In an article in the Times Online, the departure of Dr. Wakefield from Thoughtful House is confirmed, but also a statement is made:
It has also emerged that Arthur Krigsman, director of the gastroenterology clinic at Thoughtful House, has stepped down in recent weeks. The departure is not thought to be directly related to Dr Wakefield’s situation
Dr. Krigsman is still listed on the Thoughtful House website, where he is still listed as director of the gastroenterology clinic.
Dr. Krigsman is the director of the gastroenterology clinic at Thoughtful House Center for Children in Austin, Texas.
I am unclear on whether “stepping down” means he is still with Thoughtful House but not as director, or whether he has left Thoughtful House altogether.
Dr. Krigsman is the lead author on a paper which came out recently purporting to support Dr. Wakefield’s research.
Left Brain Right Brain 
This is only a guess, but I suspect it is due to health insurance companies not paying for experimental and non-indicated procedures at Thoughtful House.
I think this is from the main stream media attention out of Chicago and LA. The whole thing could implode very quickly.
“Rats off a sinking ship” doesn’t seem like quite the right aphorism… Maybe “sinking ship jettisons rats”?
Speaking before the verdict, Dr Wakefield said: “My work will continue at Thoughtful House until we get a definitive answer into whether vaccines can cause autism.”
Well, that explains it, then: Wakefield believes that his work is done.
I’m sure there’s a plan afoot. Like TH knows they have to try to look legit, so Wakefield steps aside for a while (I’m awaiting the “I was just too much of a distraction due to the media attention…” line from Wakefield) while they regroup. TH can make it appear that, rather than damage control, this is proof of how careful they are about what they do, etc., etc. Wakefield will be back at some point I bet. They just need the media stuff to blow over and then quietly reemerge with new resolve re: the same old nonsense.
I don’t understand Krigsman leaving Thoughtful House. He just published his scientific paper at Autism Insights on the 143 consecutive colonoscopies he did on ASD children in New York. You know, the one he didn’t get ethical committee (IRB)approval for, either for colonoscopies or for just writing up his results on children.
He and the hospital parted ways. Now, he’s published his paper in Wakefield’s own peer review journal. For IRB approval, he used a commercial company and severely limited what they were judging. The paper does not say anything about his rejection by the New York IRB.
I’ve sent an email to the commercial IRB and haven’t got a response
http://vaccineswork.blogspot.com/2010/01/letter-to-copernicus-group-re-ethics.html
““Rats off a sinking ship” doesn’t seem like quite the right aphorism… Maybe “sinking ship jettisons rats”?”
How about, “The fleas are deserting the sinking rats”?
I suspect this has something to do with medical regulators and/or the IRS.
David, I suspect same. As I posted over at Orac’s blog…I get visits from Thoughtful House, as identified by their domain. But their server/ISP is not the one it should be according to whosehostingthis.com (Hosting: We believe Rochen host the domain thoughtfulhouse.org: IP Address: 174.36.117.185: Name Servers: ns1.thoughtfulhouse.org, ns2.thoughtfulhouse.org).
Instead, the host for the Thoughtful House domain is state.tx.us. For email and for Web visits. Perhaps someone who is more network savvy could explain that. If you’re under search warrant-protected audit for your Web and email-related activity, can the gov’t run all your activity through its server as a sort of wiretap?
Also, I heard through some grapevine somewhere that medical regulators had indeed taken an interest in ThoHo.
The official Statement from Thoughtful House
Re: Dr. Krigsman
Dr. Krigsman’s decision to relocate his clinical practice to a facility outside
Thought House reflects his belief that the complexities inherent in a
referral-based practice can be best addressed by his working independently. We
will continue to refer patients for GI evaluations
when appropriate, and we look forward to continuing to work with Dr. Krigsman on
research projects. We are grateful to Dr. Krigsman for his dedication to
Thoughtful House and for the work he does on behalf of the children we serve.
Just to be clear, this is official.
Jane
Aww, c’mon. Thoughtful House is trying to reposition itself as thoughtful. As if! Where is Carol ‘Try me shithead’ Stott? This is sounding really pathetic.
The snarky collective tone of these posts is puzzling. My son’s health and well-being was restored by Dr. Krigsman, and I know of many others he has helped. I have no idea what is transpiring behind closed doors — nor, obviously, does anybody else here — but Krigsman and Wakefield are heroes who have sacrificed their own professional and personal lives to help our sick kids. Their intentions are pure, even if the conventional medical community (who never did jack s–t for my sick kid) continues to persecute and discredit them.
No one’s intentions are ever pure, and in this case, there is abundant evidence of a lack of purity of intention. The only reason Wakefield and Krigsman “sacrificed” their professional lives is because they didn’t seem to think that it was necessary to follow what the rest of the world of research and medicine have decided are appropriate ethical standards. That doesn’t make them heroes, it makes them–Wakefield demonstrably–unethical. There are doctors out there who save lives and advance medicine every day. They are not considered heroes. Often, they practice and do research in relatively quiet obscurity, and they do so while following rules that exist for very real reasons–to keep them from taking advantage of vulnerable populations. Real heroes don’t do what Wakefield has been guilty of doing. Real heroes don’t short circuit ethics and harm children and take advantage of people’s vulnerabilities. They just don’t. And whatever good they’ve done or seem to have done doesn’t excuse that behavior. I would never argue that because someone helped my son it’s OK for them to circumvent ethical practice.
@ Mary Brown – What treatments did Dr Krigsman use on your son? Roughly how much they cost? What improvements do you see? Just wondering.
Dr. Krigsman also has restored health to my child – who absolutely has clinical pathology. He performed endoscopies on my child and it’s the only reason his bowel disease has been treated. He also happens to be developmentally delayed and has an older brother with autism. These were not the reasons, though, that we did the procedures. It was the mounting laboratory evidence indicating bowel disease that made the decisions for us, for those of you who think any physician will just scope a child on a whim.
For Clay, the treatment for autoimmune bowel disease MAY INCLUDE steroids, non-steroidal anti-inflammatories, possibly antibiotics, and other conventional medicines. The cost would be, of course, determined by your insurance. We happen to have fantastic insurance and EVERYTHING we’ve done has been covered. AGAIN, because my child has biopsied clinical pathology. It kills me that people speculate that Dr. Krigsman has “scoped children unneccessarily.” Dr. Krigsman was the only person who took my child’s illness as seriously as we did. He is responsible for the second chance my son has now.
As respects improvements…after four months of treatment, my child’s stools are normalizing and he is not screaming and laying on the floor in pain all day. Also, he has begun to gain weight for the first time in over a year. Coincidentally or not, his language and socialization have also dramatically increased. We’re just one story, but I’ve met others in exactly the same boat as us. We are forever grateful to Dr. Krigsman and the team at Thoughtful House, no matter what happens.
For Emily, I disagree with you. If you saw your child in pain constantly and someone told you that they could change that course, you’d at least consider giving it a shot. No ethical rules were broken, and our child is healing. For us, that’s all that matters. That’s all any parent wants for their child.
Thanks to krigsman,
there is nothing unusual about a paediatric gastroenterologist helping children with bowel disease. After all it is their job.
As for Emily, I think you have misunderstood her when she wrote
Real heroes don’t short circuit ethics and harm children and take advantage of people’s vulnerabilities. They just don’t. And whatever good they’ve done or seem to have done doesn’t excuse that behavior. I would never argue that because someone helped my son it’s OK for them to circumvent ethical practice.
I took that to mean that just because a doctor has done good i individual cases, as seems to be the case for your child, that does not excuse unethical behaviour elsewhere.
Dr Krigsman left Lenox Hill Hospital under suspicion of performing colonoscopies for research purposes and without IRB approval. there was a strong suspicion by the authorities at LHH that some of these colonoscopies were not clinically indicated. Rather than release the medical charts from his private practise that could vindicate him, Krigsman first sued the hospital, then when he lost his case he quit. Thus ending the investigation without settling the question.
There is good reason to believe that he has continued in the same vein at Thoughtful House. The current FAQ offers this justification for endoscopies and colonoscopies.
What’s the point of diagnostic endoscopy/colonoscopy in a child with an autistic spectrum disorder?
It has been our clinical experience that many children with an autism spectrum disorder often have abnormal GI symptoms. Of the patients that have symptoms warranting a referral for GI services, approximately 85% have an identifiable and treatable digestive problem. These include autism-associated enterocolitis, reflux, food sensitivities, food allergies, acid-peptic disease, Barrett’s esophagus, Celiac disease, Crohn’s Disease, and infections. There are times when the only way to make a certain diagnosis is to perform an endoscopy or colonoscopy in order to inspect the tissue samples under a microscope.
An earlier version of the FAQ which I quoted on my blog in May 2006 reads
What is the purpose of doing a diagnostic endoscopy/colonoscopy in a child with an autistic spectrum disorder?
Children with ASDs and chronic gastrointestinal symptoms often have a disorder known as Autistic Enterocolitis. The only way to diagnose this with certainty is to perform a diagnostic endoscopy and biopsy and inspect the tissue under a microscope.
It is good that Dr Krigsman has dropped the reference to autistic enterocolitis as this disease does not exist. But it is equally clear that he continues to argue that you should not treat the symptoms of GI disease without first establishing the cause. And the diagnostic tool of choice remains endoscopic/colonoscopic investigation.
This seems contrary to normal clinical practise in which you treat the symptoms and only enquire further if those symptoms do not respond to treatment. But according to Dr Krigsman’s FAQ we should not treat symptoms which might include diarrhea, pain, constipation, abdominal distention, malabsorption, and growth retardationuntil after the condition is diagnosed.
In answer to the question
Why not simply treat all children with ASD who have GI symptoms the same and bypass the need for diagnostic testing?
the FAQ states
It’s poor medical practice to empirically treat conditions that have not been properly diagnosed. This is especially true for treatments involving medications with potentially unpleasant or dangerous side effects, and for conditions in which empiric treatment would obscure the validity of subsequent proper diagnostic tests.
So how many doctors reading this blog would regard it as poor medical practise to treat diarrhea, pain, constipation, abdominal distention, malabsorption, and growth retardation without a colonoscopy? I suspect that the key is in the last part of that answer. If you treat the symptoms you obscure the validity (remove the evidence for) subsequent diagnosis of autistic enterocolitis and thus undermine the whole Wakefield/Krigsman research project.
Mike Stanton,
Check it out.
http://www.mayoclinic.org/crohns/diagnosis.html
So, if the Mayo Clinic says it’s the appropriate diagnostic tool, is it ok for you?
In fact, Dr. Krigsman uses the same IBD serology laboratory tests that Mayo uses. I called and asked. The University of Michigan uses it too.
Also, regarding the following:
“Mayo Clinic has been instrumental in developing advanced imaging techniques that make it possible for doctors to thoroughly inspect the small bowel and was one of the first major medical institutions to use them.”
I’m fairly certain they are referring to use of the pillcam endoscopy, which is inserted in the throat during upper endoscopy. Several hours of photography are taken to view the stomach and small bowel. We had that done as well under Dr. Krigsman.
Again, our insurance covered all of these procedures. They, too, agreed these procedures were deemed necessary. Am I to believe it’s all just coincidence that Dr. Krigsman was “ethical” regarding my son’s care? Kind of like how my son’s developmental delays have been “coincidental,” and that his older brother’s autism (and recovery!) are also “coincidental…”
If you haven’t walked a day in my shoes and those of my children, I don’t quite understand how you can be so judgmental.
I don’t think anyone challenges the methods as appropriate–when clinically indicated.
If the Mayo Clinic reviewed Dr. Krigsman’s records from the children referred to the Lenox Hill Hospital and said they were all appropriately referred and the tests all clinically indicated, I certainly would have no problem agreeing with them.
We don’t have the Mayo Clinic, or anyone for that matter, who has reviewed those records.
I would ask the question back to you: if an independent body reviewed Dr. Krigsman’s records and found that children were tested without clinical indication, would you agree that this was inappropriate?
For example, people have reviewed the records of the subjects in Dr. Wakefield’s now retracted Lancet paper. Some were found to be not clinically indicated. Is that an ethical practice?
At the recent hearings at the GMC most of the parents whose children took part in the study supported Dr Wakefield even after the findings of fact that he had breached medical and research ethics. As parents we are too emotionally invested in the process when we take our children for medical treatment to be the final arbiters of right and wrong. An independent body that has not walked a mile in our shoes is much better suited to the task.
The problem with Dr Krigsman is that questions have been raised by parents and professionals concerning his clinical and research practice. Dr Krigsman successfully obstructed the enquiry into his activities at Lenox Hill. We still await independent arbitration of the charges he left behind him when he left Lenox Hill.
As I’m not a physician or the parent of the children in the Lancet paper, I cannot speak regarding what would be considered ethical or not regarding their procedures.
My point was that Dr. Krigsman’s treatment of my son has been nothing but respectful, thorough, and right on the mark. It seems that the majority of posters on this blog are quick to chastize him after hearing rumors about what may or may not have happened in the past with people none of us currently know!
As respects “clinical indication,” you do realize you could line up ten different doctors and each one might tell you something different, no? My son’s labs “indicated” inflammation and Crohn’s Disease (meaning he had two positive test results for autoimmune antibodies specifically indicative of Crohn’s in his blood), but the medical review panel for our insurance company told me those were not the reasons they approved his endoscopy procedures. Their “go ahead” was given because I showed them, at their request, labs from the prior 12 months that “indicated” his blood iron level was dropping. It was not “abnormal” even, just on its way down. Of course, I shared that exchange of information with not only Dr. Krigsman, but also our regular Pediatrician in our hometown. Both physicians scratched their heads regarding that response. In my experience, each medical personnel I’ve dealt with has his/her own protocol, not to mention set of ethical standards.
The most ironic part about my journey with autism and bowel disease has been that at no point has any physician told me what I “should do.” It’s always been my decision. Ironic, as I am the most unqualified person in the room, right? So really, isn’t the question what are the ethical standards of each parent?
After walking my son through the endoscopy procedures, I hardly find that experience to be considered invasive compared to the constant pain, screaming, year of no growth, and delayed language my son endured. My perspective is different because I’ve been through it. And, of course, there’s the recovery that we’ve seen – and documented. It would be interesting to hear the comments from any of the people on this blog if faced with some of the decisions we’ve had to make on behalf of our son.
I told a small portion of our story because he’s been nothing but absolutely wonderful to my family and my son in particular. Like I said, he’s given him another chance at a normal life.
And regarding your last comment I would say this…if your independent body reviewed my son’s records and determined his endoscopies were not clinically indicated, does that negate the independent pathologist’s report, clearly determining non-specific ileo-colitis?
I’ve met two sets of parents whose children’s labs did not indicate what my son’s labs did, however, both children has positive pathology reports. I’m just saying, sometimes there’s more than meets the blood, so to speak…
My apologies for the length of this. I am happy that my posts have been approved. Clearly our perspectives are different but maybe we might learn from one another. The bottom line for my family is that my kids were in a heap of trouble medically and Dr. Krigsman changed all that for us. No more, no less.
Can anyone give me info on how to contact Dr.Krigsman(hospital,clinic,private visite phone etc…).What I read in this blog gives me hope that he can do a lot for my daughter.Excuse my poor english.You can also contact through my personal email michelelimongi@hotmail.com
No. Do try to read the blog a bit closer. Dr. Krigsman is not thought of as a helpful doctor, actually we think he is a quack. You need to look elsewhere.
I guess I would ask why you think Dr. Krigsman could be of help to your child. If your child has gastro-intestinal issues (GI), find a pediatric GI doctor in your area.
If you child does not have GI issues, you don’t need Dr. Krigsman.