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By DAN OLMSTED
Washington, DC, Apr. 28 (UPI) -- Part 2 of 2. Dr. Elizabeth Mumper, a
pediatrician in Lynchburg, Va., is concerned that the increasing number of
childhood vaccinations in the 1990s may have triggered a huge increase in autism
and other developmental disorders. This article looks at treatment strategies
she and others are trying based on that view.
Mumper has just been named top adviser on autism treatment for Defeat Autism
Now! (DAN!) and is medical director of their physician training lecture series.
Mumper graduated from the Medical College of Virginia and completed her
residency at the University of Virginia.
This weekend, at a conference in Charlottesville, she and other doctors and
scientists who advocate this approach will outline their strategies for treating
autism as a biomedical disorder.
Mainstream medical and scientific groups say autism is primarily a genetic
disorder and there is no link between vaccines and autism or other mental or
physical problems.
Q. Give us a sense of your overall philosophy in treating autistic children.
A. The basic premise of our treatment strategy is to tailor our treatments to
the unique constellation of the child's problems, as determined by history,
careful physical exam and targeted laboratory evaluations. Certain treatments
are helpful to some children, but would not be expected to help other autistic
children with different problems.
Many autistic patients have significant gastrointestinal pathology, which can be
well characterized by endoscopy and pathology. Standard treatments targeted at
their esophagitis, gastritis or inflammatory bowel disease often lead to
improvements in self-abusive behaviors such as head banging, which we believe
are frequently signs of physical pain in children who cannot communicate their
distress.
Many patients who have major sleep problems begin sleeping through the night
when their erosive esophagitis is treated with classic medications.
Many patients who had unexplained crying or sudden meltdowns become calmer when
their inflammatory bowel disease is treated with standard anti-inflammatory
medications.
Q. What about the neurological problems that are clearly a central feature of
autism?
A. Many autistic children demonstrate abnormalities in methylation pathways.
Methylation is the biochemical process of adding a carbon (atom) and 3 hydrogens,
and is crucial for the formation of new DNA, the synthesis of neurotransmitters
and the creation of phospholipid cellular membranes.
Careful study of the individual child's cellular biochemistry can lead to
treatments with methylcobalamin and folinic acid, which have been demonstrated
to correct deficiencies in reduced glutathione, which is the major intracellular
anti-oxidant.
Glutathione also has vital roles in immune function, gut structure and
detoxification. Correcting this biochemistry makes the child healthier and often
improves language acquisition and socialization.
Q. You believe that part of what's going on here is that some children have a
genetic or metabolic deficiency in methylation and glutathione pathways that
make it harder to excrete heavy metals -- like the mercury that was used as a
preservative in many childhood vaccines through the 1990s. How does that figure
in to your treatment plan?
A. Many children in the autism spectrum have problems with sulfation pathways
and detoxification systems. Therapeutic strategies aimed at enhancing the body's
mechanisms for eliminating environmental toxins are associated with a decrease
in so-called autistic behaviors in some children.
Our patients frequently have evidence of significant oxidative stress, which can
be treated effectively with relatively simple therapies, such as vitamins A, C,
and E and selenium.
Q. How many patients have you treated this way in your practice?
A. We estimate that there are about 800 patients with neurodevelopmental
disabilities in our practice who have been treated with some combination of
biomedical treatments. We try to look for underlying medical problems that are
amenable to treatment, so that the child will be healthier and more attentive
for (his or her) educational and behavioral therapies. We believe strongly in
working as a team with educators and therapists.
Q. How well is this working, in your opinion?
A. There are some patients that we have not really helped much, despite our best
efforts. There are other patients whose parents describe extraordinary
improvements in language, behavior and socialization. Sometimes it is as if a
light bulb has been turned on.
One of the most gratifying moments of my career was when a 6-year-old non-verbal
girl said "Mama" for the first time several months after we began working on
correcting her biochemical abnormalities. I will never forget the look on that
mother's face when she thanked me. Of course, I cannot prove she would not have
spontaneously said "Mama" in the absence of our interventions.
Another gratifying moment came when a 15-year-old boy, who had not slept through
the night for four years, began sleeping all night within one week of having his
erosive esophagitis identified by endoscopy and treated with standard
medications. He must have been in agony. His mother had been chronically
exhausted.
He is nonverbal, but just this morning typed to me on his Alpha Smart (portable
word processor) in complete sentences how much better he has felt since he
started coming to our practice.
Q. The counter-argument to this is that some autistic children improve anyway;
that their disorders might not have been as severe as originally believed, or
that behavioral treatments going on at the same time really made the difference.
How do you respond to that?
A. We are very aware of the potential for bias in detecting improvements -- or
the lack thereof -- when parents or healthcare providers are the only ones
assessing the child.
We try to keep teachers, therapists and second-degree relatives "blinded" to the
fact that biomedical interventions are being added. We ask the parents to record
any spontaneous comments that are made, and frequently get comments that suggest
significant improvements in language or behavior over baseline.
We also compare the developmental trajectory at baseline and after biomedical
interventions. For example, a child in speech therapy may have made four months'
worth of progress in 18 months prior to our interventions, then 10 months of
progress in the three months after our treatments, which suggests -- but does
not prove -- effectiveness.
This morning I saw a 3-year-old patient with autism who started on
methylcobalamin and folinic acid 12 weeks ago. At baseline he had about 50
words. He added 100 new words the first six weeks and 50 more words the next six
weeks. That seems to be a significant improvement over baseline and is
documented with a specific list of words recorded by his therapist.
There is a 140-question assessment tool we use to evaluate the effects of our
methylcobalamin and folinic acid regimen. It utilizes data from observers
blinded to the intervention. The MIND Institute at the University of California
at Davis is carrying out a double-blind, placebo-controlled trial of the
protocol, which will utilize sophisticated psychological and educational testing
before and after.
I am working with some colleagues who are carrying out multiple-blinded
behavioral and educational assessments at baseline and after biomedical
interventions, such that each child establishes his or her own developmental
trajectory and changes can be tracked by therapists unaware of the medical
interventions.
Q. What do your fellow pediatricians think of all this?
A. Most of my pediatric colleagues have accepted the conclusions of the IOM and
honestly think the case is closed on the issue of the vaccine-autism link. (An
Institute of Medicine panel concluded last year the epidemiology favors
rejecting any link between autism and the mercury in vaccines or the vaccines
themselves.)
I am concerned that some of my colleagues think I have lost my mind.
Q. So, what are you basing your theories on?
A. My conclusions about the science implicating vaccines came after reading over
50 books, including some very technical ones about neuropsychopharmacology,
biochemistry and immunology.
My interest in these subjects was piqued when I was asked to write a book
chapter about developmental pediatrics, which includes autism and ADHD, and
another chapter about allergy and immunology. Since then, I have read hundreds
of articles in peer-reviewed scientific literature about those topics.
I have a paradigm in my mind where much of the science fits together in ways
that make the vaccine-autism link quite plausible -- although clearly not the
only factor in autism.
My husband, Mike, is a psychiatrist. He has a theory that pediatricians are, as
a group, such nice people committed to helping children that the thought that we
may have unintentionally harmed a generation of children is too painful to face.
--
This ongoing series on the roots and rise of autism aims to be interactive with
readers and will take note of comment, criticism and suggestions. E-mail:
dolmsted@upi.com
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