Download Obesity, PANDAS, Smoking, and Gun Violence

Editorial
Obesity, PANDAS, Smoking,
and Gun Violence
Stanford T. Shulman, MD
T
his issue of Pediatric Annals
is devoted to pediatric gastroenterology and is guest edited
by Dr. Vincent F. Biank. The article
topics range from Crohn’s disease to
eosinophilic esophagitis to failure to
thrive, pancreatitis, and nonalcoholic
steatohepatitis, and will be useful to
primary care providers.
In this editorial, I cover several
topics that I feel are of interest to the
readership, including some that I have
covered in the past.
OBESITY
Dr. Tom Farley, my one-time pediatric resident and mentee who is the
former Commissioner of Health for
New York City, is the author of a recent book Saving Gotham: A Billionaire Mayor, Activist Doctors, and the
Fight for 8 Million Lives1 as well as
Pediatric Annals Editor-in-Chief Stanford T.
Shulman, MD, is the Virginia H. Rogers Professor
of Pediatric Infectious Diseases at Northwestern
University Feinberg School of Medicine and
Former Long-Time Chief of the Division of
Infectious Disease at the Ann & Robert H. Lurie
Children’s Hospital of Chicago.
An avid stamp collector, Dr. Shulman chooses
relevant stamps from his personal collection to
accompany his column each month.
Address
correspondence
to
Stanford T.
Shulman, MD, via email: [email protected].
doi: 10.3928/00904481-20160119-01
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a recent op-ed piece in The New York
Times called “Fighting Obesity is not
Just for Kids.”2 Dr. Farley points out
that obesity rates in children age 6
to11 years have stabilized at 18% and
among 2- to 5-year-olds have fallen
below 10% for the first time since
the 1980s.2 However, adult obesity
rates have continued to climb, now at
38%, with 70% of US adults considered overweight, and half diabetic or
prediabetic. Most of those adults were
not obese as children, supporting Dr.
Farley’s belief that the basic problem
in the US is that normal people are
overwhelmed by food marketing that
is aided by more than $14 billion in
ads annually. He argues that conquering the obesity epidemic will require
fighting the marketing of junk foods
everywhere, not only in schools but
everywhere.2
PANDAS
Most practitioners are aware of
the proposed clinical entity PANDAS
(Pediatric Autoimmune Neuropsychiatric Disorders Associated with
Streptococci), which I and many other
streptococcal experts believe has not
been proven to be a specific entity. Although both streptococcal pharyngitis
and certain neurobehavioral disorders
(obsessive compulsive disorder, tics,
Tourette’s, perhaps others) are quite
common in children, an etiologic connection has not yet been confirmed.3
A recent New York Times review4 of
the book Infectious Madness: The
Surprising Science of How We ‘Catch’
Mental Illness by Harriet Washington5
unfortunately appears to accept the
validity of this unproven relationship
even though the great preponderance
of scientific evidence on this topic has
been nonsupportive. It is unfortunate
that PANDAS is frequently in the lay
press, but it may be significant that the
book reviewer is writing a book about
autoimmune disease and chronic fatigue syndrome.
GUN VIOLENCE
As pediatric health care providers,
we are of course concerned about the
This 1998 stamp from Macedonia shows the importance of HIV awareness.
Copyright © SLACK Incorporated
Editorial
A pair of stamps from Serbia showing a hand grasping an illustration of the virus that causes AIDS.
health of all children. It is depressing to learn that 693 children age 0
to 11 years and 2,685 teens (age 12
to 17 years) were killed or injured by
gun violence in the US in 2015 (9.3
incidents per day), which was an increase from 628 and 2,371 in 2014,
respectively (8.3 incidents per day).6
Overall, gun violence-related deaths
increased from 12,575 to 13,322 and
injuries from 23,040 to 26,914.7 The
trend is obvious and highly tragic.
Gun deaths (including suicides) for
the first time in 2014 reached the
number of traffic fatalities, and exceeded vehicle deaths in 21 states and
the District of Columbia according to
the Centers for Disease Control and
Prevention.7 Studies show that a gun
in the home is 22 times more likely
to be involved in a family homicide,
suicide, or accident than being used in
self-defense.8 More than 1.5 million
children live in homes with loaded,
unsecured guns, and they are 16 times
more likely to be killed than in a home
where the guns are secured or where
there are no guns.8 How can this be
tolerated in our society? How can we
begin to make inroads against this epidemic?
PEDIATRIC ANNALS • Vol. 45, No. 2, 2016
SMOKING
The health effects of smoking are
undisputed and we know how often
this habit begins in childhood. In Hawaii, the proportion of high school
students trying their first cigarette
each year is almost 25%, and on January 1, 2016 the state became the first
to raise the legal smoking age to 21
years for both electronic and real cigarettes.9 The percentage of high school
students smoking e-cigarettes quadrupled over 4 years to 22% in 2015 and
increased 6-fold among middle school
students to 12% in 2015.9 Ontario also
has banned the sale of e-cigarettes to
those under age 19 years, effective
January 1, 2016.10 It remains to be
seen how effective these measures are
in reducing acquisition of the smoking
habit among students in those formative years.
THIS MONTH’S STAMPS
I have selected stamps that relate
to one of the most important health
problems of this era—HIV infection.
They are the 1998 stamp from Macedonia, the pair of 2007 stamps from
Serbia showing a hand grasping an
illustration of the virus that causes
This Bangladeshi stamp portrays the range of HIV
transmission methods.
AIDS, and a Bangladeshi stamp portraying the range of methods of HIV
transmission: pregnancy, transfusions,
needles, heterosexual, and homosexual relations.
REFERENCES
1. Farley T. Saving Gotham: A Billionaire
Mayor, Activist Doctors, and the Fight for
8 Million Lives. New York, NY: W. W. Norton & Company; 2013.
2.Farley TA. Fighting obesity is not just for
kids. The New York Times. December 18,
2015.
3.Shulman ST: Pediatric autoimmune neuropsychiatric disorders associated with
streptococci (PANDAS). Curr Opin Ped.
2009;21:127-130.
4.O’Rourke M. Microbes and the mind. The
New York Times. January 3, 2016.
5.Washington HA. Infectious Madness: The
Surprising Science of How We ‘Catch’
Mental Illness. Boston, MA: Little, Brown
and Company; 2015.
6.Gun Violence Archive website. www.gunviolencearchive.com. Accessed January 26,
2016
7.Ingraham C, Johnson CY. CDC: Guns, car
accidents now kill at same rate. Washington
Post. December 21, 2015.
8.Despair about guns is not an option. The
New York Times. December 13, 2015.
9.Hawaii raises smoking age to 21. Sarasota
Herald-Tribune. January 1, 2016.
10. Ontario restricts e-cigarette sales. Sarasota
Herald-Tribune. January 2, 2016.
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