One of my past teachers is to be awarded the Nobel Prize for Medicine today.
Professor Robert Edwards, who developed In-Vitro Fertilization, gave an annual series of seminars on embryology to about a dozen Cambridge students specialising in physiology. I was a member of the 1982-3 class, when Edwards was a prominent public figure; not only as a scientist, but also because of his decision to publicly discuss the ethical aspects of IVF in a very proactive way.
Unlike other aspects of the course, where we did experiments on rats, pigs, cats, and ourselves, there were no “practicals” in embryology. So the seminars were, to be honest, a bit dry and theoretical. The realities of fertility only became apparent when I was a clinical student in obstetrics and gynaecology, a couple of years later.
But on one occasion, Professor Edwards’ partner, the pioneering obstetrician Patrick Steptoe, came to tell us about the early days of IVF in Oldham, and we heard also about how they overcame opposition from the various establishment bodies of the day. The scientist and the clinician both loosened up and brought the subject, appropriately enough, to life.
“Autism is a serious, lifelong and disabling condition” (1) according to the chief executive of the National Autistic Society (NAS), which continues its excellent work in raising awareness about developmental disorders. But I wonder sometimes if this all-or-nothing headline message might discourage people from seeking treatment, when they see themselves as having milder problems.
The idea that autism is a spectrum not just of how it presents, but also of how severe it is, shading into normality in both respects, has been around for a while now. I have recommended Simon Baron-Cohen’s book The Essential Difference to several patients, because I thought it might be helpful to see how one leading researcher into autism views this issue.
It is likely that there are many people who are functioning, perhaps working, but not really doing very well, who probably have mild autistic spectrum disorders. Traditionally, psychiatry has assumed that “perfectionism” or “rigidity” are fixed and untreatable personality traits. This has been challenged by many studies now, and this week a report from researchers in Lyon, France (2) adds to the evidence that medications can improve the core features of autism.
Treatments (or “interventions”) in severe or moderate developmental disorders do not usually cure in the sense of moving the features of the condition into the spectrum of “normality”. A change from severe to moderate, or moderate to mild, would be considered a good response. But by starting off with a mild disorder, and moving towards normal functioning, whatever that is, you might have good reason to think that you had been cured of your disability.
(1) The Times, February 6th, page 29. Also at: http://www.timesonline.co.uk/tol/life_and_style/health/article7017168.ece
(2) Andaria et al (2010), early epublication of abstract at: http://www.pnas.org/content/early/2010/02/05/0910249107.abstract
I will talk about non-medication-based approaches for autistic spectrum disorders in a future posting(s).