12/13/2010

Hyman's Anecdotal Healings: Now The Autism

Mark Hyman loves the case study; when one of his posts at Huffington Post deals with an almost magical healing he's engendered, well, chances are, there's gonna be a kid involved. This time up, it's Hyman curing autism cuz he's teh man.


Let's look at his first paragraph: "Imagine being the parent of a young child who is not acting normally and being told by your doctor that your child has autism, that there is no known cause, and there is no known treatment except, perhaps, some behavioral therapy."


Fortunately, I don't have to imagine this scenario; I can and do speak from experience. The whole assessment thing for Bobby was hell on wheels from 1994 when we first began the process through 1998 when we got a thorough assessment. We were never told there were no known causes. Even in the mid 90s there were known causes and tests to run, like Fragile X, so that right there is BS on Hyman's part. We were also, despite the crap we were told, never told there was no known treatment. Speech, OT, PT and therapy were begun in 1994, even as we went through a string of inaccurate diagnoses.


"[N]ot acting normally"? How about we fix that with a child who is developmentally delayed? That's better, isn't it? Not meeting milestones? More descriptive, too, don't you think?


Onto the remainder of that paragraph: "That is exactly what Jackson's parents were told as their 22-month-old son regressed into the non-verbal psychic prison of social withdrawal, disconnection, and repetitive behaviors typical of autism." "[P]sychic prison"? Hyman's batting a thousand, isn't he? Alright, maybe these parents were indeed really told these things; we weren't there and we don't know the competence of the diagnostician. After all, our family's personally been through more crappy psychologists than good ones, so I can allow that this anecdote may be an accurate representation.


Let's look at the rhetorical function, though, of Hyman's introductory paragaph. His title leads you to believe that the focus of the article is on the latest research to come out: "Autism Research: Breakthrough Discovery on the Causes of Autism." Why the need for this appeal to emotionalism, then? Hyman sets the piece up that there's no information about why autism happens and how to lessen the severity of nonadaptive behaviors and symptoms, only to immediately launch into the exact opposite in the second paragraph: "While we don't have all the answers, and more research is needed to identify and validate the causes and treatment of autism, there are new signs of hope." Which is it? Do we know nothing, or do we have some answers?


At any rate, this new hope Hyman holds out refers to the new study in JAMA on mitochondrial dysfunction and autism that Emily Willingham takes a good look at at The Biology Files and that I cautioned we should not overinflate (good thing, too, as this is exactly what Hyman does). Hyman doesn't appear to be one to advance cautiously. Instead of noting the small sample size and that only 5 of the 10 autistic sample and 2 out of 10 of the control sample had mitochondrial DNA overreplication, and yet, Hyman writes that this preliminary study of 10 autistic children "discovered a profound and serious biological underpinning of autism." No, it didn't. As Emily Willingham notes in her post, "Do these findings mean that all or most people with autism have mitochondrial dysfunction? No. The study results do not support that conclusion. Further, the authors themselves list six limitations of the study. These include the possibility that some findings of statistical significance could be in error because of sample size or confounders within the sample and that there were changes in some of the endpoints in the autistic group in both directions. In other words, some autistic children had much higher values than controls, while some had lower values, muddying the meaning of the statistics. The authors note that a study like this one does not allow anyone to draw conclusions about a cause-and-effect association between autism and mitochondria, and they urge caution with regard to generalizing the findings to a larger population."


So, how can Hyman hype this as he does? And, why? Why do this? Ah  well, because Hyman cures the toddler he introduces in the first paragraph because he already knew what he said the study proves, of course. First, Hyman reduces the autism debates into a false dilemma: "whether or not autism is a fixed, irreversible brain-based genetic disorder, or a systemic, reversible body-based biological condition that has identifiable causes, measurable abnormalities, and treatable dysfunctions. In other words is autism a life sentence or a reversible condition?" Of course, by now, you should know that Hyman thinks it's the latter and he can fix it. The problem with this is no one in his right mind thinks that autism "is a fixed, irreversible brain-based genetic disorder." It is a neurological condition that  presents as pervasive developmental delays, difficulties in social reciprocation, language, and fixed interests, along with possible  motor function issues. It is a large spectrum, where individuals may have no language delays and high intelligence to individuals who are severely impacted, tremendously delayed, with accompanying comorbids of intellectual disability and self-injurious behaviors, and every possible combination in between. Note that his second options completely belies his first paragraph, as well: "systemic, reversible body-based biological condition that has identifiable causes, measurable abnormalities, and treatable dysfunctions."  Certainly there are DAN! practitioners and others like the Geiers who are out there touting autism as something that can be cured with chelation, chemical castration,  and other alternative treatments. Autism is a spectrum disorder, and the people out there promoting treatments, "cures" and the like are also a spectrum, ranging from the evidence-based to the plausible-but-not-empirically-validated to the outright woo-nuts who think that fecal transplants and  mining chelators on breakfast cereal are viable fixes for autism.


Hyman goes on to push himself as an expert in mitochondrial disorders based on his two books on metabolism.  Of course, Hyman is the hero in his piece: "I found all these problems in Jackson, and over a period of two years we slowly unraveled and treated the underlying causes of his energy loss which included gut inflammation, mercury, and nutrient deficiencies. Over time, the tests for his mitochondrial function and oxidative stress (as well as levels of inflammation and nutrient status) all normalized. When they became normal, so did Jackson. He went from full-blown regressive autism to a normal, bright beautiful six-year-old boy."  Make sure not to miss the mercury bit in the quote.


Of course, Hyman presents himself as the one with all the answers, even when it means co-opting something that the researchers in autism have been saying for more than a decade: "There is no such thing as "autism." Rather there are "autisms" -- different patterns of biological dysfunction unique to each child that result in multiple insults to the brain that all manifest with symptoms we call autism." Thanks, Hyman, for pointing out something that researchers and those well-versed in the field already knew. There are multiple causes for what we term pervasive developmental disorder.  Hyman doesn't stop there; he then goes onto say that researchers need to work together (no shit, really?), and that the approach to treat autism must be comprehensive (oh, wow, the insights here!). 


It's bad enough to co-opt these two things that autism researchers and those who work in the field  already know and acknowledge: multiple etiologies and a need for comprehensive therapies, as his own stroke of insight; Hyman then asserts that the mainstream must follow in the line of the alternative practitioners with their lines of woo.


Hyman's post rests on unsupportable assertions: the idea that mainstream researchers and practitioners don't know anything and can't do anything, while alternative practitioners have all the answers and the cures. And of course, Hyman's one of them.

3 comments:

lifewithasperger said...

Good job, Kim. "psychic prison" really got my dander up. :-)

Clay said...

Hyman needs to be punctured. (Metaphorically speaking.) ;-)

KWombles said...

Thanks, Laura.

Hey Clay, nice of you to come visit. That's an image I'd rather not have had in my mind. :)