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Autism Prevalence Higher than Thought

Crossposted from NeuroLogica Blog

Over the last 20 years the prevalence of autism (now part of autism spectrum disorder, ASD) has been increasing. The medical community is largely agreed that this increase is mostly due to expanding the diagnostic category and greater efforts at surveillance. There remains some controversy over whether or not these factors explain all of the measured increase, or if there is a small real increase hidden in there as well. But largely – we are finding more children with ASD because we are casting a wider net with smaller holes.

If this is true, then we do not yet know what the true prevalence of ASD is. There must be a pool of undiagnosed children out there. Eventually the measured prevalence will hit the ceiling of the true prevalence (unless, of course, we expand the definition further) – but where is the ceiling?

That is the question researchers recently set out to answer, and they did so with a comprehensive 5 year study conducted in South Korea. The results surprised even them:

Results: The prevalence of ASDs was estimated to be 2.64% (95% CI=1.91–3.37), with 1.89% (95% CI=1.43–2.36) in the general-population sample and 0.75% (95% CI=0.58–0.93) in the high-probability group. ASD characteristics differed between the two groups: the male-to-female ratios were 2.5:1 and 5.1:1 in the general population sample and high-probability group, respectively, and the ratios of autistic disorders to other ASD subtypes were 1:2.6 and 2.6:1, respectively; 12% in the general-population sample had superior IQs, compared with 7% in the high-probability group; and 16% in the general-population sample had intellectual disability, compared with 59% in the high-probability group.

The previous estimate of autism prevalence was 1% of the population, or about one child in 100. This study found a prevalence of 2.64%, or about one child in 38 – more than twice the previous estimate. They came upon their higher measurement by taking a thorough survey of the general population. Previous studies have looked at high probability groups – children receiving special services or who have already been diagnosed. This study went into the general population and did a thorough survey for undiagnosed cases. Therefore there is a vast untapped pool of potential ASD diagnoses out there.

The results above also indicate that children with undiagnosed ASD in the general population had less intellectual disability than those in the recognized high probability group. They were also less likely to be male and less likely to have classic autism rather than a more subtle variant than the high probability group – which is not surprising. In other words, the undiagnosed children in the general population met the diagnostic features to be considered on the spectrum, but were largely functioning well in mainstream classrooms. In some cases parents were in denial about their child’s condition, in other cases the parents simply had no idea. In South Korea there is apparently still some stigma attached to the diagnosis.

While the authors conclude that their results indicate the need for still better detection of ASD, many of the undiagnosed children would likely not require or even benefit from special services. Although some would, and of course it would be desirable to capture all of those children.

While 2.6% is a high number for any such disorder, it is not out of line with other common mental disorders such as anxiety, depression, or ADHD. Of course these questions always bring up the very relevant issue of where to draw the line between “normal” and “disordered.” As I discussed recently, categorizing brain function is tricky business. Any identifiable psychological or neurological trait seems to vary at least along the classic bell-curve. You can therefore take any trait and declare two standard deviations to either side as the cut-off for “normal” (a standard practice in much of medicine) and declare those at the fringes to have one or another disorder. That would result in 5% of the population being abnormal.

But it takes more than being at the tails of the bell curve to be considered as having a disorder. The definition also requires that the identified traits are associated with (and plausibly cause) some dysfunction or negative outcome. In the case of ASD the disorder is a lack of social ability (not just learned skills, but the raw neurological hardwiring that underlies our ability to socialize). Interestingly, the current measured rate of 2.64% is almost exactly two standard deviations to the left of the curve (the other 2.5%, making a total of 5%, is the cutoff to the right of the curve – those with high social ability, which is generally not considered a disorder).

Since many of the children captured in the current study seemed to be doing fine, it is possible that the current definition of ASD is simply capturing the left two standard deviations of human variability along the bell curve of social ability. Perhaps the definition is therefore too broad, and needs to be tied more closely with some measure of disability. That is a subject for future research.

The bell curve hypothesis also can be used to support those in the “neurodiversity” community. They argue that ASD is just what I described – normal human neurological variation. I agree with this view to some degree, and I think the data above support that. However – when you get out far enough to the left side of the bell curve you do get to the point where dysfunction is undeniable. At some point it is useful to consider a neurological phenomenon to be a disorder. Children with low social ability (even if they make up for it in other ways) tend to have difficulty in school, with making friends, and later in life functioning in the work environment. No matter what you choose to call it, it is useful to identify children who can benefit from programs to help them compensate for their lack of social ability.

Also – we cannot assume that ASD is simply everyone more than two standard deviations to the left of the bell curve. It is possible that the actual curve is not a pristine bell-shape but is bi-modal, representing one hump of normal human variation, and then another hump at the low end of social ability that represents a theoretically definable separate population. This second hump might represent those with one of a group of genetic variants that leads to what we recognize as autism. This is almost certainly true, as children with autism have a higher incidence of intellectual impairment and seizures, suggesting a neurological disorder and not just normal variation. There is also increasing evidence of genetics links to autism.

Further – the low end of the bell curve of normal variation would blend imperceptibly into the second hump of autism disorder. At present the diagnosis of ASD is based entirely on clinical features, making it difficult to separate out different underlying causes. (As I stated above, we can make subtype distinctions based upon associated neurological conditions, but this is still a clinical inference rather than a distinction based upon known cause.)

As neuroscience advances, h0wever, it may become possible to tease out the current mixed bag of clinical ASD by identifying specific underlying genetic or neurological conditions. We may undo the lumping of all these children into one ASD spectrum by identifying subtypes by either their genetic profile, or perhaps their neurological function as examined by functional MRI scanning or a similar functional scan. We are already making significant progress in this area, but this is still an area ripe for further research.

Conclusion

This study adds an interesting data point to the whole picture of ASD. If correct, then the theoretically upper limit of ASD prevalence is about 2.6% of the population, more than twice the previous estimate. It also indicates that when you undergo a program of thorough searching, you will find more diagnoses. No one can reasonably think that the true prevalence of ASD suddenly doubled.

While it doesn’t prove that the steady increase in ASD diagnoses over the last 20 years was due to increased surveillance, it does support that hypothesis by showing the potential of just looking harder. Those children with ASD were always there, they were simply not identified.

Posted in: Neuroscience/Mental Health

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82 thoughts on “Autism Prevalence Higher than Thought

  1. windriven says:

    As with ADHD, there is a growing bias to diagnose. I’m not suggesting a conscious, malevolent effort to defraud. But when there is a freshly decorated pigeonhole, it attracts pigeons.

    When a kid presents with imperfect social skills the kid can be categorized as “going through an awkward phase” or could be diagnosed as having ASD.

    Diagnosis implies treatment and doing something seems better than doing nothing. Doctor and parent each have something to latch on to.

  2. Costner says:

    I’m assuming we can expect to see the antivaxxers coming out of the woodwork to profess that clearly the reason South Korea has a similar rate of autism to the US is that they share a similar vaccination schedule.

    I tend to agree that the data suggests much of the “increase” in ASD diagnoses comes down to a broader definition of what is considered an ASD, but that doesn’t seem to convince everyone.

    Coincidentally this debate mirrors that of cancer in many ways. We often hear comments from the uniformed that suggest years ago people either didn’t die from cancer, or that cancer wasn’t nearly as common as they try to suggest environmental factors or injested chemicals are responsible for so much of the cancer that exists today. I’ve heard everything from using plastic containers in the microwave to a side effect of consuming too much sugar.

    What these people fail to understand isn’t that there is more cancer today… it is that we are so much better at detecting, diagnosing, and treating it. I’m quite certain many of our ancestors suffered from cancer, but when they died it was often classified as “old age” or some other unknown cause. Granted when the life expectency is in the low 50s due to other risk factors, poor nutrition, and communicalble disease… cancer probably was less of an issue.

    These are the types of issues experienced when people try to replace science with casual observation or personal experiences.

  3. roblindeman says:

    Until we have determined what we ought to do about “it”, we need first to establish what “it” is, or even if there IS an “it”!

    Much as I admire Dr. Grinker from his monumental book “Unstrange Minds”, I fear he is adding more heat than light to the debate.

    We have no idea what are the pathological correlates of ASD. Without objective criteria, we have only subjective criteria (survey data, for example) to define the character of a “disease”.

    I predict the incidence of ASD will continue to increase. What’s to stop it from doing so?

  4. cervantes says:

    This can be viewed as a case of medicalization. These children are labeled with a disease because an observer decides that they meet certain behavioral and, as a matter of fact, social criteria, i.e. that they don’t have a lot of friends or they are bullied. But in fact, the children in the general population who get this label have no significant IQ deficit (the average for the diagnosed children was 98, the researchers don’t give a p value for deviance from the population norm but even if it’s <.05 the magnitude is trivial), and they are performing normally in school. The only reason they have a "disease" today and didn't yesterday is because the American Psychiatric Association decided to call people like them "diseased." We could also decide that they are within the normal and acceptable range of human variation. Presto! Cured!

  5. windriven says:

    @Costner

    “I’m quite certain many of our ancestors suffered from cancer, but when they died it was often classified as “old age” or some other unknown cause. ”

    Or they died of something else before they ever developed cancer. Life expectancy wasn’t what it is today.

  6. David Gorski says:

    Coincidentally this debate mirrors that of cancer in many ways. We often hear comments from the uniformed that suggest years ago people either didn’t die from cancer, or that cancer wasn’t nearly as common as they try to suggest environmental factors or injested chemicals are responsible for so much of the cancer that exists today. I’ve heard everything from using plastic containers in the microwave to a side effect of consuming too much sugar.

    What these people fail to understand isn’t that there is more cancer today… it is that we are so much better at detecting, diagnosing, and treating it.

    The term is overdiagnosis:

    http://www.sciencebasedmedicine.org/?p=565
    http://www.sciencebasedmedicine.org/?p=2249
    http://www.sciencebasedmedicine.org/?p=6940

    Actually, I’ve come to appreciate that it is a good rule of thumb in medicine that the more you look for a condition (as in screening asymptomatic populations) the more of that condition you will find. Almost always. Autism is indeed very much like cancer in this way. Twenty years ago the diagnostic criteria were broadened, but there was also undertaken a huge effort to find children with autism, many of whom had previously been classified as having different conditions (diagnostic substitution). Is it any wonder that the apparent prevalence has risen markedly over the last two decades?

    Not to anyone who understands a bit about screening.

    Let’s compare this to breast cancer. There is a form of breast cancer known as ductal carcinoma in situ (DCIS), which is defined by cancerous cells within the milk ducts that have not yet invaded into the surrounding tissue. Before mammographic screening, DCIS was an uncommon disease. Now it’s very common indeed. The problem is, we don’t know for sure what percentage of DCIS will progress to become life-threatening invasive breast cancer; so we treat it all. Be that as it may, what we have in DCIS is a disease whose apparent incidence skyrocketed after the introduction of a screening test. More than likely, the true incidence never changed or didn’t change nearly as much as the screening would lead us to believe.

    There’s no reason to think that the same thing hasn’t happened with autism/ASD.

  7. Rick says:

    I thought ASD has an overdiagnosis rate of 20%. While I couldn’t find that study I did find the following.

    The Autism Diagnostic Interview – Revised (ADI-R)[17] is the most established autism-specific diagnostic interview and consists of 93 questions relating to current skills and behaviors, as well as in relation to how these behaviors were manifest at 4–5 years of age (or ‘ever’ in some cases).

    The most widely used and best validated diagnostic assessment is the Autism Diagnostic Observation Schedule (ADOS),[16] a semi-structured interactive assessment administered by a trained examiner.

    Mazefsky and Oswald compared the diagnostic outcomes from the ADOS and the ADI-R with the consensus clinical diagnosis of a specialist clinic team, based on DSM-IV criteria.[23] Diagnostic agreement with the team diagnosis was 77% with false-positives of 16% for both instruments, indicating a slight tendency to ‘overdiagnose’.

    http://www.medscape.com/viewarticle/716433_3

  8. cervantes says:

    Right. And is DCIS even a “disease” at all? You could also label it a risk factor for the disease of breast cancer, although we don’t actually know what the risk ratio is.

    This “diagnosis” of ASD in children who happen to meet certain criteria that somebody made up is just disease mongering, as far as I’m concerned. Sure, there might be ways of helping kids whose social talents aren’t that great, but we don’t apply a disease label to kids who have difficulty with math, or aren’t very athletic, or whose talents in whatever area aren’t the greatest. We’re all different, good at some things, not so good at others. The disease frame isn’t necessarily the most helpful in such circumstances, and this is likely to be one of them.

  9. roblindeman says:

    “we don’t apply a disease label to kids who have difficulty with math, or aren’t very athletic, or whose talents in whatever area aren’t the greatest.”

    Give it time.

  10. You’re missing the point about the criteria for being considered a “disorder”

    You have to lack an ability or function that most people have, and this lack has to cause demonstrable harm.

    And – disorders are not necessarily diseases. They could just be ways of identifying populations that need special attention or services.

    But it certainly gets fuzzy. A lack of reading ability is called dyslexia, and warrants special attention in school. Lack of math ability is not so recognized, but it could be. One might have neurological damage that causes acalculia – an inability to perform math. That would be a disorder, and it can be caused by a stroke or other brain injury.

    Some kids who are not athletic are so because they have muscular dystrophy, or a genetic nerve disorder, or a cerebellar problem. Identifying kids as “not athletic” and then screening them for neurological disorders is actually not a bad idea.

  11. windriven says:

    @Dr. Novella

    “[You're] missing the point about the criteria for being considered a “disorder”

    Perhaps roblindeman overstated the observation that we are all different, all have strengths and weaknesses, and that sometimes the tendency is to celebrate the strengths as personal triumphs while seeking pathologies to explain the weaknesses.

    The notion of a disorder as you define it is technically significant but practically less so. If I present to my physician claiming depression I am likely to be prescribed an antidepressant whether or not my melancholy rises to the level of “demonstrable harm.”

  12. windriven,

    People who aren’t suffering are unlikely to go to their doctors and ask for help.

    I can tell you about that. I spent two years asking for help and being told I wasn’t sick enough. By the time I was sick enough to be offered help I had lost my job and my friends and was stuck in an abusive relationship.

    There was no value-add in making me suffer that much in order to deserve help. None.

    I’d been struggling for years before deciding for myself that I needed to ask for help. I don’t think that’s in the least unusual. Turning me away so that I could get “sick enough” to need help rather that paying attention to the fact that I didn’t think I could manage on my own any more was just archaic.

    So one marker of someone having a “disorder” as opposed to “normal variation” is that they think it’s a problem and they ask for help with it.

  13. Woody says:

    @ cervantes
    “This “diagnosis” of ASD in children who happen to meet certain criteria that somebody made up is just disease mongering, as far as I’m concerned. ”

    This statement borders on denialism and resembles statements made about other mental health disorders by a famous Hollywood actor that will remain unnamed.

    Behavioral scientists who have dedicated their careers to understanding and helping individuals with ASDs did not just “make up” the criteria – they developed them over time using appropriate scientific principles, and have revised those diagnostic instruments over the years to reflect better understanding of the disorder.

    I hope you are not arguing that individuals who are significantly impacted by their ASD symptoms do not exist? Try walking in the shoes of a teenager on the spectrum who is nonverbal, routinely engages in self-injurious behavior, and will likely never be able to live independently.

  14. windriven says:

    @Alison Cummins

    “People who aren’t suffering are unlikely to go to their doctors and ask for help.” You apparently have never met a hypochondriac or a ‘tiger mom’ focused on tweaking her offspring into ubermenschen.

    I have no doubt that there are many sufferers of any number of maladies who have a difficult time getting much needed help. The situation you describe cozies right up to nonfeasance. But that is far afield from my point.

    I was addressing two issues, the most important being clinical mission creep that can happen when people are assigned to convenient bins because it is, well, convenient. Dr. Novella made the point that there is an actual threshold for “disorder.” My counterpoint was that while technically accurate, out in the world of limited time, DRGs, and coding for insurance companies, practical diagnoses may not be held to that high standard. And if a study (and I don’t know if any have been or will be) is based on a review of specific diagnosis codes, it may be skewed by this expedient.

    The lesser point was that people sometimes see their strengths as marks of personal achievement (which they often are) but their weaknesses as something beyond their control (which sometimes they are not).

  15. kulkarniravi says:

    What is interesting in all this debate is a lack of any attempt at either identifying a root cause or at least pointing to some relevant research. What about the environmental factors? Do the long term consumption of certain food additives cause issues such as ADS in progeny? Has anyone studied this in detail. I expect the usual, “there is no evidence” mantra. Perhaps no one has looked for the evidence.

    More than ever, we have started eating frankenfoods. In the USA, the agricultural lobby owns the government, so no one will even consider GM foods evil. In fact manufacturers are actively discouraged from labeling their food GM-free. What about all the sweeteners, preservatives that we consume? How about the regular use of plastics in packaging. There are many recent developments, which may turn out no so benign after all. It makes total sense to avoid many of these avoidables.

  16. “The notion of a disorder as you (Steven Novella) define it is technically significant but practically less so. If I present to my physician claiming depression I am likely to be prescribed an antidepressant whether or not my melancholy rises to the level of “demonstrable harm.””

    and…
    I have no doubt that there are many sufferers of any number of maladies who have a difficult time getting much needed help. The situation you (Alison Cummins) describe cozies right up to nonfeasance.

    If you think your melancholy is harming you but you also think your doctor shouldn’t prescribe you an antidepressant until you are “demonstrably harmed,” then you think that cozying up to nonfeasance is the proper thing to do.

    Do hypochondriacs complain of depression when they are happy?

    Hypervigilant parenting is a little different. It’s the job of parents to protect their children and promote their interests. It’s the job of pediatricians to provide a reality check and reassurance where appropriate. Even then, if a parent or child is distressed that’s a reason to investigate further. If a parent is worried enough about a child’s depression to consult a doctor, exactly how harmed does the child need to be in order to get anything beyond instructions to go away and get over themselves?

    I understand that there’s a theoretical concern that spectrum traits could be medicalized and treated even when they aren’t disorders or causing anyone any problems. I don’t think that in the real world that’s what happens. If you think that’s a significant issue, unless you have evidence, that’s denialism.

  17. another commenter said “we don’t apply a disease label to kids who have difficulty with math, or aren’t very athletic, or whose talents in whatever area aren’t the greatest.”

    roblindeman’s response “Give it time.”

    The learning disability (not disease) associated with math skills is called Dyscalculia.

    “The first neuropsychological definition of developmental dyscalculia was put forward by the researcher Kosc (1974), who defined it as a difficulty in mathematical performance resulting from impairment to those parts of the brain that are involved in mathematical processing, without a concurrent impairment in general mental function. This definition is the same definition that researchers in cognitive neuroscience use today when searching for the causes and features of dyscalculia.”

    To read more “http://www.oecd.org/document/8/0,3343,en_2649_35845581_34495560_1_1_1_1,00.html”

    You can decide (without evidence) that “labeling” children is too harmful and it’s better to let them slide through school focusing on their strong points (like drama, public speaking or art) and ignoring their mathematical weak points. You could also fail them in math while heaping lots of scorn on them “for not really trying”.

    But if you do that, please don’t complain when some of the general population doesn’t understand basic math, much less algebra, biology, chemistry, statistics, etc.

    Childhood is an opportunity to learn how to overcome your weaknesses. Sometimes, due to neuroplasticity, if a LD or other disability is found early and interventions are offered, dysfunction can be mitigated or eliminated entirely. Unfortunately most children with a learning disability or speech impairment or gross motor delay or fine motor delay or auditory processing disorder, etc, don’t just figure things out for themselves. If they could, it would be a disability Also unfortunately, often the intuitive intervention approach doesn’t work. This is why we send children with a stutter to a speech therapist, not just tell them, ‘spite it out!’, ‘slow down’ or ‘focus’.

    One is unlikely to be able to research the most appropriate interventions or apply them to help children without some sort of labeling system.

  18. whoops “If they could, it would be a disability” I meant “wouldn’t be a disability.”

  19. windriven says:

    Good Christmas Alison, substitute the condition of your choice for depression. You are obsessing on an example that happened to resonate with a personal experience. This isn’t about you.

    The gravity of many conditions exists along a distribution – some should be treated, some should not. Most drugs and all surgical interventions carry risks along with benefits. Leaving clinical depression untreated is wrong. But so is spending scarce resources on people who do not have clinically significant conditions. And so is exposing a patient to potential risks that outweigh the malady that they suffer or think themselves to suffer. And yes, we educate, license and compensate physicians to make those calls.

    We have a huge problem with drug resistant bacteria in part because of the willingness to prescribe antibiotics when they weren’t clinically indicated. That exposes ALL of us to danger in much the same way the vaccine denialists expose to disease by compromising herd immunity.

  20. Scott says:

    @ kulkarniravi:

    Nobody’s looked at the potential effects of green tea in causing autism, either. Without some sort of reason to look at it, it’s not reasonable to do so. We can’t look at EVERYTHING somebody feels like asserting without foundation should be investigated.

  21. David Gorski “Let’s compare this to breast cancer. There is a form of breast cancer known as ductal carcinoma in situ (DCIS), which is defined by cancerous cells within the milk ducts that have not yet invaded into the surrounding tissue. Before mammographic screening, DCIS was an uncommon disease. Now it’s very common indeed. The problem is, we don’t know for sure what percentage of DCIS will progress to become life-threatening invasive breast cancer; so we treat it all.”

    Interesting comparison. It seems to me one difference between testing for autism and DCIS is that DCIS can be progessive, I’m assuming without noticeable symptoms and cause death if left too late.

    I believe non-regressive autism (not associated with seizures or a neurological progressive disease) is not progressive, generally not deadly and mostly a concern for it’s symtoms.

    In that case, a fair comparison would be testing for hearing loss in children. Better testing now can show up a variety of levels of of hearing loss. If the form of hearing loss found is mild, not progressive and the child is not experiencing speech delays, behavior, academic or social problem, then many experts find that it is perfectly acceptable to do nothing, aside from agreeing to look at the situation again if changes occur.

    If there is some level of dysfunction in a child who tests indicate mild hearing loss (social, behavior, education, speech) then it seems that a interventions such as hearing aids or schoolroom sound field systems, auditory training, speech therapy, etc, is general accepted.

    It seems this is the process with many tests for disease or disorders. A positive test does not necessarily indicate a need to treat unless there are problematic symptoms.

  22. Windriven, I’ve been told the Goldberg depression scale is reasonably reliable in determining the severity of depression and level of dysfunction when used by a trained clinician.

    Any doctor that immediately prescribes anti-depressants on complaint of the blues without determining the severity, level of dysfunction or other symptoms the patient is experiencing is not a good doctor, IMO.

    Depression can be a fatal disease or it can be a passing or mild disease or it can be a symptom of another disease. It’s complex, so I doubt that one will find some simple solution for sorting the mildly moppy from the people in real danger. That is a good time to use science, so we can sort out the most cost effective ways of saving the most lives and bring a better quality of life to others.

    If you believe that not testing or treating patients that complain of symptoms of depression is superior to testing and treatment if needed, then it would be good to see some evidence in support of that theory.

  23. kulkarniravi – you are officially on my ‘commentors who only have one thought’ list.

    Since I’ve read that thought one thought a few times, it’s seems pointless to read or respond to more of your comments.

  24. My apologies for multiple posts that are also fraught with errors. I’ll leave you all be now.

  25. windriven says:

    @micheleinmicingan

    “If you believe that not testing or treating patients that complain of symptoms of depression is superior to testing and treatment if needed…”

    I cannot imagine what I have ever written that would draw someone to infer that. I was merely arguing that, like the ball in a roulette wheel, a patient has to be coded somewhere and that can lead to the appearance of increased incidence.

    I was secondarily echoing Dr. Novella’s observation that conditions exist along a continuum but that while specific benchmarks may exist that define clinical significance, those bright lines can blur in the real world of a busy medical practice.

    I chose depression as an example because of the difficulties that some physicians I know have in assessing and treating patients with apparently mild depression, anxiety, stress and other mental and emotional complaints. Mea-frigging-culpa if I offended anyone.

  26. kulkarniravi says:

    Scott,

    In my opinion it is a cover up. May not be deliberate, perhaps not even conscious, but I have seen a great reluctance among the medical community to consider the dietary and environmental causes for disease. Is it because they have zero or very little training in diets? Is it because it is harder to make people change something as fundamental as diets?

    Other than genetics, diet must be the most important factor in health. Its influence on pregnancy and the fetus must be equally strong. So your contention that we can’t study everything is a red herring. Diet and nutrition and its effects should put under more intense scrutiny and I am sure many interesting factors will emerge. Question is who will bell the cat? Not pharma, for there is nothing in it for them. Not doctors because they are not trained. Not FDA because they are in the pockets of pharma and AMA. Poor common man!

    The long and the short of it is that common man has no recourse but do his or her own research and avoid all stuff that’s not natural. There is a simple test. If your grandma does not recognize something as food, don’t eat it!

  27. kulkarniravi says:

    Michele,

    You are entitled to your opinion just as I am.

  28. Harriet Hall says:

    @kulkarniravi,
    “I have seen a great reluctance among the medical community to consider the dietary and environmental causes for disease. Is it because they have zero or very little training in diets? Is it because it is harder to make people change something as fundamental as diets?”

    I don’t know what you’ve seen, but if you had looked in the right places you would know that the medical community has considered and continues to seriously consider dietary and environmental causes for disease. They are not giving as much emphasis to changing diets and avoiding environmental hazards as you do because the evidence is not convincing.

    “avoid all stuff that’s not natural” Oh, no! Not the natural fallacy again! That argument doesn’t fly on this website.

  29. Chris says:

    Scott:

    Nobody’s looked at the potential effects of green tea in causing autism, either. Without some sort of reason to look at it, it’s not reasonable to do so.

    But kids with autism have been looked at for malnutrition. See Permanent visual loss due to dietary vitamin A deficiency in an autistic adolescent and Severe feeding disorder and malnutrition in 2 children with autism.

    Some are because of their own food aversions, others are caused by restricting their diets as a treatment (gluten free, etc). We don’t know how diet effects autism, but childhood malnutrition is pretty well understood.

  30. Chris says:

    Dr. Hall:

    “avoid all stuff that’s not natural” Oh, no! Not the natural fallacy again! That argument doesn’t fly on this website.

    Usually I offer some nice castor beans and a cup of foxglove tea whenever I see the “it has to be natural!” bit. They are both quite natural, and will kill you quite nicely. Last year near where you live a woman died because she used hemlock in a salad. It looks very similar to the Sweet Cicily I have growing in my garden.

  31. windriven “I cannot imagine what I have ever written that would draw someone to infer that. I was merely arguing that, like the ball in a roulette wheel, a patient has to be coded somewhere and that can lead to the appearance of increased incidence.”

    I was responding primarily to this statement “The notion of a disorder as you define it is technically significant but practically less so. If I present to my physician claiming depression I am likely to be prescribed an antidepressant whether or not my melancholy rises to the level of “demonstrable harm.””

    It seems I misread and we are in more in agreement than I thought.

    Just FYI, I was disagreeing with your statement (as I read it), not offended by it. If my tone was terse it is due to a bad nights sleep, And sorry for that.

    I do not know enough latin to be so creative in a response.

    For clarity, of my overly numerous comments, I was attempting to express offense in only one of them. Which was that lack of variety in KLK’s thought process. This is referred to in the art world as “self-plagiarism”. It is generally eschewed, not only because it leads the artist to repeat the same errors over and over but also because it is completely and utterly dull.

  32. vicki says:

    Kulkarniravi–

    Where do you live, and what is the medical community you’re dealing with? Where I am, and where my friends are, the medical community is forever saying things like “you need to reduce your salt intake,” “your triglycerides are through the roof, switch to lowfat milk and/or replace some of it with water or seltzer,” “stop eating red meat,” and “start drinking either red wine or red grape juice.” (The last two are instructions that different members of my family have been given for high cholesterol.)

  33. kulkarniravi

    “Michele,

    You are entitled to your opinion just as I am.”

    Actually, it’s not my opinion that you only post with one thought. If you look back at your comments as evidence you will see that your initial post on each topic has been basically the same argument, regardless of the content of the article.

    So that is a fact and (everyone sing it) you are not entitled to your own facts.

    Whether repeating the same thing, over and over and over and over and over and over (infinity) is a good or bad thing, is an opinion, of course. And you are certainly entitled to that.

  34. kulkarniravi says:

    Michelle,

    I am advocating that we should get to the root cause, instead of using the usual, cut/slash/burn/medicate method that is so common. If that’s one thought argument so be it. Prevention is better than cure. Much bigger gains can be obtained at the root causes than by finding palliative medications that are narrow in focus and have to be consumed life long.

  35. “Much bigger gains can be obtained at the root causes than by finding palliative medications that are narrow in focus and have to be consumed life long.”

    What is the palliative medication for Autism?

  36. Chris says:

    vicki, just a reminder that kulkarniravi thinks his specific diet is the cure for us all. Like micheleinmichigan says, he is a “one thought” commenter, and I personally think that his ideas for autistic children would lead to more issues with malnutrition (see links I provided above, which were both on the first page of a PubMed search using “autism malnutrition”).

  37. kulkarniravi – in your furor to stay on message, it seems that’s you’ve ignored the content of the article. Read This.

    “The prevalence of ASDs was estimated to be 2.64% (95% CI=1.91–3.37), with 1.89% (95% CI=1.43–2.36) in the general-population sample and 0.75% (95% CI=0.58–0.93) in the high-probability group. ASD characteristics differed between the two groups: the male-to-female ratios were 2.5:1 and 5.1:1 in the general population sample and high-probability group, respectively, and the ratios of autistic disorders to other ASD subtypes were 1:2.6 and 2.6:1, respectively; 12% in the general-population sample had superior IQs, compared with 7% in the high-probability group; and 16% in the general-population sample had intellectual disability, compared with 59% in the high-probability group.”

    One could speculate from this that what we think of as autism is not a disorder that has one physiological source, but one that may have two or more sources. How the heck are you supposed to do epidemiological “preventative” research before you know what you are trying to prevent? Or even, in some cases if you need to prevent it (in the case of a positive autism test where the patient experiences no dysfunction).

    But, instead of saying “Oh it’s great that conventional medicine is attempting to clarify a diagnoses in order to better understand it and hopefully aid in prevention*.” You are stuck on “Conventional medicine isn’t interested in prevention. Eat natural foods.”

    *Like conventional medicine did with spinal bifida and cleft lip and palate, where there have been good strides in prevention with folic acid.

    Oy, why do I bother?

  38. windriven says:

    @micheleinmichigan

    Perhaps I wasn’t as clear as I had hoped to be. Dr. Novella made the point, similar to yours, that there are tests that can be used to differentiate clinical significance. But in the real world treatment decisions may not adhere exactly to those lines.

    Staying with my blighted depression example, a patient may present to their internist or family practitioner with what may appear to be mild depression. The family practitioner could send the patient for a psych workup – and the patient may even be resistant to that – or the physician might instead prescribe an antidepressant or anxiolytic. When the physician just prescribes the antidepressant does that mean that the incidence of clinical depression is rising?

    The context of my comment was “Autism Prevalence Higher That Thought.” Further, it was not me but Dr. Novella who cited the benchmark of “demonstrable harm.”

    I apologize to you for my bit of pique.

  39. Scott says:

    In my opinion it is a cover up. May not be deliberate, perhaps not even conscious, but I have seen a great reluctance among the medical community to consider the dietary and environmental causes for disease.

    No, you haven’t. What you have seen is a great reluctance to assume that some magical superfood is the cure for all disease, or some other cursed food is the cause of all disease, when there is no good evidence for such. Mainstream medicine is very concerned with diet and other lifestyle factors.

    Other than genetics, diet must be the most important factor in health. Its influence on pregnancy and the fetus must be equally strong.

    Argument by assertion gets you nowhere.

    So your contention that we can’t study everything is a red herring.

    Did you not notice that my example was also dietary? It’s a simple fact that there do not exist resources to study even a tiny fraction of all possible dietary influences. Only those with some sort of indication that they are relevant can be examined.

    The long and the short of it is that common man has no recourse but do his or her own research and avoid all stuff that’s not natural. There is a simple test. If your grandma does not recognize something as food, don’t eat it!

    See: naturalistic fallacy. The idea that “natural” things are somehow safer is just wrong. Not to mention that the many/most foods currently considered “natural” have in fact been subject to far greater human modifications already than what Luddites like to call “frankenfoods” (a term of no meaning).

  40. kulkarniravi says:

    Harriet,

    “I don’t know what you’ve seen, but if you had looked in the right places you would know that the medical community has considered and continues to seriously consider dietary and environmental causes for disease.”

    To be fair, it is a larger societal issue and medical community is only partly to be blamed. They are only trained to diagnose and treat diseases and not work on changing lifestyles and diets. If you don’t agree with me that diet and nutrition are not taken seriously in the US, all you have to do is to look at the obesity epidemic around us.

    So as a society we have to make the right investments and the best results can be obtained by investing in the root cause analysis. If even a fraction of the research dollars that go into pharma research are used in diet and nutrition research I think there would be a revolution. It is not just about discovering the cause and effect, but also making suitable changes to public policy that will guide the population towards a healthier lifestyle. Some people will call it a nanny state, but these changes are not easy but necessary.

  41. kulkarniravi says:

    Chris,

    “vicki, just a reminder that kulkarniravi thinks his specific diet is the cure for us all. Like micheleinmichigan says, he is a “one thought” commenter, and I personally think that his ideas for autistic children would lead to more issues with malnutrition (see links I provided above, which were both on the first page of a PubMed search using “autism malnutrition”).”

    Please show me where I have said there is a specific diet that prevents autism. Nor am I advocating my personal diet to others. I have found what works for me and I will stick with it thank you very much.

  42. kulkarniravi says:

    Michele,

    “How the heck are you supposed to do epidemiological “preventative” research before you know what you are trying to prevent?”

    Does anyone ask the same questions when they are developing medicines for diabetes, heart disease or cancer. Each of these is a spectrum, not a narrow disease. That did not prevent the pharma companies from developing palliative measures that only work half the time with double the side effects.

  43. kulkarniravi says:

    “Oy, why do I bother?”

    I wonder that myself – why does Michele bother?

  44. Scott says:

    They are only trained to diagnose and treat diseases and not work on changing lifestyles and diets.

    So all the extensive discussions of diet, exercise, etc. my doctor has with me, and those all my friends and family report their doctors have with them, are hallucinations? If you can tell me where to find a doctor who doesn’t emphasize such, please do.

    If you don’t agree with me that diet and nutrition are not taken seriously in the US, all you have to do is to look at the obesity epidemic around us.

    Doesn’t in any way, shape, or form show that diet and nutrition aren’t taken seriously. It just shows that significant lifestyle changes are hard.

  45. windriven, Thanks for clarifying, I did not understand that the emphasis of your comment was on the (perceived) increase in autism rates.

    and no worries.

  46. Chris says:

    Scott:

    Not to mention that the many/most foods currently considered “natural” have in fact been subject to far greater human modifications already than what Luddites like to call “frankenfoods” (a term of no meaning).

    Which is why I have bought seeds through a catalog that included multi-colored chard, beans, tomatoes, and lettuces. Centuries ago carrots were just white, but now come in a variety of colors. All due to human intervention of their breeding.

    And as a reminder that not all natural things are good for you: the root of the hemlock looks like a white carrot.

  47. kulkarniravi says:

    Scott,

    “No, you haven’t. What you have seen is a great reluctance to assume that some magical superfood is the cure for all disease, or some other cursed food is the cause of all disease, when there is no good evidence for such. Mainstream medicine is very concerned with diet and other lifestyle factors.”

    Strawman argument. I never said there is one superfood is a cure for all disease nor that I know a specific food is a cause of a disease. I am only saying the diet and nutrition seem to be major contributors of disease after genetics.

    “Argument by assertion gets you nowhere.”

    Please, do you know of any causes that are bigger than diet after genetics?

    “It’s a simple fact that there do not exist resources to study even a tiny fraction of all possible dietary influences. Only those with some sort of indication that they are relevant can be examined.”

    I would like to know what percentage of medical research money goes into researching diets. Even more importantly who decides what is a good lead. Leads do exist in the form of communities that are less prone to certain diseases – for example, Malaysians, Greeks and Brazilians are less prone to colon cancer. It must be more than the genetics.

    “See: naturalistic fallacy. The idea that “natural” things are somehow safer is just wrong. Not to mention that the many/most foods currently considered “natural” have in fact been subject to far greater human modifications already than what Luddites like to call “frankenfoods” (a term of no meaning).”

    Oh please, I am not recommending exotic herbs or animals. I am only saying that a tomato grown organically is better than a GM tomato grown with loads of chemical fertilizers and pesticides.

  48. Chris, thank god for Google. You are talking about Conium maculatum, “Poison hemlock” (looks like queen Anne’s lace and or wild carrots) not Tsuga canadensis, Canadian Hemlock. You had me worried there for a minute. And I was wondering why anyone would want to dig up their pine trees and eat the roots.

  49. kulkarniravi says:

    Scott,

    “So all the extensive discussions of diet, exercise, etc. my doctor has with me, and those all my friends and family report their doctors have with them, are hallucinations? If you can tell me where to find a doctor who doesn’t emphasize such, please do.”

    Everybody makes such claims, but I have lived here for 10 years continuously and haven’t met one doctor who has the time or patience to have a detailed discussion on diets or nutrition. They simply do not have the time, they have to see as many patients as possible to just make ends meet. I don’t blame them, as I said it is a larger societal issue. Perhaps we should see dieticians and nutritionists as regularly as we see doctors.

  50. Chris says:

    kulkarniravi:

    Please show me where I have said there is a specific diet that prevents autism. Nor am I advocating my personal diet to others. I have found what works for me and I will stick with it thank you very much.

    Perhaps not prevent, but you did say: “Do the long term consumption of certain food additives cause issues such as ADS in progeny?”, which implies that food is a cause.

    Then there is the post I linked to above where you said: “Diet is the low hanging fruit for most people. It may be habitually difficult to change, but once you are convinced it matters, it is possible. In my opinion, that one change, will completely alter the healthcare situation in the US.” Which is pretty much advocating we adopt your particular lifestyle.

    Also you said on this thread, which is about autism: “Prevention is better than cure. Much bigger gains can be obtained at the root causes than by finding palliative medications that are narrow in focus and have to be consumed life long.” This implies that diet can prevent autism and/or other issues, and either you were going completely off topic or you have no clue about autism and its therapies (mostly speech, occupational and physical therapies, not meds).

    Perhaps in the future you learn to remember what you wrote, and also make it a habit to provide actual scientific documentation for your claims (see the links I provided on malnutition and autism).

  51. kulkarniravi says:

    “Which is why I have bought seeds through a catalog that included multi-colored chard, beans, tomatoes, and lettuces. Centuries ago carrots were just white, but now come in a variety of colors. All due to human intervention of their breeding. ”

    Human intervention that you mention uses simple cross breeding. That’s not the same as cutting and splicing of genes that Cargill (to take one name) indulges in. For example, viral genes do not even belong to the herbs, who knows what will be long term impact on humanity of eating such foods. We will only know it after several generations and that too only if we seriously study the cause and effect.

  52. kulkarniravi says:

    Scott,

    “Perhaps in the future you learn to remember what you wrote, and also make it a habit to provide actual scientific documentation for your claims (see the links I provided on malnutition and autism).”

    There is a difference between saying perhaps diet is a cause to saying that a specific food causes a specific disease. I am clear about what I believe and I have stated it many times over. Diet is the second most important factor that affects health, and we are not doing enough to manage it better. If you think that’s wrong, I would like to know what is the second leading cause of disease.

    Ravi –
    “Diet is the low hanging fruit for most people. It may be habitually difficult to change, but once you are convinced it matters, it is possible. In my opinion, that one change, will completely alter the healthcare situation in the US.”

    Scott –
    Which is pretty much advocating we adopt your particular lifestyle.”

    I am not advocating my diet. All I am saying is that diet is a serious issue, do your own research and then adopt what works for you. I think you need to get rid of that strawman you have built – that’s not me.

  53. Chris says:

    micheleinmichigan:

    You are talking about Conium maculatum, “Poison hemlock” (looks like queen Anne’s lace and or wild carrots)

    Just read the news link I posted in my comment to Dr. Hall. It has pictures, and the stuff grows wild everywhere (even near hemlock fir trees!). The story describes how someone who became very ill but did not die actually pulled it out of his own garden thinking it was a white carrot!

    I will place a bet that those who use the natural fallacy and champion non-GM have no clue about gardening, horticulture or that common plants can be poisonous. Especially when they have no idea that every food plant is “GM”, which means Genetically Modified. Something humans have been doing for over ten thousand years by selective breeding (which modifies the plant’s genetics).

  54. Scott says:

    Strawman argument. I never said there is one superfood is a cure for all disease nor that I know a specific food is a cause of a disease. I am only saying the diet and nutrition seem to be major contributors of disease after genetics.

    I didn’t intend to say that you personally did, but rather that those are the typical attitudes.

    Please, do you know of any causes that are bigger than diet after genetics?

    You make the claim, burden of proof is on you.

    It must be more than the genetics.

    Again, argument from assertion. Also, even if it’s something other than genetics, what’s the evidence that said something is diet?

    Oh please, I am not recommending exotic herbs or animals. I am only saying that a tomato grown organically is better than a GM tomato grown with loads of chemical fertilizers and pesticides.

    If you’re saying that, then you should provide evidence in support of the claim. Said evidence should take into account that organic farming uses plenty of fertilizers and pesticides too. And no, you don’t get to simply claim that they’re fine because they’re “natural” without any sort of evidence.

  55. kulkarniravi says:

    “If you’re saying that, then you should provide evidence in support of the claim. Said evidence should take into account that organic farming uses plenty of fertilizers and pesticides too. And no, you don’t get to simply claim that they’re fine because they’re “natural” without any sort of evidence.”

    On the contrary the onus in this case is completely on the companies that make changes to the genetic make up of herbs and animals. They have to prove that their products are completely safe, across multiple generations.

  56. Chris says:

    “Human intervention that you mention uses simple cross breeding.”

    That is Genetic Modification. Actually the bacteria used in Genetic Engineering has a plant tumor plasmid that is very common. It causes galls on plants. You should like it, it is perfectly natural.

    You sound like the folks that firebombed a university building because they mixed up the terms “Genetically Modified” with “genetic engineering.” The targeted researcher was using cross breeding on poplar trees. He has given talks explaining the processes in both GM and GE, and lack of intelligence of the fire-bombers (even showing a photo of the huge SUV driven by the lead eco-terrorist).

    But we are straying way off topic. I suggest we get back to the subject at hand, and that you learn to actually document your assertions.

  57. kulkarniravi says:

    “You make the claim, burden of proof is on you.”

    There is much circumstantial evidence. More obses people tend to get heart disease and diabetes. Certain diseases are more common in the US than in, say India or vice versa. The question is, who will do the research rule in or out the diet as the major contributor of disease? Our bodies grow and sustain based on the food we eat. If this is not enough evidence, then I suppose nothing will ever convince you that diet is important.

  58. kulkarniravi says:

    Previous post, I meant obese, sorry about misspellig.

  59. I said,

    “How the heck are you supposed to do epidemiological “preventative” research before you know what you are trying to prevent?”

    Kulk said “Does anyone ask the same questions when they are developing medicines for diabetes, heart disease or cancer. Each of these is a spectrum, not a narrow disease. That did not prevent the pharma companies from developing palliative measures that only work half the time with double the side effects.”

    Perhaps you could consider that the article is talking about autism. I know it’s hard and outside your comfort zone. But perhaps you could address what is actually in the article that you are commenting on.

    Why not, just for the heck of it, read the article, then comment on the content of the article. Live a little and stretch that lovely brain of yours. Could be it’s good for you.

  60. Scott says:

    On the contrary the onus in this case is completely on the companies that make changes to the genetic make up of herbs and animals. They have to prove that their products are completely safe, across multiple generations.

    You said:

    I am only saying that a tomato grown organically is better than a GM tomato grown with loads of chemical fertilizers and pesticides.

    That is not questioning whether there’s enough safety testing, that is very explicitly stating as fact that the one is better. Either you have evidence for that claim, or you do not.

    If this is not enough evidence, then I suppose nothing will ever convince you that diet is important.

    You didn’t say “important.” You said

    Other than genetics, diet must be the most important factor in health.

    Important, nobody questions. But you went WAY beyond that.

    You keep changing your position every time it’s challenged.

  61. kulkarniravi says:

    Scott,

    “That is not questioning whether there’s enough safety testing, that is very explicitly stating as fact that the one is better. Either you have evidence for that claim, or you do not.”

    Humans have eaten organic tomatos for thousands of years. We know they are safe when consumed in reasonable quantities. Until proven otherwise, they are bettern than GM tomatos.

    “Important, nobody questions. But you went WAY beyond that.”

    No, I said most important after genetics. That position stands. If you want to solve the problem, go after the important factors first.

  62. Scott says:

    Humans have eaten organic tomatos for thousands of years. We know they are safe when consumed in reasonable quantities. Until proven otherwise, they are bettern than GM tomatos.

    Organic tomatoes haven’t been subjected to the level of safety testing you’re demanding of GM tomatoes either. So no, not better on that basis.

    No, I said most important after genetics. That position stands.

    You might have noticed that I included the genetics bit in the quote. And no, the position does not stand because you’ve provided not a whit of reason to believe it. You simply assert it.

    For that matter, genetics being most important is ALSO something you’ve simply chosen to proclaim that everyone must recognize as true just because Kulkarniravi Says So.

  63. kulkarniravi says:

    Scott,

    There are some things that will be never researched into because there is simply not enough money as someone said earlier. Genetics and/or diet as the leading contributors would be one of those. You have to start somewhere when you do research. Diet as a major cause of disease could be taken as a hypothesis because it seems reasonable.

    Again I ask you – if you believe diet is not a major cause of diseases, do you think there are other causes that might be? I sincerely want to know.

  64. kulkarniravi says:

    Scott,

    “Organic tomatoes haven’t been subjected to the level of safety testing you’re demanding of GM tomatoes either. So no, not better on that basis.”

    Prior to agricultural revolution, people did not use chemical fertilizers and/or pesticides. Such tomatos have been consumed for thousands of years. I would say such foods do not require proof that they are safe in reasonable quantities.

  65. lillym says:

    “Everybody makes such claims, but I have lived here for 10 years continuously and haven’t met one doctor who has the time or patience to have a detailed discussion on diets or nutrition. ”

    How many doctors have you seen in the last few years? And why do you discount what everyone says based on your personal and perhaps limited experience?

    I can say that in the past 10 years I’ve seen 2 doctors regularly (my GP and my psychiatrist) and over the course of the past couple of years several urologists.

    Every single one, at one point or another, has told me that I would benefit greatly from losing weight. Now, I don’t hear this everytime I go to the doctor, but especially when I was trying to track down my bladder issues I heard that losing weight would be better for me.

    Both my psychiatrist and urologist have told me to give up caffeine (and I have. several times). My psychiatrist did some blood work and discovered I have a Vitamin D deficiency and besides telling me to take supplements told me to get outside and get exercise for sun exposure and eat more foods rich in D.

  66. windriven says:

    @kulkarniravi-

    You speak as if everyone eats the same things. There are distinct regional differences in diet. Compare the typical Mediterranean diet with the diet in the American South with the diet in Korea. They are wildly different. And there are, in fact, some interesting difference in incidence of certain cancers and cardiovascular disease across different diets. It isn’t accurate to suggest that no research has been done here.

    There are many researchers looking at causes of and treatments for a variety of diseases. They research where they expect to find new information. If you believe you have the one true cause of all disease, why don’t you do the research. Or if you aren’t appropriately educated, form a 501(c)(3), collect donations from like-minded naturocrats, and fund research in this area.

  67. Scott says:

    There are some things that will be never researched into because there is simply not enough money as someone said earlier. Genetics and/or diet as the leading contributors would be one of those.

    “Diet disease contribute” turns up 2223 hits on PubMed. “Genetics disease contribute” turns up 16548. Clearly no research being done at all.

    You are (deliberately?) confusing research into a general field with research on a specific topic within that general field.

    Again I ask you – if you believe diet is not a major cause of diseases, do you think there are other causes that might be?

    Good grief. To quote myself:

    Important, nobody questions. But you went WAY beyond that.

    YOU claimed that diet is the second most important cause of disease. And that genetics is the most. This was a very specific claim which is COMPLETELY different than simply acknowledging that they are important. In particular, you deny that anything else is as important.

    Prior to agricultural revolution, people did not use chemical fertilizers and/or pesticides.

    Yes, as a matter of fact, they did. Manure, for instance, is a chemical fertilizer. (EVERYTHING is chemical.) You really mean “synthetic,” but there are no grounds whatsoever to believe that there is any significant difference.

    I would say such foods do not require proof that they are safe in reasonable quantities.

    Oh? Organic tomatoes could have significant negative effects that accumulate over generations, exactly as you’re claiming for GM foods. Nobody would have noticed. Your claim

    who knows what will be long term impact on humanity of eating such foods. We will only know it after several generations and that too only if we seriously study the cause and effect.

    applies just as well.

    You’re really starting to appear to be a simple knee-jerk Luddite, assuming that anything new is automatically bad simply because it’s new, without bothering to think about applying the same standards to things which aren’t new.

  68. I know the GM foods issue is off topic, but I think it’s important to note that many crops are genetically modified in order to provide pest resistance* and reduce the use of pesticides (and pesticide resistance in pests).

    *possibly the Pièce de résistance of pest resistance.

    pests…what to do about pests?

  69. daedalus2u says:

    While I agree that genetics and diet are important in health, I don’t think that either of them are the two most important things.

    When there are multiple things that are all important, it is difficult to prioritize them. Good health is like a chain, with many links and each link is important and the chain is only a strong as its weakest link. “Broken” genes or a “broken” diet can lead to a “broken” phenotype and “broken” health, just like any broken link can lead to a broken chain.

    The very large cohort full genome scans have pretty clearly shown that genetics is not the most important thing for many diseases (including autism). If the “genes for disease X” can’t be found, what basis is there for still maintaining the position that genetics is the most important factor?

    Similarly none of the large diet interventions have shown the ability to completely prevent or to completely cure diseases, except for deficiency diseases.

    There are some completely natural treatments that do restore good health (for some conditions) better than any other treatment. For example one of the best treatments for inflammatory bowel disease is an infestation of parasitic worms. Real parasitic worms as opposed to the faux parasites that Dr Crislip mentioned in his recent post.

    http://www.ncbi.nlm.nih.gov/pubmed/18680198

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2863045/

    As far as parasitic worms in the gut, you can’t get much more “natural” than that ;). Gut worms are much more natural than cooking food, agriculture or anything humans have evolved to do in the last 10 million years or so.

    Why wouldn’t we expect adverse effects from getting rid of something our ancestors evolved with?

  70. D2u

    Giardia may be natural, but it’s still a pain in the butt. ;)

    (I’m not actually trying to make a point, I just couldn’t resist…)

  71. weing says:

    “Humans have eaten organic tomatos for thousands of years. We know they are safe when consumed in reasonable quantities. Until proven otherwise, they are bettern than GM tomatos.”

    Actually, they were thought to be poisonous for quite some time. So the GM ones have something in common with the organic ones.

  72. Prometheus says:

    I can’t resist.

    Now that “kulkarniravi” (“K”) has hijacked the thread onto the “organic, non-GMO foods” track, it seems only fair to mention that the so-called “chemical fertilisers” (note to “K”: everything, except vacuum, is a “chemical”) are merely the nutritive chemicals found in manure (or “night soil”) without the pathogenic bacteria, viruses and parasites, without the polyphenolic compounds left over from partial digestion of tannins and lignins and without the seeds and spores.

    In short, “chemical” fertilisers give you the “good” parts of manure (or “organic” fertiliser) without the “bad” parts.

    Growing food plants with “chemical” fertilisers does reduce the risk of food-borne illness, so that might be a “down-side” to their use, if you’re a fan of diarrheal illnesses.

    I’d also love to hear the data “K” has showing that GM plants are dangerous. The data I’ve seen don’t support that claim, but, of course, I’m always eager to learn.

    It’s funny that “K” hasn’t posted any data supporting his/her claims, but I guess he/she has been busy. I’m willing to wait ’til you have a free moment, “K”, but move “provide data to support assertions” a bit higher on your “to-do” list.

    Prometheus

  73. windriven says:

    @michele

    “pests…what to do about pests?”

    Send them to live with the trolls ;-)

    Speaking of which, haven’t seen Th1Th2 for a while.

  74. kulkarniravi says:

    Prometheus,

    Point taken about the term chemical. What I really meant was synthetic inorganic chemicals. There is a big difference between organic manure and synthetic fertilizers. It is well known that synthetic fertilizers have left many fields completely sterile after a few years – it has happened in India. I don’t know the state of the art in fertilizers, but I would hazard a guess that in a few years or decades we will find that the newer ones cause some other issues. The cycle goes on, while the manure lives on.

    The onus of proving that GM foods are safe is on the manufacturers. It can’t be proven in a few years, it takes at least a few generations. Secondary risk is that they will wipe out the prevailing natural food crops by their superior resistance and adaptability. So if the data doesn’t exist, you haven’t looked for it yet.

  75. windriven says:

    @theincrediblekulk

    “It is well known that synthetic fertilizers have left many fields completely sterile after a few years – it has happened in India.”

    Dude(ette?) – you need to get a serious grip on your use of the English language. Simply stringing words together doesn’t necessarily communicate a fact.

    “It is well known” – by whom? By you alone? Are there others? Who are they?

    “synthetic fertilizers” – there are many. Are they all sterilizers? Do you know the names or chemical compositions of these debasers of the land? Has someone convinced you that C6H3Cl3N2O2 is a synthetic fertilizer?

    “[H]ave left many fields completely sterile ” How many completely sterile fields are there? Do you have any idea what completely sterile means or is this simply polemical overstatement?

    “[I]t has happened in India.” Has it now? Where in India has this happened. And when? And which fertilizer(s) were used? Were they applied as directed?

    Look, we all like to go green. I compost. I tend to seek out local produce from organic farmers. And yes, India has some soils that have excessive nitrate levels because of OVERUSE of nitrogen fertilizers. I’d like to point out that a good application of chicken crap can have a similar effect. But the point I want to leave you with is that before the so-called green revolution, famine was a fact of life in a lot of third world countries. Without synthetic fertilizers and carefully engineered crops, untold numbers of human beings would have died of starvation.

  76. daedalus2u says:

    What is ironic is that plants can’t absorb the nutrients in “organic” fertilizers, they have to wait until bacteria break them down into nutrients they can absorb like ammonia or nitrate.

    Plants are one of the (relatively) few organisms that don’t need anything organic. Most of them can synthesize all that they need from minerals, light, H2O and CO2.

    There simply isn’t enough nitrogen from natural sources for plants to make enough protein to sustain the current human population. The nitrogen in the manure that organic farmers like so much, mostly comes from synthetic ammonia used to fertilize the fields that grow the feed used to feed the animals that produce it.

    What is also ironic is that any kind of manure is considered “organic”, even if it has high levels of arsenic from the feed, the way that chicken manure does. Chickens are fed arsenic, essentially all of which ends up in their manure which so-called “organic” farming has no regulations about. If it comes out of a chicken, it must be pure 100% natural “goodness”, no matter what went into the chicken.

  77. Woody says:

    -kulkarniravi

    “What is interesting in all this debate is a lack of any attempt at either identifying a root cause or at least pointing to some relevant research.”

    Ugh. This is profoundly dismissive. Look before you spout:

    http://www.autism-insar.org/

    That meeting just took place over the past three days. Over a thousand researchers in attendance, doing some “relevant research”.

    -d2u

    “The very large cohort full genome scans have pretty clearly shown that genetics is not the most important thing for many diseases (including autism). If the “genes for disease X” can’t be found, what basis is there for still maintaining the position that genetics is the most important factor?”

    My interpretation of those studies is that monogenic causes of autism are unlikely in most cases (though clearly implicated in some). That does not exclude polygenic causes, nor does it exclude gene/environment or purely environmental causes. Twin studies (~60-70% concordance in monozygotic twins) and at risk sibling cohorts clearly indicate that heritability is an important factor.

    I think it is reasonable to consider dietary factors of the mother during pregnancy or while lactating, but keep in mind that in simplex (only one of multiple children affected) families, it is likely that the same dietary practices were maintained in the household. So if kulk’s point is valid, there should be equal risk to all children in the household.

    Also, the prevalence data from multiple countries suggests a prevalence range somewhere between 1 and 3%. These countries don’t have all the same dietary practices, yet have similar prevalence – makes a dietary cause less likely in my opinion.

  78. daedalus2u says:

    Monozygous twins also share an in utero environment, not just their genome.

    Other than the CNV types of autism which are pretty much always de novo, the familial type of autism has very complicated genetics with no single gene producing more than a few percent causation.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947401/?tool=pubmed

    The say:

    “Our findings appear to rule out a common allele increasing relative risk by 2-fold or more. Much larger samples will be required to detect subtle effects on relative risk (e.g. 1.2), which is more typical of risk loci for common diseases.”

    By 2-fold or more they mean from 1 per 100 to 1 per 50.

    They are unable to find the genes that cause the 10x-20x increase in siblings, from 1 per 100 to 1 per 10 to 1 per 5.

  79. Woody says:

    They just need more participating families to do the appropriate analyses. They elaborate further on the point you quoted above:

    “All of these results spring from a relatively small sample size for GWA studies (n ≤ 1369 families), limiting both our power to detect association and the certainty of the associations detected. Unbiased estimates of odds ratios detected by GWA studies are typically in the range of 1.1–1.3; to have good power to detect such effect sizes requires many thousands of samples, which is beyond the reach of the autism genetics community at the moment.”

    A good argument for promoting public interest in the advancement of science, eh? It also makes one wonder how many families that might have participated in such studies do not because they have been misinformed by the anti-vax movement.

    I agree that in utero insults probably play an important role, but even that may interact with a genetic predisposition.

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