It’s Natural!
January 25th, 2012
I think I need to switch radio stations.
If you remember, last summer, the station I was listening to on my weekly drive to Downstate Univ. was carrying advertisements for a pseudo-study of a “natural” remedy for “low testosterone”. Lately, the same station has been bombarding me with ads for a “natural” way for post-menopausal women to ”restore hormonal balance”. This “hormonal balance”, we are told, will not only eliminate the hot flashes and other problems of menopause, it will allow us to “eliminate that stubborn belly fat”. On top of that, the advertisement assures us that it is “natural” (Note: so are hemlock, tetanus and dying in childbirth).
Up to now, I have dealt with this by simply changing the station, but I recently had a friend tell me that she had started this “natural” remedy in an attempt to ”restore hormonal balance” (and, I suspect, to get rid of her “stubborn belly fat”, although neither of us brought that up). She was quite enthusiastic about the remedy, although on closer questioning she admitted that the hot flashes hadn’t gotten much better, although she was positive they were “less intense”, if just as frequent as before.
What finally got me out of my “if you can’t say something nice…” reticence, though, was when she told me that she felt this “natural” remedy was vastly superior to the hormonal replacements her doctor and she had discussed (and decided against). And those of you who have read my ‘blog before can probably guess why…
“It’s natural!”
Cautiously, I asked her a few questions. First, I asked her if she knew what was in the pills she was taking; she didn’t, but a few minutes on the Internet corrected that. To her surprise (but not mine), the ingredients were, well, chemicals! Various succinates and fumarates and - wonder of wonders! - monosodium glutamate (MSG)! Now, I don’t have any problem with monosodium glutamate - I don’t think it is the Devil’s spawn or even a potent neurotoxin - but, then again, I am a biologist. My friend - whose information about MSG came primarily from the Internet - was appalled.
It turns out that she hadn’t actually read anything about how this remedy was supposed to work. According to their website, the succinates, fumarates and glutamate all somehow (and indefinably) enhance hormone signalling. They also - according to the website - “stabilize” hypoxia-inducible factor and “slow down” mitochondria and reduce the generation of oxygen free-radicals (not to mention ATP, if they really did “slow down” mitochondria). Many of these claims were “supported” with citations of research studies, none of which explained how any of it would enhance estrogen signalling.
Apparently, the “natural” part of this is that it is supposed to make you more sensitive to the little bit of estrogen your ovaries still make rather than replacing the estrogen with, well, estrogen or (as so many other “natural” menopause remedies do) with phytoestrogens - plant compounds that mimic estrogens.
At this point, with my friend in a mild state of shock over discovering chemicals (Oh. My. God.) in her “natural” menopause remedy, I asked her a thought-provoking question: “Is menopause a natural process?”.
This took her by surprise. On consideration, she allowed that menopause, for all of its discomforts and difficulties, was at least a natural process - at least as natural as women living past the age of 40. I then asked her, “What is natural about reversing a natural process?”.
Don’t misunderstand me - I’m all for reversing or preventing any number of natural processes, from infection to cancer to cardiac disease. However, I’ve often wondered why people turn to “natural” products (or, as in this example, products that claim to be natural) to forestall or treat processes that are also natural, like menopause, aging or dying of infectious diseases. If “natural” is good, and pure and “holistic”, why try to meddle with it?
My friend didn’t have an answer. Neither do I. Do you?
Prometheus
Filed under: Critical Thinking, Health Alerts, Help for the bewildered, Myths About Science | 3 Comments »
Autism and Insurance: Myths vs Reality
December 22nd, 2011
Earlier this week, I had arranged to have coffee with a close friend of mine. When I arrived, she was holding a copy of the weekend edition of the Wall Street Journal and was quite upset about an article on the “Affordable Care Act” (”Obama-care”). In this article, it was mentioned that the department of Health and Human Services was planning to leave it up to the various states whether or not to mandate “autism treatment” coverage. This, she felt, was a cruel blow to families with autistic children. Fortunately, I had been through this all before, many years ago, when my child was first diagnosed with autism, so I had some perspective to offer.
Back in those dark days, we were casting about for something, anything to do to help our child, even to the point of attending a “DAN! conference”. In that “conference” (it was more like a revival meeting than a conference), we heard repeated, over and over, that health insurance plans would not pay for anything related to autism, the dreaded “299.0″ (ICD-9 code for autism). As I later recalled, this “fact” was most often mentioned by practitioners who offered “alternative” treatments for autism.
Shortly after returning from that “conference”, I had the opportunity to question (”interrogate” might describe the flavour of that exchange better) our paediatrician about that point. He was - and is - an exceptionally patient person and managed to answer my question without adressing my obvious hostility.
As he explained it, the insurance companies look over each bill and ensure that - among other things - that the procedural code (CPT codes) matches up with the diagnostic code. They want to ensure that a doctor isn’t claiming reimbursement for an appendectomy when the diagnosis is “bunion”, for example. For this reason, chelation and HBOT aren’t “approved” for autism because - as I’ve outlined in several ‘blog postings - they haven’t been shown to be effective in the treatment of autism, just as appendectomy hasn’t been shown to be an effective treatment for bunions.
Other issues that arise, especially in the “alternative” treatment of autism, are when the “treatment” is either of questionable effectiveness, such as “Applied Behavioral Analysis”, or its effectiveness has not been demonstrated. Insurance companies usually see these as “experimental” treatments and refuse to pay for them.
However, parents have also complained that they are unable to get insurance companies to pay for “mainstream” therapies, such as speech therapy and psychiatric consultation when the diagnosis was “autism”. This, according to our patient paediatrician, is due to the ignorance of the practitioner. There is no universal treatment for “autism” - it is too broad and heterogenous a diagnosis for that. So, to justify - for example - speech therapy, another diagnosis is needed, since the diagnosis of “autism” does not, in itself, imply a need for (or benefit from) speech therapy. Experienced and well-trained practitioners are aware of this requirement and so don’t submit bills that don’t have proper justification for the prescribed (or recommended) therapies.
When I later questioned some of the parents who had complained about having insurance companies refuse to pay for “autism”-related treatments, I found that a few things kept cropping up:
[1] Many (but not all) had to submit the insurance claim themselves because the practitioner refused to bill insurance directly (for those not in the US, this is unusual - most doctors send their bill directly to the insurance companies). The parents paid - up front - for the visit and/or treatment and were given “documentation” to send to their insurance company.
[2] Many of the treatments that were “refused” by insurance companies were “alternative” treatments, either because they have not been shown to work for anything (e.g. homeopathy) or because they haven’t been shown to work for autism (e.g. chelation, thiazolidinediones, etc.).
[3] The charges - for office visits, at least - were significantly above the norm for the community. In a region where a first visit to a paediatric neurologist or child psychiatrist can run $150 - $200 (covered by insurance), there were “practitioners” who had not completed a residency who were charging $400 to $800 for a one-hour visit. Some were also charging $500 an hour for “telephone consultation” (which included answering questions about complications of the “therapy”). Not surprisingly, insurance companies declined to pay these inflated charges.
In contrast, my own experience with insurance companies, while often frustrating, has shown that if the practitioner knows the basics about insurance billing, there is no problem getting appropriate care paid for. We have gotten our insurance plan - not a “gold-plated” plan, but plain vanilla PPO-type insurance - to pay psychiatrists, psychologists, neurologists, gastroenterologists, orthopaedic surgeons, speech therapists, occupational therapists, etc. We have also gotten it to pay for a variety of physician-prescribed medications.
The “trick” for getting insurance to cover medical care for autism? Apparently it’s nothing more than avoiding questionable practitioners. Legitimate practitioners know how to bill insurance appropriately and - more importantly - are conscientious enough to do it and do it correctly.
Just to clarify - our insurance plan has covered all of these practitioners and treatments, but little or none of it has been for “autism”; it’s been for “dysfluency”, “gastroesophageal reflux”, “oppositional disorder”, etc. This is what competent and experienced practitioners do. If your doctor can’t or won’t do that….
Prometheus
Filed under: Autism Policy, Autism Practitioners, Health Alerts | 31 Comments »
“Latex causes autism”: a “Brave (but dead) Maverick Hypothesis“? [Part 3]
December 9th, 2011
Enough people have shown interest in having a “part 3″ of this series, so here it is! These are the “odd bits” I thought were curious but didn’t fit neatly into the main posts.
How much latex is in vaccine or medication vials?
In the book, Vaccine Delivery and Autism (The Latex Connection), the authors repeatedly assert that H. brasiliensis proteins (and genetic material, but more on that later) leach out of latex-containing vaccine vial stoppers and into the vaccine. In support of this, they cite one study (Primeau et al 2001) and one case report (Hoffman 2000) and a raft of news articles.
Let’s take a look at Primeau et al (2001). In this study, they prepared vials containing a mixture of phenol, saline and human albumin and sealed with either natural rubber (latex) or synthetic rubber (bromobutyl or synthetic isoprene) stoppers. For detection, they performed intradermal skin testing on a group of 12 latex-allergic (LA) and 11 non-latex-allergic (NLA) volunteers. What they found was that 2 of 12 LA volunteers reacted to solution from vials with natural rubber stoppers that had been punctured only once and 5 of 12 LA volunteers reacted to solution from vials with natural rubber stoppers that had been punctured 40 times.
There are two “take home lessons” from this study. First is how few of the latex-allergic volunteers - people with a documented history of reacting to latex - reacted to either preparation. The second lesson is that vial stoppers that have been repeatedly punctured are more likely to lead to a reaction. This latter lesson is significant because multi-use vials of children’s vaccines pretty much disappeared when thimerosal was taken out in 2000 - 2001. In addition, pre-filled syringes, even those with natural rubber plungers, never have the rubber components punctured - not even the rubber needle caps. Something to think about and something the authors should have considered.
The case report (Hoffman 2000) is about a six-year-old girl who “developed erythematous, raised lesions at the site of her insulin injections”. Intrdermal skin testing revealed a latex allergy and switching her to an insulin “pen” solved the problem. But here is the part - which was also in the abstract - that the authors of Vaccine Delivery and Autism should have noticed:
“The reactions occurred when isophane and lispro insulin were administered individually or combined but not when insulin was obtained from the bottle after the septum had been removed.”
In other words, even if the insulin was from a vial that had a natural rubber stopper, it didn’t contain enough latex protein to trigger a reaction, even in a person who was latex allergic and had recently been “provoked” by latex. Only when the needle was inserted through the natural rubber stopper did the insulin pick up enough latex proteins to cause a reaction. Again, this is particularly significant in light of the fact that using pre-filled syringes of vaccine (or other medications) does not involve puncturing the rubber components.
So, the “bottom line” is that H. brasiliensis proteins are found in medications stored in vials with latex-containing stoppers, but that the amount is so low - even in combination with natural rubber “cored” out of the stopper by the needle - that it does not reliably trigger a reaction even in already sensitised subjects.
Filed under: Autism Science, Critical Thinking, Myths About Science, Recent publications | 11 Comments »
“Latex causes autism”: a “Brave (but dead) Maverick Hypothesis“? [Part 2]
December 5th, 2011
Welcome back, my friends, to the show that never ends….
In the last episode, we saw how Mr. Dochniak goaded me into reviewing his latest book, Vaccine Delivery and Autism (the Latex Connection) and my impressions of the format of that book. Now, we get to the meat of the book - and the science!
A few positive notes:
One of my mentors, early in my graduate school career, taught me that whenever I graded a paper or reviewed a proposal, article or book, I should first endeavor to find at least two positive things. That, I was told, would help me retain my objectivity, since every piece of writing has something good in it. This dovetailed nicely with what my mother always said: “If you can’t say something nice, don’t say anything at all.”
Well, as anyone who has read my writings on this ‘blog or my comments here and elsewhere knows only too well, I haven’t always followed my mother’s instructions. However, I have always tried to find at least two good things in everything I read, even if I don’t always mention them.
In the case of Vaccine Delivery and Autism (the Latex Connection), the most positive feature of the book was the passion the authors have for their crusade to eliminate latex from vaccine vials and syringes. Mr. Dochniak, at least, has spent a great deal of time and credibility promoting his hypothesis (Ms. Dunn seems to keep a lower profile) on the Internet. It wasn’t until I was writing this review that I realised Mr. Dochniak and I had “crossed pens” on this subject before, back in 2007 on my “proto-’blog”. My advice to him then was the same as my advice to him now: go out and find some actual data and use that to support or modify the hypothesis.
The second positive aspect of the book is that the authors (although I’m inclined to think this is mostly Mr. Dochniak) are very well-informed about the commercial production of natural rubber. I learned a lot about how rubber is harvested and processed from this book.
Carbohydrate loading:
Reading this book was not easy - not because the material was beyond me and not because I had philosophical objections to the authors’ arguments. The problem was abysmally poor writing. The writing was choppy and veered from one topic to another - unrelated - topic without so much as a transitional sentence. There was a great deal of “information” introduced with the preface of “it is understood”, “it is generally known”, “it is becoming clear” without ever citing or otherwise indicating where that information came from. After some searching of the medical and biological literature, I came to the conclusion that the authors were the source of this “information”.
On several occasions, section headings ”promised” information they did not contain. For example, under the heading ”Does atopy affect some of the symptoms associated with allergy-induced-regressive [sic] autism” was mention of a study showing that atopic individuals reported symptoms of irritable bowel syndrome more often than the general population and an article about latex allergy in a medical device trade journal. No mention was made - anywhere in the section - about how these two “factoids” might tie in to autism. Fortunately, being intimately (some might say nauseatingly) familiar with the autism lore about bowel problems and autism, I was able to “connect the dots”. Parents of autistic children looking for “answers” - the target audience - might not. Let’s say I’m ambivalent about that.
I also found a great deal of “copypasta” (it’s easy to do and very filling) in the book - sentences and even whole paragraphs that had been copied directly from articles (usually from the abstract) with little or no modification. Although the articles were cited, there was no indication (e.g. inverted commas, italicisation, indentation, etc.) that they had been copied verbatim or nearly so. While this may not quite rise to the level of plagiarism, it comes perilously close. I fully understand that sometimes it can be difficult to come up with a unique way to say a simple fact (”The sky is blue”), but the proper way to “copypasta” is to clearly identify those sections that are taken verbatim.
As an exercise, I chose one chapter from the book - Chapter 4 - that was of average length (seven pages) for this text and applied the process I use when I suspect students of copypasta: I picked long, unusual phrases and did an Internet search. What I found was that at least 46% of the chapter - by column inches - was copied directly, with minimal if any change, from other sources. In addition, I found a paragraph copied from a European patent application that wasn’t cited. That is plagiarism!
Apart from the ethical considerations, the large amount of verbatim material is at least partly responsible for the choppy and disjointed writing style, since so many different authors’ words are being jammed together in such close proximity.
Filed under: Autism Science, Critical Thinking, Help for the bewildered, Recent publications | 67 Comments »
“Latex causes autism”: a “Brave (but dead) Maverick Hypothesis“? [Part 1]
December 1st, 2011
Let the Nonsense begin!:
Before May of this year, I was in blissfiul ignorance of the “hypothesis” that latex - specifically, latex in vaccines (of course) - was the cause (or a cause) of regressive autism. But then Orac (of the Respectful Insolence ‘blog) posted a short notice (here) of a press release for the book Vaccine Delivery and Autism (The Latex Connection), by Dochiak and Dunn. It was a small post, with only a minimum of “respectful insolence” added, since the premise of the book seemed laughable enough. The press release described the authors thusly:
“Michael J. Dochniak and Denise H. Dunn are leading experts in the etiology of allergy-induced regressive autism and have previously authored a book for Nova Science, entitled ‘Allergies and Autism.’ Dochniak is a scientific researcher in the field of Hevea brasiliensis natural-latex induced autism. Dunn is an early childhood educator who works closely with autistic children and adults, and has been teaching for more than 15 years.”
Fortunately, it wasn’t too hard to check on Mr. Dochniak’s credentials as a “scientific researcher in the field of Hevea brasiliensis natural-latex-induced autism”. In reality, he has a bachelor’s degree in chemistry and psychology (both awarded in 1985) and has published - apart from the two books - one article in Medical Hypotheses. That article - needless to say - had no data. In fact, Mr. Dochniak’s only “research” into autism has been in the library and on the Internet, although he has written a few articles on latex for adhesive and sealant trade newsletters and is on a number of patents and patent applications, including one for a “Method to affect the development of autism spectrum disorders” (#20070034214).
A day after the post, the lead author, Mr. Michael Dochniak, appeared in the comment thread and - as they say - hilarity ensued.
Filed under: Autism Science, Critical Thinking, Help for the bewildered, Recent publications | 37 Comments »