Seth’s blog

Gary Taubes pointed to this PNAS paper about climate change and noted that one of the authors, Stephen Schneider, had a big non-financial conflict of interest: If it turns out the whole argument is wrong, he looks like a fool. The accompanying statement (”The authors declare no conflict of interest”) is, if taken to mean the authors have no conflict of interest, wildly inaccurate. Readers unaware of Schneider’s history wouldn’t know this.

I came across a similar example today. A reader of this blog wrote extensive criticisms (here and here) of the idea that prenatal ultrasound may cause autism. He believed Caroline Rodgers, my source for that idea, misrepresented the evidence. In particular, Rodgers pointed to a study that found ultrasound disturbed neuronal migration in mouse fetuses. She said it supported her idea. The reader disagreed, saying,

The bottom line for me is that Dr. Rakic (from the mouse study) clarified, “Our study in mice does not mean that use of ultrasound on human fetuses for appropriate diagnostic and medical purposes should be abandoned. Instead, our study warns against its non-medical use.” Yes. Okay. No more boutiquey, keepsake ultrasounds. Great. But for Rodgers to skew this data (along with the FDA’s and others’) into claiming that ultrasounds under the care of an Obstetrics professional (and for medical use) are causing autism is disingenuous at best, unethical propaganda for the Midwifery Way at worst.

The reader is a professor who teaches composition. Maybe an English professor.  He or she takes Rakic seriously, where I completely ignore his statement because of a conflict of interest. If Rakic questions “appropriate” ultrasound, he will be attacked in many ways, making his life unpleasant. I have no idea whether this swayed Rakic, but he would be only human if it did.

Of course developing neurons are unable to distinguish appropriate and inappropriate ultrasound. Rakic’s statement is ridiculous as Rakic and all insiders (neuroscientists) know, I believe. All insiders know that there are dozens of examples where findings from mouse brains have turned out to be true for human brains, in spite of the many differences between them, and that there are thousands of grant proposals in which mouse brains are claimed to be a worthwhile model for human brains. All insiders know this, realize the pressure on Rakic to say what he said, and, like me, just ignore it. As far as I can tell, Rakic pays no price for misleading outsiders because the outsiders don’t know they are being misled. (Just as with political lobbying: the public doesn’t understand what’s happening.) The composition professor doesn’t know this, as far as I can tell.

Rodgers is not claiming that ultrasounds “are causing autism”. She is saying they might cause autism, that there are several reasons to think so, and therefore (a) the ultrasound-autism idea deserves further scrutiny and (b) ultrasounds should be avoided as much as possible until more is known.

I previously blogged (also here) about Carolyn Rodgers’s idea that prenatal ultrasound may cause autism. It turns out that she isn’t the only person with this idea; researchers at the University of Louisville recently published the same idea.

I learned about the Louisville study from Anne Weiss, who said the connection has been plausible for a long time.

Ultrasound was introduced into obstetrics in the 1970’s and was generally restricted to high-risk pregnancies.  By the 1980’s policy statements were issued by ACOG, the NIH and equivalent bodies in Europe and Canada stating that its use should remain limited to high-risk cases. Despite these recommendations, ultrasound technology became common in hospitals and doctors’ offices and routinely applied to low-risk populations. Within a short time the majority of pregnant woman were being exposed at prenatal visits, during multiple scans in hospitals, and during continuous monitoring during labour (which could mean 12 to 14 hours during childbirth alone). Skills and techniques used to monitor the fetus prior to the introduction of ultrasound (in utero and during the birth process) were slowly undermined by the technology and often underutilized.  Iatrogenic effects from false positive readings, - unnecessary C- sections, inductions, instrumental deliveries etc. caused harm to moms and babies, especially in the early 1980’s.

Three important names in the 1980s were (1) Robin Mole, who presented a paper “Possible Hazards of Imaging and Doppler Ultrasound in Obstetrics” to the Royal Society of Medicine Forum on Maternity and the Newborn:  Ultrasonagraphy in Obstetrics, April 1985. She was former director of the Medical Research Council Radiobiology Unit, England.  Also the work of (2) M.E. Stratmeyer - Research in ultrasound.  A public health view.  Birth and Family Journal 1980 and (3) Doreen Liebeskind - still at Albert Enstein and a prof of radiology- presented at a symposium at Columbia in 1983.   She was concerned that ultrasound may be producing subtle changes in the fetal brain perhaps affecting behavioral mechanisms, possible changes in reflexes, IQ, attention span or some of the more subtle psychological, psychiatric or neurological phenomena.  Referred to animal and lab studies that showed ultrasound may cause chromosomal damage, breakdown of DNA, etc.  There are others who sounded the warning that this was not a benign technology but these voices were crowded out for varied reasons like threats of litigation, loss of the traditions skills of birthing etc.

There were also Japanese studies that raised concerns about ultrasound. Weiss continued:

Unfortunately the use of ultrasound in obstetrics has not declined, despite safety concerns and the lack of research to rule out serious neurological effects.  It’s so entrenched in modern obstetrical practice.    Doctors use the machines to protect themselves from litigation - in the case of fetal abnormalities, undetected multiples, placenta previa, neurological or physical damage to the fetus during childbirth, stillbirth etc.  It has almost become a form of entertainment - you can get photos and videos of baby’s ultrasound.  It’s disturbing how benign it appears.

Within the context of the work I do, ultrasound is just one of many concerns I have with the over-management and medicalization of childbirth.  My clients come to me to find ways to subvert this within the hospital setting or to prepare for a home birth with a midwife.   I also get referrals from doctors whose patients are dealing with difficult issues while pregnant.

Caroline Rodgers, whose ideas I blogged about yesterday, wrote to me about lack of research on the possibility that prenatal ultrasound causes autism:

I have heard confidentially that applications for funding of prenatal ultrasound studies (not specifically investigating autism) have been repeatedly denied over the years — which helps explain the great paucity of safety studies, especially since the early ’90s, when the FDA approved an allowable eightfold increase in acoustic output. As recently as this year, funding was denied an ambitious, multi-site study that would have investigated if there was a relationship between ultrasound and autism.

In 2006 when Yale neuroscientist Pasko Rakic announced the results of his study that found prenatal ultrasound interrupted neuronal migration in mice in a way that was consistent with the brains of autopsied autistics, I was surprised that several scientists, including Rakic, did their best to downplay the results. At the time, Rakic was one of many of Autism Speaks’s scientific advisors.

I have spoken with various people throughout the NIH about my concerns [about ultrasound]. They all pointed to various large studies they believe are investigating ultrasound as a possible environmental cause of autism — most recently, the National Children’s Study and EARLI, but when I tracked down the study designs, it turned out that ultrasound is not being studied.

In a report at the time Rakic’s study was published, he indeed downplayed the results:

Dr. Pasko Rakic, chairman of the Yale department of neurobiology and leader of the study, was quick to offer parents reassurance about the safety of ultrasound — done for the proper reasons — in human pregnancies.

“If I had a daughter and she was pregnant, I would recommend she had it for medical reasons,” Rakic said.

Another researcher agreed:

“I couldn’t agree with him more,” said Dr. Joshua Copel, a professor of obstetrics, gynecology and reproductive sciences at Yale and spokesman for the American College of Obstetrics and Gynecology (ACOG). He was not involved in the study. . .

The researchers noted that mice are very different from humans, so the results of their study must be interpreted with caution.

“The forms of migration [of brain cells] and the timing of migration differ in primates like humans than in mice,” Copel said. “In humans, there is a much longer period in which neurons [nerve cells] are migrating.”

Does that sound “very different”?

I blogged earlier about Caroline Rodgers’s idea that prenatal ultrasound may cause autism. She believes this idea isn’t getting the attention it deserves.

Recently she wrote to the head of Health and Human Services:

The latest autism prevalence figures released in December showed that while the overall autism rate increased more than 50% in the four years ending in 2006, there were significant differences across ethnic groups. White women had a much higher incidence of autism among their children than Black or Hispanic women. White mothers had 9.9 autistic children per 1,000, versus Black mothers who had 7.2 and Hispanic mothers who had 5.9.

There were also geographic differences. Among the 10 states with monitored sites, Alabama and Florida had the lowest autism rates, with averages of 4.2 and 4.6 per 1,000, respectively – far lower than the two states with the highest autism rates, Arizona and Missouri, which tied at 12.1 per 1,000. One interesting apparent statistical anomaly occurred among Alabama’s Hispanic population, which had a 68% decrease in autism while the overall national increase was 57%. In trying to understand why Alabama Hispanics had such a decrease in autism, I searched for evidence of public health policy changes. What I found was a surprise: according to a CDC multi-state surveillance report, Alabama and Florida were two of three states that had cutbacks in Medicaid funding for prenatal care during the time mothers in the study were pregnant. (The third state, West Virginia, was not among those monitored for autism in the latest study.)

Digging deeper, I turned up a CDC report on the timing of entry into prenatal care. The report showed that although most women started prenatal care in the first trimester, the percentages of both Black and Hispanic women who lacked early (first trimester) prenatal care were nearly twice that of White women . . . Over the span of the 10-year study, more women [in] all ethnic groups received early prenatal care, but the 2-to-1 ratio remained the same. . . .
Taken together, these three CDC reports tell a disturbing story: as more women . . .  received more early prenatal care, the autism rate among their children increased, with those women receiving the most early prenatal care having the highest percentage of autistic children. . . .

A rigorous UC Davis study, published in January, of California children born between 1996 and 2000 identified 10 autism clusters . . . Highly educated women were much more likely to have children diagnosed with autism than parents who did not finish high school. In six of the clusters, the rate was as high as 4 to 1. Returning to the CDC Entry into Prenatal Care report, it is striking to note that in 1997 only 8.5% of pregnant women with some college education had delayed prenatal care, versus 29.9% of women who were not high school graduates – further [linking] early prenatal care [and] autism.

A study published in November on prenatal ultrasound trends from 1995-2006 found that the odds of a woman receiving an ultrasound during a prenatal visit nearly doubled over [those] 10 years. . . . The geographical and ethnic differences . . . dovetail with many of the geographical and ethnic differences found in the latest autism prevalence report. For instance, Southern women were 40% less likely to receive an ultrasound during a prenatal visit than Northeastern women, which could help explain why Florida and Alabama had the lowest autism rates among the states monitored. Also, Hispanics, who had the lowest overall autism prevalence rates in both the 2004 and 2006 CDC reports, were 20% less likely to receive an ultrasound during a prenatal than White women.

Not all the statistics available in these reports support the idea that prenatal ultrasound is causing autism. For instance, Southern states such as Georgia and North Carolina did not have low autism rates, but [perhaps this is because] the ultrasound trends study did not take into account “keepsake” ultrasound . . .

She also notes that a study by Yale neuroscientist Pasko Rakic “found that prenatal ultrasound disturbed neuronal migration in mice.”

Here is the broad argument. 1. Autism is correlated with wealth. It is absurd that autism causes wealth; it is unlikely that both are caused by something else. Thus this correlation makes it plausible that autism is caused by something that rich people have more of than poor people. Obviously rich people have more prenatal ultrasound. 2. A localized decrease in autism happened at the same time autism almost everywhere was increasing. At the same place and time prenatal ultrasound screening surely declined. This correlation is very difficult to explain with other ideas about what causes autism. Dozens of things (e.g., genes, diagnostic criteria) previously proposed as explanations of autism remained roughly constant at the same time as the decrease. 3. The mice data make the linkage considerably more plausible, assuming (a) the ultrasound dosage was reasonable and (b) humans with autism have unusual neural wiring that resembles the changes seen in the mice.

The full letter is on her blog. An article by Rodgers about this

Darrin Thompson writes:

Thanks for the pointer awhile back to the GAPS diet. It caught my eye and my wife and I implemented it for us and our autism kids. After about a month we are experiencing marked reductions in psoriasis and allergy symptoms. Our 3 autism kids are [now] doing well with no huge barrages of expensive vitamin supplements. We’re keeping up only with Vitamin E, DHA and eventually selenium. We’re noticing improvements in their communication skills.