Autism and the environment

This post was stimulated by an exchange on Autism Gadfly in which I was asked to state my position on the vaccine issues in autism.

My answer was that I don’t like talking about the vaccine issues, because at the moment it is an unresolved, controversial and highly polarised matter, which I cannot contribute to or resolve. It is an issue that has, in part due to the inappropriate ways in which it has been dealt with, distracted our attention. However because I was asked to state my position and because yes, in my views, vaccination might well be implicated in some cases of autism, I will none the less discuss below this controversial matter.

First point I would like to make is that Autism Spectrum Disorders (ASD), regressive autism, Pervasive Developmental Disorder-Not otherwise Specified (PDD-NOS) are conditions that are on the increase starting from about 1988. I believe this is a real increase that is not just related to a greater awareness of the conditions and change of diagnostic criteria. However, there is no clear picture as far as Asperger Syndrome (AS) is concerned. There is no data on prevalence of AS alone, and almost certainly this condition was essentially unnoticed, considered as some sort of quirkiness, even in very recent past. Equally, many adults with AS have remained undiagnosed to this day. It is therefore possible that AS is not on the increase, in any case, the data is not there yet to answer this question accurately. However for the rest of the ASD kids, the increase seems real. I can argue this point using a range of additional arguments, but let’s not get too distracted, even if this is an essential point. (more on this here)

The second point I would like to make is that it is not just autism that is on the increase, allergy, asthma, ADHD, MS, cancer, fertility problems, to name but a few, are all on the rise. In the case of allergy for example, before the industrial revolution, when people started to work on allergy problems, for example related to pollen, it was very difficult for doctors to identify a sufficient number of cases. The condition was essentially unknown. This would suggest that the changes associated with our industrial environment are contributing to the rise in prevalence of this condition and very likely to that of others. The environment is complex and constantly changing, many of the substances found in the atmosphere and the food chain affect health of various organisms incl. humans, and many substances have unknown toxicity. Additionally, many work in complex synergistic association. ADHD for example was recently found associated with higher urine level of organophosphates, which comes form excessive pesticide use. Any disease or condition that is on the rise is typically viewed, even in mainstream quarters, as resulting from both genetic susceptibility and environmental changes. Classic cases are cancer. As far as autism is concerned, there is a growing interest to look at how the environment impacts on the condition. For more see Autism and Environment: The NIH is finally searching for answers. There are a number of known ways in which a gene-environment interaction can be causal to a phenotypical modulation of traits/ condition/disease. For example epigenetic, but there are other ways too. I don’t want to go into much details, but I want to stress, that both in autism and in other areas, known and established mechanisms have been proposed to explain causality and phenotypical variation very adequately.

The third point which I have raised time and time over, is that currently individuals with autism are diagnosed according to 3 main behavioral features, even though we know the conditions can be associated with a wide range of unrelated genetic, metabolic, physiological and clinical conditions. In other words, autism is not a single conditions, but a group of syndromes. The implications are that what affects someone might be unique to this person. Equally, the answer in terms of remedial treatments can be very unique. More on this here. The inadequacy of diagnostic criteria is partly to blame for the misunderstanding of the aetiologies (causalities) of the condition.

The fourth point I would like to make is that Autism is associated in about 60% of the cases with health issues, digestive system, immune system and commonly presents with a regressive feature (again about 60% of cases). Some preliminary reports can be found discussed in the BMJ. This is important because we are starting to conceive that some people might be more vulnerable than others if they are placed in situations of overload. Overload can be understood quite broadly. Overload in terms of insult to the immune system, overload in terms of specific toxins (e.g. organophosphates), or overload in terms of stress, etc.

How can someone with autism be helped and understood?

When I meet people with autism I listen to what they or their family say and express. I listen to their history, complaints, issues, traits, preferences etc. I have come across many highly detailed and convincing stories of children suddenly regressing after vaccination. Equally, I have had cases who regressed after a severe infection. Or some who were regressing after general anaesthesia. But equally, I have cases who regressed with no clear association we could identify. And also of course, cases with no regression, where the child presented with developmental differences apparent from very early on, typically before age one. We have also cases for whom we highly suspect an early pre-natal insult (e.g. anti-epileptic usage in the mum, or drug usage), though these cases are more rare. I am unsure about the impact of birth trauma, but certainly in our sample of 400 children, as many as 25% have experienced very dramatic deliveries. Shortage of oxygen supply can affect brain function and development. Very likely though, we are not talking about a single trigger working centrally in isolation, but a sum of triggers. None the less though, in the current complex environment we live in, it is totally conceivable and likely that some very specific and particularly challenging triggers will constitute the final load, the last straw on the camel's back, that tip someone’s function out of balance. Biologically speaking, vaccines are amongst the most challenging experience vulnerable individuals are exposed to.

The issue of vaccination is not the only factor potentially implicated in autism

I believe that many doctors are aware of the potential side effects of vaccines, not just to children but also to adults and elderly. They have expressed their reservation and concerns in private very clearly, yet, they will not stand publically to say it to the exception of a few doctors.

What the government has in mind is that vaccination on balance saves lives, and it does. The argument is about the herd immunity. And this argument has been fine all along, partly because the numbers of causalities were essentially unnoticed, or low, or affecting people no one was particularly adamant to fight for. On balance therefore vaccinations have helped preventing diseases. But things have started to change when children appeared to become affected shortly after new vaccinations were introduced. The difference here is that we are talking about a significant number of similar accounts, and more importantly still, we are talking about the most precious people in the world, children. And their parents who are in their 20-40s, are very able and motivated to fight for them and defend their rights. To them even a very low risk of side effect associated with vaccination is an unacceptable risk. The herd immunity concept no longer makes sense when the side effect consequences are experienced within the family.

In short, yes, in my opinion vaccination is implicated in some cases of autism, my guess estimate is in about 20% of cases of today's autism, possibly more, but not less. There are other issues that are very important to consider and vaccination almost certainly affects a person in combination with others environmental factors and together with a genetic susceptibility.

The governmental and health authorities should reconsider the safety issues of our environment drastically, across the board, industrial emissions, pesticides use, the quality of the food we ingest (nutritional value is known to be on the decline), life style etc. We should also reconsider the way patients and people are being treated once they enter the health care system. Listening to what people have to say is so essential and relevant to what happened to them. Science and medicine should remain a lot more independent from any industry, because there is too much conflict of interest. One cannot trust a study that is conducted by anyone that aims to promote a product or has a vested position. Or at least it should be highly scrutinised by an independent panel of experts, which is not always the case even with the current peer-reviewed system. We should keep in mind that in science, there are very few true independent individuals, except those who are perhaps somewhere on the spectrum, for whom conventions are unimportant compared to necessity to focus centrally on what makes the most sense and is more likely true.

Returning to the start of this post, I don't think debating on these issues, in the current autism political climate is helpful. I prefer instead with others, to focus on individuals and their specific needs and assisting them to access to the services and treatment they can benefit from. However, I am not afraid to debate and discuss my views if being asked.