An Interview with Dr. Michael Goldberg

 

Q: How does your approach differ from other doctors?

A. I think that a very simple way would be to say that the autism we were taught as doctors was autism of thirty or forty years ago. It is not what these children represent today. Every child I have seen gives evidence of immune factors, viral factors. So the difference is we're looking at an illness creating a dysfunction in what was previously a regular child rather than this vague concept of something happening in utero. When you look at the data we have on these children, the viral markers and the progression of development with these children, it becomes very obvious that we can only explain this by a disease state.

Q: Do you agree that autism is an epidemic?

A. Yes. Everybody seems to agree that we have an epidemic of what is diagnosed as autism. But many good researchers forget that you cannot have an epidemic of any type of a developmental or genetic disorder. It is literally scientifically impossible. When I make that statement, I see people beginning to understand that autism is an illness and we need to treat it that way.

Q: So you're saying these children were born normal?

A. Yes. I think the whole key here - and most mothers have felt this from day one - is that these children started out okay. And somewhere between 12, 15 or 18 months - sometimes even later - the children slowly digress into this disorder called autism. But if you look at how the brain works, if you understand biology, you cannot have a normal child for 12, 15, 18 months of life who shows skills in developing and then lose those skills or stop progressing and somehow try to think that something went wrong before that child was born. This is only explainable by a disease process.

Q: Are you able to treat this disease we're calling autism?

A. I think the key here is that even though there is a wide spectrum, a wide range, you start understanding this as a disease. It's like any other disease. You can have mild, moderate, and severe cases, but it's all the same process. It's safe to say at this stage that literally a hundred percent of the children are immune mediated. Not every child has a virus, although a lot more have a virus than was anticipated a few years ago. If you only think of autism as a development disorder, you can try to educate the child but you can't really fix what's wrong. But if you understand this as a disease, the first goal is to get that child healthy, to get the brain and the body working and then education - what really becomes rehabilitation - is a lot more successful and a lot easier.

Q: Do we first need to know the cause?

A: In the past, we have looked for a reason for the disease and then figure out how to treat that. Thankfully, part of the idea behind the NIDS Research Board is to turn to researchers who have the ability to define a dysfunction and look at how to apply a therapy to that. You don't have to know what specifically created the cause of a dysfunction to treat it. As we go along, we will separate this out into which kids have viruses and what other factors are going on. But the hope right now is that we can build upon the knowledge that has come through in medicine in the last twenty years and apply new agents and new therapies to a disorder without having to specifically say exactly what caused the dysfunction in each kid.

Q: What message would you like to give to parents?

A: I think there are two things I'd like to say. One goes back to pediatrics. The first lesson in pediatrics was "listen to the mothers." The parents should believe in themselves. Their instincts about their children are more right than probably 99% of the experts at this point. The other key is that if they realize this is an illness, a disease, then they also have the right to believe in their child and to seek care and to seek changes for that child.

Q: How do they get care?

A: This has been one of the very difficult areas. As a pediatrician over the years, I have thankfully been associated with many advanced researchers on the NIDS Research Board who gave me the support to stick my neck out to do things that were not standard therapy at the time. Our plan is to help doctors around the country focus on the fact that this is a disease and to help them provide care for these children. We want parents all across the nation to have access to care while we pursue new agents and the clinical trials that will be necessary. My goal, as strong as I can say it, is that we do not make the kids wait another five or ten years for help.

Q: What kind of wake-up call do you give the medical community?

A: The good news is that when I lecture and speak to groups of doctors, it's become very easy to build a case that this is a disease process. It become much more logical to think of this as a disease than as old, vague idea of something called autism. The old way of thinking had no objectivity, no specific finding, and was a very nebulous idea to start with.

Q: How do you keep up with the growing patient load?

A: Everyone looks at this mystique called autism. And yet when you understand these children as children, it became very obvious to me as a pediatrician that I was dealing with children who were ill. I try to travel to various regions to meet with parents and I follow a large number of patients by phone. But this has become a crisis for me as I cannot be in fifty states at one time. These kids need medical care.

Q: What needs to be done?

A: I think that after years of struggling, as it has become obvious that we are looking at a disease, a neuro-immune dysfunction syndrome, the goal right now is to rapidly create a system out there of doctors who are willing to work together, provide centers that parents can trust, and who will give good pediatric care to these children.