History of MedicineHistory of Medicine Body health dependent on the Body health dependent on the

balance of 4 humours:balance of 4 humours: Blood, phlegm, bile, and black bileBlood, phlegm, bile, and black bile

Sweating, vomiting, urinating, Sweating, vomiting, urinating, bleeding, oozing pus were ways to bleeding, oozing pus were ways to restore balancerestore balance

Treatment linked to this theoryTreatment linked to this theory Blood letting – cutting, cupping, leechesBlood letting – cutting, cupping, leeches Induce vomiting - Ipecac, calomelInduce vomiting - Ipecac, calomel Blistering – mustard pack to induce Blistering – mustard pack to induce

infection infection

History of MedicineHistory of Medicine

News Flash 1799! George News Flash 1799! George Washington has a sore throat!Washington has a sore throat! Blistered throatBlistered throat Leeches behind ears and on throatLeeches behind ears and on throat EnemaEnema EmeticEmetic More blood letting = 5 pints!More blood letting = 5 pints!

History of MedicineHistory of Medicine

News Flash 1881! President News Flash 1881! President Garfield Shot!Garfield Shot! Drs probed wound with fingersDrs probed wound with fingers ““Healthy pusHealthy pus”” discharged – Whew! discharged – Whew!

We thought he might die…We thought he might die… Died of infection – strep bacteria Died of infection – strep bacteria

were introduced by probing of were introduced by probing of doctorsdoctors

History of MedicineHistory of Medicine Rise of Thomsonians in early 1800sRise of Thomsonians in early 1800s

Less violent treatmentLess violent treatment Thought that disease was a result of coldThought that disease was a result of cold Herbs used to purge the bodyHerbs used to purge the body Warm bathsWarm baths Return medicine to laypeopleReturn medicine to laypeople

OthersOthers Homeopaths: Let nature do it…diet, Homeopaths: Let nature do it…diet,

exercise, hygieneexercise, hygiene Hydrotherapy: Diet, bathing Hydrotherapy: Diet, bathing

These beat throwing up and enemas!These beat throwing up and enemas!

History of MedicineHistory of Medicine Why were these therapies supported?Why were these therapies supported?

No cures!No cures! Some benefits – diet, exercise, Some benefits – diet, exercise,

cleanlinesscleanliness Accidental successes – Many diseases Accidental successes – Many diseases

are self limiting – are self limiting – ““post hoc ergo propter post hoc ergo propter hochoc””

Popular pressPopular press Placebo effect Placebo effect Reason was used instead of Reason was used instead of

experimentationexperimentation

History of MedicineHistory of Medicine

New Advances…Europe 1800sNew Advances…Europe 1800s Microscope, stethoscope, Microscope, stethoscope,

thermometersthermometers Study of BacteriologyStudy of Bacteriology Study of parasitesStudy of parasites Epidemiology: Correlation of disease Epidemiology: Correlation of disease

and treatments - found bleeding to and treatments - found bleeding to be ineffective – Whew!be ineffective – Whew!

History of MedicineHistory of Medicine

James Lind - 1747James Lind - 1747 In a controlled experiment, gave In a controlled experiment, gave

oranges/lemons to British sailors and oranges/lemons to British sailors and they didnthey didn’’t develop scurvyt develop scurvy

Joseph Lister – 1850s and 1860sJoseph Lister – 1850s and 1860s Aseptic surgery Aseptic surgery Antiseptic carbolic acidAntiseptic carbolic acid 4% mortality rate4% mortality rate

Paradigm shift:Paradigm shift: Development of microscopeDevelopment of microscope Humours to microorganismsHumours to microorganisms

Claude Bernard:Claude Bernard:

““Why think? Exhaustively Why think? Exhaustively experiment, then think.experiment, then think.””

History of MedicineHistory of Medicine

Advances in U.S.Advances in U.S. Johns Hopkins dies and leaves 3.5 Johns Hopkins dies and leaves 3.5

million to open a university/hospital million to open a university/hospital Quaker trustees of estate decided on Quaker trustees of estate decided on the German modelthe German model

Research and experimentation Research and experimentation began with much successbegan with much success

Immunizations – Typhoid, cholera, Immunizations – Typhoid, cholera, rabiesrabies

Research Culminated In…Research Culminated In…

First Cure 1891: DiphtheriaFirst Cure 1891: Diphtheria

““El garrotilloEl garrotillo””

Francisco de Goya1746 - 1828

History of MedicineHistory of Medicine

Sometime in the early 1900s…Sometime in the early 1900s…

““a random patient, with a random a random patient, with a random disease, consulting a doctor disease, consulting a doctor chosen at random had, for the first chosen at random had, for the first time in the history of mankind, a time in the history of mankind, a better than fifty-fifty chance of better than fifty-fifty chance of profiting from the encounterprofiting from the encounter””

- Lawence Henderson, Harvard, 1964- Lawence Henderson, Harvard, 1964

Science Makes a Difference!Science Makes a Difference!

01020304050607080

# Y

ears

Average Life Expectancy

Current Tx in Autism FieldCurrent Tx in Autism Field Rapid prompting Rapid prompting Sensory integrationSensory integration Facilitated communicationFacilitated communication EDTA ChelationEDTA Chelation Xango juiceXango juice Mega-VitaminsMega-Vitamins GFCF dietGFCF diet Auditory integrationAuditory integration Relationship development interventionRelationship development intervention Psychomotor patterningPsychomotor patterning SciopathySciopathy Behavior Analysis*Behavior Analysis*

Current Tx in Autism FieldCurrent Tx in Autism FieldWhy are there so many?Why are there so many?

No cure for autismNo cure for autism Accidental successesAccidental successes

Kids may improve for unknown reasonsKids may improve for unknown reasons Kids may improve due to concurrent TxKids may improve due to concurrent Tx

Press and internet blogsPress and internet blogs ““(Child(Child’’s name) reasoning and behavior have changed for the s name) reasoning and behavior have changed for the

better since drinking this juice. better since drinking this juice. ““

Placebo effect?Placebo effect? Lack of appropriate experimentation – Lack of appropriate experimentation –

sound familiar? Reason vs experimentssound familiar? Reason vs experiments

Current Tx in Autism FieldCurrent Tx in Autism FieldWhy are they used? (contWhy are they used? (cont’’d)d)

Proponents tell us that Tx is Proponents tell us that Tx is supported by supported by ““ResearchResearch”” But sometimes studies donBut sometimes studies don’’t have t have

objective measurementobjective measurement Some studies donSome studies don’’t establish t establish

causalitycausality

Current Tx in Autism FieldCurrent Tx in Autism FieldShould I Try This One?Should I Try This One?

Is there scientific support?Is there scientific support? Make Make evidence-basedevidence-based decisions decisions Are the studies that support it Are the studies that support it

correctly done?correctly done? Weigh risks/costs vs benefitsWeigh risks/costs vs benefits

Short term vs long termShort term vs long term What about cost of not trying What about cost of not trying

alternativesalternatives

Beware of Beware of ““Research ShowsResearch Shows”” HRT (Hormone replacement therapy during HRT (Hormone replacement therapy during

menopause)menopause) 1985: 122,000 nurses studied by Harvard 1985: 122,000 nurses studied by Harvard

Medical SchoolMedical School HRT is effective at managing menopausal HRT is effective at managing menopausal

symptomssymptoms Also, concluded that nurses taking HRT during Also, concluded that nurses taking HRT during

menopause had 1/3 as many heart attacksmenopause had 1/3 as many heart attacks This result formed the basis of therapeutic wisdom This result formed the basis of therapeutic wisdom

for the next 17 yearsfor the next 17 years

Beware of Beware of ““Research ShowsResearch Shows”” 1998: Heart-Estrogen Replacement (HERS) 1998: Heart-Estrogen Replacement (HERS)

Clinical Trial– post-menopausal womenClinical Trial– post-menopausal women Concluded that estrogen increased frequency of Concluded that estrogen increased frequency of

heart attacks in those women who had existing heart attacks in those women who had existing heart disease.heart disease.

2002: Women2002: Women’’s Health Initiative (WHI) s Health Initiative (WHI) Clinical Trial – post-menopausal womenClinical Trial – post-menopausal women Concluded that HRT was a potential health risk for Concluded that HRT was a potential health risk for

all post-menopausal women including heart all post-menopausal women including heart disease, stroke, breast cancer. But may offer disease, stroke, breast cancer. But may offer protection from osteoporosis and maybe colorectal protection from osteoporosis and maybe colorectal cancer.cancer.

2011 – Effects of HRT less clear – short term 2011 – Effects of HRT less clear – short term use maybe OKuse maybe OK

Observational Study - NursesObservational Study - Nurses

Drug No Drug

Collection of Subjects: Some take Drug and some do not

Assignment for Analysis

Healthy User Bias: Those who take the drug do many things right! (diet, exercise)

Compliance Effect: Those who follow Dr orders are generally healthier!

Prescriber Effect: Drug may be prescribed to healthier (or sicker) patients

BIAS!!

Observational StudiesObservational Studies

““They can distinguish associations They can distinguish associations between events…But they cannot between events…But they cannot inherently determine causation…inherently determine causation…””

-Gary Taubes, New York Times, Science Journalist-Gary Taubes, New York Times, Science Journalist

Controlled Experiment – HERS/WHIControlled Experiment – HERS/WHI

Subjects

Drug Placebo

Random Assignment

No Systematic Bias