One in every 100 children Autistic?

AT: Why are we seeing such a rise in autism? Is this real or simply
an artifact due to broader defi nitions and better reporting?
Dr Herbert: Certainly, there’s more awareness and more reporting.
The more affected people you have, the more you’re going to
see it and the more you’ll report it. And it’s on the news all the
time. There were children I saw during my residency whom we
would now call autistic, but we didn’t then. In these cases, the
problem back then was awareness. Regarding broader defi nitions,
I don’t think the diagnostic criteria have changed a lot in the past
15 years—certainly not enough to explain the 10-fold increase in
the numbers. Some people say, “Oh, they haven’t changed lately,
but it takes people time to learn what the new ones are.” Then
other people say, “Well, people get called autistic because that’s
how they get services, even if they aren’t really autistic.”
I think all of this is true, to one degree or another, but it begs
the question, do all of those lines of arguments exhaustively
explain how the numbers shot up from 3 to 4 in 10 thousand in the
mid 1980s to current fi gures of 1 in 150 or even more? A recent UKreport said 1 in 86 children are on the autism spectrum. You’d have
to be pretty confi dent that all those inferences explaining these
numbers away, such as “It’s just better diagnosis” and so forth,
were absolutely, solidly, the only possible explanation for such
striking increases. And if you are not absolutely clear about the
reasons why, then you had better treat this as a public health emergency
until proven otherwise.
I think there’s an emotional issue going on here, too, that people
are conservative, and they don’t want to say something alarmist
if it’s wrong. There is also cognitive dissonance—how could a
genetic disease truly increase? People don’t realize how tenuous
the evidence is for this truly being “genetic” so they treat the genetic
model of this condition as fact. Many of my colleagues who will
not consider the possibility of an epidemic have no vested interest
in anything that would bias their judgments except that this is
what they believe and it’s very hard for them to entertain anything
else. To consider that we may have an epidemic of autism and
childhood neurodevelopmental disorders is emotionally painful
because it raises profound questions about our environment, our
progress, our way of life, and what we deeply trust. To avoid asking
those painful questions, people try to maintain the assumption
that nothing signifi cant is changing.
But if you look at graphs of the number of new-to-nature molecules
that the chemical industry has produced, you get an astonishing,
exponential increase in substances on the planet that we’ve
never seen before. That’s just the physical substances, the chemicals.
The next thing that happens, when you start thinking about
this, is that it becomes so overwhelming that you go back to genetics
because it feels like at least we can study that in an organized
fashion, whereas looking at environmental factors would be total
chaos. This argument is one of the standard talking points of some
of my genetics researcher colleagues.
Advanced scientists should start to realize that the only way
they can maintain this point of view is to advocate advanced techniques
to study genetics and old-fashioned insensitive techniques
to study environment. They need to partition their intellects to do
this. As I’ve already said, we’re learning so many more sensitive
ways of measuring things, including the impacts of these new environmental
inputs, and this is so new that we have hardly had time
to think of how to apply these things. One of the expressions
around this that I like is, “Absence of evidence is not the same as
evidence of absence.” The intellectually honest thing to say is not
that there is no evidence, but that we have hardly started to look.
Then, when you get interested in looking, you see that there isn’t a
lot of support for such investigations, and there is a fair amount of
resistance. This becomes a political and economic question as well
as a scientifi c question. Who’s going to fund it, and who’s going to
get paid by which vested interest to shoot down whatever you say,
who’s going to sue you if you uncover anything that sheds a bad
light or creates potential liability, and all the other related considerations?
Given all these potential challenges, it’s ever so important
to think carefully and strategically about how to proceed.