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Archive for September, 2006

The Desecration of Childhood in America

Friday, September 15th, 2006

Somehow the British are more direct and to the point than Americans in calling for a national debate on topics that effect everyone in the society. Great Britain is a smaller population but no less diverse, and this time they’ve raised an issue that America ignores at its peril.

Until the 20th century children throughout history have started working alongside adults as soon as they were physically able. Only in the last 100 years have we understood that they’re not miniature adults, and their development takes years.

In most of the world children are still working from young ages due to economic conditions, but in the West where economic conditions permit the evolution of childhood we’re crippling children in ways far worse than sending them to plow the fields.

In a letter to the London Daily Telegraph, 110 teachers, psychologists, and authors called on the government to take action to protect Britain’s children from, essentially, technological run-over and consequent mindless parenting.

The letter was circulated in Britain by Sue Palmer, author of Toxic Childhood and former head teacher, and signed by eminent professionals who work in areas concerned with childhood development.

Deeply concerned with escalating incidences of childhood depression and children’s behavioral and developmental conditions, the professionals lay the blame for the current condition on:
• Processed “junk” foods; children, especially, need fresh “real” foods
• Electronic (sedentary) entertainment which has replaced play (aerobic exercise, social skills, etc)
• Marketing that pushes them to act and dress like mini-adults
• Ever-earlier start to formal schoolwork and overly academic test-driven primary curriculum
• Media exposure to the world’s issues that children should be insulated from
• Need for regular real-life interaction with the significant adults in their lives

In America, the problems are all the same. Jonne Ramsey is the tragic icon of children dressed up as adults. But in any mall you’ll see gaggles of 10-13yo with acrylic nails and heels and make-up that their fresh, young faces shouldn’t be wearing. Where are their parents? But I’ve seen 7-year-olds dressed as adults WITH mom! Where’s the parents’ mind?

In America, we are increasingly drugging our children. Can’t cope with daily life? We have a drug for you, Johnny, just like Mom and Dad’s. In fact, drugs for behavioral problems for very young children probably has more to do with lack of parenting skills and an average seven-minute visit with the pediatrician, which doesn’t allow time for anything more than writing script.

From 1991 to 1995, there was a 3-fold increase in prescriptions of psychotropic drugs for children ages 2 to 4yo. (JAMA, 2/23/00) We’re drugging them for the “terrible twos”—the age when they’re learning to say “no” and assert themselves! That was 200,000 toddlers on drugs in the late ‘90s.

A study of children in six major health plans (n=750,000) showed that prescribing drugs for children continued to rise through the end of the decade. Between 1995-99 prescriptions for stimulants used to treat attention-deficit/hyperactivity disorder (ADHD) increased by 26 percent. Prescriptions for depression and anxiety, brands like Prozac and Zoloft, rose by 62 percent.

The younger children, ages 10-14, were primarily given stimulants; the numbers rose from 24 to 30 of 1,000 kids from 1995-99. Then they were depressed by ages 15-19, the ages that primarily were prescribed anti-depressants. (Ambulatory Pediatrics, Mar-April ’02)

We have no data on how these drugs effect the developing brain, heart, kidney and liver of children. But, as a nation, the incidence of drugging our children is continuing to rise. These are reports of the 1990s.

In summer 2006, one-quarter of the 3 million children who went off to US summer camps took along medications for ADHD, psychiatric, and mood disorders. With their orange juice in the morning they were downing pills; so many kids now take “meds” they no longer have to pretend the pills are “vitamins”. And before taps were played at bedtime America’s children lined up for sleep aids because the daytime drugs hamper sleep.

NIH drug abuse chief Alan Leshner was quoted in Pediatrics in 2000: “Treating the underlying (behavioral) disorder significantly reduces the probability they will use drugs later on.”

Really? First of all, since we don’t know the effects of drugs on children’s development, there could be no “later on” or they could suffer life-time ailments.

When my youngest was entering puberty, and she was set on making her sisters’ life miserable, I was giving her homeopathic remedies to mellow her–obviously too often. Once when she was in a pile of tears and ignatia instantly stopped the tears, the precocious 10-year-old said to me, “What was it that you gave me? Don’t always give me medicines, Mom. Let me feel my emotions.”

Lesson learned: medicines (of any kind) can become a crutch that we lean on instead of dealing with life’s real issues.

Measuring Value is more than Costs of Healthcare

Friday, September 1st, 2006

Recent reports regarding healthcare costs in the U.S. force the conclusion: economists have DNA that deviates from the rest of humanity. The genes that focus on numbers cause myopia and offset the ability to see the larger picture and determine “value” beyond costs.

In an article in the New England Journal of Medicine (8/31/06) economists from Harvard and the University of Michigan measured the costs of medical care in the U.S., 1960-2000. They actually titled the article “The Value of Medical Spending…” However, value is a measure of broad outcomes, not costs.

The researchers estimated life expectancy in 1960, 1970, 1980, 1990, and 2000 for four age groups. Granting that environmental improvements and increased general knowledge of exercise, smoking, and nutrition may be contributing factors, the authors attributed 50 percent of the longevity gains to medical care.

Between 1960 and 2000, lifetime medical spending (adjusted for inflation) increased by $69,000 or the inflation-adjusted costs from birth rose fivefold from the 1970’s to the 1990’s. During those 40 years the life expectancy for newborns increased by 6.97 years so the cost per year of life gained was $19,900.

Healthcare costs soared 5x in 20 years
The cost of an additional year of life peaked at $36,300 in the 1990’s. The Associated Press interpreted that to mean that each health care dollar of the 1990’s bought a fifth as much real value as 20 years earlier. In other words, the latest pills of out the labs, in addition to being riskier because they haven’t had years of “trials” in the general population, are much more expensive than older, cheaper, and effective medicines.

The costs-per-year-gained goes off the chart for the elderly. At 65 years of age costs rose more rapidly than did life expectancy. By the 1990’s, 65-year-olds paid $145,000 for each additional year gained, but these are statistics. The figure is skewed (as is the value) by the exorbitant end-of-life care costs that, statistically, don’t add much time.

So the question arises, what is the value of such a study? It’s already documented that the US healthcare system is broken—the monies spent are twice what the second most expensive economies spend (France and Canada); they have universal coverage while the Census Bureau released figures this week that the number of uninsured Americans rose by 1.3 million in 2005 to 46.6 million with no health coverage.

Healthcare sector “driving” the economy?
Now the Economist’s World View grows more myopic or bizarre. Currently the U.S. spends nearly 16 percent of its gross domestic product (GDP) on health care, and as the population ages that figure is expected to ratchet ever higher.

By 2030, this figure could reach 25 percent of the GDP. University of Chicago economist Robert W. Fogel thinks this is just fine—we have to spend our money somewhere, better on more pills than on another television set. The healthcare sector, the Nobel laureate proclaims, will become “the driving force in the economy” just as railroads drove the economy at the start of the 20th century.

Whoa! Brake that engine! Railroads contributed immensely to the growth and building of the nation. It’s hard to argue that the healthcare sector, as it works or fails to work, contributes to the nation’s growth. Ask the 20-somethings, the 70-somethings or actually two in every five Americans, and they’ll say the healthcare sector is a dragon in the cave threatening to devour them—literally. Even Princeton economist Angus Deaton couldn’t figure out what was the real cost, much less, real value of his own operation.

Take the amount spent in the healthcare industry (read: AMA-related visits, labs, pharmaceutical drugs) and add the costs to the economy of uncovered workers and children and the long-term public health costs of an unhealthy population without health care and we have a real mathematical model/puzzle for the economists.

Anybody guarding the door?
Unless there is an overhaul of the healthcare system, insurance companies will be paying most health costs. As the population ages, Medicare will be the largest insurer, which means the taxpayers are footing the bill. Who is the watchdog of this Cash Cow? When a 20-minute office procedure of removing a cataract is billed at $2,400, who’s monitoring these offenses?

Who, in good conscience or with a conscience, will claim that this sector is building or constructive to the economy or nation? The human costs are far more complex to calculate and, I plead, not in the realm of the economists’ mathematical models or, indeed, genetic possibilities.

 
 
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