Thursday, December 03, 2009

Questionable Autism Epidemic Commentary by Dr.Maria Gieron-Korthals

"Maria, your article is irresponsible. How dare you state an opinion as fact? Your arguments on the reason for increased rates of autism are speculative at best. "

The above comment was posted in response to Dr. Maria Gieron-Korthals article in the Tampa Bay Tribune "Despite rising numbers, autism is not an epidemic"

The comment author, "pithetake", is correct. Dr. Maria Gieron-Korthals does present as fact her opinion that there is no real increase in rates of autism:

"A startling jump in the number of reported cases of autism – recent government-funded studies state that the disorder may affect one out of every 100 children– might lead you to the think there's an autism epidemic. Well, the good news is there is no epidemic. So why are we seeing such high numbers?

There are two main reasons. First, the definition of autism has broadened, which would include more children and, therefore, increase the total number. Second, there is a greater awareness of autism, so more parents are going to the doctor sooner, and doctors and other professionals are making the diagnoses earlier"

To my knowledge no one disputes that a substantial increase in autism diagnosis occurred because of the broadening of the definition of autism in the early 1990's (1993-4). But no amount of creative, wishful, thinking can credibly explain how that definition change at that time accounts for continual and rapid expansion in the numbers of autism diagnosis 15 years later. From 1 in 500 to 1 in 250, 166, 150 and now 1 in 100. In just the last two years estimates are being raised from 1 in 150 to 1 in 100 and the good Doctor explains such an increase primarily on a diagnostic definition change 15 years ago? Baloney.

It seems reasonable to assume that, like most aspects of life in the Internet era, there is greater awareness and there is undoubtedly greater advocacy driving increased autism awareness, but there is no irrefutable and precise measure of the impact of such general factors on increased autism diagnoses. Given the startling increases as measured by the CDC more than superficial assumption is required to credibly explain why there are so many autistic children today. Saying that, in essence, we just didn't notice them, or think of them that way as recently as a couple of years ago just doesn't cut it.

In expressing her opinion Dr. Maria Gieron-Korthals ignores the study by Irva Hertz-Picciotto, Ph.D., of the UC David MIND Institute which concluded that environmental factors may be partly behind the increases in autism diagnoses. Dr. Hertz-Picciotto was featured on WebMD where she acknowledged the role of diagnostic definition changes and increased awareness in increasing autism diagnoses but also referenced the possible contributions of environmental factors:

"When you put it all together, this doesn't come close to explaining the increases in the last 10 years. The more you whittle away at this increase, the more you have to say that what is left over is real. ... Given that autism cases keep going up, and can't be fully explained by artifacts, environmental factors deserve serious consideration.

The awareness thing is very hard to quantify. But at some point, as more and more parents became aware of autism, the increase should have leveled off. Instead we see a continued increase in autism.

Time is passing and science has a lot to do to find the real causes of autism. A lot has changed in the environment over the last 10 to 15 years. And I paint with a broad brush when I say environment: These changes include things like medications people take and assisted reproduction technology as well as what is in soaps and pet shampoos and toothpaste and so forth."

Even the very cautious and conservative IACC, Interagency Autism Coordinating Committee, recognizes in in its 2009 Strategic Plan for Autism Disorder Research that environmental factors likely play a role in causing or triggering autism:

"It is imperative that resources be devoted to research commensurate with the public health need. Specifically, we need research that deepens our understanding of ASD, including the complex genetic and environmental factors that play a role in its causation; development of improved ASD diagnostic approaches and treatments ... Having sound research on the risk factors and the environmental triggers for ASD ultimately may allow us to achieve the goal of prevention: preventing the development of the disorder in some people at risk or reducing the degree of severity in those affected... As with many complex disorders, causation is generally thought to involve some forms of genetic risk interacting with some forms of non-genetic environmental exposure. The balance of genetic risk and environmental exposure likely varies across the spectrum of ASD."

Dr.Maria Gieron-Korthals's statements dismissing any real increase in autism are opinions not facts. Her opinions do not appear to be consistent with current study or informed opinions about the role of environmental factors in causing real increases in autism.

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