september 03 senior bulle#d2901 - aap.org · s te adil yn c rg h ou f ,b the direction of, the...

Message from theChairpersonAvrum L. Katcher,MD, FAAPChairperson, Section for Senior Members

First, my understanding, from the august, eminentlinguistically unchallenged New York Times. One oftheir op-ed persons emphasized that the very term,Chairperson, is poor English and not to be usedexcept by those who seek ignominy. I’ve used it formany years, since I felt thatChairman is a sexist term,like motorman. As a young attending, working withsecond year medical students (late 1960s or early1970s) to teachhistory taking andphysical diagnosis.One of the groups I sought to help was composed offour women. At some point, seeking to move themalong, I said, “Come on guys, let’s see what we canlearn from this patient.” The air became a bit chilly,but we went on our way.

A fewdays later theChairman (hewas amale person)of Community Medicine, who happened to be incharge of the teaching program called me. The fourladies had filed a complaint. By calling them“guys” Ihad insulted their femininity. Just barely, I suppresseda laugh. All of our children (three girls andaboy) usedthe term “guy” indiscriminately to identify a friend,associate or classmate. But I did not forget, and havebeen on the lookout since. For example, eachmorn-ing about 11:30 our roadside mailbox receives USPSmaterial fromamail carrier. Our trash is pickedupbya trash collector. And, by golly, I am, and shall remainuntil the endofmy term, a chairperson. So fie on you,NewYork Times!

Youwill be hearingmore later this year and next yearabout what we hope will be a new venture of theSection for Senior Members. That will be amore for-

What’s Inside?Message from the Chairperson . . . . . . . . . . . 1-2

Executive Committee/Subcommittee Chairs . . . 2

John Bolton, MD, FAAP . . . . . . . . . . . . . . . . 3-4

Promoting Longevity In The ERA .... . . . . . . . . 4

Website Announcement. . . . . . . . . . . . . . . . . . 4

A Season of Discontent . . . . . . . . . . . . . . . . . . 5

Eisenhower’s Farewall Address . . . . . . . . . . . 6-8

The Quiet Achiever. . . . . . . . . . . . . . . . . . . . 8-9

Editor’s Note . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Alternative Medicine . . . . . . . . . . . . . . . . . . . 10

A Push for Direct Deposit . . . . . . . . . . . . . . . . 10

Alcohol Use Disorder: A Lost Decade... . . . 11-12

Book Review: John Donne . . . . . . . . . . . . 12-14

Travel Medicine . . . . . . . . . . . . . . . . . . . . 14-15

Valuable Attorney’s Advice - No Charge . . . . . 16

On Retirement . . . . . . . . . . . . . . . . . . . . . 17-18

What Is Intelligence? . . . . . . . . . . . . . . . . 18-20

Alternative to Golf . . . . . . . . . . . . . . . . . . 20-21

The Mysterious Processes of A New Person . . 22

The Girl Who Slept For A Year . . . . . . . . . . . . 22

There’s More To It than Darts . . . . . . . . . . . . . 23

“On Wheezing” . . . . . . . . . . . . . . . . . . . . 24-25

Copyright© 2007 American Academy of Pediatrics Section for Senior Members

Continued on Page 2

A A P S e c t i o n f o r S e n i o r M em b e r sVolume 16 No. 4 – Fa l l 2007

Opinions expressed are those of the authors and not necessarily those of the American Academyof Pediatrics. The recommendations in this publication do not indicate an exclusive course oftreatment or serve as a standard of medical care. Variations, taking into account individualcircumstances, may be appropriate.

SENIOR BULLETINEditor: Joan Hodgman, MD, FAAPAssociate Editor: Arthur Maron, MD, MPA, FAAPAdvocacy for Children Editors: Lucy Crain, MD, MPH, FAAP

Burris Duncan, MD, FAAPDonald Schiff, MD, FAAP

Travel & Leisure Editor: Herbert Winograd, MD, FAAPFinancial Planning Editor: James Reynolds, MD FAAPHealth Maintenance Editor: Avrum Katcher, MD, FAAPComputers Editor: Jerold Aronson, MD, FAAPGeneral Senior Issues Editors: Avrum Katcher, MD, FAAP

Eugene Wynsen, MD, FAAPOutdoors Editor: John Bolton, MD, FAAP

mal structure and set of objectives for our group. My interest goes backto 1993, when we were a provisional Section whose survival was a bituncertain. At that time we did a survey of members, noting that of 390responders, 70% described their health as unimpaired. Of those age 70or over, that proportiondropped to 54%. Just over 23%said that theywereless satisfied with life than ten years previously. Gender, state of healthand occupational status showed a small association with satisfaction.

Whatever the reason, itwas felt that theAAPneeded to knowmore aboutthis drop-off in satisfaction. Does it really exist? If so, why, and whatcould or shouldbedone to ameliorate the situation for this group? Itwasclear in 1993 that the health care system in its relationship to the entireeconomy,wouldbea zeroornegative sumsystem for the future.Thatpre-dictionhasbeen found true.We felt issues of efficiency, effectiveness andeconomy would be every more prominent.We said:

“One of the most expensive of all resources used for child health is thepediatrician. Each one costs the economymanymillions of dollars overa lifetime. A great deal of research is devoted to the effectiveness and effi-ciency of a variety ofmedical treatments, drugs, procedures, appliances.Some research is done relating to how the pediatrician utilizes herselfor himself. Very little is done on the pediatrician to answer questionsabout the relationship betweenperceived life satisfaction, or stress, andthe quality of that individual’s professional performance, or on the tra-jectory of that person’s career, how long that individual remains in themedical profession, and why. “Just as in child health care, a pediatriccareer canbe viewed fromadevelopmental perspective.There are char-acteristic milestones, times for important decisions, expected attain-ments. Progress may be enhanced by factors which promote resiliencyand impaired by factors promoting vulnerability. Little is knownof thesefactors.”

Iwould contend that the abovedescription is valid today. Iwould furthercontend that theSection for SeniorMembers should take the lead toworkwith the AAP to see what might be done for the individual pediatrician.It has been quite some time since the AAP recognized the importance ofworkingnot only for thewelfare of children, but also for the effectiveness,efficiency and self-utilization of pediatricians. That is, the satisfactiontaken fromwork, and the juncture of professional andpersonal lives.Wehavebegun someof this already. Look at ourweb site, so ably created andmaintained by Jerry Aronson. Here you’ll find a bonanza of informationabout LivingWell, Pre-Retirement issues, Health and Fitness and otherlinks to enable you domaintain yourself in the best possible condition,both while in practice and subsequently.

We have made other suggestions, and are now entering into a stage ofplanning, in consultation with Ken Slaw, Director of the Department ofMembership, and Jackie Burke, our Section manager. Keep alert! We’llneed to work together.

Avrum L. Katcher,MD FAAPChairperson, Section for Senior Members

American Academy of Pediatrics

2 Senior Bulletin - AAP Section for Senior Members - Fall 2007

Executive Committee

Avrum L. Katcher, MD, FAAPChairFlemington, NJ

David Annunziato, MD, FAAPImmediate Past ChairEast Meadow, NY

Michael O’Halloran, MD, FAAPEau Claire, WI

George Cohen, MD, FAAPRockville, MD

Lucy Crain, MD, MPH, FAAPSan Francisco, CA

John Bolton, MD, FAAPMill Valley, CA

Arthur Maron,MD, MPA, FAAPBoca Raton, FL

Subcommittee Chairs

ProgramLucy Crain, MD, FAAP

Financial PlanningJames Reynolds, MD, FAAP

MembershipGeorge Cohen, MD, FAAP

History Center/ArchivesDavid Annunziato, MD, FAAP

Newsletter EditorJoan Hodgman, MD, FAAP323/[email protected]

Associate EditorArthur Maron, MD, FAAP561/[email protected]

StaffJackie Burke,Sections Manager800/433-9016, ext. [email protected]

Tracey Coletta,Sections Coordinator800/433-9016, ext. [email protected]

Mark A. Krajecki,Pre-Press Production Specialist847/[email protected]

Message from the Chairperson Continued from Page 1

John Bolton grew up inthe small town of SaintPaul, deep in theClinchMountains of Virginia,about 60miles fromDr.Lucy Crain’s birthplacein Eastern Kentucky.He spent his highschool and collegesummersdating, danc-ing and driving a fueltruck for his father’sbulk oil plant, not nec-essarily in that order.By his senior year inhigh school he hadsaved up enough to goto boarding school.This led to admissionto The University ofVirginia andeventuallyto Duke University

Medical School where he received his MD.

A couple of summer quarters allowed him to finishmedical school sixmonths ahead of his class.To helpfund his postgraduate training he joined the UnitedMineWorkers’Union andwent towork in oneof theirhospitals back in his home county. Sincemany of theother physicians employed by the union had comefrom other parts of the country, he spent a good dealof time on bedside rounds translating Appalachianspeech into themoremodern formof English spokenby the“outlanders.”Notmanyof these docs knew themeanings of words like “risins,” “biles,” “thrash,” etc.

Given that his family first came to the ClinchMountains in the 1700’s, he alsometmany of his dis-tant relatives in the hospital.

While at Duke, his pediatric mentor was Dr. DorisAhleeHowell. At her suggestionhewent toMontrealChildren’s Hospital for the first two years of his resi-dency.Despite his SouthernMountain accent andhishalting command of French, he thrived in Quebecand even became president of the English SpeakingIntern’s Union at his hospital.

He then spent two years in CDC’s EpidemicIntelligence Service, the first of which was at the USArmyHospital, FortOrd, California,waiting forNIH’snew RSV vaccine. The study was closed down beforeany of the vaccine arrived at Fort Ord. It had beennoted that vaccine recipient kids were much sicker

withnatural RSVdisease than thosewhohad receivedthe placebo.His next year in the EIS was as an epidemiologist onloan to the California State Department of HealthServices inBerkeley, dually assigned to the InfectiousDisease and Vaccine Assistance Programs. He wassent all over the state to investigate various outbreaks,ranging from botulism exposure in a Highway Patroldetachment to a typhoid fever outbreak in a Stanfordfraternity.

He completedhis final yearof residencyt r a i n i n g a tJohns HopkinsHo sp i t a l i nB a l t i m o r eb e f o r ereturning toCalifornia tojoin a grouppractice in SanFrancisco inJune of 1968,just after the“Summer ofLove.” His initial practice was a mixture of middleclass San Franciscans and colorful hippie familiesfrom theHaightAshbury. After a lively couple of years,28bus loadsof these samehippies followed their gurutoTennessee to found“TheFarm,” a communewheremanyof them live to this day. (Check it out onGoogleif you don’t believe me.)

Senior Bulletin - AAP Section for Senior Members - Fall 2007 3

Continued on Page 4

Dr Bolton stops to pose withhis grandson, Adrian, andfaithful bird dog Maggie.

Shown l-r bottom row are: son John, son Mark withgrandson Adrian, son Nate. Back row: grandsonBenjamin, Grandpa John and son Adam.

Granddaughter Scarlett is up andready to roll with mommy and daddyto San Francisco.

John Bolton, MD, FAAPMember, Executive Committee, Section for Senior Members

John has been very active in the Academy. At theChapter level he has chaired several committees andhas been Chapter President and Vice President.Nationallyhehasbeenonboth theCouncil onFederalGovernment Affairs and the Council on StateGovernment Affairs. He has represented the AAP inhearingsbefore theFDA, andcommittees ofCongressand the California legislature.

He and his wife, Liz, live in Mill Valley, at the foot ofMountTamalpais.Theyhave four sons, threeofwhomlive in the San Francisco Bay Area. They also have

three grandchildren. Both JohnandLiz are very activewith their community association and open spaceland trust. John is also a member of the AdvisoryBoard of theMarin Salvation Army.

He now works part time in two group practices andteaches a course in General Pediatrics at SamuelMerritt College in Oregon. He spends at least twomonths of each year at his family’s cabin in theBitterrootValley of Montana, fly fishing and workingthe fields with his faithful bird dog,Maggie. His over-all appraisal: “It’s a good life.”


John Bolton, MD, FAAP Continued from Page 3

Faculty for the 2007 NCE Section for Senior Members CME Program October 29

“PROMOTING LONGEVITY IN THE ERA OF STEM CELL RESEARCH”

DaleE.Bredesen,M.D. is Professor ofNeurology at theUniversity of California, SanFrancisco(UCSF) andPresident&CEOof theBuck Institute for AgeResearch (www.buckinstitute.org) inNovato, California, near SanFrancisco.Dr. Bredesen’s research focuses onmolecular processeswhich control intrinsic cell deathpathways.The Bredesen laboratory has discovered alternative pathways to apoptosis and has research models forAlzheimer’s disease. Also, the lab studies the development of cancer as outcome of malignant cells failing tocommit suicide, but continuing to grow and survive.Implications of these and other areas of molecularresearch are the scientific passion of Dr. Bredesen,who speaks with authority and clarity on the subject.

Bruce Miller, M.D. is Professor of Neurology atUCSF, where he is Director of the Center on Memory& Aging. Dr. Miller’s experience as a clinician whodiagnoses and treats various types of memory lossand dementia define him as an expert in procuringfrom neuro cognitive research those clini-cal/behavioral elements needed to define applica-tions and strategies which can be crucially importantto thosewithmemory loss and/ordementia.Dr.Milleris much in demand as an outstanding speaker on thesubject of memory and various dementias.

Martin Pera, M.D. is Research Professor and thedirector of theCenter for StemCell andRegenerataiveMedicine at Keck School ofMedicine at theUniversityof Southern California in Los Angeles. Dr. Pera’sresearch focuses onextrinsic factors involved inmain-tenance of the pluripotent state in human embryonicstemcells and thepractical questionswhich remain tobe solved in this area.His abilities to translate researchfindings into understandable terms for non-molecu-lar biologists is highly regarded. He is a member ofthe International Stem Cell Initiative and has beenintegrally involved in state, national and internationalregulation for scientific basis of human embryonicstem cell research.

Website Announcementby Jerold M. AronsonMD FAAP

Are you getting ready for autumn fun and lookingfor a new digital camera to record your greatmoments with grandchildren and family?Considering upgrading your computer with thenew Microsoft Vista Operating System? Are youplanning your transition to retirement? Perhapsyouare looking for tips to keep youandyour lovedones physically fit?Makingplans for theAAPNCEin San Francisco late October 2007?

If the answer to any of the questions above is Yes,please visit your AAP Section for SeniorMembers(SFSM) website at www.aap.org/seniors. YourHome Page is replete with news and informationthatprovide answers to thesequestions.Of course,youcanalso surf the insideSectionsof theweb siteto keepupwithwhatwe aredoing simply by click-ing on the Section Names on the right side of thepage.

Wewelcomeyour feedback and comments on theSFSMwebsite through email toWebmaster JeroldAronson MD FAAP. Of utmost importance - thewebsite welcomes any and all content and pic-ture submissions for posting to thewebsite. Shareyour experiences, questions, concerns with us.We’d love to hear from you.

A Season of Discontentby DonaldW. Schiff,MD, FAAP

An early summer marked by forest fires over 12 western states and breathtaking lethal floods in Texas andOklahoma seem to match the mood of the nation. The war in Iraq and the nasty disputes over immigrationissues continue to heighten the rift in thinking about our country’s future.

Another problem of an immediate nature, whichmay be resolved by the time you read this, is the September,2007 deadline for reauthorization of the State Children’s Health Care Plan (SCHIP) initiated in 1997 for aperiod of 10 years. This program, which is a voluntary joint state-federal success story, has enrolled over fivemillion previously uninsured children whose higher family income prevents them from participating in theMedicaid program but is not sufficient (generally <200% poverty level) to buy private health insurance.

The present goal of our Academy, working with other child advocacy groups, is to convince Congress to pro-vide sufficient funds tomatch the current programneeds and also reduce the number of currently uninsuredchildren by enrolling the twomillion who are eligible but not yet enrolled in SCHIP.

In spite of the universal admiration for the program, the administration proposed budget for SCHIP next yearwould provide for less than half of the funds needed by the states tomaintain their current enrollment, muchless cover all uninsured children below the 200% poverty level. A bipartisan recommendation by theNationalGovernors Conference to budget sufficiently to maintain at least current enrollment was met by an adminis-tration comment that “states shouldmake better uses of themoney they already had.”

TheSCHIPprogramhasbecomeentangled in themazeof Washingtonpre-electionyearpolitics.TheDemocrats(MaxBaucus,Montana, Chair of the Senate FinanceCommittee) haveproposedproviding $50billion over fiveyears to adequately fund theSCHIPprogram.However, theDemocrats have adoptedabudgetarypolicy of“pay-as-you-go,” whichmeans that every dollar in the next budget must have an identified source, and this wouldhold true for SCHIP. As yet, the source of these dollars remains to be determined.

TheRepublicanparty is somewhat dividedon the funding issue.TheWhiteHouse is holding the line ona lowerlevel clearly inadequate to maintain current enrollment numbers.

An additional view was stated in theWall Street Journal on June 29, 2007 by Kimberly A Strassel, who believesthat theGOPneeds toput forth a freemarket health care reform to replace thepresent system. She further sug-gests that the SCHIP funding controversy could determine the future direction of our health care system bybecoming the next step in a broad expansion of government health programs. It is difficult to determine howwidely such an opinion is held, but as the critical struggle to protect this vital children’s health insurance pro-gram continues through the summer, children’s advocates must speak up for children.

The most likely result of this battle over SCHIP will be approval of a compromise funding level which will begreater than the original budget recommendation but not sufficient to cover the additional two million chil-dren eligible but not enrolled in SCHIP.

A final note of special interest to senior pediatricians is a report by theUrban Institute, quotedby John Iglehartin the New England Journal of Medicine July 5, 2007, which concludes that children have been a diminishingnational priority during the past half century. In this period, real (inflation adjusted) federal spending on chil-dren inmore than 100 programs (health and non-health) grew from$53 billion in 1960 to $333 billion in 2006,a change from 1.9% to 2.6% of the GDP (Gross Domestic Product). The comparison of spending on the largefederal entitlementprograms, the“non-child” components of Social Security,Medicare andMedicaid that ben-efits disabled and elderly, nearly quadrupled from 2% to 7.6% of the GDP, from $58 billion to $993 billion.

Call orwrite your congressmenand senators about SCHIP.Make your opinions known. Andplease contactmeat [email protected] with your thoughts and suggestions.



Good evening, my fellow Americans: First, I shouldlike to expressmygratitude to the radio and televisionnetworks for the opportunity theyhave givenmeoverthe years tobring reports andmessages to ournation.My special thanks go to them for the opportunity ofaddressing you this evening.

Three days fromnow, after a half century of service ofour country, I shall lay down the responsibilities ofoffice as, in traditional and solemn ceremony, theauthority of the Presidency is vested inmy successor.

This evening I come to you with a message of leave-taking and farewell, and to share a few final thoughtswith you, my countrymen.

Like every other citizen, Iwish thenewPresident, andall whowill laborwith him,Godspeed. I pray that thecoming years will be blessed with peace and pros-perity for all.

Ourpeople expect their President and theCongress tofind essential agreement on questions of greatmoment, the wise resolution of which will bettershape the future of the nation.

My own relations with Congress, which began on aremote and tenuous basis when, long ago, amemberof the Senate appointedme toWest Point, have sinceranged to the intimate during thewar and immediatepost-war period, and finally to themutually interde-pendent during these past eight years.

In this final relationship, the Congress and theAdministration have, on most vital issues, cooper-ated well, to serve the nation well rather than merepartisanship, and sohave assured that thebusiness ofthe nation should go forward. Somyofficial relation-ship with Congress ends in a feeling on my part, ofgratitude that we have been able to do so muchtogether.

Wenowstand tenyearspast themidpoint of a centurythat has witnessed four major wars among greatnations. Three of these involved our own country.Despite these holocausts America is today thestrongest, the most influential and most productivenation in the world. Understandably proud of thispre-eminence, we yet realize that America’s leader-ship and prestige depend, not merely upon ourunmatched material progress, riches and military

strength, but on how we use our power in the inter-ests of world peace and human betterment.

ThroughoutAmerica’s adventure in free government,such basic purposes have been to keep the peace; tofoster progress in human achievement, and toenhance liberty, dignity and integrity amongpeoplesand among nations.

To strive for lesswouldbeunworthy of a free and reli-gious people.

Any failure traceable to arrogance or our lack ofcomprehension or readiness to sacrifice wouldinflict upon us a grievous hurt, both at home andabroad.

Progress toward these noble goals is persistentlythreatenedby the conflict nowengulfing theworld. Itcommands our whole attention, absorbs our verybeings. We face a hostile ideology global in scope,atheistic in character, ruthless in purpose, and insid-ious inmethod.Unhappily the danger it poses prom-ises to be of indefinite duration. To meet itsuccessfully, there is called for, not somuch the emo-tional and transitory sacrifices of crisis, but ratherthosewhichenableus to carry forward steadily, surely,and without complaint the burdens of a prolongedand complex struggle – with liberty the stake. Onlythus shall we remain, despite every provocation, onour charted course toward permanent peace andhuman betterment.

Crises there will continue to be. In meeting them,whether foreign or domestic, great or small, there isa recurring temptation to feel that some spectacularand costly action could become themiraculous solu-tion to all current difficulties. A huge increase in thenewer elements of our defenses; development ofunrealistic programs to cure every ill in agriculture; adramatic expansion in basic and applied research –these and many other possibilities, each possiblypromising in itself,may be suggested as the onlywayto the road we wish to travel.

But each proposal must be weighed in light of abroader consideration; theneed tomaintain balancein and among national programs – balance betweentheprivate and thepublic economy, balancebetweenthe cost andhoped for advantages – balancebetweenthe clearly necessary and the comfortably desirable;

Ike had it Right . . .

Eisenhower’s Farewell Address to the NationJanuary 1177,, 11996611by John Bolton, MD, FAAP

Continued on Page 7


balance between our essential requirements as anation and the duties imposed by the nation upon theindividual; balance between the actions of themoment and the national welfare of the future. Goodjudgment seeks balance and progress; lack of it even-tually finds imbalance and frustration.

The record of many decades stands as proof that ourpeople and their Government have, in the main,understood these truths and have responded to themwell in the face of threat and stress.

But threats, new in kind or degree, constantly arise.

Of these, I mention two only.

A vital element in keeping the peace is our militaryestablishment. Our arms must be mighty, ready forinstant action, so that no potential aggressor may betempted to risk his own destruction.

Our military organization today bears little relation tothat known by any of my predecessors in peacetime,or indeed by the fighting men of World War II or Korea.

Until the latest of our world conflicts, the UnitedStates had no armaments industry. American mak-ers of plowshares could, with time and as required,make swords as well. But now we can no longer riskemergency improvisation of national defense; wehave been compelled to create a permanent arma-ments industry of vast proportions. Added to this,three and a half million men and women are directlyengaged in the defense establishment. We annuallyspend on military security more than the netincome of all United States corporations.

This conjunction of an immense military establish-ment and a large arms industry is new in theAmerican experience. The total influence – eco-nomic, political, even spiritual – is felt in every city,every Statehouse, every office of the Federal gov-ernment. We recognize the imperative need for thisdevelopment. Yet we must not fail to comprehend itsgrave implications. Our toil, resources and liveli-hood are all involved; so is the very structure of oursociety.

In the councils of government, we must guardagainst the acquisition of unwarranted influence,whether sought or unsought, by the military-indus-trial complex. The potential for the disastrous rise ofmisplaced power exists and will persist.

We must never let the weight of this combination

endanger our liberties or democratic processes. Weshould take nothing for granted. Only an alert andknowledgeable citizenry can compel the propermeshing of the huge industrial and militarymachinery of defense with our peaceful methodsand goals, so that security and liberty may prospertogether.

Akin to, and largely responsible for the sweepingchanges in our industrial-military posture, has beenthe technological revolution during recent decades.

In this revolution, research has become central, italso becomes more formalized, complex, and costly.A steadily increasing share is conducted for, by, or atthe direction of, the Federal government.

Today, the solitary inventor, tinkering in his shop, hasbeen overshadowed by task forces of scientists in lab-oratories and testing fields. In the same fashion, thefree university, historically the fountainhead of freeideas and scientific discovery, has experienced a rev-olution in the conduct of research. Partly because ofthe huge costs involved, a government contractbecomes virtually a substitute for intellectual curios-ity. For every old blackboard there are now hundredsof new electronic computers.

The prospect of domination of the nation’s scholarsby Federal employment, project allocations, and thepower of money is ever present – and is gravely to beregarded.

Yet, in holding scientific research and discovery inrespect, as we should, we must also be alert to theequal and opposite danger that public policy coulditself become the captive of a scientific-technologicalelite.

It is the task of statesmanship to mold, to balance, andto integrate these and other forces, new and old,within the principles of our democratic system – everaiming toward the supreme goals of our free society.

Another factor in maintaining balance involves theelement of time. As we peer into society’s future, we– you and I, and our government – must avoid theimpulse to live only for today, plundering for, forour own ease and convenience, the preciousresources of tomorrow. We cannot mortgage thematerial assets of our grandchildren without askingthe loss also of their political and spiritual heritage.We want democracy to surv ive for all generations tocome, not to become the insolvent phantom oftomorrow.

Continued on Page 8

Eisenhower’s Farewell Address to the Nation Continued from Page 6

During our pediatric careers, all ofus have known, either personallyor by their accomplishments, the“Big Guns” in our Specialty.However, for me personally, I canthink of no one that I have morerespect or admiration for than thePediatrician’s Pediatrician, Dr. BobGrayson.

I have known Dr. Grayson sincethe late fifties and, as the title ofthis article says, he has alwaysbeen, and still is, the quietachiever. I met him at a Pediatricmeeting in Miami, Florida in 1957

or 1958, I don’t really remember,but what I do remember is that wehit it off right away, both being“damn yankees” and sharing acommon interest in caring forPreemies, me in Jacksonville,Florida and Dr. Grayson in Miami,Florida.

His early days were spent estab-lishing a practice in Miami Beach.However, during this time, he alsoquietly organized the Departmentof Pediatrics at Jackson MemorialHospital in Miami, bringing intothe department such “Big Guns”

as Dr. Bill Cleveland to chair thedepartment and Dr. EdwardoBancalari as the first Neo na -tologist in the Miami area.

In addition to his work at all thelocal hospitals, Dr. Grayson wasvery active in the Miami PediatricSociety and, if my memory servesme correctly, he served as itsPresident for a number of yearsquietly accomplishing many goodthings for the children in theMiami area.


Down the long lane of the history yet to be writtenAmerica knows that this world of ours, ever growingsmaller, must avoid becoming a community of dread-ful fear and hate, and be, instead, a proud confeder-ation of mutual trust and respect.

Such a confederation must be one of equals. Theweakest must come to the conference table with thesame confidence as do we, protected as we are by ourmoral, economic, and military strength. That table,though scarred by many past frustrations, cannot beabandoned for the certain agony of the battlefield.

Disarmament, with mutual honor and confidence, isa continuing imperative. Together we must learn howto compose differences, not with arms, but with intel-lect and decent purpose. Because this need is so sharpand apparent I confess that I lay down my officialresponsibilities in this field with a definite sense of dis-appointment. As one who has witnessed the horrorand the lingering sadness of war – as one who knowsthat another war could utterly destroy this civiliza-tion which has been so slowly and painfully builtover thousands of years – I wish I could say tonightthat a lasting peace is in sight.

Happily, I can say that war has been avoided. Steadyprogress toward our ultimate goal has been made.But, so much remains to be done. As a private citizen,I shall never cease to do what little I can to help theworld advance along that road.

So – in this my last good night to you as your President– I thank you for the many opportunities you have

given me for public service in war and peace. I trustthat in that service you find some things worthy; as forthe rest of it, I know you will find ways to improve per-formance in the future.

You and I – my fellow citizens – need to be strong inour faith that all nations, under God, will reach thegoal of peace with justice. May we be ever unswerv-ing in devotion to principle, confident but humblewith power, diligent in pursuit of the Nations’ greatgoals.

To all the peoples of the world, I once more give_expression to America’s prayerful and continuingaspiration:

We pray that peoples of all faiths, all races, allnations, may have their great human needs satisfied;that those now denied opportunity shall come toenjoy it to the full; that all who yearn for freedommay experience its spiritual blessings; that thosewho have freedom will understand, also, its heavyresponsibilities; that all who are insensitive to theneeds of others will learn charity; that the scourgesof poverty, disease and ignorance will be made todisappear from the earth, and that, in the goodnessof time, all peoples will come to live together in apeace guaranteed by the binding force of mutualrespect and love.

Now, on Friday noon, I am to become a private citi-zen. I am proud to do so. I look forward to it.

Thank you, and good night.

Eisenhower’s Farewell Address to the Nation Continued from Page 7

The Quiet Achieverby Richard J. Boothby, MD, FAAP

Continued on Page 9

On the State level, he chairednumerous committees in theFlorida Pediatric Society, not theleast of which was the Fetus andNewborn Committee that heeventually turned over to me afterhe had quietly got it up and run-ning to his satisfaction. In duetime, his State peers recognizedhis many talents and he served aspresident of the Florida PediatricSociety for a number of years.During his tenure, he quietlyworked with another “Big Gun,”Dr. Gerry Schiebler to get Stateinsurance for uninsured new-borns and State funding for theFlorida Neonatal Intensive CareProgram. Both efforts were suc-cessful.

By this time (and probably muchsooner), the folks in the Nationaloffice of the American Academy ofPediatrics recognized Dr. Gray -son’s abilities and accomplish-ments, and sure enough, he waselected District Chairman for theAmerican Academy of Pediatricsin the Southeastern United States.What he quietly accomplished on the National level would fill volumes, but suffice it to say, his bottom line was always the improvement of care for allchildren.

After who knows how many yearsin private practice – thirty or forty,I don’t remember exactly, or inwhich year he actually retired – butwhen Dr. Grayson finally did hangup his stethoscope it did not meanhe was finished doing things forthe Academy. He had an idea afterhe retired, which he brought tofruition when he initiated anddeveloped a Senior Section withinthe American Academy of Pedia -trics. Needless to say, he quietlyassumed the responsibility ofbeing its first Chairperson. And toall of you who are now members ofthe Senior Section, the rest is his-tory thanks to Bob’s efforts. Well

not quite, because he went on toput together the Senior SectionBulletin and was Editor-in-Chiefof the publication for a number ofyears before turning the job overto the very competent people thathave followed him. Incidentally,the Senior Bulletin has been rec-ognized as one of the best publica-tions distributed by the Academy.

Just what Dr. Grayson is quietlydoing for children at the presenttime I can’t honestly say, becauseit has been quite a few monthssince I last spoke with him. On thatoccasion, he was leaving thatsame day to visit his adult childrenin Washington D.C. and NewEngland. This has been typical ofour relationship over these manyyears, going months without talk-ing to each other, and then eithermaking a phone call or seeing oneanother at a State or NationalPediatric meeting and catching upon each other’s activities.

One of the best “old war stories”that I can tell you about the two ofus, and believe me there havebeen many, dates back to the dayswhen there were no such peopleas Neonatologists. We took care ofPreemies the best way we knewhow to at the time (late fifties, earlysixties), Dr. Grayson in Miami andI in Jacksonville as I mentionedearlier. One day, we got on thephone and talked about usingFibrinolysin to help Preemiesdiagnosed with HyalineMembrane Disease. The idea (nowplease don’t chuckle) was that theFibrinolysin put into the vaporiz-ers in their isolettes would dissolvethe hyaline membranes in thebabies’ lungs. Needless to say, itdidn’t, and we moved on to moreconventional treatments, like theUsher Regime for respiratory aci-dosis and the various breathingmachines that helped the babiestremendously while their lungsmatured. Also at this time, a new

group of specialists calledNeonatologists appeared and tookover the special care that thesebabies required. The time hadcome for the Bob Graysons andthe Dick Boothbys and all theother “fly by the seat of our pants”General Pediatricians to step backand let modern pediatric medi-cine progress as it should and did.

Finally, for all of us who know BobGrayson the man, I don’t think anyof us have known him to be angrywith anyone – upset maybe,because children were not beingcared for as he thought theyshould be – but never angry. Hehas always spoken with a gentle,quiet voice and has always had abroad smile on his face.

To those of you who do not knowhim, I sincerely hope you will havethe opportunity to meet him atsometime in your careers.


The Quiet Achiever Continued from Page 8

Editor’s NoteDo you want to know whatSCHIP has done?

The following outlines whywe need to continue ouractive support.

In 10 years SCHIP has:

1. Brought 6 million uninsuredchi ldren into the hea l th system.

2. Reduced the percentage ofuninsured children by 1/3.

3. Allowed many children whodid not qualify for Medicaid toget low-cost comprehensivehealth coverage.

4. Given all states flexibility toexpand health coverage andreduce family poverty.

To learn about SCHIP programsin your state, go to www.Insurekidsnow.gov.

New Findings on Americans’ Use of CAMThe findings below, presented at the North AmericanResearch Conference on Complementary andIntegrative Medicine, are based on data from the 2002National Health Interview Survey of over 31,000American adults (nccam.nih.gov/news/report.pdf). The CAM supple-ment was funded by NCCAM.

Patterns of Herb UsePaula Gardiner, MD, of Harvard Medical School’sOsher Institute, presented new findings about peoplewho use herbs for health purposes. The survey partic-ipants who used herbs were more likely than otherparticipants to be uninsured, female, and more highlyeducated; to live in the West; to use prescription orover-the-counter medications; and to identify theirrace/ethnicity (R/E) as “Non-Hispanic Other.” Thepeople who used herbs less tended to identify theirR/E as “Non-Hispanic Black” and to live in the Southor Midwest. The herbs most commonly used wereechinacea (41 percent), ginseng (25 percent), ginkgo(22 percent), and garlic (20 percent). Herbs were usedmost commonly for head or chest cold (30 percent),musculoskeletal conditions (16 percent), and stom-ach or intestinal illness (11 percent). Seventy-two per-cent of the people who used herbs also usedprescription medications. More than half of the peo-ple who used both an herb and a prescription med-ication did not tell a conventional health care providerabout this.

Use by People With CVDGloria Yeh, MD, and Russell Phillips, MD, also of theOsher Institute, found that 36 percent of the partici-pants who had cardiovascular disease (CVD, or dis-eases of the heart and circulatory system) usedCAM—a rate similar to that in the general population.Among these CAM users with CVD, 23 percent usedmind-body therapies (MB) such as meditation, yoga,tai chi, and others. They used MB most commonly formusculoskeletal complaints (24 percent), anxi-ety/depression (23 percent), and stress/emotionalhealth/wellness (16 percent). Only 13 percent usedMB for their CVD specifically, but 94 percent of themfelt that MB for that use was helpful. Using MB formental health treatment and stress management mayalso have cardiac benefits.

Social FactorsAccording to this study’s authors, studies indicatethat CAM use is linked to factors such as gender, R/E,and socioeconomic position (SEP)—more specifi-cally, women, non-Hispanic whites, and people ofhigher SEP are more likely to use CAM. Maria Chao,Dr.P.H., and colleagues at the Richard and HindaRosenthal Center for Complementary Medicine,Columbia University, analyzed more closely the inter-play among those social factors. They found that SEPinfluenced how likely it is that a person will use CAM,regardless of the person’s gender. While SEP also playsa role in whether a person of specific R/E will useCAM, that influence is not as strong.

Alternative MedicineVolume XIII, Number 2: Summer 2006

by Avrum L. Katcher, MD, FAAP


A Push for Direct Depositby Joan Hodgman, MD, FAAP

Four in ten Americans have been victims of identity theft or know someone who has, yet many don’t believeusing direct deposit will prevent financial crime, according to a new poll. The U.S. Department of Treasury-sponsored survey is part of the Go Direct campaign to encourage recipients of federal benefits to switch frompaper checks to electronic transfer of payments into bank accounts. Officials report that about 57,000 signa-tures were forged on Treasury-issued checks last year, a loss of about $54 million. During the same period, prob-lems with direct-deposit payments were negligible. Although officials tout the security advantages of directdeposit, many recipients are wary: 40% percent incorrectly believe receiving paper checks is more effective thandirect deposit at fighting theft or preventing lost payments. For more information on Go Direct, call 1-800-333-1795 or visit www.godirect.org.

Editor’s note:The editor would like to call our readers attention to the following. Although this is only anecdotal information,I have been receiving my county pension by direct deposit for 20 years with no problems.

At some time during their lives, more than 30 percentof U.S. adults surveyed in 2001-2002 had met currentdiagnostic criteria for an alcohol use disorder (AUD),according to an article in the current issue of theArchives of General Psychiatry. Many of those personsnever received treatment, and many others did notreceive treatment until well after AUD onset.

Of those with alcohol dependence, only 24.1 percenthad received any type of treatment, broadly definedto include treatment either by a physician or otherhealth professional, or by 12-step programs, crisiscenters, employee assistance programs, or others. Ofthose with alcohol abuse, only 7.0 percent hadreceived treatment. Although average age of alcoholdependence onset was 22.5 years, average age of firsttreatment was 29.8-a lag time of 8 years. Average ageof alcohol abuse onset was 21.9 years, but averageage of first treatment was 32.1-a lag time of 10 years.

“A lost decade between AUD onset and treatmentleads to personal disability and societal damage,”according to National Institute on Alcohol Abuse andAlcoholism Director Ting-Kai Li, M.D. “Today’s reportsignals the need for intensive efforts to educate pro-fessionals and the public to identify and addressAUDs early in their course.”

Age of disorder onset, related disability, and treat-ment age and type are several of multiple new analy-ses from the 2001-2002 National EpidemiologicSurvey on Alcohol a n d Re l a t e d Cond i t i o n s(NESARC), a representative survey that involved43,000 face-to-face interviews of noninstitutional-ized U.S. civilians aged 18 years and older.

Conducted by the National Institute on Alcohol Abuseand Alcoholism (NIAAA) with supplemental supportfrom the National Institute on Drug Abuse, theNESARC is the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psy-chiatric conditions among gender, age and ethnicsubgroups, including minority subgroups (i.e., AsianAmericans, Native Americans) not previously studiedin sufficient numbers to permit comorbidity analyses.Also for the first time, the authors examine specificand some rare psychiatric conditions that frequentlyco-occur with AUDs, exclude other psychiatric disor-ders due to substance use or other medical condi-tions, and control for the comorbidity of disorderswith each other.

“NESARC data can be used by researchers and healthprofessionals to target preventive and treatmentinterventions for populations at greatest risk,” Dr. Linoted. “They also can be used by policy makers andproviders to plan and allocate treatment resources,and by scientists to explore the common and inde-pendent biological and psychosocial factors thatunderlie AUDs and related psychiatric diagnoses.”

Conclusions from the 2001-2002 NESARC include

Sociodemographic CorrelatesProbability of lifetime alcohol abuse is greater amongpersons aged 30-64 years-the baby boom and gener-ation X cohorts — and lower among persons whonever married and have lower incomes and a highschool education. Probability of lifetime alcoholdependence is greater in the youngest age groupsand among unmarried persons, persons with lowerincomes, and Native Americans.

Disorder Onset and CourseRisk for incurring AUDs is greatest at age 19 anddiminishes thereafter. About 72 percent of personswith lifetime AUD experience a single episode; theremainder experience five episodes, on average, withaverage duration of the longest episodes 2.7 years forabuse and 3.7 years for dependence. Although AUDscan recur, recovery is possible with or without treat-ment see http://www.niaaa.nih.gov/NewsEvents/NewsReleases/Recovery.htm.

AUD-Associated DisabilityAlcohol abuse is associated with reduced social androle emotional functioning, whereas alcohol depend-ence is highly associated with mental disability inaddition to social and role dysfunction. Disabilityincreases steadily with alcohol dependence severityand is greatest among those who do not receive treat-ment. Mental disability among persons with alcoholdependence is comparable to that among personswith drug abuse, mood, and personality disorders.

Co-Occurring DisordersThrough statistical advances introduced in the study,NESARC researchers determined that unique factorsunderlie relationships between alcohol dependenceand most frequently co-occurring disorders. Forexample, different factors explain in part the co-occurrence of alcohol dependence with bipolar dis-


Alcohol Use Disorder:A Lost Decade

Between Onset and TreatmentAuthors Call for National Campaign to Change Public and Professional Attitudes

Continued on Page 12

These two volumes are to be read together. Stubbs hascreated not simply a biography of one of the three orfour most distinguished poets writing in English. Hehas also repeatedly shown how a particular poemrelates to events in Donne’s life (1572-1631), and howthe tumultuous history of England, the political andmilitary relationships with other countries in Europe,during the reign of Elizabeth I and her successors,interacted with Donne’s career, and influenced hischoice of topics for his poems.

If you have a copy of the poems, look at the first of theSongs and Sonnets, titled, The Good-Morrow:

I wonder, by my troth, what thou and IDid till we lov’d? Were we not wean’d till then,But suck’d on country pleasures childishly?Or snorted we in the Seven Sleeper’s den?‘Twas so; but this, all pleasures fancies be.If ever any beauty I did seeWhich I desir’d and got, ‘twas but a dream of

Book Reviewby Avrum L. Katcher MD, FAAP

The Complete Poems of John DonnePackard and Company, Chicago, 1942

John Donne: The Reformed SoulA biography by John Stubbs

Norton and Co. New York, 2007

order, specific phobia, and histrionic and antisocialpersonality disorder. By contrast, the co-occurrenceof alcohol dependence with other affective, anxiety,and personality disorders appears to be related tocommon factors that underlie those other disorders.

TreatmentTreatment rates in 2001-2002 were slightly lower thanrates in the predecessor survey conducted a decadeearlier. Although the current study did not explorereasons for the decline, the authors point to otherstudies that found clinical knowledge gaps, inade-quate organizational support, and low clinician andpatient expectations among possible explanations.

“Evidence on the effectiveness of alcohol treatment isinconsistent with these negative beliefs,” saidNESARC principal investigator, Bridget Grant, Ph.D.,pointing to NESARC findings that treatment and 12-step program participation significantly and substan-tially increase the likelihood of recovery from alcoholdependence. An important first step toward closingthe treatment-need gap would be “an intensive pro-gram ... to educate the public and professionals aboutthe signs and risks of alcohol dependence, to destig-matize the illness, and to promote understanding ofthe benefits of intervention.”

The NESARC data are publicly available and haveproduced more than 90 articles in more than 20 sci-entific journals. Wave 2 of the NESARC, conducted in

2005 among the individuals who participated in Wave1, will yield longitudinal information beginning in2008.

For an interview with Dr. Grant, Chief of the NIAAALaboratory of Epidemiology and Biometry, pleasetelephone the NIAAA Press Office. For an interviewwith lead author Deborah Hasin, PhD, please tele-phone 212/543-5035.

The National Institute on Alcohol Abuse andAlcoholism, part of the National Institutes of Health,is the primary U.S. agency for conducting and sup-porting research on the causes, consequences, pre-vention, and treatment of alcohol abuse, alcoholism,and alcohol problems and disseminates researchfindings to general, professional, and academic audiences. Additional alcohol research informationand publications are available at http://www.niaaa.nih.gov/.

The National Institutes of Health (NIH) — TheNation’s Medical Research Agency — includes 27Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is theprimary federal agency for conducting and support-ing basic, clinical, and translational medical research,and it investigates the causes, treatments, and curesfor both common and rare diseases. For more infor-mat ion about NIH and i t s programs, v is i thttp://www.nih.gov.


Alcohol Survey Reveals ‘Lost Decade’ . . . Continued from Page 11



thee.

And now good morrow to our waking souls,Which watch not one another out of fear;For love all love of other sights controls,And makes one little room an everywhere,Let sea-discoverers to new worlds have gone,Let maps to other, worlds on worlds have shown,Let us possess one world: each hath one, and isone.

My face in thine eye, thine in mine appears,And true plain hearts do in the faces rest.Where can we find two better hemispheres,Without sharp North, without declining West?Whatever dies was not mix’d equally;If our two loves be one, or thou and ILove so alike that none do slacken, none candie.

This poem was written to the great love of his life,Ann More, a 15 year old girl, raised in the cloisteredfashion for women of that time, who, except for theunusual characters of wit and determination, wereclose to chattels. She came from a family of wealthyand well-landed country people. Donne, although adescendant of one of England’ s greatest martyrs, SirThomas More (his maternal great-great uncle), wasthe son of an ironmonger and spent most of his lifeattempting to achieve status according to the rules ofthe day. The marriage was clandestine. They eloped.Donne was 15 years older. Ann’s family were not told.The wedding ceremony was conducted by a friend ofDonne’s. Just about every rule of the upper class soci-ety of the day was broken, and it took many years forAnn and John, in particular John, who had to be abreadwinner, to overcome. But he loved that woman,and she him. She bore a dozen children. More thanhalf died—another customary event of the day. Wornout, she died in childbirth herself, aged 33. Dunnewrote for her gravestone, “At this the widower himself,infant with grief, commanded that this stone speak.”During military service, he often was separated fromher. For one of these occasions, he wrote,

Our two souls, therefore, which are one,Though I must go, endure not yetA breach, but an expansion,Like gold to airy thinness beat.

The other great poem of their love, which I shall notquote, is The Extasie also found in the same volumeas one of the Songs and Sonnets. Donne was con-stantly scribbling his work but did not publish untilshortly before he died. He kept his work for himself.

In his life, he had a number of careers, changing hisefforts according to his perception of where best hemight rise in society. Donne studied classics, and thentrained for the law. At a much later age, his legal advicewas, “Yf any man will sue thee at lawe for thy coate,Let him have thy cloak too, for if thine adversary haveit not, thine advocate will.” Meanwhile, he was apromiscuous seducer of women, and many of hisscintillating songs arose from these experiences. Inlater life, he spoke of chastity, “chastity is not chastityin an old man…but a disability to be unchaste.” Onelove poem, The Relique, speaks of the results of theshortage of graveyard space. Decomposed bodieswere often moved to a public dumping ground.Donne hoped that whoever came to move him, onfinding two skeletons linked by a “bracelet of brighthair about the bone,”

Will he not let’s us alone,And think that there a loving couple lies.

Donne’s career led him from the Inns of Law, toemployment by several of the mighty as a secretary, adogsbody, a man of all work, in the hopes that serv-ice would lead to promotion. He courted the influen-tial aristocrats, making full use of the “ornate poetryof compliment, which was a distinct genre ofRenaissance literature.” When this did not succeed(the impact of his marriage was never overlooked) hewent with the military on several expeditions, most ofwhich ended calamitously, and he was fortunate to beable to return home to resume his earlier efforts. Hehad written one friend, “I am but mine own secretary.”Eventually, in the reign of King James, who succeededElizabeth I, he attained the position of Dean at St.Paul’s cathedral, where he remained until his death.He had survived the transition from the Catholicchurch to the protestant which was the cause of somuch turmoil then, and later of bloody civil war.

During this time, repeated epidemics of disease tookfrom him many relatives and friends. He himself wasoften severely sick and close to death. Once headdressed death directly:

Th’earths face is but they Table; there are setPlants, cattell, men, dishes for Death to eate.In a rude hunger now hee millions drawes Intro his bloody or plaguy, or sterv’d jawes.

On another occasion, he wrote differently aboutDeath in one of his “Divine Poems.” Before beinggiven religious orders, he was in the Navy, fightingthe Spaniards, and although as seen below he could

Book Review . . . The Complete Poems of John Donne . . . Continued from Page 12


Those of us who love to travel are frequently con-cerned about exposure to uncommon illnesses. Wecan travel halfway around the world in a single dayand, as a result, be exposed to diseases which wereformerly considered to be exotic. Here’s an outline ofthe prophylactic measures necessary to prevent someof these diseases including vaccinations and med-ications.

MalariaThe drugs available to prevent malaria includechloroquine, sulfadoxine-pyrimethamine, meflo-quine, atovaquone-proguanil, quinine, and doxycy-cline. In addition, primaquine, which is active againstthe dormant hepatic phase of the parasite may pre-vent relapses. One cannot take primaquine if G6PDdeficient. The drug of choice depends upon the areabeing visited, the probable species of malaria beingencountered, and the drug resistance pattern of theparticular species. The CDC website is very helpful inselecting a drug and providing the appropriate dose.In addition, the CDC has a malaria hotline at (770)488-7788. Most licensed travel clinics should be up todate on malaria prophylaxis. It is frequently recom-mended to begin taking the medication prior to leav-ing. Remember that because of the dormant phase, itis possible that symptoms could not begin until weeksafter contracting the infection. For this reason, pro-phylactic medications must be taken for some timeafter returning home.

Yellow FeverThe areas at risk for yellow fever include

sub-Saharan Africa, Trinidad, Colombia, and theinterior of South America. Western Africa is a partic-ularly high risk area.

Vaccination is the preferred method of prevention.The vaccine must be manufactured under theapproval of WHO and must be administered at anapproved yellow fever vaccination center. A singledose of 0.5ml. of vaccine is administered subcuta-neously. Due to international regulations, the centerthat administers the vaccine must issue a validInternational Certificate Of Vaccination AgainstYellow Fever. If there is a medical contraindication toyellow fever vaccine, the traveler must present aphysician’s letter stating the reason for the waiver andthe letter must bear the stamp of the official vaccina-tion center. The vaccine does have some side effectswhich should be made apparent to the recipient.However, in most cases it is best to get vaccinatedrather than take the risk of exposure without protec-tion.

Despite the efficacy of the vaccine, one must still becareful to limit exposure to mosquitoes.

CholeraThis disease is prevalent in underdeveloped coun-tries in many different parts of the world. There is noimmunoprophylaxis available for cholera. The onlyvaccine manufactured and sold in the US has beendiscontinued. The best means of prevention is to becareful of what is eaten and drunk. Quoting directly

chide or even taunt Death, he himself feared, becausenot all souls awaken in harmony; some find them-selves in everlasting pain. Biographer Stubbs pointsout that the following is one of a number of the DivinePoems which were written by a soul that found itselfalone.

Death, be not proud, though some have called theeMighty and dreadful, for thou art not so;For those whom thou think’st thou dost overthrowDie not, poor Death, nor yet canst thou kill me……………….Why swell’st thou then?One short sleep pass’d, we wake eternally,And death shall be no more. Death, thou shalt die.

As a final note, I shall mention A Hymn to God theFather, written in 1623 after one of his dreadful ill-nesses, made more dreadful by the assaults of hisphysician, concluding,

Swear by thyself that at my death, thy SunShall shine as it shines now, and heretofore;And having done that, thou hast Donne.I have no more.

Read Donne’s poems, and then, if you wish, fit theminto the events and history of a time of troubles, asbeautifully written by Stubbs.


Book Review . . . The Complete Poems of John Donne . . . Continued from Page 13

Travel Medicineby Stanford A. Singer, MD, FAAP



from the CDC website: “Travelers who follow theusual tourist itineraries and who observe food safetyrecommendations while in countries reportingcholera have virtually no risk. Risk increases for thosewho drink untreated water or eat poorly cooked orraw seafood in disease endemic areas.”

SmallpoxIn 1982, WHO deleted smallpox from the list of dis-eases subject to regulation. As a result, smallpox vac-cination need not be given for international travel.

Typhoid FeverTyphoid fever is a risk with travel to the IndianSubcontinent and Africa and to developing countriesin the Caribbean, Asia, Central America, and SouthAmerica. Maps of at-risk areas are available on theCDC website.

There are two vaccines available, however they areonly 50%-80% effective so it is still a good idea toexercise caution in selection of food and drink.

The oral vaccine is a live attenuated Ty21a strain ofS.Typhi and is administered as four capsules taken 48hours apart over a 7 day period. The capsules requirerefrigeration and all four capsules must be taken toachieve maximum efficacy. The capsules are takenone hour before a meal and the entire course of vac-cination must be completed one week before poten-tial exposure. Administration of this oral vaccineneeds to be delayed until 24 hours after completionof an antibiotic regime.

The intramuscular vaccine is made from Vi capsularpolysaccharide and is administered as a single 0.5ml.injection. This vaccine must be administered twoweeks before expected exposure.

Traveler’s DiarrheaThis is probably the most common illness to whichtravelers are exposed. 85% of cases are due to bacte-ria, 10% due to parasites, and 5% due to viruses. Traveldestination determines the amount of risk with thehighest risk areas being Asia, the Middle East, Africa,and Central and South America.

The key to prevention is cautious selection of foodand drink. Food should be eaten piping hot andfreshly cooked. Beverages diluted with water and

foods washed in water should be avoided. Only bev-erages that are bottled and sealed should be consid-ered safe. Other safe beverages are those which havebeen boiled or treated with iodine. It is not safe to eatundercooked meat or seafood and fresh fruits andvegetables. Avoid buying food or beverages fromstreet vendors.

Bismuth subsalicylate is readily available over thecounter and can reduce the incidence of traveler’sdiarrhea. The dose is two ounces of liquid or twochewable tablets four times a day.

Probiotics such as lactobacillus are being studied,but so far results have been inconclusive.

While not recommended for routine use, antibioticsmay prevent traveler’s diarrhea. TMP-SMX and doxy-cycline are no longer efficacious. The first choice atpresent are the flouroquinolones, however increasingbacterial resistance is being reported. Due to thisresistance, Azithromycin is preferred for travel toThailand and Nepal. Rifaximin is a new antibioticrecently approved for diarrhea caused by non invasivestrains of E.Coli. One problem with antibiotic prophy-laxis is that it gives the traveler a false sense of secu-rity causing neglect of necessary food and waterprecautions.

Common ImmunizationsIt is prudent for international travelers to be fullyimmunized against Hepatitis A and Hepatitis B.Tetanus immunization should be updated if therehas been no booster for 10 years. If not previouslyimmune, MMR and Varicella immunizations shouldbe given. In some areas of the world, a single boosterof IPV is recommended.

Cruise ShipsThe CDC under its Vessel Sanitation Program per-forms a complete inspection on a rotating basis ofevery cruise ship leaving from a port in the US.Reports of these inspections can be found on the CDCwebsite (under the tab “Traveler’s Health”). It is wiseto check these inspection reports prior to booking acruise.

Vacations are expected to be enjoyable. By followingthese guidelines, you will be doing your part to makeyour trip a pleasant experience.

Travel Medicine Continued from Page 14


Valuable Attorney’s Advice - No ChargeRead this and make a copy for your files in case you need to refer to it someday. Maybe we should all take someof his advice! A corporate Attorney sent the following out to the employees in his company.

1. Do not sign the back of your credit cards. Instead, put “PHOTO ID REQUIRED.”

2. When you are writing checks to pay on your credit card accounts, DO NOT put the complete account num-ber on the “For” line. Instead, just put the last four numbers. The credit card company knows the rest of thenumber, and anyone who might be handling your check as it passes through all the check processing chan-nels won’t have access to it.

3. Put your work phone # on your checks instead of your home phone. If you have a PO Box use that instead ofyour home address. If you do not have a PO Box, use your work address. Never have your SS# printed on yourchecks. (DUH!) You can add it if it is necessary. But if you have it printed, anyone can get it.

4. Place the contents of your wallet on a photocopy machine. Do both sides of each license, credit card, etc.You will know what you had in your wallet and all of the account numbers and phone numbers to Call andcancel. Keep the photocopy in a safe place. I also carry a Photocopy of my passport when I travel either hereor abroad. We’ve all heard horror stories about fraud that’s committed on us in stealing a Name, Address, SocialSecurity number, and credit cards.

Unfortunately, I, an attorney, have firsthand knowledge because my wallet was stolen last month. Within aweek, the thief(S) ordered an Expensive monthly cell phone package, applied for a VISA credit card, had acredit line approved to buy a Gateway computer, received a PIN number From DMV to change my drivingrecord information online, and more. But here’s some critical information to limit the damage in case thishappens to you or someone you know:

5. We’ve been told we should cancel our credit cards immediately. But the key is having the toll free numbersand your card numbers handy so you know whom to call. Keep those where you can find them.

6. File a police report immediately in the jurisdiction where your credit cards, etc., were stolen. This proves tocredit providers you were diligent, and this is a first step toward an investigation (if there ever is one).

But here’s what is perhaps most important of all: (I never even thought to do this.)

7. Call the 3 national credit reporting organizations immediately to place a fraud alert on your name and alsocall the Social Security fraud line number. I had never heard of doing that until advised by a bank that calledto tell me an application for credit was made over the internet in my name. The alert means any companythat checks your credit knows your information was stolen, and they have to contact you by phone toauthorize new credit.

By the time I was advised to do this, almost two weeks after the theft, all the damage had been done. Thereare records of all the credit checks initiated by the thieves’ purchases, none of which I knew about before plac-ing the alert. Since then, no additional damage has been done, and the thieves threw my wallet away thisweekend (someone turned it in). It seems to have stopped them dead in their tracks.

Now, here are the numbers you always need to contact when your wallet, etc., has been stolen:

1.) Equifax: 800-525-6285

2.) Experian (formerly TRW): 888-397-3742

3.) Trans Union : 800-6807 289

4.) Social Security Administration (fraud line):800-269-0271

We pass along jokes on the Internet; we pass along just about everything. If you are willing to pass this infor-mation along, it could really help someone that you care about.


JAMA. 2007;298:147-148.

Midnight, June 30, 1990, was thelast moment of my so-calledworking life. Nineteen days shortof my 68th birthday, it was notsuffused with pleasure. I hadbeen a pediatrician in a varietyofprivate practice and academicroles. In particular, I had beenmarvelously enriched by the careof patients and the constantopportunity to aid in nurturingthe young in my profession.Pediatrics was my vocation andmy avocation.

My residency experience at theHarriet Lane Home in Baltimorehad left me uncertain. My yearas chief resident did not offerthe epiphany for a next careerstep, a fellowship or privatepractice. I confessed my uncer-tainty to the department chief,whose re sponse was brief: “Ifyou even think about practice,you don’t belong here.” I wentinto practice.

Residency in those years (andtoday?) prepared the nascentpediatrician best for a role wenow define as a hospitalist. Thatbecame clear on my first day inthe real world when a patient’smother asked me nothing ofwhat had consumed me for themany years of training and onlyabout the propriety of her 3-year-old daughter seeing her parentsnude around the house. I had alot to learn and, with yet a longway to go, I have tried during the64 yearssince to learn as much aspossible.

That was part of my problem.Any age, certainly 68, is tooyoungto stop learning, and I didnot want to give up being partytobursting knowledge, to findingout what might be there toknowthe next day and the next. Other

interests or distractionswere notcompelling and, with my mindnot yet fuzzy, it was difficult tostop. Too, I worried that stoppingmight diminishmy sense of self.I still wanted to feel like a pedia-trician. That meant continuingto see children, to teach, and,certainly, to learn.

The chief of our pediatricsdepartment in 1990 was open tosuggestion and did not oftendally with decision-making. Isuggested a continuing role inthe department, attending, goingto clinic regularly, serving oncommittees, particularly internselection, and participating inconferences and other teachingand learning sessions. In return,I asked for office space, part-timesecretarialassistance, funding forone or two trips a year to profes-sional meetings, malpracticeinsurance, and a parking space,but not for a salary. We shookhands on it.

That’s how I got started. It hasbeen almost 17 years. I’mapproaching 85, still feelingwhole; still a pediatrician; stilllearning. The arrangement hasmorphed. I am now a teachingattending, freed of many of thetasks in the customary role. Myprimary responsibility is theexperience of our medical stu-dents. Going to professionalmeetings is infrequent becausemost old colleagues no longerattend. The Internet comple-ments the abundant learningopportunities in the departmentand, of course, in the associationwith the children and our brightyoung residents and students. Avacation of perhaps one month ayear is now a “sabbatical” of fiveto six months. I do not go to clinicvery often, but I am a consistentparticipant on the committees

and at morningreports and con-ferences.

My gratitude runs deep for thesupport of my wife and our fam-ily, for good fortune, for my med-ical and surgical caretakers whohave thus far kept me reasonablywhole despite serial challenges,and for professional colleagueswho must have reasoned that apediatrician first nurtured in the1940s might yet have a capacityto serve. There is a caveat. Theremust be careful consideration ofthe appropriate time to stepaside. This is impelled by fearthat I will not appreciate a lossof clarity and that that might fallto others, who will then try to tellme in a kindly, considerate fash-ion.

There is abundant gratitude, too,for the children and for theyoungin our profession. They are sosmart and they have grasped somuch that is not second naturefor a mid-20th-century gradu-ate—the immune system, forexample. My lecture notesremind me that a lecturer inpathology in 1944 noted that thethymus gland exists and that hedid not know why but that, “assure as God made little greenapples, there had to be a reason.”Our presentunderstanding is buta fraction of what has comealong in the past more than sixdecades, and the learning by thisolder pediatrician has had to bedeliberate, often difficult, paced,and earnest.Knowledge does notnow necessarily flow for me aseasily as it seems to for myyounger colleagues. The dailychallenges they offer are a deli-cious justification just for beingin itwith them.

The struggle to keep pace withContinued on Page 18

On Retirementby Henry M. Seidel, MD, FAAP

Columbia, [email protected]

Most people believe that IQ scores determine an indi-vidual’s intelligence. After all IQ does meanIntelligence Quotient. However, that belief may not bebased in fact. Understanding just what IQ tests assessrequires an understanding of how and why they cameinto existence.

They were a serendipitous happening whose indirectbeginnings lie in the philosophical perspectives ofJean Jacque Rousseau.

Jean Jacque Rousseau reacted negatively to the Age ofReason that was profoundly influencing French soci-ety at the beginning of the nineteenth century. It washis opinion that expression of emotion was a vitalpart of human existence. Emphasis on reason and

logic during the earlier part of the century banishedemotion to distant corners of the heart, suppressingits expression. S uppression of emotion created soci-eties built on cold hard logic, a condition which,according to Rousseau, placed humankind in “chains’,limiting their enjoyment of life and warping theirnatures. He urged a return to man’s natural environ-ment, away from cities, back to fields, streams, andforests where humankind began its existence. It wasonly in such surroundings that humankind’s com-prehensive nature, both emotional and intellectual,could be fully expressed.

In 1798, near the village of Aveyron, France, a boy ofabout eleven years of age emerged from the forest. He



the young asks then what I mighthave had the chutzpah to think Icould offer. Basically, it is toremind constantly of what wehave been reminded so oftenbutwhat seems too often lost in theintimidating impact of dailydemands. For one, there is theunderstanding that taking a his-tory and doing a physical exam-ination involve the story of aperson, unique in time, not just apatient with a chief complaint,and that all chief complaints aremotivated by what has beencalled the iatrotopic stimulus,the doctor-seeking stimulus.1 Iffive people wake up with a sorethroat and four go to work andone goes to a doctor, why did thatone decide to go to the doctor atthat particular time?1

That poses the necessary ques-tion, What is the full meaning ofthe person we would serve, andwhat is it that makes theparticu-lar experience unique? Why isthis happening just nowand howwill the individual influence themanagement and theresult? Theanswers enable the potential of

more success in outcomes thanthe mere pursuit of a diagnosisand the invocation of a pre-scribed regimen. The humancondition, marked by variability,is subject to a Gaussian distribu-tion in constant play. Knowledgealone of the numerator experi-ence almost always lacks theinsight and the feel for uncer-tainty and probability betterassured by the context providedby the denominator.

Indeed, there are too often noclear answers or evident regi-mens. Given this, we need con-stantly and appropriately toshare uncertainty with thepatient, to say unabashedly “Idon’t know” and to pursueunderstanding together andoften with the help of others.Uncertaintysuggests a search forwhat a long-ago colleague calledthe therapeutic intervention.Appreciation of the unique statusof the individual facilitates thediscovery of an interventionmore likely toheal, albeit only inthe one circumstance. Themature clinician,then, enlists the

patient as an ally in the pursuit ofsolutionsand has the skill to dis-cover as fully as possible theessence of the patient, comfortwith uncertainty, and an under-standing of possibilities, proba-bilities, and risk that allows amechanistic approach to be putaside. This is part of the sub-stance that I hope I have beenable to offer as balance for somuch that I have taken in thepast 17 years. This, and the joy!

The point, of course, is that thereare so very many like me in ourprofession. Our conscientiouslypursued experience ofyears maymake valid a resource for teach-ing that can enrich the availableand growing base of knowledge.There is the hope, too, that theexample set by the departmentchairs at Hopkins will be emu-lated so that others in their rolemay not be too quick to put the“retired” aside.

REFERENCES

1. Feinstein AR. Clinical Judgment.Baltimore, MD: Williams &Wilkins; 1967:144.

On Retirement Continued from Page 17

What Is Intelligence?by Alvin S. Yusin

Former Director of the Child Development ProgramLos Angeles County – USC Medical Center

was naked and dirty, and it was not clear as to how hehad survived. However, he piqued the interest of theFrench government. He was Rousseau’s “natural sav-age”, pure and innocent, not yet warped by the chainsof society. It was their hope that he could be incorpo-rated into French society with minimal disruption ofhis “natural state”. The boy’s care was relegated to aphysician residing in Paris, who had worked exten-sively with the deaf. The physician’s name was JeanItard. He called the boy Victor, and established a sys-tem of evaluating and teaching children that becamethe basis of present day approaches.

He first determined what knowledge and activitiesParis society expected of eleven year old boys. Hethen developed assessment tools to determine which,if any, of these expectations Victor met. Having iden-tified Victor’s deficits, he developed programs to teachhim what he did not know.

Itard had a student named Edouard Seguin. Seguinsubsequently applied Itard’s system to large popula-tions of developmentally delayed children. He deter-mined what was expected from children of differentages by French society. He developed tools to assessthe children he followed to identify what deficits theyhad. He then created programs to teach them theinformation they lacked.

Cognitive functions evaluated by Itard and Seguinrelated to what is now called adaptive behavior.Adaptive behavior includes self help skills, communi-cation with others, ability to socialize, and motorfunctions required to carry out communication, selfhelp activities, and socialization.

Itard and Seguin provided the foundation for devel-opmental assessment. It had three components:Determine what functions were required of a normalpopulation of children of a given age, develop assess-ment tools to determine if the population of childrenthey were evaluating could perform those functions,and provide programs to make up the deficienciesidentified by the assessments should functionaldeficits be identified. There is little more to be saidabout such assessments until the Franco – PrussianWar of 1870 at which time assessments were divertedfrom evaluations of adaptive behaviors to evaluationsof academic information.

During the reign of Napoleon III [1851 – 1870], therewere populations of children who were not attendingschool. They ran the streets of Paris getting into mis-chief. They were referred to as street urchins. The aris-tocratic government of Napoleon III, although

sensitive to some extent to the needs of the poor, tookno interest in these children. The emperor was over-thrown after the war, and the third French republicwas established. The government of the third repub-lic was interested in these children, and wanted themto go to school. However, they had no idea as to whatacademic information, if any, these children had.They hired Theodore Binet, a psychologist, and AlfredSimon, a pediatrician, to make that determination.Binet and Simon utilized Itard and Seguin’s approachto evaluation. However, they did not evaluate whatFrench society expected of children of different ages,but rather what academic information these childrenwere expected to have. They used the school curric-ula to fashion their assessment tools. If a child’s aca-demic information was commensurate with what wasexpected of children of their chronological age theywere said to be at grade level. It they had more aca-demic information than what was expected, they weresaid to be above grade level, and if they had less, theywere said to be below grade level. The results of theseassessments were used to establish proper academicprograms to meet their individual needs.

Binet and Simon used chronological age [CA] for thechild’s actual age. However, they used the term men-tal age [MA], instead of academic age, to describe thechild’s level of academic information. Subsequently,a German psychologist by name of Kuhlman, decidedto make a ratio of the MA over the CA and multiply itby 100. He called the result a Mental Quotient.

Henry Goddard, Director of the Vineland School forthe Retarded, brought these tests to the United States.He began to use them to assess American children,but quickly realized that the tests had been standard-ized using information derived from Paris school cur-ricula, not the curricula of American schools. Thematerials were turned over to Lewis Turman, a psy-chologist at Stanford University, who provided thatstandardization, creating the Stanford – BinetIntelligence Scales. Turman continued the practiceof using the ratio of MA over CA, and multiplying it by100. However, he introduced the term IntelligenceQuotient [IQ] for the product obtained.

What becomes quite clear from this review is that, socalled IQ tests were designed to determine what aca-demic information a child had in order to providethat child with a proper academic program. AnIntelligence Quotient [IQ] determined by creating aratio of MA over CA and multiplying it by 100 was anartificial contrivance whose purpose is not clear.However, its creation resulted in a subtle change in the


What Is Intelligence? Continued from Page 18


When I turned 65 plus, I thought,like others of the Roosevelt-influ-enced crowd of seniors, it was timeto quit. Wow! No more night calls,inconvenient trips to the E.R. orrushed C-sections. I knew I wouldmiss my “kids”, their loving,earnest parents, and even thosewell-meaning kooks who occa-sionally would, perhaps feelingunder duress, bring their childrenin and tell you what was wrongand what should be done about it.As I even now am reluctant toadmit, sometimes they were right.

I’ve been fortunate in that I havebeen able to continue to work parttime, avoiding the strains of run-ning a practice, yet still being able

to function as a practicing pedia-trician. Admittedly, after 40 yearsin practice, many colleagueswould not opt for such an arrange-ment.

I naively thought that with all myextra time I would clean out mygarage, read all the books piled onmy night stand, and become amaster painter eagerly sought bygalleries and museums.

Alas - it’s been hard to overcomeold habits and start a new life.When one has resposibilitiesand committments that are preordained it is difficult totransition into an entirely self-directed mode. I am still mak-

ing the transition.

Feeling the lack of perhaps morecommunity oriented projects, Idecided to try and connect withthe Huntington Library andGardens in San Marino.

This is a truly amazing institutionwhich seems to improve each year.They have a great many volunteersin a variety of programs and runactive cultural and educationalprograms for adults and for schoolchildren.

They put out a call for docents toparticipate in a program for 5th,8th and 11th graders, in which


interpretation of academic test results. Instead of testresults being used to provide academic programsbased on a child’s level of academic information, theywere used as IQ scores to assess levels of intelligence.Those with lower levels of intelligence were labeled asbeing mentally retarded with fixed cognitive deficits.

There is a myth accepted as truth that IQ tests, are cul-turally biased. This review clearly identifies the properfunction of IQ tests. They were never developed to cre-ate an artificial score called the IQ. They were devel-oped to provide proper academic programs for schoolchildren. So-called IQ tests are not biased. They doexactly what they are supposed to do. They identifywhat academic information a child has regardless ofhis or her cultural background, so that a school sys-tem can provide that child with a proper academicprogram. With the introduction of IQ scores humanbeings contaminated the original and true purposeof those tests. Indeed, using the term IntelligenceQuotient for the score implies that IQ representscomprehensive intelligence. That implication is notcorrect.

If ratios and scores involving academic achievementdo not constitute comprehensive intelligence, whatdoes?

Perhaps a more reasonable definition of comprehen-

sive intelligence is the human beings’ ability to usetheir cognitive functions, e.g. logic, reason, memory,ability to problem solve, ability to attend, etc. to sur-vive in the diverse environments into which they areborn, and which they encounter as their lives unfold.The school environment is but one of these environ-ments. Within this suggested definition, achievingwell academically represents the ability to survive inan academic environment. The same cognitive com-ponents used to survive in an academic environmentare used to survive in physical environments, such asthe jungle or the desert, in a vocational training envi-ronment such as carpentry, plumbing, and any otherenvironment in which a child, or adult for that mat-ter, finds him or herself.

Hopefully the information presented here will makeus rethink our notions regarding intelligence.Hopefully it will allow us to see that doing poorly in anacademic environment in spite of a proper program,simply means that a child is not doing well academ-ically, not that the child is lacking in intelligence.Hopefully it will allow us to realize how absurd it is toarbitrarily create a ratio multiplied by 100 and call itintelligence. There is no question but that the conceptof IQ and mental retardation has caused more harmthan good. Academic tests should be used as theywere meant to be used, to provide appropriate aca-demic programs for children, and nothing more.

What Is Intelligence? Continued from Page 19

Alternative to Golfby Stanley Rappoport, MD, FAAP


these school groups would be leadon a tour through the Library andAmerican Art Gallery. The themebeing the “Struggle for Freedom”.

Some 40 of us were eventuallyselected for the program whichentailed a month long series oflectures and talks once a week, fol-lowed by practice tours and thena committment to give 1-3 half-days a week to providing this serv-ice. The group consisted of retiredpeople, most of whom seemed tobe teachers, with an occasionalengineer, ex-business man, lawyerand even a retired judge. I think Iwas the only mostly- retired M.D.

Without going into great detail,the aim of the program has beento tie into the standard curricu-lum for U.S. History, a demonstra-tion of original documents andpaintings, in the impressive envi-ronment of the Library whichhopefully would make memorableto the students some of the impor-tant struggles in our history.Although there has been muchviolence in our history, one of theaims of the tour is also to empha-size how we have been successfulin changing things by peacefulmeans.

I personally hadn’t thought aboutthese issues since college and per-sonally experienced a whole newappreciation of our liberties whichwe all take for granted. The story ofa ragtag group of revolutionarieswho managed to conduct a suc-cessful rebellion against the great-est power in the world and thendraft a constituion and Bill ofRights (a really revolutionarystatement of the individuals rightsin society) which became the envyof most of the world which wasthen suffering under oppressiveregimes, still has an air of irreality.Of course, we didn’t get everythingright and the inherent contradic-tions in our young democracy

could not solve all problems, leav-ing such issues as slavery to festeralongside the glowing pronounce-ments of the Declaration ofIndependance.

To bring home to students theevents leading to the Civil War, andthe actual horror and destructionof this period in our history hasbeen a challenge. This and theperiod following the Civil War,with the great promise of emanci-pation degenerating into the real-ities of segregation need to bereemphasized. How our countryhas coped with this, and therelated issues of our sordid treat-ment of American Indians providelessons we need to make sure arenot minimized. Bringing theseissues up to date by discussing thesubsequent amendments to theconstitution and some of the per-tinent supreme court decisions allmake for a crowded tour and achallenge to the aspiring docent.

As an MD talking to children Ithink we tend to be authoritarianand not necessarily listen to theprotests of our patients since whatwe do is, after all, for their owngood. Seeing experienced teach-ers in action and how they haveinteracted with the kids has beena good learning experience.

As a docent, since we are not themain person responsible for theireducation on these issues, thechallenge is to try and dramatizethese issues so they are not merewords on paper. Also since this isnot a school situation, it is impor-tant to get them to react and askquestions and hopefully relateemotionally to these very impor-tant issues. Perhaps we shouldmake the effort to use thisapproach more in dealing withour patients.

The struggle for freedom is anongoing event. Another challenge

for me personally has been to tryand relate these issues to currentevents. It is a difficult task some-times to try to be pertinent andnot be political. The goals of free-dom and democracy can be glori-fied, but the realities of war needto take priority. The lessons ofwhat we have accomplished bynonviolent means do need to takeprecedence.

It’s been a worthwhile experienceto be a docent. There are, ofcourse, many institutions in So.Cal. who use volunteers and whooffer training of this type for thosewho participate. The experienceto continue learning (which oneneeds to do largely on one’s owntime) is valuable and as all theexperts seem to agree, will help usavoid Alzheimers and the horrorsof daytime television.


Alternative to Golf Continued from Page 20

Sunday’s sermon was . . .“Forgive Your Enemies”

Toward the end of the service,the Minister asked, “How manyof you have forgiven your ene-mies?” 80% held up their hands.

The Minister then repeated hisquestion. All responded thistime, except one small elderlylady.

“Mrs. Jones?”; “Are you notwilling to forgive your enemies?”

“I don’t have any.” She replied,smiling sweetly.

“Mrs. Jones, that is very unusual.How old are you?” “Ninety-eight.” she replied. “Oh Mrs.Jones, would you please comedown in front & tell us all how aperson can live ninety-eightyears & not have an enemy inthe world?”

The little sweetheart of a lady tottered down the aisle, facedthe congregation, and said: “Ioutlived the witches”.

The girl (call her Sue) was in highschool. She was popular, an excel-lent student, had lots of friends herown age. Her father was a psychi-atrist, a wise and insightful man;her mother a warm, loving, moth-erly person. Sue returned to schoolfor her sophomore year after awonderful summer and camedown with the same virus thatafflicted half her class. She spent aweek in bed, then went back toschool and promptly pooped out.She spent another week in bed,tried again to go back to school,pooped out again. Her classmatesby this time were all back in schooland functioning normally. Herparents brought her to see me.

Her physical exam was normal.Her laboratory studies were nor-mal. She was not depressed. She

didn’t have any personal or familyproblems. I thought perhaps shehad post-viral fatigue and recom-mended another two weeks athome. She stayed in bed anothertwo weeks, then pooped out again.

Her father was worried; so was I. Iwas pretty sure she didn’t haveanything seriously wrong with her,but pretty sure isn’t alwaysenough. Her father suggested weconsult with his University col-leagues in neurology, psychiatry,endocrinology, hematology. Suehad EEG’s, brain imaging, andextensive laboratory tests. Nothingturned up.

I recommended that she beallowed to continue sleeping everyday for as long as she felt the need.She slept all fall, all winter, all

spring. She ate three meals a day,didn’t lose any weight, remainedcheerful and without symptoms.She did enough studying at hometo keep up with her class. Dad hadher re-examined by his colleagues.Nothing turned up.

Later the second summer shegradually regained her old vivacity.She went back to school withoutincident, graduated from highschool, and went on to a success-ful career in college. She never feltunduly sleepy again.Strange things happen in adoles-cence. They are not necessarilysymptoms of disease or psycho-logical disorder. They test the skilland tact of the physician to theutmost to avoid pathologizing anormal if unusual process.

Pediatricians have long recog-nized that the basic processes thatwork to form a new person arevery robust, and that most of ourefforts are aimed at helping thoseprocesses to work undisturbed.Supply vitamin D, and the childwill grow his own straight bones.Supply a rich and nurturing socialenvironment, and the child willdevelop his own personality. Thereis mystery and magic in thoseprocesses by which an infantbuilds, out of raw, unformedmatrices, the structures thatbecome the differentiated adult.

Gender identity is one of thosemysterious processes. You can seeit taking form even in the first fewmonths after birth. Girl babies onemonth old flirt with their Dads andare all business around Mom. Ayear later they like Mom better. It’san extremely robust process, andthe average parent will never haveto give it a second thought.

When parents do bring up theissue, it is usually to report, won-deringly, that their fifteen-month-

old boy insists on banging toystogether and shoving wheeled toysaround to the sound of motor-likenoises. As one Mom told me, “Iused to be an environmental per-son—you know, a believer that theenvironment controlled this. Buthe’s such a boy, and nobody taughthim!”

One little boy, just 27 months old,came to my office with his foot-ball—almost as big as he was—and spent the whole timethrowing it up and catching it,dropping it, running after it, andrepeating the whole sequence.

Dads sometimes worry when theirtoddler son insists on carryingaround a stuffed toy. I reassurethem that the stuffed toy is not adoll. It is a surrogate identity figureand must be respected at all costs.

Girls have surrogate identity fig-ures too. At sixteen months: Mom: Well, she rubs its nose. Shehad a lot of cold, and she appar-ently gets a tissue and she will rubthe little baby’s nose.

Doctor: “The doll has a runny nosebecause I have a runny nose,” so tospeak.

A three-year-old girl complainsabout the new baby: “He crawls inmy room and knocks over my dol-lies.” I sympathize and makealliance with her and her motherto “keep that kid out of yourroom.”

Shyness is not a gender identityissue. Both boys and girls have aright to use shyness to protecttheir boundaries and controlinteractions with others until theyfeel secure enough to drop thatdefense.

Gender identity is a process thatyou watch unfold. You are not incharge of it. Attempts at deliber-ate, conscious control are notlikely to have any success at all. Italmost always turns out the wayyou hope and expect. What youcan do is to avoid messing in andmessing up that process.


The Mysterious Processes of A New Personby John Gall, MD, FAAP

The Girl Who Slept For A Yearby John Gall, MD, FAAP

While investors themselves may use some prettyunconventional methods to identify attractive stocks,the experts toe a more scientific line. There are threemain approaches that active, as opposed to passive(index funds) portfolio managers use to pick individ-ual stocks; fundamental analysis, quantitative analy-sis and mathema tical analysis. Since mutual fundmanagers often times focus on a single strategy, itmay make sense for investors to incorporate mutualfunds whose managers employ different stock selec-tion techniques in order to maintain a truly diversifiedportfolio. The key is to gain a general understandingof the different approaches used in the stock selectionprocess.

Fundamental analysis examines the relationshipbetween a company’s intrinsic value and its stockprice. The intrinsic value quantifies what the com-pany would be worth if it were to be sold tomorrow,and then determines its corresponding stock price.Research activities surrounding fundamental analy-sis include examining factors such as dividends, cashflow, outstanding debt, and earnings growth rate s.Fundamental research is focused on finding the com-panies whose current stock price doesn’t fully reflectthe potential or growth opportunities of that specificcompany. The goal of the researchers is to find stocksof companies that, based on their fundamental analy-sis, appear to be undervalued by the market.

Quantitative analysis is similar to fundamental analy-sis from the standpoint that both are attempting tofind undervalued stocks. The difference is that ana-lysts and researchers measure and make predictionsutilizing data relating to company performance, ana-lyst estimates, earnings ratios, and economic eventsin an effort to select the most attractive stocks. Theytake their research even further by frequently usingwhat is known in the industry as the “black box”method, which is essentially proprietary softwaremodels that measure such probabilities as how a stockmight perform during a particular interest rate cli-mate or an estimated economic growth rate environ-ment. In contrast to fundamental analysis,

quan titative analysis removes the emotion and anypersonal biases toward a company from the stockpicking process. This may, however, also prove to bea disadvantage since it often fails to take into accountthe human skills utilized primarily in fundamentaltypes of analysis.

Mathematical analysis essentially eliminates the needto use portfolio managers or research analysts toselect stocks, by relying on a carefully constructedmathematical formula to seek performance thatexceeds a market index or other specific benchmark.One of the potential advantages of mathematicallybased portfolio management is the opportunity fordisciplined risk management. Unlike fundamentaland quantitative management, which generally relyon portfolio managers to determine when to sell astock, mathematical models have predetermined risklevels to ensure that market volatility is effectivelymanaged by knowing exactly when a stock will besold, regardless of a gain or a loss.

As most investors know, diversification is a key deter-minant of portfolio returns and potential overall riskreduction. While most investors think of diversifica-tion as investing in various asset classes such as stocks(domestic and international small, medium, large,companies) , bonds (domestic and international) andcash equivalents, it may also make sense to diversifythe methods used to actually select the specific secu-rities. The mutual fund industry, in general, makes thistask relatively easy and straight forward by promotingtheir stock selection process within their own salesand marketing literature. Fund managers may evenuse a combination of these three approaches or otherless well known methods in selecting stocks to includein their fund. Understanding how a mutual fund port-folio manager chooses stocks within the fund is yetanother tool for efficient investment portfolio man-agement.

Mr. Blau and Mr. Paprocki welcome readers’ ques-tions. They can be reached at 800-883-8555 or at


There’s More To It Than Darts, Ouija Boardsand Crystal Balls

by Joel M. Blau, CFP™ and Ronald J. Paprocki, JD, CFP™MEDIQUS Asset Advisors, Inc.

“Results. One client at a time.”(sm)

Securities offered through Joel Blau, a registered representative of Waterstone Financial Group, Member NASD/SIPC.

Waterstone Financial Group and MEDIQUS Asset Advisors, Inc. are independently owned and operated.


The earliest information I could find related to asthmacame from a 5000 years old Chinese folklore talewhich hints of their knowledge of a plant that couldhave been used to relieve respiratory ailments, theycalled it “Ma Huang”. In Western botanical languageits name is now Ephedra Sinica.

Another legend says that around 2700 BC Shen Nong,also known as the “Red Emperor” and who is consid-ered to be the father of Chinese herbal medicine, wasthe first to recognize the medicinal properties of MaHuang. One hundred years later Huang Di, the “YellowEmperor”, in conference with his minister Chi’ Po dis-cussed its application to a disorder characterized byshortness of breath. Huang Di said: “Those who do notrest and whose breath is noisy have a disorder in theregion of Yang Ming (the sunlight) When the disease islocated in the lungs it should improve during the win-ter. If it does not improve in the winter, it will becomemore serious in the summer. If death does not follow inthe summer, the disease will arise again in the fall.One should avoid eating or drinking cold things andshould not wear chilly clothing”. Nagayoshi Nagai(1884- 1929), prestigious Japanese chemist, isolatedephedrine in 1885. In 1893 he was made Professor ofChemistry and Pharmacy at Tokyo University.

History tells us that in Ancient Egypt people believedthat illness and cure were the results of divine inter-vention; that is why physicians were both: priest andhealers. If a patient died but was treated according toa manner approved by the other priests, the priest-physician was not to be blamed.

The Egyptian god of healing was Djehuty, betterknown by his Greek name: Thoth. He was representedwith a human body but with the head of an ibis whichwas a sacred bird for the Egyptians; it had long legsand a long downward bill. Thoth was considered to bethe Creator of Time and Order in the Cosmos. He wasalso said to attend to the birth of all the kings. Thisstory is described in the Ebers Papyrus found in 1873by a German Egyptologist called Georg Ebers. Hefound it at the lower portion of a well preservedmummy. It is twenty meters long and contains almostone thousand prescriptions with remedies forasthma, hepatitis, epilepsy, scurvy, gonorrhea, bald-ness, etc. In the Ebers Papyrus asthma is described asa disorder of the ducts that distribute air to the organs.

Among the identifiable substances mentioned were:frankincense, yellow ochre, grapes, figs, fruit ofjunipers and goose grease. The papyrus also recom-mends the use of inhalations.

In Greek culture, Hippocrates (460-337 BC) is attrib-uted with the creation of the word asthma whichtranslated means “wind” or “to blow” but in clinicallanguage he applied it with the meaning of “panting”.He said: “Such person as become hunchbacked fromasthma or cough before puberty, die”.He understoodthe relationship between respiratory disease and theenvironment. Hippocrates believed that “panting wasthe product of cacochymia (disequilibrium) on thehuman humors which caused phlegm to arise in thebrain, pass through the pituitary gland, condensed inthe nasal cavities and flow into the lungs. The lungswill be blocked due to excess of catarrh.”

In 200 BC, Aretaeus, the Cappodocian, a Greek physi-cian who practiced in Rome is credited with the ear-liest documentation of a description of asthma. Hewrote in Ionic language: “If from running, gymnasticsor work the breathing becomes difficult, it is calledasthma. Orthopnea is also called asthma for thepatient seats erect, pants on account of his breathingand, if reclined, there is danger of being suffocated.”

Clarissimus (“most brilliant”) Claudius Galen (129 -199) was the personal physician of emperor MarcusAurelius and was the first to describe respiration as aresult of muscular contraction and not the expansioncaused by breath warming the heart.

Pliny, the Elder (23- 79) recognized pollen as thesource of respiratory problems and recommendedephedra in red wine for the treatment of asthma.

Among the Hebrews, the Talmud contains a collectionof prescriptions organized according to the parts ofthe body. Chapter IV: “Sickness and their treatment”describes, “the breathing of people is different. Somepeople have a long breath but if they have short breathsthey are possessed by Ruach Katakton” (Ruach fromHebrew: noise, Katakton from Greek: katarryton,catarrhal). The Talmud also recommends the use ofHiltith, Arabic name for asafetida, an odoriferousresin from a plant from the Carrot family which had

Editor’s Note:Before his death in December of last year, Maurice Liebesman sent us several of his distinctive articles about MedicalHistory and we will continue to publish them.

On Medical Stories and Myths . . .

“On Wheezing”by Maurice Liebesman, MD, FAAP



been used by Assyrian doctors as early as 669 BC. Itwas believed that the digestion and elimination ofthis volatile oil through the lungs had therapeuticeffect.

In Ancient Hindu medicine also called Vedic becauseits information was based in the Vedas (holy Sanskritbook) the use of herbs was known for many years andthis knowledge was usually transmitted by oral tradi-tion. The oldest Hindu medical book is attributed toCharaka, a physician to King Kanishka (101- 162).Indian physicians believed that “winds” were essen-tial to the function of the body. If one of the “winds”was working improperly, the “dosas” (juices) will takeover the body and cause disease. Hindu physicianswere first to observe the rhythm of respiration and todocument that a person breaths sixteen times perminute. Their herbal armamentarium was vast. Twoof them: the kuth root and the thorn-applewere usedto extract stramonium known for its relaxing proper-ties. (The British troops during the occupation ofIndia introduced to the West the practice of smokingstramonium for the treatment of asthma).

During the Islamic hegemony, sciences like mathe-matics and medicine, flourished producing manyphysicians who became famous. On the WesternCaliphate (al-Andalus, Arabic name for southern

Spain) physicians like Averroes (1126- 1198) andMaimonides (1135- 1204), and on the EasternCaliphate physicians like Avicenna and Al-Razi, bet-ter known in Europe as Rhazes. This Persian physician(865- 932) was born in Rai, a small town near modernTeheran. He wrote in Arabic his famous Encyclopedia“El- Hawi” where he presents a treatment for wheez-ing: “two drachmas of dried and powdered lungs of afox mixed with a decoction of figs added to drink”

And in the Americas, the early people used naturalresources as cures. Even before the arrival ofEuropeans the Aztecs used to inhale Atochietl andTzompilihuizxihuitl for coryza and to clear up thehead. In Peru, the Incas used “quina-quina” (quinine)extracted from the bark of a tree and for the treat-ment of fever. They also knew of erthoxylon coca as atopical anesthetic. The natives of Brazil used the dryroot of the shrub ipecacuanha, which is known tohave expectorant (and emetic) properties. Sir WalterRaleigh brought tobacco to Europe thinking thatcould be used for enjoyment and the treatment ofasthma. We know now that the idea did not work outwell.

Then came early European medicine but that is a longsubject we will address in a future story.

“On Wheezing” Continued from Page 24

THE SNEEZE They walked in tandem, each of the ninety-two students filing into the already crowded auditorium. Withrich maroon gowns flowing and the traditional caps, they looked almost as grown up as they felt. Dadsswallowed hard behind broad smiles, and Moms freely brushed away tears. This class would not pray during the commencements — not by choice, but because of a recent court ruling prohibiting it.

The principal and several students were careful to stay within the guidelines allowed by the ruling. Theygave inspirational and challenging speeches, but no one mentioned divine guidance and no one askedfor blessings on the graduates or their families. The speeches were nice, but they were routine . . .untilthe final speech received a standing ovation. A solitary student walked proudly to the microphone. Hestood still and silent for just a moment, and then, it happened. All 92 students, every single one of them,suddenly SNEEZED!!!!

The student on stage simply looked at the audience and said, “GOD BLESS YOU, each and every one ofyou!” And he walked off stage ... The audience exploded into applause. The graduating class found aunique way to invoke God’s blessing on their future with or without the court’s approval.

Isn’t this a wonderful story? Pass it on to all your friends.

This is a true story; happened at the University of Maryland.

A A P S e c t i o n f o r S e n i o r M e m b e r sVolume 16 No. 4 – Fa l l 2007

Opinions expressed are those of the authors and not necessarily those of the American Academyof Pediatrics. The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

SENIOR BULLETINEditor: Joan Hodgman, MD, FAAPAssociate Editor: Arthur Maron, MD, MPA, FAAPAdvocacy for Children Editors: Lucy Crain, MD, MPH, FAAP

Burris Duncan, MD, FAAPDonald Schiff, MD, FAAP

Travel & Leisure Editor: Herbert Winograd, MD, FAAPCareer Changes Editor: Jacqueline Noonan, MD, FAAPFinancial Planning Editor: James Reynolds, MD FAAPHealth Maintenance Editor: Avrum Katcher, MD, FAAPComputers Editor: Jerold Aronson, MD, FAAPGeneral Senior Issues Editors: Avrum Katcher, MD, FAAP

Eugene Wynsen, MD, FAAPOutdoors Editor: John Bolton, MD, FAAP

september 03 senior bulle#d2901 - aap.org · s te adil yn c rg h ou f ,b the direction of, the...

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