February 19th, 2009 by Stacy Stryer, M.D. in News, Opinion
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By Stacy Beller Stryer, M.D.
Bristol Palin hasn’t said anything new or different than the other teen moms I have met. When asked, every teen mom I have spoken with has said that she loves her child but it has been very difficult and, if given another chance, she would never have had a baby as a teen. All would have waited until they were much older. Bristol Palin says 10 years older. When I worked on the Navajo reservation, I did a program at a local high school where I invited teen moms to come in and speak to the students. They spent quite a long time talking about how difficult it was to have a child and how their lives, as they knew it, were gone forever. These teen moms advised every student to wait as long as possible.
During her recent interview, Bristol commented on how she is no longer living for herself and how her new life is not “glamorous” at all. And, although her son is not even two months old yet, Bristol has decided that she wants to become a spokesperson for the prevention of teen pregnancy. This teen mom thinks that merely telling a teen to be abstinent is not realistic.
Although the teen birth rate had been decreasing steadily for over a decade, the most recent national data, compiled in 2005 and 2006, documented a 3% increase in teen births from 40.5 to 41.9 births per 1,000 girls ages 15 to 19. This increase was seen in almost every age and racial group. During a similar time period, teens surveyed in schools nationwide more frequently reported being sexually active and less frequently used contraception, when compared to the previous decade. Experts in the field have speculated as to why these numbers have begun to increase again. Possible reasons include societal changes, recent high profile teen pregnancies (such as Jamie Lynn Spears and, yes, Bristol Palin), positive display and lack of consequences when sex and teen pregnancy occur in the media, fewer educational programs available, and changing policies within the nation (such as teaching abstinence only as the only alternative).
Bristol is lucky because she has a lot of family support, both emotionally and financially. However, most teen moms don’t have much help, and they face extreme financial difficulties. Teens, who are used to following their own schedule and thinking mainly about themselves, must deal with being awakened multiple times a night and basically being at their baby’s beckon call. They can no longer shower when they want, sleep when they are tired, and eat on their own schedules. Teen moms must also deal with the increased risk of medical problems in themselves and their children. They are less likely to have adequate prenatal care, their babies are more likely to be born early, at a lower birth weight, and to die in the first year of life.
In terms of education, it becomes difficult for teen moms to even finish high school. Only 40% of teen moms graduate from high school, compared to 75% of those who don’t have kids. Plus, teens are more likely to live in poverty, as greater than 75% of unmarried teen moms go on welfare within 5 years of having a baby. Their children also suffer. About 78% of them live in poverty, compared to 9% born to married, women over age 20 who have graduated from high school. These children are also more likely to do poorly in school and drop out before graduating high school.
Unlike other high profile teen parents, Bristol is speaking out. She is telling teens to wait to have kids. And she is telling adults that teaching abstinence is not enough. We need to be discussing these topics at school AND at home. We need to know where our teens are when we’re not home. And they need to know about sexually transmitted diseases, teen pregnancy and contraception before they have a sexual relationship. They must be prepared.
February 2nd, 2009 by Stacy Stryer, M.D. in Opinion
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By Stacy Beller Stryer, M.D.
After my blog last week discussing the recent increase in Haemophilus influenzae B (Hib) cases in Minnesota, I received a comment from “Indian Cowboy,” who is a blogger and fourth year medical student. While Indian Cowboy admits that he isn’t completely against vaccines, he does question their safety and says that, “if my (future) patients were to ask me specifically, scientifically, what the risks of vaccines are, I would be forced to shrug my shoulders and say I actually have no idea.” He suggests that pediatricians, in general, are not open and honest with their patients about any side-effects associated with vaccines. Furthermore, Indian Cowboy comments that he is a member of the “current generation of medical students,” where evidence-based medicine is important. Does this mean that we old-timers (yes, I am an ancient 45 years old), don’t practice medicine based on results of quality studies and proof of what actually works?
That is far from the truth. My colleagues and I practice medicine based on what has been proven to work and not just what we learned on a whim. We continue to read reputable journal articles and other medical literature, often discussing treatment changes based on new research. And I do not know any pediatrician who makes a blanket statement that vaccines are 100% safe. Personally, I spend a fair bit of time talking to parents who question vaccine safety. I tell them that anybody can have a reaction to a vaccine, just like anybody can react to an antibiotic, food, or something in the environment. I also discuss more common side effects of vaccines, such as fever, redness, and irritation at the injection site. In addition, I mention that there are very rare, more serious side effects associated with some vaccines, such as seizures and encephalitis. I am certainly not the only honest pediatrician in the United States. In fact, reputable organizations such as the Centers for Disease Control (CDC), which are major advocates for vaccines, clearly state on their website that no vaccine is 100% safe or effective.
Just as importantly, and an absolute necessity is discussing that the risk of becoming seriously ill or dying secondary to a vaccine is much lower than the risk of developing a serious illness or dying if a child becomes ill with one of the infections for which they could have been vaccinated. Parents must be aware of the benefits of receiving these vaccines. And they should know that vaccines are one of the greatest medical discoveries of the 20th century and have increased life expectancy and quality of life significantly.
Back to Indian Cowboy – he also comments that we really don’t know much about vaccine safety because studies only last days or, at most, a couple of weeks. This is also far from the truth. Before a vaccine is licensed, the Federal Drug Administration (FDA) requires testing. Once the vaccine is being used, the CDC and FDA look for any problems and investigate them through the Vaccine Adverse Event Reporting System. It’s true that this system depends on pediatricians and parents to report side effects. This was recognized as a problem, so in 1986 a National Childhood Vaccine Injury Act was developed which, among other things, required experts to intensively review any possible adverse effects of vaccines. In 1990 the Vaccine Safety Datalink project was developed, where researchers gained access to the medical records of over 5.5 million people to evaluate for common and rare side effects associated with vaccines. All of these different safety methods have led to changes in vaccines to make them safer. In 2000, children began to receive the inactive polio instead of the live polio vaccine due to the rare risk of developing polio from the oral vaccine. More recently, the pertussis vaccine was changed from a whole cell to an acellular one because of the increased risk of rare neurological side effects.
I could continue, but the bottom line is that immunizations have been tested extensively for safety and continue to be monitored by reputable, quality organizations. There is an abundance of information available on safety for every vaccine. It is true that we cannot assure parents that their child will not develop a severe allergic reaction or a rare side effect to a vaccine. And we cannot say that we are 100% sure that vaccines do not affect the brain or the immune system, such as we cannot assure them that they will not get into an accident when they step into a car or that they will not be hit by a car when they cross a street. But we can reassure them that the chances of such an event are rare and that the benefit of receiving the vaccine far outweighs the risk of not receiving it.
I certainly hope that the one case of epiglottitis and pertussis that Indian Cowboy saw last year makes him realize not only how serious these infections can be in infants and children, but also that he only saw one case of each whereas, without immunizations, he would have seen many more and, most likely, a few deaths.
January 29th, 2009 by Stacy Stryer, M.D. in Health Policy, Uncategorized
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By Stacy Beller Stryer, M.D.
Just last week three parents in my practice either refused or asked to alter the recommended vaccine schedule for their infants, and so far this week there have been another two. None of them have had good reasons, and none had truly researched the pros and cons of having their child receive each vaccine. The other day there was a memo on my desk, from the American Academy of Pediatrics, which discussed 5 children under age 3 years who had developed haemophilus influenza (Hib) in Minnesota last year, one of whom died. Three of the children who became ill, one of whom died, were unimmunized because of parent refusal. Another had a recently diagnosed problem with the immune system, and the last hadn’t finished the Hib series at the time of illness.
It is difficult to hear these parents refuse the vaccine, and, although asked by parents, I cannot choose which vaccines they should get now and which they should get later because all are potentially deadly. If only parents could see what I saw as a medical student and resident, before there was the widespread use of the Hib vaccine, and before the development of the pneumococcus vaccine. If only they could see the infants and toddlers admitted with terrible infections, such as meningitis, where some developed permanent brain damage or total hearing loss, and others were not so lucky. Or the children who developed epiglottitis and could barely breathe, where even asking them to open their mouths or agitate them by examining them was risky and could cause respiratory collapse. Or those who developed arthritis in their hip or bones and received antibiotics for weeks, hoping that they would not need surgery or develop permanent damage. And, of course the many children who were admitted to the general ward or intensive care unit with pneumonia and significant respiratory distress. These are just some of the things I saw before the development of these two vaccines, most of which I just do not see anymore.
According to the Centers for Disease Control, before the widespread use of the vaccine about 15 years ago, Hib occurred in over 20,000 children per year, and about one in 200 children under age 5 years developed meningitis, with 25% of those affected developing permanent brain damage. Since the use of the vaccine, the number has dropped dramatically but is now beginning to increase again because parents are not immunizing their children adequately. The Hib vaccine prevents against infections such as meningitis, epiglottitis, septic joints, bone infections, soft tissue infections and pneumonia. There are no known serious side effects to this vaccine. The pneumococcal vaccine prevents against pneumonia, sinusitis, ear infections, meningitis, and soft tissue infections, among others.
Not only do parents harm their own children refusing a vaccine, but they also harm others. If parents don’t immunize their children, they are at greater risk of becoming ill with serious illnesses, are more likely to infect others with these infections, decrease the general “herd” immunity in the community, and may need to be excluded from school or other activities during outbreaks with vaccine-preventable illnesses. I am asking you to read about these vaccines, look at the research on their association with autism, ask your physician questions (we did spend seven years in medical school and residency learning about this), and make an informed decision. I am confident that, if you educate yourself, your decision will be the right one.
January 22nd, 2009 by Stacy Stryer, M.D. in Health Tips, Opinion
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By Stacy Beller Stryer, M.D.
We are asking a lot of President Obama. We are asking him to end the wars around the globe, help societies in need, bring jobs and prosperity back to the United States, provide healthcare for all Americans, improve our children’s education, and so on. In his inaugural address, President Obama agreed to tackle many of these issues. We must remember, however, that he is not Superman. He has told us many times, including yesterday, that he cannot make these changes alone but needs the help of all Americans. As he said, “What is required of us now is a new era of responsibility – a recognition on the part of every American, that we have duties to ourselves, our nation and the world …”
Why am I, a pediatrician, discussing an inaugural speech on a website about healthcare? Because, as the President said, each and every one of us has the responsibility of contributing as much as possible to our society and to the world-at-large. As a pediatrician, one of my responsibilities is to guide mothers and fathers toward being the best parents possible. As a parent, each of you has the responsibility of doing the best job you can in raising your children, even before they are born. This means eating well, and refraining from smoking and drinking during pregnancy. It also means providing for them in as many was as possible. This includes, not only giving them appropriate clothing and food, but also stimulating their minds and hearts. It means treating them with respect, acting as positive role models, and teaching them right from wrong – why smoking and having sex as a teen is wrong, why doing well in school is important, and why all people should be treated equal, whether they are black or white, straight or gay, fat or thin. It means boosting your children’s self confidence and letting them know how much you love them. It means becoming involved in activities which help the environment, community, and those in need. And when children become teens, parents must also change their ways – they must learn to recognize when teens need space and when it is time for them to develop their independence.
President Obama is certainly asking a lot of us. But I know we can rise to the occasion. By being good parents and role models, we will not only have fulfilled our duties and responsibilities, but we will also have prepared the next generation to do the same. Here’s to President Obama – and to each and every parent in America.
