Q:  Reader Inquires about the "Pfeiffer Approach"

Regarding "Pfeiffer Approach": I read with interest the recent posting asking about the Pfeiffer Treatment Center. Before I continue, here is the PTC web link: http://www.hriptc.org, as well as a link to their research projects: http://www.hriptc.org/research_studies.html.

I was hoping that Dr. Phelps might be able to take a quick look at Pfeiffer papers and provide a first impression (at least one was published in a peer-reviewed journal: http://archneur.ama-assn.org/cgi/content/abstract/63/8/1161). I am a professional academic researcher, but have no biochemistry background.

I think they have an interesting and complementary approach to psychiatric medicine, although I'm in no position to evaluate it. While they don't advocate getting off of psychotropics -- although some of their clients do succeed -- they base their research on correcting chemical deficiencies in the body through supplements. Apparently, their autism research has been fruitful. 
 

Dear Rachel --

Given that there is so little information on effective treatments for autism, it is understandable to look broadly for any clues that might lead to some sort of beneficial treatment. One might even consider treatment approaches for which there is relatively little evidence, particularly if for some reason one could believe that they carried relatively little risk.

Of course, this very situation also leads to great enthusiasm for any emerging treatment that might show even suggestive evidence of benefit. So we should all be mindful that it is easy to approach these decisions with a bias toward belief. Again, this does not mean that the belief might ultimately prove to be unwarranted. It just means that we are all likely to be susceptible to scant evidence interpreted favorably.

That would be my interpretation of the work of the Health Research Institute referenced here. So far, they have produced some interesting work on possible "biochemical abnormalities", which would of course warrant replication by an independent research group before we were to presume that these are indeed part of the mechanism of autism. Nevertheless, they are interesting findings and not unimportant.

Reading on, in their literature, one comes to a treatment approach they have developed based on these initial biochemical findings. They are reporting "open trial data", meaning that the results they describe are in consecutive patients offered the treatment. The patients were not randomized to the treatment, versus a control treatment. As you probably know from your own work in science, the "randomized controlled trial", with blinded participants and researchers, is the gold standard by which to judge a treatment's effectiveness. The open trial is designed to provide evidence suggesting that a randomized trial is warranted.

Sometimes however, all we have to go on is open trial data, because the randomized trial data is either pending or unlikely to arrive at all because of a lack of funding for such research. From the references you sent, it looks to me like that is the stage at which the Pfeiffer Approach stands at this point. I wrote another reply this week to someone asking about "holistic" treatments which expands further on the difficulties one faces in evaluating the risk/benefit ratio of novel treatments. You might be interested in that note as well.

Dr. Phelps



Published May, 2007