Guaranteed Autism Prevention! Oh, really?

There's no doubt that autism represents a significant health issue, not just in the U.S., but around the world. Current estimates put the prevalence of autism spectrum disorders (ASD) at around 1 in 88 children. Over the years, awareness of ASDs has increased; tests and diagnostic tools have been developed that can detect ASDs earlier and within a wider range of severities; and diagnostic criteria have shifted, generally leading to more inclusive criteria, meaning that a greater number of less severe cases are diagnosed. For those families dealing with more severe autism, the burden can be incredible, physically, emotionally and financially. Frequent, violent behavior from those more severely affected, as well as bolting or self-injurious behaviors, can wear a person out very quickly. Going out is often difficult, due in part to the needed vigilance and in part because of the lack of understanding from members of the public; families tend to withdraw and become isolated, lacking the emotional support they need day by day. States are beginning to enact legislation that requires insurance companies to cover certain autism treatments, but there is still a long, long way to go to ensure that those who need services get them without undue financial burden and stress. Even with good health coverage, there may be other costs to bear, such as respite care or remodeling of the home space to meet the needs and challenges of autistic family members. (This is not to say that all people with ASDs deal with this level of hardship; there is a broad range, from those requiring professional support to those who are "quirky".)

Thus it should come as no surprise that wanting to prevent autism in the first place would be a godsend. Part of the difficulty, however, lies in the fact that, to date, we know very little about the causes of autism. We know about congenital rubella syndrome, Fragile X and Reyes' Syndrome as causes of ASDs, and current research strongly hints at multiple genetic and prenatal factors that could play some role in ASDs. But without solid understanding of how autism comes about in the first place, there is not a whole lot that we can do to prevent it.

Enter Dr. David Berger of Wholistic Pediatrics in Tampa, FL. Dr. Berger was interviewed by Heather VanNest, an anchor with WTSP 10 News, in an article titled How to prevent autism: 3 ways to lower the risk.
You see, Dr. Berger has developed a protocol that, he claims, can prevent autism. How do I know? Because after VanNest asks, "Can you REALLY [sic] prevent autism?", Dr. Berger responds:

So far, we have had a tremendous amount of success. In over 10 years and hundreds of children born into our practice, we know of no children who have gone on to develop autism, even in families who have had one child already.

So there you have it! In over 10 years of practice and with hundreds of children born there, not a single case of autism. Therefore, his protocol must work.

Yeah. Feel free to discuss the logical fallacies present in his statement down in the comments. To me, the next logical question to ask would be, "That's quite impressive! Where have you published your findings?" I mean, think of how this could revolutionize how prenatal, postnatal and pediatric medical practice! Publish in peer review so that others can see what you're doing, replicate it to make sure there's something actually there and ultimately put the protocol into practice. Autism rates would plummet! But VanNest didn't bother to ask that question, though a commenter did. Her response?

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Because there's no money in it; Big Pharma^TM, apparently, is the only source of research dollars; and only large, double-blind studies would provide any useful information, Dr. Berger has not published anywhere, in VanNest's opinion. Umm, Ms. VanNest? Regarding money, I can imagine that insurance companies and local and state governments would be all over preventing autism since it would dramatically reduce their costs. Also, there's this little, humdrum organization called the NIH. Perhaps you've heard of it? They provide grants to researchers to study things, and since autism is a pretty big topic these days, cutting edge research like Dr. Berger's would probably be a shoe-in for one. Then there's the whole marketability of new drugs and devices to prevent autism that industry might want to cash in on. The market for preventing autism would be significantly larger than the market for treating autism (88 per 88 children, compared to just 1 per 88). But you're right...there's no money in it. That's why you didn't bother asking Dr. Berger where his findings have been published. Oh, and the type of study needed? Large scale double-blind studies, while certainly ideal, aren't necessary at this early stage. Dr. Berger could probably get by with a small- to medium-scale cast control study to get some initial findings out there. Then other researchers could try to replicate his work and see if it actually holds water.

At any rate, VanNest didn't bother asking or reporting it in her article. So, naturally, I paid a quick visit to PubMed to search for "David Berger autism" (minus the quotes). Here are the results:

No, I didn't forget to paste anything in between the last paragraph and this one. There were no results. Zero. Nada. Zilch. A big ol' goose egg.

Just what does the good doctor look for?

#1 NUTRITIONAL DEFICIENCIES:

Including Iron, B-vitamins, Omega-3 fatty acids and Vitamin D levels.

Dr. Berger says low levels of vitamin D in the mother have been linked to delayed language development and weaker immune systems.

#2 THYROID HEALTH:

Untreated Hypothyroidism is a known cause of developmental delays in children.

#3 TOXINS:

Including pesticides, lead, and mercury, which have been linked to learning disorders.

Essentially, lots of speculation. The tests he chooses to do have, at some point, been linked, however tenuously, to learning or developmental delays of some variety. Therefore, dealing with these can prevent autism. (There's that leap off a cliff, leaving logic behind, again.)

Again, Ms. VanNest, let's look a little more closely at what you've reported. 1) Autism is a developmental disorder, true. But not all developmental disorders or learning delays are autism. 2) None of the items listed has been shown to have a causal link to autism. There is certainly speculation (e.g., some studies suggest that low levels of vitamin D in utero may play a role in autism, but there has yet to be anything definitive). And some things have been shown to have no connection at all to autism (e.g., mercury in the form of the ethylmercury found in thimerosal).

VanNest did include a link to an article Dr. Berger wrote for the Autism Science Digest, a non-indexed journal run by the home for wayward quacks mavericks, AutismOne, which plays host to just about any biomedical nonsense marketed as a treatment for autism, such as the work of Mark and David Geier. If you can stomach it, From Preconception to Infancy: Environmental and Nutritional Strategies for Lowering the Risk of Autism is a wealth of practice in spotting logical fallacies and anti-vaccine tropes. I'll leave it as an exercise for my readers to delve into.

What could have been a good opportunity to ask critical questions. Instead, we get what basically amounts to advertising for a doctor making claims that are not supported by data. It's all well and good to make sure that families, and in particular women who are about to become or are pregnant, practice a healthy lifestyle. However, to claim that autism can be prevented by Dr. Berger's protocol, when we have no research actually validating it, is premature and irresponsible.

VanNest and Dr. Berger should both be ashamed: VanNest for irresponsible journalism and Dr. Berger for failing to do due diligence before making extraordinary claims. If his protocol actually works, that would be great, but the truth is that we do not know and will not know until the research is done. At best, Dr. Berger is Florida's version of Dr. Jay Gordon. At worst, he's a crank (which I'm leaning toward after viewing the Wholistic Pediatrics web site). Both do an incredible disservice to families who may expend added resources for no actual gain.

I'd be interested to hear my reader's thoughts on the article and Dr. Berger's claims. What do you think?