July 10th, 2009 by Jonathan Foulds, Ph.D. in Uncategorized
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As many of you may know, the famous tobacco control scientist and advocate, Professor Stan Glantz, has over the past few years been focusing on the issue of depictions of smoking in movies. Part of the concern stems from good evidence that young people are highly influenced by movies due to their cultural value and glamorous nature.
The other part stems from a history of use of “product placement” in movies. This refers to the movie producers agreeing to include a specific product in their movie in return for some incentive (typically money). A famous example of this is a letter from Sylvester Stallone agreeing to smoke particular brands of cigarettes in his movies for $500,000. So when one combines the financial power of the tobacco industry with product placement we end up with a hell of a lot more gratuitous smoking in movies than is necessary.
Of course the movie companies and many movie enthusiasts argue about the need for art to imitate life etc., etc. However numerous examples demonstrate that to be a lot of nonsense. Professor Glantz points to depictions of Marlboro cigarettes being dragged around or used by aliens in movies like Men In Black. Is it really true that those aliens prefer Marlboros and so showing the brand was necessary for the movie to be accurate? Mmm….I doubt it.
My favorite example comes from the film “A Beautiful Mind”. The movie stars Russell Crowe in the lead role portraying the (still living and working) Princeton University professor, John Nash. In real life, John Nash suffered from schizophrenia but did not smoke. In the movie he suffered from schizophrenia, but smoked. I’m not sure why the producers changed this aspect of reality or what it added to the movie.
But these are details. Professor Glantz’ main point is that movies made to be viewed by kids do not need to include smoking, and therefore should be given an R rating if they do, just as they are if they depict illicit drug use. Note that an R doesn’t stop people under 17 from seeing the movie in a movie theater. It just means they need to be accompanied by an adult. It also doesn’t ban smoking from movies, it just means that movies with smoking in them will receive an R rating, just as sex, drugs, cursing and certain types of violence will get a movie an R rating. Of course the movie industry is very clear that a large part of its audience is kids and particularly teens. The net effect of the rating changes professor Glantz is recommending would be that gratuitous smoking will be taken out of many movies and particularly those aimed at kids.
I must admit that I didn’t initially pay much attention to this proposal, and my natural inclination was to doubt whether it really was worth the effort. But while I was at the UK National Smoking Cessation Conference in London last week I heard Professor Glantz talk about this idea and I came around to thinking its maybe not as extreme as I first thought. In fact he convinced me that it’s a reasonably sensible idea that would likely result in thousands fewer teens taking up smoking. Sometime soon the full audio recording of Professor Glantz’ presentation will be posted on the conference website along with his slides. I’ll post the link when its available, but for now those interested in this subject may want to check out the following website:
http://smokefreemovies.ucsf.edu/
This post, Should Movies With Smoking In Them Receive An R-Rating?, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
July 9th, 2009 by DrRob in Better Health Network, True Stories
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My worst night as a doctor was during my residency. I was working the pediatric ICU and admitted a young teenager who had tried to kill herself. Well, she didn’t really try to kill herself; she took a handful of Tylenol (acetaminophen) because some other girls had teased her.
On that night I watched as she went from a frightened girl who carried on a conversation, through agitation and into coma, and finally to death by morning. We did everything we could to keep her alive, but without a liver there is no chance of survival.
Over ten years later, I was called to the emergency room for a girl who was nauseated and a little confused, with elevated liver tests. I told the ER doctor to check an acetaminophen level and, sadly, it was elevated. She too had taken a handful of acetaminophen at an earlier time. She too was lucid and scared at the start of the evening. The last I saw of her was on the next day before she was sent to a specialty hospital for a liver transplant. I got the call later that next day with the bad news: she died.
The saddest thing about both of these kids is that they both thought they were safe. The handful of pills was a gesture, not meant to harm themselves. They were like most people; they didn’t know that this medication that is ubiquitous and reportedly safe can be so deadly. But when they finally learned this, it was too late. They are both dead. Suicides? Technically, but not in reality.
For these children the problem was that symptoms of toxicity may not show up until it is too late. People often get nausea and vomiting with acute overdose, but if the treatment isn’t initiated within 8-10 hours, the risk of going to liver failure is high. Once enough time passes, it is rare that the person can be cured without liver transplant.
Acetaminophen overdose is the #1 cause of liver failure in the US. According to a Reuters article, there are 1600 cases of liver failure from this drug per year (2007). This is a huge number. In comparison consider that the cholesterol drug Cerivastatin (Baycol) was withdrawn from the market when there were 31 deaths from rhabdomyalysis (severe muscle break-down, which is far more common than liver failure in these drugs). These happened mainly when the drug was used in combination with another cholesterol drug.
Should the drug be pulled from the market? No, it is safe when used properly. The toxic dose is generally 10 times the therapeutic dose. My complaint is not that they have dangerous drugs available; ALL drugs should be considered dangerous. Aspirin, decongestants, anti-inflammatories, and even antacids can be toxic if taken in high dose. The problems with acetaminophen stem from several factors:
- Most people don’t realize the danger.
- There has been very little public education and no significant warning labels on the packages.
- The drug is often hidden in combination with other drugs, including prescription narcotics and over-the-counter cold medications. This means that a person can take excess medication without knowing it.
I would advocate putting warning labels on medications containing this drug. I am sure this doesn’t thrill the drug manufacturers, but the goal is not to make them happy. I have thought this since that terrible night during residency. If there was such a warning, perhaps she wouldn’t have died.
It seems a bit silly that this action by the FDA is coming after their pulling of children’s cough/cold medications. Those drugs have very small numbers of true harmful overdoses. The reason they were pulled was probably more that they didn’t do anything over the fact that they were dangerous. Acetaminophen, on the other hand, can be deadly.
Just ask the parents of my two patients.
*This blog post was originally published at Musings of a Distractible Mind*
July 8th, 2009 by Nancy Brown, Ph.D. in Better Health Network
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Just a friendly reminder to parents that dating does not equal sex. I cannot tell you how many teens have shared with me that the first lecture they got from their parents when they started dating was about sexually transmitted infections, including HIV and unwanted pregnancy. Their reactions were “what?”
When young teens start dating it is because they have found themselves twitterpated (which is apparently not a real word), and attracted to someone. Chances are good it is more of an emotional attraction than a sexual one, and one that will wax and wane, usually end with tears, but not kill them.
It is easy to understand why parents panic and worry about sexuality and the risks associated with that sexuality – we live in an extremely over-sexualized culture that can make us believe that everyone is having sex – which is not true. Please remember that only half of teens start being sexual before they are 18, but most fall in love at least once before leaving high school.
Dating is about learning how to be in a relationship, and you will be doing your children a great service if you talk with them about relationships, not sex. It is a good idea to make the difference really clear for them, and make your expectations very clear, too! If you expect your teen to not become sexual, tell them that, and why. Ask them to tell you what there limits and expectations about relationships and sex are. Here are some topic suggestions:
- What do they think dating includes?
- What does sexual pressure look and feel like?
- How would your child resist sexual pressure?
- How long do they think people should date before the topic of sex even comes up?
- How will they know if someone is the “one?”
- What would have to happen before they did think about sexual behavior?
If the possibility exists that they will be sexual, then, you can have the conversation about sex – but not if they tell you they will not be swayed and are not interested – you have to trust them.
Many teens are afraid of dating or choose not to date because a partner may expect sex, so they find a friend or pseudo partner to attend events with and protect them from having to resist sexual pressure – which is a great strategy, but keeps them from trying on relationships.
Oh the conversations that we might have … keep talking and make sure they know you are open to talking – even about things that make you squirm.
This post, Teen Dating Does Not Mean They’re Having Sex, was originally published on
Healthine.com by Nancy Brown, Ph.D..
July 8th, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Tips
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I used to feel guilty when I would say “no thanks” but not any more. I no longer by the line: “Ok…but you do know she might get behind…many of the other kids do continue for the summer.”
I’m ok with it…and so are my kids. And, you know what, not once have they “fallen behind” in any of their activities, even the ones they are at the top of their game on, in sports or in the arts.
It’s a myth that the sports world is the only world with year ‘round pressure. The music and arts worlds have it, too. Those worlds, in fact, can be more insidious about it because it’s done under the guise of “enrichment” and “culture”. The 24/7 wear and tear on our kids bodies, minds, and souls is, nonetheless, the same as with a ‘year round sport and it’s time music, dance and other fine arts parents recognize that their kids, too, need an off season.
The way to look at it is that any school year after school activity that occupies a great deal of time and focus and goes on for most of the school year, or more than 1 celestial season, requires an off season. The model is in the pro worlds. Pro athletes get off seasons and professional dancers and musicians do take breaks from the intense rigor of their professional season.
Our children have 1 childhood and only so much time in it to explore themselves and pursue activities that interest them. Given how much of the school year’s schedule is dictated by adults, the summer is the best time to hand over the reins to our kids and find out what they want to do and make it happen. The summer is the most perfect time to spread wings and try on something new, something that they may have had to shelve by necessity during the school year.
So, don’t buy into the “she’ll get behind” line – in sports or in the arts. Give your kids the off season this summer they deserve. Just like the off season in the pro worlds, kids use the time so productively that by the time they return to their beloved passions, they have a new found energy, zeal and focus. The rust will come off amazingly quickly and they’ll surge ahead again as if the summer never occurred.
Why not just keep on going, you ask? You could…but you may end up turning an activity your kids love into a complete grind and burn them out entirely. Plus, injury rates increase dramatically in sports and the arts when kids don’t have a break. Musicians and dancers put wear and tear on their bodies just like athletes, but with different muscle groups. Those areas of their bodies need to rest and rehab, in addition to their minds and souls having a chance to not focus so intensely for a while.
Childhood isn’t about specialization, it’s about variety. We’ve forgotten that along the way, and our kids’ bodies and spirits are paying a steep price.
*This blog post was originally published at Dr. Gwenn Is In*
July 2nd, 2009 by Nancy Brown, Ph.D. in Better Health Network, Health Tips
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I went to a great grand rounds the other day about osteoporosis and learned that all teenage girls should be taking about 1,500 mg of calcium with Vitamin D a day in addition to a multivitamin. Three glasses of milk provide about 1,200 mgs, but most teens are not drinking that much milk. Dark green vegetables are another good source of calcium. Exercise and weight-bearing activity is also important in the prevention of osteoporosis.
Calcium is a mineral that gives strength to your bones. Calcium is also necessary for many of your body’s functions, such as blood clotting and nerve and muscle function. During the teenage years (particularly ages 11-15), your bones are developing quickly and are storing calcium so that your skeleton will be strong later in life. Nearly half of all bone is formed during these years.
Women develop most of their bone strength before they are between 25 and 35. After that, bone is broken down faster than it is created, leading to a small loss of bone mass every year. For women, bone loss accelerates during menopause, but slows again around age 60.
There are specific risk factors for osteoporosis that teens should know:
- Being white;
- Having irregular periods;
- Doing little or no exercise;
- Not getting enough calcium in your diet; Being below a normal weight;
- Having a family history of osteoporosis;
- Smoking; and
- Drinking large amounts of alcohol.
Osteoporosis can be prevented, but teens need to start early.
This post, How Much Calcium Do Teen Girls Need?, was originally published on
Healthine.com by Nancy Brown, Ph.D..
