Nearly everything that we've been told about genes and autism is wrongThe best geneticists know this but there is a fortune to be made pretending otherwise(Editor’s note: This article is too long for many email systems so please click on the headline to read the whole thing on the Substack site.) The University of Sydney caps doctoral theses at 80,000 words (excluding references). The theory is that external reviewers don’t want to read more than that (true!). One can apply to the Dean to increase the word limit to 100,000 which is what I did. But my doctoral thesis as initially written was closer to 140,000 words. So I had to cut three chapters that I really liked — the political economy of theories of genetic causation, how evidence-based medicine was captured by Big Pharma, and the history of the regulation of mercury. I believe that some of the information in those excised chapters would be useful to policy makers in Washington D.C. trying to figure out how to deal with the epidemics of chronic disease in children. So today I am sharing my original (slightly updated), never before seen, chapter 6 which challenges the entire paradigm of genetic determinism in disease causation. I. IntroductionIn the first chapter I showed that the rise in autism prevalence is primarily a story of environmental triggers (with some smaller percentage due to diagnostic expansion and genetics). The story of how genetic theories became the dominant narrative in the autism debate thus needs to be explained. The hegemony of genetic theories of disease causation comes at a tremendous cost to society because they crowd out more promising alternatives. This problem is particularly acute in connection with autism where genetic research swallows up the vast majority of research funding — and has for more than twenty years. So one of the keys to effectively addressing the autism epidemic will be to demonstrate the flaws in the genetic approach to disease causation and replacing it with a more comprehensive ontology that has better explanatory power. To put this debate in context I want to recap the genetic argument in connection with autism as I have presented it thus far. In the 1990s it was routine for scientists, doctors, and policymakers to assure worried parents that autism was genetic. To the extent that anyone ventured a guess, the explanation was autism was 90% genetic 10% environmental. Then the state of California commissioned sixteen of the top geneticists in the country (Hallmayer et al. 2011) to study birth records of all twins born in the state between 1987 and 2004. Hallmayer et al. (2011) concluded that at most, genetics explains 38% of the autism epidemic and they pointed out twice that this was likely an overestimate. Blaxill (2011) argues that the eventual consensus will be 90% environmental, 10% genetic. And in chapter 5, I showed a model from Ioannidis, (2005b, p. 700) that suggests that only 1/10th of 1% of “discovery oriented exploratory research studies” (which include nutrition and genetic studies with massive numbers of competing variables) are replicable. And yet, a disproportionate share of federal research money in connection with autism is going to study genetic theories of disease causation. In 2013 the Interagency Autism Coordinating Committee spent $308 million on autism research across all federal agencies and private funders participating in research (IACC, 2013a). This is a shockingly low amount to spend on research given estimates that autism is currently costing the U.S. $268 billion a year (Leigh and Du, 2015). When one drills down into how the IACC spent the $308 million, it is largely focused on genetic research (especially if one examines the funding in the funding category “What Caused This To Happen And Can This Be Prevented?”) (IACC, 2013b). This is in spite of the fact that several groups of leading doctors and scientists including Gilbert and Miller (2009), Landrigan, Lambertini, and Birnbaum (2012), the American College of Obstetricians and Gynecologists (2013), and Bennett et al. (2016) have all concluded that autism and other neurodevelopment disorders are likely caused by environmental triggers. In this chapter I will:
First, I will define a few terms used in this chapter (all of which come from NIH). Genetics is “the study of genes and their roles in inheritance.” Genomics is “the study of all of a person’s genes (the genome), including interactions of those genes with each other and with the person’s environment.” And the genome is “the entire set of genetic instructions found in a cell. In humans, the genome consists of 23 pairs of chromosomes, found in the nucleus, as well as a small chromosome found in the cells’ mitochondria. Each set of 23 chromosomes contains approximately 3.1 billion bases of DNA sequence.” II. A very brief history of geneticsThe story of genetics begins with Austrian monk Gregor Mendel in the 1860s and his experiments with pea plants. He examined how flower color and the shape and texture of the seeds were transmitted between generations of pea plants. But Mendel never saw a “gene” (which is a word that was invented after his time); rather, Mendel just thought that some “factor” must surely exist to explain what he was seeing and much of the search over the last 150 years has been an attempt to find that factor (Hubbard, 2013, pp. 17-18). Mendel’s work languished in obscurity until 1900 when it was rediscovered by biologists who were now able to see structures inside the nucleus of a cell. The Danish botanist Wilhelm Johannsen first used the word “gene” in 1905 in an attempt to describe Mendel’s missing “factors.” But it was still not clear to what biological structure inside the cell the word “gene” might apply. Experiments with fruit flies suggested that “genes must lie along the chromosomes, like beads on a string” but that remained a best guess (Hubbard, 2013, p. 18). James Watson and Francis Crick (1953) first described the double-helix model of the structure of DNA and they were later awarded a Nobel Prize in Physiology for this discovery. At last it seemed that the location of “the gene” had been found — it was just a question of figuring out which DNA molecule coded for what phenotype. Convinced that they were on to something big, at one point Crick declared to colleagues at the pub that he and Watson had “found the secret of life” (Hubbard, 2013, pp. 19-20). More recent scholarship reveals that Watson and Crick likely took credit for discoveries initially made by Rosalind Franklin (see “Rosalind Franklin and the Double Helix” [2003] and Rosalind Franklin: The Dark Lady of DNA [2003]). Congress authorized the Human Genome Project (HGP) in 1984 and it officially launched six years later. The aim of the $3 billion project was to map, for the first time, the more than three billion nucleotide base pairs that make up the human genome. The hope was that in so doing it would enable scientists to identify the genes responsible for everything from heart disease to cancer and develop treatments to improve health and extend life. The theory behind the HGP — that genes cause many types of disease — seemed promising. Prior to the completion of the HGP, single-nucleotide polymorphisms had been identified that increased the risk of cystic fibrosis, sickle cell anaemia, and Huntington’s disease; a single gene variant had also been associated with Alzheimer’s disease and mutations to two genes, BRCA 1 and 2, are associated with an increased risk of breast cancer (Latham and Wilson 2010). It is little wonder then that when autism became a public health concern in the late 1980s many in the scientific community reached for genetic explanations. When the first draft of the human genome sequence was announced in June 2000, President Clinton called it “the language in which god created life” (Hubbard, 2013, p. 23). He continued, saying that this discovery would “revolutionize the diagnosis, prevention, and treatment of most, if not all human diseases” (Ho, 2013, p. 287). At a news conference, Francis Collins announced that genetic diagnosis of disease would be accomplished in ten years and treatments would start five years after that (i.e. 2015) (Wade, 2010, para 6). “William Haseltine, the chairman of the board of the Human Genome Sciences, which participated in the genome project, assured us that ‘death is a series of preventable diseases.’ Immortality, it appears was around the corner” (Lewontin, 2011). But even as the Human Genome Project was nearing completion there were signs that these claims were overblown. Craig Venter, whose privately funded company Celera Genomics had competed with the publicly funded HGP, said in 2001, “We simply do not have enough genes for this idea of biological determinism to be right. The wonderful diversity of the human species is not hard-wired in our genetic code. Our environments are critical” (McKie, 2001). But a wave of funding rushed in regardless as various biotech companies attempted to turn genetic research into patentable profitable cures. In the early 2000s, researchers were largely limited to candidate gene association (CGA) studies. These studies are relatively inexpensive to conduct and begin with likely genetic targets (usually because they have been associated with disease in previous human or animal studies) and then test human subjects who have that disease to see if those same DNA sequences show up (Patnala, Clements, and Batra, 2013). More than 600 associations between particular genes and various disease were reported (Hirschorn et al. 2002). But the replication rates were abysmal. Hirschorn et al. (2002) found that only 3.6% of reported associations were successfully replicated (and even there, the usual caveat applies that correlation does not equal causation). Soon however, the cost came down on genome sequencing and hundreds of genome wide association (GWA) studies were launched to identify the genes associated with about 80 different diseases (Latham and Wilson, 2010). As the name suggests, a GWA study compares the entire genome between different individuals and looks for associations between common traits and particular DNA sequences (Hardy and Singleton, 2009). The first GWA was published in 2005, and by 2009, 400 genome wide association studies had been completed at a cost of several million dollars each; but they yielded almost nothing of use (Wade, 2010). Goldstein (2009) in NEJM wrote that genomic research was “packing much less of a phenotypic punch than expected” (p. 1696). Wade (2010) wrote, “Indeed, after 10 years of effort, geneticists are almost back to square one in knowing where to look for the roots of common disease.” Lewontin (2011) wrote, “The study of genes for specific diseases has indeed been of limited value.” But then a curious thing happened. In the face of overwhelming evidence that CGA and GWA had failed to find an association between genes and most major diseases, genetic researchers regrouped and declared that genes for various diseases surely must exist, the problem was just that the tools for finding them were inadequate or the genes were hiding in unexpected places (Manolio et al., 2009; Eichler, et al., 2010). Geneticists started calling these unseen genes “dark matter” with the justification that “one is sure it exists, can detect its influence, but simply cannot ‘see’ it (yet)” (Manolio et al. 2009). Investors and government seem persuaded by this “dark matter” theory and continue to pour billions of dollars into genetic and genomic research. But a growing chorus of critics has stepped forward to make the case that genetic theories of disease represent an out-dated, unscientific, and/or ethically dubious paradigm that should be replaced with more accurate representations of biological systems. Krimsky and Gruber (2013) gathered 17 of these critics in the edited volume Genetic Explanations: Sense and Nonsense and I build off of their work in the rest of this chapter. III. A gene is an “idea” but not actually reflective of how biology worksMany of the authors in Krimsky and Gruber (2013) argue that the idea of a “gene” — a single master molecule that contains a blueprint that drives phenotypic outcomes — is a myth that does not accurately describe how cells and organisms work. Krimsky (2013) explains that one of the ways that Watson and Crick popularized their discovery of DNA was through constructing a metallic model of the double helix. He calls that the “Lego model” and argues that it has since undergone considerable revision (Krimsky, 2013, p. 3).
Dupré (2012) argues that DNA is neither a blueprint nor computer code for biological outcomes but rather a sort of warehouse that the body can draw upon for a range of different purposes.
Richards (2001), in a passage that builds off of earlier critiques by Dennett (1995) and Lewis (1999) complains that, “Molecular genetics often has the feel of greedy reductionism, trying to explain too much, too fast, under-estimating the complexity and skipping over whole levels of process in the rush to link everything to the foundations of DNA” (p. 673). IV. Cultural constructs and unpredictable outcomesHubbard (2013) confirms that recent discoveries have suggested that biology works differently than Mendel imagined. And it turns out that the idea of something like a gene is often imbued with the cultural assumptions of the researchers of the era. Hubbard (2013) writes, “The usual shorthand ‘the gene for’ must not be taken literally. Yet this way of thinking about genes has turned DNA into the ‘master molecule,’ while proteins are said to fulfill ‘house keeping’ functions. (And one need not be a raving postmodernist to detect class, race, and gender biases in this way of describing the molecular relationships.)” (p. 23). The Cartesian reductionism that characterizes much of the public health debate about genetic causation of disease may actually impede paradigm shifts because billions of dollars are spent on the search for “the gene for” when in in fact the human organism and DNA itself do not work that way.
Hubbard (2013) points out that lost amidst the exuberance of the discovery of DNA and the double helix and the mapping of the human genome, lies the potential for unintended consequences. Biological systems are more complex than the monogenic theory of disease causation suggests. This means that one simply cannot know how genetically engineered interventions will turn out.
If Hubbard is correct — that one cannot predict ahead of time how a genetically modified organism will impact its host — that potentially has profound implications for the autism debate. That is because one of the changes that followed the passage of the 1986 National Childhood Vaccine Injury Act was the introduction of genetically engineered vaccines — starting with the Hepatitis B vaccine in 1987. Four genetically engineered vaccines are currently on the CDC’s recommended schedule for the whole population: Hepatitis B, human papillomavirus (HPV), influenza, and Covid-19. Since 2006, the MMRII has been grown in a medium that includes recombinant (genetically engineered) human albumin (Wiedmann, et al. 2015, p. 2132). There is concern amongst some researchers that the Hepatitis B vaccine may be responsible for the surge in autism prevalence (Gallagher and Goodman, 2008 and 2010; Mawson et al. 2017a and 2017b). But one does not even need to accept the conclusions of these studies or the first hand accounts of parents in order to be concerned. Hubbard (2013) is saying that genetic engineering is a field still in its infancy, still unable to accurately predict its effects. For policymakers to then require medical interventions involving genetically modified organisms from the first day of life as a condition of citizenship (for admission to day care, schools, some jobs, welfare benefits, etc.) seems an extraordinary overreach that potentially opens the door to unintended consequences. V. Toward a new understanding of (and a better set of metaphors to describe) genetic scienceKeller (2013), Moore (2013), and Talbott (2013) argue that the idea of the “gene” is outdated and attempt to describe the current state of genetic science more accurately. Keller (2013) notes that “the early days of the Human Genome Project brought the promise that in time we would be able simply to replace defective sequences with normal ones (gene therapy), but that hope has failed to materialize” (p. 38). The reason it has failed to materialize is that our current understanding of how DNA works is radically different from how Mendel, Watson and Crick, or even the Human Genome Project initially conceived of it (p. 38).
As mentioned above, Mendel’s “factors” were described as akin to a master giving instructions to a servant. Later metaphors for genes included the gene and/or cell and/or body as a machine and DNA as a computer code that the body then carries out. Keller (2013) argues that all of these notions are outdated as is the view that DNA is a causal agent:
Print media, the internet and TV news programs are full of stories about the discovery of a gene for everything from obesity to infidelity to political affiliation. Moore (2013) argues this runs counter to how most geneticists think about their research:
One of the many problems with monogenic theories is that they overlook the role of the environment and other biological systems in the body. Moore (2013) writes:
Increasingly, the deterministic account of Mendel has been replaced by an understanding that the same strand of DNA can operate in a wide variety of different ways depending on its interactions with other parts of the cell, hormones, and environmental factors:
Moore (2013) even challenges the conventional understanding of three prototypical cases where it at first appeared that a single “gene” (or the absence of a single “gene”) caused a disease:
Talbott (2013) provides some helpful new conceptual metaphors that better reflect the current state of thinking in genetic research.
In more recent genetics research one sees the same entity express itself in different ways. Talbott (2013) writes, “[T]he ‘same’ proteins with the same amino-acid sequences can, in different environments, ‘be viewed as totally different molecules’ (Rothman, 2002, p. 265) with distinct physical and chemical properties” (p. 53). Talbott (2013) argues that the static, mechanistic, and deterministic metaphors that are used in the popular press do not reflect the latest thinking amongst geneticists themselves.
Interestingly, Talbott (2013) indicates that genetics themselves may bear some responsibility for this misunderstanding of their work:
The more scientists discover about the actual workings of genetics, the more it reveals how little we know about disease causation; but reductionist narratives about genetic causation persist because they are profitable. VI. The Fruitless Search for Genes in Psychiatry and PsychologyMonogenic theories of disease causation are problematic in general and particularly problematic in connection with psychiatric disorders. One can make the case that autism spectrum disorder (ASD) is not properly understood as a psychiatric disorder given that it appears to involve pathologies in a whole host of different systems from the gut to the central nervous system. But the DSM-V lists ASD as a psychiatric disorder so for the purposes of this discussion I will focus on the failures to identify genes for various psychiatric disorders. Risch et al. (2009) observed that “few if any of the genes identified in candidate gene association studies of psychiatric disorders have withstood the test of replication” (p. 2463 in Joseph and Ratner, 2013, p. 95). Joseph and Ratner (2013) argue that there are two possible explanations for the fact that “the genes for” various psychiatric conditions have not been discovered in spite of extensive research (p. 95). On the one hand, perhaps such genetic sequences do exist but simply have not been found because the methods are inadequate or the sample sizes too small. This is the explanation favored by genetics researchers, investors, and government health agencies. On the other hand, there is the possibility that “genes for” psychiatric disorders do not exist at all. This is the view favored by Joseph and Ratner (2013). Latham and Wilson (2010) note that with a few exceptions, “according to the best available data, genetic predispositions (i.e. causes) have a negligible role in heart disease, cancer, stroke, autoimmune diseases, obesity, autism, Parkinson’s disease, depression, schizophrenia and many other common mental and physical illnesses...” They continue, “This dearth of disease-causing genes is without question a scientific discovery of tremendous significance... it tells us that most disease, most of the time, is essentially environmental in origin” (Latham and Wilson, 2010). Even much relied upon twin studies that are the stock-in-trade of genetic researchers have come under renewed criticism.
Joseph and Ratner (2013) argue that:
If twin studies themselves are problematic then that changes things considerably in the autism debate where twin studies are routinely accepted at face value by public health officials. VII. Changes in how scientists think about genetics in connection with autism spectrum disordersHerbert (2013) confirms the criticisms of genetic theories of causation, specifically as they pertain to autism. She writes “evidence is shifting the conception of autism from a genetically determined, static, lifelong brain encephalopathy to a multiply determined dynamic systems disturbance with chronic impacts on both brain and body” (p. 129). Later she recognizes environmental theories of causation:
She continues:
Herbert (2013) portrays the field of genetics as blinded by their own hubris. She makes the case that given alarmingly high (and rising) autism rates, “anything we can do sooner rather than later to stem the tide ought to make eminent public health sense” (Herbert, 2013, p. 144). And she argues, “Clearly, gene myths are a problem in autism and are among the forces putting obstacles in the way of implementing a full-force public health campaign to reduce environmental risks” (Herbert, 2013, pp. 145-146). Herbert (2013) also hints at the need for a sort of medicine from below. She writes:
If, as Herbert suggests, parents, not doctors, are at the leading edge of researching treatments, that would seem to open up a whole host of questions about epistemology and the current state of science and medicine. The epistemological hierarchy set up by mainstream science and medicine has medical specialists above doctors who are above parents. But is it possible that in the case of autism, this hierarchy has it backwards? Furthermore, if, as Herbert argues, the observations and intuitions of parents produce better treatment outcomes, might they also be right about the causes of autism? VIII. The political economy of genetic researchSo if monogenic explanations for disease are not consistent with the scientific evidence of how most diseases work, then why do biotech companies, popular media, and the CDC continue to promote the search for such explanations?
Gruber (2013) is troubled by the political economy of genetic research.
Gruber (2013) argues that current genetic research is “full of hubris and bordering on faith” (p. 271). Gruber (2013) argues that genomics has not delivered on its early promise and that the turn towards this sort of research has resulted in a decline in useful innovations.
Genetic and genomic research is driven not so much by Merton’s idealized search for scientific knowledge nor even by traditional capitalist forces of supply and demand for products that meet a need in society. Rather genetics and genomics exist through a unique combination of government funding created by biotech lobbying for that funding and speculative investment that is trading more on hope and hype than evidence of effective treatments (Gruber, 2013, p. 100). The total market capitalization of the top 25 biotechnology (which includes genetics and genomics) companies was $990.89 billion in 2014, $1.225 trillion in 2015, and $1.047 trillion in 2016 (Philippis, 2016). The U.S. spends more than any other nation on genetics research (35% of the world total); 1/3 of the total comes from government and two-thirds from private investment (Pohlhaus and Cook-Deegan, 2008). The Biotechnology Innovation Organization (BIO) is the primary trade association for the genetics and genomics industry. BIO was formed in 1993 as the result of the merger of two smaller biotechnology industry associations (Sourcewatch, n.d.). Its more than 1,100 members include both genetics and genomics firms in addition to a wide range of pharmaceutical, agricultural, and medical companies that employ 1.6 million people in the U.S. (BIO, 1993). From 2007 to 2016, BIO spent an average of $8 million a year on lobbying (Sourcewatch, n.d.). It has been remarkably successful at lobbying the U.S. government for funding, regulatory rules, and tax provisions that benefit member companies. For example, from 1993 to 2014 the budget of the NIH increased from $10 billion to over $30 billion. In 2016 the NIH budget was $32.6 billion of which $8.265 billion was devoted to genetic and genomic research which includes the categories Genetics, Gene Therapy, Gene Therapy Clinical Trials, and Genetic Testing (U.S. DHHS, 2016). But this underestimates the total spent on genetic research because there is also genetic research happening within other disease categories in the NIH budget. BIO secured $1 billion in tax credits for biotech companies in the 2011 federal health-care legislation (Gruber, 2013, p. 277). BIO routinely pushes the FDA for faster approval times for medical interventions (Weisman, 2012). Gruber (2013) notes that many academics and university science departments have grown wealthy through their ties with biotech firms. “Universities should be places where healthy skepticism of claims about science and its applications are pursued. But more than almost any other high-technology business, the biotechnology industry maintains extremely close ties with leading academic institutions...” (Gruber, 2013, p. 277). Public funding for genetic research persists in spite of the fact that it is a less promising approach than mitigating environmental or lifestyle factors. “Given the many complex interactions that underlie almost all human diseases, even improving existing approaches to identifying and modifying genetic risk factors will often have significantly less value than modifying non-genetic risk factors” (Gruber, 2013, p. 280). But again, addressing environmental or lifestyle factors — doing less of the things that cause harm — is generally not profitable. Because U.S. elected officials and regulators are captured by corporate interests, Congress funds genetic research to the exclusion of more promising (but less profitable) pathways. Like Herbert (2013), Gruber (2013) sees the misplaced focus on genetics as crowding out more promising research while producing little improvement in public health. “The promise of genomics may have provided policy makers with a simple narrative of basic health research investment, but it has led to poor decision making on their part and has proved to be an insufficient standard bearer in the fight to improve the human condition” (Gruber, 2013, p. 282). Like Mirowski (2011), Gruber (2013) sees an entire system that is dangerously out of balance.
Latham and Wilson (2010) have the sharpest political economy critique of all:
As it relates to autism, what started out looking like the epitome of cutting edge science in the race to understand a disease, starts to look like a distortion of science and a distraction from more promising research pathways driven by financial interests rather than concern for public health. IX. ConclusionIn the 1990s and 2000s government and industry had a theory of the case — that genes are responsible for disease — that has now been largely refuted. In the meantime an entire industry and public health infrastructure was built around this idea. So when the underlying theory was discredited, proponents simply modified the theory (to the search for the “missing dark matter”) so that the industry could keep going and continue to receive government funding. When this evolving research agenda produces profitable corporations and well-paid scientists but little to nothing that reduces human suffering it is an enormous problem for society. The fact remains that Gilbert and Miller (2009), Landrigan, Lambertini, and Birnbaum (2012), the American College of Obstetricians and Gynecologists (2013), and Bennett et al. (2016) have all concluded that autism and other neurodevelopment disorders are likely caused by environmental triggers and are thus preventable through law and policy. Even if sophisticated genetic and genomic research is able to find ways to reduce symptoms and severity, it is still going to be orders of magnitude more cost effective (not to mention more ethical) to prevent autism in the first place by keeping toxic chemicals out of children’s bodies. Currently, genetic research is soaking up the vast majority of autism research funding and preventing more effective prevention strategies from emerging. 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MMR® II manufactured using recombinant human albumin (rHA) and MMR® II manufactured using human serum albumin (HSA) exhibit similar safety and immunogenicity profiles when administered as a 2-dose regimen to healthy children. Vaccine, 33(18), 2132-2140. https://doi.org/10.1016/j.vaccine.2015.03.017 Blessings to the warriors. 🙌 Prayers for everyone fighting to stop the iatrogenocide. 🙏 Huzzah for everyone building the parallel society our hearts know is possible. ✊ In the comments, please let me know what’s on your mind. As always, I welcome any corrections. You're currently a free subscriber to uTobian. For the full experience, upgrade your subscription. |
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