What is going on with the JAOA?

[DrWBD]

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This letter was published in the February 2009 issue of the JAOA:

Does Prenatal Ultrasound Increase Risk of Autism? Christopher D. Olson, DO

To summarize, this "osteopathic family physician who practiced obstetrics for many years" decided he would write a letter to the JAOA musing about the possibility of prenatal ultrasound causing an increase in autism. Never mind that his letter included three references, none of which actually supported his suspicions. Also never mind that no actual research of his own was presented - in fact Dr. Olson admitted "I am not in a position to conduct research into such a possible connection".

One would expect that a letter like this would never see the light of day in any reputable medical journal. Maybe it was a slow month at the JAOA?

Thankfully, the most recent JAOA contained two Letters to the Editor that, appropriately, took Dr. Olson and the JAOA to task.

Letter by K. Chung, DO (a pediatrician)
Letter by J. Magen, DO (a psychiatrist and instructor at MSU-COM)

From Dr. Chung's letter:

I believe that a...dangerous public health situation can arise from Dr Olson's bold statements(1)—with no supporting scientific evidence—claiming that ultrasonographic examinations may cause the onset of ASD. Dr Olson did not conduct any form of investigation, such as a case report, case control study, retrospective chart review, or meta-analysis of the current evidence. In fact, Dr Olson(1) stated, "I am not in a position to conduct research into such a possible connection, and I am also well aware of potential roadblocks to conducting such research." He then proposed several research ideas and "challenged" our osteopathic medical colleagues to conduct such studies for him. By comparison, Dr Wakefield(2) at least conducted a systemic study and presented his results in a peer-reviewed journal.

Of course, every US citizen has the Constitutional right to free speech. But is it ethical to make the unsupported claim of an autism-ultrasound association without considering the damage it can cause to the general public and the osteopathic medical profession?

I believe that Dr Olson's letter(1)—containing an assumption with great public health risk but no solid scientific data to support it—is an unacceptable way to present ideas of possible autism causes. I am quite disappointed in JAOA—The Journal of the American Osteopathic Association for publishing such a letter without considering the consequences for the greater public health and safety. I view the JAOA as a representation of the osteopathic physician within the scientific community. Do the JAOA's editors not realize the potential harm that such an unsupported claim can inflict on our public image? (emphasis mine)​

Call me crazy but I think the supposed flagship journal of the osteopathic profession shouldn't be going to such great lengths to make us look foolish. Hopefully this was a temporary lapse of judgment by the JAOA staff, but I'm not optimistic.

 

[cyclohexanol]

T
Call me crazy but I think the supposed flagship journal of the osteopathic profession shouldn't be going to such great lengths to make us look foolish. Hopefully this was a temporary lapse of judgment by the JAOA staff, but I'm not optimistic.

Seems like it's just par for the course to me? Month after month JAOA consists mostly of 1-2 some 'studies' on how OMT can be used to treat drowning victims or some such nonsense, using a n<10 study on cadaveric cats.

As the flaship journal of the osteopathic profession, I think the editors are portraying exactly what they want as far as the 'osteopathic profession' goes.

-shrug-

 

[TexasTriathlete]

That is the most ludicrous bull**** I have read maybe ever.

Every single person gets prenatal ultrasound, so it must be the cause of autism, right? Same with vaccinations. ****ing ******s.

I think that the combination of hearing, seeing, and smelling can cause autism. Ow many deaf mutes with anosmia do you know who are autistic? That's what I thought.

 

[DrWBD]

One of my favorite parts of Dr. Olson's letter:

I would like to challenge the osteopathic medical research community—particularly DOs in obstetrics—to take on this research project for the benefit of our patients​

In other words, you guys can do my homework for me.

 

[cyclohexanol]

One of my favorite parts of Dr. Olson's letter:

I would like to challenge the osteopathic medical research community—particularly DOs in obstetrics—to take on this research project for the benefit of our patients​

In other words, you guys can do my homework for me.

Maybe he's onto something here... we should all try to write in to JAOA and challenge various groups to take on research projects for us.

 

[Old_Mil]

I'm the biggest critic of the AOA and JAOA around. That having been said, you shouldn't be too hard on the guy. This is a letter, not something claiming to be a double blind, randomized controlled trial. It's a little more than an effort at brainstorming.

While I've never read or heard anything to support the hypothesis that prenatal ultrasound can cause autism, the fact remains that we don't know what causes autism (and a whole host of other medical conditions.).

Human life has changed radically in the past 50 years. Because of it, we have a couple of highly experimental generations living on planet earth today. If we start slapping down people who ask "hmm, what if..." medical progress will come to a standstill.

They laughed at the guy who discovered H. Pylori, too.

 

[schrute]

I'm the biggest critic of the AOA and JAOA around. That having been said, you shouldn't be too hard on the guy. This is a letter, not something claiming to be a double blind, randomized controlled trial. It's a little more than an effort at brainstorming.

While I've never read or heard anything to support the hypothesis that prenatal ultrasound can cause autism, the fact remains that we don't know what causes autism (and a whole host of other medical conditions.).

Human life has changed radically in the past 50 years. Because of it, we have a couple of highly experimental generations living on planet earth today. If we start slapping down people who ask "hmm, what if..." medical progress will come to a standstill.

They laughed at the guy who discovered H. Pylori, too.

I'm no less prone to mocking the JAOA, but have to agree with the Old one.

I've honestly never really thought about the possibility of ultrasound causing problems...most people haven't, and consequently blow it off in a gush of laughter as being preposterous, but something as benign as sound waves to the adult human may have much more implications on the neurobiologic level (depending on the frequency) to a developing fetus in an enclosed liquid environment ...though the duration of US exposure to most fetuses is quite minimal over the course of development. A retrospective study shouldn't seem that outlandish.

We shouldn't brand the guy a quack for helping us remove focus from the vaccine crowd.

 

[DrWBD]

I'm the biggest critic of the AOA and JAOA around. That having been said, you shouldn't be too hard on the guy. This is a letter, not something claiming to be a double blind, randomized controlled trial. It's a little more than an effort at brainstorming.

While I've never read or heard anything to support the hypothesis that prenatal ultrasound can cause autism, the fact remains that we don't know what causes autism (and a whole host of other medical conditions.).

Human life has changed radically in the past 50 years. Because of it, we have a couple of highly experimental generations living on planet earth today. If we start slapping down people who ask "hmm, what if..." medical progress will come to a standstill.

They laughed at the guy who discovered H. Pylori, too.

Barry Marshall (discoverer of the H.Pylori-ulcer connection) actually put his money where his mouth was and did the studies necessary to prove his point, unlike Dr. Olson. I don't think your comparison is appropriate here.

I'm more critical of the JAOA than Dr. Olson. In this age of evidence-based medicine, the correct way to present a hypothesis in a medical forum is with supporting data, not idle speculation. I expect better out of the journal that supposedly represents osteopathic medicine to the scientific community, as Dr. Chung put it.

Dr. Olson seems to me to be the old-school osteopath that doesn't really get it, which seems evident in his reply to Drs. Chung and Magen. The self-reference to being an "osteopathic family physician who practiced obstetrics for many years" suggests to me that he's more about "eminence-based" medicine as opposed to "evidence-based" - his experience trumps the need for real data.

 

[JaggerPlate]

To Scrute + Old ....

I really don't disagree with you, but I think the point which remains relevant is the fact that publishing these brainstorms in magazines like this can cause irrational fear/panic. Especially in subjects as sensitive as Autism. Progress and great ideas can stem from almost anything, but the harm done by women avoiding screening because they vaguely heard of this, despite what it was -brainstorming sess, theory, etc - could be bad.

 

[homeboy]

In this age of evidence-based medicine, the correct way to present a hypothesis in a medical forum is with supporting data, not idle speculation. I expect better out of the journal that supposedly represents osteopathic medicine to the scientific community, as Dr. Chung put it.

Dr. Olson seems to me to be the old-school osteopath that doesn't really get it, which seems evident in his reply to Drs. Chung and Magen. The self-reference to being an "osteopathic family physician who practiced obstetrics for many years" suggests to me that he's more about "eminence-based" medicine as opposed to "evidence-based" - his experience trumps the need for real data.

I ultimately agree.

 

[Hernandez]

you guys actually read the JAOA? I'll be honest, I pretty well trash it as soon as I get it, if it weren't for the occasional editorial, I've not learned anything useful from it in the 6 years I've recieved it.

 

[DrWBD]

you guys actually read the JAOA? I'll be honest, I pretty well trash it as soon as I get it, if it weren't for the occasional editorial, I've not learned anything useful from it in the 6 years I've recieved it.

Unfortunately (in this matter at least), the JAOA is indexed in Medline/Pubmed. Meaning that while the articles themselves may be lining the bottom of a hamster cage, they are preserved digitally for anyone who wants to make a case against osteopathic medicine.

 

[ceftazidime]

Does anybody find it funny that often times there are articles published in the JAOA that have NOTHING to do with "osteopathic medicine", but is simply written by a DO so it gets published. For example, the July issue has a case report about Brain Amyloidoma with Cerebral Hemorrhage. There are MRI images, histopathology slides... not a single word about A.T Still and the tenets of osteopathy, though. I can't believe they allowed this rubbish! 😉

 

[Old_Mil]

Does anybody find it funny that often times there are articles published in the JAOA that have NOTHING to do with "osteopathic medicine", but is simply written by a DO so it gets published. For example, the July issue has a case report about Brain Amyloidoma with Cerebral Hemorrhage. There are MRI images, histopathology slides... not a single word about A.T Still and the tenets of osteopathy, though. I can't believe they allowed this rubbish! 😉

That was just part 1 of the article; part 2 in the next issue is titled "Management of Cerebral Hemorrhage and Amyloidoma With Cranial Techniques"