Huffington Post Health Watch: Mark Hyman's Faux Autism Cure
As the author of several best-selling books about health and wellness, and one who runs a prestigious wellness center on the East Coast, Dr. Mark Hyman is one of the most recognized medical experts on the Huffington Post. Hyman helped to pioneer functional medicine, a specialty which purports to offer more tailored, personalized care to patients than that of mainstream medicine. His work has placed him in the same league as wellness gurus Andrew Weil, Dean Ornish and Deepak Chopra. Dr. Hyman also has influence in the corridors of power, having spoken before the prestigious Institute of Medicine as well as with White House officials about health and health reform.
Dr. Hyman also has plenty of critics, including my colleague here at Salon, Dr. Robert Burton. He recently wrote a piece challenging Dr. Hyman's latest book and PBS special as nothing more than a collection of unproven ideas. Dr. Hyman responded here.
I have heard Dr. Hyman speak in the past. He is smart, sincere and passionate about his approach to health. Many of my colleagues have great respect for him. But his most recent post on the Post, "Why the Current Thinking on Autism is Completely Wrong," raises many questions about his approach to this complex disorder. In it, Dr. Hyman claims to have a unique understanding about the cause of autism. He then tells us that his insights allow him to cure patients with this complex disorder.
Yet neither of these claims is true. A close look at Dr. Hyman’s essay shows him to be just like many other Huffington Post health bloggers I’ve discussed in the past, who use shaky science and cite questionable experts to promote unproven cures. In Dr. Hyman's case that prescription is also identical to that of the anti-vaccine group, Defeat Autism Now! (DAN!)--which promotes the kind of "biomedical cure" (expensive tests, vitamins and herbs, extreme food restriction and drugs to detoxify the body) which is costly and potentially dangerous. The final punchline here is that Dr. Hyman’s piece is a recycled essay that is two years old, and doesn’t take into account many new revelations that have debunked his claims.
Hyman begins his assessment of autism by trying to draw a contrast between his own thinking and the rest of the medical community:
" 'Autism is a genetic brain disorder.' " That is what most people -- and most of the medical community -- believe today," he writes. "The real reason we are seeing increasing rates of autism is simply this: Autism is a systemic body disorder that affects the brain. A toxic environment triggers certain genes in people susceptible to this condition. And research supports this position.
Dr. Hyman thus sets up his thesis: "Today I will review some of this research and explain how imbalances in the 7 keys systems of the body may be the real cause--and thus the real cure--of autism."
There's nothing groundbreaking here when we translate this into clearer terms: Genes + Environment = Disease. This is known as the two-hit hypothesis, a famous theory postulated for cancer in 1971. This theory is well-accepted and is now standard medical school fare about many diseases other than cancer. The two-hit hypothesis applies to autism as well. Just look at the American Academy of Pediatrics clinical report from 2007, which puts Dr. Hyman’s special insight out in the open for doctors and parents everywhere:
"...the expression of the autism gene(s) may be influenced by environmental factors. Although currently under investigation,these factors may represent a "second-hit" phenomenon that primarily occurs during fetal brain development. That is, environmental factors may modulate already existing genetic factors responsible for the manifestation of [autism] in individual children.
Dr. Hyman then cites Harvard neurologist Martha Herbert as an expert to lend credence to his argument. Dr. Herbert, he writes, "has painted a picture of autism that shows how core abnormalities in body systems like immunity, gut function, and detoxification play a central role in causing the behavioral and mood symptoms of autism." Then he links to a 2005 review article by her. In that paper, she proposes autism is "a behavioral syndrome…influenced by…gene-environment interactions." Herbert then goes onto list a plethora of possible mechanisms by which toxins may be triggering autism—all of them still unproven today.
I asked Ken Reibel, the parent of an autistic child who blogs about autism, vaccines and other controversies about Herbert. He is skeptical. "Herbert isn't really saying much - all we know is that she suspects "environmental influences" for "rising rates of autism", and that it would be a mistake to ignore vaccine safety. This is the language of politics and PR, not science," he told me.
Still, Dr. Herbert is admired in the anti-vaccine and biomedical faction of the autism community. She is the Director of Treatment Guided Research for the Autism Society of America, which like DAN! believes that vaccines cause autism and that biomedical treatments cure it. In 2006, she was an expert witness in a lawsuit in Massachusetts (MacGregor v. Born). The plaintiff in the case alleged that mold exposure led her child to develop autism. Herbert was hired by the mother’s attorney as an expert witness, but her testimony was dismissed because according to court documents:
"Dr. Herbert’s publications indicate that she is an outspoken advocate of increased attention to the possibility of environmental influences. Even she, however… speaks in her published work of possibilities and potentialities, rather than of the ‘reasonable degree of medical certainty’ to which she offers to testify under oath in this case. Neither Dr. Herbert’s publications, nor any others cited, identify mold exposure as even a suspected, still less a known or proven, trigger of autism...Clearly, Dr. Herbert’s method is not generally accepted in the scientific community. Dr. Herbert’s theory of environmental triggers of autism may some day prove true. It has not yet. Her proffered testimony does not meet the standard of reliability required by the case law, and cannot be admitted in evidence at trial."
Regardless of the questions about Herbert, journalist Arthur Allen told me that her ideas are still seductive. Allen has written extensively about autism and vaccines (including an excellent expose in Slate earlier this year debunking many of the concepts and cures Dr. Hyman espouses in this piece). "Having a Harvard professor on their side helps the DAN! people rally the troops. By talking about the general effects of 'toxins', including vaccines of course, she provides a way for their arguments to be impermeable to the data showing no link to vaccines. Finally, if it's 'toxin' damage then you can charge the parents thousands of dollars to buy a lot of vitamins and enzymes," Allen told me.
Following his references to Baker and Herbert, Dr. Hyman goes on to tell the story of a boy with autism who was brought to him by the boy's parents. Hyman says the child was healthy until he received vaccines. Then he begins to plug his own program to cure this child, and anyone else with autism. While his tale is certainly powerful, nothing that Dr. Hyman prescribes has been proven to work. His prescription includes lots of tests and treatments for vitamin deficiencies, heavy metal poisoning, yeast overgrowth and food allergies—the much ballyhooed biomedical cure.
Dr. Hyman’s protocol, which he details in his essay, is virtually identical to the one DAN! provides special training to doctors to use (Dr. Hyman is not listed as a "DAN! Doctor"). This treatment includes chelation therapy, which is based on tests that artificially elevate levels of mercury and other heavy metals in a person's urine to create the false impression that they are toxic. According to Ken Reibel, DAN! recently had to purge their ranks of providers because many have been disciplined by state medical boards. At least one child with autism has died at the hands of a DAN! doctor.
What's most bothersome is that Hyman's post is actually not new at all. It's a recycled post from 2007, which you can find on his own website. In that time, there have no new research findings to support his or Martha Herbert's views. On the other hand, there have been many further studies and revelations that refute that vaccines cause autism, including a 2008 paper showing climbing rates of autism despite the use of mercury-free vaccines, and the landmark case of the so-called vaccine court against families seeking damages because they believe vaccines caused their children to develop autism. In addition, several exposes of biomedical cures for autism, most notably by Paul Offit in his book Autism’s False Prophets, continue to cast doubt on the science behind and motivation of groups like DAN!
In response to questions about why the Post would allow Dr. Hyman to recycle a piece without instructing him to review it for new facts, a spokesman answered, “We welcome experts including their past writings in their updated discussions on current topics, and thus making that knowledge available to a new and larger audience.”
Once again, the Huffington Post isn’t paying attention to itself. Dr. Hyman did not update his discussion at all. It is, word for word, the exact same article. That Hyman does not update his essay with emerging information is unprofessional. That the Huffington Post allowed him to republish it for the consumption “a new and larger audience” is just another reminder of the Post's continued lack of editorial oversight when it comes to health and medicine.
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Comments
And it's not like the cure for autism is a medication they aren't taking. Whatever the causes, rehabilitation therapy is pretty much the standard treatment. And it's near impossible to prove the two hit theory with endangering children in a clinical trial. So Autism remains in something of a scientific state of limbo.
Finally. You must be incredibly impressed with the way OS editors have vetted your work. I see you published it at 11:21 p.m. They must have been up all night checking the medical journals!
The plural of anecdote is not data. Anecdotes are sometimes a good way to formulate an hypothesis. Followed by real science to test that hypothesis. Hyman et al skip over all of this and go straight to therapies based on anecdotes and untested hypothesis, sure.
But they also, as you point out here, ignore science that might be, and in fact is, contra to their ideas. Hard not to conclude that HuffNPuff is anti-science.
I've seen some aspects of change in diet work to improve certain symptoms for my kid with Asperger's. But in no way do I kid myself that this constitutes a "cure." What bothers me the most about folks like Dr. Herbert and the peddling of a "cure" for autism is two-fold.
First, it creates the myth that any child with autism can be rendered symptom-free, so long as you poke, prod, and fiddle with things enough. While many things WILL help, symptom-free is out of reach for most kids, and parents waste valuable time and effort trying to "cure" their kid as opposed to teaching him or her the coping skills they need to function in a world where most people's brains work differently than theirs.
And how many of these kids, who get close to the appearance of normal but remain symptomatic are going to feel like they have somehow "failed" because they could not be "cured" of a disease that really, has no cure? Like the young girl who starves herself to get to a size two only to discover that the fashion and film industries have since gone on to lionize the wonders of size 0, are we placing these kids and their parents on a hamster wheel, making them exert superhuman effort to acheive a goal that ultimately will never be within their grasp without causing serious detriment to thier health and sanity?
Second, we do a disservice to the kids on the other end of the spectrum. It's folks like Herbert who cause people who know I have a kid with Aspies to come up to me and tell me that I shouldn't worry, because they've read stuff online and know that with enough effort, my son can be cured. While it's nice of them to hold out hope for me, and I appreciate their attempt at support, the fact is that while my child may eventually reach the place where he is indistinguishable from his peers, his brain will always work differently, and he will always have to cope with that.
And what of the kids who are further down the spectrum, like my husband's other son? There is no hope of a "cure" for him. I would hate for anyone to think that his mother doesn't do enough for him simply because she was unable to see him "cured" via all the hokum peddled by the DAN people. Autism can be, in the more serious cases, a seriously debilitating affliction, and lately those cases get neglected because the large number of more mildly afflicted kids who can be "cured" end up being the focus of attention. Parents of seriously autistic kids deserve better help than pie-in-the-sky talk of a "cure" that really doesn't offer them any real relief from the very serious burdens they bear.
None of this, of course, ever stopped a snake-oil salesmen who saw an opportunity for profit.
Your snark about OS vetting his work was also fascinating and totally irrelevant. OS editors don't claim to fact check any of the work on the site. Thus his piece obviously lacks the imprimatur of a site like HuffPo.
I'm not sure if you missed the Rahul's point that HufPo failed to follow its own guidelines when publishing Dr. Hyman's piece. You make it sound like he expected HuffPo to be a medical journal, when what he expected was simple fact checking and an updated piece, as HuffPo itself promises.
It sounds like you have an ax to grind.
Maybe my comment about being vetted came off a little snarky. But, as I've stated before, on Rahul's blog, I find Huffpo and Oprah and their "doctors" very easy targets, and not even a fraction of the problem.
The problem is the U.S health care system, which doesn't sufficiently provide desperate parents with the resources they need. So most of them can't even get traditional treatment even if they wanted it.
And the problem is autism, at this point still a mysterious condition. I think that Rahul's article implies that there is a lot of definitive science on this. I'm not convinced there is.
I wish, just once in a while he would mix it up a little and attack some of the more substantial problems and issues.
I don't believe that Rahul was being overly definitive. He was saying that it is likely that Autism is caused by genetics and environment, but there is no definitive proof what the environmental causes are. However, there is proof that it's not vaccines and that chelation, for example, doesn't cure anything. At least that was what I got from the piece.
Maybe HuffPo and Oprah's "doctors" are easy targets, but large targets with large audiences should be debunked whenever necessary.
I'm not sure if the "U.S. health care system" is the sole problem here. That seems like an awfully easy target as well, and so vague as to comprise virtually everything medically related.
We don't have these doctor media wars in Canada because doctors don't really profit from them. We don't have massive amounts of pharmaceutical ads, because pharmacists are required to by law to give out the generic brands. We just have good health care, and substantially lower mortality rates. And our doctors don't have to wrestle with the same level of cynicism and distrust yours do.
Austism, however, remains a problem and a tragedy for many families. It's extremely expensive to treat, whether you're getting standard treatment, or alternative. Nothing ever seems to be enough. And yes, people are desperate.
A good health care system at least ensures that everybody else in the family is in good enough shape to deal with it. And that their attention is focused on the autism, and not all the other health problems that afflict stressed out families.
From where I'm sitting the U.S. health care is a pretty huge factor in this desperation. And at this critical juncture, any doctor who isn't devoting a good portion of his energy arguing for a single-payer system, is almost part of the problem. My gut sense is that these doctor media wars over, at this point, incurable illnesses, are more distracting than helpful.
But there is no study to prove that.
Bingo! There is no known cause for most types of autism, and no known cure. Dr. Hyman and other bio-med opportunists speak of "recovery" from autism, but his community has yet to settle on a definition for that word.
Bio-med treatment for autism is built on an illusion - that some children "get better" after chelation, HBOT, GF-CF, magic detox rays, etc. And no doubt some do, which should surprise no one. Autism is a pervasive developmental delay, which means the kids continue to develop, grow, adapt, and mature. They just do so at their own pace. Given enough time, and lack of a control group, grape jelly can look like a cure.
My brother has autism and if parents want to dose their autistic kids with harmless stuff like vitamins, I have no problem with it, but some of the "treatment" touted by quacks contrary to all scientific research is just plain child abuse.
It makes me absolutely furious.