February 29, 2016

CHW LogoThe Milwaukee harbor looked especially beautiful from the air as I flew above it today, bright blue and sparkling on this uncharacteristically warm and sunny February day.  Unfortunately, my enjoyment of it was marred by the knowledge that the harbor contained a particularly unsavory collection of bacteria – the kind of antibiotic-resistant “superbugs” increasingly causing hard-to-treat infections.  A recent study revealed that bacteria in water samples from that harbor had extremely high rates of resistance to multiple antibiotics.  In fact, bacteria in the harbor were far more likely to be multiply drug resistant than bacteria obtained from sewage samples or from hospitalized patients!  It turns out that antibiotics that get into the water – from being excreted in the urine of patients taking them, from unused medications being flushed down the drain, from agricultural runoff from farms that use antibiotics in animal feed – concentrate in the lake sediment.  This persistence of low levels of antibiotics provides the sort of selective pressure that, through natural selection, leads to the emergence of resistant organisms.

This is a striking example of the way our health care system, designed to heal disease and promote health, can have unintended negative consequences.  Overuse of antibiotics and other antimicrobial compounds (the kinds found in “germ killing” soaps, lotions, fabrics, etc.), and their improper disposal, is paradoxically creating a reservoir of bacteria that will be increasingly hard to destroy.  It’s like an antimicrobial arms race.  And the bacteria are winning.

Our value of health calls on us not only to take care of ourselves, but to think about the impact of what we do on the health of the environment.  After all, environmental factors have a bigger impact on our health than medical care does.   The antibiotic stewardship program at Children’s Hospital of Wisconsin promotes more appropriate antibiotic prescribing.  As individuals, we can also only take (or prescribe) antibiotics when truly necessary.  As tempting as it may be to flush that expired bottle of cefdinir down the toilet, take it to a medication collection station instead.  Consider purchasing antibiotic-free meat and dairy products.  The next time you drive by and admire the beauty of Lake Michigan, consider whether you are inadvertently helping create monsters lurking on the bottom.



Kids Will Be Kids

February 12, 2016

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In many ways, childhood is being extended in the contemporary West.  Until the 1960s, age 18 was considered the beginning of adulthood.  Now, the average age of first marriage continues to rise, teens are encouraged to take a “gap year” before starting college, young people are permitted to be covered by their parents’ health insurance regardless of whether they are considered “dependents,”  new science shows how brain development isn’t really complete until the mid-20s.  Yet at the other end of the age spectrum, childhood is being truncated.

A recent article in The Atlantic by Erika Christakis documents how kindergarten and even pre-school is becoming more focused on drilling and testing, at the expense of the kind of creative play and exploratory building of social, emotional, and cognitive skills that go along with it.  The pendulum has swung, as she describes it, “between a ‘protected’ childhood and a ‘prepared’ one.”  Christakis argues that this is actually counterproductive.  She cites research showing that such highly structured “school readiness” programs – built around direct instruction and repetitive drilling – actually led to worse performance in later grades.

Moreover, the long-term effects of placing such demands on such young children remains unclear.  According to a New York Times story about the Success Academy Charter School in Brooklyn, teachers are encouraged to motivate students as young as kindergarten by fear.  One teacher was video-recorded ripping a first grade girl’s paper in half, putting her in time out, and berating her in front of the class because she was unprepared to discuss a math problem.  Another teacher made a kindergartener who stumbled on a math problem cry so hard she vomited.

This is reminiscent of the relentless focus on academics and performance that characterizes the “tiger mother” approach to child rearing.  The sacrifice of “frivolous” activities is said to be worth the high performance of the resulting child prodigies.  Yet studies show that true creativity is engendered not by hours of math problems and violin practice, but by sufficient unstructuredness during childhood.  For example, in one study, the most highly creative teens in a school (top 5% by teacher rating) were compared with their less creative peers.  The ordinary children had more than 6 times the number of household rules as the most creative ones.  Repetition and drilling may foster skills, but not learning.

Kids have plenty of time to be adults.  When they’re young, let them be kids.

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