December 19, 2011
New York Times
By CHRISTIE ASCHWANDEN
THE HYPOTHESIS

THE INVESTIGATOR

Dr. John T. McBride, Akron

Children’s Hospital.

The sharp worldwide increase in childhood asthma over the past 30 years has long perplexed researchers, who have considered explanations as varied as improved hygiene and immunizations. Over the last decade, however, a new idea has emerged.

The asthma epidemic accelerated in the 1980s, some researchers have noted, about the same time that aspirin was linked to Reye’s syndrome in children. Doctors stopped giving aspirin to children with fevers, opting instead for acetaminophen. In a paper published in The Annals of Allergy and Asthma Immunology in 1998, Dr. Arthur Varner, then a fellow in the immunology training program at the University of Wisconsin School of Medicine, argued that the switch to acetaminophen might have fueled the increase in asthma.

Since then, more than 20 studies have produced results in support of his theory, including a large analysis of data on more than 200,000 children that found an increased risk of asthma among children who had taken acetaminophen. In November, Dr. John T. McBride, a pediatrician at Akron Children’s Hospital in Ohio, published a paper in the journal Pediatrics arguing that the evidence for a link between acetaminophen and asthma is now strong enough for doctors to recommend that infants and children who have asthma (or are at risk for the disease) avoid acetaminophen.

Dr. McBride based his assertion on several lines of evidence. In addition to the timing of the asthma epidemic, he said, there is now a plausible explanation for how acetaminophen might provoke or worsen asthma, a chronic inflammatory condition of the lungs. Even a single dose of acetaminophen can reduce the body’s levels of glutathione, an enzyme that helps repair oxidative damage that can drive inflammation in the airways, researchers have found.

“Almost every study that’s looked for it has found a dose-response relationship between acetaminophen use and asthma,” Dr. McBride said. “The association is incredibly consistent across age, geography and culture.”

A statistical link between acetaminophen and asthma has turned up in studies of infants, children and adults. Studies have also found an increased risk of asthma in children whose mothers who took acetaminophen during pregnancy.

For instance, a study published in The Lancet in 2008 examined information collected on more than 205,000 children from 31 countries as part of the International Study of Asthma and Allergies in Childhood, known as the Isaac study. The 2008 analysis found that children who had taken acetaminophen for a fever during the first year of life had a 50 percent greater risk of developing asthma symptoms, compared with children who had not taken the drug. The risk rose with increasing use — children who had taken acetaminophen at least once a month had a threefold increase in the risk of asthma symptoms.

A study published by British researchers in 2000 using data from the Isaac study found that the prevalence of asthma increased in lock step with sales of acetaminophen in the 36 countries examined. The more acetaminophen used in a country, the greater that country’s prevalence of asthma.

A meta-analysis published in 2009 calculated that children who had taken acetaminophen in the past year had nearly double the risk of wheezing compared with those who had not taken the drug. “We know that acetaminophen can cause increased bronchial constriction and wheezing,” said Mahyar Etminan, a pharmacoepidemiologist at the University of British Columbia and lead author of the study.

Still, Dr. Etminan believes it is not yet clear that acetaminophen itself is responsible for the increasing prevalence of asthma. “Children who take acetaminophen are usually getting it for fever control, and they get fevers because they have viral infections, which on their own are associated with developing asthma later in life,” Dr. Etminan said. “It’s hard to tease out whether it’s the drug or the viral infection.”

Another potential problem, Mr. Etminan said, is that many of the studies required parents to accurately recall how much acetaminophen they gave their children, and how often. Parents whose children have asthma are likely to scrutinize the events that preceded an attack, he said, and thus may be more likely than other parents to recall giving their children the drug.

So far, only one randomized controlled trial has investigated the link. Researchers at Boston University School of Medicine randomly assigned 1,879 children with asthma to take either acetaminophen or ibuprofen if they developed a fever. The results, published in 2002, showed that children who took acetaminophen to treat a fever were more than twice as likely to seek a doctor’s care later for asthma symptoms as those who took ibuprofen.

Other trials are in the works. Dr. Richard Beasley, a professor of medicine at the Medical Research Institute of New Zealand, is just completing a 12-week randomized controlled trial of acetaminophen to see if the drug provokes or worsens asthma in adults. The results of that trial will be completed next year. Dr. Beasley said the highest priority now should be rigorous trials to test whether acetaminophen use in infancy increases the risk of developing asthma.

“I cannot say with 100 percent certainty that acetaminophen makes asthma worse, but I can say that if I had a child with asthma, I would give him or her ibuprofen for the time being,” Dr. McBride said. “I think the burden of proof is now to show that it’s safe.”

Not all experts agree. “At this time I just don’t feel you can recommend one over the other,” said Dr. Stanley Szefler, head of pediatric clinical pharmacology at National Jewish Health in Denver. “They both have advantages and disadvantages.”

Aspirin and other nonsteroidal anti-inflammatory drugs, including ibuprofen, are known to provoke asthma attacks in some people, Dr. Beasley noted. He suggested a middle course for parents: Simply use acetaminophen (also known as paracetamol) more sparingly. “We should be reserving paracetamol for very high fevers or for major pain relief,” he said. “We know that paracetamol is used much more widely than that — when a child is a bit irritable or teething or having an immunization.”

To read the complete article, go to: http://www.nytimes.com/2011/12/20/health/evidence-mounts-linking-acetaminophen-and-asthma.html?ref=health

October 18, 2011
New York Times
By AGENCE FRANCE-PRESSE

Watching television or videos is discouraged for babies younger than 2 because studies suggest it could harm their development, a pediatricians’ group said Tuesday.

Instead of allowing infants to watch videos or screens, parents should talk to them and encourage independent play, said the first guidelines on the subject issued in more than a decade by the American Academy of Pediatrics.

The advice is the same as that issued in 1999 by the group, the country’s largest association of pediatricians, but this time it also warns parents that their own screen-watching habits may delay their children’s ability to talk.

“This updated policy statement provides further evidence that media — both foreground and background — have potentially negative effects and no known positive effects for children younger than 2 years,” it said. “Thus the A.A.P. reaffirms its recommendation to discourage media use in this age group.”

The latest guidelines do not refer to interactive play like video games on smartphones or other devices, but to programs watched passively on phones, computers, televisions or any other kind of screen.

Dr. Ari Brown, a pediatrician in Austin, Tex., who is a member of the academy, said the update was needed because of the explosion of DVDs meant for the under-2 age group, and because as many as 90 percent of parents acknowledge that their infants watch some sort of electronic media.

“Clearly, no one is listening to this message,” she said. “In this ubiquitous screen world, I think we need to find a way to manage it and make it a healthy media diet.”

The American Academy of Pediatrics urges pediatricians to discuss media use with new parents, and says adults should be aware of how distracted they become when the television is on.

“I like to call it secondhand TV,” said Dr. Brown, who is the lead author of the guidelines.

Studies cited in the guidelines say that parents interact less with children when the television is on, and that a young child at play will glance at the TV — if it is on, even in the background — three times a minute.

“When the TV is on, the parent is talking less,” Dr. Brown said. “There is some scientific evidence that shows that the less talk time a child has, the poorer their language development is.”

Though about 50 studies have been done in the past decade on media viewing by young children, none have followed heavy television watchers into later childhood or adulthood, so any long-term effects are not known. Heavy media use in a household is defined as one in which the television is on all or most of the time.

To read the complete article, go to: http://www.nytimes.com/2011/10/19/health/19babies.html?hp

October 14, 2011
New York Times
By TARA SIEGEL BERNARD

It took five attempts for one prospective college student and her mother to fill out the 106-question federal form that would determine whether she would be eligible for financial aid. And that was not just because the form was frustratingly complicated. What tripped them up was the fact that the student had two legal mothers — and the form had room for only one.

Further confusing matters, her mothers had since split and married other women; they have six children among them. “It was so stressful and so frustrating to try to fit our family into those forms when so clearly it wasn’t going to fit,” said the student, who is now a senior at a university in Illinois and wanted to remain anonymous to keep her family’s financial affairs private. “You feel like you are lying no matter what you do.”

The aid form, the Free Application for Federal Student Aid, is the single most important document in determining how much and what type of financial aid students get. But the form, informally called Fafsa, has not kept up with the changing composition of families, in large part because the federal agency that issues it has to abide by the Defense of Marriage Act, which recognizes only heterosexual marriage. Because these students cannot fully portray their family’s finances, the amount of aid they receive may not fairly reflect their needs.

“In some cases, they are robbed of aid they would have otherwise received, and in other instances they benefit from it,” said Crosby Burns, special assistant for the Lesbian, Gay, Bisexual and Transgender Research and Communications Project at the Center for American Progress, a research organization that recently published a report about these issues in the financial aid process.

This is not solely an issue for children of same-sex parents. Any children with unusual family circumstances — whether their parent is in jail, involved in a messy divorce or simply refuses to provide support — can have trouble filling out the form. The form’s length and complexity is often a deterrent for would-be students with lower incomes, too. No numbers are available on the number of students from gay and lesbian families who are affected, though Gary Gates, a demographer with the Williams Institute, which studies sexual orientation law and policy issues, has calculated that about 220,000 children under age 18 are being raised by same-sex parents.

Though it is not immediately clear from the actual form, officials from the Department of Education, which issues it, said that applicants with two married mothers or fathers must fill out the Fafsa as if the couple were divorced. They must choose the legal parent who provides more support, which means that the other parent’s income and assets are often ignored. That can give the impression that the student requires more aid — or less — than one from an identical family headed by heterosexual parents. Applicants with same-sex partners, meanwhile, may not be able to include their spouses or other dependents on the form. Other gay students, who are now out on their own because their families have cut off support on learning about their sexual orientation, have difficulty establishing themselves as financially independent. (In some instances, however, colleges could choose to include more information provided by the student and include it in their calculations.)

“Since most other financial aid depends on the application for federal aid, these distortions will trickle down throughout the entire financial aid application process, even outside the federal government’s support,” Mr. Burns said.

The section of the financial aid form that asks for parental information has two lines: one for the applicant’s father/stepfather and another for mother/stepmother. The form also asks for the parents’ marital status, as well as the applicant’s marital status, using the federal definition.

“There is the stigma and indignity of having to list them as divorced, when they are, in fact, not,” said Emily Hecht-McGowan, director of public policy at the Family Equality Council, “It creates confusion and this extra step that children raised by L.G.B.T. parents have to go through,” she added referring to lesbian, gay, bisexual and transgender individuals.

An undergraduate at Harvard, meanwhile, said his challenge was trying to figure out how to get financial aid while excluding his parents. He said that when he was home during winter break in his sophomore year, he told his parents he could not change his sexual orientation. His parents promptly decided to cut off their financial contribution to his studies, he said, and asked him to leave the family home. (The student wanted to remain anonymous to protect his parent’s identities.) He scraped together the last of his savings to get a plane ticket back to Harvard, and his resident dean helped him find a place to stay for the remainder of the break.

But figuring out how to pay tuition was a bigger hurdle. Students under the age of 24 generally must have their parents fill out the Fafsa, unless they can persuade their institution to grant them independent status, which colleges have the power to do. But the Harvard student said that he was told that the university typically required students to take two years off to be deemed independent. “When I first heard this, I was mildly panicking,” he said. “I had no idea what I could do for two years or where I could do it.”

Ultimately, the university agreed to grant him independent status, as long as he took out about $10,000 in total loans, kept a part-time job, and visited a counselor (which made him uncomfortable, since his only experience with therapists was with those who tried to convince him that he could change his sexuality). He was also required to get a letter from his parents explaining why they cut off financial support — something he knew he could not possibly do.

Eventually, Harvard relented and told him it would not require him to get the letter and allowed him to continue his studies. But college officials did urge him to take short break to clear his head. “It was a pretty intense series of steps to get into this independent status,” he said. He is taking the current semester off, and will start his senior year in January. “I know if I had been at any other university, I would have had to drop out,” he said, since he had a support system that included his dean. Even so, “It was a pretty excruciating experience.”

To read the entire article, go to:
http://www.nytimes.com/2011/10/15/your-money/for-children-of-same-sex-couples-a-student-aid-maze.html?hp