Saturday, December 20, 2008


I'm reading a book at the request of a parent: Healing the New Childhood Epidemics: Autism, ADHD, Asthma, and Allergies, The Groundbreaking Program for the 4-A Disorders, by Kenneth Bock MD.

OMG, it's FAIL!

Firstly, Dr. Bock asserts a number of controversial claims as established facts - e.g., that there's an autism epidemic and that thimerosal in vaccines correlates with this epidemic. Objectivity would dictate that one explain for the reader the evidence on both sides of the argument, non? Dr. Bock doesn't bother.

Throughout the book he says, "in my experience" and "I believe" and "I recommend" without explaining the basis for his personal confidence.

When Dr. Bock provides something that might pass for objective data, I'm actually embarrassed for him. If he were a student in my statistics class, he'd fail. Example:

Chelation therapy has been successfully applied to thousands of children on
the autism spectrum, under the supervision of DAN doctors and other integrative
physicians. The results have generally been gratifying and promising. The
positive response rate, as quantified in the ongoing series of Autism Research
Institute parent evaluations, is as follows:

Symptoms improved: 76 percent
No discernible effect: 22 percent
Symptoms worsened: 2 percent

These parent evaluations represent a 38-to-1 ratio of improvement of
symptoms compared to worsening symptoms... No other single element in the
biomedical treatment of autism has been rated this highly. (
pg. 305)
Okay class, what further information might you want before drawing any conclusions from the survey data above? Yes, the file drawer effect! Good job! It's likely that many chelation patients didn't fill out the ARI evaluation, human laziness being a Universal Law n'all. Before interpreting the stated percentages, we'd need to know the total number of patients treated with chelation and how many didn't do the form.

Any other problems with Dr. Bock's conclusion that chelation works? Right again! We don't know what might have happened without treatment. There's no comparison group. Imagine if we had a no-treatment group and it looked like this:

Symptoms improved: 96%
No change: 2%
Symptoms worsened: 2%

Compared to these numbers, chelation would seem harmful rather than helpful, eh?

Other obvious problems with Dr. Bock's data: We don't know what "improved" means. We don't know the degree of intra- and inter-rater reliability for "improved."

Now, anecdotal data has its place. There's nothing wrong with doctors sharing case reports with colleagues. By comparing notes, we figure out where to put new research efforts.

But Dr. Bock's been at this chelation stuff for many, many years. He's had plenty of time to put his ideas to the test in a real study with adequate controls. For him to pimp the "chelation works" notion without evidence at this late date is, frankly, shameful.

My conversation with the parent who urged me to read this book was awkward. "These are DAN (Defeat Autism Now!) doctors, the leading autism experts in the country! How can you say they haven't got evidence? Haven't you heard of the Autism Research Institute?"

Dr. Bock mentions setting up a credentialing program, something like an autism treatment sub-specialty. I'm imagining it will be like the ABA (Applied Behavioral Analysis) Board Certification. For anyone at a doctoral level, these certifications are a joke. Yet parents, teachers, and funders have bought the marketing hook, line, and sinker. "Doctor, are you ABA Certified?" If you don't buy the certificate *cough*, you're not an expert.

My fellow physicians, we are in deep shit. The rules of evidence have been broken and the thieves are minding the store.

I'm calling red alert. All hands on deck. Battle stations!

Get those Reiki wankers out of the feckin' hospital, to start.


  1. Have you seen the "American Medical Autism Board", the newly created "board" to justify the DAN! treatment of autistic children and an attempt at credentialing themselves? Their link is

    Oh, and did you know that the DAN! meetings now have actual CME that physicians can use? I am currently writing up a post on that one, and I will invite all physicians to write and stop this. It is amazing to me that they even have gotten this far in attempting to create credibility for their quackery.

    BTW, I saw your comments on Orac's board, right on!

  2. I forgot, I hope your neurons are intact for the most part after reading the book! Sometimes it is just too painful to read these books in one sitting.

  3. Hi storkdok,

    I fear BigPharma, BigMedicine, BigScience, BigUsual are no match for organized BigBullshit.

    If we're serious about evidence-based practice, we have to clean up the hospitals. No more woo in the hospitals.

    The mere juxtaposition of woo with medicine makes cargo cult credentialling possible.