Dr. Yazbak/BMJ - Did retracting the paper matter? 4 March 2010

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http://www.bmj.com/cgi/eletters/340/feb02_4/c644

Did retracting the paper matter?

4 March 2010

F. Yazbak,

Pediatrician

Falmouth, Massacusetts 02540

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Re: Did retracting the paper matter?

It is clear that many

were pleased when the Lancet retracted “the paperâ€. The question is:

Did that accomplish much? Did it change the fact that

" Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and

pervasive developmental disorder in children " are related? Did it

wipe out the brilliant observation by the GI team at the Royal Free that

a gut- brain connection existed? The answer is obviously NO.

Dr. Wakefield, Professor Simon Murch and others elaborated further on the

autism-related gastro-intestinal findings when they published a review

article in 2002, titled “The concept of entero-colonic encephalopathy,

autism and opioid receptor ligandsâ€. The authors proposed that it was

plausible that exogenous, gut-derived neurotoxins entered the systemic

circulation “during a critical window of vulnerabilityâ€, damaged the

central nervous system and caused autism.

They also mentioned that the gut-brain axis is central to certain

encephalopathies and that opioid peptides may mediate some aspects of

autism. Most importantly, they gave hope to the rapidly increasing

population of parents with affected children by pointing out that

modification of the diet was likely to reduce the toxicity of certain

opioids and improve symptoms.

Obviously Wakefield’s opponents were not too happy. They went on

discrediting his theory that the brain injury and deficits in regressive

autism were related to very specific GI findings and they claimed that

his findings had not been reproduced by others, when indeed they were in

multiple centers in the U.S. They also never mentioned how effective the

gluten-free and casein-free diets were in improving symptoms in many

affected children.

In late 2009, just when the GMC was getting ready to reveal its

“verdictâ€, a team from Norway published an important and very

carefully conducted study. At any other time, the reported findings would

have and should have caused world-wide interest. They did not, probably

because they would have vindicated Wakefield and shown that the GMC was

“on a collision course with reality†as a good friend put it.

In a review article titled " The possibility and probability of a

gut- to-brain connection in autism " and published in the ls of

Clinical Psychiatry, Reichelt and Knivsberg reported that “In autistic

syndromes, we can show marked increases in UV 215-absorbing material

eluting after hippuric acid that are mostly peptides. We also show highly

significant decreases after introducing a gluten- and casein-free diet

with a duration of more than 1 year. We refer to previously published

studies showing improvement in children on this diet who were followed

for 4 years and a pairwise matched, randomly assigned study with highly

significant changes.â€

The authors added that the literature now showed abundant data pointing

to the importance of a gut-to-brain connection in autism and concluded:

“An effect of diet on excreted compounds and behavior has been found. A

gut-to-brain axis is both possible and probable.â€

The Lancet paper didn’t matter after all!

Competing interests: Grandfather of a child with regressive autism

Sheri Nakken, R.N., MA, Hahnemannian

Homeopath

Vaccination Information & Choice Network, Washington State, USA

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