Parenting Solved

Pediatric Grand Rounds - January 13, 2007

After doping up on fruitcake over the past few weeks the blogosphere finally seems back in sync for this first PGR of 2007. What was lacking in the quantity of submissions was made up in quality. I want to thank everyone who participated.

In the category of heady stuff is Phillip Gordon’s post in Tales from the Womb, Ashley X and the Red Flag of Eugenics. For those of you unfamiliar with the case, Ashley X is a child in the Seattle area who has undergone removal of her uterus and breast buds in order to stave off growth and the development of secondary sexual characteristics. This is clearly the stuff that medical ethicists thrive on and Dr. Gordon gives us a great jumping off point. If you’re interested in black and white jpegs of the original authors (suitable for framing) of this case as well as their personal attributes, you can check out his follow up post.

Perhaps the most thought provoking post in the pediatric blogosphere is Malaria from Neonatal Doc. He takes on the issue of worldwide allocation of resources by comparing the cost of resuscitating one preemie with that of widespread malaria prevention. Neonatal doc is your destination if you like clean, solid writing. And speaking of a great voice, check out Signout. I particularly liked Behavior that Persists.

Breath Spa for Kids has posted on the use of alternative and complementary medicine on the other side of the pond. In Homeopathy and Herbalism on the NHS Shinga covers a recent paper from the British Journal of Pharmacology that found that among all ages, patients under 12 months are among the most likely to receive herbal or homeopathic therapy in Scotland. This is really good or really bad depending how you look at it.

Sandy Szwarc at Junkfood Science takes on the misconceptions about healthcare costs in chubby children in Fat Children Burdens. Her embedded discussion concerning the myth of cholesterol screening in kids is right on (note to self: be sure to post on the lunacy of cholesterol screening in healthy kids). And while I thought mercury thermometers went out with the hula hoop, we’re reminded that this isn’t quite the case. Sandy’s post, Does the World Have a Fever, cites thermometer mercury as the latest source of public health hysteria. While reading this one I was preoccupied with the thought, “where the Sam Hill did she dig up these articles?”

Over the past two weeks I’ve have the charge of covering the inpatient transplant service at Texas Children’s Hospital in Houston. For me it’s been quite easy to wrap myself in the numbers and levels that represent my patients. Moreena in The Wait and The Wonder shakes me from it all with her stark view from the other side titled, Interstitial. When I hear criticism of the blogosphere all I have to do is read posts like this to feel the power of one voice. As recent as 10 years ago voices like this were sequestered quietly in their hospital rooms.

If my issue this week was iron in formula, Master Flea’s was antibiotic abuse and its consequences. In Another Source of Irritation his controlled mini-rant exposes the nasty habit of using superdrugs when they’re not necessary. Apparently the makers of those superdrugs aren’t sending Flea the proper reps. And this week Flea introduced me to a new blog, Just Practicing. It’s a candid look inside a small practice on the recovering Mississippi Gulf Coast.

And I wasn’t sure whether to be frightened or amused when I received an email this week from a patient who had visited my blog but only wanted to know about Flea. Who is he? Were we med school buddies and what did I know about him? She never asked about me and Parenting Solved. Must be the bad boy picture and the guitar.

If you love words and language like I do, don’t miss Blog MD's Cancer Slang. You’ll find a primer on the linguistics of oncology. This is well done and deserving of more attention. And by the way, my favorite language blog happens to be Away With Words. Not medical, just fun if you like to think about the way we communicate.

Left for dead in late 2006, Clark Bartram is back and bigger than ever in 2007 with PGR’s first ever post on the sebaceous nevus in Revenge of the Not So Normal Nursery. The photo in the post is from either a senior citizen or a baby with aggressive progeria syndrome - you be the judge. While I might have expected Clark to have written Google – Where Antiimmunization Pseudoscience Reigns, it comes from from Medgadget. This edgy post suggests that Google searches on the topic of vaccinations may be biased against immunization. Perhaps the spiders pick up on the fanatics who seek to read only what they already believe? Speaking of vaccinations, I’m going to order this book on Amazon: Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver. The blog looks great. For a quick summary of the AAP’s new vaccine recommendations take a peek at Pediatrics Info.

It’s a true sign of the times when parents themselves post on the merits and misconceptions of allergy testing. This is what you’ll find at the Purple Puzzle Place in Allergy Diagnosis and Testing. Now this is what I call parental empowerment. If you still keep up with the MSM, The Epidemic of Diagnoses essay found in the New York Times brought comments from Flea and Diseaseproof. Check it out.

I want to thank Shinga for providing valuable tips this week. Pediatric Grand Rounds for January 28th is Clark Bartram at Unintelligent Design. Check his site continuously for updates on deadlines, etc.

Mead Johnson Discontinues Low Iron Formula

In a memo to health care providers, Mead Johnson Nutritionals announced yesterday that low iron preparations of Enfamil Lipil are being discontinued. While the company’s formal release doesn’t suggest when we’ll see low iron Enfamil disappear from store shelves, the word on the street seems to be that this will occur sometime in the late spring.

Mead Johnson Nutritionals should be commended for setting a new standard for infant nutrition. For too long the voodoo practice of attributing constipation to normal concentrations of iron in infant formula has driven the market for these inappropriate formulas. Hopefully Ross Nutritionals (makers of Similac) will follow the example set by Mead Johnson and make low iron formulas a thing of the past.

For a more detailed review of why low iron formulas are risky, check out my post, Low Iron Formula – Bad for Babies.

Postpartum Illegal Aliens Gone Wild

Every year Toys R Us honors America’s firstborn baby with a $25,000 bond a brief encounter with fame. The requirements of the sweepstakes, however, stipulate that eligible mothers must be legal residents of the United States. As it turns out, one of this year’s first babies was born to a mother who was not a legal resident. The award went to a runner-up from Gainesville, GA. The disgruntled parents who did not qualify for the contest have won the support of some prominent community leaders who have embarked on a email campaign to smear the Toys R Us brand. You can read the sordid tale in today’s New York Times.

Toys R Us and its Babies R Us stores do a remarkable job of contributing to the community irrespective of race, color creed or immigration status. As an example, their Expectant Parent Seminars available at stores nationwide provide valuable education on such topics as breastfeeding and infant safety at no cost to young parents. It’s unfortunate that those with such disregard for the law are trying to change the rules and consciously soil the reputation of a company trying to give something back.

Is There an Epidemic of Diagnoses?

I caught wind of the NYT piece, Epidemic of Diagnosis via Flea’s blog. The article suggests that we’re all suffering from an epidemic of diagnoses, or medicalization.

The phenomenon of medicalization is a complicated derivative of the advancement of medical science. The more we know the more we seek to explain. For example, the exquisite detail now available with imaging technology has uncovered deviations and differences that were never known to exist. Genetic advances have changed how we define one another. Some women with inexplicable infertility we’re once left to believe that to be childless was their fate. Mild forms of cystic fibrosis are now known to explain why some of women can’t bear children.

And no discussion of medicalization in children would be complete without the mention of colic. Perhaps the original diagnosis of infancy, its description has served as the disease of choice in babies with unexplainable irritability. With advances in our understanding of the infant digestive system and the variability of newborn temperament, this description-cum-diagnosis is slowly going the way of leeches and thymus irradiation.

While the NYT piece would have us believe that it was this generation of physicians that invented the cockamamie diagnosis, a review of any 19th century medical textbook proves otherwise. The concept of a diagnosis is one way that we define deviations in our own physiology. And as technology advances we will continue, for better or worse, to define ourselves.

Pediatric Grand Rounds 2007

I'm pleased to be hosting the year's first PGR extravaganza on January 13. Let's aim for a deadline of 1700ish central time, that's 2300ish GMT on January 12th, shall we? I'm not so good with arithmetic so if my international conversions are off, email me or notify my attorney.

Submit material to fox42 AT mac dot com. I'm looking forward to seeing the best that everyone has to offer in the new year.