Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
In Clinical Pharmacology and Therapeutics, Destefano(1) recently
offered a brief, thoughtful historical review on the link between autism
and vaccines, clarifying once again that the available evidence does not
support a causal association. Unfortunately, other unsubstantiated
opinions about this link continue to arise, and we agree with Goodman
NW,(2) who stated in a letter to the editor of BMJ that “some things are
just too attractive to the media.”
Other controversial viewpoints have recently been published. For example,
in The Lancet Neurology, Michael Fitzpatrick(3) recently offered criticism
of theories reported in Richard Lathe’s book, Autism, Brain, and
Environment, as reviewed by Geier(4). At issue in Fitzpatrick’s critique
were important claims regarding the purported epidemic of Autism, the
possibility that exposure to environmental toxins play a vital role in the
rise of this epidemic, and the efficacy of biomedical treatments including
chelation therapy and dietary restrictions and supplements. Here, we offer
evidence of the impact of the “attractive” controversy at hand, which is
apparent in Italian daily clinical practice, and is particularly
pronounced in communicating accurate information to parents in the
clinical setting.
At the Pediatric Neuropsychiatry Unit of the University of Catania, we
follow
about 180 children (3-18 years of age) diagnosed with Autism Spectrum
Disorder (ASD).
After an initial inpatient diagnostic phase is completed, we follow up
with the children
every three months, using treatment including applied behavioral analysis
(ABA), in
accordance with National Institute of Mental Health guidelines(5). In
response to the
controversy surrounding environmental toxicity and ASD, 27 % of our
children
began to follow biomedical treatments incorporating dietary exclusions and
heavy metal
chelation therapy in addition to continuing the traditional, recommended
treatment for
ASD, including ABA. However, 1.5 % of the children in our program left the
recommended treatment altogether in order to pursue heavy metal chelation
therapy.
Indeed, this increasing trend has had a profound financial impact on
families.
The typical Sicilian family has an average monthly income of €1800(6). In
order to pursue
heavy metal chelation therapy, a family would typically need to travel to
north Italy in
order to meet with a consultant, often incurring total costs approaching
€600. Moreover,
during our clinical follow-up visits, we must invest a significant amount
of time
attempting to communicate scientifically accurate information about
alternative
treatments, and attempting to allay the sense of guilt that is often
incurred by families
concerning the potential exposure their children may have had to
environmental toxins or
vaccines that may have been administered to their children in the past .
Finally, perhaps in accordance with Sicilian cultural biases and as a
result of the confusion surrounding the controversy, we have experienced
increased difficulty in advising families to participate in genetic
examinations, with as many as 20% of parents refusing to participate in
these examinations.
The recent controversy surrounding associations between vaccines,
environmental toxins,
and ASD, and in particular the possibility of other methods of treatment
for ASD such as
chelation therapy, poses important difficulties for clinicians in daily
practice, as well as in communication with the parents, and imposes
significant financial and psychological costs on families with children
affected by ASD.
References
1. Destefano F.
Vaccines and autism: evidence does not support a causal association. Clin Pharmacol Ther. 2007 Dec;82(6):756-9. Epub 2007 Oct 10. No
abstract available.
2. Goodman NW.
MMR scare stories: Some things are just too attractive to the media. BMJ. 2007 Aug 4;335(7613):222. No abstract available.
3. Fitzpatrick M. Autism and environmental toxicity.
Lancet Neurol. 2007 Apr;6(4):297. No abstract available.
4. Geier MR
Evolving views on the causes of autism specrum disorder. Lancet Neurology
2007; 6:
212
5. Department of Health and Human Services
Mental health: A report of the Surgeon General. Rockville, MD: Department
of Health
and Human Services Administration, Center for Mental Health Services,
National
Institute of Mental Health, 1999.
6. The National Institute of Statistics (Istat). http://www.istat.it.
Italy, 2004.
Competing interests:
None declared
Competing interests:
No competing interests
21 December 2007
Luigi Mazzone
M.D., Ph.D
Benjamin C. Gunter, B.S. and Liliana Ruta, M.D.
Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Catania,Italy
Negative consequences of the continued controversy surrounding Autism in the clinical setting
In Clinical Pharmacology and Therapeutics, Destefano(1) recently
offered a brief, thoughtful historical review on the link between autism
and vaccines, clarifying once again that the available evidence does not
support a causal association. Unfortunately, other unsubstantiated
opinions about this link continue to arise, and we agree with Goodman
NW,(2) who stated in a letter to the editor of BMJ that “some things are
just too attractive to the media.”
Other controversial viewpoints have recently been published. For example,
in The Lancet Neurology, Michael Fitzpatrick(3) recently offered criticism
of theories reported in Richard Lathe’s book, Autism, Brain, and
Environment, as reviewed by Geier(4). At issue in Fitzpatrick’s critique
were important claims regarding the purported epidemic of Autism, the
possibility that exposure to environmental toxins play a vital role in the
rise of this epidemic, and the efficacy of biomedical treatments including
chelation therapy and dietary restrictions and supplements. Here, we offer
evidence of the impact of the “attractive” controversy at hand, which is
apparent in Italian daily clinical practice, and is particularly
pronounced in communicating accurate information to parents in the
clinical setting.
At the Pediatric Neuropsychiatry Unit of the University of Catania, we
follow
about 180 children (3-18 years of age) diagnosed with Autism Spectrum
Disorder (ASD).
After an initial inpatient diagnostic phase is completed, we follow up
with the children
every three months, using treatment including applied behavioral analysis
(ABA), in
accordance with National Institute of Mental Health guidelines(5). In
response to the
controversy surrounding environmental toxicity and ASD, 27 % of our
children
began to follow biomedical treatments incorporating dietary exclusions and
heavy metal
chelation therapy in addition to continuing the traditional, recommended
treatment for
ASD, including ABA. However, 1.5 % of the children in our program left the
recommended treatment altogether in order to pursue heavy metal chelation
therapy.
Indeed, this increasing trend has had a profound financial impact on
families.
The typical Sicilian family has an average monthly income of €1800(6). In
order to pursue
heavy metal chelation therapy, a family would typically need to travel to
north Italy in
order to meet with a consultant, often incurring total costs approaching
€600. Moreover,
during our clinical follow-up visits, we must invest a significant amount
of time
attempting to communicate scientifically accurate information about
alternative
treatments, and attempting to allay the sense of guilt that is often
incurred by families
concerning the potential exposure their children may have had to
environmental toxins or
vaccines that may have been administered to their children in the past .
Finally, perhaps in accordance with Sicilian cultural biases and as a
result of the confusion surrounding the controversy, we have experienced
increased difficulty in advising families to participate in genetic
examinations, with as many as 20% of parents refusing to participate in
these examinations.
The recent controversy surrounding associations between vaccines,
environmental toxins,
and ASD, and in particular the possibility of other methods of treatment
for ASD such as
chelation therapy, poses important difficulties for clinicians in daily
practice, as well as in communication with the parents, and imposes
significant financial and psychological costs on families with children
affected by ASD.
References
1. Destefano F.
Vaccines and autism: evidence does not support a causal association. Clin Pharmacol Ther. 2007 Dec;82(6):756-9. Epub 2007 Oct 10. No
abstract available.
2. Goodman NW.
MMR scare stories: Some things are just too attractive to the media. BMJ. 2007 Aug 4;335(7613):222. No abstract available.
3. Fitzpatrick M. Autism and environmental toxicity.
Lancet Neurol. 2007 Apr;6(4):297. No abstract available.
4. Geier MR
Evolving views on the causes of autism specrum disorder. Lancet Neurology
2007; 6:
212
5. Department of Health and Human Services
Mental health: A report of the Surgeon General. Rockville, MD: Department
of Health
and Human Services Administration, Center for Mental Health Services,
National
Institute of Mental Health, 1999.
6. The National Institute of Statistics (Istat). http://www.istat.it.
Italy, 2004.
Competing interests:
None declared
Competing interests: No competing interests