IACC: what caused this and can it be prevented

24 Sep

I bet you thought the nagging was over after this post. Nope, that was for the “services subcommittee”.

There is another deadline still out there–the end of September. That’s when comments are due for the big one–the Strategic Plan.

We’ve discussed two sections so far: “When should I be concerned” and “How can I understand what’s happening“. But, there are another four sections! Plus, there’s the question of vaccines.

The entire draft Strategic Plan is public.

The third section is “What causes this to happen”. This has the “aspirational goal” of:

ASPIRATIONAL GOAL: CAUSES OF ASD WILL BE DISCOVERED THAT INFORM PROGNOSIS AND TREATMENTS AND LEAD TO PREVENTION/PREEMPTION OF THE CHALLENGES AND DISABILITIES OF ASD

As before, instead of copying the entire section, I am taking just the “Research Opportunities” and the “goals” for discussion. First the research opportunities:

Research Opportunities
• Genetic sequence variations in ASD and the symptom profiles associated with these variations.
• Family studies of the broader autism phenotype that can inform and define the heritability of ASD.
• Standardized methods for collecting and storing biospecimen resources from well-characterized individuals with ASD as well as a comparison group for use in biologic, environmental and genetic studies of ASD.
• Case-control studies of unique subpopulations of people living with ASD that identify novel risk factors.
• Monitor the scientific literature regarding possible associations of vaccines and other environmental factors (e.g., ultrasound, pesticides, pollutants) with ASD to identify emerging opportunities for research and indicated studies.
• Environmental and biological risk factors during pre- and early post-natal development in “at risk” samples.
• Cross-disciplinary collaborative efforts to identify and analyze biological mechanisms that underlie the interplay of genetic and environmental factors relevant to the risk and development of ASD.
• Convene ASD researchers on a regular basis to develop strategies and approaches for understanding gene – environment interactions.
• Exposure assessment — efficient and accurate measures of key exposures for us in population and clinic based studies and standards for sample collection, storage, and analysis of biological materials.

OK, inside there is one of the land-mines of the Strategic Plan: vaccines. Let’s pull that out:

Monitor the scientific literature regarding possible associations of vaccines and other environmental factors (e.g., ultrasound, pesticides, pollutants) with ASD to identify emerging opportunities for research and indicated studies.

Some people would like to see even more discussion of vaccines. Frankly, I would like to see this section taken out. Of course they will monitor the literature for environmental factors–as well as monitor the literature for any big new discoveries in autism. The Strategic Plan doesn’t limit the NIH or any other governmental agency from exploring a subject that isn’t written in the Plan.

If you agree, send the IACC an email. Just click the link and send them a short note that vaccines don’t need to be mentioned explicitly in the Plan.

Short-Term Objectives
• Initiate studies on at least five environmental factors identified in the recommendations from the 2007 IOM report “Autism and the Environment: Challenges and Opportunities for Research” as potential causes of ASD by 2010.
• Coordinate and implement the inclusion of approximately 20,000 subjects for genome-wide association studies, as well as a sample of 1,200 for sequencing studies to examine more than 50 candidate genes by 2011.
• Within the highest priority categories of exposures for ASD, validate and standardize at least three measures for identifying markers of environmental exposure in biospecimens by 2011.

Long-Term Objectives
• Determine the effect of at least five environmental factors on the risk for subtypes of ASD in the pre- and early postnatal period of development by 2012.
• Conduct a multi-site study of the subsequent pregnancies of 1000 women with a child with ASD to assess the impact of environmental factors in a period most relevant to the progression of ASD by 2014.
• Identify genetic risk factors in at least 50% of children with ASD by 2014.
• Support ancillary studies within one or more large-scale, population-based epidemiological studies, to collect nested, case-control data on environmental factors during preconception, and during prenatal and early postnatal development, as well as genetic data, that could be pooled (as needed), to analyze targets for potential gene/environment interactions by 2015.

The first short term goal refers to the IOM report “Autism and the Environment: Challenges and Opportunities for Research”. This is a transcript of a meeting held to discuss environmental contributions to autism. This report is sometimes misrepresented. If you head the Omnibus proceedings, you know what I mean. The PSC lawyers acted as though this was on a par with the 2004 IOM report on vaccines and autism, discussing the conclusions of the report. (Hint–it is a transcript of personal opinions of the participants).

That aside, this is a big section of the Plan. There is a lot of work to be done in those goals. There aren’t even good “subtypes” identified (although some have been proposed). I don’t know how time consuming and expensive the genetic testing is, but anything involving 20,000 subjects is big. Pushing the genetic risk factors up to 50% is going to be challenging, considering that most genetic links found are under 2% of the total. The Plan states that about 10-20% of the genetic links are already known–that leaves 30-40% to be found. Likely that’s about 30-40 (or more) genetic risk factors.

I’d like to have more information on this statement:

Within the highest priority categories of exposures for ASD, validate and standardize at least three measures for identifying markers of environmental exposure in biospecimens by 2011

Does this mean that some method of testing in petri-dish type experiments will be validated? So, we don’t have any more thimerosal dumped on cancerous cells and a link claimed to autism declared? I’m all for that. I wonder if it’s possible, just like I wonder if an animal model is possible.

That said, take a look. Discuss below and please, email them.

One Response to “IACC: what caused this and can it be prevented”

  1. Ms. Clark September 25, 2008 at 08:25 #

    Determine the effect of at least five environmental factors

    Uhm, don’t they have those already? Like, prenatal rubella exposure, prenatal valproic acid exposure, prenatal alcohol exposure, prenatal misoprostol exposure, maternal age and paternal age? Are they saying they want to know exactly how 5 different environmental factors work to cause autism? I doubt they can find any post-natal “environmental factors” as in “toxins” that are associated with autism. I wonder how much of the budget would have to go into chasing something like that that might not exist?

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