Dr. Mark Hyman mangles autism science on–where else?–The Huffington Post

Dr. Mark Hyman is famous as the “founder” of a form of woo known as “functional medicine.” This new form of woo is…well, I’m not sure what it is, and neither are Wally Sampson (1, 2, 3, 4). Suffice it to say that it appears to be a serious grab bag of various forms of woo that, according to Dr. Hyman’s website itself, involve environmental inputs, inflammation, hormones, gut & digestive health, detoxification, energy/mitochondria/oxidative stress, and, of course, “mind-body,” whatever that means. No woo would be complete without mind-body, you know. Actually, no self-respecting woo would leave out “detoxification,” either.

In any case, “functional medicine” is such a–shall we say?–“target-rich” environment that I could do a number of posts about functional medicine in general and Dr. Hyman in particular. Having discovered his “Ultrawellness” website, blog, and podcast, I can see that Dr. Hyman will be the gift that keeps on giving, at least as far as blog material goes. It’s only a wonder that I haven’t really delved into the serious, serious woo that Dr. Hyman lays down on a regular basis before. Learning that, it now depresses me even more that Dr. Hyman is one of the Four Horsemen of the Woo-pocalypse, as I have dubbed the four woo-loving physicians whom Senator Tom Harkin invited to testify in front of his Senate committee as a as a “two-fer” from their concurrent engagement at the Institute of Medicine and Bravewell Collaborative woo-fest being held on the same days. The three physicians in addition to Dr. Hyman physicians included Dr. Andy Weil, Director, Arizona Center for Integrative Medicine, University of Arizona, Vail, AZ; Dr. Dean Ornish, Founder and President, Preventive Medicine Research Institute, Sausalito, CA; and Dr. Mehmet C. Oz, Director, Cardiovascular Institute and Complementary Medicine Program, New York-Presbyterian Hospital, New York, NY. Of the four, thanks to “functional medicine,” Dr. Hyman is by far the most quacktastic of the four, and that’s why I’m depressed. That such a woo-meister could be called to testify in front of the Senate as though he were a respectable academic physician boggles my mind, which is why I will be turning my sights on Ultrawellness.

Eventually.

In the meantime, Dr. Hyman has popped up on the one web commentary outlet where he should truly feel at home, namely The Huffington Post.

How do I know this? Easy. A whole bunch of you sent me the link to a truly execrable article that appeared on HuffPo on Saturday entitled Why Current Thinking About Autism Is Completely Wrong. Damn it! I was trying to take the weekend (mostly) off from blogging, with some previously written stuff scheduled to post, and here you all were, trying to tempt me back. Fortunately, my will held strong, and I managed to delay writing anything about this quacktastic woo-fest until last night.

Two days haven’t made me feel any more merciful towards it.

That’s especially true because Dr. Hyman’s HuffPo article is virtually identical to an article he wrote almost two years ago for his Ultrawellness Blog, entitled–surprise! surprise!–Why Current Thinking about Autism is Completely Wrong. Indeed, there’s even a video:

Recycled material on HuffPo? Who’da thunk it? I doubt HuffPo will care much, though. after all, if the editors there don’t give a rodent’s posterior about the medical accuracy of the anti-vaccine line that bloggers there so regularly lay down, I doubt that a little thing like republishing a two year old post would bother them. At least I label my repeats as being repeats.

Be that as it may, Hyman starts out by demonstrating his lack of understanding in no uncertain terms:

“Autism is caused by poor mothering.” That was the belief of the medical community until the late 1960s.

“Autism is a genetic brain disorder.” That is what most people — and most of the medical community — believe today.

I’m here to tell you that neither one of these statements is true.

Think about it. Rates of autism have skyrocketed over the years, from an estimated 1 child in 3,000 to just 1 in 150 kids today. Sure, wider criteria for diagnosis and better detection might explain some of it — but not an increase of this magnitude.

How many times have I been over this issue before? Apparently Dr. Hyman clearly doesn’t understand the confluence of factors, including the marked broadening of the diagnostic criteria for autism in 1994, increased awareness, and, of course, increased screening. Diagnostic substitution has a lot to do with it, of course. Also, although it is controversial whether the incidence of autism has increased over the last couple of decades, it is not controversial that the real rate of autism hasn’t increased by nearly as much as it appears to have increased. True, the apparent rate of autism appears to have increased dramatically over the last 20 years, but careful studies that have been done suggest that we are moving towards a new consensus prevalence of autism and autism spectrum disorders of around 1% and that autism prevalence, if it has changed over the last few decades, has not changed by anything even close to 200-fold. Indeed, the National Autistic Society explains the discrepancy well, pointing out areas of uncertainty and referring to the example of Tourette’s disorder, which is 1,000 times more common than had previously been thought. That’s nothing compared to Hyman’s figures, which, if correct, would suggest that that autism is “only” 20 times more common than previously thought.

It’s also quite clear that Hyman is pulling the old “science was wrong before” gambit. Skeptico, John Jackson, and I have discussed why this is a dubious gambit beloved of advocates of pseudoscience. The CliffsNotes version is that, just because science may have been wrong in the past does not mean that Dr. Hyman is correct now.

Dr. Woo–I mean Dr. Hyman–then goes on to cite a whole lot of, well, woo:

Dramatic scientific discoveries have taken place during the last 10 to 20 years that reveal the true causes of autism — and turn conventional thinking on its head. For example, Martha Herbert, MD, a pediatric neurologist from Harvard Medical School has painted a picture of autism that shows how core abnormalities in body systems like immunity, gut function, and detoxification play a central role in causing the behavioral and mood symptoms of autism.

She’s also given us a new way of looking at mental disease (and disease in general) that is based on systems biology. Coming from the halls of the most conservative medical institution in the world, this is a call so loud and clear that it shatters our normal way of looking at things.

Everything is connected, Dr. Herbert says. The fact that these kids have smelly bowel movements, bloated bellies, frequent colds and ear infections, and dry skin is not just a coincidence that has nothing to do with their brain function. It is central to why they are sick in the first place! Yet conventional medicine often ignores this.

Dr. Herbert’s work shows nothing of the sort. Go ahead. Head over to PubMed and look at Dr. Herbert’s publication record. I’ll wait. She has listed 15 publications about autism, of which:

  • six are review articles
  • two are in alt-med journals, and one of these is an interview
  • one is a paper with dozens of authors reporting the results of mapping autism risk loci using genetic linkage and chromosomal rearrangements. (Dr. Herbert is solidly right in the middle of the huge pack of authors.)

Of the remainder, Dr. Herbert only appears to be first author or senior author on four publications on autism containing original research, and these appear to be all imaging studies of the brains of autistic children. In other words, Dr. Herbert is making claims far beyond what her publication record in the peer-reviewed literature can, even under the most charitable interpretation possible, support. Nothing at all in her publication record appears to support the concepts above of autism being a systemic, rather than brain-based condition. There’s nothing about systems biology there (and I actually rather like systems biology); nothing there to support a link between autism and gut disorders; nothing to support a link between autism and immune dysfunction; and nothing to support a link between “environmental influences” and autism. That’s not to say that there aren’t environmental factors that influence the development of autism; it’s just that there’s nothing in Dr. Herbert’s publication record to support such a hypothesis or to identify what, if anything, those environmental factors might be.

In other words, there is nothing at all to support Dr. Hyman’s claims, which appear to be based on Dr. Herbert’s claims. Certainly, there’s nothing there to support the grandiose claims that Dr. Hyman makes. Not that that stops Dr. Hyman from pulling the Galileo gambit:

My friend and mentor, Sidney Baker, MD — a pioneer in the treatment of autism as a body disorder that affects the brain — often says, “Do you see what you believe or do you believe what you see?”

The problem in medicine is we are so stuck in seeing what we believe that we often ignore what is right in front of us because it doesn’t fit our belief system. Nowhere is this true more than in the treatment of autism.

Such a criticism may be at least partially true of scientific medicine at times, but not in the way that Hyman apparently means, and in this case Dr. Hyman can’t produce one whit of evidence to persuade me that it is true for autism. Perhaps it never occurred to Dr. Hyman that the reason his belief system is not taken seriously by autism scientists is because there’s no credible scientific evidence to support it. But, boy, oh, boy does Dr. Hyman have anecdotes. Actually, strike that. It’s not plural. He has a single anecdote, an “N of 1,” if you will.

Dr. Hyman sets the stage:

He received diphtheria, tetanus, whooping cough, measles, mumps and rubella, chicken pox, hepatitis A and B, influenza, pneumonia, hemophilous, and meningitis vaccines — all before he was 2 years old. Then something changed.

He lost his language abilities and became detached. He was unable to relate in normal ways with his parents and other children. And he became withdrawn, and less interactive. These are all signs of autism.

Sam was taken to the best doctors in New York and “pronounced” as having autism, as if it were a thing you catch like a bug. His parents were told that nothing could be done except arduously painful and barely effective behavioral and occupational therapy techniques. The progress would be slow, and his parents should keep their expectations low, the doctor said. Devastated, the mother began to seek other options and found her way to me. While we have just started working together, the results in only a few weeks have been remarkable.

Note the clever way this story is told. Dr. Hyman doesn’t explicitly blame vaccines, but he makes a very definite point of mentioning that the child received his vaccines…and then “something changed.” No mention of the time course is given. Did this change occur right after vaccination, or did it occur weeks or months later? Who knows? Even if it occurred weeks or months later, the implication is still there: The vaccines done it!

Then there’s the very same structure to the story that we often see in alt-med testimonials. Rejected by conventional medicine. No hope. Then began the search, and, at the end, the savior is found and that savior is Dr. Hyman, who diligently subjected the child to a hole heapin’ helpin’ of woo. None of this “biomedical” woo was based on any clear science. In fact, it’s a hodge-podge–a grab bag, if you will–of remedies based on metabolic tests finding alleged gluten allergies, amino acid abnormalities, methylation abnormalities, various nutritional deficiencies. These remedies included:

Step 1: Fix His Gut and Cool the Inflammation There

This step included a number of different tactics including:

  • Taking away gluten and other food allergens
  • Getting rid of his yeast with anti-fungals
  • Killing off the toxic bacteria in his small intestine with special antibiotics
  • Replenishing healthy bacteria with probiotics
  • Helping him digest his food with enzymes

Step 2: Replace the Missing Nutrients to Help His Genes Work Better

In Sam’s case we:

  • Added back zinc, magnesium, folate, and vitamins A, B6, B12, and D
  • Supported his brain with omega-3 fats

Step 3: Detoxify and Reduce Oxidative Stress

  • Once his biochemistry and nutrition was tuned up, we helped him detoxify and reduce oxidative stress.

Improve nutrition, reduce inflammation, heal the gut, detoxify — this should sound familiar.

Well, actually, yes, this does sound very familiar. Woo-meisters the world over love “detoxification” of unknown and unnamed “toxins” that are supposedly the cause of all disease, all accompanied by a boatload of various supplements.

Dr. Hyman is the protoypical brave maverick doctor who don’t need no steekin’ randomized controlled studies to tell him what works. It matters not one bit to him that autism is a condition of developmental delay, not developmental stasis. Autistic children do develop, regardless of what treatments they are subjected to, but the assumption n is all too often that these children don’t develop, which leads “brave maverick doctors” like Dr. Hyman to attribute any improvement they observe in an autistic child to whatever the woo du jour to which they happen to be subjecting the child at the time. The thought of a randomized clinical trial never enters their mind because they know this stuff works. They’ve seen it. Never mind that without a proper scientific randomized, double-blind, placebo-controlled clinical trial with a large number of children there’s no way of knowing if any improvement observed in Sam was due to any of the woo to which he was being subjected or just natural aging and development. Indeed, there is evidence that as many as 19% of autistic children move “off the spectrum” by their 7th birthday. Indeed some “recover” spontaneously. With an N of 1, we have no idea if Sam is just such a child. One wonders whether Dr. Hyman will ever publish his “recovery” rate for autism based on a large number of children.

Somehow I doubt it.

How do I know this? Easy. Dr. Hyman concludes with these appeals:

Every child with behavior problems, ADHD, or autism is unique — and each has to find his or her own path with a trained doctor. But the gates are open and the wide road of healing is in front of you. You simply have to take the first step.

Please visit the Defeat Autism Now! website for more information on this subject, including resources and conferences for doctors and parents.

Yes! An appeal to visit the quack site of all autism quack sites, coupled with an appeal to sign up for Dr. Hyman’s newsletter and (eventually, I’d guess) later appeals to buy his stuff. What else would we expect?

The truly depressing part of this whole thing is that Dr. Hyman is actually taken seriously as an “expert” in “wellness” and “alternative” medicine. Not only that, but he’s much sought after as a speaker, and, as I mentioned before, has testified and spoken at the very highest levels of government as though anything he has to say on “wellness” should have any bearing on any health care reform legislation that may be passed this year.

That’s how far woo has infiltrated not only academic medicine, but our government as well.