Robert Delaney is a geologist who does environmental cleanup in Michigan. While cleaning up an abandoned military base, he found remarkably high contamination by a chemical called PFOS. He had been wondering what causes autism. He came across a rodent study that found that the combination of PFOS and ultrasound was much more damaging to the nervous system than either alone. (See also this study.) He remembered that study when he read my posts about ultrasound and autism. He wrote to me:

You will know the chemical PFOS (perfluorooctane sulfunate) from spray-on fabric treatments that protect clothes from stains and water. IÂ want to tell you about the possible connection between PFCs (perfluoroalkyl chemicals, especially long chain PFCs) and autism. Â I learned that mice and rats contaminated with PFOS, a PFC, when exposed to ultrasound convulsed and died. Â I was reminded of that finding when I read your blog about Caroline Rodger’s idea that prenatal ultrasound causes autism. Â I have thought that PFCs were causing autism for some time. I wondered if lower levels of PFOS would cause some type of brain injury, short of convulsions and death, when the mice were exposed to ultrasound.

I work on cleaning up military sites and attend a lot of related conferences and meetings.  I am working on a focus group with the Association of State and Territorial Waste Managers Organization that is looking at emerging contaminants (contaminants that are not regulated or so recently regulated they are still a problem). Because of that, I was recently made aware of the PFCs because the military had identified these contaminants in firefighting foams.  I was doing a cleanup at the former Wurtsmith Air Force Base in Michigan.  I decided we should check for PFOS and PFOA at the site. There were high levels of both PFOS and PFOA even though it was 20 years since the based had been used. When we checked groundwater, we found it in every well at every depth.  In my 25 years in the environmental business I have never seen anything like it.

I started researching the chemicals as it was apparent that I would have to deal with them. Â I discovered that at least 98% of Americans have them in their blood. That isn’t surprising because they are in everyday products such as food wrappers and popcorn bags, shampoos, cleaning supplies, carpeting, furniture materials, clothing, and dental floss. They are used in firefighting foams, pesticides, automotive parts, computers, electronics, and lubricants. Â They have ended up in our food supply and drinking water.

I had been researching the occurrence of autism for other reasons.  It had occurred to me that whatever was causing the dramatic rise in autism around much of the world, it had to be ubiquitous in the environment, of recent origin, with increasing use, and found in at least the US, Canada, Europe, Japan and Australia where the autism rates were exploding.

PFCs fit these characteristics. Â They are found around the world in mammals, birds, fish, shellfish, etc. Â In fact, the Canadian government reported that the blood levels of PFCs in polar bear above the Arctic Circle were higher than the levels of any pesticides they had ever measured.

Research in the Great Lakes Region is showing high levels of PFOS in the lakes. In some places in the Lakes the contamination exceeds preliminary drinking water standards. Because these are huge bodies of water, to have so much contamination is amazing. High concentrations have been found in mink, fish, gull eggs, eagles, etc. around the Great Lakes. Fish and drinking water in Minnesota have been impacted over large areas. Europe has now banned PFCs for most applications.

What got me wondering about autism and PFCs was that in lab animals and in test tube experiments with human brain cells they are developmental neurotoxins. Many chemicals are neurotoxins, such as chlorinated pesticides and other chlorinated compounds (such as PCBs), organic mercury, and lead. Â However, we in the western world have been aware of these facts and for the last thirty years have been reducing use and exposure to these chemicals. Â But while we have been reducing our exposure to mercury, lead, and so on, neurologic diseases have been on the rise. Â No one suspected PFCs were harmful to humans. Their use has continued to increase.

The half life of the chemicals in our body is around 5 years, so in 5 years, if you have not gotten any more exposure to PFCs, half of them would still be in your body.

There are a lot of reasons to think PFCs may cause autism. Here are a few. First, the company that invented PFCs (3M) is located in Minnesota. There is widespread PFC contamination in Minnesota. As I was preparing a talk last week, I googled…”autism state rates.”  The first site to pop up listed Minnesota as having the highest levels of autism of any state. New Jersey has unusually high PFO contamination of drinking water; they also have a very high level of autism. The military, which has used a great deal of fire-fighting foam, has double the rate of autism of the general U.S. population.

In laboratory experiments PFCs influence brain wiring. The impact of PFCs in some mammals is sex-dependent with males being more affected; autism is 4 times more common in boys than in girls. PFCs are associated with repressed immune systems in animals which has been associated with autism as well. Deranged behavior/ADHD behavior has been reported in PFOS-exposed mice. Â ADHD in children has been associated with prenatal exposure to PFCs.

Unfortunately, the EPA did not include PFCs in their list of chemicals that might be causing autism. My colleague and I have put together a web page if people want more information: https://www.autism-pfos.net/

Yes, why does Minnesota have such high autism rates? It is not an industrial state. It is not a rich state. Yet it is where PFCs were invented and manufactured in large amounts (e.g., ScotchGuard). I can’t think of a plausible alternative explanation. The lab results (ultrasound plus PFOS far more damaging than either alone) makes perfect sense: If there is a bad molecule in neural tissue, it is going to do a lot more damage if you start shaking it, which is what ultrasound does.

I previously blogged (also here) about Carolyn Rodgers’s idea that prenatal ultrasound may cause autism. It turns out that she isn’t the only person with this idea; researchers at the University of Louisville recently published the same idea.

I learned about the Louisville study from Anne Weiss, who said the connection has been plausible for a long time.

Ultrasound was introduced into obstetrics in the 1970′s and was generally restricted to high-risk pregnancies. By the 1980′s policy statements were issued by ACOG, the NIH and equivalent bodies in Europe and Canada stating that its use should remain limited to high-risk cases. Despite these recommendations, ultrasound technology became common in hospitals and doctors’ offices and routinely applied to low-risk populations. Within a short time the majority of pregnant woman were being exposed at prenatal visits, during multiple scans in hospitals, and during continuous monitoring during labour (which could mean 12 to 14 hours during childbirth alone). Skills and techniques used to monitor the fetus prior to the introduction of ultrasound (in utero and during the birth process) were slowly undermined by the technology and often underutilized. Iatrogenic effects from false positive readings, – unnecessary C- sections, inductions, instrumental deliveries etc. caused harm to moms and babies, especially in the early 1980′s.

Three important names in the 1980s were (1) Robin Mole, who presented a paper “Possible Hazards of Imaging and Doppler Ultrasound in Obstetrics” to the Royal Society of Medicine Forum on Maternity and the Newborn: Ultrasonagraphy in Obstetrics, April 1985. She was former director of the Medical Research Council Radiobiology Unit, England. Also the work of (2) M.E. Stratmeyer – Research in ultrasound. A public health view. Birth and Family Journal 1980 and (3) Doreen Liebeskind – still at Albert Enstein and a prof of radiology- presented at a symposium at Columbia in 1983.  She was concerned that ultrasound may be producing subtle changes in the fetal brain perhaps affecting behavioral mechanisms, possible changes in reflexes, IQ, attention span or some of the more subtle psychological, psychiatric or neurological phenomena. Referred to animal and lab studies that showed ultrasound may cause chromosomal damage, breakdown of DNA, etc. There are others who sounded the warning that this was not a benign technology but these voices were crowded out for varied reasons like threats of litigation, loss of the traditions skills of birthing etc.

There were also Japanese studies that raised concerns about ultrasound. Weiss continued:

Unfortunately the use of ultrasound in obstetrics has not declined, despite safety concerns and the lack of research to rule out serious neurological effects. It’s so entrenched in modern obstetrical practice.  Doctors use the machines to protect themselves from litigation – in the case of fetal abnormalities, undetected multiples, placenta previa, neurological or physical damage to the fetus during childbirth, stillbirth etc. It has almost become a form of entertainment – you can get photos and videos of baby’s ultrasound. It’s disturbing how benign it appears.

Within the context of the work I do, ultrasound is just one of many concerns I have with the over-management and medicalization of childbirth. My clients come to me to find ways to subvert this within the hospital setting or to prepare for a home birth with a midwife.  I also get referrals from doctors whose patients are dealing with difficult issues while pregnant.

Caroline Rodgers, whose ideas I blogged about yesterday, wrote to me about lack of research on the possibility that prenatal ultrasound causes autism:

I have heard confidentially that applications for funding of prenatal ultrasound studies (not specifically investigating autism) have been repeatedly denied over the years — which helps explain the great paucity of safety studies, especially since the early ’90s, when the FDA approved an allowable eightfold increase in acoustic output. As recently as this year, funding was denied an ambitious, multi-site study that would have investigated if there was a relationship between ultrasound and autism.

In 2006 when Yale neuroscientist Pasko Rakic announced the results of his study that found prenatal ultrasound interrupted neuronal migration in mice in a way that was consistent with the brains of autopsied autistics, I was surprised that several scientists, including Rakic, did their best to downplay the results. At the time, Rakic was one of many of Autism Speaks’s scientific advisors.

I have spoken with various people throughout the NIH about my concerns [about ultrasound]. They all pointed to various large studies they believe are investigating ultrasound as a possible environmental cause of autism — most recently, the National Children’s Study and EARLI, but when I tracked down the study designs, it turned out that ultrasound is not being studied.

In a report at the time Rakic’s study was published, he indeed downplayed the results:

Dr. Pasko Rakic, chairman of the Yale department of neurobiology and leader of the study, was quick to offer parents reassurance about the safety of ultrasound — done for the proper reasons — in human pregnancies.

“If I had a daughter and she was pregnant, I would recommend she had it for medical reasons,” Rakic said.

Another researcher agreed:

“I couldn’t agree with him more,” said Dr. Joshua Copel, a professor of obstetrics, gynecology and reproductive sciences at Yale and spokesman for the American College of Obstetrics and Gynecology (ACOG). He was not involved in the study. . .

The researchers noted that mice are very different from humans, so the results of their study must be interpreted with caution.

“The forms of migration [of brain cells] and the timing of migration differ in primates like humans than in mice,” Copel said. “In humans, there is a much longer period in which neurons [nerve cells] are migrating.”

Does that sound “very different”?

I blogged earlier about Caroline Rodgers’s idea that prenatal ultrasound may cause autism. She believes this idea isn’t getting the attention it deserves.

Recently she wrote to the head of Health and Human Services:

The latest autism prevalence figures released in December showed that while the overall autism rate increased more than 50% in the four years ending in 2006, there were significant differences across ethnic groups. White women had a much higher incidence of autism among their children than Black or Hispanic women. White mothers had 9.9 autistic children per 1,000, versus Black mothers who had 7.2 and Hispanic mothers who had 5.9.

There were also geographic differences. Among the 10 states with monitored sites, Alabama and Florida had the lowest autism rates, with averages of 4.2 and 4.6 per 1,000, respectively — far lower than the two states with the highest autism rates, Arizona and Missouri, which tied at 12.1 per 1,000. One interesting apparent statistical anomaly occurred among Alabama’s Hispanic population, which had a 68% decrease in autism while the overall national increase was 57%. In trying to understand why Alabama Hispanics had such a decrease in autism, I searched for evidence of public health policy changes. What I found was a surprise: according to a CDC multi-state surveillance report, Alabama and Florida were two of three states that had cutbacks in Medicaid funding for prenatal care during the time mothers in the study were pregnant. (The third state, West Virginia, was not among those monitored for autism in the latest study.)

Digging deeper, I turned up a CDC report on the timing of entry into prenatal care. The report showed that although most women started prenatal care in the first trimester, the percentages of both Black and Hispanic women who lacked early (first trimester) prenatal care were nearly twice that of White women . . . Over the span of the 10-year study, more women [in] all ethnic groups received early prenatal care, but the 2-to-1 ratio remained the same. . . .
Taken together, these three CDC reports tell a disturbing story: as more women . . . received more early prenatal care, the autism rate among their children increased, with those women receiving the most early prenatal care having the highest percentage of autistic children. . . .

A rigorous UC Davis study, published in January, of California children born between 1996 and 2000 identified 10 autism clusters . . . Highly educated women were much more likely to have children diagnosed with autism than parents who did not finish high school. In six of the clusters, the rate was as high as 4 to 1. Returning to the CDC Entry into Prenatal Care report, it is striking to note that in 1997 only 8.5% of pregnant women with some college education had delayed prenatal care, versus 29.9% of women who were not high school graduates — further [linking] early prenatal care [and] autism.

A study published in November on prenatal ultrasound trends from 1995-2006 found that the odds of a woman receiving an ultrasound during a prenatal visit nearly doubled over [those] 10 years. . . . The geographical and ethnic differences . . . dovetail with many of the geographical and ethnic differences found in the latest autism prevalence report. For instance, Southern women were 40% less likely to receive an ultrasound during a prenatal visit than Northeastern women, which could help explain why Florida and Alabama had the lowest autism rates among the states monitored. Also, Hispanics, who had the lowest overall autism prevalence rates in both the 2004 and 2006 CDC reports, were 20% less likely to receive an ultrasound during a prenatal than White women.

Not all the statistics available in these reports support the idea that prenatal ultrasound is causing autism. For instance, Southern states such as Georgia and North Carolina did not have low autism rates, but [perhaps this is because] the ultrasound trends study did not take into account “keepsake” ultrasound . . .

She also notes that a study by Yale neuroscientist Pasko Rakic “found that prenatal ultrasound disturbed neuronal migration in mice.”

Here is the broad argument. 1. Autism is correlated with wealth. It is absurd that autism causes wealth; it is unlikely that both are caused by something else. Thus this correlation makes it plausible that autism is caused by something that rich people have more of than poor people. Obviously rich people have more prenatal ultrasound. 2. A localized decrease in autism happened at the same time autism almost everywhere was increasing. At the same place and time prenatal ultrasound screening surely declined. This correlation is very difficult to explain with other ideas about what causes autism. Dozens of things (e.g., genes, diagnostic criteria) previously proposed as explanations of autism remained roughly constant at the same time as the decrease. 3. The mice data make the linkage considerably more plausible, assuming (a) the ultrasound dosage was reasonable and (b) humans with autism have unusual neural wiring that resembles the changes seen in the mice.

The full letter is on her blog. An article by Rodgers about this