January 15th, 2009 by Stacy Stryer, M.D. in News, Uncategorized
Tags: cold medicines, health care, lipid screening, sids, stacy beller, stacy stryer, sudden infant death syndrome, third hand smoke, top pediatric stories
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By Dr. Stacy Beller Stryer, M.D.
Reflecting on the past year’s successes and failures as a parent is an important and worthwhile exercise to do each January. In previous January blogs, I have published my own list of resolutions for the New Year to help you get your own creative juices flowing. This year, however, I have decided to talk about the top five news stories related to pediatrics in 2008.
The top news story in 2008 is the election of Barack Obama as our next President. President-elect Obama wants affordable, comprehensive and portable health care for everybody . His goal is for all uninsured children to be able to sign up for healthcare plans. He wants to expand Medicaid and state health insurance programs, and to develop a government-funded health insurance plan that will compete with other companies. President-elect Obama also wants comprehensive health education taught in schools.
A second important pediatric-related news story is the recall of cough and cold medicines, including decongestants, expectorants and antitussives, for children, particularly those ages 2 years and less. The reason for the recall is because studies have found that the risks of dangerous side-effects far outweigh the benefits. A study which came out last year from the Centers from Disease Control found that over 1500 children under age 2 visited the emergency room for serious side effects due to taking cold medicines in 2004 and 2005, and that 3 children died. In addition, insufficient studies have evaluated the efficacy and side effects in children. Actually, these medicines were previously developed based on studies done with adults.
Another important finding concerns the use of cigarettes. If you smoke and light up that cigarette only when you are outside your house or when your children aren’t home, you may still be harming them (OK – this was reported in the January issue of Pediatrics but I heard about it December 31st!). According to a recent study published in Pediatrics , this “third-hand smoke” causes toxins to remain everywhere, such as on clothes, hair, couch cushions, and carpets, for extended periods of time. The toxins include heavy metals, carcinogens, and radioactive materials that children may ingest, especially if they are crawling on the carpets. If this isn’t enough of a reason to quit smoking, I don’t know what is!
Unlike some other fatal illnesses, researchers have been able to decrease the risk of sudden infant death syndrome (SIDS) significantly over the years when they discovered that placing an infant to sleep on his back significantly reduced the risk. Another study published last October in the Archives of Pediatrics and Adolescent Medicine that placing a fan in an infant’s room during sleep decreased the risk of SIDS by 72%.
The last news story which made significant changes in pediatric practice this past year concerns the identification and treatment of elevated cholesterol levels in toddlers and children. In July, the journal Pediatrics published revised guidelines for pediatricians, including initiation of lipid screening in children, beginning at age 2 years, in those who have a family history of high cholesterol or early heart disease, or in those who are overweight, have diabetes, or smoke. The American Academy of Pediatrics has also begun to recommend a decrease in the fat content of milk in overweight children beginning at age 1 year. Finally, they now recommend medication as early as age 10 years in certain children with elevated lipid levels despite exercise and diet change.
There are many other important findings from 2008, but I thought that these were among the most important. Now stop reading and get back to your New Year’s Resolutions for 2009!
January 9th, 2009 by Dr. Val Jones in Uncategorized
Tags: pediatric blogger, Pediatrics, revolution health, stacy stryer
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Can you think of a really good caption for this medical cartoon? The winner will receive a Better Health t-shirt, effusive praise, and bragging rights. The winning caption will be chosen on the basis of subjective criteria by a panel of 3 judges of variable wit. List your captions in the comments section. Enjoy!
January 6th, 2009 by Dr. Val Jones in Uncategorized
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The Washington Post reported today that Sanjay Gupta, CNN’s medical correspondent, is being considered for the office of Surgeon General by President-elect Obama. This came as quite a shock to me, as I’ve met and interviewed 3 of the recent Surgeons General over the past few years. Of course, I like Sanjay Gupta as a reporter. He’s a fine communicator and does a good job covering subjects for a consumer audience. But I don’t think he has the gravitas or appropriate experience for the role of Surgeon General of the United States.
I spoke with one source close to the nomination proceedings, and he said that most senior people were secretly disappointed with the choice. My source requested that I not reveal his name.
If Sanjay Gupta is confirmed as Surgeon General he will achieve the immediate rank of admiral, even though he has no previous military or public health experience whatsoever. It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department. The office of Surgeon General is a very important position given only to the most senior and experienced medical professionals with decades of achievements in their fields. Gupta is a good reporter, he should consider a role in public relations for the U.S. government, not the office of Surgeon General.
When the Bush administration chose an inexperienced person, Mike Brown, to head FEMA – it was a disaster. I hope that the Obama administration doesn’t make a similar mistake with Gupta. However, a nomination is not a confirmation – Gupta still has to be approved by Senator Kennedy’s Health, Education, Labor and Pensions Committee before taking the office of Surgeon General. Unfortunately, it’s possible that the committee will feel pressured to confirm Gupta to maintain a good relationship with the new administration, rather than to vote their conscience. But I can tell you that many people are not pleased with this nomination, and feel that there are more appropriate choices that are being overlooked.
It will be interesting to see how far this nomination goes, and if there will be an outcry from the military and medical community over Sanjay Gupta’s apparent nomination. What do you think?
January 6th, 2009 by Dr. Val Jones in Uncategorized
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The Office on Women’s Health (which is part of HHS) recently sent me a book to review: The Healthy Woman – A Complete Guide For All Ages. It is on sale at the U.S. Government bookstore. The book says that it provides “easy to understand information from the nation’s leaders in women’s health.” And I agree that it lives up to that promise.
When I receive a general consumer health book there are a few sections that I generally read first to determine whether or not the book is trustworthy: complementary and alternative medicine (CAM), nutrition, and hormone replacement therapy. The Healthy Woman passed my test on these subjects, though I could quibble with some of their content. For example, they suggest that homeopathy requires “more research” to determine it’s potential therapeutic uses – one could say the same for fairy dust I suppose, though I wouldn’t waste tax payer dollars on that research. I also think they overstate the literature on salt consumption (for people without renal failure, CHF, or severe hypertension, there doesn’t seem to be much reason to worry about salt intake in my opinion).
However, overall the book does an admirable job of synthesizing the scientific literature in a simplified and consumer-friendly form. Compared to other books I’ve been sent by supposed “health experts” (which were so filled with pseudoscience that I declined to review them), this one is outstandingly good. By and large it can be relied upon by readers to provide an accurate introduction to the various diseases and conditions likely to affect women at various ages and stages of life.
A few shortcuts were taken in creating this book – Getty images replaced original photography in many instances, questionnaires were adapted from research literature without careful thought being given to the likely readership (one screening questionnaire asks the reader if they’re “living in prison” or “blind”), no original research studies are cited in the reference section of the book, and the medical glossary is quite sparse (I noted only 6 entries under the letter “v,” one being “voyeurism.” I had not expected that particular v word would make it into the top 6 in a general medical text, but I digress.)
The book is written at a sixth grade reading level which is appropriate for the general public. It is a fine introductory reference guide to women’s health – though I doubt that women will want to read it cover-to-cover, but rather delve into the sections relevant to them.
The strength of the book lies in its plain writing and accessible format. Its weakness is that, because it covers all diseases and conditions that affect women, it does not offer the kind of depth necessary to master any of the health topics.
In the final analysis, I’m grateful that this book exists as a counterbalance to the sea of misinformation constantly churned out by publishers looking to turn a profit on “miracle cures your doctor won’t tell you about.” Thank you, HHS for making the effort.
*Purchase the book here*
January 5th, 2009 by Dr. Val Jones in Audio, Uncategorized
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Amy Tenderich
Amy Tenderich is a leading online voice for diabetes advocacy. She is author of the popular blog, Diabetes Mine, and has type 1 diabetes herself. I caught up with Amy recently to discuss her concerns about a potential slowdown in diabetes research due to an increasingly risk-adverse FDA. You may listen to our conversation here, or read my summary below.
[Audio: http://blog.getbetterhealth.com/wp-content/uploads/2009/01/amytenderich.mp3]
Dr. Val: I understand that there’s a new petition asking the FDA to better serve the needs of people with diabetes. What is your role in that?
Tenderich: The petition represents the collective online voice of the diabetes community. It was spearheaded by Kelly Close, Manny Hernandez, and myself in response to what seems to be an increasing climate of extreme risk aversion on the part of the FDA. Patients generally don’t know much about the FDA’s actions, so we bloggers are stepping in to raise awareness.
Dr. Val: What do you think is making the FDA so risk-adverse?
Tenderich: As noted by Rebecca Killion, one of the few Patient Representatives who works directly with the FDA (and also has Type 1 diabetes), we’ve seen intensified regulatory issues in the post 9-11 era due to an increasing culture of fear. In addition, this country is so litigation happy, that everyone is trying to cover themselves. The media tends to dramatize things and they come out with headlines like “diabetes drugs will kill you.” In reality, certain drugs may be very helpful to millions of people, with caution only required for those in high risk groups. We need to counteract some of this fear and exaggeration by having patients speak up. We can’t just be yanking whole classes of drugs off the market because of a risk found in a small subgroup of potential users.
Dr. Val: Can you explain how the FDA’s new safety requirements might stymie diabetes research?
Tenderich: The FDA is adding additional cardiovascular research requirements to the development of all new oral diabetes drugs. This will have a chilling effect on innovations in diabetes care. As Rebecca has pointed out, it’s pretty unreasonable to require cardiac testing in phase II and phase III drugs that have not given us any reason to believe that they may pose a cardiac risk. The additional expense and time lag caused by testing the drugs for potential cardiac side effects will slow down the whole process and makes some research cost-prohibitive for smaller companies. It takes thousands of additional study subjects to rule out the possibility of cardiac harm, which can add up to tens of millions of dollars.
Patients put a lot of faith in the FDA and they just assume that it’s looking out for their best interest – both in terms of mitigating risks and also in regard to encouraging research in the right areas. However, the FDA can be very political – with individual researchers driving their own agendas, without specific regard to patient needs. The diabetes community would definitely like to see a stronger patient voice at the FDA.
Dr. Val: So in a perfect world, what changes are you hoping that the next FDA Commisioner will make?
Tenderich: We’d like to see the new Commisioner remove excessive research hurdles to pave the way for new drugs and innovations. Of course we want the FDA to keep safety in mind and issue warnings to appropriate at-risk populations, but we don’t want them to remove patient and physician choices. We’d like to see the FDA help (rather than hinder) the development of new technologies to improve quality of life, such as continuous glucose monitors. These devices can make a huge difference in diabetes management, but insurance companies are pushing back hard on coverage for them because of the high up-front costs for a long term gain.
The purpose of the petition is to implore the FDA to set up a Diabetes Advisory Council made up of patients, researchers, and physicians “in the trenches” and actively engaged in diabetes care on a day-to-day basis. That way the decisions made by the FDA will be more in tune with the needs of real patients.
To sign the petition, please go to www.healthefda.com.
For more information, please check out Amy’s blog post at Diabetes Mine.
