Roy Rutherford and the Autism Treatment and Prevention Centre

We were fascinated to see that Dr Roy Rutherford (who helped found Dore and is listed as a Medical Consultant there) has now set up the Autism Treatment and Prevention Centre (AUTAP). Given that there is currently very little in the way of proven autism treatments/prevention techniques, we were fascinated to see what they had to say about autism treatments. We were not impressed.

The site offers lots of referency, sciency-looking links – so we thought we would follow through a few of these. One might first note that a positive link to What Doctors Don’t Tell You is not a good sign. However, optimistically, we ploughed on.

Looking at suggested nutritional treatments for autism, we found a number of interesting claims. The AUTAP notes that

There is some suggestion that supplements of vitamin B6, Vitamin C and Vitamin A may help some autistic behaviours…Magnesium is an essential mineral required for the function of our DNA and many chemical processes. It is often given with vitamin B6 in treatments for autism.

As if to back this up, they provide a link. Even better, the link is to a 2005 Cochrane review – we like those. However, what the review concludes is that

Due to the small number of studies, the methodological quality of studies, and small sample sizes, no recommendation can be advanced regarding the use of B6-Mg as a treatment for autism.

It is a shame that AUTAP does not make this clear in the page where they link to the review.

We were also fascinated to learn from AUTAP that

Researchers have already shown the benefits of supplementing diets with Omega 3 fats in autism, ADHD, DCD and dyslexia. There are noticeable improvements in attention, hyperactive behaviour and learning.

Once again, we checked out the link to back up this claim. The study linked looks of reasonable quality: it is a double-blind randomised, placebo-controlled study. However, it lasted 6 weeks and involved 13 children: the authors are (rightly) quite clear that this is only a pilot study. Personally, we would like a treatment recommendation to be based on rather more evidence.

It might look as if we’re being picky here. However, on the same page, we see how this inadequate approach to research can have worrying consequences. AUTAP consider various theories of and approaches to treating autism:

There are a number of theories which suggest that poor bowel function, due to various possible causes (fungus overgrowth, immune reactions, bacterial overgrowth etc), leads to gut wall leakiness. This allows peptides (small chains of amino acids which when linked form protein molecules) which do not normally enter the bloodstream to leak into the blood.

These peptides can act like opiates (chemicals found in the opium poppy which are used to make morphine, diamorphine (heroin), pethidine and codeine etc). The opiates circulate in the blood and cross the barrier between the blood and brain to affect brain receptors linked to certain neurotransmitter hormones (usually dopamine and serotonin). These then lead to functional changes which cause the autistic behaviours.

Others believe that toxic elements e.g. dioxins and PCBs (xenobiotics) are responsible with others believing that heavy metals such as mercury (vaccines, amalgams and diet) and lead (contaminated water, dirt and dust) are the cause.

By using a range of approaches using exclusion diets (gluten and casein), probiotics (healthy gut bacteria), digestive enzymes (chemicals which are released by our gut to digest certain foods), supplementation with vitamins and minerals etc (whose absorption are affected by poor gut function), or using specific chemical treatments designed to extract pollutants from the blood (chelation therapy), practitioners report varying success rates for improving autistic symptoms

Many of these theories – such as the belief that autism is caused by opioid peptides – are unlikely and/or falsified. Many of these treatments are useless and/or dangerous. One would hope that an MD-led centre claiming to specialise in treating autism would offer an evidence-based assessment of this. However, AUTAP actually states that

There are undoubtedly some benefits which have been shown to occur in autistics with such treatments if there is strong enough evidence of these disorders being present. However not all autistics have these issues and not all will benefit from a single approach.

This is incorrect: there is, for example, no good evidence that chelation therapy is effective for autism; this treatment does, though, carry serious risks.

AUTAP’s credulous approach here nicely illustrated the point that non-evidence-based approaches to treating autism are not benign. They will have a cost (even if only a financial cost or an opportunity cost), and can have unpleasant consequences. As a medical doctor – and one who claims an expertise in the field – Rutherford really should know better.

BPSDB

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5 Comments

Filed under patrick holford

5 responses to “Roy Rutherford and the Autism Treatment and Prevention Centre

  1. BloggerT

    Wonder why they left out this new small study also:

    http://jad.sagepub.com/cgi/content/abstract/12/5/394

    • It can’t possibly be because of the desperately disappointing results for Eye Q?

      A majority did not respond to omega 3/6 treatment. However, a subgroup of 26% responded with more than 25% reduction of ADHD symptoms and a drop of CGI scores to the near-normal range…A subgroup of children and adolescents with ADHD, characterized by inattention and associated neurodevelopmental disorders, treated with omega 3/6 fatty acids for 6 months responded with meaningful reduction of ADHD symptoms.

      They can dress it up how they like but it is clear that there is no decent outcome if you were to use Intention to Treat – and there is no indication that one might be able to identify those children who would be responders.

      Nonetheless, it is good to see it published rather than languishing in a desk drawer.

      Overall, of course, this is rather sad – as the risk of sounding reductionist, it would be so useful for families if a comparatively straightforward intervention such as this were to be clinically significant.

      Interesting to see an indication of the fact that children do improve and progress spontaneously.

      At the end of Study Period 1, 26% (9/34), all boys) in the active group and 7% (2/30, 1 boy, 1 girl) in the placebo group were clinically meaningful responders with more than 25% improvement in ADHD symptoms…

      Plus, although the abstract sounds unduly positive about the outcomes, the discussion is rather more realistic before it dives off into sub-group analysis territory:

      Overall, this is an essentially negative study. The double-blind randomized placebo-controlled trial demonstrated that for the whole group of children and adolescents with ADHD, omega 3/6 supplementation for 3 months was not statistically superior to placebo…

      A clinically meaningful response tended to be more frequent in the sugbroup of children with associated neurodevelopmental comorbidity, that is, RWD, DCD, LD, or AS, and was lacking altogether in children with ODD, depression, or anxiety diagnoses…This might tentatively be taken to mean that omega 3/6 treatment may be specifically effective for children with the phenotypie of deficits in attention, motor control, and perception…The results indicate that it may be helpful to select patients with this phenotype and reading or writing difficulties for future research trials and treatment with omega 3/6 fatty acids.

    • To be very charitable, AUTAP may have wanted to focus on research in children on the autistic spectrum…

      Very interesting – if rather sad – article though. Thanks very much for the link – interesting reading!

  2. Pingback: Dore Group (NZ) go under « gimpy’s blog

  3. Pingback: Dore research ‘is rubbish’, but I still can’t tell you so « Brainduck’s Weblog

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