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UPDATES

Medical societies press for universal coverage

There's no longer any doubt about it: The professional societiesthat represent America's physicians are committed to the goalof universal health-care coverage and willing to back a varietyof approaches to make it a reality. In mid-June, a consortiumof physicians' organizations announced the launch of a campaignto make universal coverage the number one priority in the upcomingyear 2000 elections. The American Academy of Pediatrics is partof the group, along with the American Academy of Family Physicians,the American College of Emergency Physicians, the American Collegeof Obstetricians and Gynecologists, the American College of Physicians-AmericanSociety of Internal Medicine, the American College of Surgeons,and the American Medical Association.

"Our goal," said Whitney Addington, MD, Presidentof the American College of Physicians,"is to have every Congressionaland Presidential candidate promise to create or support a planto solve the problem of the uninsured within his or her firstyear of taking office." The groups plan to use their organizationalresources and grassroots membership of more than 600,000 doctorsto press political candidates on the subject of the uninsured.To find out how you can get involved, call the Washington officeof the AAP at 202-347-8600.

Pet allergies

If you routinely advise allergic patients to get rid of theirfurry pets, you might as well save your breath. According to atelephone survey commissioned by Pfizer, the manufacturer of Zyrtecallergy medication, pet allergies are common (occurring in 1,000of 6,000 households called) and symptoms can be severe. Nevertheless,about half the households that included pet allergy sufferersalso included a dog or cat. Getting rid of the family pet seemsto be out of the question for these households: 75% had neverthought about it, and 83% had never done it. What's more, in mosthouseholds with allergic members and pets, the kind of preventivemeasures pediatricians routinely suggest are ignored:

• 77% say they don't confine the pet to a single room or area of the house
• 70% don't make any part of the house--an allergic child's bedroom, for example--off limits to pets
• 67% don't keep the pet outdoors
• 49% don't bathe the pet especially often.

Pfizer has just launched a website touting these and similarcommon-sense measures for reducing contact with pet allergensand other indoor irritants like dust mites, mold, and fungi. Yourpatients can find it at www. petallergy.com. But judging by thepoll, even if pet owners find the advice, they won't take it.

New pediatric subspecialties

Pediatricians who want to be certified in a subspecialty havethree new choices, recently approved by the American Board ofMedical Specialties. They are:

• Developmental-behavioral pediatrics, certified by the American Board of Pediatrics. The goal of this specialty is to foster understanding and promotion of optimal development of children and families through research, education, clinical care, and advocacy. Training requirements include a three-year general pediatric residency plus a three-year fellowship in developmental-behavioral pediatrics. Eligibility requirements for the certifying examination are being developed. The first examination is anticipated in 2002, at the earliest.
• Neurodevelopmental disabilities, certified jointly by the ABP and the American Board of Psychiatry and Neurology. This specialty will concentrate on children with developmental delays and learning disorders, including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism, and other chronic neurologic conditions. Training requirements include two years of general pediatric residency, one year of adult neurology, and three years of combined training in child neurology and neurodevelopmental disabilities. Eligibility requirements for the certification examination are being developed.
• Pediatric rehabilitation medicine, certified by the American Board of Physical Medicine and Rehabilitation. Certification in this field will require either a four-year physical medicine and rehabilitation residency followed by a two-year fellowship in pediatric rehabilitation, or a five-year combined physical medicine and pediatric residency followed by a one-year fellowship.

Poison pen retires

The Tenth Circle of hell, according to the author of an articlethat ran in the August, 1985, issue of Contemporary Pediatrics,should be reserved for drug dealers who peddle methamphetamineto young people. That article was the first appearance in thesepages of the writer known as Poison Pen, aka Ronald B. Mack, MD,Professor of Pediatrics at Wake Forest University School of Medicinein Winston-Salem, NC. The erudite reference to Dante Alighieri'sDivine Comedy was typical. Dr. Mack has been mixing toxicologyand literature for us ever since, whether the subject was turpentinepoisoning (references to Don Giovanni and hellfire), imidazolineoverdose (quoting W. H. Auden's line, "Pack up the moon anddismantle the sun"), or poisonous herbs (in an article titled"Something wicked this way comes," from Macbeth).

Dr. Mack has just retired from the full-time faculty at WakeForest, an event that was celebrated on May 16 at a slap-up dinnerin his honor. Attending the festivities at Winston's posh PiedmontClub were Marcia Mack, Dr. Mack's wife of 48 years, children Cindy,Jill, Michael, and Bradley--each with spouse--and grandchildrenJeb, 19, Joseph, 12, Carson, 10, Suzanne, 9, and Sophie, 3, alongwith what Dr. Mack called "an overwhelming number" offaculty, house staff, and assorted well-wishers. We wish him well,too.

What to do for febrile seizures

The appropriate management advice for parents of a child withfebrile seizures is a matter of some dispute. The seizures arefrightening; parents find reassurance that they do no harm hardto believe, and most want to take some kind of action to see thatthey don't recur.

Pediatricians looking for guidance on how to respond can nowturn to a practice parameter published by the AAP's Committeeon Quality Improvement, Subcomittee on Febrile Seizures (Pediatrics1999;103:1307). The Committee concluded, on the basis of theirreview of more than 300 journal articles, that simple febrileseizures are common, benign, and have an excellent prognosis.While anticonvulsant medications such as valproic acid, phenobarbital,and diazepam may prevent additional seizures, that benefit isnot worth the cost of potentially serious adverse effects thesemedications can have. Therefore, the Committee does not recommendanticonvulsant therapy for febrile seizures. As for antipyretictreatment, it may make a feverish child feel better but it won'tdo a thing to prevent seizures. The bottom line is: Don't intervene.While the Committee recognizes that recurrent episodes of febrileseizures create anxiety in some parents and their children, theremedy they suggest is "appropriate education and emotionalsupport."

Bang, bang. You're dead

The policeman looked impressive in his uniform, and the 48preschool children listened attentively to his message: "Don'tplay with guns. Guns are dangerous. If you see a gun, don't touchit. Go tell a grownup." The kids were so impressed they couldrepeat the "don't play with guns" message verbatim.But when they were left alone in a room that contained some real(disarmed) guns, along with toy guns and other toys, guess whatvideotaped observation revealed? As Marjorie Hardy, PhD, AssistantProfessor of Psychology at Muhlenberg College in Pennsylvaniawrote in an op-ed article in the New York Times, "The childrenpicked up the guns and shot everything in sight." So didanother group of 70 preschoolers Dr. Hardy and her colleaguestested, who had been given a more intensive gun safety interventionover a five-day period that included practice in making choices,resolving conflicts, and being assertive. Across both studies,65% of the children who received one or the other educationalintervention played with the guns; some of them even tried usingcrayons for bullets. What's more, the research shows, these preschoolchildren had a problem telling the difference between a toy gunand the real thing (although older children were more accuratethan younger ones), and parents who thought their children didn'tknow where they kept their gun were often mistaken. Would yourpreschooler touch a gun if she had the chance? Probably, Dr. Hardythinks. Her son did, despite the police officer's lecture, andthen he lied about it when asked. Education doesn't seem to bean adequate answer, at least for children as young as those shetested.

Calendar

July 25-29, American Society of Clinical Laboratory Science,New Orleans. Call 301-587-5282

August 22-28, 9^th Annual Pediatric Board Review,Bethesda, MD. Contact Children's National Medical Center at 800-787-0700

September 1-7, National Child Injury Prevention Week

September 8-10, International Congress on Cytokines and Chemokinesin Infectious Diseases, Bethesda, MD. Contact International ImmunocompromisedHost Society at 770-271-8817

September 29-November 3, American Society of Dentistry forChildren, Los Croabas, Puerto Rico. For information, call 312-943-1244

September 29-October 1, National Association of Children'sHospitals and Related Institutions (NACHRI) Annual Meeting, Detroit,MI. To register, call 703-684-1355

October 7-9, Children and Adults with Attention-Deficit DisordersMeeting, Washington, DC. Call 954-587-3700

October 9-13, American Academy of Pediatrics Annual Meeting,Washington, DC. To register, call the AAP at 708-228-5005

October 21-24, North American Society for Pediatric Gastroenterologyand Nutrition, Denver, CO. To register, call 609-848-1000.

--Judith Asch-Goodkin

Eye on Washington

When the members of Congress adjourned for the Memorial Dayrecess, the most pressing piece of unfinished business they leftbehind was the "Violent and Repeat Juvenile Offender Accountabilityand Rehabilitation Act of 1999." Passed in mid-May by theSenate only with the tie-breaking vote of the Vice President,this legislation makes it possible to try youngsters over theage of 14 as adults when they are accused of violent feloniesor serious drug offenses; appropriates $1 billion to finance stateprojects to study and punish crimes by juveniles; and includesa set of gun control measures. The gun control provisions areconsiderably more modest than those proposed by President Clintonin the immediate aftermath of Littleton; they do provide for backgroundchecks before a person can buy a gun at a gun show or pawn shopand require licensed gun dealers to sell safety locks or storageboxes with new guns. The House failed to act on the legislationbefore adjournment.

In other federal actions this month,

The Advisory Committee on Immunization Practices (ACIP) ofthe Centers for Disease Control and Prevention issued recommendationsfor the use of Lyme disease vaccine (MMWR 1999;48:RR-7). Immunizationshould be considered for persons ages 15 to 70 who have frequent,prolonged exposure to tick-infested areas and may be consideredfor those with occasional exposure. Three doses are required,with the first two doses a month apart and the third dose a yearafter the first. The second and third doses should be given severalweeks before the season for transmission of Borrelia burgdorferi,the causative agent, begins--usually in April.

The Supreme Court, by a five to four vote, ruled that schooldistricts can be liable for damages under federal law for failingto stop a student from subjecting a schoolmate to "severeand pervasive" sexual harassment. Dissenters feared thatthe ruling would "teach little Johnny a perverse lesson inFederalism" by over-extending the reach of the federal government.On the contrary, snapped Justice O'Connor, the author of the majorityopinion; the decision will "assure that Little Mary may attendclass" without fear of harassment.

The Health Insurance Association of America, the people whobrought you Harry and Louise's mockery of the Administration'soriginal plan for national health insurance, is now expressingconcern that 43 million Americans lack health insurance. Associationspokesmen are urging the federal government to expand CHIP, thenew Children's Health Insurance Program, to cover uninsured peopleof all ages with incomes below the federal poverty level, andto provide vouchers to subsidize the purchase of insurance forthose with incomes between 100% and 200% of the official povertylevel.*