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GAPS in a doctor’s reasoning about vaccines and autism

August 1, 2011

Category: Alternative medicineAntivaccination lunacyAutismMedicineQuackery
Posted on: August 1, 2011 3:00 AM, by Orac

As hard as it is to believe, I’ve been blogging about anti-vaccine nonsense and autism quackery since early 2005. Before that, I had been a regular on the newsgroup, where I had also encountered anti-vaccine pseudoscience, but the topic had not been a top priority for me. In fact, when I started this blog back in late 2004, I did not imagine at that time that I would somehow end up becoming one of the “go-to” bloggers for taking on anti-vaccine nonsense. Yet somehow I did, and dealing with the misinformation, lies, and pseudoscience of the anti-vaccine movement has remained a major topic of not only this blog, but the other not-so-super-secret blog of my alter ego, and I’ve even found myself giving talks on it. As a side effect, because one of the most pervasive anti-vaccine myths is that vaccines somehow cause autism, I’ve learned a lot about autism, autistic children, and the difficulties parents with autistic children have. Unfortunately, I’ve also learned of a whole lot of quackery to which parents subject autistic children to try to “recover” them from “vaccine injury” or “toxic injury.”

All of which is yet another example of my longwinded way of introducing a topic. In this case, my long background of having been blogging about vaccine issues and autism quackery serves as the backdrop for my surprise at recently having encountered an autism quack (in my opinion) of whom I had never heard before. I first encountered this practitioner at–surprise! surprise!–at a website that is one of the foremost sources of alternative medicine pseudoscience and quackery on the Internet, a hive of scum and quackery even more wretched than The Huffington Post and only rivaled by and I’m referring, of course, to, where Joe Mercola himself posted a video entitled How a physician cured her son’s autism, in which he interviewed a physician named Dr. Natasha Campbell-McBride, who claims, well, that she cured her son of autism:

The red flags are there from the very beginning when Campbell-McBride states quite confidently:

My first born son was diagnosed autistic at the age of three which threw me into a huge learning curve because I had to find a solution to his problem because my own profession had nothing to offer which was a bit of a shock for me.Having found all those solutions, I went back to the university. I completed a second postgraduate degree in human nutrition and learned many more other things. As a result, my son fully recovered. He is not autistic anymore. He is living a normal life.

Whenever I hear stories like this, I always refer back to Prometheus’ excellent post entitled Testimonials: Listening to people’s stories. This post is, in part, about how it is not nearly as uncommon as parents think for children with a diagnosis of autism to improve spontaneously. Indeed, most parents think this never happens spontaneously, and that’s one (among many) reasons why they assume that whatever quackery they treat their child with must be the cause of their child’s improvement. Yet, autism is a disorder of developmental delay, not developmental stasis; autistic children can and do develop. In fact, a significant minority can even lose the diagnosis of autism or AST by age seven as they develop. As Prometheus points out, promoters of the vaccine-autism myth don’t like to hear that, mainly because it casts doubt upon whether the quackery they choose to treat their children actually does anything. After all, if autism were truly a condition of developmental stasis, then you almost wouldn’t need a control group. If an autistic child improved on a treatment, it would not be unreasonable to conclude that the treatment was beneficial. However, autism is extremely variable. Autistic children can develop, often in spurts punctuated by longer periods of apparent developmental stasis. If one of those spurts happens to occur after a new round of quackery, it’s very easy to conclude that the quackery was responsible.

Dr. Campbell-McBride also falls for the myth of the “autism epidemic.” It always disappoints me to see a physician fall for this myth so hard, much as it disappoints me whenever our favorite anti-vaccine-sympathetic pediatrician to the stars, Dr. Jay Gordon, shows up to promote this myth, but fall for it Campbell-McBride does:

DM:So about the same time I did. Do you recall the incidence of autism around then? Was it about 1 in 100,000 or so? What is your current estimate as to the incidence today in the UK?DC: It was 1 in 10,000 when I graduated. It was a very rare disorder. Even I as a medical graduate have never seen an autistic patient. By the time I graduated from my medical school I have never an autistic individual. I have seen other psychiatric conditions through my course in psychiatry but have never seen an autistic child. To be honest, the first autistic child that I have encountered was my own.

As I said, 20 years ago in the Western world and certainly in the English-speaking world, we were diagnosing one child in 10,000. Fifteen years ago, we were diagnosing and five years ago we were diagnosing one child in 150 which is almost a 40-fold increase in incidence. Now in Britain and some countries, we are diagnosing one child in 66.

Apparently, the concept of diagnostic substitution is alien to Dr. Campbell-McBride. It turns out that most research supports the concept that broadening of the diagnostic criteria for autism in the 1990s led to a shift in diagnoses towards autism and ASDs and that the actual prevalence of the condition has remained relatively stable over the last few decades. True, the studies aren’t so bulletproof that they don’t completely rule out a small real increase in autism/ASD prevalence, but they do pretty authoritatively close the door on their being an autism “epidemic.”

In the next part of the interview, Dr. Campbell-McBride gets to the heart of her “treatment” for autism by describing what she thinks is the cause of autism. Basically, she does not believe there is a genetic component to autism, at least not in the way that real scientists do. Instead, she expresses an absolute certainty that autistic children are born with “perfectly normal brain and perfectly normal sensory organs and they are supposed to function normally.” So what disrupts this normal functioning?

This, apparently:

What happens in these children, they do not develop normal gut flora from birth, from the beginning of their life. Gut flora is a hugely important part of our human physiology. Recently research in Scandinavia has demonstrated that 90% of all cells and all genetic material in a human body is our own gut flora. We are just a shell. We are only 10%. We are a habitat for this mass of microbes inside us. We ignore them at our peril.What happens in these children they develop very abnormal gut flora from the beginning of their lives. So as a result their digestive system instead of being a source of nourishment for these children becomes a major source of toxicity. These pathogenic microbes inside their digestive tract damage the integrity of the gut wall.

So all sort of toxins and microbes flood into the bloodstream of the child and get into the brain of the child. That usually happens in the second year of life in children who were breast fed because breastfeeding provides a protection against this abnormal gut flora.

Recognize this? It wasn’t so long ago that I wrote about detoxification quackery. What Dr. Campbell-McBride is talking about here is nothing more than a variant of the ancient concept of autointoxication, whereby our own human waste products “poison” us. The difference is that she’s attributing it to bacteria living in our gut. But where do many of the bacteria living in your gut end up? In your poop, of course! In any case, Campbell-McBride even has a name for her invented autism syndrome: Gut and Psychology Syndrome (GAPS). She’s even developed a whole cottage industry of dietary woo to treat it, which can be found on various websites, including Gut and Psychology Syndrome, The GAPS Diet, and in her book Gut and Psychology Syndrome Book: Natural Treatment For: Autism, ADD, ADHD Depression, Dyslexia, Dyspraxia, Schizophrenia. And, of course, she has her own website, and if you check it out you’ll see that she claims to be able to treat anything from acne to depression to diabetes to autism to ADHD to schizophrenia to tummy pain. Yes, tummy pain. (I always thought that a good shot of Pepto-Bismol would take care of your basic tummy pain much of the time.) Here is her pseudoscience explained:

Basically, when it comes to autism (due to GAPS, natch!) Dr. Campbell-McBride blames abnormalities in the gut flora (due to GAPS again, natch!) as the cause. The information and claims on her websites can be boiled down into two or three things:

  • If you don’t breastfeed, your child’s gut flora will be abnormal, and he will likely develop GAPS, which can lead to autism, ADHD, and a variety of other conditions.
  • Females who aren’t breastfed will grow up to be women who have children whose gut flora will be abnormal too, because infants acquire their gut flora mainly from their mother. (How’s that for blaming the mother for autism?)

Of course, listening to Dr. Campbell-McBride’s claims, I had to ask one thing: Where’s the evidence? Surely, such a hypothesis should be easy to test. For instance, if it were true, wouldn’t bottle fed babies be far more likely to develop autism than breastfed babies? The problem is, this doesn’t appear to be so. Yes, there is evidence that breastfed babies have a lower incidence of autism, but the effect, if real, is nowhere near as strong as Dr. Campbell-McBride claims, certainly not strong enough to be a cause of the “autism epidemic.” In fact, the correlation argues otherwise. Indeed, as the authors of one study pointed out, the prevalence of breastfeeding increased during the 1970s, decreased during the 1980s, and then increased again during the 1990s. By 2002, breastfeeding prevalence had reached an all-time high. Using typical anti-vaccine logic, that correlation should imply that breastfeeding causes autism, not that it protects against it. The bottom line is that the evidence is at best inconclusive that breastfeeding might be somewhat protective against the development of autism, and that’s not good enough to sustain a hypothesis like Dr. Campbell-McBride’s. On the other hand, perhaps that’s why she believes it so strongly.

Not surprisingly, though, like all good autism pseudoscientists, Dr. Campbell-McBride has a fallback hypothesis. Even less surprisingly, it’s those evil vaccines, and she claims to be able to identify children who are susceptible to “vaccine injury” based changes in their gut flora identified by various woo-tastic urine and stool tests:

In my book Gut and Psychology Syndrome, I wrote a whole chapter what I described a proposal to the authorities of what they should do with our vaccination strategy because the standard vaccination protocol is damaging these babies. They’re not fit to be vaccinated this way.Seeing that the proportion of GAPS children in the population is growing, nobody has calculated how many children today are born GAPS. I would love for somebody to do that study to actually ascertain how many children and what proportion of the population are GAPS children. But this proportion is going to grow and grow and grow. These children are not fit to be vaccinated with the standard vaccination protocol.

Another problem is that vaccinations are commercial products and the number of them is growing and growing because they are highly profitable for the pharmaceutical industry, for the governments in the West and for those who administer vaccines, for the medical industry as well. It’s become a profit making industry (vaccination).

Yep, the tropes are all there: That the medical industry is out only for profits, that there is a predisposition to “vaccine injury” causing autism and various other health issues. And, of course, Dr. Campbell-McBride has the cure, a special diet. How do we know it works? Why, because of the testimonials, of course! Certainly, properly conducted scientific research culminating in randomized, double-blind clinical trials has nothing to do with it.

I suppose, in a way, that I should thank Dr. Campbell-McBride. After over six years of blogging about vaccine- and autism-related topics, I had begun to become a bit complacent, thinking that there was no quackery that I haven’t seen or examined. Dr. Campbell-McBride’s concept of GAPS as a cause of autism has taught me otherwise.

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