this hasn't stopped some people from seeing a connection. It's not their fault - finding connections is what our brains are "hardwired" to do - even when there isn't a connection.

[3] RF energy (from cellphones, of course) - this seems to be a revival of the old "cellphones cause brain tumors" urban legend and should be as readily dismissed. Yes, the use of cellphones has paralleled the rise in autism. So has use of the Internet, popularity of Britney Spears and numbers of hybrid automobiles.

Doubtless, there are many others that I have overlooked. Feel free to e-mail me your favorite "theory of everything" for autism.


Sunday, April 08, 2007

The Age of Unreason

Before I get too far into this narrative, I should divulge that I am a “Baby Boomer”. This is not something I am proud of, as “My Generation” was one of the most spoiled and self-centered generations of all time. The fact that there are innumerable members of the Baby Boom generation who are rational, selfless and modest does not change how history will see the generation as a whole.

Our legacy will be one of self-absorption, greed, obsession with youth and – at the end of our lives – pitiful attempts to shift the blame for our actions and inactions. This latter failing is clearly shown in Billy Joel’s immortal song, “We Didn’t Start the Fire”. It is the story of how T-shirts and bumper stickers failed to have any significant impact on world events.

But I digress.

The 1960’s were often referred to – by the generation we now call the “Baby Boomers” – as the “Age of Aquarius”. This simply shows their appalling sense of reality, since the earliest that astrologers place the dawning of the “Age of Aquarius” is 2150. By then, the “Aquarian generation” will all be dead. Even those who don’t believe in such negative things as “death”.

Astronomers, incidentally, place the beginning of the “Age of Aquarius” at 2600.

In the 1960’s, the Baby Boomers felt that an era of peace and worldwide love was in the offing and that they were the generation that was going to make that a reality. Their beliefs could be summed up by something I found on an astrology site:

“The key phrase for Aquarius is ‘I Know,’ but that knowledge is not a righteous, superior or exclusionary knowledge. It's a sort of wisdom that draws people together, for Aquarians are, above all else, social animals.“

I couldn’t have said it better. So, the Baby Boomers spent their twenties trying various magical means to bring about world peace and brotherly love (or just getting stoned out of their minds) and then got distracted by making a fortune in the stock market, buying loft condos and finding a way to keep from getting old.

However, the magical thinking never left them – and they’ve passed it on to succeeding generations.

So, after centuries of slow but steady progress against the forces of unreason, a single generation is trying to send us back to the Dark Ages. After centuries of scientific progress in medicine, a single generation brings back homeopathy, naturopathy and introduces any number of new variations on shamanism. Crystals, “The Secret” and Quantum Healing are all the result of this steady erosion of critical thinking.

It is this sort of unreason that has led people to make the most absurd statements without any apparent fear of contradiction, since – as the postmodernists tell us – there is no privileged reality. It has reached the point where many people believe that wanting something to be true will make it true. Some examples:

[1] Iran’s nuclear program is much in the news of late and all reports include a comment to the effect that “Iran claims that the nuclear program is solely for power generation”. What I never hear said is that Iran is a net exporter of oil and has an infrastructure that is so dysfunctional that it has to import gasoline.

It seems extremely unlikely that Iran would put the money and effort into something so complicated as nuclear power when it could buy oil-fired power plants for a fraction of the cost. And without stirring up the threat of UN sanctions.

Still, the talking heads and pundits seem to all be of the mind that by not actually saying that Iran’s rationale is full of baloney, they won’t have to face the ugly truth that Mahmoud Ahmadinejad is trying to make a nuclear bomb in order to destroy Israel – as he has repeatedly said he was.

[2] Ardent believers in “Intelligent Design” (the belief system formerly known as “Creation Science”) repeatedly claim that their brand of bunkum is a “science”, despite the fact that it has no data to support it (it is, in fact, unfalsifiable and so untestable) and makes no predictions about the universe. Some of the top people in the “ID” world are scientists who should know better. Yet, somehow, they have the conviction that by saying that “ID” is a science that it will become one.

In the end, “Intelligent Design” is not science, not even bad science. It is religion dressed up to look like a science – if the light is bad and you squint a lot. And yet it has a serious following, even among people who call themselves “scientists”.

[3] “Quantum connectedness” continues to be all the rage in the Western world, as demonstrated by the number of people who mindlessly repeat bits of the movie, “What the #$*! Do We Know!?”. People who wouldn’t recognize a wave function if it bit them on the bum splutter on about its collapse by an observer which, so they claim, means that we can create our own reality by thinking it. Or they will wax eloquently about how quantum entanglement shows that we are all connected.

One of the most famous of the quantum-confused is Deepok Chopra, whose many books cash in on the general public’s ability to understand only that quantum physics is strange and seemingly paradoxical. He has repeatedly claimed that he has studied quantum physics, but his writings convince me (and others) that he may have studied it, but he surely hasn’t understood it.

[4] Much of “alternative” medicine encourages people to abandon scientific principles that have brought us in the West to a level of health and longevity that are unrivalled in human history. If we want to see what happens when that happens, we only have to look to those parts of the world where – for economic or philosophical reasons – scientific medicine is unavailable.

Yet, in the midst of the best medical care in the world – now or ever in history – a growing number of people are turning to magic. Whether it’s “quantum healing”, homeopathy, chiropractic, “energy medicine”, “thought field therapy” or any of a thousand others, it’s magic if it invokes unmeasurable “energies” or other undetectable properties.

This is not to say that there aren’t energies or other properties of the universe that we can’t currently detect or measure – not at all. It’s just that if we can’t currently detect or measure them, how can anyone propose that they exist? To echo that infamous movie, “How the #$*! Do They Know!?”. What special power do they have that allows them to know that these energies or other properties exist?

One of the common responses from these folks is that Newton didn’t know about radio waves, even though they existed (from the Sun other natural sources) in his time. True enough, but Newton also didn’t make any hypotheses that required radio waves. That’s the difference.

I could go on, but I won’t. I hope you get the point.

Our society is growing more and more dependent on rationality, science and technology to keep it from collapsing. It’s too late to turn back, now – giving up on reason and returning to magical thinking will cause a human (and probably environmental) catastrophe that would beggar the imagination. And, at the same time, the forces of Unreason encourage us to turn our back on reality in favor of “The Secret” or other such nonsense.

The technology that most people take for granted is far beyond the knowledge of the “average” citizen – not because they can’t understand it, but because they don’t. We run a very real risk of having an increasingly smaller proportion of our population that understands how critical technologies work or – even worse – the principles behind them.

Now is the time to take a stand – to come out on the side of Reason over Unreason, of Science over Magic, of Reality over Fantasy.

Or, we can all sit and meditate on a happier future.


Friday, April 06, 2007

If Everything works, is Anything Working?

A few weeks ago, I wrote about ARI’s parental survey and how that could be used to show the natural progression of untreated autism. Today, I’d like to delve a bit deeper into some of the implications of all of those “effective” (or not) treatments.

Even with the caveats previously noted about the shortcomings of the survey results, one thing that can certainly be said is that a rather large number of therapies are felt to be effective in the treatment of autism. Picking a threshold level of 10:1 on ARI’s “better:worse” scale (see previous posting for a discussion on this), the following treatments are felt to be “effective”:

Antifungals: Diflucan
Candida Diet
Cod Liver Oil
Digestive Enzymes
Fatty Acids
Feingold Diet
Food Allergy Treatment
Gluten- /Casein-Free Diet
Removed Eggs
Removed Milk Products/Dairy
Removed Wheat
Rotation Diet
Vitamin A
Vitamin B3
Vitamin B6
with Magnesium
Vitamin B12
Vitamin C

Again, even if these treatments aren’t actually effective (and most, if not all, probably aren’t), this still speaks to the dizzying number of treatments that parents are claiming work to treat autism.

Now, I’ve read the chelationista apologists’ hypotheses of how all (or most) of these treatment “successes” can be explained by mercury poisoning, but I’m still waiting for the data. “Could be explained…” is a long, long way from “Is explained by…” – despite what many of the chelationistas might wish.

So, we have a large number of treatments with no discernible connection that are all reported to be effective in the treatment of autism. And that’s if we apply a pretty high cut to the pack.

And what does it usually mean when a disparate group of treatments are all felt to be effective for a single disorder?

[1] The disorder isn’t a single entity; it’s a group of several disorders with similar presentations (but different causes and underlying abnormalities).

[2] None of the treatments is effective, which is why so many of them seem equally effective. Placebos all trend toward the same degree of effectiveness with prolonged use.

[3] Both [1] and [2] are true.

Case [1] is what we saw up to the late 1800’s in the treatment of “fever”. A variety of different (and usually unrelated) treatments showed true effectiveness, but only in certain patients. Quinine worked for some, willow bark for others but it wasn’t until modern microbiology developed that we understood why (it wasn't until the late 1900's that we understood how willow bark actually worked).

Case [2] was widely seen up to the early 1900’s, when not only a variety of treatments but also entire treatment philosophies had relatively equivalent efficacy. Homeopathy, naturopathy and chiropractic were equally as effective (or equivalently ineffective) as “mainstream” medicine of the time. It was only when “mainstream” medicine developed safe and effective treatments and medicines that it began to show a distinct “edge” over the others in effectiveness.

It is only fair to say that some of the myriad of “alternative” autism therapies may eventually be shown to be effective in a subset of autism – or whatever autism fragments into in the future. All that can be said today is that the few “alternative” treatments that have been studied in a scientific manner have been found wanting (e.g. secretin).

You would think that, having seen secretin burst onto the scene, become wildly popular (with countless anecdotes of success) only to crash and burn when it was tested, that the others would be somewhat more cautious in their claims.

But it hasn’t worked out that way. The pattern to date has been one of over-ambitious claims (one might even say hyper-inflated claims) followed by dozens of testimonials and speaking engagements, then disappointment, retrenchment of the “true believers” and eventual consolidation into a core of die-hard followers.

In a way, it reminds me of the evolution of a white dwarf star.

The sad thing is that the people in the middle of it all – the poor parents – don’t have the historical perspective to see it coming (or they are assured, “This isn’t like secretin – our treatment really works!”). So, they are either consumed in the inflationary helium burning stage, blown out with the planetary nebula or remain as the white-hot core of “true believers”.

Oh, if they could only know and believe the history of such things!

Here is another point to ponder.

“Mainstream” medicine is not a very fastidious entity; it will absorb anything that works, regardless of its history. When H. pylori was found to be a causative agent in stomach ulcers, “mainstream” medicine gulped it up without so much as a “by your leave”. The same thing has happened time and again – whenever “alternative” medicine comes up with something that really works, “mainstream” medicine takes it, like a schoolyard bully taking a ball.

Poor “alternative” medicine is left with the dregs – the therapies that don’t work or haven’t (yet?) been shown to work. To take the bully analogy a bit further, they are left with the broken toys and the ones they can’t figure out.

My point is this: if these therapies actually worked - if they could truly be shown to work – then they wouldn’t be “alternative” anymore. “Mainstream” medicine would have scooped them up and claimed them for itself.

Maybe that’s why the “alternative” practitioners won’t release their data – they’re afraid of the playground bully: “mainstream” medicine.

So, to get back to the title of this post, if there are so many disparate "therapies" that "work", what does that tell us in the absence of any hard data? Again, if everything works, then it is all too likely that nothing is working and we are simply seeing the unaltered natural course of the disorder.

We have some hint of this in that many of the "alternative" autism practitioners are still using secretin (again, a therapy very thoroughly discredited in the treatment of autism) and claiming that "it works!". If secretin - which is no more effective for autism than placebo - works as well as the rest of their "therapies", well, that's all we need to know.