Evidence-Based Pediatric Special Needs Medicine

EvidenceAt an autism fundraiser lately, I took the opportunity to speak with one of the leaders in our local treatment community. I felt that his understanding of complementary and alternative protocols was limited at best, and looked upon with suspicion and even derision at worst.

When I stated to the Director that I was a pediatrician who treated children with autism, he exclaimed, “Well, we do evidence based medicine. What’s with that Wakefield fellow?” “Ummm,” I replied, “that was, like, over 15 years ago. Why am I responsible for that stuff?”

“And, what about that Bradstreet guy? I went to hear him speak once, and the information about secretin was already in, and he was still lecturing about it’s value? What makes you different?” asked the gentleman.

“Well, we do a suitable medical workup, and, depending on the findings, treat patients with safe and often effective interventions.

Perhaps we could go to lunch and talk about the manner in which doctors, such as myself, practice? And by the way, what about that decision by the AAP that early autism screening isn’t supported? They claim that more evidence is required. Do you subscribe to that?”

Evidence Based Medicine
Certainly, the goal of modern treatment is to follow best-practices protocols, which have been documented as safe and effective, and evaluated with scientific scrutiny. The gold standard for medications has been a repeatable and repeated, double-blind (examiner not aware if drug is med-in-question or placebo), crossover (give real med to one group then reverse), randomized (who gets, who doesn’t), controlled (follow specific protocol) trial of sufficient number of patients (determined and crunched by statisticians).

A noted expert has written in the British Medical Journal, What it is, and what it isn’t:

It’s about integrating individual clinical expertise and the best external evidence.

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough.

Evidence based medicine is not “cookbook” medicine.

May raise rather than lower the cost of their care.

It will continue to evolve.

As noted in Wikipedia, “A 1994 study concluded that 58% of life science companies indicated that investigators were required to withhold information pertaining to their research as to extend the life of the interested companies’ patents… A major flaw and vulnerability in biomedical research appears to be the hypercompetition for the resources and positions that are required to conduct science… seems to suppress the creativity, cooperation, risk-taking, and original thinking required to make fundamental discoveries. Other consequences of today’s highly pressured environment for research appear to be a substantial number of research publications whose results cannot be replicated…”

Discussion
This past week, a mom reported that her 5 year-old child with signs and symptoms of autism was taking “some type of sleeping pill” given by a respected local psychiatrist. The medicine was Buspirone – an antipsychotic. Where is the evidence for that? Another child had just gotten a sleep study – from another physician – with no history of any sleep problems. Antibiotics for colds, Tamiflu for upper respiratory infections, and anti-seizure medications, are all routinely prescribed with less-than-solid evidence. Not to mention the complete lack of a laboratory investigation.

For several years now, the Medical Academy of Pediatric Special Needs has stressed that conventional therapies combined with a proper medical evaluation and appropriate intervention results in better ASD outcomes. There is a large body of evidence to support the protocols that are so successful in reducing unusual behaviors and prompting communication. Dr. Dan Rossignol has led an organization that stresses the use of evidence-based research and applying that knowledge to patient care.

Anyway, it’s not simply complementary and alternative medicine that we practice. Nor is it holistic, integrative, allopathic, osteopathic, Western or Eastern. It’s the provision of safe and effective interventions that ASD families seek. It’s medicine.

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Brian D. Udell MD
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