Saturday, September 18, 2010

I Like Bacon

Disclaimer: I like bacon. And steak and chicken.

But I don't like antibiotic-resistant bacteria.

It's no secret that the reason US livestock producers can raise thousands of animals in close confinement is because they use antibiotics not to treat, but to prevent infections in animals. This means every animal receives antibiotics at certain ages as a matter of course. It also means that when bacteria ultimately learn how to survive in those conditions - and they always do - that they are resistant to the antibiotics that include many that humans use. And that spells trouble not only for the herds of animals but for humans who come in contact with the resistant microbes in their meat.

From a recent NYT article that outlines the issue and talks about possible enhanced regulations on livestock antibiotic use: 
"In a letter to Congress in July, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, cited “compelling evidence” of a “clear link between antibiotic use in animals and antibiotic resistance in humans.”"

I understand the food economics argument, that the use of antibiotics keeps the price per animal down, which translates into cheap food to feed our citizens. But I also understand that Americans eat too much fatty food - and that includes bacon and hamburger. Maybe a small increase in price would encourage smaller portions, or meals without meat as a centerpiece, or more consumption of plant-based foods.

And I understand the commodity argument, that livestock growers make a slim profit per animal and that profit would be reduced if they could not use antibiotics in the current way. But it sounds as if Denmark farmers - who produce most of Europe's pork - have found ways to keep their animals healthy without antibiotics. Here is testimony given by a representative of the Danish Veterinary and Food Administration explaining their success.

I think limiting or eliminating the use of prophylactic antibiotics in animals is a step in the right direction. We have a decent model provided by our Danish friends, let's follow it.


Thursday, September 16, 2010

Mean People Suck

When my oldest son was beginning to take swim lessons, around age 4, we took the advice of many preschool moms and enrolled him with Miss B, a tough older woman with a large pool outside of her magnificent house on the banks of the Chattahoochee River here in Atlanta. We had heard about her tough-love approach to teaching swim lessons, so I was somewhat prepared for a no-nonsense, let's-do-this attitude. That's fine. I'm from the Midwest where no-nonsense is practically a middle name. But instead of the  familiarity of "my people," we found ourselves unexpectedly thrust into a foreign land of ridicule, abuse, and actually some danger. That's because Miss B's approach to teaching a shy, cautious child to swim boiled down pulling him into the deep end of the pool and then letting him go to find his own way to the side. She sidestroked alongside him, far enough away that he couldn't reach out to her, but close enough to barrage him with negative comments along the lines of "don't be a baby," and "big boys learn to swim."

When my son reached the side, crawled out of the pool, and then collapsed into a puddle of shrieking goo on the pool deck, she clasped her hands together, looked toward the sky, and said, "Please God, give me patience to deal with this child."

It happened so quickly that I was in shock. One minute, a sunny day, a swim lesson, a grandmotherly person. In my memory I can hear birds. See clouds. Admire the green of the trees lining the river. The next minute, my heart is pounding and I'm running to the side of the pool (she requested that parents stay away from the pool during lessons - warning!), this old lady is sarcastically praying, and my son is a mess. Ten years later, my feelings can still race from from serene to murderous just thinking about that day.

Needless to say, one "lesson" was all we took from her. But over the years I've been raising kids, I've seen more than one Miss B - nurses who are impatient, doctors who want preschoolers to "man up" and not be scared of shots, teachers who think the best way to learn is to sit down, shut up, and finish that work sheet. I've always wondered why these people wanted to work with children in the first place.

They seem especially crazy (and mean) when you run into professionals who really "get" working with kids.  Since the Miss B episode, our family has been fortunate to experience many gifted professionals who put the kids first. One first grade teacher I especially loved would simply open the door to her classroom, which was next to the playground, and shoo the kids outside when the wiggles got to be too much. A quick 10-minute expenditure of energy and the kids could resume the day's schedule with appropriate focus. Imagine that. Letting kids play. I also fondly remember an upper-GI specialist singing "drink chugalug, chugalug, chugalug" in order to help my son down the nasty drink that would provide contrast to the x-ray he was having of his throat and esophagus. There are good eggs out there.

So we've experienced bad, and we've experience good. But my kids are neurotypical and can bounce back from the bad (as long as it is an isolated incident) without losing a lot of traction. We still talk about how crazy Miss B was, but the following summer, my son willingly took swim lessons and ended up being a wonderful swimmer.

Parents of kids with autism can't be guaranteed of such a benign outcome. A bad run-in with a doctor may mean it is almost impossible to get the kid in the door the next time - a dire situation when a broken bone, cut hand or other medical emergency requires quick action. An impatient dentist could mean saying bye-bye to dental care for years. It takes a PhD in empathy on top of whatever other professional degree the person has to provide care or instruction to kids who live on the edge of fight or flight.

An Atlanta mom, who has a son with an autism diagnosis, has experienced her fair share of knuckleheaded doctors. Fortunately, she found an angel of a dentist, whose approach to working with  children with special needs should be taught in medical, dental, nursing, education, any school that is turning out professionals who will work with people. Here is her blog posting explaining what makes a good health professional for kids with special needs. She also has an example of a bad doctor visit a few entries earlier. Compare and contrast, if you will.

So for the Miss Bs, the bad doctors, the grumpy teachers, I say, find something else to do. You're doing more harm than good. But for those good ones, well, I hope you know how special you are.


Sunday, September 12, 2010

Tell me it ain't so

Please tell me that it is not novel for doctors to send unusual cases that stump them around to their colleagues, and their colleagues' colleagues, via online networks.

From the Diagnosis column in today's NYT Magazine: "If he was the second opinion, then the patient clearly needed a third. Suddenly Schumann had an idea. What if they opened the mystery of his symptoms to other doctors? What if they put his case on the Internet — on a blog read mostly by doctors — and let some new eyes and brains work on this problem? The patient was excited by the idea."

Hello, medical profession? There's this new thing called the Internet. We think you'll like it.

Friday, September 10, 2010

More Research is Needed

Yesterday, the details of the US government's settlement with a family whose daughter has an autism diagnosis became public. Hannah Poling had been developing normally, but began regressing after receiving multiple childhood vaccines during her 18-month-old check up. The Vaccine Injury Compensation Program found Hannah's case credible in 2008 and yesterday released the details of the monetary settlement.

The emergence of these details has many saying vaccines cause autism. It's doubtful that is true. What is true, however, is that kids are not genetically identical to each other and often have underlying sensitivities that are exacerbated by vaccines or other environmental factors, such as pollution or food dyes or gluten. 

By admitting that vaccines may have triggered Hannah Poling's autism because of her mitochondrial disorder, the US government raised a larger issue: If autism can result from vaccines + mitochondrial disorders, why aren't kids tested for such mitochondrial problems before vaccines are given? If such knowledge was available, parents and pediatricians could assess whether the risk of significant childhood disease outweighs the risk of vaccinating against it.

Admittedly, mitochondrial disorders are rare. Some estimates note that approximately only 4,000 infants are born each year with them (out of over 4 million babies born each year in the US). But those are the most severe cases, where the physical manifestations of mitochondrial disorders, e.g., eye or respiratory problems, delayed development, etc., are present. What about mild cases that may go unnoticed until later in life, when diseases such as Parkinson's disease, Alzheimer's disease, or cancer develop?

Mitochondrial issues are not something that are routinely tested for. But can they be? Anything that might address the epidemic of autism should be explored. Never forget that the United States government exists to work for us. Let your Congressional representatives know that you encourage research into mitochondrial diseases so that s/he can influence the National Institutes of Health's research agenda.

Don't know who your Congressional reps are? Go here to find out.

The Foundation for Mitochondrial Medicine  supports research and therapies for mitochondrial disorders.

Here is the CBS News Report on the Poling family.

The Poling family opened the door for the rest of the country. Let's build on what they started.