Autism 'Patchwork' Begins During Pregnancy
June 28, 2012 --
Today the Supreme Court upheld the 2010 health care law in a dramatic victory for President Barack Obama. The lead up to today's decision has prompted debate between opponents and supporters of the Patient Protection and Affordable Care Act two years ago. Take a look at how we got to the health care system we have in place today.
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Prior to the 20th century, nothing even close to what could be called a health care system existed in the United States. Although the Civil War had led to some medical breakthroughs in terms of surgical techniques and pain management, medical knowledge, techniques and treatment availability at the time left little hope that patients would actually recover from severe ailments. As NPR's Alex Blumberg and Adam Davidson point out, medical treatments may have been downright medieval at the time, consisting of potions. But at least it was cheap. "In 1900, the average American spent $5 a year on health care ($100 in today's money)," they note in their report.
How the Civil War Changed Modern Medicine
In 1912, Theodore Roosevelt was the first presidential candidate to get behind the idea of a national health insurance plan. Roosevelt ultimately didn't win election that year. Proponents of government-provided health care tried to press the issue through state initiatives, only to see their efforts fail in 16 states. Roosevelt's plan may have certainly been ahead of its time, particularly since there weren't that many services that doctors could actually provide patients during that era.
At the same time, however, developments within the medical community changed the face of the industry. The horrors of World War I led to advances in the areas of wound care, sanitation, pain management and more, according to an article published in the Journal of the Royal Society of Medicine. Hospitals in the United States began to widely adopt the practice of using antiseptics to sanitize their facilities, preventing the possibility of medical personnel or patients becoming exposed to infection. That decade also saw the introduction of the first employer group insurance contracts (though not specifically for health insurance) as well as the first physician service and industrial health plans.
In 1928, Alexander Fleming made one of the most important discoveries in the history of medicine: penicillin, a life-saving drug used to treat countless millions. It would be decades, however, before penicillin would be mass-produced. Fleming's discovery was the signature achievement in an era that saw medical treatment become more effective, and, as a result, expensive. The Great Depression also fueled concerns about affordability of medical treatment as millions of Americans suddenly found themselves out of work. In 1929, Baylor Hospital provided the first group health insurance plan in the United States through an agreement with Dallas-area teachers. The plan was the forerunner of Blue Cross. The effort wasn't just meant to be in the best interests of patients, but also the hospitals. Patient facilities saw more empty beds as fewer patients during the Great Depression could afford treatment without participating in these collective prepaid health insurance plans.
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As part of his push to create a social safety net for Americans during the Great Depression, President Franklin D. Roosevelt advocated the passage of national health insurance. Roosevelt pushed ahead with efforts to pass Social Security first, a bill which intentionally omitted any mention of medical care to ensure its passage. Harry Truman attempted to carry on Roosevelt's legacy in 1945 by calling on Congress to create such a program. His efforts failed, partly due to criticism by the American Medical Association (AMA), who called the plan "socialized medicine." In this photo taken in 1937, First Lady Eleanor Roosevelt examines a chart of enrollment of health care insurance plans.
Like its predecessor, World War II would lead to new medical advancements, including the widespread adoption of antibiotics and the use of ultrasound. The war would also have a similar effect in terms of the spread of employer-sponsored health plans. Because the nation was in a state of emergency and had a legally mandated wage freeze as a result, employers had to attract workers to assist the war effort by providing them with benefits, including health insurance. Tax laws passed between 1943 and 1945 also gave breaks to employers who provided insurance to their employees, which gave businesses all the more incentive to offer coverage. Following the war, employer-sponsored health insurance became common. In 1951, around 77 million Americans had some kind of coverage, according to an insurance industry trade group. That era also saw one of the most celebrated medical achievements in history: Jonas Salk's polio vaccine.
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Although health insurance was widely available to employed Americans in the mid-20th century, the unemployed and the elderly were often excluded from these plans. President John F. Kennedy campaigned on the issue of insuring these groups. President Lyndon B. Johnson succeeded where Kennedy left off, securing the passage of a bill through Congress creating Medicare and Medicaid. At the bill-signing ceremony, shown here, Johnson presented former president Truman with the nation's first Medicare card. Within the medical industry itself, an increasing number of doctors began specializing in certain fields of medicine rather than acting as general physicians. By 1960, more than two-thirds of doctors reported themselves as full-time specialists, rather than general practitioners.
Starting with Richard Nixon in 1970, presidents have offered successive plans for covering the nation's uninsured, but they have have stalled for different reasons. In 1974, Nixon put forward a plan to cover all Americans through private insurance, only to have the Watergate scandal force him out of office. An economic crisis prevented Jimmy Carter from pushing forward with a national health plan. Congress late in Reagan's second term attempted to expand Medicare, only to have the law repealed the following year. Bill Clinton had a 1,300-page health care reform bill that was never even taken up for a vote in Congress. Since Nixon's presidency, health care costs have continued to rise, often outpacing inflation. This increase is due to a number of factors, including the increased use of new medical technologies for diagnosis and treatment. The Patient Protection and Affordable Care Act signed by President Barack Obama was intended to cover the 30 million Americans who live without health insurance, according to the bill's authors. It has been the most far-reaching piece of health care legislation since Johnson's signed the legislation creating the Medicare and Medicaid health care programs.
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The brains of children with autism contain a built-in patchwork of defects, suggesting that the developmental disorder begins while they are growing in the womb, reported a study Wednesday.
Researchers described their findings in the New England Journal of Medicine as "direct evidence" of a prenatal origin for autism, which affects as many as one in 88 children in the United States and has no known cure.
"Building a baby's brain during pregnancy involves creating a cortex that contains six layers," said co-author Eric Courchesne, professor of neurosciences and director of the Autism Center of Excellence at University of California, San Diego.
"We discovered focal patches of disrupted development of these cortical layers in the majority of children with autism."
For the study, researchers dissected brain tissue from 11 children, aged 2 to 15, who had been diagnosed with autism spectrum disorder (ASD) and who had died, most of them by drowning.
Looking for a specific set of 25 genes that had "robust, consistent, and specific expression patterns in the cortex," they compared them to brain samples from 11 children without autism, said the study.
Researchers found that 91 percent of the autistic brains were lacking -- or showed an unusual pattern -- of the expected genetic markers in several layers of the cortex.
The signs of disorganization were found in patches across the different layers of the frontal and temporal lobes of the brain, the parts that are responsible for social function, communication, emotions and language.
"The most surprising finding was the similar early developmental pathology across nearly all of the autistic brains, especially given the diversity of symptoms in patients with autism, as well as the extremely complex genetics behind the disorder," said co-author Ed Lein of the Allen Institute for Brain Science in Seattle.
Researchers said they still don't understand why these changes come about in some children, apparently leading to autism, but not in others.
The patchwork nature of the defects does, however, provide a clue as to why autism can affect people in various degrees, from severe to mild disabilities.
It also may explain why some children respond to intensive therapy and become better communicators when identified early, since the brain may be able to rewire some connections to overcome the areas that are not working.
NOAH K. MURRAY/THE STAR-LEDGER/Corbis
"While autism is generally considered a developmental brain disorder, research has not identified a consistent or causative lesion," said Thomas Insel, director of National Institute for Mental Health, which funded the study.
"If this new report of disorganized architecture in the brains of some children with autism is replicated, we can presume this reflects a process occurring long before birth."
The same research team had previously found that the brains of children with autism were heavier than other children's, and that they had more neurons in the prefrontal cortex.
The brains sampled for this study "represented nearly the entirety of tissue suitable for study at the Brain and Tissue Bank for Developmental Disorders at the National Institute of Child Health and Human Development and the Harvard Brain Tissue Resource Center," said the article.
Still, the fact that only 11 were studied means that more research is necessary, said Andrew Adesman, chief of developmental and behavioral pediatrics at Steven & Alexandra Cohen Children's Medical Center of New York.
"This study would have been stronger if they had a larger sample and included a group of children who had neurologic deficits but not autism," said Adesman, who was not involved with the research.
He nevertheless described the team's techniques for identifying microscopic brain abnormalities as "extremely sophisticated."
While some of the physical brain changes in autism were already known to science, the latest research provides a more detailed look at how this happens.
"This study is particularly important as it points to the potential role of several genes involved in the specification of distinct cortical layers during early brain development," said Patrick Hof, vice-chair of the Fishberg Department of Neuroscience, Friedman Brain Institute, and Seaver Autism Center at the Icahn School of Medicine at Mount Sinai.
Research like this "can provide us with crucial clues to develop novel therapeutic strategies toward a cure," he said.