Update: Hyperbaric Oxygen for Autism

We have updated and upgraded our Autism page. Finding scant evidence for hyperbaric oxygen therapy, we now provide more helpful links to patient and clinical resources, to the 2009 Undersea and Hyperbaric Medical Society (UHMS) position paper, and to the indispensable 2011 book, Thinking Person's Guide to Autism. Here's hoping you find our new page nearly as thoughtful.

Hyperbaric oxygen therapy is not FDA cleared or UHMS approved for autism spectrum disorder. That's not apt to change anytime soon. From our new commentary:

People living with autism, beware. Perhaps no patient community today is so beset by healthcare fraud and quackery. Hyperbaric oxygen therapy has gotten caught up in a powerful movement away from evidence-based practice and toward alternative therapists promising miracle cures. Their claims are as wild as their HBOT is mild. What thin evidence we have on HBOT for autism is fraught with contradictions and undercut by investigator bias.

Frankly, we would prefer never again to write of HBOT and autism. But we will keep our eyes peeled for relevant hyperbaric news and especially clinical evidence. Until then, let our new, carefully researched page stand as our final word on the subject.

Hyperbaric Oxygen for Autism: New Rossignol Literature Review Does Not Impress

In May we cheered Ahmad Ghanizadeh's new systematic review of the published clinical evidence on hyperbaric oxygen for autism. Ghanizadeh encouraged further study but found scant evidence to support practice. This month another paper, reviewing the same body of medical literature, and published in the same online open-source journal Medical Gas Research [doi:10.1186/2045-9912-2-16], arrives at a much more optimistic conclusion. The review and analysis was led by Dr Daniel A. Rossignol (pictured right). We are wholly unimpressed. To us this paper smells of wishful thinking and investigator bias. It's almost (but not quite) enough to make us ban Medical Gas Research from our journal club. Read the abstract or download the provisional PDF of the full article and decide for yourself. After exhaustive reading and reflecting, we have at long last completed our update to the HyperbaricLink autism page, now in press. Our writeup and commentary will fully reflect the weakness of the medical literature in this important area of research.

Freezer Malfunction at Harvard Tissue Bank a Setback for Autism and Other Brain Research

A freezer and alarm failure, causing severe damage to one-third of the frozen brain tissue specimens stored at one Harvard Brain Bank center at McLean Hospital in Belmont, Massachusetts, a collection owned by Autism Speaks, is a real setback to autism research and a wake-up call to other brain banks. The study of donated brains drives some of the most important research into autism, Alzheimer's, traumatic brain injury, and other neurological and psychiatric conditions. We have written before about the Center for the Study of Traumatic Encephalopathy (CSTE), a brain bank affiliated with the Boston University Medical Center and the Sports Legacy Institute at the Bedford Veterans Administration Medical Center in Bedford, Massachusetts. Several groups are investigating the Harvard incident. More in the excellent boston.com story.

[Image: Harvard Brain Tissue Resource Center]

Autism Postscript: State of the Science on Causes and Mechanisms

Friday we lamented the lack of any clinical evidence to support the use of hyperbaric oxygen therapy in children with autism. Yet the science in this field continues to fascinate. Later that night we enjoyed Charlie Rose's enlightening conversation with some leading autism experts: Eric Kandel of Columbia University, Gerald Fischbach of the Simons Foundation, Uta Frith of University College London, Matthew State of Yale University, and Alison Singer of the Autism Science Foundation. Part of Rose's ongoing Brain Series, the discussion touched on the latest findings and prevailing theories about the (especially) genetic causes and mechanisms of autism spectrum disorders.

Hyperbaric Oxygen for Autism: New Systematic Review of the Medical Literature

For anyone interested in the use of hyperbaric oxygen to treat children with autism, we note the publication today of a simple but helpful systematic review in the online open-access journal Medical Gas Research, by Ahmad Ghanizadeh, Director of Research Center for Psychiatry and Behavioral Sciences at Shiraz University of Medical Sciences in Iran. From today's abstract:

The electronically [sic] search resulted in 18 title of publications. Two studies were randomized, double-blind, controlled-clinical trials. While some uncontrolled and controlled studies suggested that HBO therapy is effective for the treatment of autism, these promising effects are not replicated. Therefore, sham-controlled studies with rigorous methodology are required to be conducted in order to provide scientific evidence-based HBO therapy for autism treatment.

Ghanizadeh's findings support the prevailing view of the evidence-based medical community. Even the two supposed randomized controlled trials (RCTs) he identifies do not, in our view, support the practice, except in the course of clinical investigation. Nor do the eight studies listed on ClinicalTrials.gov show much promise of answering the important questions. Look for a quick update of our autism page in the weeks ahead.

Postscript: Autism mHBOT Kerfuffle at Meadowlands Hospital Medical Center, Secaucus, New Jersey

The scandal continues in the New Jersey case involving hospital-sponsored mild hyperbaric therapy for children with autism. See our December 19 post, "Hyperbaric Oxygen for Autism: Evidence-based News and Further Reading." Now the main character in this story, director of the hospital's Neurosciences Center, has been fired and his appointment to the New Jersey Commission for Brain Injury Research delayed for review. Read all about it in "Meadowlands hospital neuroscientists fired over controversial autism treatment" on NJ.com. Controversial indeed. Go to our autism page for preliminary information on the clinical evidence and links to the medical literature and other resources.

Hyperbaric Oxygen for Autism: Evidence-based News and Further Reading

We've been watching with great interest the recent kerfuffle at Meadowlands Hospital Medical Center, Secaucus, New Jersey, surrounding the use of mild hyperbaric oxygen therapy for children with autism. November 27 the Star-Ledger posted "Questions, risks surround hyperbaric chamber treatments for autistic children," reporting that the New Jersey state Department of Health would rule in January whether the hospital "should be allowed to offer this experimental and controversial treatment." Just five days later appeared "Meadowlands Hospital Medical Center pulls out of request to use controversial autism treatment" in the same paper. Good call. Let's chalk this up as (1) a victory for evidence-based hyperbaric medicine and (2) another moving family story to inspire legitimate clinical investigators to get to work.

As we read and study for our long-overdue autism page update, we've run across some more required reading for anyone interested in this important and fascinating subject. "The prevalence puzzle: Autism counts" in Nature [479, 22-24 (2011)] looks thoughtfully at whether the rise in autism is due to heightened awareness, better diagnosis, or actual incidence. Last week the Los Angeles Times ran "Discovering Autism," an excellent four-part series covering very similar ground.

[Image: Nature]

California Autism Twins Study: Nature-Nurture Conundrum

What causes autism? Just last month we shared some important new science about genetic clues. (See our June 12 post, "Autism: Genetic Mutations New Cause For Excitement.") Now a study published last week in the Archives of General Psychiatry, looking exclusively at autism in fraternal twins, makes a strong case for environmental causes—specifically in the pregnancy and birth environment. Genetics alone could not account for high rates of autism spectrum disorder (ASD) among nonidentical twins.

Autism Speaks summarizes:

The California Autism Twins Study suggests environmental influences, which could include parental age, low birth weight, multiple births, and maternal infections during pregnancy may greatly increase risk for ASD. The study suggested that both genetic and shared environmental factors significantly increase risk for ASD: an estimated 38 percent of risk being associated with genetic heritability and 58 percent with the environment that twins share during pregnancy and perhaps early infancy. The study also found that the relative contributions of shared genes and shared environment are similar for males and females.

These interesting findings once again provide more questions than answers. They also stoke the heated war of words between outspoken factions in the autism community. We direct your attention to CommonHealth for a brief, clear, and fair backgrounder by guest blogger Karen Weintraub, who helpfully organizes the current research into environmental causes: (1) immune problems; (2) chemicals in the air, water, food, or on the ground; (3) problems during birth or delivery; (4) medications; and (5) nutrition.

You will next hear from us on this topic when we publish our updated and upgraded autism page. Then you will not hear from us again until someone publishes meaningful new clinical evidence to support any practical role for hyperbaric oxygen in addressing this national public health crisis.

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

Autism: Genetic Mutations New Cause For Excitement

Three studies breaking this week in the journal Neuron reveal strong new genetic clues to the riddle: What causes autism? Start with the preview, "Solving the Autism Puzzle a Few Pieces at a Time." Better yet, catch Ira Flatow's discussion with a panel of experts on Science Friday.

Time will tell what might be the primary causes behind the spontaneous genetic mutations described in these papers, and whether hyperbaric oxygen holds any biological plausibility. But surely this work opens an exciting new route of investigation. And how refreshing to see some real science make the autism headlines. There. We said it.

[Image: Daniel Geschwind/UCLA/NIMH via Science Friday]

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

Bill Gates Chimes In On Vaccine-Autism Debacle

Now here's a man who knows something about the population health benefits of immunization, and he appears sincerely angry about the damage done by Dr Andrew Wakefield and followers. Click the video below. Read the transcript of his interview with Sanjay Gupta on CNN.



The fraud doesn't end with autism. Along the fringes of the hyperbaric community we often hear about the treatment of so-called Gardasil injuries. Gardasil is the brand name of one of the vaccines that protects against human papillomavirus (HPV), which causes cervical cancer. The other brand name is Cervarix. Casually, some HBOT practitioners have approached us, and said, "Well, we're seeing a lot of Gardasil injuries lately." Then they go tell the local TV health beat reporter.

Such scaremongering is a menace to the public health. We urge any patient or parent who wants to get the facts and weigh the evidence on the HPV vaccine to go straight to the Vaccine Safety section of the CDC website. The Centers for Disease Control and Prevention operate the Vaccine Adverse Event Reporting System (VAERS) to track side effects and adverse events following vaccination. See for yourself how vigilant and transparent the medical community and the CDC have been since the HPV vaccine was introduced in 2006. Physicians who suspect adverse events following vaccination should pursue the matter through these proper channels.

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

Autism Study Invalidated: No Link to Vaccines

Many news sources have picked up the report by Brian Deer in BMJ.com, the online arm of the British Medical Journal, that the 1988 study linking autism and the measels, mumps, and rubella (MMR) vaccine contained numerous instances of altered clinical data. Highlights from the report include:

• Three of nine children reported with regressive autism did not have autism diagnosed at all. Only one child clearly had regressive autism.

• Despite the paper claiming that all 12 children were “previously normal,” five had documented pre-existing developmental concerns.

• Some children were reported to have experienced first behavioral symptoms within days of MMR, but the records documented these as starting some months after vaccination.

Numerous other subsequent studies have shown no link between the vaccine and autism spectrum disorders, and the original paper was withdrawn by the Lancet. Unfortunately, in the time since the publication of the bogus study the scare it started has caused needless illnesses and deaths and a resurgence of the diseases the vaccine prevents.

This latest development underscores the vital importance of well designed clinical studies of any diagnosis--or treatment. Although a number of studies have been conducted to evaluate the effectiveness of hyperbaric oxygen therapy in treating patients with autism, there is currently not a sufficient body of evidence to conclude scientifically that HBOT is effective.

Vaccines, Autism, the Supreme Court, and the burden of (scientific) proof.

The New York Times today reports the Supreme Court will consider a case involving the relationship between vaccines and autism. Given some of the Roberts court's recent decisions it's possible to infer the interests of large corporations and science will nicely coincide in this case, but in a group of nine people where one of the two most ideologically similar members describes the other as a "nut" there is latitude for surprising outcomes.

In recent decisions, notably Citizens United v. Federal Election Commission, the Roberts court has demonstrated a muscular inclination to broaden the legal protections afforded to corporations. Cases the court has agreed to hear in the near future provide it the opportunity to continue to create an expansive definition of corporate rights.

There is no scientific evidence that autism is linked to vaccines, measles-mumps-rubella or any other kind. Despite the energy advocates pour into claims to the contrary, their position cannot be regarded as evidence-based.

Taken together, these factors would point to a slam-dunk in favor of the vaccine manufacturer. The issue before the court, however, relies not a determination of rights or preponderance of evidence but on the question of legislative intent: did congress intend to prohibit certain types of lawsuits against drug manufacturers? Their answer has implications for the effects of such lawsuits on evidenced-based medicine that reach beyond the absence of scientific grounds for the claim in the case in question.

Treatment of autism with hyperbaric oxygen therapy to facilitate development, improve behavior, or eliminate the condition remains experimental and without strong scientific support despite numerous anecdotal reports from respectable sources of positive outcomes. While changes in the legal standards for product defect lawsuits involving vaccines have no direct bearing, such a decision could be a bellwether for a change in evidentiary standards by a court that has demonstrated a willingness to overturn settled law.

August Is (Was) National Immunization Awareness Month

The CDC wants to remind you that immunization is (was) "one of the most significant public health achievements of the 20th century," as we lament its wide disrepute in the 21st. Vaccine pioneer Dr Thomas C. Peebles died earlier this month, Tara Parker-Pope wrote an illuminating piece on whooping cough, the federal government did its bit with NIAM, and still no hoopla or a single PSA in the mainstream news. These days our best shot at disease prevention gets no respect.

Maybe the Internet has stirred up public mistrust. Maybe there's an evidence-based argument we're missing. What constantly surprises, though, is the confusion among otherwise well-informed, practicing physicians.

We saw a frank and fair airing of the issue in "The Vaccine War" on PBS's Frontline in April. Others, like the Alliance for Natural Health, watched the same program and saw media bias and a cover-up.

In certain circles of hyperbaric medicine, the criticism of vaccines has not been limited to autism, where a rather significant segment of patients, families, and providers believes vaccines contain toxins that cause the disorder. Lately we've also been monitoring claims that HBOT is an effective treatment for seizure-related disorders allegedly caused by human papillomavirus (HPV) immunizations.

These developments merit our brief undivided attention, later this week, with some helpful information about how the medical community and public health authorities monitor the safety of vaccines.

O2.O is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

Mitochondrial Disease: Expert Unenthusiastic About HBOT

In a truly informative teleconference sponsored by MitoAction on Friday 6 August, the Cleveland Clinic's Bruce Cohen, MD, professed his knowledge and passion for mitochondrial physiology but cast a vote of no confidence for hyperbaric oxygen therapy. Dr Cohen (photo right) illuminated his skepticism with a fine basic explanation of how the amazing organelle, the powerhouse of our body's cells, normally works and sometimes malfunctions. He also included a helpful discussion of the scientific method and the clinical trial process.

Cohen doesn't put much stock in case reports and makes no apology for not being able to explain the anecdotal successes his listeners shared, with considerable emotion. From his personal experience, he mentioned witnessing the unfortunate death of a child receiving HBOT and his own successful management of Crohn's disease with an unproven diet regimen. He also insisted that he's open to being proven wrong about the efficacy of hyperbaric oxygen therapy for mitochondrial disease.

But the burden for producing first-class evidence for HBOT, he maintains, lies with the hyperbaric medical community. We quite agree. He points to the ongoing cerebral palsy trial at the Children's Medical Center of Dayton as exemplary. Cohen's ideal randomized controlled trial for mitochondrial disease would be a crossover study of 20 patients with confirmed genetic disease, with 10 patients receiving HBOT and 10 receiving sham therapy to start, then switching the groups midway through the trial.

Sounds good to us. Let's get on it!

CLICK HERE to access an audio recording of the call, complete with illustrative slides, a lively Q&A session, and postpresentation discussion with patients and families.

Dr Cohen was also on the panel of the Mitochondria and Autism Symposium co-sponsored by the United Mitochondrial Disease Foundation and Autism Speaks. The panel reports that 5%-10% of patients with autism may also have a likely mitochondrial dysfunction. Not much enthusiasm for HBOT among these experts, either.

CLICK HERE to read the official Autism Speaks blogpost on the symposium.

O_2.0 is the news blog of HyperbaricLink, the independent guide to hyperbaric oxygen therapy treatment centers, physicians and clinicians, diseases and conditions.

Autism: Second CARD Study Finds HBOT Ineffective

A new study, supplementing last year's work by the same Center for Autism & Related Disorders (CARD) team, casts yet more doubt on the efficacy of mild hyperbaric oxygen therapy (mHBOT) for children with autism. The original paper is forthcoming in Journal of Autism and Developmental Disorders, the leading peer-reviewed, scholarly periodical on autism spectrum disorders.

These investigations are of a lower order than the Rossignol random controlled trial, where the efficacy of mHBOT was demonstrated. But still we consider CARD's null findings and well-played refutation an even more important contribution to the medical literature today.

We're also aware of the sometimes combative passions within the autism community, even among normally dispassionate scientists, and especially surrounding the Defeat Autism Now! (DAN!) movement. Rossignol excites us, too. Yet it disturbs us whenever we hear mHBOT practitioners ready to take Rossignol to the clinic, to the home, or (ahem) to the bank. We've seen him present and heard him emphasize just how much more work there is to be done.

In the final analysis, none of the studies published to date could charitably be called landmark science. We're very early in this important pursuit, and we encourage investigators to take stock and look ahead. Again we draw the reader's attention to the nicely balanced UHMS position statement on "The Treatment of Autism Spectrum Disorder with Hyperbaric Oxygen Therapy." (See our June 16 post, HBOT For Autism: Junk Science?)

Autism Midyear Review

Boy oh boy has 2010 produced a rash of autism stories in the press and in showbiz. From the very beginnings of this blog we've been openly fascinated by the topic, if not wholly persuaded there's any serious role for HBOT in the treatment of children with this all-too-prevalent condition. Our evaluation of the medical evidence stands firmly on scant. Yet we follow the autism news faithfully and here share our bookmarks to mark the midyear.

AWARENESS, RISK & PREVALENCE

As the autism spectrum widens to include more disorders, such as Asperger syndrome, the CDC now reports the prevalence of autism spectrum disorders (ASDs) is approaching 1% of US children aged 8 years, and says: "Although some of these increases can be accounted for by improved identification and awareness, the steady increase in ASD symptoms in the population possibly reflects increased risk, particularly among males."

Searches for risks in environmental toxins or any specific chemicals or pollutants behind local autism clusters turned up little or nothing. (Wow, did Nicholas Kristof ever miss the mark.) But here comes the blockbuster headline from the front lines of the vaccine war.

MEDICAL LITERATURE & RESEARCH

British medical journal The Lancet took the almost unprecedented action of retracting a 1998 paper that suggested vaccines cause autism. At the risk of offending our welcome guests from the autism community, we always found the evidence against vaccines flimsy and Dr Andrew Wakefield's ill-gotten results a menace to the public health.

In the wake of The Lancet news Adam Winkler, writing for The Daily Beast, marvels at "how much ordinary people distrust the major medical associations and health organizations," and so do we. Lian Kupferberg Carter, writing in The Huffington Post, calls for civility, and so do we. Dr Glenn Goodhart of Atlanta Hyperbaric quite astutely observes, "Few minds will be changed by The Lancet retraction," and we reluctantly concur.

A study into the genetic roots of autism, published in Nature and surprisingly well covered by USAToday, produced more questions than answers—just the latest smudge on the shiny hopes for the Human Genome Project.

IN THE COURTS

In another harsh setback for the antivaccine movement, three judges ruled against a class action by 5,000 families of children with autism seeking compensation from the federal vaccine fund.

The father of a 7-year-old Chicago boy, engaged in a bitter divorce and custody battle, sued two Defeat Autism Now! doctors over "medically unnecessary and unjustified" chelation therapy. Litigation is pending.

BOOKS, NEWSPAPERS, FILM & TELEVISION

After watching CNN's Sanjay Gupta interview author Karl Taro Greenfield one Sunday morning, we spent the entire afternoon in an armchair at the local bookstore devouring Boy Alone, a most original and powerful memoir about autism and family and language and memory and buy it.

The New York Times added six must-see autism stories to its excellent Patient Voices series.

There's plenty of Emmy buzz surrounding Claire Danes's portrayal of autism hero/advocate and animal behavior genius Temple Grandin on HBO. We first noticed Grandin some 15 years ago in the book An Anthropologist on Mars by Oliver Sacks. She last drew our attention in February with her amazing TED lecture. The world needs all kinds of minds, indeed.

On Showtime the documentary film "Dad's in Heaven with Nixon" earned rave reviews, too.

Quick, take one more look at that CBC story that stirred up such a hornet's nest in Canada.

Maybe the highlight of the television season was The Vaccine War on PBS's Frontline, whose website also offers a rich page of links to answer the question, What's behind the rise in autism? Absolutely stellar and refreshingly frank reporting on a tough subject.

Finally, in related news, Jenny McCarthy and Jim Carrey are splitsville.

HBOT For Autism: Junk Science?

Yesterday "hyperbaric oxygen chambers to cure autism" made the Junk Science Week shortlist in a major Canadian newspaper. National Post financial columnist Terance Corcoran, darting about from fear to hype to hope, fails to build much of a case for such harsh judgment. And his entire tirade stems from a pretty finely balanced television story on CBC's The National.

We're on record, in this blog and on the HyperbaricLink autism page, in favor of more well-designed clinical investigations to build on last year's interesting work by Rossignol, et al, using mild HBOT. The UHMS December 2009 position statement on "The Treatment of Autism Spectrum Disorder with Hyperbaric Oxygen Therapy" concurs:

... there is a strong case for further trials to be done in this area. Any future trials would need to be well planned, appropriately powered and include several relevant treatment arms.... These clinical efforts should be combined with efforts to elucidate the basic mechanisms by which mild hyperbaric therapy might exert a therapeutic effect.

Now does that sound like Junk Science to you? Let's be ever mindful of the canyon that lies between "unstudied" and "disproven" medical claims, especially when seeking effective treatments for such a poorly misunderstood condition as autism.

Autism Speaks: In The News, On A Roll

We remain ever watchful for promising news from the world of autism research, and Autism Speaks keeps us up-to-date and filled with hope. In five short years the organization has become the undisputed leader and champion of autism awareness, fundraising, science, and advocacy. And we're always impressed with the clarity of message across such a breadth of activity. Catch up with co-founders Suzanne and Bob Wright on this morning's Morning Joe, below. And bookmark our autism page for the latest research findings on hyperbaric oxygen therapy.

Visit msnbc.com for breaking news, world news, and news about the economy

Autism: HBOT Among "Risky Alternative Therapies"?

Strong words from the recent Chicago Tribune autism treatment series. At the risk of offending some parents and physicians of children with autism, we recommend it as required reading. Not that we'd lump hyperbaric oxygen in with "risky alternative therapies," but perhaps an HBOT researcher or two can honestly be said to have "hijacked" science to suit their objectives.

Still, individual successes and powerful anecdotes do matter. Medicine invented higher education by case study, after all. O2.0 simply won't view skepticism and hope as mutually exclusive principles but, rather, as equally strong motivators for good evidence-based medicine. So let's get on with it. Once more we urge researchers to raise the pressure from mild to true HBOT and raise the stakes by organizing larger prospective trials and observational studies.

(Baltimore Sun photo by Algerina Perna of Dr Carlos Pardo at Johns Hopkins.)

Off-Label HBOT: Autism

As promised (see our November 9 post), we've read the CARD study, we've spoken with one of its authors, and we're downgrading our Evidence Index score on hyperbaric oxygen therapy for autism. Indeed the early results using room air at mild pressures are now decidedly mixed.

Far be it for us to deny that real children with autism are enjoying real benefits from their hyperbaric oxygen therapy. It would be hasty to dismiss Rossignol's hypotheses and findings altogether. And O2.0 loudly repeats its call for physicians' responsible off-label usage and continuing investigations at higher pressures and 100% oxygen. But from where we sit, that's the sad state of the evidence on HBOT for autism in today's published medical literature: scant.

We've nothing to add but praise for any investigators who bemoan

...the lack of publication of studies with null results. Studies showing a lack of evidence for treatment efficacy are as important as studies demonstrating positive results because they provide important information about treatment approaches with only spurious or anecdotal evidence.

Hear, hear! Jump to our updated autism page learn more and to use our HyperbaricLink Evidence Index to guide your personal research.