FDA actions & autism

When my article, “Questions about Prenatal Ultrasound and the Alarming Increase in Autism,” http://www.midwiferytoday.com/articles/ultrasoundrodgers.asp was published in Midwifery Today in 2006, I hoped it would inspire research into whether this ever-more-popular form of diagnostic imaging were responsible for the boom in autism prevalence. Sadly, little has been done to investigate this possibility.

At the time, the U.S. autism prevalence was 1 in 160 — a number I expected would change quickly. It did. Within months the prevalence changed to 1 in 150, then a few years later to 1 in 110 and, most recently, stands at 1 in 88 — seemingly on its way to catching up to the world record holder, South Korea, which reported a 1 in 38 autism prevalence.

Countless studies have been published throughout these years of surging autism numbers, most of which could be interpreted to support the idea that prenatal ultrasound plays a role in causing this neurodevelopmental disorder and have been covered in this blog. A twin study surprised many when it established that genetics were not as important as environment in causing autism. https://carolinerodgers.wordpress.com/2011/08/18/why-genetics-cant-be-the-only-or-even-main-factor-in-sibling-autism-risk/ A California study identified autism clusters and found that highly educated women were much more likely to have children with autism than their less-educated neighbors. https://carolinerodgers.wordpress.com/2009/12/31/moms-to-be-drop-out-of-school-to-avoid-having-autistic-children/ A study of the 78% increase in autism documented between 2002 and 2008 loosely parellels an 80% increase in the number of ultrasound scans women had during these pregnancies. https://carolinerodgers.wordpress.com/2012/04/02/parallels-between-autism-prenatal-ultrasound-increases/ Most recently, a study found an association between obesity and autism — yet although obesity is a problem in the United States, where 1/3 of women are obese, this does not explain South Korea’s prevalence, where fewer than 4% of the population is obese.  http://carolinerodgers.wordpress.com/2012/04/09/maternal-obesity-autism-ultrasound-probe-may-be-a-factor/, while South Korea markets itself as Asia’s go-to place for high-tech medicine and would naturally use that form of ultrasound with all pregnancies, as it yields much clearer images.

If prenatal ultrasound is causing autism, eventually the truth will be impossible to hide — yet that never stopped anyone from trying. Recent actions and news releases by the FDA are very interesting. Today U.S. Marshalls, acting upon information from the FDA,  seized a batch of contaminated ultrasound gel: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm299409.htm

This focuses attention on a topical gel spread instead of the more serious possible threat caused by ultrasound’s acoustic energy exposing developing fetal tissue to heat increases.

Just a month ago, the FDA warned about a range of skin products including lotions, creams and soaps that contain mercury — which should be enough to excite those who still believe that mercury in vaccine preservatives cause autism.

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm294849.htm

While FDA notices and recalls are important public health actions and to be commended, consumers should not lose sight of the bigger picture when considering what might be causing autism.

Of Alzheimer’s, the scientific method & educated guesses

I attended the Advisory Council on Alzheimer’s Research, Care, and Services meeting in Washington on April 17th – a historic occasion, as the first Draft National Plan to Address Alzheimer’s Disease (1) was approved for presentation to Health and Human Services (HHS) Secretary Sebelius. At the end of the day, members of the public were given an opportunity to speak. What follows are my remarks:

My name is Caroline Rodgers. Some of you may recall that in January, I presented my hypothesis that Alzheimer’s disease is caused by dental X-rays shortening the lifespan of the brain cells that keep sustain neurons, fatally stranding them (2). The article it was based on was reviewed by scientists specializing in Alzheimer’s, neurology or radiology during manuscript development and in the course of peer review before it was published in Medical Hypotheses last July (3).

But that’s not what I am here to talk about.

I am here to talk about the scientific method versus expediting answers. Thomas Edison was a great one for applying scientific method. He exemplified how persistence can conquer multiple failures when he had his lab test 10,000 different filament substances before finding tungsten. That was a great feat, but he was only looking for a way to light up the world that was already aglow with candles.

Alzheimer’s is different. Darkness is descending on the minds of the elderly and the not-so-elderly with savage rapidity. Every day we fail to discover what is causing Alzheimer’s and how to treat it, countless more individuals are doomed to losing their minds and ultimately, their lives in a manner that does not go gently into the night. We don’t have the time to test 10,000 possibilities – we need to ask new questions and to make educated guesses that will vault us into new territory.

Clinical trials are the “gold standard” of evidence-based medicine. But when a treatment does not pass a clinical trial, it is not gold, it is lead. Recently one scientist involved with clinical trials of Alzheimer’s drugs said that some 100 treatments were in the works, most of which targeted brain plaques. Since more than one clinical trial of a plaques-clearing treatment has been halted for doing more harm than good, it is time to consider that clearing plaques is not the answer and no alchemy can turn it into gold.

Meanwhile, we can’t afford the time and money to be as systematic as Edison – we need educated guesses that, like leaps of faith, close the gap quickly. The answer is probably a simple one; the very speed with which Alzheimer’s has become a killer argues against a complex etiology, since the more factors required for an outcome, the more difficult it is to meet all of the conditions necessary to cause it. Plus, simple answers are easily overlooked, which is why it took nearly 300 years for scientists to discover that rickets was caused by a lack of sunshine.

Are dental X-rays causing Alzheimer’s? I can’t answer that question because my hypothesis has yet to be tested. But I’m told it would take only about $20,000 to launch a pilot study that could bring us closer to the truth. We need to investigate this and other out-of-the-box ideas. While the Research Subcommittee’s draft recommendations call for timelines, strict metrics and cooperation among what it terms “industry players,” we need to go beyond these business models and find ways to attract and fund fresh avenues of Alzheimer’s research. Scientific method is important, if it is not used to  explore creative educated guesses it may be a long time before we strike gold.

Thank you.

(1)   http://aspe.hhs.gov/daltcp/napa/#Apr2012Mtg

(2)   http://aspe.hhs.gov/daltcp/napa/Comments/2012PubCom.shtml#PC63

(3) http://www.medical-hypotheses.com/article/S0306-9877(11)00118-6/abstract

More thoughts on obesity & autism

My previous two posts covered this issue, yet one more point begs for attention. If obesity in mothers increased the risk of having a child with autism, our autism demographics would look very different than they are today. Black, non-Hispanic women have the highest obesity rate yet only the second highest risk of having a child diagnosed with autism. On the other hand, White, non-Hispanic women, with the lowest obesity rate, have the greatest risk of bearing a child with autism. Hispanic women, who fall between the other two ethnic groups in terms of obesity, historically have the lowest risk of bearing a child with autism. Here are the most recent CDC figures on obesity by ethnic group, vs. autism by ethnic group*:

  • Obese non-Hispanic black women, 39.2%
  • Non-Hispanic black children with autism, 10.2 per 1,000
  • Obese Hispanic women, 29.4%
  • Hispanic children with autism, 7.9 per 1,000
  • Obese White, non-Hispanic women, 21.8%
  • White, non-Hispanic children with autism, 12.0 per 1,000

Clearly, something besides obesity is at work, although the apparent association reported by the recently -published MIND Institute study is valuable information and will help discover what is causing autism.

* Ethnic designations are derived from CDC data.

Sources:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5827a2.htm

http://www.cdc.gov/mmwr/pdf/ss/ss6103.pdf

Obese moms & autism: The short version

My previous post today, Maternal obesity & autism: ultrasound probe may be a factor provides a detailed response to a new study that found an association between obese mothers and children with autism or other developmental delays. While biochemical issues such as insulin resistance and glucose tolerance can be debated at some length, the evidence that something other than body fat is at work is clear:

  • South Korea autism prevalence: 1 in 38
  • South Korea obesity rate: less than 4%
  • United States autism prevalence: 1 in 88
  • United States obesity rate: about one-third

To check out obesity rates by country, visit:

http://www.nationmaster.com/graph/hea_obe-health-obesity

Maternal obesity & autism: ultrasound probe may be a factor

A new study from the MIND Institute published in Pediatrics today found that obese moms were 67% more likely to bear children with autism or other developmental delays — which is very interesting, in the light of two recent CDC reports showing an increase in developmental disabilities(1) and a 1 in 88 autism prevalence(2). The authors noted that one-third of all mothers are obese women and that these women are more prone to conditions such as insulin resistance, chronic inflammation, elevated maternal glucose levels, depleted oxygen supplies and fetal iron deficiencies, which could affect fetal development.

However, it is worth noting that obstetricians monitoring pregnancies of obese women often use a vaginal ultrasound (u/s) probe instead of the more traditional transabdominal transducer. The vaginal u/s probe allows doctors to view the embryo more clearly at early stages of development. In the case of obese women, the vaginal u/s probe may be the only way to view the embryo/fetus with any clarity, due to the presence of abdominal fat layers. The probe’s image is sharper for three reasons: 1) the acoustic signal is not impeded by the abdominal wall; 2) the u/s probe positions the transducer much closer to the embryo; 3) the u/s probe transducer emits more power than the transabdominal transducer. If energy from ultrasound sometimes disturbs the neuronal development of fetuses, certainly ultrasound transmitted in this manner — closer to the fetus, passing through fewer layers of tissue and at a higher energy output — would increase the risk to exposed embryos/fetuses. Considering the percentage of mothers who are obese prior to pregnancy, the number of women who are routinely exposed to this particular kind of ultrasound for routine and diagnostic scans could be considerable.

The vaginal u/s probe, like other ultrasound innovations over the last couple of decades, has moved swiftly from occasional, specifically-indicated use to standard care. When the vaginal u/s probe was first introduced, it was used in only a small percentage of cases and no earlier than the 9th or 10th week. One of the many ways the role of the vaginal probe has expanded has been to confirm pregnancy as early as five weeks. Dr. Eric Courchesne, also at the MIND Institute, noted back in 1997 that the fifth week of gestation may be a “window of vulnerability” for autism (3).

In considering why obese women have a higher risk of bearing children with autism, this major difference in ultrasound exposure should be further investigated.

1. Boyle CA, Boulet S, Schieve LA, et al. Trends in the prevalence of developmental disabilities in US children, 1997-2008. Pediatrics. 2011;127(6);1034-42. Epub 2011 May 23.

2. Centers for Disease Control and Prevention. Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2009. MMWR 2012;61(No.3)

3.) Courchesne, E. (1997) Brainstem, cerebellar and limbic neuroanatomical abnormalities in autism. Curr Opin Neurobiol 7(2):269-78.

Parallels between autism & prenatal ultrasound increases

The CDC autism prevalence figures released last week are daunting. A survey of children who were eight years old in 2008 found that 1 in 88 had autism, an increase of 78% since 2002 (1).  

Over a similar period of time, the use of prenatal ultrasound increased 80% (2). How do these numbers match up?

  • Children who were eight years old 2002 were in gestation between 1993 and 1993/1994. In the time span just two years after the gestational window in question, between 1995-1997, the average number of ultrasound scans per pregnancy was 1.5.
  • Children who were eight years old in 2008 were in gestation between 1999 and 1999/2000. There was a big increase in the average number of ultrasound scans per pregnancy between 1998-2000 and 2005-2006, which covers the gestational period in question, although the endpoint of 2.7 average scans by 2005-2006 cannot be evaluated until 2014-2015, when that group of children turns eight years old.

The official explanation for this huge jump in autism over six years is better diagnosis – but that assumes that autism is easily overlooked. Should we wait until 2014-2015 to investigate the role that prenatal ultrasound may be playing in causing autism or should we start now?


[1] Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators et al. MMWR Surveill Summ. (2012). http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6103a1.htm?s_cid=ss6103a1_e Accessed 3-29-2012.

[2} Siddique J, Lauderdale DS, et al. Trends in prenatal ultrasound use in the United States, 1995 to 2006. Med Care, 2009 Nov: 47(11):1129-35. 

Dyslexia, vision and hearing: Friend or enemy?

Today’s New York Times has an interesting opinion piece on new research regarding dyslexia (http://www.nytimes.com/2012/02/05/opinion/sunday/the-upside-of-dyslexia.html), a reading disability that affects up to 15 percent of the U.S. population. The article highlights recent findings revealing that while dyslexics have trouble reading in the center of their visual field, they have better peripheral vision than typical readers. However, such enhanced peripheral vision may be related to a separate condition common to people with dyslexia — reduced voice recognition (Perrachione TK, Del Tufo SN, Gabriell JD. Human voice recognition depends on language ability. Science. 2011;333(6042):595.).

Since people with visual impairments are known to develop enhanced hearing, it should not be surprising that people with a hearing impairment would develop an enhanced visual perception that would help compensate for the loss. It makes evolutionary sense that the decreased ability to recognize voices would be paired with better peripheral vision, as it is exactly this part of the field of vision that would provide the cues necessary to determine if an approaching person were a friend or enemy.