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I’ve always wondered what kind of irresponsible, misguided parent brings children to Las Vegas. Now I have the answer, right in the mirror. Don’t judge: My sister lives there, so if the kids are ever going to see their cousins, they have to share the road with trucks that say, “Girls! Girls! Girls!” (We told the 9-year-old that these were advertisements for clothing, which the women pictured seemed to need.)
It’s true that Las Vegas has become more family friendly...for the Kardashians. We did, however, manage to make the trip educational. In psychology, the kids found that after 10:00 p.m., everyone’s tempers are shorter than a 9-year-old boy lost in a crowd. In chemistry, they discovered that no substance yet synthesized can mask the smell of cigarette smoke. And in meteorology, they learned never to step in a puddle on The Strip; whatever it is, it’s not rain.
Hope falls
Is there anything we wouldn’t do to prevent someone from dying of cancer? We will ride bikes 150 miles, run marathons, and wear endless seas of pink, even though honestly it’s not everyone’s color (you know who you are). So if there were, say, a safe and effective means of preventing up to 4,000 cancer deaths a year, certainly doctors would be first in line to make sure everyone is protected, right?
Sure...between half and two-thirds of the time, according to a new analysis from the Centers for Disease Control and Prevention. That’s how often providers recommend human papillomavirus (HPV) vaccine to their eligible female and male patients. Maybe cervical, anal, penile, and oropharyngeal cancers need to get together and claim a color that looks good on everyone: Is cerulean taken?
I know we all get frustrated with vaccine deniers, but why aren’t we at least recommending HPV vaccine to 100% of our patients? Is it because they won’t be our patients by the time they get cancer? Is it because the vaccine is more expensive and more painful than some (both true, but again, y’all, cancer)? Is it because it’s awkward to talk to parents about how their cherubic 11-year-old is one day going to grow up into an adult who is likely to have, you know, S-E-X?
Whatever the reason, I share Assistant Surgeon General Dr. Anne Schuchat’s disappointment that only 37.6% of eligible girls and 13.6% of eligible boys got vaccinated against HPV last year. When poor parental uptake is the problem, we need to work on education. But when we as providers are not even recommending the vaccine, you can color me embarrassed.
Yellow-bellied?
Parents look at me like I’m crazy all the time, which I resent, because I’m only crazy most of the time. For the first 3 months of their baby's life, I tell parents to call me at the first sign of a fever; then I tell them fever is a nothing to worry about. I say that sleeping face-down can be deadly until their baby learns to roll back-to-front; then I tell them not to worry. And for the first 7 days of life, I tell them that newborn jaundice can cause severe brain damage, until I start saying it’s normal, especially in breastfed infants. I flip-flop more than a candidate for Congress.
A new study may reassure some mothers of nursing infants who look a little orange (the infants, that is; orange mothers should still be concerned). We’ve always known that breastfed infants tend to keep high levels of indirect bilirubin in their bloodstreams long after the first week in life, but no one yet had bothered to establish the typical range and time course. Dr. M. Jeffrey Maisels and a team from Oakland University William Beaumont School of Medicine changed all that with the use of transcutaneous bilirubin (TCB) monitors and 1,044 predominately breastfeeding infants.
Not only did they determine that at age 3-4 weeks between 34% and 43% of these infants still had TCB measurements over 5 mg/dL, they also reaffirmed that we doctors are really bad at guessing bilirubin levels from looking at babies. They asked trained clinicians to guess the “jaundice zone scores” of the infants, which sound like a customer loyalty program at a sporting goods store but are really just an estimate of how far down the infant’s body it looks yellow. The scores were so far off that a baby with a score of 0 could have a bilirubin level as high as 12.8 mg/dL. I can only hope that with his expertise in ferreting out bad human judgment, Dr. Maisels’s next study will investigate candidates for Congress.
Inattention
A complex society cannot function without some degree of trust; there’s all sorts of scary stuff I’d like to know, and I’m happy to pay a few dollars in taxes to make sure someone more qualified than I am is checking. Does this bridge I’m crossing have severe erosion? Is there another plane in our airspace? What was my 14-year-old daughter texting to her “boyfriend” last night? (Thanks, National Security Agency!)
Drug safety is one of those things, especially when many of my patients and one of my own children are taking said drug. A new study from researchers at Boston Children’s Hospital suggests that perhaps when it comes to the long-term safety of attention-deficit/hyperactivity disorder (ADHD) medications, the U.S. Food and Drug Administration has not looked as hard as it might. Paging Dr. Edward Snowden!
One might assume that since up to 10% of U.S. children now carry a diagnosis of ADHD, and since those children start medications as young as age 4 and continue to use them for many years, the safety studies that got these drugs approved would have been especially rigorous. Yeah, no. Only 5 of 32 preapproval trials focused on safety, these trials enrolled an average of 75 patients (as opposed to the recommended 1,500), and few lasted as long as 12 months, with approval sometimes granted after only 8 weeks of study and some older drugs being “grandfathered” in with essentially no safety data whatsoever.
I see one bright spot in this desert of data. Whenever I prescribe a stimulant for ADHD, I’ll understand that I’m taking a gamble, and I’ll fondly remember our family trip to Las Vegas.
David L. Hill, M.D., FAAP, is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.
I’ve always wondered what kind of irresponsible, misguided parent brings children to Las Vegas. Now I have the answer, right in the mirror. Don’t judge: My sister lives there, so if the kids are ever going to see their cousins, they have to share the road with trucks that say, “Girls! Girls! Girls!” (We told the 9-year-old that these were advertisements for clothing, which the women pictured seemed to need.)
It’s true that Las Vegas has become more family friendly...for the Kardashians. We did, however, manage to make the trip educational. In psychology, the kids found that after 10:00 p.m., everyone’s tempers are shorter than a 9-year-old boy lost in a crowd. In chemistry, they discovered that no substance yet synthesized can mask the smell of cigarette smoke. And in meteorology, they learned never to step in a puddle on The Strip; whatever it is, it’s not rain.
Hope falls
Is there anything we wouldn’t do to prevent someone from dying of cancer? We will ride bikes 150 miles, run marathons, and wear endless seas of pink, even though honestly it’s not everyone’s color (you know who you are). So if there were, say, a safe and effective means of preventing up to 4,000 cancer deaths a year, certainly doctors would be first in line to make sure everyone is protected, right?
Sure...between half and two-thirds of the time, according to a new analysis from the Centers for Disease Control and Prevention. That’s how often providers recommend human papillomavirus (HPV) vaccine to their eligible female and male patients. Maybe cervical, anal, penile, and oropharyngeal cancers need to get together and claim a color that looks good on everyone: Is cerulean taken?
I know we all get frustrated with vaccine deniers, but why aren’t we at least recommending HPV vaccine to 100% of our patients? Is it because they won’t be our patients by the time they get cancer? Is it because the vaccine is more expensive and more painful than some (both true, but again, y’all, cancer)? Is it because it’s awkward to talk to parents about how their cherubic 11-year-old is one day going to grow up into an adult who is likely to have, you know, S-E-X?
Whatever the reason, I share Assistant Surgeon General Dr. Anne Schuchat’s disappointment that only 37.6% of eligible girls and 13.6% of eligible boys got vaccinated against HPV last year. When poor parental uptake is the problem, we need to work on education. But when we as providers are not even recommending the vaccine, you can color me embarrassed.
Yellow-bellied?
Parents look at me like I’m crazy all the time, which I resent, because I’m only crazy most of the time. For the first 3 months of their baby's life, I tell parents to call me at the first sign of a fever; then I tell them fever is a nothing to worry about. I say that sleeping face-down can be deadly until their baby learns to roll back-to-front; then I tell them not to worry. And for the first 7 days of life, I tell them that newborn jaundice can cause severe brain damage, until I start saying it’s normal, especially in breastfed infants. I flip-flop more than a candidate for Congress.
A new study may reassure some mothers of nursing infants who look a little orange (the infants, that is; orange mothers should still be concerned). We’ve always known that breastfed infants tend to keep high levels of indirect bilirubin in their bloodstreams long after the first week in life, but no one yet had bothered to establish the typical range and time course. Dr. M. Jeffrey Maisels and a team from Oakland University William Beaumont School of Medicine changed all that with the use of transcutaneous bilirubin (TCB) monitors and 1,044 predominately breastfeeding infants.
Not only did they determine that at age 3-4 weeks between 34% and 43% of these infants still had TCB measurements over 5 mg/dL, they also reaffirmed that we doctors are really bad at guessing bilirubin levels from looking at babies. They asked trained clinicians to guess the “jaundice zone scores” of the infants, which sound like a customer loyalty program at a sporting goods store but are really just an estimate of how far down the infant’s body it looks yellow. The scores were so far off that a baby with a score of 0 could have a bilirubin level as high as 12.8 mg/dL. I can only hope that with his expertise in ferreting out bad human judgment, Dr. Maisels’s next study will investigate candidates for Congress.
Inattention
A complex society cannot function without some degree of trust; there’s all sorts of scary stuff I’d like to know, and I’m happy to pay a few dollars in taxes to make sure someone more qualified than I am is checking. Does this bridge I’m crossing have severe erosion? Is there another plane in our airspace? What was my 14-year-old daughter texting to her “boyfriend” last night? (Thanks, National Security Agency!)
Drug safety is one of those things, especially when many of my patients and one of my own children are taking said drug. A new study from researchers at Boston Children’s Hospital suggests that perhaps when it comes to the long-term safety of attention-deficit/hyperactivity disorder (ADHD) medications, the U.S. Food and Drug Administration has not looked as hard as it might. Paging Dr. Edward Snowden!
One might assume that since up to 10% of U.S. children now carry a diagnosis of ADHD, and since those children start medications as young as age 4 and continue to use them for many years, the safety studies that got these drugs approved would have been especially rigorous. Yeah, no. Only 5 of 32 preapproval trials focused on safety, these trials enrolled an average of 75 patients (as opposed to the recommended 1,500), and few lasted as long as 12 months, with approval sometimes granted after only 8 weeks of study and some older drugs being “grandfathered” in with essentially no safety data whatsoever.
I see one bright spot in this desert of data. Whenever I prescribe a stimulant for ADHD, I’ll understand that I’m taking a gamble, and I’ll fondly remember our family trip to Las Vegas.
David L. Hill, M.D., FAAP, is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.
I’ve always wondered what kind of irresponsible, misguided parent brings children to Las Vegas. Now I have the answer, right in the mirror. Don’t judge: My sister lives there, so if the kids are ever going to see their cousins, they have to share the road with trucks that say, “Girls! Girls! Girls!” (We told the 9-year-old that these were advertisements for clothing, which the women pictured seemed to need.)
It’s true that Las Vegas has become more family friendly...for the Kardashians. We did, however, manage to make the trip educational. In psychology, the kids found that after 10:00 p.m., everyone’s tempers are shorter than a 9-year-old boy lost in a crowd. In chemistry, they discovered that no substance yet synthesized can mask the smell of cigarette smoke. And in meteorology, they learned never to step in a puddle on The Strip; whatever it is, it’s not rain.
Hope falls
Is there anything we wouldn’t do to prevent someone from dying of cancer? We will ride bikes 150 miles, run marathons, and wear endless seas of pink, even though honestly it’s not everyone’s color (you know who you are). So if there were, say, a safe and effective means of preventing up to 4,000 cancer deaths a year, certainly doctors would be first in line to make sure everyone is protected, right?
Sure...between half and two-thirds of the time, according to a new analysis from the Centers for Disease Control and Prevention. That’s how often providers recommend human papillomavirus (HPV) vaccine to their eligible female and male patients. Maybe cervical, anal, penile, and oropharyngeal cancers need to get together and claim a color that looks good on everyone: Is cerulean taken?
I know we all get frustrated with vaccine deniers, but why aren’t we at least recommending HPV vaccine to 100% of our patients? Is it because they won’t be our patients by the time they get cancer? Is it because the vaccine is more expensive and more painful than some (both true, but again, y’all, cancer)? Is it because it’s awkward to talk to parents about how their cherubic 11-year-old is one day going to grow up into an adult who is likely to have, you know, S-E-X?
Whatever the reason, I share Assistant Surgeon General Dr. Anne Schuchat’s disappointment that only 37.6% of eligible girls and 13.6% of eligible boys got vaccinated against HPV last year. When poor parental uptake is the problem, we need to work on education. But when we as providers are not even recommending the vaccine, you can color me embarrassed.
Yellow-bellied?
Parents look at me like I’m crazy all the time, which I resent, because I’m only crazy most of the time. For the first 3 months of their baby's life, I tell parents to call me at the first sign of a fever; then I tell them fever is a nothing to worry about. I say that sleeping face-down can be deadly until their baby learns to roll back-to-front; then I tell them not to worry. And for the first 7 days of life, I tell them that newborn jaundice can cause severe brain damage, until I start saying it’s normal, especially in breastfed infants. I flip-flop more than a candidate for Congress.
A new study may reassure some mothers of nursing infants who look a little orange (the infants, that is; orange mothers should still be concerned). We’ve always known that breastfed infants tend to keep high levels of indirect bilirubin in their bloodstreams long after the first week in life, but no one yet had bothered to establish the typical range and time course. Dr. M. Jeffrey Maisels and a team from Oakland University William Beaumont School of Medicine changed all that with the use of transcutaneous bilirubin (TCB) monitors and 1,044 predominately breastfeeding infants.
Not only did they determine that at age 3-4 weeks between 34% and 43% of these infants still had TCB measurements over 5 mg/dL, they also reaffirmed that we doctors are really bad at guessing bilirubin levels from looking at babies. They asked trained clinicians to guess the “jaundice zone scores” of the infants, which sound like a customer loyalty program at a sporting goods store but are really just an estimate of how far down the infant’s body it looks yellow. The scores were so far off that a baby with a score of 0 could have a bilirubin level as high as 12.8 mg/dL. I can only hope that with his expertise in ferreting out bad human judgment, Dr. Maisels’s next study will investigate candidates for Congress.
Inattention
A complex society cannot function without some degree of trust; there’s all sorts of scary stuff I’d like to know, and I’m happy to pay a few dollars in taxes to make sure someone more qualified than I am is checking. Does this bridge I’m crossing have severe erosion? Is there another plane in our airspace? What was my 14-year-old daughter texting to her “boyfriend” last night? (Thanks, National Security Agency!)
Drug safety is one of those things, especially when many of my patients and one of my own children are taking said drug. A new study from researchers at Boston Children’s Hospital suggests that perhaps when it comes to the long-term safety of attention-deficit/hyperactivity disorder (ADHD) medications, the U.S. Food and Drug Administration has not looked as hard as it might. Paging Dr. Edward Snowden!
One might assume that since up to 10% of U.S. children now carry a diagnosis of ADHD, and since those children start medications as young as age 4 and continue to use them for many years, the safety studies that got these drugs approved would have been especially rigorous. Yeah, no. Only 5 of 32 preapproval trials focused on safety, these trials enrolled an average of 75 patients (as opposed to the recommended 1,500), and few lasted as long as 12 months, with approval sometimes granted after only 8 weeks of study and some older drugs being “grandfathered” in with essentially no safety data whatsoever.
I see one bright spot in this desert of data. Whenever I prescribe a stimulant for ADHD, I’ll understand that I’m taking a gamble, and I’ll fondly remember our family trip to Las Vegas.
David L. Hill, M.D., FAAP, is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.
