Pesticides and Autism

Those who know me well will tell you that I am certainly NOT a person without opinions on policy or politics.  Here I endeavor to stick with the facts of my specific expertise as a pediatrician and I want to continue that approach today.  However, in this month’s medical journal BMJ a large, well designed study from the UCLA School of Public Health described troubling findings regarding pesticides and autism.  Let’s discuss.

Covering 38,000 people and almost 3,000 autistic children, the study identified areas of greater risk–pregnant women living within 2 km(approximately 1 1/4 miles) of a “highly sprayed” area–10-16% more autism, and 30% more risk for autism AND intellectual impairment. Children living in that area for the first year of life had a 50% increased risk for those problems.

The study was thorough in its efforts to eliminate outside influences like pollution, family history, or demographics to confuse the conclusions; the authors pointed out that its data probably held up for children born or living an additional 500 meters(almost 3/4 mile) further out.  It showed a slightly greater association for boys than girls, but that was mostly due to numbers of boys compared to girls and how that affected the math in the statistical calculations.

A wide variety of chemical agents were identified–organophosphates, diazinon, malathion, pyrenthroids, glyphosphates, avermectin, methyl bromides, and chlorpyrifos. The Trump Administration has been outspoken in opposing government regulations generally and has actively worked to liberalize the rules controlling the use of these products, most recently focusing on chlorpyrifos.  It is their position that these rules create economic drag–raising prices to consumers and placing barriers to hiring and job creation.  I will refrain from commenting on any of those claims.

But let’s be clear: this study demonstrates that there are serious consequences to innocent children from these chemicals, and the more and greater use, the more and greater risk.  This study takes place in California, and we can try and look away–telling ourselves that this does not involve us or our families–but agriculture is a big part of the economy in the Garden State and Ocean County specifically, to say nothing that we and our children are all eating this stuff.  So next time we hear talk of “big government,” “government over-reach,” “administrative red tape,’ or other such complaints of government regulations, please keep this study in mind.  Overdoing it?  At times, most likely.  But often, there are good reasons for many of these rules, and often enforcing those rules mean protecting children’s lives or well being.

There are newer economic models estimating SOME of the costs of this diagnosis on our society.  With that in mind, and if one adds in the heart ache to families and the tragedy of lives disrupted and dreams unrealized by autism, one must ask: is it worth it?

Send along questions and comments, and thanks for following.

 

Update on Research Studies

Ah, Denmark this time of year–ice skating, The Little Mermaid, tulips, windmills.  Well, the tulips and windmills are Holland, I think–but both have friendly blond people, great chocolate, beer, and cheese. And Denmark has produced some important recent medical research; let’s discuss.

One study followed children from 1995-2015 (>1.7 million children) and found a strong association between antibiotic use < 1 year and celiac disease.  The author’s postulate that changes in intestinal bacteria types and amounts, altered by the antibiotic, causes physiologic changes not yet explained that leads to this serious digestive problem.  And it makes sense.   Nature intends for bacteria to colonize our intestines(that’s why they are there), and, of course, antibiotics will change that. Disrupt that natural order and all kinds of unexpected outcomes–some serious– can occur. It’s foolish to think we can completely isolate the good from the bad  with this approach.

For example, the competition of bacteria in and on our bodies is one of nature’s ways to PREVENT infection. They compete with each other for nutrients produced by our bodies; that competition helps keep any one bug from causing infection.  Think of it like this: lions and leopards compete with each other to eat antelopes on the plains of Africa.  Kill the leopards and the lions eat more antelopes and make more babies.  Their population goes up.  Same with bacteria: take an antibiotic and the bacteria that are sensitive to it die allowing the resistant bugs to grow faster (no antibiotic kills everything). Those heartier bugs then are MORE able to cause infection(and those bacteria tend to be more dangerous species like MRSA or “C dif.” ) That’s why we need to use antibiotics cautiously and with clear indications.  Please keep the above in mind if you find yourself in an urgent care center, where studies show 40% of children with respiratory illness are prescribed antibiotics despite good medical studies showing that < 5% of respiratory illnesses in children are caused by bacteria. Better yet, please allow me to suggest that you try and wait until regular office hours so we can look at these situations carefully.

The other study involved–you guessed it–MMR and autism.  Danish researchers studied > 600,000 children from 1999-2010 and found NO correlation between the 2. This study followed up another study from 1991-98 of >500,000 children with the same result.  Let’s recall that, up until even 1980’s, measles killed millions across the globe but by 2016 we were down to about 100,000. Now, of course, measles is spreading again.  In the last 2 years there have been almost 8,000 new cases and 12 deaths in Italy.  ITALY!!  And, of course, we are seeing outbreaks across the US–in New York City, Rockland County as well as 30 cases right here in Ocean County.

Seriously–this should shock the conscious of any responsible person. I must ask–if 20 years and > 1 million patients followed is not sufficient data to convince one of the reality that no correlation between MMR and autism exists, then what will? In the face of this mountain of evidence (and there is more) when does this inquiry leave the realm of reasonable, legitimate concern and become merely a stubborn mentality closed to facts and reality?

So kudos to our Great Dane colleagues for this valuable information, and thanks for following.