If Everything works, is Anything Working?
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”:
Cod Liver Oil
Food Allergy Treatment
Gluten- /Casein-Free Diet
Removed Milk Products/Dairy
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?
 The disorder isn’t a single entity; it’s a group of several disorders with similar presentations (but different causes and underlying abnormalities).
 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.
 Both  and  are true.
Case  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  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.