Friday, June 22, 2012

Smear Blogging

Today must be my lucky day, my last post was the subject of a smear post written by the lord high smear blogger himself, Orac. Or, since he decided to get personal from the start, I think I should just call him by his real name, David Gorski. Gorski apparently didn't like the subject of my last post and decided to write one of his typical rambling rants about it, or as I like to call them, smear posts.

I call them smear posts because the good doctor doesn't like to confine himself to facts and talking about ideas. No, he seems to feel the need to editorialize about and impugn the character of everyone he writes about while impressing us with his brilliance. For example, I apparently don't understand science based medicine.

I was going to respond to his post with one of my own but after reading the comments on the his post I changed my mind.  I actually had to laugh at how inane some of these people are.

One particularly sad person took me to task for not thanking Gorski for plugging my blog and giving me a forum to correct my errors before telling me my "tone" was offensive.  According to this person, I defend child abusers.

Another explained to me that because I was having saying inappropriate things about MMS that I am one of its defenders.  And another one counted the number of words I wrote and decided that I spent too many words saying the wrong about MMS thing therefore I had to be defending it.  That was right before he said that I was "sampling the wares".

You really can't make stuff like this up.  I didn't think that my thoughts on MMS were unclear, but in case anyone didn't get the point, here it is from the top of the other post -
Now, let me be perfectly clear here. I see absolutely no reason to think that using this stuff will do anything to help my children's autism and I see a lot of potential for harm.
I can see why there is all of the confusion, that statement (and others like it) were totally ambiguous.  Or maybe, if you believe the post and the people making comments, I am really secretly an MMS sympathizer and my entire post was just a ruse.  Drat, they figured me out.

Like I said, I was going to respond to Gorski's points but, after reading some of the comments, I realized that it is completely pointless.  There is absolutely no point in engaging with these people because many of them are just fanatics.  Internet blowhards like Gorski exist because they can collect followers who feed into their desire to be important and because people will actually engage them.  If you can't see the huge ego staring out from behind Gorski's writing then you aren't paying attention.

I don't have any need or desire to prove to the world that mine's bigger than everyone else's.  You can take what I say and agree with it, disagree with it, or tell me I am an idiot, it is entirely up to you.  Gorski apparently thinks I'm an idiot and I really couldn't care less.

So, yea, good job David, you really showed me. Although, just between you and me, you really sound like an idiot when you say stuff like paying attention to differences in chemical composition is pedantry and it is the class of chemical that is more important.  Because I can totally see how that option fits into science based medicine.   After all, acetaminophen and ibuprofen are both pain relievers so they are exactly the same thing too, right?

But since I do care about accuracy, I will correct one potential mistake that I made in the last post.  The dose of chlorine dioxide in a single, uhm, serving of MMS might be higher than I thought it was.  I said that I though it was around 1 ppm and I based that on comments that I read around the internet.  According to Gorki, that dose is like 80 ppm and while I think that figure is probably wrong (anyone with a good knowledge of chemistry want to chime in?), I also think my figure is an under estimation.

However, even if you remove that one point, the rest of the post still holds true.  The hyperbolic rhetoric employed by people like Gorski and his ilk might be good for firing up the minions but it does nothing productive for the larger autism community.

Tuesday, June 19, 2012

OMG, Its Bleach! (Updated)

There are some days that the autism community drives me crazy.  It seems like it is impossible for any of the various factions to put aside their ideology and, just for once, communicate clearly and accurately about important issues.

Take for example the latest craze gripping the blogosphere - an autism "treatment" that goes by the name of "Miracle Mineral Solution", or MMS, that has been around for years but recently had a presentation at Autism One.

There were many presentations at Autism One that covered a wide range of subjects.  But which presentation does the remnant of the old neurodiversity movement focus on and hold up as the poster child of the conference?  MMS, of course, and how it is so dreadful that immediate action is needed to stop the horror.

The current coverage of MMS sounds awfully like the rhetoric about HBOT that was being spread by almost the same group of people several years back, so I spent some time looking at all of the current claims about MMS.  If you want to spare yourself some time and effort reading what follows, the best word to summarize the current claims is overblown.  Using MMS is, more likely than not, a bad idea but listening to all of the nonsense being said about it is also a bad idea.

Still here?  Well, don't say I didn't warn you that this was going to be a bit long.

If you haven't heard of MMS until now you are not alone.  I didn't know what it was until the stories about it started popping up all over the place.  According to the little bit of research I did, MMS is supposed to do many wondrous things by killing everything that it comes into contact with, except the things that it shouldn't, by summoning the magical scrubbing bubbles of ClO2.

Ok, that wasn't very clear or accurate, but I got as far as the word "Miracle" in the name and was immediately skeptical.  Miracle cures don't work unless you are Miracle Max.  But, if you seriously want to know the details of what this stuff is supposed to do, I suggest looking at here or at the presentation given at Autism One.

Now, let me be perfectly clear here.  I see absolutely no reason to think that using this stuff will do anything to help my children's autism and I see a lot of potential for harm.

The FDA said as much when they put out a warning about using it.  But, then again the FDA takes a dim view of anything claiming to have medicinal properties that has not gone through its review process, so harsh words from the FDA is not an automatic sign that a product doesn't work.

But I don't want to talk about the fact that MMS likely doesn't do anything helpful, that topic has been covered ad nauseam by many others.  No, what I wanted to talk about are the misleading statements such as  MMS is bleach, MMS is "industrial bleach (which means it's stronger)", and that using it is, as the (cough, cough) Thinking Person's Guide To Autism so nicely put it, "child abuse and tantamount to torture of autistic children".

The core of these claims is that giving MMS to your children is the same as giving them bleach and we all know that giving your child bleach is morally wrong.  And that line is both right, wrong, and completely irrelevant at the same time.

Just to set the ground rules, the standard that ANY treatment should be measured against is how well it works and how much damage it causes while working.  In a perfect world, all treatments would be both perfectly effective as well as perfectly safe.

We do not live in a perfect world.

In our imperfect world world, there are no perfectly effective treatments that have no side effects.  Almost every treatment to have some level of undesirable side effects to go along with any possible benefits.  So the goal of any treatment is to make sure the good that comes from a treatment outweighs the bad.

So for MMS, lets cut to the chase and assume that the stuff doesn't do anything good for you and look at the bad side to see if the harm rises to the level of torture.

The first claim on the harm side is that MMS is bleach.  Now, I don't know about you, but when I think of bleach, this is the stuff that comes to mind -

(Picture of bleach bottle removed) 

MMS is not the same as this stuff.

This stuff is (typically) a mixture of (roughly) 5% sodium hypochlorite while MMS is 28% sodium chlorite.  While the names sound quite similar, they are not the same thing nor do they have the same properties.  The best thing you can say is that they are similar chemicals that do similar things.

But most people aren't going to care (or understand) about the chemical differences between the two.  Most people are going to hear "MMS is bleach", make the automatic association to the stuff in the picture above, and react emotionally based on that.   As Wikipedia puts it "the solution of sodium hypochlorite [...] is so ubiquitous that many people just call it 'bleach'".

That is the first problem with the claims, the choice and usage of the word "bleach" almost seems designed to create confusion.  The structure of many of the references I have seen makes it seem like it is a reference to the stuff in the bottle above because the reference reads like "bleach" is a proper noun.

The say "MMS is bleach" the same way that a person would say "this bottle is bleach".

A better and less confusing way to rewrite the sentence is that MMS is a bleach to indicate that it is a bleach in the technical and more generic sense of the word.  As in (again, Wikipedia), a bleach is "a number of chemicals that remove color, whiten, or disinfect, often via oxidation."

So no, MMS is not bleach in the common use of the word, but you might be able to say that MMS is a bleach.

But then again, if you wanted to get really technical, the claim that MMS is a bleach is still partially wrong.  My chemistry is a little weak but, from what I understand, the sodium chlorite in MMS isn't a bleach by itself but needs to be combined with something else to form the actual bleach.   The same holds true for the stuff in the bottle; it isn't much of a bleach until the chlorine is separated from the sodium by some chemical reaction.

In the case of MMS, the real bleach is chlorine dioxide.  And, as I have learned over the past year of balancing the level of chlorine in a swimming pool and hot tub, not all forms of even chlorine are the same let alone bleaches that are different types.  For example, lithium forms of chlorine are about half as effective as sodium forms, even at the same concentration.

That last bit is kinda important, so it bears repeating.  The strength of a bleaching chemical is determined by the amount and type of bleach that is present in the final mixture, not by the initial concentration.  You can't assume that one form of a bleach (chlorine) is going to be equivalent to another, chemically different form of bleach (chlorine dioxide).  If you do even a little bit of research into the differences between chlorine and chlorine dioxide you would know that they aren't the same thing.

If all of that gets too technical, just go with what the FDA had to say about the process -
The product, when used as directed, produces an industrial bleach that can cause serious harm to health. The product instructs consumers to mix the 28 percent sodium chlorite solution with an acid such as citrus juice. This mixture produces chlorine dioxide, a potent bleach used for stripping textiles and industrial water treatment
Or basically, when used as directed, the end result is that MMS forms a chemical that can remove color, whiten, or disinfect, i.e. a bleach.

The FDA adds in additional "industrial" phrase, and that is true, chlorine dioxide is used in the textile as well as other industries.  But that also ignores the fact that chlorine dioxide is also used in making processed foods, in sanitizing water for human consumption, and (as sodium chlorite) in some personal care products.

Certain people also seem to be misreading the "industrial" word as meaning extremely strong instead of meaning the more literal meaning of used in industry.  Another example of the "industrial" uses of this product is making white flour - in some cases, flour is literally sprayed into the air in a room full of chlorine dioxide to remove the color (and all of the nutrients) from the flour.  If you ever wondered how flour turns white or why it has to be enriched after the fact it is because it was bleached.  So, if you eat white flour, you are possibly eating a food that has been bleached by the same bleach in MMS.

But lets forget about the "industrial" scare and the different types of bleach for a minute and talk about some of the other common uses of bleach.  Have you ever gone in a swimming pool or hot tub?  Then, chances are, you have gone swimming in bleach.  There is no difference between the chlorine in a swimming pool an the chlorine generated by a standard household bottle of bleach.  If you children have ever swallowed any pool water (I know mine do all of the time), they you have basically given your children bleach.

Other common household uses include personal care products such as toothpaste or mouthwash, sanitizing reverse osmosis water filters, and your everyday cleaners.  Do you let you kids eat off of a table after you just used a cleanser on it?  Congratulations, you probably just gave them some bleach.

And then there is the fact that many municipal water supplies (in the US at least) are sanitized using some level type of bleach.  There are detectable levels of bleach or bleach by-products (yes, those sometimes count as bleaches) in normal everyday tap water.

The point is that expose to or ingestion of bleaching chemicals is not some rare or horrific event.  It literally happens every day.  And, if you are really worried about chemical exposures, then you really should be more concerned about antibacterial soap, Bisphenol A, household cleaners, VOCs, and a host of other chemicals that children are being exposure to everyday.

Of course the counter argument here is that MMS is a "purer" form of bleach, and that is partially true.  You may be will be exposed to more of a bleaching chemical when you drink an MMS cocktail than when you shallow some water from an average residential swimming pool.  How much more (or less) depends on exactly how much MMS is used, what exactly it is mixed with, and how fluid much it is diluted in afterwards.

The target number that you are supposed to get to with MMS is 1 ppm (part per million) of chlorine dioxide.  Although since there are so many variables that determine the final amount of the bleaching chemical in the final mixture it would be pretty easy to make a mistake and make it far stronger than it should be.

For reference, residential tap water can contain up to 0.8 ppm of chlorine dioxide and a residential swimming pool typically has about 5 ppm of chlorine.

However, the variable strength of the mixture is one of the two large drawbacks to using MMS.  You should not need a degree in chemistry to be able to safely use an over the counter supplement.  The other drawback is, of course, that it is likely that drinking even a properly mixed MMS cocktail doesn't do anything good for you.

Regardless, assuming that you use the product "correctly", you would be exposed to not much more chlorine dioxide than is allowed in tap water and, on a ppm basis, less than what is in a typical swimming pool.  Again, my chemistry is a little weak, but I don't think that 1 ppm of chlorine dioxide is going to do much harm when tap water contains almost that much and a typical swimming pool contains 5 times that amount of a different type.

So, the idea that giving this mixture to a child is some sort of child abuse or torture is just plain silly.  If that level of exposure is torture, I would hate to see what these people would say about me letting my children spend hours in the pool everyday.

EDITED TO ADD : Ignore the crossed out text above, it is wrong. The bottom line is that even using a single drop of MMS is a standard sized glass is a little over six times stronger than pool water - roughly 32ppm.  And it gets worse the more drops that you use at a time or if you take it multiple times per day.  See this discussion for more details.

But lets side aside the whole "bleach" idea and look at what harm this stuff can do if you take it.  Remember, any treatment should be judged on the benefits it gives and the harm that it does.  Even if we agree that MMS doesn't do anything at beneficial, we can still look at the harm side to see whether it is just another pointless treatment or whether it is truly harmful.

If this idea seems contrived then just think of all of the mainstream treatments that are used every day that can have harmful side effects and yet give no real benefit.

 If you read the lists of potential side effects that are being published everywhere, this stuff sounds almost like straight poison.  But there is a difference between all of the theoretically possible side effects that are included in these lists and the ones that will happen on a regular basis.

So lets put these side effects into perspective.  The following items are "common" side effects from MMS, two drugs, and a supplement.  All of these things are commonly used yet have times that they are used when they might have few, if any, benefits.

See if you can figure out which one is which without peeking at the answers below.

1. Headache, nervousness, drowsiness, dizziness, heartburn, constipation, diarrhea, stomach pain, increased salivation, pain, especially in the arms, legs, or joints.

2. Nausea, vomiting, diarrhea, symptoms of severe dehydration,

3. Fever, nausea, vomiting, diarrhea, metallic taste, kidney and stomach damage.

4. Upset stomach, vomiting, diarrhea.

Figure it out?

The item in question are

1. Aripiprazole - a drug to treat irritability in autism
2. MMS
3. Zinc supplements
4. Amoxicillin, a commonly used antibiotic.

So, the side effects of MMS are very similar to those that can happen when using other common treatments.  Does that mean giving Aripiprazole to your child when it isn't clear that there will be benefits "child abuse"?  Does the medical profession's constant overuse of antibiotics qualify as torture?

Of course you can say that MMS doesn't have any potential benefits to offset the negatives.  You can say that all it does do is rid you of those couple of extra dollars that were floating around in your wallet.  But, in reality, you can't even say that.

There is a tiny little distinction in evidence based medicine that is commonly forgotten but is really important to the whole thing.

There are treatments that have evidence that show that they are effective.  These are the treatments you should, more likely than not, be using.

There are treatments that have evidence that shows that the treatment are not effective.  These are the treatments that, more likely than not, you should not be using.

And then there are the treatments that have no real evidence one way or the other.  You can say that these treatments don't have evidence that they work but you can't say that they have evidence that they don't work.  A lack of data is a lack of data - not evidence against the treatment.

I think it goes without saying but if you want to attempt to use a treatment from that last category, you should  do your homework and exercise extreme caution in doing so.  But, having said that, if you shy away from a possible autism treatment just because it is not completely supported by the evidence, then you don't have many treatment options to work with.

MMS clearly falls into that last category - there is nothing that says it works but there is nothing that says that is doesn't either.  So, if you are going to be one of the, uhm, brave souls to try it, you had best be very careful and be sure you understand exactly what it might do and the harm it could cause before even thinking about it.  And if you can't do the calculations to figure out what amount of sodium chlorite is needed with what type of acid to produce the required ppm of chlorine dioxide in your head then you shouldn't be using it.

In all seriousness, it is pretty likely that MMS doesn't do anything beneficial but it still has some very real side effects.  But, it is not as bad as everybody is making it seem.  MMS may be a type of bleach but it is a far cry from pouring pure, concentrated laundry bleach down a kids throat - which is what everybody seems to be implying.  And using it is certainly not a form of torture or child abuse.

And that is really the point of all of this.

A calm, non-emotional, and objective look at MMS shows that it likely does nothing that we want to do and it has some potentially problematic side-effects.  And that is the standard that should be used to judge ANY treatment for a child with autism - evidence based or not.

The standard should not be who can make the most absurd claims or who can get a nonsensical claim repeated the most.  It is in everybody's best interest to go for clear, accurate information and to forgo the polarizing rhetoric that seems to be far to common in the autism world.  These sorts of claims might be good for getting the troops all lines up and ready to go, but it does very little to actually help anybody.

So, how about we all turn down the rhetoric a little?

EDITED TO ADD: And in case you didn't get the point about MMS from what I already said above, here it is very simply put - don't use it.

Sunday, June 17, 2012

Study : Oxidative Stress of Oxidative Shielding?

An interesting new paper is suggesting that the role of oxidative stress in chronic conditions such as autism might be misunderstood.  Instead of being a damaging process that needs to be controlled, the process might instead be a protective mechanism that is preventing more damage.

I don't know enough about this subject to have much of an opinion either way.  But the suggestion that we look beyond the oxidative stress to what is causing it certainly seems like a good idea.

The abstract is below.

Oxidative Shielding or Oxidative Stress?
Naviaux RK.

In this review I report evidence that the mainstream field of oxidative damage biology has been running fast in the wrong direction for over 50 years. Reactive oxygen species (ROS) and chronic oxidative changes in membrane lipids and proteins found in many chronic diseases are not the result of accidental damage. Instead, these changes are the result of a highly evolved, stereotyped, and protein-catalyzed "oxidative shielding" response that all eukaryotes adopt when placed in a chemically or microbially hostile environment. The machinery of oxidative shielding evolved from pathways of innate immunity designed to protect the cell from attack and to limit the spread of infection. Both oxidative and reductive stress trigger oxidative shielding. In the cases in which it has been studied explicitly, functional and metabolic defects occur in the cell before the increase in reactive oxygen species (ROS) and oxidative changes. ROS are the response to disease, not the cause. Therefore, it is not the oxidative changes that should be targeted for therapy, but rather the metabolic conditions that create them. This fresh perspective is relevant to diseases that range from autism, Type 1 diabetes, Type 2 diabetes, cancer, heart disease, schizophrenia, Parkinson's disease and Alzheimer disease. Research efforts need to be redirected. Oxidative shielding is protective and is a misguided target for therapy. Identification of the causal chemistry and environmental factors that trigger innate immunity and metabolic memory that initiate and sustain oxidative shielding is paramount for human health.

PMID: 22700427

Friday, June 15, 2012

Study : Not All Historically Missed Cases of Autism are High-Functioning

If you have been exposed to almost any discussion about why the number of children with a diagnosis of autism has risen sharply over the past several decades, I am sure you have run across the idea that a large part of the increase is in the high-functioning group.  And, to an extent, this idea is true - there are more children being diagnosed today than in the past that fit into the high-functioning bucket.

But what is often not mentioned is that there has been an equally large (if not larger) increase in the number of middle and lower functioning children as well.  This pattern is plainly visible in many of the recent estimates of autism prevalence (I hope to have a post up about that soon, time permitting).

Of course the reason or reasons for the sharp increase are still unknown; whether it be more awareness, better services, an expanding definition of autism, an actual increase in the number of cases, or some other reason entirely.

So, in light of all of this, I found this recent re-examination of a historical data set from 1980 to be of interest. I haven't had a chance to look at the full text of the paper yet, but it does raise some questions.  The immediate thing that jumps out at me is that the "missed" group is comprised of children who would likely be very low functioning, having an average IQ of 35 (!) .

The original group was solidly in the intellectually disabled range (i.e. low functioning) and yet the group identified in this re-examination had an even lower average IQ than that.  For reference, an "average" person's IQ is about 100 and intellectual disability starts at about 70.

The abstract is below.
Autism Spectrum Disorder Reclassified: A Second Look at the 1980s Utah/UCLA Autism Epidemiologic Study.
The purpose of the present study was to re-examine diagnostic data from a state-wide autism prevalence study (n = 489) conducted in the 1980s to investigate the impact of broader diagnostic criteria on autism spectrum disorder (ASD) case status. Sixty-four (59 %) of the 108 originally "Diagnosed Not Autistic" met the current ASD case definition. The average IQ estimate in the newly identified group (IQ = 35.58; SD = 23.01) was significantly lower than in the original group (IQ = 56.19 SD = 21.21; t = 5.75; p < .0001). Today's diagnostic criteria applied to participants ascertained in the 1980s identified more cases of autism with intellectual disability. The current analysis puts this historic work into context and highlights differences in ascertainment between epidemiological studies performed decades ago and those of today 
Of course, the real question about this result is what exactly is the "current ASD case definition" that was used and how it was determined whether an original participant met this definition.  As we saw with other recent studies, it is not always easy (or possible) to map the data collected years ago into what the criteria for autism look like today.


Miller JS, Bilder D, Farley M, Coon H, Pinborough-Zimmerman J, Jenson W, Rice  CE, Fombonne E, Pingree CB, Ritvo E, Ritvo RA, McMahon WM. Autism Spectrum Disorder Reclassified: A Second Look at the 1980s Utah/UCLA Autism Epidemiologic  Study. J Autism Dev Disord. 2012 Jun 13. [Epub ahead of print]
PubMed PMID: 22696195. DOI: 10.1007/s10803-012-1566-0