Posts Tagged ‘Vaccine’

Flu Shots in Pregnancy May Increase Autism Risk

Sunday, December 4th, 2016

jamaThe Journal of the American Medical Association recently published a study entitled, Association Between Influenza Infection and Vaccination During Pregnancy and Risk of Autism Spectrum Disorder.

Whispering Down the Lane
Health News from NPR, Fox News, Medscape.com and even the American Academy of Pediatrics echoed each other, claiming the paper offers proof of the flu vaccine’s ‘safety’ when given during pregnancy.

Do these reporters really read the research? I reviewed the same literature, and decided that the title of this post should highlight the opposite position.

Results
1. “…maternal influenza infection during pregnancy was not associated with increased autism risk.”
If a pregnant woman gets the flu, the child is considered safe from the standpoint of developing ASD. This is not necessarily supported by other research (1 , 2, 3, 4), but this finding provides some level of comfort.

2. “There was a suggestion of increased risk of autism spectrum disorders among children whose mothers received an influenza vaccination during their first trimester…”
At the earliest time in gestation, many women may not be aware of a pregnancy, which might be risky, if they receive the ‘shot’. Fudge factor: “…the association was statistically insignificant after adjusting for multiple comparisons, indicating that the finding could be due to chance.”

3. “Our findings do not call for vaccine policy or practice changes but do suggest the need for additional studies.”
Is that explanation supposed to make that make families feel more comfortable about this issue? How about this? One of the principle authors “…received research grant support from GlaxoSmithKline, Sanofi Pasteur, Merck, Pfizer, Protein Science, MedImmune, and Novartis.”

Other literature
Research demonstrating effectiveness of the vaccine, especially in the face of a specific epidemic is the principle motivation for the recommendation to vaccinate in pregnancy. The publications from the beginning of this century have demonstrated efficacy and safety for the mother and the baby. Previous studies have also shown an increase in small or preterm infants associated with influenza during pregnancy.

However, there is a lack of research regarding ASD outcome when flu vaccine is administered, and pharmaceutical industry funding is ubiquitous.

The flu shot is not recommended for children under the age of 6 months. It is advocated for pregnant women. So, it’s OK if you are a fetus? The use of acetaminophen for a fever, which is certainly a known complication of ‘shots’, has been identified as a possible contributor to ASD.

Conclusion
Whose interests are being served by the widespread use of these vaccinations? For the very old or infirm, it seems a reasonable option. Concerning the immunocompromised, even if herd immunity could be achieved (~90% vaccinated), that would only cover only a handful of the possible viral pathogens that exist – with new ones popping up every day.

The product generates billions of dollars for the drug makers. Money used to fund studies, such as these, needs to come from completely independent sources.

The present study indicates a slightly increased risk of autism from a flu vaccination given early in pregnancy. Since there is less evidence that the flu, itself, leads to significant developmental disorders, it appears that more information needs to be made available in the face of the modern autism epidemic.

Pediatricians and Autism

Sunday, November 6th, 2016

“I think that your toddler may have some signs of autism. That’s a complicated subject. I’ll give you a referral for…”

Sound familiar? Was that the first time that you heard what you (or your spouse) had suspected from a medical professional?

This story is not meant merely to ventilate. Education is the goal. The challenge is how to get an uninterested, overworked, under-reimbursed, skeptical group of intelligent individuals to pay attention. We are standing in the middle of the childhood epidemic of our time, and the professionals continue to worry that there aren’t enough vaccinated kids! It’s insane.

That was the ventilation part.

Education
At the first sign of a thyroid problem, e.g., a doctor doesn’t just send a patient straight to the endocrinologist. Rather, a baseline blood level is ordered, the results are evaluated in the light of the patient’s signs and symptoms. Next, the clinician is expected to explain all pertinent information, and refer to the most relevant specialist.

In the case of developmental delay, it seems that such a protocol is rarely followed. Even the expert (neurologist, or developmental pediatrician) seldom follows a prescribed course of action. An EEG and MRI? That depends on the family’s insurance status. Chromosomes or genetic testing? The usual advice is, if you aren’t having any more children, that won’t be necessary. Or, “The results won’t matter, anyway.”

External factors such as these should not be the determining factor in the 21st century workup of any patient, let alone a child whose growth is not proceeding in a normal fashion. A previous post details the top ten things all pediatricians should know about ASD. There is a workup to be done.

After a visit with the neuro-developmental doctor, a follow-up examination should take place with the ‘main’ practitioner, who ought to become the child’s medical advocate, rather than the parent. Pediatricians who believe that a family is ignorant or ill informed about the use of an off-label treatment need to learn more about all of the options, in order to assist the family in such decisions.

Discussion
This year (Jan-Nov, 2016), there were eight articles in The Journal of Pediatrics specifically about ASD. That is less than one significant article per month in our major pediatric publication.

Autism Spectrum Disorders and Metabolic Complications of Obesity
Autism and antidepressant use in pregnancy
New rapid autism screening test
Applied Behavior Analysis as Treatment for Autism Spectrum Disorder
To Screen or Not to Screen Universally for Autism is not the Question: Why the Task Force Got It Wrong
Predictive Validity of the Modified Checklist for Autism in Toddlers (M-CHAT) Born Very Preterm
Reported Wandering Behavior among Children with Autism Spectrum Disorder and/or Intellectual Disability
Comorbidity of Atopic Disorders with Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder

The best way to address this present state of outworn medical attention is to fund and publish more research. This involves a paradigm shift in the diagnosis and therapy of ASD. The condition is of multifactorial origins and consists of a variety of signs and symptoms that can be ameliorated.

Pediatric residencies must adopt a new clinical rotation for this important malady. Practitioners who do not believe that, in complicated medical conditions, their role should be ‘captain of the ship’, might consider other medical specialties that do not carry this type of obligation.

Conclusion
It is simply not enough for a present-day pediatric clinician to exclaim, “Well, I don’t know much about autism.” The preferable, and intelligent answer should be, “I’m going to have to do a bit of study about this condition. They didn’t teach us about this in med school, but it seems important.”

Perhaps parents can use this essay to inspire/challenge your doctors to develop a modern attitude toward this medical mystery.

Medical Academy of Pediatric Special Needs – Fall 2016

Sunday, September 11th, 2016

This week, the Medical Academy of Pediatric Special Needs held its semiannual conference in downtown Atlanta, GA. This is ‘Ground 0’ for practitioners, researchers and professors from all over the world to meet, learn, explore and discuss a myriad of relevant topics.

Members who have been returning for 100’s of lecture hours generally choose the advanced courses. For some, the conference has become a group of ~50 experienced and knowledgeable practitioners who meet to discuss ‘workups’, basic science, relevant research and treatment protocols for those who are most affected with ASD.

Notes and Observations
Day 1 – Tough Cases
I really enjoyed our lectures by the plain-speaking Dr. John Green, of Portland, OR. Dr. Green not only reviewed those who improved because of his medical expertise, but those who got better in spite of him, those who haven’t gotten better, those who got better but he can’t figure out why, and the most frustrating – patients who improve only to suffer frequent relapses.

Dr. Sid Baker, a pioneer of the biomedical movement, described his early medical experiences in Africa that morphed into his lifelong dedication to treating patients with ASD. He expressed his disappointment that so many conventional colleagues disagree with our practice.

Dr. Baker elucidated how he initiates care with new patients. He discussed increasingly resistant cases, covering topics from severe speech apraxia to the approach to children with injurious behaviors.

The first day was filled with the most frustrating and difficult cases you can imagine. Eminent practitioners Drs. James Neuenshwander, Michael Elice, and Julie Buckley challenged our diagnostic and therapeutic knowledge, attempting to navigate the complicated courses of those who improved and those who didn’t.

Day 2
Dr. Daniel Amen‘s morning lecture was entitled “3D Brain SPECT Imaging”. The takeaway message was that SPECT scans – technology – could/should/will become a mainstay for a multitude of CNS disorders. His manner and stories of research, technical evaluation, and clinical practice, were positively spellbinding and inspirational.

Dr. Theoharides presented his research and extensive knowledge about the important role of allergy in ASD. Dr. Theo continues to publish a mountain of monumental works, not only on the topics of autism and the role of mast cells, but treatments, as well.

Toxins were the subject of the afternoon’s lectures. We learned about the identification of substances in the environment that are dangerous, how they are measured, how damage is done, and the means to control and treat. For the skeptical reader, there was a plethora of supporting scientific evidence of the relationships to autism (and many other modern conditions).

As has become customary, Dr. Dan Rossignol rounded up the day with a roundup of all of the latest scientific research. Rapidly.

Day 3 – Advanced Clinical Cases
Severe behaviors and speech apraxia. For patients who are most resistant to conventional and alternative treatments, essential oils, acupuncture, and even worms were explored as possible solutions.

Throughout the afternoon, cases got even tougher! Lyme, Persistent Lyme, Non-Lyme Lyme, PANDAS, PANS, parasites… an increasing number of reasons to have signs and symptoms that are called autism. Such information extends our knowledge and leads to better diagnoses for our patients, and possibilities for treatment.

Dr. Green discussed biomarkers. Though these ‘labs’ are not specific to ASD, per se, this will become a necessary next step to document level of involvement and response to treatments.

A brand new treatment, repetitive Transcranial Magnetic Stimulation was presented by Dr. Arun Mukherjee. The jury is still out on this expensive intervention.

Conclusions
One important reason that I return to this meeting, is simply that I feel at home among like-thinking practitioners. Members don’t agree on every subject, but we are respectful and actually enjoy our practices.

In traditional medicine, conferences are basically show-and-tell affairs, where researchers report their data, previously published in medical journals. When doctors think outside the box, practitioners with diverse skills, who are scattered over the globe, discover improved results by networking in this fashion.

Patients, parents, and families can feel confident that progress is being made (slowly), as serious, dedicated doctors continue to try to unravel this modern mystery.

Finally, I am proud to report that, at this meeting, I was awarded Fellowship status in the Medical Academy of Pediatric Special Needs.

Home Schooling Children with Autism Issues

Monday, September 5th, 2016

Home schoolADHD, aggression, bullying and being bullied, meltdowns, oppositional, auditory, visual and other Sensory Processing Disorders, are among the many challenges of modern school-aged children who are recovering from the conditions that are categorized under Autism Spectrum Disorder.

Individualized educational plans have gone a long way toward providing an increasing number of affected youngsters with a more appropriate academic environment. Yet, there remain numerous educational situations in which young children face significant obstacles.

Considering such challenges, an increasing number of families have chosen to home school their neuro-diverse offspring. Here is some of the valuable information that parents have provided about the decision to undertake such a situation.

What are the common characteristics of families who choose to home school?
The most disruptive children require additional medication, and/or one-on-one supervision. Sometimes, only a family member or therapist can achieve control, performed at home (or equivalent).

Families live in locations where there is an serious shortage of appropriately trained personnel.

The IEP and associated adjudication of services do not appear adequate to meet their child’s need. This could involve a lack of classrooms with ‘higher’ functioning individuals, or not enough services for those who have more troubling signs and symptoms of autism.

Parents concerned that, inattention, lack of focus, and hyperactivity in the neurotypical academic environment – by their own child and others – will likely negatively affect performance, grades, and self esteem. Indeed, the psychological profile scores are usually ‘all over the place’, indicating that processing is affected, not IQ.

Sometimes, the choice is influenced by the reluctance to administer stimulant and/or anti-anxiety medication, especially in the youngest students.

What are the biggest challenges?
Relationships with affected children, neurotypical siblings, and blending teaching with family activities, takes a quantum leap in patience, time and effort.

The discipline to prepare lessons and implement the required syllabus is a full-time job.

The outcome of all of this work requires evaluation to assess whether avoiding a traditional program is the preferable course. Has it been worth it?

Caretakers need to determine the best means to ensure exposure to others, and additional ways to foster socialization.

Ultimately, there needs to be a decision if/when to merge the children into a traditional academic environment.

Conclusion
Home schooling enables the ‘teacher’ to maximize learning by individualizing. Caretakers notice when affected children are ‘present’, or allow the necessary time to ‘get the jitters out’. If a youngster is able to avoid taking a test on a particularly squirrelly day, their score will probably be higher. Self esteem improves and anxiety abates.

For those under the age of 6, any suggestion that medication will ‘improve the academic situation’ should be carefully scrutinized. When there is a stay-at-home-parent, additional help, and other resources, home schooling may be the better option, especially for those who are most affected with ASD.

Though it’s not for every parent, or child, this path does provide some families with the most optimal opportunity to guide their offspring to their highest potential.

Top 10 Annoying Comments to Parents of Children with Autism

Sunday, July 24th, 2016

MeasureParents of children with special needs are frequently challenged by friends, relatives, acquaintances, social and other media. Sometimes, it is well-meaning advice, but there are comments that can be especially thoughtless, or even unkind.

Here are the most outstanding remarks that families have experienced, and their answers (or thoughts), mostly delivered with grace and love:

10. Polar white littleGod only gives us what we can handle.

Polar Black littleWe have no choice but to carry on. Should that make us feel better?

9. Polar white littleWhat is your autistic child’s special talent?

Polar Black littleIs that because, if you’re autistic, you must have one?

8. Polar white littleWe don’t want to get him that same gift every year… what else can we give?

Polar Black littleHow about, what he really likes, not what makes you feel better?

Polar white little7. You’re wrong, ignorant, and/or misinformed. Childhood vaccinations have been proven safe.

Polar Black littleNot for our child. Not for all children. And, I’ll bet you wouldn’t say that if your child had ASD.

Polar white little6. That gluten free- casein free, specific carbohydrate, paleo, etc. diet is stupid.

Polar Black littleYou didn’t ask if it worked.

Polar white little5. Did you see Rain Man?

Polar Black littleIs that how you think the child will grow up? That was last century.

Polar white little4. Is your child high functioning?

Polar Black littleIs yours?

Polar white little3. We don’t want to invite your child to the birthday party… we don’t think that he will fit in.

Polar Black littleWho is uncomfortable, the parents or kids? Could you be any crueler?

Polar white little2. I heard it’s not really an epidemic, we just called it ‘retardation’ in the past.

Polar Black littleA condition whose prevalence rises from less than 1/2,500 to 1/68 in a few decades is an epidemic.

Polar white little1. Can’t you handle your (misbehaving) child?

Polar Black littleHe’s autistic, you #*$%&$][ ! (That’s in the thought bubble).

Life is not black or white. Neurodiversity is here. As we understand this phenomenon called ASD, we learn about how all of our brains work.

In the meantime, let’s become more educated
and kind to each other.

Acetaminophen And Autism

Sunday, July 10th, 2016
tylenol9

A Tylenol® by any other name; including Xumadol, Paracetamol, Tirol, Calpol, Panadol, etc, etc.

Evidence supporting an another pharmaceutical connection to autism was recently presented in a study entitled, Acetaminophen use in pregnancy and neurodevelopment: attention function and autism spectrum symptoms, which appeared in The International Journal of Epidemiology.

Given our current state of ignorance, support, rejection, and often, polarizing opinions have already surfaced.

The Present Study
The authors concluded, “Prenatal acetaminophen exposure was associated with a greater number of autism spectrum symptoms in males and showed adverse effects on attention-related outcomes for both genders…”

Recent Supporting Evidence
2014: Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders
Conclusion – “Maternal acetaminophen use during pregnancy is associated with a higher risk for HKDs and ADHD-like behaviors in children.”

2014: Associations between Acetaminophen Use during Pregnancy and ADHD Symptoms Measured at Ages 7 and 11 Years
Conclusion – These findings strengthen the contention that acetaminophen exposure in pregnancy increases the risk of ADHD-like behaviors.

2013: Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort
Conclusion – “Children exposed to long-term use of paracetamol during pregnancy had substantially adverse developmental outcomes at 3 years of age.”

Opposing Opinions
2016: Use of acetaminophen (paracetamol) during pregnancy and the risk of autism spectrum disorder in the offspring.
Summary – “… the empirical data are very limited, but whatever empirical data exist do not support the suggestion that the use of acetaminophen during pregnancy increases the risk of autism in the offspring.”

Dr. James Cusack, research director of Autistica, “…insisted there was “not sufficient evidence” to back the suggestion. “The results presented are preliminary in their nature, and so should not concern families or pregnant women.”

The ‘experts’ say, “Don’t even worry about those studies”
claiming a relationship between Autism and Acetaminophen.
Really?
Where is the proof that it’s SAFE?

Discussion
First available in US in the 1950s, Tylenol Elixir for children became even more popular 30 years later when aspirin was reported as a contributing factor to an often fatal Liver – CNS disorder (Reye’s Syndrome). Interestingly, the authors of a 2007 literature review wrote, “The suggestion of a defined cause-effect relationship between aspirin intake and Reye syndrome in children is not supported by sufficient facts.”

Throughout the globe, there are over 100 names for acetaminophen. Plus, it is an ingredient in hundreds of other over-the-counter remedies. It is widespread and readily available. The increased use of this chemical tracks with the explosion of autism into the 21st century.

The medication can cause liver problems and freely crosses the placenta. There are studies that link pretreatment with Tylenol to address fever associated with childhood inoculations, and an increased risk of ASD. Furthermore, the mechanism of action includes the creation of oxidative stress, which is thought to play a significant role in autism.

Conclusion
What about occasional use? The present research concluded, “These associations seem to be dependent on the frequency of exposure.” However, until further investigations are performed, there could be specific times in pregnancy that are more sensitive than others, regardless of the dose.

A single, relatively uncomplicated question – whether there is an association between Tylenol and ASD – needs to be answered. This is but one example of why numerous other substances in our poisoned environment are so difficult to pin down. And, forget about combinations of substances. Why is the establishment so quick to point out the weakness of the present research, and declare that, “Everything is fine?”

Until more information is collected, conservative advice is warranted. Acetaminophen usage in pregnancy should be placed high on the ‘This Deserves Further Study’ list of important autism associations.

Addendum:
From the New York Times – 9/24/26
The Trouble with Tylenol and Pregnancy

Vaccination Redux

Sunday, April 17th, 2016

TheAutismDoctor has been asked to weigh in on the recent media attention regarding the film Vaxxed, which was scheduled, but not shown, at this year’s Tribeca Film Festival.

Robert De Niro, who helped organize the exposition, announced that he has an 18 year-old son with autism, and felt that the point of view presented in the documentary was important enough to explore. However, he decided to pull the film because the controversy is so heated that it deterred the public’s enjoyment of the rest of the event.

Do Vaccinations cause Autism?
The topic has been covered in this venue over 35 times, so I’m fairly certain that another protestation will confer little additional sanity.

Regardless of the volume and frequency with which Jenny McCarthy, Robert De Niro or Dr. Udell voice the opinion that we are not against childhood inoculations, ‘anti-vaccination’ is usually the way that the information is characterized. Opinions are either, “All or none, for or against, pro-science or anti-vaccination, educated or ignorant, healthy or dangerous.” Such points of view offer no middle ground and so this dispute won’t go away any time soon.

Discussion
I posed the following question to the ‘pro-vax’ father of a 6-month old, “You are asked to enter your baby into a formal study in which there are two groups.”

Group A – Present Schedule

Start at birth (Hepatitis B in hospital)
Fever OK (give Tylenol)
Mild illness OK
9 or more components at once OK
Negative previous reaction OK
‘Make up shots’ (for missed doses) OK
Other medical conditions OK
Development not on track OK

Group B – Other factors considered

Wait to begin until infant is clearly healthy
No shots if child is sick
Fewer components at each time
No pretreatment with Tylenol
Medical evaluation if previous problems
Appropriate testing if medically unstable (e.g. frequent infections, premature, GERD, eczema, asthma, abnormal stooling…)

Dad’s answer? “The safe one!” Really? Is that the one that the ‘scientists’ and government say is all right? And by the way, even if a physician might answer the hypothetical by responding, “Group A is perfectly fine,” their partner would probably protest, “Are you crazy? Not my kid!”

When that scenario is too cumbersome to recite, I pose another question. “Which is a more reasonable statement? ALL vaccinations are good for ALL children ALL of the time,” or “SOME inoculations might not be good for SOME toddlers in SOME situations?”

If the answer is the latter, it begs the question, “Which ones, when, under what conditions?”

Conclusion
Childhood vaccinations have been a true victory for modern medicine. They have prevented a variety of devastating diseases suffered by so many for millennia.

This movie, subtitled, From Cover-up to Catastrophe certainly stokes the controversy, as does its outspoken lightning rod, Andrew Wakefield.

No matter how frequently, dogmatic or pedantic the ‘Vaxxers’ pontificate, this polarization will continue until we understand more abut the present autism epidemic. Once that diagnosis is accurately understood and described, ‘real’ science demands independent, prospective, randomized, controlled, double-blind crossover studies of each and every component of the modern protocol to prove safety and efficacy.

Response to Inaction by US Task Force on Autism

Saturday, August 8th, 2015

August 8, 2015
This week, the U.S. Preventive Services Task Force on screening for autism disorder in young children recommended that more research needs to be performed before they can propose the institution of a formal program.

In a 2011 special article in Pediatrics, the authors concluded, “… we believe that we do not have enough sound evidence to support the implementation of a routine population-based screening program for autism.” That same year, the American Academy of Pediatrics recommended integrating such tools as a preventive measure.

Screening Today
The most popular screening tool, the Denver Scale, was introduced 40 years ago and last revised in 1992. It was invented at a time when the most serious childhood problems were mental retardation and cerebral palsy.

According to one study, “… the test has been criticized to be unreliable in predicting less severe or specific problems.” The author of the DDST has replied, “… it is not a tool of final diagnosis, but a quick method to process large numbers of children in order to identify those that should be further evaluated.” Like the many scientific tools available to screen for autism.

Autism Screening Tools
The CDC has developed a detailed schematic mechanism for diagnostic screening. “Myths About Developmental Screening” included these facts:

… today sound screening measures exist. Many screening measures have sensitivities and specificities greater than 70%.
•Training requirements are not extensive for most screening tools…
•Many screening instruments take less than 15 minutes to administer…
•Parents’ concerns are generally valid and are predictive of developmental delays.

Success of Early Screening
Fifteen years ago, a Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Societystated, “Early identification of children with autism and intensive, early intervention during the toddler and preschool years improves outcome for most young children with autism.”

The effects of intellectual functioning and autism severity on outcome of early behavioral intervention for children with autism, published in 2007, concluded “… These findings emphasize the importance of early intensive intervention in autism and the value of pre-intervention cognitive and social interaction levels for predicting outcome.”

A 2008 study noted, “Randomized controlled trials have demonstrated positive effects in both short-term and longer term studies. The evidence suggests that early intervention programs are indeed beneficial for children with autism, often improving developmental functioning and decreasing maladaptive behaviors and symptom severity at the level of group analysis.”

A Randomized, Controlled Trial of an Intervention for Toddlers With Autism, first published in 2009, demonstrated, “… the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.”

A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders, in 2011, “… resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs…”

Research in 2014 at UC Davis demonstrated that 6/7 high-risk infants (6 to 15 months old), “…caught up in all of their learning skills and their language by the time they were 2 to 3.” Therapy was provided by instructing parents on interventions that could be done at home.

Discussion
Dr. David Grossman, task force vice chairman and pediatrician, said that while early treatment is promising for the more severely affected, that hasn’t been studied in children who have mild symptoms that may be caught only in screening. So – don’t screen at all?

The USPSTF in question lists potential harms as including, “… time, effort, and anxiety associated with further testing after a positive screening result, particularly if confirmatory testing is delayed because of resource limitations. Behavioral treatments are generally thought to not be associated with significant harms but can place a large time and financial burden on the family.”

A common theme among most of the parents who are interviewed about the manner in which their child’s autism diagnosis was handled, is the wish that the pediatrician had been more knowledgeable and forthcoming about developmental red flags. The cost of autism runs into millions of extra dollars over the lifetime of individuals who continue to be affected.

When it comes to all-vaccinations-for-all, anything related to ebola, guns not-under-control, poisons in our environment, etc., the government has rarely demonstrated reluctance to recommend. When it comes to children’s health, what happened to erring on the side of caution?

The task force VP said, “… of course you should screen if the parent is concerned.”
IF THE PARENT IS CONCERNED?

Shouldn’t it be the doctor???

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 increased possibility of 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. 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 herd.

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.

Addendum:

http://www.aol.com/article/2016/07/27/two-thirds-of-americans-ok-if-doctors-ask-about-guns/21439181/

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.

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Brian D. Udell MD
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