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Preventing overdiagnosis: how to stop harming the healthy

BMJ 2012; 344 doi: (Published 29 May 2012) Cite this as: BMJ 2012;344:e3502

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Re: Preventing overdiagnosis: how to stop harming the healthy

A particular concern is population screening projects for autism as a potential target group for newly developed psychiatric drugs.

A Time Magazine article last year [1] publicised a pilot screening project for autism, funded by US charity Autism Speaks, that had taken place in the Korean city of Goyang and apparently discovered an incidence among school children of 1 in 38. Lead author Dr Young Shin Kim was apparently not perturbed by the numbers:

“Kim stresses that the results of her study shouldn't alarm parents into thinking that autism has suddenly exploded in schools. "It doesn't mean there is an increase in new cases," she says. "We just didn't know how to find them and diagnose them. Now we know there are kids with social problems who are not being treated, and we know how to help them."”

Time reported:

“The researchers say they would expect to see similarly high rates of autism emerge in the U.S. and elsewhere if the same data collection strategy were used. "The kids picked up in Korea, many had never been recognized in medical records as having autism," says Geraldine Dawson, chief science officer for Autism Speaks. "That's what needs to be done, that kind of broad screening."”

However, the magazine did not report was that 67% of the screened-positive children seem to have pulled out before the study was completed [2]:

"For the 1,214 sampled screen-positive students, 869 parents (72%) consented to participate in the full assessment. Of these, 286 (33%) completed full assessments. Of those who completed the assessment, 201 (70%) were confirmed to have ASDs (autistic disorder, N=101; other ASDs, N=100), yielding a crude prevalence for any ASD of 0.36% (autistic disorder, 0.18%; other ASDs, 0.18%)."

What the report also did not disclose was that appointment that very same week of Robert H Ring to Autism Speaks:

"Robert H. Ring, previously a Pfizer senior director, will join Autism Speaks in Princeton, N.J., on June 1 in the newly created position of vice president of translational research. His focus will be on helping move drug experimentation from laboratories to clinical trials, "with the goal of improving outcomes for individuals with autism spectrum disorders," according to the nonprofit organization." [3]

While still at Pfizer Ring stated:

“This is a real opportunity to really make a difference for a huge unmet need using expertise we’ve acquired over a number of years. In fact we’re working right now to build a pre-competitive consortium amongst our competitors, including Lilly, Roche, Novartis, Janssen, and trying to agree that this is an important population to be developing medicines for…” [4]

This led to an announcement of a partnership between Autism Speaks, Roche and King's College, London earlier this year [5].

[1] Alice Park, 'South Korean Study Suggests Rate of Autism May Be Underestimated'

[2] Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC, Cheon KA, Kim SJ, Kim YK, Lee H, Song DH, Grinker RR., 'Prevalence of autism spectrum disorders in a total population sample.' Am J Psychiatry. 2011 Sep;168(9):904-12. Epub 2011 May 9.

[3] Lee Howard, 'Past Pfizer autism unit chief to join major advocacy group
By Lee Howard' 12 May 2011,

[4] Pfizer News, 'Autism research unit at Pfizer to address autism spectrum disorders'

[5] 'Unprecedented Academic-Industry Collaboration Seeks New Drugs and Novel Treatments for Autism',

Competing interests: Autistic son

05 June 2012
John Stone
UK Editor
London N22