Browsing Tag

Policies & Procedures

It’s Official: We Can All Calm Down About Screen Time

By October 6, 2015 4 Comments
Share:

Pediatric use of screen time is something I’m a little sensitive about. I spent six months of my life working on it and for six months of my life it was all screen time, all the time. Once my portion of the project was over I swore I would never talk about screen time again, that’s how exhausted of the topic I was.

But frankly, I’m tired of seeing parents shamed for allowing their kids watch an episode or two of Daniel Tiger’s Neighborhood while they fold the laundry or make dinner. The science doesn’t support the level of derision that parents receive for even minimal uses of screen time. So when the American Academy of Pediatrics (AAP) issued new working group recommendations on screen time last week, I decided to make an exception and talk about the subject one more time.

I like to refer to subjects like exclusive breastfeeding, screen time, and the amount of time parents spend with their kids as “Modern Mom Guilt.” I think I and just about every other interested parent in America breathed a sigh of relief when the AAP let us know that screen time was one less thing parents had to feel guilty about.

Tags: , , , ,
Categories: Ages + Stages, Mental, Emotional, + Behavioral Health, School-Aged Children, Science 101 + Mythbusting, Toddlers + Preschoolers

Despite Carson and Trump’s Sidestepping, No, Vaccines Don’t Cause Autism

By September 17, 2015 4 Comments
Share:

There were major face-palms happening during one of the early GOP Debates here at The Scientific Parent’s headquarters when former presidential hopeful Dr. Ben Carson massively sidestepped a pretty simple question about vaccines and autism.

I’m not going to get into the specifics of the debate or comment on the politics, just the piece that concerns us here on our blog, which is all about science-based parenting.

When CNN’s Jake Tapper asked Dr. Carson if he thought Donald Trump should “stop saying that vaccines cause autism,” Carson avoided challenging Donald Trump’s stance directly, (which has been highly public and scientifically incorrect) and said:

ben_carson“Well let me put it this way…there have been numerous studies, and they have not demonstrated that there is any correlation between vaccinations and autism. This was something that was spread widely 15 or 20 years go and it has not been adequately… revealed to the public what is actually going on.”

-Dr. Ben Carson, GOP Debate 9/16/2015

Carson, an incredibly educated physician, went on to redirect the conversation before being interrupted by Tapper, who once again pushed him to disagree with Trump. Which Carson would not do.

While that’s in essence not a problem (challenging someone’s opinion when you would prefer not to engage in a battle), language and presence is persuasive, particularly when you’re an expert in front of tens of millions of viewers. It’s what these debates are all about. You put potential leaders in a room with cameras and you listen to how they command power, expertise, and thoughts on issues that are relevant to the public. And then viewers at home are left with new information, some correct, some not-so-correct, and to make the best judgment call they can about the candidates and the issues from what they know, and what they heard.

Carson is a former pediatric neurosurgeon who has dealt with some of the most medically fragile patients around during his tenure at Johns Hopkins Hospital. He knows the science surrounding the safety of vaccines as he touched on it in his initial response, referencing studies which you can read about in this quick crash course compiled by the CDC. He’s an expert, so one would assume that what he says is accurate.

Posed with the same question, Donald Trump, whose command of authority is essential to his business image, did not stand down from the question:

trumpface“Autism has become an epidemic. Twenty-five years ago, 35 years ago, you look at the statistics, not even close [to what it is now]…I am totally in favor of vaccines but I want smaller doses over a longer period of time.”

–  Donald Trump, GOP Debate 9/16/2015

And, after alluding to a baby being “pumped” with vaccines in the amount “meant for a horse,” he pointed to evidence of an employee of his, whose child “…went to have the vaccine and came back and a week later got a tremendous fever, got very, very sick, now is autistic.”

Trump concluded by pointing to vaccine spacing as what will reduce autism in America. Since vaccines aren’t linked to autism, and science backs that, how does spacing non-autism-causing shots reduce autism? It’s a mystery to us. But it does have an undercurrent of the conspiracy theory about pediatricians we’ve addressed before on The Scientific Parent. And I’m not even going to touch the epidemic and anti-autistic language here. That’s for another time, and another post.

Where I nearly flipped a table over is when Carson followed up to Trump’s comments by agreeing with Trump about vaccine spacing, and then reiterating his stance that vaccines don’t cause autism. The doctor said WHAT?

Though children get nearly two dozen vaccination shots by the time they are two years old (for a series of deadly, preventable diseases), there’s no general belief in the medical community that this nationally applied schedule of vaccines is a problem for healthy children. In fact, the CDC and American Academy of Pediatrics recommend the current vaccine schedule based on what is considered safe and prudent according to a wide array of factors, most important being what a child’s immune system is able to tolerate at different points in their growth and development, and what’s absolutely essential to protect them against at the earliest possible age.

Vaccines from 0-6

Example vaccine schedule from CDC, ages 0-6: http://ow.ly/SkmZM

Not convinced yet? Take a look at this document, which explains what the Advisory Committee on Immunization Practices is. It’s a panel of experts who are rigorously vetted and have a range of expertise, and they have multiple public meetings a year where they review a range of information, research, and clinical data to determine what’s safest for children. They’re the ones who provides the CDC with schedule recommendations. And I’m pretty sure they know a lot more than either Mr. Trump or Dr. Carson could dream about vaccine science and safety.

So again, challenging someone you don’t want to challenge is in essence, not a problem. What is a problem however, is for a nation that’s worked hard to eradicate so many tragic infectious diseases, to have Dr. Carson publicly representing pediatric medicine and not correcting something that is a matter of life, death, and severe disability through disease injury for millions of Americans and their children. We’ve covered that elsewhere on this blog, which you can read here, here, here, and here. We really, really hope he moves to correct this in upcoming public statements, and we’re not alone.

Misinformation of this nature spreads quickly and keeps its hold for a long time, because oftentimes it’s rooted in fear. Trump’s vaccination stance has been highly visible and what he says, if it were true, is scary to even consider. A few snapshots of his comments on Twitter, for example:

Trump Twitter 3

 

Trump Twitter 1

When you’re an expert in medicine and you allow misinformation to linger as Dr. Carson did, particularly misinformation that can be fatal if in the wrong hands, it can have massive impacts. It can lead to malpractice if you’re an actively practicing or teaching physician. And in front of a nation of attentive TV viewers, it can lead to a whooooole lot of people listening to the more bold candidate and believing that he or she is speaking the truth. It’s what terrifies the masses that leads to situations such as what happened with Tara Hills, the formerly anti-vaccination advocate mother of 7 children who ended up with whooping cough, who was misinformed and fearful by messages similar to what Trump said on stage last night.

The damage is done, though many, many websites and blogs such as our own took to the interwebs that night, as we do often, to argue in favor of science and safety.

Ask anyone who works or has worked in broadcast and we’ll tell you the same thing. People (myself included) tune out after the first few seconds of a soundbites, and they surely did given how circular political-speak can get during those debates.  Lets just hope that for a nation dependent on vaccinations for so much of its basic health protection, we can keep the facts straight from the opinions. Cast your vote where you may, but protect your kids, please, they’re our most precious candidates for this nation’s future.

Tags: , , , , , ,
Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

Child-Free By Choice: How Old Is Too Young for A Vasectomy?

By August 20, 2015 5 Comments
Share:

Since I was a teen I was not interested in having children. I’m not a kid hater or parent hater, but that lifestyle was never something that appealed to me.  I like kids, I also like to hand them back to their parents at the end of the day.  The decision to be child-free is not something I grew out of as I aged, if anything I became more steadfast in my decision to not have children. As a result, I had decided around age 20 to pursue sterilization. I wanted a vasectomy.

That vasectomy took me 15 years.

Not for lack of trying.

Understand that I have always taken my sexual health very seriously and was not after a vasectomy as an easy way to get away from condom use. A vasectomy won’t prevent certain STDs the way a condom will.  My decision to have one was purely for birth control.  While I understand that sterilization has a permanence to it that other forms of birth control don’t, in my 15 year quest to have a vasectomy it seemed strange to me that I didn’t have the right to control my own reproductive health.  As a man, the only form of birth control outside of a vasectomy that I had at my disposal were condoms, and condoms are all well and good, but they aren’t as effective as a vasectomy.

Before I approached my doctor at age 20 to talk about a vasectomy, I did my research.  I had asked him about it previously in passing and I’d also made a purely informational appointment with a urologist to better understand the procedure.  I understood the effectiveness, side effects, consequences and permanence of my decision.

So, at 20 when I sat down with my doctor to talk about actually going through with the procedure, I made sure I was clear.  I explained myself, my wish never to have children, my research and my understanding of the permanence of my request.

Screen Shot 2015-08-19 at 9.29.18 PM

A comparison of the efficacy of birth control methods, c/o CDC.gov

My doctor countered immediately with the argument that I was too young, and “What if you meet someone who wants to start a family,” and something about how this is usually done when you are married and wish to have no more children.

Bottom line: “No. Come back later when you are older”. No defined time frame, just “older”.

At age 20, although I was headstrong, I never thought to argue or advocate for myself. I mean, you just don’t argue with your doctor right?

Life moves along. I was age 25 and had moved to another city. When I was settled in I found a GP and had a physical done, and again asked about a vasectomy.

Same response. “You’re not old enough, you’re not married with kids, come back when you are 30”. I also got a lecture on the use of condoms. I think my new GP thought I was trying to find a way to forgo condom use, which again, I was not.

When I was around 31 I had a new GP and was in a long term relationship. My then girlfriend also didn’t want to have kids so I thought that for sure I would have success this time around!

Denied. At least he was the nicest out of my doctors. He said that this was a permanent procedure and that most men requesting it were married and already had kids. I did argue a little bit, explaining my firm decision to remain child-free and that I’d asked for the procedure several times since age 20.  He asked me to wait a year, he’d put a note in my file and we’d talk. That seemed fair. Mostly, I just wanted to satisfy whatever arbitrary conditions there were.

Life got in the way.  I married my long-term girlfriend and we moved clear across the country.

Again, I had a new GP and I expected the same kind of brush-off from her that I’d received from my previous GPs. My current GP is a no-nonsense, very clinical sort of doctor. Logical and to the point. I like her. When I told her “I am interested in getting a vasectomy” and said I’d already done my homework she simply gave me a referral.

Since she gave me the referral, I’ve occasion to chat with her and asked about the vasectomy referral. I was specifically curious if she would have referred 20 year old me to the urologist. Her answer was simple. “Yes, you are a well informed patient, and have obviously done your due diligence, so if you were that way at age 20, why not?”

The visit with the urologist was great. He was also very matter of fact, straight up. He asked 2 questions. One: Do you have kids? Two: Is your partner is aware of the procedure?

His response to my child-free status was “That’s OK, I’ve met plenty of men not interested in having children”. I also asked him a few questions. He would have performed the procedure on 20 year old me, if I was as confident and well informed as 35 year old me. This was bizarre.  After being told for 15 years that I was too young, that I needed to wait, I was suddenly being told by two health care providers that they would have performed the procedure on me when I was 20.

After 15 years I finally was able to have the procedure and am confident that my wife and I will be child-free.

But I’m left with some nagging doubts about the path it took me to get here.  Is relative youth reason enough to deny someone the right to control their reproductive health?  Only about 5% of men who have had a vasectomy will ever have it reversed.  I can see my previous providers’ concerns about my age, as a study found that the younger a patient is when they decide on sterilization the more likely they are to try to have it reversed, but that’s still a very small percentage.  I also can’t help but wonder how skewed the numbers are right now, as 90% of those who have had vasectomies are married or are in long-term relationships.  I know that my vasectomy now falls into that category, even though I’d been trying to obtain it since I was 20.  While I know I’m not in the majority, I have to wonder how many men like me are skewing the data, thus making it harder for men like me to obtain a vasectomy before marriage and reaching an arbitrary age.

So I’m left wondering, what was it that lead doctor after doctor to deny me a vasectomy over 15 years?  Was it age, gender or were they placing their own morality above my medical wishes?  I’m not sure, but looking back, it sure seems like it was all three.

In retrospect I would have told 20 year old me to go and find another GP and to agitate and advocate more. Lesson learned, I am now my own fiercest health advocate, as I should be. – Edited by Leslie Waghorn

Tags: , , , ,
Categories: Pregnancy, Birth + Family Planning

Is Your Pediatrician on Big Pharma’s Payroll?

By August 4, 2015 4 Comments
Share:
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.

Tags: , , , , ,
Categories: Science 101 + Mythbusting

Rear-Facing Car Seats Until Age 2 … And Beyond

By July 22, 2015 1 Comment
Share:

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.

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

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

By July 20, 2015 No Comments
Share:

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

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

Since When is Same-Sex Marriage a Pediatric Health Issue?

By June 29, 2015 No Comments
Share:

Shortly after the U.S. Supreme Court issued its landmark decision effectively legalizing same-sex marriage in all 50 states, the American Academy of Pediatrics (AAP) released a brief statement applauding the decision. It didn’t take long after that for my friends to start weighing in on the statement on Facebook.

Part of me was super psyched because I had so many friends talking about the AAP on social media (hooray for informed parents!) and the other part of me wanted to slam my head on the desk as I realized how misunderstood the statement had been. Even the friends who were happy about the SCOTUS decision seemed wary about what they viewed as a neutral health care organization venturing into a divisive political issue.

I can totally understand my friends’ confusion. We’re used to the AAP talking to us about ear infections and car seats, not so much about two adults of the same sex being able to marry or not. The AAP’s release didn’t exactly clarify matters as it was extremely short and without any background to explain why the organization viewed this decision as having an impact on child health.

For starters, the AAP is an organization that focuses on all factors that impact a child’s physical and mental health. This includes things such as family structure and a child’s home environment, which are part of what public health nerds call the psychosocial determinants of health. In short, psychosocial factors are generally created by other people in a child’s life and are things in which the child has little control. Things like home environment, family structure and stability all have massive impacts on a child’s physical and mental health, which is why organizations like the AAP, the American Academy of Family Physicians and the CDC study them.

For decades social scientists have studied children of same-sex couples and for just as long those on both sides of the same-sex marriage debate have used those studies to support their side. In 2013 the AAP reviewed the existing meta analyses of these studies and came to the same conclusion that the SCOTUS did after reviewing the same studies: A child’s well being depends much more on their relationship with their parents than it does on their parents’ gender or sexual orientation.

After reviewing the studies in 2006 and 2013 the AAP found that children of same-sex parents do not disproportionately suffer negative outcomes as a result of their parents sexuality. What the AAP did find was that the lack of uniform same-sex marriage rights across all 50 states does put children of same-sex couples at a disadvantage. This may seem bizarre as there are many children being raised by unmarried opposite-sex parents, or by single parents or by divorced parents. But the difference here is that the children of those relationships are legally recognized as being the children of those parents, which matters significantly in terms of custody and visitation rights, as well as access to medical benefits through the parents’ employers. It’s those disparities that negatively effect the physical and mental health of the children of same-sex couples, and why the AAP supports the same-sex marriage movement.

 


Resources:
The American Academy of Pediatrics Applauds Supreme Court Decision to Recognize Same-Gender Marriage in All 50 States. American Academy of Pediatrics. Published online 06/26/15. Accessed 06/28/15
The Social Determinants of Health FAQ. The Centers for Disease Control. Accessed 06/28/15

Collection: The Committee on Psychosocial Aspects of Child and Family Health.  Pediatrics -Official Journal of the American Academy of Pediatrics. Accessed 06/28/15

Definition: Social Determinants of Health Policy.  American Academy of Family Physicians. Accessed 06/28/15

Perrin, E.C., Siegel, B.S., et al. Technical Report: Promoting the Well-Being of Children Whose Parents are Gay or Lesbian. Pediatrics – Official Journal of the American Academy of Pediatrics. March 30, 2013. doi: 10.1542/peds.2013-0377. Accessed 06/28/15.

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

Lightning Won’t Make Your Plane Crash, and Other Dad Facts

By June 4, 2015 1 Comment
Share:

I swore to myself back in 2002 that I would never fly Delta Airlines again – that is, until this past weekend. In 2002 I was an undergrad and a terrible white-knuckle flyer,  and some horrendous weather delayed my flight from Boston to Atlanta. That meant I missed my connection to Southern California and was stranded for seven hours overnight in the Atlanta airport. I remember asking the attendants repeatedly to let me off the flight while we were still grounded (with the door open) just to avoid it. I was in tears by the time I got to Hartsfield-Jackson Atlanta International Airport, especially after the Delta desk attendant gave me a $5 voucher for food from vendors who had gone home hours before, saying it was the only compensation they could offer me. After all, it was a weather delay, and per policy, most airlines don’t do much for their passengers in those cases. But I was hungry, I was tired, and as a 20-year-old female, I was scared to be sleepy in a partially-shutdown airport alone. Delta was a bad word in my lexicon for a long, long time.

So this past weekend against my better Delta PTSD judgment, I booked a last minute set of moderately priced flights with them, from San Diego to Baltimore-Washington International Airport…by way of Atlanta. Eeek, I thought, here’s to second chances. I joked with my fiance  – how many times can lightning strike in the same place?

In this case, the proverbial answer was twice.

With a monster storm system trailing down the eastern seaboard, we spent seven hours overnight on Monday trying to sleep in one of Delta’s Atlanta terminals. Overnight in Atlanta! AGAIN – ACK! A weather delay in Baltimore meant we would either miss our connection in Atlanta or have to take a series of more complicated options Delta offered that would be costly, something we couldn’t afford. So we missed our second flight due to one of the more awful lightning storms I’ve ever witnessed with my own eyes. Lightning was striking over and over, sometimes even touching down around the Baltimore area.

I’m a pretty reasonable person. I don’t blame the crew of that plane or the airport for grounding the flight the way that they did. After all, it’s safety first, and Federal Aviation Administration regulations required it for them and other airlines. I also knew that Delta would be trying to relocate their crews and plane back to their main hub in Atlanta, so they’d likely push to get our flight out as soon as the weather permitted, passengers be damned. It just seemed like a safety stretch to be in the air at all when all other airlines had cancelled their flights.

So, like any rational person scared out of my mind in a metal lightning-rod-tube-with-wings sitting on a tarmac, the sky filled with flashing light, and no reassurances from the crew, I texted my father. He’s a veteran flight operations professional who handles things with both directness and humor. In this case, he was (and is) my Scientific Parent:

Dad quotes 1

My father’s usually a man of few words, so that was pretty much all I needed to hear. He’s a pilot, he’s Federal Aviation Administration certified for a host of compliance and safety topics, and he’s not one to get alarmed. This is a man who can sleep through turbulence and wake up refreshed as though he’s lounging on a beach. But he knows me well enough, and a few minutes later, this dropped in:

Dad quotes 2

Now this I didn’t know. My concept of bad weather+airplanes is something along the lines of the made-for-TV movie of Stephen King’s Langoliers. But the reality is much, much safer.

Static Discharge Points Along A Jet's Wing - via Wikipedia, courtesy Adrian Pingstone

Static Discharge Points Along  a Jet’s Wing – via Wikipedia, courtesy Adrian Pingstone

Lightning happens when high-current electricity is discharged (i.e. it sparks) in the atmosphere. That electricity is created by (to put it simply) liquid and ice and negative and positive electrical charges in the clouds colliding.  That can happen between clouds, within clouds, in the air, or between the cloud and the ground. I’m not going to get into the complicated science about it, but what is helpful to know is that 90% of all lightning strikes happen between clouds and the ground, which is why it’s so vitally important for those airports to operate cautiously. Because a single bolt can contain 1 million volts of electricity. Airports are big, flat spaces with tiny humans and large metal planes, and millions of gallons of combustible jet fuel, which is just asking for trouble.

As our plane sat on the tarmac at Baltimore, ground crews were cleared for their own safety against possible lightning strikes on the ground, and planes were halted in position. And while I was glad that we were safe in the plane both on the ground and in the air, I didn’t quite understand why.  So here’s how it works.

Planes’ fuselages are mostly aluminium, which is a great conductor of electricity. So great that it sounds crazypants to fly in bad weather at all.  Not surprisingly, while 10% of lightning strikes on planes happen due to a wrong-place-wrong-time scenario, 90% actually happen because the plane inadvertently causes it. But they’re also built to protect against that very occurrence. With all the smooth lines and curves of an airplane’s design, and a layer of embedded metal mesh, when lightning strikes, electricity flows over the plane, not within it.  Add in elements on the plane that help discharge additional electricity and ground all of the electrical equipment inside (elements such as shields, wire mesh, strips, etc.), and you’re actually quite safe. For all you freaked-out flyers like myself: this means you’re not going to get zapped, fried, and the plane isn’t going to suddenly stop working and fall out of the sky after a strike. Thank goodness!

From Boeing.com: Lightning travels along the airplane and exits to the ground.

From Boeing.com: Lightning travels along the airplane and exits to the ground.

Also, if lightning wasn’t a big deal for the plane why in the world weren’t we taking off if we were fueled up and ready to go? Because awful weather means awful turbulence. But that’s a whole other can of worms to open on another day.

I’m glad we’re finally home, and that our flight crew operated with a safety-first mentality, although the inconvenience factor without adequate allowances we experienced was atrocious. As a writer and policy person, I can’t really wrap my head around for-profit companies that have policies lacking contingencies for extended-hour delays, aimed at keeping customers both safe and supported. A kudos to Delta for making customer service more accessible these days  (props to WB at @DeltaAssist on Twitter, and a thank you to the crew and staff for being impeccably kind and warm despite their own exhaustion and lack of resources), but really corporate guys, you can do better than the policies you’ve got. I’m not looking to have that third proverbial lightning strike anytime soon.

 

 


 

Resources:

Metro Web Reporter. Amazing Picture of Planne Being Struck By Lightning above Heathrow. May 12, 2011. Metro.co.uk.

Jack Williams. How Things Work: Lightning Protection. July 2011. Air and Space Magazine.

Greg Sweers et. al,  Lightning Strikes: Protection, Inspection and Repair. April 2012. Boeing Aeromagazine.

Natalie Wolchove. How Passenger Jet Survived Direct Lightning Strike. May 12, 2011. LiveScience.com

Natalie Wolchoe. How Plane Electronics Are Grounded. May 12, 2011. LiveScience.com

Clarence E. Rash. When Lightning Strikes. June 2010. Aerosafety World Magazine of Flightsafety.org.

A. Powlowski. Can Lightning Bring Down A Plane? August 17, 2010. CNN.

Jack Williams. Why is an Airplane Safe From Lightning Strikes? August 27, 2014. The Washington Post.

Edward J. Rupke. What Happens When Lightning Strikes an Airplane? August 14, 2006. Scientific American.

Transport Airplane and Engine Issue Area Electromagnetic Effects Harmonization Working Group Task 2 – Lightning Protection Requirements  Policies & Procedures Recommendations. February 2001. Federal Aviation Administration Aviation Rulemaking Advisory Committee.

Tags: , , ,
Categories: Accidents, Injuries, + Abuse, Science 101 + Mythbusting