Could declines in smoking be behind the autism epidemic?

No good deed goes unpunished

An Autism Epidemic?

One spring day in 1999, a Los Angeles Times newspaper article brought a problem to the attention of the nation. A fiercely disabling, but previously rare childhood developmental disability, autism, was being seen in more and more children throughout California, with a 273% increase in incidence in the previous 10 years. Parents of autistic children, struggling to help them, wanted a cure, prospective parents worried about being in the same position, and this report soared to national attention. Soon many, perhaps even most, Americans had heard of autism.Bar chart of the number (per 1,000 U.S. resident children aged 6–17) of children aged 6–17 who were served under the Individuals with Disabilities Education Act (IDEA) with a diagnosis of autism, from 1996 through 2007.

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Vaccines To Blame?

An additional reason for alarm was a 1998 paper published in the prestigious medical journal, the Lancet, with the author, Andrew Wakefield suggesting that the MMR vaccine in some cases induced an adverse autoimmune reaction in the vaccinated children, causing autism and an associated bowel disorder.

Wakefield suggested that instead of the widely used triple vaccine, children should be immunized with separate vaccines for Measles, Mumps and Rubella (German measles) with each vaccine being spaced a year apart, to quote: "If you give three viruses together, three live viruses, then you potentially increase the risk of an adverse event occurring, particularly when one of those viruses influences the immune system in the way that measles does." Such vaccines were not generally available at the time however.

Both the medical establishment, and governments were displeased by this study. Neither trusted the public much, and they feared that parents would simply avoid the vaccinations. Moreover, three separate vaccines would increase costs.

Thus battle lines in Britain (where Wakefield worked) were drawn, and all parties performed as expected. Doctors fell over themselves to dismiss the possibility of vaccine harm, the government refused to provide separate vaccines, and the public kept their children away from the vaccinating needles.

Toxic Vaccines And Heavy Metal Poisoning.

Moreover, a new issue soon sprung to life, raising new concerns even for those who accepted studies and data analysis dismissing the possibility of autoimmune vaccine injury. As it happened, many vaccines were manufactured and dispensed with a mercury based preservative, thimerosal. Mercury is quite neurotoxic, and a handful of noted scientists in the US contended that the thimerosal contributed to the development of autism. The US government and medical establishment were generally dismissive (or at least officially dismissive) of this notion, but with several other nations demanding mercury free vaccines, it was decided that reducing mercury levels would help to ensure that the public would accept vaccination.

Mercury reduction was accordingly implemented, but as of yet, no great reduction in autism prevalence has been noted. Government and establishment sources have settled on this fact as proving the complete safety of the vaccines, but neither camp of vaccine critics is convinced. So far as the immune effects are concerned after all, nothing has much changed, with children still being injected with three weakened, but live and infectious sets of disease germs, although few Americans focus on this factor. So far as the mercury is concerned, any approval of the government's new rules is rather squelched by the fact that the officially permitted description "mercury free" does not mean that mercury is not an ingredient, but rather means simply that there is not enough thimerosal in the vaccine when it is diluted to dosage strength to provide reliable preservation. While the levels of mercury per vaccine have come down, the number of vaccines that children are now supposed to receive have gone up, and many people are thus convinced that the amount of mercury remaining is enough to cause autism.

Other Possible Causes.

Going beyond vaccines, while the geneticists are pressing the idea that the condition is almost completely inherited, people have looked to other environmental influences as well.

Studies have lately linked high rates of autism to high rainfall, suggesting a possible autism connection to vitamin D deficiency, indoor pollution exposure, or even increased juvenile television watching. The situation is further confused by questions about just how much of an epidemic there is in the first place. Autism would not be the first disease to have many of its sufferers misdiagnosed, and more widespread awareness might lead to a specific diagnosis where before a generic label like "retardation" might have been applied. Further, autism is now generally held to be a "spectrum" with several related conditions of varying severity but a common mechanism or cause. This understanding and concept might easily lead to children being diagnosed as autistic where before, despite their problems, the designation would not have been held to be appropriate.

Of course, whether or not there are more autism cases then previously, does not change the needs of the autistic kids one whit, but this question is very important if we are to catch any environmental or non-genetic provocation that will push a child towards autism.

The Latest.

Now a new study has emerged, which just might suggest an environmental cause of an entirely different sort.

COLUMBUS, Ohio – Scientists have identified a relationship between two proteins in the brain that has links to both nicotine addiction and autism............

The discovery identified a defining role for a protein made by the neurexin-1 gene, which is located in brain cells and assists in connecting neurons as part of the brain’s chemical communication system. The neurexin-1 beta protein’s job is to lure another protein, a specific type of nicotinic acetylcholine receptor, to the synapses, where the receptor then has a role in helping neurons communicate signals among themselves and to the rest of the body.

Rene Anand

This function is important in autism because previous research has shown that people with autism have a shortage of these nicotinic receptors in their brains. Meanwhile, scientists also know that people who are addicted to nicotine have too many of these receptors in their brains.

“If we were to use drugs that mimic the actions of nicotine at an early time in human brain development, would we begin to help those and other circuits develop properly and thus significantly mitigate the deficits in autism? This is a novel way of thinking about how we might be able to use drugs to approach autism treatment,” said Rene Anand, associate professor of pharmacology in Ohio State University’s College of Medicine and principal investigator of the research.

Now all this is very important on its own terms, as there is the possibility of a treatment, or even cure for autism. The study begs the question however, if drugs that "mimic the actions of nicotine" might cause a brain predisposed toward autism to develop properly, then would not nicotine itself do the same thing? It would be ridiculous of course to hand a small child a cigarette "for their health", but what if someone effectively did?

As many a public health warning has pointed out, cigarette smoking by a pregnant woman affects her unborn child, and a smoker's baby is born with a brain that developed in a nicotine tainted environment. Some of the milder manifestations of autism like Asperger syndrome seem to manifest themselves as almost a hyper-nerdiness. Is it possible that an autistic child born to a chain smoker would be born weak, sickly, and undersized due to the harmful effects of smoking, just as the public health announcements tell us, but also be a notable but functional nerd, rather than be a child completely disabled by autism?

Of course there is also the possibility that the brain changes causing autism manifest primarily postnatally, and I have never seen a two year old light up! However, children are exposed to secondhand smoke. Is secondhand smoke enough to provide a dose of nicotine? Well a number of studies claim so. Even allowing for exaggeration, (it is easy to become enthusiastic when fighting so dangerous a habit) it seems reasonable, or at least not impossible to suppose that there might be enough nicotine to "shake loose" malfunctioning neural cells. If secondhand smoke would "do the job" then this is very important as well because of the truly massive historical exposure. A great many women throughout the 20'th century who did not smoke, had a spouse who did. The smoking rate has been dropping steadily and consistently however (note that the above chart goes back only to 1965, when smoking had already been declining for many years), and the decline in prenatal and childhood exposure to nicotine has been much greater because habitually smoking parents have increasingly taken steps to avoid smoking around children, having been (correctly) told that secondhand smoke is a hazard to them. Such a precaution would have been quite alien 60 or 70 years ago.

Summing Up

Overall of course, eliminating tobacco use is of enormous benefit to everyone, and the harmful effects of secondhand smoke or prenatal exposure are very well established. Even if nicotine helped to prevent autism, smoking around children would make ill more children than it would cure.

This being said however, there are exceptions and caveats to most rules or truths in the world, and it is interesting to consider the possibility of HARMFUL side effects to the reduction of the generally harmful habit of smoking. This theory, or the research that prompted it, may turn out to be incorrect, and certainly I am going to keep an open mind on the subject, but at the same time it would be a mistake to simply dismiss the study as a fluke. Until recently, the actual mechanisms behind autism were almost entirely unknown, and the new study shines some light into this dark corner of medicine. It is generally harmful to inhale significant amounts of smoke, no matter what is burning, but nicotine has its addictive and stimulant qualities because it is a near analogue to a substance naturally found in the brain and nervous system. Native Americans used tobacco in medicine, and when tobacco was introduced to Europe, well before the development of a giant industry, it was used as a medicine as well. Both tobacco and cannabis are most commonly used for recreational purposes, but both contain chemicals that naturally regulate significant portions of the human nervous system. It has been unfortunate that disapproval of recreational use has prevented cannabis from being used fully in medicine, and we should not toss the medicine out with the cigarette butt.

[FULL DISCLOSURE: I do NOT smoke tobacco (or anything else for that matter), and NEVER DID. I did NOT grow up in a family of smokers, etc. etc. I do NOT work for a tobacco company, own tobacco company stock, benefit from cigarette advertisements, or even work for a shop that sells cigarettes. I have NO CONFLICT OF INTEREST here. My opinions stand on their own intellectual merits, not some hidden agenda, and of course, implicit in the use of a blog, I certainly understand and appreciate that you, the reader might disagree. If you have a point to make, I welcome comments. ]

Helping children, or hunting them?

Today, a bit of news in my state, with the governor signing a bill altering its recent, and notorious safe-haven law permitting parents to drop off children that they do not want/feel-able to care for, at a hospital without being prosecuted for child abandonment. Instead of the law covering all minors, from newborn to 18, the law will now only cover babies one month old, or less.

Why the change? Well apparently most of the children that have been dropped off over the last few months have been teenagers and pre-teens, rather than the archetypal "baby in the basket".

Some scheme permitting the safe drop-off of the "baby-in-a-basket" has a long history in the Western world, with Pope Innocent III

Pope Innocent III

instituting, in the year 1198 AD, a device, the "foundling wheel" in the appropriate Catholic charitable institutions. The foundling wheel was a revolving hollow cylinder with a gap in the side, which would be set in an outside wall. A mother who wished to discard her baby (this was commonly motivated by an out-of-wedlock birth in a moralistic era) would revolve the cylinder until the gap in the side was accessible, place the child inside, and then rotate the cylinder until the opening faced the interior of the building. Since nobody could see the person on the other side of the wall, this device permitted the mother to abandon her baby anonymously, and would discourage the infanticide of unwanted infants.

Foundling wheel at the "Ospedale Santo Spirito in Rome

***

Now everyone will acknowledge that parents, including of course, the parents of small babies should take care of them, and not abandon them, but even in the Middle Ages, it was acknowledged that sometimes parents are not willing or able to live up to these obligations and to some degree, the public must step in.

With the Nebraska safe-haven law adjusted to a degree that would suit 12'th century convictions (and to be quite fair, the Nebraska law is generally similar to those anywhere else in the nation) it occurs to me that though "progress" is an overused philosophical theme, social services might, and should be improved beyond medieval levels. Continuing in this vein, it was my assumption that child-protective-services, present in every state, and the very profession "social worker" were in no small part focussed on just that; the rescuing of children in completely dysfunctional families. Thus I have been astonished to see a vast amount of criticism directed at the original Nebraska law covering all minors.

Clearly the concept of state care of older children is not foreign to either Nebraska or the rest of the US. There are more than 500,000, a full half-million children in foster care in the US! Are we supposed to assume that none of the parents of these children might recognize their lack of parenting skills? Sure, dumping your kids is irresponsible, but how many people do YOU know who would actually give away their children? I can see little to celebrate in the behavior of such a parent, but frankly, if there is a parent who does not want to take care of their kids, or who does not think that they are capable of doing so, well I am inclined to agree!

None of this is to say that being given up to the state is not going to be emotionally hurtful to the children involved, but I also do not see how being with a parent who WANTS to give you up is not going to be hurtful. Moreover, if not being with their parents is the worst thing that can happen to a child, bar none, then an entirely different set of reforms need to be implemented, and the better part of the half million young Americans in foster care need to be returned to their parents immediately.

There is in fact, something of a case in the latter concept as a great many children have been taken from their families due to "inadequate housing conditions", something which not uncommonly means that a family does not enough money to afford proper quarters. Kids are effectively being taken from their families because they are poor.

There is a lot of disagreement (in the US at least) about just how much help the state should provide to poor families, but I cannot see any moral means of avoiding the point that any level of poverty that the state does not alleviate and correct is by definition, a level of poverty, with all the conditions that accompany such a state, that cannot justify depriving a person of the custody of their children.

To continue further into the question of poverty alleviation, it is worth noting that a couple of the Nebraska families (profiles of the families are here ) have as their biggest problem, poverty. Nonetheless, ending or reducing poverty should not be a substitute (it is a worthy enough goal on its own!) for a safe haven law because wealth does not eliminate catastrophic parenting, and poverty does not ensure it.

Finally, it is worth noting exactly what motivated the safe-haven dropoffs of older children and teens in the first place. As it happens, almost all of these children were mentally ill, and if you look at their profiles, they were commonly violent. Now it would seem natural for me to have listed this information first, because it is probably easier to understand why a parent would give up their child if he is a knife-wielding psychotic, or is torturing the family pets.

I did not for two reasons. First, I think that it is a vital point that effective child protection demands that social service agencies acknowledge self acknowledged parental incompetence.

Second, I am quite sure that some people will NOT sympathize, and there are other reasons that everyone should agree that the law should be retained, or care outside the family need be provided. In fact, to think so, you would even need to be very concerned about the children. Take Skylar for example.

"Lavennia Coover is a kindergarten teacher and mother of three who says her main goal in life is to get help for her youngest son, Skyler, 11. She said she used the law because Skyler is dangerous. She was worried about the danger to herself but especially to her other son, 12-year-old Colby. She says Skyler often beat up his older brother and threatened him with knives and sharp sticks."

"I mean, he threatened to kill the next-door neighbor little boy, screaming to the top of his lungs," Cynthia said. "I've tried to explain to him by doing that -- if somebody else was to do that -- they would take you to jail. That was where he was going to end up if we didn't do something."

So Cynthia walked through the emergency room doors of Immanuel hospital and there, she said, she talked to a caseworker, but, says she never used the words Safe Haven. She said she told the nurses the boy needed to see his psychiatrist and be readmitted to residential treatment.

Never mind whether or not you suppose that SOME person would be capable of dealing with this. I am fairly certain that there are some people who will NOT, and I should not want to have this fellow, if he does NOT receive parenting that is adequate to his needs, by his own mother's description, roaming the streets of our collective future.

Then there was the 11 year old who;

"had threatened to kill his mother and siblings and had tortured the family cat several times" , was prescribed medication, but refused to take it, and had (mind this is an 11 year old) already been arrested for criminal mischief.

One need not rely on obscure psychological indicators to see that he might become a threat to the public, what with the death threats, but anyone interested might note the animal torture. There are quite a few famous people who liked torturing animals; serial killers Ted Bundy, David Berkowitz (the "Son Of Sam") , Jeffrey Dahmer, and Edmund Kemper for example, or school shooters Brenda Ann Spencer ,Eric Harris and Dylan Klebold, Luke Woodham ,Michael Carneal ,Andrew Golden and ,Kip Kinkel. I have little doubt that more such examples could be found, but the research is stomach turning, and I think that these examples should serve to make the point!

There is something very wrong with a system, not just in Nebraska, but also around the nation, which is happy to strip children from their homes against the will of their families by the thousands, but which cannot accept a child when the parents recognize that they cannot provide proper care. That so absurd a situation could arise strongly suggests that the social services and child protection agencies have become obsessed with capture and seizure, loosing track of the children in the process.

Most likely, many troubled children and teens require mental health treatment, including inpatient or residential treatment, and would not be, and would not need to be abandoned by their parents, but the rash of safe-haven cases certainly points to a system that is not adequately helping severely troubled children. Beyond the misery of the children themselves, we cannot ignore the fact that anything from a rock, to a knife, to a car or truck can be a lethal weapon in the hands of a violently mental ill individual. To stop headline-grabbing tragedies, we need to ensure that mentally ill minors get treatment and are raised by someone who can handle them.

Links for additional child protection information

National Coalition for Child Protection Reform

NCCPR Child Welfare Blog

Paparazzi for the state

Here is a rather unhappy development.

At paparazzi schools in South Korea, students are taught how to stalk their prey and get them on film, but it's not the celebrities they're after, just ordinary citizens committing minor crimes.

As the article details, the South Korean government has instituted a set of rewards paid to people informing on the minor infractions of their neighbors, be it smoking in non-smoking areas, to littering. Not only have these measures empowered the busybodies of society, but the rewards are sufficiently large that a new class of professional informers have emerged, the ssu-parazzi (garbage paparazzi) trained at private academies in the techniques of celebrity hunting journalists, and equipped with hidden cameras to catch more media-shy prey.

A global threat?

While most of us, indeed even people with scant sympathy towards wealthy and camera-shy celebrities, are likely to be disgusted by this harassment of the common man or woman, do we all need to be actually concerned by this development? After all, it is not difficult to find abuses of most any sort in some corner of the globe, and Korea has a very long history of oppressive government monitoring. Even in the 15'th, and 17'th centuries, in service of a feudalistic system that bound peasants to the land, Koreans were forced to carry Hopae , identification tags made of metal or wood containing their personal information; a rather noxious combination of the bureaucratic and the medieval.

Without further indication of such a scheme actually in the works, I do not think that it is possible to predict that something so strange as the ssu-parazzi ARE coming to the rest of the world, but the barrier to such a development or other pervasively intrusive monitoring in pursuit of trivial offenses might be lower than you think.

New moralities open doors for new methods of enforcement

In the first place, the motivations behind the use of informants in Korea are not obsolete and decrepit. Iran and Saudi Arabia for example, have morality police that pursue people for petty offenses that generally have little effect on others. While these nations are likely to to remain socially conservative, the necessity for specialized morality police gives the game away. Only a special force could be relied on to take up the chase because the offenses in question are so trivial that the regular police would tend to ignore them. This structure confirms the widely circulated reports that most Saudis and Iranians are not inclined to support social strictures as strict as are now imposed. The sorts of novel oppressions that these nations might now devise are unlikely to spread because so extreme a manifestation of the belief system that supports them is itself decrepit and crumbling.

By contrast, the offenses that South Korean informants are chasing are those connected with widespread emerging moralities. Anti-smoking rules are expanding rapidly, both in the sense that these rules are spreading internationally, and in the sense that their scope is widening. A ban on smoking outdoors would have been unimaginable a generation ago, but today legal proposals are being made that smoking in your own apartment should be forbidden.

Environmentalism has recently taken on a moralistic and quasi-religious tone, with traditional religious authorities jumping on the bandwagon; the Vatican declaring pollution a mortal sin for example.

These new modern sins are what the ssu-parazzi pursue, targeting smokers, littering, and shopkeepers who give away free plastic bags ( apparently forbidden by a regulation designed to prevent waste, and likely related to other pollution-minded plastic bag bans seen throughout the world). When there is a shift in morality, with new taboos emerging, otherwise offensive measures to enforce these taboos begin to seem increasingly reasonable.

The ongoing redefinition of privacy


One of the distinctive features about the most swiftly advancing portions of modern technology (including the Internet) is that these technologies facilitate the documentation of an increasingly large portion of our lives, and enable the gathered information to be arranged into a meaningful and revealing whole.

When a person has a conversation with a person over the phone, walks past a store with surveillance cameras, or makes a purchase, they generate recorded data.

Each of these actions has a ready equivalent going back thousands of years, and each of these actions might have been noted by various people in the past.

A shopkeeper can recognize a person that makes a purchase, or walks by his store, and anyone who had a conversation would leave a memory with the other person in the conversation at least.

Anybody wanting to reconstruct these events however, would either need the cooperation of all of the many people who interacted with an individual, or would need to follow the targeted person while attempting to avoid detection in their surveillance. Either questioning a person's associates or dogging their footsteps would require extraordinary effort, and neither course of action would be practical against the majority of the population.

Increasingly however, information of this type on everyone resides in a few databases. Once entrance to these databases has been obtained, every one's activities are revealed. This obviously has privacy implications, as intrusions that would previously been ruled out due to impracticality, now become a threat to everyday life. A person might instinctively sense that something is immoral, or in this case, intrusive and a violation of privacy, but in defining what is permissible or not, a definition of privacy, and implicit with this, the listing of the boundaries of privacy becomes necessary.

America: legitimization of the parts triggers legitimization of the whole

The US legal response to the development of modern electronic data gathering and storage.
has been limited, with the courts concluding that as long as the individual transactions and bits of data in a database were legally and legitimately obtained, the compilation of this information to create a picture of a person's life is legitimate as well. Accordingly, companies have sprung up to compile all available pieces of information in order to target advertising, provide credit ratings, and the like.

While legal, the pervasive databasing of personal information is not favored by the public. Indeed the awareness of the threat of pervasive surveillance has recently been turned into law with the introduction of anti-stalker laws. However, anti-stalker laws are legally, if not always socially interpreted as being strictly anti-harassment measures, not as recognition to a right to privacy against the threat of cocooning, but bit by bit legal, information gathering.

While the public thus might oppose the pervasive collection of their personal information, this collection remains protected by law, and should this remain true, over time the legal standard is likely to drag the social standards into line behind it.

The boundaries of privacy in the US are thus being drawn as functions of trespass, i.e. nobody can place a camera in your living room without your permission. The ssu-parazzi however (unlike many a paparazzo) , are not distinguished by their trespass into restricted space, but are distinguished by their pervasive monitoring of the public. As there are already many private companies which profit by pervasively monitoring the public, the addition of the fact that the ssu-parazzi report on illegality is not likely to stand out as distinctively offensive if the public comes to accept pervasive monitoring.

Europe: privacy as government access monopoly

In Europe, by contrast, private industry is considerably restricted in their ability to profit by trawling through the data of the public. There are several strands of thought behind European privacy regulations. The strongest would seem to evolve from the fact that particular private facts would be most disruptive were they revealed to particular individuals. In most cases when a person particularly seeks privacy against the knowledge of someone, that someone is not working for the government in an official capacity. Of course most of the things that a person would prefer to remain private would likewise be of little interest or significance to an advertiser or the bank either, meaning that if this logic is accepted fully, then the widespread US commercial data gathering would likewise be of little importance. Such commercial information compilers are much more restricted in Europe however. State information gathering is much less restricted, and other than regulation mandating that the government grant proper permits to itself, there is little to stop security and law enforcement from prying where it will.

At this point it would be common to praise the European privacy protections, and sneer a bit at US distrust of government. Certainly a sneer at the US would be in order, even if the criticism is quite precisely targeted given the fact that virtually no protection against privatized privacy violations has been provided, and to top it off, the US government has lately engaged in pervasive 'trespass' violations of private communication, despite the law.

The real deterioration of privacy in Europe can be seen however, if one tries to project comparable government and private behaviors back in time. Would a European nation in the 18'th or 19'th century have been praised for its protection of privacy if shopkeepers were forbidden from swapping information on sales, so as to target customers, but all such information was required to be submitted to the secret police? Would it have been a triumph of personal privacy if a butcher could not try to listen in on conversations in the pub, or seek out gossip to find out when somebody was having a party (and hence a sales opportunity), BUT the bartender was REQUIRED to take notes on all conversations he overheard, and keep those notes for the convenience of the secret police? Most of Europe requires that the telecom and Internet providers provide this governmental access to private communications and indeed in many cases, requires that the companies keep detailed records of citizen communications for the convenience of the "security services".

One may of course, fuss about terrorism, but the proverbial "bomb-throwing" radical has been around for a long time, and it was a rare government in Europe in the last few hundred years that did not face the threat of invasion, political revolution, or coup, any one of which would threaten more people than any thinly-supported Islamic radical in Europe could today.

In Europe, the boundaries of privacy have been set on the boundary of private action. Governmental actions taken to enforce the law or protect the public against a "security threat" are discounted as serious privacy violations.

Looking at the ssu-parazzi, they are after all, assisting in the enforcement of the law, and while smoking is scarcely a terrorism threat, an enthusiastic public-health campaigner will have little difficulty in claiming that secondhand smoke is an equal problem. Frankly, terrorism (defined as radical or extremist attack on the public, as opposed to actions taken by the state to terrorize the public into obedience) simply does not kill very many people, and while secondhand smoke deaths are not common, nor are the statistics for such a threat of the best stability, the figures being thrown about, such as 40,000 deaths supposedly induced by secondhand smoke though heart disease, are much higher than terrorism deaths.

Littering is perhaps, less of a public health threat, but environmentalists do not seem to have much difficulty in transmuting a particular environmental threat into the survival of life of earth itself.

That the surveillance serve the officially-defined public interest is simply not enough of a protection to preclude pervasive violation of privacy. Custom throughout the world would presently bar the ssu-parazzi and the informant system behind them, but custom has a way of yielding to the defined logic and ethics of society. If we do not wish to face the privacy intrusions of celebrities, and face them without the wealth and power that accrues to their status, then all of us, around the world need to insist on privacy and insist on a logic of rights and freedoms that will secure privacy through the continued evolution of technology.