Tuesday, January 31, 2012

Health care costs

     Health care costs have become so expensive. One area that does get discussed at times is the cost of medications. Unfortunately, you often do not know the cost of the prescription until you pick it up at the pharmacy. For most conditions that require a prescription, there are less expensive alternatives available. Sometimes these alternatives may be generic forms of medications, they may be 2 or 3 times a day instead of once a day, and they may be a little less likely to work. But they can be free or $4 or otherwise very reasonable. There are many name-brand-only medications for children that are $70-150 for a 10 day or one month supply.
     The technology exists to be able to do something amazing with the prescriptions. What if the doctor could tell you, based on the medication, your insurance, and the pharmacy, how much the prescription was going to cost? No more surprise at the pharmacy. I think this could take a minute or so with a computer. Both the doctor and you the family could make a more informed choice. And it would be natural to pick something cheaper if it was otherwise "just as good". Many programs do this on the Internet when you are searching for a DVD or a coffee maker.
      An added benefit to having this ability is that it would likely push everyone to use more generics. With many antibiotics, that is a good thing. Because the older antibiotics are often not the "big guns", we would all be encouraged to use the "weakest thing that is likely to work". That would help us keep the bacteria from becoming more resistant over time.
     Although I think a computer program that provided this information would save this country millions and millions every year in medical care costs, it sadly will not come to exist anytime soon. The reason is that the pharmceutical companies and the pharmacies will lose money. But I think pediatricians and the families that they serve would love this ability. Maybe some day....

Sunday, January 29, 2012

Childhood Obesity

     Childhood obesity is an increasing problem in the United States. A combination of less activity, large portion sizes, less healthy food, and other factors have more than doubled the cases of childhood obesity in the last twenty years. Many things can be done to help fight obesity, although many of these actions are not easy and are not going to be popular. But to help make our children physically, socially, and psychologically healthier, these are important things to work on as a family. Tackling a few of these to begin with is a good start.
     The American Academy of Pediatrics recommends: eating 5 fruits and vegetables per day; getting 1 hour of physical activity per day; limiting screen time to less than 2 hours per day; limiting consumption of sugar sweetened drinks; eat breakfast daily; switch to low-fat dairy products; regularly eat family meals together; limit fast food, take out, and eating out; prepare foods at home as a family; eat a diet rich in calcium; eat a high fiber diet; and breastfeed exclusively until 6 months and maintain breastfeeding after introduction of solid foods until 12 months of age.
     Annual checkups are important for many reasons. Getting feedback about your child's growth is important in making sure they are maintaining healthy growth. If your child is overweight or obese, they can help you make a plan to make positive changes in their diet and their activity level. Set a healthy example for your children by making healthy choices yourself.
     Do not get too discouraged about this issue. As families, as communities, and as a nation, we can help our children lead healthy lives.

Friday, January 27, 2012

New information on fever reducers

     Medications such as acetaminophen and ibuprofen have been available over the counter for some years now. They are commonly used to treat elevated temperatures and pain. They are quite safe at the recommended doses and at the recommended intervals. Acetaminophen is metabolized by the liver and large over-doses can result in severe liver damage and death. Ibuprofen is metabolized by the kidneys and large doses over time can cause kidney damage.
     In recent years, studies have looked at how acetaminophen use may affect you in other ways. It has been common practice to recommend that infants receiving their vaccines that day be dosed beforehand with acetaminophen. One study looked at how this affected how immune the child was in the coming months to those vaccines. The infants who received acetaminophen on the day of their vaccines were LESS immune. It is believed that the acetaminophen dulled the infant's immune system's ability to make good protection. However, the study was done in Europe with a small number of infants.
     In addition, a number of recent studies have showed there is a correlation between acetaminophen use and developing asthma. At least two possibilities explain this. One is that the effect the acetaminophen has on your immune system may in some way make the asthma more likely. The other possibility is that respiratory viruses that can aggravate your lungs lead to asthma. And since a common symptom of a respiratory virus is a fever, the treatment of the fever with acetaminophen happens more often with those kids and adults who develop asthma.
     More research into how these medications affect us will happen. We all look forward to having more information on this topic. Stay tuned. And in the mean time, ask your physician and their staff about their recommendations for safely using these medications.

Thursday, January 26, 2012

Children who are sick all the time

     One of the most common questions that we are asked as pediatricians is about children who are "sick all the time". Many of these children are in daycare, preschool, or grade school. Many of them are in the first few years of being exposed to common childhood infections: colds, flus, pink eye, etc. Many of these children do not naturally do a very good job of avoiding other germs: they touch the world around them then touch their face, eyes, nose, and mouth. They do not avoid playing with a toy the other 2 year old just played with and he has a runny nose and a cough. They will pick up a spoon just used by their recently ill sibling and put it in their mouth. And the vast majority of children will build up a better immunity to these germs through these early illnesses. Down the road, these children often are rarely sick as they do a better job of avoiding the illnesses and they have a better immunity to fight them off if they are exposed.
     My three sons went through a similar story. Each was in daycare around many other children. Each of them went through dozens and dozens of illnesses: upper respiratory viruses, stomach flus, pink eye, ear infections, bronchiolitis, croup, roseola, hand foot and mouth disease, and fifth's disease. My oldest son was in a small, private daycare his first year. My wife and I circled the calendar date that year if he did NOT have a cold or cough that day. By the end of the year, we had only circled 5 days! Now that they are 16, 12, and 12, they are much healthier with an illness being a rare thing.
     Although some children who are "sick all the time" do have an underlying problem with their immune system, most do not. And the children that do have a "immune deficiency" often have unusual bacteria cause their infections or have unusual infections (for instance, a joint infection when there was no injury to that joint before the infection). The most common immune deficiencies are self-limited -- they require no special treatment and will resolve on their own.
     If you have concerns about your child and their infections, discuss it with their doctor.