UPDATES

UPDATES

Stockman receives St. Geme award

The drawing at right shows James A. Stockman III, MD, President of theAmerican Board of Pediatrics (ABP) and member of the Contemporary Pediatricseditorial board, duking it out with Founding Editor Frank Oski, in a 1994debate on the future of pediatrics. We thought reproducing it here was afitting way to announce that Dr. Stockman is this year's winner of the JosephW. St. Geme, Jr., Leadership Award. He joins a distinguished company. Previoushonorees include Dr. Oski; Contemporary Pediatrics editorial board membersLewis Barness and Morris Green, and such pediatric luminaries as Sam Katz,Robert Haggerty, Abraham Rudolph, Vincent Fulginiti, Ralph Feigin, JimmySimon, Errol Alden, and Catherine DeAngelis.

The award honors the memory of Dr. St. Geme, a distinguished and caringpediatrician whose untimely death in 1986 was mourned by the entire pediatriccommunity. The award is sponsored by the Ambulatory Pediatrics Association,the American Academy of Pediatrics, the ABP, the American Pediatric Society,the Association of Medical School Pediatric Department Chairmen, the Associationof Pediatric Program Directors, and the Society for Pediatric Research.Recipients must be currently active pediatricians who are perceived as rolemodels for others to emulate, who have contributed to broad areas of pediatricsbeyond the normal course of their professional activities, and who havebeen part of "creating the future" of the specialty. That's anapt description of Jim Stockman. We congratulate him.

Teaching hospitals renege on HCFA bargain

Two years ago, the Health Care Financing Administration offered teachinghospitals a bribe: Hospitals that cut back the number of residents theytrained by 25% over a six-year period would continue to have their residencytraining programs subsidized by Medicare at the same rate as if the personnelcuts hadn't been made. The offer sounded too good to refuse, and many hospitalsaccepted.

But over time, the reward began to look less attractive. In New YorkCity, where the program began, half the hospitals that originally signedup have dropped out. The hospitals left the program, spokesmen say, becausethey found they couldn't take care of all their patients without the servicesresidents provide, nor could they afford to replace residents with fullytrained MDs, who command three times a resident's salary for half the hoursresidents put in per week.

The hospitals' action is understandable. But unfortunately, it leavesthe problem HCFA set out to solve--an oversupply of physicians that drivesup health-care costs--in place. Time to go back to the drawing board, itseems.

Flap over SIDS

The article on a possibly causal relationship between a prolonged QTinterval and SIDS in the New England Journal of Medicine last November wasnot particularly startling (Schwartz PJ, Stramba-Badiale M, Segantini A,et al: Prolongation of the QT interval and the Sudden Infant Death Syndrome:N Engl J Med 1998; 338:1709). The authors had been publishing findings fromthis Italian study at intervals over the last 20 years, and most SIDS researcherswere familiar with the argument--even if they didn't find it persuasive.But something in the article and the accompanying editorial was too muchfor Jerold F. Lucey, MD, Editor in Chief of Pediatrics: the suggestion thatin-office technology to screen for prolonged QT intervals be developed andthe hint that--once this was feasible--pediatricians could then prescribeb-blockers for infants at risk of SIDS. Dr. Lucey fears that QT intervalscreening could become the latter-day equivalent of apnea monitors, whichhave "wasted hundreds of millions of dollars" without proof oftheir value, and he was "even more alarmed" at the suggested b-blockertreatment. So he took the unusual step of publishing his qualms in his ownjournal (Pediatrics 1999;103;812), with additional comments from expertreviewers the journal uses for SIDS manuscripts. The reviewers were equallyskeptical. As Joan E. Hodgman, MD, and Bijan Siassi, MD, of the Universityof Southern California School of Medicine put it, the recommendation toscreen and treat infants on the basis of a prolonged QT interval risks "addingyet another chapter of futile, sometimes dangerous, management of risk forSIDS to the depressing story that already exists." Where does thatleave primary care pediatricians? With the Back to Sleep, and No Smokingcampaigns, preventive measures that, as Dr. Lucey emphasizes, have broughtabout substantial reductions in SIDS rates throughout the world.

New food pyramid for kids

What's new in the new food pyramid for children 2 to 6 years of age,unveiled by the Department of Agriculture in March, isn't the recommendations;it's the graphics (right). Foods most children actually eat are prominentlyfeatured: things like single-serving pudding containers in the milk group(still two servings a day), peanut butter and a hamburger in the meat group(also two servings), and cold cereal--along with spaghetti and waffles--amongthe grains (six a day). Additionally, wildly active children jump rope andkick soccer balls on the margins, illustrating the value of physical activityfor maintaining good health.

It's hard to see how anyone could object, but critics have. The NationalSoft Drink Association fired off a huffy letter to the Secretary of Agriculture,objecting to the soda can at the top of the pyramid with the rather mildinjunction to "eat less." And the Center for Science in the PublicInterest objected to the hamburger, cheese slices, and ice cream in thepyramid, which they say encourages children to continue the unhealthy habitof eating foods high in saturated fats.

Despite these qualms, you may want to inform parents that a pamphletcalled Tips for Using the Food Guide Pyramid is chock-full of nutritionaladvice and available without cost on the web at www.usda.gov/cnpp.If you'd like a copy of Tips, as well as a 25" by 33" color postershowing the pyramid for your waiting room wall, call the Government PrintingOffice (202-512-1800) and ask for publication number 001-000-04665-9. Thecost is $5.

Vaccines for the 21^st century

Back in 1995, the National Institute of Allergy and Infectious Diseasesasked the Institute of Medicine (IOM) to help the research community setdomestic vaccine priorities for the future. Now, working with a quantitativecomputer model, the IOM has released a report that compares the cost andhealth benefits of developing more than two dozen different candidate vaccines.And for the first time in such forecasts, the new report includes therapeuticvaccines for chronic diseases as well as vaccines to prevent infectiousdisease.

The analysis is limited to vaccines that would be feasible to licensewithin the next 20 years; primary criteria are anticipated health benefitsand expected net savings of health-care resources.

Twenty seven vaccines that met these criteria were placed in four categories:most favorable, more favorable, favorable, and less favorable. Vaccineslisted in the most favorable category are:

• cytomegalovirus vaccine for 12-year-olds
• influenza virus vaccine for the general population
• insulin-dependent diabetes mellitus therapeutic vaccine
• multiple sclerosis therapeutic vaccine
• rheumatoid arthritis therapeutic vaccine
• Group B streptococcus vaccine for pregnant women and high-risk adults
• Streptococcus pneumoniae vaccine for infants and 65-year-olds.

For a listing of the vaccines in all four categories, with additionalinformation on the criteria used in the report, see the Vaccines for the21^st Century, executive summary, on the web at www2.nas.edu/hpdp.

What people really think about herbs and supplements

Natural remedies are hot these days, taking up more and more space ondrugstore shelves and prompting manufacturers of more traditional pharmaceuticalsto jump on the herbal bandwagon. So when National Public Radio teams upwith the Kaiser Family Foundation and the Kennedy School of Government todo a survey of public attitudes on the subject, the findings are worth reading.They show that more than half the respondents in this national sample arefamiliar with herbal products, about a fourth use them regularly or sometimes,and 18% give supplements to their children.

Additional findings reveal some interesting confusions in public attitudes:

• 64% believe products that "boost the immune system" help prevent people from getting sick, but 42% also believe the phrase means supplements help you get better if you're already sick.
• About a third believe (erroneously) that the government regulates herbal supplements, that the products are adequately tested, and that they provide the health benefits they claim. Yet over half believe that there isn't as much regulation as there should be to make sure supplements are pure and don't harm people, and that advertising claims about health benefits are true.
• More puzzling still, almost three quarters of the respondents say that even if a government agency said the dietary supplement they used most often was ineffective, they'd go right on using it.

When it comes to children, however, respondents are wary. Three quartersagree that supplements produced specifically for children should be morestrictly regulated than supplements for adults. Perhaps, now that supplementsadvertised specifically for children are starting to come on the market,Congress will take heed.

Calendar

May 27­30, National Rural Health Association Annual Conference, SanDiego. For information, call 816-756-3140, or E-mail to mail@nrharural.org

May 30­June 3, American Society for Microbiology General Meeting,Chicago, IL. Contact the Society at 202-942-9356

June 4­6, North American Society for Pediatric and AdolescentGynecology,New Orleans, LA. To register, contact NASPAG at 215-955-6331

June 5­7, New and Reemerging Infectious Diseases, Atlanta, GA. ContactKip Kantelo, 301-656-0003, ext. 19, or E-mail kkantelo@aol.com

July 16­18, Current Concepts in Pediatric Allergy and Otolaryngology,San Diego, CA. Contact Jenny Boyd at 619-576-4072

July 20­23, Society for Pediatric Dermatology, Thompsonville, MI.For information, call P. Fraser, 773-583-9780

July 28­August 1, American Academy of Dermatology Annual Meeting.Call the Academy at 847-330-0230

September 26­29, Interscience Conference on Antimicrobial Agentsand Chemotherapy, San Francisco. Contact ICAAC at 202-942-9254

October 9­13, American Academy of Pediatrics Annual Meeting,Washington,DC. Contact the AAP at 708-228-5005

November 18­21, Infectious Disease Society of America, Philadephia,PA. Contact IDSA at 703-299-0200 or E-mail to info@idsociety.org.

--Judith Asch-Goodkin

EYE ON WASHINGTON

Last month in our capital city, Congress was home on a spring break,the fabled cherry trees were in bloom (except for those that succumbed tothe attack of some beavers that turned up in the Tidal Basin), and the nightlynews broadcasts were filled with the far-away sounds of war in Yugoslavia.

Before they left, Republicans and Democrats had fed versions of a "Patients'Bill of Rights" into the legislative hopper. The two versions agreeon expanding consumers' right to appeal denials of coverage, making it easierfor patients to use the nearest emergency room, and giving physicians theright to discuss the full range of treatment options with patients. ButRepublicans would leave the initial judgment of medical necessity for treatmentin the hands of HMOs, while Democrats would give physicians the power tomake those decisions. The Democratic version would also make it easier forpatients to sue HMOs for denial of care.

In other federal actions last month, The FDA applied labeling rules todietary supplements, insisting on a complete list of ingredients, levelsof vitamins and minerals, common names of herbal products, and the partof the plant used to manufacture the supplement. The Agency is also crackingdown on direct-to-consumer advertising that make false or misleading claims,including ads for remedies that treat allergies, asthma, high cholesterol,high blood pressure, hair loss, and sexually transmitted disease.

The Institute of Medicine issued a favorable report on the medical usesof marijuana, specifically for treating pain, nausea, and weight loss associatedwith AIDS. In addition, the IOM's analysis of the medical literature foundno evidence that giving marijuana to sick people would increase illicituse in the general population, or that using marijuana was a "gateway"that led to using harder drugs such as cocaine and heroin.

The Advisory Commission on Medicare disbanded, unable to reach agreementon how to keep the system solvent. Eight Republican members of the Commissionand two Democrats voted for a plan to give recipients a fixed amount ofmoney to buy a public or private health plan. The hold-outs (and PresidentClinton) denounced the proposal as a plan to convert Medicare from a universalguarantee to a voucher for private insurance. The President plans to announcehis own save-Medicare proposal soon.

The Departments of Education, Justice,and Health and Human Services announceda $180 million grant program to schools for antiviolence programs. The Administrationplans to ask Congress for an additional $120 million for such grants overthe next two years.*