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Do Dogs and Cats Pose a Health Risk to Infants and Children?

By August 17, 2015 1 Comment
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This post is in response to a question from TheScientificParent.org reader, Melissa. 

 

In the age of helicopter parents, it’s practically expected that moms and dads will move mountains, part seas and do pretty much anything humanly possible to protect their little ones. Preventing common illnesses like colds, flus, and infections is no exception, so it makes sense that some parents are wary around potential “germ hubs” like animals or other children. However, when it comes to household pets, shielding your child from dirt and dander from dogs and cats isn’t doing him or her any favors.

While it is true that dogs and cats are generally considered dirtier than humans because of their exposure to unsanitary floors and the great outdoors, their presence actually helps young children stay healthier during childhood and develop fewer allergies as adults. A large body of research suggests that this protective effect may be due to early exposure to the various bacteria carried by dogs and cats. Exposing young children to these bacteria early in life helps prime and train their immune systems early so that they’re stronger and better able to resist illness and allergies down the road.

To determine the correlation between family pets and childhood illness, Finnish researchers asked a group of parents to record health information about their children during their first year of life. The researchers found that compared to kids in pet-free homes, kids in homes with dogs had fewer respiratory tract infections, were less likely to develop ear infections, and needed fewer treatments of antibiotics. The study’s lead scientist explained that this might be because of exposure to dirt brought inside by dogs – especially because they found that children saw the greatest health benefit where the family dogs spent a good deal of time outside.

This positive health effect could also be because of the microbiome hypothesis, which states that early-life exposure to a variety of good microbes improves the immune system, by altering the microbes in the intestine to protect against allergies and infections.

Living with pets can also help lessen the chance of developing an allergy later on, but only if the pet is living with the child during the first year of life. In one study, researchers performed allergy tests on a group of 18-year-olds and compared the results with information about the child’s early home life. They found that babies who grew up in homes with a cat were about half as likely to develop a cat allergy, as compared to those in homes without cats. In addition, boys who grew up with a dog were half as vulnerable to developing dog allergies. Again, this is because the pet dander and bacteria are thought to accustom the body to different allergens, building up a natural immunity.

And it doesn’t stop there – children with more pets often experienced even better immunity. Of the kids surveyed in a similar allergy study, those who had grown up with two or more pets had up to a 77% reduction of risk. They were also less likely to develop allergies to dust mites, short ragweed, and blue grass (no, not the music).

There are plenty of other studies with similar results (which you can find complied here in an article on EverydayHealth.com). One found that children who were raised on farms with animals were less likely to develop allergies. Another found that children ages 5-11 in three schools in England and Scotland had fewer sick days if they had pets at home. A survey of 11,000 Australians, Chinese and Germans found that pet owners made up to 20% fewer visits to the doctor per year than non-pet owners.

Couple these health benefits with the plethora of emotional and social benefits, and it’s no mystery why more and more families welcome furry four-leggers into their homes.

Of course, there are always exceptions to the trend. Certain children are more prone to illness due to immune system weaknesses or other variable circumstances, and parents of these children should always follow their doctor’s advice about how to manage interactions with pets, other children, and even adults. In addition, children who have already developed allergies to dogs or cats should not be exposed to fur and dander if it’s avoidable.

For most young children, being around a pet does not pose any additional risks to their health. As I’ve said here, when introduced early in life, a pet can actually strengthen a children’s immune systems, keep them healthier, and lower their chances of developing allergies in the future. This information certainly doesn’t mean that you should get a cat or dog simply to improve your child’s immunity or lower the risk of allergies, but it’s just another reason to show man’s best friend a little extra love.

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Categories: Ages + Stages, Newborns + Infants, School-Aged Children, Science 101 + Mythbusting, Toddlers + Preschoolers

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

There Is No Holistic Murder Conspiracy Afoot. Seriously.

By and August 3, 2015 No Comments
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For weeks now, stories have been circulating the internet about five holistic health providers who were mysteriously killed or died in untimely and undisclosed ways. Of course, the stories around them have played up the “mystery” aspect, and have had corresponding articles heavily implying that it is all a part of a vast, dark conspiracy by either “big pharma,” the FDA, or both. Here at The Scientific Parent, we rolled our collective eyes at the claim, especially as we dug into the articles.

First, to entertain that these claims might be real despite the total lack of evidence, you’re going to have to suspend disbelief. You would have to believe that the alleged entity known by conspiracy theorists as “Big Pharma” with its myriad of pharmaceutical drugs at its disposal would choose to kill these providers violently and poorly dispose of their remains. You’re would also need to believe that multiple large pharmaceutical companies, which are fierce competitors with one another, would come together as the mythical super-drug-beast known as “Big Pharma” to kill five providers whose combined work would not impact their revenues at all, removing any financial motive whatsoever.

We aim to be judgment-free on this site. Though we disagree with it, we can understand why some parents are afraid to vaccinate their children, why some parents want to share a bed with their newborn, and why parents avoid discussing difficult and essential topics with their children. But how anyone could believe this conspiracy theory? We’re raising an eyebrow of judgment. Say what?

Nevertheless,  in our Scientific Parent tradition, people have asked us this question, so we’re going to dig into the stats and the individual claims to see if there’s any evidential merit to them.

First, let’s go over the claims:

  • Five holistic providers have died mysteriously over a month and a half;
  • They are:
    • Jeff Bradstreet, MD, was a controversial provider who was under investigation by the FDA for treating children with autism with a dangerous and unapproved chemotherapy drug. His body was found in the Rocky Broad River in Chimney Rock, NC with an alleged self-inflicted gunshot wound to the chest. Dr. Bradstreet was found dead shortly after authorities executed a search warrant on his offices in relation to his use of the unapproved drug on children.
    • Bruce Hedendal was a chiropractor with a small practice in Florida. He was found dead, at the age of 67 in his car, and police say that no foul play is suspected.
    • Baron Holt was a chiropractor with a local practice in North Carolina. His practice was low-key and though he was young at age 33, no cause of death has been released.
    • Teresa Sievers, MD provided medical care to the transgender community but used a holistic approach. She was brutally murdered in her home and authorities say her death was not random. While there have been no arrests in the case, they allege that she knew her murderer.
    • Lisa Riley, MD was an emergency room physician in Georgia with no ties to the holistic medical community. Like Dr. Teresa Sievers, police say someone known to Dr. Riley brutally murdered her, allegedly her husband. Her husband, a former boxer, was previously charged with attempted murder of his former girlfriend by shooting her in the head.

We don’t think that doctors Riley and Sievers should be considered part of the alleged big pharma murder conspiracy, since they’re both traditional doctors with little to no connections to the holistic community. Frankly we’re not quite sure how their names were associated with the conspiracy rumors in the first place. But, we warned you, this is going to take a leap of disbelief (and an utter disregard for regression analysis) to get you over the proverbial finish line.

Does this sound like an abnormal pattern of deaths? First we’d need to establish what “normal” would be. As much of holistic medicine is unregulated, it’s difficult if not impossible to get clear statistics on how many individuals are in practice and what their attrition rate is, either by death, disability, retirement, or leaving the business. However, we do have solid statistics on those type of attrition rates for traditional doctors (MDs and DOs), so we’re going to use that as our fuzzy baseline average for the holistic realm for the purposes of this article.

It may shock you to discover that traditional doctors die from murder or suicide at a much, much higher rate than the general population. We were surprised too – it seems awful, given the level of care and healing these people aim to do. Including both MDs and DOs there are currently 904,556 active primary care and specialist physicians in the US. Of those, approximately 400 will commit suicide each year. In fact, physicians kill themselves at a rate 70% higher than non-physicians. This sadly means that eight doctors commit suicide every week.

It’s a bit harder to get statistics on physicians that are murdered each year for a number of reasons (publicity, visibility, nature of the crime, investigations, etc.). But we do know that over the span of a decade the average is that approximately 15 health care providers are killed in workplace shootings each year. That’s at least one murder a month.

Dwight Conspiracy MemeWith that said, even if we consider all five individuals named in the holistic-doctor-Big Pharma-FDA murder conspiracy plot statistically using the MD-DO statistics are our baseline, their collective death rate contribution is not an anomaly. Though individually, it’s terribly tragic and sad.

In the cases of Baron Holt and Bruce Hedendal, no cause of death has been released. Nothing abnormal there – coroners don’t typically publicly release a cause of death without the next of kin’s permission unless it’s in the public interest. So not having a publicly released cause of death falls far short of “mysterious,”and more along the lines of family privacy.

When examining the circumstances around each death it seems that only Dr. Bradstreet’s family is protesting his death as something other than what is being claimed by authorities. The whole thing sounds like a tragic and awful affair. But we can understand why Dr. Bradstreet’s family views his death as suspicious, since the practitioner spent most of his career in opposition to established medical research. Considering the implications of what Dr. Bradstreet was doing – using medication unapproved in the US and illegally obtained on the black market for use on children with autism, without approval – the investigation had the potential to not only end his career, but also put him in jail for a long time. That could potentially be enough pressure to make someone emotionally break down and consider suicide as a way out, as authorities have ruled it.

We also think that if anyone was murdered by Big Pharma, there would be more stealth and cunning, and also some sort of undetectable pharmaceutical way to do it. As conspiracies go, these data points are all too inconsistent to look like a trend.

Regardless of the circumstances for these five individuals, we feel for each of them, their families and loved ones. But ultimately, we don’t think a conspiracy is at work.

 

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Categories: Science 101 + Mythbusting

Rear-Facing Car Seats Until Age 2 … And Beyond

By July 22, 2015 1 Comment
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Several readers have written in to say that grandparents claim that keeping toddlers in rear-facing car seats until they are age two (and beyond) is cruel or can damage the child’s legs. We tapped an expert for answers. – The Scientific Parent Editorial Staff

Why is rear-facing safer?

Instead of having your head pull violently away from your chest, as happens when you are forward-facing in a frontal crash, the rear-facing child is cradled in their seat in much the same way as you catch a fastball in a mitt. This video shows two 12-month-old crash test dummies each secured in the same car seat but one is rear-facing and one is forward-facing – watch how much the forward-facing dummy’s head and neck move – and remember that this video is slowed down tremendously as crashes happen quicker than the blink of an eye. For more on the physics behind why rear-facing is safer, see here.

Current Research and Evidence:

What seats are big enough for 2-year-olds rear-facing?
Convertible seats are ones that start rear-facing and then convert to forward-facing for older kids; kids typically start using a convertible seat rear-facing after out-growing an infant seat. The weight limit for rear-facing is now typically 40 pounds for most convertible seats, with several even going to 50 pounds rear-facing. The height limit is typically the same for most rear-facing seats – the child’s head must be at least 1 inch below the top of the car seat.

Common Questions from Parents + Grandparents:

DSC_0146-300x198What about their legs?
As kids get older, their feet will touch the back of the vehicle seat; this is both comfortable and safe. Ever wonder why a 5-year-old can sleep comfortably with his chin on his chest and never wake up complaining of a stiff neck? It’s because kids’ joints aren’t fully formed, which lets them sit comfortably in positions that would be painful for even a yoga master. For this reason, a 3-year-old can sit comfortably rear-facing with her legs crossed or in the “frog leg” position.

Other parents worry about leg injuries; studies show that forward-facing kids suffer many more leg injuries than rear-facing kids. The leg injuries to forward-facing children occur when the child’s legs fly up and hit the back of the front seat and the front seat moves backwards, compressing the child’s legs. Rear-facing kids will often go into a “cannonball” position during a frontal crash… meaning that however scrunched they might look, they end up super scrunched in the instant of a crash and we know that this does not cause injury.

My toddler wants to see out!
Rear-facing does not have to be boring! Older kids can ride quite upright so they can see out the side and rear windows. If there’s a head rest blocking your child’s view out the back window, you can usually remove it. By 9-12 months your baby knows you’re there when you talk to them from the front – even though they can’t see you. You can calm and entertain your child with songs and stories – and for older children games of “I spy” – all while they are rear-facing.

My toddler gets motion sick!
Volvo looked at several thousand pre-schoolers and found the same rates of motion sickness in those riding rear-facing as those riding forward-facing. Regardless of the direction your child rides, placing them in the center seat with an unobstructed view out the front/back window (and limited visibility out the side windows) will help keep the nausea away. See here for more info about how to help a child who gets motion sick.

My toddler gets bored!
Here are some toys and games for kids of different ages that are travel friendly.

The Car Seat Lady’s Recommendations

It’s not coincidence that flight attendants sit rear-facing. Rear-facing is the safest way for everyone to travel, not just babies. Therefore, it is our recommendation that children ride rear-facing until at least age 2 – and ideally longer, until reaching the maximum height or weight for rear-facing in their convertible car seat, which for most kids is around 2-4 years old.

Note that it is now law in a few states that children ride rear-facing until at least age 2.

A version of this post originally appeared on The Car Seat Lady website and can be found here.

Resources:

American Academy of Pediatrics, Committee on Injury, Violence & Poison Prevention. Child Passenger Safety. Pediatrics. 2011; 127: 788-793.
Henary B, et al. Car Safety Seats for Children: Rear Facing for Best Protection. Injury Prevention. 2007; 13 (6): 398-402.
Bull M, Durbin D. Rear-Facing Car Safety Seats: Getting the Message Right. Pediatrics. 2008; 121 (3): 619-20.
Watson E, Monteiro M. Advise Use of Rear Facing Child Car Seats for Children Under 4 Years Old. BMJ. 2009; 338: b1994.
Arbogast KB, et al. Injuries to Children in Forward Facing Child Restraints. Annu Proc Assoc Adv Automot Med. 2002; 46: 213-30.

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Newborns + Infants, Policy, Politics, + Pop Health, Toddlers + Preschoolers

What’s the Difference Between Organic and Conventional Milk

By July 21, 2015 3 Comments
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This post was written in response to a question from TheScientificParent.org reader, Andrea.

It’s tough being a parent these days. Sometimes I think it was easier for our parents and grandparents before the internet when they didn’t have so many mixed messages thrown at them. Today we are bombarded with all sorts of messages about food and nutrition. Every day we’re told what to eat or not eat. What food or ingredient might be “toxic”, or which are the “superfoods”. Attractive food bloggers, svelte trainers, celebrity chefs, and even TV doctors all have something to say about what you and your family should be eating and if we don’t follow their advice we’re told that we’re poisoning our children.

On most shopping lists you’ll find written “milk”. In the 80s and 90s your decision about milk usually came down to 2% or skim, but now the sheer number of options make it even make more confusing and overwhelming, so does the sometimes misleading marketing. Milk cartons read, “organic,” “antibiotic free,” and “hormone free.” What does all of this mean and does it make a difference when it comes to nutrition?

Before I go on, I want to disclose that I work for a supermarket chain that processes and sells both organic and conventional milk, so I know this issue rather well.

What does “organic” mean?   The use of the word “organic” and the USDA organic symbol is regulated by the US Department of Agriculture (USDA) and means that products must conform to certain standards set by the National Organic Program (NOP). In dairy farming these standards have to do with type of feed (it must be organic), access to outdoors and grazing, and treatment of the animal not necessarily with the quality of the milk itself.

What about taste and nutrition? If you read the NOP standards for dairy farmers it mentions nothing about taste, because how things taste can depend on the individual. Some consumers find that organic milk tastes better, but perhaps it’s the marketing that’s lead them to believe there’s a taste difference.

The NOP standards also don’t mention nutritional standards. The way organic milk has been marketed has lead consumers have been led to believe that organic milk is nutritionally superior to conventional milk. The jury is still out on this topic. One meta analysis found that organic milk is higher in protein and omega 3 fatty acids, but if you were to compare their nutrition facts panels you would find that generally in terms of calories, fat, protein and calcium there is little or no difference between conventional and organic cow’s milk.  A recent meta analysis looked at over 200 published studies and found that the nutritional quality of a cow’s milk was not as much due to the fact that the cows were on a conventional or organic dairy farm but a multitude of factors including the breed, age and the health of the cow and what they are being fed or were grazing on.

What about antibiotics? Dairy farmers, both organic and conventional, do not routinely give their cows antibiotics. The NOP prohibits the use of antibiotics, unfortunately that messaging that may lead some to assume that conventional dairy farmers routinely give their cows antibiotics but this is not the case.

On a conventional farm antibiotics are only administered when cows are sick, usually with an infection that human mothers are familiar with: mastitis. The antibiotics are prescribed and administered after the cow is examined by a veterinarian. Antibiotics can be expensive, which makes their routine use simply not financially feasible for dairy farmers.

Beyond this there are regulations regarding the use of antibiotics known as the “withdrawal time” which is the time after a cow is given an antibiotic that their milk can be used commercially. Additionally all milk is tested at the farm and at the milk bottling plant for the presence of antibiotics. If antibiotics are detected the milk cannot be used for human consumption.

What about hormones? All milk has hormones – even organic milk! Think about it, in order for a cow to produce milk they must have the right hormones that occur naturally in their bodies, just like in a nursing human mother.

But that’s not what most people are referring to when they talk about hormones, they usually mean artificial growth hormones (rbST & rbGH). Artificial hormones are used to increase a cow’s milk supply and they are not permitted in organic farming.

Many conventional farmers do not use artificial growth hormones, but some do. It is important to note that the Food and Drug Administration (FDA) does not consider these hormones to be dangerous to humans since they are broken down during digestion and not absorbed in the body.

What about the size of the farm – aren’t organic farms smaller? The size of the farm has little to do with the quality of the milk, the treatment of the cows, or whether the farm is organic or conventional.   The majority of U.S dairy farms (74%) have less than 100 cows. The majority of U.S dairy farms (97%) are family owned and operated. In 2008 less than 2000 dairy farms in the United States were classified as USDA organic.

So what’s the bottom line? It’s your choice whether you want to buy milk that comes from organic or conventional dairy farmers, just make sure you’re doing it for the right reasons. Personally, I buy either conventional or organic milk regularly (it depends what’s on sale) and I drink milk daily.

 

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Categories: Food, Nutrition, + Infant Feeding, Science 101 + Mythbusting

When Can Your Child Ask for Birth Control Without Your Consent + Other Uncomfortable Issues

By July 20, 2015 No Comments
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As parents we’re used to knowing every detail of our kids’ lives. We have video baby monitors in their rooms, their clothing can track their breathing and temperature and daycares and sitters leave us detailed written records of their days when we’re not there. Sometimes it’s hard for us to tell when our kids deserve the right to privacy and when they’re able to make certain decisions on their own.

The issue of a child’s right to autonomy – the right to make decisions about one’s own healthcare – is a common, but messy, topic in health care. We see this most often in issues of reproductive health, for example, when a minor seeks a prescription for birth control or access to an abortion without the parents’ knowledge.

The issue of a child’s medical autonomy raises many ethical questions, all of which tend to make parents uncomfortable. Recently, this notion came up again in response to a post on Reddit, in which a mother, who is opposed to vaccines and did not vaccinate any of her children, relates how she discovered her eldest daughter got herself vaccinated in secret, much to the mother’s chagrin. The mother asks if she can take any legal action against the doctor who vaccinated her daughter without her knowledge.

A screen capture of the original question posed on Reddit, which has since been removed by the author.

A screen capture of the original question posed on Reddit, which has since been removed by the author.

The July 8, 2015 post to the legal advice subreddit was eventually removed, but not before garnering a robust response. Quite a few commenters pointed out that given the girl’s age (16 years), she is fully entitled to make her own health care decisions without her parents’ consent. For those who support vaccines, it’s a great story: a teenage act of rebellion where the teen is the smart one, taking her health into her own hands.

Before we go on, I want to address that there is some question as to whether this story is actually true or not. Some details cast doubt on it, such as the idea of the girl paying for any of the vaccines with her babysitting money as Canada has universal healthcare, which covers all routine vaccinations. While some private clinics would charge for a vaccine, they are uncommon, and many of the nurses and doctors staffing a walk-in clinic are still covered by the Ontario Health Insurance Plan. None of this means it did not happen, but there are reasons to doubt and no means of verifying the elements of the story.

Whether the story is true or not, it brings up an important question: do the parents have a right to their daughter’s medical records? Do they have a right to legal action against the clinics for vaccinating their daughter without their consent? Do the parents’ rights supersede their daughter’s right to privacy and autonomy over her own healthcare?

Capacity to consent is, in many locations, not so much a matter of ability as it is of arbitrary age cut-offs set by law. For instance, in the United States, as far as the law is concerned, you are incapable of safely operating a car unsupervised until you are 16. Only when you reach 18 are you considered an adult, capable of making your own decisions and even altering how our country functions (via voting). But you cannot make decisions, legally, about drinking alcoholic beverages until you are 21 years old, despite the fact that, in all other regards, you are legally an adult.
As far as the legal question in the Reddit story goes, per Ontario law, anyone who is at least 16 years old has guaranteed medical autonomy, barring any conditions or disorders that impair their decision-making capacity. That means that as soon as a child turns 16, they can make their own medical decisions and their medical records are a private matter between the child and their doctor. The mother in the story has no legal right to view her daughter’s records nor to take action against the clinics or the provincial Department of Public Health for complying with her daughter’s wishes.

But what if she were 15 years old? Would her parents have a right then? Not necessarily.

While Ontario law guarantees autonomy once a person reaches 16 years of age, the province is one of several that recognizes that the ability to make medical decisions for oneself is not a simple matter of age. They employ a “mature minor” standard in that there is no statutory minimum age required for a child to consent to medical treatment on their own. If, in the physician’s judgment, the child understands the nature and consequences of their decision, then they are capable of making the choice for themselves, without any other input from the parents. Before her parents would be able to obtain the medical records relating to her autonomous decision or to take action against the clinics, her parents would need to challenge her capacity as a mature minor in court. In short, they would need to demonstrate that she did not understand the nature or consequences of her decision and that she is therefore unfit to make her own medical decisions.

But what about the ethical angle? Regardless of what the law says, should a parent have unfettered control over their child’s healthcare decisions? Should a child be considered completely autonomous and allowed to make decisions without the consent of their parents? From an ethical perspective, the answer to both questions would tend toward “no”, though more realistically, the answer is, “it depends”.

Some research notes that adolescents are capable of making informed medical decisions, and able to understand the consequences of their decisions, by the time they are 14 years old. Other research argues that people are not fully cognitively developed until they are 21 years old and can’t truly understand consequences.

Obviously, there is variation from individual to individual, and from situation to situation. A child may be capable of an informed medical choice at a young age, where they are free of peer (or parental) influence and the consequences are limited in severity. The same child may be incapable of making a medical decision for themselves when they are under the strong influence of friends or their parents, or where the outcomes are of such a great magnitude that the child is incapable of fully understanding. Whether a child is mature enough to make their own medical decisions, whether to accept or refuse treatment, depends on the child and the situation.
If the child can demonstrate that they understand, that they truly comprehend their situation and the options available, then from an ethical standpoint, they ought to be able to give or refuse consent, without the intervention of their parents. They are individuals in their own right, and as such are deserving of respect as an individual. They are not objects owned by their parents. They are not chattel for the parents to do with as they please. They are individual human beings.

In an ideal world, parents and their children would make medical decisions together, and when the child is mature enough, whether as early as 14 or not until they are legally adults at 18, decision making moves into their hands. It may be difficult for parents to accept that their children are growing up, that their kids do not need them anymore. And it can be even harder for some parents to view their children as individuals capable of making their own decisions rather than property, to put aside their own desires and beliefs in deference to what is objectively best for their child.

But no matter what age a child begins deciding for themselves, the parent does not have an absolute right over their child. When it comes to medical decisions, the parent has an obligation to do what is in the best interests of their child, even if that decision is at odds with the parent’s wishes, as is the case with vaccines and parents opposed to vaccination. Likewise, within the parent-child-doctor relationship, the doctor’s duty is to the child, not to the parents.

Unfortunately, there is no hard and fast rule, no clear cutoff point at which we can say, “This person is now capable of making informed medical decisions on their own.” It is a complex issue that is very situation-dependent. But at the very least, we can respect that parents do not own their children, no matter what misguided Kentucky politicians might say. Parents are not free to do with their children as they please, because children are not property. They are not owned. Children have rights, too. That includes the right to protect themselves when their parents fail to do so. – Edited by Leslie Waghorn

– A version of this post originally appeared on Harpocrates Speaks

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Categories: Ages + Stages, Policy, Politics, + Pop Health, Tweens + Teens

The Kids Are Alright. Really.

By July 15, 2015 No Comments
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 For decades, children have been born to or adopted by same-sex couples. Before the advent of legal marriage beginning 10 years ago in Massachusetts, many same-sex couples built families on a rickety legal foundation and by careful navigation of adoption agencies, fertility clinics, supportive or unsupportive family members, and limited social acceptance of our “alternative” families. Why would so many same-sex couples—as well as single LGBT people, choose this often complicated and stressful path to parenthood? It’s simple: our desire to be parents and to experience the life-altering journey of raising a child is greater than our fear of the backlash of bias, bad attitudes, and outright discrimination that so many of our families have endured.

While the recent SCOTUS ruling changes the legal landscape for same-sex parents, it does not erase the myths and misperceptions about our families. Some of these myths are veiled in “concerns for the children,” for example the worry that our children are more likely to be gay, lesbian or bisexual, or that they will experience higher levels of bullying, confusion about gender roles, or somehow end up unhappy. We appreciate the concern for our children – we are concerned about them too, but our concerns are those more typical of all parents – keeping them safe at the playground, helping them make friends easily, providing them with good teachers, and teaching them to be kind and generous.

(excerpt): Some of these myths are veiled in “concerns for the children,” for example the worry that our children are more likely to be gay, lesbian or bisexual, or that they will experience higher levels of bullying, confusion about gender roles, or somehow end up unhappy.

Having two moms or two dads does no harm to children; what does harm them, however, is the homophobia and bullying which they can sometimes face. To date, thirty years of peer-reviewed social science research concludes that children raised by lesbian and gay parents do just as well in key areas of development – social relationships, emotional well-being, academic performance, and connection to family – as do children raised by heterosexual parents.

Yet, with all of this research along with hundreds of thousands of thriving children with same-sex parents living among us, there still persists the belief that children do best with a married mother and father, and that children lose something if they are raised in other family structures.

Let me put to rest some of the myths and misinformation that, in fact, are the very thing that chip away at our children’s optimal well-being.

My two daughters have two moms. We are intentional parents—our children were wanted and planned; in fact, we joke that our children are “more processed than Velveeta cheese.” We did not have the option of getting pregnant the old fashioned way—we had to find a donor, track ovulation, time the inseminations just right, lay out a lot of money, and put legal documents in place (this was well before marriage equality in Maryland, where we live); whether pursuing adoption or assisted reproduction, our paths to building families takes time, money, and will. I am well aware that many heterosexual couples and single people face fertility and financial challenges as well, which I am in no way diminishing. I’m simply making the point that LGBT people only have alternative options to consider from day one of their family planning experience. The foundation for our families is strong in that our children are wanted, planned, and our intention to parent is clear. I would think this is a foundation we would ideally want for all of our children, regardless of family structure; when families are ready, willing and able to parent to the best of their ability. In these scenarios, children do better, getting the attention, nurturing, and support they need in order to thrive.

Ellen and her family

Ellen and her family

It is a myth that our children are more likely to be gay or lesbian, or confused about their gender. If you ask a roomful of gay people whether they have gay parents, typically not one person will raise their hand. In other words, it’s statistically more likely that children who are lesbian, gay or bisexual will be born to straight parents, because straight individuals are a higher percentage of the total population. Sure, some LGBT parents will have LGBT kids, but not at any higher a rate than those raised by non-LGBT parents. Research on adolescents and young adults with LGBT parents suggests that those who are same-sex attracted feel safer “coming out” to their family, which is good for their mental health. On the contrary, many LGBT children and teens are terrified to come out or express these feelings to their straight parents for fear of being rejected. In terms of child well-being, it is essential that parents are supportive and accepting of their LGBT children even if it’s hard for them personally, since the impact of parental rejection can be as severe, but not limited to suicide. Sexual orientation—who you are attracted to—is wired and can’t be changed, and children with same-sex parents have the same statistical potential as all children of being something other than heterosexual.

Those same studies that found that having same-sex parents does not increase a child’s likelihood of being gay also found that having same-sex parents does not cause gender confusion.  There are all types of modern families which are breaking traditional gender roles, including those with “stay at home” dads and working mothers, ones in which the mother and father more equally divide household chores according to what they enjoy, versus what a 1950s version of Good Housekeeping magazine endorses. Some men cook, some women mow the lawn; it is good for children to see equity in household management and the full range of what is possible for girls and boys to do rather than live with prescriptive, limiting gender expectations. Our sons and daughters will see that there are many different ways to be men or women, that there are no hard and fast rules about how they parent or how they help around the house. They are not confused about gender roles– they are simply learning the expansive nature of what it means to be male or female in a modern society.

The most important myth to counter, in my mind, is that our children will be unhappy. To my earlier point, the greatest harm to our children’s emotional well-being comes from bias and discrimination toward our families. What children need is one, two, or more parents or guardians who are consistent caregivers, unconditionally supportive, and invested in helping them become the best people they can be. Whether those parents are straight, gay, transgender, rich, poor, or married has little to do with their capacity to be good parents. When children face discrimination, bullying, or rejection, they are more likely to be depressed, anxious, and to struggle with their emotional well-being. There is no evidence in any research on LGBT families to support this notion that our children will suffer, but there is research that shows the impact of trauma on children, and it’s the trauma of homophobia and rejection on the part of people outside of our families that is of greatest concern to us, and to our children.

My daughters have two loving parents, an extended support network of family, friends and neighbors, and are being raised in a community that is generally LGBT-inclusive and where there are many other visible families headed by same-sex couples. They know their family structure is in the minority and that there are still people out there who don’t like the idea of two men or two women raising children, and they will be the first to tell you that they are all right—beyond all right, in fact. For too many of our families across the country, feeling isolated and marginalized on the soccer field, at the PTA meeting, or at the local playground is still a reality–marriage equality or not. All of us can have a role in creating a community that embraces family diversity, that recognizes the many ways in which my family is like so many others—doing the best we can to raise happy, healthy children. Letting go of myths and getting to know LGBT parents and their children is the best thing you can do to support our families and your own – Edited by Julia Bennett + Leslie Waghorn

 

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Categories: Mental, Emotional, + Behavioral Health, Policy, Politics, + Pop Health

Two Months After Whooping Cough: An Update from Tara Hills and Her Family

By and June 16, 2015 5 Comments
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We’ve received a lot of questions from our readers about the status of Tara Hills, the formerly anti-vax mother whose 7 children caught whooping cough, just a week before their updated vaccination schedule was supposed to begin. It’s been a couple of months since we’ve posted an update, so we interviewed Tara this week.

Read more about Tara’s story:
Learning the Hard Way: My Journey from #AntiVaxx to Science – April 8, 2015
Whooping Cough is so Rotten, That We Couldn’t Post the Video – April 9, 2015
With 7 Kids in Recovery from Whooping Cough, Tara Hills Answers Your Questions – April 15, 2015

Here’s what she told told us:

So first up, even though it’s more than two months later we still get emails and messages asking about how your kids are doing now. How is everyone doing post whooping cough?

I’m touched that 2 months later people around the world care enough to ask about our family. Really touched. Physically everyone is well. The 7 kids responded to the antibiotic treatment and turned a corner within days. That cough is awful though and has lingered in our youngest. It can linger up to 12 weeks so we’re hoping it goes away soon. Mercifully no one went into respiratory distress so we don’t expect long-term damage.

Emotionally the kids are fine and life is normal again. I’m another story. I still think of this everyday. Painful reminders, what ifs, gratitude, self-consciousness as strangers say they ‘know me’. Many, many lessons learned the hard way.

How about how the medical community in Ottawa responded to you during and after the crisis? Did you feel any judgement from your doctor, the hospital or public health agencies?

They were excellent. We were assigned a nurse from Ottawa Public Health from day 1 when the results came back positive. She was our go-to through and after the crisis. She worked with us (over the phone) step by step, was very calm, helpful, and professional. We were in great hands.

Something which shocked Julia and Leslie was that other parents seemed to be understanding and supportive of you online, but both the pro-science and anti-vaccine communities seemed to have harsh words for you but for different reasons. Have you lost any friends in either camp due to your post?

Our story hitting international news was shocking and surreal. I was willing to ‘speak into the microphone’ even though I felt sick in front of such a huge audience. But we stood by our core message and still do. I stayed away from news comment feeds because I was too involved and overwhelmed with everything. It was all so “out there” so the harsh words didn’t affect me. Closer to home, all our key relationships were fine. Some friendships were strained temporarily and only 1 was lost, mostly due to disagreements with how I handled what was a very difficult situation for our family.

It was hard to hear the harsh judgement from the pro-science community. We thought they’d embrace us with open arms. We had already learned our lesson and booked the catch-up appointments. We expected the anti-vaccine community to react harshly to us, but to have the pro-science community rub our faces in a pile of shame was disgustingly unhelpful in advancing their cause. Some asked “what if it had been polio?” I know! Don’t you think I KNOW? That’s exactly why we shared our story and withstood the firestorm from every angle.

WC TimelineWere there any misconceptions that bothered you?

Some people have said that whopping cough is no biggie so they “aren’t convinced” or alarmed enough to reconsider examining the vaccine issue much less get their kids or themselves vaccinated. For most of our kids it wasn’t a nightmare, but it was awful for the youngest ones. The two youngest would cough so hard they threw up, none of us slept that week.

Our story was illustrative of a vaccine-preventable illness sweeping through one family. That’s why I shared our story in that context. Some people online dismissed it and acted like the whole thing was one big stay-cation for our family. That truly shocked me. I couldn’t believe that after hearing the sounds of our children struggling to breath through coughing fits they would dismiss the risk to infants. It was beyond shocking.

Waiting to make sure our 5-month-old niece and 2 immune-compromised family members were going to be okay was indescribable. I had so much guilt and fear, there are no words to describe the waiting to hear if our infant niece was hospitalized or worse, all because of us.

For me one of the most shocking things was people alleging there were ‘holes’ in my story and that I was a paid actress. Even more bizarre is that some people alleged that I was covering up a more scandalous truth. Are you kidding me? I would have given anything for our family to not have gone through what we did!

When you changed your minds about vaccines do you think (honestly) there was anything anyone could have said to you to change your mind?

Maybe? How they approached me would have made a huge difference. Respectfully validating and addressing versus sarcastically dismissing my concerns and questions would have made a difference. Building our trust through caring, patient dialogue would have helped. Just talking to me at all like an intelligent caring person would have helped.

If someone had said in a genuinely kind tone. “Tara, you are a great mom who loves her kids dearly. I know there is so much confusion about vaccines. I care about you and want to help you make a informed decision you feel really confident in. Would you be willing to share some of your concerns with me so we could go through them one by one? In the end it’s your decision. I want to make sure you are totally confident in your decision since it’s so important.” I would like to think I would have stepped willingly into that kind of conversation. There was no threat or attack that would trigger defensiveness.

It’s hard to talk to loved ones about vaccines. Hopefully our sharing will help people have those talks in a constructive way, guide them to a starting point they can relate to, and maybe help save some lives.

You said in an earlier post that the Disneyland measles outbreak was part of what contributed to your rethinking of your anti-vaccination stance. When you finally began your new wave of research, can you clarify how that happened, and how did you look for and find your information?

It had been building for some time. Seeing the hatred and fear towards people who didn’t vaccinate (like us) was alarming. I knew if push came to shove, and we lost the freedom to choose, we would have to be rock solid certain of our stance. So in February, I came out of the anti-vax closet by posting on my personal Facebook wall that I was that mom. That I felt caught between a horrible rock and terrible place. That somehow no matter how much I searched for solid answers I’d never really know. That it would boil down to a coin toss with our kids’ health in the balance. So I set out to prove we were right NOT to vaccinate. I had my kids’ health at stake and my pride to defend. So I started reading anti-vaccine books, publications, and popular sites to bolster my position. But I knew a fair trial demanded I listen to both sides. A public health advocate (The Scientific Parent’s Leslie Waghorn) suggested I list my key concerns/questions, and offered to go through them with me one by one. She disarmed my defensive posture by validating that it was okay to ask questions and even better to seek solid answers. Turns out that all my concerns boiled down to only a few key questions, which I addressed in my first Q&A.

Were your older children aware of your decision to stop vaccinating, and if so how did you talk to them about your decision to resume vaccination?

Our oldest (10) and I had discussed it back in February or March when she saw me doing a lot of research and reading about vaccines. So she had the backstory when the pertussis hit our family. I talked to her using an analogy of imaginary kids playing at our park. It went like this: What if after playing Johnny, Suzy came along and whispered “don’t play with Johnny. His family is dirty and will make your family sick!” What should you do? Just believe her words or go check her story to see if it’s true? How could you know for sure? Then I bridged to the vaccine issue, shared our story from when she was little, how all the Suzys were talking and we got scared and confused. We froze when we should have dug deeper for solid answers. A painful life lesson I hope our children will not repeat.

Do you have any advice for parents who are skeptical about vaccines or have questions?

That I commend them for taking the time and effort to focus on this vital part of parenting! To make sure to consider their biases and check their sources carefully and to not cherry-pick the information they like best. They should also talk to their doctors before making any decisions about vaccines. Our doctor was very understanding when we said we wanted to catch the kids up on their vaccines. We didn’t consult him before we stopped vaccinating because we were afraid of being judged or worse. I now wish I’d talked to him because he was very understanding.

 

– Edited by Leslie Waghorn and Julia Bennett

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Categories: Infectious Disease + Vaccines