- Email: [email protected]
Packing therapy for autism
Correspondence
*Benjamin Queyriaux, Alexis Armengaud, Charles Jeannin, Elisabeth Couturier, Françoise Peloux-Petiot [email protected] French Institute of Public Health Surveillance, South Inter-regional Epidemiology Unit, 13008 Marseille, France (BQ, AA PM); French Forces Institute of Tropical Medicine, Marseille, France (BQ); Mediterranean Mosquito Control Interdepartmental Alliance, Montpellier, France (CJ); French Institute of Public Health Surveillance, Paris, France (EC); and Departmental Health Authority, Nice, France (FPP) 1
2
Chretien JP, Linthicum KJ. Chikungunya in Europe: what’s next? Lancet 2007; 370: 1805–06. Rezza G, Nicoletti L, Angelini R, et al, for the CHIKV study group. Infection with Chikungunya virus in Italy: an outbreak in a temperate region. Lancet 2007; 370: 1840–46.
estimates. Depending on the level of exposure, an appropriate package of interventions can then be implemented in the targeted areas. Rapid diagnostic tests allow for rigorous monitoring of malaria burden, which is essential for strengthening the momentum towards elimination of malaria. Populations have to believe eradication is possible, and one way is to show them that malaria is not universal, that areas where it exists can be identified, and that, with effective interventions, it can be controlled and even eliminated. We declare that we have no conflict of interest.
*Roly D Gosling, Chris J Drakeley, Daniel Chandramohan
Panos Pictures
The printed journal includes an image merely for illustration
724
Effective malaria control: better burden estimates needed
[email protected] London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK 1 2
Effective malaria control leading to reduced incidence and transmission is possible (Oct 27, p 1459).1,2 The main hindrance is identifying the right areas in which to apply the appropriate interventions. The commonly held belief, as quoted in your Editorial,1 is that malaria affects 3·2 billion people globally, 80% of whom reside in subSaharan Africa. These figures are overestimates since the models3 that generate them do not account for reduced transmission of malaria in ever-growing small urban settlements. Similarly, the current estimates of malaria prevalence that guide country policies are overestimated because they are based on clinical diagnosis, which is known to be non-specific. To establish effective control, a rigorous assessment of the geographical distribution of the disease is needed. Since transmission of malaria is focal, identification of areas for aggressive malaria control should be done in small geographic units.4 Malaria parasite prevalence surveys are costly and difficult to interpret. Use of serology5 for the assessment of exposure to malaria in populations would give reasonable
3
4
5
The Lancet. Is malaria eradication possible? Lancet 2007; 370: 1459. Bhattarai A, Ali AS, Kachur P, et al. Impact of artemesinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. Plos Med 2007; 4: e309. Snow R, Guerra CA, Noor AM, Myint HY, Hay SI. The global distribution of clinical episodes of Plasomodium falciparum malaria. Nature 2005; 434: 214–17. Yazoume Y, Kyotbutungi C, Louis VR, Sauerborn R. Micro-epidemiology of Plasmodium falciparum malaria: is there any difference in transmission risk between neighbouring villages? Malaria J 2007; 6: 46. Drakeley CP, Coleman PG, Tongren JE, et al. Estimating medium and long term trends in malaria transmission using serological markers of malaria exposure. Proc Natl Acad Sci 2005; 102: 5108–13.
the child to rid itself progressively of its pathological defence mechanisms against archaic anxieties”,3 where “archaic anxieties” refer to the child’s response to his or her earliest relationships. Rhode is therefore incorrect when she says that presentday psychoanalytic workers do not subscribe to such a theory—at least one of them does. I did not say that the Tavistock Clinic uses packing in its treatment of autistic children; however, many French children are being treated in this way. Delion and others believe that packing is beneficial. Many parents of autistic children believe that not only is it ineffective, but it is cruel. The results of the first ever clinical trial of the treatment have not yet been published. Although I appreciate the enormous challenge that the management of autistic children presents to doctors and other professionals, surely the question is whether they should be allowed to practise such a controversial treatment before it has been properly assessed? I declare that I have no conflict of interest.
Laura Spinney [email protected] c/o The Lancet, 32 Jamestown Road, London NW1 7BY, UK 1 2 3
Packing therapy for autism I take issue with Maria Rhode’s response (Jan 12, p 115)1 to my World Report2 on packing. In the 2005 edition of his book Le packing,3 Pierre Delion, who pioneered the technique for children, suggests that the child in the pack undergoes a regression, replaying in a secure environment the relationship between a mother and her newborn. He has also written that when packing is used as a therapy for autistic children who self-harm, it “allows
Rhode M. “Packing” therapy for autism. Lancet 2008; 371: 115. Spinney L. Therapy for autistic children causes outcry in France. Lancet 2007; 370: 645–46. Delion P. Le packing avec les enfants autistes et psychotiques. Ramonville Saint-Agne: Erès, 2003.
Department of Error Durrheim D. A clarion call for greater investment in global sanitation. Lancet 2007; 370: 1592–93—In this Comment (Nov 10), the image on p 1593 should have been credited to Still Pictures. The Lancet. Global HIV/AIDS estimates—looking beyond the numbers. Lancet 2007; 370: 1802— In this Editorial (Dec 1), the third sentence of the first paragraph should have read “However, with 6800 new infections and more than 5700 deaths every day, AIDS is still a leading killer globally and remains one of the primary causes of death in Africa, especially in sub-Saharan Africa.”
www.thelancet.com Vol 371 March 1, 2008
*Benjamin Queyriaux, Alexis Armengaud, Charles Jeannin, Elisabeth Couturier, Françoise Peloux-Petiot [email protected] French Institute of Public Health Surveillance, South Inter-regional Epidemiology Unit, 13008 Marseille, France (BQ, AA PM); French Forces Institute of Tropical Medicine, Marseille, France (BQ); Mediterranean Mosquito Control Interdepartmental Alliance, Montpellier, France (CJ); French Institute of Public Health Surveillance, Paris, France (EC); and Departmental Health Authority, Nice, France (FPP) 1
2
Chretien JP, Linthicum KJ. Chikungunya in Europe: what’s next? Lancet 2007; 370: 1805–06. Rezza G, Nicoletti L, Angelini R, et al, for the CHIKV study group. Infection with Chikungunya virus in Italy: an outbreak in a temperate region. Lancet 2007; 370: 1840–46.
estimates. Depending on the level of exposure, an appropriate package of interventions can then be implemented in the targeted areas. Rapid diagnostic tests allow for rigorous monitoring of malaria burden, which is essential for strengthening the momentum towards elimination of malaria. Populations have to believe eradication is possible, and one way is to show them that malaria is not universal, that areas where it exists can be identified, and that, with effective interventions, it can be controlled and even eliminated. We declare that we have no conflict of interest.
*Roly D Gosling, Chris J Drakeley, Daniel Chandramohan
Panos Pictures
The printed journal includes an image merely for illustration
724
Effective malaria control: better burden estimates needed
[email protected] London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK 1 2
Effective malaria control leading to reduced incidence and transmission is possible (Oct 27, p 1459).1,2 The main hindrance is identifying the right areas in which to apply the appropriate interventions. The commonly held belief, as quoted in your Editorial,1 is that malaria affects 3·2 billion people globally, 80% of whom reside in subSaharan Africa. These figures are overestimates since the models3 that generate them do not account for reduced transmission of malaria in ever-growing small urban settlements. Similarly, the current estimates of malaria prevalence that guide country policies are overestimated because they are based on clinical diagnosis, which is known to be non-specific. To establish effective control, a rigorous assessment of the geographical distribution of the disease is needed. Since transmission of malaria is focal, identification of areas for aggressive malaria control should be done in small geographic units.4 Malaria parasite prevalence surveys are costly and difficult to interpret. Use of serology5 for the assessment of exposure to malaria in populations would give reasonable
3
4
5
The Lancet. Is malaria eradication possible? Lancet 2007; 370: 1459. Bhattarai A, Ali AS, Kachur P, et al. Impact of artemesinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. Plos Med 2007; 4: e309. Snow R, Guerra CA, Noor AM, Myint HY, Hay SI. The global distribution of clinical episodes of Plasomodium falciparum malaria. Nature 2005; 434: 214–17. Yazoume Y, Kyotbutungi C, Louis VR, Sauerborn R. Micro-epidemiology of Plasmodium falciparum malaria: is there any difference in transmission risk between neighbouring villages? Malaria J 2007; 6: 46. Drakeley CP, Coleman PG, Tongren JE, et al. Estimating medium and long term trends in malaria transmission using serological markers of malaria exposure. Proc Natl Acad Sci 2005; 102: 5108–13.
the child to rid itself progressively of its pathological defence mechanisms against archaic anxieties”,3 where “archaic anxieties” refer to the child’s response to his or her earliest relationships. Rhode is therefore incorrect when she says that presentday psychoanalytic workers do not subscribe to such a theory—at least one of them does. I did not say that the Tavistock Clinic uses packing in its treatment of autistic children; however, many French children are being treated in this way. Delion and others believe that packing is beneficial. Many parents of autistic children believe that not only is it ineffective, but it is cruel. The results of the first ever clinical trial of the treatment have not yet been published. Although I appreciate the enormous challenge that the management of autistic children presents to doctors and other professionals, surely the question is whether they should be allowed to practise such a controversial treatment before it has been properly assessed? I declare that I have no conflict of interest.
Laura Spinney [email protected] c/o The Lancet, 32 Jamestown Road, London NW1 7BY, UK 1 2 3
Packing therapy for autism I take issue with Maria Rhode’s response (Jan 12, p 115)1 to my World Report2 on packing. In the 2005 edition of his book Le packing,3 Pierre Delion, who pioneered the technique for children, suggests that the child in the pack undergoes a regression, replaying in a secure environment the relationship between a mother and her newborn. He has also written that when packing is used as a therapy for autistic children who self-harm, it “allows
Rhode M. “Packing” therapy for autism. Lancet 2008; 371: 115. Spinney L. Therapy for autistic children causes outcry in France. Lancet 2007; 370: 645–46. Delion P. Le packing avec les enfants autistes et psychotiques. Ramonville Saint-Agne: Erès, 2003.
Department of Error Durrheim D. A clarion call for greater investment in global sanitation. Lancet 2007; 370: 1592–93—In this Comment (Nov 10), the image on p 1593 should have been credited to Still Pictures. The Lancet. Global HIV/AIDS estimates—looking beyond the numbers. Lancet 2007; 370: 1802— In this Editorial (Dec 1), the third sentence of the first paragraph should have read “However, with 6800 new infections and more than 5700 deaths every day, AIDS is still a leading killer globally and remains one of the primary causes of death in Africa, especially in sub-Saharan Africa.”
www.thelancet.com Vol 371 March 1, 2008