The Anti-Vaxxer

Andrew Wakefield has been a boon for the tiny coffin industry. The motherfucker belongs in prison. Don’t recognize the name?
He created the modern antivaccine movement. 

Estrogen and Autism

[The latest news about possible link between autism and Estrogen in the womb. The findings are promising, but not absolutely conclusive. But it does seem to point to further research in this direction.]

High levels of estrogen in the womb linked to autism

July 29, 2019

Source: University of Cambridge

Summary: Scientist have identified a link between exposure to high levels of estrogen sex hormones in the womb and the likelihood of developing autism.

What are vaccines saving us from, exactly?

April 10, 2015

Dear Cecil:

Can you do the teeming millions a favor? The Jenny McCarthy contingent is going on about the risks of vaccinations, but absent from this discussion is any consideration of the risk of the diseases.

— Mark J. Costello

Dear Cecil:

This recent measles outbreak got me wondering about the cost. I read an article saying the Centers for Disease Control report that "every dollar spent on the measles, mumps and rubella vaccine saves the U.S. $23.30 in medical costs.” It also said that Arizona spent $800,000 to contain an outbreak. I understand the necessity for vaccinations, but what costs are they talking about?

— Bob from Lansing

Cecil replies:

You’re asking whether vaccination is worth it. There could be stupider questions — just wait till some C-grade celebrity leads the charge against indoor plumbing and electric lights. However, for now those questioning the value of vaccination pretty much have the market cornered on idiotic. By any measure childhood immunization has been one of humanity’s great achievements, substantially eradicating diseases that in centuries past depopulated continents and in the memory of persons still alive killed or crippled thousands every year. But today few have any clue, leading some to ask why we still need to poke babies with needles and all that jazz.

Court Rulings Don't Confirm Autism-Vaccine Link (Conspiracy Theories)

Forbes

2013

Emily Willingham

There’s a post making the rounds courtesy of something called “Whiteout Press” with the headline “Courts confirm vaccines cause autism.” It’s spreading across sites, through chains of elementary school parent communities, and onto radars of other communities that overlap. In other words, it’s viral. If only there were a vaccine for it.

The post itself is a cobbled together retelling of stories everyone’s already known for years. Whiteout Press might have been surprised to learn about this “ongoing story,” but each element of it has been widely reported in the mainstream media over the last decade and a half, in exceptional detail.

The centerpiece of the “courts confirm” article is the 2012 finding of a local Italian court that a child was diagnosed with autism a year after receiving an MMR. The court, in linking the two things, relied very heavily on the retracted and fraudulent 1998 Wakefield MMR Lancet paper and the testimony of a single physician, hired by the plaintiff’s attorney (widely known for advising parents on how to avoid compulsory vaccinations). The physician, Massimo Montinari, it seems, has written a book on how vaccines cause autism and peddles an autism “cure” that he’s devised.

Italian courts, provincial or otherwise, are not known for basing their rulings in science. They are, after all, part of the system that led to a manslaughter conviction of six scientists for not predicting the 2009 L’Aquila earthquake, disregarding completely the obvious fact that such predictions are not, in fact, scientifically possible. In a similar way, the Italian court that made the MMR-autism ruling–the centerpiece of this latest “courts confirm” tripe–ignored completely the science made available to it and focused almost solely on the retracted Wakefield paper and a physician with a COI in making its decision. A decision that is, by the way, under appeal.

Study finds link between pesticides and autism

Jun 23, 2014

WASHINGTON (AFP) - A California study out on Monday found that pregnant women who lived near farms where pesticides are applied had a two-thirds higher risk of having children with autism.

The findings in the journal Environmental Health Perspectives examine the association between living near commercial pesticide applications and having offspring with autism, but do not show cause-and-effect.

Autism is a neurodevelopmental disorder that ranges in severity and has been on the rise in recent years. Health authorities say it now affects as many as one in 68 children in the United States.

The latest research was based on data about commercial pesticide applications in California, combined with residential addresses of about 1,000 participants in a study of families with an autistic child.

"We mapped where our study participants' lived during pregnancy and around the time of birth," said principal investigator Irva Hertz-Picciotto, vice-chairman of the Department of Public Health Sciences at the University of California, Davis.

California law requires detailed records on what kinds of pesticides are applied, where and when and how much.

"What we saw were several classes of pesticides more commonly applied near residences of mothers whose children developed autism or had delayed cognitive or other skills." About one-third of study participants lived within 1.25km to 1.75km of a site where commercial pesticides were applied.

Researchers found risks of autism were highest when the chemicals were applied during the second and third trimesters of pregnancy.

The study authors said the developing foetal brain may be particularly vulnerable to pesticides.

"This study validates the results of earlier research that has reported associations between having a child with autism and prenatal exposure to agricultural chemicals in California," said lead study author Janie Shelton, a UC Davis graduate student.

"While we still must investigate whether certain sub-groups are more vulnerable to exposures to these compounds than others, the message is very clear: Women who are pregnant should take special care to avoid contact with agricultural chemicals whenever possible."

[I am interested in Autism and the possible cause of it, and so I have included this news report as part of the "research" or findings on autism and the cause of it.

However, the Straits Times report is atrociously incomplete and possibly alarmist.

The actual report is more nuanced. There is this paragraph:

Earlier this year, scientists examining more than two million births in Sweden reported that inherited genes make up about 50 percent of a child’s autism risk, while environmental factors make up the other half.

And this:

Earlier this year, researchers showed that people with a gene variant associated with autism and high exposure to air pollution had an increased risk of autism over people with the same gene variant but lower exposure to air pollution.

Which suggest that genetics also play a part.

Also the age of the father.

But if you need to do something, here's a finding that may help:

... one recent study suggests that taking folic acid during pregnancy may actually decrease chances for ASD. ]

Autism - Father's contribution; Autoimmune Disorder?

New York Times

Father’s Age Is Linked to Risk of Autism and Schizophrenia

August 22, 2012

By BENEDICT CAREY

Older men are more likely than young ones to father a child who develops autism or schizophrenia, because of random mutations that become more numerous with advancing paternal age, scientists reported on Wednesday, in the first study to quantify the effect as it builds each year. The age of mothers had no bearing on the risk for these disorders, the study found.

Experts said that the finding was hardly reason to forgo fatherhood later in life, though it might have some influence on reproductive decisions. The overall risk to a man in his 40s or older is in the range of 2 percent, at most, and there are other contributing biological factors that are entirely unknown.

But the study, published online in the journal Nature, provides support for the argument that the surging rate of autism diagnoses over recent decades is attributable in part to the increasing average age of fathers, which could account for as many as 20 to 30 percent of cases.

The findings also counter the longstanding assumption that the age of the mother is the most important factor in determining the odds of a child having developmental problems. The risk of chromosomal abnormalities, like Down syndrome, increases for older mothers, but when it comes to some complex developmental and psychiatric problems, the lion’s share of the genetic risk originates in the sperm, not the egg, the study found.

Previous studies had strongly suggested as much, including an analysis published in April that found that this risk was higher at age 35 than 25 and crept up with age. The new report quantifies that risk for the first time, calculating how much it accumulates each year.

The research team found that the average child born to a 20-year-old father had 25 random mutations that could be traced to paternal genetic material. The number increased steadily by two mutations a year, reaching 65 mutations for offspring of 40-year-old men.

The average number of mutations coming from the mother’s side was 15, no matter her age, the study found.

“This study provides some of the first solid scientific evidence for a true increase in the condition” of autism, said Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine, who was not involved in the research. “It is extremely well done and the sample meticulously characterized.”

The new investigation, led by the Icelandic firm Decode Genetics, analyzed genetic material taken from blood samples of 78 parent-child trios, focusing on families in which parents with no signs of a mental disorder gave birth to a child who developed autism or schizophrenia. This approach allows scientists to isolate brand-new mutations in the genes of the child that were not present in the parents.

Most people have many of these so-called de novo mutations, which occur spontaneously at or near conception, and most of them are harmless. But studies suggest that there are several such changes that can sharply increase the risk for autism and possibly schizophrenia — and the more a child has, the more likely he or she is by chance to have one of these rare, disabling ones.

Some difference between the paternal and maternal side is to be expected. Sperm cells divide every 15 days or so, whereas egg cells are relatively stable, and continual copying inevitably leads to errors, in DNA as in life.

Still, when the researchers removed the effect of paternal age, they found no difference in genetic risk between those who had a diagnosis of autism or schizophrenia and a control group of Icelanders who did not. “It is absolutely stunning that the father’s age accounted for all this added risk, given the possibility of environmental factors and the diversity of the population,” said Dr. Kari Stefansson, the chief executive of Decode and the study’s senior author. “And it’s stunning that so little is contributed by the age of the mother.”

Dr. Stefansson’s co-authors included C. Augustine Kong of Decode, and researchers from the University of Iceland, Aarhus University in Denmark and Illumina Cambridge Ltd.

Dr. Stefansson said it made sense that de novo mutations would play a significant role in brain disorders. At least 50 percent of active genes play a role in neural development, so that random glitches are more likely to affect the brain than other organs, which have less exposure.

In the end, these kinds of mutations may account for 20 to 30 percent of cases of autism, and perhaps schizophrenia, some experts said. The remainder is probably a result of inherited genetic predisposition and environmental factors that are the subjects of numerous studies.

Dr. Stefansson and other experts said that an increase in the average age of fathers had most likely led to more cases of autism. Unlike other theories proposed to explain the increase, like vaccinations, it is backed by evidence that scientists agree is solid.

This by itself hardly explains the overall increase in diagnoses, at least in the United States. The birthrate of fathers age 40 and older has increased by more than 30 percent since 1980, according to government figures, but the diagnosis rate has jumped tenfold, to 1 in 88 8-year-olds.

And it is not clear whether the rate of schizophrenia diagnosis has increased at all in that time.

Nonetheless, if these study findings hold up and extend to other brain disorders, wrote Alexey S. Kondrashov of the University of Michigan, in an editorial accompanying the study, “then collecting the sperm of young adult men and cold-storing it for later use could be a wise individual decision.”

That very much depends on the individual. “You are going to have guys who look at this and say, ‘Oh no, you mean I have to have all my kids when I’m 20 and stupid?’ ” said Evan E. Eichler, a professor of genome sciences at the University of Washington in Seattle. “Well, of course not. You have to understand that the vast majority of these mutations have no consequences, and that there are tons of guys in their 50s who have healthy children.”


[And then there is this article that suggests that autism is sparked off in the womb during an inflammatory infection.]

New York Times
August 25, 2012

An Immune Disorder at the Root of Autism

By MOISES VELASQUEZ-MANOFF

IN recent years, scientists have made extraordinary advances in understanding the causes of autism, now estimated to afflict 1 in 88 children. But remarkably little of this understanding has percolated into popular awareness, which often remains fixated on vaccines.

So here’s the short of it: At least a subset of autism — perhaps one-third, and very likely more — looks like a type of inflammatory disease. And it begins in the womb.

It starts with what scientists call immune dysregulation. Ideally, your immune system should operate like an enlightened action hero, meting out inflammation precisely, accurately and with deadly force when necessary, but then quickly returning to a Zen-like calm. Doing so requires an optimal balance of pro- and anti-inflammatory muscle.

In autistic individuals, the immune system fails at this balancing act. Inflammatory signals dominate. Anti-inflammatory ones are inadequate. A state of chronic activation prevails. And the more skewed toward inflammation, the more acute the autistic symptoms.

Nowhere are the consequences of this dysregulation more evident than in the autistic brain. Spidery cells that help maintain neurons — called astroglia and microglia — are enlarged from chronic activation. Pro-inflammatory signaling molecules abound. Genes involved in inflammation are switched on.

These findings are important for many reasons, but perhaps the most noteworthy is that they provide evidence of an abnormal, continuing biological process. That means that there is finally a therapeutic target for a disorder defined by behavioral criteria like social impairments, difficulty communicating and repetitive behaviors.

But how to address it, and where to begin? That question has led scientists to the womb. A population-wide study from Denmark spanning two decades of births indicates that infection during pregnancy increases the risk of autism in the child. Hospitalization for a viral infection, like the flu, during the first trimester of pregnancy triples the odds. Bacterial infection, including of the urinary tract, during the second trimester increases chances by 40 percent.

The lesson here isn’t necessarily that viruses and bacteria directly damage the fetus. Rather, the mother’s attempt to repel invaders — her inflammatory response — seems at fault. Research by Paul Patterson, an expert in neuroimmunity at Caltech, demonstrates this important principle. Inflaming pregnant mice artificially — without a living infective agent — prompts behavioral problems in the young. In this model, autism results from collateral damage. It’s an unintended consequence of self-defense during pregnancy.

Yet to blame infections for the autism epidemic is folly. First, in the broadest sense, the epidemiology doesn’t jibe. Leo Kanner first described infantile autism in 1943. Diagnoses have increased tenfold, although a careful assessment suggests that the true increase in incidences is less than half that. But in that same period, viral and bacterial infections have generally declined. By many measures, we’re more infection-free than ever before in human history.

Better clues to the causes of the autism phenomenon come from parallel “epidemics.” The prevalence of inflammatory diseases in general has increased significantly in the past 60 years. As a group, they include asthma, now estimated to affect 1 in 10 children — at least double the prevalence of 1980 — and autoimmune disorders, which afflict 1 in 20.

Both are linked to autism, especially in the mother. One large Danish study, which included nearly 700,000 births over a decade, found that a mother’s rheumatoid arthritis, a degenerative disease of the joints, elevated a child’s risk of autism by 80 percent. Her celiac disease, an inflammatory disease prompted by proteins in wheat and other grains, increased it 350 percent. Genetic studies tell a similar tale. Gene variants associated with autoimmune disease — genes of the immune system — also increase the risk of autism, especially when they occur in the mother.

In some cases, scientists even see a misguided immune response in action. Mothers of autistic children often have unique antibodies that bind to fetal brain proteins. A few years back, scientists at the MIND Institute, a research center for neurodevelopmental disorders at the University of California, Davis, injected these antibodies into pregnant macaques. (Control animals got antibodies from mothers of typical children.) Animals whose mothers received “autistic” antibodies displayed repetitive behavior. They had trouble socializing with others in the troop. In this model, autism results from an attack on the developing fetus.

But there are still other paths to the disorder. A mother’s diagnosis of asthma or allergies during the second trimester of pregnancy increases her child’s risk of autism.

So does metabolic syndrome, a disorder associated with insulin resistance, obesity and, crucially, low-grade inflammation. The theme here is maternal immune dysregulation. Earlier this year, scientists presented direct evidence of this prenatal imbalance. Amniotic fluid collected from Danish newborns who later developed autism looked mildly inflamed.

Debate swirls around the reality of the autism phenomenon, and rightly so. Diagnostic criteria have changed repeatedly, and awareness has increased. How much — if any — of the “autism epidemic” is real, how much artifact?

YET when you consider that, as a whole, diseases of immune dysregulation have increased in the past 60 years — and that these disorders are linked to autism — the question seems a little moot. The better question is: Why are we so prone to inflammatory disorders? What has happened to the modern immune system?

There’s a good evolutionary answer to that query, it turns out. Scientists have repeatedly observed that people living in environments that resemble our evolutionary past, full of microbes and parasites, don’t suffer from inflammatory diseases as frequently as we do.

Generally speaking, autism also follows this pattern. It seems to be less prevalent in the developing world. Usually, epidemiologists fault lack of diagnosis for the apparent absence. A dearth of expertise in the disorder, the argument goes, gives a false impression of scarcity. Yet at least one Western doctor who specializes in autism has explicitly noted that, in a Cambodian population rife with parasites and acute infections, autism was nearly nonexistent.

For autoimmune and allergic diseases linked to autism, meanwhile, the evidence is compelling. In environments that resemble the world of yore, the immune system is much less prone to diseases of dysregulation.

Generally, the scientists working on autism and inflammation aren’t aware of this — or if they are, they don’t let on. But Kevin Becker, a geneticist at the National Institutes of Health, has pointed out that asthma and autism follow similar epidemiological patterns. They’re both more common in urban areas than rural; firstborns seem to be at greater risk; they disproportionately afflict young boys.

In the context of allergic disease, the hygiene hypothesis — that we suffer from microbial deprivation — has long been invoked to explain these patterns. Dr. Becker argues that it should apply to autism as well. (Why the male bias? Male fetuses, it turns out, are more sensitive to Mom’s inflammation than females.)

More recently, William Parker at Duke University has chimed in. He’s not, by training, an autism expert. But his work focuses on the immune system and its role in biology and disease, so he’s particularly qualified to point out the following: the immune system we consider normal is actually an evolutionary aberration.

Some years back, he began comparing wild sewer rats with clean lab rats. They were, in his words, “completely different organisms.” Wild rats tightly controlled inflammation. Not so the lab rats. Why? The wild rodents were rife with parasites. Parasites are famous for limiting inflammation.

Humans also evolved with plenty of parasites. Dr. Parker and many others think that we’re biologically dependent on the immune suppression provided by these hangers-on and that their removal has left us prone to inflammation. “We were willing to put up with hay fever, even some autoimmune disease,” he told me recently. “But autism? That’s it! You’ve got to stop this insanity.”

What does stopping the insanity entail? Fix the maternal dysregulation, and you’ve most likely prevented autism. That’s the lesson from rodent experiments. In one, Swiss scientists created a lineage of mice with a genetically reinforced anti-inflammatory signal. Then the scientists inflamed the pregnant mice. The babies emerged fine — no behavioral problems. The take-away: Control inflammation during pregnancy, and it won’t interfere with fetal brain development.

For people, a drug that’s safe for use during pregnancy may help. A probiotic, many of which have anti-inflammatory properties, may also be of benefit. Not coincidentally, asthma researchers are arriving at similar conclusions; prevention of the lung disease will begin with the pregnant woman. Dr. Parker has more radical ideas: pre-emptive restoration of “domesticated” parasites in everybody — worms developed solely for the purpose of correcting the wayward, postmodern immune system.

Practically speaking, this seems beyond improbable. And yet, a trial is under way at the Montefiore Medical Center and the Albert Einstein College of Medicine testing a medicalized parasite called Trichuris suis in autistic adults.

First used medically to treat inflammatory bowel disease, the whipworm, which is native to pigs, has anecdotally shown benefit in autistic children.

And really, if you spend enough time wading through the science, Dr. Parker’s idea — an ecosystem restoration project, essentially — not only fails to seem outrageous, but also seems inevitable.

Since time immemorial, a very specific community of organisms — microbes, parasites, some viruses — has aggregated to form the human superorganism. Mounds of evidence suggest that our immune system anticipates these inputs and that, when they go missing, the organism comes unhinged.

Future doctors will need to correct the postmodern tendency toward immune dysregulation. Evolution has provided us with a road map: the original accretion pattern of the superorganism. Preventive medicine will need, by strange necessity, to emulate the patterns from deep in our past.

Moises Velasquez-Manoff is the author of “An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases.”

Jaundice, autism co-related?

Oct 11, 2010

CHICAGO - AUTISM is more common in children who had jaundice at birth, a big Danish study found, but researchers cautioned they don't know how the two conditions might be related and that new parents shouldn't be alarmed.

Mild jaundice is fairly common and generally harmless. Severe, untreated jaundice is known to cause brain damage, but it's also rare and hasn't been proven to cause autism. It's possible that children genetically predisposed to autism might also be more vulnerable than others to jaundice.

But if autism and jaundice are related, the study doesn't answer whether one of the ailments might have caused the other, said Rikke Damkjaer Maimburg, the lead author and a researcher at Denmark's Aarhus University.

Mr Maimburg and colleagues examined medical data on all 733,826 children born in Denmark between 1994 and 2004. The results were prepared for release online Monday in Pediatrics.

More than 35,000 newborns had jaundice, while autism was eventually diagnosed in 577 children. Among autistic children, almost 9 per cent had jaundice as newborns, compared with 3 per cent of other children.

Previous studies on a possible autism-jaundice link have produced conflicting results. -- AP

Gene linked to schizophrenia

Apr 13, 2010

MONTREAL - PEOPLE with a specific mutated gene may be prone to schizophrenia, according to a Canadian study published on Monday in a US scientific journal.

The study led by University of Montreal researchers found new mutations in the so-called 'SHANK3 gene' in schizophrenic patients.

'That these new mutations occur in schizophrenia is rather unexpected and may explain why the identification of the genes linked to this disease has been so difficult,' senior author Guy Rouleau said in a statement. 'Our findings show that a significant number of schizophrenia cases are the result of new genetic mutations in the SHANK3 gene,' he said in the study published in the US Proceedings of the National Academy of Science.

Schizophrenia is a mental disorder that affects about one per cent of people worldwide. It is most commonly manifested as auditory hallucinations, paranoid or bizarre delusions, or disorganised speech and thinking. It often leads to significant social or occupational dysfunction.

SHANK3 proteins are involved in maintaining the physical structure of nerve cells, and mutations in the gene result in specific abnormalities in cell shapes. These deformations have been observed in schizophrenia patients.

Lead study author Julie Gauthier said the SHANK3 gene had 'previously been linked to autism,' which suggests 'a molecular genetic link between these two neurodevelopmental disorders.' It also means that SHANK3 'may have a role in other brain disorders,' she said. -- AFP

Early diagnosis for autism?

Nov 8, 2008

WASHINGTON - BABIES who were later diagnosed with autism played with toys in unusual ways, spinning or rotating them more than other babies, US researchers reported on Thursday.

Their findings, reported in the journal Autism, might help doctors and parents identify children at risk of autism and start to help them earlier, the researchers said.

Babies who went on to develop autism also stared noticeably at objects such as bottles or looked at them out of the corners of their eyes, Dr Sally Ozonoff of the University of California Davis and colleagues found.

'There is an urgent need to develop measures that can pick up early signs of autism, signs present before 24 months,' Dr Ozonoff said in a statement.

The American Academy of Pediatrics has recommended that all infants be screened for autism before they turn two, and most pediatricians look for the classic social and communication symptoms.

'The finding that the unusual use of toys is also present early in life means that this behaviour could easily be added to a parent check-list or quickly assessed during a visit to a pediatrician's office,' Dr Ozonoff said. 'The earlier you treat a child for autism, the more of an impact you can have on that child's future.'

Dr Ozonoff and colleagues studied 66 1-year-old babies considered at high risk of autism, mostly because they had siblings with autism.

Nine of them were eventually diagnosed with autism, and seven of these spent significantly more time spinning, rotating and looking sideways at objects than the other children.

No one knows what causes autism, which is marked by impaired social interaction and communication and can range from mild symptoms to profound behavioural difficulties and mental retardation.

Autism and related disorders such as Asperger's syndrome affect an estimated one out of every 150 US children, the Centres for Disease Control and Prevention estimates.

Most evidence suggests it is caused by a combination of genetic and early environmental factors - perhaps even before birth. It is usually diagnosed by age 3.

'About a third of parents notice signs before a child's first birthday,' Dr Ozonoff said. -- REUTERS

Oxytocin, music of love

Oct 11, 2008
DAEDALUS: TECHNOLOGICAL TRIUMPHS & CHALLENGES

By Andy Ho
THE Home Ministry is looking for face recognition software to use with its surveillance footage. After it was discussed here last Saturday, a reader asked if such software might help her autistic child.

Such parents are, commendably, always looking for solutions for their kids who generally don't like to look at faces. Autistic children tend to avoid eye contact, have limited facial expression themselves and are usually socially withdrawn.

Since perception of faces is a very basic component of social interaction, the brains of the autistic may well have problems processing faces. In 2000, special MRI scans confirmed this to be the case.

We tend to remember and recognise faces more easily than we do names. This is because there is a specific part of the brain as small as a pea that responds to human faces twice as strongly as it does to non-face objects - like cars, cats, cows and so on. This spindle-shaped site, called the fusiform face area (FFA), is located halfway back in the head, at the bottom of the part of our grey matter that interprets visual images.

The FFA enables us to assess a person's sex, age, mood, intentions, sincerity and so on within seconds of contemplating his or her face. In cases where the part of the brain the FFA is now known to be located has been injured, patients may develop 'face blindness'. Such patients can recognise a face as a face - as distinct from non-face objects - but cannot identify individual faces any more. So they can't grasp why robbers in movies would use face masks.

In normal people, the sight of faces stirs up not just the FFA but also certain parts of the brain it is connected to. These parts are involved in language, memory, attention and emotions (the last being specifically called the limbic system). These distributed neural networks connected to the FFA are involved in processing the complex social meanings that facial expressions convey and communicate.

Unlike those with face blindness, however, autistic kids can discriminate among the faces of people they meet every day. It is now known that, in autism, the FFA and its extended neural circuitry are activated to a lesser degree than in normal people. Thus, when the autistic person sees a face, fewer memories or emotional cues are evoked. He or she processes faces more like objects than socially significant countenances.

Because this network of 'social' neurons does not work as smoothly in them as it does in normal people, autistics tend to be socially awkward. Perhaps, a nectar of serenity, bonding and love, if one exists, is what autistic children need?

There is, in fact, such a nectar - or a hormone, to be precise - one that is the very antithesis of adrenaline, the hormone of excitement and aggression. That love chemical is called oxytocin. It surges in the brain post-orgasm, initiates womb contractions that lead to child birth, and triggers milk production in mothers.

Oxytocin also lowers the blood pressure and feelings of stress while making one feel sociable and lovey-dovey. Some clubbers resort to Ecstasy, the cuddle chemical that increases feelings of generosity and intimacy towards others. In rats, Ecstasy causes a brain surge of oxytocin just as it does after orgasm.

Post-orgasmic human males feel sensual, not sexual. They feel really good about the person they are with. Even rats given Ecstasy tend to stick close to one another to 'chill out'.

In 2003, University of Stockholm scientists discovered that people who sing together release more oxytocin in their brains, which may lead to 'limbic resonance'. When the emotion processing network called the limbic system (which is linked to the FFA) resonates among people, they become attuned to one another's feelings. Then they sing in harmony, feel similarly aroused, and think they are truly at one with others. Perhaps that is why church services have always included congregational singing.

There is interdisciplinary interest in this link, like yesterday's conference at Arizona State University on 'Oxytocin and Music'. When people sing or listen to music, the brain releases more oxytocin. This may be why music fans feel so connected to their idols, argues Professor Daniel Levitin - a former rock musician himself and now a neuroscientist at McGill University in Canada.

In his recent book, The World In Six Songs: How The Musical Brain Created Human Nature, Prof Levitin argues that all music talks about one or more of six things. These are friendship, joy, comfort, knowledge, religion and love - all of which have to do with human emotions. The link between them is that music releases oxytocin. Perhaps that is why music therapy does help autistic children.

So oxytocin, not face recognition software, might help these kids. Last year, it was reported that autistics who were administered oxytocin seemed to do much better. There is, in fact, an ongoing US trial in this connection.

In deploying any hormone therapeutically, however, one must be aware that it has a normal level that the body maintains in fine balance with the normal levels of other hormones too. We don't know yet how boosting oxytocin levels might cause other hormones to go out of whack. It could also cause the body itself to stop producing oxytocin naturally.

So parents of autistic children should wait to see how the US study goes. But since music may well be the food of love, play on.

andyho@sph.com.sg

Saving people from peddlers of false hope [Autism]

Aug 20, 2008
ALTERNATIVE THERAPIES

By Radha Basu


AFTER their children are diagnosed with autism, many parents here drift from one therapist to another, hooked on the hope that someone, somewhere, somehow can make their little ones better. With mainstream medicine offering no cure, these parents say they have no choice but to knock on the doors of a motley crew of people who practise over 20 'alternative' therapies here.

A 43-year-old teacher The Straits Times spoke to has consulted more than 10 practitioners since her only son, now 11, was diagnosed as autistic in 1999. Under their guidance, she has pumped the boy with vitamins and drugs, pock-marked his arm with injections and even put sensors on his head to map the way his mind works. Nothing worked.

'Every therapist I went to said they had seen good results in 99 per cent of the cases they treated,' said the mother. 'But my son was always the exception.'

Autism refers to a wide range of brain-based disorders that affect a person's ability to communicate, form relationships and respond appropriately to the environment. Autistic people live in their own worlds, seldom looking people in the eye or expressing emotion.

Usually diagnosed in childhood, the condition is lifelong. That is a bitter pill that many parents find hard to swallow. Desperate for a solution, they turn to anyone who holds out hope. But hope often becomes disillusionment.

When a human resource manager took her autistic daughter to see a doctor who dabbles in alternative therapies, she was sold a $160 bottle of supplements to help with what was diagnosed as a 'weak immune system'. The mother came home, did a quick Google search and was 'shocked' to discover that the doctor had sold her a multi-level marketing product, for which sellers typically get a commission. 'Are doctors even allowed to do that?' she asked.

In another case, a mother said she spent nearly $100,000 on various alternative therapies here and overseas in the hope that her child would 'recover'. When the boy's younger sister was also diagnosed with the condition, the family ran out of money - and determination - to repeat the same cycle with the girl. They stuck to conventional treatments - like speech and occupational therapy - and took the girl to a government-subsidised autism intervention programme. Ironically, she is coping much better today than her brother.

Since these alternative remedies have no scientific basis, doctors have long harboured doubts about their efficacy. Many regard such 'complementary therapies' as placebos or pseudo science at best, and brazen quackery at worst.

Increasingly, parents here too are realising that such therapies are not just a drain on their wallets, but also may harm rather than heal their child.

In the face of their growing discontent - and an avalanche of literature on the potential harmful effects of some therapies - a government-appointed committee has begun drafting a series of guidelines on the autism therapies available here. The guidelines will highlight therapies that appear to be working, those that are not evidence-based and those that are downright dangerous.

But can more be done to protect parents from practitioners who peddle false hope? At least one country has shown the way. In January this year, the British government announced stricter regulations of various kinds of 'alternative' or 'complementary' medicine such as homeopathy, aromatherapy and traditional Chinese medicine. The move coincided with reports in the British media highlighting the questionable practices of autism practitioners. The new British regulations, however, apply to most alternative medicine practitioners, not just those who treat autism.

In April, a new regulatory body - the Complementary and Natural Healthcare Council - was set up to provide a voluntary register of therapists and practitioners. The main aims of the council, its website says, are to protect patients, build trust and boost consumer confidence. It can register therapists - thereby giving them a seal of legitimacy - but also strike them off the rolls if complaints against them are found to be true.

Perhaps it's time for a similar move in Singapore as well. With 400 children diagnosed with autism annually in public hospitals alone, advocates such as Member of Parliament Denise Phua are hoping that clinics or centres that 'profess to cure people of autism' can be registered or licensed. The Ministry of Health, she added, should take the lead in initiating the move. Ms Phua, who has a son with autism, is head of the Autism Resource Centre (ARC), which helps those with autism get better education, employment opportunities and care.

The ministry 'may not be an expert on autism', said Ms Phua, but it could set up an assessment panel by working with local autism bodies such as ARC and overseas experts such as the Britain-based Research Autism.

Autism advocates insist that licences must be based on a set of objective criteria. These could include:

# Whether the effectiveness of the treatment is based on hard evidence;

# Potential risks to the patient;

# Cost of treatment;

# Knowledge and skills of the practitioner; and

# Reference checks on the practitioner.

'Licences should be provisional before confirmation and then renewable on proof of performance,' argued Ms Phua. Most importantly, a 'whistle-blowing policy' should also be put in place so that investigations can be conducted in case of misconduct.

Practitioners themselves say licences could help to separate the grain from the chaff. A homeopath said that while 'individual practitioners can fail, therapies cannot'. The difference between failure and success depends on the 'skills and experience' of the practitioner, she said, adding that she would be willing to put herself to the test by applying for a licence.

In another interview, an energy healer said that while she knows of fellow practitioners who have slipped up, her own track record has been '100 per cent successful'.

Tired of such hyperbole, parents are hopeful that licensing can help them make the best of a desperate situation - and protect their children from further harm. Wanting to see their children get better has made them vulnerable to exploitation - and heartbreak.

Licensing practitioners and penalising them for false claims may just be the wake-up call parents hooked on hope need to jerk them back to reality.

Autism: Desperately seeking a cure

Aug 16, 2008
DAEDALUS: TECHNOLOGICAL TRIUMPHS AND CHALLENGES

By Andy Ho

ABOUT 80 per cent of an online support group of 560 parents here have resorted to some alternative therapy for their children's autistic condition.

These run the gamut from megadoses of vitamins C and B6 or omega-3 fatty acids to gluten-free or casein-free diets. Then there are the potentially deadly therapies, including the use of Avandia and Actos.

These are drugs for diabetes that came to market in the late 1990s. But it was only last year that they were confirmed to cause, on occasion, heart failure in the young with normal hearts. (When a drug intended for a specific ailment - say, diabetes - is prescribed for something else - say, autism - that is called an off-label use. Such use is not illegal, per se.)

Traditionally, autism was diagnosed only in children who showed a profound indifference to, a lack of empathy for and social withdrawal from other people, including parents and siblings.

In 1994, however, the American Psychiatric Association expanded its definition of autism in its Diagnostic And Statistical Manual (4th edition), or DSM-IV, to encompass a broader range of disorders. Autism is now referred to as Autism Spectrum Disorder (ASD), and includes related disabilities, such as PDD-NOS (pervasive developmental disorder, not otherwise specified).

In the DSM-IV, the psychiatrist's bible the world over, all items on the checklist for autism - including language impairments, developmental delays, sensory impairment, personality disorders and so on - are given equal weightage. However, 90 per cent of these symptoms are not specific to autism.

As is true with all other DSM-IV disorders, the diagnosis of ASD is based solely on symptoms. There is no specific laboratory test to nail it down objectively, so there might be non-autistic kids diagnosed with ASD. The numbers diagnosed as being autistic, not unexpectedly, rose after DSM-IV - and, in tandem, so did the demand for offbeat therapies.

Here's why: There is no known cure for autism but one therapy known to help patients is that which teaches patients to imitate their teachers. This behavioural therapy is done one-on-one for up to 40 hours a week over many years. This being an arduous process, parents naturally look for short cuts.

Sometimes, fad therapies seem to work because autism, like many other disorders, displays a natural pattern: Symptoms get worse at times and diminish at others. When symptoms get really bad, parents hunt for magic cures; and when the symptoms abate naturally afterwards, the improvement is attributed to the new 'cure'. Parents want to believe.

Moreover, fad treatments are now widely discussed on the Internet. As a result, parents who are extremely motivated to help their kids become easy prey for quacks. If parents perceive their doctors to be dismissive or dogmatic, they might even abandon mainstream treatment altogether. So the Health Ministry has rightly formed a committee of experts to review available research on and issue guidelines about alternative therapies for autism by next year so parents can choose more wisely among them.

One particular therapy the committee should review is chelation, where certain chemicals are administered orally or intravenously in the hope that they will stick to heavy metals present in the body, which are then flushed out in the urine. Advocates of this treatment say the mercury (as thimerosal) in childhood vaccines is the cause of autism, so chelation to bind mercury in the body should help.

Though approved only for acute heavy metal poisoning, there are some doctors here who administer chelating agents using in-office intravenous drips. Most doctors do not believe chelation can help in autism cases. After reviewing the world's best studies, the US Institute of Medicine concluded in 2004 that thimerosal is not a cause of autism.

Nevertheless, widespread belief in the link persists. In fact, advocacy groups are now parading a US court decision in March in which a family sued the government, claiming that vaccines had caused their daughter's autism. The US government settled the suit after concluding the baby shots had 'significantly aggravated an underlying mitochondrial disorder' which caused a brain disorder 'with features of autism spectrum disorder'.

When those tiny power stations in our cells called mitochondria don't function well, many normal body functions go awry - much like a factory located in an area with frequent brownouts. What the US authorities actually conceded was that the vaccines had exacerbated an underlying condition caused by sick mitochondria in the child, who then developed symptoms found in DSM-IV's long checklist for an ASD diagnosis.

Those symptoms, it ought to be noted, can also be found in many non-ASD patients who encountered problems in their brains as the organ was developing.

Thus the child in question must have been initially diagnosed as ASD, whereas further tests revealed that she actually had a mitochondrial disorder instead. The United States Centres for Disease Control and Prevention has stated categorically that it was 'a complete mischaracterisation of the findings of the (court) case, and...of the science' to say vaccines cause autism.

But as the case was settled for an undisclosed sum, court documents have been sealed. Predictably, advocates smelt a cover-up.

The Singapore committee of experts has its work cut out. Sceptics, wedded understandably to hope, will scrutinise its report very carefully. We wish it well.

andyho@sph.com.sg

[Every now and again, I wonder if psychiatry has progress much beyond Freud's pscyho-analysis, and every now and again, I have to conclude that it hasn't advanced very much. Everybody is a scientist. Everyone uses Occam's razor to cut away the details to get at the simplistic explanation. What is clear is that the increasing number of Autism diagnosis is due to the expanding DSM-IV definition of autism spectrum disorder. And many of these "disorder" are nowhere near what is generally understood to be true autism. Perhaps Singapore will be brave enough to say, "we know what autism is and what it is not and most of those diagnosed as autistic are not. They have developmental delays or issues, but they are not autistic." This is like the false memory pandemic. If you have a hammer, everything looks like a nail. If you have a gun, everything looks like a target.]

New genes involved in autism discovered

July 11, 2008

WASHINGTON - HARVARD University researchers have discovered half a dozen new genes involved in autism that suggest the disorder strikes in a brain that cannot properly form new connections.

The findings, based on families in the Middle East, Turkey and Pakistan, also may help explain why intense education programs do help some autistic children: certain genes that respond to experience were not missing but were merely stuck in the 'off' position.

'The circuits are there, but you have to give it an extra push,' said Dr Gary Goldstein of the Kennedy Krieger Institute in Baltimore, Maryland, which was not involved in the gene hunt but is well-known for its autism behavioural therapy.

The genetics suggest that 'what we're doing makes sense when we work with these little kids - and work and work and work - and suddenly get through,' he said.

But the study's bigger message is that autism is too strikingly individual to envision an easy gene test for it. Instead, patients are turning out to have a wide variety, almost a custom set, of gene defects.

'Almost every kid with autism has their own particular cause of it,' said Dr Christopher Walsh, chief of genetics at Children's Hospital Boston, who led the research published in Friday's edition of the journal Science.

Autism spectrum disorders include a range of poorly understood brain conditions, from the mild Asperger's syndrome to more severe autism characterised by poor social interaction, impaired communication and repetitious behaviours.

It is clear that genes play a big role in autism, from studies of twins and families with multiple affected children. But so far, the genetic cause is known for only about 15 percent of autism cases, Dr Walsh said.

So Dr Walsh's team took a new tack. They turned to the Middle East, a part of the world with large families and a tendency for cousins to marry, characteristics that increase the odds of finding rare genes.

They recruited 88 families with cousin marriages and high incidences of autism, from Jordan, Saudi Arabia, Kuwait, Oman, Pakistan, Qatar, Turkey and the United Arab Emirates. They compared the DNA of family members to search for what are called recessive mutations, where the mother and father can be healthy carriers of a gene defect but a child who inherits that defect from both parents gets sick.

In some of the families, they found large chunks of missing DNA regions that followed that recessive rule. The missing regions varied among families, but they affected at least six genes that play a role in autism.

Here is why this matters: All the genes seem to be part of a network involved in a basic foundation of learning, how neurons respond to new experiences by forming synapses, or connections between each other.

In the first year or two of life, when autism symptoms appear, synapses rapidly form and mature, and unnecessary ones are 'pruned' back. In other words, a baby's brain is literally being shaped by its first experiences so that it is structurally able to perform learning and other functions of later life.

'This paper points to problems specifically in the way that experience sculpts the developing brain,' explained Dr Thomas Insel, director of the National Institute of Mental Health, which helped pay for the work.

Some earlier research had pointed to the same underlying problem, so these newly found genes 'join a growing list to suggest that autism is a synaptic disorder,' he said.

If that sounds discouraging, here is the good news: The missing DNA did not always translate into missing genes. Instead what usually was missing were the on/off switches for these autism-related genes. Essentially, some genes were asleep instead of doing their synapse work.

'I find that hopeful' because 'there are ways that are being discovered to activate genes,' Dr Walsh said. 'This might be an unanticipated way of developing therapies in the long term for autism: Identifying these kids where all the right genes are present, just not turned on in the right way.'

At Kennedy Krieger, Dr Goldstein thinks the work may provide a gene-level explanation for why some children already are helped by intense therapy.

'We have trouble getting through to these children, but with repeated stimulation we can do it,' he said. 'These are circuits that have an ability not so much to recover but to work around the problem.' -- AP

Researchers identify rare genetic glitch that increases risk of autism

Jan 10, 2008

TRENTON - A RARE genetic variation dramatically raises the risk of developing autism, a large study showed, opening new research targets for better understanding the disorder and for treating it.

Research into the causes of autism has focused on genetic causes because so many families have multiple children with the disorder.