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The Future of Medicine: Digital Self-Monitoring

Using Smartphone apps and sensors, a group of high tech pioneers are tracking their own body systems and providing themselves and medical researchers with a trove of health data. The goal is to use digitalized medicine to help us all lead healthier lives.

Dr. Larry Smarr is a 63 year old astrophysicist turned IT guru who as Director of the California Institute for Telecommunication and Information Technology (Calit2), is a proponent of a new kind of medical science called “self quantification” in which “everyday Joes and Janes” monitor their own bodily functions to an extent previously thought impossible. At the forefront of this movement is Quantified Self (http://quantifiedself.com/), a website with branches in 50 cities worldwide (the closest to Cleveland is in Pittsburgh or Chicago) with a core group of self trackers estimated at about 7500. Their motto is “self knowledge through numbers” and they believe that using thorough data analysis and statistics can optimize how we live.

When you log on to the website, you see one woman’s fascinating experimentation with the dosage and timing of her vitamin D supplementation. In a very rigorous manner, she tracks her dosing, her mood, her sleep patterns and determines that it is more helpful “for her” to take vitamin D in the morning. To conduct a large scale study that looks at all these parameters would cost tens of thousands of dollars; take about 2 years to plan, get through an ethics board and analyze the data and another 2 years to publish.

Some scientists scoff at this form of scientific research, noting that it says nothing other than “what works for that individual” and cannot be generalized. Moreover, there may be what researchers call observer bias that is introduced because the person conducting the study is the same one who is interpreting the data. But increasingly, we are becoming aware that medicine is not one size fits all. After all, if we are monitoring what to do about high blood pressure, why should we make the patient come into the office when we can get 24 hours of blood pressure readings by using an app on a Smartphone? Diabetics can soon measure their blood sugar noon invasively (without drawing blood) with another app on their Smartphone. Dr. Eric Topol, a cardiologist (formerly at the Cleveland Clinic) and now Professor of Genomics and Director of the Scripps Translational Science Institute in La Jolla, California, believes that this is future of medicine. He notes that people like Smarr who wear a band on their arms that tells them their daily calorie consumption, their number of footsteps and their heart rate, who sleep with a Zeo headband that records sleep stages by measuring brain activity at night and who use information about their gene sequences to influence their daily activity are just the earliest examples of a time when “Patients will know more about themselves than their doctors do….and that is a good thing.”

We, at Senders Pediatrics, believe that this digital future is almost here and that with the speed of digital change, the world of the gadflies will be our world very soon. Government regulations about confidentiality are rapidly breaking down. After all, when self trackers, readily share their data on line, we will be hard pressed to not allow our patients to share their data with us. Insurance companies are starting to come on board with these new technologies. Rick Lee from Healthrageous, a company that advises insurance companies, runs a platform where self trackers upload their data and in exchange, receive comprehensive health tracking. He envisions a day when people who don’t self track, may pay higher premiums. We already know that certain drugs don’t work or have more side effects in some patients more than in others. And with the sequencing of the genetic code, we are just a few short steps away from using data about your gene type to tell us which test is helpful or necessary and which intervention (medicine or non medicine) will work the best. More about this exciting new world as digital tools become more readily available.

The effects of diet on ADHD

In the February edition of Pediatrics, the official journal of the American Academy of Pediatrics, there is a wonderful review of studies done to evaluation the effects of diet on ADHD.

1. Additive free diets: Variations on the Feingold diet have been around since the 1970s. Recent studies show that in susceptible individuals, there has been a 65-89% increase in symptoms in children challenged with foods with additives. Foods to be avoided include apples, grapes, luncheon meats, hot dogs and cold drinks. Permitted foods include grapefruit, pears, pineapple, bananas, beef and lamb, milk and eggs. This is a very challenging type of diet which is not routinely recommended. Patients with a history of eczema may be more likely to respond to this type of diet.
2. Protein elimination diets: According to this approach, allergenic foods include cows milk, cheese, wheat, egg, chocolate, nuts and citrus fruit. Permitted hypoallergenic foods include lamb, potato, tapioca, carrots, peas and pears. This too, is a time consuming type of diet and blood or skin tests are unreliable. The authors recommended that families interested in trying variations on this diet eliminate foods for 2-3 weeks at a time to see if there is any effect.
3. Sugar elimination diets: There is real data supporting the existence of sugar responders and sugar non responders. Some studies believe this is because of the biochemical effect on beta endorphins, one of the most potent brain chemicals controlling mood and some studies relate the sugar effect to hypoglycemia or low blood sugar. Unfortunately, no study found it at all helpful to measure sugar levels in the blood in patients with ADHD so once again, reducing sugar becomes a tedious dietary intervention in a patient with ADHD.
4. Iron deficiency: There is a subset of patients with iron deficiency who benefit from iron supplementation. The authors believed that doing routine blood work for iron deficiency would be valuable in the initial evaluation of a patient with ADHD.
5. Zinc deficiency: Most studies on the effects of zinc on ADHD come from Middle Eastern countries where the diet is low in zinc. It is unlikely that zinc deficiency contributes significantly to ADHD in this country.
6. Megavitamins: There is no study demonstrating efficacy of megavitamins but there is one study that shows that children given megavitamins had a 42% chance of having liver function abnormalities. In summary, megavitamins show no improvement and possible danger.
7. Health diet pattern: In a recent Australian study, children who consumed a diet high in fish, vegetables, fruit, legumes and whole grains foods had lower incidences of ADHD than those who had diets high in total fat, saturated fat, refined sugars and sodium and deficient in omega 3 fatty acids, fiber and folate. The point is that healthy eating may play a role in the treatment of ADHD or may simply be a marker of living a healthier lifestyle.
8. Diets high in Omega 3 Fatty Acids: There is some evidence that daily supplementation of Omega 3 and Omega 6 FA at a 10:1 ratio may benefit a subset of patients with ADHD. This is the latest research interest and whether low levels of Omega 3 FA in the blood cells of patients with ADHD is benefitted by therapy with oral Omega 3 FA remains to be seen.

As you know, we pride ourselves on our eclectic approach to many health conditions. We use traditional medications when their use is supported by placebo controlled studies in the child. But we are also open to other approaches. This is a comprehensive review that may be helpful for families of children with ADHD. The takeaway message is that ADHD is not one single disease and that a thoughtful approach to diet and medication is warranted in every patient. If you would like to discuss any of these approaches, please schedule an ADHD follow up appointment during which we can plot a unique approach for your child.

The Chardon High School Murders – A word from Dr. Shelly Senders

Within minutes, the shooting at Chardon High School was broadcast on Twitter and Facebook. We all saw the pictures of the alleged shooter and his victims. We saw the pictures of the guns and read the note on Wikipedia. And throughout the day, students and parents all over the country but particularly here in the Greater Cleveland area, tried to make sense of what can only be described as a senseless act.

There will be a lot of emotions spent over what exactly happened at Chardon High School. We may not really know the truth for months or years. So how do we use this tragedy as a springboard for learning more about the causes of school violence and how do we prevent similar such tragedies in the future? Part of the answer can be culled from looking at what scientific research has uncovered about such incidents in the past. The first, a book, is directed at what we as parents and loved ones, can do to identify problems in our own children. The second, a scholarly article, helps teachers and school administrators figure out when things are going wrong. The data is not sensational, it is not emotionally driven but it will give us a lot of insight about what we can really do to prevent school massacres down the road.

In his book, Why Kids Kill (MacMillan, 2009), author Peter Langman details the 10 lessons that can be learned from studying school massacres over the past two decades.

1) There are limits to privacy – Parents of teenagers are usually very respectful of their privacy. But if you discover bombs or disturbing notes or links to The Anarchist’s Cookbook in your child’s room, privacy rules no longer apply. Parents of angry children often don’t know how far to go to explore the depths of their child’s rage. The answer is that professional help should be sought for such children from us, your pediatricians or from competent mental health authorities.

2) Don’t lie to protect your child. Don’t deny a family history of mental illness if there is a strong history. Don’t lie to authorities about guns in the house or about the depth of your child’s anger. And don’t let a potential family scandal color your view of your child’s activities.

3) Follow through with due process no matter who is involved. In many previous massacres, the perpetrator was treated differently because his parents were teachers or because he came from a family of privilege. It is imperative for parents and school officials to follow the rules, no matter whose child is involved.

4) If the school is concerned about your child, pay attention. In the months before Columbine, Dylan Klebold wrote a story about a mass murder that so disturbed the teacher that she called the family in to discuss the story. Teachers read thousands of essays, many of which are very disturbing. If they call you about something that is an outlier even for them, listen carefully and take them seriously.

5) Eliminate easy access to guns. This is not a Bill of Rights issue. It is plain and simple, a safety issue. If your child knows how to get at a gun or a cache of guns, then you have just as well placed them in his or her hands.

6) Assume threats are serious until proven otherwise. In 2007, Asa Coon, a name known to all of us in Cleveland, threatened to come to school and kill everyone. Many of his friends heard him. A few days later, he came to school and went on a rampage. Empower your child to report threats. We live in a world of social networking and kids are often on the cutting edge of death threats. If they see bizarre things posted on Facebook, Twitter or any other platform, empower them to tell a responsible adult.

7) It just takes one person to stop a school shooting. There are many examples of arms dealers, friends and even people who found a disturbing notebook in a parking lot who were successfully able to prevent a shooting. There is a beautiful Jewish story about why there was only one person created first. The reason offered is that each person should view him or herself as the person for whom the world was created. Each person has the power to change the world by him or herself and the life and death of each person is equivalent to the life and death of all of creation.

8 Recognize possible rehearsals of attacks. In some ways, this is easier to notice today because of YouTube and Facebook. Everyone posts videos, including potential mass murders. If you see lots of guns and lots of shooting, tell someone in a position to do something about it and encourage your children to do so as well.

9) Punishment is not prevention. In fact, suspension from school often makes things worse for people already on shaky ground. Langman details the story of Kip Kinkel who was suspended from school for carrying a gun. Later that day, he killed his parents and the next day, he came back to school and killed another 27 people. The point is not that suspension is not an appropriate response. But suspension without monitoring or treatment often makes things worse for kids who are in crisis.

10) There are limits to physical security. Often the response to a shooting is to increase means of identification and install metal detectors. In Columbine, there were cameras and in Red Lake, there were cameras and metal detectors. Most school massacres are perpetrated by students, not outsiders so ID badges are not helpful. And most are bent on inflicting the greatest amount of harm so they will shoot guards and blow out cameras. By the time a student is walking up the driveway, it is too late.

So how about teachers and school administrators? What can they do to prevent an attack? The answer is to know as much as possible about the profiles of school homicides. An article in the Journal of the American Medical Association in December, 2001, tells us what to look for. It reviewed 220 events resulting in 253 deaths. 202 involved a single death while 18 involved multiple deaths. Students accounted for 68% of the deaths and the vast majority were homicides. 50% occurred while official school activities were in progress with 17.8% occurring near the start of school, 17.8% during lunchtime and 21.3% occurring near the end of the school day. Over half were preceded by some action that indicated potential for such an event (like a suicide note, a video posting or a poem). Homicide perpetrators were nearly 7 times more likely to have expressed suicidal thoughts, 3 times more likely to have had a history of criminal charges, 3 times more likely to have been a gang member, twice as likely to have associated with high-risk peers, or been considered a loner and twice as likely to have used alcohol or drugs on a weekly basis. Finally, homicide perpetrators were twice as likely to have been bullied by peers, more likely to have been reported to the principal’s office for disobeying an authority figure and less likely to have participated in extracurricular affairs.

The study revealed a number of findings that should guide violence prevention activities in the future.

1) Since most events occurred during transitions, it is essential to reduce crowding, increase supervision and have protocols for handling disputes that occur during such transition times (school entry or close and lunchtime).

2) Since over half were preceded by a note, threat or journal entry, it is important to empower students to report such threats and to encourage school officials to take such threats seriously.

3) Since suicidal thinking is so common amongst perpetrators and suicidal thinking may be occurring in up to 20% of all high school students, it is important to focus on risk factors for suicidal behavior in our schools.

4) Finally, since so many perpetrators have been described as having been bullied by their peers, it is important to develop programs that sensitize teachers to recognize and respond to bullying incidents between students.

These scholarly pieces give us a lot of dry information. But armed with data about what we can “really” do, we can really do a lot.

Clicking with you!

Did you ever meet someone with whom you just hit it off perfectly from day one? Someone with whom conversation flowed naturally, with whom there were no embarrassing pauses? Did you ever notice how some people just naturally “click” with one another while others have to work hard to develop and maintain a relationship? There is a science behind “clicking”, a science that explains the magical moments when we feel fully engaged and really connect with another person, place or activity. Click (Broadway Books, 2010) by Ori and Rom Brafman explores the multifaceted components of this unique behavior. And we at Senders Pediatrics use the science behind clicking to help develop the kinds of relationships that stand the test of time.

The Brafmans detail a series of 5 “click accelerators” that help nurture clicking relationships. The first is vulnerability. Most of us believe that when we make ourselves vulnerable, we put ourselves in a “one down” position. But really, the opposite is true. Vulnerability and self disclosure actually accelerate our ability to connect with those around us. By putting ourselves at emotional, psychological or physical risk, the Brafmans point out, we inspire trust and lay the groundwork for a faster, closer personal connection. That is why I tell stories about my own family. By talking about how I dealt with my own children’s apple juice fascination or my daughter’s screaming fits in first grade or my son’s toilet training experiences, I am admitting that I, too, am vulnerable and I set the tone for a closer relationship.

The second click accelerator is proximity. Studies have shown that college students were far more likely to develop relationships with their neighbors and military recruits with their dorm mates than with anyone else. Part of the reason is what psychologists call spontaneous communication, the unplanned conversations that occur simply because people work next to one another. But in a study of college students, just seeing someone day in and day out, made one more likely to perceive that person as attractive and a potential friend. We have found that this works wonderfully in our office as well. We go to office bowling parties and baseball games because we have found that just sitting in the seat next to someone else for 2-3 hours enhances the “clicking” between office mates.

The third click accelerator is described as resonance. There are two components to resonance, what psychologist Mihaly Csikszentmihalyi describes as “flow” and what medical researchers label, “a transformative presence”. To experience “flow” you need two things. You must be an expert in what you do and you have to be adequately challenged. Ask Tom Brady what it felt like to be down 21-0 to the Buffalo Bills and you will understand how he helped the Indianapolis Colts score 49 unanswered points. Or ask Mario Andretti what it was like competing in the Indianapolis 500 at speeds of almost 200 mph and with cars whizzing all around and you will realize how he succeeded in winning the race. Transformative presence is defined as “a meaningful interaction that touches the lives of those involved in a uniquely profound manner”. There are 4 components of transformative presence. The first is intentionality, giving someone your undivided attention. We know that we are not always on time. But with all of us, when we are with you, we are with you fully from the moment we enter the room until your last question is answered. The second is mutuality or being both open and available to meet the other person where they are. Although we spend a good deal of time giving advice, we are only successful to the extent that we truly understand what you are going through. It is easy to be open or available. But to be both takes a lot of patience and humility. When someone suffers a real tragedy and there is nothing meaningful to say to provide comfort, I will often simply say, “I don’t know why but I’ll be there for you.” The third component of presence is individuality, or being aware of our own emotional reactions. I cannot truly help you unless I know my own demons and how your problem really affects me. That is why we often meet as a team to process how to handle a particularly challenging situation. The final component of presence is attentiveness. In any discussion between people, the interaction must be one give and take and where both parties are actively involved in the conversation. We do not view ourselves as your bosses but as your trusted guides. Research shows that resonance, the combination of flow and presence, is contagious. When someone around us is stressed, so are we and when someone around us is laughing, we are more likely to be happy. More importantly, when someone around us is resonant with us, we are more likely to be resonant with them. We are more likely to click. This clicking is hard wired in our brains. Special neurons in our premotor cortex called “mirror neurons” are activated when we see other people experiencing happiness or pain.

Similarity is another click accelerator. According to the Brafmans’, “Similarity, no matter what form it takes, leads to greater likability.” This makes sense if you have the same interests. But it turns out that if you have the same birthday (I click with the great guy responsible for cleaning my office for a lot of reasons. But the fact that he and I share a birthday is what may have started things off in the right direction) or the same first name or the same interest in sports makes us part of an in group. And being a part of an in group makes it easier to click.

Finally, sharing adversity is a strong click accelerator. Researchers found that veterans who experienced deadly combat, were nearly twice as likely to maintain friendships as veterans who were not involved with death situations. And the greater the adversity, the stronger the bond. During the financial downswing two years ago, employees who went through the challenges of bringing their company out of the tank, were far more likely to stay with the company, precisely because of their experience of shared adversity.

When it is really important to develop a relationship, it is necessary to understand how to click. Clicking involves making yourself vulnerable, putting yourself in close proximity and learning how to resonate with one another, identifying characteristics that make you similar and working through hard problems together. We want to click with you, our patients and their families. And we use the most modern scientific methods to insure that we continue to maintain such close relationships. Because at the end of the day, close, clicking relationships are proven to yield healthier children.

Do Chinese Parents Produce More Successful Children?

Do Chinese parents produce more successful children because they refuse to allow them to attend a sleepover, have a play date, be in a school play, watch TV or play computer games or get any grade less than an A? Should screaming at your children, calling them “garbage” if they produce substandard work and refusing to allow them to go to sleep until they perfect a piece of music be considered child abuse or simply a different way of motivating them. Yale Law professor, Amy Chua, ignited a firestorm of protest with her recent publication of Battle Hymn of the Tiger Mother (Penguin Books, 2011) in which she lambasts the liberal attitudes of American parents. She notes three differences between Chinese parents and Western parents. 1) “Western parents are extremely anxious about their children’s self esteem. They worry about how their children will feel if they fail at something and they constantly try to reassure their children about how good they are notwithstanding a mediocre performance on a test or at a recital.” In contrast, Chinese parents assume strength, not fragility. According to Chua, Chinese parents demand perfect grades because they believe their child can get them and they are invested in insuring that they put in the time to achieve perfection. 2) Chinese parents believe their children owe them everything and therefore Chinese children must spend their lives repaying their parents. Western parents by contrast, believe that parents have brought their children into the world and therefore, it is the parents who owe their children a good life. 3) “Chinese parents believe they know what is best for their children and therefore (can) override all of their children’s own desires and preferences.” Western parents, on the other hand, respect their children’s individuality and provide positive reinforcement and a nurturing environment at every opportunity.

I have read dozens of op-ed pieces and blog responses to Chua’s book in an effort to understand why she strikes such a raw nerve in Western society. And after probing the angry and thoughtful responses, I believe I have come up with an approach that extracts the best of what Chinese parents offer while preserving what Western parents are truly seeking. Chua is right that children need to believe in their ability to succeed. Too many of us are willing to accept mediocrity just because Johnny or Janie produced it with their own little hands. There is a real focus in early childhood education on “efforts” and “production”. If children produce a substandard play or a weak effort at athletic success, we spend a lot of time praising them for their efforts. But I believe that we do our youngsters a disservice by dumbing down excellence. I believe that children know when their work is substandard and that hewing to a reproducible standard is helpful for them. Set the bar high. After all, that is what John Collins articulated in his landmark book, Good to Great (HarperBusiness, 2001). Great companies believe there is something they do better than everyone else. They believe they can do anything. They believe they can be great. We need to raise the next generation to believe that they too can do anything! Chua is right that we need to maintain standards of excellence and teach our children to strive for excellence. But where I differ greatly from Chua is in what to do when your child can’t achieve excellence in a particular area. After all, despite our protestations to the opposite, in our heart of hearts, we all know that each person can not really do everything. The answer for Chua is for parents to do anything in their power to push their child to the top including browbeating and yelling. The answer for me is to praise effort and move on to a new challenge. We must praise effort but we can never redefine success with effort. And we must use each failure as a teachable moment. We must help our children learn to view each failure as a steppingstone to the next success, each poor grade as a lesson that will build to the next good grade.

Do children owe us everything? I categorically disagree with Chua in this area. Having a child is a privilege and all privileges come with responsibilities. Every child has 6 inalienable rights that come with being a child: food, clothing, shelter, education, health care and love. Our children owe us only one thing and that is gratitude for bringing them into this world. But it is our responsibility as parents to teach them gratitude. That is after all, the essence of the Fifth Commandment to Honor Your Mother and Father. Unlike Chua, I believe children owe us gratitude which translates into respect but they don’t really owe us anything else.

Do parents know best or do children know best? I believe who knows best is best viewed as a continuum that begins at birth and ends at age 18 years. In the beginning, parents know all and by the end of childhood, children have to be given the wings to be successful on their own. At some point along the way, parents have a responsibility to teach their children how to be independent and that often means ceding some power and allowing them to make mistakes. The pendulum has swung too far with 5 year olds being given tremendous choice in their foods, play and educational opportunities. Chua admits that at some point parents have to allow their children to fly. The major difference between us is one of timing and degree.

And so, I agree with Chua on the importance of motivating our children to believe they can be excellent and on setting the bar as high as possible. And I disagree with her emphasis on production at all cost, on what children truly owe their parents and on the omniscient, all knowing nature of parents. But my disagreement goes one step further. And this is a point made by economist and former Harvard President, Larry Summers in a debate with Ms. Chua at the World Economic Forum in Davos. According to Summers, “part of the point of childhood is childhood itself. Childhood takes up one quarter of one’s life and it would be nice if children enjoyed it.” James Bernard Murphy takes this concept a step further in a beautiful op-ed piece in the Wall Street Journal on February 9, 2011, “Children are not merely adults in training. They are also people with distinctive powers and joys. A happy childhood is measured not only by the standards of adult success, but also by the enjoyments of the gifts given to children alone.” Children have the gift of moral innocence which teaches them confidence in human goodness. They have the gift of openness to the future which allows them to be open to outrageous new adventures. And they have the gift of being freed from the constraints of time. And since they have unlimited time, there is no time to be wasted. Chua takes all the fun out of childhood. For her, childhood is simply a time to prepare for adulthood and everything must be focused on adult activities. For Summers, Murphy and me, the goal of preparing for adulthood is the same but the means of getting there are very different. For us, and hopefully for you as well, the best preparation for adulthood is to turn childhood into an opportunity to learn how to believe, how to dream and how to transcend time.

Online Video Games

Playing online video games might just save the planet. This may come as a shock to followers of Senders Pediatrics, where reading has been a part of our DNA for the last 11 years, since the inception of Daily Dose of Reading. But in her thought provoking new book, Reality is Broken, Dr. Jane McGonigal (recently named one of BusinessWeek’s 10 most important innovators to watch) presents a controversial argument for engagement in the world of “gaming”. And I think she makes a point worth considering.

Dr. McGonigal notes that whether we like it or not gaming is here to stay. Gamers make up almost half of the world’s total population of 1.7 billion and collectively, the planet is now spending more than 3 billion hours a week on gaming. In the United States alone, there are 183 million active gamers (defined as individuals who play computer or video games an average of 13 hours a week). The demographics are fascinating. In this country, 69% of heads of households and 97% of all youth play games. 40% are women and 25% are over 50. The average gamer is 35 years old and has been playing games for 12 years. Moreover, 61% of all CEOs, CFOs and other senior executives take daily game breaks at work. Most gamers lead real lives, function in school and in the workplace and are indistinguishable from non gamers. But according to Dr. McGonigal, “The real world just doesn’t offer up as easily, the carefully designed pleasures, the thrilling challenges and the powerful social bonding afforded by virtual environments. Reality doesn’t motivate us as effectively. Reality isn’t engineered to maximize our potential….Reality, compared to games is broken.”

If so many people are engaged in gaming, Dr. McGonigal believes it is time to stop trashing the gaming world as escapist and begin to realize that computer and video games are fulfilling genuine human needs by inspiring, teaching and engaging us in ways that our real lives do not. “Game developers know better than anyone else how to inspire extreme effort and reward hard work. They know how to facilitate cooperation and collaboration at previously unimaginable scales. And they are continuously innovating new ways to motivate players to stick with harder challenges, for longer, and in much bigger groups.”

According to Dr. McGonigal, games can make us happier. Good games teach us about “fun failure”. In almost any walk of life, when you win, the fun ends. According to Raph Koster, author of A Theory of Fun in Game Design, “Fun from games arises out of mastery. It arises out of comprehension…With games, learning is the drug.” The more you master a game, the more it loses its fun. That is why games are consumable. After squeezing out all the learning, it’s on to another game. Fun failure that we learn from games teaches us how to stay optimistic in the face of failure and is an important emotional strength that carries over into our every day lives. But what happens when we are unrealistically optimistic? Mild depression may be an adaptive mechanism to prevent us from falling victim to this form of blind optimism and squandering our energies on the wrong activities. One of the hallmarks of today’s society is that we all set unrealistic personal and professional goals. We believe we can do anything and when we find that we can’t, major depression sets in. Good games shift our attention from our depressingly high goals and teach us flexible optimism where we can modify our goals to the point that they are achievable.

Games can also engage the world. The concept of crowdsourcing in which you outsource a problem to a crowd has been used very effectively in the gaming community. Wikipedia is one

simple example. Whether you believe Wikepedia is an accurate source of information or not, it is a real example of what games are capable of doing. It represents the efforts of over 100 million hours of human thought, engaging 10.7 million players (contributors) and 3.05 million unique players (articles), 7500 completely explored dungeons (exhaustively documented articles with excellent citations) and 2700 boss levels (top rated articles). Similarly, when a financial scandal rocked the House of Commons in 2006, the British newspaper, The Guardian, created a game to motivate people to investigate the hundreds of thousands of available documents. In 80 hours, over 20,000 people had reviewed 170,000 documents leading to the resignation of 8 members of Parliament.

Finally, games can also help us change the world. The game, Spore, is one of the games most intentionally focused on getting players to believe themselves as capable of changing the world. In Spore, players control the development of a species through 5 stages: from single cell origins, to sociable creature, to tribes, to civilizations and finally to intergalactic explorers. According to the developer, “the game is meant to spark a sense of creative capability among players and to inspire them to adopt the kind of long-term planetary outlook that can save the real world.” For those players who reach the final level, there is pushback to the real world. Players are told, “Your gameplay has prepared you to become a real creator and protector of life on Earth”. And the reason this is an accurate statement is that such players have demonstrated energy and creativity that can and should be funneled back into their everyday activities.

Dr. McGonigal is onto something big. Reading gives a person one path towards achieving success by providing the building blocks of knowledge. But after reading Reality is Broken, I am increasingly tantalized by the world of “good” games as an alternative road towards developing the necessary creativity for success for many children. Interestingly enough, Dr. McGonigal decries the mindless television viewing that afflicts so many of our youth. Where she intersects with the traditional academic world is in the importance of stimulating creative thinking.

See our website for a partial list of games that Dr. McGonigal thinks can very well change the world. The ones I have tried have changed mine.

Vaccines Don’t Cause Autism

Finally there is evidence that the entire “vaccines cause autism” claim is a financial hoax perpetrated on society by an individual whose motives were based on profiteering and personal gain.  In 1998, a British surgeon named Andrew Wakefield, published a research paper in the respected medical journal, The Lancet, that claimed that the MMR (measles, mumps and rubella) vaccine caused autistic enterocolitis, a new disease that combined autism and bowel disease.  He also claimed to have studied 12 children with this disease.  As Dr. Paul Offit points out in a January 11 op-ed piece in the Wall Street Journal, Dr. Wakefield’s article “created a firestorm.  Thousands of parents in the UK and Ireland chose to not vaccinate their children.  Hundreds …were hospitalized and 4 died of the measles.”  In 2008, for the first time in 14 years, measles was declared endemic or native to the UK.  In this country, Dr. Wakefield’s claim led to a general distrust of vaccines and the rise of the anti-vaccine movement.  The current epidemic of whooping cough on the West Coast can be attributable directly to reduced vaccination rates because of fears of vaccines.
The first trouble with Dr. Wakefield’s report is that it never proved that MMR vaccine “caused” autism.  It simply reported on a number of cases of autism and made the assumption that there was a relationship.  Causality can only be demonstrated when you look at the development of autism in hundreds of thousands of children, some of whom received the MMR and some of whom did not.  14 studies using that approach have been conducted.  One published in the British Medical Journal, looked at 2,000,000 children and found no relationship. So there has never been a study that has found an association between MMR vaccine and autism.

Worse yet, it is now clear that Dr. Wakefield’s original data was fabricated.  Some of the children in the report developed autism before they got the vaccine and some never developed autism.  The investigators appear to have altered and falsified the medical records of the children in question.  Last year, The Lancet, retracted the article because it was bad science.  And this past week, Brian Deer, the reporter who has studied this story since 2004, reported on what Dr. Wakefield’s real agenda was.  It turns out that before the first patient was out of the hospital, he had met with business partners about marketing a diagnostic testing kit for autistic enterocolitis that he had developed.  In a prospectus aimed at raising 700,000 pounds, Dr. Wakefield noted that the initial market for the test would be from lawsuits brought by families of children with autism.  Indeed, a lawyer hoping to bring a lawsuit against vaccine manufacturers funded much of Dr. Wakefield’s research.  Finally, Dr. Wakefield was hoping to market a “safer, single measles shot” for which he, alone, held a patent. 

This would all be a bad dream if it hadn’t spawned an entire movement dedicated to wiping out decades of progress on vaccination.  During my training a little over 2 decades ago, the average pediatrician saw 4 kids a year with meningitis, 2 died and 1 became completely deaf.  Chicken pox went from a mild disease of childhood to a disease associated with the “flesh eating” form of strep.  Hepatitis B caused end stage liver disease and measles caused misery and death.  Almost all of these diseases are gone now because of vaccinations. 

Is autism a terrible, terrible disease that takes a huge toll on families?  Yes.  Are we diagnosing more cases of Aspergers disease, autism and pervasive developmental disease now than before?  Yes.  Do we understand the true cause of autism? No.   But it is time to stop blaming vaccines for autism. There has NEVER been a study that has demonstrated a relationship between MMR and autism. There have been FOURTEEN studies that have shown no relationship.  Dr. Wakefield will go down in history as a scheming fraud whose desire for financial gain made him a central figure in one of the biggest medical hoaxes of all time.  Its time to pick up the pieces from this sad, sordid affair and get back to trusting real scientists who spend their lives working in the trenches to insure that our children stay healthy.  Its time to stop the emotion and get back to vaccinating our children with vaccines that have been rigorously tested and thoroughly vetted.

Missions In Life

There is a Jewish tradition that in the moments before a baby is born, an angel administers an oath that directs him or her to be morally righteous and stay away from evil.  The message of course is obvious.  Each human being has a mission to accomplish on this earth.   For some that mission will be a great one, one that influences the lives of millions as a President or a Prime Minister, as a Judge or a Senator or as a Minister, a Priest or a Rabbi.  For some, that mission will be more focused and involve fewer individuals, perhaps just a single person, as a teacher, a friend or a peer mentor.  Some missions are long in duration, lasting a lifetime and some pass in just a single minute.  Finally, some people engage in multiple missions in a lifetime and others have a single mission to accomplish.  We often never know the what, the when, and the how of our missions but we always have to be prepared to serve.

I recently saw a high school student who was failing out of school.  Captain of his sports team, he came for help with academics.  For a dozen years, he had never been able to focus in class.  His parents and teachers had been unable to help him and he coasted along with poor grades until he realized that if he failed, he would be letting his team down.  His “mission” was to lead his team to victory and if it meant confronting his academic challenges, he was finally prepared to do so. 

I saw another patient with a serious illness who is one of the most private and introverted individuals that I know.  But when the national organization that raises funds for research into her illness came to her for help, she responded by allowing herself to be featured in a national web-based campaign to heighten awareness about her disease.  Her “mission” was to help find a cure for her disease.  She never asked for it, she never wanted it but when it presented itself to her; she grabbed the mantle of leadership and ran with it. 

On a daily basis, I see parents who ask me to help them with parenting problems.  One family I saw recently, had sailed through the formative years of their first 2 children but on their third child, ran into a brick wall with an individual who did not respond to any of their previously successful interventions.  They have slowly and painstakingly gone for parent coaching to learning how to help raise this amazingly spunky little girl.  Their “mission” is simply to help understand their own child and help her become a confident adult, but in some ways, it is as challenging a “mission” as the two previously mentioned examples.

We have 2 “missions” at Senders Pediatrics.  The first is to “Help Figure Kids Out”.  It may be in the traditional clinical areas such as promoting healthy eating, preventing anemia, maintaining strong bones or avoiding drug and alcohol abuse.  Or it may be in parenting areas such as providing structure, identifying approaches to discipline that work, and helping with successful toilet training.  Increasingly, however, we are moving into areas of academic and emotional “figuring out”.  We are about to launch a program that will help you and your child’s teachers understand your child’s personality type and the manner in which he or she is most likely to succeed in learning.  We are increasingly engaging with parents in helping their children using the science of neuroplasticity which has proven that it is possible for the brain to change and grow if stimulated in creative new ways.  Our commitment is to use the best of what is available to help “figure your child out”.  And this blog is one more effort to help you succeed.  Each posting will contain information that can help you raise that amazing child of yours into the healthiest, most emotionally-stable, educationally-solid and confident adult possible.  We encourage your responses because knowledge is born in the marketplace of ideas.

But our second “mission” is to create a Pediatric Care Community.  In a world that is increasingly more depersonalized, where the nuclear family has broken down, where knowledge is exploding in all directions, we hope to provide you with an oasis of stability.  When you need a social group to deal with a particular problem, we hope to provide you with that network.  When you need a specialist to help tackle a vexing problem, we will give you names as well as provide a “heads up” to that individual.  And when you need help in taking on a system, whether in the medical or educational realms, we will provide guidance and support every step of the way.  Once again, this blog can help as we highlight ideas that bring people together.

If we all have a “mission” in life, our “mission” is to support your “mission”.  As your “mission” changes, let us help you be as prepared as possible to take on that new “mission”.  And if we can help others like you, feel free to forward our blog information locally and to friends elsewhere.  The larger the community, the more powerful the result!