Are ADHD medications safe?
The American Heart Association (AHA) last week released new guidelines regarding heart screening for children and teens taking stimulant medications for attention deficit/hyperactivity disorder. The recommendations suggest all those taking such medications have a risk screening for family history of heart problems and an EKG.
Stimulant medications are extremely effective in treating ADHD and have been used safely for decades. There is, however, a VERY SMALL risk of sudden death when these medications are given to a person who ALREADY HAS a heart problem. Please note that the medications do not CAUSE heart problems in otherwise healthy people.
It is our view, and one shared by the American Academy of Pediatrics, that the AHA recommendations are too aggressive. We agree that screening for a family history of heart problems is important. This is something we do each time we see a new patient and then annually beginning at age 10. However, obtaining an EKG on each person receiving stimulants will produce a large number of tests read as abnormal despite being done on a normal person. This will then result in further testing and a lot of worry for parents and patients before it is ultimately found that everything is fine.
So, if your child is taking medications for ADHD, please don't worry. The medicines are very safe. But let us know if you discover a history of heart problems (other than heart attacks in older folks) in your family. If you are still concerned, give us a call.
Wednesday, April 30, 2008
Thursday, April 17, 2008
Doctor, Do Vaccines Cause Autism?
We may as well kick off the blog with a biggie. We have been fielding this question a lot lately because the alleged vaccine-autism connection has been in the news for the last couple of weeks.
You have a choice:
The short answer: NO. Stop reading now.
The long answer:
No, vaccines do not cause autism. Autism is a neurological disorder affecting a child's ability to learn, socialize, and interact with the world around him/her. Autism is becoming more common. This is due in part to better diagnosis on our part but there is also a real increase in cases and we do not understand why. We also do not understand what causes autism. There is likely an interaction between genetics and the environment that predisposes one to autism. The genetic predisposition is clear from studies of twins and siblings. If one has autism, the twin or sibling is at increased risk.
But that's not the whole story. What are the environmental factors? Is it something that happens before birth? During birth? During infancy? Later? We just don't know.
But we do know that it's not the vaccines. There have been several very large, very well done scientific studies that have shown absolutely no relationship between autism and vaccines. They show no difference in autism rates between immunized and non-immunized populations. They show no decrease in autism in populations that stop immunizing. They show no rise in autism rates when immunization is resumed. There is just no relationship.
Lately, much has been made of the "thimerosal connection". Thimerosal is a chemical preservative that was used for decades to help stabilize vaccines so they would have a longer shelf life. It happens to contain ethyl mercury. Because people understand mercury as being toxic, this led to a belief that the thimerosal was "causing" autism in children receiving vaccines. However, there is a huge difference between ethyl mercury and methyl mercury. Ethyl mercury has not been shown to have toxic effects. I liken the difference to oxygen: two atoms of oxygen put together give you the oxygen we need to breathe and live. But three atoms put together gives you ozone, which is deadly. Same oxygen. Big difference. Having said all that, how do we know that thimerosal isn't causing the autism problem? Well, thimerosal was removed from all vaccines (except for some flu vaccines) about five years ago. Have autism rates dropped? Nope. Still rising.
Finally, you may have read recently that the U.S. Vaccine Court found a relationship between autism and vaccines. This is not really true. The Vaccine Court is the body that awards damages to people who have been injured by vaccines. The family of an autistic child filed a claim based on their assertion that vaccines contributed to the autism in their daughter. The Vaccine Court did, in fact, support their claim. However, the important detail is this: this child has an underlying, complex, metabolic problem, making her body more susceptible to stress. The child received several vaccines and developed a fever. The fever was the stress that worsened her metabolic problem, causing brain injury. However, ANY stress that caused fever, etc. would have produced the same effect. Had she gotten the flu, or pneumonia, or an ear infection, the result may have been the same. It wasn't the vaccine, it was the stress combined with this child's very rare metabolic disease that caused the problem.
Autism is a serious problem and we need to get serious about finding answers. But the more time, money, and effort we spend debunking the autism-vaccine "connection", the less we spend trying to figure out what is really going on.
You have a choice:
The short answer: NO. Stop reading now.
The long answer:
No, vaccines do not cause autism. Autism is a neurological disorder affecting a child's ability to learn, socialize, and interact with the world around him/her. Autism is becoming more common. This is due in part to better diagnosis on our part but there is also a real increase in cases and we do not understand why. We also do not understand what causes autism. There is likely an interaction between genetics and the environment that predisposes one to autism. The genetic predisposition is clear from studies of twins and siblings. If one has autism, the twin or sibling is at increased risk.
But that's not the whole story. What are the environmental factors? Is it something that happens before birth? During birth? During infancy? Later? We just don't know.
But we do know that it's not the vaccines. There have been several very large, very well done scientific studies that have shown absolutely no relationship between autism and vaccines. They show no difference in autism rates between immunized and non-immunized populations. They show no decrease in autism in populations that stop immunizing. They show no rise in autism rates when immunization is resumed. There is just no relationship.
Lately, much has been made of the "thimerosal connection". Thimerosal is a chemical preservative that was used for decades to help stabilize vaccines so they would have a longer shelf life. It happens to contain ethyl mercury. Because people understand mercury as being toxic, this led to a belief that the thimerosal was "causing" autism in children receiving vaccines. However, there is a huge difference between ethyl mercury and methyl mercury. Ethyl mercury has not been shown to have toxic effects. I liken the difference to oxygen: two atoms of oxygen put together give you the oxygen we need to breathe and live. But three atoms put together gives you ozone, which is deadly. Same oxygen. Big difference. Having said all that, how do we know that thimerosal isn't causing the autism problem? Well, thimerosal was removed from all vaccines (except for some flu vaccines) about five years ago. Have autism rates dropped? Nope. Still rising.
Finally, you may have read recently that the U.S. Vaccine Court found a relationship between autism and vaccines. This is not really true. The Vaccine Court is the body that awards damages to people who have been injured by vaccines. The family of an autistic child filed a claim based on their assertion that vaccines contributed to the autism in their daughter. The Vaccine Court did, in fact, support their claim. However, the important detail is this: this child has an underlying, complex, metabolic problem, making her body more susceptible to stress. The child received several vaccines and developed a fever. The fever was the stress that worsened her metabolic problem, causing brain injury. However, ANY stress that caused fever, etc. would have produced the same effect. Had she gotten the flu, or pneumonia, or an ear infection, the result may have been the same. It wasn't the vaccine, it was the stress combined with this child's very rare metabolic disease that caused the problem.
Autism is a serious problem and we need to get serious about finding answers. But the more time, money, and effort we spend debunking the autism-vaccine "connection", the less we spend trying to figure out what is really going on.
Welcome!
Hello to our practice families. This is Dr. Stephens. Dr. V and I created this blog to help keep you updated on health happenings and happenings at Preferred Pediatrics. It's easier than sending email and it won't clog up your inboxes! I will probably be doing most of the posting, since I am the designated office "computer geek". Our goal with this blog is to comment on health issues that you may see in the paper, online, or on TV. The issues may include pediatric health issues, health care delivery issues, or information regarding the operation of our office. Please use a newsreader to subscribe to the RSS feed for this blog so you will know when we post new information. Feel free to comment on these posts as often as you like and let us know what you think about this method of communication.
--Dr. Stephens
--Dr. Stephens
Subscribe to:
Posts (Atom)
