On Things That Won't "Cure" Autism

One of the tendencies of the assorted parents' groups which I find most annoying is the tendency for many of them to promote an attitude of desperation towards autism -- and, with it, the idea that a parent should try anything and everything which could help their child "recover". In practicality, of course, this means anything or everything that someone somewhere claims will help.

The fact that people get swindled as a result is among the least appalling aspects of this.

The list of things which have been promoted as such -- and which parents have tried -- is absurdly long and often just plain absurd. Seriously, it almost mocks itself at times. If it wasn't for the fact that parents are actually doing these things to their kids (which I cannot emphasize enough) out of desperation to "cure" or "recover" their children, it would actually be comedic.

Among other things, the horrific list of things which parents have done includes (but is by no means limited to):

•  Feeding their kids massive overdoses of vitamins to the point that they suffer from or risk vitamin poisoning.
• Putting their kids into a potentially explosive tube full of compressed air for a prolonged period of time (usually around an hour per session).
• Getting their kids high on marijuana.
• Forgoing protection against potentially deadly diseases.
• Strapping their kids down for several hours while they pump an irritant into said child's veins.
• Deliberately infesting their children with intestinal parasites.
• Chemically castrating their children.
• Feeding their kids an industrial chemical which has never been subjected to proper safety testing.
• Making their children drink an industrial bleaching agent.
• Giving their children bleach enemas.

 
 This is a highly incomplete list.

When I say that the stigmatization and panic-mongering that organizations like Autism Speaks engage in has real consequences for autistic people... the above is just one of the things I'm talking about.

Take this as you will.

Edit: Was corrected on a relatively minor point.

"Words to the Wise"

As I write this, I am sitting in a computer lab with a copy of Thomas Szasz's "Words to the Wise". It's an utterly fascinating collection of quotes and sound-bites on a wide-ranging collection of topics by one of the most controversial authors in the field of clinical psychology. Some of the quotes I agree with; others I don't. All, however, are thoughts worth considering. Despite the format, it's one of the most thought-provoking books I've seen in a long time.

Ten of the quotes more relevant to today's autism issues:

If a person ingests a drug prohibited by legislators and claims that it makes him feel better, that proves that he's an addict.

If he ingests a drug prescribed by psychiatrists and claims that it makes him feel better, that proves that mental illness is a biomedical disease.

When and why do we say that a behavior is caused rather than willed?

We say that chemicals in the brain cause depression and suicide; but we don't say that chemicals in the ovaries or testicles cause lust and marriage.

The child cannot match the adult in most accomplishments. Hence, we reward him for effort as well as achievement. Yet, the child must learn that what counts in life is not effort but achievement. The child over-rewarded for effort may grow up to seek approval for trying instead of for succeeding. This dooms him to failure. If he succeeds, he succeeds only at trying hard. If he fails, he fails miserably.

When a woman finds having a fetus in her body annoying, she can abort it by taking an abortifacient drug or having a surgical abortion.

When a woman finds having a child in her home annoying, she can abort his persona by having a child psychiatrist give him a chemical straitjacket.

Diagnoses are not diseases.
Diagnoses are names, human fabrications.
Diseases are phenomena, facts of nature.

Demonstrable bodily lesion is the gold standard of medical diagnosis. Without practical convertability into gold, the value of paper money rests only on faith. Without conceptual convertability into bodily lesion, the diagnosis of disease rests only on faith.

A patient with cancer says: "If I had refused my surgeon's suggestion that I have my tumor removed, the cancer would have killed me."
A patient with depression says: "If my psychiatrist had let me refuse the electroshock treatment he recommended, I would have killed myself."
The difference between these two sentences sums up the difference between bodily illness and mental illness.

Three principal rules of conduct:

1. The Golden Rule: Do onto others as you want them to do unto you.

2. The Rule of Respect: Do unto others as they want you to do unto them.

3. The Rule of Paternalism: Do unto others as you in your superior wisdom know ought to be done unto them in their own best interests.

Formerly, debasing the Other by calling him a "nigger" was considered politically correct: the speaker was viewed as a protector of the race or nation from those bent on defiling it.
Today, debasing the Other by calling him "sick" is considered politically correct: the speaker is viewed as a protector of the debased person's best mental health interests and of the nation from a danger to the public health.
Replacing the former rhetoric by the latter is considered moral progress.

Today, everyone claims to be working for the patient's best interests. No wonder the patient is in deep trouble.

Note that I selected these quotes based on relevance, not agreement. I don't, as a matter of fact, agree with a lot of Szasz's thinking. This said, he's an incredibly thought-provoking author. In this blog post, I'm not going to take a stance on any of these. Instead, I'm going to give an "assignment" of sorts to each of my readers.

Read these quotes. Think about them. What does each of them mean? What do they imply? Is this statement -- or implication -- accurate? Is Szasz right or wrong? Why?

Then post an explanation here, answering at least one of these questions for at least one of these quotes. Feel free to do so anonymously or pseudonymously. I don't care about that (although I will delete SPAM posts or personal attacks). If you aren't the first to reply to this, also reply to at least one of the previous replies.

My own replies here will be mostly playing "devil's advocate", issuing responses also intended to make people think and facilitating discussion. Unless I state specifically that a position is my own personal belief, please don't think that it is. I will likely issue arguments against your position even if I agree with it.

The point, after all, is to get people thinking about this sort of thing.

In addition to the obvious, this exercise should give you a pretty good idea of why I highly reccommend this book. It has nothing to do with agreement (although I strongly agree with both the contents and sentiments of many of the quotes, this cannot be said about many others). It has everything to do with the way the book makes you think.

Oh, and it's a treasure mine for anyone who wants quotes for articles, the beginnings of book chapters, and the like. Lots of grade-A quotes here... which is the entire point of the book.

Edit: Added a link.

A Few Things You Probably Didn't Know About Hyperbaric Oxygen Therapy

As with megavitamin "therapy", hyperbaric oxygen as a "treatment" for autism can be accurately classed as too much of a good thing.

In medicine, too much of a good thing can be a very bad thing, and the research reflects this. Essential nutrients can easily become poisons if you consume too much of them, and many of today's common medical problems can be laid at the feet of too much consumption of essential macronutrients... and macronutrients are generally far better tolerated than the micronutrients which are used to excess in "megavitamin therapy".

In fact, hyperbaric oxygen chambers allow for a greater exposure to oxygen than would normally be theoretically possible. Put into more technical language, a hyperbaric chamber allows for partial pressures of oxygen within the lung that wouldn't be possible without active pressurization.

While this isn't the only mechanism of action for HBOT (for instance, the increased overall pressure has therapeutic value when treating decompression sickness), it's the main one, and the one which most of the various explanations of HBOT as an autism treatment hinge upon. Specifically, increased partial pressure is increased effective in-lung exposure to oxygen, and this is supposed to increase oxygen content in the bloodstream, increase oxygen flow to the brain, etc., etc.

Oxygen qualifies as a drug when used this way. As with vitamins, it's quite possible to overdose on it. This is known by a variety of names, but the most common of these are "oxygen toxicity" (for the phenomenon) and "oxygen poisoning" (for the medical condition).

Frankly, oxygen poisoning can be nasty. At lower levels, oxygen is a very good thing. At higher levels... it isn't. In fact, oxygen has neurotoxic properties at high enough doses, and these doses are acheivable even without a hyperbaric chamber.

So, if that's the case, why is it that that we don't see autistic children vomitting, suffering from tunnel vision and shortness of breath, convulsing, twitching, and generally showing the symptoms of oxygen poisoning after HBOT? The answer is actually rather simple -- and says a lot about the people peddling HBOT for autism.

The partial pressure of a gas within a mixture is equal to the percentage of the mix formed of that gas times the total pressure of the gas. So, for instance, the partial pressure of oxygen in a gas mixture which contains 20% oxygen and is held at 1 bar (normal atmospheric pressure) is .2 bar. Doubling either the percentage of gas or the overall pressure of the mix will also double the partial pressure of oxygen, yielding a partial pressure of .4 bar.

It's worth noting that a partial pressure of up to about one bar (depending on altitude, weather patterns, and just about anything else that effects atmospheric pressure) is achievable without pressurization -- 1 bar is the partial pressure of oxygen in a pure oxygen "mix" at normal atmospheric pressure. Keep that in mind as I continue.

A recent paper, using fairly typical practice for HBOT treatment for autism, used a 24% oxygen mix at 1.3 bar of pressure. Doing the math, this yields a partial pressure of about .31 bar... or roughly equivalent to what could be acheived by using a 31% oxygen mix without the hyperbaric chamber. It's actually pretty trivial to go to a SCUBA supply shop and buy a tank full of a mix that's richer in oxygen than that.

Of course, typical air is roughly 21% oxygen, meaning that the gas they used was only trivially different from room air in terms of oxygen content; the increase in partial pressure was almost entirely achieved by a raise in pressure.

While this sort of level is typical in practice, however, it's worth noting that I've seen documentation of much more "intense" regimens, ranging up to 100% oxygen at 1.5 bar. Caveat emptor -- and beware oxygen poisoning.

Finally, I suppose I should also mention that there's a second theorized action mechanism, involving gas transport via blood plasma (as opposed to the hemogloboin-based transport of red blood cells), which is increased substantially under hyperbaric conditions. This mechanism is equally implausible for reasons which are much harder to explain, but I should probably mention it in the interest of fairness.

Still -- 1.3 bar isn't enough pressure to make much of a difference there, either.

A Little Gem

I came across the following quote while reading Snodgrass, 1992 as part of my research into quackery:

Methylation of mercury compounds increases their ability to enter the CNS and
also prolongs their stay in the body. Since mercuric ions can be biomethylated
by cobalamins, persons taking large doses of folate and B12 may be more likely
to be harmed by mercury should they contact it. (p. 51-52)

The irony here is pretty spectacular.

Reference:

Snodgrass, S. R. (1992). Vitamin neurotoxicity. Molecular Neurobiology, 6, 41-73.

Megavitamin Stupidity, Part Two

As I observed in a previous post, people tend to think of the effects of having not enough of a vitamin, but tend to ignore the effects of having too much. As such, I've compiled a list of some of the known effects of the latter. This is not intended to be a comprehensive list or anything -- just a simple list of some of the health hazards of having too much of a vitamin in your system. It's not even a full list of the effects of every vitamin, just the few that were easiest to find data on. As I note below, my research methods for this were not anything special.

It's also worth noting that there are differences between chronic and acute vitamin toxicity. Acute toxicity generally requires a higher dose of the vitamin in question, while chronic effects occur from a lower dose over a longer period of time. Both can present substantial health risks.

Finally, parenteral administration is generally more dangerous than oral. There are a number of safeguards that normally prevent the body from absorbing a massive overdose of certain vitamins that don't necessarily apply to "vitamin shots" (thiamine comes to mind here).

My research strategy was hardly anything to write home about -- I went down to NSU's medical library and checked out a textbook. This isn't information that's hard to come by... unless you're trying to get it from the various fad "health gurus", from DAN doctors, or from other, similar sources.

So, without further ado...

• An overabundance of vitamin A is associated with hair loss, ataxia, bone and muscle pain, cheilitis, conjunctivitis, headache, liver damage, hyperlipemia, hyperostosis, membrane dryness, itching, pseudotumor cerebri, various skin disorders, and visual impairment. Vitamin A also acts as a teratogen, but this usually isn't relevant to the use of DAN-reccommended megavitamin supplements (i.e. I've never heard of a DAN protocol being used to treat a pregnant woman).
• Vitamin D poisoning can result in hypercalcemia, hypercalciuria, anorexia, nausea, vomitting, thirst, polyuria, muscular weakness, joint pains, diffuse demineralization of bones, disorientation, and irreversable calcification of the heart, lungs, kidneys, and other soft tissues. The vast majority of the death-by-vitamin-overdose case reports I've read (which may or may not be a representative sample) have been due to hypervitaminosis D.
• Vitamin B3 overdose effects depend on the specific form of the vitamin involved. Nicotinic acid toxicity is associated with vasodilation, burning or stinging sensations in the face and hands, nausea, vomiting, diarrhea, hyperpigmentation of the skin, abnormal glucose tolerance, hyperuricemia, peptic ulcers, hepatomegaly, and jaundice. Nicotinamide overdose has been known to cause liver damage and may cause cancer (further research was required according to the textbook I read, which was published in 2001. I have not conducted a search for more recent information).
• Chronic overdose of Vitamin B6 has been associated with neuropathy (motor, sensory, and peripheral), vesicular dermatosis, loss of reflexes, impaired touch sensation in limbs, dizziness, nausea, breast discomfort or tenderness, and photosensitivity.

This is nowhere near a complete list, even from within the sole book which served as my reference. Think on that.

Reference:

Rucker, R., Suttie, J., McCormick, D., & Machlin, L. (Eds.). (2001). Handbook of Vitamins (3rd Ed., Revised and Expanded). New York, NY: Marcel Dekker, Inc.

Megavitamin Stupidity, Part One

The principle of homeostasis is one of the most basic in medicine. My experience with parents of autistic children has been that they don't understand this.

Oh, don't get me wrong -- it's not their fault. It's hardly reasonable to expect every parent of an autistic child to have an understanding of it.

To expect at least most them to have heard about it, yes -- it's covered in most high-school biology courses (or it's supposed to be). Understanding, however... let's just say that American high schools often fail in their goal of promoting understanding of the subjects they're supposed to teach.

In essence, however, the principle states that organisms exist in a state of balance, maintained by a series of feedback mechanisms. Too little of something important can be bad -- but so can too much of the same thing. While the relationship between insulin and blood sugar is perhaps the most common example of this referenced in a purely medical context in popular culture (mostly because of the conditions of hyperinsulinemic hypoglycemia and diabetes, each of which is defined by the a type of breakdown of this balance), there are countless others.

So -- why is this important for understanding the problems with megavitamins?

Well, the principle of homeostasis accounts for why the same thing can have radically different effects depending on how much of it is involved... or, for that matter, why extremely low amounts of it and extremely high levels of it can have the same or similar effects.

It's all about the dosing... which is where the problem comes in.

Vitamins, like all other chemicals (and yes, vitamins are chemicals -- get over it), are subject to this. Simply put, it's quite possible to overdose on them.

I have heard -- anecdotally -- mentions of a child overdosing on Vitamin C from drinking too much orange juice... but most of the stories I hear of involve supplementation.

No, not megavitamin supplementation, either. I'm talking about regular, normal, over-the-counter dietary supplements. There's a very good reason why modern multivitamins are really, really careful about their iron content, for instance (although that's technically a mineral, not a vitamin).

Vitamins are one of the classic cases of "a little medical knowledge is worse than none" -- and, as I write this, I'm visualizing an exchange:


"But it's good for you!"


"Yeah, well, it's good for you to have enough... too much and it becomes a poison. Homeostasis and all."


Anyway, the point of all of this (beyond general medical education) is pretty simple -- as with all drugs, it's quite possible to overdose on vitamins.


And yes, vitamins, when taken as suplements (at least -- their status as such when consumed in food is more debatable), are drugs.

There's even a medical term for this -- it's called "hypervitaminosis".

So, in short -- people always tell you about the health benefits of vitamins. They don't tell you about the hazards thereof. Going overboard is stupid and can risk serious health problems.

QED.

Next time, I'll detail exactly what happens with overdoses of certain vitamins. I think my readers will be unpleasantly surprised.

Huffington, woo!

After viewing the latest bit of quack-promoting stupidity at the Huffington post, I felt compelled to comment for some reason. I'm not quite sure why -- it's harder to take the author's ramblings seriously as an argument for her favored cause than it is to take Treevenge seriously an argument for abolishing Christmas.

Or, in other words, her rant is a pure appeal to emotion and a blatant pity ploy. I'm feeling particularly unsympathetic to those at the moment.

I wish parents would stop the "oh woe is me, I have an autistic child! Look at how I'm suffering!" ploys -- not only does this help perpetuate the environment of desperation that's feeding scum like the Geiers and Eisenstein, but is also actively encouraging harmful parental attitudes in ways that others have expressed far better than I can.

The fact that those selfsame autistic kids that they're complaining about are generally less than sympathetic to their whining is quite unsurprising. This stupidity regularly kills people like us.

One particularly nasty piece of her little rant, however, deserves specific attention:

One of the flimsy claims the insurance lobby makes for excluding autism is that its treatments are not proven. However, there are now hundreds of children who have recovered through IVIG, diet and chelation therapy. Further, there are thousands of cancer patients who die each year despite having received costly "medically proven" chemical treatments. The difference? There are ten thousand times more children with autism than cancer, and ten of thousands more coming down the pike each year who the insurance lobby don't want to treat. This is a tidal wave epidemic that government and society can longer ignore. As a champion in autism Rick Rollens often says: "Autism is the fire at the door."

Rick Rollens? A "champion in autism"? We're talking about the same piece of scum, right? Okay, so at least a few of his actions have shown some level of common sense, but that hardly excuses his actions over the years. We're talking about a piece of work who's referred to the existence of some of the people who I respect most in the world, the existence of people who I consider friends, and the existence of people like me as "this plague of a disease". We're talking about a guy who was instrumental in founding an organization dedicated to convincing our parents to torture us.

And that's hardly the most outrageous or offensive item in that paragraph. The blatant use of the whole autism/cancer thing is so unspeakably offensive as to be damn near unprintable. These are the idiots who call us insensitive?

I'm not even going to dignify her so-called "argument" using that analogy with a response. It's just too damn stupid.

I will, however, address the following:

One of the flimsy claims the insurance lobby makes for excluding autism is that
its treatments are not proven.

Actually, there is one proven "autism treatment", one thing which is consistantly related to better outcomes in every study I've read (that looks for it, anyway). The available evidence even suggests quite strongly that it's a causal relationship.

No, it's not chelation (of which the most complementary thing I can say is that it's less nasty than some of the other quackery out there). It's not megavitamins. It's not the mystic healing power of horses.

It's good, old-fashioned education... and no, I don't mean "special" education. Somehow, I don't see parents complaining that insurance doesn't cover it.

I do, however, see them ripping their hair out over the frustrations involved with IEP meetings. Given the level of psychosocial stigma that morons like this woman are perpetuating, every parent trying to get decent services for his or her child should be cursing her name.

And for the insurance companies not paying for quackery... seriously, lady. Could you imagine if emergency rooms were run that way? They only pay for evidence-based medicine for a reason!

Hubris Syndrome: The Newest Psychiatric Disorder?

Although it may seem like it at times, not everything I read is about autism. Not all of it is about ABA, either.

Among other things, I at least try to keep up with what the psychiatrists are up to, no matter how crazy I may think they are.

And yes, I think the psychiatric establishment needs its own services. A recent paper published in the prestegious neurology journal Brain helps illustrate why. Coauthored by an American psychiatrist and a member of the UK House of Lords, it sets out to identify and provide case studies of a "new" mental disorder for potential inclusion in the DSM-V and the ICD-10.

The paper's title? "Hubris syndrome: An acquired personality disorder? A study of US Presidents and UK Prime Ministers over the last 100 years."

To quote the paper: "But the matter can be formulated differently so that it becomes appropriate to think of hubris in medical terms."

... yeah.

The proposed criteria for hubris syndrome included seeing the world as a place to "excercise power and seek glory", a predisposition to act to enhance their image. (And a concern/obsession with said image), use of messianic hyperbole, regarding themselves as their country/nation, using the royal "we", excessive confidence in their own judgement, extreme self-confidence... and a number of others.

The paper then went on to "diagnose" George W. Bush, David Lloyd George, Neville Chamberlain, Margaret Thatcher, and Tony Blair.

It also notes that Ritalin looks promising as a treatment.

And these are the people who classify autism as a disorder. Somehow, I'm not surprised that we made the DSM.

Autism and violence? Or is that drugs?

As I spent a while this morning, I came across this article. I find it rather difficult to express the sheer horror I felt as I read it.

The story is an account written by the mother of an autistic child, a Ms. Ann Bauer. Beyond pointing to some earlier commentary by her, I won't try to analyze the causes of her son's violent behavior. I lack enough details to form proper conclusions.

I will, however, point to the conclusions that Ms. Bauer herself reached and challenge the validity of her conclusions. I will also point out that she is hardly the first person to reach this sort of conclusion.

Psychoactive drugs, as a class, are dangerous. Abilify, the first medication that she mentions, has been known to induce diabetes and cause strokes, among an extensive list of other, frequently nasty, side effects. Compared to most antipsychotics, that's actually fairly prosaic. When I did a brief clinical practicum at a gateway program to a South Carolina mental hospital, I saw a level of drug-induced brain damage (usually in the form of tardive dyskinesia) that would have stunned most people.

What's more, her son's rage, violence, etc. appears to be highly ego-dystonic. As has been repeatedly observed, autism is anything but.

Ms. Bauer has my most sincere sympathies for what happened to her and her son. I do not, however, believe that it is appropriate for her to blame autism for it. But, then again, emotions are rarely the language of reason. I cannot blame Ms. Bauer for lashing out, even in writing. I just wish she'd chosen a different target.