Monthly Archives: July 2011

4

Anti-vaccine Stories Sell Papers, Children Suffer

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Written by Natasha Burgert MD

A recent Baltimore Sun op-ed headline popped with an eye-catching and concerning title. It read, “We don’t know enough about childhood vaccines.”

After reading the headline, I immediately raised my eyebrows and took a deep breath. As a pediatrician who recommends and administers vaccines during my clinic time with children, I thought

“We don’t?”

I continued to read Ms. Dunkle’s commentary with the goal of learning something new, something relevant. Keeping up-to-date with medical science is an important part of my job. I need to be confident and certain, to the best of my ability, in the recommendations I give my families. As a advocate for the health of children, I owe my patients and their families that dedication. So, if there is peer-reviewed, evidence-based data that challenges or disputes current medical practice, I need to know.

In that framework, the opinion piece by Ms. Dunkle was sorely disappointing. She attempts to report on “new” findings revealed in the Journal of Toxicology and Environmental Health claiming to associate increased vaccination rates with increased rates of autism and speech/language impairments. She attempts to poke and prod at the reader, trying to pick a fight about semantic details; events, doses, shots. Then she quickly turns the corner, bringing up intentionally alarming half-truths about vaccine components, preservatives, and stabilizers.

Ms. Dunkle, however, failed to mention a very important point. The author of the reported study, Gayle Delong, is not a scientist, a medical doctor, or doctorate researcher. Ms. Delong is a economics professor with expertise in “international finance” and “money and banking” (as listed on her public CV.) More importantly, she is also on the executive board of a large, anti-vaccine group. The results obtained by Ms. Delong’s research have been shown to be biased and statistically flawed by additional reviewers. Therefore, the interpretations made from her analysis need, at minimum, recalculation.

With a small amount of fact-checking and investigation into these stories, the intention of the authors quickly become clear. Ms. Dunkle and her analysis is a great example of how anti-vaccine groups create junk studies to promote fear. And how media outposts, eager for a hot headline, will regurgitate this information with complete disregard of the potential effect this propaganda could have on our children.

Anti-vaccine stories sell papers, your child suffers.

In the face of the resurgence of measles and other vaccine preventable illness, it is unfortunate that the editors of the Baltimore Sun allowed this manipulation of its readers.

For an additional response to Ms. Dunkle’s commentary, click here.

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

Childhood Obesity. Let’s Focus on Successes

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Written by Joanna E. Betancourt MD., FAAP

First Lady Michelle Obama has decided to tackle a very important health issue that is affecting children in the US. That issue is Obesity.

I’m glad she is bringing awareness with her “Let’s Move!”  campaign because the data is staggering.

In America, more than 1 in 3 children and adolescents is overweight or obese. According to the U.S. Surgeon General, obesity in children under age 11 has tripled since 1980 from 6.5 to 19.6 percent, and obesity in adolescents (ages 12-18) went from 5 to 18.1 percent.

Weight is the No. 1 health issue facing US children today, and with “data for adults suggesting that overweight prevalence has increased by more than 50 percent in the last 10 years” it is imperative that we address this issue.

At age seven, I diagnosed a patient in our office with obesity. As part of our comprehensive care, we coordinated services with a nutritionist and an endocrinologist. The patient was showing signs of high insulin; which usually precedes the development of diabetes among other health concerns.

Four years later, countless visits to the endocrinologist, and numerous consultation with a nutritionist, her BMI (body mass index), which was above the 95th percentile, came down to the 75th percentile.

Today, I saw the patient in my office again where I shared and celebrated the progress she had made. After seeing her I felt, that after all, what we do is worth it…. 1 kid at a time! Because of her progress and the effort of the clinical care team, and the benefits of our patient centered medical home, the patient has a much lower risk of developing diabetes and a much higher chance of being a healthy adult.

Just like we ought to bring awareness to childhood obesity, we should also bring awareness to the children and their families that have worked hard to lose weight and adopt healthy lifestyles by celebrating their successes. Good for her and her family! Lots of hard work still ahead! But it is paying off. Thus, we should celebrate!

Dr. Betancourt practices in Algonquin IL. This post was originally posted on her practice’s blog. As a pediatrician, one of Dr. Betancourt’s many goals is to help every child reach his or her full potential. 

2

Mr. Obama Has Some Reading to Do

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By Suzanne Berman, MD

The Obama administration recently announced plans to use a series of “mystery shoppers” to see whether it’s true that patients with Medicaid have problems getting appointments with doctors.

This isn’t just idle curiosity; Medicaid patients are supposed to get care equal to privately-insured individuals. The equal access provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(30)(A), states that:

“A state plan for medical assistance must . . . provide such methods and procedures relating to the utilization of and the payment for, care and services available under the plan to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population.”

While I’m pleased to see that someone at the federal level appears to be paying attention to Medicaid access problems, this initiative wasn’t all that novel, and in fact seems downright redundant: for years, doctors have been documenting the difficulties with Medicaid access in peer-reviewed medical journals.

About ten years ago, pediatrician and AAP president Steve Berman published a study that documented that, nationally, children with Medicaid indeed had much poorer access to private pediatricians than their privately-insured counterparts. Based an excellent cross-sectional survey of private pediatricians nationwide, its results were impressive for their comprehensiveness; the conclusion wasn’t that surprising or novel, even in 2002.

Since then, the Medicaid/private insurance access to appointments disparity has been studied broadly, again and again – with strikingly similar results every time. Just a few of the studies conducted within the past decade (many of which have even used the “mystery shopper” technique) include evaluation of:

Even yours truly at Survivor: Pediatrics compiled a survey of Tennessee pediatricians showing that Medicaid-insured children in Tennessee do not have the access to pediatricians enjoyed by their privately-insured counterparts.

A few days after its announcement, the Obama administration announced that it was cancelling its mystery shopper initiative. Hopefully, someone decided that re-inventing the wheel wasn’t necessary after all.

Suzanne Berman is a practicing general pediatrician in rural Tennessee. Her study of Medicaid access was supported by a grant from the American Academy of Pediatrics’ Community Access to Child Health (CATCH) program.

Kids, Athletics, Fitness and Summertime

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Written by Jesse Hackell MD FAAP

It has finally warmed up, even in the more northerly reaches of our land, and school is out. Our children will—we hope—be spending much greater amounts of time outdoors—at the beach, lake or pool, playing sports, both organized and pick up, in camp or in neighborhood parks. They will be doing what children do so well—playing and expending energy, freed from the constraints of classes and short daylight hours of the winter.

As much as pediatricians encourage this activity—and we do, strongly, extol the benefits to kids, and our nation as a whole, of vigorous physical activity—this support is extended hand-in-hand with a number of cautions and warnings. We want our children to play and to exercise, but most importantly we want them to do so safely. Prevention of injury goes right along with participation in activities.

Bikes

Bicycles are a great means to keep active during the summer months. And bicycle safety is something which must be taught to children from the moment they get their first set of wheels. Helmets are a mandatory and non-negotiable element of this safety education. Many states and communities have laws requiring helmets for all cyclists; even in those areas which do not have such laws, it is imperative that parents and pediatricians insist that all riders, no matter their age or the distance they will be riding, wear helmets for every ride. Nor should we forget about scooters and skateboards and rollerblades—a fall from any of those wheeled vehicles can lead to a head injury just as serious as a fall from a bicycle. Get them out there moving on their wheels—but make sure that their heads are protected.

Water

Water safety should be a given, since every year, emergency rooms see drownings and near-drownings of toddlers and children left alone and unsupervised “for just a moment.” Whether they can swim or not, children must be supervised or have a capable buddy with them at all times when in, or even near, water bodies. Remember that falls and head injuries which occur at the edge of a pool can still lead to an unconscious child falling into the water and being incapable of self-rescue.

Sun

And don’t forget about sunscreen and protection of a child’s delicate skin from both the acute and long-term dangers of excessive UV ray exposure. A sunburn is painful, as we all know; a child’s skin is thinner, with a thinner outer layer, and even more susceptible to a painful or blistering burn than that of an adult. In addition, unprotected sun exposure will start a child down the long-term road to wrinkles, leathery, sun-damaged skin as well as melanoma and other skin cancers.

Protect your children from the sun’s damaging rays every day. There are new labeling requirements which will be showing up on sun protection products over the coming months. In summary, the key points of sun protection are as follows:

  1. Use enough product to be effective—an average adult needs to use a full ounce of sunscreen to adequately protect the body; an average child may require half an ounce, while adolescents should be treated as adult-sized bodies.
  2. Use it often enough—most sunscreen protection needs to be re-applied every two hours or so, and more often if the child is spending a lot of time in the water. Sunscreens are NOT waterproof, and they lose their effectiveness due to swimming and sweating. So re-apply it frequently.
  3. Use the right product. An SPF greater than 30 confers little additional protection, at greater cost. Additionally, SPF protection only refers to UVA protection, so it is important to make sure that all sunscreen products specifically state that they protect against both UVA and UVB rays, in order to protect against all forms of skin-damaging UV rays.

Hydration

Organized team sports and fitness activities are great ways for kids to get in shape and stay in shape through the summer months (and year round, in fact). But especially in the heat of the summer, heat stress is a major factor in exercise-related injury to children. Because of their large body surface area relative to their weight, as well as their relatively thinner skin, children have a greater tendency to lose water by perspiration than do adults.

In addition, the volume of fluids that they can consume at one time is less than an adult. So the risk of dehydration is always present for kids who are active and playing vigorously, especially in the heat of the day. Fortunately, the days of trying to “toughen” up a child athlete by restricting water intake during practices and games are long past, and most coaches and trainers allow and encourage free access to water at all times.

But for our younger children, who may not be supervised at all times of their play by an adult, ensuring adequate fluid intake becomes even more urgent. When kids play out in the hot sun for an entire day, frequent water breaks and rest periods out of the direct sun are needed, and need to be enforced by parents. While it is not possible to specify a fixed amount of water needed by a child, a good rule of thumb is to check the color of your child’s urine at the end of each day.

Clear or very pale yellow urine indicates adequate hydration; dark yellow urine is a sign that the child has not had enough fluid intake that day, and need to “top off the tank” before another day outside in the heat.

We want our kids to have fun and active summers, doing the sorts of activities that kids love to do and do so well. By taking care and paying attention to some very basic safety rules, we as parents and pediatricians can assure that a fun summer will also be a healthy one.

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.

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Are Pediatricians Different Than Other Physicians?

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By Herschel Lessin, MD

You know, I’ve noticed that pediatricians are different from other doctors. Other physicians are usually found dressed either in starched white lab coats or conservative dark suits discussing serious health issues with their adult patients.

Pediatricians are also involved in discussing serious health issues but, more often than not, we are found dressed in Mickey Mouse ties sitting on the floor playing pat-a-cake with a toddler.

You see, children are not simply little adults. The most common mistake people make when dealing with Pediatrics is to assume that all you have to do is to take the same approach you take with adults and make it smaller to fit children.

Unfortunately, the health needs of children are neither smaller nor the same as those of adults. A completely different approach is needed. This goes way beyond our efforts to help the children get over their fear and anxiety. It goes way beyond playing with them and often acting silly. The fact remains, and I repeat: children are not little adults.

They may have similar problems such as cancer, substance abuse, heart disease, and high cholesterol, but the approach to these and other problems is vastly different from the approach you would take with an adult.

Remember, we are talking about children: The way a problem shows up, is different in children, its progression and symptoms are different in children, and its outcome can be very different in children. To make matters even more complicated, all of the above factors can change dramatically with a difference of a few years of age. The course and prognosis of an illness can change completely in a 1 year old vs. a 5 year old. Can the same be said if the patient were 51 years old vs. 55 years old?

The difference starts in our approach to the patient. Most kids learn at an early age that the doctor’s office is a place that various sneaky and nasty things will happen to them. It really doesn’t matter that it’s for their own good. No one likes needles, no matter how much good they do. It’s a fact of life for pediatricians that it is difficult to appreciate subtle differences in the sound of the heart and lungs when a child is screaming bloody murder into your stethoscope.

Therefore, a good pediatrician is often like a stage performer. Even if he’s had a lousy day, when he goes to examine the child, it’s SHOWTIME. All of a sudden, a grown adult with more than 20 years of education under his or her belt will be known to emit rather unusual gurgling, cooing and squealing noises. His face will undergo astounding contortions. Games that most other adults have not thought of since childhood will come pouring forth in a torrent of activity.

The tools of his trade will be adorned with stickers or brimming with unusual critters of all varieties. Animals may reside in the pocket of his coat or in his desk drawers. And if all of this activity has the desired result, the child will be smiling, happy and cooperative, and perhaps, despite the sharp implements to come, will even remember having a good time.

Pediatricians seem to have more fun. We are very lucky people. Because of our job, we seem to have a license to act silly, to act like children. For those of us that happily use this license, it is a wonderful reliever of stress. For no matter how bad the day has been, no matter what terrible illnesses or problems you’ve seen, you can always retreat and play with the children.

And over the years, as the children grow up, you get recognized when you’re out shopping or at the mall. All of those kids that were terrified at the office are now calling out: “Look there’s Dr. Lessin!”, as they run up and say hello. All the crying and discomfort is forgotten and you can forget about all those middle of the night calls, long hours, and much of the aggravation. It’s a nice feeling!

Because of all of these factors, doctors that care for children need a specialized approach and specialized training in the care of children. Knowing how to care for adults is not enough. Even though they are not often viewed as such, Pediatricians are specialists, specialists in children.

Dr. Lessin has been a practicing pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children’s Medical Group

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If a patient can charge for her time, why can’t the doctor charge for his?

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By Brandon Betancourt

Today I came across an article on CNN Health that talked about a woman that billed her doctor for the time he made her wait.

“It’s ludicrous — why would I wait for free?” said the woman that billed her physician. She billed the doctor $100.

I work at a doctor’s office and I think billing the doctor for the time she makes a patient wait is a great idea. But why should we stop with doctors?

Why not bill everybody that wastes our time?

For example, I could bill the IL Tollways for the hours I sit in traffic thanks to their tollbooths. They are huge funnels, thus creating unnecessary traffic jams. Pay for tolls and wait too? Ludicrous.

We could also bill restaurants that tell us it will be 5 to 10 minutes for a table when in fact, it is really 20 minutes before me and my family gets to sit down. You know? Who they think they are? Our time is valuable too.

How about if we bill the movie theaters? Movies don’t start when they say, but rather roll advertising and previews for 20 minutes. I paid to see a movie on time, damn it! By the time the movie begins, I’ve already eaten all my popcorn. That ain’t right!

Oh, and let’s not forget amusement and parks like Disney. Waiting for “It’s a Small World” for over an hour… “pay up Mickey!” My kids’ time is valuable too.

Doctors should be able to get in the game too. How about if doctors charged patients when patients wasted the doctors time with unnecessary questions or for questions that already have been answered, phone calls, filling out forms, sending out pre-authorizations, calling the pharmacy, billing the insurance on the patient’s behalf or waking up in the middle of the night because the patient is not feeling well and can’t wait a couple of hours to be seen in the morning?

How about we do this…

If the patient takes up more than 15 minutes (the patient’s insurance company doesn’t pay for more) we bill by the minute which is paid at the time of service.

One last thing, when doctors run late, it usually isn’t because the doctor was doing something for themselves, but rather because they were doing something for another patient.

Perhaps an even better idea is to have patients like Elaine Farstad (the woman in the CNN story) that want to bill their doctor for the “wasted” time, bill all the other patients the doctor saw before her. Because in fact, they are the reason the doctor was running late for her appointment.

Brandon Betancourt is a practice administrator and blogs regularly at PediatricInc.com