What Walter Russell Mead dubbed the “pivot" to single payer has begun as various folks point out that if we only had a total government takeover, these issues wouldn’t put the whole system in danger. I’ve seen more than a few progressive commenters suggest that maybe an epic fail will finally open the way to the single-payer system we should have had in the first place.
In private, and occasionally in public, conservatives are expressing the same fear. There’s a pretty popular conspiracy theory running around to the effect that this was the Barack Obama administration’s intent all along: Design this big Rube Goldberg apparatus that couldn’t possibly work, and when it fails, sweep in and “fix” things by enacting the single-payer scheme you wanted all along.
Protesters fill the Miami office of Florida state Rep. Manny Diaz Jr. on Sept. 20 to protest his stance against expansion of health coverage in the state.
Joe Raedle/Getty Images
President Obama Tuesday appointed one of his top management gurus, Jeffrey Zeints, to head the team working to fix what ails Healthcare.gov, the troubled website that's supposed to allow residents of 36 states enroll in coverage under the Affordable Care Act.
But even if the team gets the website working as it should, millions of Americans may still log on to discover that they aren't eligible for any health coverage at all. And that won't be due to any technical glitch. It's because their state has decided not to expand its Medicaid program.
This is not the way the health law was designed and enacted, says Bruce Siegel.
"Originally the idea was that millions and millions of Americans would get health insurance," says Siegel, president and CEO of America's Essential Hospitals, a group that represents safety net institutions around the country. "They'd get coverage through Medicaid or through private insurance on the exchanges."
Currently in most states you have to be a child, be pregnant or disabled to get Medicaid. The health law was supposed to change all that — expanding the program to include nearly everyone with incomes up to about 133 percent of the federal poverty level, or about $15,000 a year for an individual.
But in the summer of 2012, when the Supreme Court upheld the health law as constitutional, it did something unexpected, Siegel says. "They said states had the option of expanding their Medicaid program or not expanding it. And that led to a very, very different landscape than what we expected."
Even with Ohio's decision earlier this week to opt in, still only half the states have said they will expand their Medicaid programs, even though the federal government is paying the entire cost of the additional people for the first three years, and 90 percent going forward.
As a result, according to the Urban Institute, between 6 and 7 million low-income uninsured adults live in states that are so far not expanding their programs.
And some of those states have among the largest populations of low income uninsured people.
"Over 3 million of them live in just four states," says Genevieve Kenney, senior fellow and co-director of the Urban Institute's Health Policy Center. Those states are Florida, Texas, Georgia and North Carolina.
The problem, says Kenney, is that for many of those people the law offers them nothing. Because they were supposed to get Medicaid, they're not eligible to buy private insurance at the exchanges unless their incomes are above the poverty line. That's about $11,000 a year for an individual.
"I think it's going to be confusing for individuals who are applying for coverage," says Kenney. "It certainly makes the message about the new affordable coverage that's available a lot more complicated to target."
Among the people who could get left behind is Ellen Wall. She's a nanny and sometime music teacher from Atlanta. She says her income fluctuates, but most years it's right around the poverty line. She says as long as she can pay her bills, she doesn't mind earning that amount.
"I love doing what I do because I'm very good at what I do, that's why I've chosen this profession," she says. "But there are those years when it's quite lean and then I'm just barely making it. And what am I gonna do if something comes up and I'm really sick and I need some help?"
Wall doesn't have and hasn't had health insurance. She says that was a real problem a few years back when she was in the hospital after an asthma attack.
"It was kind of a very embarrassing situation to be in, not to have the health insurance that could have covered that few days that I was in the hospital," she said.
If Wall lived in a state expanding Medicaid she would clearly qualify. But so far, Georgia isn't. And her income may or may not be high enough to let her qualify for help buying private coverage on the state's exchange. So she'll likely remain working, poor and uninsured.
Most advocates say people like Wall should turn to community clinics and public hospitals if they can't get insurance. But there's a problem there, too, says public hospital advocate Siegel. The health law cut funding for public hospitals because it assumed so many more people would have insurance. But in those states that aren't expanding Medicaid, the need for free care is likely to go up instead of down.
"Many of these hospitals will be overwhelmed," Siegel says. "Some of them are already overwhelmed; many of them are already losing money, providing a high level of service to people in need. And this will simply not be a tenable position."
Public and other hospitals are among those lobbying hard for Medicaid expansion in the states that so far have opted not to expand their Medicaid programs. Some states are still considering opting in. But in others, patients left behind may have to scramble even harder to find care if they get sick.
Contact: Sonia Neves sonia.furtado@embl.de European Molecular Biology Laboratory
3D structure reveals protein's Swiss-army knife strategy
The molecular machine that makes essential components of ribosomes the cell's protein factories is like a Swiss-army knife, researchers at the European Molecular Biology Laboratory (EMBL) in Heidelberg, Germany, and the Centro de Investigaciones Biolgicas in Madrid, Spain, have found. By determining the 3-dimensional structure of this machine, called RNA polymerase I, for the first time, the scientists found that it incorporates modules which prevent it from having to recruit outside help. The findings, published online today in Nature, can help explain why this protein works faster than its better-studied counterpart, RNA polymerase II.
"Rather than recruiting certain components from outside, RNA polymerase I has them already built in, which explains why it is bigger, and less regulated, but at the same time more efficient," says Christoph Mller from EMBL, who led the study. "Because everything is already assembled, there's no time delay," explains Maria Moreno-Morcillo, who carried out the work.
There are three different RNA polymerases, each of which makes specific types of RNA molecule. For example, RNA polymerase II makes messenger RNA the 'middle-man' that carries the information encoded in DNA to a ribosome where it can be used to make a protein. RNA polymerases I and III make parts of the machinery which reads that messenger RNA: I builds the RNA that will eventually form a ribosome, while III makes the transfer RNA that carries the protein building blocks to the ribosome for assembly. Scientists have known for over a decade what RNA polymerase II looks like and how it works, but obtaining detailed information on the structures of its counterparts has proven extremely difficult. Now that they have managed to do so for RNA polymerase I, Mller and colleagues have found explanations for some of the protein's particularities.
Part of the difficulty in studying RNA polymerase I is that it is a larger molecule than RNA polymerase II. When they determined its 3-dimensional structure, the scientists found that some of the 'extra' modules in RNA polymerase I are remarkably similar to other, separate proteins that RNA polymerase II needs to do its job. It seems that RNA polymerase I has brought those helper modules permanently on board. In another part of the molecule, Mller and colleagues found that RNA polymerase I appears to have combined what in RNA polymerase II are two separate modules into a single, multi-tasking component. Together, these changes likely explain why RNA polymerase I can produce RNA molecules at a faster rate than RNA polymerase II.
The findings also imply that the cell has fewer ways of controlling RNA polymerase I's activity, since it can't influence it by changing the availability of helper proteins as it does in the case of RNA polymerase II. But here, too, RNA polymerase I's Swiss-army knife strategy provides a solution. The structure showed that this molecular machine has a built-in regulatory mechanism: it can stop itself from attaching to DNA by bending a loop in its structure to block the space the DNA would usually dock onto.
###
The work was carried out in collaboration with Carlos Fernndez-Tornero's lab at the Centro de Investigaciones Biolgicas in Madrid, Spain, as well as researchers at the University of Gӧttingen, Germany and the SOLEIL synchrotron in France, where some of the structural data was obtained. Structural data was also obtained at the Petra III ring at EMBL Hamburg, on the DESY campus in Germany.
Christoph Mller recently received an Advanced Grant from the European Research Council (ERC) to study RNA polymerase I and the proteins it interacts with.
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Bigger, better, faster
PUBLIC RELEASE DATE:
24-Oct-2013
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Contact: Sonia Neves sonia.furtado@embl.de European Molecular Biology Laboratory
3D structure reveals protein's Swiss-army knife strategy
The molecular machine that makes essential components of ribosomes the cell's protein factories is like a Swiss-army knife, researchers at the European Molecular Biology Laboratory (EMBL) in Heidelberg, Germany, and the Centro de Investigaciones Biolgicas in Madrid, Spain, have found. By determining the 3-dimensional structure of this machine, called RNA polymerase I, for the first time, the scientists found that it incorporates modules which prevent it from having to recruit outside help. The findings, published online today in Nature, can help explain why this protein works faster than its better-studied counterpart, RNA polymerase II.
"Rather than recruiting certain components from outside, RNA polymerase I has them already built in, which explains why it is bigger, and less regulated, but at the same time more efficient," says Christoph Mller from EMBL, who led the study. "Because everything is already assembled, there's no time delay," explains Maria Moreno-Morcillo, who carried out the work.
There are three different RNA polymerases, each of which makes specific types of RNA molecule. For example, RNA polymerase II makes messenger RNA the 'middle-man' that carries the information encoded in DNA to a ribosome where it can be used to make a protein. RNA polymerases I and III make parts of the machinery which reads that messenger RNA: I builds the RNA that will eventually form a ribosome, while III makes the transfer RNA that carries the protein building blocks to the ribosome for assembly. Scientists have known for over a decade what RNA polymerase II looks like and how it works, but obtaining detailed information on the structures of its counterparts has proven extremely difficult. Now that they have managed to do so for RNA polymerase I, Mller and colleagues have found explanations for some of the protein's particularities.
Part of the difficulty in studying RNA polymerase I is that it is a larger molecule than RNA polymerase II. When they determined its 3-dimensional structure, the scientists found that some of the 'extra' modules in RNA polymerase I are remarkably similar to other, separate proteins that RNA polymerase II needs to do its job. It seems that RNA polymerase I has brought those helper modules permanently on board. In another part of the molecule, Mller and colleagues found that RNA polymerase I appears to have combined what in RNA polymerase II are two separate modules into a single, multi-tasking component. Together, these changes likely explain why RNA polymerase I can produce RNA molecules at a faster rate than RNA polymerase II.
The findings also imply that the cell has fewer ways of controlling RNA polymerase I's activity, since it can't influence it by changing the availability of helper proteins as it does in the case of RNA polymerase II. But here, too, RNA polymerase I's Swiss-army knife strategy provides a solution. The structure showed that this molecular machine has a built-in regulatory mechanism: it can stop itself from attaching to DNA by bending a loop in its structure to block the space the DNA would usually dock onto.
###
The work was carried out in collaboration with Carlos Fernndez-Tornero's lab at the Centro de Investigaciones Biolgicas in Madrid, Spain, as well as researchers at the University of Gӧttingen, Germany and the SOLEIL synchrotron in France, where some of the structural data was obtained. Structural data was also obtained at the Petra III ring at EMBL Hamburg, on the DESY campus in Germany.
Christoph Mller recently received an Advanced Grant from the European Research Council (ERC) to study RNA polymerase I and the proteins it interacts with.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Jerky treats for dogs and cats have been linked to pet illnesses and deaths. But it's still unclear what is causing the problems.
iStockphoto.com
Jerky treats for dogs and cats have been linked to pet illnesses and deaths. But it's still unclear what is causing the problems.
iStockphoto.com
The Food and Drug Administration has a mystery on its hands.
Thousands of dogs and at least 10 cats have become sick after eating various forms of jerky for pets over the past few years. Some 580 animals have died, the agency says. But it's not sure why.
Some of the cases have been diagnosed as "kidney failure, gastrointestinal bleeding, and a rare kidney disorder," the agency said. Overall, a little less than two-thirds of the cases have been some kind of gastrointestinal illness. Nearly a third have "involved kidney and urinary systems."
The FDA released a summary of complaints potentially tied to jerky treats, including quite a few from this year. Here's an unedited example involving a 3-year-old miniature pinscher:
"I took my Min-Pin to the vet to get her teeth cleaned and upon doing bloodwork before the procedure, discovered she had high levels associated with kidney disease. A week and a half later, I had to put her down due to a rapid decline of health despite efforts to correct the problem. It was speculated that her cause of death was a more than likely a result of the chicken treats from China that have been removed from the market. I am greatly saddened and heartbroken of her loss and at the same time furious to find out that no one is being held liable for this."
In the FDA's search for answers, the agency has run lots of tests on various jerkies, tenders and strips made with chicken, duck, sweet potato, dried fruit and combinations of those ingredients. "To date, none of the tests have revealed the cause of the illnesses," the agency said in a fact sheet.
What should pet owners be on guard for? Loss of appetite, listlessness, vomiting, diarrhea (sometimes bloody), drinking a lot more water and also increased urination. See a veterinarian if you suspect a problem.
The investigation has focused on products imported from China. "We still are extensively testing treats for a number of things," FDA's Martine Hartogensis, a deputy director at the FDA's Center for Veterinary Medicine, told NBC News. "We do seem to be getting some leads, but we still have a little bit of a ways to go." (The detailed testing report is here.)
The FDA wants your help. "If you have a dog or cat that became ill after eating jerky pet treats, the Food and Drug Administration would like to hear from you or your veterinarian," the agency said in a statement posted to its website Tuesday. You can report information to the FDA online here.
In late 2011, FDA warned pet owners about a potential problem with chicken jerky products for dogs. Many dog owners and vets complained to the agency about illnesses that appeared to be associated with jerky. There were other FDA warnings dating back to 2007.
"Our fervent hope as animal lovers is that we will soon find the cause of — and put a stop to — these illnesses," Dr. Bernadette Dunham, director of the FDA's Center for Veterinary Medicine, said on the agency's website.
The death of Florida congressman Bill Young is likely to lead to the first congressional election in a competitive district following the government shutdown and debt ceiling fight. An election date has not yet been set by Gov. Rick Scott, but could be in March.
It's almost impossible to actually watch an event when you're covering it live. Whether you're transcribing what's being said, or providing play-by-play commentary, color, and analysis, you're forced to pay only partial attention to what's going on because the rest of your attention is busy digesting, translating, and expounding on it. So, after I finished doing the [live iMore show[(http://www.imore.com/imore-show-369-ipad-mac-event-live) during Apple's 2013 iPad and Mac event I had to go back and watch it in order to fully appreciate everything that went on, to get the subtleties and nuances, to catch the slips, and to formulate an overall opinion of the event. I've done that twice now. And overall, I'm conflicted.
I can understand what Nick Bilton of the New York Times experienced at the event:
Lately, however, [Apple] events have replaced the “wow” with the “boring.”
Bilton thinks the products are still good, but the presentation is getting old. Marco Arment:
Something felt a bit off about this week’s Apple event.
Arment chalks it up to a combination of lack of surprise, flat presentation, repetitive messaging, and a lack of timely preorders.
I can also understand what John Gruber of Daring Fireball experienced:
Apple’s events are more like watching episodes of the same TV show, but with different bits each time. The show itself grows ever more familiar, but the content changes with each episode.
If there was any event in recent memory that demonstrated the depth and scope of Apple’s products, it had to be this one. Every new product tied into the last and the next announcement in one way or another. Whether iOS or Mac, software or hardware, the connection was there.
So, what's going on?
Predictability
The iPad mini going Retina was predictable, but would anyone rather have had it go down in display density instead? That would have been a surprise, but not a good one. The iPad turning into the iPad Air was predictable too, but would anyone have better welcomed it getting heavier and thicker? This, of all arguments against the Apple event, is the most tenuous. Absent new products, any updates to existing products will be logical and incremental. A triangular iPad would be different, but it would also be stupid.
Mavericks and the redesigned Mac Pro were technically new, but Apple had already shown both off at WWDC 2013, so they were expected, and hence not really, truly new. Likewise the new MacBook Pros, even though the 13-inch ended up being thinner and lighter again, were anticipated because their product cycles are linked to Intel's processor roadmap and Haswell had already come to both the MacBook Air and iMac lines. It was their turn. So, again, not really, truly new.
The iWork and iLife app updates were new, but also existing product lines, and it turns out some people aren't very happy with them, so they get to be both not really, truly new, and, by some, unwelcome for their not really, truly newness.
The problem is, the world tends towards patterns, and humans are really good at spotting patterns. When things make sense, they're predictable, and as much as we love that, we also kind of hate it.
Ad to that Apple's massive manufacturing scale, which makes leaks more likely than ever, and we have people doing the gadget equivalent of reading a movie script before going to the theater, and then being upset the movie doesn't surprise them. Spoiler. Alert.
Making the iPad Air as thin as it is wasn't easy. Going to Retina in the iPad mini this year was even less easy. Apple barely got it done in time (look no further than the "later this November" shipping date). Pushing Apple A7 chipsets across the entire new iPad lineup wasn't easy either. It was, dare I say it, a surprise. (Or more technically, a payoff years in the making). Not having Touch ID in the new iPads, most likely because Apple is struggling to produce enough sensors for the iPhone 5s lineup as it is, was also a surprise. Also an unwelcome one by many.
Like "one more things", true surprises at Apple events are few and far between. They're the iPods and iPhones and iPads. They're 2001 and 2007 and 2010. Apple will almost certainly attempt more of them, perhaps even as soon as 2014, and we'll likely suffer the same "oh, a wearable, we expected that!" and the follow on "oh, an updated wearable, where's the iCar?!"
We're an incredibly connected, keyed in, revved up, informed, insightful, and grown up community and customer base now. We've bitten of the Apple, and we've lost the paradise of - and appreciation for - the mysteries of our youth.
In this case, with this complaint, it's not Apple that's failing to deliver, it's our expectations that can no longer reasonably be met.
Presentation
Yeah. There were stumbles. Black Knight? It was like watching dad try to twerk. (Or watching me try to use twerk in a sentence.) It was a script pulled too tightly over too much event. Apple used to release new iPads in the spring, new iPhones in the summer, new iPods in the fall, and new Macs whenever they were ready. For the last two years, they've released everything but iPods, iPhones, and a smattering of Macs at one small event in October. It is, arguably, too much.
Mavericks, new MacBook Pros, the new Mac Pro, iWork for iOS, OS X, and iCloud. The iPad Air. The Retina iPad mini. And updates to a bunch of other Apple apps. It's almost inarguably too much. I'm tried merely from typing it out. Yet October was when Mavericks was ready. It was when the new MacBook Pros got the Haswell chipsets they needed. It was when the iPad Air and, especially, the Retina iPad mini could be shipped before the holidays. It was Apple putting the pedal to the metal and getting stuff out as fast as technology and components would allow. And it was exhausting just to watch, never mind orchestrate.
Eddy Cue in his Kung Fu shirt, and Roger Rosner awkwardly helping him make mock album art was painful. But there have been awkward - and slow - moments at keynotes for years. It's when it all adds up, the slips, the pace, and the pain, that it begins to create that "off" feeling.
Steve Jobs wasn't immune to this either. Tossing cameras into the audience, losing it over Mi-Fis, getting lost in small features for minutes at a time. But he was Steve Jobs. Unfortunately, he's who Apple's current slate of presenters, from Tim Cook on down are following. Worse, the romanticized memory of Steve Jobs is what Apple's current slate of presenters, from Tim Cook on down, are following. And that's an impossible position for anyone to be in. Apple is still lightyears ahead of most other tech companies when it comes to presentations, but they're held to a higher standard than any other tech company because of it.
There were moments - "mind blown", for example - that stood out, but given it was an Apple event, given all the announcements were recapitulations or upgrades, given the sheer mass of them, and given the stumbles, there weren't enough.
Repetitiveness
As a result of incremental updates and presentation problems, Apple's events have felt more repetitive than they have in the past. They're not, of course - Apple events have been repetitive for years - but once an illusion shatters, it tends to stay that way.
The advantage to repetitiveness is that, when it works, it's magical. It's the chorus in the song you can't stop playing over and over again. It's the signature line you're always waiting for the hero to utter. It's the moment when anticipation becomes reality.
The disadvantage to receptiveness is that, when it doesn't work, it falls absolutely flat.
There's an old saying that the key to a great fight is in the matchmaking. Fighters can have great skills and great game plans, and without changing a thing, explode one night and fall apart another. Likewise with presentations. An off night for Apple's executives, a malaise among the media, and a few flubs plus a few long moments of silent non-reaction and things start to go south fast.
Does that mean Apple's gotten stale? Does it mean the media is hopeless jaded? Maybe, and of course not. It's not immediately clear to me how Apple could, or even if Apple should change their event formula. Having attended numerous events by other companies, including almost all of Apple's competitors, I can objectively say no one else comes close in terms of clarity of message delivered. Apple tells you what they're going to say, says it, then tells you what they said. With big, helpful, charts detailing products, pricing, and availability.
Would sideways cars on a broadway stage, or HALO jumpers landing on the roof make Apple events more interesting? Maybe. But would it make them better? I'm not convinced.
What would make it better is a little more relaxation on stage. A little more energy and a little more sense of fun. Apple introduced some great products. The executives knew that as well as the media. We just needed to see that knew it. That they loved it. And that they were willing to worry less about script, and risk getting lost in it just a little more.
Immediacy
There were no pre-orders for the iPad Air, just like there were no pre-orders for the iPhone 5s. My guess is its for similar reasons - there's simply not enough stock to allow for meaningful pre-orders and supply retail stores for launch day. Instead of having an almost immediate sell out thanks to low pre-order quantities in advance, and under serve people who go to the actual stores on day one, Apple is opting to give retail some breathing room by starting online the same day. In a perfect world, Apple would have enough iPad Air stock to have started pre-orders last week, but we live in the real world and sometimes deadlines are sprints all the way to the end.
Likewise the iPad mini, which is crossing the finish line so hot it isn't even going to be ready to ship with the Air. Whether or not Apple announces pre-orders for it remains to be seen, but there simply aren't enough to start selling this week. Even more so with the new Mac Pro. However, that's such a niche, high-end product it doesn't have the holiday sales pressure on it that the iPad line does.
Mavericks, iWork, iLife, and the new MacBook Pros shipped the same day as the event. Can't get any more immediate than that.
So
As Apple events go, the products announced last week were absolutely amazing. The equivalent of nuclear weapons in a conventional theater. I still can't believe they managed to get the iPad Air and Retina iPad mini ready to go as quickly as they did. Mavericks is solid, and the new Mac Pro is porn. I understand the complaints about the new iWork suite, but I also have an idea of the compromise that had to be made there. And there new MacBook Pros are pretty damn fine as well.
But the presentation was rough. They had all the elements, but they just didn't nail the landing. That's something that can and should be improved. They'll never be Steve Jobs, but they can all be good, and relaxed, and happy, and paced, and themselves. The predictability, the repetitiveness, those are things that shouldn't and almost certainly aren't concerning Apple. Keep making great products and nail the presentation, and no few, if anyone, will complain about either of those things next time.
That, or save something like the new Mac Pro for the October event next time. WWDC already had iOS 7 and Mavericks, after all.
Pediatricians tackle controversial issues in new point-counterpoint sessions at AAP conference
PUBLIC RELEASE DATE:
26-Oct-2013
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Contact: Debbie Jacobson djacobson@aap.org 847-434-7084 American Academy of Pediatrics
Discussions on mandatory ECG screenings, medicating for ADHD, infant formula for breastfeeding, and testing for Strep infections
ORLANDO, Fla. -- Pediatric experts will debate the pros and cons of the most contentious issues pediatricians face in their daily practice during the new point-counterpoint sessions at the American Academy of Pediatrics (AAP) National Conference & Exhibition in Orlando Oct. 26-29.
For the "Controversies in Pediatrics" series, a new topic will be debated each day by some of the most influential pediatricians in the fields of sports medicine, infectious disease, children with disabilities, and breastfeeding. Reporters interested in covering any of these sessions should check in at the press room, W203B.
The schedule includes:
ECG Screening Prior to Competitive Sports: Should it be Mandatory in the US?
4-5 p.m. Saturday, Oct. 26
Pro: Victoria Vetter, MD
Con: Reginald Washington, MD, FAAP
When a seemingly young, healthy athlete dies suddenly while competing in a sporting event, people want to know how, why, and more importantly, what could have be done to prevent it?
Research has found that mandatory electrocardiograms (ECGs) for student athletes can save more lives, but nationally, it would cost more than $2 billion a year to cover everyone. Estimates from the American Heart Association have shown that the false-positive rate can range from 10 percent to 40 percent because athletes can undergo changes while training that can alter test results. In Italy, all student athletes are required to have a physical exam and ECG, at no cost to the child or parent. In the U.S., not everyone can afford the test, and it is not always covered by insurance. The controversy remains: if even one life can be saved, should cost be an issue?
Kung Fu PANDAS: Stealth Attacks of Streptococci?
4-5 p.m. Sunday, Oct. 27
Pro: Susan Swedo, MD, FAAP
Con: Donald Gilbert, MD, FAAP
For the past 15 years, there has been conflicting research results regarding PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) being etiologically associated with some cases of obsessive-compulsive disorder (OCD) and tics. Highlights of this session will involve discussion of the controversies about appropriate testing and treatment.
Dr. Swedo will present the pro-PANDAS case, that Strep is a trigger for acute-onset OCD and other neuropsychiatric symptoms. She will argue that pediatricians should obtain a throat culture from any child who suddenly develops obsessions, compulsions, separation anxiety or other signs of PANDAS. If the strep infection isn't recognized and appropriately treated, symptoms can worsen. Repeated episodes may result in chronic, treatment-resistant OCD or other debilitating mental illness.
Dr. Gilbert will debate that if a child presents with new onset OCD or other neuropsychiatric symptoms, the child should be managed with standard-of-care behavioral or pharmacological treatments, and pediatricians should rarely be testing for Strep with throat cultures or blood tests. These approaches are validated in longstanding practice and published evidence.
Preschoolers with ADHD: To Medicate or Not?
4-5 p.m. Monday, Oct. 28
Pro: Mark Wolraich, MD, FAAP
Con: William Barbaresi, MD, FAAP
Is it appropriate or necessary to treat children 4 to 5 years of age with stimulant medications? In 2011, the AAP published a clinical practice guideline recommending behavioral therapy as the first line of treatment for preschool-age children.
Dr. Wolraich will present evidence why stimulant medication should be considered if behavior therapy is not successful for preschoolers diagnosed with ADHD. Dr. Barbaresi will make his case against using medication as treatment in the primary care setting.
What's Wrong with Just One Bottle? Pros and Cons of Choosing to Supplement Breastfed Babies
8:30-9:30 a.m. Tuesday, Oct. 29
Pro: Mandy Brown Belfort, MD, FAAP
Con: Susan Landers, MD, FAAP
It has been longstanding AAP recommendation for babies to be exclusively breastfed for about 6 months, followed by continued breastfeeding as complementary foods are introduced. However, a recent study has shown that small amounts of formula can be used to supplement breastfeeding with positive results. Experts will present both sides of this debate, as well as review the factors that lead breastfeeding mothers to use formula and stop breastfeeding.
###
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Pediatricians tackle controversial issues in new point-counterpoint sessions at AAP conference
PUBLIC RELEASE DATE:
26-Oct-2013
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]
Share
Contact: Debbie Jacobson djacobson@aap.org 847-434-7084 American Academy of Pediatrics
Discussions on mandatory ECG screenings, medicating for ADHD, infant formula for breastfeeding, and testing for Strep infections
ORLANDO, Fla. -- Pediatric experts will debate the pros and cons of the most contentious issues pediatricians face in their daily practice during the new point-counterpoint sessions at the American Academy of Pediatrics (AAP) National Conference & Exhibition in Orlando Oct. 26-29.
For the "Controversies in Pediatrics" series, a new topic will be debated each day by some of the most influential pediatricians in the fields of sports medicine, infectious disease, children with disabilities, and breastfeeding. Reporters interested in covering any of these sessions should check in at the press room, W203B.
The schedule includes:
ECG Screening Prior to Competitive Sports: Should it be Mandatory in the US?
4-5 p.m. Saturday, Oct. 26
Pro: Victoria Vetter, MD
Con: Reginald Washington, MD, FAAP
When a seemingly young, healthy athlete dies suddenly while competing in a sporting event, people want to know how, why, and more importantly, what could have be done to prevent it?
Research has found that mandatory electrocardiograms (ECGs) for student athletes can save more lives, but nationally, it would cost more than $2 billion a year to cover everyone. Estimates from the American Heart Association have shown that the false-positive rate can range from 10 percent to 40 percent because athletes can undergo changes while training that can alter test results. In Italy, all student athletes are required to have a physical exam and ECG, at no cost to the child or parent. In the U.S., not everyone can afford the test, and it is not always covered by insurance. The controversy remains: if even one life can be saved, should cost be an issue?
Kung Fu PANDAS: Stealth Attacks of Streptococci?
4-5 p.m. Sunday, Oct. 27
Pro: Susan Swedo, MD, FAAP
Con: Donald Gilbert, MD, FAAP
For the past 15 years, there has been conflicting research results regarding PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) being etiologically associated with some cases of obsessive-compulsive disorder (OCD) and tics. Highlights of this session will involve discussion of the controversies about appropriate testing and treatment.
Dr. Swedo will present the pro-PANDAS case, that Strep is a trigger for acute-onset OCD and other neuropsychiatric symptoms. She will argue that pediatricians should obtain a throat culture from any child who suddenly develops obsessions, compulsions, separation anxiety or other signs of PANDAS. If the strep infection isn't recognized and appropriately treated, symptoms can worsen. Repeated episodes may result in chronic, treatment-resistant OCD or other debilitating mental illness.
Dr. Gilbert will debate that if a child presents with new onset OCD or other neuropsychiatric symptoms, the child should be managed with standard-of-care behavioral or pharmacological treatments, and pediatricians should rarely be testing for Strep with throat cultures or blood tests. These approaches are validated in longstanding practice and published evidence.
Preschoolers with ADHD: To Medicate or Not?
4-5 p.m. Monday, Oct. 28
Pro: Mark Wolraich, MD, FAAP
Con: William Barbaresi, MD, FAAP
Is it appropriate or necessary to treat children 4 to 5 years of age with stimulant medications? In 2011, the AAP published a clinical practice guideline recommending behavioral therapy as the first line of treatment for preschool-age children.
Dr. Wolraich will present evidence why stimulant medication should be considered if behavior therapy is not successful for preschoolers diagnosed with ADHD. Dr. Barbaresi will make his case against using medication as treatment in the primary care setting.
What's Wrong with Just One Bottle? Pros and Cons of Choosing to Supplement Breastfed Babies
8:30-9:30 a.m. Tuesday, Oct. 29
Pro: Mandy Brown Belfort, MD, FAAP
Con: Susan Landers, MD, FAAP
It has been longstanding AAP recommendation for babies to be exclusively breastfed for about 6 months, followed by continued breastfeeding as complementary foods are introduced. However, a recent study has shown that small amounts of formula can be used to supplement breastfeeding with positive results. Experts will present both sides of this debate, as well as review the factors that lead breastfeeding mothers to use formula and stop breastfeeding.
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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.
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