In waging war against disease, modern medicine augments the evolutionarily derived defenses of the human immune system and saves millions of lives. Despite this fact, medical science continues to be plagued by denalism, particularly in regards to the condition known as autism.
Through hundreds of millions of years the process of biological evolution has, through trial and error, refined the vertebrate immune system to an astonishing degree. However, despite these great successes, humans continue to be susceptible to the attacks of bacteria and viruses, as well as to assaults from blunders in our own internal physiological processes. Luckily, through the process of science, which includes clinical evaluation and peer-review, modern medicine augments the natural fortifications of the human immune system as it opposes illness. In the evolutionary arms race against disease, medicine is an essential armament and doctors are very much needed arms dealers. Unfortunately for those on the front lines, not all arms dealers are equally sound.
As a case in point, back in 2005 Diana L. Vargas and other scientists published a paper in which they described the occurrence of neuroinflammation (‘neuro’ = brain; ‘inflammation’ = irritated) in the brains of recently deceased patients who had lived with confirmed autism. The brain tissues autopsied in conjunction with the study had been provided by the Autism Tissue Program, and all samples were taken from people who had died of accidental deaths; deaths such as drowning, hyperthermia, trauma, and other non-pathogenic causes. Clinically, neuroinflammation is a symptom that is often associated with immune system disorders and its connection to autism is, for the most part, not yet understood. The potential for misinterpretation and misuse of the paper’s inflammation-to-autism link inspired the researchers to emphasize in the conclusion of the study and elsewhere that although “the role of neuroinflammation in the context of the genetic and other factors that determine the autism phenotype remains an important issue to be investigated.” The paper made clear that treating persons afflicted with autism with protocols for immune dysfunction was not recommended.
And yet since publication of this neuroinflammation paper, it has been used by ‘doctors’ as a rationale for treating children with alternative and non-standard procedures aimed at immune system disorders… Despite the lack of evidence, quacks, particularly those associated with the Defeat Autism Now network, have been promising progress to the parents of autistic children through the use of strong immunosuppressant drugs, hormone treatments, intravenous immunoglobulin, and therapies using hyperbaric oxygen chambers.
Scary stuff… It seems as though ‘snake oil’ is abundant resource when there’s money to be made. It’s a real shame that these treatments bring only slight and transient emotional relief to agonized parents. Especially when considering that such harsh treatments bring only pain and suffering to the kids on the receiving end. The victims in this case happen to be diagnosed with autism – a condition that is already widely misrepresented as being brought about by life-saving vaccinations.
Vaccinations are disease preventing medical treatments that stimulate a natural immune response through the bodily introduction of biological molecules. As a product of evolution, the immune system attacks foreign, potentially pathogenic proteins; because the agents introduced during vaccination contain a molecule that is structurally similar to the protein of a disease causing microorganism, the body’s chemistry reacts defensively. The immune system first seeks-out the foreign protein; it then records its identifying characteristics as ‘military intelligence’ for later operations before finely destroying the medically infiltrated invader. Through this process, vaccinations effectively increase the immune system’s repertoire of available defensive tactics, thus reducing the likelihood of serious besiegement when the real pathogen is encountered.
Most medical procedures – including vaccines – have a potential for adverse side effects which can range from minor aches and pains to death; BUT, when compared to the risks inherit to the disease itself there is absolutely no comparison – vaccines are the hands-down best option. Key to the effectiveness of vaccination programs is public participation; this starts with gaining confidence through the elimination of misinformation, which in the case of autism is a substantial quantity…
Although there is no valid, or for that matter even plausible, connection between autism and vaccination, or any reason to treat autism with therapies designed for immune deficiency, the spread of misinformation on these topics is rampant. The resulting distrust of medical science has contributed to numerous illness and deaths that would have otherwise been preventable. Those in the anti-vaccine movement are similar to creationists; they allow personal bias, subjective opinion and their penchant for conspiracy theories to override rationality, facts and morals. In the case of medical science this denialism comes at a tremendous price.
References:
Vargas, D., Nascimbene, C., Krishnan, C., Zimmerman, A., & Pardo, C. (2005). Neuroglial activation and neuroinflammation in the brain of patients with autism Annals of Neurology, 57 (1), 67-81 DOI: 10.1002/ana.20315
Persistent pursuits by TRINE TSOUDEROS and PATRICIA CALLAHAN Chicago Tribune
Image of human blood from Wikipedia
Vargas, D., Nascimbene, C., Krishnan, C., Zimmerman, A., & Pardo, C. (2005). Neuroglial activation and neuroinflammation in the brain of patients with autism Annals of Neurology, 57 (1), 67-81 DOI: 10.1002/ana.20315
John Humphreys
Since his graduation from Kent State University where he studied biology and geology, John Humphreys has worked in a variety of scientific fields ranging from paleontology to conservation. Currently he resides in Florida where he is a fulltime ecologist and part time student. ...
Read more about John Humphreys ->
More on these topics:
Adaptation, Causality, Creationism, Denialism, Disease, Evolution, Immune system, Medicine, Science News, Vaccination, Vaccine controversy
Tom says:
God designed babies to sleep on their stomachs. In 1992 the Back to Sleep Campaign was initiated in the USA to prevent infants from getting Deep Sleep which is when infants die of SIDS. Of course, Deep Sleep (AKA Stage 3/4 NREM Sleep) is when our brain transfers memory traces temporarily stored in the Hippocampus to the Neocortex. This "download" is critical for memory consolidation and learning which happen to be two areas that children with "Autism Spectrum Disorder" have problems with. Of course, there is no "Autism Epidemic" but rather a broad spectrum of negative side effects due to the SIDS Back to Sleep Campaign. BTW, all Western Industrialized nations began back to sleep campaigns between 1987 and 1994. As far as I know our Mammal cousins such as dogs and cats are looking at us as if we are idiots.
Mike Smith says:
seems like everyone has their favorite theory. one guy on slate argued that early tv might be the cause. i think people just need to recognize that we don't yet understand autism. the wild guessing doesn't help.
Jake Crosby says:
The Chicago Tribune journalists ignored literally hundreds of pages of science sent to them by the doctors and scientists they smeared, science denialism in its purest form so much so that anyone who would read their credulous reporting and conclude that they were anything but must have an inherent misunderstanding of science, like this reviewer apparently.
The person writing this also has a complete lack of understanding about autism and its history. Defeat Autism Now! is part of the Autism Research Institute, founded by Bernard Rimland in 1967. Rimland was the first to debunk the Refrigerator Mother claim that parents caused their children's autism, the purveyor of that claim, Bruno Bettelheim, turned out to be a complete crank and a fraud who falsified his credentials and research while plagiarizing his writing.
In an act of history repeating itself, the Chicago Tribune staff, when questioned, did not deny that they met with Bettelheim's successor, Bennett Leventhal. Leventhal dismissed the vaccine-autism link up front as "rubbish" when it was first raised as a concern by Rimland in 1995, just as Bettelheim did when Rimland said autism had an organic basis. Bennett was also on the speaker's bureau for Bristol-Myers Squibb/Otsuka, the company that makes Abilify, which was just approved for autism irritability.
Bizarrely, the clinical success of Abilify was reported weeks before Trine Tsouderos's original hit piece on the Geiers and chelation therapy in May 2009, and experts she interviewed to counter the Geiers had drug industry ties to companies that use or have used thimerosal in their vaccines.
Similarly, her most recent attacks in collaboration with Patricia Callahan strangely correlate with that drug's FDA approval for autism.
Even though opponents may claim Abilify is "evidence"-based because it may have gone through clinical trials for a few weeks, many holes remain in its long-term safety and effectiveness, not to mention drugs like it in general. The whole class of drugs it is a part of, Anti-Psychotics, has been found to cause long-term neurodegeneration overtime, not to mention diabetes, and even death. It can also grow milk-producing breasts on children, even boys. Parents are pulling their kids off these drugs by the droves and putting them on alternative therapies like the ones bashed by the Tribune. Manufacturers of drugs like Abilify and doctors tied into them like Leventhal have every motive to spread FUD about alternative therapies for autism.
In the end, it seems to me that Trine Tsouderos's junk journalism was nothing more than a few anti-science hit pieces so another dangerous anti-psychotic drug can get a head start in the market.
Joanne Drayson says:
I agreed with the start of this article but not the later part I think the jury is still well and truley out on that matter.
Interesting research done by Judith Miklossy supports the inflamatory process.http://www.miklossy.ch/401/index.html
Research done by Robert Bransfield finds a link with Lyme Induced Autism and other infections http://www.lymeinducedautism.com/
Robert Bransfield is the current President of ILADS http://www.ilads.org/
I had the priviledge of hearing Bransfield present at Lyme Disease Action conference last year http://www.lymediseaseaction.org.uk/conf2008/index.htm
Also the work recently being done with XMRV retrovirus and Autism and the mention of vaccines was interesting as was the link into the TV program.
http://www.huffingtonpost.com/david-kirby/is-autism-associated-with_b_316986.html
Tony Bateson says:
Of course there is denying science and then again there is denying science. Somehow I think that arithmetic is more robust than a lot of science I read especially in respect to autism. In my view it is clear that vaccines do cause autism the only question that remains is how.
I pointed out to the Geiers in November 2002 that despite rigorous searching I had been unable to find unvaccinated autistic individuals in the UK even though there is a very large cohort, possibly some three millions in size, of individuals not vaccinated as children since 1966.
The Geiers went on to check out VAERS in 2003 and found an association between exposure to vaccines and autism. They were followed by Dan Olmsted who found no autism in the Amish and the Homefirst communities.
That seems to be four large groups wih no autistic individuals and an absence of vaccination. I suggest that someone looks at Nevada County California because I will happily bet anyone $500 that this community will contain few autistic people! It's not science ormedicine it's arithmetic.
Tony Bateson, Oxford, UK
John Humphreys says:
Tom,
Always good to have some someone comment that knows the mind of a god :)
Well, I’m neither a medical doctor nor an expert on autism, BUT - like you - I am able to recognize correlations through temporal association. For the sake of argument, and if we placed ethics aside, we could perform long-term ‘experiments’ in which alternative sleeping positions were evaluated. After all, a changed sleeping position seems less invasive than some of the protocols described above.
Placing ethics aside would be a necessary precondition of our proposed study because the Back to Sleep Campaign resulted in a substantial decrease in SIDS, thus the infants participating in our experiment may experience elevated rates of SIDS related death.
Death… Maybe we should hold-off on the experiment for now? At least until there’s a more plausible connection that incorporates the ‘download error’ you mention with the observed physiological characteristics of autism – there’s more to autism than poor memory.
Correlation doesn’t equal causation.
As far as the opinions of our mammal cousins, I’m quite sure that my dogs think of me as a genius – at least when it’s time to eat.
Thanks for the comment.
John Humphreys says:
Mike,
Very true.
For clarity, in the article above I didn’t intend to imply that the world should stand idly by and wait for JAMA to publish a ‘cure’ – there’s a big difference between thinking of possible connections/alternatives and getting rich selling (at best) experimental treatments.
The focus of my angst isn’t those professionals that seek management/mitigation of symptoms or discomfort through pharmaceutical, nutritional, or even herbal therapies, rather I’m perturbed by those that push untested and unproven ‘cures’ or ‘treatments’ with false promises.
Thanks for stopping by!
John Humphreys says:
Jake,
No. Ridiculous, unreasonable, unscientific, unfounded, or just plain old B.S.
Your arguments are unjustifiable and you are spreading misinformation.
Firstly, though I certainly took my lead from the referenced Tribune article, the statements above have been independently corroborated and are in no way dependent on it – I enthusiastically stand by the Faster Times article. Furthermore, whatever occurred, or didn’t occur, at the Tribune following its postings is irrelevant to the arguments here and immaterial to the fight against autism.
Secondly, in addition to being one of the greatest scientists to have ever graced the planet, Isaac Newton was also a dedicated alchemist. Perhaps we should follow the genius’s lead and start funding a lead-to-gold institute in the US – it would certainly help with the economy! Humans, even smart ones, are fallible. Rimland’s vaccine-autism connection has not only been overwhelmingly rejected, his methods of making the link were invalid in the first place. Your propping of Rimland’s work is wrong in terms of evidentiary value and is logically untenable from the perspective of discourse.
Thirdly, whatever evil motives you think are bound to the darkened hearts of pharmaceutical companies are not only silly, but they’re also non sequitur. Yes, drug companies like to make money. Yes, drug companies look after their own financial interest. Yes, drug companies make mistakes. No, drug companies don’t hold sovereignty over tens of thousands of independent scientists, hundreds of universities, newspaper companies and, according to the website linked from your name, all blogs on the ScienceBlogs network ( http://scienceblogs.com/ ) Conspiracy theories get us no where.
As chance would have it, there was an exceptionally humorous example of this flawed way of thinking posted just two days ago at the blog ‘Science-Based Medicine.’ I encourage everyone to check it out: http://www.sciencebasedmedicine.org/?p=3222 – it’s a hoot.
Jake, I value your participation here and hope that you return, but at the same time I wish that you would evaluate you mode of thinking - not so much what you think, but how you think. Rather than focusing on resources discussing autism, or medicine at all, you may want to seek websites and books that explain the process of rationalism and skeptic inquiry. An excellent place to start would be Carl Sagan’s ‘Demon-Haunted World’ – an outstanding book!
Thanks for your visit!
John Humphreys says:
Joanne,
I’m not precisely certain which portions of the article you agree with and which you don’t, but I sincerely appreciate the reading material that you listed. I’ll check them out shortly.
In general, if I implied that ‘science’ has all of the answers in hand, it was unintentional. Science isn’t a noun, it’s a verb; a process of methodical and skeptical inquiry - science is not a ‘body of knowledge’. Continued research goes hand-in-hand with the scientific process in a collaborated endeavor to improve our current understanding of the natural world and to gain novel insights into the phenomena we see around us everyday. My point above is that the process, though not ‘fool’ proof, is our best bet at finding answers - in this case finding medical treatments. I detest those that skew the process for personal gain or unethical experimentation.
Incidentally, I have read some stuff about Dr. Mikovits and the XMRV… And XMRV in regards to cancer… The hypothetical connection that I recall was that IF indeed autism turned out to be viral in nature, stimulating the immune system with a vaccine MAY activate viruses ALREADY contained in the body. Even if we assumed this hypothesis to be true, it means that vaccines don’t cause autism anymore than does catching the chickenpox, or other immune stimulating illness – diseases, which (once again relying on my recollection) I believe Mikovits endorsed vaccines to combat.
Thanks for the comment!
John Humphreys says:
Tony Bateson,
Your reputation precedes you – the social entrepreneur from the UK that quotes non-existent studies and his own ‘independent research’ in making the case against the level-headed peoples of the Earth – welcome to the Faster Times, I’m honored!
Tony to make this reply short and sweet, please scroll up and have a look-see at the reply left for Jake.
By the way, although I didn’t touch the text in your comment above, I did admittedly kill the link to your website – I couldn’t bear the thought of someone being duped into making a donation to you from here.
Cheers!
Marc Draco says:
I see the voices of lunacy are still widely spread. These "God" fearing non-scientists would do well to study psychology 101 where we learn about Dualism and the fact that humans are simply animals - just like all the others.
I fear that by engaging these people John, we merely qualify their arguments.
The voice of unreason (my personal favorite of mine Sir Peter Vardy) are invariably quite rich and have the ears of our politicians. Vary was knighted by the Labour loons and has now switched side to the Tories just as they look certain to win the election.
A*hole. I despair.
John Humphreys says:
6,
You’re likely right; I constantly host debates with myself over the value of confronting the purveyors of argumentum ad ignorantiam. Alas, I’m a slave to my emotions…
Great to know you stopped by – hope to hear from you again.
mattheww says:
Who was this article for? It reads like one of those content mill pieces that aggregate the widely-known facts on a stale topic. I mean, the evil-vaccine loons will always take the bait, but I'm pretty sure the rest of the world moved on a looong time ago. Whattaya know about "staycations," though?
John Humphreys says:
Mattheww,
I think that your conceptualization of the ‘rest of the world’ is likely relative – based on the views that you hold personally. I’d like to think that the ‘rest of the world’ has moved on in regards to believing in astrology, ghosts, ESP, UFOs and Bigfoot but statistics from the National Science Foundation and Gallup often tell a different story – substantial portions of the ‘rest of the world’ hold pseudoscientific beliefs (around 75% in the US alone!).
That said, I’m more than happy to take suggestions on topics more to your liking.
Thanks for the comment.
Raven says:
Tony Bateson, it is incorrect that there are no Autistics in Amish communities. The Amish people treat Autistic individuals very differently than those in the bell curve world treat Autistic individuals. The Amish find ways in which to help Autistics integrate into their communities to the degree to which they are able to be integrated.
Dan Olmsted only considered one the Amish of Lancaster County, Pennsylvania. Oddly enough, however, there was a study done on children from the same Amish community as the one Dan Olmsted identified as having children who did not have Autism or display Autism-like behaviours. The study's results were markedly different than Olmsted's anecdotal commentary. The study showed that there was, indeed, Autism in the community (Source: http://www.medpagetoday.com/Neurology/Seizures/2954). What's more, facts point to 70% of individuals from the Amish in Lancaster County, PA being vaccinated (Source: Clinic for Special Children, Strasburg, PA).
Here's something Dan Olmsted and others like him ought to consider.
You cannot compare how the Amish raise their children to how the majority of American society raises their children.
I have noticed over the years that the rate of diagnosis of children in First Nations (North American Indian) children appears to be non-existent when rates are reported. If you drop by any rez, you're not likely to 'see' any children that appear to have Autism. It would be easy for someone like Olmsted to declare that North American Indians do not have Autism and to claim that our children are not vaccinated based on the poor health care in place on most reservations.
The fact of the matter is that our culture is radically different than non-Aboriginal culture and we do not view our children with Autism as being afflicted but rather we choose to see them as gifted and blessed. It's because of their ability to see the world differently that things that might otherwise be overlooked are seen.
Yes, cultures that operate differently than mainstream society MAY be misrepresented as being Autism-free but that is not the case. We have children, youth and adults with Autism. We just don't treat them the same way children, youth and adults with Autism are treated in other cultures.
John Humphreys says:
Thanks for the info Raven!
John Humphreys says:
Got this hate letter in my email...
In case anyone is curious, I didn't vote for Bush and I'm still waiting on my check from Big Pharma...
-----------------------------------------------------------------------------
from: Patrick Russell
date: Sun, Jan 3, 2010 at 12:42 PM
subjectre: autism article.....
I'm sure by now you've most likely received tons of negative emails about your article, "Bad Science..."....I guess what's so annoying the most is how "scholarly" you try to come off and teach us about "vaccines" and "disease" and of course, "neuroinflammation (’neuro’ = brain; ‘inflammation’ = irritated)"....wow, what a revelation, jeez, I didn't know any of THIS!!! OMG!!!!....
Do you ever watch Giant Pharma drug commercials on TV by chance? Do you ever see the parts about all the possible negative side effects? Do you see how people are still taken in by all these nice ads and take this crap at the expense of their health....? Do you see the Legal ads on TV after it comes out that some of these nice Rx's have some rather adverse side effects that possibly might be remedied by a large class action law suit?...
Did you know that some of these nice vaccines that are given en masse to our children are created by Big Pharma? I'll bet you did.
I find it amusing that the "scary stuff" you talk about for solutions for ADHD are actually pretty tame next to the shit I saw in the last Chantix commercial I saw....
So let me understand this , you chastise those for attempting to find a remedy (though in your view "snake oil") for ADHD and it kinda seems like you either are unaware or want to totally ignore the link between Thimerosal used in many vaccines and ADHD...
funny how the CDC notes that there have been no new vaccines by the FDA since 2001 using Thimerosal even though no link has been established between Thimerosal and ADHD...though there are still immunizations routinely given to children WITH Thimerosal still including at no extra charge...http://www.immunizationinfo.org/thimerosal_mercury_detail.cfv?id=3....
so I don't really get your pompous argument...
kinda seems like your protecting the status quo here which in my mind ain't too good...and poo pooing the notion of looking for solutions like a hyperberic chamber , shades of Michael Jackson!!!....yeah maybe not such a good idea.....maybe you got somethin' better? the alternative therapies for the majority of people with mental health issues are all fraught with some pretty nasty crap....so until something better is found, and I hope you never have to deal with your child who has ADHD, people are going to look for something because Big Pharma just ain't doing it....ie which Bad Science is worse? - That which is feed to us by travelling salesmen or conventional Big Pharma?...answer me that Mr. Science scholarly dude?
Did Big Pharma pay you to write your nifty little article or are you just naturally ignorant on this subject?
ig no rant, [ig-ner-uhnt]
1. lacking in knowledge or training; unlearned: an ignorant man.
2. lacking knowledge or information as to a particular subject or fact: ignorant of quantum physics.
3. uninformed; unaware.
4. due to or showing lack of knowledge or training: an ignorant statement.
Thanks and gosh I'll bet dollars to doughnuts your probably voted for George Bush in both elections...
Natasa says:
Nice attempt John, shame that you failed to mention hundreds of other studies pointing to chronic neuroinflammation and general immune dysfunction in autism.
Interesting that you failed to mention autism being a very well known sequelae of viral encephalopathy, and hundreds of parallels between well researched NeuroAids and hardly-researched idiopathic autism.
Interesting also that there are at least 3 mechanisms (involving neurotropic viruses) by which vaccines could be triggering the cascade of events leading to viruses, including the newly discovered XMRV, entering or reactivating within CNS and subsequent appearance of autism.
John, you really, really should know this stuff much better before setting to write about it.
http://autismcalciumchannelopathy.com/Infectious_Agents.html
Natasa says:
John you said: “The hypothetical connection that I recall was that IF indeed autism turned out to be viral in nature, stimulating the immune system with a vaccine MAY activate viruses ALREADY contained in the body. Even if we assumed this hypothesis to be true, it means that vaccines don’t cause autism anymore than does catching the chickenpox, or other immune stimulating illness – diseases, which (once again relying on my recollection) I believe Mikovits endorsed vaccines to combat…”
Yes indeed, and there are reports of children regressing into autism following immune-stimulating illnesses.
BUT, and this is a huge issue, vaccines are hardly ever given one at a time. Routing childhood vaccinations almost involves simultaneous administration of many (4,5,6 or many more) vaccines in a single setting. And each of those vaccines comes with its own immune stimulant. In a single setting.
So the statement “that vaccines don’t cause autism anymore than does catching the chickenpox” might have to be re-worded into “that vaccines don’t cause autism anymore than does catching the chickenpox, MEASLES, RUBELLA, POLIO, HEPATITIS B, DIPHTERIA AND TETANUS ON A SINGLE DAY”. That sort of thing.
Natasa says:
"Routine", not "Routing", sorry typo
John Humphreys says:
Natasa,
Perhaps I missed something? Where do I suggest that the immune system shouldn’t be studied in regards to autism research? Actually, I thought that I was DEFENDING the work of Vargas and similar minded scientists?
Maybe you’re erroneously equating vaccines to autoimmune disease???
Vaccines work precisely because they stimulate the immune system; but, there’s a big difference between autoimmunity and ‘autoimmune disease’. Likewise, there’s a big difference between ethically conducted research and using scare tactics to dissuade parents from vaccinating their children. In regards to possible environmental triggers of autoimmune disease, a common cold is just as likely to cause onset as is the entire list that you provided.
I have little doubt that “there are reports of children regressing into autism following immune-stimulating illnesses.” There are also a myriad of reports in which vaccines are allegedly suppressing natural immune response - also causing regression into autism… So, by your rationale perhaps we should simultaneously treat children with drugs for both ‘over-stimulated’ and suppressed immunity?
Let’s keep in mind that we’re talking about a speculative vaccine-immune link made by a doctor that CONTINUES TO ENDORSE VACCINATION. I’m a little confused in that you seem to boast about what Mikovits admitted to be speculation, while at the same time you refuse to accept what Mikovits positively affirms – that vaccinations are safe and should continue as matter of practice. What gives?
Thanks for the comment.
Nick says:
For parents or people that are affected by autism in anyway, here is a link to a great innovative autism treatment program called rethink autism http://bit.ly/6s1G3J the best part about it, its ABA and its affordable! good luck.
Liz Ditz says:
The final title of this post is "Autism Activists and Science Denialism"
I just want to point out that the anti-vaccination or"infectious disease promotion movement" (IDPM) is just a small, but vocal, segment of the larger autism community.
In other words, "autism activism" does not equal "anti-science, anti-vaccination".
The pro-vaccination, pro-science wing just isn't as vocal or as well-funded. You can find representative members at (for a small sample) LeftBrain/RightBrain, Autism News Beat, Countering Age of Autism, Action for Autism, and Natural Variation. A very large array can be explored at the Autism Hub.
John Humphreys says:
Thanks Liz – Valid point!
Originally the title of the post was “Bad Science plus Autistic Children equals Big Money;” but, being a bit cumbersome, it was later changed.
Great blog by the way - I Speak of Dreams
Bob says:
A while back, you responded to a post by "Tom" about a possible link between autism and the "Back to Sleep" campaign against SIDS. In your argument, you bring up some important issues:
"Placing ethics aside would be a necessary precondition of our proposed study because the Back to Sleep Campaign resulted in a substantial decrease in SIDS, thus the infants participating in our experiment may experience elevated rates of SIDS related death."
You then worry about an increased death rate, and say we shouldn't experiment until a more clear mechanism is shown, concluding:
"Correlation doesn’t equal causation."
While I don't have an opinion on the link between autism and "Back to Sleep" recommendations, I think you need to examine the same issues of correlation/causation with the SIDS campaign.
That is to say -- yes, back sleeping reduced the death rate for SIDS. However, BY DEFINITION, SIDS deaths are UNEXPLAINED. If they were explained, there would be a different cause of death listed. So far, there have been dozens of proposed explanations for the causes of SIDS, and almost every major hypothesis also has some other study arguing against it.
So, all we have is the following data points:
--the SIDS rate for (white) babies who sleep on their backs: ~ 1 in 2000
--the SIDS rate for (white) babies who sleep on their stomachs: ~ 1 in 1000
Since the cause of SIDS is not determined, we cannot conclude that back sleeping will reduce the risk of SIDS for ANY PARTICULAR BABY, only that the OVERALL RATE IN THE POPULATION is reduced. Without definitive causation, we only have a correlation.
What are the implications?
Well, for one, what's to say that we're not KILLING some babies already with this recommendation? It could be (and it usually seems to be assumed) that if baby A and baby B were at risk of dying from SIDS, perhaps baby A would survive due to back sleep, while baby B still succumbed, even on his back. (Hence, the reduction of about 50% from back sleeping.)
BUT -- why couldn't it also be that babies A and B BOTH survive, but now baby C dies when placed on his back, even though he would have been fine if placed on his stomach?? In this case, the overall rate of SIDS goes down, but because we haven't identified a distinct CAUSE (only a CORRELATION), we've saved the lives of some with the new recommendation, but we ended up killing others who would have been fine before the recommendation.
Is this really possible? Well, for one thing, studies have shown that babies who never sleep on their backs experience a MUCH greater risk when sleeping on their stomachs. Instead of being twice as great (as for normal stomach sleepers versus normal back sleepers), the infant who is rarely placed on his stomach may have an increase of 20 TIMES as much risk for SIDS. This is such a danger that there is a whole campaign emphasizing that you need to sleep on back CONSISTENTLY... all the time, every time, for night sleep, for naps, etc. But some poor grandmother or babysitter or even a mother wanting to try something else sleeps the baby on his stomach, and now he dies, when more frequent stomach sleeping may have prevented this. Or, the baby flips himself onto his stomach (as all babies eventually do), and then dies because he isn't used to this position.
This is just one possible problem that may cause otherwise unnecessary deaths from SIDS. (Another could be in babies who have trouble sleeping soundly on their backs, but then occasionally fall into a much deeper sleep due to exhaustion -- also, sleep apnea cases are often made worse by back sleeping, and that is one proposed contributory factor to SIDS.)
Say you had a patient who sleeps on her stomach. You tell her that if she sleeps on her back, she'll have a 50% less chance of dying from lung cancer. Most would say she should do it. But then say that if she does this, she needs to do it consistently... if she were to sleep on her stomach at some point in the future, suddenly her risk of death goes up TENFOLD from what it would be if she never stopped. Now what would be the suggested course of action? Add to this that you then told her that actually we couldn't prove any causality relating lung cancer to sleep position, only a correlation. What would you recommend?
In essence, the "Back to Sleep" campaign already is an experiment, and while it undoubtedly saves some lives, it's an open question about how many it might be killing, given that the back-sleeping SIDS cases are still unexplained.
Now, do I think it likely that all the babies who are flipped over are saved, and the ones who die are a completely separate set who would have been fine on their stomachs? No. But without actually proving a cause, all we've done is decrease the death rate, not necessarily made things safer for all babies. If the death rate decrease was 10-fold or more, perhaps we wouldn't need a cause to issue such a blanket recommendation. But when the rate only goes down by a factor of 2... well, more research needs to be done to establish cause.
Add to all of this potential side effects like developmental delays, decreased slow wave sleep, and who knows what else... without a distinct cause, shouldn't these factors be considered in the ethics of a back-sleeping campaign?
John Humphreys says:
Bob,
It wasn’t my intention to suggest that an infant’s sleeping position is causative to Autism. Rather, I was trying to emphasize the moral dilemmas that rise from the practice of experimenting with human infants.
Unless I’m mistaken (and please correct me if I am), the procedures promoted by the Back to Sleep Campaign have demonstrated a correlated decrease in infant SIDS of more than 50%. Considering this, regardless if your presented hypothetical scenarios are valid or not valid (and they’re not), deviating from the guidelines still presents a moral dilemma.
In addition, I’m also confident that the exceptions associated with consistency and general infant health are discussed in the campaigns recommendations.
Thanks for the comment.
PS: I assert above that your hypothetical situations are not valid because, as you emphasized, the “OVERALL RATE IN THE POPULATION” is what is being considered - not individual infants. The 50% reported by the Campaign is not a likelihood for any individual infant’s chance of survival; instead this correlation simply reports a decrease in total cases. So, unless you have evidence that total non-SIDS infant deaths correspondingly increased with the spread of the Campaigns guidelines…
Beach Mama says:
Just wanted to add to the SIDS/back sleeping debate:
I don't have the link on hand to back this up, but from what I understand, the "50%" decrease in SIDS that occurred in the 90's also coincided with an change in the way SIDS deaths were coded. Many infant deaths are now being coded "unknown" instead of as SIDS. Also, people became more aware of SIDS in general due to the campaign, and changed other risk factors. An infant that was placed on a fluffy quilt on their stomach surrounded by blankets might have been coded as SIDS back in 1980 even though what happened was they stopped breathing due to blankets being in their face. Nobody wants to place blame on grieving parents who obviously only wanted to do what was best for their baby so they label the death as sudden infant. Now people know not to put babies in beds with quilts and fluffy blankets, and that they should use a fitted sheet, a firm mattress, etc to keep the baby from suffocating.
Also, people in the early 90's became more aware of second hand smoke. I was born in the early 80's and I remember a time when it was totally normal to see people smoking in restaurants, malls, airports, you name it! In my state, they only very recently banned it in bars. Prenatal care has gotten much better, the internet came out which provided us with tons of information that we didn't have access to before. Lots of things have changed since 1990.
So now we have millions parents who are being advised to put their babies on their backs...in order to prevent them from falling into a deep sleep! There is a reason why babies sleep all the time and that is because they NEED IT! That deep sleep is important for babies brain development! Despite SIDS being a very scary possibility, it is actually quite rare, and it is too bad that we have to deprive all babies of a good night's sleep in order to prevent this from happening to some.
And now we have millions of babies who aren't meeting developmental milestones and being diagnosed with Autism. Hmmm.
I am with Tom that this campaign is what triggered this Autism epidemic.
John Humphreys says:
Beach Mama,
Even if we assume that what you state about the “50%” calculation is true (and I’d really like to see the link, if you find it), this in no way substantiates the argument that the campaign has been causative to autism.
To be clear, I’m not asserting that I know you are absolutely wrong about the campaign, or any possible ties to second hand smoke; rather, I’m saying that these ideas are speculative and have no affirmative evidentiary support in their favor.
You mentioned the internet… Isn’t it curious that the growth of the internet and computer technology beginning in the late 70’s and early 80’s just happens to coincide with an “epidemic” of “babies who aren’t meeting developmental milestones and being diagnosed with Autism. Hmmm.”
Thanks for the comment.