EDITORIAL – New York Times
The Puzzle of More Autism Cases
Published: April 1, 2012
The latest federal survey suggests that more than 1 percent of all children in the country have been identified as having autism or two related disorders by the age of 8, a far higher percentage than found in previous surveys. But no one knows whether the increase shows that the disorders are more common or whether it simply reflects better detection of cases that would previously have been missed. Either way, the survey by the Centers for Disease Control and Prevention suggests that more children and parents may need help in coping with these disorders in their schools and communities. Related News
Diagnoses of Autism on the Rise, Report Says (March 30, 2012) The survey examined records at health clinics and schools for evidence that children were suffering from either full-fledged autism, Asperger syndrome, or a related disorder known as pervasive development disorder. These so-called autism spectrum disorders run the gamut from severe cases in which the children don’t talk and have limited intelligence to relatively mild cases in which children are socially awkward but able to function at a reasonably high level.
Last week, the agency reported that the most recent survey, conducted in 2008, showed the prevalence of autism spectrum disorders among 8-year-olds in 14 areas of the country was 1 in 88, a 78 percent increase from 2002. Thomas Frieden, director of C.D.C., said there is “a possibility” that the increase in cases is entirely the result of better detection. Advocacy groups for autism patients suggested that much of the increased prevalence is real.
There is a move within the psychiatric profession to tighten the criteria for autism to exclude many of the milder forms of the disorder. If that change were to appear in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, the surveys would adopt the new definition and the prevalence numbers would likely decline.
The surveys say nothing about the disorder’s cause. Some parents continue to blame vaccines taken in childhood, but a wide range of research has firmly exonerated vaccines as the cause. The surveys showed that the median age at which children were first identified with the disorders was 4 — at least two years later than when most experts recommend autism screening. The earlier therapy begins, the better the chances the child will benefit.
More Doctors ‘Fire’ Vaccine Refusers
Families Who Reject Inoculations Told to Find a New Physician; Contagion in Waiting Room Is a Fear
By SHIRLEY S. WANG, WSJ.com 2/15/2012
“There’s more noise among pediatricians, more people willing to argue that it’s OK to do this versus 10 years ago,” said Douglas Diekema, a professor of pediatrics at the University of Washington in Seattle. Dr. Diekema wrote the AAP’s policy on working with vaccine refusers, which recommends providers address the issue at repeated visits, but respect parents’ wishes unless it puts a child at risk of significant harm.
Most pediatricians consider preventing disease through vaccines a primary goal of their job. The Centers for Disease Control and Prevention and AAP issue an annual recommended vaccination schedule, but some parents ask if their child’s immunizations can be pushed back or skipped altogether, pediatricians say.
While rates for several key inoculations in young children rose between 2009 and 2010, according to the CDC, lower immunization rates have been blamed as a factor in U.S. outbreaks of whooping cough and measles in recent years.
Parents often voice concerns about autism or that their child’s immune system may be overwhelmed by too many vaccines at once. Worries about a link between vaccines and autism arose because some parents noticed their children regressed, or lost some skills, around the time
of their vaccinations at two years of age. Another concern centered on the former use of mercury as a vaccine preservative.
Numerous studies since have dispelled these concerns among scientists. Rather, scientists say, it is more likely that autism symptoms begin showing up around the same age children are vaccinated.
The rise in patient firings reflects another factor. As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients, said Arthur Caplan, a bioethics professor at the University of Pennsylvania. In addition, doctors may feel financial pressure to see more patients and so have less time to contend with recalcitrant ones.
Pediatricians fed up with parents who refuse to vaccinate their children out of concern it can cause autism or other problems increasingly are “firing” such families from their practices. Stefanie Ilgenfritz has details on Lunch Break.
For Allan LaReau of Kalamazoo, Mich., and his 11 colleagues at Bronson Rambling Road Pediatrics, who chose in 2010 to stop working with vaccine-refusing families, a major factor was the concern that unimmunized children could pose a danger in the waiting room to infants or sick children who haven’t yet been fully vaccinated.
In one case, an unvaccinated child came in with a high fever and Dr. LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. “I lost a lot more sleep than I usually do” worrying about the situation, he said.
“You feel badly about losing a nice family from the practice,” added Dr. LaReau, but families who refused to vaccinate their kids were told that “this is going to be a difficult relationship without this core part of pediatrics.” Some families chose to go elsewhere while others agreed to have their kids inoculated.
Pediatricians disagree about what their duty is to these families. “The bottom line is you should try to do whatever you can to maintain the family in the best care,” said Michael Brady, chair of the pediatrics department at Nationwide Children’s Hospital in Columbus, Ohio, and a member of the AAP’s immunization committee. “If they leave your practice, they’re probably going to gravitate toward another practice with unhealthy practices.”
Other physicians say they rarely have had luck persuading vaccine opponents to change their minds.
David Fenner and his 20-plus colleagues at Children’s Medical Group in Rhinebeck, N.Y., discuss vaccine concerns but ask families to leave if they don’t comply by a certain point.
Dr. Fenner said he tells new families, “You’ve been bombarded with information before you came here, some accurate and some not.” Iif a family refuses to vaccinate after a discussion of the issue, he tells them “there are so many things we’re not going to see eye-to-eye on.”
So far, the practice has fired a couple of families per year since it implemented the policy about five years ago.
Pamela Felice, who lives in an Atlanta suburb, had difficulty finding a pediatrician for her two children though they have waivers from a previous pediatrician exempting them from school requirements for immunizations. Her older child had gastrointestinal trouble and regressed development after receiving vaccines, she said, which she believes were related to the shots.
Ms. Felice received a letter from her pediatrician a few years ago stating that because the family chose not to vaccinate, it needed to find another doctor. She called four or five other practices but none would agree to an appointment after she told them she was opposed to vaccines. The family ended up with an elderly family doctor who said he had “seen it all” and was willing to treat the children if they got sick, Ms. Felice said.
“A doctor should feel obligated to discuss [potential vaccine] risks with any parent who wants to discuss them,” said Ms. Felice.
Shirley S. Wang at shirley.wang@wsj.com
Mailing Chickenpox Lollipops And Other Infected Items Is Illegal, Prosecutor Tells Parents
By ERIK SCHELZIG 11/ 4/11 04:42 PM ET Associated Press
NASHVILLE, Tenn. — Parents fearful of vaccinations are being warned by a federal prosecutor that making a deal with a stranger who promises to mail them lollipops licked by children with chickenpox isn’t just a bad idea, it’s against the law.
Jerry Martin, U.S. attorney for the Middle District of Tennessee, said he was spurred by reports this week by KPHO-TV in Phoenix and WSMV-TV in Nashville about people turning to Facebook to find lollipops, spit or other items from children who have chickenpox.
“Can you imagine getting a package in the mail from this complete stranger that you know from Facebook because you joined a group, and say here, drink this purported spit from some other kid?” Martin told The Associated Press.
Isaac Thomsen, a specialist in pediatric infectious diseases at Vanderbilt Children’s Hospital, said it’s unlikely the items will succeed in giving other children chickenpox.
“If there’s a very high load on the virus and shipped very quickly, it’s theoretically possible,” he said. “But it’s probably not an effective way to transmit it. It typically has to be inhaled.”
But Thomsen warned the lollipops could carry more dangerous viruses, including hepatitis.
Martin said it is a federal crime to send diseases or viruses across state lines, whether through the U.S. Postal Service or private services like FedEx or UPS. Sending the lollipops would be illegal under the same law that makes it illegal to mail contagions like anthrax. He said a conviction could lead to a sentence from less than a year to 20 years in prison.
Martin said the items are sought by parents who don’t want to give their children vaccines. He said he could neither confirm nor deny that his office is investigating or seeking charges against anyone.
According to the TV reports, parents have turned to a Facebook group called “Find a Pox Party in Your Area” to link up people looking to share the virus.
One of the Facebook postings from Wendy Werkit of Nashville offered a “fresh batch of pox in Nashville shipping of suckers, spit and Q-tips available tomorrow 50 dollars via PayPal.”
Werkit told WSMV that the money was used to cover the shipping costs of the lollipops had been licked by her children.
“They can’t get (chickenpox) the normal way anymore of just naturally catching and just naturally getting the immunity for life,” Werkit said.
Thomsen, the Vanderbilt physician, said he was even more concerned by a person in the KPHO report seeking items tainted with measles to avoid a school-required vaccination. Measles has a significant mortality rate, causes more complications and is very infectious compared with chickenpox, he said.
And law enforcement won’t take any such cases lightly, Martin said.
“If you are engaged in this type of behavior, you’re not only potentially exposing innocent people to dangerous viruses and illnesses and diseases, you’re also exposing yourself potentially to federal criminal prosecution,” he said.
Boys Should Get HPV Vaccination, Too: Panel
ATLANTA — A government panel wants young boys as well as girls to get the controversial HPV vaccine, in part to prevent them from spreading the sexually transmitted virus to girls.
The HPV vaccine has been recommended for young girls to protect them against cervical cancer and genital warts for the last five years. But the vaccine has been slow to catch on – only about a third of adolescent girls have gotten all three shots.
Experts say the HPV vaccine could protect boys against genital warts and some kinds of cancers. But they also say vaccinating 11- and 12-year old boys could help prevent them from spreading the human papilloma virus to girls.
The Advisory Committee on Immunization Practices made the recommendation Tuesday in a unanimous vote. Federal health officials usually adopt what the panel says and asks doctors and patients to follow the recommendations.
More: http://www.huffingtonpost.com/2011/10/25/boys-hpv-vaccine-shot_n_1030551.html
Centers for Disease Control and Prevention: HPV Vaccine – Questions & Answers
http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm
Child’s Eyesight Linked With Outdoor Play, Study Finds
If you’re worried about your child’s vision, forget the carrots. Instead, a new study suggests you should shut off the television and head to the park.
Recent findings out of the University of Cambridge reveal a child’s exposure to sunlight could improve his or her nearsighted vision, also known as myopia, reports the Telegraph.
After examining eight studies with a total of 10,400 participants on outdoor time and myopia in children and adolescents, Dr. Scherwin and his team found that the chance of myopia dropped by 2 percent for each additional hour spent outdoors per week, notes the Cambridge News.
Huffinton Post, read more:
http://www.huffingtonpost.com/2011/10/24/eyesight-outdoor-play_n_1029074.html
Pediatric Care – Change is Needed
Modern Pediatrics Needs Health Care to Evolve
Posted: 10/20/11 12:02 PM ET
Why can’t the United States have a smarter health care system?
That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP). The study, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and what doctors call anticipatory guidance (“Is Suzy using a car seat?”). No big surprise that the longer the duration of the well-child visit, the greater the likelihood that the visit adhered to recommended guidelines.
Unfortunately one-third of visits were reported as being less than 10 minutes in duration; these occurred to a greater degree in private practice. Longer visits of 20 minutes or more made up 20 percent of the encounters and were more likely to occur in community health centers. The big winners in the pinch for time? Guidance on immunizations and breastfeeding were offered in 80 percent of even the shortest visits. The biggest loser — developmental assessments, which don’t even achieve a mediocre occurrence of 70 percent until we pass the 20-minute mark for visit duration.
What’s behind all this? A profound disconnect between our medical resources and our health care delivery. Nowhere has modern pediatric care evolved more dramatically than in the arena of well-child care and preventive medicine. What has not evolved along with our scope of knowledge is our delivery system. Our fee-for-service approach to health care dictates that procedures and tests pay well while addressing a child’s emotional problem gets a doctor little more than a backed up waiting room.
Whether we think about it or not, the notion that health insurance companies and the pharmaceutical industry shape medical practice — and our collective health — through their policies, marketing and aggressive lobbying is one that is embedded in our health care culture. The result is a lopsided distribution of health care that overmedicalizes the well-insured while undertreating the underinsured. Consider that a whopping 25 percent of U.S. children are on chronic medications while, according to this UCLA study, half the children in pediatric practice are not receiving basic screening and advice.
The obsolete business models that the health care industries rely on are like the tyrannosaurus rex in the room, emphasizing expensive, short term productivity rather than cost-effective long term quality, while cognitive care — a high level of skill and expertise delivered face to face in a personal manner — is in danger of becoming extinct. The scope and challenges of our health grow ever more complex, and chronic conditions like obesity and diabetes overtake acute threats. Yet we keep trying to squeeze our health care delivery into the model we used back when you only went to a doctor to treat your pneumonia, or to have a farm implement removed from your foot.
It is not surprising that community health centers are associated with longer, higher quality well-child visits. The doctors are salaried, which means they are somewhat insulated from the array of financial disincentives that currently infuse primary care, like the need for rapid patient turnover. The centers are also likely to utilize a more rational division of labor, so that every issue doesn’t immediately make its way to the most expensive professional in the room (and the one with the prescription pad) simply because that is the only person we know how to par for the visit. Nurses at all levels of skill are used for a wider scope of encounters, and there are often ancillary resources — nutritional and mental health services for example — that expand the kinds of care the patient receives, approaching the ideal of a comprehensive medical home for all patients. It is also not surprising that the practice settings that are successfully evolving into medical homes are largely publicly funded. By their very nature, they put patients’ best interest above profit, and have a vested interest in long term outcomes as opposed to short term productivity.
So back to the study from UCLA. We know what every child should receive in the way of well-child care, and we know that quality primary care saves money in the long run. We have professionals at all levels of training and pay scales capable of delivering high quality care. We have incredibly skilled and dedicated pediatricians who can coordinate this kind of teamwork. So why are we wasting our time arguing about how to pay for obsolete delivery models and payment systems? Why not design a system that offers what we are capable of, and saves us money in the long run.
We all know what is standing in our way: Profit. Special interest. Self-serving politics. That is why we need to keep asking the fundamental question: Why can’t we have a smarter health care system?
Some pediatricians taking stand for vaccine program
Doctors at certain practices refuse to treat kids whose parents refuse immunization schedule
July 06, 2011|By Deborah L. Shelton, Tribune reporterA small but growing number of parents think vaccines against childhood diseases are unsafe and are refusing or delaying shots for their children, despite the discrediting of a medical study linking vaccines and autism that stirred alarm.
Ground zero in the debate is the pediatrician’s office.
Some frustrated pediatricians are drawing a line in the sand by requiring parents in their medical practices to vaccinate their children or seek health care elsewhere, a position that rubs some medical professionals the wrong way.
Among those taking a stand are the eight pediatricians of Northwestern Children’s Practice in Chicago. They no longer see children whose parents refuse to follow the childhood immunization schedule developed by the Centers for Disease Control and Prevention and the American Academy of Pediatrics. A letter and email sent to parents this year announced the policy, which went into effect in June.
More, Chicago Tribune: http://tinyurl.com/3cmro8l
New AAP Pertusis Recommendation
Boston.com/health 09/26/2011
New Grandparents Need Whooping Cough Vaccine, AAP says
By Deborah Kotz, Globe Staff
Grandparents spending time with infants need to get vaccinated against pertussis or whooping cough to protect babies under six months who are too young to receive the vaccine. That’s a new recommendation announced today by the American Academy of Pediatrics.
The policy statement issued by the Academy recommends that anyone over age 65 who is caring for a baby receive the tetanus-diptheria-acellular pertussis (Tdap) vaccine. They already had the recommendation in place for parents of babies who hadn’t yet received Tdap, which was approved for use in 2005.
In fact, some hospitals in the local area offer the immunization to new parents before they head home with their newborn. Babies don’t receive their first diptheria-pertussis-tetanus (DPT) vaccine until two months of age and aren’t fully immunized until six months.
Pertussis has been a growing problem in the U.S. with 27,550 cases reported last year, according to the US Centers for Disease Control and Prevention. California had the worst outbreak since 1947 with 9,143 cases and 10 infant deaths. (Mass. had fewer than 500 cases last year.)
“Outbreaks at middle and high schools can occur as protection from childhood vaccines fades,” said the CDC on its website. A study last week found that protection from whooping cough fades after three years in young children who were immunized.
For this reason, the AAP urged parents today to get their children the Tdap booster between ages 7 and 10 if they’re behind on their DPT immunizations. And the policy statement also noted that kids who had just the DT shot can still get Tdap shortly after since studies haven’t found evidence of any harmful effects from getting the two immunizatons close together.
Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
World Obesity
The percentage of the population older than 15 with a body-mass index greater than 30.
New California law gives children access to vaccines without parental knowledge or consent
National Vaccine Information Center Calls New California Vaccine Law A “Violation of Parental Informed Consent Rights and Federal Law”
WASHINGTON, Oct 10, 2011 (BUSINESS WIRE) — The National Vaccine Information Center (NVIC) today criticized California Governor Jerry Brown for bowing to pressure from the pharmaceutical and medical trade lobby and signing a controversial bill (AB499) into law that allows 12 year old children to be vaccinated without the knowledge or consent of their parents. The new California law allows minor children as young as 12 years old to be given Gardasil and hepatitis B vaccine, as well as future vaccines for sexually transmitted diseases, without the informed consent of their parents.
“The law, which Governor Brown must take personal responsibility for enacting, is a violation of parental rights and federal vaccine safety law,” said NVIC co-founder and president Barbara Loe Fisher. “He has done what a lot of powerful people are doing today in America, which is making it easy for big corporations and trade organizations, including doctors and drug companies protected from vaccine injury lawsuits, to exploit ordinary people to increase influence and profits. This law will put the lives of minor children too young to make medical decisions at risk. California parents, who will not be informed before their minor children are given vaccines, will be the ones left to deal with the consequences legally and financially if their child becomes vaccine injured.”
The National Vaccine Information Center worked with Congress to secure vaccine safety provisions in the 1986 National Childhood Vaccine Injury Act, including the requirement for doctors and vaccine providers to fully inform parents about vaccine side effects before minor children are vaccinated. The 1986 law, which created a federal vaccine injury compensation program that has awarded more than $2 billion to the vaccine injured, also mandated that doctors and all vaccine providers record and report vaccine adverse effects to the government to help reduce vaccine injuries and deaths.
NVIC Director of Advocacy, Dawn Richardson, who designed NVIC’s online Advocacy Portal (www.NVICAdvocacy.org), worked with families in California to provide Governor Brown and the public with information about why the proposed legislation violated parents’ long held legal right to make medical decisions for their minor children. “Governor Brown’s signing of this legislation signals a negative trend in state public health policy making. Big Pharma has been working behind the scenes in California, Washington and other states to take away parental rights and vaccine exemptions,” said Richardson. “Under federal law, parents are supposed to get vaccine information before their children are vaccinated to help minimize risks and this new California law raises, rather than reduces, vaccine risks for children.”
AB499 is estimated to cost the state of California millions of dollars to implement because Merck currently sells Gardasil vaccine to the government for more than $100 per dose and sells hepatitis B vaccine for $27 per dose. Three doses of each vaccine are given. Future vaccines for sexually transmitted diseases, such as genital herpes, chlamydia, gonorrhea and HIV/AIDS, will likely be more expensive. In addition to vaccine purchase costs, there are additional costs for vaccine delivery and administration.
NVIC is a non-profit organization founded in 1982 and dedicated to preventing vaccine injuries and deaths through public education and defending the informed consent ethic in medicine. NVIC advocates for the institution of vaccine safety and informed consent protections in the vaccination system and does not advocate for or advise against the use of vaccines. For more information, visit www.NVIC.org .
SOURCE: National Vaccine Information Center (www.NVIC.org)
Copyright Business Wire 2011