The story presents almost no information from the research study. We just know it was about MRIs in males with autism and that the researchers found something abnormal. We don’t know what the abnormal findings were, except they were related to how the hemispheres communicate. We don’t know whether the findings fit with a theory about the biology of autism or whether this was simply a fishing expedition. We don’t know how many of the 80 patients had the abnormality, if the MRI required special equipment or software, and if these were findings that any radiologist could detect. That’s simply too many gaps to make the story reliable. Study authors’ comments came from a news release. To its credit, the story did include cautious comments from one observer at the end. The challenge for this story is they are reporting on a basic science study, just one that happens to use MRI rather than bench techniques and one that was published in a specialized, technical journal.
Autism is one of the most polarizing subjects in health, and the press can bear a big part of the blame. Reporting on autism tends to rely heavily on celebrity spokespeople, anecdotal profiles and advocacy organizations. It also has relied too much on science that has been improved upon or even discredited. That’s why it is even more important for reporters covering new research in autism to bring a very critical eye to the topic and to make good use of independent experts who can separate the emotions that understandably run high around the disorder from the science behind the research.
It takes until the very end of the story for there to be a comment on costs. An autism activist mentions,"So if there’s no targeted treatment to follow up on the results of this kind of scan, then it’s just another expensive test for parents who are already barraged with so many tests at diagnosis," she said. "And in that case, I see this as just a waste of money." We don’t know enough about the benefits or the harms so it’s hard to say if it’s a waste of money. The cost information about MRIs would not have been hard to find.
The benefits are not quantified. The implication here is that these physical defecits are only found in patients with autism and are never found in patients with "normal" brains or with any other disorders. This, of course, is difficult to conclude based on a study of 80 patients.
The story does something worse than failing to quantify the potential harms of MRIs. It allows an autism activist to say, "I’m always glad to see there’s more autism research underway, and there’s certainly no risk to having an MRI." No risk? At the very least there is the potential for MRIs to lead to unnecessary procedures. A recent study showed, for example, that there was a direct correlation between the availability of MRIs in an area and the number of back surgeries. The study’s authors concluded, "if increased MRI availability is associated with increased early use of low back MRI as well as with subsequent use of low back surgery, both of which have questionable clinical benefit, then widespread MRI diffusion may put patients at risk of a decrease in the quality of care they receive." Another risk is for renal injury when MRI is performed with contrast dye.
The story leaves readers very confused about the study, presenting neither the evidence nor the quality of the evidence. It says that, "Using MRI imaging, the team searched for differences in brain activity patterns in the microstructure of white matter tissue in 80 autism patients between the ages of 10 and 35." This makes it sound like the study only included autism patients, but then it goes on to say, "Communication deficits between the two hemispheres of the brain were, in fact, uncovered by MRI scans — differences that the team said were not found in the brains of people without autism." Does this mean that half the people had autism and half did not? Or was there another control group that is not quantified in the story? There is nothing in the story about the study design, and there is very little about the study’s limitations.
The story does a nice job steering clear of the typical suspect statistics about autism prevalence, and in characterizing autism disorders, it does a fairly good job. "The current effort, focused on patients already diagnosed with autism, used MRIs to locate areas of the brain where the left and right hemispheres do not communicate properly. These so-called "hot spots" are central to motor function, attention, facial recognition and social behavior — types of behaviors that are abnormal in people with autism."
The story does, technically, bring in an outside source, but the source is not someone with expertise in diagnosing autism disorders or in radiology. The source is "Laura Bono, the Durham, N.C.-based former chair of the National Autism Association and member of the board of directors of the autism advocacy group Safe Minds." It is good that Bono "expressed a certain amount of hesitancy about the prospects for MRI-driven diagnoses." But she may not be the best source to evaluate the results of this study.
The story makes no attempt to explain how autism is currently diagnosed or what this new information might do for patients in comparison to existing methods of diagnosing and managing the autism disorders.
MRI is FDA approved and has been around for a good while and is available to most of the US population. Still, there is no explicit mention in the story of MRI’s availability in general, nor any specific mention some mention of how much difficulty patients might have seeking an MRI for this use.
There is no claim made of novelty here. Nor is there any sense of how this study fits into the broader picture of autism research, whether this is a significant advance or what patients should do with this information. Is this the first study to look at this issue in patients with autism? If not, how does it fit with prior studies?
The story relies far too much on a press release from the journal Cerebral Cortex.