EBD Blog

Although I have followed the promotion of secretin as a treatment for Autism pretty much since the first reports about it, I hadn’t checked on it lately. My initial foray into the topic in 1998 resulted in some skepticism with hedges. As the research evolved, it became clear that the skepticism was warranted.

However, I was surprised that Stephen Edelson, writing in a 2008 article entitled The secretin story: Still a promising treatment for autism,” considered “the studies investigating the efficacy of secretin have been very positive.” Coupled with some vaguely remembered notion that fewer than 50% of physicians discouraged use of secretin, the article gave me pause. I thought, “Hmmm. Maybe you’re earlier analysis was hasty, John.”

At first, I was mystified that the results could have turned around so strongly. But as I read on into Mr. Edelson’s article, I realized that he was referring to studies that did not test for effects (e.g., one showed that secretin-like substances were present elsewhere in the body) and that the study he described as showing effects was about the only one among the existing studies that did so. Maybe those results hadn’t turned around so strongly.

Still, I thought I ought to look into the matter a tad. I already knew that, in work reported via the Cochrane Collaboration, an international organization that provides accurate information about the effects of health-care interventions, Katrina Williams and colleagues had reviewed the literature about secretin and discouraged its use. They concluded their review in this way:

There is no evidence that single or multiple dose intravenous secretin is effective and as such it should not currently be recommended or administered as a treatment for autism. Further experimental assessment of secretin’s effectiveness for autism can only be justified if methodological problems of existing research can be overcome.

But, after all, the quite-careful Williams review was from 2005, so maybe there was newer research. I found a reference to secretin and autism by Tristram Smith (2008), of the University of Rochester (NY, US), but he depended on the Williams review in his paper in The Scientific Review of Mental Health Practice.

There was another review (Sturmey, 2005) that reported essentially the same results as Williams et al. But, then I found a study by Y. Toda and colleagues (2006), who reported that 7 of 12 (within chance, I bet) of the children had a behavioral improvement. The study (a) had no control group, (b) included only a dozen children and (c) focused primarily on biophysical effects.

More recently, though, the reviews are still about the same. In 2008, Susan Levy and Susan Hyman reiterated their earlier (2005) observation that secretin was not effective, even going farther and writing, “Some [complimentary and alternative medicine] practices have evidence to reject their use, such as secretin.” David Posey of Indiana University School of Medicine and colleagues (2008) mentioned that secretin does “not appear to be efficacious for [Autism's] core symptoms.” However, these papers are focused on complimentary and alternative therapies, not an exhaustive review of the literature on secretin.

In short, I found nothing that overturned the results of the Cochrane Consortium review by K. Williams and colleagues. So, I’m sticking with my original skepticism: Secretin is an unproven treatment for Autism.

Still, all this caused me to wonder about the penetration of “evidence-based medicine” into the general population of physicians. In their survey that helped make me pause, Allison Golnik and Marjorie Ireland (2009) reported that, in fact, only 43% of the physicians in their survey (warning: low response rate) of physicians discouraged use of secretin. Not all of the other 57% necessarily encourage use of secretin (some may not have responded to the question), but given the evidence, I hope the other doctors read the reviews.

Link to the online version of Professor Smith’s review, via the Web site, Association for Science in Autism Treatment (and check the other valuable resources there when you visit the site). Link to my earlier Web page about secretin and autism; there’s a lot of additional information there.

References

Golnik, A., & Ireland, M. (2009). Complementary alternative medicine for children with autism: A physician survey. Journal of Autism & Developmental Disorders, 39, 996-1005.

Levy, S., & Hyman, S. (2005). Novel treatments for autistic spectrum disorders. Mental Retardation & Developmental Disabilities Research Reviews, 11, 131-142.

Levy, S., & Hyman, S. (2008). Complementary and alternative medicine treatments for children with autism spectrum disorders. Child And Adolescent Psychiatric Clinics Of North America, 17, 803-820.

Posey, D., Erickson, C., & McDougle, C. (2008). Developing drugs for core social and communication impairment in autism. Child And Adolescent Psychiatric Clinics Of North America, 17, 787.

Smith, T. (2008). Empirically supported and unsupported treatments for autism spectrum disorders. Scientific Review of Mental Health Practice, 6, 3-20.

Sturmey, P. (2005). Secretin is an ineffective treatment for pervasive developmental disabilities: A review of 15 double-blind randomized controlled trials. Research In Developmental Disabilities, 26, 87-97.

Toda, Y., Mori, K., Hashimoto, T., Miyazaki, M., Nozaki, S., Watanabe, Y., et al. (2006). Administration of secretin for autism alters dopamine metabolism in the central nervous system. Brain & Development, 28, 99-103.

Williams, K. J., Wray, J. J., & Wheeler, D. M. (2005). Intravenous secretin for autism spectrum disorder. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003495. DOI: 10.1002/14651858.CD003495.pub2. [Summary; Full Text]