2010-06-26

Needless Death in California

The Ultimate Price of a Flawed Argument:
Five Infants Die in California for Lack of a Simple Shot

Now and then, an intervention will spark the suspicion of the community, and independent of any facts or evidence, will be considered potentially dangerous.   Even after decades of good observation and research demonstrating the intervention is safe, it will often be shunned or avoided simply out of suspicion.

Two prominent examples of the power of rumor and suspicion are the fluoridation of water and immunizations.  When doctors and dentists first noted that kids growing up in the Rockies had almost no cavities, and that adding fluoride to water could offer this protection to all children, the public reacted with a very emotional fear, initially articulated as a vague sense that adding fluoride to water was a terrorist-like move of secret Communist influence in the US government.  We may laugh at the irrationality of this reaction, but strong anti-fluoride sentiment still is very strong in our country, it just uses other arguments to stay alive.

The other example of the tragic power of irrational fear in blocking good help getting to children is the avoidance of immunizations.  Clearly, giving a child a shot is a traumatic event.  Jabbing someone with a needle is simply not a nice thing to do to anyone, it hurts, and it looks scary.  But few interventions have as solid a record of saving  lives as the key immunizations of childhood.  Because of immunizations, parents no longer really have to worry about infections posing a deadly risk to their infant and child.  Infant meningitis is nearly eliminated, polio is eliminated from the Western hemisphere, almost no one gets tetanus or diphtheria anymore.  And pertussis was in sharp decline.  Almost every child used to get measles, and 1 in 1000 of children with measles ended up with permanent, severe brain damage from the infection, but now almost no one gets measles, and so crippling the brain damage from measles is now nearly eliminated.

And yet, despite the blazing triumph of immunizations in stopping germs from hurting our children, the power of suspicion has worked its way, and a rapidly increasing number of children in the United States are not getting immunized.  I understand the suspicion.  Drug companies have simply squandered our trust with harmful, devious marketing practices that leave all of us unsure of what to believe from them.  And immunizations have been proliferating, with so many developed against relatively harmless illnesses, one has to wonder if the next immunization is being developed to save lives or make money.

But sadly, these suspicions have led many families to block their baby's access to basic immunizations that could save a life.

This trend is right now being tragically demonstrated in California.  Enough families have opted out of giving their babies pertussis immunization that right now a deadly epidemic of whooping cough rages in California.  As of June 23, 2010, nearly 1000 children have had documented cases of whooping cough, and now 5 babies are dead who did not need to die.  All the deaths were in infants under 3 months of age.  

Controversies are the very stuff of American entertainment.  Politics, scandals, medical controversies fill our airwaves, cables, and Internet pages.  It's sort of fun to question the party line, and actually an urgent priority  to protect one's family from suspicious vendors.  But this game of American dialogue and controversy becomes less entertaining when lives of infants hang in the balance.  The draw of the immunization controversy has lured good minds into the fray, with the Sears family of physicians and Dr. Oz offering "alternative" immunization schedules.  A rather disappointing spectacle has emerged in which the shock of a famous celebrity outweighs decades of good, solid scientific study on a subject.

But now, given the recent expose of the group that invented the suspicion that MMR causes autism (see post on this earlier this month), and now the death of five young infants in California, it is time to call the suspicion of basic immunizations for what it is:  groundless and dangerous.

Pertussis is a bacterial infection of the airway- nose, eyes, throat, and lungs.  In older children and adults, it can be harmless.  But the younger you are, the greater the chance it can kill you, even with modern ICU's and IV antibiotics available, as the tragedy of the 5 dead young infants in modern California sadly demonstrates.

This is precisely the reason we recommend protecting your newborn from deadly infections, as soon as the immunization can work.  In the case of pertussis, that age is 6-8 weeks old.

Bottom Line
Basic immunizations, like those that protect against tetanus, diphtheria, pertussis, and meningitis, offer protection to infants by as young as 6 weeks of age.   We urge families to protect their children from these potentially deadly diseases by no later than 2 months of age.

The ongoing epidemic in California dramatizes a very simple point:  these immunizations are incredibly safe and incredibly important.  Getting these shots causes no lasting harm, but not getting them can be deadly.

Again, I fully respect, and share, a deep distrust of the marketing of American pharmaceuticals.  We will continue, at Advanced Pediatrics, to do everything in our power to weigh every immunization's potential risks and benefits.  To that end we will continue to prohibit any solicitation or gifts from any pharmaceutical company, stay up-to-date on research related to immunizations, and provide as measured a judgement on each immunization as possible.

With all that in mind, let us find a way as a community to reject both the pressures of social movements and the marketing of corporations, and continue efforts to always re-focus our attention on the best interests of our children.  It is time to step away from the cynical movements spawned by the likes of Dr. Wakefield in England, and return to a calm, cool consideration of the facts: namely, the key basic immunizations (DTap, Hib, PCV) are very safe and withholding them presents a clear and present danger. 

Dr. Arthur Lavin





*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.
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2010-06-21

Report on Lead in Juice and Baby Foods- Cause for Concern?

Report on Lead in Juice and Baby Foods- Cause for Concern?

I recently received a question regarding a report about lead in baby and children's foods.
Here was my response to the parent:

Dear Parent,

Thanks for your inquiry regarding the disturbing article on lead being in children's juices and baby foods, http://www.valleycentral.com/news/story.aspx?id=470720

The article refers to an organization that measured the level of lead in various juices and purees fed to infants and children.  They found levels that exceeded the level set as safe.

The study raises the most important question in toxicology:  what levels of exposure to a dangerous chemical are safe?  And its corollary, if that level of exposure is exceeded, when and how does damage occur?  That is, if the line is crossed even a tiny bit, does harm occur; or, do harmful events start happening only at double, triple, or 10 times the "safe level," and does the level at which bad things happen vary from child to child.

The article you sent gives no indication if the lead levels seen in sold foods actually hurt anyone, or achieved levels of exposure that can lead to actual harm.

My conclusions, therefore, are:
1.  It is very upsetting to see lead leak into what one would think would be a lead-free product.
2.  I urgently want to know how high the level of lead got, and whether these levels are indeed actually seen to cause real harm.
3.  And, if so, work hard to eliminate the lead from these foods.

Dr. Lavin*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2010-06-08

Multiple Vaccines and Neuropsychological Outcome

What is the Impact of Multiple Shots at One Visit
on Brain Development?

Over the last few years, a rapidly growing number of families have become concerned about whether giving more than one shot to an infant might hurt brain development or ultimate cognitive function.

The June issue of Pediatrics features an important study that tries to answer this question.

The study was conducted at the University of Louisville School of Medicine in Kentucky, and compared the intellectual, emotional, and behavioral levels of performance of over 1000 children.  They looked at the outcome of 42 tests of intellectual, emotional, and behavioral levels of performance at age 7-10 years old, as a function of how many vaccines the children received at visits to their doctor in infancy.

In not a single instance did they find that children who had their infant immunizations spaced out perform better on tests of intellectual, emotional, or behavioral function.  In every single instance, kids who got all their shots in the recommended sequence, including several appointments with 3-4 shots for as many as 5-8 different diseases, in the same visit, did as well, or better on the tests of brain function at age 7-10 years old, than those whose infant immunizations were spaced out.

Many questions are raised, but now and then answers can be given.  

For the question of whether spreading out vaccines helps brain function in anyway, the answer from this important study is no.

For the question of whether giving vaccines together in the recommended schedule impairs or hurts brain function later in childhood, the answer is no.

Bottom Line

The immunization schedule is the product of over 50 years of very detailed and careful research whose goal is very simple:
To provide protection to your infant to dangerous infectious diseases as soon as possible, with the fewest doses of immunizations necessary.
If we want to prevent dangerous infectious disease, we should do so as rapidly as possible.  After all, why let an infant run the risk of developing tetanus or meningitis for a year when they may only need to be at risk for a few weeks>

This study lays to rest the fair question of whether multiple shots lead to any harm to the developing brain.  After all, infants getting few or many shots were evaluated in very close detail long afterwards, at age 7-10 years old, and found to have no difference in intellect, emotion, or behavior whether they got single or multiple vaccines at infant care visits to the doctor.

Therefore, if giving shots on time is safe for the brain, there is little purpose to increase the danger to the infant by delaying the day they will be protected from dangerous infectious diseases.

Our recommendation is to give the protection that can help infants as soon as it can work, that is, use multiple vaccines at a visit to provide multiple protection.


Dr. Arthur Lavin


*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Bedtime Improves Academic Performance

Regular Bedtime Improves School Outcomes

A large study of sleep habits and school success demonstrates that setting a regular
bedtime alone can have an impact on your child's success in school.

The study was reported on NPR on June 7, 2010.

This study looked at 8000 young children, and compared the academic success of children
whose parents set a regular bedtime to those whose families did not.  

The research tracked bedtime practices from ages 9 months old through age 5, and looked at academic levels of ability in Kindergarten.

Children with a regular bedtime scored 6 percentage points higher in reading and 7 points higher in math.

A simple intervention, with an interesting impact on reading and math abilities.

The results are not surprising, as sleep is one of the brain's key requirements for learning and good function.

Bottom Line   Set a regular bedtime.

Dr. Arthur Lavin




*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2010-06-01

A Clarion Call: The Time Has Come to Limit Pesticide Exposure

A Clarion Call:  
The Time Has Come to Limit Pesticide Exposure

Today, the American Academy of Pediatrics' flagship journal, Pediatrics,
published what I believe will become a landmark article on the link between
toxins in the environment and the epidemic of cognitive dysfunction in our
children.


The study observes an association between exposure to a certain class of pesticides, the organo-phosphates, and the chance that a child could develop AD/HD.

The authors found that for children who had higher than average levels of some forms of this pesticide in their urine, the chance of developing ADHD nearly doubled.

The research was done well.  The researchers were from Boston University, University of Montreal, and Harvard (including the site of my residency training, Boston Children's Hospital).
The sample size was large, including 1,139 children from a national sample that is carefully constructed to represent a wide swath of backgrounds, in this case children 8-15 years old from 2000-2004.

Organo-phosphates are a very common category of pesticide.  In the United States about 73 million pounds are applied on our lawns, homes, and food every year.  In 2008, the US reported that one could find organo-phosphates on 28% of frozen blueberry, 25% of strawberry, and 19% of celery samples.

The authors refer to other studies that show a link between organo-phosphate exposure during pregnancy and the development of autism spectrum disorders, particularly PDD.   Children ages 6-11 tend to have the highest levels of organo-phosphate in their body of any age group due to patterns of intake and metabolism.

The study looked at one urine sample in each child, so a complete picture of the overall level of exposure could not be made.  But even so, the results were not influenced by the child's gender, age, ethnicity, time from last meal, urinary function, or level of poverty/wealth.  In every group examined, as the level of pesticide went up in the urine, the chance of having ADHD increased.

Further, the levels of pesticides in the urine did not drop over time.  This means that as a group, it is likely that American children had no drop in the amount of pesticide in their body during the time period of 2000-2004.

Organo-phosphate pesticides are widely used in homes, lawns, and food.  There is even an organo-phosphate form of lice therapy, sold under the brand name of Ovid, but chemically known as malathion.  (This is exactly why Advanced Pediatrics has always been opposed to the use of Ovid).

Organo-phosphates work by making sure electrical signals across key nerves fail to progress.  In insects they work essentially like nerve gas, paralyzing the insect.  In fact, some of the most famous nerve gases developed for human warfare, Saran and VX, are also organo-phosphate compounds.  So it makes sense that a low dose of such a compound could cause neurologic dysfunction. 

This study adds a very significant piece of evidence to the growing body of evidence that pesticides, and certainly the organo-phosphates, are poisons to human minds, particularly developing minds.  

Bottom Line 
  1. Organo-phosphate pesticides are now clearly associated with increased risks of developing AD/HD and autism spectrum disorders.
  2. The nature of these compounds the observation of an association is sufficient, in my mind, to call for the most stringent steps to avoid exposure to organo-phosphate pesticides, at any age.
  3. To that end, we recommend that:
    1. All fruits and vegetables be either organic or thoroughly washed before eating
    2. Ensure that no pesticides applied to your lawn contain organo-phosphate pesticides.  This can be done by asking your lawn service what the category of pesticide is that they use.  For pesticides bought by you, search the web for each active ingredient and determine the category of each active ingredient.  If they contain organo-phosphates, dispose of them responsibly ASAP.  If your lawn service uses organo-phosphates, insist that they stop.
    3. Ensure that no pesticides applied in your home contain organo-phosphate pesticides.  This can be done by asking your pest control service what the category of pesticide is that they use.  For pesticides bought by you, search the web for each active ingredient and determine the category of each active ingredient.  If they contain organo-phosphates, dispose of them responsibly ASAP.  If your pest control service uses organo-phosphates, insist that they stop.
****Organo-phosphate pesticides may cause harm to developing and even developed brains, we urge everyone to take these steps to protect anyone you care about from being exposed to them.****

Dr. Arthur Lavin




*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.