July 17, 2025
Dear Mr. Secretary,
We have vital information that is instrumental to your commitment in understanding the incidence of autism spectrum disorders. We are compelled to share our knowledge and life’s work about cobalamin (vitamin B12) deficiency and how it’s being misdiagnosed as autism. Untreated vitamin B12 deficiency is an unrecognized public health care crisis costing state and federal agencies billions of dollars and costing millions of people their health. It can strike any age, race, religion, or socioeconomic background, but often times strikes infants and young children the hardest. We are requesting to discuss this urgent matter with you. We also reached out to Congressman John James in our district.
We are from Macomb County, Michigan and are practicing clinicians in the emergency department (ER nurse and emergency medicine physician) both for over 30 years. We are also the authors of Could It Be B12? An Epidemic of Misdiagnoses, Quill Driver Books (2005), 2nd Ed. (2011), which includes a chapter on pediatric B12 deficiency. Ten years later, we devoted an entire book to exposing the continued misdiagnosis and mismanagement of pediatric B12 deficiency, Could It Be B12? Pediatric Edition, Quill Driver Books (2015).
Lack of vitamin B12 during the rapid growth and wiring of the brain in fetuses, infants and young children can cause permanent injuries or lifelong disabilities. Vitamin B12 is critical for various brain development processes (myelination, synaptogenesis, and neurotransmitter synthesis). A deficiency impairs these processes, leading to structural brain abnormalities, developmental delays (motor, sensory, speech, language) and cognitive impairments. The signs and symptoms of autism are virtually identical to the symptoms that stem from neurologic damage due to pediatric B12 deficiency. Clinicians are not screening women in pregnancy, during breastfeeding, nor in symptomatic infants or young children. In the 21st century, there is no excuse for a child to acquire a brain injury from B12 deficiency and have it mistaken or misdiagnosed as “autism.” Just as in stroke, “time is brain,” this too applies to pediatric B12 deficiency.
B12 deficiency has several causes and is both preventable and treatable, yet most clinicians do not screen high-risk groups or patients who are symptomatic. Besides children, many adults with untreated B12 deficiency go undiagnosed and suffer needlessly from mental illness, dementia, anemia, neuropathy, fall-related trauma, and vascular occlusions. Diagnosis is generally late, and the disease can progress to a debilitating condition causing injury, often times requiring long-term care. Billions of healthcare dollars are squandered by failing to properly screen and treat B12 deficiency and using other medications and treatments in its place.
I (S.P.) started the fight for this cause back in 1998. We have published four books* (one of which has been translated into several other languages), created B12awareness.org, have lectured in the US and in Europe, and have appeared in a documentary. Additionally, an 87-minute feature film was made about my life story by E.L. Productions. Sally Pacholok won best feature film at the 2015 D.C. Independent Film Festival. The film’s tagline was, “This nurse could save your life.” It debuted at the U.S. Naval Heritage Center Base in Washington, D.C. and actress Annet Mahendru, well-known for her role in The Americans, played me.
Despite our minor accomplishments and dedicated work in exposing this epidemic, past healthcare leaders and governmental officials we previously contacted have all turned a blind eye. Untreated B12 deficiency has unnecessarily turned into a chronic disease over the past four decades, silently attacking Americans of all ages. We can help Make America Healthy Again. Addressing B12 deficiency is common sense. A comprehensive list of possibilities is well beyond the scope of this letter. Please allow us the opportunity to brief you on this critical matter injuring our children and unknowingly contributing to the incidence of “autism.” We are available upon your request.
Sincerely,
Sally M. Pacholok, R.N., BSN
Jeffrey J. Stuart, D.O.
Pacholok, SM, Stuart JJ. Could It Be B12? An Epidemic of Misdiagnoses. Quill Driver Books; 2005.
Pacholok, SM, Stuart JJ. Could It Be B12? An Epidemic of Misdiagnoses, (2nd Ed.) Quill Driver Books; 2011.
Pacholok, SM, Stuart JJ. Could it Be B12? Pediatric Edition: What Every Parent Needs to Know About Vitamin B12 Deficiency. Quill Driver Books; 2015.
Pacholok, SM. B-12 Sally! Ingram Sparks; 2024, Kindle Direct Publishing; 2024.