Vol. 115 June 15, 2014 Sometimes a picture IS worth a thousand words.

June 15, 2014

 

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THE LAST OF MY “FOOD BLOGS” FOR A WHILE.

After blogs about the evils of excess added sugar, added trans fats, the obfuscation of ingredient lists, and manipulative marketing by food manufacturers  I find it easy and appropriate to finish up this series with pictures that capture more than I can write.

 

Food cartoons1

 

Some churches have come up with the ultimate answer to WWJD?  Gluten-free communion wafers!!

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Food cartoons2

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Wouldn’t it be great if parents were as paranoid about gun deaths – 500 children per year – as we are about peanut allergy deaths – 150 children and adults per year.

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Food cartoons3

As a pediatrician with 45 years of experience and a grandfather, I think that the moment depicted here is much more important in the long run for the child than reading the % of trans fat or sugar content in the ingredients list.

 

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Vol. 58 January 1, 2012 Top 15 Medical Fun Facts of Hubslist 2011

January 1, 2012

“WHAT IS PAST IS PROLOGUE”
-William Shakespeare, The Tempest

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1. Measles vaccination does NOT cause autism and the author of that study, discredited as a physician in the U.K., now runs a profitable private clinic in Texas without a U.S. medical license. 1/15/11

2. Many hospitals, physicians and more than half of consumers currently favor a single-payer system. 5/1/11

3. Fishermen die at work 15 times more often than policeman and 45 times more than firemen. 5/15/11

4. Four men jogging can produce MORE carbon dioxide emissions than a hybrid car driving them the same distance. 5/15/11

5. 93% of 44 children who were avoiding 111 foods because of non-threatening allergic reactions (eczema, atopic dermatitis, and hives) were NOT allergic to those foods. Milk allergy was the most common over-diagnosis. 5/30/11

6. Your parenting style has less effect on your child’s “success” than your own educational level, income, and where you live. 9/1/11

7. Watching Sesame Street is entertaining for infants and toddlers , but it is NOT educational until they are 2 ½ years old. The educational benefits to the over 30-month old viewers persist to age 17 years. 11/1/11

8. Eating turkey is no more apt to make you sleepy than eating chicken, pork chops, lamb chops, or salmon. 12/1/11

9. The average DAILY number of text messages by a high school kid is 300-500. 11/1/11

10. 85% of teenagers take their cell phone to bed at night. 11/1/11

11. The five-year trial of “managed competition” between private health insurance companies in the Netherlands resulted in increased health care costs, increased percentage of people receiving government subsidy for health insurance, and increased number of uninsured, now called “defaulters”. 8/15/11

12. The many modes of obesity treatment other than surgical gastric bypass are only 4% effective. 8/1/11

13. Ninety million (90 MILLION) swine flu (H1N1) vaccinations were given in China and only 11 cases of Guillian-Barre syndrome (GBS) occurred. This rate was less than the rate expected in a general, unvaccinated population. 5/15/11

14. Baseball players CAN see better than umpires. 2/15/11

15. If your friends on Facebook are obese, you are more apt to be obese. 1/1/11


Vol. 46 May 30, 2011 For Kids (and their parents) Only

May 27, 2011

“Apparently you can leave your heart in San Francisco, but your foreskin is going home with you.”

-Lewis Black on The Daily Show Nov.16, 2010

Age-old Circumcision Debate Heats Up in San Francisco
The 7,000 signatures required to put a question on the ballot in San Francisco have been obtained for a proposal to outlaw male circumcisions. A fine of $1000 or a year in jail would be levied against anyone circumcising a male under 18 years of age. A group called Bay Area Intactivists (check out their website at www.sfmgmbill.org -“mgm” stands for “male genital mutilation”) has been campaigning for the bill for years.

The debate, of course, has been going on for decades (see “The Rape of the Phallus” published in 1965). (1) The Cons have called it “unnecessary surgery”, “a needless expense”, a waste of excellent tissue for grafting if the person gets a serious burn in the future, and “something that diminishes sexual sensitivity for the male”. That last one is a particularly hard one to prove or disprove, or even get public testimony on. The Pros say it reduces the occurrence of penile cancer (a study done in Bowery bums), reduces risk of urinary tract infection in males in the first year of life, reduces HIV infection in African males, and may reduce the spread of HPV (a cause of venereal warts and cervical cancer) to females. Up until this point no one has opposed it as a form of genital mutilation.

Given the religious and cultural traditions of male circumcision (Jews and Muslims consider it a religious event, not a medical one. Australian Aborigines have practiced it probably the longest) and the non-compelling medical evidence of its benefits despite low risks, the American Academy of Pediatrics and the American Medical Association neither recommend nor advise against male circumcision. A reflection of this lack of compelling medical evidence either way is the family of one of my pediatric colleagues. Half of his sons are circumcised, and half are not. None of them are Jewish or Muslim, and they all seem to be doing very well in life, and love.

Screening for Autism in the Pediatric Office
Of 800 toddlers screened for autism in a Utah pediatric office 10 children “had significant signs of autism”. This is close to the CDC estimated occurrence rate of 1 in a 100.(2) 192 (24%) kids had “positive results for autism” on the 23 question paper checklist, MCAT (Modified Checklist for Autism in Toddlers), completed by a parent. Only 47 (25%) of these were deemed “still positive” after a 6 question, structured telephone interview, and they were asked to return for an in-person evaluation. Of the 30 who returned, 10 of them “remained positive for significant signs of autism”.   

The messages here are: 1) ask your pediatrician for the MCAT questionnaire if s/he hasn’t offered it by age 18 months, 2) obviously don’t panic if s/he asks for more information since the MCAT is designed to be very sensitive and has lots of “false positives”, and 3) remember, the sooner that educational and behavioral resources are supplied to the child who shows significant signs of autism, the better the outcome. 

Autism is the biggest unspoken fear of new parents and has replaced fear of SIDS.
At least, that is my impression in my pediatric practice. Sudden Infant Death Syndrome (SIDS) occurrence has dropped dramatically in the U.S. from a level of 1.53 deaths per 1000 live births in 1980 to the current rate of 0.51 per live births. Since the cause (or causes) of SIDS is still unclear, the reason for this great reduction in risk is also unclear. Most people credit the extensive campaign of the American Academy of Pediatrics to get parents to put their infants to sleep on their backs, “Back To Sleep”, started in 1990 on the basis of studies done in Australia. Unfortunately, SIDS remains the leading cause of death for children in the U.S. under 1 year of age, and the American SIDS Institute is striving to reduce the occurrence rate this year to 0.25 per 1000. The Institute of Medicine has found no association between SIDS and vaccinations.

Most kids who avoid certain foods because they are allergic are NOT ALLERGIC TO THAT FOOD.
The “gold standard” for diagnosing a food allergy is an “oral challenge”; you give the food to the child to eat and see if an allergic reaction occurs in a medically controlled setting. 93% of  food oral challenges were NEGATIVE in 44 children who were avoiding 111 foods because of non-threatening allergic reactions (eczema, atopic dermatitis, hivesalso) AND also had positive allergy skin tests or blood tests.  Only 23% of the children who were avoiding peanuts were truly allergic to peanuts. Milk allergy was the most common over-diagnosis with only 13% of the children who were  told that they were milk-allergic based on blood or skin tests actually were. Children who had had life-threatening allergic reactions to food previously were excluded from the study. (3)

Caffeine can reduce sleep time in children, just like in “real people”.
A study of 228 children from age 5 to 12 years showed that increased caffeine consumption during the day slightly reduced their total sleep time at night. Not surprising, but what was interesting to me was that the average cola beverage consumed per day was 12 oz. for 5-7 year olds and 24 oz. for 8-12 year olds. Reassuringly, the average sleep duration for 5-7 year olds was 9.5 hours and  8.7 hours for the 8-12 year olds. (4)

But what about getting the child to actually go to sleep?
A study of over 500 New Zealand healthy 7 year olds  showed that on average they took about 26 minutes to fall asleep. The range of this “sleep latency” was 13 to 42 minutes. The 10% of these children whose parents had identified as “having difficulty falling asleep” had a much longer average sleep latency of 41 minutes. Increased physical activity during the day and sleeping longer during the night were associated with shorter sleep latencies. Each hour of sedentary time during the day added about 3 minutes to the duration of sleep latency. There was NO association between duration of TV exposure and length of sleep latency. (5)

Are those adolescents really asleep?
An estimated 75% of teens own cellphones. Since 54% of the teens use their phones for texting and about 25% log on to social media sites more than 10 times a day, cell phone use “under the covers” at night might be contributing to teen sleep deprivation(6) . An amazing  86% of 14 year olds take their cell phones to bed (7). Reminds me of the “old days” of reading magazines under the covers at night with a flashlight (note to younger readers: a flashlight is a silent tubular device without a screen that requires batteries).

References:

1. JAMA vol.193, 1965 pg. 123
2. Pediatrics 2011 May 127:866
3. J Pediatric 2011 Apr;158:578
4. J Pediatric 2011 Mar 158:508
5. Arch Dis Child 2009 Sep: 94:686
6. Pediatrics 2011 Apr; 127:800
7. Robin D’Antona, EdD, BU School of Medicine Developmental and Behavioral Pediatrics Conference, Mar 25, 2011


Vol. 24 July 1, 2010 More Things That Can Harm or Kill Ya.

July 1, 2010

Average number of Americans hospitalized each July with sparkler injuries: 1,020 (1)

Per cent of 1255 people (100%) going to the ER with serious food allergy symptoms due to peanuts or milk respectively:  23% / 15% (2)

Per cent of people who self-report having a milk allergy or a peanut allergy that actually have a positive skin or blood test for either allergy: <1% (3)

Amount spent by food companies on cross-promotion advertising (agreements between different companies to promote each other’s products) to children and adolescents in 2006:  $195 million (4)

Number of cross-promoted products in 2006 and 2008 respectively: 96 / 171

Per cent of cross-promoted food that met the Institute of Medicine’s standards for foods sold in schools: 18%

Increased risk of collision when texting while driving: X 23 (5)

Number of annual traffic accidents associated with use of cell phone talking or texting: 1.6 million

Per cent of all traffic accidents associated with same: 28%

Number of states that have passed laws regarding cellphone use while driving: 40

Rate of gastrointestinal bleeding within 30 days of a colonoscopy: 1.6 per 1000 exams (6)

  • This very low rate and the even lower rate of 1 perforation per 5000 exams means that colonoscopies are quite safe.

Per cent reduction in rates of all kinds of cancer in people who eat lots of fruits and vegetable: 3%

  • This massive study of 500,000 people in 11 European countries completing a year-long food-frequency questionnaire with an average of 9 years of follow-up led the NIH to the conclusion that “a broad effort to increase fruit and vegetable consumption would not have an effect on cancer incidence” …unless you are a smoker or a heavy drinker. (7)

Increased risk of dying from a motorcycle injury if you are over 40 years old rather than under 40:  x 2  (8)

Per cent of injured motorcyclists who were wearing a helmet:  73% for both over and under 40 years old

Number of poisonous gases , chemicals, or metals identified in tobacco smoke:  250 (9)

Number of those that are classified as class A carcinogens: 11

Chance that a lifelong smoker will die prematurely from a complication of smoking:  50% (10)

Per cent who resume smoking within one month after trying to quit on their own: 80%

  • There is no question that nicotine is addictive, and that smoking is a highly efficient means of drug administration.
  • Smoking tobacco “improves concentration, reaction time, and performance of certain tasks. Relief from withdrawal symptoms is probably the primary reason for this enhanced performance and heightened mood.”

Number of Burmese pythons captured in the Everglades in 2000 and 2008 respectively:  2 / 343   (11)

  • Such pythons grow to 20 feet in length, weigh up to 200 pounds, and EAT alligators! “By the time they reach two years of age, not much can eat them in the Everglades.” This population was started by the release of pet snakes which can grow from 20 inches to 8 feet in a single year.

Number of minutes of cell phone use equivalent to one day’s exposure to radio frequency waves if you live next to a cell phone tower: 30  (12)

  • This study of 1400 cancer cases in children over a 3 year period in the U.K. showed no increase in childhood cancers in offspring of mothers who lived near cell phone towers while pregnant.

References:
1. Harper’s Index; June 2010, U.S. Consumer Product Safety Commission
2.Pediatrics April 2010
3. JAMA May 2010
4. Public Health Nutr March 2010
5. NEJM June 10, 2010; 362:23
6. Clin Gastroenterol Hepatol 2010 Feb.
7. J Natl Cancer Inst 2010 Apr 21,
8. Univ. of Rochester medical Center
9. NEJM June 17, 2010, 326:24, pg. 2319 National Toxicology Program
10. NEJM 362:24 June 17, 2010, pg. 2295, “Nicotine Addiction”, N. Benowitz, MD
11. Sci Am Feb 2010, pg. 16
12. BMJ online, June 23, 2010, Paul Elliot


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