Browsing Tag

Ethics

Failure to Plan Parenthood in Texas

By March 1, 2016 2 Comments
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 The other day, I had a craving for coconut ice cream.

Stick with me here (and no, I’m not pregnant–this was just a garden variety gluttony)

I was dying for it, and in a stroke of luck I didn’t have to rush home to my kids that day, I had the chance to fully indulge myself. Of course, now that I had the opportunity to indulge, I went to four different stores looking for some and then I finally gave up. I had the motivation to drive all over creation to find it, the time and the ability to seek it out, and the money to pay for it once I found it but I STILL couldn’t get what I wanted when I wanted it.

That’s just life sometimes, and as a mother I’ve realized that’s life more often than not. But my great unfulfilled quest to find coconut ice cream made me think of a study I’d just read in the New England Journal of Medicine. Yes, I know. When you work in public health your brain never shuts off about this stuff.

Heading home without my ice cream was no big deal, but what if I’d been looking for something else instead. The only impact of me not getting my ice cream was that I was disappointed and Haagen-Dazs lost a sale. But what if I’d been looking for something of life-changing importance and I wasn’t able to get it? Let’s imagine we’re talking about birth control.

I know this seems like a stretch, but like I said, stick with me here.

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

Can Bleach, Turpentine or Miracle Mineral Solution Cure Childhood Ailments?

By February 16, 2016 4 Comments
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Would you ever consider swallowing bleach or turpentine? What about giving yourself an enema with bleach? To most of us this sounds horrible, but a small group of well-meaning but terribly misguided parents is choosing to feed their children these toxic substances in hopes of curing everything from the common cold to autism.

While small amounts of bleach can get your white clothes white, and turpentine can strip paint and varnish off furniture, no adult or child should ever ingest either of these substances in any form. As a pediatrician and a parent I can’t imagine ever feeding my child or a patient bleach or turpentine. I’ve struggled to understand why any loving parent would ever feed them to their children.

What’s most concerning about this trend for me is that parents are doing this because they believe bleach or turpentine will cure their children.  In addition many parents mistake the signs of significant damage (chemical burns, shedding of the intestinal lining, lethargy etc…) as signs that the bleach and turpentine are effectively ridding their child’s body of ‘toxins’. In fact it’s just the opposite.

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Categories: Accidents, Injuries, + Abuse, Disability + Disability Advocacy, Science 101 + Mythbusting

Family Nudity Is All About Comfort Level, NOT Sexuality

By February 15, 2016 1 Comment
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Celebrity blogger Perez Hilton caused an online uproar back in October after he posted a partially obstructed picture of himself in the shower with his 2 year old son on Instagram, which you can see to the right. Comments and concerns raised by this situation ranged from positive and supportive of bathing with own’s own small children to outraged and accusations of child abuse. So, what is the “right” answer?

When parents ask me how to address nudity, I usually ask them to reflect on their own levels of comfort with nudity. The general rule with respect to parents’ and children’s nudity is that everyone needs to be comfortable with how much is bared. In particular, it is very important that parents agree on how much nudity they are comfortable with showing in front of their children. If parents have very different views about their comfort levels, I advise families to err on the side of modesty. That way no one feels uncomfortable.

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Categories: Ages + Stages, Mental, Emotional, + Behavioral Health, School-Aged Children, Toddlers + Preschoolers, Tweens + Teens

Ladies, Don’t Drink and Don’t Have Babies: When Public Health Messaging Fails

By and February 8, 2016 1 Comment
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We strive to be evidence-based communicators here at The Scientific Parent, and sometimes we collectively wring our hands at public health messaging by our counterparts at other organizations. After all, the public health nerd core tends to be made up of nerds, and while we love nerds (seeing as how we consider ourselves members of that tribe), sometimes nerds can get lost in health data and forget that it doesn’t exist in a vacuum. Data may be objective in the eyes of researchers and statisticians, but in the real world and life, those numbers have context.

That’s why over the last two weeks we’ve found ourselves squirming over recent public health campaigns. For example: common sense would suggest that telling women in Texas to simply not get pregnant due to the threat of catching the Zika virus is utterly unhelpful. First, because of the lack of universal access to free contraceptives for both sexes, and also because the messaging places an undue burden on women with no equivalent advisory (i.e.: ‘don’t get anyone pregnant’) for men. Also, family planning and expansion usually doesn’t stop because viral outbreaks, as public health officials in every other country on the planet can tell you (including those in Brazil who are seeing women avoid mosquitos that carry Zika, not pregnancy).

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

My Son Deserves to See His Fourth Birthday

By February 3, 2016 5 Comments
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A few days ago a plea I made on Facebook for my son’s life went viral. As of today it’s been shared over 6,000 times, but still I worry my plea has been unheard.

My son, my precious two year old Atticus, is fighting a form of childhood cancer called Acute Lymphoblastic Leukemia (ALL), right now. Except for the cancer and his treatment he’s like every other two-year-old. He loves dinosaurs, silly jokes, his dog, his five-year-old sister and did I mention dinosaurs? Atticus is a hefty, strong kid – I have never had to put a band-aid on him, he’d never had an ear infection, never had a fever, never threw up, he was literally never sick a day in his life until he got cancer.

His type of leukemia, ALL, is the most common, most researched childhood cancer, yet it cannot be predicted or prevented, only treated. Everyone who has ever met my AtticusterMan is always amazed at just how happy he is. His baseline for existing is just to see the world as all sunshine and rainbows, and I have done my best to keep that for him. He actually loves broccoli, but the chemo has killed off most of his taste buds, so right now, nothing except super strongly flavored food tastes like anything to him. So we do what we can to get him to eat.

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Categories: Ages + Stages, Chronic Illnesses + Conditions, Infectious Disease + Vaccines, Newborns + Infants, Toddlers + Preschoolers

“My Kids Aren’t Guinea Pigs,” Says Parent Affected By Porter Ranch Gas Leak

By January 4, 2016 4 Comments
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A brave parent stepped forward to talk to The Scientific Parent about the Porter Ranch gas leak, and asked that he remain anonymous, for fear of retaliation against his family. Here is his story.

I am part of one of the 3,000 families displaced by the Southern California Gas Company (SoCalGas) leak in Porter Ranch, but I consider my family lucky, because we’re finally safe. The latest reports say that an additional 3,000 more families are waiting to leave the area, and are still living in a zone that’s being called the biggest environmental disaster since the BP oil spill. Notice I say leave, not evacuate. I’ll get back to that.

On Oct 23, 2015, SoCalGas announced that their Aliso Canyon Storage Facility was leaking a combination of methane and mercaptan gases into my community, which is in Los Angeles, California. Methane is a natural gas. Mercaptan is the chemical the gas companies add to make it smell so people are warned when there’s a gas leak in their home.

At the time, they said the leak shouldn’t affect us, and at that point we didn’t know that symptoms of exposure to those gases are headaches, dizziness, weakness, nausea, vomiting, and loss of coordination. If we had, we would have realized that my family had been experiencing these symptoms for some time.

For weeks, our 3-and-a-half-year-old son, was lethargic and didn’t have his usual energy to do things. What normal three year old isn’t constantly running around and into things? My wife was complaining about nausea, and that her breathing was short and challenging. I had headaches every day when I came home from work. We never thought any of those things were related.

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Categories: Accidents, Injuries, + Abuse, Policy, Politics, + Pop Health

How I Got H1N1 (the “Swine Flu”) and Changed My Mind About Vaccines  

By December 7, 2015 1 Comment
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About 10 years ago I thought vaccines caused autism. I didn’t believe this fallacy with any fervor or passion – in fact, I hadn’t researched it any sense of the word.  It was just something I’d picked up from what I call background noise, the kind of passive media consumption we all tend to do in this super-technical world we live in.

Then I was hospitalized with a vaccine preventable disease  – and I suddenly cared a lot about vaccines, autism and how one person’s decisions can impact a community.

I was in my mid-20s when it happened. I didn’t have any kids or plans for kids in my immediate future, so vaccines and autism were not things at the forefront of my mind. I’d had all my shots as a kid, I got an annual flu shot, but that was about as far as I went when it came to vaccinations.

It was during the height of the H1N1 media hysteria (or the “swine flu,” as it was dubbed, based on its common animal host) when my husband and I attended a party with some friends.  I was 27 and despite the excessive media coverage, catching that virus wasn’t something I was concerned about.  I was young and healthy with no major medical issues.  If I got it, I figured, it would just be a bad flu, and I’d survive. I was above the media hype.

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Categories: Faith + Beliefs, Infectious Disease + Vaccines, Science 101 + Mythbusting

Is Your Pediatrician on Big Pharma’s Payroll?

By August 4, 2015 4 Comments
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Kid and Doc

Pediatricians are some of the lowest paid physicians

Have you ever wondered how your pediatrician gets paid? It’s probably not something you spend a ton of time thinking about, however, there are some people who claim that every time a doctor writes a prescription or delivers a vaccine that they are paid by a pharmaceutical company to do so. Well, I am a pediatrician and I’m here to set the record straight.

Pediatrics isn’t a lucrative specialty

Before we can talk about how much your doctor makes and where that money comes from, we need to talk about what it cost them to become a doctor in the first place, because it has a big impact on how many of you may view pediatricians and their relationship to profit in general.

On average, 4 years of medical school costs over $200,000 and the average medical student graduates with $180,000 in student loan debt. After graduation, prospective pediatricians train in a 3-year residency program (pediatric specialty training) with an average salary during these years of about $55,000 per year, depending on location. Even with a 20-year loan repayment plan, the monthly payment on the loan would be $1,374, or more than half of a resident’s take-home salary. For this reason many pediatric residents put off paying their loans until they have their first job. While a resident doesn’t have to make payments during those three years of deferment, their loans still collect interest. That makes the $180,000 in student loans compound to a total of approximately $217,430 when the former-resident-turned-doctor gets their first job, and begins making payments on them.

Why is this relevant?

Next to family and general practice, pediatrics are the lowest paid medical specialty a clinician could choose to pursue. Pediatricians graduate with a massive amount of student debt and their salary makes it difficult for them to pay it off. The typical starting salary for a pediatrician may be $130,000-150,000 depending on their location. Therefore, their monthly student loan repayment for 10 years would be 30% of their monthly income, or 15% over 20 years.

If pediatricians were in it for the money, they would have chosen much more lucrative specialties. Those who choose pediatrics are not doing it for the money but are doing it because they generally love to care for children and their families. That takes gets us full circle to the point of how physicians, pediatricians specifically, get paid.

Doctors are paid by their employers, who are paid by insurance companies, not pharmaceutical companies

There are many options for career paths once out of their 3-year residency, and each of them will have an impact on how much money a physician will take home. For example, one can choose to work for a hospital, a large multi-specialty group, or a small practice, and each of these have a different baseline for overhead costs, all which come before the pediatrician’s paycheck. As the process goes, doctors see patients, and based on the time and complexity of the care that they provide, they submit a corresponding bill for that care to a patient’s insurance company. The insurance company then pays the doctor’s employer for an accepted cost of care, usually negotiated between the two sides. From that amount, once overhead costs and staff are paid, the employer, whether it is a hospital or small practice, then pays the doctor. None of that process includes income from a pharmaceutical company.

It’s actually an infrequent occurrence to have money flow directly from a pharmaceutical company to a physician. Scenarios where this may occur is one where a physician may decide to be an expert speaker for a pharmaceutical company and be paid for speaking engagements. Alternately, some physicians choose to do research with a pharmaceutical company, and that position would also likely be paid. However, this can not be stated enough, the vast majority of pediatricians seeing patients on a day-to-day basis do not receive direct compensation by any drug company.

Every conspiracy starts somewhere – and this one is linked to the “Big Pharma” myth

So where is this conspiracy theory coming from?

Distrust of the medical establishment and fear of modern medicine (vaccines first and foremost) is too large a topic to discuss here. However, I believe this is how it started. Accusing a doctor of being paid by “Big Pharma” is an attack on the doctor when no other substantive evidence is available to support an allegation or claim of bias. For example, if a pediatrician defends the safety and efficacy of vaccines to someone who is anti-vaccine, they may be accused of being in the pockets of the companies that produce or distribute the vaccines. These claims are not supported by scientific fact or logic (i.e. fiscally responsible behavior), since purchasing and storing vaccines is such an expensive undertaking that many small practices lose money by offering them at all.

Concerned? Ethics check: does your physician sell medications direct?

Concerned? Ethics check: does your physician sell medications direct?

Of course, in the past, there was an indirect incentive for physicians to recommend certain medications from pharmaceutical companies. Prior to appropriate legislative action, physicians were offered elaborate vacations and dinners by certain pharmaceutical companies in the hopes that these doctors would recommend a certain drug over another. However, this has dramatically changed in the past several years through legislation. It is now illegal to try to influence physicians with gifts, including those once-famous pens so many of us might remember in our doctors’ offices years ago. In my company, we rarely see representatives from pharmaceutical companies and we have a policy against free lunches. Many residency programs have the same policy, and many hospitals and clinics ban solicitations of that nature entirely.

Doctors choose the most appropriate medicine for an illness or injury given the circumstances

Making decisions about which medication to use for a given illness is complicated. Antibiotic recommendations are made based on what is most certain to kill the bacteria most likely to be the cause of an infection. For other conditions, scientists develop medicines based upon the known cause of a condition. Yes, this typically gets done at a pharmaceutical company, but that is because they have the money to do so. In fact, anyone who is independently wealthy and wants to hire scientists to develop medications is free to do so!  Once a medication has been developed and studied, it doesn’t simply enter the free market – the company must go through a rigorous FDA approval process. Even after several tiers of studies are completed and FDA approval is set, doctors still rely on large panels of experts to look at all of the available evidence to decide if a medication should be recommended or not (some of this is what we reference as “peer reviewed” studies).

So when a doctor is examining a patient and needs to treat a condition, he/she considers the patient’s needs and ability to comply with their recommendations, the latest medical guidelines for that condition, and then considers the patient’s medication options, including a treatments’s effectiveness, its side effect profile and most importantly, insurance coverage for that treatment. Frequently, in pediatrics the generic version of a medication is what is typically covered. Therefore, the expensive brand name medications advertised by pharmaceutical companies on TV and on the internet are rarely prescribed as they’re much less frequently covered or accessible to these patients.

On a final note, if you are worried about a doctor profiting off of prescribed treatments, you may want to consider how you’re being provided those treatments. Is it coming from a pharmacy, in the hospital or at your local store? You have little to nothing to be concerned about in terms of doctor bias. However, i your doctor selling directly to you? If they are, you may want to dig deeper. This could be a red flag. Who profits if you see an alternate practitioner who sells you herbs, supplements or homeopathic remedies, which are not proven to be safe or effective? Probably that practitioner. That’s what we call a conflict of interest in the care of a patient, and there is an ethical code that MDs and DOs are held to that do not violate that extra layer of protection.

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Categories: Science 101 + Mythbusting