Monday, December 6, 2010

What If MRI is Right, Dx is Wrong?

I posted a link to this article a few days ago:
In Study, MRI Scan 90% Accurate Identifying Autism
The full story cautions that this is merely one study, but it is interesting. From the story on CNN's website:
Scientists are finding more pieces of the autism puzzle of with the help of MRI scans of brain circuitry, according to a study published Thursday online in the journal Autism Research. 
By scanning the brain for 10 minutes using magnetic resonance imaging, researchers were able to measure six physical differences of microscopic fibers in the brains of 30 males with confirmed high-functioning autism and 30 males without autism.
Here is my question:
What is confirmed high-functioning autism?

HFA is not a standardized diagnosis, as it does not appear in the DSM-IV. It is a subjective diagnosis, and there are constant debates as to what differentiates HFA from Asperger's Syndrome or PDD-NOS. I have even heard discussions claiming it is easy to confuse "moderate" (whatever that means) autism with a "correct" diagnosis of ADD/ADHD with co-morbid conditions.

I have to wonder, what if the MRI is correct when it identifies a specific physical form of autism (what we might call a physical expression or manifestation, though I dislike both terms for etiological markers) and the psychological diagnosis is "wrong" by some measure?

We know that one person (take me, for example) screened by different "experts" with different backgrounds can be diagnosed with several different and even conflicting conditions. Even the medical experts make mistakes; it is hard to tell some forms of seizures from migraines, for example. If a patient has a complex history, an accurate diagnosis is a challenge for even the best neurologists.

What if the MRI is more accurate than traditional autism diagnostic instruments? We already know that diagnostic instruments, especially screening questionnaires, are of variable quality. I'm merely wondering, since MRI tests are less variable, less subjective, what if the MRI is accurate and some of the existing diagnoses of test subjects were wrong? (Yes, I know "right/wrong" is a complex argument, as well. I'm trying to stress the subjective vs. objective nature of the MRI.)

I'm not claiming there is nothing special about those subjects the MRI did not identify. What I am suggesting is that the MRI researchers might have stumbled upon one, and only one, unique form of autism we could label as a physical condition of the brain. I'm certain there are other "autisms" to be discovered, as well.

6 comments:

  1. That cannot happen because of circular reasoning.

    How do they know that the scan has detected autism?

    Because they have already decided who is autistic before testing the scan.

    Let us suppose that cars with a particular engine signature were Toyota lexuses (lexi?)

    Sure an instrument designed to scan for that engine signature would detect a lexus, but only because a lexus had been designed that way.

    In other words you can only scan effectively for what you already know, the decision was made at some point.

    I'll guarantee there will be proprietry scans before long which contradict each other (a whole nother story entirely), but that's commerce for you, was there ever anything honest about "scientific" discovery. Not at all, it has been dirty tricks and private enterprise more than co-operation.

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  2. There is no circular reasoning -- autism diagnoses are subjective and were apart from the scanning. That the scanning identified a physical trait unique to those also diagnosed with autism is not circular reasoning.

    A better comparison: if you hid the manufacturer's symbols on 20 cars and by inspection alone I was able to identify which ten were similar in design.

    The scanning team did not know which people had the diagnoses. The scan readings were matched to the individuals after the similarities were found and identified. That's the norm with any neurological / physical study.

    Also, the University of Utah isn't exactly a commercial powerhouse. Why would you assume "commerce" is involved at a publicly-funded university? The research grants seem to be from the federal government in this case.

    And yes, there are companies selling bogus scans. These have been profiled in the U.S. on the PBS show "Frontline." Most of the scanning companies aren't owned or operated by doctors, even. Really sad, but people are always looking for easy answers.

    Your cynicism towards science is disheartening. I trust the scientists I've worked with a lot more than any other community of humans. Most scientists really do love the exploration and quest. I can't say that about most humans -- who are anything but intellectually curious.

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  3. - And I must admit, I have no idea, none at all, how research is conducted and funded in the European university model. In the U.S., where I have been involved in several grant-funded projects, the controls are fairly rigid at state-supported universities, including limits on the ability of a researcher to commercialize findings.

    It is hard to compare various university and government approaches to research. All my projects were grant-funded through states.

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  4. I have a right to be cynical.

    To begin with this research has not even been peer reviewed yet, (even by sympathetic reviewers)

    Secondly it already has a rival with Declan Murphy's team.

    Universities (over here at least) do claim intellectual copyright over any application that can be developed and commerciallised, that had been produced by researchers who are either studying or in there employ, its part of the deal.

    This scanning does have potential implications for big Pharma in targeting psychotropic medication.

    Finally it is of no more import than ordinary radiography, to return to the example of a broken leg. Yes it's useful to have an X ray, but that tells you nothing about the situation of the leg's owner, nor the impact of that break on there life.

    A scan won't so much diagnose autism as confirm it, the impact of autism is in the social and educational world and will remain so.

    BTW there are no sinister backers funding my educational research, I remain self funding, though I am open to offers.

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  5. I wish we had more funding for educational and support research, which is why I don't like the funding biases of non-profits. Too may "autism charities" and government grants are seeking "cures" instead of ways to help people living with disabilities and challenges.

    I think you are making an important point about how society treats "autism" no matter how it is confirmed. I'm merely hoping that any and all confirmation of autism helps reduce some of the rhetorical nonsense from those either denying the existence of HFA/AS (etc) or suggesting that only a subset of "autism" deserves support funding.

    It seems too easy for some of the parent / advocate groups to dismiss what I have heard called the "shining Aspies and Auties." I don't like such derogatory suggestions that the "mildly afflicted" (blech) don't need support or benefit from some (not all) research.

    Also, I admit the dependence of institutions on funding. Private universities and some public R1 institutions are dependent on external research grants, both governmental and private. That does shape which research is conducted and published. Usually, a funding source receives a part of the intellectual property rights, which are somehow split with the institution.

    I have an acquaintance who works in the IP department at a major research university in California. The legal tangles are worth the potential rewards to the institution -- which uses any income to fund both research and student financial aid. It is one of the top universities in America, and relies heavily on such income to subsidize tuition. Sadly, even at $10,000 or more, tuition doesn't really cover the costs.

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  6. What the study suggests to me is that the diagnoses were 90% accurate in detecting a real physical difference in the brains of adults. I find that reassuring. (I wonder about the 10% that did not show the differences under MRI.)

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