Posts Tagged ‘Vaccine’

Docs, Glocks and Autism

Thursday, July 30th, 2015

gunMiami Herald
July 28, 2015
Appeals court upholds doctor-patient gun law

According to the article, “The law subjects healthcare providers to possible sanctions, including fines and loss of license, if they discuss or record information in a patient’s chart about firearms safety that a medical board later determined was not “relevant” or was “unnecessarily harassing.” The law did not define these terms.”

The law did not define these terms
It has been reported that U.S. Circuit Judge Gerald Tjoflat, the author of the majority opinion, understands that, in a patient at-risk for suicide, this might be a valid medical concern.

How about this case?

A fifteen year-old male who suffers from moderate-to-severe autism (or any other medical – psychiatric condition), takes Zoloft for aggressive behaviors, perseverates on violent video games, and doesn’t seem to grasp the line between fantasy and reality.

Would it be fair to say that a discussion by the physician with the parents about weapons in the home is appropriate?

The risk factors

  • The patient’s sex.
  • The person’s age.
  • Medication(s) use. There is even a ‘Black Box’ warning on SSRIs about the possibility of increased suicide.
  • The predilection for violent video games related to behaviors.
  • The teen’s inability to discern reality vs. fantasy. When asked, “Who is your best friend,” for example, one patient responded with the name of person who he had never met.
  • Constant bickering with parents over school.
  • A loaded gun in the house.

Discussion
Such a situation might be equally as valid when a patient experiences conditions other than ASD. Indeed, people ‘on the spectrum’ are probably less likely to act with outward aggression. Certainly, a discussion about elopement is absolutely a necessity in the face of autism, as are questions about a pool safety and the ability to swim.

Surely, there are a gaggle of gun-toting attorneys who can poke holes in my case. The law has been upheld. After all, I’m just a healthcare provider.

The lawyers representing the doctors got it wrong. This is not about the first amendment rights of physicians to discuss the issue of guns. This is about public safety. And, let’s face it, when it comes to vaccinations-for-all, as an example, there’s no problem protecting the public.

Perhaps just as certain, is the possibility that, should a shooting death occur in this scenario, a lineup of litigators would appear on the radar screen, accusing the (ir)responsible doctor of not taking the obvious and necessary steps to prevent such a tragedy. “An Accident Waiting to Happen,” might be the headline.

Conclusion
This is an insane law that supports the NRA’s unyielding position about the rights of gun ownership. It is proof of how corrupted our system has become, due the superabundance of lobbying money.

Gun control is what we need, in the face all the senseless shooting deaths by too many young men, who obviously have mental challenges. However bizarre, it is a standing law that has now been upheld by the Florida Court of Appeals.

More information will be required to illuminate the holes that are created by this imprecise lawyer-speak.

Cali-Vaccination Law

Sunday, July 5th, 2015

Senate Bill 227, mandating childhood vaccinations, will take effect in California in 2016, joining 36 other states that no longer allow an exemption for personal or religious beliefs. Non-compliant families will not be able to use licensed daycare facilities, in-home daycare, private or public preschools, and after-school care programs.

Children who are not up-to-date will be required to home school. Also, the legislature may add any additional vaccines that they deem necessary. Parents are left with few viable alternatives.

Exemptions
Ironically, unvaccinated students with IEPs will still be able to access those programs.
Those with a preexisting personal exemption may continue until the next school year.
Parents requesting a medical exception must provide a physician’s statement that details which ‘shots’ are not OK, and the reason(s) for non-compliance.

The Government Doesn’t Always Get it Right
According to the Innocence Project, 330 post-conviction DNA exonerations have occurred since 1989. Twenty people were on death row and the average length of time served per exoneree was 14 years. Whoops.
The CDC keeps dropping the ball with the flu vaccines. After admitting that the 2015 ‘shot’ is ineffective, as in previous years, the universal message given to the public from the government and mainstream media was to “get the flu shot anyway.” There is evidence that some flu vaccines could make things worse.
As demonstrated in the case of antibiotic overuse, the FDA can’t regulate even when scientific research is convincing. Important practical issues, such as incorrect vaccine labelling and storage have never been adequately addressed.

Future studies may identify specific individuals, such as those with genetic Copy Number Variations, G-I, and immune system difficulties, who are susceptible to vaccine injury. Differences have recently been identified regarding the effects of medications on men vs. women, infants vs. adults, and there are now even individualized chemo treatments. In medicine, one size does not fit all.

The herd has been protected so far.
Even though the number of cases increased sharply in 2014, there were still less than 700 reported measles and 1150 mumps cases. Many patients had  previously been vaccinated, or were too young to get a shot. Worldwide, there were ~ 400 cases of polio reported in 2013. Working together (mutually beneficial relationships), drug companies and governments have done a fairly effective job.
With CDC surveillance and public health reporting, outbreaks can be detected using appropriate testing with inoculations to avert tragedy.

Based on an incidence of 1/68 children, the number of patients with autism equalled nearly 60,000 in the US.

Conclusions
There doesn’t seem to a great deal of wiggle room for parents who remain convinced that an inoculation altered the course for their typically developing child. Does a previous child with autism after a shot count? How about those who are already not developing normally? Many children have fevers and diarrhea following a vaccination, so that is significant. Should febrile seizures be a concern? Does a child with Tuberous Sclerosis who does not show signs of autism (yet) count?

An already elevated titer against a disease seems to be a contraindication to revaccination. There are patients with high or low white blood cell counts, so this might become a possible possible temporary exemption.

Finding a physician willing to assist in the process is one part of the journey. Crossing t’s and dotting i’s to adhere to regulations will take time for already-resource strapped families.

The change in the law is a knee-jerk reaction based on inadequate scientific information, conflicts of interest from those who are supposed to be protecting us, and presents an unnecessary barrier for thoughtful, intelligent, concerned parents.

For many parents, homeschool dot-coms may be the most preferable alternative.

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.

Autism, Inoculations, and Fantasyland

Sunday, January 25th, 2015

Recent news about the increase in measles that has sprung up in California, has brought about the usual media finger-pointing, claiming that the cause is unvaccinated children whose parents unnecessarily worry about the risk of autism.

As documented in my previous posts on this topic, this physician believes in the value of those twentieth century miracles. Nonetheless, a lingering question remains, “Are all of the vaccinations safe and effective for all young children?”

The Three Main Reasons for the Measles ‘Outbreak’

Lack of Knowledge

We really don’t know the reason(s) for the newest episode. The increase may have little to do with lack of compliance by anti-vaccination zealots. Many of the infected individuals were Disney workers who had probably already been vaccinated, and were no longer immune. Plus, the venue is an international attraction, with visitors from all over.

The Wakefield Effect – Any time there is any story involving vaccines and ASD, the controversial and now-infamous British study that implicated measles virus as a possible cause, seems to mar all perception and reason. Media pundits are quick to avail themselves of that ill-fated research.

Conventional medicine is still debating whether increases are merely due to changes in diagnostic criteria. Every week a new association pops up; including maternal weight, paternal age, environment and toxins, stress, and circumcision. If compliance is the issue, certainly such confusion shakes one’s faith in the ‘science’.

Polarization

The experts would have a great deal more validity and success, if they could add more understanding and kindness to their approach. Those who question the status quo are considered kooky, ignorant and ill-informed. That creates more polarization, with fewer parents possibly choosing to vaccinate.

Pro-vaccination declarations are rarely equivocal, and conclusions no longer contain the statement, “The topic deserves further study.” Anti-vaccination supporters suffer a similar shortcoming, and conspiracy theories are a scientific distraction. There doesn’t seem to be any compromise position.

Issues, such as the recent CDC whistle-blower case, or reports of safety violations have not been adequately addressed.

There still aren’t any definitive, prospective, randomized, controlled, double-blind crossover studies with long-term outcomes evaluating various vaccine schedules to document safety. Holistic medicine is frequently chastised by the establishment for such an omission in alternative protocols.

Lack of Confidence & Trust

A great deal of money is handed to drug manufacturers to manage these vaccination programs. Concerns abound about whether large multi-national companies always have our best interests in mind.

The Flu vaccine fiascos that permeate each winter do not engender a great deal of confidence about how our medical establishment handles the inoculation issue.

The government continues to send out inaccurate and conflicting messages regarding our public health. Antibiotics in our food are proven unsafe, but the practice continues. There were 2 cases of ebola and Congress appointed a ‘czar’, but they couldn’t confirm a Surgeon General.

Public trust in the FDA and CDC has been eroded by frequent lapses in judgement and execution.

Conclusion:
The vast majority of the scientific literature is quite insistent that there is no relationship between the present vaccine schedule and ASD. To all of the experts, ‘true’ scientists, and colleagues – I get it!

That fact remains that there are too many parents who have noted developmental regression proximate to a childhood vaccination. They deserve better answers.

Five Steps to Improving Vaccination Compliance

Saturday, October 4th, 2014

In a recent Wall Street Journal editorial, “The Anti-Vaccination Epidemic”, Dr. Paul I-never-met-a-vaccine-I-didn’t-like Offit whined about the ignorant public, The Wakefield Effect, “fringe” doctors, foolish families and the “inaccurate” media. The subtitle, Whooping cough, mumps and measles are making an alarming comeback, thanks to seriously misguided parents, sums up the position of Dr. He-ain’t-Jonas-Salk.

The mainstream approach to the childhood vaccination-autism controversy is that there is no blame on the part of the ‘experts’ or the doctors who follow the pharmaceutical industry’s dogma. The logic that says,”If you knew how bad those diseases were, you would believe,” doesn’t work on me. I have lived through many previous epidemics.

The major problem is trust. Confidence in the government is at an all-time low. More than half of the population doesn’t trust the FDA. That bureaucracy can’t manage to stop antibiotics in our food, even when there is evidence of negative effects.

The CDC has similar problems. The current whistle-blower incident, involving questionable data inclusion/exclusion affecting an association with MMR and autism in African-American males, hardly discourages vaccine skeptics. Furthermore, the present viral epidemics appear to reinforce public fear about the competence of that prestigious organization. It was media scrutiny that prompted investigators to secure the living quarters of the Texas ebola patient!

How to Improve Vaccine Compliance:

1. It is difficult to believe that an agency has ‘learned from its mistakes’ when they don’t even own up to them. There have been problems in the past. A neurologic illness has been related to some vaccines, and the Swine Flu ‘epidemics’ were debacles. Public trust would best be furthered by declaring, “We understand what happened and those issues are behind us,” if it’s true. If it isn’t, caution is warranted.

2. Pediatricians need to give better advice. Often, the doctor who professes vaccine safety also missed the child’s ASD diagnosis. Parents are not “bad”, “ignorant”, or misinformed. They simply don’t agree, and professionals should be armed with the facts, not paternalistic warnings.

3. Doctors need to listen. A previous sibling or relative with autism is cause for concern. Fevers or illness that followed other vaccinations should be highlighted in the chart, not dismissed. Co-morbidities, such as eczema or asthma need to be controlled, before adding to the immunologic load.

4. Research that challenges the norm warrants evaluation, not immediate dismissal. Instead of proclaiming the autism-vaccination question a dead issue, confidence would be elevated by experts who calmly declare, “That study deserves further attention.”

5. A practitioner’s willingness to agree to an individual family’s reasonable request to adjust the number and frequency of ‘shots’ will be met with more, not less, compliance. Furthermore, kicking an insubordinate family out of the practice is neither ethical nor helpful.

The present strategy of threats and intimidation is not working to decrease the number of families who either choose an alternative schedule, or the risky position of total noncompliance.

Further understanding and kindness is the best prescription for a more successful approach.

Miracle Mineral Solution Treatment for Autism

Saturday, May 24th, 2014

I hadn’t really expected MMS to gain any traction as a viable autism treatment. It seems complicated and scary, and the FDA first issued a warning about it four years ago. Perhaps there is no measurable re-emergence, but it seemed so when I attended the Autism Today Second Conference in Miami this week.

I sat among eighty mostly-bewildered parents, representing children who are so affected that they are attracted to outlier theories and treatments. This is largely because the information supplied by the conventional medical community is so woefully inaccurate, incomplete, and unproductive for many patients.

Due to some scheduling glitches, this conference ended up focusing on the very controversial topic of MMS. The treatment was explained by Ms. Kerri Rivera, “a biomedical consultant for an autism clinic in Puerto Vallarta,” and mother of recovered child. Her experience was then authenticated by Dr. Andreas Ludwig Kalcker, inventor of “The Parasite Protocol,” which is an essential element in the therapy.

The Chlorine Dioxide Protocol is not about bleaching your kid. That was the first message. Well, it’s not about making your intestines white, but the word does mean “to sterilize.” Anyway, that refers to sodium hypochlorite, according to Ms. Rivera, not the chemical that MMS is utilizing. In that sense, it’s not about dipping your child in Clorox. Except that Chlorine dioxide is used in “stripping textiles and industrial water treatment,” and it does involve purging and cleaning the “excess of pathogens.”

  • The diet – organic vegetables and meats. GF/CF/SF/sugar free (especially fruits).
  • Supplements – Stay away from all anti-oxidants.
  • Main Ingredient – Ocean water and acid (lemon juice, e.g.), to make a dilute solution of Chlorine Dioxide.
  • How it is administered – Doses and administration depending on a pre-established protocol, plus alterations depending on symptoms and response to treatment. In the gut, it is supposed to remove the biofilm and so expose organisms that get flushed through the G-I tract. Breathed into the lungs, it addresses asthma and bronchitis. The cutaneous route helps eliminate bad skin cooties and detoxify. Enemas and rectal suppositories to directly address lower intestinal issues. There is also and Eye and Ear spray form.
  • What happens – The elimination of bad bacteria (and, admittedly some good ones – but they have a product to fix that), viruses, fungi, and worms. Lots of worms. Plenty of worm pics. Worms that no laboratory in the world, apparently, can document.
  • Acceptable additional treatments listed as HBOT, chemical chelation and GcMAF, probiotics, l-carnosine, carnitine, plant fatty acids, GABA, digestive enzymes, tryptophan, DMG and TMG (the last 2 are anti-oxidant precursors).
  • She claims to have helped over 6000 families, and 131 cases of patients losing the diagnosis.

The ‘Parasite protocol’ was presented by Dr. Andreas Ludwig Kalcker, who recommends Chlorine Dioxide treatment.  He lists his credentials as, “… first licensed in economics and later in biophysics and alternative health (Ph.D)
Although his German accent is compelling, the science that he presented was not. He listed the symptoms of parasites and noted similarities to many autistic behaviors (?cause and effect?). He claims that his key discovery was that regressive autism is due to “Parasitological Vaccinosis“. That term describes toxins that are later released by parasites in susceptible children who become vaccinated.
He made many grand overstatements, using real research papers that only prove the one point, frequently mixing apples and oranges. Slides such as “Larval migraines induced by vaccine,” not only lack a scientific citation, I couldn’t find any match over the entire Internet.

In the Q&A session, I asked a simple question, “131 ‘cured’ is the numerator, what is the denominator?” This resulted in Ms. Rivera and Dr. Kalcker blustering about how that number couldn’t be documented, and how it wasn’t really important. That begs the comment, “Well, if you don’t know how many have been treated in this manner, you also wouldn’t really know how many have experienced significant negative reactions.”

As expressed by top autism researcher, Dr. Martha Herbert, I do not believe that parents who attend these conferences are “gullible, dangerous, and/or don’t love their children, and the people who pass them off are snake oil salesmen.” I was there to learn about new ways to approach our most resistant patients, not to criticize. Advertising MMS in this manner is not the way to go about proposing innovative and controversial treatments. It promotes The Wakefield Effect.

Dismissing conventional medicine as being completely ignorant and challenging treatments from all sides takes strong scientific proof. Proof of concept in animal models and proof of efficacy and safety in appropriate human treatment trials. To be specific: no, I would not recommend this treatment for my patients. There is too much missing information. A few pictures of recovered children and parental testimonials should not sway a prudent professional.

At The Child Development Center, we have improved the lives of many of our patients by addressing and treating G-I health with a proven, safe, well-tolerated protocol. Nutritional status must be evaluated, treated and monitored. With appropriate behavioral therapies, child development gets on the right track.

For successful autism treatment, each piece in the puzzle has to fit into the bigger picture.

A Mother’s Intuition About Autism

Saturday, May 10th, 2014
Mother's Day 2014

Mother’s Day 2014

Every new patient at The Child Development Center has a unique history and physical presentation. Often, however, the children share the experience that their mother:
a. Already knew, or highly suspected, ASD, and
b. Heard the doctors proclaim that they were “reluctant to make a diagnosis, at this time, because the child is so young.”

Is there any other serious medical condition that carries this ‘wait and see’ attitude? “It’s probably not cancer, so let’s wait a few months and see what grows.” “The eardrum looks red and is bulging, if the fever gets any higher we will consider antibiotics.” “I hear wheezing, call us in a day or two.” And vaccinations? The first one is foisted upon newborns, with many more to follow, in order to prevent disease.

Study after study documents important gains that come from early intervention for developmental delays. Despite that, there are neurologists and psychiatrists who continue to claim that “You can’t make the autism diagnosis before the age of 2 or 3.” That imposes a waiting period, postponing intervention at the most critical juncture of development.

In order to assign an accurate diagnosis, both the DSM IV, and the present iteration of the Diagnostic and Statistical Manual of Mental Disorders 5.0, contain the stipulation that delays should be noted in early childhood. The previous manual stated, “Delays or abnormal functioning… with onset prior to age 3 years… ” The present DSM 5.0 describes, “Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).” There is no mention of a waiting period.

Yet, in the midst of this epidemic, and with all of the press coverage about the rise in autism, mother is usually the one who makes the diagnosis. Is it any wonder that the parents go to the Internet to get their information or seek alternative treatments when the doctors weren’t even willing to assign a diagnosis, let alone suggest any therapy?

At our Clinic, there are now many younger siblings of children who carry a ‘Spectrum’ diagnosis. Some demonstrate developmental red flags. A 2 year-old male who doesn’t speak and walks on hs toes but shows good eye contact. A 1 year-old female who turns to her name, but doesn’t stand or vocalize. A six month-old boy who suffers from GERD, eczema and chronic diarrhea.

The youngsters were all high-risk and the mom couldn’t sleep, worrying about the future. What is wrong with offering immediate action targeted to specific symptoms? The youngest children can use a probiotic, stop using PPIs and stay away from antibiotics. The older ones need speech and language, OT, ABA and/or PT. STAT.

These are real examples of some brothers and sisters who have gone on to neuro-typical development. Did earlier intervention prevent autism? Bottom line – who cares?

Try this analogy: It is the Middle Ages and The Plague has struck several neighboring cities. The first sign is a flu-like illness that rapidly advances, ending in death. So, when a local sufferer visits the doctor because of a runny nose and sore throat, the physician should be thinking “The Black Death,” not a cold.

Twentieth century poet Helen Steiner Rice wrote, “A mother’s love is patient and forgiving when all others are forsaking, it never fails or falters, even though the heart is breaking.”  When Mom thinks that something is wrong and the doctor dismisses it, saying “It will probably will go away,” families should run, not walk, to a professional who will listen.

Happy Mother’s Day
f
rom Dr. Udell
and the staff at the Child Development Center

The Autism Wars: Frank Bruni vs. Jenny McCarthy

Friday, May 2nd, 2014

Perhaps to mark the end of Autism Awareness month, but seemingly out of the blue, New York Times op-ed contributor, Frank Bruni, decided to weigh in on the vaccination-autism non-connection issue with this April 21, 2014 article. He accused Jenny McCarthy of being an “agitator… the intemperate voice of a movement that posits a link between autism and childhood vaccinations and that badmouths vaccines in general, saying that they have toxins in them and that children get too many of them at once.”

In this corner – Foodie Frank
Who is Foodie Frank to attack Gorgeous Jenny? His bio in the Times describes, “Over his years… he has worn a wide variety of hats, including chief restaurant critic… Rome bureau chief…  also written two New York Times best sellers: Born Round (“as in as in stout, chubby, and always hungry”), and Ambling Into History, (about George Bush)… coauthor of A Gospel of Shame: Children, Sexual Abuse and the Catholic Church.” Wikipedia adds that he “… became the first openly gay op-ed columnist…” of the Times.

Nothing in Mr. Bruni’s curriculum vitae points to any learned knowledge of science, biology, immunology, ecology or child development. The only extant association between Mr. Bruni and autism is this vacuous article that he penned. There is no evidence that he possesses any special information. Oh, that’s right, he did say that Yale’s autism expert, Dr. Fred Volkmar, told HIM that the vaccination controversy “diverts people from what’s really important, which is to focus on the science of really helping kids with autism.” A diversion from the important stuff, huh? As in, this bullshit op-ed story.

And, in this corner – Gorgeous Jenny
And what role does Jenny McCarthy play in this complicated, emotional and misunderstood quagmire that is the present autism epidemic? Her pediatricians didn’t even know what she was talking about when her child was diagnosed with autism. The conventional medical community says that, “Autism is what it is… you got what you got… deal with the situation and get (really expensive and difficult-to-find) therapies. Good luck.”

Parents are admonished not to listen to anyone who says that they can help with medical treatment, other than the standard psycho-stimulant meds. Even if Mom witnesses a change (from a GF/CF diet, e.g.), professionals warn that “It’s probably just a coincidence, like that disproven vaccination theory.”

Ms. McCarthy warned the country and the world that a storm was coming. Regarding ASD, doctors have displayed ignorance at best, and have even caused harm, due to delays and misdiagnosis. And, while we’re on the subject, if it turns out that her son, Evan, has one particular version of autism, that hardly constitutes some sort of fraud for the purpose of gaining visibility. Smack of bullying, Frank?

The child’s complicated diagnosis – made by the doctors –  doesn’t make McCarthy someone “who sows misinformation, stokes fear, abets behavior that endangers people’s health.”
Only the CDC, FDA, and AMA are allowed to do that.

I have been witness to the miraculous improvements served by childhood vaccinations. I recommend them to our patients; perhaps more diligently than might serve the ‘herd’, however, in susceptible individuals, doctors need to be very conservative. It shouldn’t be so complicated for the medical community to produce independent, prospective studies about the present vaccine schedule with 3 year follow-up aimed at developmental outcome, especially as it applies to higher risk infants.

No Winner is Declared
My advice is for Mr. Bruni to go back to his core competencies, Ms. McCathy to continue to fight for her child and help raise money for autism awareness-treatment-and-prevention, and for medical science to work on a better explanation(s) for this epidemic.

An agitator produces lots of heat with little light.
What a desperate mother does, is search for answers why her perfect, beautiful toddler became non-responsive and stopped talking.

Is Tamiflu for You?

Friday, February 7th, 2014

As a physician who cares for at-risk infants and children, I am frequently asked to weigh in on the topic of flu vaccine and the medication, Tamiflu.

Ever since the introduction of Oseltamivir Phosphate, an anti-viral preparation to ‘cure’ influenza, controversy has ensued. There are a number of websites that discuss the issue in detail, pro and con.

Forbes magazine, which generally takes fairly conservative positions, recently published “The Myth of Tamiflu“. The FDA doesn’t seem to have a problem with it; even recommending Tamiflu for infants as young as two weeks.

Consumer Reports, recently concluded, “Not unless you’re very sick with the flu or … are otherwise at high risk.” That respected medical journal’s opinion was to administer Tamiflu to the group that might get ‘sickest’ from the disease.

Cost(s):
A typical course has been reported to cost $120, more or less. For an entire family of 4 or more, it becomes fairly pricey.
Does Medicaid or insurance pay? If they are willing to cover (call, push buttons, and argue at your own peril), you may have to wait until the prescription is authorized; thus, mitigating the “at the earliest sign of the flu” advice. Co-pays can be more expensive as well, e.g. $25 or more. Keep your Tamiflu coupons handy.

Benefit(s):
Symptomatic relief occurring 1-2 days (out of 1-2 weeks of influenza) sooner is possible, but that is no certainty. The condition may not be the ‘flu’, the virus strain may not show responsiveness, or the patient waited too long to initiate treatment.
Additionally, I am sure that Roche has a ‘Days of Reduced Productivity From the Influenza Virus’ PowerPoint slide to persuade beaurocratic personnel that their concoction is worthwhile.

Risk(s):
Warnings listed in the Physician’s Desk Reference include:
• Severe allergic reactions.
• Serious skin reactions.
• Neuropsychiatric events, signs of abnormal behavior – how can you tell about this in your ASD affected child?
• Dyspepsia (upset stomach), with increased rates of vomiting – which is a common symptom in children, and many with autism.
• Diarrhea – another frequent physical sign in our high-risk patient population.
• “Caution in nursing” –  but it’s recommended if you’re pregnant? Also, most babies should be nursing; so, it’s OK as a liquid, but not OK in breast milk?

The Genentech website cautions:
“People with the flu, particularly children and adolescents, may be at an increased risk of seizure, confusion, or abnormal behavior early during their illness.”
“The most common side effects are mild to moderate nausea and vomiting, diarrhea and stomach pain.”

Conclusions:
So far, the risks appear to outweigh the benefits of Tamiflu. The cost seems high, considering that the drug only results in a possible, slightly shortened course of the flu. There are important lingering questions; including, whether there are fewer complications and deaths.

Long-term outcomes will have to wait until Tamiflu is used long term. This medicine was not available in the last century, begging the question of how there could be truly valid safety information when this antiviral is administered to a 2 week-old infant.

Recommendation:
Healthy older children and adults who exhibit the onset and suffering, or wish to prevent the flu in their virus-ridden environment, and can afford it, might give it a try.

My preference is to prescribe Tamiflu to those who are not pregnant, breast feeding, or very young children, in the hopes of preventing infectious transmission to those who are at increased risk for complications, without incurring the risks of the drug.

The greatest benefit that I see, is to the pharmaceutical company Roche,
and its member company, Genentech.

Autism Review 2013

Sunday, December 29th, 2013

Here is this year’s crop of stories (listed in Medical News Today) that I consider to be the most informative, interesting, and likely to change the knowledge base concerning the epidemic of childhood signs and symptoms presently called Autism Spectrum Disorder.

January
Can Children Lose Their Autism Diagnosis? – Uh, yes. And, many more than this group reports.
New Gene Variants Linked To Autism Discovered – The perfect storm of environmental toxins and susceptible individuals (genetic variation).
Epilepsy Drug Linked To Increased Risk Of Autism – The perfect storm of environmental toxins (medication) and susceptible individuals.

February
Feeding Problems And Nutritional Deficits A Significant Risk For Children With Autism – Ya think?
Attention Deficits Picked Up In Babies Who Later Develop Autism – The ‘Spectrum’ diagnosis involves a combination of signs and symptoms, not just the ‘core’ deficits.
Help Needed For Youths With Autism Spectrum Disorder Transitioning To Adult Health Care – Transitioning in general, don’t you suppose?
Autism Study Finds Behavioral Therapy For Children Can Impact Brain Function – So, the autistic brain can exhibit plasticity. Just like every other human brain.
Brain Connections Differ In Kids With Autism – There were lots of brain connection articles this year. The problem is understanding WHY the brains work that way, since it’s pretty obvious that some circuits are crossed and/or missing.

March
Study By Kennedy Krieger’s Center For Autism And Related Disorders Reveals Key Predictors Of Speech Gains – This is why it’s so important for kids to play with others.
Suicide Ideation And Attempts A Greater Risk For Autistic Children – Why doctors shouldn’t put teenage patients on anti-psychotic medications.
Old Drug Offers Hope For New Autism Treatment – This article covers it all; inflammation, immunity, the environment, mitochondria, stress and recoverability. It’s just in a mouse model, but offers a unifying theory.
One In 50 Kids Has Autism In U.S., CDC – And, we’re still arguing the ‘E’ word (? epidemic ?)
Gaze Shifting Delay Has Potential To Diagnose Autism At 7 Months – Plenty of research about earliest diagnosis, not much about how to intervene.
Multiple Vaccines Not Linked To Autism Risk, CDC – So they keep telling us.

April
Link Between Autism And Increased Genetic Change In Regions Of Genome Instability – The perfect storm… you get it.
Minocycline Show Benefits In Children With Inherited Cause Of Intellectual Disability And Autism – Some assistance for patients with Fragile X syndrome, one of the known causes of ASD.
Study Shows Different Brains Have Similar Responses To Music – Love of music is universal.
Propranolol Could Improve Working Memory In Autism – Several of the older blood pressure medicines perform in some fashion to help affected individuals.
Taking Valproate While Pregnant Raises Autism Risk – Drugs taken during pregnancy may not be good for the developing brain. Well, at least it’s in print now.
A Newborn’s Placenta Can Predict Risk For Autism – Now, there’s an early predictor! Again, what to do about it?
Significant First Step In The Design Of A Multivalent Vaccine Against Several Autism-Related Gut Bacteria – Formal recognition that there is a gut-brain connection in autism.

May
Researchers Successfully Treat Autism In Infant – OK, so maybe you can do something about the earliest red flags.
Early Intervention Program For Children With Autism Found To Be Cost Effective Through School Years – More documentation such as this is needed so that governments, insurance companies, and the like will take notice.
Link Between Epilepsy And Autism Found – The literature reports that 40% – 80% of patients have seizures (much lower at The Child Development Center, however).

June
A Third Of Autism Cases Also Have ADHD Symptoms – It’s not ALSO, it’s an integral part of the picture for some children.
Autism Discovery Offers Hope For Early Blood Test And Therapeutic Options – One of the reasons that I prescribe tryptophan (5-HTP) to address some ASD signs and symptoms.
Racial And Ethnic Disparities Found In Gastroenterology, Psychiatry Or Psychology Care For Children With Autism – Yeah, professionals need to get on the same page.
Air Pollution Raises Autism Risk – The environment. Again.
Single Mutation Can Destroy Critical ‘Window’ Of Early Brain Development – Genes. Again.
Autism In Children Affects Not Only Social Abilities, But Also A Broad Range Of Sensory And Motor Skills – Recognition of signs and symptoms that every parent of an ASD child observes. More such information was published subsequently.

July
The Gut May Offer Clues About Autism – By now, even pediatric gastroenterologists should be getting the message.
Autism Training Program For Pediatricians Meets ‘Critical Need’ For Earlier Identification – Until now, I don’t think that my fellow pediatricians are doing such a great job at early diagnosis.
First Full Genome Sequencing For Autism Released By Autism Speaks Collaborative – This kind of valuable information is why all of the parties in the autism community should work together, rather than criticize each other in public forums.
Early Intervention Benefits Young Children With Autism Regardless Of High-Quality Treatment Model – So, if early intervention helps, and we can make the diagnosis earlier, then the situation should be improving. Right?
Oxytocin not found to offer symptom relief in autism – A bunch of these articles this year, both pro and con. My experience is that it does help in a small percentage of affected individuals.
Fresh fuel reignites Asperger’s debate – Combining two conditions that we don’t understand – couldn’t that make us twice as ignorant?

August
Oxytocin, the ‘love hormone’ may have relevance in autism – This was one of the ‘pro’ articles.
New research sheds light on previously under-researched area of study – females with autism – We really need more information about the difference between boys and girls with ASD.
Induced labor linked to higher autism risk – Here is my advice (as a Board-Certified Neonatologist): Have the baby when the time comes. Sometimes, Mother Nature does know best.
Risk of autism in further children – study findings – This is the type of information that prospective parents frequently seek, and little is really known.

September
Young adults on the autism spectrum face tough prospects for jobs and independent living – This highlights why early diagnosis and intervention are so vital.
Genetic disorder 22q could be misdiagnosed as autism – Or, this could be just one of the causes of autism. No?

October
Improving understanding of brain anatomy and language in young children – This is the type of knowledge that needs to be elucidated as we try to solve this puzzle.
New cases of autism in UK have levelled off after five-fold surge during 1990s – Well, good for England (if it’s true). This is not the case in the U.S., or most other countries, however.
Autistic children look less friendly to peers – And, vice-versa, I would say.
Web-based autism intervention tool shows promise – Lots of tech stuff for autism appeared this year. I still like Proloquo2Go the most.
Link examined between pregnancy weight gain and autism spectrum disorders – An even EARLIER diagnosis. How about a fetal Speech and Language therapist?

November
Health-care changes needed to help adults with developmental disabilities – Much more information needs to become available to address the growing numbers of older individuals with autism.
Autism increases risk for synaesthesia – Maybe shedding some light on the sensory issues in ASD.
Relationship between bedroom media access and sleep problems among boys with autism – As if parents didn’t know this! Well, it’s official, now.
Gender differences in gene expression in male and female brains – I’ve described this clinical difference before. There’s the “girl kind”, and the “boy kind”.
Autistic children’s ability to perform everyday tasks improved by occupational therapy – This one should help with insurance reimbursement.

December
Genes and air pollution combine to increase autism risk – Circling back… genes and the environment.
Brain function in children with autism improved by a single spray of oxytocin – It works. It doesn’t work. Which is it?
Autism-like behaviors in mice alleviated by probiotic therapy – Human probiotics, by the way.
Research linking autism symptoms to gut microbes called ‘groundbreaking’ –  Well, it’s important, but groundbreaking? This association has been ‘documented’ since the “Refrigerator Mom” days.
Hospital infection in pregnancy tied to higher risk of autism – Perhaps it’s the antibiotics that are given, not the infection itself?

Hopefully, 2014 will bring more in-depth research with targeted treatments, so parents will have an increased number useful protocols to assist their developmentally challenged children.

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