On Sunday, the New York Times published an opinion piece, An Immune Disorder at the Root of Autism, by Moises Velaquez-Manoff, the author of a recent book that takes a broad-spectrum look at the role of the immune system in human health.
In it the author expresses his opinion (emphasis mine) that inflammatory disease may account for a large chunk of autism cases: "At least a subset of autism — perhaps one-third, and very likely more — looks like a type of inflammatory disease. And it begins in the womb." I emphasize the word opinion because as you get further into the piece, you realize that there really isn't much science to back up that statement.
Actually, people who study autism aren't sure that it "begins" in the womb, whatever that means. Neither does the rich literature of autism research - mostly ignored here - suggest that any kind of consenus has been reached on the complex developmental factors that may play in a role. The further you read, the more you realize that Velaquez-Manoff appears to have built his theory by largely avoiding autism research and stitching together studies that may - or may not - be relevant. To some extent, he acknowledges this. When citing the work of a scientist who studies parasitic infections in wild rats, he notes: "He's not, by training, an autism expert." At another point, he admits that overstating the role of immunology would be "folly."
One of the giveaways to the soft science problem is the author's repeated use of the word "generally", as in "Generally speaking, autism also follows this pattern" or "Generally, the scientists working on autism and inflammation aren't aware of this..." In other words, generally, the research just isn't there and, generally, the author is writing his way around that problem.
Fortunately, the science blogger Emily Willingham (in my opinion, one of the best working today) posted a response today that does a terrific job of exploring and interpreting the shaky science behind this particular story. You should read the whole thing because it's so smart but I'll note a couple of her points here, beginning with: "The piece is packed with overstatements and overinterpretations and lacks much-needed modulation and qualification. More than that, it promises a "preventative" for autism that is, pardon me, off the hook(worm)."
The worm comment refers to a Velaquez-Manoff suggestion that perhaps we could reduce the incidence of autism if we were all just a little more infected with things like parasitic worms. His idea is that in the good old days of massive infection, our immune systems got a better workout and were therefore better controlled. As Willingham points out, he supports that suggestion in part by citing studies that actually haven't taken place yet. And, she adds: "The worm in question is a whipworm that typically parasitizes pigs, and there doesn’t seem to be a disease or disorder it or its wormy brethren are not claimed to help. Some of it may be valid and looks quite interesting, but the successful trials have been in autoimmune disorders. No data exist to support using them to treat or prevent autism, much less to claim that they would be preventative. Lest we handle this too lightly, I’ll add that infections with parasitic worms afflict an estimated 740 million people and can cause anemia and malnutrition. Having a bunch of worms growing in your intestines generally isn’t preferable to not having them there."
I should mention that this particular opinion piece has stimulated a fair amount of discussion among my science writing colleagues about whether newspaper opinion sections should start fact-checking their authors. The New York Times has the reputation of producing some of the best science in the country - and this kind of work does absolutely nothing to enhance that.
--- Deborah Blum