|Do little white pills cause autism spectrum disorders?
Wanting simple answers to complex problems
On a sunny Sunday morning, as I tried to ignore the sad news of the latest mass shooting in Santa Monica (near my former home), I tunneled through the perpendicular worlds of scholar.google.com (peer-reviewed, fact-based) and google.com (popular, fear-based). I was researching a drug called terbutaline, also known as brethine, an asthma medication that has long been used off-label to stop contractions in pre-term pregnant women.
In 1999, I was one of those women. And until a few days ago, I had never given terbutaline another thought. But while speaking with another mom of a son with developmental disabilities and mood disorders, my spine chilled and my ears started to ring when she said, “I was hospitalized for pre-term labor and given terbutaline.”
My contractions started after a long hike in my 29th week of Michael’s pregnancy. At first I thought they were just strong Braxton-Hicks, but when they wouldn’t stop, I ended up in the emergency room. I was given an injection, hospitalized for a few days, and sent home on bed rest with a bottle of little white pills.
What I remember most about the pills was the breathtakingly awful headaches and painful tremors they caused. I also remember feeling resentment toward the baby in my body, for making me endure so much pain. In the end, he was born on his due date—and he was the happiest, sweetest baby a mother could ask for.
And now, 13 years later, Michael is still happy and sweet—except when he isn’t. He can’t tie his shoes or remember to brush his teeth. He walks with an awkward gait and has serious sensory integration issues. His most recent diagnoses include PDD-NOS and juvenile bipolar disorder.
Which is where Ms. McCarthy comes in. I have a great deal of sympathy for Jenny McCarthy. Any parent whose child is diagnosed with a life-changing condition, whether it’s cancer or juvenile diabetes or autism, wants to know why. What happened to cause this? Why did this happen to my child?
After her son was diagnosed with autism in 2005, McCarthy famously latched on to a 1998 Lancet study that incorrectly linked autism to vaccinations. That controversial study, which followed 12 children diagnosed with developmental disabilities, has now been retracted; there is no sound scientific evidence linking vaccinations, even those containing thimerosol, to autism.
Even though I have sympathy for McCarthy, I routinely assign the autism/vaccination controversy to my students as a critical thinking exercise in learning how easy it is to latch on to an “easy” but often wrong answer. As that wit H.L.Mencken famously said, “There is always a well-known solution to every human problem — neat, plausible, and wrong.”
So as I scour Google Scholar for recent articles about terbutaline and autism, I have to ask myself: am I pulling a McCarthy? Do I want this one thing to be the answer, to the exclusion of all other possible things? Do I need an easy answer?
To be fair, the FDA has taken recent studies linking terbutaline to possible developmental delays seriously, issuing a Black Box warning for the drug in 2011: “Terbutaline should not be used to stop or prevent premature labor in pregnant women, especially in women who are not in a hospital. Terbutaline has caused serious side effects in newborns whose mothers took the medication to stop or prevent labor.”
I find myself inevitably drawn to comparisons with Thalidomide, the infamous 1960s drug prescribed off-label for morning sickness that caused thousands of teratogenic birth defects worldwide. Thalidomide was one of the first drugs to provide solid, irrefutable evidence that substances ingested by the mother can cross the placenta and cause harm to the developing fetus.
If the link between terbutaline and autism is substantiated, then the comparison to thalidomide is an apt one.
In today’s paper, the front page story (right below the Santa Monica shooting) featured a young man headed off to UCLA at the age of 14—a bright, promising chess player with true gifts in math and science. My son Michael attended the same exclusive magnet school until he was asked to leave because his behavioral problems were too distracting to the other students.
Would that story have been about my son, if only I had refused to take terbutaline?
Simple answers are usually wrong. In the end, the question comes down to a philosophical one: free will or determinism. Genes, environment, nutrition, medication—all these must certainly play a role in developmental disorders. But they don’t determine the outcome of our lives. Michael still has choices, and good options, which will only improve with ongoing research and changes in society’s current understanding of mental illness and mental disorders.
Thalidomide babies were often born without limbs, or with phocomelia (“Seal limbs”). But that very visible disability didn’t stop Mat Fraser from becoming a drummer, or Tony Melendez from playing the guitar (with his feet), or Thomas Quasthoff from singing his heart out.
Michael’s disability is less visible, but no more deterministic. He too can be what he wants to be. The path just might be longer and more roundabout than I expected that summer morning, when my hike triggered early contractions that set my son’s life—and my life—on this path.