You mean the health of the people of the world?

It's highly asymmetrical. But where do you set your bar? I, as an academic physician involved with global health, have my own views on it, but what would your particular criteria be?

Autism is a brain development disorder that typically develops before the age of three. Autism has many different symptoms and attributes, however there is no accurate explanation for the origin of autism. What we do know is that autism is a highly heritable trait. The actual genes responsible for autism are not yet identified, which I fell leaves this subject matter wide open for opinion and theories.

Autism is unique in that the people who have these traits are limited in some ways, yet they have immense potential for achieving great feats in their lives. My opinion comes into play at this one question; is autism truly a handicap, or are the people with autism quite simply living and perceiving a totally different reality from the norms of society?

I will address this question in segments, starting with the question posed, is autism a handicap? There is no one symptom that defines the diagnosis of autism, but rather a series of symptoms, often displayed in patterns. There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling.

The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.

Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can't understand social cues, such as tone of voice or facial expressions, and don't watch other people's faces for clues about appropriate behavior. They lack empathy.

Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. According to history, Van Gogh committed acts of self destruction, and had episodes of explosive anger; he was also very obsessive about his art. He may have possibly had high functioning autism (HFA). People with autism also tend to start speaking later than other children and may refer to themselves by name instead of "I" or "me." Children with autism don't know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.

Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.

There are unique characteristics that also develop with autism. Whenever a person with autism develops an interest in something, that interest can develop into an obsession. There are autistic people with an extraordinary ability to memorize massive amounts of information, and there are those with autism that immerse themselves into the world of art. Not too far back in history these extraordinary artists and information reservoirs were called idiot savants, but with the progression of medical, scientific, and psychological studies, these savants have been both renamed and diagnosed. There currently is no cure for autism, but there are measures that can be taken to assist the developmental process to give the individual an opportunity to cope in and with society. There have been very many success stories accredited to the autistic, and generally they are able to cope well as time progresses.

Finally, I want you to take into account that perception is an individual's reality. Just as autistic people do not recognize emotional cues and act the way they perceive to be right, we create our own perceptions of reality as well. Does this mean that we have a handicap as society? We've already studied the structures that outline autism, and I'm sure that we would conclude that autism is in fact a handicap. Even though we are productive and don't have totally negative contributions to the world, we do not perceive that our actions are in anyway wrong, just as autistic people don't. Yes, there is an ulterior motive to this thesis. I wish to point out the sickness of our society. We live in a world full of people, and we all share the same planet, yet we are divided. Here are the symptoms; we have greed, animosity, segregation, gullibility, fear, and emotional dependence on fictitious creations of imagination. We are sick, and we need medication, and that medication is unity, codependence, and rationality.

A lot of the negative symptoms we have are codependent in and of themselves. Greed drives us to desire domination over other people, creating segregation between groups of people. The weak minded masses that follow these greedy men are gullible and believe whatever the greedy and powerful tell them. Both curiosity and gullibility lead people to believe in supernatural powers that they must be appreciative and loyal to. The greedy men of power see the opportunity to play on people's convictions and emotions, and use these religions to accommodate their personal interests. They then create consequences for not complying to the religion, driving the people into fear, subsequently engraining the belief that much deeper. Kind of a masturbate and you'll go blind tactic. These beliefs then drive people to believe they are somehow different, or even better than other groups of people, and the seed of segregation grows into a tree of division between all mankind. Just as the autistic, we think that this is just fine, and we accept it as the way things are. But unlike those with autism, we have a cure.

Tear down the walls of segregation, recognize every person and country as necessary for our overall survival, and put everything that we accept as the norms of society into retrospect, and reevaluate our sentiments and their necessity. If in a social environment perception becomes our reality, we need to perceive that change is both necessary and realistic. We have a cure, and we should take advantage of this cure; some people don't have that advantage.

In last week's New England Journal there was an article that identified a genetic polymorphism that was present in 1% of American and European autistic kids, but virtually absent in the general population. That doesn't mean that that gene is causal, it could just be linked with a different causal gene through genetic segregation. I would find it extremely hard to believe that Van Gogh had an autistic spectrum disorder. I've cared for probably hundreds of kids with autistic spectrum disorders. Abstract creativity is something that would be exceedingly unlikely, even for a savant.

But why are we talking about autism? You asked about the state of health in the world, and the example you focus on is all in all a fairly uncommon, non-communicable condition that puts little demands on any society (even though it puts great demands on the affected family).

Why don't you talk about malaria, hookworm, tuberculosis, or any one of thousands of other diseases with huge importance to health?

In other words, I don't quite follow how you've gotten from your initial question to your exposition on autism.

There may be a lot of truth there, but at the same time I think it's hard to generalize. In general I regard health as a state of physical being that allows people to self-actualize -- i.e. to live the lives they want. But health is an active process too, it's something that has to be maintained.

Yes. I'm triple-boarded in pediatrics, internal medicine, and pediatric infectious diseases. I'm a junior faculty member at a major medical school, and I do research, teaching, and clinical care.

In all honesty by far the most important relationship here is that certain psychological dispositions prevent people from taking good care of themselves. They can neglect themselves, do self-destructive things, underutilize the medical system, overutilize the medical system, and sometimes will simply have great difficulty understanding their own agency in their health.


Well, the world is very complicated. Start from the worst places on earth and move up. You first need peace. Without peace nothing is possible. You then need the basic infrastructure and health care to prevent rampant infant, child, and maternal mortality. You then need good education and literacy, along with equal access for women. You then need reasonable societal freedoms. Only then will people have enough physical, mental, and societal empowerment to take care of themselves and actually have a meaningful self-image. And empowerment is what this is all about -- the idea that people have some control over their own destiny.