AP to Comply with CDC: No FluMist this Year

The CDC Issues a Dramatic Reversal Today

FluMist No Longer Recommended

Advanced Pediatrics to Respect the New Findings: No Nasal Spray for Flu Protection this Fall, only the Shot

It seems every year, the immunization effort to prevent infections from the influenza virus, which causes 1/3 of all wintertime colds and flus, has a twist.

One year, it was a national shortage of all flu immunizations.  Last year, it was a severe shortage of the nasal form of the immunization, FluMist.

Today, the surprise are recently shared findings from the CDC that the FluMist, long a better performer than the shot, no longer works as well.

Today, the CDC announced that the FluMist product has slipped.  It now fails to protect as many as 20% of children who might get it as well as the shot.    The CDC committee charged with monitoring immunization policy came out with a formal recommendation that we no longer use it:

http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html

This is truly breaking news.   The data on how well FluMist performed compared to the flu shot were made available to the CDC a few weeks ago, and the CDC presented their conclusions on them just today.

This is also remarkable news for two reasons:

1.  Until today, the reported literature on how the FluMist works showed it worked better than the flu shot.

2.  Almost all live vaccines work better than dead ones.  FluMist is a live vaccine, the flu shot is a dead form of the influenza immunization.

It appears this new development reflects problems in the manufacture of FluMist, which were foreshadowed last year by the failure of the company to even deliver the product.

Although a surprise, it is truly surprising, and unprecedented in our experience, to see a product we have vetted and trusted turn into one we can no longer trust, we cannot use it this year.

Although a disappointment, we much prefer the pain free approach of a nasal spray to a shot, we cannot use it this year.

We hope that next year the company that makes FluMist gets it right, but the CDC finds it has not, so we cannot use it this year.

Bottom Lines

1.  A surprise set of findings from last year's flu epidemics finds that FluMist, long the superior choice, no longer works as well as the flu shot in preventing infections from the influenza virus.

2.  The CDC's committee on immunization practice voted yesterday to recommend not using FluMist this upcoming flu season.

3.  THEREFORE, EFFECTIVE IMMEDIATELY ADVANCED PEDIATRICS WILL NOT OFFER THE NASAL SPRAY FORM OF FLU IMMUNIZATION THIS FALL.  ONLY THE SHOT FORM OF FLU IMMUNIZATION WILL BE MADE AVAILABLE.

4.  The shot form works well, and it turns out hurts less than many fear.  It is what we used almost entirely last year, and will work well again this year.

5.  If and when the manufacturer of FluMist develops a product the CDC works better than the flu shot, Advanced Pediatrics will consider using it once more, but not this year.

Stay tuned for announcements for when FluFest 2016, our fun provision of easy access to influenza immunization, featuring Mitchell's Ice Cream, will be later this year.

To Your Health,

Dr. Arthur Lavin

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*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.

Celebrating a Hero in our Community

Celebrating a Community:

An Appreciation of the NBA Championship in Cleveland

A friend once surprised me with this question many years ago:  what's the difference between sports and theater?   Answer:  In sports you never know how the drama will end.

Last night, Cleveland, and all those connected to it, were treated to a deep and profound drama.  We got to see a true hero reach....

...and make it.

LeBron James is a true hero.  

Families in the practice who live in or near Akron have recently shared stories with me that astound.

This child of Akron has purchased blocks in what we call "the inner city," but are actually structurally set areas of many generations of despair.  LeBron has purchased some of these blocks and transformed their housing and business infrastructures into middle class neighborhoods, and they work.

The people of the place have jobs and earn enough to live good lives.  A barber who could not afford the new rent was given free rent by LeBron so he could finish his career continuing to care for the people he has groomed for many years.

Here is a man of rare talent, who oriented use of his gift to the benefit of others.  How may elite athletes volunteer to leave a championship game and endless wealth, to come home to a team that has sunk to irrelevance, with no hopes of even playoff play?  This is LeBron, he came home to inspire Akron and Cleveland, his homes.  

I have observed that, if lucky, most of us get to be really good at a small number of things, maybe 1, maybe 2 or 3, but rarely many more skills.   Think of them as our gifts, and if we are really lucky, we get to pursue and develop them.   When that happens, life becomes a story in part of how a person takes their gift and overcomes struggles to help as many people as possible.  That is one of the great narratives we have available to us as people.

It is in that sense that I right this appreciation of the Cavaliers winning the championship last night.  I was lucky enough to be with my wife at a small restaurant across the street from the Q last night.  We heard of people flying in from Hawaii to Massachusetts to be there for the moment, and sat with people from Cleveland, Baltimore, and Cincinnati.  The  downtown, the center of our greater Cleveland community, was as full of people as we have ever seen.  We all held our breaths as these two teams, each who had scored 610 points over the first 6 games of the Finals, traded leads in the tightest game of the Finals.

 As the last minute came, a strange elevation took place in the room.  People had trouble following the details, all we knew was something we would never experience again was happening, and we drew together, so happy.  That joy and amazement filled downtown in that instant.  Prospect Street became a carpet of people screaming for joy, dancing, happy.  A fire engine parked in 9th Street with all its lights on, with the crowd standing and cheering on it.  We drove home to see urban Cleveland, Cleveland Heights, and Shaker Heights filled with scenes of celebration.

And all as the result of a good man pursuing his gift, against monumental odds, reaching.   LeBron James, son of our NorthEast Ohio community, directly applied all his efforts to deliver a championship to his community, with the express intent to inspire us to be better.  To come together, and to care for each other as he has.

So here is my thank you to this truly great man, I am deeply grateful.   And I am so pleased we could come together last night.

As a small token of our gratitude, Advanced Pediatrics will be closed for part of the day this Wednesday, to join with you all to be at the parade acknowledging the power of a gift that cares.  Dr. Hertzer and I will remain available throughout the day for calls of course, and the office will remain able to help.

To your health,
Dr. Arthur Lavin

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*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.

Folic Acid- A Third Benefit for your Child

Folic Acid- A Third Benefit for your Child:

Lowering the Risk of Obesity

Vitamins have promised extraordinary benefits for many years, including hopes of curing colds, ending cancer, slowing aging, boosting energy.  The very name vitamin suggests magical powers.

But the record is quite disappointing.  All vitamins offer nutritional benefits that are met by eating very tiny amounts of them, but with one exception, taking extra turns out to offer no benefits whatsoever.  Famous vitamins whose claims have come and gone include Vitamin C, Vitamin E, B complexes, etc.  Claims of powerful benefits for Vitamin D are still under scrutiny, but no positive proof of great benefit has been found yet.

One vitamin stands alone as having proof that taking more than is found in a regular diet could offer a benefit, and that is folic acid (aka, folate, Vitamin B9, Vitamin Bc).

Folic acid, and only folic acid, has been shown to change a real outcome in a population.  

If pregnant women take 400 mcg of folic acid during pregnancy, they nearly eliminate spina bifida, a congential defect in spinal cord development.  We know it works because when pregnant women did this, the number of children with spina bifida (aka myelomeningocele) actually dropped dramatically.

In the last few years, two new benefits of folic acid appear to be real as well.

The first reported was that if women take 400 mcg of folic acid a day prior to conception and throughout pregnancy, the risk of their child developing autism drops 5-fold.  This is an association in a published study.  We have not seen actual drops in the rate of autism in response to taking folic acid in this manner.  But the finding does make it plausible that we could see a drop with this use of folic acid.

Now comes a report that studied the impact of blood levels of folic acid in pregnant women on the chance that their babies would grow up to be obese.  The researchers looked at mother-child pairs in China, Chicago, Boston, and several other cities.   They studied over 1500 such pairs, and followed the babies born to an average age of 6.  

They then asked, what is the difference of risk of becoming obese by age 6 if the mother had a high or low folic acid blood level.    It turns out comparing kids of moms whose folic acid blood level was in the top three-quarters v. those in the lowest quarter, there was 45% more obesity in kids whose Mom's folic acid levels were in the lowest quarter.   

For obese Moms, those who had the lowest folic acid blood levels had children with triple the risk of obesity of those Moms not in the lowest level.

This study is at this website:

http://archpedi.jamanetwork.com/article.aspx?articleid=2528517

And the NY Times story on it is here:

http://well.blogs.nytimes.com/2016/06/15/folic-acid-during-pregnancy-may-lower-risk-of-childhood-obesity/?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=7&pgtype=sectionfront&_r=0


BOTTOM LINES

1.  Vitamins have been shown to offer no benefit when taken in amounts that exceed what you eat, with one exception, folic acid.

2.  One proven benefit of taking folic acid early in pregnancy is the near elimination of the chance of your child having spina bifida, an astounding benefit.

3.  An association not yet proven as solid is a dramatic drop in your child developing autism if the mother takes 400 mcg daily from before conception through pregnancy, a five-fold drop.

4.  Now comes an early observation that raises the possibility of a third benefit, actually changing the chance that your child will become obese.  This benefit is not seen with the 400 mcg dose, but only if the actual blood level of folic acid in the Mom goes up.  So this benefit requires a blood test.

5.  The elimination of spina bifida is a proven benefit of folic acid.  The reduction in risk for autism and obesity are highly enticing possibilities, not yet fully proven.

6.  How interesting that the chemical profile of a Mom in pregnancy could define if her child will become obese.  It makes us rethink obesity.

To your health,
Dr. Arthur Lavin

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*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.

Lazy- A Troublesome Concept

Lazy- A Troublesome Concept

Many kids in school struggle to succeed.  The national average is 1 in 6 children, millions of school children!

There are a web of complex reasons why we find ourselves facing so many of our children not enjoying school and having such a hard time getting the work done.

But one reason that we hear as much as any other reason should be put aside:  laziness.

When we meet with families, one of the most common thoughts about why their child is not performing well in school is that the problem is the child's attitude gets in the way.  The child either does not care, or seems to be dismissive of the work.  It actually makes perfect sense for any parent to think that the child's attitude is a major piece of the puzzle.  And if that's the case, why not conclude that they are being lazy?

So why would we urge everyone to no longer think of laziness as relevant to the problem of children doing poorly in school?   The problem is that there is a major difference between laziness and other reasons for not doing work, and for nearly every child struggling in school, laziness is not the problem.

To be clear, the word lazy means that the child is not doing work because they do not want to do any work, or anything.  When the word lazy explains a situation, we are concluding that the problem is the person has a fundamental defect in their relationship to work, and it's a simple one- they don't work because they object to working itself.

There may be lazy children and youth, but we haven't seen any.  With no exceptions that I can recall, everyone seems to want to do something.  It may not be what we want them to do, but nearly everyone likes doing something.

In nearly every instance, what looks like laziness is far more likely to be someone choosing to do something else for a very good reason.  Those reasons can vary quite a bit, but nearly all are compelling, once understood.

The key reasons children who are failing school avoid doing school work:
1.  There is a cognitive dysfunction that makes the work very, very difficult to do.
2.  There is an emotional problem blocking the path towards doing the work.
3.  They would rather do something else.
4.   A physical illness prevents access to the work.
5.  Conflicts with the teacher or parents make doing the work very difficult to do.

A look at the real reasons children who are failing school avoid doing their school work.

Cognitive dysfunctions

A great many children who struggle in school have one, or several, problems with how their mind works that make learning new facts, writing new essays, reading new books, doing math or science, paying attention or focusing actually very, very difficult.   One can be quite brilliant, and have one of these problems, and end up essentially being unable to some of the work schools assign.

Consider how hard it is for any of us to do something our minds cannot do without tremendous stress. This is a very unpleasant experience, and like anyone, we avoid the unpleasantness and do something else.

Emotional problems

Anxiety, depression, and/or mania affect large numbers of people, including children.  When any of these conditions is active they can have a devastating effect on anyone's ability to get work done.

Rather do something else

This is a unifying theme as nearly every child will have grades or days when they would rather do something else, and is the sense all children who struggle in school have when the other issues are present.

Physical illness

Of all the reasons kids refuse to do their work, this is the one not confused with laziness.  If someone's eyes are injured, no one thinks the child is lazy if they avoid reading.  The same goes for nearly all physical illnesses, especially acute illnesses.

Conflicts

It would surprise many to find out how many times a problem in school reflects conflicts with teachers, and parents, and friends.


Why none of these reasons are explained by the concept of lazy.

For each of the five examples of reasons children who struggle in school do not do their work, laziness simply fails to explain anything.

If your mind cannot think through the problem at hand, your emotions keep you from attending, you are too physically ill, have serious conflicts related to the work, or would rather do something else you end up doing something else.

It is almost never the case that laziness explains any behavior, notice how in each case noted, the child ends up doing something else, not nothing.

Finally, assuming the reason school work is not done is laziness causes two very major problems:
1.  Since it is not true, it misses the ability to do anything about the situation.
2.  It is not an explanation, but really down deep, just an insult.

BOTTOM LINES
1.  Many, many children struggle to do their school work, about 1 in 6 risk failure.
2.  In nearly every instance, a reason explains their difficulty.
3.  That reason is almost never laziness.
4.  Thinking it is laziness seems reasonable, after all they are not doing their work. 
5.  But calling your child lazy, in addition to being wrong, usually just makes matters worse, as it is more of an insult than explanation.

We recommend highly that if your child struggles in school, that the real reason(s) be found, only then can situations change and the situation get better.

To your health,
Dr. Arthur Lavin 

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*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.