Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Increasing autism awareness: a role for MMR?
- M A Tatman Tatman (10 January 2003)
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Increased awareness vs Increased prevalance of autism
- Lenny Schafer (12 January 2003)
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Re: Increasing autism awareness: a role for MMR?
- Richard. C Miles (12 January 2003)
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Staring us in the face
- Lisa C Blakemore-Brown (13 January 2003)
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Research without data
- Antony M Bellows (14 January 2003)
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US study shows 10-fold increase in autism over the past 20 years
- Raymond W. Gallup (14 January 2003)
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Is the hormone 1,25-D exacerbating ASD?
- Trevor G Marshall, Frances E. Marshall (17 January 2003)
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M A Tatman Tatman, Consultant community paediatrician Coventry PCT, Gulson Hospital CV1 2HR
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In 1993 as a paediatric junior doctor I met my first autistic child. I had to get literature from the library to find out what it was. By the late 1990s as a consultant giving diagnoses to parents, I found that they too had to read up about autism to know what it was. Now if I tell a parent "I think your child has autism", the most common reply is "I suspected it myself." The likelihood of diagnosis has increased due to this greater level of recognition. Could the media campaign against MMR itself be responsible for the increased public awareness of autism? Competing interests: None declared |
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Lenny Schafer, Editor and Publisher 9629 Old Placerville Rd. Sac., Ca. 95827
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There has been some speculation, especially by the American Centers for Disease Control and Prevention and other public health agencies, that the increase in population of those diagnoses with the most severe form of autism is the result of increased awareness by the public. The less severe forms of autism are not a factor in the most recent prevalence studies. Parents, as well as the diagnosticians, are now more familiar with the symptoms because of the vaccine controversy and as a result, more children make the roster of disability agencies and public schools. Thus, they have become more visible. However, severe autism is unlike a tick or a stutter, which might go unnoticed by a parent who might not keep up the lay press or medical journals. Severe autism presents such profound behavioral disorders it is just as unlikely to have gone unnoticed 10 years ago, as it is unlikely now. The message behind this "spin" is that since there is only the perception of increased autism prevalence because of all the purported awareness, there is no real increase. It would follow then that there is no need to spend additional research resources on the matter. Problem solved. This speculation is so weak; there is not even much anecdotal evidence to support it. This did not restrain the CDC from invoking it as a conclusion to the Atlanta study, however. Kudos belong to the BMJ for avoiding the duplicity of repeating it in their reportage. Competing interests: Author has a child with autism |
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Richard. C Miles, Coordinator , Autism Research Campaign for Health London W6 9NW
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Increased awareness of autism, whether by doctors or parents, is indeed better, hardly surprising because the condition has dramatically increased at least ten fold as the latest Atlanta study has confirmed. Mounting cases of acquired or late onset autism have contributed to the increase of autistic spectrum disorders (ASD) , over classic autism, the latter more often present at birth. Environmental factors such as the effect of synergistic action between the three combined live virus components of MMR vaccine on gut and neurological immune processes , cannot be so confidently dismissed by epidemiological population studies of medical database records , as ASD is a disorder with no single phenotype, rather than a disease with a root cause and outcome. Age of diagnosis varies enormously, more so in the early to mid nineties, when most GP's, then unfamiliar with autism were first faced with it. This was compounded by uncertainty , when in some cases, a previously normal child patient lost skills , speech and communication .These puzzling symptoms often led to investigations into "glue ear", hearing tests and grommet insertion, before autism was eventually diagnosed after exhausting alternatives, two or three years later. Boys outnumber girls 4:1 and often have immune dysregulation. An autoimmune component, triggered by environmental factors, in those with perhaps a genetic susceptibility and a family history of autoimmune disease, merits urgent publicly funded investigation.However the only treatment and clinical studies of these children so far undertaken, rely on private funding alone,and have been boorishly dismissed as bad science and refused government grants, due to the negative polarisation of political, vaccination and economic issues. Against this background, one thing is for sure, doctors will become more expert in diagnosing autism as numbers continue to increase without government support and funding for clinical investigation and treatment. Competing interests: None declared |
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Lisa C Blakemore-Brown, Independent Chartered Psychologist UK
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Increasing numbers of parents do not run around looking for intensive, highly expensive exhausting home based treatments or special school accomodations if their children do have have very considerable problems. School staff do not leave in droves just because a perception has shifted. Both of these groups have different reasons for wanting the same thing. They both want to be able to reach the child. Staff who say they will be leaving teaching include the increasing difficult behaviours of the children as one of the major reasons. Reception staff just last week reported on the increasing numbers of children arriving at school with communication problems. The controversy and association with DPT, Mercury and MMR has grown since it became obvious first to parents, then to teachers, that vast numbers of children are no longer reachable and this has reached public consciousness in relation to vaccines because vast numbers of parents have seen a change in their children following their triple vaccine. Not little changes, not little things that can be made into big things by a shift in perception - but major change to their child's communicative development and often to their behaviour and to their health. Parents and teachers are responding to the extreme behaviours of the children in front of them - to the problems stariung them in the face and demanding vastly different ways of relating to and educating. If the children do not present with increasing autistic problems, attentional deficits, bowel problems, asthma etc, following triple vaccines, and the Government statistics tell them that there is no increase in such conditions - why on earth would these groups rush to the media to make it up? Parents and teachers want `normal` children, academically and socially. Parents of today are better educated and better informed about education, health and child development than ever before.The last thing the vast majority of parents and teachers would want to do is create a storm in a teacup if their children were all OK. Competing interests: None declared |
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Antony M Bellows, IT Manager, Rosscot Group St Helier, Jersey, C.I., JE2 4LU
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The basic fact, which is beyond dispute, is that there has been a massive increase in the number of cases diagnosed as autistic. However, the reasons for that are varied, and alternatives to an "epidemic" have been suggested. Firstly, it is suggested that the increase in figures must be normalised against the increase in population growth, particularly in California, which is where the most notable published data has emerged. Yet if population growth is the major determinant, then it should also reveal a similar and remarkable increase in other developmental handicapping conditions, which would be as newsworthy. The proponents of this argument have failed to produce evidence of this, and have produced no statistics correlating autism well with population growth, which surely would strengthen their case beyond all doubt. Secondly, it is suggested that the increase in figures are due to a widening of the diagnostic criteria. While it is certain that the diagnostic criteria have widened considerably since Kanner's orginal work, they would appear to have become relatively stable and consistent during during the last ten years. However, the secondary implication of this argument must be that there is as large a percentage of the population beyond school age since the 1990 (as a baseline) who exhibit the same range of features in the same proportion. Proper experimental procedure would suggest that age ranked surveys of the adult population be carried out to determine if the same proportion of the population show autistic spectrum disorders, and in roughly the same proportions (mild to severe). as the junior population; if the condition changes with age, and becomes less severe, one would simply expect the same distribution patterns for different age groups, but either shifted or skewed in a regular (and mathematically consistent) manner. Also, where are the children undiagnosed earlier, and how did they cope without invention? It is possible that adults with aspergers have developed varied strategies for coping, and their condition may have lessened as these strategie became more automatic, and that such adults were diagnosed differently, but an aged ranked survey would using today's diagnostic instruments would help to clarify this. But it is also probably, that without suitable support mechanisms, that a significant proportion of these children, if classified under the ESN category in use then, would have ended in Special Needs Schools, or special Hospital units, like those with other handicapping conditions, or of milder, dropped out of the school system, and to as large a degree (adjusting for population increase) as those currently identified in the present "epidemic". It is remarkable that if a comparable large population of children exhibiting a similar cluster of symptoms existed that no one noticed it. Lastly, not enough attention has been given to peer group dynamics and identification, acceptance or rejection of the unusual child. Do children notice the "oddity" of their peers on the autistic continuum? Studies of peer group dyamics regarding children diagnosed with ADHD have shown that their peers easily mark them out as different (Landau and Milich 1988), often, although not always, with a degree of rejection. Clearly any survey would have to be stratified and random, and would be dependend upon the vagaries of memory, but if the same identification applies to children on the autistic spectrum, one would expect, as a rule of thumb, for it to apply to adults recalling any "odd" peers in their school days. However, the small scale surveys I have carried out on a percentage basis, while by no means representative enough, do nonetheless call into question the idea that the same proportion of children were on the continuum. I would feel happier with this report by Scott Gottlieb if children and adults had actually been assessed, rather than basically reviewing old data and diagnostic notes. Competing interests: child with autism |
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Raymond W. Gallup, Accountant and Founder of the Autism Autoimmunity Project 45 Iroquois Avenue, Lake Hiawatha, NJ 07034, USA
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Dear Sir: Our organization, The Autism Autoimmunity Project is currently tracking the US Department of Education figures on autism since they first started them in 1991/1992. They used the same criterion since then to the present in recording autistic school children from ages 6-21 and the increase nationwide has skyrocketed. These figures can be looked at on our web site under Research at http://www.autismautoimmunityproject.org/. In the July 8, 2000 edition of The Lancet, I wrote a letter that was published in the Correspondence section under "The MMR Question". I mentioned some of the figures both in the US and in the UK. The Centers for Disease Control (CDC) had a chance to check the immune blood panels of the children they examined in the Brick, NJ study but didn't. I made note of that in my letter. Our son has gastrointestinal problems as well as tested for elevated measles antibody titers by two immunologists. Also he tested positive for myelin basic protein antibodies. He was normal at birth and then regressed into autism. No one seems to want to replicate this clinical science because of the controversy regarding the MMR vaccine and autism. This science should be looked into. Recently, the National Institutes of Child Development and Health (NICHD) funded a porn arousal study at Northwestern University for the amount of $147,000.00. The NICHD won't fund any independent research linking the MMR vaccine to autism but consider porn arousal studies to be science. They spend millions of dollars to look for an elusive gene in autism but nothing on clinical research regarding the immune and gastrointestinal dysfunctions involving children with autism. To date our organization has funded independent research in the amount of $120,000.00 for such researchers as Dr. Andrew Wakefield, Dr. Vijendra Singh and Dr. James Oleske. More needs to be done. Raymond Gallup, Founder
Competing interests: None declared |
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Trevor G Marshall, Research Director SarcInfo, 3423 Hill Canyon Ave, Thousand Oaks, CA 91360, Frances E. Marshall
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I was fascinated to see Richard Miles' mention of immune disorders as being possibly associated with Autism. We have focused our research on the most serious of those disorders, Sarcoidosis, which is now known to have both an hereditary component and an infectious component. We are noticing that the children of Sarcoidosis patients seem to be diagnosed with ADHD or ASD at a relatively high rate. Since we know there is a genetic component leading to the sarcoid immune hyper-sensitivity, we, too, have wondered whether these diagnoses of their children might indicate an association with some form of hypersensitivity immune reaction. Let me suggest an alternative hypothesis to the MMR-Mercury theory. What if there had been something added to U.S. kids' diets in the last 20 years — something that hypersensitized the immune system — allowing the MMR vaccines to cause a chronic immune reaction, one which leads to the ongoing cognitive and behavioral problems... We use a simple test to detect immune hyper-activity. 8ml of serum is drawn and sent for assay of the 1,25-dihydroxyvitamin-D (1,25-D) and 25-hydroxyvitamin-D (25-D) levels at any of the U.S. labs (e.g.). We then calculate the D-Ratio as outlined in reference 1. A D-Ratio above 1.3 (the normal mean) indicates extra-renal production of 1,25-D, typical of a hyper-activated immune system. We have described the inflammatory biochemistry by which 1,25-D (a secosteroid hormone) hyper-activates the immune system. We can't get the darn thing published ("too specialized") but you can find a simplified outline on Clinmed. 1,25-D acts directly on the brain and a number of other organs, including the thyroid and parathyroid. It stimulates the differentiation of Monocytes and Macrophages within the inflamed tissue. Its effects on the brain are profound, ranging from irritability, hyperactivity and loss of memory to alternating loss and enhancement of cognitive ability. Vitamin D has been extensively added to the U.S. food chain in the last 30 years, and the body synthesizes both 25-D and 1,25-D from it. Sarcoidosis patients are told to avoid it. But here in the U.S.A., avoidance has become a very difficult task. It is added to milk, milk products, breakfast cereal, health bars, diet foods, root beer, and even orange juice (e.g.). It is a component of most multi-vitamin preparations. Now I am not suggesting that all ASD kids have a predisposition to sarcoidosis. But maybe they have a lesser immune anomaly, one which is being activated by the excess dietary Vitamin D to cause a vigorous immune reaction upon vaccination. One that, like sarcoidosis, can be sustained by a combination of the injected viral material and excessive levels of the D metabolites. Except for our own data2, there is virtually no information on the level of 1,25-D, and whether it has changed subsequent to the increased supplementation of our diet during the last few decades. Does anyone have any data on this hormone in Autism? We would urge the use of this assay whenever one is trying to diagnose a patient of any age, and we would be happy to help with any data interpretation issues. References: 
Competing interests: None declared |
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