TMC PULSE

T M C » P U L S E | N O V E M B E R 2 0 1 8 17 Join us at the Texas Medical Center Innovation Institute February 7-8, 2019 for the Precision Medicine Leaders' Summit South Hear from over 50 thought leaders in Precision Medicine keynotes, panel discussions, roundtables, and numerous networking opportunities. Topics of discussion include: SPEAKERS FROM: Mayo Clinic MD Anderson Roche Geisinger Genome Medical Baylor College of Medicine Fabric Genomics Cleveland Clinic University of Arizona Myriad Women's Health plus many more.... For more information contact Nigel Russell at nrussell@thejournalofprecisionmedicine.com or 317-762-7220 Visit www.precisionmedicineleaderssummit.com to Register - Use Code "TMC" for a 20% discount. Register now at pmlssouth.com - Immunotherapy and the Microbiome - Precision Medicine Clinical Trials and Novel Designs - AI's Potential Impact on Precision Medicine - Novel Methods for Computational Precision Medicine - Women's Health & Precision Medicine - Precision Medicine at Scale: How to Benefit Each Individual and their Communities - Precision Medicine in Women's Health - Innovation in Genomic Medicine Implementation - Investment Strategies in Precision Medicine - Molecular Tumor Boards autism scientists, psychiatrists, neurologists and bioethicists and people from the autism community. Q | What are the clinical mark- ers of autism and how early do children receive this diagnosis? A | The clinical expression of autism is at its most florid often around 18 to 24 months of age. That's the time when, according to the Centers for Disease Control and Prevention, a lot of children on the autism spectrum get diagnosed. That clinical expression of autism coincides with when you see a big increase in brain volume expan- sion on an MRI. We have a good MRI marker of autism through that brain volume expansion, and that's important because that's around the same time parents often remember their kid got vaccinated. Now, a research group at The University of North Carolina at Chapel Hill can go back a full year before and actually show changes on an MRI at six months of age that will predict which children are going to go on to develop those big changes at 18 months. And now a group at the University of California, San Diego can show that the changes are beginning prenatally. So we have a very good theory that there are genetic and epigenetic changes that are beginning prenatally that set into motion a developmental progression. The problem is, that's not a soundbite. Q | Rachel is now working at Goodwill. How is that going? A | Goodwill really came to the rescue for us in a big way. The philosophy of Goodwill is: It doesn't matter who you are, we're going to make it work. It's a very nurtur- ing place. Rachel walks to work and spends two hours a day there, Tuesday through Friday, sorting clothes. You can't underestimate the power of someone getting their first paycheck. In terms of affirming Rachel's existence, the satisfaction she gets is huge. The pride she has in that job—you can't put a price tag on that. Q | Back to vaccines and measles. Anything you'd like to say to parents trying to decide whether or not to vaccinate their kids? A | As recently as the 1990s, mea- sles was the single leading killer We used to say autism was 10 to 1 boys to girls, but it's probably far closer to 1 to 1 than we realize. It's just different for girls on the autism spectrum. They camouflage it better; they're more verbal, more interactive, but oftentimes in a very odd way. — PETER HOTEZ, M.D., PH.D. of children in the world and we've allowed it to come back because we've allowed an anti-vaccine move- ment to go unopposed. Vaccines Did Not Cause Rachel's Autism was very much driven by living in Texas and seeing what's going on down here with large numbers of kids not being vaccinated—with seeing what an anti-vaccine movement looks like unfiltered, unopposed. Somebody's got to speak out. The conversation was edited for clarity and length.

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