Date: 10/31/2008
By RACHEL JOHNSON
The Aiken Standard
AIKEN, S.C. (AP) _ One mother’s persistence saved her son’s life.
After watching medical personnel roll their eyes and express the “not you again” body language numerous times over the past year, Nicole and Stephen Householder finally found some answers to the mysterious rash that was written off as eczema, the abnormal bowel symptoms, the bruising, excessive diaper rash, cradle cap and other symptoms that manifested in her 13-month-old son, Landin.
“Are you a first-time mother?” nurses frequently asked Nicole, or they said, “He looks fine and acts fine so there isn’t anything wrong.”
Nicole knew in her heart something was wrong with her son, and she persisted until she found answers. “I knew something wasn’t right with him.”
Since Landin was born Sept. 21, 2007, he has been a familiar face at his pediatrician and the hospital. Nicole recalls they have been going to the doctor’s office at least seven or eight times a month. Initially, he was hospitalized for chronic constipation which later turned to chronic diarrhea — issues the Householder family has been dealing with since birth.
Just a few days before Landin’s first birthday, Nicole noticed red splotches on Landin’s back. “It looked like an allergic reaction,” she said. She was not alarmed as children frequently have reactions.
Observing the area over the weekend, Nicole noticed the redness spreading. Landin never seemed to notice; he never itched the area and continued crawling, playing and learning to walk.
Nicole took Landin to his pediatrician where Landin was diagnosed with eczema and given a topical cream for treatment. Over the next few days, not only did the rash become more severe, Landin’s skin began to turn black and blue. He still didn’t itch and the bruises didn’t appear to hurt.
The Householders returned to the doctor where Landin was tested for meningitis. He never ran a fever and appeared perfect.
“They kept telling me he’s acting fine, but as a momma I wanted answers,” said Nicole. “What was he supposed to look like or act like? I knew something was wrong and I felt like I wasn’t being taken serious.”
Landin was referred to a hematologist/oncologist as there was concern for leukemia. His platelet levels came back normal, his blood work was fine. Next he was referred to a dermatologist who agreed that if it were eczema, Landin would be scratching.
After three and a half weeks of watching her child turn blue and the rash worsen while doctors told her it was eczema and prescribed creams for it, Nicole and her family wanted answers.
Two biopsies were performed on the rash on Landin’s back and returned with results testing positive for Langerhans cell histiocytosis. The dermatologist referred the Householders to an oncologist to explain the disease to the family.
Nicole’s mother, Gwen Koon, spent the next 24 hours frantically researching Langerhans cell histiocytosis online, while Nicole and Stephen dealt with the devastating news.
They discovered that histiocytosis is a rare blood disease caused by an excess of white blood cells called histiocytes. The histiocytes cluster together and can attack the skin, bones, lung, liver, spleen, gums, ears, eyes and/or the central nervous system.
Information provided to the Householder family by a specialist states in big bold letters “There is no known cure,” there is only treatment. Landin’s treatments will either be chemotherapy for six months to a year, prednisone shots or surgery.
The cause of the disease is unknown, but it can be triggered by an unusual reaction of the immune system or by something commonly found in the environment. It is not hereditary or communicable.
“The doctor told me I saved my son’s life by being a paranoid mother,” said Nicole. “Don’t give up when you know something is wrong; you’re the parent. People really need to look at what’s going on when their child is not getting better. You know if something is wrong with your child.”
Copyright 2008 The Associated Press.
Therapy plus Zoloft helps kids with anxiety
Date: 10/30/2008 2:53 PM
By LINDSEY TANNER
Associated Press Writer
CHICAGO (AP) _ A popular antidepressant plus three months of psychotherapy dramatically helped children with anxiety disorders, the most common psychiatric illnesses in kids, the biggest study of its kind found.
The research also offers comfort to parents worried about putting their child on powerful drugs — therapy alone did a lot of good, too.
Combining the drug sertraline, available as a generic and under the brand name Zoloft, with therapy worked best. But each method alone also had big benefits, said Dr. John Walkup, lead author of the government-funded research. It’s estimated that anxiety disorders affect as many as 20 percent of U.S. children and teens.
In many cases, symptoms almost disappeared in children previously so anxious that they wouldn’t leave home, sleep alone, or hang out with friends, said Walkup, a Johns Hopkins Hospital psychiatrist.
“What we’re saying is we’ve got three good treatments,” he said.
While many kids have occasional fears or anxiousness, those with full-fledged anxiety disorders are almost paralyzed by these feelings. Three types of disorders were studied: separation anxiety, generalized anxiety and social phobia, Walkup said.
Affected kids may be so worried that something bad will happen to their parents that they repeatedly refuse to go to school. Or they’ll be so afraid of thunderstorms that they get chronic stomachaches, even when it’s not stormy. Those with social anxiety disorder may just seem shy, but they are so self-conscious that they won’t seek out friends or take part in class so their grades suffer, Walkup said.
“These kids were really miserable at the start of the study,” and many ended up “really happy,” March said.
Sertraline is among antidepressants linked with suicidal thoughts and behavior in children with depression.
In this study, only a handful of the more than 200 kids using it had suicide-related thoughts and there were no suicide attempts, Walkup said. Suicidal tendencies are more common in depression than in anxiety, he said.
Zoloft, mostly used to treat adult depression and anxiety, is approved for treating obsessive-compulsive disorder in kids, but not anxiety. Some doctors use it for that, however. And some smaller, less rigorous studies have suggested it and other antidepressants can help.
The new study, paid for by the National Institute of Mental Health, is the largest examining treatment of childhood anxiety disorders, said co-author Dr. John March of Duke University,
Dr. Thomas Insel, the institute’s director, said the study provides strong evidence that combined treatment is “the gold standard,” but that sertraline or therapy alone can be effective.
Dr. Sharon Hirsch, a University of Chicago psychiatrist not involved in the study, said it echoes benefits she’s seen in her own young anxiety patients on both treatments. But she note that the study shows that therapy alone is also good news for parents who don’t want to put their children on an antidepressant.
The study, published online in the New England Journal of Medicine, was scheduled for presentation Thursday at an American Academy of Child and Adolescent Psychiatry meeting in Chicago.
Several study authors reported receiving consulting fees or other compensation from drug companies, including antidepressant makers.
The study involved 488 children aged 7 to 17 treated at six centers around the country. They were randomly assigned to one of four 12-week treatments: up to 200 milligrams daily of sertraline; 14 hour-long sessions of psychotherapy alone; both treatments together; or dummy pills.
In the combined treatment group, 81 percent of children were much improved by three months, compared with 60 percent in the therapy-only group, 55 percent in the sertraline-only group, and 24 percent in the placebo group.
The therapy used in the study was cognitive behavior therapy, which emphasizes that thoughts can be irrational and cause troubling feelings. It encourages patients to focus on positive thinking that allows them to develop ways of confronting fearful situations.
Improvement, measured on a psychiatric scale, meant that anxiety had lessened so much that kids could do things they’d refused to do before, such as sleep in their own beds, go to school and socialize.
There was only one serious “adverse event” considered possibly linked to treatment — worsening behavior in a child on drug treatment only.
___
On the Net:
NEJM: http://www.nejm.org
National Institute of Mental Health: http://www.nimh.nih.gov
Copyright 2008 The Associated Press.
By LINDSEY TANNER
Associated Press Writer
CHICAGO (AP) _ A popular antidepressant plus three months of psychotherapy dramatically helped children with anxiety disorders, the most common psychiatric illnesses in kids, the biggest study of its kind found.
The research also offers comfort to parents worried about putting their child on powerful drugs — therapy alone did a lot of good, too.
Combining the drug sertraline, available as a generic and under the brand name Zoloft, with therapy worked best. But each method alone also had big benefits, said Dr. John Walkup, lead author of the government-funded research. It’s estimated that anxiety disorders affect as many as 20 percent of U.S. children and teens.
In many cases, symptoms almost disappeared in children previously so anxious that they wouldn’t leave home, sleep alone, or hang out with friends, said Walkup, a Johns Hopkins Hospital psychiatrist.
“What we’re saying is we’ve got three good treatments,” he said.
While many kids have occasional fears or anxiousness, those with full-fledged anxiety disorders are almost paralyzed by these feelings. Three types of disorders were studied: separation anxiety, generalized anxiety and social phobia, Walkup said.
Affected kids may be so worried that something bad will happen to their parents that they repeatedly refuse to go to school. Or they’ll be so afraid of thunderstorms that they get chronic stomachaches, even when it’s not stormy. Those with social anxiety disorder may just seem shy, but they are so self-conscious that they won’t seek out friends or take part in class so their grades suffer, Walkup said.
“These kids were really miserable at the start of the study,” and many ended up “really happy,” March said.
Sertraline is among antidepressants linked with suicidal thoughts and behavior in children with depression.
In this study, only a handful of the more than 200 kids using it had suicide-related thoughts and there were no suicide attempts, Walkup said. Suicidal tendencies are more common in depression than in anxiety, he said.
Zoloft, mostly used to treat adult depression and anxiety, is approved for treating obsessive-compulsive disorder in kids, but not anxiety. Some doctors use it for that, however. And some smaller, less rigorous studies have suggested it and other antidepressants can help.
The new study, paid for by the National Institute of Mental Health, is the largest examining treatment of childhood anxiety disorders, said co-author Dr. John March of Duke University,
Dr. Thomas Insel, the institute’s director, said the study provides strong evidence that combined treatment is “the gold standard,” but that sertraline or therapy alone can be effective.
Dr. Sharon Hirsch, a University of Chicago psychiatrist not involved in the study, said it echoes benefits she’s seen in her own young anxiety patients on both treatments. But she note that the study shows that therapy alone is also good news for parents who don’t want to put their children on an antidepressant.
The study, published online in the New England Journal of Medicine, was scheduled for presentation Thursday at an American Academy of Child and Adolescent Psychiatry meeting in Chicago.
Several study authors reported receiving consulting fees or other compensation from drug companies, including antidepressant makers.
The study involved 488 children aged 7 to 17 treated at six centers around the country. They were randomly assigned to one of four 12-week treatments: up to 200 milligrams daily of sertraline; 14 hour-long sessions of psychotherapy alone; both treatments together; or dummy pills.
In the combined treatment group, 81 percent of children were much improved by three months, compared with 60 percent in the therapy-only group, 55 percent in the sertraline-only group, and 24 percent in the placebo group.
The therapy used in the study was cognitive behavior therapy, which emphasizes that thoughts can be irrational and cause troubling feelings. It encourages patients to focus on positive thinking that allows them to develop ways of confronting fearful situations.
Improvement, measured on a psychiatric scale, meant that anxiety had lessened so much that kids could do things they’d refused to do before, such as sleep in their own beds, go to school and socialize.
There was only one serious “adverse event” considered possibly linked to treatment — worsening behavior in a child on drug treatment only.
___
On the Net:
NEJM: http://www.nejm.org
National Institute of Mental Health: http://www.nimh.nih.gov
Copyright 2008 The Associated Press.
Kids’ eye problems often emerge in homework battle
Date: 10/27/2008
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) _ Your 9-year-old’s eyes hurt during homework? Your teen’s a slow reader plagued with headaches? They may have a common yet often missed vision problem: Eyes that don’t turn together properly to read.
As many as one of every 20 students have some degree of what eye doctors call “convergence insufficiency,” or CI, where eye muscles must work harder to focus up-close. And those standard vision screenings administered by schools and pediatricians won’t catch it — they stress distance vision.
When symptoms such as eye strain, headaches, double vision or reading problems trigger the right diagnosis, doctors prescribe any of a hodgepodge of exercises designed to strengthen eye coordination. Now a major government study finally offers evidence for the best approach: Eye training performed in a doctor’s office for 12 weeks.
The right treatment can make a profound difference, says Adele Andrews of Rydal, Pa., whose son Thomas participated in the study when he was 10 — and improved enough to at last start reading for fun.
His mother knew something wasn’t right early on: Reading seemed to require a physical struggle of Thomas that his three older siblings never experienced.
“He always wanted to buy books but he wouldn’t read them. He wanted to but it was too hard for him,” she recalls.
Then homework began and “I don’t even want to tell you how bad it was,” Andrews adds. “He would get frustrated. He wouldn’t do it. … I tried bribery, I tried everything. It got to the point where it was just a battle.”
Why? To bring print or other close-in work into focus, both eyes must turn slightly inward, or converge. As its name implies, convergence insufficiency means the eyes aren’t doing that properly. Words may appear blurry or double, or disappear as readers lose their place. How much extra effort eye muscles must exert to compensate and bring that image into focus determines whether someone has obvious symptoms and how bad they are.
Complaints are rare in very young children because pictures and large type don’t require as much convergence. Parents tend to start noticing a problem once homework and deeper reading begins. Some people complain only in the teen or college years, perhaps when their workload outpaces their ability to compensate. Others find they can read with one eye closed and do fine.
Nor does everyone experience obvious symptoms. How many compensate enough that CI truly doesn’t matter — and how many quietly try to avoid reading? No one knows.
Dr. Mitchell Scheiman of the Pennsylvania College of Optometry at Salus University is suspicious when a child’s “behavior is, ‘I don’t want to read, I don’t like reading, I can’t concentrate.” His advice then: “Just rule it out.”
Diagnosis requires seeing an ophthalmologist or optometrist trained to treat children who can measure convergence with some simple tests such as moving a pencil steadily closer to the nose until the person sees double.
But which treatment works best: The most commonly prescribed “pencil push-ups,” practicing that pencil-to-nose test at home? At-home computer eye games? Or more varied eye exercises, including computer-based ones, performed in a doctor’s office with at-home techniques for reinforcement?
A study funded by the National Eye Institute aimed to find out, by randomly assigning 221 9- to 17-year-olds to one of those approaches or to a control group given “dummy” exercises at the doctor’s office.
Three months later, nearly three-quarters of the office-treated patients had greatly improved — compared with no more than 43 percent of home-treated patients, Scheiman and colleagues report in this month’s Archives of Ophthalmology. The study will continue tracking patients for a year, to ensure the benefit lasts.
At roughly $75 a visit, office treatment is clearly more expensive. Why would it work better? First, they got more intense treatment. The NEI’s Dr. Brian Brooks says a combination of more varied in-office exercises may hold a child’s attention better — along with a doctor acting like a personal trainer, ensuring the youngster does each technique properly and doesn’t slack off.
What’s not clear is the more intricate in-office techniques could be adapted for home use and work just as well, he cautions.
But Andrews witnessed the difference between the two techniques as they’re practiced today. Thomas was originally assigned to pencil push-ups but improved only slightly. After his 12 study weeks were over, researchers switched him to office-based treatment — and his mother saw a rapid lessening of the homework battles.
Today at 13, Thomas has “become pretty serious about his schoolwork,” says a relieved Andrews. “He’s going to do OK.”
___
EDITOR’s NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2008 The Associated Press.
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) _ Your 9-year-old’s eyes hurt during homework? Your teen’s a slow reader plagued with headaches? They may have a common yet often missed vision problem: Eyes that don’t turn together properly to read.
As many as one of every 20 students have some degree of what eye doctors call “convergence insufficiency,” or CI, where eye muscles must work harder to focus up-close. And those standard vision screenings administered by schools and pediatricians won’t catch it — they stress distance vision.
When symptoms such as eye strain, headaches, double vision or reading problems trigger the right diagnosis, doctors prescribe any of a hodgepodge of exercises designed to strengthen eye coordination. Now a major government study finally offers evidence for the best approach: Eye training performed in a doctor’s office for 12 weeks.
The right treatment can make a profound difference, says Adele Andrews of Rydal, Pa., whose son Thomas participated in the study when he was 10 — and improved enough to at last start reading for fun.
His mother knew something wasn’t right early on: Reading seemed to require a physical struggle of Thomas that his three older siblings never experienced.
“He always wanted to buy books but he wouldn’t read them. He wanted to but it was too hard for him,” she recalls.
Then homework began and “I don’t even want to tell you how bad it was,” Andrews adds. “He would get frustrated. He wouldn’t do it. … I tried bribery, I tried everything. It got to the point where it was just a battle.”
Why? To bring print or other close-in work into focus, both eyes must turn slightly inward, or converge. As its name implies, convergence insufficiency means the eyes aren’t doing that properly. Words may appear blurry or double, or disappear as readers lose their place. How much extra effort eye muscles must exert to compensate and bring that image into focus determines whether someone has obvious symptoms and how bad they are.
Complaints are rare in very young children because pictures and large type don’t require as much convergence. Parents tend to start noticing a problem once homework and deeper reading begins. Some people complain only in the teen or college years, perhaps when their workload outpaces their ability to compensate. Others find they can read with one eye closed and do fine.
Nor does everyone experience obvious symptoms. How many compensate enough that CI truly doesn’t matter — and how many quietly try to avoid reading? No one knows.
Dr. Mitchell Scheiman of the Pennsylvania College of Optometry at Salus University is suspicious when a child’s “behavior is, ‘I don’t want to read, I don’t like reading, I can’t concentrate.” His advice then: “Just rule it out.”
Diagnosis requires seeing an ophthalmologist or optometrist trained to treat children who can measure convergence with some simple tests such as moving a pencil steadily closer to the nose until the person sees double.
But which treatment works best: The most commonly prescribed “pencil push-ups,” practicing that pencil-to-nose test at home? At-home computer eye games? Or more varied eye exercises, including computer-based ones, performed in a doctor’s office with at-home techniques for reinforcement?
A study funded by the National Eye Institute aimed to find out, by randomly assigning 221 9- to 17-year-olds to one of those approaches or to a control group given “dummy” exercises at the doctor’s office.
Three months later, nearly three-quarters of the office-treated patients had greatly improved — compared with no more than 43 percent of home-treated patients, Scheiman and colleagues report in this month’s Archives of Ophthalmology. The study will continue tracking patients for a year, to ensure the benefit lasts.
At roughly $75 a visit, office treatment is clearly more expensive. Why would it work better? First, they got more intense treatment. The NEI’s Dr. Brian Brooks says a combination of more varied in-office exercises may hold a child’s attention better — along with a doctor acting like a personal trainer, ensuring the youngster does each technique properly and doesn’t slack off.
What’s not clear is the more intricate in-office techniques could be adapted for home use and work just as well, he cautions.
But Andrews witnessed the difference between the two techniques as they’re practiced today. Thomas was originally assigned to pencil push-ups but improved only slightly. After his 12 study weeks were over, researchers switched him to office-based treatment — and his mother saw a rapid lessening of the homework battles.
Today at 13, Thomas has “become pretty serious about his schoolwork,” says a relieved Andrews. “He’s going to do OK.”
___
EDITOR’s NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2008 The Associated Press.
Vaccine slashes diarrheal illness in kids
Date: 10/25/2008 2:05 PM
By MARILYNN MARCHIONE
AP Medical Writer
WASHINGTON (AP) _ A vaccine against rotavirus, the leading cause of diarrhea in infants, has led to a dramatic drop in hospitalization and emergency room visits since it came on the market two years ago, doctors reported Saturday.
A bonus: the vaccine seems to be preventing illness even in unvaccinated children by cutting the number of infections in the community that kids can pick up and spread.
“We’re a little surprised by the degree of impact given the coverage we’ve achieved,” said Jane Seward of the federal Centers for Disease Control and Prevention. Only about half of young children had received the vaccine and very few had received all three doses when the studies were done.
Results were reported Saturday at an infectious diseases conference in Washington.
Before the vaccine, more than 200,000 U.S. children were taken to emergency rooms and more than 55,000 were hospitalized each year with rotavirus, which causes vomiting and diarrhea, mostly from January through May. Worldwide, the virus kills 1,600 young children each day.
Since Merck & Co.’s Rotateq came out in 2006, hospital visits and stays due to the virus have dropped 80 percent to 100 percent, studies by the CDC and several other groups show.
Last winter, rotavirus cases started and peaked two to three months later and were much less extensive than in previous years, CDC scientists report. Hospitals in a network that tracks these cases for the CDC saw more than an 80 percent drop in admissions from them, one study showed.
Another study, by Merck, found a 100 percent drop in hospitalizations and ER visits during the 2007 and 2008 rotavirus seasons compared to previous ones. The study was based on a review of health insurance claims for about 61,000 infants and diagnoses by doctors in routine clinical practice.
Rotateq is an oral vaccine given at two, four and six months of age. In June, a second rotavirus vaccine came on the market — GlaxoSmithKline’s Rotarix. It requires only two doses, completed by four months of age.
Also at the conference, scientists reported that a new version of Wyeth’s Prevnar vaccine seems to better protect kids against germs that cause pneumonia, meningitis and ear infections, but whether it makes it onto the market before dangerous strains become a big problem remains to be seen.
Scientists have been retooling Prevnar, which came on the market in 2000 and is advised for children under age 2. It protects against the seven strains of Strep bacteria that were causing the most serious infections at the time. Since then, new strains have become more of a threat and increasingly are resistant to common antibiotics.
The experimental new vaccine adds six of these to the original seven. Scientists from Wyeth and from Johannes Gutenberg University in Mainz, Germany, compared immune responses to the new vaccine, given to 293 babies, versus those of an equal number of babies given the old one.
The new vaccine did about as well as the old one on the original strains and well on five of the six new ones.
The company has said it plans to seek federal approval for it in early 2009, and review can take a year or more. British-based GlaxoSmithKline has a similar vaccine in final-phase testing that targets 10 strains common in Europe and other regions.
In the meantime, parents should continue to have their toddlers get the existing Prevnar, and to use antibiotics only when needed because they don’t work against the common cold and overuse worsens the bacteria resistance problem, said Dr. Cynthia Whitney, a pneumonia expert at the CDC.
___
On the Net:
Infectious disease meeting: http://www.icaacidsa2008.org/
CDC: http://www.cdc.gov/vaccines/.
Copyright 2008 The Associated Press.
By MARILYNN MARCHIONE
AP Medical Writer
WASHINGTON (AP) _ A vaccine against rotavirus, the leading cause of diarrhea in infants, has led to a dramatic drop in hospitalization and emergency room visits since it came on the market two years ago, doctors reported Saturday.
A bonus: the vaccine seems to be preventing illness even in unvaccinated children by cutting the number of infections in the community that kids can pick up and spread.
“We’re a little surprised by the degree of impact given the coverage we’ve achieved,” said Jane Seward of the federal Centers for Disease Control and Prevention. Only about half of young children had received the vaccine and very few had received all three doses when the studies were done.
Results were reported Saturday at an infectious diseases conference in Washington.
Before the vaccine, more than 200,000 U.S. children were taken to emergency rooms and more than 55,000 were hospitalized each year with rotavirus, which causes vomiting and diarrhea, mostly from January through May. Worldwide, the virus kills 1,600 young children each day.
Since Merck & Co.’s Rotateq came out in 2006, hospital visits and stays due to the virus have dropped 80 percent to 100 percent, studies by the CDC and several other groups show.
Last winter, rotavirus cases started and peaked two to three months later and were much less extensive than in previous years, CDC scientists report. Hospitals in a network that tracks these cases for the CDC saw more than an 80 percent drop in admissions from them, one study showed.
Another study, by Merck, found a 100 percent drop in hospitalizations and ER visits during the 2007 and 2008 rotavirus seasons compared to previous ones. The study was based on a review of health insurance claims for about 61,000 infants and diagnoses by doctors in routine clinical practice.
Rotateq is an oral vaccine given at two, four and six months of age. In June, a second rotavirus vaccine came on the market — GlaxoSmithKline’s Rotarix. It requires only two doses, completed by four months of age.
Also at the conference, scientists reported that a new version of Wyeth’s Prevnar vaccine seems to better protect kids against germs that cause pneumonia, meningitis and ear infections, but whether it makes it onto the market before dangerous strains become a big problem remains to be seen.
Scientists have been retooling Prevnar, which came on the market in 2000 and is advised for children under age 2. It protects against the seven strains of Strep bacteria that were causing the most serious infections at the time. Since then, new strains have become more of a threat and increasingly are resistant to common antibiotics.
The experimental new vaccine adds six of these to the original seven. Scientists from Wyeth and from Johannes Gutenberg University in Mainz, Germany, compared immune responses to the new vaccine, given to 293 babies, versus those of an equal number of babies given the old one.
The new vaccine did about as well as the old one on the original strains and well on five of the six new ones.
The company has said it plans to seek federal approval for it in early 2009, and review can take a year or more. British-based GlaxoSmithKline has a similar vaccine in final-phase testing that targets 10 strains common in Europe and other regions.
In the meantime, parents should continue to have their toddlers get the existing Prevnar, and to use antibiotics only when needed because they don’t work against the common cold and overuse worsens the bacteria resistance problem, said Dr. Cynthia Whitney, a pneumonia expert at the CDC.
___
On the Net:
Infectious disease meeting: http://www.icaacidsa2008.org/
CDC: http://www.cdc.gov/vaccines/.
Copyright 2008 The Associated Press.
EPA tightens health standard for airborne lead
Date: 10/16/2008 7:30 PM
By DINA CAPPIELLO
Associated Press Writer
WASHINGTON (AP) _ Three decades after removing lead from gasoline, the Environmental Protection Agency is slashing the amount of the toxic metal that will be allowed in the nation’s air by 90 percent.
EPA officials, under a federal court order to set a new standard by midnight Wednesday, said the limit would better protect public health, especially for children. They can inhale lead particles released from smelters, mines and waste incinerators and ingest it after it settles on surfaces.
Exposure to even low levels of lead early in life can affect learning, IQ and memory in children. Lead can cause cardiovascular, blood pressure and kidney problems in adults.
“Our nation’s air is cleaner today than just a generation ago, and last night I built upon this progress by signing the strongest air quality standards for lead in our nation’s history,” the EPA chief, Stephen Johnson, said Thursday. “Thanks to this stronger standard, EPA will protect my children from remaining sources of airborne lead.”
The new limit, 0.15 micrograms per cubic meter, is the first update since 1978, when the government helped phase out leaded gasoline. It is 10 times lower than the old standard, 1.5 micrograms per cubic meter.
The EPA estimates that 18 counties in a dozen states will violate the new standard. That means state and local governments must find ways to further reduce lead emissions.
The new limit is in the lower end of a range recommended in May by the agency’s independent scientific advisory panel. By contrast, the Bush administration did not follow its own staff’s advice or its science advisers when it set health standards for smog and soot that were less stringent than recommendations.
The EPA also said it would require lead to be measured in 101 cities and near sources that release at least 1 ton of lead per year.
A representative for the Association of Battery Recyclers said the new standard would be difficult to meet. Several members of the group, which represents 14 facilities that recycle lead from car batteries, met two weeks ago with White House and EPA officials to seek a less stringent standard.
“We have put in the best controls and we are going to still have compliance problems,” said Robert Steinwurtzel, a lawyer for the group. “We explained to them our concerns that if the standard was promulgated at lower end of EPA’s range it would threaten viability of industry.”
Environmentalists hailed the move but said the agency could have done more to monitor emissions and ensure the standard is met.
“We commend EPA for taking a giant step in the right direction, but they need to greatly expand the lead monitoring network if they hope to enforce this standard,” said Dr. Gina Solomon, a senior scientist with the Natural Resource Defense Council.
The EPA will designate areas that fail to meet the new standard by October 2011. Based on air quality data from collected from 2005-2007, 18 counties in Alabama, Colorado, Florida, Illinois, Indiana, Minnesota, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Texas would fail to meet the standard.
The EPA said the cost of the reductions would be between $150 million to $2.8 billion, but the standard would produce economic benefits of $3.7 billion to $6.9 billion. In calculating the benefits, the agency assumed that children would be smarter and earn more money as a result of less lead in the air.
The government was under a court order to review the standard after a 2004 lawsuit by the Missouri Coalition for the Environment on behalf of two former residents of Herculaneum, Mo., the home of the last lead smelter in the U.S. The smelter repeatedly has violated the older health standard for lead in recent years. Blood taken from children in the area in 2002 showed elevated concentrations of the toxic metal.
The Doe Run Co., which operates the Herculaneum smelter, said the facility is now in compliance with the current standard. Dan Vornberg, the company’s vice president for environmental affairs, said the new standard “will have a significant impact on our operations” and will require exploring options such as new technologies and process adjustments.
The suit charged that the EPA had failed to review the lead standard every five years as law requires. Since 1990, more than 6,000 studies have examined the effects of lead on health and the environment, according to the agency.
“They still have to enforce it,” said Kathleen Logan Smith, executive director of the coalition. “But it is there. It is a start.”
___
On the Net:
EPA lead site: www.epa.gov/air/lead
Doe Run. Co.: http://www.doerun.com/
Copyright 2008 The Associated Press.
www.lead-info.com
By DINA CAPPIELLO
Associated Press Writer
WASHINGTON (AP) _ Three decades after removing lead from gasoline, the Environmental Protection Agency is slashing the amount of the toxic metal that will be allowed in the nation’s air by 90 percent.
EPA officials, under a federal court order to set a new standard by midnight Wednesday, said the limit would better protect public health, especially for children. They can inhale lead particles released from smelters, mines and waste incinerators and ingest it after it settles on surfaces.
Exposure to even low levels of lead early in life can affect learning, IQ and memory in children. Lead can cause cardiovascular, blood pressure and kidney problems in adults.
“Our nation’s air is cleaner today than just a generation ago, and last night I built upon this progress by signing the strongest air quality standards for lead in our nation’s history,” the EPA chief, Stephen Johnson, said Thursday. “Thanks to this stronger standard, EPA will protect my children from remaining sources of airborne lead.”
The new limit, 0.15 micrograms per cubic meter, is the first update since 1978, when the government helped phase out leaded gasoline. It is 10 times lower than the old standard, 1.5 micrograms per cubic meter.
The EPA estimates that 18 counties in a dozen states will violate the new standard. That means state and local governments must find ways to further reduce lead emissions.
The new limit is in the lower end of a range recommended in May by the agency’s independent scientific advisory panel. By contrast, the Bush administration did not follow its own staff’s advice or its science advisers when it set health standards for smog and soot that were less stringent than recommendations.
The EPA also said it would require lead to be measured in 101 cities and near sources that release at least 1 ton of lead per year.
A representative for the Association of Battery Recyclers said the new standard would be difficult to meet. Several members of the group, which represents 14 facilities that recycle lead from car batteries, met two weeks ago with White House and EPA officials to seek a less stringent standard.
“We have put in the best controls and we are going to still have compliance problems,” said Robert Steinwurtzel, a lawyer for the group. “We explained to them our concerns that if the standard was promulgated at lower end of EPA’s range it would threaten viability of industry.”
Environmentalists hailed the move but said the agency could have done more to monitor emissions and ensure the standard is met.
“We commend EPA for taking a giant step in the right direction, but they need to greatly expand the lead monitoring network if they hope to enforce this standard,” said Dr. Gina Solomon, a senior scientist with the Natural Resource Defense Council.
The EPA will designate areas that fail to meet the new standard by October 2011. Based on air quality data from collected from 2005-2007, 18 counties in Alabama, Colorado, Florida, Illinois, Indiana, Minnesota, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Texas would fail to meet the standard.
The EPA said the cost of the reductions would be between $150 million to $2.8 billion, but the standard would produce economic benefits of $3.7 billion to $6.9 billion. In calculating the benefits, the agency assumed that children would be smarter and earn more money as a result of less lead in the air.
The government was under a court order to review the standard after a 2004 lawsuit by the Missouri Coalition for the Environment on behalf of two former residents of Herculaneum, Mo., the home of the last lead smelter in the U.S. The smelter repeatedly has violated the older health standard for lead in recent years. Blood taken from children in the area in 2002 showed elevated concentrations of the toxic metal.
The Doe Run Co., which operates the Herculaneum smelter, said the facility is now in compliance with the current standard. Dan Vornberg, the company’s vice president for environmental affairs, said the new standard “will have a significant impact on our operations” and will require exploring options such as new technologies and process adjustments.
The suit charged that the EPA had failed to review the lead standard every five years as law requires. Since 1990, more than 6,000 studies have examined the effects of lead on health and the environment, according to the agency.
“They still have to enforce it,” said Kathleen Logan Smith, executive director of the coalition. “But it is there. It is a start.”
___
On the Net:
EPA lead site: www.epa.gov/air/lead
Doe Run. Co.: http://www.doerun.com/
Copyright 2008 The Associated Press.
www.lead-info.com
Food allergies increasing in US kids, study says
Date: 10/22/2008 8:04 AM
By MIKE STOBBE
AP Medical Writer
ATLANTA (AP) _ Food allergies in American children seem to be on the rise, now affecting about 3 million kids, according to the first federal study of the problem.
But experts said that might be because parents are more aware and quicker to have their kids checked out by a doctor.
About 1 in 26 children had food allergies last year, the Centers for Disease Control and Prevention reported Wednesday. That’s up from 1 in 29 kids in 1997.
The 18 percent increase is significant enough to be considered more than a statistical blip, said Amy Branum of the CDC, the study’s lead author.
Nobody knows for sure what’s driving the increase. A doubling in peanut allergies — noted in earlier studies — is one factor, some experts said. Also, children seems to be taking longer to outgrow milk and egg allergies than they did in decades past.
But also figuring into the equation are parents and doctors who are more likely to consider food as the trigger for symptoms like vomiting, skin rashes and breathing problems.
“A couple of decades ago, it was not uncommon to have kids sick all the time and we just said ‘They have a weak stomach’ or ‘They’re sickly,’” said Anne Munoz-Furlong, chief executive of the Food Allergy & Anaphylaxis Network, a Virginia-based advocacy organization.
Parents today are quicker to take their kids to specialists to check out the possibility of food allergies, said Munoz-Furlong, who founded the nonprofit in 1991.
The CDC results came from an in-person, door-to-door survey in 2007 of the households of 9,500 U.S. children under age 18.
When asked if a child in the house had any kind of food allergy in the previous 12 months, about 4 percent said yes. The parents were not asked if a doctor had made the diagnosis, and no medical records were checked. Some parents may not know the difference between immune system-based food allergies and digestive disorders like lactose intolerance, so it’s possible the study’s findings are a bit off, Branum said.
However, the study’s results mirror older national estimates that were extrapolated from smaller, more intensive studies, said Dr. Hugh Sampson, a food allergy researcher at the Mount Sinai School of medicine.
“This tells us those earlier extrapolations were fairly close,” Sampson said.
The CDC study did not give a breakdown of which foods were to blame for the allergies. Other research suggests that about 1 in 40 Americans will have a milk allergy at some point in their lives, and 1 in 50 percent will be allergic to eggs. Most people outgrow these allergies in childhood.
About 1 in 50 are allergic to shellfish and nearly 1 in 100 react to peanuts, allergies that generally persist for a lifetime, according to Sampson.
Some people have more than one food allergy, he said, explaining why the overall food allergy prevalence is about 4 percent.
Children with food allergies also were more likely to have asthma, eczema and respiratory problems than kids without food allergies, the CDC study found, confirming previous research.
The study also found that the number of children hospitalized for food allergies was up. The number of hospital discharges jumped from about 2,600 a year in the late 1990s to more than 9,500 annually in recent years, the CDC results showed.
Also, Hispanic children had lower rates of food allergies than white or black children — the first such racial/ethnic breakdown in a national study.
The reason for that last finding may not be genetics, said Munoz-Furlong. She is Hispanic and said people in her own family have been unwilling to consider food allergies as the reason for children’s illnesses. “It’s a question of awareness,” she said.
___
On the Net:
The CDC report: http://www.cdc.gov/nchs
Copyright 2008 The Associated Press.
By MIKE STOBBE
AP Medical Writer
ATLANTA (AP) _ Food allergies in American children seem to be on the rise, now affecting about 3 million kids, according to the first federal study of the problem.
But experts said that might be because parents are more aware and quicker to have their kids checked out by a doctor.
About 1 in 26 children had food allergies last year, the Centers for Disease Control and Prevention reported Wednesday. That’s up from 1 in 29 kids in 1997.
The 18 percent increase is significant enough to be considered more than a statistical blip, said Amy Branum of the CDC, the study’s lead author.
Nobody knows for sure what’s driving the increase. A doubling in peanut allergies — noted in earlier studies — is one factor, some experts said. Also, children seems to be taking longer to outgrow milk and egg allergies than they did in decades past.
But also figuring into the equation are parents and doctors who are more likely to consider food as the trigger for symptoms like vomiting, skin rashes and breathing problems.
“A couple of decades ago, it was not uncommon to have kids sick all the time and we just said ‘They have a weak stomach’ or ‘They’re sickly,’” said Anne Munoz-Furlong, chief executive of the Food Allergy & Anaphylaxis Network, a Virginia-based advocacy organization.
Parents today are quicker to take their kids to specialists to check out the possibility of food allergies, said Munoz-Furlong, who founded the nonprofit in 1991.
The CDC results came from an in-person, door-to-door survey in 2007 of the households of 9,500 U.S. children under age 18.
When asked if a child in the house had any kind of food allergy in the previous 12 months, about 4 percent said yes. The parents were not asked if a doctor had made the diagnosis, and no medical records were checked. Some parents may not know the difference between immune system-based food allergies and digestive disorders like lactose intolerance, so it’s possible the study’s findings are a bit off, Branum said.
However, the study’s results mirror older national estimates that were extrapolated from smaller, more intensive studies, said Dr. Hugh Sampson, a food allergy researcher at the Mount Sinai School of medicine.
“This tells us those earlier extrapolations were fairly close,” Sampson said.
The CDC study did not give a breakdown of which foods were to blame for the allergies. Other research suggests that about 1 in 40 Americans will have a milk allergy at some point in their lives, and 1 in 50 percent will be allergic to eggs. Most people outgrow these allergies in childhood.
About 1 in 50 are allergic to shellfish and nearly 1 in 100 react to peanuts, allergies that generally persist for a lifetime, according to Sampson.
Some people have more than one food allergy, he said, explaining why the overall food allergy prevalence is about 4 percent.
Children with food allergies also were more likely to have asthma, eczema and respiratory problems than kids without food allergies, the CDC study found, confirming previous research.
The study also found that the number of children hospitalized for food allergies was up. The number of hospital discharges jumped from about 2,600 a year in the late 1990s to more than 9,500 annually in recent years, the CDC results showed.
Also, Hispanic children had lower rates of food allergies than white or black children — the first such racial/ethnic breakdown in a national study.
The reason for that last finding may not be genetics, said Munoz-Furlong. She is Hispanic and said people in her own family have been unwilling to consider food allergies as the reason for children’s illnesses. “It’s a question of awareness,” she said.
___
On the Net:
The CDC report: http://www.cdc.gov/nchs
Copyright 2008 The Associated Press.
Parents press states for autism insurance laws
Date: 10/19/2008 2:49 PM
By CARLA K. JOHNSON
Associated Press Writer
CHICAGO (AP) _ In Washington state, Reza and Arzu Forough pay more than $1,000 a week for behavior therapy for their 12-year-old autistic son.
In Indiana, Sean and Michele Trivedi get the same type of therapy for their 11-year-old daughter. But they pay $3,000 a year and their health insurance covers the rest.
Two families. Two states. Big difference in out-of-pocket costs.
If autism advocates get their way, more states will follow Indiana’s lead by requiring health insurers to cover intensive and costly behavior therapy for autism.
In the past two years, six states — Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana — passed laws requiring such coverage, costing in some cases up to $50,000 a year per child.
The powerful advocacy group Autism Speaks has endorsed bills in New Jersey, Virginia and Michigan and is targeting at least 10 more states in 2009, including New York, California and Ohio.
Other states, including Illinois, have similar bills in the works but aren’t working directly with Autism Speaks.
“This is the hottest trend in mandates we’ve seen in a long time,” said J.P. Wieske, a lobbyist for an insurance coalition that argues that these state requirements drive up insurance costs for everyone. “It is hard to fight them.”
For lawmakers, voting against these measures means voting against parents who are struggling to do the best for their children.
Parents tell moving stories about how behavior therapy works better than anything they’ve tried. In two states, bills got nicknames like “Steven’s Law” and “Ryan’s Law,” so voting against them was tough.
Arzu Forough of Kirkland, Wash., who is pushing a bill in her state, credits behavior therapy for teaching her son Shayan, at age 3, to make a sound to ask for a drink of water. Now 12, he is learning to converse about his favorite food and music, and to talk about his frustrations rather than throw tantrums.
Trained therapists, using principles of applied behavior analysis (ABA), created a system of rewards to teach Shayan these skills. As a preschooler, he got a piece of cheese when he said “bubba” for water. Now a therapist rewards him with tokens when he responds in conversation. He uses the tokens to “buy” privileges like going for a car ride.
Shayan’s improvements are a welcome relief to his mother, who once called for police help with her out-of-control son while she was driving.
“I pulled over to the side of the road,” she said. “I had to call the police to drive behind me so I could drive safely home.”
The Foroughs have health insurance, but it doesn’t cover Shayan’s therapy. Although they both work full time, they must live rent-free with her elderly mother to be able to afford his treatment.
Meanwhile, the Trivedi family of the Indianapolis suburb of Carmel, get 25 hours a week of behavior therapy for 11-year-old Ellie. They contribute co-pays and a deductible, totaling about $3,000. Insurance pays the rest, about $47,000 a year.
Michele Trivedi is an autism activist. She fought for years after a vaguely worded 2001 Indiana law required coverage but insurers still refused to pay for ABA. Finally in 2006, she helped convince the state’s insurance commissioner to issue a bulletin spelling out what was expected of insurers.
“It’s no longer acceptable that blatant discrimination against people with autism occur,” Trivedi said.
Autism is a range of disorders that hinder the ability to communicate and interact. Most doctors believe there is no cure. An estimated 1 in 150 American children are diagnosed with it.
Supporters say behavior therapy has decades of research behind it and can save money in the long run by keeping people out of institutions. Researchers agree, but say much remains unknown about which therapy works best for autistic kids, whether long-term gains can be claimed, and whether it works with older children.
Some states require behavior therapy coverage up to age 18 or 21. But the scientific evidence for ABA is strongest for the youngest, ages 2 to 5. Some researchers have reported on individual children with autism who no longer appeared disabled when they reached school age.
The most rigorous studies, though, show mixed results. A study published in 2000 showed that preschoolers who got intensive behavior therapy had greater gains in IQ than children who didn’t get the therapy. But there was little difference in the two group’s language development or the intensity of behavior problems. And the children most severely affected by autism showed no comparative gain.
Another study in preschoolers, published in 2005, showed little difference between an intensive ABA-based program run by therapists and less-intensive therapy from parents; children in both groups improved.
When it comes to older children, the research is sparse, said Tristram Smith of the University of Rochester Medical Center in New York, who co-authored the 2000 autism study.
“You could make a decent case for the little kids up to 6 or 7 that (insurance mandates) would be appropriate,” Smith said. “I think it would be hard to make that case for older kids.”
Another autism researcher, Laura Schreibman of the University of California at San Diego, said “fly-by-night” behavior therapists could defraud insurers with ineffective therapy.
“I would like to see insurance cover this kind of intervention because it’s documented to be effective,” she said. “But insurance companies have every right to monitor whether it’s working. If it’s been two years and there are no gains, an insurance company should be saying, ‘What are we paying for here?’”
The Council for Affordable Health Insurance, the industry lobbying arm, estimates autism mandates increase the cost of insurance by less than 1 percent by themselves, but when combined with other requirements make insurance less affordable.
Susan Pisano, a spokeswoman for America’s Health Insurance Plans, said the industry has been wary of laws ordering a specific treatment because when new scientific evidence emerges, the mandate remains frozen. And she questions whether behavior therapy is medical or educational.
The American Academy of Pediatrics includes ABA therapy in its clinical report on autism, but describes it as an “educational intervention.”
“There has been an effort to transfer the response to autism from school systems to the health care system,” Pisano said.
Nevertheless, some big companies and the U.S. military are providing ABA-based autism therapy as a benefit.
The U.S. military’s Tricare health insurance program not only covers up to $2,500 a month for the therapy, but also recently expanded the definition of who can provide it to make it more accessible. And some self-insured companies, including Microsoft and Home Depot, pay for autism behavior therapy.
Gaining insurance coverage state by state is the top lobbying priority for Autism Speaks.
“It’s the No. 1 thing we hear from parents,” said Elizabeth Emken, the group’s vice president of government relations. “What’s more difficult than knowing there’s an effective treatment for your children, but you can’t afford to offer it to them because it’s not covered by insurance?”
A new federal law requiring insurers to make coverage for mental health conditions equitable with other health coverage was tacked onto the recent financial industry bailout package.
Autism Speaks applauds the law, but says autism is not a psychological condition and that the insurance industry has refused to cover autism treatments in states with mental health parity laws on the books.
“We hope it sets the stage for the Congress and the next president to continue this effort to end discrimination in the health insurance marketplace,” Emken said. “Whichever party is elected, autism will be on the table and be a major point of discussion. There may have to be a federal mandate.”
Copyright 2008 The Associated Press.
By CARLA K. JOHNSON
Associated Press Writer
CHICAGO (AP) _ In Washington state, Reza and Arzu Forough pay more than $1,000 a week for behavior therapy for their 12-year-old autistic son.
In Indiana, Sean and Michele Trivedi get the same type of therapy for their 11-year-old daughter. But they pay $3,000 a year and their health insurance covers the rest.
Two families. Two states. Big difference in out-of-pocket costs.
If autism advocates get their way, more states will follow Indiana’s lead by requiring health insurers to cover intensive and costly behavior therapy for autism.
In the past two years, six states — Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana — passed laws requiring such coverage, costing in some cases up to $50,000 a year per child.
The powerful advocacy group Autism Speaks has endorsed bills in New Jersey, Virginia and Michigan and is targeting at least 10 more states in 2009, including New York, California and Ohio.
Other states, including Illinois, have similar bills in the works but aren’t working directly with Autism Speaks.
“This is the hottest trend in mandates we’ve seen in a long time,” said J.P. Wieske, a lobbyist for an insurance coalition that argues that these state requirements drive up insurance costs for everyone. “It is hard to fight them.”
For lawmakers, voting against these measures means voting against parents who are struggling to do the best for their children.
Parents tell moving stories about how behavior therapy works better than anything they’ve tried. In two states, bills got nicknames like “Steven’s Law” and “Ryan’s Law,” so voting against them was tough.
Arzu Forough of Kirkland, Wash., who is pushing a bill in her state, credits behavior therapy for teaching her son Shayan, at age 3, to make a sound to ask for a drink of water. Now 12, he is learning to converse about his favorite food and music, and to talk about his frustrations rather than throw tantrums.
Trained therapists, using principles of applied behavior analysis (ABA), created a system of rewards to teach Shayan these skills. As a preschooler, he got a piece of cheese when he said “bubba” for water. Now a therapist rewards him with tokens when he responds in conversation. He uses the tokens to “buy” privileges like going for a car ride.
Shayan’s improvements are a welcome relief to his mother, who once called for police help with her out-of-control son while she was driving.
“I pulled over to the side of the road,” she said. “I had to call the police to drive behind me so I could drive safely home.”
The Foroughs have health insurance, but it doesn’t cover Shayan’s therapy. Although they both work full time, they must live rent-free with her elderly mother to be able to afford his treatment.
Meanwhile, the Trivedi family of the Indianapolis suburb of Carmel, get 25 hours a week of behavior therapy for 11-year-old Ellie. They contribute co-pays and a deductible, totaling about $3,000. Insurance pays the rest, about $47,000 a year.
Michele Trivedi is an autism activist. She fought for years after a vaguely worded 2001 Indiana law required coverage but insurers still refused to pay for ABA. Finally in 2006, she helped convince the state’s insurance commissioner to issue a bulletin spelling out what was expected of insurers.
“It’s no longer acceptable that blatant discrimination against people with autism occur,” Trivedi said.
Autism is a range of disorders that hinder the ability to communicate and interact. Most doctors believe there is no cure. An estimated 1 in 150 American children are diagnosed with it.
Supporters say behavior therapy has decades of research behind it and can save money in the long run by keeping people out of institutions. Researchers agree, but say much remains unknown about which therapy works best for autistic kids, whether long-term gains can be claimed, and whether it works with older children.
Some states require behavior therapy coverage up to age 18 or 21. But the scientific evidence for ABA is strongest for the youngest, ages 2 to 5. Some researchers have reported on individual children with autism who no longer appeared disabled when they reached school age.
The most rigorous studies, though, show mixed results. A study published in 2000 showed that preschoolers who got intensive behavior therapy had greater gains in IQ than children who didn’t get the therapy. But there was little difference in the two group’s language development or the intensity of behavior problems. And the children most severely affected by autism showed no comparative gain.
Another study in preschoolers, published in 2005, showed little difference between an intensive ABA-based program run by therapists and less-intensive therapy from parents; children in both groups improved.
When it comes to older children, the research is sparse, said Tristram Smith of the University of Rochester Medical Center in New York, who co-authored the 2000 autism study.
“You could make a decent case for the little kids up to 6 or 7 that (insurance mandates) would be appropriate,” Smith said. “I think it would be hard to make that case for older kids.”
Another autism researcher, Laura Schreibman of the University of California at San Diego, said “fly-by-night” behavior therapists could defraud insurers with ineffective therapy.
“I would like to see insurance cover this kind of intervention because it’s documented to be effective,” she said. “But insurance companies have every right to monitor whether it’s working. If it’s been two years and there are no gains, an insurance company should be saying, ‘What are we paying for here?’”
The Council for Affordable Health Insurance, the industry lobbying arm, estimates autism mandates increase the cost of insurance by less than 1 percent by themselves, but when combined with other requirements make insurance less affordable.
Susan Pisano, a spokeswoman for America’s Health Insurance Plans, said the industry has been wary of laws ordering a specific treatment because when new scientific evidence emerges, the mandate remains frozen. And she questions whether behavior therapy is medical or educational.
The American Academy of Pediatrics includes ABA therapy in its clinical report on autism, but describes it as an “educational intervention.”
“There has been an effort to transfer the response to autism from school systems to the health care system,” Pisano said.
Nevertheless, some big companies and the U.S. military are providing ABA-based autism therapy as a benefit.
The U.S. military’s Tricare health insurance program not only covers up to $2,500 a month for the therapy, but also recently expanded the definition of who can provide it to make it more accessible. And some self-insured companies, including Microsoft and Home Depot, pay for autism behavior therapy.
Gaining insurance coverage state by state is the top lobbying priority for Autism Speaks.
“It’s the No. 1 thing we hear from parents,” said Elizabeth Emken, the group’s vice president of government relations. “What’s more difficult than knowing there’s an effective treatment for your children, but you can’t afford to offer it to them because it’s not covered by insurance?”
A new federal law requiring insurers to make coverage for mental health conditions equitable with other health coverage was tacked onto the recent financial industry bailout package.
Autism Speaks applauds the law, but says autism is not a psychological condition and that the insurance industry has refused to cover autism treatments in states with mental health parity laws on the books.
“We hope it sets the stage for the Congress and the next president to continue this effort to end discrimination in the health insurance marketplace,” Emken said. “Whichever party is elected, autism will be on the table and be a major point of discussion. There may have to be a federal mandate.”
Copyright 2008 The Associated Press.
Child virus kills 3, sickens 110 in east China
Date: 10/19/2008 9:57 PM
BEIJING (AP) _ Hand, foot and mouth disease has killed three children and sickened about 110 others in eastern China, state media reported.
The official Xinhua News Agency said late Sunday that all the cases were reported in Jian’ou city of Fujian province from October 1 to 17.
Citing a provincial health official, Xinhua said the children who died from the infectious disease were under a year old and came from different towns. Twenty-two of the infected children were still hospitalized for treatment, the report said.
The provincial government has sent eight epidemic prevention experts to the city to help local medical staff conduct citywide checks on children, Xinhua said.
Hand, foot and mouth disease is common in young children and is characterized by fever, mouth sores and a rash with blisters. It is spread by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. It is not related to foot and mouth disease, which infects cattle, sheep and swine.
In spring, the spread of the virus sickened more than 24,000 people and killed dozens across China before authorities reported a slowdown in infections in May in Anhui, the province where the outbreak was first reported.
Anhui was the worst-hit province with 26 deaths, and the outbreak was first reported there in March.
Copyright 2008 The Associated Press.
BEIJING (AP) _ Hand, foot and mouth disease has killed three children and sickened about 110 others in eastern China, state media reported.
The official Xinhua News Agency said late Sunday that all the cases were reported in Jian’ou city of Fujian province from October 1 to 17.
Citing a provincial health official, Xinhua said the children who died from the infectious disease were under a year old and came from different towns. Twenty-two of the infected children were still hospitalized for treatment, the report said.
The provincial government has sent eight epidemic prevention experts to the city to help local medical staff conduct citywide checks on children, Xinhua said.
Hand, foot and mouth disease is common in young children and is characterized by fever, mouth sores and a rash with blisters. It is spread by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. It is not related to foot and mouth disease, which infects cattle, sheep and swine.
In spring, the spread of the virus sickened more than 24,000 people and killed dozens across China before authorities reported a slowdown in infections in May in Anhui, the province where the outbreak was first reported.
Anhui was the worst-hit province with 26 deaths, and the outbreak was first reported there in March.
Copyright 2008 The Associated Press.
NJ flu-shot mandate for preschoolers draws outcry
Date: 10/16/2008 4:33 PM
By DAVID CRARY
AP National Writer
As flu season approaches, many New Jersey parents are furious over a first-in-the-nation requirement that children get a flu shot in order to attend preschools and day-care centers. The decision should be the parents’, not the state’s, they contend.
Hundreds of parents and other activists rallied outside the New Jersey Statehouse on Thursday, decrying the policy and voicing support for a bill that would allow parents to opt out of mandatory vaccinations for their children.
“This is not an anti-vaccine rally — it’s a freedom of choice rally,” said one of the organizers, Louise Habakus. “This one-size-fits-all approach is really very anti-American.”
New Jersey’s policy was approved last December by the state’s Public Health Council and is taking effect this fall. Children from 6 months to 5 years old who attend a child-care center or preschool have until Dec. 31 to receive the flu vaccine, along with a pneumococcal vaccine.
The Health Council was acting on the recommendations of the federal Centers for Disease Control and Prevention, which has depicted children under 5 as a group particularly in need of flu shots. But no other state has made the shots mandatory for children of any age.
“Vaccines not only protect the child being vaccinated but also the general community and the most vulnerable individuals within the community,” New Jersey’s Health Department said in a statement. It has depicted young children as “particularly efficient” in transmitting the flu to others.
Opposition to the policy is vehement. Assemblywoman Charlotte Vandervalk, one of the speakers at the rally, said she now has 34 co-sponsors for a bill that would allow for conscientious objections to mandatory vaccinations.
“The right to informed consent is so basic,” she said in an interview. “Parents have a right to decide for their own children what is injected in their bodies.”
State policy now allows for medical and religious exemptions to mandatory vaccinations, but Vandervalk said requests for medical exemptions often have been turned down by local health authorities. She said 19 other states allow conscientious exemptions like those envisioned in her bill.
New Jersey’s health department has come out strongly against the legislation.
“Broad exemptions to mandatory vaccination weaken the entire compliance and enforcement structure,” it said.
The department also contends that New Jersey is particularly vulnerable to vaccine-preventable diseases — with a high population density, a mobile population and many recently arrived immigrants.
“In light of New Jersey’s special traits, the highest number of children possible must receive vaccines to protect them and others,” the department said.
Several hundred people attended Thursday’s rally, some with signs reading, “Mommy knows best.”
Among the speakers was Robin Stavola of Colts Neck, N.J., who said her daughter, Holly, died in 2000 at age 5 less than two weeks after receiving eight different vaccines, including a booster shot.
“I am not against vaccines, but I do believe there are too many,” she told the crowd.
State health officials and the CDC insist the flu vaccine is safe and effective, but Vandervalk and the parent groups who support her bill contend there has been inadequate research into the vaccine’s impact on small children. Critics note that flu vaccines contain trace amounts of thimerosol, a mercury-based preservative; the CDC says there’s no convincing evidence these trace amounts cause harm.
More generally, many of the parents mobilizing against the state policy believe various types of vaccine are being overused, resulting in more cases of autism, attention deficit hyperactivity disorder and other neurological problems in children.
“There’s not been a response from the government that is credible in terms of doing the scientific research that will screen out vulnerable children,” said Barbara Loe Fisher, a speaker at the rally. She is co-founder of the National Vaccine Information Center in Vienna, Va., an advocacy group skeptical of vaccination policies.
“There’s an acknowledgment that prescription drugs can cause different reactions in people, but there’s a blanket statement by health authorities that we all have to vaccinate, all in the same way,” Fisher said.
Fisher is a prominent player in a nationwide movement challenging the scope of vaccination programs. She was harshly critical last year when school officials in Maryland’s Prince George’s County threatened to impose jail terms and fines on parents whose children didn’t get required vaccinations.
Many of the activists in New Jersey accept the need for mandatory vaccinations for certain highly dangerous diseases, such as polio, but argue that the state went too far in requiring flu shots.
“The flu is not a deadly disease,” said Barbara Majeski of Princeton, N.J., who does not want her two preschooler sons to get the vaccination.
In fact, flu kills about 36,000 Americans a year and hospitalizes about 200,000. But children make up a small fraction of the victims — 86 died last year, from babies to teens, according to federal figures. Only two flu deaths of children in New Jersey have been recorded since 2004.
“Mother Nature designed our bodies to be able to fight off infections through natural means — you need to be exposed and develop immunity,” Majeski said. “We’ve just gotten a little too overprotective with our children.”
___
Associated Press writer Mel C. Evans in Trenton, N.J., contributed to this report.
Copyright 2008 The Associated Press.
By DAVID CRARY
AP National Writer
As flu season approaches, many New Jersey parents are furious over a first-in-the-nation requirement that children get a flu shot in order to attend preschools and day-care centers. The decision should be the parents’, not the state’s, they contend.
Hundreds of parents and other activists rallied outside the New Jersey Statehouse on Thursday, decrying the policy and voicing support for a bill that would allow parents to opt out of mandatory vaccinations for their children.
“This is not an anti-vaccine rally — it’s a freedom of choice rally,” said one of the organizers, Louise Habakus. “This one-size-fits-all approach is really very anti-American.”
New Jersey’s policy was approved last December by the state’s Public Health Council and is taking effect this fall. Children from 6 months to 5 years old who attend a child-care center or preschool have until Dec. 31 to receive the flu vaccine, along with a pneumococcal vaccine.
The Health Council was acting on the recommendations of the federal Centers for Disease Control and Prevention, which has depicted children under 5 as a group particularly in need of flu shots. But no other state has made the shots mandatory for children of any age.
“Vaccines not only protect the child being vaccinated but also the general community and the most vulnerable individuals within the community,” New Jersey’s Health Department said in a statement. It has depicted young children as “particularly efficient” in transmitting the flu to others.
Opposition to the policy is vehement. Assemblywoman Charlotte Vandervalk, one of the speakers at the rally, said she now has 34 co-sponsors for a bill that would allow for conscientious objections to mandatory vaccinations.
“The right to informed consent is so basic,” she said in an interview. “Parents have a right to decide for their own children what is injected in their bodies.”
State policy now allows for medical and religious exemptions to mandatory vaccinations, but Vandervalk said requests for medical exemptions often have been turned down by local health authorities. She said 19 other states allow conscientious exemptions like those envisioned in her bill.
New Jersey’s health department has come out strongly against the legislation.
“Broad exemptions to mandatory vaccination weaken the entire compliance and enforcement structure,” it said.
The department also contends that New Jersey is particularly vulnerable to vaccine-preventable diseases — with a high population density, a mobile population and many recently arrived immigrants.
“In light of New Jersey’s special traits, the highest number of children possible must receive vaccines to protect them and others,” the department said.
Several hundred people attended Thursday’s rally, some with signs reading, “Mommy knows best.”
Among the speakers was Robin Stavola of Colts Neck, N.J., who said her daughter, Holly, died in 2000 at age 5 less than two weeks after receiving eight different vaccines, including a booster shot.
“I am not against vaccines, but I do believe there are too many,” she told the crowd.
State health officials and the CDC insist the flu vaccine is safe and effective, but Vandervalk and the parent groups who support her bill contend there has been inadequate research into the vaccine’s impact on small children. Critics note that flu vaccines contain trace amounts of thimerosol, a mercury-based preservative; the CDC says there’s no convincing evidence these trace amounts cause harm.
More generally, many of the parents mobilizing against the state policy believe various types of vaccine are being overused, resulting in more cases of autism, attention deficit hyperactivity disorder and other neurological problems in children.
“There’s not been a response from the government that is credible in terms of doing the scientific research that will screen out vulnerable children,” said Barbara Loe Fisher, a speaker at the rally. She is co-founder of the National Vaccine Information Center in Vienna, Va., an advocacy group skeptical of vaccination policies.
“There’s an acknowledgment that prescription drugs can cause different reactions in people, but there’s a blanket statement by health authorities that we all have to vaccinate, all in the same way,” Fisher said.
Fisher is a prominent player in a nationwide movement challenging the scope of vaccination programs. She was harshly critical last year when school officials in Maryland’s Prince George’s County threatened to impose jail terms and fines on parents whose children didn’t get required vaccinations.
Many of the activists in New Jersey accept the need for mandatory vaccinations for certain highly dangerous diseases, such as polio, but argue that the state went too far in requiring flu shots.
“The flu is not a deadly disease,” said Barbara Majeski of Princeton, N.J., who does not want her two preschooler sons to get the vaccination.
In fact, flu kills about 36,000 Americans a year and hospitalizes about 200,000. But children make up a small fraction of the victims — 86 died last year, from babies to teens, according to federal figures. Only two flu deaths of children in New Jersey have been recorded since 2004.
“Mother Nature designed our bodies to be able to fight off infections through natural means — you need to be exposed and develop immunity,” Majeski said. “We’ve just gotten a little too overprotective with our children.”
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Associated Press writer Mel C. Evans in Trenton, N.J., contributed to this report.
Copyright 2008 The Associated Press.
Pediatricians double vitamin D recommendations
Date: 10/13/2008 12:07 AM
By LINDSEY TANNER
AP Medical Writer
CHICAGO (AP) _ The nation’s leading pediatricians group says children from newborns to teens should get double the usually recommended amount of vitamin D because of evidence that it may help prevent serious diseases.
To meet the new recommendation of 400 units daily, millions of children will need to take daily vitamin D supplements, the American Academy of Pediatrics said. That includes breast-fed infants — even those who get some formula, too, and many teens who drink little or no milk.
Baby formula contains vitamin D, so infants on formula only generally don’t need supplements. However, the academy recommends breast-feeding for at least the first year of life and breast milk is sometimes deficient.
Most commercially available milk is fortified with vitamin D, but most children and teens don’t drink enough of it — four cups daily would be needed — to meet the new requirement, said Dr. Frank Greer, the report’s co-author.
The new advice is based on mounting research about potential benefits from vitamin D besides keeping bones strong, including suggestions that it might reduce risks for cancer, diabetes and heart disease. But the evidence isn’t conclusive and there’s no consensus on how much of the vitamin would be needed for disease prevention.
The new advice replaces a 2003 academy recommendation for 200 units daily.
That’s the amount the government recommends for children and adults up to age 50; 400 units is recommended for adults aged 51 to 70 and 600 units for those aged 71 and up. Vitamin D is sold in drops for young children, capsules and tablets.
The Institute of Medicine, a government advisory group that sets dietary standards, is discussing with federal agencies whether those recommendations should be changed based on emerging research, said spokeswoman Christine Stencel.
The recommendations were prepared for release Monday at an academy conference in Boston. They are to be published in the November issue of the academy’s journal, Pediatrics.
Besides milk and some other fortified foods like cereal, vitamin D is found in oily fish including tuna, mackerel and sardines.
But it’s hard to get enough through diet; the best source is sunlight because the body makes vitamin D when sunshine hits the skin.
While it is believed that 10 to 15 minutes in the sun without sunscreen a few times weekly is sufficient for many, people with dark skin and those in northern, less sunny climates need more. Because of sunlight’s link with skin cancer, “vitamin D supplements during infancy, childhood and adolescence are necessary,” the academy’s report says.
Recent studies have shown that many children don’t get enough vitamin D, and cases of rickets, a bone disorder often associated with malnourishment in the 1800s, continue to occur.
Greer, a University of Wisconsin pediatrician, acknowledged that most studies suggesting vitamin D may play a much broader role in disease prevention have been observational, not the most rigorous kind of medical evidence.
Nonetheless, many doctors consider the research compelling and many have begun to offer patients routine vitamin D testing.
Adrian Gombart, a vitamin D researcher at Oregon State University, said the new recommendations are safe and conservative but that 400 units “is probably not enough.”
Gombart’s lab work in human tissue has shown that vitamin D helps increase levels of a protein that kills bacteria. He said many experts believe that between 800 and 1,000 units daily would be more effective at helping fight disease.
Several members of an academy committee that helped write the guidelines have current or former ties to makers of infant formula or vitamin supplements.
___
On the Net:
Academy: http://www.aap.org
Institute of Medicine: http://www.iom.edu
Copyright 2008 The Associated Press.
By LINDSEY TANNER
AP Medical Writer
CHICAGO (AP) _ The nation’s leading pediatricians group says children from newborns to teens should get double the usually recommended amount of vitamin D because of evidence that it may help prevent serious diseases.
To meet the new recommendation of 400 units daily, millions of children will need to take daily vitamin D supplements, the American Academy of Pediatrics said. That includes breast-fed infants — even those who get some formula, too, and many teens who drink little or no milk.
Baby formula contains vitamin D, so infants on formula only generally don’t need supplements. However, the academy recommends breast-feeding for at least the first year of life and breast milk is sometimes deficient.
Most commercially available milk is fortified with vitamin D, but most children and teens don’t drink enough of it — four cups daily would be needed — to meet the new requirement, said Dr. Frank Greer, the report’s co-author.
The new advice is based on mounting research about potential benefits from vitamin D besides keeping bones strong, including suggestions that it might reduce risks for cancer, diabetes and heart disease. But the evidence isn’t conclusive and there’s no consensus on how much of the vitamin would be needed for disease prevention.
The new advice replaces a 2003 academy recommendation for 200 units daily.
That’s the amount the government recommends for children and adults up to age 50; 400 units is recommended for adults aged 51 to 70 and 600 units for those aged 71 and up. Vitamin D is sold in drops for young children, capsules and tablets.
The Institute of Medicine, a government advisory group that sets dietary standards, is discussing with federal agencies whether those recommendations should be changed based on emerging research, said spokeswoman Christine Stencel.
The recommendations were prepared for release Monday at an academy conference in Boston. They are to be published in the November issue of the academy’s journal, Pediatrics.
Besides milk and some other fortified foods like cereal, vitamin D is found in oily fish including tuna, mackerel and sardines.
But it’s hard to get enough through diet; the best source is sunlight because the body makes vitamin D when sunshine hits the skin.
While it is believed that 10 to 15 minutes in the sun without sunscreen a few times weekly is sufficient for many, people with dark skin and those in northern, less sunny climates need more. Because of sunlight’s link with skin cancer, “vitamin D supplements during infancy, childhood and adolescence are necessary,” the academy’s report says.
Recent studies have shown that many children don’t get enough vitamin D, and cases of rickets, a bone disorder often associated with malnourishment in the 1800s, continue to occur.
Greer, a University of Wisconsin pediatrician, acknowledged that most studies suggesting vitamin D may play a much broader role in disease prevention have been observational, not the most rigorous kind of medical evidence.
Nonetheless, many doctors consider the research compelling and many have begun to offer patients routine vitamin D testing.
Adrian Gombart, a vitamin D researcher at Oregon State University, said the new recommendations are safe and conservative but that 400 units “is probably not enough.”
Gombart’s lab work in human tissue has shown that vitamin D helps increase levels of a protein that kills bacteria. He said many experts believe that between 800 and 1,000 units daily would be more effective at helping fight disease.
Several members of an academy committee that helped write the guidelines have current or former ties to makers of infant formula or vitamin supplements.
___
On the Net:
Academy: http://www.aap.org
Institute of Medicine: http://www.iom.edu
Copyright 2008 The Associated Press.