Monday, January 30, 2012

Pseudoscience Alert: Lyme-Induced Autism

Emily Willingham

This post was originally written in September, however questions and assertions about "Lyme-Induced Autism" still occasionally percolate online. Please do feel free to counter such concerns with a link to this analysis by our TPGA Science Editor. -The Editors


In the "this isn't science or news" category, a local Fox station story out of Sacramento. Let's take this bit by bit, shall we?

Headline: "Doctors find link between Lyme disease, autism"

Problem 1: The story isn't about "doctors" finding "links." It's about one doctor claiming to have seen children in her practice (more on that later) who are "cured" of their autism after treatment for Lyme disease after testing positive for it. In reality, the story presents only one example to support the claim.

Problem 2: The story doesn't show any "link" in the scientific sense of the word, at all. In fact, it produces no science whatsoever. Yet, the headline sounds so very, very sciencey, does it not?

Although the mystery of autism continues to puzzle the medical community, some doctors are finding a link between autism and Lyme disease, which is called "Lyme-Induced Autism," FOX40 Sacramento reported.
See above. "Some doctors" appears to be "one doctor." And yet, they've named it "Lyme-induced autism." A search of PubMed for this new disease turned up exactly no hits.

Mary Hendricks, 19, was diagnosed with a severe case of autism at the age of 2, but also showed symptoms of digestive problems, skin infections and pain.

After 17 years of constant doctors' visits to diagnose the problem, a specialist told Mary's mother, Tina, that the key to diagnosing her daughter would be to diagnose her first.

In the past, Tina had suffered from colitis, fibromyalgia and flu-like symptoms.
The mother has a history of vague, non-specific symptoms. The child was diagnosed with autism at age 2.

Bring in the specialist:
Doctors ordered a Lyme disease test, which came back positive. Then, the same test showed that Mary also suffered from Lyme disease. After receiving the results, Tina recalled that before getting pregnant with Mary, she had two ticks removed from her skin and hadn't thought about it since.

If a child has autism from birth, many times it's because the child inherited an infection from the mother. I do think that Lyme disease, especially congenital Lyme is a cause of autism," autism specialist Dr. Lynn Mielke told FOX40.
What? Where are the data showing that "if a child has autism from birth, many times [italics mine] it's because the child inherited an infection from the mother"? This is an etiology that is absent from most scientific discussions of autism I've seen. It's not that people haven't looked into it. They have. And they found no link between maternal infections throughout pregnancy and autism diagnosis. "No association was found between any maternal infection and diagnosis of ASDs in the child when looking at the total period of pregnancy: adjusted hazard ratio = 1.14 (CI: 0.96-1.34)."

That study did find that hospital admissions specifically for viral infections in the first trimester or bacterial infection in the second trimester were associated with an increased risk for an autism diagnosis. But nothing that fits the alleged pattern of a pre-pregnancy Lyme infection and autism.

In fact, as noted, there are no hits combining Lyme infection and autism as an entity in the literature, and there are only four hits on the two terms combined at all. Only one of these directly addresses it. This paper is from the journal of questionable questionableness, Medical Hypotheses. I was curious about the authors on this paper in this questionable journal, so I looked them up. The first author, Robert Bransfield, is president of the International Lyme and Associated Diseases Society, which is weird, because he's a psychiatrist. This association aligns itself with the viewpoint that current diagnostic testing for Lyme disease is faulty and encouraging people not to rely on test results for Lyme's (see point 5). In some courts, this insistence that the microbial presence of the causative agent in Lyme's is elusive enough to evade all testing and that some people thus suffer chronic, undetected Lyme is considered woo. He's referred to as a "Lyme warrior" by some (warriors are big in the woo world). There is a bit of a cottage industry around this one.

I also looked into the other authors. What I found is something that I've seen again and again: the hypothesis echo chamber, in which the only people who continue to talk about the hypothesis are the ones who devised it in the first place. And offer "tea recipes" as a cure. Or are allied with non-standard practices and have also published in Medical Hypotheses. Alt-Med conferences on chronic Lyme and/or autism, papers in Medical Hypotheses, LLCs. Does not impart confidence.
Mielke said she thinks that Mary contracted Lyme disease from her mother during the pregnancy, which played a big role in Mary's development of autism. He started intense treatment on Mary's Lyme disease, and the outcome was successful beyond their expectations.

"As we treat Mary for her Lyme, some of her check list autism symptoms are disappearing," Tina said.
"For her to wake up, smile and giggle and laugh .. we haven't heard that for years," added her father, Danny.
Miekle told FOX40 the severity of Mary's autism may mean she'll only improve minimally, but for the Hendricks even small improvements translate to huge miracles.
"I have had patients in my practice with autism, who when we treated their Lyme disease, their autism improved so much that they were no longer autistic," Mielke said. 
Again, where are the data on these patients? Is it actually possible to become "no longer autistic" as a result of a treatment in the years beyond early childhood? A search of PubMed on various term combinations yields no such evidence, although some people do appear to develop out of the diagnosis.

And finally, the selected expert: The expert selected for this story is Dr. Lynne R. Mielke. This Dr. Lynne R. Mielke. This Dr. Lynne R. Mielke lists biomedical "treatments" for autism on her Website that include hyperbaric oxygen and detoxification, which includes intravenous infusions of chelators ("heavy metal detoxification agents"), and both treatments may actually do harm. Oh, and there's a page labeled "vaccine issues" which offers up equivocation about vaccines, against the evidence-based guidelines of the American Academy of Pediatrics. Based on what she writes on the site, she is a DAN! (Defeat Autism Now!) practitioner. In other words, this is wall-to-wall non-evidence-based therapies for autism. Is Lyme mentioned on the site? Why, yes, it is. From the page:
In general, at this time Dr. Mielke will not be the prescribing doctor for the complex antibiotic and herbal protocols that chronic and acute Lyme patients need. She will refer patients to the appropriate ILADS physician for that. However, she will work closely with those doctors, making sure that the Lyme patients have all of the additional therapies that they need for an optimal treatment outcome.
Echo chamber and logrolling in our time, anyone? The choice of this "expert" with a clear dog in the hunt for input about a putative Lyme-autism link was a massive fail.

The bottom line: This "news" story with its sciencey headline misses the science entirely because there is none. It uses an "expert" with a clear dog in the hunt -- her clinic offering non-evidence-based autism "treatments." It cites "doctors" when only one is quoted. It uses a single case to illustrate a broad, unsupported statement. It offers zero counterpoint or information from anyone about (a) whether chronic/undetected Lyme exists or (b) whether there is any science supporting the link asserted in the headline. It offers nothing in the way of a scientific study to support what it says.

In other words, "fair and balanced"? Um, no.


A version of this essay was previously published at