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Editorial

This issue of Pediatric Annals is devoted primarily to a variety of infectious disease topics that

relate to neonates and young infants. These include diverse topics such as congenital syphilis, neonatal tubercu-losis, congenital cytomegalovirus con-troversies, neonatal infections with non-polio enteroviruses, and the molecular diagnosis of neonatal herpes simplex virus infection. Dr. Kenneth Alexander has done an excellent job of organizing this important set of review articles.

None of us needs to be reminded of the serious childhood obesity epidemic in our country, one which dispropor-tionately affects many children from poor neighborhoods in rural areas, in urban neighborhoods, as well as in seg-ments of some suburban communities.

Dr. Thomas Farley, a former resident at Children’s Memorial Hospital, the forerunner of the new Lurie Children’s Hospital in Chicago, IL, the recent past New York City Health Commissioner, and now CEO of the nonprofit Pub-lic Good Projects, and Russell Sykes,

member of the National Commission on Hunger and past deputy commissioner of the New York State Office of Tem-porary and Disability Assistance, have recently published a thought-provoking

op-ed piece in the New York Times en-titled “See No Junk, Buy No Junk.”1 They argue that, because 1 in 5 deaths in America are caused by unhealthy diets, the government should work harder to ensure that its biggest nutri-tion program truly supports good nutri-tion. They highlight that the problem in poor neighborhoods is not a shortage of food but rather a shortage of healthy food. Only one-sixth of low-income zip codes have a supermarket, and many small corner and convenience stores fill the gap—with shelves stocked pri-marily with unhealthy selections. Pub-lished data indicate that supermarkets have an average of almost 140 feet of shelf space for fresh fruits and the same amount for vegetables, whereas small stores devote 3 times as much shelf space for unhealthy junk food and not to fruits and vegetables; the ratio in con-venience stores is almost 30:1.2,3

Farley and Sykes1 argue that changes in the federal government’s $70 bil-

lion food stamp program for 46 million low-income people (The Supplemental Nutrition Assistance Program [SNAP]) could lead to significant changes in what people buy and consume. SNAP now is the only federal nutrition pro-gram that allows purchase of sodas, chips, and candy with public funds, with an estimated $1.7 billion of SNAP benefits spent on high fructose drinks alone. Can this be changed? The US Agriculture Department found that fruit and vegetable consumption increased 26% by giving SNAP recipients an extra 30¢ in benefits for every $1 dollar they spent on fruits and vegetables, but this pilot project has not been generalized.1,4 Farley and Sykes1 suggest that, because food stamps can’t be used to buy ciga-rettes or alcohol, junk food could also be added to that ban. Such proposals have been opposed strongly by lobby-ists in the beverage and grocery indus-tries, but this addition could lead to im-portant change.

Another idea is to modify the fed-eral standards that stores must meet to participate in the SNAP program. They now are incentivized to stock at least a small amount of bread, canned veg-etables, meat, milk, and cheese, but it could be mandated that stores accepting food stamps must use more shelf space for healthy foods and limit junk food to no more space than what is devoted to fruits and vegetables. Two studies have found that doubling the shelf space for fruits and vegetables increased sales by 30% to 60%.2,4 This is important be-cause Americans on average consume

Junk Food ThoughtsStanford T. Shulman, MD

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.

doi: 10.3928/00904481-20150512-01

The problem in poor neighborhoods is not a

shortage of food but rather a shortage of healthy food.

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Editorial

PEDIATRIC ANNALS • Vol. 44, No. 5, 2015

about half of the recommended fruit and vegetable quantities, and a 50% increase in fruits and vegetables could lead to a 15% decrease in heart disease.1 Stores could actually profit from these changes because produce is among the most profitable areas for grocery stores.

There is a precedent for these kinds of changes in the SNAP program. The federal Women, Infants, and Children (WIC) program in 2009 raised the re-quirements for the kind of food that needs to be stocked by participating stores, and despite some reluctance nearly all small stores chose to meet the healthier standards, and WIC users sub-sequently consumed significantly more whole grains, low-fat milk, and fruits.1

THIS MONTH’S STAMPSThis month’s stamps honor the Ba-

cillus Calmette–Guérin (BCG) vaccine against tuberculosis (TB) and its French developers Albert Calmette (1863-1933) and Camille Guérin (1872-1961). The BCG vaccine was commemorated on the dark blue stamp issued in 1956 by Yugoslavia and on the red 1957 stamp from the Dominican Republic that bears the slogan “Vaccinate your children with BCG.” A meta-analysis in 1994 reviewed 1,294 published articles

and focused on 14 prospective trials and 12 case-controlled series to assess the efficacy of BCG in preventing tubercu-losis.5 This study concluded that BCG was about 50% effective in preventing TB, with up to 64% to 71% efficacy against TB deaths, meningitis, and dis-seminated disease. More recently, even greater efficacy was reported, with 90% reduction in tuberculosis meningitis and miliary TB after BCG immunization of infants and children.6 BCG continues to be used today in a large number of middle- and lower-income countries.

Calmette and Guérin are shown on the two stamps from Monaco (1996) and the French African colony of Afars and Issas, now Djibouti. Calmette was a French physician, bacteriologist, and immunologist who trained under Louis Pasteur and Emile Roux and estab-lished Pasteur Institutes in Saigon and Algiers. Guérin was a veterinarian, bac-teriologist, and immunologist whose father and wife both died of TB. From 1905-1915 and 1918-1928, Calmette and Guérin worked together to attenu-ate Mycobacterium bovis by serially passaging it 230 times over 13 years in the presence of bile. Subsequently, attenuated BCG vaccine was first ad-

ministered to humans in 1921 (first to neonates at Hôpital Charité in Paris). Except for a major problem in 1930 when 77 of 271 vaccinated children in Lubeck, Germany, died of TB from vaccine contaminated with M. tuber-culosis, BCG immunization has been highly effective and has saved probably millions of lives.

REFERENCES 1. Farley TA, Sykes R. See no junk, buy no

junk. The New York Times. March 21, 2015. 2. Farley TA, Rice J, Bodor JN, Cohen DA,

Bluthenthal RN, Rose D. Measuring the food environment: shelf space of fruits, veg-etables, and snack foods in stores. J Urban Health. 2009;86(5):672-682.

3. Boder JN, Rose D, Farley TA, Swalm C, Scott SK: Neighborhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment. Public Health Nutr. 2008;11(4)413-420.

4. Boder JN, Ulmer VM, Dunaway LF, Far-ley TA, Rose D. The rationale behind small food store interventions in low-income urban neighborhoods: insights from New Orleans. J Nutr. 2010;140(6):1185-1188.

5. Colditz GA, Brewer TF, Berkey CS, et al: Ef-ficacy of BCG vaccine in the prevention of tuberculosis. JAMA. 1994;271(9):698-702.

6. Mangtani P, Abubakar I, Ariti C, et al. Pro-tection by BCG vaccine against tuberculosis. Clin Infect Dis. 2014;58:470-480.

The Bacillus Calmette–Guérin vaccine commem-orated in 1956 by Yugoslavia. From 1957, this stamp from the Dominican Republic

bears the slogan “Vaccinate your children with BCG.”

Albert Calmette and Camille Guérin are shown on a 1996 stamp from Monaco.

Vaccine developers Albert Calmette and Camille Guérin shown here on a stamp from Djibouti.