Safety

Is the rising cost of prescription drugs preventing patients from accessing life-saving medication?

Prices of prescription drugs in the United States are among the highest in the world. Most recently, the skyrocketing price of the epinephrine pen, EpiPen, has been the subject of major news headlines. Many have been enraged by the dramatic price increase of the EpiPen ($100 to over $600 in the span of a few years). Unfortunately, the EpiPen is one of many prescription drugs that has been affected by such dramatic inflation. Many fear that the rising cost of life-saving medication will limit access to those who need it. Healthcare providers cannot stand idly as these changes negatively impact patients. We need to have a better understanding of the prescription drug industry so that we can find reasonable solutions for our patients. (more…)

Addressing the violence in the news with children

Children are indirectly exposed to acts of violence and terrorism almost continuously via the media.  News media continually cycles global events onto screens in every household. The stress of witnessing a shooting is no longer limited to the bystanders and civilians caught on the scene, but is spread diffusely across state and national borders to viewers in their homes including children. Pediatricians can help children and their caretakers process these tragedies better.  

Exposure to such news stories can contribute to a stressful environment for the child. In recent years the AAP has focused on ‘toxic stress’ in a child’s life. Toxic stress has been defined as “the excessive or prolonged activation of the physiologic stress response systems in the absence of the buffering protection afforded by stable, responsive relationships” (National Council of Science: Excessive stress disrupts the development of brain architecture). A growing body of evidence suggests that ecology and biology interact to effect development, i.e., the ecobiodevelopmental framework. In the case of toxic stress, a stressful ecology inculcates lasting detrimental effects in biology and behavior. It can lead to development of poor coping skills, unhealthy lifestyle choices, chronic cardiovascular diseases and serves to perpetuate health disparities to mention a few.

Opinions vary on the extent and significance of the effect of exposure to news media coverage of acts of terror and violence. Increasingly, after such an incident, many articles emerge suggesting how parents should talk to their children about violence. Unfortunately, many children do not have the “buffering protection afforded by stable, responsive relationships” with their parents. Parents themselves may face a difficult time coming to terms with the same tragedies. This gap can be bridged by the pediatrician, school and public policy.

Pediatricians can routinely screen for toxic stress. The AAP has put forward many helpful resources which advise parents on how to talk to their children regarding media violence, tragedies they may have witnessed, school shootings and disasters. Whenever such news is circulating, pediatricians can ask parents if they have trouble communicating with their children about it, expand on their anticipatory guidance using the pre-existing AAP guidelines and recommend appropriate resources to them.  Further, pediatricians in collaboration with mental health professionals can meet with parent-teacher associations to share how children are able to best process these events.

Schools can engage their own mental health services and counselors to have a discourse with children in an age-appropriate manner. In the absence of adequate resources, these sessions could be done in groups and limited to when the event is local.

Finally, state government officials can improve funding for mental health services for children and implement strategies to incentivize an increase in the mental health professionals catering to the pediatric population. Legislators can formulate guidelines for Social and Emotional Learning (SEL) curriculum for grades K-12 as exist for pre-kindergarten. As of December 2015, free-standing guidelines for Social and Emotional Learning exist only in the states of Illinois, West Virginia and Kansas. Bills proposing training of teachers and principals to address social and emotional development needs of students have been previously introduced in the U.S. House (H.R.850; H.R.497) and the U.S Senate (S.897) in 2015. In the same year, a bill (HB 3289) was also introduced in the Texas Legislature proposing formulation of a local school health advisory committee to address mental health concerns existing in school efforts and to make recommendations to the school district concerning the integration of social and emotional learning into the academic curriculum.

Adopting such a multi-pronged approach will better preserve the childhoods of the current generation and safeguard their adult lives as well.

References:

1.       National Scientific Council. Excessive stress disrupts the development of brain architecture. Journal of Children’s Services. 2014 Jun 10;9(2):143-53. Accessed July 11, 2016. URL: http://developingchild.harvard.edu/wp-content/uploads/2005/05/Stress_Disrupts_Architecture_Developing_Brain-1.pdf

2.       Shonkoff, J.P.; Garner, A.S. Technical Report: The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012. doi:10.1542/peds.2011-2663

3.       Committee on psychosocial aspects of child and family health, committee on early childhood, adoption, and dependent care, and section on developmental and behavioral pediatrics. AAP Policy Statement: Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012. doi:10.1542/peds.2011-2662

4.       Busso, D.S.; McLaughlin, K.A.; Sheridan, M.A. Media exposure and sympathetic nervous system reactivity predict PTSD symptoms after the Boston marathon bombings. Depress Anxiety. 2014 July ; 31(7): 551–558. doi:10.1002/da.22282

5.       Marie Leiner, M.; Peinado, J.; Villanos, M.T.M.; Lopez, I.; Uribe, R.; Pathak, I. Mental and emotional health of children exposed to news media of threats and acts of terrorism: the cumulative and pervasive effects. Frontiers in Pediatrics. 2016. doi: 10.3389/fped.2016.00026

6.       Collaborative for Academic, Social and Emotional Learning. Identifying K-12 Standards for SEL in all 50 States. 2015. Accessed July 9, 2016. URL: https://pedsadvocacy.files.wordpress.com/2016/07/a46cb-state-scorecard-summary-table-for-k-12-12-16-15.pdf

7.       Collaborative for Academic, Social and Emotional Learning. Identifying Preschool Standards for SEL in all 50 States. 2015. Accessed July 9, 2016. URL: http://static1.squarespace.com/static/513f79f9e4b05ce7b70e9673/t/55df7c05e4b031d82f728c5d/1440709637809/preschool-table-8-27-15.pdf

8.       Texas Education Agency. Accessed July 9, 2016. URL: http://tea.texas.gov/index2.aspx?id=2147495508

 

Gohar Warraich, M.D.

 

The Dangers of Indoor Tanning

It’s summertime! Many kids are excited that the warmer weather means a few months off school and a change in daily routine. This often includes time at the pool with friends, which can motivate teens to want to look their best. For some, this means having a tan, and many teens will head to the tanning salons to darken their skin and achieve a bronze “summer glow.” However, the use of tanning beds has been associated with deadly forms of skin cancer, and kids and teens are at the highest risk. It is time for pediatricians to encourage lawmakers to create legislation protecting children from these dangers.

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Consciously Supporting Concussion Awareness

In recent years, public interest has increased surrounding concussions/mild traumatic brain injuries (MTBI). This is due in large part to the recent hypothesis that concussive forces from contact sports may be a risk factor for the development of chronic traumatic encephalopathy (CTE), a disease seen most often in former boxers and professional football players.

Research, legislation, and documentaries have sought to better define the incidence and risks of concussions, its relationship to these 2 diseases, and to increase public awareness of this issue. Currently, legislation is pending in both the U.S. House of Representatives and the Senate that has the potential to further achieve these goals by increasing general awareness about concussions and giving parents and youth the ability to make informed decisions about the sports in which they participate. We as pediatricians can advocate for the safety of our patients by contacting our local representatives and asking them to become cosponsors for the “SAFE PLAY Act” (H.R. 829).

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Binge Drinking in Adolescents, a Pediatrician’s Role.

Adolescence is a period of limit testing in which children and young adults are at increased risk of substance abuse. The most frequently used substance by adolescents is alcohol.  Adolescents who drink alcohol have an increased rate of binge drinking compared to adults. Adolescent alcohol abuse is associated with an increased risk of chronic alcohol abuse leading to serious illnesses as adults. Also, alcohol use can be associated with the leading causes of death and serious injury in ages 15 to 24 (unintentional injury, homicide, suicide).

The AAP Committee on Substance Abuse recently released a Clinical Report titled Binge Drinking (http://pediatrics.aappublications.org/content/136/3/e718.full). In the report, binge drinking is defined and characterized, risk factors are discussed, and neurobiology is addressed.  The authors provide screening guidance for pediatricians.   The report explains that at age 9, children start having positive feelings about alcohol and start thinking that alcohol may not be just for adults. This means that ages 9-15 is a critical period for screening and intervention.   The report recommends that pediatricians should screen every patient for alcohol use starting at age 9.

The NIAAA collaborated with the AAP to develop a quick two-question screening tool that varies by the  patient’s age.  The questions focus about asking the patient about their own alcohol usage and their friend’s alcohol usage.

Here is an image summarizing the screening tool:

Screen Shot 2015-09-30 at 4.29.54 PM
In addition to screening patients, pediatricians can support the Sober Truth on Preventing (STOP) Underage Drinking Reauthorization Act (H.R. 1717, S. 728).
This bill will reauthorize an act targeted at reducing underage drinking through research, a highly-visible national media campaign, and grants to public health care providers/community organizations/ and partnerships with higher education institutions.
( https://www.congress.gov/bill/114th-congress/house-bill/1717?q={%22search%22%3A[%22sober+truth%22]}&resultIndex=1 )

What YOU can do:

  • Educate yourself about alcohol use in adolescents and it’s health effects.
  • Screen every patient starting at age 9 for alcohol use; intervene as necessary.
  • Talk to your patients and their parents about alcohol-related risks.
  • Contact your federal representatives and ask them to co-sponsor and support  the Reauthorization of the STOP Act.

 

Sources and Resources:
AAP Clinical Report, Binge Drinking. http://pediatrics.aappublications.org/content/136/3/e718.full
http://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuideOrderForm.htm
http://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/underage-drinking
http://www.stopalcoholabuse.gov/Default.aspx
http://www.samhsa.gov/underage-drinking

https://www.congress.gov/bill/114th-congress/house-bill/1717?q=%22search%22%3A%5B%22sober+truth%22%5D&resultIndex=1)

Paul Teran, MD

How should the FDA regulate E-Cigarettes and other tobacco products? Comments due 8/31/2015

The Food and Drug Administration published an advance notice of proposed rulemaking in July 2015 seeking public input for the regulation of e-cigarettes and novel tobacco products (i.e. dissolvables, lotions, gels, and drinks). Currently, the FDA regulates cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco. The FDA is considering extending its regulations to cover e-cigarettes and other novel tobacco products.

The agency is asking for specific information as it considers an expanded regulation, and it asks for comments on two general areas:

1) What health advisory warnings, if any, should be displayed on e-cigarettes and novel tobacco products? Should pictures be included?

2) Should the FDA require child-resistant packaging for liquid nicotine and other products?

 

You can read the full Advance notice of proposed rulemaking here: https://www.federalregister.gov/articles/2015/07/01/2015-16151/nicotine-exposure-warnings-and-child-resistant-packaging-for-liquid-nicotine-nicotine-containing#page-37556

-or-

http://www.regulations.gov/#!documentDetail;D=FDA-2015-N-1514-0001

 

How can you make your voice heard?

The notice has numbered questions for both areas of concerns, which you can address in your comments. Comments can be submitted electronically and via regular mail until August 31, 2015. Make sure to include Docket No FDA-2015-N-1514 in your letter.

 

Sources:

https://www.federalregister.gov/articles/2015/07/01/2015-16151/nicotine-exposure-warnings-and-child-resistant-packaging-for-liquid-nicotine-nicotine-containing#page-37556

https://www.federalregister.gov/articles/2014/04/25/2014-09491/deeming-tobacco-products-to-be-subject-to-the-federal-food-drug-and-cosmetic-act-as-amended-by-the

 

Fariha Hussain, M.D.

Child Trafficking: A Public Health Concern

Human trafficking is not only a global issue, but also a major public health concern within the United States. Studies suggest that up to half of trafficking victims seek medical attention at least once during their trafficking situation. This represents a large, often-missed opportunity for healthcare professionals to intervene. The injustices of human trafficking include forced labor, involuntary servitude, child soldiers, and sex trafficking. Some estimate that over 20 million men, women, and children are victims of human trafficking worldwide. [1] However, the scope of the problem is difficult to quantify, given the covert nature of the crime. The U.S. government no longer includes official estimates in its annual “Trafficking in Persons” reports. In 2004, the Department of Justice estimated that 14,500-17,500 trafficking victims were brought to the U.S. each year. [2] In addition to the victims brought illegally to this country, another 300,000+ youth within the U.S. are thought to be at risk of exploitation. [3]  As many as 80% of trafficking victims are female, and one-third to one-half are minors. [4] Cases of child trafficking have been confirmed in all 50 U.S. states over the last decade. [3]

Here’s what pediatricians can do to help: (more…)

Update: Firearm Injuries and Deaths in Children and Adolescents – A Call to Action

Dr. Nancy Kelly authored a policy brief on July 15, 2014 emphasizing the importance of family counseling and legislative advocacy in preventing pediatric injury and death from firearms. Since then, the American Academy of Pediatricians (AAP) has updated their recommendations regarding keeping our children safe from gun violence. Additionally, new bills have been filed for consideration during the 84th meeting of the Texas Legislature that have the power to impact pediatricians and their patients positively or negatively. Recent tragic events in Boston shed light on the need for increased firearm regulations, especially in health care settings.

  (more…)

Please support the extension of Medicaid and CHIP funding

Medicaid and CHIP are essential to children’s healthcare in the United States. It is critical that we continue to fund both of these programs to ensure that our nation’s children continue to receive well child care from their primary care provider.  Well child care includes routine visits for vaccinations, ongoing surveillance visits for chronic health conditions, or yearly “check-ups.” (more…)

Protecting Our Children from Accidental Liquid Nicotine Exposure

E-Cigarettes are quickly rising in popularity and becoming a more common household item. The liquid nicotine containers used to refill e-cigarettes are particularly dangerous to children. Ingestion or even absorption through the skin can produce very serious and potentially fatal effects. Currently there are no laws regulating child-proof packaging of liquid nicotine for E-cigarette use. We need to protect our children from accidental nicotine poisonings by supporting the Child Nicotine Poisoning Prevention Act which will require child-resistant packaging of liquid nicotine. (more…)