Read today's smh, Mr Newton (are you really journalist?)

Yes Sue are you really Public hospital clinician and what is point of comment?

Seems to me a Journalist might know how to research Prof. Whitehouse's work then ask a meanful question about it.

"Perhaps the opinion expressed here has something to do with Prof. Whitehouse's own research: if the opinions and theory expressed in the documentary were to be proven valid, the theory and work of Prof Whitehouse has to be invalid, for example, the ability to screen for or predict 'elevated risk of autism' as he discusses the subject in today's SMH"

Mia - your comment appears based on an assumption that scientists fear being proven wrong.

if scientists are human, than YES. But let me add some words from Rinaldo Bellomo, The dangers of dogma in medicine (MJA 195 (7) · 3 October 2011):

"The cognitive “illusion of knowledge” also plays a role. We have to believe we know the answer and that there is only one answer, the one we have. To accept that we do not know the answer, or that other people might know the answer while we do not, is emotionally challenging and calls into question our very professional essence. Best to believe that what we think we know is actually true. As Thomas Kuhn would have it, at any time in history we operate within “paradigms”, the “soft” (but often strongly enforced) dogmas — that blood-letting saves lives; that lobotomy cures mental illness; that radical mastectomy is necessary to cure breast cancer; that immediate fluid resuscitation will save lives in patients with penetrating torso injuries; that early oral feeding after colorectal surgery is dangerous; that tight glucose control will save lives in intensive care patients; and that fluid resuscitation will save children with severe sepsis. We use such paradigms as totems and make challenging them a professional taboo."

Mia - there is also a danger in applying Bellomo's words like a blanket across all scientists - he pointed out a danger, but did not claim that all doctors or scientists blindly apply dogma.

I refer you back to Andrew's 4th and 5th paragraphs where he did not question the validity of the science, but the manner in which the documentary presented it:

"The documentary left me with a sense of unease. The link between gut bacteria and autism is certainly an interesting area and very worthy of investigation. But the ideas are far more complex – and the research far less advanced – than was presented in the documentary.

I do not question the quality of the science on which this theory is based. Like all research, these studies have good aspects as well as limitations. But the documentary did not mention that the small-scale treatment studies have not yet cleared the first hurdle of scientific discovery – replication – despite having been studied for over a decade. Without replication in large-scale studies, a theory cannot be passed off as reality."

This is not an expression of fear on the part of Professor Whitehouse that his own work may somehow be under threat but merely points out that the research, as it currently stands, is inadequate for the purpose for which the documentary appeared to suggest it should be used - that is faecal transplants following Vancomycin treatment. A study of 11 children is a way to indicate the need for further research, but inadequate for devising a treatment.

As a practitioner in this field for the last 15 years I have seen so many claims about ASD (lets be very clear - a NON homogeneous group) as if it is one thing for all. The science in this field has been trumped too often by industries who profit off parental desperation. There is a lot of research about predictor variables and therapy efficacy that needs to be done. But that does not make for good media. I hope and even suspect that for 'some' kids with ASD this may be useful. I can cite examples from my own practice. Yet Prof Whitehouse is correct in what he said and his sense of unease.

I would argue that the conservative approach to science has saved more lives than it has cost. Furthemore, the Helicobacter pylori is a poor analogy. In the field of Autism there is no consensus or resistance from the scientific or medical industry on any one belief about ASD. Indeed that is why it is a field so susceptible to fads and fashions. Good science has been lacking in ASD for some time. In the case of stomach ulcers you have a clear condition (ASD expressed in thousands of ways) a clear measure of effect (the ulcer alters its form or existence - ASD improvements can be shown to be under a variety of factors at any one time due to the very complexity of human development itself and the highly subjective way in which people report on it) and the medical community in the case of stomach ulcers were wedded to a belief on cause (stress) where no one is wedded to any belief on ASD on a large scale level (there is no consensus).

I really hope there is something in this research. I also believe there probably is. I see absolutely anything wrong with Professor Whitehouses article and think it both responsible and accurate.

"The opinion expressed in this article reminds me of the rocky road to acceptance (even consideration!) by the medical community that bacteria might play a role in stomach ulcers."

This example is often misused by people who have not followed the actual history of Helicobacter and its treatment. The scientists involved did not just insist that people pay attention to them - they set about doing the solid research that supported their model. This research was replicated. And, within a couple of decades, this radical re-thinking has been incorporated into existing knowledge.

Rather than an indictment of modern medicine, the Helicobacter story is an example of how medicine and science adapt their models to the best available evidence at the time.

IF such a breakthrough were to occur within austim/ ASD research, and the findings were able to be replicated in good quality research, are people really paranoid enough to think that paediatricians would ignore it just because they didn;t think of it?

It has been claimed that the H. pylori theory was ridiculed by the establishment scientists and doctors, who did not believe that any bacteria could live in the acidic environment of the stomach. Marshall has been quoted as saying in 1998 that "(e)veryone was against me, but I knew I was right."[5]
http://en.wikipedia.org/wiki/Barry_Marshall

Both doctors involved in this research were ridiculed, mocked and systematically undermined by the wider medical community in the press. But do not take my word for it, above is Barry Marshall quoted on the subject.

Or:
A single study, conducted in 1954, did not find evidence of bacteria on biopsies of the stomach stained traditionally; this effectively established the acid theory as dogma. This paradigm was altered when Warren and Marshall effectively proved Koch's postulates for causation of PUD by H. pylori through a series of experiments in the 1980s; however, an extensive effort was required to convince the medical community of the relevance of their work.

http://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disease_and_Helicobacter_pylori

I still remember the vicious attacks when then presented their research, the ridicule. There was a knee-jerk/emotional reaction to the dogma being challenged and it required almost superhuman perseverance from them to persist.
If you google the subject, the remnants of this are still available:
"The Nobel Prize-winning breakthrough was one thing. Selling it to the medical world was another. Julie Robotham reports."
"It wasn't molecular biology or anything hard like that … it's the notion that there can be something right under your nose that everyone else is missing."
http://www.smh.com.au/news/national/of-guts-and-glory/2005/10/04/1128191720223.html

If this is a 'good' example of scientists being openminded or "how medicine and science adapt their models to the best available evidence at the time", I am afraid to hear the bad stories on the subject.

"It just seemed so improbable that this chap who was a registrar … could have [found the cause of peptic ulcers] when it had eluded people for so long," Ellard recalls. "People asked reasonable questions, which Barry answered very scientifically and appropriately, but it was hard to accept."

http://www.smh.com.au/news/national/of-guts-and-glory/2005/10/04/1128191720223.html

Hi Ricky,

If you don't think parents might see this documentary and think it is suggesting therapies, you might also like to see the response to 'similar' topics
accessible by links at:
http://www.emilywillinghamphd.com/2012/08/autism-immunity-inflammation-and-new.html

In particular the bit that goes:
"Lest you think I exaggerate about what people will do at the slightest hint of efficacy in autism, see here, here, here, here, and here. "

(each 'here' is a link).

I'd be very interested to see a blind, placebo-controlled study here, where you give your child food which you believe contains the scary "chemicals" and and otherwise-indistinguishable food which does not and you present a judgement of effects in your child's symptoms.

Luke, I understand and once shared your cynicism - as did (note past-tense) my parents, my in-laws, and our friends. As a science-practitioner myself I share your longing for blind, or even double-blind placebo-controlled studies (and they do exist, just not with my son)! As a parent it's easier to do it via an elimination diet and food challenges.

However, we have tested the evidence as best we can, because quite frankly I have NO INTEREST in restricting my child's diet without necessity. So here's what we have done: when our son is reacting to a substance, we don't tell others that he's had a dietary slip up - if they couldn't tell the difference, then maybe it's in our heads. Without fail, the comments we get from family / friends in these instances are "oh my gosh, what have you fed him"; "this isn't your child"; "I've never seen him like this" - we don't get those comments at any other time (no need, he is a delight). There have also been occasions where other care-givers (eg grandparents) have accidentally slipped up - and we know by our son's behaviour. When we clarify with the caregiver, we are always right about the culprit ("but I thought he was okay with white marshmallows", "only if they're pascalls"). Additionally when we were doing the elimination / challenge component to assess his reactions, we kept data (pre, during, post) on all kinds of things - number of tantrums; number of times he clocked his sibling; compliance to requests; etc, etc.

The reactions to each chemical is specific - eg tears with salycilates; aggression and loss of eye contact with amines; tantrums and stimming with preservatives; the list goes on.

They're not "scary" chemicals - they are just ones my son reacts to, and not all people do. Our other child reacts to far less, and quite differently. I wish it was my imagination - I would love to cook less, use more processed foods, and let my child eat whatever his heart desires. And let me reiterate - diet changes did not CURE my son's autism - brilliant behavioural interventions did the bulk of the work to get him where he is today - but dietary control is part of our ongoing management.

I do hope people read Theophania's and Giovanna's contributions before they take the opportunity provided by this "Conversation" article to give us their preconceived ideas.

Unlike most others commenting above, I found Professor Whitehouse's article to be pretty thin. He is asking us to be careful and not jump to conclusions based on this Canadian documentary. The Canadian protocol (as I understand it here) is to knock out the existing gut bacteria and then relaunch gut bacteria re-population with a faecal implant. I have no expert knowledge in this area, but think it is fair to suggest that any "knock-out" therapy of this severity is likely to have unintended consequences - possibly very serious ones.

There is a danger on this issue (as in many others) that skeptics set up a straw man to criticise, rather than dealing with the subtleties and experience of parents like Giovanna and Theophania. It's likely, surely, that what Giovanna found works best in her family would not work best in Theophania's.

Reading books by Dr Natasha Campbell McBride leads me to regard the issue as far more complex and dynamic than the skeptics are prepared to consider. Don't we each have around 500-1,000 different microbes in our gut (not only bacteria, but viruses, parasites, protozoa)? And aren't the profiles we have unique? Not only do the proportions of different microbe species vary between individuals, but also the places in the gut where they reside. Then there is the way these microbes damage optimal human gut processes: in some cases it can be toxins produced by bacteria; in others it can be the displacement of beneficial bacteria by others. The combinations are infinite and change by the hour.

I would like to see more emphasis put on prevention of autism spectrum disorders. And the preventive measures suggested (I say suggested, because it is early days) by Dr Campbell McBride are simple, harmless and easy (if you do not permit cultural preferences and fashions of the day to rule out strategies for healthy living).

"He is asking us to be careful and not jump to conclusions based on this Canadian documentary"

Why is that a bad thing. As a parent you can bet I am going to be careful and not jump to conclusions - I support Theophania's and Giovanna's comments - but they too have been cautious in their approach and the actions they have taken have been appropriate for their children's unique circumstances. The Documentary did not outline a cure or protocol - it speculated. Dr Finegold and the other authors specifically warn against using their preliminary work as the basis for a treatment - why would you ignore that warning?

"There is a danger on this issue (as in many others) that skeptics set up a straw man to criticise"

Really? has someone done that - could you even describe Andrew Whitehouse as a skeptic given his started support for the value of the research? I think you are seeing opposition to further work where there is none.

"Reading books by Dr Natasha Campbell McBride leads me to regard the issue as far more complex and dynamic than the skeptics are prepared to consider. Don't we each have around 500-1,000 different microbes in our gut (not only bacteria, but viruses, parasites, protozoa)? And aren't the profiles we have unique?"

Reading books by one author, who has an unproved hypothesis, and on that basis is selling a wide range of products... It is not a "Skeptic" sho should be concerned about that but any consumer at all. If someone independant does some research that demonstrates that there is more to the claims then I'd happily endorse them myself.

" And the preventive measures suggested (I say suggested, because it is early days) by Dr Campbell McBride are simple, harmless and easy "

Preventative measures? for a child that already has autism? And faecal transplant and diet are not necessarily harmless - all interventions have risk. I'll take the advice of our paediatrician, GP and a dietician any day over a book on a website on the internet that promises results it cannot guarantee to deliver - that is the definition of snake oil!

Not ragging on pro-biotics as such, just on the blind faith in a single individual's approach to using them as a cure-all.

"The intestinal habitat of an individual contains 300–500 different species of bacteria" (1)

(1) Guarner, F., Malagelada, M. 2003 Gut flora in health and disease. Lancet Vol 361: 512–19

Nicole - perhaps the problem is that assistance should be available in the basis of objective need, rather than diagnosis.

It has been said that the tying of assistance to diagnosis is the main reason for the apparent rise in autism incidence, which is actually an epidemic of classification (in order to "qualify" for assistance).

How frustrating that parents need to fight for a label rather than being supported in providing for their child's unique needs.

the US figures used to create these plots are way below the prevalence data published by the CDC (see http://www.cdc.gov/Features/CountingAutism/).
Based on more than a single source of information, the author of the recent Nature article (see http://www.nature.com/news/the-prevalence-puzzle-autism-counts-1.9280) said "Shifting diagnoses and heightened awareness explain only part of the apparent rise in autism. Scientists are struggling to explain the rest."

Lisa,

My question to you would be - why has professor Finegold, notable in his field, been unable to establish sufficient evidence to prove the hypothesis even though his research into this area has been ongoing?

I'm not saying his work is wrong, it is just that the research into this particular area is extraordinarily complex.

"Rather most of the early citations refer to "controversial treatment", "unscientifically supported", "questionable treatment", "sparks concern". The only seemingly objective citations were from 'alternative' or 'complimentary' therapy citations."

I am not sure why you consider skeptical views of the research as non-objective and favourable comments as objective - that seems to be rather subjective in truth. When a new hypothesis is proposed, and the evidence to support it is limited, it is expected that it will be challenged and tested. The fact that there are additional citations of the paper suggests it did not go unnoticed and there has been ongoing work by Finegold and others to attempt to gather more information. A significant barrier here was raised by Finegold and Sandler who correctly pointed out the significant problems with attempting to maintain a regime of administering Vancomycin with the potential side effects of that course of treatment.

Even if the research does succeed in demonstrating a causal link between gut flora and autism, this does not mean we have a 'cure' since we still can't dose every child with that form of autism with Vancomycin. The documentary seemed to point parents towards faecal transplants following antibiotic use - but there is simply no evidence to suggest that this works as a way to 'cure' autism.

Sadly, some of the links to positive citations lead directly to websites selling supplements, including pro-biotics, which does not bode well for their credibility.

"Another example of the western medical "establishment" apparently having an agenda other than the health and well-being of the population."

As a parent of a child with autism, who employees researchers to carry out work that includes people with autism I can assure you that for my part at least this is a great untruth. I want the very best for my child, but there are not any magic fixes - and I have seen most of them.

Finegold's research is good research, it is interesting work and very valuable, but it has not yet cleared the hurdles that must be set to move from 'hypothesis' to 'theory'.

As for autism researchers getting excited? They do, often, but always cautiously so because there have been far to many cases of these amazing hypotheses not panning out and giving parents false hope is sickeningly unethical.

An article of interest looking at a range of treatments for autism and evidence to support them (or lack of it in many cases), can be found here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597185/?tool=pubmed

Grendelus,

I'm not sure what would count as sufficient evidence?

He seems to have demonstrated the correlation between gut flora and autism well?

Gastrointestinal microflora studies in late-onset autism. Finegold SM. et al. Clinical Infectious Diseases. 35(Suppl 1):S6-S16, 2002 Sep 1.

Real-time PCR quantitation of clostridia in feces of autistic children.
Song Y. Liu C. Finegold SM. Applied & Environmental Microbiology. 70(11):6459-65, 2004 Nov.

Pyrosequencing study of fecal microflora of autistic and control children. Finegold SM. et al. JA 3rd.
Anaerobe. 16(4):444-53, 2010 Aug.

"I am not sure why you consider skeptical views of the research as non-objective and favourable comments as objective" I see these statements as political, not healthy scientific scepticism.

"When a new hypothesis is proposed, and the evidence to support it is limited, it is expected that it will be challenged and tested." Hence my incredulity at the lack of challenge and testing. Very few researchers, and only more recently, have taken up the challenge. Fully 8-9 years went by without the 'scepticism' being tested.

Vancomycin as a barrier to treatment has nothing to do with the hypothesis nor the reluctance for further investigation.

Your link reinforced to me the reluctance by researchers (maybe it's actually research funders?) to follow up on this theory.

"Dietary treatments are not the only gastrointestinal treatments that are pursued. Gastrointestinal symptoms of gastroesophageal reflux, constipation, diarrhea, feeding refusal and others are frequently reported in clinical settings 57 although there is not yet documentation of increased population based prevalence of gastrointestinal abnormalities 26,55. Given the frequent report of symptoms, digestive enzymes are used by some families 12. No evidence based studies are available to evaluate efficacy. Probiotics are also used to improve the microbial environment in the intestine 11."

You might be interested in a related hypothesis from a credible source? Gut and psychological syndrome GAPS. A diet is offered to enable healthy gut flora.

There was an interesting review of the area of newborn and childhood gut flora on another thread on this site:

Microbiologist Andrew Holmes said: "Although birth is when we first encounter microbes, the process of acquiring a stable gut microbiota takes time. As any parent knows, an infant’s poo will change dramatically in texture, smell and even colour over the first year and introducing anything new to the diet often precedes an interesting experience. A stable microbial community isn’t formed until we have a fully developed immune system and an adult diet pattern – well after age three."

So-called Gut and Psychology Syndrome is hardly "from a credible source". it is an untested model created by a single individual. As far as I can see, she has not published the results of her interventions.

These are promising areas for research. Good quality research needs to continue to accumulate before people try to sell simple solutions to vulnerable families.

Natasha Campbell-McBride MD MMedSci (neurology), MMedSci (nutrition). "After practising for five years as a Neurologist and three years as a Neurosurgeon she started a family and moved to the UK." Not credible?

"These are promising areas for research. Good quality research needs to continue to accumulate before people try to sell simple solutions to vulnerable families."

Why do we need complicated solutions Sue? If the diet works as many parents attest to the GAPS diet as well as other dietary measures as improving their childrens' conditions. Why should they wait another 12 years for the research to catch up? If it were my child I would try any and everything.

Macfabe's research suggest avoidance of PPA would be a good start given the striking rat demonstration. "PPA is part of normal metabolism, it isn’t good or bad, it’s part of the intermediates of fat metabolism. But also interestingly it’s in a lot of the foods that contain refined wheat and dairy and cheese, either naturally occurring or added as an anti-mould compound in foods."

Sue, I am not sure what would constitute sufficient evidence either, but I do know what there is now, is not sufficient because Professor Finegold says that it is not - actually I'd recommend emailing the corresponding author from tht paper and asking their opinion, and perhaps enquire what further research might be underway.

"He seems to have demonstrated the correlation between gut flora and autism well?"

In the small sample of children (and it is just a handful) he certainly does seem to demonstrate a correlation. The problem is (and the authors acknowledge this) did the gut flora differences cause the autism, or did the autism cause the gut problems - the presence of a correlation does not describe the relationship, or even demonstrate that one exists, it merely indicates the presence of both conditions at the same point in time.

As a further complication, if there is a causal link, does the gut issue 'cause' autism, or exacerbate the symptoms of autism. I realize that to parents that last point may well be less important since short of a cure they may be keen to see any improvements at all.

I don't know whether there is a real reluctance to investigate or not, there may have been an assumption that Prof. Finegold may have continued the work with his colleagues. Or perhaps the taint of Wakefield makes that avenue of research unappealing (that is pure speculation on my part - I cannot imagine the researchers I know being dissuaded by that aspect). I suspect the reality is that the research so far has not provided a sufficient basis for exploration, no matter how the documentary sold it.

I checked The Gut and Psychology Syndrome and Dr McBride's website. I am perplexed how you can consider the views of a single researcher as credible when it has not been researched at all thoroughly and the website is busy selling books, ratfish oil, probiotics! Diet DVDs and more. Isn't this exactly what we accuse doctors of doing with pharmacology companies? In this case it is based on the hypothesis of a single person, and regardless of her qualifications I would have to question the efficacy of her approach.

This is where the mercury AND iron TOGETHER causes autism.

"The Redox/Methylation Hypothesis of Autism:A Molecular Mechanism for Heavy Metal-Induced Neurotoxicity"
http://webcache.googleusercontent.com/search?q=cache:8ckutRndnHMJ:www.crcnetbase.com/doi/pdf/10.1201/9781420068870-c7+%22thioredoxin+reductase%22+autism&hl=en&gl=ca

I don't know where my autistic son would have got his iron from. Like other children with autism, he was fussy about food right from the start and is now still below the lowest percentile on the weight charts at the age of 7. He must have breathed it in!

Tom - the authors disagree with you.

The paper is clear enough in its conclusions - you cited part of the abstract out of context - have you even read the paper?

In any case how about you contact the corresponding author and ask them if they agree with your original statement that "iron is the possible cause of autism"

Their details are:
Claudio De Felice
Neonatal Intensive Care Unit, University Hospital Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy

Corresponding author. Address: Neonatal Intensive Care Unit, University General Hospital, Azienda Ospedaliera Universitaria Senese, Viale M. Bracci, 16, I-53100 Siena, Italy. Tel.: +39 0577 586542; fax: +39 0577 234009.

geniente@gmail.com

However I think you are wasting your time since in the paper's conclusion they state: "A critical question regards the issue of whether increased OS is a primary contributor or just a secondary consequence of autism. In the lack of an universally accepted experimental model of autism it is currently impossible to solve this puzzle at this time. Future investigations in this animal models are certainly needed in order to better dissect at the molecular level the relationship between OS damage and neurodevelopment."

This pretty much acknowledges that their work may or may not have found something useful and that more research is required. You are selling the word "possible" as if it were a certainty. This fits with your regular Fe-trolling. I think you should change your name to "Iron Troll".

We have different views, Grendelus, on the validity of the GAPS approach to ASD conditions, but I have to say I am with you 100% on your approach to informed, civil debate on the internet. Well said!