I recently published a reflection on KevinMD, “A doctor’s duty on 9/11 in a small town,” a piece about clinical duty, quiet advocacy, and legacy. Boston University included it in my nomination for their Advocacy, Equity & Social Justice Alumni Award. I sent it to every major news outlet in my region. No one responded. One station asked if I’d go on camera. I agreed. Then, silence. This is …
Why the media ignores healing and science
Idaho has become the first state to end Medicaid funding for Applied Behavior Analysis (ABA) therapy. This marks a shift away from concerns about inflated billing and variable outcome metrics toward a model focused on measurable and inclusive care. As a pediatrician who participated in NIMH-RUPP trials and has observed the clinical evolution of ABA, I recognize the significance of Idaho’s decision. The state acted proactively rather than awaiting federal …
A new autism care model in Idaho
You arrive on time: 8:20 a.m. for your 8:30 appointment. You’ve done your part; you showed up early, brought your insurance card, and maybe even filled out the forms online. You expect to see your doctor at 8:30. After all, that’s what the schedule says. But the clock, like the system, runs on its own rules. At 8:35, you’re still at the front desk. They’re scanning your card, verifying your …
The problem with the 15-minute doctor appointment
The Trump administration recently released a long-promised report decrying the sorry state of the health of American children and saying how it planned to change this.
They correctly begin by noting that “Despite outspending peer nations by more than double per capita on health care, the United States ranks last in life expectancy among high-income countries and suffers higher rates of obesity, heart disease, and diabetes.” Unfortunately, they then largely focus …
The flaws in the new child health report
My son Gideon is almost 12 years old. He is funny in that sharp, unexpected way that catches you off-guard. He is deeply expressive and full of life. He gives love and joy more freely than most kids his age. He is curious and social. He is healthy, and I am grateful for it. We are endlessly proud of who he is.
And, our family constantly walks the edge of breaking …
The need for pediatric respite care
When parents bring their children to the clinic, they often expect quick advice: “Eat healthy. Exercise more.” But after years in practice, I’ve learned those generic prescriptions rarely work. Families leave feeling uncertain, children feel pressured, and real changes at home are hard to sustain.
That’s why I focus on a family-centered, personalized approach. Nutrition is not just about a child; it’s about routines, traditions, and stresses that affect the whole …
A better way to talk about kids’ nutrition
For decades, I practiced developmental-behavioral pediatrics with a focus on coordinated care, measurable goals, and clinical accountability. I believed that if we could define a child’s needs clearly and track progress with integrity, we could build systems that honored both science and dignity.
But I now realize I missed something critical.
After reviewing the #BanABA initiative and speaking with Dr. Henny Kupferstein, I’ve come to understand the full scope of harm linked …
A pediatrician’s reckoning with behavior therapy
The terrain I refused to leave
At Madigan Army Medical Center, I built a diagnostic model that delivered autism answers in under 30 minutes. No shortcuts, just smarter care. A Ph.D. pediatric nurse practitioner performed triage. I conducted the Screening Tool for Autism in Toddlers (STAT-MD), a targeted autism screening protocol developed at Vanderbilt, confirmed criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and families left …
The collapse of developmental pediatrics
I learned that in a rural exam room where four agencies circled a child with autism; and no one moved. Not the nurse. Not the case manager. Not the system. The child failed the Autism Screening Test. He was nonverbal, avoided eye contact, even with his parents, and flapped his hands while playing with toys in unusual ways. The signs were classic. The diagnosis was clear. I spoke the “A” …
What is professional inertia in medicine?
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Emergency physician Drew Remignanti discusses his article “A world without vaccines: What history teaches us about public health.” In this conversation, Drew reflects on historical lessons from smallpox, polio, and measles to …
How misinformation endangers our progress against preventable diseases [PODCAST]
Autism was never meant to be diagnosed in 15 minutes.
The original vision, born in war-torn Vienna and postwar Baltimore, called for deep observation, multidisciplinary insight, and time. But somewhere between the ideal and the insurance code, we lost the standard.
Today, families navigate a system built for speed, not truth. And children pay the price.
The ideal vs. reality
In theory, pediatricians perform routine developmental surveillance. Screenings like the M-CHAT happen at 18 …
The crisis in modern autism diagnosis
Parents are inundated with advice and guidance on all manner of topics from an array of sources, but as a pediatric emergency medicine physician, I have been astonished to realize that parents hear almost nothing about the risk that actually poses the greatest threat of causing serious harm to their children. Approximately 10 percent of children in the United States experience sexual abuse, with one in four girls and somewhere …
The childhood risk we never talk about
Florida has seen over 1,300 pertussis cases this year, an 81 percent increase from 2024. I didn’t speak as a retired pediatrician. I spoke as a witness: a witness to systems retreat, a witness to the dismantling of public health, and a witness to the consequences of ignoring coordinated care.
The numbers are staggering. Over 1,500 confirmed measles cases in 2025. Three deaths, the first measles-related fatalities in the U.S. in …
The dismantling of public health infrastructure
The first thirty years of my life were about becoming a doctor. I grew up in a middle-class family in a safe neighborhood with good schools and steady routines. My parents valued hard work and education, and I learned early that if you studied, followed the rules, and kept your head down, good things would follow. Private Catholic elementary school, public high school, then college and medical school. Every step …
The difference between a doctor and a physician
I entered medicine not just to treat illness, but to confront injustice. I wanted to be a force for good, battling death, yes, but also misinformation, institutional neglect, and the quiet superstition that children with developmental disabilities were somehow less worthy of coordinated care. That conviction led me to align my career with the legacy of Eunice Kennedy Shriver, whose advocacy gave rise to the Special Olympics and helped shape …
The case for coordinated care for children
In 1995, I stood at the edge of a map most policymakers ignored: Appalachian Ohio. The Surgeon General’s 2002 report, “Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation,” would later cite our work as a model for rural specialty outreach. But long before that recognition, we were ledgering care into counties where children with developmental disabilities had no clear path to diagnosis, let …
How health disparities affect children
I shake my head in disbelief. Is this really happening in the United States? As a pediatrician and public health advocate, I believe we are witnessing the literal systematic dismantling of our health care system.
Case in point: the federal government’s mishandling of two recent lead contamination crises (in Michigan and Wisconsin). These failures not only expose children to preventable toxic harm, but also reveal a deeper breakdown in democratic accountability …
A pediatrician on the lead contamination crisis
My wife, Kathy, had stage 4 end-stage renal disease. She was slowly dying, but never stopped living. Her resilience in managing peritoneal dialysis made travel possible, even with the logistical complexities involved. Ireland had long been on our bucket list, inspired by Kathy and Stephanie’s earlier visit while we lived in Peoria. With careful planning, we booked our flights using points out of Orlando, knowing the drive would minimize Kathy’s …
Traveling with end-stage renal disease
In Minot, I practiced a kind of pediatrics no flowchart could predict: improvised, airborne, and often surgical. Minot didn’t always follow the flowchart. One night, a toddler arrived in the emergency room, inebriated. Her father had given her vodka for teething pain, never imagining she’d swallow it. She did. She stopped breathing. I called a code and began CPR, ordering a blood alcohol level (BAL) and routine labs. Her BAL …
My experiences as an Air Force pediatrician
Is your baby’s safe sleep a privilege?
In my Bronx clinic, I often sit across from new families who are well-versed in the American Academy of Pediatrics’ (AAP) safe sleep guidelines. Babies should sleep alone, on their backs, in a crib free of soft bedding and toys. Yet despite this knowledge, many parents, especially those who choose to exclusively breastfeed, face real-life barriers in following these recommendations. For single mothers and …
How pediatricians can address infant mortality in underserved communities
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