Pediatric Annals

Editorial Free

Obesity, PANDAS, Smoking, and Gun Violence

Stanford T. Shulman, MD

This 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 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 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?

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 AIDS, and a Bangladeshi stamp portraying the range of methods of HIV transmission: pregnancy, transfusions, needles, heterosexual, and homosexual relations.

This 1998 stamp from Macedonia shows the importance of HIV awareness.

This 1998 stamp from Macedonia shows the importance of HIV awareness.

A pair of stamps from Serbia showing a hand grasping an illustration of the virus that causes AIDS.

A pair of stamps from Serbia showing a hand grasping an illustration of the virus that causes AIDS.

This Bangladeshi stamp portrays the range of HIV transmission methods.

This Bangladeshi stamp portrays the range of HIV transmission methods.

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. December18, 2015.
  3. Shulman ST: Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS). Curr Opin Ped. 2009;21:127–130. doi:10.1097/MOP.0b013e32831db2c4 [CrossRef]
  4. O'Rourke M. Microbes and the mind. The New York Times. January3, 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. December21, 2015.
  8. Despair about guns is not an option. The New York Times. December13, 2015.
  9. Hawaii raises smoking age to 21. Sarasota Herald-Tribune. January1, 2016.
  10. Ontario restricts e-cigarette sales. Sarasota Herald-Tribune. January2, 2016.
Authors

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: pedann@Healio.com. 

10.3928/00904481-20160119-01

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