The average KevinMD reader may wonder why I’m so prolific in my commentary on pediatric medicine and the systemic reforms it demands. The answer is simple: I go to the source. Always.
That habit was forged nearly 30 years ago when the American Academy of Pediatrics invited me to serve as contributing section editor for Developmental-Behavioral Pediatrics in AAP Grand Rounds. My role: select key studies, critique methodology, and distill bottom-line takeaways for clinical use. Most pediatricians skim abstracts. I was tasked with translating evidence into action.
I also served as theme abstract reviewer and moderator for the Pediatric Academic Societies’ Annual Meetings in 2001, 2002, and 2008, reviewing every submission in neurodevelopmental disabilities. I’ve stood at the gate. I’ve seen what tries to pass. And like Gandalf against the Balrog, I’ve learned when to say: “You shall not pass.”
Why ABA gets funded and what gets ignored
ABA therapy continues to dominate funding and media attention, despite documented harm and lack of efficacy. A 2021 article in Frontiers in Psychology exposed pervasive conflicts of interest (COI) in ABA research and concluded that “there is no treatment” in the conventional sense, only compliance training, often enforced through aversive techniques.
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Yet ABA remains the default, not because it works, but because it’s profitable. Non-autistic-led organizations like Autism Speaks (often called Autism Speak$) have built empires on this model. Their campaigns are shrill, persistent, and lucrative. They batter clinicians with claims of effectiveness while ignoring the ethical and scientific reckoning now underway.
What actually works and why you don’t hear about it
Risperidone and aripiprazole are FDA-approved medications for treating irritability, aggression, and self-injury in children with autism. They’re not miracle drugs. But they work. They make children more amenable to therapies that actually help.
No conflicts, just clarity
I have no conflicts of interest. My affiliations with universities and the Department of Defense ensured it. My stock slide for lectures and presentations quoted Oscar Wilde in 1882: “I have nothing to declare except my genius.” It was my way of signaling that I answer to evidence, not incentives.
In only one setting (Phoenix) did I meet with a pharmaceutical representative. I told her that my clinical experience with the drug she was marketing didn’t match the “nine out of ten clinicians” narrative. Its duration of action was highly variable and unreliable. I predicted that once her company had a new medication to push, she’d “bad-mouth” the one she was hawking today. Turned out to be true.
We had a better relationship talking about women’s college basketball. She’d played twice a year against Diana Taurasi from UCONN. She told me I played as tough in the pharmaceutical game as Diana did on the court. High praise, for a UCONN fanatic.
I’ve had speech and occupational therapists hug me after starting a shared client on risperidone. When irritability dissipates, therapy becomes possible. The gates of patient compliance open. That’s not marketable. That’s just medicine.
So why aren’t these medications advertised?
Because their patents expired decades ago. They’re generic. They’re cost-effective. And that makes them invisible in a system that rewards marketing over medicine.
Instead, we get ads for “bipolar depression,” a term that doesn’t exist in the DSM-5. It’s a marketing invention, used to sell high-side-effect medications for mild conditions. The DSM-5 separates mood disorders into “Bipolar and Related Disorders” and “Depressive Disorders.” A depressive episode is part of bipolar disorder, not its own entity.
Clinicians know the drill: steak dinners, pushy reps, and “educational seminars” that resemble stock broker scams more than scientific discourse. The overlap between pharmaceutical marketing and high-end menus is purely coincidental, I’m sure.
CMS and DHHS: biased against science
The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (DHHS) remain biased against evidence-based care. They fund what’s loud, not what’s proven. ABA gets airtime. Risperidone gets silence. The result? Children suffer. Families are misled. Clinicians are left navigating a landscape where truth is buried beneath profit.
This isn’t just a funding issue. It’s a moral failure. When generic medications with proven efficacy are sidelined in favor of expensive, unproven therapies, we’re not just wasting money, we’re betraying patients.
Why I keep writing
I write because silence is complicity. I write because I’ve seen the evidence, and the erasure. I write because someone must bear witness.
AAP Grand Rounds taught me to translate research into practice. KevinMD gives me the platform to translate truth into reckoning. I’ve spent decades reviewing the literature, moderating the abstracts, and treating the children. I know what works. I know what doesn’t. And I know what gets funded.
I write because I refuse to let the Balrog pass.
Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military medicine, academic leadership, and national advocacy for dignity-centered neurodevelopmental care. His NIH-funded work with the RUPP Autism Network helped define evidence-based approaches to autism and related developmental disorders.
He directed the LEND Program at The Ohio State University and founded JBLM CARES, a $10 million autism resource center for military families. His writing spans clinical scholarship and long-form fiction. He is the author of The Mercy Directive and the six-novel Cassandra series, a completed political and medical fiction saga tracing the rise of the Cassandra system from its origins to its national and international legacy. His forthcoming memoir, The Quiet Architect, examines how conscience and structure collide in modern medicine.
He shares updates on LinkedIn.
