Prenatal Vitamins and Parental Responsibility

Flickr photo by beautifulcataya

If you really want to piss off a parent whose child has autism, just tell them that they are in some way responsible for their child's condition.  That accusation takes us back to the bad old days of autism when the prevailing theory was that autism was caused by cold and uncaring parents.

Fortunately, that sort of thinking has disappeared from the medical world and only survives in ignorance of the general public.  Or has it?

As Harold Doherty pointed out on Facing Autism in New Brunswick, a "science" blogger by the name of Harriet Hall, MD (aka SkepDoc) seems to have just suggested that parents, mothers specifically, are responsible for their children's autism.

The statements that I am talking about come in the context of a recent study that found that prenatal vitamins may decrease the risk of autism when taken during the 3 months before or the first month of the pregnancy.  The results of the study are somewhat confusing, to say the least.  On the one hand, the study seems to say that the simple act of taking prenatal vitamins before pregnancy might help to prevent autism.

But then you have to consider that another study suggested that prenatal vitamin use during pregnancy was associated with a greater risk of autism.  And then there is the fact that, over the past several decades, prenatal vitamin use has become much more common (at least in the U.S.).  So if prenatal vitamin use played a large role in autism, I would expect that the rate of autism would have dropped as prenatal vitamin use increased, which certainly hasn't happened.

I also have to wonder if the study controlled for whether the pregnancy was planned or unplanned.  It is much more likely that the mother would be taking prenatal vitamins if the pregnancy were planned than if it weren't.  I haven't read the full text of the study and the abstract doesn't specify whether that was taken into account.  If it wasn't taken into account then I suspect that could account for the results of the study.

But back to the point.  In the context of talking about this study, Dr. Hall had this to say -

How will the anti-vaccine contingent react to this new study? It was convenient and satisfying for parents to be able to blame vaccines and accuse the evil medical establishment of causing their children’s autism. Now will those parents accept that at least part of the responsibility lies with their own genetic contributions and the mother’s actions prior to pregnancy? That’s not as palatable a thought, but it’s more realistic.

In this context, the word "responsibility" says that parent's are responsible for their child's autism.  Responsible, according to dictionary.com, means -

1. answerable or accountable, as for something within one's power, control, or management (often followed by to  or for ): He is responsible to the president for his decisions.
2. involving accountability or responsibility: a responsible position.
3. chargeable with being the author, cause, or occasion of something (usually followed by for ): Termites were responsible for the damage.
4. having a capacity for moral decisions and therefore accountable; capable of rational thought or action: The defendant is not responsible for his actions.

The core idea behind the word in this context is that the parent had the ability to control a situation and so the result of the situation is because of what the parent did or didn't do.

So back to Dr. Hall's statements.

The idea that a parent is "responsible" for their "genetic contributions" just doesn't make sense.  A person has no ability to control their genetic code nor can they make any impact on which parts of it are passed onto their children.  The only decision that you can make in regards to your genetic code is whether to have children or not.  So the only "responsibility" here is the decision to have a child in the first place.

Perhaps more to the point, if a parent has some unknown genetic mutation that interacts with some unknown environmental influence, are they "responsible" for the outcome of that interaction even if they have no knowledge (or way of knowing) about either factor?  I don't think so.

The second part of the idea is that the mother is "responsible" for their actions prior to the pregnancy and this is true, to a point.  If you do something during (or before) the pregnancy knowing that it will harm the child, then you are responsible for the outcome.

But if you have no idea that a specific action or inaction can lead to an outcome like autism, can you really be "responsible" for the outcome?  The word "responsible" implies a choice as well as the ability to control.  If you have no knowledge that there even is a choice to be made or that you can control the outcome, can you be "responsible" for the outcome?

In general, that question is hard to answer.  However, when you are talking about evidence based medicine, the answer is simple.

In evidence based medicine, the only things that you should be doing (medically) are those things that are supported by the evidence.  If there is no evidence to support the action, then you shouldn't be doing it.  So, under evidence based medicine, can you really say that someone is "responsible" for failing to take an action that is not supported by evidence?

I think the answer is an obvious no.

So how can a science (aka evidence-based medicine) blogger such as Dr. Hall cast "responsibly" onto a parent for listening to what evidence based medicine has to say?  And do we really want to let medical doctors get back into the habit of blaming the parents for their child's autism?