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Aug 28 2012

Disassembling the Magic Button

This weekend, The New York Times once again demonstrated that one can say basically anything in print as long as it’s confined to the opinion pages. In this case, it was yet another theory of autism.

In autistic individuals, the immune system fails at this balancing act. Inflammatory signals dominate. Anti-inflammatory ones are inadequate. A state of chronic activation prevails. And the more skewed toward inflammation, the more acute the autistic symptoms.

Nowhere are the consequences of this dysregulation more evident than in the autistic brain. Spidery cells that help maintain neurons — called astroglia and microglia — are enlarged from chronic activation. Pro-inflammatory signaling molecules abound. Genes involved in inflammation are switched on.

These findings are important for many reasons, but perhaps the most noteworthy is that they provide evidence of an abnormal, continuing biological process. That means that there is finally a therapeutic target for a disorder defined by behavioral criteria like social impairments, difficulty communicating and repetitive behaviors.

It sounds wonderful, doesn’t it? A cause that points us toward treatment! It’s all in the immune system, and it can be cured by dirt. Well, parasitic worms in the dirt, which is kind of gross, but hey, hope! We can lick this autism stuff!

Of course, we’ve been promised that before. Autism has been “curable” by tackling toxins and diet and hormones. The only problem is that none of them have worked, and all of them have involved subjecting autistic children to treatment that is expensive, ineffective, sometimes dangerous, and always disruptive–a non-trivial matter for autistic children.

A couple decades or so ago, we had better excuses for being this cruel to children. We understood so much less. We didn’t understand why diagnoses were increasing so quickly. We didn’t understand how to intervene and make life better for these children. We certainly didn’t understand that autism comes with abilities as well as disabilities, that there are places in adult life where people with moderate forms of autism get along quite well.

That was then, though. This is now, and we really should know better than to deal in the kind of theorizing labeled as truth that ends up printed in opinion pages rather than science pages.

That’s part of why it’s lovely to see Emily Willingham examine this opinion in detail, using sound, skeptical science. How well does it hold up?

This example of overstatement is just one of many that litter Velasquez-Manoff’s piece. In fact, the opening of the article is an overstatement. I’ll step over the lede’s reference to autism as an “affliction” (terminology that pains and incenses many autistic people) and go straight to graf two. There, we find what Velasquez-Manoff calls “the short of it.” He claims that a “subset of autism–perhaps one third and very likely more–looks like a type of inflammatory disease. And it begins in the womb.”

I’m guessing the headline writer didn’t make it to the second paragraph. But what has me scratching my head more is how Velasquez-Manoff can say without qualification that autism “looks like” an inflammatory disease that “begins in the womb” when actual autism researchers don’t have any firm idea of what causes autism or what the factors in the womb are. A subset of autism may be immune related, in part because of genetics. The writer doesn’t source his “one third” value, but I think it’s a generous inference from this Italian study. One third does not, however, equate to all cases of autism. Nowhere else in this piece does Velasquez-Manoff remind us of that subset distinction or qualify generalizations about autism, perhaps one of the most idiosyncratic of neurobiological conditions.

Velasquez-Manoff goes on to say that your immune system should work like an “action hero,” leaping into action accurately and without misfires before returning to a “Zen-like calm.” Your immune system is never in a state of Zen-like calm unless maybe you’re living in a sterile room at Plum Island, sanitized to the gills. In addition, your immune system is much more of an unpredictable and ungrateful harpy who will, on occasion, totally overreact to viral invasion and just kill you in the process; see, for example, the Spanish flu or the recent outbreak of H1N1. An action hero, this is not. Your immune system is not your buddy. It’s a cellular gang that follows instructions, even if those instructions result in collateral damage.

Emily is an excellent science writer and one who is steeped in the details of current autism research for reasons that are fairly personal. She is motivated, though, not to reach out for the first cure (or the second or the fifteenth) that is handed to her, but to advocate for the best care for children who are often treated as more of a puzzle or problem than as people. And she does it by making sure that any theory or proposed treatment matches all that we know about autism.

That turns out to be both quite a lot and woefully inadequate for supporting theories of all autism. Read all of Emily’s piece if you want to know more about autism research than you will ever discover in the opinion pages. Read it, too, for one of the best examples of compassionate skepticism in action you’re likely to see.

4 comments

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  1. 1
    Amarantha

    Thanks for this. So many non-autistic people keep claiming to speak for us, and we can find it so challenging to speak for ourselves. I’m trying to learn some self-advocacy skills but my job makes it hard to find the time. It’s good to know that someone has our back.

  2. 2
    Stephanie Zvan

    Emily is really amazing on this issue. Thorough, articulate, science-based, and apparently tireless. You could do much worse than to follow her blog and forward her posts to people who need to understand you better.

  3. 3
    Amarantha

    Duly bookmarked/rss’d. Thanks.

  4. 4
    revjimbob

    “Pro-inflammatory signaling molecules abound.”
    Indeed.

  1. 5
    A Taste of 2012 » Almost Diamonds

    [...] A couple of researchers and their recommended proxy suggested that their review of the literature said that stereotype threat wasn’t a real problem. I read the paper and discovered otherwise. The question of human races as “subspecies” came up again, and I talked to a biological anthropologist to make sure I understood what that would mean. I talked about how our default assumptions affect how we describe developmental processes. I also took a moment to appreciate CSICon’s approach to presenting contentious social psychology topics and to point to a blogger who handles these topics exceedingly well. [...]

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