US Physicians Who Write Clinical Practice Guidelines Often Have Financial Conflicts of Interest

According to two research letters in JAMA Internal Medicine, on October 29, 2018, authors including Dr. Rishad Khan examined 18 clinical practice guidelines authored by 160 doctors. 49.4 percent declared they received payment in the practice guideline or supplemental materials. 31.3% of the doctors declared they were paid from industries marketing one of ten high-revenue medications recommended by a guideline. Over a quarter of physicians received payment of a high-revenue medication but did not disclose payment.

Pharmaceutical companies give these payments for a reason. As long as this practice continues, we will never know if practice guidelines are based on research evidence or represent another form of advertising.

https://www.psychiatryadvisor.com/practice-management/financial-conflicts-of-interest-prevalent-among-clinical-practice-guideline-authors/article/811951/

Artificial Sweeteners, Autism, the Microbiome and the Loss of My Brother's Healthy Compulsive Behavior

According to recent research in animals, maternal gut bacteria may influence the development of autism by altering the immune system in pregnant mothers, (Catherine R. Lammert, Elizabeth L. Frost, Ashley C. Boite, Matt J. Paysour, Mariah E. Shaw, Calli E. Bellinger, Thaddeus K. Weigel et. al., "Cutting Edge: Critical Roles for Microbiota-Mediated Regulation of the Immune System in a Prenatal Immune Activation Model of Autism," Journal of Immunology 201, no. 3 (2018): 845-850).

In another recent study, artificial sweeteners have been found to be toxic on gut bacteria (Dorin Harpaz, Loo Pin Yeo, Francesca Cecchini, Trish H. P. Koon, Ariel Kushmaro, Alfred I. Y. Tok, Robert S. Marks et. al., "Measuring Artificial Sweeteners Toxicity Using a Bioluminescent Bacterial Panel," Molecules 23, no. 10 (2018): 2454).

Diet for many reasons in addition to the microbiome is an integral part of health. If there was one compulsive behavior that was good for my brother, it was his need to eat cantaloupe every day with dinner. I remember during a long day of residency training my brother called me at work rather anxious, there was no cantaloupe in the house. He was staying with me for a few weeks while my parents took a vacation. Even though I was exhausted after the ten to eleven hour day, I knew if I did not pick up a cantaloupe on the way home from work, it would have been much worse if I came home without one. However at his new residence, no matter how often my mother and I prompted the staff, there was often no cantaloupe there for my brother. Now that that routine is broken, he refuses to eat any fruit there at all.

My First Protester

Three days ago I gave a lecture along with a board certified behavior analyst and an attorney titled "Applied Behavior Analysis, Public Health Implications and the Law" I discussed the evidence and risks of medication, research on aversives and my brothers' treatments. I discussed Matthew's success with his seven positive behavior contracts, functional communication tokens and supplementary aversive shock, now off medications 29 years and holding a job at school and how his identical twin ended up on twenty medications. When I was done speaking, a protester yelled out twice "Torture!" I replied, "Not one anti-aversive activists would try my brother's 20 medications for one day and see what it feels like."

Regarding medications, our health care and education system for many individuals does not provide other avenues to address behavior. The standard 15-20 minute med check does not provide opportunities to explore other treatment options that may be safer and more effective while effective psychosocial interventions are often unavailable. In the clinic model, individuals with special needs sometimes have long waiting periods to be seen. While in the waiting room, there are noisy crowds and boredom with a lack of activity, a breeding ground for the problem behaviors we are supposed to be treating. At Judge Rotenberg Center, the primary care physician, psychiatrist and dentist are all located in the school building. Individuals can remain with their structure until it is time to be seen.

What we really need to protest is drugs which may have toxic side effects replacing a good school. We need to protest the medical business model which emphasizes quantity over quality and how some individuals have no access to care at all. Finally, we need to stop heartlessly judging others when we have not lived their lives.

Antidepressants and Antibiotic Resistance

While it is well known that excessive use and misuse of antibiotics can lead to resistance, by forming the creation of deadly "superbugs" a recent study links Prozac (fluoxetine) to antibiotic resistance, (Min Jin, Ji Lu, Zhaoyu Chen, Son Hoang Nguyen, Likai Mao, Junwen Li, Zhirguo Yuan et al., "Antidepressant fluoxetine Induces Multiple Antibiotics Resistance in Escherichia Coli via ROS-mediated Mutagenesis," Environment International 120(2018): 421-430, doi:10.1016/j.envint.2018.07.046). Bacteria that were exposed to Prozac developed mutations resulting in resistance to the antibiotics, tetracycline, amoxicillin, chloramphenicol and others. Higher doses of Prozac increased antibiotic resistance.

Prozac was introduced in 1987. In just the first five years, 4.5 million Americans consumed it. After over 30 years since development, a new side effect just emerged. While most individuals with severe behaviors have no access to applied behavior analysis, they do have easy access to medications with mystery side effects. While there are significant efforts to ban a two second skin shock, the same "advocates" have made no effort to stop substituting medications, which can have dangerous and even deadly side effects, for applied behavior analysis, which has no side effects. While some of these "advocates" are against applied behavior analysis, they are silent when medications are replacing education.

Special Needs Can Also Mean Special Abilities

A very informative video on how intelligent individuals with autism can perform well professionally with the right support https://www.cbsnews.com/video/welcoming-autism-into-the-workplace/