It is difficult to imagine more of a hornets' nest than the
etiology of mental illness. So when Cornell University economist
Michael Waldman poked it with a stick last fall, suggesting
that television was to blame for the rise in the incidence
of autism among young children in the US, he got plenty of
stinging criticism, much of it from the medical community.
Last week The Wall Street Journal demonstrated why that newspaper remains the gold standard
for journalistic explanation. In a story headlined "Mind
and Matter," WSJ reporter Mark Whitehouse laid out not only the controversy
attending Waldman's paper, but also described the nimbus of
doubt that surrounds the current vogue among economists to
discover "natural experiments" whose mysteries may be plumbed
through the use of "instrumental variable" statistical techniques.
The rest of the page one headline asked, "Is an Economist
Qualified to Solve the Puzzle of Autism? Professor's Hypothesis:
Rainy Days and TV May Trigger Condition."
Autism, of course, is the condition mentioned by that name
first in 1912 but authoritatively characterized only in 1943
that presents itself in some children, almost always before
the age of three: they experience social and language
difficulties, and engage in restricted and repetitive activity.
Perhaps you'll want to read the piece itself.
A subscription to the online WSJ is required to read it here
for free -- otherwise you can buy it, get a copy from a friend
or visit a library. Read the story carefully, and you'll
see that Whitehouse has laid out the story in sufficient detail
to understand the controversy, and placed it within a broader
context, as well.
For it is not just Waldman's findings of the effect of television
viewing on autism that are of interest, but those of Joshua
Angrist on the effect of Vietnam service on draftees' lifetime
earnings; Caroline Hoxby on competition among schools and
student performance; Steven Levitt on police "feet on the
street" and crime. Venerable authorities appear throughout
the story, like a Greek chorus, counseling caution: the University
of Chicago's James Heckman, MIT's Jerry Hausman, Berkeley's
David Card.
In each case, to make an argument, the investigator had to
find a proxy, an "instrument," through whose variation could
be gauged the suspected but otherwise unobservable relationship
of cause and effect between primary variables.
In Waldman's case, it was rain.
This business began in the autumn of 2003, when his two-year-old
son was diagnosed as having a mild autistic disorder. This
sometimes is enough to turn spouses on each other. Waldman,
then 48, an applied theorist who had worked on wage and promotion
practices, pricing strategies, copyright policies and business
cycles, turned his energy outwards. He began an energetic
study of the condition, and, in addition to pursuing the standard
treatments, sharply reducing his son's exposure to television.
(A sister had been born the summer before.)
Within six months, his son ceased to present symptoms of
autism. This in itself was unusual since, ordinarily,
autism is expected to last a lifetime. Waldman formed
the opinion that television had been the root of his son's
problem. He sought to interest medical researchers in his
theory. Unable to do so, he embarked on research himself.
What he had in the beginning was his intuition. The
incidence of autism diagnoses had been exploding (from one
in 2500 children in the US in 1975 to one in 160 children
today). The growth of television viewing by young children
was thought to be growing dramatically, too, thanks to new
technologies (cable, VCR and DVD). Perhaps the two were
connected
But there are no Nielsen ratings to point to what little
kids are watching, at least not yet. Nor is there any obvious
way to launch a clinical trial of the no-television treatment,
the way pharmaceutical researchers would investigate the properties
of a new drug: identify a population of susceptible babies,
randomly assign them to two groups, one with television privileges
and one without, and see what happened. With rare exceptions,
economists don't work that way.
If television were a trigger for autism, Waldman reasoned,
it should be more prevalent in communities where children
watched more TV. So, unable to measure TV time directly, Waldman
went looking for a proxy variable -- an "instrument." That's
where the weather came in. The more precipitation, the
more time in front of the TV, at least for some kids -- that
much had been established by the Bureau of Labor Statistics
American Time Survey.
And precipitation was something that people did measure carefully.
Working with county-level data for three states in which
the weather varied widely from place to place -- California,
Oregon and Washington -- Waldman found that autism diagnoses
correlated positively with precipitation. (What if it were
too much time spent indoors that causes autism?) He
tried a different technique, this time comparing California
and Pennsylvania, finding that autism diagnoses correlated
positively with cable television subscriptions, and venturing
the unusually firm conclusion that the spread of cable had
caused roughly 17 percent of the increase in autism in those
two states in the years between 1972 and 1989. (What if cable
TV news was covering the autism crisis?)
Along the way, Waldman enlisted in his project Cornell health
economist Sean Nicholson and Nodir Adilov, a professor of
economics at the Fort Wayne campus shared by Indiana and Purdue
universities. Last October, the three presented a paper, provocatively
titled "Does Television Cause Autism?," at a workshop of the
National Bureau of Economic Research. Cornell prepared a press
release.
That it gained sudden prominence owed to a coincidence. Gregg
Easterbrook, a political writer and science journalist, last
September had written an article for Slate,
called "In Search of the Cause of Autism: How about Television?"
When he learned about Waldman's paper a month later, he wrote
a second story: "TV Really Might Cause Autism: a Slate Exclusive,
Findings from a New Cornell Study." The fat was in the fire.
In his Wall Street Journal article, Whitehouse noted the great swings in expert opinion about the
causes of autism that have occurred over the decades. For
twenty years or so after World War II, many psychologists
believe that a lack of maternal affection produced the affliction
in some children. Child psychologist Bruno Bettleheim, among
others, popularized this "refrigerator mother" theory, also
blaming absent fathers, making life miserable for uncountable
numbers of parents -- until clinical studies showed there was
no support whatsoever for the hypothesis. Hereditary
factors then took over as the preferred explanation, with
a brief vogue for a link to measles vaccinations, which since
has been dispelled.
"Some experts think that in reaction to the discredited theories
the pendulum has swung too far away from the family," wrote
Whitehouse. He quoted Anna Baumgaertel, a developmental-behavioral
pediatrician at Children's Hospital in Philadelphia, who thinks
TV "may lead to autistic behavior in susceptible children,
because it interferes with the development of Ôlive' auditory,
visual and social experience." (Some of her autistic patients
have been heavy viewers of video and TV from a very early
age, she says.) The American Academy of Pediatrics recommends
against any television for children under two; Waldman thinks
the age of three would be more appropriate until more is known.
The wide gap between Waldman's findings and the skepticism
expressed by many in the medical community can be accounted
for in large measure by the difference in research styles,
says Alan Krueger, a Princeton University economist who is
a member of the board of reviewing editors of Science magazine. In medical science, no publicity is permitted
until an article is accepted, he notes; authors can't even
put their papers up on websites until then. A very different
ethic prevails in economics, because the journals are so slow.
Papers may be publicized as soon as they are published as
"working papers" by the Social Science Research Network or
National Bureau of Economic Research. The lesson, says Krueger,
at least in economics, is "buyer beware."
Waldman ands his co-authors have been invited to submit their
paper to a medical journal. There they'll deal with
the many objections that have been raised -- including the
conviction on the part of some researchers that there is no
autism epidemic, that the dramatic rise in reported rates
is the result of wider public awareness of the condition and
better diagnostic tools rather than any significant change
in its incidence. They'll lay out the steps they think
will be necessary to delineate the pathways by which they
think television can produce the physiological changes that
are characteristic of autistic children.
And, almost certainly, they'll be forced into closer cooperation
with pediatricians, brain scientists, cognitive psychologists,
linguists, psycho-pharmacologists and other experts dealing
with the riddle of autism, engaging in the "multilateral reciprocal
scrutiny" that Thomas Schelling has advocated, in a slightly
different connection.
Either that or they'll go back to economics.