In the Car: Rear Face as Long as Possible

In the Car:  

Rear Face as Long as Possible

The American Academy of Pediatrics has just issued a new guideline:  keep your infant facing backwards until age 2, unless they outgrow their rear-facing car seat.

As doctors, we spend a lot of time and energy thinking and responding to illnesses, but for Americans ages 1-50 years old, injuries are the #1 cause of death, far more likely to cause harm and fatality than any illness or condition.  That makes injuries the very #1 cause of death and harm in childhood, after one year of age!

One of the main causes of death and harm from injury is the car.  We are used to cars, nearly everyone has been in one, so we tend to forget just how dangerous they really are.  Cars are far more safe now than many years ago, but still remain the most dangerous part of our lives.

Perhaps the greatest step forward in reducing the chance of death or injury has been the invention of the seat and shoulder belt.  Wearing it saves lives, lots of them.  Cars, however, are sold to adults, not kids, so their safety belts only fit people who are taller than 4 foot 9 inches.  If you are shorter than that, at any age, you need some sort of adapter to have the seat and shoulder belts actually fit, that is, actually work.

Until this month, the recommendation for children from birth to 1st birthday was to be in an infant car seat, facing backwards, until both 1 year old AND 20 pounds.

A study from 2007 recently showed that the benefit of facing backwards should be extended another year.

http://www.ncbi.nlm.nih.gov/pubmed?term=henary%20B%2C%20Sherwood%20CP

This study found that for children ages 1-2, the risk of serious injury was indeed reduced if they were facing backwards.  I have reviewed this study and find that the evidence is compelling.

Therefore, we at Advanced Pediatrics support the AAP recommendation and urge all families to have their children, when in a car, be in a rear-facing car seat to age 2, unless they cannot obtain a car seat that can fit their child up to that age.  In which, case the child should advance to the larger seat prior to age 2.

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.

A Curious Finding Suggests Immunizations May Prevent Some Cancers

A Curious Finding Suggests 

Immunizations May Prevent Some Cancers

A well-respected team of researchers from one of the nation's leading medical centers, the Houston Medical Center, has published a strong association that suggests that childhood immunization may decrease the risk of developing childhood cancer, in particular childhood leukemia, brain tumors, and lymphoma.

http://www.jpeds.com/article/S0022-3476(10)01048-6/abstract

This rather remarkable claim at this point is simply an observation.   The authors report that if you look at thousands and thousands of children across Texas who did and did not develop these cancers, a pattern emerges in which those who received immunizations were less likely to develop the most common forms of childhood cancer.  The overall reduction in the childhood cancers studied was 20% and for some immunizations the level of prevention went as high as nearly 40%.  A curious linkage between chickenpox and brain tumors was found as well, where getting the varicella (chickenpox) vaccine or the actual disease decreased the chance of developing brain tumors.

No one knows for sure what the cause of this observation is.  We are not even sure if the observation will yield a real cause-link between getting immunizations and less cancer in childhood or whether something else related to getting immunized is the explanation.  The authors did a very good job of eliminating other possible causes such as parental education, social status, smoking, age, and many other possible influences.

If this observation stands up to further scrutiny, it will advance the compelling emergence of the very curious "hygiene hypothesis."  This concept emerged from the fact that allergies are raging across the developed world.  In the 1960's only about 0.1% of men in Finland had any sort of allergic disease (eczema, hay fever, asthma).  Now about 11% do.  One explanation being put forward is that as the modern world has reduced the burden of infectious diseases, the immune system has switched from killing deadly germs to attacking harmless substances like dust, pollen, and milk.  There is actually a growing body of proof to support this idea.  We can measure the level of dirt that kids on farms eat, and the more dirt they eat, the less allergy they develop, and at no cost, they have no more actual infections, just more exposure to a wider variety of germs.

The idea flies directly in the face of the fear of germs and also against the widely held belief that a newborn's immune system is a delicate thing that best not be perturbed.   The hygiene hypothesis boldly states that the developing immune system needs a good fight to properly mature, and failing that it will take matters into its own hands and start picking fights that cause the child to have allergies.

Now, the researchers in Houston have added more fuel to this intriguing idea, by observing that perturbing the immune system with shots may actually help it prevent childhood cancer.  Again, this is not an observation that has any explanation proven yet.  But in these days of grave concern over the impact of immunizing children against many illnesses, I felt it was urgent that families know that it may turn out that immunizing their children will do far more than protect them against dangerous infections, it may help their immune system protect them against cancer.

Please also note that this research received no support from any drug company and had no other conflict of interest as well.

Bottom Line

A trustworthy group of researchers from one of country's leading medical centers has found an association between having your child fully immunized and a 20-40% drop in the chance of developing childhood leukemia, brain tumor, and lymphoma.

If this finding holds up, the entire concept that the newborn immune system is fragile system that must be kept at peace will be shattered and a more realistic vision of a baby's immune system will emerge- it must be used to work well.

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.

A Reminder that Fever is Harmless

A Reminder that Fever is Harmless

Advanced Pediatrics was very pleased to be contacted by a reporter from Suite 101.com to discuss the recent American Academy of Pediatrics (AAP) campaign to remind families that fever is not a harmful symptom.

Suite 101.com is rated as one of the top 10 blog spots and receives 28 million hits a month, so we were especially pleased that we could get our message out to over 300 million people a year.

Here is our interview, we hope you find it informative and helpful.

http://www.suite101.com/content/american-academy-of-pediatrics-launches-fever-phobia-campaign-a357897

Our key points are:

• Fever remains a fearsome symptom for two key reasons:

1. For most of human history, infections were the number one cause of death in childhood, causing as many as one in four children to pass.
2. Even today, fever makes everyone feel terrible.

• Fever today should no longer create fear for two key reasons:

1. In the US and the rest of the developed world, death from infection is now very, very rare in childhood.  Fever no longer indicates a likely hazard.
2. Fever, although uncomforrable, is not dangerous.  Everyone gets fevers, everyone.  With almost no exceptions, fever itself causes no actual harm.

• More important to be concerned about than fever are signs of serious infection:  Stiff neck, trouble getting air in and out of the chest, severe pain, worrisome rashes.

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.

FDA to take up to 500 cold medicines off the market

Image via WikipediaFDA to take up to 500 cold medicines off the market

The FDA announced on March 1, 2011 that it would now investigate over 500 cold and cough medications, and that for any that do not work, the manufacturer would have 90 days to stop making it and 180 days to stop shipping it, according to a report in the Washington Post FDA today.  http://voices.washingtonpost.com/checkup/2011/03/fda_cracks_down_on_unapproved.html

A list of drugs that will be investigated can be seen at http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/SelectedEnforcementActionsonUnapprovedDrugs/ucm238675.htm#cough

This development continues a clear trend that we have been communicating to families since 1985, now over 

25 years ago- that the cold and cough remedies simply do not work, and that no good reason exists to give your child a medicine that does not work.

As these drugs come under increasing scrutiny, we look forward to two steps being taken:

1.  That all families stop using the cold and cough remedies currently on the market.

2.   That scientists find interventions that really do help people who have colds and coughs.

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.

More Germs, Less Asthma

More Germs, Less Asthma

This weeks New England Journal of Medicine adds an important addition to a very large body of evidence that exposure to more germs in childhood can actually dramatically decrease the chance of developing asthma.

The original observation from a large number of studies from around the world is that kids growing up on farms have a much smaller chance of developing asthma than kids growing up in cities.

What is becoming clear is that a large part of the reason has to do with exposure to a broad range of bacteria, and fungi (molds and yeasts).  The more a child is exposed to bacteria and fungi, the less chance they have of developing asthma.

The benefit of exposure to bacteria and fungi is large, it can drop the chance of developing asthma by 50%!

We have no actual recommendations regarding exposing our kids to bacteria and fungi.  But one thing is now much clearer.  The whole germ phobia phenomenon is now clearly pointing in the wrong direction.  In fact, it may be that the overall approach of trying to keep surfaces free of germs has caused a tremendous surge in a real illness, asthma.

Bottom Line:  

Bacteria and fungi are a radically different problem than viruses.  Viruses never just hang around, they can only cause illness.  But bacteria and fungi are an important, constant, valuable part of our lives.  No human alive has ever spent a moment of their life entirely coated by bacteria and fungi.  The whole planet is covered by bacteria and fungi.  If we could somehow rid ourselves of them altogether, it is very likely that many of our systems would fail, including our skin, gut, and lungs.  We would likely not be able survive well, or at all, in a bacteria free world.

Infections from bacteria almost always are due to some unusual opportunity our body gives them- a cut, a viral infection.  But for almost our entire lives, bacteria help us live and do not infect us.

Now we know that in our craze to banish these helpful partners of life, we have possibly and inadvertently caused a raging epidemic of asthma.

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.

Beware of Magazine Ratings of Colleges and Hospitals

Beware of Magazine Ratings of 

Colleges and Hospitals

In the February 21, 2011 issue of The New Yorker, Malcom Gladwell, the author of The Tipping Point, takes a close look at US News & World Report's rating system for colleges and hospitals.

What he finds is that there is essentially no meaning to the ratings.  The problem he exposes is that it is very hard to compare two very complex items that are meant to satisfy a complex list of needs.  

He starts his analysis by looking at a similar rating system, Car and Driver's ranking of cars.  He looks at their ranking of sports cars and finds that depending on what you like, the Porsche Cayman, Chevy Corvette, and Lotus Evora would rank 1,2,3, or 3,2,1, or 2,3,1, all depending on what you were interested in getting. If you use the same rating system for all cars you get one ranking, but if you adapt a ranking system to sports cars that elevates the value of sporty look and a fun ride, you get the opposite ranking.  Ranking by cost gives you a third ranking altogether.

Just so for colleges.

Gladwell then uses the example of ranking countries by the incidence of suicide.  That can be done and in that system each country gets one number to describe its rank.  But the problem is that nations vary in the acceptability of suicide in their culture.  Even in the US, where most deaths from isolated car injuries (one car, one driver, no known physical cause) are thought to be suicides, most such deaths are not listed as suicide.

Just so for colleges.

As Gladwell puts it, "There's no direct way to measure the quality of an institution- how well a college manages to inform, inspire, and challenge its students."  So, instead of measuring the unmeasurable but important, the rating scales of US News & World Report simply measure the less important, that they hope reflects the core purpose of college.  For example, 20% of US News & World Report rankings are based on faculty data, such as how much are the faculty paid.  But good studies find no correlation at all between a professor's salary and his/her teaching excellence.  The same goes for the reputation variable in the US News & World Report's rankings.  National university presidents have to rank about 250 other schools from one to 250 on reputation to help US News & World Report devise this rank variable, it makes no sense.

Hospitals

Now we come to hospitals.  Here Gladwell cites an important study from one of the world's top medical journals, the Annals of Internal Medicine.  The study looked at the US News & World Report ranking of top US hospitals, and looked at objective measures of hospital excellence such as the chance of a person dying from a standard surgery, patient safety records, key technology availability.  They found there was no connection at all between US News & World Report's reputation rating and the actual excellence in practice of a hospital.

The Absurdity of the US News & World Report College and Hospital Ranking System

Gladwell goes on to cite the fact a Michigan Supreme Court Chief Justice sent a ranking questionnaire to 100 of his colleagues.  Penn State at that time was ranked by these elite members of the legal community as the fifth best law school in the United States.  But at that time Penn State did not even have a law school!

The only variable that the US News & World Report college ranking firmly correlates with is how much money the school has.  Wealthy schools alway outrank less wealthy schools.

BOTTOM LINE

When it comes to complex needs, such as those we require from colleges and hospitals, put the magazines away.  Their rankings can only serve one purpose- to sell the magazine.

For colleges, think about what your child needs and is interested in and seek the college that provides that unique set of needs best for her or him.

For hospitals, keep in mind that no hospital actually solves a medical problem, only a person or a small group of people- your doctor, your specialist, your nurse.  So one should only use the medical system with a clear eye towards what the questions are, what the needs are, at that moment, and be sure your doctor can organize the best team possible to help get those needs met.

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.

An Occassional Reminder of Magnificence

This morning, the morning of George Washington's birthday, the residents of the Greater Cleveland area were treated to one of nature's most astounding sights- a burst of light as the morning sun's rays wildly illuminated all branches and wires coated with ice and snow.

This is a rare treat, and only occurs when several events in nature come together at just the same moment.

The first condition is that it has to be winter, since all depends on ice and light.  The second condition is that it has to be cold enough to freeze water to ice, but not to cold to force precipitation into snow.   At just this right temperature in sky and on ground, a sleety, slightly wet, freezing rain can fall, and on hitting branches and wires turn to ice.  If the conditions are just right, a smooth coating of ice will cover these round branches and wires.  We had such perfect conditions in Cleveland on Sunday night the 20th, but we were missing one final element, sunshine.

Last night, the 21st, we got a coating of snow over the ice, transforming the background to the ice-encrusted branches to a fresh, bright, white appearance.

This set the stage for the final element to appear during the dawn of the 22nd, a bright, blazing sun in a deep and perfectly blue sky.

Put it all together, and we were treated to an astonishing site this morning outside of the windows of our homes, cars, and offices.  Against the stark white background of the earth, and the azure blue of the sky, every branch and wire blazed with a light that could not shine any brighter.  The color of the blaze is white, but a white that carries the intensity of the sun.  It is striking to think that on any sunny day, the air carries light of this intensity, but rarely do we get to see its full blare unless the right material catches it, and holds it for us to see.

And that is just what these ice-covered branches and wires have done this morning, they can catch the morning sun's rays and hold them, seeming to concentrate them, so that we get to see a very intense slice of the sun's power without being overpowered.

The fact that the light is held by branches offers another treat, the chance to see the full network of a tree's branches in their full glory.  It turns out that all branching networks of life share a similar shape, a geometry known as fractals.  Fractals are designs of lines that repeat themselves up and down the scale.  So a web of large arteries has the same shape as the web of smaller arteries they flow into, and as the web of capillaries they flow into.

These fractal networks are the shape of life itself, and are seen in the patterns of tree branches, the blood vessels of our body, and the network of air tubes of the lung.  In fact, if you are looking at a glowing tree today, imagine if you could cut the trunk at its base, hold it upside down by the end of the cut trunk, and see the branches branching downward instead of upwards.  You would be seeing a very close representation of the branching lung.

Another observation- all life requires energy to operate, and all energy for all life on land comes from the sun.

So this morning, we get a fleeting glimpse of the magnificent improbability of life.  We get to see the power and beauty of sunlight on branches that normally cannot hold such light long enough for us to see it.  And, the light illuminates the underlying structures of life's networks, the shape of networks inside all living organisms.

I learn to affirm
Truth's light at strange turns of the mind's road,
wrong turns that lead
over the border into wonder.... 

by Denise Levertov

So, I hope you too got to see this extraordinary sight this morning, a rare treat.

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.