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

Re: Did retracting the paper matter?

Did retracting the paper matter?

4 March 2010

F. Edward 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 paper”. 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 ligands”. The authors proposed that it was plausible that exogenous, gut-derived neurotoxins entered the systemic circulation “during a critical window of vulnerability”, 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 “verdict”, 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 Annals 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.”

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.”

The Lancet paper didn’t matter after all!

Competing interests: Grandfather of a child with regressive autism