After an involuntary hiatus, it's always invigorating to re-engage with the "real work" (Beat poet Gary Snyder's words), especially when the initial reconnect is celebratory in nature. Especially when the celebration involves an institution at the heart of the mission, in this case journalism.
And so, with a bow to journalist Robert MacNeil, I begin this summer's phase of my investigation into the twin epidemics of autism and developmental disabilities. His investigative report Autism Now, which aired on the PBS NewsHour in April, reacquainted me with the issues I'm exploring in the Ohio River Valley, where the rain is toxic and data show the kids just aren't quite right, developmentally speaking. Three years' into this project, I've not found a more honest or enlightened media report.
"Last month, a committee convened by public health officials in Washington called [autism] a national health emergency." - Robert MacNeil, journalistThe timing on Autism Now, for me at least, was fortuitous. My creative energies these past 15 weeks were consumed by a class I taught at the IU School of Journalism called "Environment in the News." I lectured students on the fundamentals of public-interest journalism -- as outlined in the book The Elements of Journalism -- and how they apply to coverage of the environment.
But while we spent time on the positive -- the rise of nonprofit investigative journalism, for example -- we mostly talked about how the news media routinely fails to uphold those principles on a host of environmental issues, from energy to transportation to climate change to children's environmental health.
Before dissecting parts of MacNeil's report, I should note that I have long included him among a tiny handful of journalistic giants in the corporate press, in the same class as his also-retired PBS colleague Bill Moyers. So, it was especially gratifying to end a demanding semester with an example of journalistic excellence from one of my professional heroes. At long last, I told my students, a mainstream journalist has honestly addressed the autism debate.
Thank you, Mr. MacNeil.
Of particular relevance to my work were Parts 1 and 3 of Autism Now, which addressed suspected environmental causes of autism in general and vaccines in particular.
In a textbook example of journalistic transparency, MacNeil declared his personal conflict at the outset in "Part 1: Robert MacNeil Shares Grandson Nick's Story." In this compelling piece, viewers see a grandpa coping with autism and learn how this developmental disability has impacted three generations of MacNeils on the most human levels -- father to daughter, mother to son, grandfather to grandson.
"Everything we know looks like this is a multitude of disorders, all under the umbrella that we call autism spectrum disorders." - Dr. David Amaral, MIND Institute, UC-Davis
You also learn that 6-year-old Nick regressed into autism after receiving three vaccinations in one doctor's visit. His mother, MacNeil's daughter Alison, suspects a correlation and advocates for vaccine safety studies.
In "Part 3: Autism's Causes: How Close Are We to Solving the Puzzle?," viewers see MacNeil the dispassionate journalist who co-anchored various incarnations of the PBS MacNeil-Lehrer NewsHour from 1975 to his retirement in 1995. The segment provides an overview of current thinking on the causes of autism, including vaccine-induced.
Part 3 parallels and updates the results of my three years asking the same questions. As Dr. Christopher McDougle, an autism researcher at the IU School of Medicine and head of the Department of Psychiatry, told me in November 2009, no one knows what causes autism. But they suspect genetic predispositions to "environmental hits" cause children to regress from normality into the spectrum of autism disorders.
To define and add understanding about those hits, MacNeil interviewed Dr. David Amaral from the University of California, Davis, MIND Institute in Sacramento (UC-Davis); Dr. Gerald Fishbach from the Simons Foundation; Dr. Martha Herbert from Harvard Medical School; and Dr. Craig Newschaffer from Drexel University.
Before asking them how close science is to discovering the cause of autism, MacNeil put the issue in perspective.
The latest data on autism incidence is 1 in 110 children, he said. And rapid increases in these numbers have spurred a surge of scientific research over the past decade to find the cause.
"Last month, a committee convened by public health officials in Washington called it a national health emergency," MacNeil said.
MIND Institute Director of Research Amaral said science is close to identifying several causes of autism, not a single one, because autism is not a single condition.
"My belief is we will find root causes of autism at particular synapses in the brain." - Dr. Gerald Fishbach, Simons Foundation
"Everything we know about autism is that there are multiple genes that confer risk," he said. "The children have various co-morbid problems. And everything we know looks like this is a multitude of disorders, all under the umbrella that we call autism spectrum disorders."
"I don't think there's going to be a single cause," he said.
Newschaffer, professor of epidemiology and biostatistics at Drexel in Philadelphia, agreed, noting some of those causes have been identified on the genetics front. But the task, he added, is formidable.
"If I can interpret your question as complete understanding of all of these complex causes of autism," he said, "I think we're still quite a ways away."
Acknowledging the autism puzzle is immensely complex, MacNeil asked the researchers what hunches they had on where the answers will be found.
Fishbach, from the Simons Foundation in New York City, called the brain a communicating organ. "My belief is we will find root causes of autism at particular synapses in the brain," he said.
Amaral said at least 20 or more genes seem to be associated with autism. But any particular one is only related to about 1 to 2 percent of the cases.
"I think what's clear now is that there's not going be a single autism gene," he said. "But there are many, many."
Herbert, a professor of neurology at Harvard, said hundreds of genes are actually being found.
"We're finding boutique genes," she said. "We're finding genes that kids have and the parents don't have -- their own parents."
As IU's McDougle told me two years ago, Drexel's Newschaffer suggested non-genetic causes commonly referred to as environmental, "with a capital E" -- lifestyle factors, exposures, "things of that nature."
"We're finding genes that kids have and the parents don't have -- their own parents." - Dr. Martha Herbert, Harvard School of Medicine
Among them, Herbert said, are environmental forces that overwhelm the body's ability to metabolically cope, forces "that are overwhelming our immune system."
"The collective impact of that is to deplete our protective systems," she said. "And I think that's what's causing autism."
The question of environmental toxins, she said, was "definitely" worth pursuing.
"Some of them act like our own molecules, like hormones, for example," she said. "That's called endocrine disruption. Some of them get confused with neurotransmitters. Some of them damage our cell membranes. Many, many of them damage our mitochondria, our energy factories in our cells."
Newschaffer said he believes the prenatal, intrauterine period will be found "very, very important," citing maternal diet, infections and chemicals in the environment as possible causes.
"I think these things are likely to play a role," he said. "How large, how small, I think, is yet to be determined."
MacNeil then asked about an issue he said science considers settled that won't go away -- "the parental belief that vaccines cause autism."
Bowing to public opinion, as he put it, the Inter Agency Coordinating Committee, which sets priorities in autism research, "has recommended studies to determine whether small subgroups might be more susceptible to environmental exposures, including vaccines."
"Vaccinations for those children actually may be the environmental factor that tipped them over the edge of autism." - Dr. David Amaral, MIND Institute, UC-Davis
Fishbach said many epidemiological, or population, studies have produced "no evidence that current vaccines in their present form have triggered autism."
And UC-Davis's Amaral agreed, to a point. "In general, vaccines are not the culprit."
But that's not to say there isn't a small subset of children who may be vulnerable to vaccines, from illness or preconditions like mitochondrial defects. "Vaccinations for those children actually may be the environmental factor that tipped them over the edge of autism," he said.
Amaral said it is "incredibly important" to determine what vulnerabilities, if any, might put some subsets of children at risk with certain vaccinations.
Harvard's Herbert agreed and questioned the validity of population studies that have shown no correlation between autism and vaccines. Such studies do not have the statistical power to find small subgroups of children for whom chemicals in vaccines could trigger autism.
"I think it's possible that you could have a genetic subgroup," she said. "You also might have an immune subgroup. There are a variety of subgroups."
Amaral credited the vaccine issue for again opening eyes "to the idea that the immune system is an important component of autism."
Herbert said the brain, the immune system and the gut are intimately related. Their cells have common features. "They work together seamlessly," she said, "and when you disregulate one, you disregulate all the others."
She questioned whether the brains of children with autism are miswired or misregulated.
"I've come to think the brain is misregulated," she said.
Amaral said vaccines are but one venue through which children are exposed to harmful chemicals. "There are myriad other kinds of toxic chemicals that we're putting into the environment."
And there isn't enough research on these environmental factors, he said. "Frankly, I think it's very expensive. It's difficult research to do. ... You start trying to develop a list of how many new things there are in the environment now, from 30 years ago. And it'll be a very long list."
"If I can interpret your question as complete understanding of all of these complex causes of autism. I think we're still quite a ways away." - Dr. Craig Newschaffer, Drexel UniversityWhile the MacNeil series did not elaborate, more than 80,000 industrial chemicals are approved by the U.S. Environmental Protection Agency for release into the environment every day. The vast majority have been developed since World War II.
Herbert cast the issue against that historic backdrop.
"When we were having this explosion of our chemical revolution, we didn't have any way of knowing the subtle impacts on cellular function," she said. "We thought if it doesn't kill you, it's probably okay. But now we're learning that it can alter your regulation way before it kills you."
MacNeil ended the how-close-to-a-cause segment asking if the researchers were discouraged that, after so much effort and investment by some of the best minds in the world, "autism is still so baffling."
Fishbach from the Simons Foundation said he was not.
"I think we're addressing one of the most profound problems in not only all of medicine but in all of human existence," he said. "We're talking about the ability to relate to other people, to empathize in a certain way and to comprehend. And I think it's the most worthwhile, most challenging effort in science that I've ever been involved in. So I'm not discouraged at all."
One of the most profound problems in all of human existence.
Talk about the real work.
Steven Higgs can be reached at .
