An MD and a homeopath walk into a podcast… and agree on everything: The autoimmune epidemic no one is talking about, and why most doctors are missing it.

A post about PANS/PANDAS, and what could be the overnight change in your child.

I recently listened to episode 113 of Strange, Rare & Peculiar Homeopathy Podcast and found it very informative on many levels. I enjoy this podcast generally, but this particular episode struck a deeper chord — partly because of the guest, and partly because of the host.

Denise Strages is a teacher I studied with and respect enormously. She is, to my mind, one of the first homœopaths to work consistently with autoimmunity, and she has been an inspiration and mentor to many of us in the field. I had the privilege of going through the Post-Graduate program at the Academy of Homeopathic Education, completing their Acute Helpline Training, and volunteering on the Homeopathy Help Now Helpline — and the quality of clinical thinking I encountered there has shaped how I approach every case. Hearing Denise in conversation with Dr. Nancy O’Hara was, frankly, a gift.

What is PANS/PANDAS?

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANS — Pediatric Acute-onset Neuropsychiatric Syndrome — is the broader umbrella, encompassing non-strep triggers such as Lyme disease, mold, viruses, anesthesia, and environmental toxics. Both are characterised by an abrupt, often overnight onset of OCD, tics, anxiety, and dramatic behavioural changes in children.

Dr. O’Hara was candid about the terminology itself: she feels the name PANS/PANDAS may actually be misleading, and is used largely for the comfort of medical coding rather than clinical precision. She noted that Dr. Susan Swedo — who coined the term PANDAS and is considered its grandmother — would prefer the more accurate label autoimmune encephalitis of the basal ganglia associated with streptococcal infections, because that is what it truly is. Dr. O’Hara herself uses that language when writing letters to other physicians, precisely because it communicates the seriousness and biological mechanism of the disease without the ambiguity of a catchy acronym.

She also stressed that the “P” stands for pediatric — so technically, the term should only be used in children. Adults can and do develop the same condition, particularly through tick-borne illness or mold exposure, or when childhood cases were missed or mistreated. But she prefers to call those adult presentations by their more accurate name.

PANS and PANDAS are disorders of the immune system estimated to affect approximately 1 in 200 children, with an episodic or waxing-and-waning course that can be difficult to understand. In Dr. O’Hara’s own practice, however, she is seeing closer to 1 in 2 or 1 in 3 — and she estimates the broader population prevalence is now approaching 1 in 150.

The landmark research defining this field was led by Dr. Susan Swedo at the NIMH. The pivotal 2012 paper by Swedo, Leckman & Rose expanded the PANDAS framework to describe PANS, removing sole reliance on Group A strep for diagnosis. The distinction between the two disorders is that PANDAS is specifically triggered by Streptococcus A infection, whereas PANS can have broader triggers — other infections, metabolic changes, and environmental factors.

Why Aren’t Doctors Recognising It?

Dr. O’Hara was direct: conventional medical appointments of 5 to 15 minutes are simply not long enough to understand the complexity of these cases. She also pointed to the fact that PANS/PANDAS remains controversial in part because it is a clinical diagnosis — there are no tests that definitively prove or disprove it — and because it was largely defined by a woman who, as O’Hara noted, didn’t name it after herself.

Her guiding principle, borrowed from her mentor Dr. Sydney Baker, the grandfather of functional medicine: “Follow those who seek the truth; flee from those who have found it.”

For families hitting walls with dismissive physicians, her practical advice is to find a practitioner who truly understands the condition (resources at Aspire.care and the PANDAS Physicians Network), and rather than arriving with a stack of articles, to bring the one or two best-evidenced papers — or a case study that mirrors their child’s experience.

The Autoimmune Mechanism

This is not an infectious disease. It is an autoimmune disease, triggered by an infection or environmental insult in a genetically susceptible child. Antibodies or immune proteins cross the blood-brain barrier, causing inflammation in the basal ganglia — the brain region governing movement, emotion, and compulsive behaviour. The amygdala, hypothalamus, caudate, and putamen all become inflamed, and that inflammation — not the original infection — is what produces the symptoms families find so devastating.

Simply treating the strep with antibiotics and a little ibuprofen, Dr. O’Hara argued, leaves the deeper autoimmune fire entirely unaddressed — and often makes things worse, disrupting the gut microbiome and increasing immune vulnerability.

“Genetics loads the gun. Environment pulls the trigger.”

That one sentence maps almost perfectly onto the homœopathic concept of susceptibility — what Hahnemann called miasms — and onto what modern epigenetics describes as inherited predispositions to disease. The fact that an MD trained at the University of Pennsylvania arrived at the same framework as Hahnemann, through a completely different route, is not a coincidence. It is a convergence.

Professor Yehuda Shoenfeld and the Autoimmune Revolution

One of the moments in this episode I found most fascinating was Dr. O’Hara’s mention of Professor Yehuda Shoenfeld from Israel, one of the world’s leading autoimmunologists and author of numerous foundational texts on autoimmune disease. Interestingly, I first encountered Shoenfeld’s work over a decade ago, when I was researching the HPV vaccine for my own daughters — his teachings on the relationship between vaccines, adjuvants, and autoimmune responses opened a door for me that I have never closed.

Dr. O’Hara shared a memorable story from one of Shoenfeld’s lectures: when his daughter gave birth via C-section, it fell to him (as grandfather) to perform the vaginal seeding — rubbing the mother’s vaginal mucosa over the newborn to transfer beneficial microbiota that C-section babies miss. In the emotion of the moment, he forgot. And in the next slide, there was a photograph of the family dog enthusiastically licking the newborn — which Shoenfeld presented, with humour, as nature’s workaround.

The point was serious: with more than 30% of births now by C-section, babies are missing their foundational microbial inheritance. Add reduced breastfeeding, COVID-era sanitisation, screen-based isolation, and the relentless stress of modern family life — and you have a population whose baseline immune resilience has been profoundly eroded across generations.

COVID, Screens, and the Lowering Baseline

Both speakers noted that the PANS/PANDAS landscape shifted significantly after COVID — reactivating dormant tick-borne illnesses, entrenching screen dependency, and collapsing the normal microbial exposure that keeps immune systems calibrated.

Children with autism were, as Dr. O’Hara put it, the canaries in the coal mine in the 1990s and early 2000s — the first signals that something was wrong with the broader environment. Today, the toxic load is so broadly distributed that the canaries are everywhere, across diagnoses and across ages.

On screens specifically: they do not calm these children. They distract them. The EMF exposure, combined with the addictive architecture of gaming and social media platforms, directly exacerbates tics, anxiety, and seizures in neurologically inflamed children. Dr. O’Hara’s test for screen addiction is elegant in its simplicity — whether the child has been on for five minutes or two hours, can they stop when asked? If not, they are addicted.

Vector-Borne Disease, Mold, Alpha-Gal, and Mast Cells

The conversation ventured into territory that will be familiar to many homœopaths seeing complex chronic cases: Bartonella now encompasses over 60 known species. A new form of Babesia can progress directly to chronic infection without any detectable acute phase. Borrelia (Lyme) remains dramatically underdiagnosed. And alpha-gal syndrome — an allergy to mammalian protein triggered by tick bites — is appearing in PANS/PANDAS patient populations with increasing frequency.

Mast cell activation syndrome (MCAS) was identified as another key overlapping feature, with mold and vector-borne illness the two primary drivers of mast cell hypervigilance in chronically ill children. These are children whose immune systems are perpetually on high alert, unable to distinguish threat from normalcy.

On Treatment: Dosing, LDN, and the Whack-a-Mole of Suppression

Dr. O’Hara’s discussion of low-dose naltrexone (LDN) was one of the most clinically interesting passages of the episode. She described using it at doses far lower than conventional protocols — sometimes as low as 0.5 mg — finding that some children responded at micro-doses who had never responded at 5 mg. The drug appears to work both as an anti-addictive agent and as an anti-inflammatory, which may explain its particular effectiveness in PANS/PANDAS.

This prompted one of the episode’s most resonant exchanges: the homœopathic concept of posology — the art and science of dose — maps precisely onto functional medicine’s growing recognition that more is not always better, and that the wrong dose of the right remedy can be as harmful as no treatment. As homœopaths, we know this well.

Both Denise and Dr. O’Hara were equally clear on suppression: drugs like Dupixent and Xolair may offer genuine relief across autoimmune conditions, but they are band-aids over a fire that has not been extinguished. Suppress one autoimmune expression without addressing the underlying terrain, and it will surface somewhere else. In homœopathy, we call this the direction of cure — or its violation. In Dr. O’Hara’s words: whack-a-mole.

A Shared Root-Cause Philosophy

This is ultimately what made the episode so valuable to me. Despite training worlds apart, Denise and Dr. O’Hara found themselves in the same place, again and again: genuine healing of PANS/PANDAS requires time, relationship, and a willingness to look at the whole family unit, not just the presenting patient. Dr. O’Hara described her case intake as extending back to preconception — what was happening with the mother before pregnancy, during pregnancy, in the first years of life, and what the background terrain looks like now: mold, tick exposure, nutrient deficiencies, toxicant load.

That is, in essence, a homœopathic case-taking.

A Closing Thought

What stays with me most from this episode is the image of a physician — conventionally trained, board-certified, UPenn-educated — who chose to think for herself rather than follow orthodoxy. Dr. O’Hara individualises every treatment, refuses to apply standard protocols to non-standard children, and keeps asking, in the spirit of her mentor Dr. Baker: “Have we done enough for this child?”

If you are navigating a complex child situation — there is help available. My colleague Adi and I work with complex cases and would be glad to speak with you. https://homeopath-orlando.com/attention-families-navigating-autism-pans-pandas-adhd-add-and-behavioral-challenges/

In the meantime, listen to this episode.

Read Dr. O’Hara’s book.

And go play in the dirt!

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Rina Amir RCHom is a Homœopathic Educator and Practioner in Sanford, Florida.

She see international and local clients both online, and in person in her Florida clinic.

Visit www.homeopath-orlando.com for more information or book a free call below.

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