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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Friday, June 10, 2005

    Accelerating Diseases: One of the most oft-repeated phrases in today's medical journalism is that "autism cases are on the rise" as in:

    Autism, a little-understood condition marked by social withdrawal, repetitive behaviors and poor communication skills, is believed to be the fastest-growing developmental disability. There are varying theories as to why autism is on the rise, from the use of mercury preservatives in childhood vaccines, to increased awareness driving more diagnoses. The Centers for Disease Control and Prevention in Atlanta estimates about 24,000 children are diagnosed annually, and that as many as 500,000 children in the U.S. have the condition.

    The idea that mercury perservatives in vaccines cause autism is the lie that will not die, thanks to a crop of special-interest groups whose existence depends on keeping it alive.

    But clearly, the drive to diagnose more cases is alive and well, as evidenced by the Wall Street Journal article linked above, which notes a trend toward diagnosing autism at younger and younger ages. The problem is, even the doctors doing the diagnosing aren't sure the children really have autism, preferring instead to call their diagnosis "provisional." With good reason, it turns out:

    In cases of very young children and dramatic recoveries, some experts raise questions about whether the children were ever suffering from autism to begin with. And some researchers say they have observed children who appear to have autistic symptoms early on but later seem to grow out of them. Marian Sigman, a child-psychiatry professor at UCLA, co-authored a study looking at a group of 14-month-old siblings of autistic children who also had significant language delays (siblings are frequently studied as they have a higher likelihood of developing autism themselves). The study found that most of these children were normally developing by 54 months.

    Diagnosing children earlier certainly raises the number of cases - even if they aren't really cases of autism - and it certainly profits the centers specializing in autism treatment. But how can they honestly measure their success if the majority of their patients would get better on the center's intervention? They can't in good conscience say that their treatment prevented the development of full-blown autism in their patients, because they have no way of knowing whether or not an individual patient would have gone on to develop recognizable autism.

    Nevertheless, it seems to give parents some comfort:

    For her part, Ms. Lyle is grateful for the early diagnosis. If Hailey, now almost 4 years old, hadn't been treated so soon, her mother says, she would have "become one of these children who sits in a corner rocking and banging her head on a wall."

    Or maybe she would be just as normal as she is now. No one knows.

    UPDATE: From a reader:

    I believe the increasing incidence of autism diagnosis is part of the self fullfilling prophecy that begins with today's vulnerable parents, already predisposed to fear for their children's health and future success, easliy frightened into seeking reassurance regarding whatever topic their neighbor, or newspapaer, or TV program dejour buzzes them with. My sister-in-law tried to get my wife to avoid the MMR series for our son because of the unfounded autism scare. Fortunately our pediatrician has a specialty in childhood infectious disease and he strongly countered the scare info.

    And I presume every clinic, regardless their good intention, sees each of those fear driven consults as a billable service. More billable events, more good work they can do.

    Of course!

    posted by Sydney on 6/10/2005 08:34:00 AM 0 comments


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