Post 1303140 - (Article advocating dangerous treatment on autistic child)

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[quote="Sophist"][quote="zendell"]Randomized, double-blind, controlled study finds chelation with oral DMSA is safe and effective for treating autism:
http://www.autism.com/danwebcast/presentations/anaheim/adams.pdf [/quote]

I have an interest in immunology and oxidation/methylation in the autism spectrum. However, upon reading through that article (which seems like an abbreviated report of the original article), I'd have to say that there is a potential extreme bias of the experimenters in that study.

[b]My Critique, Point by Point:[/b]

1) This is supposed to be a double-blind study, implying that there is a control group. Yet in this article, they report no results on the controls. Therefore, the reader is unable to contrast and compare results between the two groups.

2) It gives no indication as per the ages of the participating children nor a listing of other medicinal and nonmedicinal treatments these children may or may not be receiving. Various medications do have effects on the body's oxidation. I would assume the control group was required to be medication-free. Also, if any were receiving behavioral treatments, this went unanswered. Any of these factors could be playing a part: natural development with age, medication, or other treatment plans which are taking place concurrently or prior to the study.

3) It also says this study is supposed to be a double-blind, but they don't mention how this takes place. It's probably not all that hard to tell the autistic kids from the nonautistic; were the experimenters aware of this so that it affected their judgment? Or was it truly a double-blind, where the lab technicians did the analysis separately from the researchers who were collecting and then analyzing the larger data sets? It doesn't say. So this does a poor job of outlining the methodology so that this study could be replicated in future.

No single study does a theory make: sets of studies are needed because, even if a study's design is sound, every once in awhile you're still going to receive a false positive result just by the laws of probability.

4) There is no mention as to how the participants were recruited and how they were chosen to take part. Medical establishments? Autism Speaks? CAN? Local churches? Where they all given the ADOS and any child who tested in the autism range was included? This is important because, without knowing WHERE the participants came from, there's no way to accurately judge that this was an unbiased sample.

5) 80 began the study, only 40 finished. Even though this is enough to resemble some sort of statistical normal distribution, 40 is still a very small number for these researchers to recommend glutathione as a treatment for autism.

6) It treats the fact that glutathione is designed as a heavy metal eliminator as a surprise ("What??? It actually [i]chelates[/i]? Well shut my mouth..."). And without reporting the levels seen in the controls as far as elimination levels, it makes it seem as though only autism has such levels and, low and behold, glutathione is a chelator. It's a bit of tricky writing, implying that these levels are seen in autism alone.

7) The results of the study were compared to both parent impressions (general interview as well as ATEC) as well as the ADOS. I have two issues with this: a) yes, parents should be asked of their opinions; however, in such a study, more objective measures should be used and biased opinions avoided. The ADOS, I have personally learned, is an adequate tool for diagnosis of Autistic Disorder and PDD-NOS in young children. However, it is a poor tool for differentiating WITHIN the spectrum. Therefore, it should not have been used to detect a change in severity, especially when the shifts in severity were so subtle.

8[i][/i]) And with the ADOS, I would've liked to know who performed the first and the second ADOS. Were they the same people, potentially introducing bias? Or different people who might score the same child slightly differently?

9) Correlation between excretion levels and ADOS: This to me spoke MOUNTAINS. The most significant correlation between excretion levels and ADOS scores following the first dose was 0.36. For a little background on correlations, here are the ratings of correlations:

0.0-0.2 = no correlation
0.2-0.4 = low correlation (unlikely)
0.5-0.7 = moderate correlation
0.8-1.0 = high correlation

These occur in both positive and negative ranges, with negative numbers indicating a negative (or inverse) correlation. Most researchers ignore any correlations that aren't moderate or higher and view low correlations with suspicion.

Following the 9th dose, the highest correlation is 0.35 (another low correlation). Yet these results are espoused as being significant.

10) I have a big issue that the ADOS was not given BEFORE starting the study, so as to gather a baseline score before applying the treatment. Without a baseline, it is very difficult to compare the other two ADOS scores to each other.

11) I take issue with a study that uses a quote to make its conclusions-- a quote nonetheless originated by the leading researcher in this study: "Finding lead or mercury in an autism victim is like finding a bullet in a homicide victim-- further investigation needed for 100% certainty, but in both cases it is highly likely that one caused the other" (Adams, 2007).

Why is this a problem? Well, first off, it's clear that Adams has already made up his mind before even performing this study, which makes him a prime candidate for accidental or intentional experimenter bias. He also proposes that finding lead or mercury in autism is the guilty bullet having caused the conditions; and if that is his logic, then every child in their study should've been a "homicide victim" since every person, autistic or not, has mercury and lead in his/her body. On the same note of logic, that would also imply every person is autistic. :roll:

12) Before performing further replication studies, the researchers of this study are already recommending longer treatments for those whose lead levels were still "high". I.e., they're recommending a treatment before having tested whether it's sound and relatively risk-free but AT THE SAME TIME they continue to state that more research is needed before the treatment should be recommended. Double-talk.

13) From a single study, they have concluded there are no adverse side effects on general health.

14) Despite the low correlations, they even [b]bolded[/b] their conclusions that higher excretion decreased severity as measured by the ADOS, using techniques like bolding or highlighting to make their point stick despite that it's a weak one.

15) Their final conclusions stated, "Glutathione, lead, and mercury are linked to severity in autism, and to improvement due to DMSA." This statement is false. There was no evidence in this study proffered that linked higher mercury and lead levels to their autism participants. And even if there were, the authors have automatically jumped that extra step and assumed correlation is equivalent to causation. (Who knows, if there are higher levels, it could be very well that autism is the CAUSE of higher levels of mercury and lead, rather than the reverse.)

16) The article gives no indication as to having been published in a peer-reviewed journal. I assume this means it hasn't been published except online by websites who support the research.

I don't mean to say that the only place for publication is in respected journals, no. What is important is the peer-reviewed process. So there is no such indication.

In essence, this was a poor study, with researchers who seem to have made up their minds before performing the research and whose bias, either accidentally or intentionally, affected the design of the study. Which is unfortunate. These are important questions that should have more definitive answers. Poor research only holds back the study of the autism spectrum. :?[/quote]

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