We're all sick

No doubt you have heard all about this Korean study that finds the prevalence of autism to be 2.6%, astounding the world.

Well now. "Autism" is defined as meeting certain criteria based on a structured interview and observational protocol. It turns out that in the sample of kids from the general school population -- not those who had already been assigned to special needs programs -- the average IQ and academic performance of the kids with "autism" was indistinguishable from those without it, and in fact the proportion with superior IQs was higher than average. They were labeled as "autistic" because they had trouble making friends, and didn't have great social skills, basically.

Is this a "disease"? Does it have anything whatsoever to do with classic autism, which includes profound deficiency in language development; bizarre, perseverating and often self-destructive behaviors; and typically low IQ? There's no reason to think so.

Some kids are socially talented, some are mathematically talented, some are musically talented, some are athletically talented, etc. Most of us don't have it all going on, but I don't consider myself to have a disease because I can't dunk a basketball. There's probably something to be said for giving some form of extra help or coaching for children who are socially awkward and aren't popular, but I don't think labeling them as diseased is necessarily helpful.

Ray Moynihan, in the new BMJ, discusses this phenomenon of disease creep. It's particularly pronounced in psychiatry, but it's found everywhere. He writes, "we may sometimes be pushing boundaries too wide, and setting treatment thresholds so low, that people with mild problems or modest risks are exposed to the harms and costs of treatment, with little or no benefit." He gives as examples not only psychiatric diagnoses, but also "pre-hypertension," which afflicts 60% of the adult population; and expansion of the definition of Type 2 diabetes.

The panels that create these disease definitions, it turns out, have been populated heavily by people who get big bucks from drug companies. For example, 56% of DSM-IV panelists, and 100% of those on the sub-panel for mood disorders. (Have a Prozac.) Allen Frances, who chaired the panel, now tells Moynihan he has regrets. "He now believes that the edition unwittingly contributed to an explosion of unnecessary diagnoses in the areas of attention deficit, autism and bipolar disorder." He's worried the DSM-V will be even worse. (It's enough to give me intermittent explosive disorder.)

Of 12 panelists who created the "pre-hypertension" diagnoses, 11 got drug company money. Ditto for a 12-member panel on diabetes that, in 2009, promulgated a low blood sugar target and supported use of rosiglitazone, which is now banned in Europe and discouraged for use in the U.S.

As Moynihan suggests, we could fix this. Just ban people with conflicts of interest.