Posted On: September 23, 2011

Baltimore Research Institute Sued for Exposing Children to Lead

Here’s a “does this still happen in America?” moment: A class-action lawsuit has been filed against a Baltimore hospital for letting children be exposed to high levels of lead as part of a study.

According to, the subjects involved in the Kennedy Krieger Institute study in the 1990s were poor, minority children living in homes with high levels of toxic lead paint. Researchers wanted to observe the health effects, and failed to inform the parents that their children might be at risk.

Lead paint is toxic. It can cause irreversible brain damage, growth retardation, coma and other serious problems. We drew this ugly picture a couple of years ago. Although it was banned more than 30 years ago, many old and/or poorly maintained homes contain flaking paint that can cause lead poisoning if it is eaten or sucked on, as youngsters are prone to do.

In the study, some families were moved into homes with less lead contamination, and others were allowed to remain in lead paint-contaminated homes without being told about the health effects or the lead levels. The plaintiffs claim that Kennedy Krieger selected poor and minority test subjects to stay in contaminated homes, while generally selecting white and more affluent children as those to be moved into safer homes.

On its website, Kennedy Krieger says it’s dedicated “to helping children and adolescents with disorders of the brain, spinal cord and musculoskeletal system achieve their potential and participate as fully as possible in family, school and community life.” It’s a nonprofit hospital and research institute whose Lead-Based Paint Abatement and Repair and Maintenance Study began in 1993. The objective was to find affordable ways to reduce the risk of lead-paint poisoning for children living in older homes and apartments.

Institute officials deny that they targeted poor and minority children to remain in contaminated homes, and say that the study has led to vast improvements in lead-based paint abatement policies. The study was conducted in 13 cities nationwide and sanctioned by the federal government. Kennedy Krieger officials say it led to a 93% drop in the number of lead poisoning cases in Baltimore.

According to AboutLawsuits, the institute has settled several claims out of court, and in 2001, the Maryland Court of Appeal ruled that Kennedy Krieger officials knew that some families were living in homes with dangerous levels of lead contamination and knew the children there were suffering from elevated blood lead levels, but failed to inform those families that their children had elevated levels of lead in their blood in a timely manner.

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Posted On: September 19, 2011

Treatment for Depression Among Teens Is Troubling

Mental illness. Depression. Suicide. The dark side of the human condition is sad whenever and whomever it strikes. But when the victims are young people, it seems unacceptably unnatural. Yet suicide is the third most common cause of death among teenagers.

So programs such as TeenScreen that survey young people to determine their risk of depression make sense. Those who seem to be at risk are referred for treatment. But John Horgan, writing in Scientific American, raises profound questions about whether screening teens for mental illness is really a good idea for them, or only for a society that wants to feel as though it is doing something.

Some people are opposed to this mental health screening, contending that these issues are private for the youngsters and their families. They contend that they also promote overprescribing of psychiatric medications.

Horgan agrees with the latter concern, noting that:

  • Psychiatrists say that more than 1 in 10 children suffer from mental illnesses — from attention-deficit disorder to full blown psychosis. In 2008, the General Accounting Office estimated that 1 in 16 children is “seriously mentally ill.”

  • The number of children so mentally disabled that their families are eligible for government assistance has swelled from 16,200 in 1987 to 561,569 in 2007, a 35-fold increase. During the same period, those requiring government assistance for all other ailments declined from 728,110 to 559,448.

  • 3.5 million U.S. children take Ritalin and similar medications for (attention deficit hyperactivity disorder) ADHD, up from only 150,000 or so in the late 1970s -- or about 1 in 23 children from 4 to 17.

  • U.S.children consume three times as many ADHD medications as the rest of the world’s children combined.

  • A 2002 study estimates that 1 in 40 children 18 or younger takes antidepressants. Numerous studies indicate that whereas antidepressants can provide short-term relief for some children, some treated with antidepressants may experience side effects ranging from anxiety and insomnia to full-blown mania and psychosis.

  • Since 1995, the number of children diagnosed with bipolar disorder has multiplied more than 40-fold to roughly 800,000.

  • Children diagnosed as bipolar are treated with drugs — notably antipsychotics normally prescribed for adult schizophrenics — that have severe physiological as well as mental side effects, including obesity, diabetes and involuntary tremors.

  • More than 500,000 children (including infants) ingest antipsychotics, a trend The New York Times reported has been aggressively promoted by manufacturers of antipsychotics.

The promoters of TeenScreen, Horgan writes, have ties to the pharmaceutical industry.
Some psychiatrists advocate medicating young people deemed to be “at risk” of schizophrenia based on behavior less than compelling or because they have schizophrenic relatives.

"Mental illness is devastating for children as well as adults," Horgan concludes, "and medication, when used wisely and sparingly, can help. But clearly our current approach to treating disturbed young people is broken."

Certainly, a disturbed, dangerously unhappy teenager deserves medical attention and appropriate intervention. But before parents agree to an aggressive regimen of psychotropic drugs, they should fully inform themselves of the side effects and risks. There are a lot of ways to treat depression. Drugs is only one.

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Posted On: September 15, 2011

Keep Your Pliers Off My Kid's Wisdom Teeth!

That could be the modern parent's mantra, faced with the too common advice from dentists that a teenager should have healthy wisdom teeth removed "before they cause trouble."

Trouble is that the best evidence is that most wisdom teeth, impacted or not, never cause trouble to a young adult. And if and when they do, there is plenty of time to remove them when they send pain signals or show other signs of a real problem, and no downside to waiting until that day. Taking out healthy wisdom teeth causes, at a minimum, days of pain and need for heavy duty medications like Tylenol with codeine, and at a maximum, complications like loss of smell or taste.

Not to mention the considerable cost of paying oral surgeons and dentists to extract wisdom teeth.

The American Public Health Association says prophylactic removal of wisdom teeth injures tens of thousands of patients a year at a cost of billions of dollars. That's billions with a B.

Here is the APHA statement reviewing the scientific evidence on removal of wisdom teeth.

The only health group that supports removal of wisdom teeth before any pain arises is, you guessed it, the association of surgeons that do all the work: the American Association of Oral and Maxillofacial Surgeons.

Read more in a recent New York Times article by a thoughtful parent who ultimately concluded, after doing her own research, that "watchful waiting" was the way to go for her teen daughter.

And here are two dentists writing letters to the Times saying they agree based on their own experience that it's better to hold off and not rush into removal of wisdom teeth before you really need to.

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Posted On: September 12, 2011

Do Hospitals Overmedicate Pediatric Patients?

Is this a case of more is less? Some pediatric hospital patients, especially those with unusual disorders, are given so many drugs and therapeutic agents that their treatment is raising questions of unacceptable risks.

Readers of a report published in the Archives of Pediatrics and Adolescent Medicine are certainly invited to draw that conclusion.

The problem isn’t necessarily the number or nature of the drugs, but the fact that many facilities lack an established, scientific protocol for child safety in administering them.

Like adults, children often are given prescription drugs for “off-label” uses -- that is, to treat a problem other than the one for which the medication was developed. And also like adults, children sometimes are victims of medication errors. The groundswell of legislation in the last decade to improve the labeling and administration of medication to children is testimony to the need to separate the the determination of dosing for adults and for children.

“To advance this agenda,” the study authors wrote, “we need to refine our knowledge of the overall patterns of pediatric inpatient drug and therapeutic agent use, including what drugs and therapeutic agents are used most commonly, the number of different drugs and therapeutic agents that hospitalized children receive, and potential differences in drug and therapeutic agent exposures across different types of hospitals.”

The researchers surveyed academic medical centers, community-based hospitals and large systems of multiple hospitals. They studied more than 700,000 pediatric patients across 411 different hospitals.

The drugs most commonly given were acetaminophen (Tylenol), albuterol (for relief of respiratory issues such as asthma) and antibiotics.

On the first day of their stay in a children’s hospital, patients younger than 1 received 11 drugs and older patients received 13. In a general hospital, kids younger than 1 got eight drugs and those older got 12. By day seven of hospitalization in a children’s hospital, the youngest babies had received 29 drugs, and the older childern had gotten 35. General hospital figures were 22 and 28 respectively. The odder the illness, the more likely it would attract greater drug exposure.

That’s a lot of medicine for a developing body to metabolize, and while that is neither positive or negative, the sheer volume bears scrutiny. The authors suggest that:

  • ranking the drugs and frequency of their use for hospitalized children can suggest priorities for further research;

  • the use of multiple drugs raises concern for patient safety because such “polypharmacy” (multiple drugs) in adults has shown adverse effects;

  • establishing a database of use offers opportunities to compare effectiveness and study safety.

The point is to learn if pediatric patients receive too many drugs, too few and/or in the proper combination.

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Posted On: September 8, 2011

Vaccinating Teens for Sexually Transmitted Cancers Still Lags in Use

A study published by the Centers for Disease Control and Prevention focusing on vaccination coverage of teenagers from 13 to 17 presents a good-news/bad-news scenario.

Good news: Adolescent vaccination rates for meningococcus (MenACWY, which protects against meningococcal meningitis), tetanus/diptheria/acellular pertussis (Tdap) and human papillomavirus (HPV), all increased from 2009 and 2010. Bad news: HPV vaccination rates lagged the other two, and less than one-third of the subjects completed the three-shot series.

Vaccinating against HPV protects girls from developing cervical cancer later in life and can protect boys from genital warts and anal cancer. But the shot has to be given before sexual activity begins.

The CDC survey has collected provider-verified vaccination data since 2006 in a random telephone survey of parents or caregivers, verified by records from health-care providers. The latest survey found that almost two-thirds of respondents had received MenACWY, slightly more than two-thirds had received the Tdap and nearly half of respondents received one the recommended three doses for HPV vaccine.

From 2009 to 2010, among girls who received the three HPV doses, coverage increased by 5 in 100, which was considerably less than those observed for the Tdap (13 in 100) and meningitis (9 in 100) vaccines.

There were notable geographic differences in who got the vaccines, with states in the southeast lagging other regions.

Melinda Wharton, M.D., M.P.H. and deputy director of the CDC's National Center for Immunization and Respiratory Diseases said, "Far too few U.S. girls are getting the HPV vaccine. We can do better at this — we've got in our possession a very powerful tool: a vaccine that prevents cancer," she said. "If we all take actions to protect girls starting today, we'll have generations of women who will never be diagnosed with cervical cancer."

One manufacturer’s HPV vaccine also is recommended for adolescent males to prevent four common HPV strains that cause genital warts and anal cancer.

Wharton told Medscape that several factors might explain the disparity in rates between HPV vaccination and the other two. Adherence is a lot easier for a single-dose vaccine than for one that requires three shots. And many parents believe that girls are too young at the recommended age (11 or 12) to receive the vaccine.

There isn’t really an answer to the first impediment, and the CDC recommends a two-dose series for MenACWY. As for the second impediment, as Wharton points out, the vaccine doesn’t work “unless it is given prior to the onset of sexual activity, and that's why we recommend it so young."

"Even if we know our children very well, we don't know when they are going to be first sexually active," Wharton said. "It's also possible that most parents are not going to be as concerned about [the young age at first dose] as providers think they might," she said. "If a provider makes a strong recommendation for this vaccine ... it may be that parents won't have many questions about it."

Your pediatrician doesn’t schedule vaccinations according to personal habits or family dynamics. It’s about preventing disease the most effective way possible. Science doesn’t judge; it analyzes.

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