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Article: Legislative Help
Written By: Mark Gettleman M.D. F.A.A.P. on 3/31/2008
The Arizona state Senate just passed a bill which blocks insurance companies from denying coverage for the diagnosis and treatment of autism, including behavioral therapy. The governor signed it, it is law. Great, you may be thinking. All those poor kids now can get the treatment they need. Well, not so fast…
My first issue is with the diagnosis. As many of you have heard we are in the middle of an Autism epidemic. While medical literature has dispelled the vaccine, mercury and other assorted causes, the numbers can not lie. Or can they?
Paul T Shattuck, PhD published a study in the April 2006 edition of Pediatrics which looked at this issue. He found while there was a dramatic rise in Autistic spectrum disorder from 1994 to 2004 from 0.6 to 3.1 per 1000, there was a corresponding decline in other diagnostic categories. In other words “diagnostic substitution” where the same child who might have received another diagnosis (like Mental retardation, Learning disability or ADHD) now is being labeled as autistic.
Dr. Shattuck’s national study collaborates an earlier study by Lisa A. Croen, et al. which studied children in California from 1987 to 1994. The rates of autism increased from 5.8 to 14.9 per 10,000 (a change of 9.1) meanwhile, Mental Retardation decreased from 28.8 to 19.5 per 10,000 (a change of 9.3).
Why does this matter? Besides the fear factor, by misidentifying people as autistic we are not only giving them a label, we are also diluting research, funding and care from the kids that truly have autism. How many thousands of more children with minor behavioral issues will now be labeled “autistic,” so as to ensure payment for diagnosis and treatment? If there is a cure or better treatment out there for people with Autism, we will only find it if we are looking at people with the true genetic disorder.
If we take the IQ model as an example, in the late 1960's, 10 million people were “cured” of mental retardation instantaneously. The definition was changed from -1.5 standard deviations to -2.0. After changing the definition, people on the lower end of the bell curve (75-55) no longer had a medical disease. They were just the “tail end” of normal. I wonder if we are doing the opposite with Autism, taking kids that are normal but below average and including them in this group.
My second major concern has to do with mandating the insurance agency to cover something. It may sound reasonable and fair, and I am no fan of the insurance industry, but as you dig deeper, it it really isn't such a good idea. Cost for this type of care can be expensive, so there is a cap at $50,000. But with the number of “autistics” increasing exponentially, especially with “diagnostic substation”, this is going to be a pretty hefty bill. Unfortunately for us, it will not come out of the insurance companies profits. That means either your premiums will go up, or something you need (that does not have as strong of a lobby) will not be covered.