I learned from Dr. Neumann that cost these high cost estimates are most strongly influenced by reduced productivity in adult workers with ADHD rather than direct costs of treating children with the disorder. Productivity costs include absenteeism, and reduced work output due to difficulty focusing. Dr. Neumann explained that ADHD has many “spill over effects” in that it impacts the educational system, the justice system, the healthcare system, and our work environments. Please check out our interview video for the full story.

Congressman Tim Murphy is a clinical psychologist with three decades of experience in treating people with ADHD. He is also Co-chair of the Mental Health Caucus and GOP Doctors Caucus where he regularly works to raise awareness of healthcare accessibility needs. I had the chance to interview him also at the event.

I learned from Rep. Murphy that the costs of ADHD multiply when patients are untreated.  Getting the correct diagnosis is critical, because impulsivity and problems with focusing are not always caused by ADHD. These symptoms can be caused by lead poisoning, damage to the limbic system of the brain, metabolic disorders, or even sleep apnea. Children who are inattentive should not be put on medications for ADHD without first confirming the diagnosis by ruling out other possible causes.

Rep. Murphy recommends a team approach to the management and treatment of ADHD and he believes that costs related to ADHD are escalating because some physicians are not managing children holistically, but resorting to prescribing medications without involving counselors and family directly. He sees lack of health insurance coverage for behavioral health services as a threat to comprehensive and effective ADHD treatment.

Please watch the video for the full interview with congressman Murphy.

This post originally ran on the Better Health blog on December 14th.

WawaRed (wawa means baby in Quechua language) is a pilot project of Cayetano Heredia Peruvian University that provides pregnant women with access to health information through a cell-phone-based interactive system. Women can access for free information about what to do if they have warning signs during their pregnancy such as vaginal bleeding or severe vomiting. The system also provides them with SMS reminders for their clinical appointments and with motivational messages.

The project will soon develop an electronic medical record that will interact with a mobile phone platform. Initially, the project was focused only on health information before the delivery. Given that women expressed their desire to continuing receiving messages to remind them about clinical appointments for their newborn, vaccinations, and nutritional tips, the project is being extended to cover one year after the delivery.

The project is being conducted under the leadership of Dr. García and Dr. Curioso and it is financed by the Mobile Citizen Program of the Science and Technology Division of the Inter-American Development Bank.

Wawared has established strategic alliances with the Regional Government, through the Callao Health Division, and with Telefónica Movistar of Peru. The project has now additional support from UNICEF to include an Electronic medical record for the baby`s first year of life.

Video of the project: WaWaRed: Getting connected for a better maternal and child health in Peru by IDB’s Mobile Citizen

By Saundra Pelletier. Big numbers always make people stop and think. Big birthdays, anniversaries or milestone are moments to reflect on what once was, and what could be.

Over the last few months, media coverage of the population reaching seven billion people has been especially ponderous, causing wonder about what the pressure of so many people will do to our planet. Questions abound. What will the carbon footprint of seven billion plus people be? Will there be enough food to feed everyone?  What can we do about population growth? How many people can the planet manage?

One of the ways we can help our planet is by investing in family planning. Family planning is one of the most cost-effective, high-yield interventions that exists today. Countries that invest in family planning can reap immediate health benefits, investment savings in health and education sectors, and social and environmental benefits that extend well beyond a single generation.

As I wrote in an earlier post, the ability for women here in the U.S. to use birth control to prevent or delay pregnancy gave every woman  the power to decide if and when she wanted to have children, and how many to have. And with the ability to keep families smaller, came the ability to provide for their present and future well-being.

This argument – small-family-equal-prosperous-communities– is not lost in the broader discussion about the seven billionth baby, but while pundits stress the urgent need to reduce the size of the world’s population, nowhere near enough is being done to ensure that the 215 million women who want to use modern contraception have access to do so.

The fact that this amazing milestone has made people stop and think about the people on our planet is a good thing. A good place to start on a road to a healthy, more prosperous planet is to ensure  that the women and girls, who make up just over half of the planet, can make informed choices about if and when to have children, and that they have access to the supplies to allow them to do so. Providing this access will slow the pace to reaching 8 billion.

About WomanCare Global: It is a nonprofit organization working with partners around the world to improve the lives of women by providing access to affordable, quality reproductive health products. The organization believes that every woman, no matter where she lives, should have control over her reproductive health and family planning needs, ultimately improving her ability to care for herself and her family. WomanCare Global closes the access gap by bringing the same quality products available in the developed world to developing countries. WomanCare Global serves both public and private sectors via an established global supply chain reaching countries around the world, with particular focus on under-served markets in Africa, Asia and Latin America.

Dr. Carlson told me that the solution involves comprehensive eye exams – a full medical eye exam performed by an eye doctor. During a comprehensive eye exam, the optometrist will check the health of the eye tissues, including the eye muscles, cornea, conjunctiva, tear ducts, pupils, lens, and retina, as well as the patient’s ability to track objects, to see at different distances, and to focus adequately.

Vision correction is important at the youngest age possible because learning is greatly impacted by vision. Children who can’t see the chalk board, or who can’t read a computer screen or book, may lag behind in school or have attention challenges. In fact, it’s likely that some visually impaired children are misdiagnosed with ADHD (Attention Deficit Hyperactivity Disorder) as their interest in lessons fade since they can’t participate well without seeing what’s going on.

Dr. Carlson told me that parents sometimes erroneously believe that they’d be able to tell if their child has a visual deficit. In her experience, some children have been misdiagnosed with balance and hearing problems when they actually had a strong visual deficit in one eye. In one case, a 7 year old boy learned to ride his bicycle so that he turned right three times in order to go in a leftward direction because his left eye had poor vision.

So why are vision problems so common among children? According to Dr. Carlson, babies are all born far-sighted, and they begin to gain near vision when they’re 6 months old. However, many babies and young children lose their farsightedness at different rates in each eye. If the rates vary by quite a bit, vision can be greatly impacted, and early interventions with corrective lenses and/or eye patches can be critical in heading off long term problems. The best way to assess a baby or young child for such problems is to have a comprehensive eye exam by an eye care professional. It is recommended that children have exams beginning at age 6 months to 1 year and then every 2 years or so thereafter.

Dr. Carlson and the AOA are so committed to making comprehensive eye exams available to all Americans that they have founded the InfantSEE program. The InfantSEE website (www.infantSEE.org) provides a nation-wide list of optometrists who offer free exams to infants, regardless of the parents’ health insurance or ability to pay.

So there you have it, parents – please make sure that your child is set for success this school year by taking him or her to an eye care professional for a comprehensive exam. School vision checks are not designed to assess the whole eye and all the possible vision problems that occur. Remember that you can’t tell if your child has a vision problem just by looking at them!

This issue has never impacted me, my family or anyone close to me, but since childhood, I have been passionate about protecting children from abuse.  As early as age ten,  I was in Rock Creek Park (in Washington, DC) on a picnic with my family when I saw a mother whipping her young children with a tree branch.  I marched up to her and demanded that she stop.  As recently as a month ago, while patiently waiting for a table at IHOP,  I noticed a mom yanking so hard on her toddler’s arm that she was pulling her up from the floor.  “Um…excuse me,” I said calmly as I kept texting on my phone, “but if you keep doing that you might dislocate her shoulder.”  She stopped yanking then and angrily tried to defend herself.  I stayed within her striking striking distance and secretly hoped that she’d hit me so that I could call the police…and protect an innocent 2 year old. 

In this month’s Martha Stewart Whole Living Magazine, I was interviewed about child abuse and it’s impact on adult medical illnesses.  I was familiar with the association between early abuse and conditions such as depression, fibromyalgia, irritable bowel syndrome, and eating disorders, among others. However, it was only because of a smart journalist’s leading question that I learned about the epigenetic impact of early abuse.  Stated simply, environmental events and exposures impact whether genes are turned on or off.

According to the Center on the Developing Child at Harvard University,

“If young children or pregnant mothers experience toxic stress as a result of serious adversity (such as chronic neglect, abuse or exposure to violence) in the absence of protective relationships, persistent epigenetic changes can result.  These modifications have been shown to cause prolonged stress responses….(which can) result in increased risk for physical ailments, such as asthma, hypertension, heart disease, and diabetes.” 

CornerHouse is a non-profit agency in Minneapolis that works closely with law enforcement, child protection, and the county attorney’s office to advocate on behalf of abused children.  Each year, their annual gala, “Lets Dance” is modeled after the show, Dancing with the Stars.  Six local celebrities (Minneapolis business executives, community leaders or social figures with key contacts who can help raise visibility and money for the event) are paired with a professional dancer and dance studio who donate 15 lessons. The performance is a fully choreographed, three minute performance with the “winners” being the pair who dance the best and raise the most money.

When I was asked to be one of the local celebrities for their November 12, 2011 event, it seemed like a no-brainer.  I care deeply about the cause, have decent rhythm and have always wanted to take dance lessons. I am not afraid to be on a stage, the chance to exercise is always a plus and, of course, I’d get to wear a fabulous outfit.  Even before meeting my dance teacher, I decided to do a Latin dance since the music and fast-paced beats were similar to the Greek music I’d grown up with.

Bruce Abas at Four Seasons Dance was selected as my dance teacher and partner.  He is a perfect fit since he’d studied Tango in Argentina and Salsa in Puerto Rico and Cuba.  At the first lesson, we briefly introduced ourselves to each other,  and then Bruce quickly launched into demonstrating the Latin Basic and the Side to Side steps while we both stood in front of the mirror. “Got it! This will be easy,” I was thinking to myself.

After thirty minutes, it was time to practice the same steps while dancing together…facing each other.  And, that’s the last time this experience was easy.  It was frightening.

In order to do any ballroom dance properly, it is essential for partners to communicate with direct visual contact, arm resistance and close body contact. In addition, Latin dance requires a sensual movement of the hips in order to make it authentic and beautiful. A basic rule is that the male partner is always in control. And, finally, trust is essential.

Try this with a relative stranger.  Try this when your success has been centered around the rules, mores  and conservative behaviors of corporate America.  Try this when you have led your whole life being “in control.”  Try this when the skeletons from your past are sending you conflicting messages and fueling a heightened stress response.

Lessons two and three triggered the same fright and anxiety.  I contemplated backing out, and one friend suggested that I simply write a large check and withdraw. But, it’s my husband who encouraged me to follow through.  In fact, not only has he encouraged me to dance well, but to dance with the emotion that it will take to win.  Besides honoring my commitment to CornerHouse, it is a personal opportunity to grow.

I have had my 5th lesson and can finally make eye contact with Bruce.  I can even do a few turns. The hip thing is still a problem, but improving a little.  While Bruce is in control of the dance moves, I am finally feeling in control of my Boogeyman.

Take home message: Don’t run away from yours.

I will periodically continue to blog about this experience as we lead up to the November event. 

Originally posted on Archelle on Health on August 23rd.

Studies show that more teens start using drugs during the summer months – while unsupervised and with more free time.

• 70% of teens who abuse Rx drugs get them from family and friends.
• 68% of households do not properly secure their Rx medications.
• Studies show that unmonitored kids are four times more likely to engage in substance abuse.
• The distressed employment market makes it harder for teens to find summer jobs, leading to more boredom, restlessness and free time. 
• A new study surveyed 2,500 high schoolers and reported that one in four admitted to abusing Rx drugs.

TIPS FOR PARENTS:

• Safeguard all medicines by monitoring quantities and controlling access. Remove drugs from your medicine cabinet and lock them up.  
• Warn your youngsters that prescription drugs can be just as dangerous, addictive, and lethal as street drugs.  Studies show that teens dangerously view prescription drugs as “safer” to abuse than illicit drugs.
• Properly dispose of old or expired medicines in the trash. Hide or mix them with cat litter or coffee grounds before throwing them away.
• Don’t have kids at home? What about your grandchildren, nieces and nephews, and your friends’ kids that visit your house?

ABOUT THE ISSUE: The CDC lists prescription drug abuse as the fastest-growing drug problem among 12-17 year olds.  One in four high school students in the U.S. admits to having taken a prescription drug without a prescription.  The number of teens going into treatment for addiction to prescription drugs has increased by more than 300%.  Emergency room visits for prescription drug abuse have more than doubled since 2004, 48% of all ER visits for prescription drug abuse are by young people ages 12-20.  Prescription drugs are now involved in more overdose deaths than heroin and cocaine, combined. 

ABOUT THE CAMPAIGN: Lock Your Meds™ is the new national campaign from the National Family Partnership (NFP) to inform families that they are frequently the “unintentional suppliers” of prescription medications being abused by young people. The NFP is the largest and oldest drug-prevention group in the United States, and in 1988 developed “Red Ribbon Week” into the annual campaign that now reaches more than 80 million people each year, mobilizing parents, schools and communities.  As the nation’s oldest and largest drug prevention group, NFP is committed to keeping families informed.

One of the best and prudent ways to invest though, is in future generations.  In the US, we provide all of our children the best chance at life, with fewer worries about preventable, devastating disease.  Imagine what that kind of security could do for a family in Africa.  Healthier children in Africa would be able to stay in school.  Families would worry less about the all too common diseases of pneumonia and diarrhea, and their devastating costs.  Rather than accepting the fate that their children may fall ill, they would be thankful that new vaccines are being made available.  Throughout the years, as healthcare improves because of our investment, so would income and productivity. Our investment would return to us through a country’s improved stability, better governance, and more – and all directly relate to our own security. 

The introduction of a new vaccine is not something taken for granted in the developing world.  Up-to-date immunization cards of young children are among a family’s prize possessions.  Throughout Africa, pneumococcal vaccines, once deemed far from the reality of any African village are now being introduced and are offering hope.  Rotavirus vaccines, helping prevent one of the most deadly forms of diarrhea in young children, may soon also be a reality across Africa -  all for a relatively small fraction of the US budget.  How often do we have a chance to save so many lives with such an effective and minimal financial commitment?  Four million lives over a five-year period is a pretty good return on investment!

Let’s make wise investments

Next month, the GAVI Alliance will be holding their pledging conference to encourage donor countries like ours to contribute to providing the most basic and effective prevention.  Please tell President Obama and your local leaders that you care.  Sign the ONE petition, and tell your friends and family to do so. The more they hear from you, the more they know this is an investment we as Americans care about.  Do it for their future – and ours.

Photo credit: Adrian Brooks, Imagewis

By Jenni Sunde. The benefits of a sound mind and body can be traced all the way back to ancient Greco-Roman cultures.  Despite how long the concepts behind mind and body connection have been around, they are frequently overlooked in our modern society.  The connection between mind and body is particularly impactful for adolescents; studies have shown that happier youths are indeed, healthier youths.

Emily Shaffer Hudkins and her team of researchers at the University of South Florida conducted a study that focused on the impact that positive emotions, moods and overall satisfaction with life has on the health of teens.  Her research shows that these positive feelings, also known as subjective well-being are more significant than depression and anxiety when it comes to physical health.  Psychopathology has long been where the emphasis is placed when it comes to determining how the mind and body are connected. 

Hudkins conducted an experiment with 401 students, grades 6-8 from a suburban southeastern middle school in the US.  She monitored both their subjective well-being and psychopathological tendencies.  The study asked questions about the teens’ satisfaction with life; whether they were strong, proud and excited, and whether they felt lonely, guilty, or sad.  What Hudkins founds is that good mental health most often is linked to good physical health.  Mental health indicators explain roughly 30 percent of the difference in physical health ratings.  The findings show that subjective well-being has a significant, unique and primary affect on predicting important physical health outcomes in youth.  In other words, subjective well-being is more strongly associated with physical functioning than psychopathology.

What Emily proposes is that we change our wellness models to ones that are more holistic, so as to incorporate the entire spectrum.  With current standards, the subjective well-being is often overlooked in terms of its impact on physical health when it actually is more prominent than poor mental health in terms of how much it can affect the body.

• Some parents dress their young girls in provocative outfits
• Retailers have encouraged this behavior by marketing inappropriate clothing
• It’s OK to blame retailers, but it’s parents who are ultimately responsible
• Children need parents who will set rules, not be their friends

Rainy days and Saturdays get me down. (Sounds like a good song lyric.) Rainy days force a quiet among the constant buzz of activity. Saturdays are the closest thing to a once a week siesta. Nearly ten years ago, on a Saturday morning I had to to reflect on the beliefs I had held dear all my life as I was holding my newborn son who had just died. It took more than five years before I could wake up on a Saturday without feeling a desire to go back to sleep.

Today the rains came and brought with them memories of a Saturday past. Tears and frustration and disappointment rallied. Those feelings don’t make me feel very peaceful. Taking the analytical approach learned in grad school, I identified five causes for a peace builder in health care to have anger, frustration and the occasional tears.

Poor communication. This is a well-documented root cause for most every medical error. Earlier this week Kathleen Sebelius of the Dept of Health and Human Services and Don Berwick, MD of the Centers for Medicaid and Medicare announced the creation of a $500 billion initiative to encourage more collaboration between hospitals, health care providers, community organizations, and employers, etc to improve care and lower costs. James’s Project was among the first ten organizations to make the public pledge for the Partnership for Patients: Better Care, Lower Costs in the greater Philadelphia area. Through this website consumer and clinical organizations can seek out others with similar values for collaboration. When a cancer patient called me this week sharing she had left the hospital without discharge instructions together we took a look at this website. The large teaching hospital had not yet pledged. By the end of the week, the institution had taken the pledge but the patient is still waiting for her discharge instructions. This is new resource where patients can grab the wheels and drive change by asking their hospital, health care system, insurer and or doctor if they have signed the pledge. Also ask – what community or patients group are you collaborating with?

Gag Clauses. As a rule, people love to hate the plaintiff in a medmal case. If you actually disagree with me, think of before you knew a loved one who died from medical errors. Americans love to love the whitecoats. Anyone associated with a trial lawyer automatically becomes a blackhat.
I believe in the judicial system our forefathers created. Everything breaks down at times. As a teacher, I hope that learning happens from mistakes. With James’s case, it was clear the physicians had as much of a right to a fair trial as my son did. It could have all been spared if open communication between us had been allowed. I was offered $750K to not go to trial and to not speak of my son’s whole life. All I wanted was to cover my attorney’s fees (about 45K at that point) and a 5 minute conversation with one of the defendants. It was not an acceptable counter offer evidently.
I can reflect now that I did get that conversation (and much more than 5 minutes) with two doctors (not just the one) and I did that all on my own.
Despite the tremendous pain of our shared trauma we have been able to heal by restoring a relationship. Our story and how we did it is how money in health care conflicts can be saved. More importantly, it teaches so many what not to do when they may find themselves in a similarly shared event. I have spent years and dollars investing in formal education to share this.
Patients and their parents are still only offered money and a gag clause to “settle” the conflict. Those two offerings do not settle anything. The parents that reach out to me continue to say, “It’s not about the money.” But, are patient safety leaders only interested in transparency when the negligence found in a case is accompanied by a large financial award for the patient? These parents want to give meaning to their child’s life. Not more flowers to blanket a grave.

Dishonesty. James’s lawyer is a smart and quick-witted guy. Some of what he said in court and elsewhere I call “Jim-isms”. One of my favorites – not for its humor but for its truth, was part of trial argument, “Just because someone says something is true, does not make it so.” Another lawyer pointed out more recently that docs and lawyers are just the same as plumbers, roofers, and other professionals. The point was well made that regardless of the profession some people are just not ethical in their pursuits. The difference is that doctors (and less as much lawyers) are bestowed an immense amount of respect, influence, access, and admiration that is not always warranted. For the few who have been dishonest in medicine, the impact is far-reaching even if it is only once. I think the 114 year old man that died this week had it right. His advice – “Tell the truth from the go” (it works out better and doesn’t kill you).

Exploitation. An international patient safety leader asked for permission to borrow James’s image for a speech to be given during a large gathering. This leader does great work. Emails were kind and appreciative for the work of parents and family members of iatrogenic victims. There are alot of us out here in the world. Perhaps that is why the leader has more recently declined to engage, or even has worked against me in trying to create a space for transparency and collaboration for the next generation of parents with sick children in my area.

I, and many others like me, continue to answer the calls and requests from leaders in this patient safety industry – like taking multiple unpaid days off from work to attend conferences when they need a representation of patients (or consumers). Despite the variety and multiples of patient safety advocates, patient safety industry leaders engage with a handful of patient activists on a regular basis. Do they like our traumatic stories but not our knowledge and work?

Pictures. Hospitals spends many a health care dollar on marketing. Babies and young children are a common theme in hospital and health care advertising. The ads are in newspapers, magazines, television and anywhere you might find young families. For parents who have lost a baby in one of these hospital but not offered post-trauma conversations with its physicians or employees these pictures cause sadness and more questioning. All they continue to ask is “Why won’t someone tell me what happened?”

Grieving parents become very adept at modifying their routine to ease the unexpected waves of grief. Some take a different way to work to not pass the doctor’s office. Some change what grocery store they use. Others will simply never look to their right (or left) when passing said hospital. The only guarantee in this approach is that they cannot avoid the reminders. The hospital will have an ad on a bus, or in the newspaper they read, or even on television showing a beautiful healthy new baby.

James’s hospital did that too. These ads remind me of the handful of pictures we have of him and the one that I asked the nurse not to take.

That was nearly ten years ago. Earlier this week, another mom told me a similar story. Her baby’s nurse photographed her baby after death. She told the clinician she did not want that picture taken.

On rainy days and Saturdays when I hear a parent share a story so similar to mine except it happened last week, last month, or last year I have to handle my anger and frustration. Tears fill my eyes. Now that I have identified the cause, I can find the tools to necessary to quell them.

Do the patient safety leaders hear me? Have I been too transparent? Or not transparent enough? Or, is transparency in American medicine a privilege reserved the privileged?

Rick Guidotti

Rick Guidotti began his career focusing, like most fashion and portraiture photographers, on capturing traditional beauty. Educated at New York’s School of Visual Arts and based in Manhattan, Guidotti enjoyed the glamorous life of a successful high fashion photographer – snapping shots of conventional beauties for clients like Yves Saint Laurent, Elle and Harper’s Bazaar in traditionally beautiful places like Milan, Paris and London.

But all of that changed in 1997, when Guidotti was drawn to focus his work on a different type of beauty – the “beauty of genetic diversity.” Seeking to gain attention for this beauty he had discovered, Guidotti joined forces with Diane McLean, MD, PhD, MPH and together, the pair founded Positive Exposure (PE) – “a nonprofit organization that challenges stigma associated with difference by pioneering a new vision of the beauty and richness of genetic diversity.” The organization “utilizes the visual arts to significantly impact the fields of genetics, mental health and human rights” by forging “cross-sector partnerships with health advocacy organizations, governmental agencies and educational institutions.” 

PE does not just display Rick’s photos, though. They sponsor a number of initiatives and programs aimed at concurrently capturing the beauty of those suffering from genetic conditions and educating the broader public about them.

Still, they’re known best for their flagship undertaking – the Spirit of Difference gallery, which is a collection of images and video interviews of people, particularly children, living with various genetic conditions. PE has an online version of the Spirit of Difference gallery that you can check out here.

That’s not all PE does to impact and improve the lives of those living with these conditions, though. The organization sponsors and puts on “Self-Esteem/Self-Advocacy photographic and interview workshops” and “diversity workshops” and conducts “portable, sustainable educational and human rights programs and multi media exhibitions for physicians, nurses, genetic counselors, health care professionals-in-training, universities, elementary and secondary schools, legislators and the general public” around the country and the world. Using the photos and video interviews that Rick has taken, presenters (oftentimes Rick himself) shed light on not only the beauty but the unique spirit of his subjects, helping people to look past the differences created by their conditions and see that special, indescribable quality that so captivated Rick some 14 years ago.

But don’t just take my word for it. Check out one of Rick’s presentations, entitled “Redefining Beauty”.  I know I can’t think of a better way to celebrate the holiday than by checking it out! And, for more information about Positive Exposure and its undertakings, you can visit their website.

Children in developing countries though faced a different picture over the past decade. Pneumococcus in the developing world not only causes severe meningitis, but is a leading cause of pneumonia.  Without access to PCV, 3 month-old Dominic Mwangi, found himself in the district hospital undergoing antibiotic treatment for life-threatening pneumonia.  His mother was away from home and family for 3 days.  Dominic was lucky and recovered; An astonishing 1.5 million children, mainly in Africa and Asia, are not so lucky.  Almost half of all severe pneumonias and meningitis deaths are thought to be caused by bacteria that can be prevented by the use of vaccine. Much more disease could be prevented with better nutrition and access to care.   Dominic, because he was born in Kenya, was 112 times more likely to die of pneumonia than an American child.  In Afghanistan, that number is 400. 

2011 paints a more promising picture.   A new generation of vaccines from Pfizer and GSK providing the broader protection needed to fight pneumonia and meningitis in developing countries has been made available in Nicaragua, Yemen and now Kenya within a year of launching in the industrialized world.  By 2015 more than 40 countries will do the same. 

What changed?  It was a convergence of factors – pharmaceutical companies, seeing a greater likelihood of demand with secured financing, were willing to offer low prices to those most in need, supplying at prices of less than 90% of those in industrialized countries.  Low-income countries wanted the vaccine because they saw the potential impact and a plan again for financing.  Financing was needed – and eventually made possible by Italy, UK, Canada, Russia, Norway and the Bill and Melinda Gates Foundation who donated $1.5B to the Pneumococcal AMC, an innovative financing mechanism and the GAVI Alliance who is making up the price differentials that low-income countries cannot manage as yet.   

It took a lot of effort to see these pieces fall into place, but one that can’t stop with just this example.   In a time where all of us are paying attention to how to do more with less, efforts like this one provide an important lesson of what is possible. Investing in health, individual countries have made dramatic economic progress and this will help all of us.  Take a look at this Hans Rosling video and you’ll see why investments in health are, well, a good investment.   Children of all nations deserve a solid foundation to become healthy adults. We have more to do, we need to keep going.

It comes from my attendance at a CME course on vaccines held by Philly’s Children’s Hospital last weekend. I was privileged to hear great presentations and meet fantasic folks. Despite my work in vaccines over several decades in both government and industry, some information was ‘new’ for me, crystallizing issues and controversies in vaccines.   

 Here’s the good news:

Pediatric vaccines continue to prevent suffering, save lives and money. CDC studies show 14 million cases of disease prevented, 33,000 deaths, $9.9 Billion in direct medical costs and $43.4 Billion in savings to society. New vaccines have been added to the schedule. Is that cool or what? When I was in government, companies were leaving vaccines in droves. They’re coming back. Good news.

Rates of underinsurance for children’s vaccines have not increased, despite the new numbers of vaccines (and therefore additional cost for fully immunizing a child). Insurance and Vaccines for Children (VFC) funding is covering kids pretty well.

Pediatricians and their nurses remain unsung heroes, not getting nearly enough credit for the complexity they manage in the number of vaccines and the cost of the inventories they carry, despite the reality that they’re not adequately compensated. They could have long ago abdicated this aspect of a child’s good health. They haven’t. That’s very good news.

Kids aren’t traumatized by having many vaccines administered at once. In fact, research has demonstrated that only the first shot creates the ‘cortisol-raising’ indication of a stress reaction, subsequent shots (sometimes 3-4 others) administered at the same time, don’t.

We’re actually putting fewer antigens into kids today than at any time in history, even though we give many more vaccines! Wow, who knew?! In 1900, the smallpox vaccine had 198 antigens. In 1960, with DTP and polio added, that totaled 3,200 antigens. Today, it’s only 166-169 antigens, in part because we’ve eradicated smallpox and in part because vaccines have been improved. 

Kids – even babies – can handle those vaccines immunologically. Humans develop the capacity to respond to foreign antigens at 14 weeks gestation. There are few foreign antigens present in utero, but babies’ immune systems are challenged right from the moment of birth and have enormous immunologic capacity. And, right from the moment of birth babies can be exposed to the diseases that vaccines prevent. They’re at risk and we need to protect them, when they can be immunized they need to be and when they can’t herd immunity is needed to protect them.

Additives in vaccines aren’t harmful.  Aluminum, the third most abundant element on the earth’s surface, is in the air we breathe, the water we drink and the food we eat. Aluminum in vaccines is less than a baby would receive in breast milk or infant formulas. Except in extremely rare cases of premature and already severely-ill children (who are not candidates for immunization in any case) it does not cause harm.

But there’s bad news:

Dr. Bob’s untested ‘alternative’ vaccine schedule should never have been published. It has never been tested; its impact on providing immunization protection is unknown. It’s not science based, is more likely to induce injection pain and needle phobia and increases the time during which kids are susceptible to vaccine-preventable disease – and that assumes that the schedule works at all to provide protection.

And there’s even more bad news:

Activist celebrities continue to drive unproven fearful claims about vaccine safety – and even disease prevention need – and the media is lovin’ the controversy. As a result, parents are overloaded with confusing, inaccurate information and far too often fear the vaccine more than the disease it prevents.

Activist-created misinformation and fear have made work tougher for Pediatricians. None of them in this meeting threatened to discontinue vaccinating kids, but quite reasonably, some complained about the additional effort. Let’s face their reality, it’s costing them more on several fronts:

• First, it requires extra time for parent education.
• Second, it distracts from other important developmental issues they’d like to address.
• Third, even when parents refuse vaccines for their kids and sign statements acknowledging the risks of disease, some later have the gall to sue the pediatrician when the kid gets sick! Huh?
• Fourth, when an unimmunized kid shows up in the waiting room, they drive up costs and infect others. Here’s the story of one: a family who voluntarily chose not to immunize their child traveled with the child to Switzerland, a country with no immunization requirements and low coverage rates. The child returned with measles and was taken by his mother on errands, including to Whole Foods, and then to the pediatrician’s office for the diagnosis the illness she could not recognize. Since the measles virus contaminates air spaces for 4 hours, this required that the pediatrician track-down every adult and child who had been in the waiting room during that time. Ironically, two infants too young for the MMR vaccine (they were under 18 months) were in the office for a well-baby visit and contracted the disease.

Despite the challenges, there is good news about how the experts are responding to anti-vaccine activists:  

Vaccine information groups are more active than ever. Every Child by Two has an increasingly active response to the anti-vaccine efforts and a good set of communications to parents about the diseases vaccines present at http://www.ecbt.org/parents/diseasevaccine.cfm.

The Immunization Action Coalition continues with its premier sourcing of information to health care professionals at http://www.immunize.org/.

The National Influenza Summit has grown and continues under the able direction of LJ Tan.  

Some pediatric practice groups are getting tougher on non-vaccinator parents. After lots of discussions, they’re asking non-vaccinator parents to find other doctors. A controversial, but I think long-overdue, action.

Hospitals view influenza immunization as a patient safety measure. Some hospitals are requiring influenza immunization for workers. These mandates, done carefully and correctly, are widely accepted as one of the many measures to keep patients safe.

Some ‘vaccinator’ parents are now calling for a ‘right to know’ if the other kids in their child’s classroom have been immunized. 

Surely we could do even better and here are my proposals. The first of these addresses the need to respect rights, which are a part of our national heritage of ethics, laws and regulations: 

Rights of adults, generally. Personally, I respect the rights of any person who decides they don’t want to put a vaccine into their body.

Rights of parents. I also respect the rights of parents who choose not to put vaccines into their children.

Rights of health care workers. I also respect the rights of health care workers who decide they don’t want to put a vaccine into their body.

But with rights, come responsibilities. Hold non-vaccinators responsible. When people voluntarily choose not to vaccinate themselves or parents voluntarily choose not to vaccine their children – that is, when there is no medical contraindication or religious objection – hold them accountable for the outcome.

Some say this can’t be done, but I’m a skeptic on that point. Litigation might not result in a successful result in the first attempts, but it would make for an interesting national discussion – one we’ve not had yet and so far, seem to lack the courage to undertake.

Be responsible adults.  If a voluntarily unimmunized adult brings influenza to the workplace, they should not receive paid sick days and should cover the cost of any temporary workers required to fill their slots. They might also be so gracious as to forgo seeking reimbursement for any care, since the illness might well have been prevented in the first place.

Be responsible parents towards other families. When a parent chooses voluntarily not to immunize their child they should be required to notify other families with whom their children are in regular contact – particularly in day care and school settings. In the event their child transmits the disease to another child, the family on the receiving end should be compensated, at the very least for medical costs and parents’ time off work. If the child suffers one of the many consequences of the disease – deafness in the case of measles, sterility in the case of mumps for boys, or death – additional compensation should be required. 

Be responsible parents towards health care settings. When a voluntarily unimmunized child arrives in a waiting room and health care providers must locate those who were in the waiting room in the same time to assure they are protected, they should be compensated by the nonvaccinator parents. Forther, parents should be precluded from suing physicians when they have signed waivers voluntarily acknowledging the prospect of disease and refusing the vaccine.

Be responsible health care workers. If voluntarily unimmunized health care workers transmit vaccine-preventable disease, at the very least, any additional cost of patient care due to the disease should be covered by the worker’s own resources or by the institution itself if it fails to develop immunization policies.

Like I said, even some of my vaccine buddies won’t like these ideas. They’ll have all kinds of ‘…yeah, but…’ things to say. But how much longer, really, can we afford to pay for the consequences of preventable disease? And before the epidemic of chronic, non-communicable diseases swamps us in costs and sick people, why can’t we get past a ‘rights only approach and sign-on for being more adult and taking some ‘responsibilities’ as well?

Save the Children is addressing this with their “See where the good goes” campaign. Launched in partnership with the Ad Council, the Good Goes campaign aims to mobilize citizen action in the U.S. to help local health workers save more children worldwide by using social media strategies to raise awareness about the importance of local health workers in developing countries.

Every four seconds, a child survives thanks to the basic health care provided by local health workers – such as the ones Save the Children helps train and supply in villages around the world. Frontline local health workers can help children survive threats like newborn complications, pneumonia, diarrhea, malaria and malnutrition every day. Global estimates suggest that we need more than four million more local health care workers in order to save the children – the education and supplies for which quickly add up.

To highlight both the need and benefits of local health workers, the Good Goes campaign provides participants with a chance to actually “See where the good goes” – to see exactly what Save the Children funds provide – as a means of encouraging donations. Save the Children and the Ad Council show  rather than tell website visitors how their donations will improve the condition and quality of life of millions of children, weaving together various social media platforms to paint a more comprehensive picture of how funding improves the living conditions and daily lives of children at all corners of the globe.

The campaign’s website serves as a portal ready to transport visitors to remote corners of the world and allow them to experience firsthand the horrors and hardships of daily life. Personal blogs from local health care workers not only contextualize the experience, but add a visual element as well. The Great Wall of Good Facebook app  demonstrates how many have already pledged their support, and how many more it will take in order to save the children. The Action Center offers additional ways to get involved and make a difference beyond monetary donations. Each different social media platform provides a different viewpoint, a different insight and a different way to get involved. Put them all together and you get a very different kind of awareness/advocacy campaign.

I learned everything I didn’t want to know about the health care system, but I eventually realized that the knowledge I acquired as an advocate is equally critical to health care practitioners if they are to provide quality health care, i.e., the right care the right way at the right time.  Adding the dimension of patient-centered care means care is delivered the way patients need and want it. 

Right now, we are still learning how to advocate for the right care the right way at the right time.  It looks like we’ll have to wait a while to get care the way we need and want it.   

As a parent and a physician, I had to be extra careful in the pediatric health care world.  If I came across as too demanding, I would have been dismissed as a neurotic or helicopter parent.  (I know a couple of physician-parents who were erroneously said to have Munchausen’s Syndrome by proxy.)  If I didn’t advocate, I risked danger.  In every situation, I had to find the fine line between objectivity and subjectivity, to assure myself that I truly was balanced in my approach. 

The problem is that even though most of us know what to advocate for, we are still dealing with human beings in the health care system.  They have pressures and barriers, they have egos, they have feelings – and they have the knowledge.  The art of advocacy is getting health care providers to do the following:

• Provide the best care so the patient achieves and maintains optimal health, and
• Empower patients with the knowledge needed to make informed decisions and self-manage their health and health care. 

The art of advocacy should empower health care providers to practice the art of medicine.

Parent advocates have another equally complex system to tackle: the education system.  After learning about all the various laws, e.g., American with Disabilities Act, Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act, parents have to learn about the culture of their child’s school as well as the county and state educational systems.  Then, parents have to advocate with human beings in the educational system to practice the art of education.

When our children grow up and enter adulthood, all the rules change and we are back at square one again.  The only consistency is that the systems are devoid of supports, and as parents, it is up to us to start over and learn from scratch on how to advocate for young adults with childhood-onset conditions and disabilities.

Don Mathis, a fellow panel member, and CEO Community Action Partnership provided an interesting perspective.  “We’ve watched the obesity numbers for adults more than double over the last three decades.  Why didn’t we realize that it was just a matter of time before we saw the same trend in our children?”  Childhood obesity has tripled over the last 30 years and now stands at 17% of children and adolescents (ages 2-19); the percentage of overweight children is at, or above, 30 percent in 30 states.  Obese children and adolescents are more likely to suffer from high blood pressure, cholesterol, Type 2 diabetes and are more likely to have learning problems.

At the end of last month the CDC released a new report on adult obesity.  The news is “America’s waistline is still growing, or holding steady in some states, but not shrinking at all.”  In other words, we’re still fat.  Thirty-four percent (34%) of us are overweight and another 31% are obese.  If you’re wondering if this includes you, according to the National Institutes of Health “anyone with a body mass index (a ratio between your height and weight) of 25 or above – that’s someone, for example, who is 5-foot-4 and 145 pounds — is considered overweight.  Anyone with a body mass index of 30 or above — such as someone who is 5-foot-6 and 186 pounds — is considered obese.”  You can check out your own BMI using the quick calculators on the CDC or WebMD websites. 

So who’s the fattest?  The CDC Report states “In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women”.  Some good news, however, “The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.”  A 2009 analysis commissioned by Trust for America’s Health and the Robert Wood Johnson Foundation found that “the Baby Boomer generation has a higher rate of obesity compared with previous generations.  As the Baby Boomer generation ages, obesity-related costs to Medicare and Medicaid are likely to grow significantly because of the large number of people in this population and its high rate of obesity.  And, as Baby Boomers become Medicare-eligible, the percentage of obese adults age 65 and older could increase significantly.”

In her June 6, 2010 DW blog Fox TV’s Dr. Archelle Georgiou shared questions from her viewing audience that were especially interesting to her.  Charles, a 5’8” gentleman weighing in at 215 lbs., wrote in for help with his weight problem.  When he received Dr. Georgious’ advice, however, he seemingly took offense (or had a good sense of humor) and asked “So what you’re saying is I’m fat?”  “Yup!”, she replied, then editorialized “I’m amazed at how often people convince themselves that the BMI definitions of overweight and obesity don’t apply to them.”

It is just human nature.  We rationalize things; we deny situations or facts apply to us.  Like tobacco, obesity and inactivity increase the risks for the top three killers: heart disease, cancer and cerebrovascular ailments including strokes. Obesity and inactivity also strongly increase the risk of diabetes, the sixth leading cause of death.  But it won’t happen to me (or Charles)!

I was encouraged by Dr. Georgiou’s advice to Charles: diet, exercise, accountability, and social support.  “Join a program like Weight Watchers if you need to”, she said.  We hear a lot about diet and exercise – from our doctors, the media, and our friends.  We don’t hear enough about the other two:  accountability and social support.  These may be the ingredients we really need in our diets.

Accountable means answerable.  You make a promise; you agree to change your behavior.  You own up.  You commit to yourself.  You encourage friends and family to “keep you honest” and to support you in your efforts.  You find a partner on the same journey and motivate each other (It’s probably how Wilma and Betty stayed so thin with those Brontosaurus-size portions.  They had each other and  an occasional girls’ night out.)   Experts also recommend daily reminders, journaling, or now-a-days blogging and tweeting your goal and progress (although that might still be a little much for some of us) to keep ourselves accountable. 

One thing Dr. Georgiou didn’t mention was incentives or rewards for a job well done.  Whether they’re extrinsic ($25 to get us started with a personal health risk assessment) or just 5 minutes of fun when we meet a small milestone, incentives (motivation) are another necessary ingredient for change

I’m excited to see more and more health programs enjoining us with those in our personal support networks/communities and building in rewards.  I encourage the creators to share innovations and perspective on this blog. 

To help improve things for children with CMCD as they transition into young adults , Physician-Parent Caregivers (PPC), is launching EMERGE–a new campaign  next week…stay tuned…I will be blogging more about that in the coming weeks.  

In the meantime, I would like to introduce a special PPC young adult leader, Amy Long.  Amy is one of America’s 8.2 million amazing young adults with CMCD who push through barrier after barrier and never give up on their dreams.  Amy gave me permission to share her first person account of what it is like to be a young adult with a chronic medical condition.  She calls it, the Google Circus.

GOOGLE Circus

Five years ago, I aged out of my pediatric skeletal dysplasia clinic (a place for kids with bone diseases).   I will never forget my first two adult medicine experiences….The first happened late one Fall evening. 

I was in college dorm my senior year and I woke up  from a late afternoon nap with a terrible headache, flashes of light and floating dots in my vision. I have a rare connective tissue disorder and form of arthritis called Kniest Syndrome that puts me at risk for a detached retina.  The flashes of light and floaters are common symptoms of retina disease.  Retina detachment is only fixable in the first 24 hours. I immediately called Student Health who told me they could get me into see an eye doctor next week.  I tried to explain that I couldn’t wait that long but no one seemed to take me seriously. All the doctors had left for the day. I called a friend and we drove the Emergency department.

We arrive. I spell Kniest no less than 3 times for the tirage nurses. They lead me back to the eye exam room and leave the door open with my chart hanging there. The doctor grabs my chart, starts to come in, looks at my file. His eyes widen and he backs out of the room. Through the open door I watch him try to Google Kiiest Syndrome.  He flips through the links and then finally after five minutes comes back in and sheepishly asks me, “So what exactly is going on?” I tell him, yeah I have a migraine-like headache, and I am seeing stars. I have a collagen disorder that causes high myopia and thus very fragile retinas. “Yes, yes, how exactly do you spell your condition?” I spell Kniest 2 more times.  I then watch him turn around and type Kniest Syndrome into Google.

That night had a happy ending– I had my first migraine, not a retina detachmen,t but I couldn’t help but be terrified of what could have happened had I been really sick and I had not had adult medicine doctors who understood my disease.

A few months later it was time to find a new orthopedist because I had a nagging, worsening hip pain.  This time I had traveled six hours by car with my Mom in tow to go see an expert in adults with arthritis.

The Orthopedics department was brand spanking new and is entire separate wing of the hosptial, Mom and I decided this was a good sign. Mom and I had taken two bets that morning, one, that I would be the youngest patient by 4 decades at least and two that the doctors would have no clue what Kniest was…I lost the first bet in the waiting room, although the majority of the patients were over the 4 decade line, there was a football player who destroyed his knee and a lady about Mom’s age.

I was absolutely shocked when we were called in exactly at our appointment time, seriously Mom and I nearly passed out from shock. This may in fact be the first orthopedist appointment ever that we were actually called back on time. I passed the tech my X-rays and sat down in the consult room. The consult room was conveniently located right across the hall from the X-ray reading room, putting mom and me in front row seats for the circus.

 A crowd began to gather, Mom and I exchanged knowing glances, shoot…Then because the circus needed some PR, one of the white coats, exclaims quite loudly “Holy Moly, would you look at that…” Even more people gathered around my films.  I put my face in my hands. Mom sighed and said “We should sell tickets.”

That was my transition experience.  I was either a circus side show and/or no one had a clue how to care for me. The Google circus was terrifying, frustrating and completely unnecessary.  There is a better way to do transition both for the patients and the doctors.

Today I had a totally different experience . I just moved to a new city and am starting my first job as a pediatric resident (aka intern…aka doctor in training).  Upon moving here I was referred to the Skeletal Dysplasia TRANSITIONAL clinic at the childrens hospital.  I was a little skeptical at first because I had not seen pediatric doctors in five years. Would they treat me like a little kid?  Would they expect me to bring my parents? (who live 500 miles away)  Would they bring in 50 residents/medical students (my colleagues?!?!) to see the new weird case?

I was led to a cheerful exam room with murals and bright colors. But despite the pediatric surroundings I was treated as an adult.  Only one doctor came to see me and he was well versed in my disease both in childhood and in adulthood. My physician spent over an hour with me reviewing my current health concerns, my past history and discussing all the exciting things that go with starting my first real job.  He spoke to me as a partner in my care and encouraged me to participate in coming up with a treatment plan. He helped me line up referrals for orthopedics and an eye doctor in town.  He also helped me come up with a plan to navigate some of the more challenging aspects of my new job.  We came up with an emergency plan if I get hurt or sick so that we make sure I am cared for by doctors who know about my disease and know me.

It wasn’t rocket science, it wasn’t even an act of Congress, what happened today happened because a small group of physicians, parents and young adults in the region have realized that children with CMCD here grow up but rarely do they grow out of their need for specialty care.  For a variety of complicated reasons, adult medicine rarely gets enough training in treating childhood onset diseases much less helping young adults thrive as independent and self sufficient. It takes clinics like the one I visited where pediatric and adult doctors work together to care for young adults with CMCD.  We have a looong way to go before this is the norm but as a patient and as a doctor I am excited about being part of the movement that makes it happen. 

Because no one should have to be a part of the Google circus.

Childhood obesity was the subject of today’s Disruptive Women in Health Care’s Monthly Breakfast Series Childhood Obesity: A Big Fat National Challenge. Childhood obesity has received a great deal of media attention with First Lady Michelle Obama making it one of her platforms. As noted by all of this morning’s speakers her “Let’s Move!” campaign is well laid out and has the potential for success if we all take a role in its implementation.

Gwen Tolbart a Professional Speaker, award winning television broadcaster and moderator of this morning’s event opened with a vibrant description of a disruptive woman in her life who helped shape her views, including ones on childhood obesity.

Don Mathis, President & CEO of the Community Action Partnership discussed the issue on the federal level. He made three important points: obese kids do not do well in school, they have numerous health problems throughout their lives and they cause a national security problem by decreasing the number of individuals physically able to serve in the military. Additionally, he discussed the issue children in low-income areas have accessing healthy food, commonly referred to as food insecurity or more recently, food deserts.

Next, we took the discussion to more of a local level hearing from Diana Long and Aimee Smith, both of whom have been or are involved in the Philadelphia YMCA. The key to solving childhood obesity from their perspective, is small concrete steps. The ultimate goal is to build social values that will create the necessary behavioral changes. One way the Philadelphia Y is doing its part is by giving all seventh graders in Philadelphia a free YMCA membership. By doing this they are trying to catch kids at a point in time when they are impressionable and need the support to make healthy decisions.

Last but most certainly not least, Rainey Friedman discussed the importance of meeting kids where they are, which today is online. She also stressed the importance of making physical activities fun (and subliminally educational). As founder and executive director of the DreamDog Foundation, an organization that targets childhood development through preschool education and literacy, she had great experiences to share on how to accomplish this. One example she offered was when she developed and taught kids a song about the negative consequences of drinking soda. When she went back to meet with those same kids they had mastered the song and a vast majority of them had cut out sodas. Her final message and a good one to close with was: we need less talk and more action to address childhood obesity in the US…LET’S MOVE!

We hope you will join us for the next breakfast meeting, “HEALTH 2.0: User-Generated Health Care,” June 8, 2010 from 7:30 a.m.-9 a.m. in the Rayburn House Office Building. If you are interested in attending, please register here: www.disruptivewomen.net/breakfastseries. Men are welcome, encouraged even, to attend. We doubled the number of men, so come on, you know you want to.

Don Mathis put it this way: would you rather be in a room with boring men pontificating or in a room full of Disruptive Women in Health Care.

“Zoe, WHAT are you talking about?” I asked. “Cruises aren’t a holiday.”
“Yes they are mom. We do it every year. It’s a tradition!”

The reflex was to correct her. But, I realized that I was the one who had literally and figuratively missed the boat. I was boxed in to the traditional definition of “holiday” as a religious, cultural or national event. However, Zoe, with her seven years of wisdom, freely interpreted “holidays” as those times when we predictably spend dedicated time together as a family. To her, it is about the experience…not the calendar. Needless to say, she turned in her homework assignment with the pictures she originally selected.

The interaction was an important reminder: words take on the meaning we assign to them.

So, I started thinking about other words that are chock full of boundaries like…”family.”

What is family? The Latin term “familia” means household. The first entry in Webster’s Dictionary says family is “a group of individuals living under one roof and usually under one head.”  The Census Bureau defines family as “two or more persons, including the householder, who are related by birth, marriage, or adoption, and who live together as one household.”

Until we leave home in early adulthood, our family–particularly parents and siblings–is our most important and reliable source of guidance, love, and protection.  Ideally, our birth family continues to be a source of strength and support for us even as we marry, have our own children, and live under a different roof with our new family.  Unfortunately, all too often, the dynamics with our parents are stressful and sibling rivalry re-surfaces. Nevertheless, we generally make great efforts and sacrifices to maintain a connection with the family we grew up with.  We forgive, we tolerate, we turn the other cheek, and we try hard to make it work. It’s important.

But why? Why is it important to maintain relationships with parents and siblings? I have asked this question of others and myself over the last year. I couldn’t arrive at a logical answer on my own and kept getting answers from others that seemed superficial:
“Because they are family!” Circular logic. Doesn’t fly.
“Because blood is thicker than water.” Sorry. Last I checked, parents and siblings don’t share a common vascular system.
“Because you can’t divorce your family.” A bit irrelevant. You can’t get divorced if you never married them.

It was Laura Engler’s response that finally made sense to me:
“Archelle, staying connected to family is important because you have shared history. They are the only people who don’t need an explanation for a quirk, a family ritual, or an inside joke. They just know.”

I got it. Family = those individuals with whom we grow, develop memories, and have trust.  If we give ourselves the freedom to transcend the boundaries of the etymologic or legal definitions of “family,” then we realize that our dearest friends…are truly family. What a gift! At the same time, blood relatives with whom we no longer have memories, trust, or love…are not. While this perspective may be hard to swallow, accepting and understanding it offers peace and consolation when lifelong bonds are permanently fractured.

This of course leads to more questions: What are the definitions of friend, trust, and love. What about hope, peace, and life? Their meaning is important and very personal to you. Don’t  passively rely on traditional norms or Webster’s Dictionary. Take the time to remember your experiences around these words. Then, give yourself permission to think and act like a 7 year old who is old enough to be observant and thoughtful while young enough to see the world through a fresh new lens.

Create Health,
Archelle

This blog entry was originally posted in Archelle On Health on May 21, 2010.

In fact, I just finished reading a unique recount of the measles vaccine controversy. Something that wasn’t a paper at all, but a comic strip type account that said it all. I highly you encourage to read this. For those of you not familiar with the Andrew Wakefield measles saga, the British doctor claimed the administration of MMR vaccine was linked to autism.

The media was all over this and picked it up everywhere. Unfortunately, despite a lack of evidence to support his claims, co-authors who later removed their names claiming the study was flawed and a retraction from the Lancet in Feb 2010 after the General Medical Council in the UK found his conduct “dishonest and irresponsible” (more than a decade later), the damage was done and continues to be felt. Fueled by sensationalist media reports, many parents in the UK and around the world chose not to vaccinate their children and outbreaks of measles began to occur. The misinformation was further propagated by celebrities who get more TV coverage than the scientists who have shown through studies that there is no link between autism and vaccines.

Every adult has the right to consider what is best for themselves or their child. But shouldn’t more be done to consider the impact of disregarding the evidence has on others? There will always be risks with vaccines and science can’t always find or predict every risk. The experience with measles vaccines and the supposed link with autism shows that there also health consequences when individuals refuse to accept the findings of rigorous research.