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English the 1944 treatise by Asperger in which he claimed to have discovered . Finally, in 1994, the American Psychiatric Association (APA) recognized the diagnosis of Asperger’s syndrome in the fourth edition of its Diagnostic and Statistical Manual (DSM). The syndrome is characterized by strengths such as unusually deep, narrow interests, and challenges in social communication and inter­action, in people with average IQ or above and no history of language delay. (In the 2013 revision of the DSM, the APA deleted Asperger’s syndrome in favour of a single category, disorder.) In digging anew into the deeper

historical context of Asperger’s work, RESISTANCE. CENTRE OF AUSTRIAN OF THE DOCUMENTATION COURTESY Sheffer fills in parts of the story anticipated in John Donvan and Caren Zucker’s history of autism, In a Different Key (2016; see B. Kiser Nature 530, 159; 2016), which referred to Czech’s early findings. Sheffer reveals how the Nazi aim of engineering a society they deemed ‘pure’, by killing people they saw as unworthy of life, led directly to the Holocaust. With insight and careful historical A ward in the Am Spiegelgrund clinic in , in the 1940s. research, Sheffer uncovers how, under Hitler’s regime, psychiatry — previously AUTISM based on compassion and — became part of an effort to classify the pop- ulation of Germany, and beyond as ‘genetically’ fit or unfit. In the context Hans Asperger’s of the ‘euthanasia’ killing programmes, psychiatrists and other physicians had to determine who would live and who would be murdered. It is in this context that diagnostic Nazi collusion labels such as ‘autistic psychopathy’ (coined by Asperger) were created. Sheffer lays out the evidence, from sources Simon Baron-Cohen absorbs the grave revelations in a such as medical records and referral letters, study on a paediatrician enmeshed in autism’s history. showing that Asperger was complicit in this Nazi killing machine. He protected children he deemed intelligent. But he he Austrian paediatrician Hans societal acceptance also referred several children to Vienna’s Asperger has long been recognized and support. The Am Spiegelgrund clinic, which he undoubt- as a pioneer in the study of autism. revelations are also edly knew was a centre of ‘child euthanasia’, THe was even seen as a hero, saving causing debate among part of what was later called . children with the condition from the Nazi autistic people, their This was where the children whom Nazi killing programme by emphasizing their families, research- practitioners labelled ‘genetically inferior’ intelligence. However, it is now indisputable ers and clinicians were murdered, because they were seen that Asperger collaborated in the murder over whether the as incapable of social conformity, or had of children with disabilities under the diagnostic label of physical or psychological conditions judged Third Reich. Asperger’s Asperger’s syndrome undesirable. Some were starved, others given Historian Herwig Czech fully Children: The should be abandoned. lethal injections. Their deaths were recorded documented this in the April 2018 issue of Origins of Autism In 1981, psychiatrist as due to factors such as pneumonia. Molecular Autism (a journal I co-edit; see in Nazi Vienna pub- Sheffer argues that Asperger supported H. Czech Mol. Autism 9, 29; 2018). Now, EDITH SHEFFER lished the paper in the Nazi goal of eliminating children who historian Edith Sheffer’s remarkable book W. W. Norton (2018) Psychological Medicine could not fit in with the Volk: the fascist ideal Asperger’s Children builds on Czech’s study that first brought of a homogeneous Aryan people. with her own original scholarship. She Asperger’s clinical observations to the atten- Both Czech and Sheffer include details makes a compelling case that the founda- tion of the English-speaking medical world, on two unrelated children, Herta Schreiber tional ideas of autism emerged in a society and coined the term Asperger’s syndrome and Elisabeth Schreiber, and their refer- that strove for the opposite of neurodiversity. (L. Wing Psychol. Med. 11, 115–129; 1981). ral letters, signed by Asperger. In these, the These findings cast a shadow on A decade later, in the book Autism and paediatrician justifies Herta’s referral to the history of autism, already a long (1991), developmen- Am Spiegelgrund because she “must be an struggle towards accurate diagnosis, tal psychologist translated into unbearable burden to the mother”; and

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Elisabeth’s, because “in the family, the BIOTECHNOLOGY child is without a doubt a hardly bearable burden”. These provide proof that he effectively signed their death warrants. Nearly 800 children were killed in Am Blood, sweat, Spiegelgrund. Asperger went on to enjoy a long academic career, dying in 1980. Both Asperger’s Children and Czech’s paper converge on the same conclusion. tears and biotech Personally, I no longer feel comfortable with naming the diagnosis after Hans Asperger. In any case, this is a category Eric Topol extols a gripping account of the rise and fall rendered moot in the most recent of US medical-testing company Theranos. edition of the DSM (used in the United States). European nations will follow this diagnostic lead in 2019, with the 11th ew scandals have so gripped both the to study chemical edition of the International Classification health-care and technology indus- engineering at Stan- of Diseases. tries as the seismic rise and fall of ford University The future use of the term, of course, Fblood-testing company Theranos. In Bad in California as a is a discussion that must incorporate the Blood, acclaimed investigative journalist President’s Scholar, views of autistic people. Many take pride John Carreyrou, who broke the story in a prestigious pro- in the term Asperger’s syndrome as part 2015, presents comprehensive evidence of gramme that comes of their identity, feeling it refers to their the fraud perpetrated by Theranos chief with a grant. She personality and cognitive style, which executive Elizabeth Holmes. Specifically, dropped out in her obviously do not change simply because Holmes and the company’s former presi- Bad Blood: second year to start of historical revelations. They might not, dent Ramesh ‘Sunny’ Balwani raised more Secrets and Lies Real-Time Cures, the therefore, want a change. Others have than US$700 million through “elaborate, in a Silicon Valley Palo Alto-based com- already written about switching to using years-long fraud in which they exaggerated Startup pany that became ‘autism’ (or autism spectrum disorder, or or made false statements about the com- JOHN CARREYROU Theranos and oper- Knopf (2018) autism spectrum condition) to describe pany’s technology, business, and financial ated for 15 years. their diagnosis. performance”, as the US Securities and Carreyrou explores For brevity and neutrality, I favour the Exchange Commission put it in March Holmes’s talents and liabilities. Driven, and single term autism. However, because of this year. with an exceptional gift for selling ideas, the considerable By the time Carreyrou’s Wall Street she built up a board of high-level politi- heterogeneity “The future Journal story and a long chain of follow- cal figures, such as former secretaries of among autistic use of the term ups had led to regulators closing down state George Shultz and Henry Kissinger, people, I think Asperger’s Theranos’s labs in 2016, nearly 1 million former secretary of defence William Perry, it could be help- syndrome is lab tests had been run in California and Marine Corps general (now secretary of ful for them a discussion Arizona. A significant proportion of these defence) James ‘Mad Dog’ Mattis, and for- and their fami- that must were erroneous; all had to be voided. An mer senator Sam Nunn. Investors included lies — together incorporate the untold number of people were harmed by media magnate Rupert Murdoch; partners with autism views of autistic the erroneous results: some underwent numbered supermarket giant Safeway and researchers, people.” unnecessary procedures, received misdiag- pharmacy chain Walgreens. Channing clinicians and noses of serious conditions and experienced Robertson, a professor of Holmes’s at relevant professionals — to discuss emotional turmoil. Stanford, was a board member and adviser whether subtypes should be introduced. Carreyrou presents the scientific, human, to the company. In 2015, Holmes was rec- When Wing coined the term Asperger’s legal and social sides of the story in full. ognized by then-president Barack Obama syndrome, none of us was aware of Hans Although some of it was previously reported as a US ambassador for global entrepre- Asperger’s active support of the Nazi in his extensive coverage, he unveils many neurship. The same year, vice-president programme. As a result of the historical dark secrets of Theranos that have not previ- Joe Biden sang her praises at a launch of research by Sheffer and Czech, we now ously been laid bare. the miniLab (which Carreyrou uncovers as need to revise our views, and probably also The company’s alluring goal, which completely fake; the lab was not operational our language. Asperger’s Children should changed as it evolved, was to quickly analyse at the time). be read by any student of psychology, a drop of blood for hundreds of differ- All the while, as Carreyrou reports, psychiatry or medicine, so that we ent assays, at a fraction of prevailing costs. Holmes was lying about the nanotainer, learn from history and do not repeat its Collected in ‘nanotainers’ and allegedly contracts with the pharmaceutical industry terrifying mistakes. The revelations in tested in a diagnostic ‘miniLab’ the size of a and assay validation. She made false this book are a chilling reminder that the microwave oven, the method was publicized statements to the US Federal Drug Admin- highest priority in both clinical research as revolutionizing an industry that hadn’t istration (FDA) and to the US government and practice must be compassion. ■ changed for decades. Holmes, who idolized agency that regulates blood-testing labs, the Apple entrepreneur Steve Jobs, called it “the Centers for Medicare and Medicaid Services. Simon Baron-Cohen is director of the iPod of health care”. And she claimed that Theranos was being Autism Research Centre at the University As a child in the 1990s in the United used on the battlefield in Afghanistan, saving of Cambridge, UK, and president of States, Holmes declared that she wanted soldiers’ lives. the International Society for Autism to be a billionaire when she grew up. By Holmes described the miniLab as “the Research. age 30, she had achieved her goal. Highly most important thing humanity has e-mail: [email protected] intelligent, she had been accepted in 2002 ever built”. But at best, the lab could do

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