Thursday, August 20, 2009

HPV/Gardisil vaccine clears major safety hurdle

In the August 19, 2009 issue of the Journal of the American Medical Association, a major review of the safety of Gardisil (the vaccine against human papilloma virus first licensed in 2006)was published. This is the first publication of a comprehensive analysis of all the data by the Centers for Disease Control and the FDA. It is based on the data collected by the VAERS (Vaccine Adverse Events Reporting System). This means that this is a safety report based on the track record of this vaccine AFTER it was approved and has been administered over 23 million times.

VAERS is a national, government-sponsored reporting system. All reports (12, 121 for Gardisil) are screened and any serious problems are thoroughly investigated. Most reports were minor (fainting--at the same rate as tetanus shots; dizziness;nausea;headache;and local reactions)

Thirty two reports of deaths were made of which only two are still being investigated as possibly caused by the vaccine. All others were serendipitous (caused by diabetes, illicit drug use, viral illness, or heart failure none of which were linked to the vaccine).

All in all the safety record appears very similar to the data that was presented from pre-licensing trials. The only major change I have implemented in my office has been to watch girls for an extra ten minutes after their shot to guard against a dangerous fall from a fainting spell.

It is good to remember that about 11,000 women are diagnosed with cervical cancer each year in the US alone. About 4000 die from the disease each year. The HPV vaccine effectively protects against the main types of virus that cause 70% of these cancers.

In the global picture where folks across the world are dying at alarming rates of the common illnesses of diarrhea, malaria, influenza and pneumonia it may seem a luxury to vaccinate against a relatively rare disease with a relatively expensive vaccine. I remind patients that we ARE lucky to have this vaccine. Just as we are lucky to have good education, roads, and other amenities of a "developed" country. But let us also remember that American minority women still contract and die from cervical cancer at much higher rates than Caucasian women. Research shows that this discrepancy is due to a problem of access to medical care-- as we know a thorny problem that our country has yet to solve.

Tuesday, August 11, 2009

Dietary Supplements for Weight Gain in Teens

I am starting a "guest blogger" opportunity for any professional who does not have a personal blog but has something smart, useful, funny, new, or otherwise entertaining to say about issues related to health for adolescents and young adults.

This post is by Dr Karen Reznik-Dolins who is a registered dietician
and licensed sports nutrition expert. Her practice is in Mamaroneck
and she can be reached at

If you are interested in writing as a guest blogger,
please contact Dr Engelland at

Not a day goes by that I don't speak to a teen who has at least
considered taking supplements in order to enhance performance
or looks. This brief blog entry offers some simple, wise advice:

In my practice in Mamaroneck and with Columbia University athletes, I see plenty of kids and teens reaching for protein powders, experimenting with creatine, and other supplements in their attempts to gain weight and lean body mass. It scares me. It scares me because these types of dietary supplements are generally not studied in kids under 18. That means that your kids are experimenting on themselves.

There’s been tons of research on the purported benefits of protein powders. The consensus among scientists is clear: protein powders are no more effective than any other source of calories. What’s disturbing is that the dietary supplement industry is largely unregulated as a result of the 1994 Dietary Supplement Health and Education Act (DSHEA). Quality control varies, and laboratory analyses find varying levels of active ingredients along with other, potentially dangerous, ingredients that aren’t listed on the label.

What I tell kids trying to bulk up is simple: eat 6 times a day, don’t skip meals, be sure to fuel your workout with a pre-exercise snack, and follow your workout with recovery foods. It can be as simple as having a bowl of cereal with milk, and it works every time.

Thursday, August 6, 2009

Big Kids Come Home

I loved the New York Times piece today entitiled "Our Children, the Rude Houseguests" by Michelle Slatalla in which the author humorously tells about her (almost) grown children, ages 18 and 20, sharing the house with mom and dad during this Summer Recession of 2009.

The expectations for young adults have changed in many families, especially those who can afford the luxury of contemplation. Is it because they have been coddled and supported in ways we boomers could never have expected as kids (and if you think we had it harder, go ask a child of the Great Depression about how tough it can be)? Many of us have grown up alongside our own children to such an extent that we actually enjoy the company, companionship, conversation and creativity of our grown kids almost as much as we enjoy the company of our contemporaries.

My kids make me feel youthful and they challenge me constantly whether it's on my parenting skills viz-a-viz the youngest siblings in the family or on my perennial memory loss with respect to technology ("I showed you that last week, Mom"). I don't actually mind helping them (helping is the operative word) do their laundry. And the rewards of cooking the old standards and the favorites are still powerful and meaningful.

Nonetheless, I have said for a long time that I expect my children to move out, on and up from the family homes because I believe that is really what they are supposed to do. To a certain extent it is selfish on my part-I am ready for space and time, privacy and freedom. And I think there is great value in sharing a New York apartment with four or five others for a few years while everyone gets his or her bearings, relationships and salary established.

On the other hand, I hope they won't choose to live too far away for too long. As I contemplate leaving a big house, getting an apartment with a kind and competent super and simplifying my life, I am mindful of the need to keep a semblance of a nest for them to return to, even if it means blowing it up before they lie down in it.

Tuesday, August 4, 2009

LIsten Responsibly

The Hearing Alliance of America reported in 2005 that 15% of college graduates have a level of hearing loss equal to or greater than their parents. This is thought to be caused by listening to high volume music. Other audiological symptoms include distortion, tinnitus (ringing) and hyperacusis(loudness). What to do about this silent epidemic?

A recent article in Pediatrics, THE journal of the American Academy of Pediatrics, reports the results of a panel of experts discussing the problem of MP3-induced hearing loss among teens. Experts included scientific researchers, medical doctors, community health professionals, educators, youth workers, music entertainment experts and enforcement authorities.

The general consensus was that teens, manufacturers and parents are the most relevant parties to be involved in prevention of hearing loss. To their credit, I think, the experts agreed that it is unlikely that teens and young adults are likely to police themselves in this regard. The general recommendation is that the industry will need to regulate itself in order to protect the hearing of the nation's youth. Volume-level regulation for MP3 players may be necessary through use of a noise limiter. . It was also recommended that authorities should initiate a public health campaign to raise awareness of the problem.

As a practicing pediatrician and a school district physician, I am surprised that a standard hearing test was not recommended at the middle and high school ages. Many pediatric offices and clinics are equipped with reliable equipment for testing hearing as are many school nurses' offices. A mandate to test and counsel on this important issue would go a long ways toward raising awareness.

Taking a cue from the beverage industry, we can imagine the slogan: "Don't Text and Drive" along with "Please Listen Responsibly."