Dr. Thompson's Blog

Prenatal Exposure to Drugs

I am concerned about the article by Susan Okie in the 1/27/09 New  York Times entitled "The Epidemic That Wasn't". It discusses the absence of an epidemic of severely damaged children due to the use of crack during pregnancy. Unfortunately,  not enough children are being follow and the majority of medical school professors  quoted in the article, are not out in the community caring for kids in low income areas. If you  have directed programs, as I have, for kids with disabilities, you find many severely damaged kids from usually low income mothers who used crack or multiple drugs during their pregnancies. Many are single parents who are doing the best that they can and some because of guilt and a real concern about their children become exceptional mothers.

Unfortunately, the testing that is done by some psychologists is not adequate to detect the damage that has occurred in many of the kids. I remember a school principal who fought with me about a boy's need for special education. His school psychologist thought the boy was fine, but when we paid to have the boy tested by an outside excellent child psychologist there was an obvious reason to give the child some special help. This problem occurs far to often in the public school due to lack of funds. Hopefully, with the new budget that President Obama is advocating, the schools and public health services will get more money to help these low income mothers and kids. if we don't do it now, then we  may be paying for their care in a drug rehab program, prison, a juvenile center or an  institution. No pregnant mother should smoke, use drugs, or drink exceesively.  Educational programs in schools can help. I have spoken to many classes and shown pictures of kids who were severely damaged by drugs. I think it made a real impact on some of the girls and wish more doctors would take the time to go out to the schools and talk to the kids.

More Contaminated Peanut Butter Products

It is amazing that the contamination of peanut butter in one company's plant can have such a far reaching impact. Now it has been reported by Kim Severson in a 1-23-09 New York Times article that 130 products have been recalled thatcontain  peanut butter or peanut butter paste made by  the Peanut Corporation of America. The plant is now closed. Among the products recalled are "boxes of Valentine candy, frozen cookie cough, dog biscuits, chicken satay, peanut butter cups and stuffed celery." The Hersey's and Kraft companies say they have not bought from the Peanut Corporation, so their products should be safe.

The Kellog company has recalled seven million cases of food. So once again, it seems that we all have to read labels or grow and make our own food. It seems to get harder and harder!  Hopefully, with the new administration promising more money for the F.D.A. and higher safety standards for food, we will have fewer problems with contaminated food. Until then we all need to be aware of what we are eating and particularly what we are feeding our children and pets.

My Nomination for Surgeon General

I do not know Robert L. Martensen,M.D. but on reading his interview in the January 20, 2009 New York Times, I believe he is exactly what we need for a Surgeon General. We do not need a TV star or extremely well-paid neurosurgeon such as Dr. Sanjay Gupta. We need a man who has been there, seen almost everything and is aware of the terrible problems we now have in U.S. medicine.

The article states that Dr. Martensen, age 62, has been an ER doctor and an Intensive care doctor and has taught bioethics and medical history at both Harvard Medical School and Tulane University.  He discusses the tragedy of so many older people who are taken back and forth to the hospital in their final years because doctors do not know how to let a patient go or insist on doing everything possible to keep the patient alive. Often it is the family who want to prolong life when there is no hope, but doctors need to spend time talking with these families, so they will understand the terrible thing they are doing to their loved ones by prolonging their lives. 

I have been the doctor for many patients dying of neuromuscular disorders, such as Duchenne dystrophy, spinal muscular atrophy and other progressive neuromuscular disorders. All the patients told me that they wanted to stay out of the hospital if possible and if they couldn't have a decent quality of life then they didn't want me to do anything to keep them alive. I always respected their wishes and helped their families understand the patient's wants. I think it is a tragedy to keep someone alive in an ICU or nursing home if their life is filled  with pain. If the "pain of life outweighs the pleasure", then it is time to let a patient go. We need someone like Dr. Mortensen to help physicians, nurses, and other medical personnel, as well as families rethink their roles in making decisions about the final days of a patient's life. We also need a doctor like this as Surgeon General who understands and has experienced the widespread problems we have in  U.S. medicine.

Many Peanut Butter Products Recalled

Peanut butter added to cookies, cakes, ice cream and peanut butter crackers have now caused six deaths, 90 people to be hospitalized, and 470 to become ill. This is due to contamination with the  bacteria, salmonella. The F.D.A. spokesperson, Stephen Sundlof, said that  peanut butter in jars appears to be o.k. Two different articles in the New York Times on 1/18 and 1/19 have reported this and note that the companies who have issued recalls are: the  Kellogg Company that makes Austin and Keebler brands and the South Bend Chocolate Company that makes different candies containing peanut butter. The Peanut Corporation is thought to be the possible source of the problem. They sell to others, but do not directly make products that are distributed.

It must be very difficult to be a parent or consumer today. I certainly understand why more and more parents and others are turning to organic products or growing their own food.  We certainly need a much stronger F.D.A with more inspectors and more rigid guidelines. I hope this can happen as the old administration leaves tomorrow and we can look forward to better times in all areas of government.

Good News about Health Care for Uninsured Children and Out-of Network Services

As a pediatrician, I was delighted to read that the House had passed the long overdue health care bill for uninsured children. Mr. Bush had vetoed twice vetoed a similar bill. Now at long last it appears that our legislators are going to take care of poor and middle class people, not just the wealthy. Wonderful! A new day is dawning as President-Elect Obama makes his way into the nation's capital. Only two more days of the terrible times the country has had under the Bush administration. Now four million previously uninsured children  will be covered and the seven million who were covered will continue to have coverage. This will all be paid for by a tax on tobacco.

Some other good news for health care is that the UnitedHealth Insurance company is finally being made accountable. They have had too much control of low out-of-network fees for medical services and now they will have to pay more than they have in the past. Also a Web site is to be set up so that patients can find out what  out-of-network charges are in their particular region. This way it will be possible to find out what the insurance companies will pay and what their own payments will need to be. Hopefully, with these new changes even more control will be exerted over the greedy health insurance companies as the Democrats start listening to the majority of people in this country. No longer will the rich get richer at the expense of the poor and middle class.

Lab testing of Vitamin D Levels Found to Be In Error

With all the recent articles and interest in low levels of Vitamin in both children and adults, now we are told that the Quest laboratory has admitted that many of their labs have made mistakes in the reporting of Vitamin D levels. Quest is reported to be "the nation's largest medical laboratory company"  according to an article by Andrew Pollack in the 1/8/09 New York Times.  Most of the Vitamin D results were reported as too high, but some were not.

This article goes along with another one in today's New York Times that discusses the mess we have in the U.S. in the regulation of drugs, lab tests, and food products. it is amazing that there is no central responsible agency, but instead, as so much in our government, there are multiple people and agencies that are supposed  to oversee the safety of our foods and medicines and regulate what is done in medical laboratories. Hopefully, with the new administration, regulation can be all in one agency and instead of reacting to problems when they occur, some real regulation can occur. So far in the last eight years, the government has reacted just to crises and their reactions have often been slow, inadequate, and without long-term effects. Hopefully, things will get better in the future. As consumers and patients, I think we have to keep up-to-date on what is being done and push our legislators to do a better job than they have in the past.

Objections to Dr. Sanjay Gupta as Surgeon General

When I first heard about the possibility of a TV celebrity doctor being named as Surgeon General of the United States, I had great misgivings. Obviously Dr. Gupta is very bright and articulate, but I felt that we needed someone who had been in general medical practice and knew the terrible problems most people have in accessing and finding good medical care. A neurosurgeon works in a very rarified atmosphere and usually has had no experience with low income clinics or the medical problems of the average working person. The income of a neurosurgeon is also extremely high. In addition, Dr.Gupta makes large fees for speaking and from being a TV doctor.  How can he possibly know the problems of poor and middle class Americans?

My dismay was increased greatly when I heard on the news this evening that Dr. Gupta spoke out against Michael  Moore's excellent movie, Sicko. Michael Moore told it as it is. I have  worked many times at Hammersmith Hopsital in London where some of the scenes were taken and also spoken with people in  France, who love their health care. I have also worked in low income clinics, a hospital in a very poor section of Oakland, California and seen first hand the problems that people with disabilities have in getting and keeping good health care.

One of the principal reasons I decided to close the Center for Handicapped Children in San Francisco after 23 years was that I could no longer get the necessary procedures done on muscle biopsy specimens in this country and had to send them to Professor Sewry in London. She did them for me at no charge. I could have sent them to the Mayo Clinic, but our limited grant funds would have been used. England has the most outstanding pediatric neuromuscular program in the world. In  this country, except for special problems, I only feel comfortable about referring parents to the Mayo Clinic for their children to be seen if there is a question of a neuromucular disorder. We are far behind many other countries in the diagnosis and treatment of neuromuscular disorders. We need a Surgeon General who has wide experience and knowledge of the many medical difficulties that we have in the U.S.

Important Medical Information for Overseas Travelers

I did considerable research for my chapter on Overseas Travel in 101 Ways To The Best Medical Care. However, an article in the Sunday New York Times (1/4/09) by Mary Billard added considerably to my knowledge and I think the infrmation the author gives is important for anyone to have if they do much overseas traveling. Many young people think they will be fine and never need medical help when traveling, but if they have a broken leg or serious illness, they might not want to rely on the local medical help, particularly if they are in a remote area with few good medical facilities.

If you get ill, I suggest doing so in France or Australia. They are reported to have the best medical care in the world. If you are in some other country, you  might want to be aware of available resources and make plans before you leave. Mary Billard notes that medical travel insurance is available through the Medex Global Group. Their Web site is www.medexassist.com. To be evacuated, you need to have been hospitalized first, she  notes. That seems like a strange requirement to me.

There is also a Travel Insurance Association at www.ustia.org. Other sites the author lists that are worthwhile knowing are: "Insuremytrip.com., Squaremouth.com, and Totaltravelinsurance.com."

I have never carried travel insurance, but will probably decide to do so for my next trip unless I am lucky enough to be able to go back to France or England; two of my most favorite countries.