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Is there no end to unscientific treatments for autism?

OK, it’s true that I’m only scheduled to post every other week or so, but I couldn’t resist sharing this one with you (which I’ve cross-posted over at denialism blog).  I promise to get back to my assigned schedule after this one.  Thanks for your indulgence.  –PalMD

If you’ve been a regular reader of SBM or denialism blog, you know that plausibility plays an important part in science-based medicine.  If plausibility is discounted, clinical studies of improbable medical claims can show apparently positive results.  But once pre-test probability is factored in, the truth is revealed—magic water can’t treat disease, no matter what a particular study may say.  So it was with great dismay that I read an email from a reader telling me about parents buying hyperbaric chambers for their autistic children.  Let’s review some science.

In Breathing 101, we talked about how the oxygen delivered to your lungs depends on both the percentage of oxygen in the air, and the air pressure.  We looked at how diminishing atmospheric pressure, for example at altitude, makes it harder to breathe.

Of course it is also possible to expose people to increased atmospheric pressure, which has therapeutic uses in the form of hyperbaric oxygen therapy (HBOT).

Oxygen delivery to tissue depends on several factors.  We already talked about the air itself.  Once air gets enters the lungs, most of the oxygen transported to your tissues is carried by the hemoglobin molecules in your red blood cells (under normal conditions).  A small amount is directly dissolved in the blood.  The amount dissolved in the blood is dependent on (no surprise) the percentage of oxygen and the atmospheric pressure.  By increasing the atmospheric pressure from 1 atm (760 torr) to 3 atm, the amount of oxygen dissolved in the blood is enough to meet your body’s needs independent of heme-associated oxygen.

This is a good thing.

For example, up here in the Midwest, we have a lot of cases of carbon monoxide (CO) poisoning during the winter.  CO binds to hemoglobin much more strongly than oxygen, so even after victims are removed to a normal environment, they are still asphyxiating.

Carbon monoxide intoxication is one of the primary uses of HBOT.  Under pressure, enough oxygen is delivered to the tissues for the patient to survive.  Additionally, the increased pressure helps oxygen displace CO so that heme molecules are free to go back to the work of transporting oxygen.

The original use for HBOT was of course “the bends”.  When a person (for example a diver) is exposed to high pressures for a long period of time, nitrogen, which is normally not very soluble in blood, dissolves much more readily.  When the diver ascends, the nitrogen bubbles are released from the blood into the tissues, causing widespread damage.  HBOT can be used to help a diver “ascend” more slowly, so that the nitrogen comes out of solution in a much less damaging fashion.

HBOT can also be used to treat a variety of other conditions that are responsive to increased oxygen tension, such as anaerobic bacterial infections.  But hyperbaric chambers are not without risk.  Small errors can cause big problems, including death.

Strangely enough, though, you can buy your very own hyperbaric chamber for use in your own home, and parents of autistic children are doing just that.

So why does anyone think that HBOT might be appropriate for the treatment of autism? Is it even plausible? Autism spectrum disorder (ASD) is a very broad diagnostic category. Autism is a neurobehavioral disorder of inconsistent severity and unknown cause. There has been some decent research into etiology, and in some cases genetic causes have been implicated. There is no reason to suspect that autism has anything to do with decreased oxygen tension.

As you have no doubt read in this space, autism attracts a wide range of quackery, and HBOT for autism quacks pretty loudly. Whose idea is this, anyway?

All signs point to a guy named Dan Rossignol.  Dr. Rossignol is apparently into every form of autism crankery, including mercury poisoning, mitochondrial dysfunction, and oxidative stress (although I can’t imagine that increased PaO2 is an effective treatment for “oxidative stress”). After spending a few minutes looking through his web-based material, I’m starting to think that this guy can give the Geier’s a run for their money.

True to form, Rossignol is a “pioneer” and a “maverick”.  He goes where legitimate clinicians haven’t dared.  Based on an implausible hypothesis, he (apparently) subjects autistic children to potentially dangerous hyperbaric oxygen therapy.  He has published his ideas in the crank-magnet “Medical Hypotheses”, and in BMC Pediatrics, a journal devoted to rapid, “flexible” publication.

Even if his data were to support his nonsensical hypothesis (again, increased O2 to treat oxidative stress??), should we believe it?

Well, someone does, and that someone apparently sells hyperbaric therapy, and not just for autism.  They also treat Lyme disease, multiple sclerosis, and cerebral palsy—and anything else you can spell. The site does, however, have a very small Quack Miranda Warning on the left sidebar.

There is an unbroken chain of bad medicine here.  Some guy decides that a potentially dangerous treatment might help a protean syndrome.  He publishes his ideas in low quality journals.  Then, someone sells his treatments uncritically.

HBOT is serious medicine.  Off-label use in children with autism isn’t just foolish—it’s dangerous, and should be illegal.

References

Rossignol DA. Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism. Medical Hypotheses. 2007;68(6):1208-27. Epub 2006 Dec 4.

Rossignol DA, Rossignol LW. Hyperbaric oxygen therapy may improve symptoms in autistic children. Medical Hypotheses. 2006;67(2):216-28. Epub 2006 Mar 22.

Rossignol DA, Rossignol LW, James SJ, Melnyk S, Mumper E. The effects of hyperbaric oxygen therapy on oxidative stress, inflammation, and symptoms in children with autism: an open-label pilot study. BMC Pediatr. 2007 Nov 16;7:36.

Posted in: Neuroscience/Mental Health, Science and Medicine

Leave a Comment (28) ↓

28 thoughts on “Is there no end to unscientific treatments for autism?

  1. Brett says:

    Don’t forget that treatments involving excess oxygen, even when they are extremely plausible, could still be dangerous. That’s how thousands of premies got retrolental fibroplasia. Oxygen, despite being the vary material we breathe, is chemically quite potent stuff.

  2. Vaklam says:

    Thank you for bringing this into more light. The more people who are aware of the danger these “treatments” present, the better.

    Thank you, also, for providing such good evidence and references. Those are always the best ammunition.

  3. PAL,

    You’ve just made my Friday post a little easier. Part of it will discuss the new “American Medical Autism Board” (AMAB). I’m already lovin’ the new blood here.

  4. Kev says:

    Hi, in answer to your question ‘Is there no end to unscientific treatments for autism?’, the answer is – ‘yes’ – so far anyway. Tere are over 150 unscientific treatments purported as treatments for autism.

  5. overshoot says:

    Is there no end to unscientific treatments for autism?

    Rephrased, is the cardinality of the set “unscientific treatments for autism” infinite?

    I commend to your attention Einstein’s comment on things that are infinite.

  6. wertys says:

    HBOT for autism is child abuse. That guy should be put in jail.

  7. Vaklam says:

    Kimball: You mean the one with Mrs. Michigan United States 2008 on it?

  8. The Blind Watchmaker says:

    Hyperbaric Oxygen??? This is truely a crime against vulnerable children and their credulous parents.

    It is one thing to argue about “what’s the harm?” when it comes to herbs and strange diets. It moves to a whole new level of harm when we start talking about implausable, potentially dangerous treatments such as HBOT and chelation therapy.

  9. Niels says:

    HBOT has been used for alternative Lyme treatment ( http://www.personalconsult.com/articles/hyperbaricoxygentherapy.html ) . Lyme underlies autism, though you all deny it. http://www.lymeinducedautism.com/images/TBILB_Autism.pdf

    If doctors and CDC/FDA/AMA/IDSA could get over their lyme-denialism, then there’d be a reliable test for borreliosis that could be given to any patient on the “autistic spectrum.” Then give antibiotics as appropriate till titers reduce, CD57 goes above 60, and symptoms subside. Given that lyme is a medical condition, and antibiotics are a justified medical treatment, if proper testing was done, there’d be no need for nonsense like HBOT. The obvious medical choice would be first-line treatment for lyme. However, some people don’t like antibiotics and want something “natural”… as if HBOT is “natural.” So I’m in agreement that HBOT is probably “abuse” … except that it’s probably completely unregulated and not even really considered “medicine” … ie. you could have a child get this therapy and not even need to tell your “regular doctor.” But if one got Lyme treatment, and antibiotics, then you’d tell your doctor, and if they were the kind of people you all seem to be, you’d all call CPS and claim “abuse” because you wanted to enforce your ignorant lyme-denialism on others.

    By the way, the use of “spectrum” (as in “autistic spectrum”) should be a key indicator of BOGUS MEDICINE. But what do you expect from the fact that “Autism” is yet another totally invented bogus disease… yet another “symptom masquerading as disease.”

    PS: I noted a recent use of “spectrum” in Morgellons=DOP literature as well, which indicated that DOP, like Autism, is a bogus “symptom masquerading as disease”… This most recent journal article indicates a hedging on the “it’s just DOP.” viewpoint. Perhaps once they re-incorporate the “Restless Leg Syndrome” and DOP back into”Ekbom’s Syndrome”, people will realize that the syndrome described by Ekbom was Lyme disease.

    The abstract for “Delusional disorders in dermatology: a brief review.” states: “Morgellons disease is a controversial condition characterized by a fixed belief that fibers that are imbedded or extruding from the skin; this condition is likely in the spectrum of DP.”

    Or course, once you get into the land of psychological handwaving in place of real medicine, you docs are all happy and can go back to looking for new golf clubs on the internet… you all must have got the “medical diagnosis is hard” wanna-be-psychiatrist-Barbie doll when you were all growing up!

  10. Niels says:

    > there any evidence that vaccinating children causes autism.

    Is there any evidence that it doesn’t? IMHO, the correct caution to take at this time is to pre-test children for Lyme/Mycoplasma per http://www.lymeinducedautism.com/images/TBILB_Autism.pdf and to not vaccinate until it can be proven that the child doesn’t have a lyme-compromised immune system, which IMHO is what leads to vaccine-triggered autism.

    So the real question is how come the CDC settled the vaccine induced autism class-action suit? ( http://www.thedailygreen.com/environmental-news/latest/autism-vaccines-mercury-47030702 ). If they could prove vaccines safe, don’t you think they would have gladly done so, if for no other reason than setting legal-precedent?

    It is not the duty of patients and parents to prove medicines safe. That is the job of the companies making the medicines and the federal regulators. It is extra-insulting to the taxpayer as we’re paying out those class-action $$$’s to “bail out” patients injured by a lack of regulation, or for the purpose of covering up the unscrupulous relationship between regulator and the industries they regulate. For anybody that’s actually awake, this shouldn’t be of any more surprise than the economic crisis brought on by equally compromised regulation of the financial markets. It’s “disaster capitalism”, also known as fascism, across the board here in the USA: http://nielsmayer.com/roller/NielsMayer/entry/creative_destruction_at_work_is … hopefully a new president will begin reversing the last 8 years of wanna-be-Mussolini action on the part of President Bush.

  11. MikeBTexas says:

    Found it interesting that nobody posting on a site called Science Based Medicine caught the irony of the author’s words:

    “Even if his data were to support his nonsensical hypothesis … should we believe it?”

    And I thought some of the autism salesmen were beholden to idealogy at the expense of science! By all means let’s never let data get in the way of our firmly held beliefs… for or against something.

    This site should be called NOTsciencebasedmedicin.org…

  12. Dr Benway says:

    By all means let’s never let data get in the way of our firmly held beliefs… for or against something.

    Don’t mistake the set of well-estabished facts for “firmly held beliefs.”

    When we encounter data in support of some novel idea that contradicts everything we know about, say, chemical reactions, those data are likely misleading. If such is not the case, then some scientist will have a lot of work to do explaining how the new idea fits together with prior knowledge.

  13. Harriet Hall says:

    If someone produced data supporting the Tooth Fairy, should we believe it?

  14. Joe says:

    @MikeBTexas on 29 Jan 2009 at 1:37 wrote “By all means let’s never let data get in the way of our firmly held beliefs …”

    Properly obtained data may be regarded as facts; but the interpretation of the data is up for grabs. You may be aware that frogs do not have ears, and hypothesize that they hear through their legs. So, you train a frog to jump on command. Then you remove the legs and note that the frog no longer jumps when commanded to. You may conclude that the frog no longer hears the order; but I have another explanation.

    MikeBTexas on 29 Jan 2009 at 1:37 wrote “This site should be called NOTsciencebasedmedicin.org…”

    Perhaps the comments should be called “amateur hour.”

  15. Dr Benway says:

    The distiction between “facts” and “interpretation” is often used in a misleading way. Facts are never free of interpretation.

    Facts and interpretations are both claims about the world. Some claims are local and specific – e.g., “I have a quarter in my pocket.” Some claims are global and more abstract – e.g., “force equals mass times acceleration.”

    Claims that can be corroborated may become part of our shared map of reality. We refer to those claims as “facts” or “factually true.”

    Claims that generate predictions may be subjected to falsification. Specific predictive claims are often called “hypotheses.” General claims that apply across many tested hypotheses are called “theories” as in “the theory of gravity” or “the theory of evolution.”

    In your example you offer these claims:

    1. Frogs do not have ears.
    2. Frogs hear through their legs.
    3. If we cut the legs off a frog it go deaf.

    That third claim is a prediction. However, in your example you don’t subject that prediction to falsification. You simply seek a confirming example.

    And thus you’ve committed the fallacy of affirming the consequent.

  16. Joe says:

    Dr. Benway,

    That was a long run for a short slide. You confirmed my point that data can be interpreted different ways.

    BTW, if the frog had managed to jump on command after its legs were off, that would bring doubt on the hypothesis that it was deaf.

  17. Dr Benway says:

    You confirmed my point that data can be interpreted different ways.

    Interpretations must be subjected to corroboration and falsification before they have any merit.

    Once tested, “interpretations” become “data,” and the cycle repeats.

    It’s misleading to stop after one cycle of data–>interpretation.

  18. Joe says:

    Dr. Benway on 30 Jan 2009 at 2:22 pm,

    I don’t know where you get the idea that “Once tested, “interpretations” become “data,” and the cycle repeats.”

    In law, there is the notion that “when you cannot argue the facts, argue the law, when you cannot argue the law, argue the facts, and when you cannot argue either- just argue.” It seems that is where you are heading.

    By definition, “interpretations” never become data. Data are measurements, interpretations are what we infer from the data.

    I think philosophy is nice for people who like to argue. I don’t, I just practice science.

    Dr. Benway on 30 Jan 2009 at 2:22 pm wrote “It’s misleading to stop after one cycle of data–>interpretation.”

    Do you know what a “straw man” is? I never made such a claim.

    Sometimes I screw-up, and I acknowledge it when it comes to my attention. Maybe it is time for you to suck-it-up, too.

  19. Dr Benway says:

    “Facts” and “interpretations” are simply claims about the world. The distinction between a “fact” and an “interpretation” is arbitrary and depends upon context.

    In your example about the frog, you described the fact of the legless frog’s failure to jump on command. You offered one interpretation: the frog is deaf, and implied another interpretation: the frog can’t jump without its legs.

    We could try to eliminate one of these hypotheses via further experiment. Perhaps we measure motor neuron activity in the poor frog’s stump.

    Null hypothesis: Motor neuron output won’t change in response to hearing the word “jump.”
    Hypothesis: Motor neuron output will increase in response to “jump.”

    The results of our test cause us to reject the null hypothesis. It seems the frog can hear even without its legs.

    What was once an interpretation of data in a prior experiment has become the finding of a second experiment. It’s become a fact.

  20. Joe says:

    Dr Benway on 30 Jan 2009 at 4:32 pm wrote ““Facts” and “interpretations” are simply claims about the world. The distinction between a “fact” and an “interpretation” is arbitrary and depends upon context.”

    My apartment is 140 feet above the ground. You are welcome to jump out my window and prove a different “interpretation” according to your “context” than mine. I wish you no harm; but, I doubt your “context” will protect you. Alan Sokal wrote a book about it (“Fashionable Nonsense”) that derides your New Age philosophy. If you are teachable (see Crislip’s entry today), Sokal’s book might help you.

    You are about 40 years late to teach me about science. Thus endeth your lesson.

  21. Dr Benway says:

    I am failing to communicate my point. Allow me to try again.

    Below is a typical pseudoscientist argument (from Ken Ham):

    Creationists and evolutionists, Christians and non-Christians all have the same evidence—the same facts. Think about it: we all have the same earth, the same fossil layers, the same animals and plants, the same stars—the facts are all the same.

    The difference is in the way we all interpret the facts. And why do we interpret facts differently? Because we start with different presuppositions. These are things that are assumed to be true, without being able to prove them. These then become the basis for other conclusions.

    In this model, facts are like dots on a page. On person may connect the dots and see Darwin’s Tree of Life. Another may connect the same dots in a different way, revealing the face of Jesus. Which is correct? Well, that depends upon one’s “beliefs.” If you love Jesus, you will see Jesus.

    This model of facts vs interpretations is a misdirection. It leaves out what happens after various interpretations or explanations are generated. It leaves out the testing, the process whereby an interpretation may be rejected or may itself become an established fact.

    One way to counter this pseudoscience trick is by substituting the general term “claim” for the words “fact” and “interpretation.” This eliminates the illusion that “interpretations” have some sort of special status apart from the ordinary rules of evidence we apply to alleged facts.

    Sneaking past the rules what pseudoscience is all about. The word “interpretation” has a lot of sneak potential.

    If Ken Ham were to tell me that he looks at Nature and sees that Jesus is Lord. I would say, “Ok, you claim that Jesus is Lord. Can that claim be corroborated? Can it be falsified? No? Then it’s not a claim that scientists will take seriously.”

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