Posts Tagged ‘ASD advise’

Ten Reasons Why There Is No Autism Pill

Saturday, April 18th, 2015

“If you have seen one child with autism, you have seen one child with autism,” is an often-used aphorism. An important corollary: so far, there are only patterns to follow, and a single ‘cure’ may not be the cure.

There isn’t one kind of autism.
It’s like saying we’re going to find a cancer pill.

Controversies have existed from the first time the diagnosis was proposed; beginning with the ‘Refrigerator Mom’ theory, to the contribution of genetic influences, and the role of environmental factors (including the vaccination issues). The enigma has slowed research, while these matters are being sorted out.

Multiple systems are involved, including gastrointestinal, neurologic, muscular, and immunologic. That makes the documentation of recovery a moving target, reducing the likelihood that there is one pill.

There are multiple levels of system involvement, including genetics, proteins (proteome), metabolism (metabolome), body flora (microbiome) and those interactions.

Autism is freakin’ complicated.

The cost of researching, producing, testing and bringing a brand-new pharmaceutical exceeds 2.5 Billion dollars. Market size is important, and apparently 1/68 children does not meet that target. Unless it’s your kid.

Autism is freakin’ expensive.

There are no specific biomarkers, which are key laboratory or other diagnostic findings that identify a specific condition. That means there are few ‘levels’ to follow that identify severity or response to treatment.

The spectrum contains a variety of signs and symptoms that change over time and vary among individuals, including identical twins. There are various presentations, from mostly apraxia to mostly social isolation, and lots of combinations in between. That makes the evaluation and documentation of response to therapies problematic.

Since environmental factors have been implicated as an issue, it’s clear that pollution and toxins have been getting worse, not better. That has resulted in increasing numbers of affected people with more complicated problems. The light at the end of the tunnel seems to be moving farther away.

Conventional medicine isn’t leading the way, and falters even in the pursuit of assistance. Simply advising more therapy is frequently inadequate. Stimulant and other central nervous system medications can be a nightmare. The belief that ‘alternative’ therapies are kooky, or even harmful, polarizes – and little progress emerges.

There is an audible silence by way of a national voice towards solving this epidemic. When John Kennedy said we could get to the moon and back, America found a way. Autism needs more heroes, role models, and spokespeople.

All of that being said, it doesn’t mean that physicians cannot do appropriate testing to discover variances and abnormalities that are clues to downstream signs and symptoms to treat, and upstream interventions to alter the course.

In the absence of a pill, early detection and intervention successfully addresses many of the most debilitating and costly complications.

That Kooky Autism DIET

Sunday, April 12th, 2015

Just about every one of our patients “do the diet”. It’s different for each child. Parents are asked to avoid the foods that test in the highest range of immunoglobulin-4 (that’s I-g-G ‘four’) levels.

That is considered ‘kooky’ by medical establishment standards. I have treated several patients under the age of 7 years, lately, who were taking Zoloft, Prozac, Vyvanse, and Intunive in combination and pretty high doses, prescribed by prominent local neurologists. That, apparently, is not kooky.

The ‘diet’ is considered risky by medical establishment standards. Those are the standards that do not require testing of thyroid, lipid, vitamin, iron and other important parameters associated with autism. Checking levels is, apparently, kooky. Treating vitamin and mineral deficiencies in patients with ASD is, somehow, even kookier.

The experience of thousands of families is this: when children avoid those foods to which they are most reactive, there is an improvement in ‘brain fog’, communication, bowel movements (and, often toilet training), and aggression.

I know this to be true for two reasons. One, ‘The Diet’ – whatever it may be for each individual patient – is a pain in the ass for the family. The parents follow it because they see improvement. Two, when children transgress there is a price to be paid – in regression, yeast, sleep, hyperactivity and other behaviors.

The conventional wisdom is that IgG-4 food allergy testing is useless. That was the declaration made by the European Academy of Allergy and Clinical Immunology (EAACI), 7 years ago. The paper was entitled, Testing for IgG4 against foods is not recommended as a diagnostic tool.

It is clear that, if the problem being investigated does not include the core signs and symptoms of autism, such testing may be irrelevant.

After appropriate laboratory testing, observable results may take up to 2-3 months. Embarking upon the child’s specific diet is often challenging, but rewarding. Knowing that the results are accurate is verified when ‘fog’ lifts, there is faster processing, or less anxiety.

Skeptics frequently point out that diets are ‘dangerous’, due to vitamin and other deficiencies. Close measurement of somatic and laboratory parameters assures grandma (and others) that this protocol results in positive nitrogen balance by promoting health and preventing illness. As a result, appetite often improves and food choices become even more varied.

At a recent medical conference, one of the presenters expressed a lack of confidence about the IgG-4 food allergy findings. Those statements were challenged, and it was clear that the participants who encourage such dietary restrictions consistently observe significant positive results.

The Physician’s Desk Reference, the text that doctors use to check medications, contains ~1000 pages. There is not one mention of a treatment for speech apraxia, or eye contact. Physicians don’t seem to get it – if conventional medicine admittedly has little to offer by way of tangible treatment for their affected offspring, parents will search elsewhere.

There isn’t one ‘best’ diet. There are many reports of improvement with GAPS, FODMAPS, GF/CF, and others. Plus, there may be no value to applying the results to other conditions, such as asthma or eczema. However, imagine a parent NOT trying the Feingold diet to treat their ADHD child before giving strong, addictive medicines that carry many side effects.

Finding a diet that improves a child’s health, and gives the family some relief and hope, is not kooky. After assuring nutritional balance, it really doesn’t matter which one, as long as parents see that it is working.

Real Autism Awareness 2015

Thursday, April 2nd, 2015

Autism Awareness is not just about slogans, license plates, Autism Walks, or assorted news stories. The term carries a variety of implications, including:

Public Opinion
Awareness will come when we quit arguing about whether there is an autism epidemic or not.

We need to stop wasting time blaming Andrew Wakefield (the doctor from England who had the temerity to question the vaccine gods) for why we don’t have a cure for autism. If you want to blame someone, start with Leo Kanner and Bruno Bettelheim, who concluded that it was the result of faulty parenting.

Political / Legislative
This past August, “President Obama signed into law the Achieving a Better Life Experience (ABLE) Act, which will allow families with children with disabilities to save for college and other expenses in tax-deferred accounts. This piece of legislation is an important step toward empowering people with disabilities to achieve independence and affirms self-sufficiency.”

Insurance companies need to become more realistic about what services are required. The traditional therapies are effective, and should be reimbursed appropriately.

Autism awareness includes dealing with the situation of an aging ‘Spectrum’ population, and the resources that will be required.

Scientific
There will be more enlightenment when we stop focusing on the ‘anti-vaccine kooks’ and start researching an intelligent answer to the question, “Are all vaccinations good for all children all the time?”

We need to be cognizant that ASD continues to increase, and research has not yet uncovered the most basic questions of “Why, Who, or What?” “Where and When” is right here, right now.

Autism awareness includes mindfulness of the environmental impact.

Personal
Speaking of ‘awareness’, how about when a parent can go to the park and sit on a bench while the child plays (or tries to play) with the other kids?

Another example is the child’s awakening. Parents are thrilled when they no longer worry about elopement when the family is outside or in a crowd.

Finally, REAL autism awareness is when your child gives kisses and says, “Mommy, I love you!”

Professional Resources for Steady Progress in Autism

Sunday, March 22nd, 2015

Parents frequently express concern that their child’s progress is too slow. They want to be sure that something is not being missed. As months and years pass, and especially if there is little progress from conventional therapies, their search begins and/or intensifies.

Resources include the Internet, books, lectures, webinars, conventions and conferences, schools, professionals of all varieties, family, friends, and other parents. The weaker the science, the louder the opinions.

Here are a few helpful choices:

Websites:
Googlescholar.com is the website to search for literature on topics that require further understanding and research.

SFARI gene is the site for reliable, accurate information about any genetic variation. Results that were previously considered ‘not significant’ may be just the opposite.

Autism360.org is the place to upload your child’s data, so that individualized therapies can be developed.

PDR.net is the address for reading about pharmaceuticals prescribed by your physician. True, it’s pretty scientific, but it’s the one the doc checks (or should).

WebMD.com and Mayo Clinic both display a lot of medical information, much of it in lay language, based on reliable resources. This can be useful when the pediatric specialist, e.g., strings together an incomprehensible list of terms about your child.

Quackwatch.com is the kook meter. The mission statement describes, “… an international network of people who are concerned about health-related frauds, myths, fads, fallacies, and misconduct.” Is that because those who do not agree with their conclusions are people who are not concerned?

Tacanow.org is the cookbook resource for GF/CF recipes.

CDC.gov is the site for the most complete government data on autism in the US.

Books
Start with Dr. Martha Herbert’s The Autism Revolution. This story describes a sea change in our understanding of ASD.

Temple Grandin’s books explain autism from ‘the horse’s mouth’, so to speak. The Reason I Jump is fine, but Ido in Autismland provides more insight into the autistic mind of children and teens.

Asperger’s families can learn a lot from The Curious Incident of the Dog in the Night-time, which is presently a Broadway play.

Conferences
The International Meeting for Autism Research continues to grow in scope and size. What an ideal venue to meet the present and future experts in this field.

The Medical Academy of Pediatric Special Needs now sponsors the most academic meetings. Although the semiannual event is geared more toward professionals, many parents could benefit from some of the seminars.

Webinars
The original site for ‘DAN’ doctors is now the Autism Research Institute. The educational offerings are significant and quite helpful to families who want to better navigate such a confusing condition.

Autism Speaks performs many of the most basic and wide-ranginging of informational sites, including helpful interactive pages. The spectrum of services ranges from funding to fund raising.

Try this example:
There are reports of great progress from giving worms (Helminths), worm removal, fungal administration, (Saccromyces), fungal removal (fluconazole), and fecal restoration. Trying to achieve gut health is the common feature.

Next, what is the most scientific way to study and treat that condition? Utilizing reliable knowledge bases, a reasonable plan can be formulated. Safety, effectiveness, and predictable performance should be part of that protocol.

Conclusions:
The lack of trained professionals and overwhelming number of new patients eventually leads families to some sort of journey into the unknown.

Checking out the resources that the pros use may be helpful in that undertaking.

Autism Conference Spring 2015

Sunday, March 15th, 2015

The Medical Academy of Pediatric Special Needs provides this semiannual standard-of-care meeting, which is dedicated to teaching physicians and other practitioners who care for patients with ASD.

Various educational courses were offered, covering a variety of interests and experience. This being the 7th conference, an entire day was reserved for difficult clinical cases, discussed among ~30 doctors, who had previously passed the basic science courses.

Mitochondrial functioning played a significant role in this year’s presentations. The myriad of functions involved with these cellular power-plants was explored. This is a complicated topic that includes genetics (mitochondria even have their own chromosomes), over- under- and malfunctioning, environmental effects, cell-to-cell, cell-to-system and cell-to-environment interactions.

Impressions:
Prior to one of the lectures, there was a wonderful moment when Dr. Bob Sears, Dr. Jerry Kartzinel, Dr. James Neubrander, and Dr. Dan Rossignol were among those discussing the recent measles epidemic and what their practice was doing to address the situation. That conversation would have made a well-hit youtube video!

Another time I found myself eating lunch with Dr. Michael Elice, Dr. Stuart Freedenfeld, and other popular autism practitioners. There was a great sense of camaraderie and common purpose. This is one the few social experiences when doctors, such as myself, are not derided for our unpopular opinions.

Any new treatments?
Dr. Sid Baker, a true pioneer in the practice of the biomedical treatment for ASD, presented a wonderful historical perspective. Because of an earlier focus on autism as a genetic disorder, Dr. Baker opined that, “The last ten years have shown very little progress in the way of understanding and treatment of autism.”

One frequently discussed off-topic topic was the lack of research and safety of chlorine dioxide (ClO2), which is touted on the web as a helpful treatment. It is supposed to work by ridding the body of parasites. Ironically, however, one of the more popular new treatments involves helminth therapy (giving parasites to patients) to re-invigorate the immune system.

Conclusion:
It would be preferable if participants could return from such an educational experience with a list of novel therapies for our most challenging patients.

For now, learning key tricks and tips that address negative behaviors, or gut health, for example, are the order of the day. We learned about more precise lab tests, key findings that could point to more specific therapies, and important metabolic pathways that will help our patients, if not today, soon.

We consider what avenues to pursue, and those that need further evaluation. This organization is dedicated to providing well-researched medical solutions.

Because autism is so widespread, misunderstood, variable and mysterious, the ability to network with international experts and ‘pick the brain’ of those in the trenches is the most valuable feature that the conference provides.

“It’s supposed to be hard. If it were easy, everyone would do it”
Tom Hanks in A League of Their Own

Where Have All Those Autism Treatments Gone?

Sunday, March 8th, 2015

Secretin, OSR, Namenda (memantine), Bumex (bumetanide), Actos, Spironolactone, and more, have all been prescribed to improve the signs and symptoms that ASD individuals experience and display. Some are only used in rare circumstances, others are no longer even available. Now, it’s GcMAF.

The Situation:
For several years, that macrophage-boosting blood product has been used to improve immune functioning in various conditions, including ASD. There have been reports of successful amelioration of negative behaviors and facilitating communication.

At The Child Development Center, there have been 25 patients who received the product, either by subcutaneous or sublingual route. As reported here, ten of the children improved enough for the parent to re-order a ~$1000US solution. Improvements were reported in cognition, communication, and even toilet training.

Without any explanation regarding why the company no longer produces, GcMAF.eu now redirects the user to GcMAF.se (France to Switzerland). The site has the following disclaimer:”… it is not possible to purchase GcMAF here… A dozen companies have claimed to make GcMAF. Most of them failed…”

The website offers alternatives that are less than reassuring. “Immunobiotech.eu, … the most professional company in this field.” “An Israeli company was offering GcMAF at $1,000 a shot, but many of the people using it did not believe it worked. It was probably inactive.” Or, they plainly disparaged the product. “Saisei Mirai – a Japanese company… Somewhat risky to inject in our opinion, and their research papers don’t seem to show good results”.

The Outcome:
Presently, when one door closes on the medical treatment of autism, there are few remaining ones to explore. Conventional prescriptions gain a stronger foothold, no matter how limited they perform, or how serious are their side effects.

Professionals feel compelled to assist in ameliorating aggressive behaviors with strong CNS medications, such as Abilify, Risperidone, or even Zoloft, Prozac, and Klonopin. No medication promises to assist the acquisition of speech and language.

Alternative treatments, which may carry reduced evidence of usefulness or safety take a stronger hold, as well. Parents who are seeking improvements are neither foolish nor ignorant – they are desperate. Families are left to evaluate anecdotal reports and Internet stories.

The Conclusion:

A great deal can be learned by the experience of those treatments
that have become less popular, or even extinct.

With an ever-increasing incidence of ASD, more therapies are bound to be invented and evaluated. Parents are not going to give up their fight simply because they are admonished about being ‘unscientific’ or ‘over-‘ emotional.

As more professionals experience affected patients, newer trials are bound to take place. When pharmaceutical companies see an improved return on their investments, they are more likely to join the effort. Increased prevalence boosts enrollment in scientific research.

There is a common theme of gut improvement and addressing immune function. Mostly, what the storage locker of trial treatments contains, are some important keys to understanding, treatment and prevention.

The Dress Color Debate and Sensory Processing in Autism

Sunday, March 1st, 2015

Image Credit: J. Jastrow (1899)

It became headline news, this week, when Wired magazine reported “The Science of Why No One Agrees on the Color of This Dress.” The usual reaction by those involved in the autism community has been, “Tell us something we don’t know!”

The terms visual-, auditory-, and sensory- processing ‘disorder’ have all been invented to describe conditions that patients experience. Rather than representing separate maladies, unusual patterns of filtering are part of the fabric of ASD.

Part of the hoopla is the controversy surrounding the ‘correct’ color of the dress. Colorblindness is mostly attributed to the lack of color-producing rods in the retina, not a processing difference in the brain. In this example, ‘normal’ people disagree.

The other factor is that the present conundrum is unlike the old-time Rabbit-Duck optical illusion (pictured). Once you are told what to look for, the type of animal makes sense. In this case, it is almost impossible to understand how the dress could be any other than the colors that we perceive.

The Wired article explains how light enters the eye and is reflected, wiring in the brain, ambient light, etc., and concludes, “… your brain tries to interpolate a kind of color context for the image, and then spits out an answer for the color of the dress.” With all of those parameters, it is difficult to understand how there is ever any agreement.

Little is explained about how we arrive at an individual conclusion. This example highlights the paucity of information explaining why humans see the dress color differently. Such a situation underscores the difficulties understanding already-altered sensory processing in people with ASD.

How many times have parents, therapists and teachers asked, “Didn’t I just tell you that color?” Or, “I can’t understand why he’s such a picky eater.” “She smells everything.” It rarely occurs to us that an affected child senses a common item differently.

The controversy about the tint of the dress and the frustration of those who see it differently is but a tiny example of the sensory processing differences experienced in the face of ASD.

Whatever the underlying reason for variation in the response to the pictures of those dresses, it helps remind the neurotypical population how differently we all see the world.

10 Successful Strategies for Children with ADHD

Saturday, February 21st, 2015

Winter holidays are over. Things are back to normal at home (yeah, right, normal). School is ramping up and children with developmental concerns become even more challenged.

There is a constant stream of parents, these days, seeking relief because they are told that their child has Attention Deficit – Hyperactivity Disorder. They ask, “How do we get through the rest of this year,” and “What should we do about the next semester?”

Every child should have an appropriate workup leading to a clear, accurate diagnosis. ADHD can be a part of autism, thyroid disorder, gastro-intestinal problems, allergies, asthma, vitamin deficiency, etc. By properly diagnosing and managing a primary condition, many of the behavioral concerns may abate.

Make sure that inappropriate conduct is not due to something the child is receiving by way of medications for another condition, e.g., steroids or ‘cough and cold’ preparations.

Before becoming too aggressive with pharmaceuticals, consider the age of the child. A three- or four-year-old has time to mature and achieve self-control, while there are more academic demands on a eight-year-old.

Evaluate the difficult behaviors to better decide which intervention(s) will have the optimal chance for success with the least side effects. Occupational therapy is great if there are major sensory issues, neurofeedback might be helpful for focus, and behavioral intervention (ABA) might be more appropriate for disruption issues. Even if a parent still has to resort to medical intervention, lower doses and less frequent changes may be a result of this strategy.

Consider that inattention and poor focus could be due to mixed, missing and/or crossed signals in the CNS. With such a situation, non-preferred activities are much more difficult and therefore resisted even more than in typical peers. Until improved methods for overcoming learning disabilities are discovered, more patience and practice is required – and less criticism.

adhd bullett4dFor children who take stimulant medications, those who are able to tolerate drug ‘vacations’ will suffer less of the consequences of decreased appetite, sleep and linear growth. Sometimes, it is only for summer vacation, and other children are able to experience drug-free weekends.

Children who do not appear to be listening, are often simply listening without looking. That is not acceptable in a large, general education classroom. Nevertheless, medications that supposedly help focus and distractibility, might not do that, either. Anti-anxiety medications, starting with Intuniv, and sometimes even escalating to Prozac, are often suggested. If possible, the best improvement should come when the reason for gaze difficulty is understood.

Once parents make the decision to give medication a try, expect the most successful outcome when there is a clear understanding about positive and negative effects. It takes time to get the most desired results, and that knowledge can help the family withstand rocky periods. An ability to contact the responsible practitioner leads to increased compliance.

Be careful (and appreciative) when a treatment plan is working. Attempting to fine-tune a lingering shortcoming can lead to disastrous results. External stresses, from an ear infection to visiting relatives can disturb the calm. The child who maintains a healthy diet and necessary supplements is better prepared to weather the storm.

Inconsistency is the most consistent parental frustration. While it is in our nature to admonish the negative behaviors, remember to reward the good, as well.

DIY Autism Treatment

Sunday, February 15th, 2015

One day, you look up and notice that there is a wet spot in your ceiling. Inch by inch the spot is getting larger and even starts to drip on to the floor. What is the next thing that most people would do?

You would, I assume, call the plumber – right? Now, perhaps you would look on the Internet to find the name of a local service, instead of the yellow pages, as in the “olden days”.

How many would search the web for “drips in the ceiling,” try to understand all the possible causes of the moisture, open up the drywall and attempt to weld the hole in the pipe (or maybe it’s the joint, or something else altogether)? Yes, there is always someone who would attempt to perform this task, but it sounds pretty foolish to me. Plus, you could actually make things worse (think FLOOD).

However, when parents suspect their child might be exhibiting developmental delays, they often search the Internet for a diagnosis and even a cure, NOT a doctor! At the time of this writing, an Internet search for autism returns 74,9oo,ooo results.

Which page(s) should you believe? Which ones contain information that is incorrect, and could make things worse, or waste time and money? That is what a pediatrician is for – to take an extensive history and perform a thorough physical examination, then give you a precise diagnosis (or possible diagnoses) and work with the family to come up with a plan to get the best possible care.

Why do so many people try to “fix the leak” themselves? I’m afraid to say that the medical community should take a great deal of the responsibility when parents try do-it-yourself autism treatment.

The pediatrician who proclaimed, “he’s a boy, so they speak later… there is a new baby in the house… you speak two languages… he’s spoiled,” but didn’t comment about the lack of eye contact or toe-walking, has suffered a loss of confidence.

The professional who examines 6 patients per hour has no time to consider conditions that are not routine. Neurologists are frequently viewed as cold and unsympathetic to the devastation that an ASD diagnosis creates.

Another contributing factor is the complexity of autism itself. There are often multiple terms and the parents are caught trying to understand why the pediatrician writes “PDD-NOS” and the neurologist puts “ASD”. Too many acronyms, not enough information, and so the patient turns to the web. Finally, there are the non-doctor doctors out there who offer claims of cure and magic bullets to fix the child. Who wouldn’t want to get a completely “cured” child – even if it costs your home and future?

What is the answer?
Find a really good plumber!

The most accomplished doctors for Autism Spectrum Disorder are physicians who have specialized in the diagnosis AND treatment of affected individuals, and attend frequent conferences including the Medical Academy of Pediatric Special Needs community of physicians.

If you try to ‘research’ autism by yourself, you may occasionally get some results, but you also might create a flood.

To Vaccinate or Not to Vaccinate?

Saturday, February 7th, 2015

The measles outbreak that started in Disneyland has generated a fair amount of activity at The Child Development Center lately.

Many of our patients are either un- or under- vaccinated, according to the Vaccine Gods, so an increase in a preventable childhood disease in the U.S. is a very important healthcare issue.

In response to the media stories, and with the intention of addressing parents’ concerns, The Center emailed our patients.

The advice that was offered:
a. If the child has never had a vaccination, it is best to “bite the bullet” and go ahead with an MMR. We’re in the middle of an outbreak and it’s a very small world.

b. If the child has been previously vaccinated for MMR, you could get  “measles-mumps-rubella titers”. This is a blood test to determine if the child is still immune to the diseases, so it may be OK to hold off for now.

There were a variety of interesting responses.
Parent: “Thanks, Dr. Udell, for the heads up.”
Dr. U: You’re welcome. I’m just a messenger. Parents are the ones who have to make the final decision.

Parent: “What if the child has antibodies to eggs (allergy)?”
Dr. U: That is a big problem. I would look over the most recent laboratory tests and, depending on the child’s present state of health, and other findings, possibly still have to recommend. For what it’s worth, two of the products are actually grown on chick embryo, and almost all of our yolk-and/or-white-positive patients are negative to chicken. The German measles strain is grown on lung tissue derived from human fetus. We don’t test for that.

Parent: “Can’t you break up the shots?
Dr. U: No, the company that used to produce separates stopped years ago.

Parent: “My child was severely damaged by that shot. I’m surprised that you made this recommendation.”
Dr. U: It’s situational ethics, in a medical setting. I sympathize with your plight. Not only is there conflicting research; cases, such as yours, are completely ignored. Nevertheless, measles carries a 1/1000 chance of encephalitis (brain infection). 

Discussion:
After listening to so many complaints of proximate injury to an inoculation, it seemed that the best advice was to hold off vaccinating until the child improved, and/or the cause(s) of inflammation was discovered. There was little evidence of a rise in disease, so I felt less concern for the ‘herd’ than the family sitting in my office. The plan was to vaccinate a healthier child in 1-2 years, utilizing a judicious make-up protocol, if the parents agreed.

Each family will address this news differently, and act on their decision based upon what they consider as their child’s best interest. Questions and concerns persist. An epidemiologist just published a York Times editorial suggesting that there would be increased compliance if it were more difficult to obtain an exemption.

The line between the ‘good of the many’ and the ‘good of the one’ has shifted. Once the seal is broken, so to speak, and fewer than ~90% of the susceptible population is protected, there can be no accurate prediction of whether/where/when/how severe another outbreak will occur. The choice returns to the ‘good of the one’, so prevention is paramount.

The reality is that, if the AMA, AAP, FDA and CDC would express less dogma, become more sympathetic to those who claim injury, make fewer errors, and perform prospective studies to demonstrate efficacy and universal safety, parents wouldn’t be forced to make such a crucial decision on their own.

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Brian D. Udell MD
6974 Griffin Road
Davie
FL 33314
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Email bdumd@childdev.org
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