Doctors on Autism Environment Tightrope: Dr. Perri Klass in NYT
Posted Aug 01 2011 12:00am
By Anne Dachel
August 8, 2011 the New York Times published the story, 'Environment' Poses a Knotty Challenge in Autism , by Perri Klass, MD,Professor of Pediatrics, New York University. Doctors like Klass are in a difficult position these days. After two decades of pediatricians taking credit for the better diagnosing of autism and claiming that it was a genetic disorder that's always been around, the latest research on twins has given us stunning evidence that autism is more likely determined by factors in the environment. Now the big questions are: What's causing so many children to be disabled and how can we prevent more kids from ending up on the spectrum?
Are doctors demanding research? Are they scrambling for answers? Are they scared the numbers could get worse than the current rate of one percent?
Evidently Dr. Klass isn't too worked up over all the autism no official can explain. Her biggest problem is that parents keep asking her questions and she has no answers.
Klass said, "Although there is more research in this area than ever before, it sometimes feels as if it's getting harder, not easier, to provide answers that do justice to the evidence and also offer practical guidance."
Klass cited the research on twins, "The study sought to determine how likely the second twin was to have some form of autism. If autism was highly heritable, identical twins should have been far more likely to both have autism than fraternal twins. But the researchers found that fraternal twins were unexpectedly likely to both have autism
"The implication is that something in their common gestational or early childhood experience may have contributed to this similarity."
It would seem that autism could be prevented if we can just determine what the environmental factor/factors might be. So the obvious questions are: What are scientists looking at? What is harming our children like never before?
Before she got to that, Klass gave us the history of autism back to the days of the refrigerator mom theory. As far as the environment is concerned, Klass cited
Irva Hertz-Picciotto at UC Davis who said, "An environmental influence might be a chemical the fetus is exposed to via the placenta, or it might refer to aspects of nutrition, maternal health, stress - or perhaps exposure to a microbe."
Klass went on, "The causal links most strongly supported by research include rubella infection during pregnancy and prenatal exposure to medications like thalidomide and valproic acid, an anti- seizure drug. Other environmental factors, like air pollution and exposure to certain pesticides and other chemicals, have been found to be associated with autism, but without evidence of causality.
"In a 2010 paper in the journal NeuroToxicology, Dr. Amir Miodovnik, a pediatrician at the Mount Sinai School of Medicine, and his colleagues showed that children who had been exposed to high levels of phthalates prenatally were more likely to show social impairments at 7 to 9 years of age.
‘Yet these data don't demonstrate cause and effect,’ Dr. Miodovnik said. …'Every case is probably a result of the confluence of many factors. No case probably has one cause.'”
Miodovnik said that potential toxin are everywhere. But he did urge prospective parents to avoid fertilizers and not to micro-wave plastic.
Klass added, "Take prenatal vitamins before trying to conceive. Make sure your immunizations are up to date. Get good prenatal care. Talk to your doctor about the risks and benefits of any medications you take."
So I guess lots of things might be causal when it comes to autism. These doctors couldn’t tell us anything specific nor did they seem particularly worried about the explosion in autism, but prospective moms were urged to get vaccinated. What seemed to bother Klass most is the fact that parents keep bringing it up.
Klass ended her piece by saying, “Learning more and understanding more ought to make us more helpful to parents, and of course to children. We respect them by acknowledging that there is nothing simple in the development of autism: The causes are genetic, and not simple, and environmental, and not simple. And if the studies tell us anything clearly, it is that we have much to learn about the interplay of genes and environmental exposure and the individuality of this complex disorder.”
What’s clearly missing here is any projected date for when experts might actually be able to tell us something--anything for sure. Will autism continue to be a mystery during our lifetime? Our children’s? In a hundred years, will we be getting any closer? This was an article offering no hope. None. Just one more doctor unalarmed and unknowing about autism.
I found out some interesting things about Klass. First of all, she wrote a book called, Quirky Kids.
This is about the high end kids with Asperger's and high functioning autism who were recognized in the DSM IV in 1994. The term "quirky" made me immediately think of Dr. Paul Offit. Offit’s famous for dismissing the explosion in autism saying, "People that we once called quirky or geeky or nerdy are now called autistic."
Perri Klass admires Offit and like Offit she denies that vaccinations have any connection to autism. I found a review of Offit’s book (HERE) where Klass wrote, "Deadly Choices carries a very important message for parents, journalists, physicians, and everyone who cares about children and health. It is a passionate, but also compassionate, call for civil discourse and rational conversation on a subject which matters so much to each of us individually and to us all as a society. It is a fascinating account of society and science, politics, publicity, and public health."
Klass and lots of other doctors have been dragged kicking and screaming to the realization that the environment is harming our kids. They don’t have any answers for parents. They’re right there listing every toxins known to man, except of course the toxic stew commonly called the vaccination schedule.
Most telling of all is their blanket refusal to do two things that would give us the most conclusive findings on autism. Experts are not out there calling for research on those children who were born healthy and were developing normally and who suddenly got sick and regressed into autism and a host of other maladies. Something dramatically impacted their health. Why is it that scientists are afraid to look for the common factor? This is the research that Dr. Bernadine Healy, former head of the NIH, called for on CBS News in 2008.
Second, autism-vaccine deniers like Offit and Klass refuse to call for a study of never-vaccinated and fully-vaccinated kids to compare their rate of autism. Offit has gone on the record saying that this type of study would have to be designed with one study group not getting vaccines and that would be unethical. However, in this day and age, with so many parents afraid to vaccinate, the study group is out there.
I figure that we now have endless years ahead where experts cite this possible environmental trigger, maybe that one. They'll claim that the issue is just too complicated. We'll probably never know what causes autism in any particular child. I remember what Thomas Insel, head of the Interagency Autism Coordinating Committee, said when he was speaking at MIT in 2009.
Insel: "I said before this isn't just genetics... There have to be environmental factors."
"We have barely been able to scratch the surface."
"There are something like 80,000 potential toxicants."
Wow--80,000 potential toxicants? Autism will continue to be the disorder without a cause because we are now at a point where there are just too many possibilities? When my son was diagnosed the self-assured doctor was convinced that my husband and I were “genetically mismatched” and that's why our son had autism. Parents will now be told that their child was just in the wrong place at the wrong time and was exposed to any number of triggers. "Sorry, we have no idea what caused it. Nothing we can do."
The good news
The doctors who unabashedly tell us they know nothing are being upstaged by ones who are interested in finding answers. On August 10, 2011, the story Mercury and Autism Link Strengthened was published. All the doctors I talked about here--Klass, Hertz-Picciotto, Miodovnik, Offit, and Insel--should be interested in this news. The piece was by Ananya Mandal, MD and it explained stunning new research linking susceptibility to mercury damage and the development of autism.
"According to researchers a family history of mercury poisoning could be a significant risk factor for developing autism.
"The researchers from Swinburne University in Melbourne surveyed 522 Australian survivors of Pink disease - a form of mercury poisoning common in the early 20th century - found one in 25 of their 398 grandchildren aged six to 12 had an autism spectrum disorder. This prevalence is six times higher than the one-in-160 diagnosed in the general population. Author Associate Professor David Austin said, 'We asked the pink disease survivors to report any health conditions that their children or grandchildren had been diagnosed with. The survey included questions about Down syndrome, fragile X syndrome, attention deficit hyperactivity disorder (ADHD), epilepsy and autism.' The prevalence rate of most disorders was comparable to general population figures, however, the rate for autism was extremely high.
"Pink disease affected 1 in 500 young children with a hyper-sensitivity to mercury, it caused a range of severe symptoms including loss of speech, loss of interest in usual activities, hypersensitivity to light, pain and, in up to 20 per cent of cases, death. When mercury was identified as the culprit and removed as an ingredient in teething powders in the 1950s, the disease was essentially wiped out.
"The study, published this week in the Journal of Toxicology and Environmental Health, found the grandchildren did not have elevated rates of other conditions such as epilepsy, Down syndrome or attention deficit hyperactivity disorder. Authors write that this study added to mounting evidence of a link between genetics, mercury sensitivity and autism-spectrum disorders. They said the research also strongly suggested autism was caused by combined genetic and environmental factors."
This is reputable science and it links a known neurotoxin to a neuro-developmental disorder. A one in 25 risk for autism. It's a little hard to walk away from that statistic. And amazingly, the lead author, David Austin cautioned mothers to avoid mercury exposure, "This can be done by observing the recommendations of Food Standards Australia regarding seafood consumption, opting for non-amalgam dental fillings and requesting preservative-free vaccines from your doctor,"
So what about it, Drs. Klass, Hertz-Picciotto, Miodovnik, Offit, and Insel? Does this research give you any clues to why hundreds of thousands of children now have autism?
Dr. Insel, will the Australian mercury findings be on the agenda for the next IACC meeting? Are you going to ignore this study like all the others that have raised serious concerns over the safety of our ever-expanding vaccine schedule? Will we continue to wander in the desert as more and more kids disappear into the lost world of autism?
Anne Dachel is Contributing Editor for Age of Autism. Subscribe to her newsletter at AnneDachel.com