Trump Wants Answers About Autism. Here’s How His MAHA Can Succeed.

Simply follow the biological facts about autism like a detective on the case.

On February 13, President Trump issued an executive order establishing the Making America Healthy Again (MAHA) Commission to be chaired by the Department of Health and Human Services Director, a position filled by the confirmation of Robert F. Kennedy, Jr.

The EO made it clear that autism must be one of the MAHA commission’s priority targets, noting, fairly correctly, that rates have grown from about .04% of U.S. children to about 1 in 36 today. It also called out the rise in autism’s cousin disorder, ADHD, among other afflictions now prevalent among American youth. Trump again hammered on the need to find answers about autism in his March 4 speech to Congress.

The Commission’s initial mission includes investigating “any potential contributing causes, including the American diet, absorption of toxic material, medical treatments, lifestyle, environmental factors, Government policies, food production techniques, electromagnetic radiation, and corporate influence or cronyism.” The Commission is to “provide to the President Government-wide recommendations on policy and strategy related to addressing the identified contributing causes of and ending the childhood chronic disease crisis.”

In other words, let’s roll up our sleeves and finally figure out what is causing our obscenely huge epidemic of autism and other serious disorders (plus skyrocketing rates of pharmaceutical dependence), and here we toss out some spaghetti-on-the-wall ideas.

But what is the MAHA commission to do on this front? The National Institutes of Health, other government agencies, and private foundations have been searching for autism’s causes for more than two decades, with only small blips of success. Can MAHA succeed where conventional science has failed?

I say yes. A conditional yes. A kinda sorta yes, if. Trump’s MAHA has a good chance of making considerable progress if it does something super simple: act like a detective at a crime scene, holding tight to facts and logic. It has to think like Sherlock Holmes or Benson and Stabler on a case. It needs to assemble key pieces evidence, rigorously identify the questions raised, and take action on those, ideally with handcuffs in hand.

Goodbye to slow, plodding, incremental business-as-usual where progress is measured in millimeters, not miles. Hello to a scientific whodunnit where maybe we have a chance at solving this puzzle, or at least some chunks of the puzzle.

Thanks to two decades of research we’ve actually been pretty good at gathering basic facts. But we’ve been terrible, I mean an C minus grade, at analyzing them. We have put almost no effort into applying logic to determine the most pressing questions and most fruitful next steps to find what is causing such extraordinary rates of autism in our children.

So imagine the MAHA people with a big lay-out-the-evidence-find-the-perp wallboard. What evidentiary pictures should they pin to it? And what are the logical next steps? If I were in that room, here’s what I’d do. (Public service announcement: I’m not at all saying this is the only approach, this is just one stab, and I certainly would love to hear your own ideas.)

1. Autism rates have truly skyrocketed

Facts. I could write a book on the fraught topic of autism’s astronomical increase — and you can see one walk through the data here. Bottom line is this: despite much media dithering to the contrary, the evidence is beyond overwhelming that beginning with births in the late 1980s we’ve experienced a massive, exponential surge in autism rates. For example, California had about 3,000 autism in cases in its Developmental Services system in the 1980s. Now the number is 200,000. And this system is limited to substantially disabling forms of autism. By birth year, in the 1980s there were a couple hundred autism cases per birth year, but in 2014 about 14,000 cases. And the CDC data based on national sampling makes it clear that even limited to more severe cases we’ve seen a dramatic increase in prevalence over the past 20 years.

Logic. The logical conclusion based on this observation is that our priority should be seeking out exogenous factors that could precipitate the derailed brain development that is the hallmark of autism. Those factors must help explain the clear temporal trends. We must stop looking at genes in a vacuum, without an exposure context.

2. Autism’s roots (largely) lie in abnormal gene regulation in early development

Facts. When we say “autism” what we really mean, for the most part, is the behavioral manifestation of abnormal brain development, specifically the derailed process of gene transcription (usually a tightly regulated program) during early brain development. We mean an imbalance in the excitatory/inhibitory (E/I) processes of brain development and function. Autism brains are simply not wiring up correctly, beginning in the fetal period. The disruptions begin with neuron creation, and continue through cell proliferation, neural migration (e.g., to the cerebral cortex), cell connectivity, and synaptic function. A disruption to one of these processes can result in abnormal brain function and the phenotypes we see in autism.

Logic. We must seek biologically plausible mechanisms for these transcriptional defects. And it can’t be postnatal vaccines, or any postnatal exposure. The focus must be on factors that control gene expression, including epigenetic and other regulatory processes.

3. Autism is strongly heritable, but only weakly genetic

Facts. Autism is a strongly heritable condition, as demonstrated by high concordance among identical twins (70-90%), and high recurrence rates among siblings (16-20%). But genes do not explain this. In fact most genetic syndromes associated with autism are “de novo,” meaning they were not inherited from the parents. Further, studies have found only about 15% of autism cases can be explained by genes. This is called the “missing heritability” of autism.

Logic. We must focus on the missing heritability of autism, searching outside of standard gene-hunting approaches. This requires us to look at other molecular factors in the parents’ germ cells, not just their DNA sequence. Germ cells germ cells germ cells, I can’t repeat this enough.

4. Autism affects males at a higher rate than females, about 4:1. girls.

Facts. Probably the puzzling and repeated finding in autism research is the much higher rates in boys than girls, probably about a 4:1 ratio but maybe 3:1.

Logic. A worthy hypothesis must help explain this skewed sex ratio. Why are female brains more protected than male brains during development?

In summary, we must seek:

—Exogenous factors
—That dovetail with a mid-1980s manifestation, and increasing from there
—That perturb parents’ germ cells
—That derail the expression of brain-related genes, including the E/I balance
—That also manifest more strongly in male offspring

Over the years I’ve discussed many possible toxicants that could fit this puzzle but the one that I believe deserves the most scrutiny is modern agents of general anesthesia (GA). In other words, the parents’ histories of surgeries and other procedures under GA.

I detailed this somewhat complex hypothesis in this talk to Harvard’s TH Chan School of Public Health in December, as well as in other talks, scientific papers and publications. Do I think this is the only hypothesis worthy of attention? Of course not. Do I think it’s a good place to start? Absolutely. It fits like perfect jigsaw piece into the pattern.

So, MAHA Commission, please help identify the risk factors for autism. Don’t believe it when scientists tell you we’ve already covered the bases. They haven’t. There are many many stones left to be unturned. You can start here while also contemplating other ideas. I’m sorry this two-generation hypothesis of non-genetic inheritance is a bit complicated, but one must follow the realities of the biology and phenomenology of autism if we are to make any real progress.

Learn more: JillEscher.com