Going Screen-Free, or Trying To

An analysis of two studies of about 4,000 adolescents found that the more "screen time" these teens had, the less attached they were to parents and peers. Teens who spent a lot of time in front of the computer or watching TV were less attached to their parents, and teens who spent a lot of time watching TV were also less attached to their peers, according to a recent article in the Archives of Pediatrics and Adolescent Medicine.

I've been thinking a lot about children's attachment to parents and peers lately because I'm reading Hold On to Your Kids: Why Parents Need to Matter More than Peers by Gordon Neufeld and Gabor Mate, an excellent explanation of the advantages and perils of these relationships. In the book, the authors argue that if children do not form adequate relationships with their parents or other responsible adults, they will form inadequate and destructive relationships with their peers instead.

Although I don't agree with all their arguments, and the book carries a faint whiff of disapproval towards mothers (but not fathers) who work full time, it has made me stop and think about how to carve out more one-on-one time with my own children. TV time watching reality shows together does not really count, even though my kids now know who "Boston Rob" is, that charming devil.

So, we're off to the great outdoors and the art supply store (or, since my kids like to paint rocks and decorate shells and pine cones, the art supply store that is the great outdoors), to find better ways to spend time together. And when TV Turn-off week rolls around again in April, we'll be going screen-free, playing board games, making art projects, and perhaps getting the homework done sooner than the night before it's due.

The Shot that Stops Cancer

Although sexually-transmitted human papillomavirus (HPV) infections can cause certain cancers and genital warts in both men and women, the link between HPV infections and cervical cancer makes these viruses especially dangerous for women. For that reason, the CDC added the HPV vaccine to its schedule of recommended vaccines a few years ago. Today, girls and young women can receive an HPV vaccine to prevent infection with the viruses that cause 70% of all cervical cancers (ideally, a girl is vaccinated before she becomes sexually active).

In the past, the CDC has recommended the HPV vaccine only for girls and young women. Boys and young men, who (clearly) often pass on HPV to women, were not vaccinated. Earlier this year, however, the CDC changed a footnote in its HPV vaccine recommendations to include boys and young men.

The CDC's 2010 recommended immunization schedule rather mincingly states that "HPV4 [one of the HPV vaccines] may be administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of acquiring genital warts," no doubt to persuade parents of boys that the HPV vaccine can directly benefit their sons. Vaccinating boys, however, also helps prevent cervical cancer in their future female sexual partners.

A recent study in Pediatrics by immunization expert Dr. Gary Freed found that about 11% of parents refuse some vaccines because of concerns that the vaccine might cause health problems or autism in their children. These vaccine safety concerns have been disproved by numerous studies but persist among some parents nonetheless.

I suspect that, in an era of frequent vaccine refusal by parents, the CDC and its advisory committee, ACIP, decided that it was easier to "sell" parents of boys on the HPV vaccine if they said that the vaccine protected their boys from genital warts than if they said that the vaccine would protect their sons' future girlfriends and wives from cancer.

When parents consider getting the HPV vaccine for their boys, perhaps they should ask themselves this: if you could take one small step to prevent cancer in someone else - wouldn't you?

What Does it Take to Be an Olympic Athlete?

I really love the Winter Olympics. My favorite sports to watch are downhill skiing, snowboarding, speed skating, and ice skating.  I'll watch any winter sport that is fast, icy, and graceful.  Not that I want to try them myself, as I am a middling skier, have never tried snowboarding, and go ice skating about once a year with the kids. But I'm impressed with the skill and athletic prowess of the Winter Olympics athletes, and the joy they can take in their sport: J.R. Celski, Rachel Flatt, Apolo Anton Ohno, Hannah Kearney, the pairs skating winners Shen Xue and Zhao Hongbo.

Something seems different this year, though. I cringed as I watched three skiers crash in the women's final of the alpine downhill - one of them tossed into the air at one point like a rag doll - while navigating a course that the commentators admitted might be too difficult for them. In that event, Lindsey Vonn skied her final, gold-medal run in pain, favoring her injured right shin on the turns. I've seen the footage of J.R. Celski bleeding on the track after a serious injury during the Olympic trials in September far too many times. Already, of course, one Olympic athlete, the Georgian athlete Nodar Kumaritashvili has died on a luge training run.

The competition is not just about the participants' athletic abilities and their psychological skills in focusing on the task at hand. It's also about their ability to risk and recover from serious injuries, in order to win on courses that seem to be designed to be as dangerous as possible.

The NBC commentators recite a litany medical problems for each athlete (past knee surgeries, back injuries, concussions, severe lacerations), citing them as evidence of the athlete's triumph over obstacles. I don't see it that way. To me, it seems like reaching the level of an Olympic athlete sometimes requires the athlete to be willing to take inhuman risks in the name of winning. Grace, athleticism, and perseverance - what I enjoy watching - are secondary. Is that sport anymore? Or something else?

Is "Normal" Overrated?

I've been following the news around the draft proposal of the Diagnostic and Statistical Manual of Mental Disorders  revision (the DSM-V), the psychiatric "Bible" used to diagnose, classify, and (often) justify medicating mental health disorders. The draft of the fifth revision is open for public comment until April 2010; the final version will be released in 2013.

The Association of Health Care Journalists' Covering Health blog has a quick overview of the topic, with links to an in-depth article on the changes by Benedict Carey in the New York Times. Two big changes in the DSM-V include:

• Describing Asperger's syndrome as a type of autism, instead of a separate diagnosis, under the umbrella term of autism spectrum disorder. Unlike people with severe autism, who have trouble with behavior, communication, and socialization, people with Asperger's syndrome, considered a high-functioning type of autism, have a much easier time functioning in society. People with Asperger's syndrome generally want to make social connections, but they have difficulty understanding social interactions.
• Providing a different definition for bipolar-like behavior in children. Carey points out that children with a bipolar diagnosis are treated with sometimes-dangerous antipsychotic drugs. An alternative diagnosis, "temper dysregulation disorder with dysphoria," would be treated primarily with behavioral therapy.

Carey describes the DSM as "the guidebook that largely determines where society draws the line between normal and not normal." A person whose psychiatric problem creates a danger to himself or others certainly needs treatment. But the debate about how to classify Asperger's syndrome in particular brings up the larger question of how tolerant, or intolerant, we are of behavior that is simply different from the norm.


The blog neurodiversity.com, run by the mother of a teenager with an autism spectrum disorder, argues that diverse neurological conditions should be better understood and tolerated. Some people with autism spectrum disorders, irritated by how their conditions are misunderstood by the general public, call the rest of us "neurotypicals", bound by social conformity and a lack of creativity.

In an age that prizes - and benefits from - cultural diversity, shouldn't we allow for some neuro-diversity as well? A number of well-known people might have or have had Asperger's syndrome, including Albert Einstein, Bill Gates, and Isaac Newton. Certainly you can argue that they thought differently than the average person, but we have all benefited from their achievements.

Can Twitter Save Your Life?

I recently heard about a local 8-year-old girl with leukemia whose parents are looking for a bone marrow donor match for her. Because the girl, Natalie, is Asian, a match (i.e., someone whose cells are similar enough to the girl's cells for her immune system to accept the transplant) is most likely with an Asian donor.

There is an ongoing shortage of ethnic minority donors of bone marrow and stem cells for blood cancer patients (stem cells are extracted from the donor's blood in an outpatient procedure). As a result, Caucasian patients are about twice as likely to find a donor match as minority patients.

I looked at the site for the girl, www.hopefornatalie.com, and looked at a related bone marrow donation site, www.dkmsamericas.org, then tweeted the information to spread the word, because you never know who might be able to help. And perhaps Natalie's case will encourage more people to register as potential bone marrow donors so that patients with blood cancer will have a larger group of donors to search within the National Marrow Donor Program. Donating bone marrow, if you're the right match for a patient, is relatively simple and painless.

To spread the word and find a donor, Natalie's parents created a web page, Facebook page, and Twitter account, using social media to its fullest extent; I heard about Natalie on a Yahoo listserve. Natalie's website includes links to volunteer, register, and make donations, and a media contact number.

Thinking about Natalie's case, however, I am haunted by a  number of questions. First of all, I wonder about the families who need bone marrow or blood donors for their ill children but who don't have the tech savvy, access, or language skills to look for much-needed donors through social media.

These families can't cast a wide net looking for donors as Natalie's family has. They are less likely than Natalie's family to find a donor who can save their child. On the other hand, these families do benefit from the additional donors in the national registry who sign up when they hear about children such as Natalie. But to what degree does the surge of new registrants created by cases such as Natalie's mitigate this digital divide?

A while ago, when Twitter was quite new, I stopped to chat with the father of my daughter's classmate at pick-up time. He worked at Twitter, and I asked him what exactly Twitter was supposed to be used for - griping about your day? planning a night out with friends?

Now I know that Twitter is not just a tech toy. It played such a big role in documenting the Iranian election in 2009, for example, that the State Department asked Twitter to change its maintenance schedule in order to keep Twitter online during the protests. Twitter, Facebook, blogs, and other online media are, in fact, extremely powerful for spreading the word about any number of different causes -- political, medical, or personal. Powerful, that is, for people who have access to the technology.

Reframing the Health Care Debate

As health care reform lurches forward uncertainly, with the special election of Massachusetts Senator Scott Brown giving Republicans enough votes to block the passage of the reform bill in its current form, The New England Journal of Medicine has published a very thoughtful Perspective called "American Values and Health Care Reform."

The term "values" has been a battering ram for both political parties for so long, each side claiming that their values are better than the other's, that the word itself makes me a little nauseous. But Thomas H. Murray, Ph.D., the author of the Perspective, offers a different interpretation of the word. He argues that the values that Americans like to think they hold, such as liberty, fairness, and responsibility, are not applied evenly throughout the health care system. This inconsistency is an ethical, moral and financial loss for all Americans.

Do we really value liberty, Murray asks, when so many people are shackled to jobs they dislike because they need access to employer-sponsored health insurance? For example,

Under our current system, a young entrepreneur with a brilliant idea for a new business, a creative vision that can create jobs and wealth, can't necessarily follow that vision: if this person has a job at a large firm that provides good health insurance and has a child or a spouse with a chronic illness, the aspiring entrepreneur's freedom to pursue his or her dream is severely limited by the "job lock" imposed by our current patchwork of health insurance. The catch-22 of insurance underwriting for preexisting conditions is likely to make insurance unaffordable or unattainable for such a family on its own.

Similarly, Congress passed the 1986 Emergency Medical Treatment and Labor Act so that anyone in need can get emergency medical care, whether or not they have insurance, demonstrating that Americans feel responsible for others in dire circumstances. "Yet our achievements do not always live up to our values," Murray writes. "Consider the 20,000 people each year who, according to the Institute of Medicine, die for want of health insurance."

Americans need to see health care as a common good that benefits us all, not an individual choice. Murray writes that we need to pitch in to finance health care for everyone, and work together to make health care more efficient and effective.

Maybe calmer heads will prevail if we reframe health care reform as a reflection of our best instincts as Americans, rather than a political fight or a battle between individual and community rights.