Treatment Counters Autism

An enzyme hailed by parents of some autistic children as a possible miracle cure worked no better than a placebo in its first two rigorous studies. But just being part of the study helped children greatly.

Thousands of parents have hunted for doctors willing to give their autistic children intravenous doses of secretin--a digestive enzyme that costs $180 per vial--since a New Hampshire woman said in 1997 that one dose given during a diagnostic test had brought her son out of autistic isolation. There were reports of a black market and exorbitant prices.

That prompted a series of studies to test secretin against a placebo, because it has long been known that simply being treated can help many people, whether or not the treatment has any medical effect. Only two of the studies are complete.

One study, involving 60 children, is detailed in the New England Journal of Medicine. A study of 20 children was described by Edwin H. Cook of the University of Chicago in an article published on the Medscape Internet site in October.

Neither found any benefit from secretin.

The larger study, though, found that children who got the enzyme and those who got a placebo both improved markedly and by about the same amount.

Autism is marked by profound social withdrawal and sometimes aggressive or repetitive behavior.

Fred Volkmar, head of the Yale Developmental Disabilities Clinic, said the children on placebos were responding to all the attention from doctors, parents and others. Several treatments--most of them involving long, painstaking work with behavior or speech problems--have been proven to help autistic children, he said.

Both of the secretin studies were small, short-term and single dose--limits the researchers themselves noted.

Castration and Cancer

Men with spreading prostate cancer are five times as likely to survive if they undergo castration--either chemically or surgically--immediately after the prostate is removed, a study found.

Edward M. Messing of the University of Rochester Medical Center and doctors in five other cities around the country treated a total of 98 men whose lymph nodes were shown to contain cancer after prostate removal--men who often do "disastrously poorly" without treatment. The men were randomly assigned to undergo castration--either medically or through removal of the testicles--or to be watched until their disease progressed. Thirty-three of the men chose the hormone treatment; 13 chose surgical castration.

After seven years of follow-up, three of the men castrated--chemically or surgically--had died of prostate cancer, compared with 16 of the men who were watched for further symptoms before starting hormone treatment, the researchers report in today's New England Journal of Medicine. Cancer recurred in 41 of 51 men who got delayed treatment, compared with seven of 47 who immediately got hormone therapy.

Castration is a desperate measure, but spreading prostate cancer is a killer, and some men become impotent anyway from prostate-removal surgery.