Sunday, March 05, 2006

Do Co-morbidities Prove Pathology?

Kevin Leitch recently posted a comment he had seen in the EOHarm list indicating the following: "Which physical symptoms should be ignored in children with [alleged] mercury-induced autism, so that their parents can “celebrate their neurodiversity”?" This is followed by a list of co-morbidities, some recognized as commonly occuring with autism, most of them inconclussive or questionable. It was of course pointed out that this was an intellectually dishonest misrepresentation of what the neurodiversity philosophy is about. The trivial flaw in the question has been noted repeatedly: Evidently, you ought not to ignore these co-morbidities.

Let me provide a less disputed list of co-morbidities of autism. That is, while we can't generalize and say that all autistics have these medical liabilities, it would appear that they are far more prevalent among autistics than in the general population:


  • Allergies
  • Gastro-intestinal problems
  • Seizures and epilepsy
  • Sleep problems
  • Self-injury (SIB)
  • Upper-respiratory problems


It's not entirely clear what the thought process that led to this argument looks like, but I've done my best to attempt to generalize it below:

If a phenotype (an appearance or behavior pattern) is associated with a relatively high prevalence of recognized medical liabilities, then the phenotype should not be characterized as a 'way of being'. The phenotype must then be considered a disease that must be erradicated and cured as a whole. Treating only the co-morbidities is insufficient.


Note that it's not just one person who makes an argument along these lines. Other mercury parents apparently jumped on the bandwagon according to Kevin. So while I shouldn't generalize, for the purposes of narration, I'm going to assume that "mercury parents" have this position.

In order to determine the viability of this argument, which appears reasonable on the surface, I have decided to test its plausibility on genotypes or phenotypes other than autism.

The Ashkenazi Jewish Population

A number of significant (usually deadly) diseases are considerably more prevalent among the Ashkenazi Jewish Population:


  • Bloom's Syndrome
  • Canavan Disease
  • Familial Dysautonomia
  • Fanconia Anemia
  • Gaucher Disease
  • Mucolipidosis IV
  • Niemann-Pick Disease
  • Tay-Sachs Disease
  • Torsion Dystonia
  • Crohn's Disease


Of these, Tay-Sachs is the best known. Death usually occurs by three to five years of life due to pneumonia or other infections. Interestingly, there's some controversial research which links Tay-Sachs and other genetic diseases to higher IQ in Ashkenazi Jews [ref].

So is being Jewish a disease that must be erradicated and cured? Unless the reader is a Neo-Nazi, I'd expect the reader to disagree. But I think it's important to illustrate the correct use of the terminology with a couple of examples:


Correct: This child suffers from Crohn's Disease. He ought to be treated.

Incorrect: This child suffers from being Jewish. Let's remove his Judaism. And while we're at it, let's device a genetic test to prevent Jewish people from being born.


Historical sociologist Shelley Reuter says that the notion of a Jewish disease is flawed since “there is no DNA sequence common and exclusive to all Jews.” Guess what? Neither is there one for all autistics.

Homosexuality

I anticipated that some readers might question the last analogy on the grounds that we should not compare autism to a race. (I might someday argue why that is totally valid in a different post). Homosexuality is the natural choice for a follow-up analogy, given that it has been described as a mental disorder.

Homosexuality used to be listed in the DSM-II, which was modified in 1973 to exclude it. This action resulted from the protests of gay activits who believed that homosexuality was not a disorder at all, but simply a 'way of being' to be tolerated and respected as any other way of being. Similar activism in relation to other phenotypes classified as disorders has occurred since.

In a similar fashion to the mercury parents, some die-hard psychiatrists and semi-professionals still argue that homosexuality should be considered a disorder and treated on the basis of its medical liabilities [ref]:


  • Classical STDs
  • Enteric diseases (Gay bowel disease, Hepatatis, etc.)
  • Trauma to various body parts
  • And of course, AIDS


Some of these are quite serious. But even so, it is not correct to say that an AIDS sufferer is a person who suffers from homosexuality.

Others argue that the cost of homosexuality is alarming, both in monetary terms and social terms [ref]. What does that remind me of?

As to curing homosexuality, there are a number of behavioral approaches still in use today. Reparative therapy claims a success rate of 30% to 70%, apparently even better to that of ABA. And as you might expect, there exist people called "ex-gay" who claim to be recovered from homosexuality. You will also find some talk on the internet to the effect that homosexuality might be caused by a 'chemical imbalance' (a favorite of the drug industry) and thus may be treated with drugs.

One of the pioneers of behavioral interventions for homosexuality and transexuality was, you guessed it, O. Ivar Lovaas [ref]. That's not surprising. After all, he says children "don't have the right to act bizarrely".

Left-handedness

I know there's at least one mercury parent, John Best Jr., who actually does believe that homosexuality is a disorder that must be cured. For him and others like him here is a less controversial condition: left-handedness.

Some of the liabilities of left-handedness (and I must warn that these are controversial) are:


  • Higher incidence of sexual offenses
  • Accident proneness
  • Proneness to alcoholism
  • Allergies
  • Immune disorders
  • Lower life expectancy


Still, left-handed people are proud of their genetic heritage, are opposed to continued efforts to make them switch hands, widely reject the 'person with left-handedness' terminology, and even believe that left-handedness provides them with cognitive advantages. All they ask is for a bit of accomodation so they are able to use their left hand in various social and educational settings.

Giftedness

Here's a strange type of "abnormal" which many people would like to be. It's a lot like the tall stature phenotype or the really low body fat phenotype. We all know that giftedness must have some advantages, in some cases including savantism. Genetically, of course, given its low prevalence, it's not surprising that it comes with a number of liabilities:


  • Allergies
  • Myopia
  • Clinical depression
  • Perfectionism
  • Isolation/Introversion
  • Underachievement
  • Hypersensitivity (Sensory overload)


Is giftedness a disorder? It's not considered as such at present. But psychiatrists and school officials, in their never ending quest to label every single person in the planet as brain diseased, appear to be on the brink of classifying it as such [ref][ref].

Summary

Bigotry is alive and well. Treat the co-morbidities. Don't treat the autism.

18 comments:

  1. Hi
    you wrote

    Let me provide a less disputed list of co-morbidities of autism. That is, while we can't generalize and say that all autistics have these medical liabilities, it would appear that they are far more prevalent among autistics than in the general population:


    * Allergies
    * Gastro-intestinal problems
    * Seizures and epilepsy
    * Sleep problems
    * Self-injury (SIB)
    * Upper-respiratory problems


    I would question whether or not they are more prevalent among autistics. I suspect that autistics are less likely to "suffer in silence." so what we have is guys who complain rather than grin and bear it.

    Excellent post BTW.

    ReplyDelete
  2. You're using poor analogies. None of the other abnormalities you mention or the strictly genetic idiosyncrancies are caused by poisoning. Autism is caused by mercury and removing the mercury will cure some of the accompanying problems.

    ReplyDelete
  3. You're using poor analogies. None of the other abnormalities you mention or the strictly genetic idiosyncrancies are caused by poisoning. Autism is caused by mercury and removing the mercury will cure some of the accompanying problems.

    Your are proposing that the analogy is no good by providing an unsubstantiated belief: Causes are of a different nature. Not to mention that the cause you propose is almost certainly impossible (see my two prior posts).

    But besides that, not all of the liabilities of other phenotypes are necessarily genetic. There could be random environmental effects at play.

    ReplyDelete
  4. I would question whether or not they are more prevalent among autistics. I suspect that autistics are less likely to "suffer in silence." so what we have is guys who complain rather than grin and bear it.

    Good point. It's really hard to tell without some controlled medical data that verifies it. Most of it is anecdotal really. In any case, if you compare any arbitrary groups of people, it's not surprising that you find all kinds of differences.

    ReplyDelete
  5. John: Note also that of all the phenotypes I listed (except for the Jewish race) autism is by far the most heritable. (With the Jewish race, it's hard to make an assessment, because it's not clear how the genetics work there, or how to "diagnose" it as a race).

    ReplyDelete
  6. Why don't you chelate yourself and prove to yourself that it won't help?

    ReplyDelete
  7. Why don't you chelate yourself and prove to yourself that it won't help?

    For the same reasons you should not be chelating your son. Why create a medical problem in order to fix an imagined, unproven, factually impossible problem.

    ReplyDelete
  8. If it's an imaginary problem, I guess his recovery must also be imaginary. What are you afraid of? Just stay away from EDTA.

    ReplyDelete
  9. What chemical would you suggest over EDTA John?

    ReplyDelete
  10. Not Mercury;
    For you, I'd suggest a few Pina Coladas and some time away from neurodiverse lunatics.

    ReplyDelete
  11. Hi Joseph,

    I have tried to present you another point of view, based on personal research, so I will transcript several of your questions and will present you some of my interpretations. Glad to hear comments about. Thank you in advance.

    Questions in normal, answers in bold

    1-Considering that the prevalence of epilepsy among autistics is known to be an order of magnitude higher that that of the general population, why is the CDDS-based prevalence of autism rising at a rate of 10% annually (and even higher in the past), whereas the prevalence of epilepsy has always remained at population growth levels?

    Well, I think that the idea of a new kind of ASD without the clinical presentation of epilepsy-but subclinical perhaps- is a possible explanation of this.


    2-Why is the prevalence of CDDS clients without mental retardation (presumably based on IQ testing) going up quickly?

    I think that this is related to diagnosis criteria , so your broader awareness theory is applicable, at least partially.

    3-Why is the proportion of autistics with epilepsy going down at an annual rate of -5.5%?
    This seems a confirmation of the answer of 1, as you mentioned in your post about.

    4-Why is the proportion of autistics with mental retardation going down at a comparable rate?
    Change of diagnosis criteria/different awareness seems the most reasonable cause for this.

    5-Considering that close to no thimerosal is going into vaccines nowadays, shouldn't the following be true? (1) The number of autistic clients in the CDDS 3-5 age range should be crashing towards zero.
    Only if thimerosal is considered a CAUSE. I would wonder if the symptomatic presentation in severity is the same if I consider as a comorbility . Unfortunately the severity if measured by IQ measurements of verbal skills and I think this is wrong. I am wondering in severity in terms of clinical presentation (GI issues, immune/autoimmune, lack of speech, etc) Because the clinical information is scarce, even if now the tests are going to begin to be done, there would be no enough data to compare, only behavioral symptoms.

    (2) All newly diagnosed autistic children would be those vaccinated with thimerosal (via the Flu vaccine, as Sue likes to point out).

    Not for me. If thimerosal is removed and thinking in the sum up of a lot of individual presentations with multicausal nature of A+B+C+…Z we only erased one insult ( an important one for me) but only one. If we consider that the combination is the key and we maintain all the components of the combination-except one-, I think that a decrease – BUT a little one in TOTAL numbers- would be seen. I wonder about the severity of symptomatology-

    6- what mechanism does mercury poisoning result in savant skills?
    No known mechanism and very improbable cause for me


    7-How does mercury poisoning explain the results of Dawson and Mottron? That is, autistics score higher than the norm in the Raven IQ test. But not only this, the gap between the Weschler and Raven tests is totally the inverse (in the other direction) of what it would be in NTs.
    As I told you in other post, I think that there is a component of visual impairment in the analysis of this.

    8-How does it explain findings by Happe (2001) that parents of autistics have a "cognitive style" (weak central coherence) that can confer information-processing advantages?
    Well, this idea is in conflict with those from Dawson and Mottron, of the enhanced general perception. I think that the idea of implicit learning and enhanced general perception fits more in the findings in ASD. If think that a combination of genetics + adaptative behavior to overcome sensory integration problems can be part of the explanation of the proposed ideas.

    9-How does mercury poisoning produce significant grey and white matter volume differences in infancy?
    From Martha Herbert
    White matter is 28 % of total brain volume but contributes 65 % to the volume increase in autism. White matter enlargement is radiate, not deep or sagital. The increased WM volume is in areas that myelinate later. Radiate white matter myelinates late in first year and into second year.
    Characteristics. Cortical assymetry and model of disordered information processing
    There is no enough information to discard some mechanism of environmental insult+genetics in this case.
    10-How does mercury poisoning produce larger brain mass and size?
    Researchers identify gene involved in building brains
    Brain sizeGenes found that regulate brain size:
    One increases, the other decreases Beta catenin-ASPM
    http://www.hno.harvard.edu/gazette/2002/10.10/01-genes.html

    Role of thyroid in Brain Development and Gene Regulation
    http://www.medscape.com/viewarticle/465419_print

    Thyroid Hormone, Brain Development, and the Environment Environmental Health Perspectives Supplements Volume 110, Number S3, June 2002
    R. Thomas Zoeller, Amy L.S. Dowling, Carolyn T.A. Herzig, Eric A. Iannacone, Kelly J. Gauger, and Ruby Bansal
    http://ehp.niehs.nih.gov/members/2002/suppl-3/355-361zoeller/zoeller-full.html


    Mapping Genes that Modulate Mouse Brain Development: A Quantitative Genetic Approach
    http://www.nervenet.org/papers/BrainRev99.html
    Genetics seems the main culprit, although for me the same as above

    11-How does mercury poisoning produce increased neuron density and smaller neurons?
    Mercury can collaborate partially
    I do not include the link because is long and did not work when I tried.
    Please let me know if you want the full abstract
    12-Why do you start chelation therapy without first testing for heavy metal poisoning?
    This is not true for me. Unfortunately, the way I discovered my son´s poisoning has not been studied/reported to be discussed based on scientific reports. There are no reported studies about so it is anecdotic ( although I know of many other children from my country,( from different cities and labs)) that showed the same.
    I agree that only after careful, safe and adequate testing a procedure of chelation can be evaluated, not as treatment of ASD, but of HM poisoning and not more than this.


    13-If you have tested your child, did you use a local reputable lab or an internet lab? Did you send a control sample to verify their tests are valid?
    Local reputable lab. 2 control samples- and repeated

    14-Is there controlled evidence that chelation therapy is an effective treatment for autism?
    Chelation for me is treatment for HM poisoning. To propose other thing does not seem ethic for me.


    Is there controlled evidence that chelation therapy is a safe treatment for the duration you're planning to follow it?
    For the particular I choose, there is enough evidence of safe use, at my criteria.
    Are you following medical guidelines as to the proper duration of chelation therapy?
    Totally. Several doctors involved.
    What is the mercury-based genetic model that explains a 60% concordance for classic autism in identical twins, but a much lower concordance (2%-4%) in siblings and fraternal twins?
    This is a strong point to genetics.

    How does mercury poisoning explain a higher proportion of scientists and engineers as close relatives of autistics?
    Again, genetics

    Why do you propose that autism just cannot be simply genetic, while autism-like conditions such as Fragile-X, Rett Syndrome and Tuberous Sclerosis obviously can?
    How does mercury poisoning explain some of the alleles which have been linked to autism? GABA, SERT, etc.

    Genetics/epigenetics/ is very important for me in autism

    Given that autism is more heritable than personality, intelligence, homosexuality and left-handedness, would you say these other variations in human behavior are, too, caused by pathological environmental triggers such as mercury poisoning?

    Absolutely no.

    If you believe that autism did not exist before the 1940s, do you also believe that Down's Syndrome did not exist before 1862, that Fragile-X syndrome did not exist before 1943, and that Rett Syndrome did not exist before 1966?

    No. I think that ASD has been with us in genetics terms from long time ago, the same with the other conditions you mentioned.
    In the case of ASD, I think that before the introduction of vaccines and other potential problems for susceptible children (antibiotics, chemicals, additives, HM) the genetics and immune/autoimmune presentation based on herpes/strep/bacterian/ viruses infections (combined) was the more common. After the introduction of vaccines and antibiotics, etc, to the burden of the immune system, the burden of HM and other allergens was sum up and then the number of ASD and the severity of symptoms in many of them increase in time. Also the increase of chemical burden, environmental pollution and stress in mother/health of mother during pregnacy has impact.

    Do you realize that a prevalence of 1 in 166 today (which includes Asperger's syndrome) cannot be compared to a 1970s or 1980s prevalence?
    Yes, diagnosis criteria were different.

    Do you understand why anecdotal accounts do not prove an argument?
    Yes, but the fact that my son is anecdote for science does not imply nothing at his individual level. I have the duty and the right to give him the best treatment I can get. I can not present HIS case as an argument, what is different, or extrapolate situations.

    Per Jennifer I believe:) If autistics are unable to excrete mercury, wouldn't regular intake of mercury from the environment be enough to kill autistics over time?

    Well, I think that we must diferentiate the kind and road of exposure-ingestion, inhalation and injection and the kind of compound-in fish, metallic or as thimerosal in the case of mercury. Let´s go to accept for a moment that SOME asd children can not excrete heavy metals ( and others). So they bioaccumulate Hg.
    Some mercury is breathen so we can suppose is metallic- Hg is ubiquous in air and ingresed at 0,3 to 1,5 ug/day for an adult and 0,1 to 0,5 per day for a child (and excreted, given in stool for example for a child 0,01 to 0,05 (maximum, considering a very industrialized zone)-from a report of air quality. However, there can be other routes of exposure that you must check to have a real baseline.
    First, from when? One question about from me is which is the mechanism of hindering of excretion. Since birth? If we imagine that vaccines are a trigger of this hindering- a possibility- then the situation can be present since HepB vaccine -depending on individual.
    From fish consumption, is considered to be Hg bonded to proteins in fish. Hg ingested.
    From vaccines, injected as thimerosal.
    Therefore there is the problem of increased bolus amount with vaccines and after this the lower daily amount breathened and the occasional amount ingested as fish-if any.
    Development brings change in all the systems, even in altered systems like in ASD-and it is known that development in many cases involves improvement in autism. How do we know if, depending of the child and the burden to the detox/immune system, IF he /she is HM poisoned, time brings natural excretion?
    Beyond the Hg from vaccines, how do we know at an individual level the impact in different organs and system of the bioaccumulation not only of Hg but also of Pb, Al, Cd etc? How do we know how each child can manage in time the supposed toxic load he/she can have?

    Why are the following symptoms of heavy metal poisoning not characteristic of autism? Headaches, cold hands and feet, vertigo, inability to focus vision, joint and muscle pains, weak pulse, hard pulse, bleeding gums, blisters, tooth ache, jaw inflammation, metallic taste in mouth, loosening of teeth, persistent cough, irregular breathing, swollen lymph nodes in the neck, subnormal temperature, excessive perspiration, chest pain, changes in blood pressure, etc

    My question is how a child that is not verbal /low comunication skills can communicate many of this kind of symptoms-except the obvious for the parent:loosening of teeth, cold hands and feet and excessive perspiration?
    Inability to focus vision? Can not be related to lack of eye contact?
    Joint and muscle pains? Can not be related to hypotonia?
    Irregular breathing? Has been reported in autism-
    Dental problems have been reported in ASD children.
    What defines the characteristics of autism?DSMIV does not include anything about other things than behavior.

    María Luján

    ReplyDelete
  12. María,

    Wrong post. But I've found your answers and a I should be incorporating them into the FABNAQ shortly.

    ReplyDelete
  13. Sorry, Joseph. I apologize
    I felt that perhaps this post was adequate, because of the opinions that were developing in the other post. In general I try to post when/where is adequate, considering the situation.

    Ma Luján

    ReplyDelete
  14. Hi Joseph
    Because I do not think that autism=mercury poisoning is adequate, please consider that better we can discuss in due time in due place the list.
    Please erase from here and copy when corresponds.
    What do you think?
    María Luján

    ReplyDelete
  15. María,

    I'd like to incorporate your answers into the FABNAQ and address them there if you don't mind. You could also post your answers in your own blog, of course.

    ReplyDelete
  16. Joseph
    OK, but please consider that my comments are not thought to defend the autism=mercury hypothesis because I do not agree with this. I wanted to share another view and analysis with you, different that the two more extremes.To avoid repetitions you can find in my answer in
    "Mathematical Argument: There's No Autism Epidemic" an overview of my opinion.
    Thank you
    María Luján

    ReplyDelete
  17. I've been through chelation for the lead that supposedly caused my Asperger's and Epilepsy.
    I'd have to tell you, it didn't make a bit of a difference.
    Then again, I was 30 when I did it, to get rid of what was leaching back out of my bones that I stored as a child. I was in a test group for an oral med. It made me sick, but only while I was on it, and left no lasting ill effects.
    Merely removing that cause doesn't alleviate the permanent damage it has done.
    My doctors have been fairly certain I also experienced mercury poisoning as a child because of where I grew up. It's not in my system now, and I still behave the way I always have.
    I don't think we can treat the autism at the moment. But we can treat the symptoms, and for many mid to high spectrum forms, we can use cognitive and behavioral therapy to learn to pretend to be "normal" when we need to.
    Note, I didn't say "we can learn to be normal." 1) I don't believe in the concept of an actual normal person. 2) Why would I change who I am? I like me. I just know that sometimes in job situations, who I am isn't conducive to getting the job done or isn't conducive to keeping my job.

    ReplyDelete
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