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Food allergies, or reactions, are more common than many realize, particularly when dealing with the immature digestive system of a newborn!  Many babies simply cannot break down some of the larger proteins without difficulty. There are times when symptoms begin so severely, or immediately, that it cannot be missed.  More often symptoms increase with exposure and it is around six weeks when you begin to realize that there may be a food source causing the discomfort you are seeing in your child.

Common symptoms that are reactions to a food allergen are:

• Skin reactions – rash, eczema, cradle cap, hives
• Loose stools – blood visible in stool
• Nasal congestion – stuffiness, accompanying cough
• Persistent ear infections
• Colic – GI pain, heartburn, stomach cramps, reflux, gas
• Dark circles under the eyes
• Frequent interruption of sleep

The top 7 food allergens are:

• Dairy
• Egg
• Soy
• Wheat
• Citrus (acidic fruits)
• Peanuts/Tree Nuts
• Shellfish

While most food allergies end up being one of the top seven it is possible to react to other foods, particularly proteins.  It can be difficult to ascertain what food might be bothering your breastfed infant, particularly if dairy is one of the allergens because it can take up to six weeks before it is undetectable in breastmilk, though most moms see improvement within two days to two weeks.  Patience is a key element in this process!

Number One Food Allergen: Dairy

Dairy is by far the most common food allergy but also the hardest to eliminate because of the time it takes to completely leave the system.  However, it does begin to lower and will continue to drop as it is scrupulously kept out of the diet.  Be careful to keep an eye out for all processed foods that all too commonly have casein, whey or other hidden dairy in them.

Milk: Does It Really Do a Body Good?

http://drjaygordon.com/pediatricks/dairy.html

Dairy Terminology

http://drjaygordon.com/nutrition/dairy-terminology.html

Often when there are food allergy symptoms the elimination of dairy, egg, soy and wheat will hit on the food allergen and improvements will be seen within the first week.  If eliminating the top 4, or top 7 food allergens does not help with the identification of the culprit, consider an elimination diet that will help reduce the variables and approach it from the other direction.  While it takes commitment, it is a much easier way to get clear answers to what is causing the symptoms.

Allergy Elimination Diet and a Food Diary

While doing an elimination diet keep a food diary in which you jot down everything that you eat, leaving a column to note baby’s symptoms as well. A food that a nursing mom ingests will be into the baby’s system within 4-6 hours of consumption.  If an infant is extremely allergic to a food it may produce symptoms even from coming in contact with that food or as quickly as the first nursing after mom has eaten the food.  Space the introduction of any food item out by 4-5 days.  This is absolutely key and should not be rushed.  If you are dealing with letting the system calm down after a reaction give it this same 4-5 days.

The Beginning

The elimination diet takes you back initially to only fruits and vegetables minus anything that is very acidic:  any citrus including lemon, lime, grapefruit, orange, pineapple, tomatoes.  There is rarely a reaction to veggies and fruits that aren’t acidic, though it is still a possibility.  A few days of this diet will help you see if the diarrhea or visible blood in stools stops and green BM is turned more “normal” color.  If one of the symptoms you have been dealing with is eczema, it will take a while for the skin to clear up and heal but you should begin noticing that it isn’t as red or flared.

Adding Protein

The next food to add is beans.  This will provide a means for increasing protein without the use of meat at least for the time being.  Use one kind of bean at a time to again, reduce the variables.  I would not recommend using legumes, soybeans or garbanzo beans in the beginning stages, because sometimes children that are allergic to peanuts will react to other legumes or garbanzo beans and soy is in the top 7 food allergens.  There are still a lot of options with pintos, black beans, black-eyed peas, lima beans, navy beans, etc.  This will let you see if your baby can handle the protein in beans and get some protein back into your diet.

Adding Grain

The first grain I would suggest adding is rice. Sometimes it can be an allergen, but usually it is not.  I would continue to keep wheat eliminated in the beginning stages.  As you add other grains remember to always go through the same process of waiting 4-5 days before introducing anything else new.

Meat

I know that it is difficult, for many, to think about a diet that does not include meat, but it is my best recommendation at least temporarily while going through the process of identification of allergens.  There are some couplings of allergies that include meats.  Some babies that are allergic to dairy are also allergic to beef. Some that are allergic to eggs are also allergic to chicken.  In all my years of working with Dr. Jay I have seen one infant that reacted severely to chicken.  That experience taught me to suspect anything as a possible allergen!

You will need to really expand your thinking about veggie options.  Make soups, chili with beans, steam veggies, stir fry veggies, salads…when you get to rice experiment with ones you have never tried before and flavoring them with different veggies diced and cooked with the rice.

With this elimination diet you should begin to identify what the allergens are within a couple of weeks.  The most encouraging thing to see is in a couple of days after you begin veggies and fruits many will begin seeing their baby’s system calm down.  Most situations begin to improve in the first 2-7 days, though some can take 1-3 weeks.  Now it does take patience because their intestines and lining of the stomach are irritated from tolerating things they are reacting to, but it will calm down with a little time.

Once symptoms have subsided, and you feel you have allergens eliminated, other foods may be tested one item at a time.  Take precaution to introduce only one new item at a time with 4-5 days separation.  This gives you enough time to observe for any reactions and eliminate the food with 4-5 days for the system to calm down before introducing another.  Being vigilant about this waiting period will make the whole process easier in the long run and provide more clear answers.

A true food allergy is something that a child is likely to maintain throughout their lifetime, but sometimes what is thought to be a food allergy is actually a food reaction.  Reactions to foods are sometimes outgrown by the age of three with the maturity of the child’s digestion system.

Recommended Reading

I highly recommend the book “Is This Your Child?” by Dr. Doris  Rapp.  This is an eye-opening book regarding children’s allergies.  It’s a thick read, but even taking a look at sections of it will help you understand that food allergies can cause digestion difficulties, skin reactions and even behavioral changes.

Because of damage to Japanese nuclear reactors, radiation is being released.

The amount released has exposed dozens of people who live or work quite close to the reactors and will increase their chances of radiation illness and even cancer. But, the short term danger to those of us hundreds or thousands of miles away appears to be non-existent. Radiation getting into the winds which blow from Japan to the West Coast will not be dangerous even if there’s a complete Chernobyl-type meltdown.

A longer term fear involves contamination of the atmosphere, crops and water with long-lived radioactive iodine and other isotopes. Even this longer view still doesn’t point to any dramatic rise in the risk of illnesses including cancer for Americans. Experts are recommending postponing planned trips to Japan for a variety of reasons mostly involving loss of infrastructure, but they also caution that increased radiation exposure could occur the closer one gets to the cities in Japan containing these damaged nuclear plants.

To summarize, we don’t need potassium iodide right now, we don’t need to lose any sleep and we do need better sources of energy than nuclear power plants. We’re very much OK and not at risk from nuclear meltdowns 5000 miles away.

My thoughts are with the Japanese and those of you here with family in harm’s way.

Best,

Jay

Gisele Bundchen, Nutrition Expert?

Yes!

In a recent magazine article, Ms. Bundchen was quoted saying that breastfeeding should be the legal norm for all babies for the first six months of life.

Of course, this generated a storm of protest about “feeding choices” and whether or not we should listen to someone with her lack of credentials. Lost in the fabricated drama and controversy is the fact the we mustlisten if her advice and high profile can save babies’ lives. I’m sure that this one famous mother’s words will be heard and heeded by more mothers than we pediatricians can possibly reach. (Ms. Bundchen’s statement that post partum weight loss is faster because of breastfeeding is very much in line with current medical literature and will certainly appeal to most new mothers.)

It’s easy to misinterpret a forceful metaphorical statement about “chemical food”–infant formula–and the crucial lifesaving value of breastfeeding for six months. And, that’s exactly what pundits did to turn this into an “us against them” issue. “How dare she . . . ”

While it is tragic that a supermodel-mom dispenses better advice than many doctors and most governmental agencies, it’s impossible to misinterpret what the World Health Organization says about these artificial (chemical) feeding options:

The protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. It is estimated that high coverage of optimal breastfeeding practices could avert 13 percent of the 10.6 million deaths of children under five years occurring globally every year. Exclusive breastfeeding in the first six months of life is particularly beneficial, and infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.”…

There is a common misconception that in emergencies, many mothers can no longer breastfeed adequately due to stress or inadequate nutrition, and hence the need to provide infant formula and other milk products. Stress can temporarily interfere with the flow of breast milk; however, it is not likely to inhibit breast-milk production, provided mothers and infants remain together and are adequately supported to initiate and continue breastfeeding. Mothers who lack food or who are malnourished can still breastfeed adequately, hence extra fluids and foods for them will help to protect their health and well-being.

If supplies of infant formula and/or powdered milks are widely available, mothers who might otherwise breastfeed might needlessly start giving artificial feeds. This exposes many infants and young children to increased risk of disease and death, especially from diarrhea when clean water is scarce. The use of feeding bottles only adds further to the risk of infection as they are difficult to clean properly.”

Moreover, not breastfeeding has been found to double the risk of SIDS (Sudden Infant Death Syndrome)

Read just one sentence above aloud:

“Infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.”

No parent in America is allowed to let their infant travel in a car in the “second best” way possible: Car seats are the law in all 50 states. A breastfeeding law will not be passed soon, but there is a moral, ethical and medical imperative to get this nutrition information to mothers and families any way we can. Hyperbole is easy to ridicule but, in this case, the hyperbole will prevent the deaths of many, many babies worldwide.

The World Health Organization estimates that one-and-a-half million babies die from lack of breast milk each year. 1,500,000.

If Gisele Bundchen’s magazine interview, comments and the resultant furor cause more mothers in developing nations to breastfeed, thousands and perhaps tens of thousands of babies will be alive a year, two years or five years from now who might otherwise have succumbed to diseases caused or fatally exacerbated by lack of mother’s milk.

I certainly wish that this legal proposal/metaphor had been issued by the government, health insurers or the American Academy of Pediatrics. In lieu of those recommendations, the very intelligent suggestion of a really smart mom will have to do.

• artificial butter flavor
• butter, butter fat, buttermilk
• casein
• caseinates (ammonia, calcium, magnesium, potassium, sodium)
• cheese
• cottage cheese
• curds
• custard
• half and half
• hydrolysates (casein, milk protein, protein, whey, whey protein)
• lactalbumin, lactalbumin phosphate
• lactoglobulin
• lactose
• milk (derivative, protein, solids, malted, condensed, evaporated, dry, whole, low fat, non fat, skim)
• nougat
• pudding
• rennet casein
• sour cream, sour cream solids
• sour milk solids
• whey (delactosed, demineralized, protein concentrate)
• yogurt

Ingredients that MAY indicate the presence of milk protein:

• brown sugar flavoring
• caramel flavoring
• chocolate
• high protein flour
• margarine
• natural flavoring
• Simplesse
• A “D” on a product label next to a “K” or circled “U” may indicate the presence of milk protein.

Links

• Milk Allergy Print-out/Handout *NEW*
• Kosher Cooking – Using Pareve Foods *NEW*

Nursing babies “cost” about 1000 calories per day so breastfeeding is one of the most efficient ways to make sure that the extra fat and water added during pregnancy are transferred to the rightful owner.

Nursing moms, and almost everyone else, need about 1800 calories/day to “get by” and much less than that is not healthy. Here are a few tips for getting into shape safely and a little bit faster:

• Eat healthy foods. (All together now, “duh.”) This really is overlooked, though. Emphasize nutrient-rich foods which are not “calorically dense.” Avoid greasy snack foods and so-called healthy foods like cheese and whole milk. Eat more fruits, grains, pastas and beans and avoid red meat and salads laden with dressing.
• Try to build some outdoor activity into your day. (“In my spare time and with my spare energy??) Somehow. Walk with your baby every day and try to get a jogging stroller added to your wish list. Slings make carrying your baby more efficient and burn more calories. In my experience, even moms who really didn’t have the time and energy to exercise a little, feel just great when they somehow do it.
• Drink more water. Avoid soda and juice. These are truly empty calories.
• Combining 100 to 200 fewer calories per day of higher fat foods (that’s just a couple spoonfuls of dressing or a piece of cheese) with 20 to 40 minutes of a good walk with your baby (200 calories out) will lead to exactly the weight loss and conditioning you want. Add in a little formal or informal yoga and stretching and you’ll get there even sooner.
• Above all, be nicer to yourself. This is not a contest nor a sprint. You are an extraordinarily important and extraordinarily busy person: a Mother. Get into shape at a pace that suits you, not the rest of the world.

The warning signs in super markets about swordfish telling pregnant women to limit the number of servings per month would lead me to a similar conclusion: Why eat any mercury-containing fish at all?

Stay active, eat as well as you can focusing on meals with lots of fruits, veggies, reasonable amounts of healthy protein, avoid alcohol, decrease or eliminate dairy products to have the healthiest pregnancy and the healthiest baby.

Whooping cough, also known as pertussis, is a bacterial respiratory tract infection. It begins looking like most other upper respiratory illnesses:

There may be nothing more than a runny nose and sneezing, often with little or no fever. The first coughs can look like a common cold. After 1-2 weeks, this may progress to a stage characterized by bursts of numerous rapid coughs (paroxysms, a “machine gun” cough) followed by a loud “whooping” inhalation, which gives Bordetella Pertussis the alternative name of “whooping cough.” That “whoop,” however is not an invariable part of the illness. A final recovery stage with coughing may last weeks or months. It’s a nasty illness which the Chinese call the “100 day cough” and their number is not far off. In most cases, whooping cough is a truly miserable cough that can ruin a family’s summer plans and mean a lot of missed days of work and school. In very rare cases, it can lead to much more serious conditions. The risk is highest for infants in the first six weeks of life who can get very sick and even die from it.

At the present time, I’m aware of two families in my practice who I believe have pertussis. I have no laboratory confirmation and in neither case has anyone in the family required hospital care.

The media and many official medical organizations get the discussion of “epidemics” wrong as often as they get it right and when they finally have something to talk about in the press it’s hard to sort out the truth. Before you read any further, have a look at this New York Times article about the whooping cough “epidemic that wasn’t.”

This time, unlike the H1N1 “pandemic” scare, the avian flu hype, the measles epidemic of 132 cases, the Jewish mumps scare and the West Nile Virus fear posters at every trail head, the pertussis outbreak information might be real and might be a reason to consider getting your child vaccinated. Whooping cough is not easy to diagnose with lab tests and doctors and parents often must rely on their clinical impression the cough and the pattern of disease spread. According to the official website of Children’s Hospital of Philadelphia, an article reviewed by Dr, Paul Offit estimates that there are between “600,000 to 900,000″ cases of pertussis each year in adults and adolescents alone. This stands at odds with official data from the CDC which puts that number at 5000-10,000. This type of disparity makes the discussion of pertussis outbreaks and vaccination just a little more difficult.

I think the DTaP vaccine is the shot with the best risk/benefit ratio and it’s the vaccine I use the most often in my office week. The official schedule includes far too many shots for six-week-old babies. A lot of harm and confusion could be alleviated by vaccinating later and not giving five or six vaccines at the same time.

This “acellular” vaccine does not contain mercury (almost no vaccines still do) and has been in use for nearly fifteen years in the United States and for quite a few years before that in other countries.

DTaP vaccine prevents whooping cough and may even prevent illness or lessen the severity of illness after the first vaccine. The routine schedule includes three doses in the first six months of life, a fourth at eighteen months of age, a fifth at age five years and booster doses of a new adolescent/adult vaccine. I don’t think your babies under a year of age should be given any vaccines, including this one. The CDC and most doctors, including my colleagues in this office, disagree.

Erythromycin, Zithromax and similar antibiotics can shorten the contagious phase of pertussis and can stop the spread of the illness in a family or a school. Our office has DTaP vaccine for infants and young children and another for older children, adolescents and adults. I do not recommend this vaccine for infants unless there are unusual risk factors in a baby’s life. Again, the vast majority of experts disagree, and I understand the need for public health considerations and preservation of herd immunity but still would rather vaccinate only after 12-24 months of age and feel comfortable, in most cases, giving no vaccine at all.

Ultimately this is a parents’ decision. Do not expect the media to let up on this issue in the near future.

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Tylenol Recall Update

Since the April recall, Children’s Tylenol, Benadryl, Motrin and other McNeil Pharmaceutical products are still unavailable for purchase. The latest report says we should not expect a return of these products until 2011. You can receive updates from the makers of Tylenol on their website. In the meantime, I recommend generic brands of diphenhydramine (Benadryl) for allergies and generic acetaminophen and ibuprofen for fever control when you need it.

Here is a resource to help you determine the proper amount of acetaminophen to give your child.

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Jay Gordon, MD, FAAP

Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.

Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.

In 1918, it appears that influenza A (an H1N1, by the way) did this globe-trotting mutation and killed millions. The times and state of medical care are not comparable, but a milder parallel occurrence is possible. Perhaps this happens every 100 years or so, perhaps every three million.

Whenever possible, we should form antibodies against viruses at the right stage of their existence and at the right stage of our lives (For example, chickenpox in childhood and EBV/mono in early childhood. There are many other examples.) Getting many viral illnesses confers lifetime immunity, and very few vaccines do.

Tamiflu is a very powerful drug with little proven efficacy against this bug, and with its major side effect being tummy upset. I’m not using it at all. Psychiatric side effects are also possible.

I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.

I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry. Yes, one can measure antibodies against a certain bacterium or virus in the blood and it may be associated with someone not getting sick, but there are very few illnesses common enough or enough ethics committees willing enough to do the right tests. That is, give 1000 people the real vaccine and 1000 placebo shots, expose all of them to the disease and see who gets sick. Seriously. I know it sounds terrible.

This is, obviously, a difficult public discussion because it touches on the concept of benefits and risks, again, of morbidity and mortality. Few public officials have the courage or inclination to present all facets of this difficult decision. I give vaccines to my patients every single day, but I always err on the side of caution. Implying that this is a dangerous new shot is not scientifically or statistically correct and represents hyperbole and even dishonesty on the part of the so-called “anti-vaccine” camp.

It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.

I just think that giving this new H1N1 vaccine is not the cautious nor best thing to do.

Best,

Jay Gordon, MD, FAAP

Interestingly, the AAP may actually have dramatically increased integrity under Dr. David Tayloe, our new president, but someone else violated the first rule of publicity: Don’t complain when some one makes you look a lot better than you really are. Even if he does it on April First!!

Dr. Susan E.Burger is one of the world’s foremost experts on international nutrition and epidemiology who shared with me her submission to the New York Times. The Times did not publish this excellent article and I asked her permission to post it here. Thank you very much, Dr. Burger

JNGMD

Goliath and the Gnats:

The resuscitation of an April fools’ joke that should have been allowed to die.
by Susan E. Burger, MHS, PhD, IBCLC, RLC

Increasingly, professional medical associations are evaluating their ethical standards and setting the bar higher. The American Psychological Association responded to a grassroots effort of their membership base by placing moratorium on psychologists participating in the interrogation of detainees. The International Lactation Consultant Association, of which I am a member, recently decided to stop accepting sponsorship from a company that is no longer complying with the International Code of Marketing of Breast-milk Substitutes. On April 1st, the Journal of the American Medical Association published a proposal for controlling conflicts of interest (and it was NOT a hoax).

As a parent, I would expect a professional medical association that declares itself to be “dedicated to the health of all children” to uphold standards at least as high if not higher than others. Unfortunately, it seems as if the American Academy of Pediatrics (AAP) has become distracted by the urge to protect its reputation through silencing one of its critics, rather than clarifying and improving its ethical standards.

The AAP’s protectionist response was triggered when one of its own members posted on Lactnet, a listserve frequented by members of my profession. The pediatrician in question posted a fake press release from the President of the AAP. It does not take a neonatal surgeon to realize that the prominent display ofApril 1st and the poster’s own name suggests this was an April fools’ joke. Just in case anyone missed these obvious clues, the pediatrician clarified that the press release was a fake within several hours of his original post.

What was the essence of the spoof?

The fake press release stated that the AAP would end the ethical problem of receiving money and sponsorships from the pharmaceutical industry.

It apologized for the AAP’s role in watering down a national breastfeeding campaign and allowing a formula company logo to be printed on the Academy’s book on breastfeeding.

It finished with the assurance that the AAP would seek to comply with the International Code on the Marketing of Breast-milk Substitutes, a code published by the World Health Organization (WHO) and endorsed by the United States.

What is true in the fake press release is that the AAP does receive money and sponsorships from the pharmaceutical and formula industry; it did play a role in watering down the breastfeeding campaign; the front cover of its breastfeeding book is imprinted with a formula company logo; and it does not meet its obligations under the International Code of Marketing of Breast-milk Substitutes. What is not true in the fake press release is that the President of the AAP wrote it, apologized about the conflicts of interest, and made assurances about code compliance.

For a day, the false press release provided mild amusement and sighs of “wouldn’t it be great if this were true”. By the next day, the spoof had leaked into online forums and gone global!

A frequent blogger on issues of breastfeeding advocacy who goes by the username of Lauredhel, investigated the resulting chatter in the blogosphere and concluded, “no one who’s paying attention believes it is real”. Like many an April fools’ joke, this spoof should then have quickly disappeared into obscurity.

Unfortunately, the AAP itself resuscitated the discussion. On April 15th, the moderators of Lactnet posted a letter from Nicole Finitzo, attorney for the AAP, to ensure that members of the listserve understood the AAP’s position on the fake press release. The letter from Ms. Finitzo claimed that the fake press release “contains patent misstatements of fact and misrepresents the AAP’s position, and it is defamatory.” The breastfeeding advocacy blogger, Lauredhel, commented,“I do believe this is the very first time I’ve seen someone accused by a lawyer of defamation for claiming that an organization was more ethical than it actually is.”

Ms Finitzo also demanded of the listserve moderators that, “it will be essential for the original items and all copies on your server, wherever located, to be immediately taken out of circulation immediately.” Since the AAP has over 60,000 members and the Lactnet listserve merely comprises a few thousand members, this heavy-handed letter seems like Goliath swatting at gnats. Unfazed by the demand to remove the original items, the moderators of the listserve offered to post a statement on behalf of the AAP if they wish to further illuminate their stance on financial relationships with industry. The AAP has not yet replied.
I’m hoping that the AAP will come to its senses and realize swatting at gnats is a futile endeavor unlikely to earn anyone’s respect. I think the AAP would earn more respect if they chose to set higher standards to control the conflicts of interests that influence policies for children’s health.

Susan E. Burger, MHS, PhD, IBCLC, RLC

Proud member of the International Lactation Consultant Association, the United States Lactation Consultant Association, and the New York Lactation Consultant Association.

Excellent Follow up at HOYDEN ABOUT TOWN

In June 2000, a group of top government scientists and health officials gathered for a meeting at the isolated Simpsonwood conference center in Norcross, Georgia. Convened by the Centers for Disease Control and Prevention, the meeting was held at this Methodist retreat center, nestled in wooded farmland next to the Chattahoochee River, to ensure complete secrecy. The agency had issued no public announcement of the session — only private invitations to fifty-two attendees. There were high-level officials from the CDC and the Food and Drug Administration, the top vaccine specialist from the World Health Organization in Geneva and representatives of every major vaccine manufacturer, including GlaxoSmithKline, Merck, Wyeth and Aventis Pasteur. All of the scientific data under discussion, CDC officials repeatedly reminded the participants, was strictly “embargoed.” There would be no making photocopies of documents, no taking papers with them when they left.

The federal officials and industry representatives had assembled to discuss a disturbing new study that raised alarming questions about the safety of a host of common childhood vaccines administered to infants and young children. According to a CDC epidemiologist named Tom Verstraeten, who had analyzed the agency’s massive database containing the medical records of 100,000 children, a mercury-based preservative in the vaccines — thimerosal — appeared to be responsible for a dramatic increase in autism and a host of other neurological disorders among children. “I was actually stunned by what I saw,” Verstraeten told those assembled at Simpsonwood, citing the staggering number of earlier studies that indicate a link between thimerosal and speech delays, attention-deficit disorder, hyperactivity and autism. Since 1991, when the CDC and the FDA had recommended that three additional vaccines laced with the preservative be given to extremely young infants — in one case, within hours of birth — the estimated number of cases of autism had increased fifteenfold, from one in every 2,500 children to one in 166 children.

Even for scientists and doctors accustomed to confronting issues of life and death, the findings were frightening. “You can play with this all you want,” Dr. Bill Weil, a consultant for the American Academy of Pediatrics, told the group. The results “are statistically significant.” Dr. Richard Johnston, an immunologist and pediatrician from the University of Colorado whose grandson had been born early on the morning of the meeting’s first day, was even more alarmed. “My gut feeling?” he said. “Forgive this personal comment — I do not want my grandson to get a thimerosal-containing vaccine until we know better what is going on.”

But instead of taking immediate steps to alert the public and rid the vaccine supply of thimerosal, the officials and executives at Simpsonwood spent most of the next two days discussing how to cover up the damaging data. According to transcripts obtained under the Freedom of Information Act, many at the meeting were concerned about how the damaging revelations about thimerosal would affect the vaccine industry’s bottom line. “We are in a bad position from the standpoint of defending any lawsuits,” said Dr. Robert Brent, a pediatrician at the Alfred I. duPont Hospital for Children in Delaware. “This will be a resource to our very busy plaintiff attorneys in this country.” Dr. Bob Chen, head of vaccine safety for the CDC, expressed relief that “given the sensitivity of the information, we have been able to keep it out of the hands of, let’s say, less responsible hands.” Dr. John Clements, vaccines advisor at the World Health Organization, declared that “perhaps this study should not have been done at all.” He added that “the research results have to be handled,” warning that the study “will be taken by others and will be used in other ways beyond the control of this group.”

In fact, the government has proved to be far more adept at handling the damage than at protecting children’s health. The CDC paid the Institute of Medicine to conduct a new study to whitewash the risks of thimerosal, ordering researchers to “rule out” the chemical’s link to autism. It withheld Verstraeten’s findings, even though they had been slated for immediate publication, and told other scientists that his original data had been “lost” and could not be replicated. And to thwart the Freedom of Information Act, it handed its giant database of vaccine records over to a private company, declaring it off-limits to researchers. By the time Verstraeten finally published his study in 2003, he had gone to work for GlaxoSmithKline and reworked his data to bury the link between thimerosal and autism.

Vaccine manufacturers had already begun to phase thimerosal out of injections given to American infants — but they continued to sell off their mercury-based supplies of vaccines until last year. The CDC and FDA gave them a hand, buying up the tainted vaccines for export to developing countries and allowing drug companies to continue using the preservative in some American vaccines — including several pediatric flu shots as well as tetanus boosters routinely given to eleven-year-olds.

The drug companies are also getting help from powerful lawmakers in Washington. Senate Majority Leader Bill Frist, who has received $873,000 in contributions from the pharmaceutical industry, has been working to immunize vaccine makers from liability in 4,200 lawsuits that have been filed by the parents of injured children. On five separate occasions, Frist has tried to seal all of the government’s vaccine-related documents — including the Simpsonwood transcripts — and shield Eli Lilly, the developer of thimerosal, from subpoenas. In 2002, the day after Frist quietly slipped a rider known as the “Eli Lilly Protection Act” into a homeland security bill, the company contributed $10,000 to his campaign and bought 5,000 copies of his book on bioterrorism. The measure was repealed by Congress in 2003 — but earlier this year, Frist slipped another provision into an anti-terrorism bill that would deny compensation to children suffering from vaccine-related brain disorders. “The lawsuits are of such magnitude that they could put vaccine producers out of business and limit our capacity to deal with a biological attack by terrorists,” says Dean Rosen, health policy adviser to Frist.

Even many conservatives are shocked by the government’s effort to cover up the dangers of thimerosal. Rep. Dan Burton, a Republican from Indiana, oversaw a three-year investigation of thimerosal after his grandson was diagnosed with autism. “Thimerosal used as a preservative in vaccines is directly related to the autism epidemic,” his House Government Reform Committee concluded in its final report. “This epidemic in all probability may have been prevented or curtailed had the FDA not been asleep at the switch regarding a lack of safety data regarding injected thimerosal, a known neurotoxin.” The FDA and other public-health agencies failed to act, the committee added, out of “institutional malfeasance for self protection” and “misplaced protectionism of the pharmaceutical industry.”

The story of how government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public is a chilling case study of institutional arrogance, power and greed. I was drawn into the controversy only reluctantly. As an attorney and environmentalist who has spent years working on issues of mercury toxicity, I frequently met mothers of autistic children who were absolutely convinced that their kids had been injured by vaccines. Privately, I was skeptical.

I doubted that autism could be blamed on a single source, and I certainly understood the government’s need to reassure parents that vaccinations are safe; the eradication of deadly childhood diseases depends on it. I tended to agree with skeptics like Rep. Henry Waxman, a Democrat from California, who criticized his colleagues on the House Government Reform Committee for leaping to conclusions about autism and vaccinations. “Why should we scare people about immunization,” Waxman pointed out at one hearing, “until we know the facts?”

It was only after reading the Simpsonwood transcripts, studying the leading scientific research and talking with many of the nation’s pre-eminent authorities on mercury that I became convinced that the link between thimerosal and the epidemic of childhood neurological disorders is real. Five of my own children are members of the Thimerosal Generation — those born between 1989 and 2003 — who received heavy doses of mercury from vaccines. “The elementary grades are overwhelmed with children who have symptoms of neurological or immune-system damage,” Patti White, a school nurse, told the House Government Reform Committee in 1999. “Vaccines are supposed to be making us healthier; however, in twenty-five years of nursing I have never seen so many damaged, sick kids. Something very, very wrong is happening to our children.”
More than 500,000 kids currently suffer from autism, and pediatricians diagnose more than 40,000 new cases every year. The disease was unknown until 1943, when it was identified and diagnosed among eleven children born in the months after thimerosal was first added to baby vaccines in 1931.

Some skeptics dispute that the rise in autism is caused by thimerosal-tainted vaccinations. They argue that the increase is a result of better diagnosis — a theory that seems questionable at best, given that most of the new cases of autism are clustered within a single generation of children. “If the epidemic is truly an artifact of poor diagnosis,” scoffs Dr. Boyd Haley, one of the world’s authorities on mercury toxicity, “then where are all the twenty-year-old autistics?” Other researchers point out that Americans are exposed to a greater cumulative “load” of mercury than ever before, from contaminated fish to dental fillings, and suggest that thimerosal in vaccines may be only part of a much larger problem. It’s a concern that certainly deserves far more attention than it has received — but it overlooks the fact that the mercury concentrations in vaccines dwarf other sources of exposure to our children.

What is most striking is the lengths to which many of the leading detectives have gone to ignore — and cover up — the evidence against thimerosal. From the very beginning, the scientific case against the mercury additive has been overwhelming. The preservative, which is used to stem fungi and bacterial growth in vaccines, contains ethylmercury, a potent neurotoxin. Truckloads of studies have shown that mercury tends to accumulate in the brains of primates and other animals after they are injected with vaccines — and that the developing brains of infants are particularly susceptible. In 1977, a Russian study found that adults exposed to much lower concentrations of ethylmercury than those given to American children still suffered brain damage years later. Russia banned thimerosal from children’s vaccines twenty years ago, and Denmark, Austria, Japan, Great Britain and all the Scandinavian countries have since followed suit.

“You couldn’t even construct a study that shows thimerosal is safe,” says Haley, who heads the chemistry department at the University of Kentucky. “It’s just too darn toxic. If you inject thimerosal into an animal, its brain will sicken. If you apply it to living tissue, the cells die. If you put it in a petri dish, the culture dies. Knowing these things, it would be shocking if one could inject it into an infant without causing damage.”

Internal documents reveal that Eli Lilly, which first developed thimerosal, knew from the start that its product could cause damage — and even death — in both animals and humans. In 1930, the company tested thimerosal by administering it to twenty-two patients with terminal meningitis, all of whom died within weeks of being injected — a fact Lilly didn’t bother to report in its study declaring thimerosal safe. In 1935, researchers at another vaccine manufacturer, Pittman-Moore, warned Lilly that its claims about thimerosal’s safety “did not check with ours.” Half the dogs Pittman injected with thimerosal-based vaccines became sick, leading researchers there to declare the preservative “unsatisfactory as a serum intended for use on dogs.”

In the decades that followed, the evidence against thimerosal continued to mount. During the Second World War, when the Department of Defense used the preservative in vaccines on soldiers, it required Lilly to label it “poison.” In 1967, a study in Applied Microbiology found that thimerosal killed mice when added to injected vaccines. Four years later, Lilly’s own studies discerned that thimerosal was “toxic to tissue cells” in concentrations as low as one part per million — 100 times weaker than the concentration in a typical vaccine. Even so, the company continued to promote thimerosal as “nontoxic” and also incorporated it into topical disinfectants. In 1977, ten babies at a Toronto hospital died when an antiseptic preserved with thimerosal was dabbed onto their umbilical cords.

In 1982, the FDA proposed a ban on over-the-counter products that contained thimerosal, and in 1991 the agency considered banning it from animal vaccines. But tragically, that same year, the CDC recommended that infants be injected with a series of mercury-laced vaccines. Newborns would be vaccinated for hepatitis B within twenty-four hours of birth, and two-month-old infants would be immunized for haemophilus influenzae B and diphtheria-tetanus-pertussis.
The drug industry knew the additional vaccines posed a danger. The same year that the CDC approved the new vaccines, Dr. Maurice Hilleman, one of the fathers of Merck’s vaccine programs, warned the company that six-month-olds who were administered the shots would suffer dangerous exposure to mercury. He recommended that thimerosal be discontinued, “especially when used on infants and children,” noting that the industry knew of nontoxic alternatives. “The best way to go,” he added, “is to switch to dispensing the actual vaccines without adding preservatives.”

For Merck and other drug companies, however, the obstacle was money. Thimerosal enables the pharmaceutical industry to package vaccines in vials that contain multiple doses, which require additional protection because they are more easily contaminated by multiple needle entries. The larger vials cost half as much to produce as smaller, single-dose vials, making it cheaper for international agencies to distribute them to impoverished regions at risk of epidemics. Faced with this “cost consideration,” Merck ignored Hilleman’s warnings, and government officials continued to push more and more thimerosal-based vaccines for children. Before 1989, American preschoolers received eleven vaccinations — for polio, diphtheria-tetanus-pertussis and measles-mumps-rubella. A decade later, thanks to federal recommendations, children were receiving a total of twenty-two immunizations by the time they reached first grade.

As the number of vaccines increased, the rate of autism among children exploded. During the 1990s, 40 million children were injected with thimerosal-based vaccines, receiving unprecedented levels of mercury during a period critical for brain development. Despite the well-documented dangers of thimerosal, it appears that no one bothered to add up the cumulative dose of mercury that children would receive from the mandated vaccines. “What took the FDA so long to do the calculations?” Peter Patriarca, director of viral products for the agency, asked in an e-mail to the CDC in 1999. “Why didn’t CDC and the advisory bodies do these calculations when they rapidly expanded the childhood immunization schedule?”

But by that time, the damage was done. At two months, when the infant brain is still at a critical stage of development, infants routinely received three inoculations that contained a total of 62.5 micrograms of ethylmercury — a level 99 times greater than the EPA’s limit for daily exposure to methylmercury, a related neurotoxin. Although the vaccine industry insists that ethylmercury poses little danger because it breaks down rapidly and is removed by the body, several studies — including one published in April by the National Institutes of Health — suggest that ethylmercury is actually more toxic to developing brains and stays in the brain longer than methylmercury.

Officials responsible for childhood immunizations insist that the additional vaccines were necessary to protect infants from disease and that thimerosal is still essential in developing nations, which, they often claim, cannot afford the single-dose vials that don’t require a preservative. Dr. Paul Offit, one of CDC’s top vaccine advisers, told me, “I think if we really have an influenza pandemic — and certainly we will in the next twenty years, because we always do — there’s no way on God’s earth that we immunize 280 million people with single-dose vials. There has to be multidose vials.”

But while public-health officials may have been well-intentioned, many of those on the CDC advisory committee who backed the additional vaccines had close ties to the industry. Dr. Sam Katz, the committee’s chair, was a paid consultant for most of the major vaccine makers and was part of a team that developed the measles vaccine and brought it to licensure in 1963. Dr. Neal Halsey, another committee member, worked as a researcher for the vaccine companies and received honoraria from Abbott Labs for his research on the hepatitis B vaccine.
Indeed, in the tight circle of scientists who work on vaccines, such conflicts of interest are common. Rep. Burton says that the CDC “routinely allows scientists with blatant conflicts of interest to serve on intellectual advisory committees that make recommendations on new vaccines,” even though they have “interests in the products and companies for which they are supposed to be providing unbiased oversight.” The House Government Reform Committee discovered that four of the eight CDC advisers who approved guidelines for a rotavirus vaccine “had financial ties to the pharmaceutical companies that were developing different versions of the vaccine.”

Offit, who shares a patent on one of the vaccines, acknowledged to me that he “would make money” if his vote eventually leads to a marketable product. But he dismissed my suggestion that a scientist’s direct financial stake in CDC approval might bias his judgment. “It provides no conflict for me,” he insists. “I have simply been informed by the process, not corrupted by it. When I sat around that table, my sole intent was trying to make recommendations that best benefited the children in this country. It’s offensive to say that physicians and public-health people are in the pocket of industry and thus are making decisions that they know are unsafe for children. It’s just not the way it works.”

Other vaccine scientists and regulators gave me similar assurances. Like Offit, they view themselves as enlightened guardians of children’s health, proud of their “partnerships” with pharmaceutical companies, immune to the seductions of personal profit, besieged by irrational activists whose anti-vaccine campaigns are endangering children’s health. They are often resentful of questioning. “Science,” says Offit, “is best left to scientists.”

Still, some government officials were alarmed by the apparent conflicts of interest. In his e-mail to CDC administrators in 1999, Paul Patriarca of the FDA blasted federal regulators for failing to adequately scrutinize the danger posed by the added baby vaccines. “I’m not sure there will be an easy way out of the potential perception that the FDA, CDC and immunization-policy bodies may have been asleep at the switch re: thimerosal until now,” Patriarca wrote. The close ties between regulatory officials and the pharmaceutical industry, he added, “will also raise questions about various advisory bodies regarding aggressive recommendations for use” of thimerosal in child vaccines.

If federal regulators and government scientists failed to grasp the potential risks of thimerosal over the years, no one could claim ignorance after the secret meeting at Simpsonwood. But rather than conduct more studies to test the link to autism and other forms of brain damage, the CDC placed politics over science. The agency turned its database on childhood vaccines — which had been developed largely at taxpayer expense — over to a private agency, America’s Health Insurance Plans, ensuring that it could not be used for additional research. It also instructed the Institute of Medicine, an advisory organization that is part of the National Academy of Sciences, to produce a study debunking the link between thimerosal and brain disorders. The CDC “wants us to declare, well, that these things are pretty safe,” Dr. Marie McCormick, who chaired the IOM’s Immunization Safety Review Committee, told her fellow researchers when they first met in January 2001. “We are not ever going to come down that [autism] is a true side effect” of thimerosal exposure. According to transcripts of the meeting, the committee’s chief staffer, Kathleen Stratton, predicted that the IOM would conclude that the evidence was “inadequate to accept or reject a causal relation” between thimerosal and autism. That, she added, was the result “Walt wants” — a reference to Dr. Walter Orenstein, director of the National Immunization Program for the CDC.
For those who had devoted their lives to promoting vaccination, the revelations about thimerosal threatened to undermine everything they had worked for. “We’ve got a dragon by the tail here,” said Dr. Michael Kaback, another committee member. “The more negative that [our] presentation is, the less likely people are to use vaccination, immunization — and we know what the results of that will be. We are kind of caught in a trap. How we work our way out of the trap, I think is the charge.”

Even in public, federal officials made it clear that their primary goal in studying thimerosal was to dispel doubts about vaccines. “Four current studies are taking place to rule out the proposed link between autism and thimerosal,” Dr. Gordon Douglas, then-director of strategic planning for vaccine research at the National Institutes of Health, assured a Princeton University gathering in May 2001. “In order to undo the harmful effects of research claiming to link the [measles] vaccine to an elevated risk of autism, we need to conduct and publicize additional studies to assure parents of safety.” Douglas formerly served as president of vaccinations for Merck, where he ignored warnings about thimerosal’s risks.

In May of last year, the Institute of Medicine issued its final report. Its conclusion: There is no proven link between autism and thimerosal in vaccines. Rather than reviewing the large body of literature describing the toxicity of thimerosal, the report relied on four disastrously flawed epidemiological studies examining European countries, where children received much smaller doses of thimerosal than American kids. It also cited a new version of the Verstraeten study, published in the journal Pediatrics, that had been reworked to reduce the link between thimerosal and autism. The new study included children too young to have been diagnosed with autism and overlooked others who showed signs of the disease. The IOM declared the case closed and — in a startling position for a scientific body — recommended that no further research be conducted.

The report may have satisfied the CDC, but it convinced no one. Rep. David Weldon, a Republican physician from Florida who serves on the House Government Reform Committee, attacked the Institute of Medicine, saying it relied on a handful of studies that were “fatally flawed” by “poor design” and failed to represent “all the available scientific and medical research.” CDC officials are not interested in an honest search for the truth, Weldon told me, because “an association between vaccines and autism would force them to admit that their policies irreparably damaged thousands of children. Who would want to make that conclusion about themselves?”

Under pressure from Congress and parents, the Institute of Medicine convened another panel to address continuing concerns about the Vaccine Safety Datalink Data Sharing program. In February, the new panel, composed of different scientists, criticized the way the VSD had been used in the Verstraeten study, and urged the CDC to make its vaccine database available to the public.

So far, though, only two scientists have managed to gain access. Dr. Mark Geier, president of the Genetics Center of America, and his son, David, spent a year battling to obtain the medical records from the CDC. Since August 2002, when members of Congress pressured the agency to turn over the data, the Geiers have completed six studies that demonstrate a powerful correlation between thimerosal and neurological damage in children. One study, which compares the cumulative dose of mercury received by children born between 1981 and 1985 with those born between 1990 and 1996, found a “very significant relationship” between autism and vaccines. Another study of educational performance found that kids who received higher doses of thimerosal in vaccines were nearly three times as likely to be diagnosed with autism and more than three times as likely to suffer from speech disorders and mental retardation. Another soon-to-be published study shows that autism rates are in decline following the recent elimination of thimerosal from most vaccines.

As the federal government worked to prevent scientists from studying vaccines, others have stepped in to study the link to autism. In April, reporter Dan Olmsted of UPI undertook one of the more interesting studies himself. Searching for children who had not been exposed to mercury in vaccines — the kind of population that scientists typically use as a “control” in experiments — Olmsted scoured the Amish of Lancaster County, Pennsylvania, who refuse to immunize their infants. Given the national rate of autism, Olmsted calculated that there should be 130 autistics among the Amish. He found only four. One had been exposed to high levels of mercury from a power plant. The other three — including one child adopted from outside the Amish community — had received their vaccines.

At the state level, many officials have also conducted in-depth reviews of thimerosal. While the Institute of Medicine was busy whitewashing the risks, the Iowa legislature was carefully combing through all of the available scientific and biological data. “After three years of review, I became convinced there was sufficient credible research to show a link between mercury and the increased incidences in autism,” says state Sen. Ken Veenstra, a Republican who oversaw the investigation. “The fact that Iowa’s 700 percent increase in autism began in the 1990s, right after more and more vaccines were added to the children’s vaccine schedules, is solid evidence alone.” Last year, Iowa became the first state to ban mercury in vaccines, followed by California. Similar bans are now under consideration in thirty-two other states.

But instead of following suit, the FDA continues to allow manufacturers to include thimerosal in scores of over-the-counter medications as well as steroids and injected collagen. Even more alarming, the government continues to ship vaccines preserved with thimerosal to developing countries — some of which are now experiencing a sudden explosion in autism rates. In China, where the disease was virtually unknown prior to the introduction of thimerosal by U.S. drug manufacturers in 1999, news reports indicate that there are now more than 1.8 million autistics. Although reliable numbers are hard to come by, autistic disorders also appear to be soaring in India, Argentina, Nicaragua and other developing countries that are now using thimerosal-laced vaccines. The World Health Organization continues to insist thimerosal is safe, but it promises to keep the possibility that it is linked to neurological disorders “under review.”

I devoted time to study this issue because I believe that this is a moral crisis that must be addressed. If, as the evidence suggests, our public-health authorities knowingly allowed the pharmaceutical industry to poison an entire generation of American children, their actions arguably constitute one of the biggest scandals in the annals of American medicine. “The CDC is guilty of incompetence and gross negligence,” says Mark Blaxill, vice president of Safe Minds, a nonprofit organization concerned about the role of mercury in medicines. “The damage caused by vaccine exposure is massive. It’s bigger than asbestos, bigger than tobacco, bigger than anything you’ve ever seen.”

It’s hard to calculate the damage to our country — and to the international efforts to eradicate epidemic diseases — if Third World nations come to believe that America’s most heralded foreign-aid initiative is poisoning their children. It’s not difficult to predict how this scenario will be interpreted by America’s enemies abroad. The scientists and researchers — many of them sincere, even idealistic — who are participating in efforts to hide the science on thimerosal claim that they are trying to advance the lofty goal of protecting children in developing nations from disease pandemics. They are badly misguided. Their failure to come clean on thimerosal will come back horribly to haunt our country and the world’s poorest populations.

NOTE: This story has been updated to correct several inaccuracies in the original, published version. As originally reported, American preschoolers received only three vaccinations before 1989, but the article failed to note that they were innoculated a total of eleven times with those vaccines, including boosters. The article also misstated the level of ethylmercury received by infants injected with all their shots by the age of six months. It was 187 micrograms – an amount forty percent, not 187 times, greater than the EPA’s limit for daily exposure to methylmercury. Finally, because of an editing error, the article misstated the contents of the rotavirus vaccine approved by the CDC. It did not contain thimerosal. Salon and Rolling Stone regret the errors.

An earlier version of this story stated that the Institute of Medicine convened a second panel to review the work of the Immunization Safety Review Committee that had found no evidence of a link between thimerosal and autism. In fact, the IOM convened the second panel to address continuing concerns about the Vaccine Safety Datalink Data Sharing program, including those raised by critics of the IOM’s earlier work. But the panel was not charged with reviewing the committee’s findings. The story also inadvertently omitted a word and transposed two sentences in a quote by Dr. John Clements, and incorrectly stated that Dr. Sam Katz held a patent with Merck on the measles vaccine. In fact, Dr. Katz was part of a team that developed the vaccine and brought it to licensure, but he never held the patent. Salon and Rolling Stone regret the errors.

CLARIFICATION: After publication of this story, Salon and Rolling Stone corrected an error that misstated the level of ethylmercury received by infants injected with all their shots by the age of six months. It was 187 micrograms ? an amount forty percent, not 187 times, greater than the EPA’s limit for daily exposure to methylmercury. At the time of the correction, we were aware that the comparison itself was flawed, but as journalists we considered it more appropriate to state the correct figure rather than replace it with another number entirely.

Since that earlier correction, however, it has become clear from responses to the article that the forty-percent number, while accurate, is misleading. It measures the total mercury load an infant received from vaccines during the first six months, calculates the daily average received based on average body weight, and then compares that number to the EPA daily limit. But infants did not receive the vaccines as a ?daily average? ? they received massive doses on a single day, through multiple shots. As the story states, these single-day doses exceeded the EPA limit by as much as 99 times. Based on the misunderstanding, and to avoid further confusion, we have amended the story to eliminate the forty-percent figure.

Correction: The story misattributed a quote to Andy Olson, former legislative counsel to Senator Bill Frist. The comment was made by Dean Rosen, health policy adviser to the senator. Rolling Stone and Salon.com regret the error.

Kennedy Report Sparks Controversy

November 3rd, 2003 was a big day for Alabama emergency room pediatrician, Dr. Carden Johnston. On that date last month, he was installed as the new President of the 66,000 member American Academy of Pediatrics (AAP) at the prestigious organization’s annual meeting in New Orleans. It was also the date that he sparked what has emerged as a major ethical controversy by inadvertently pulling back the curtains on the powerful influence that a particular corporate interest appears to have in shaping AAP policy and action.

“I have to admit that I never imagined that my presidency would start off with such a bang,” Dr. Johnston says, acknowledging the debate now taking place within his organization.

At issue is a letter dated November 3rd that Dr. Johnston sent to Secretary of the Department of Health and Human Services (DHHS), Tommy G. Thompson, officially expressing the AAP’s concern over the “negative approach” of the federal agency’s soon-to-be-released, pro-breastfeeding advertising campaign. What Dr. Johnston didn’t mention in his letter, however, was that he had developed this sudden and seemingly urgent interest in this issue not via a last minute clinical review of the scientific literature, or even after consulting with the AAP’s own recognized lactation science experts.

In fact, his concern came immediately after aggressive, personal lobbying by representatives of one of the AAP’s biggest financial contributors, the $3 billion U.S. infant formula industry. Within days of a New Orleans meeting with worried formula industry reps, Johnston hurled the considerable credibility and persuasive impact of the esteemed American Academy of Pediatrics into an explicit effort to stifle the most ambitious initiative ever undertaken to promote breastfeeding in the United States.

“Some of us within the AAP have long suspected that the infant formula companies had this sort of direct access to AAP leadership,” explains Dr. Lawrence Gartner, a founding member of the Academy of Breastfeeding Medicine and chairman of the AAP’s Professional Section on Breastfeeding. “Dr. Johnston’s actions have revealed the extent of this influence more clearly than anything else I’ve seen. Many doctors within the AAP are very disturbed by this.”

Reflecting the strong opinions of a number of AAP members interviewed in the past week, Dr. Jay Gordon, a pediatrician and best-selling author of several parenting books, says that his opinion on the AAP leadership’s actions in this matter go beyond “disturbed.”

Dr. Gordon reports that, that in his view, the AAP leadership has “weakened and emasculated (the ads) to suit the manufacturers of formula,” and “as a result of their craven disregard for America’s babies and families, more infants will get sick and die each year. I wish that this greedy, immoral, reprehensible act could be met with criminal charges,” explains Gordon.

The ad campaign currently inspiring such passion among the nation’s pediatric health care providers is funded within the DHHS Office on Women’s Health (OWH), and has been in the works since 2000. Officially dubbed the “National Breastfeeding Awareness Campaign,” the creative end of the OWH project has been handled by Raleigh, North Carolina advertising agency McKinney+Silver, while the entire project is overseen by The Ad Council, the private, non-profit organization that produces, distributes, and promotes public service campaigns on behalf of charitable organizations and government agencies.

In 2002, DHHS described the upcoming breastfeeding initiative as a three-year, multimedia social marketing blitz worth as much as $40 million in advertising dollars. It is alleged by a variety of organizations representing lactation consultants, physicians, nurses, midwives, and public health activists that the AAP’s last-minute appeal to DHHS prevented the much-anticipated campaign launch from taking place as scheduled this month. Additionally, it appears that representatives of the infant formula industry – with the benefit of prematurely leaked information about the specifics of the ad campaign- have been quietly lobbying federal and Ad Council officials to change the ads’ content and tone.

According to the AAP’s own Breastfeeding Section, at least one thousand new scientific and medical papers on topics related to breast and bottle feeding have been published in just the past four years. Taken as a whole, this mounting body of research revealsdramatically different health outcomes for populations of breast and formula-fed babies, even when controlling for socioeconomic and other factors. The new ad campaign was designed to reflect this research and to catapult the issue of breastfeeding into the same category of public health concerns as smoking, carseat use, childhood vaccinations, and SIDS prevention.

While critics of Dr. Johnston’s action strongly disagree that the tone of the DHHS ads is “negative,” they concede that the new campaign does offer a fundamentally different way of looking at the breast-bottle issue. They hasten to add, however, that this new approach was completely intentional. According to those medical professionals who played a role in creating the actual content of the new campaign, the ads utilize a market-oriented and evidence-based approach to the issue, relying for the first time on the proven communications strategies that have successfully impacted other public health behaviors in recent years.

According to those who have viewed them, the ads feature catchy slogans meant to become memorable such as “Breastfeed: It’s too important not to,” and “Babies are born to be breastfed.” Some of the ads also use humor to make their points, including TV spots showing a pregnant woman participating in roller derby and riding a mechanical bull. These absurdist images are used to make the point that, just as no woman would take those sorts of risks while pregnant, mothers of infants should avoid the quantifiable risks to their babies’ health that come with not breastfeeding.

“As I understood it, this was to be the first national advertising campaign that focused on the risks of not breastfeeding as opposed to the benefits of choosing to breastfeed,” explains Dr. Audrey Naylor, a San Diego pediatrician and Executive Director ofWellstart International, as well as a member of the AAP’s Breastfeeding Professional Section, and a past consultant to the World Health Organization on infant nutrition issues. “This would definitely mark a significant change in the way this issue would be presented to the general public. It’s a change to promote breastfeeding as a public health issue rather than simply as a personal parenting choice.”

The area of the website of The Ad Council devoted to a brief discussion of the planned DHHS breastfeeding campaign offers a glimpse into this very different, market-oriented way of viewing the issue of breast vs. bottle, stating that, “Babies who are not exclusively breastfed for at least 6 months will be more likely to contract asthma, allergies, and cancer.” In previous breastfeeding promotion campaigns, this statement would have certainly read “Babies who are breastfed will be less likely to contract asthma, allergies, and cancer.”

In a presentation sponsored by the Breastfeeding Task Force of Greater Los Angeles on the planned campaign, McKinney+Silver was quoted as seeking to move from creating awareness to creating conversion with the ads.

“Shift the language from ‘If you breastfeed, your baby will be healthier,’ to ‘If you don’t breastfeed, your baby will be more prone to…,” noted McKinney+Silver in describing the campaign’s approach. The presentation went on to note that, while most American women seemed informed of the benefits of breastfeeding, few seemed aware of the potential consequences of not nursing their babies. “(There is) no perceived disadvantage if you don’t breastfeed. Many think breastfeeding is like supplementing a ‘standard diet’ with vitamins. Formula, by default, is credited with the status of being ‘the standard.’”

In much of the rest of the world, ads for infant formula directed at consumers are verboten in much the same way that television ads for cigarettes and liquor are no longer acceptable in the United States. This global aversion to infant formula advertising is due to the widespread adoption by governments and private industries outside the United States of the World Health Organization’s Code on the Marketing of Breastmilk Substitutes – known as the WHO Code.

In this country, however, there is only minimal adherance to the WHO Code by public or private entities and as a result, advertisements for different brands of infant formula are a ubiquitous part of the U.S. media landscape.

In years past, various individual government agencies, hospitals, and private organizations such as La Leche League International have attempted to counter the advertising sledgehammer wielded by the well-heeled infant formula industry via a patchwork of relatively low-budget, smaller-scale ads focusing on the “the benefits of breastfeeding.” However, the DHHS breastfeeding campaign to which the AAP leadership has now objected was to be the first national effort to utilize high-end, commercial-quality production values to position the “breast is best” public health message to go head-to-head with even the slickest Madison Avenue-produced infant formula ads.

Clearly, this was not a campaign that was going to play well with the infant formula industry, which has until now managed to create a uniquely advantageous situation in which it has positioned itself as the primary spokesman for its chief competitor in the marketplace, breastfeeding. And this new message is assuredly not the one they want projected into public consciousness.

“Ironically, infant formula companies in this country can honestly say they spend more on what they call ‘breastfeeding education’ than any other single entity,” explains Amy Spangler, a nurse and lactation consultant who currently chairs the United States Breastfeeding Committee, an umbrella consortia of health care organizations interested in breastfeeding that was intimately involved in developing the new DHHS campaign. “They also underwrite much of the research into infant feeding issues. The pay-off for them is that they then get to manipulate the message, which is always “Breastfeeding is best, but… There is always a ‘but,’ and breastfeeding is suggested as a type of ‘bonus feature’ for parenting rather than the norm.”

According to a number of sources within the medical community who were included in meetings during the planning process for the breastfeeding campaign, DHHS officials repeatedly stressed to participants that the specific messages of the ads –which were clearly shaping up to be potentially controversial- needed to be “embargoed” until their official release.

Amy Spangler attended several meetings with DHHS and OWH officials to discuss the Breastfeeding Awareness Campaign and she says that federal and Ad Council officials encouraged participants to avoid speaking publicly about the content of the planned ads before their release.

“It was never said specifically that the need for keeping the ads under wraps until release was due to anything having to do with infant formula companies, but I think we would have been naïve to assume that this was not one of the reasons why,” explains Spangler.

Despite the warnings, however, the infant formula industry did apparently gain access to much of the content of the ads, allowing them to begin an intensive and targeted lobbying effort against their release. DHHS officials are reluctant to discuss the circumstances surrounding the premature leak of the ads, saying only that “a small amount” of information about the campaign was accidentally released on The Ad Council website at some point in November. Hipmama.com has learned, however, that DHHS and Ad Council officials voluntarily met with formula industry representatives at several points during the fall, even as pro-breastfeeding stakeholders were being instructed by the same officials to keep mum in order to preserve the integrity of the ad campaign’s message.

Additionally, most or all of the actual ads were shown to dozens of attendees at a North Carolina medical conference in October, something that Office on Women’s Health spokesperson Christina Pearson says the agency didn’t authorize or even know about until after the event.

According to a variety of sources, members of Congress began hearing complaints about the pending ad campaign from infant formula manufacturers as early as the first week of October, but it was at the AAP convention in November that the industry was able to aim what is arguably the biggest weapon in its lobbying arsenal –the clout of the American Academy of Pediatrics – directly at the breastfeeding campaign.

“The reason why the infant formula industry is so successful is because they have managed to manipulate health care providers into providing them with a cloak of credibility,” explains Amy Spangler. “The bottom line here is that the president of (an infant formula company) doesn’t have to send a letter directly to a federal official when he can get the President of the American Academy of Pediatrics to do it for him.”

Public health advocates and many individual physicians, nurses, midwives, and lactation consultants have long criticized the cozy financial ties between infant formula manufacturers and major medical organizations such as the AAP, the American Medical Association, the American Academy of Family Physicians, and the American College of Obstetrics and Gynecology. The infant formula industry – part of the larger pharmaceutical industry lobby – is also recognized as one of the most effective and powerful lobbies on Capitol Hill.

Critics of this relationship between baby doctors and formula makers note that because the U.S. infant formula industry –with sales of $3 billion annually – clearly has a commercial interest in impacting parents’ infant feeding choices, the industry should not play any role in crafting public health messages relating to the industry’s clear competitor in the marketplace, breastfeeding.

“It is simply not appropriate for these companies to have a say in how publicly-funded health education campaigns present breastfeeding issues,” argues Marsha Walker, RN, IBCLC, and Executive Director of the National Alliance for Breastfeeding Advocacy (NABA), a non-profit group promoting breastfeeding. “It would be like inviting a cigarette manufacturer to have a say in the message of a government sponsored anti-smoking campaign.”

OWH spokesperson Christina Pearson disagrees, however, insisting that DHHS has made it clear all along that the agency wanted to hear from “all sides” on the issue.

While it may be reasonably asked what “sides” exist when speaking of a public health campaign promoting a free or low-cost, healthy alternative over another, expensive and less healthy alternative, the AAP leadership decided that their organization was going to take sides. In a phone interview with Hipmama.com on December 3rd, AAP President Dr. Johnston readily admitted that he was approached by representatives of infant formula companies during the annual AAP convention in the first week of November, and asked to attend a “private,” “not on the agenda” meeting to discuss some concerns that the industry had with the planned DHHS breastfeeding campaign. He says that he and the three other members of the American Academy of Pediatrics Executive Committee, Dr. Joe Sanders, Dr. Carol Berkowitz, and Dr. E. Stephen Edwards, immediate past president of the AAP, met for approximately 45 minutes with “two or three” representatives of Ross Products “and maybe one other company” to hear their concerns.

“This was the first I had heard about this planned breastfeeding promotion campaign,” says Dr. Johnston. “Sad, but true. I didn’t know it was in development until after these folks told us about it.”

Dr. Johnston’s account of his interest in and knowledge of the DHHS ad campaign differs from the version reported in the December 4th edition of the New York Times. In a story entitled “Breastfeeding Ads Delayed In Dispute Over Content,” reporter Melody Peterson writes that Dr. Johnston and Dr. Sanders “…said that they had decided to send their letter before (infant formula company) executives expressed their concerns at the Academy’s national conference, held last month in New Orleans.”

In his interview with Hipmama.com, Dr. Johnston said that he became alarmed at the tone and message of the ads after viewing samples shown to him by the infant formula company reps in New Orleans.

“They showed us more than ten but fewer than twenty printouts of something that looked like ads. It was my impression these were copies of some of the ads,” says Dr. Johnston. “A lot of the ads looked fine to me, but I shared their concerns about the negative approach overall. It worried me, as it did them, that parents whose kids got cancer or grew up dumb might feel guilty if they did not breastfeed.”

Dr. Johnston says that he did not find it inappropriate or even remarkable that a commercial interest would have advance advertising copy from a planned multi-million dollar federal public health campaign designed to convince Americans to buy less of their products.

“I never asked them where they got this stuff,” says Dr. Johnston. “I just had the feeling that their relationships within Health and Human Services were better than ours at the Academy. I was actually embarrassed that this was the first time I was being made aware of the problems with this advertising campaign. Of course, they have to be concerned about issues that impact their shareholders.”

Dr. Carol Berkowitz, who will become AAP President in 2004-2005, confirms that she also attended this meeting, however in a phone interview on December 3rd, she told Hipmama.com that the meeting was noted on her personal conference schedule when she arrived in New Orleans.

“The meeting was on my own schedule that they handed me when I arrived,” says Dr. Berkowitz. “I assumed it had been set up in advance at AAP headquarters. I saw nothing remarkable about it; I attended many such meetings while I was there and I’ve been friends with many infant formula representatives for years.”

Dr. Berkowitz says that she too was concerned about the tone of the ads based on what formula industry representatives told her when she met with them at the AAP Convention.

“At the end of the meeting, Dr. Edwards asked what they wanted us to do and they told us that they had just wanted to make us aware of the situation, ” remembers Berkowitz.

Apparently, the AAP leadership’s freshly heightened awareness led to almost immediate action on behalf on the formula industry. In a letter dated November 3rd –- while the AAP convention was still underway in New Orleans and on the very same day he was installed as President — Dr. Johnston signed off on a strongly worded statement to DHHS objecting to the ostensibly still-under-wraps breastfeeding advertising campaign, based solely on what he had been shown and told by infant formula company lobbyists.

In the letter, Johnston notes that it has “come to his attention” that an ad campaign is about to be launched, and that he formed his opinions “after reviewing the Web Page of The Ad Council.” He does not mention that his concern was, in fact, prompted by a private meeting he had just concluded with representatives from the infant formula industry. Dr. Johnston told Hipmama.com that, despite the wording in his letter to Secretary Thompson, he is not certain that he personally viewed The Ad Council webpage before signing the letter, and that he didn’t actually draft the letter himself; staff at AAP offices near Chicago did. But he says that he was comfortable signing his name to it.

“I felt that we needed to send a letter immediately because the people we met with told me that these ads were about to be released,” explains Dr. Johnston. “They conveyed a sense of urgency to me and I shared their concerns. I thought many of our members would be disturbed if these ads were released in that format. I felt we needed to act.”

Meanwhile, members of the U.S. Breastfeeding Committee and other medical professionals with an interest in the DHHS advertising campaign had no idea that the new President of the AAP had taken such an action. Within a week of the AAP convention, however, sympathetic sources within DHHS began contacting interested medical professionals around the country and quietly reporting that “something was up” with the breastfeeding campaign.

“We started hearing from people that the infant formula companies had begun an intense lobbying campaign against the ads within DHHS and other government offices, including Senator Bill Frist’s,” says Marsha Walker of NABA. “They were saying that they were unhappy with ads that told of consequences of not breastfeeding as opposed to stating the benefits.”

By mid-November, Dr. Lawrence Gartner had been alerted by a DHHS staffer to the existence of the Johnston letter sent on behalf of the AAP. Gartner says that he was very disturbed that the AAP’s own Breastfeeding Section had not been consulted or even notified about the contents of Dr. Johnston’s letter to Secretary Thompson, even though he and his colleagues in the AAP’s Breastfeeding Section had also attended the AAP Convention earlier in the month. After investigating the matter, Dr. Gartner felt compelled to send his own letters to Secretary Thompson, as well as to other AAP members.

In his letter to fellow pediatricians across the country, Dr. Gartner wrote that, “ There is every reason to believe that (the infant formula companies) are pulling out all the stops to get this ad campaign buried, or, at least, modified to be less effective… This entire affair is a very serious matter, which raises many questions about the leadership of the AAP and the influence of the formula industry on AAP activities.”

Mardi K. Mountford, Executive Director of the International Formula Council, a trade group representing the interests of infant formula manufacturers takes issue with Dr. Gartner’s assertion that her industry is seeking to discredit or delay the DHHS campaign.

“We strongly encourage mothers to breastfeed if they can, but we don’t believe that women need to be subjected to scare tactics like the ones that are in these ads,” explains Mountford. “Our only interest in reviewing the scientific claims in the ads is that they be accurate so that parents have the information they need to make their own decisions about what’s best for their families”

Mountford’s remarks highlight something that public health advocates have long noted; namely, that the infant formula industry’s tactics in lobbying against initiatives such as FDA regulation of their product, standardization of ingredients in their product, and now, the DHHS breastfeeding campaign are remarkably similar to the strategies employed by tobacco companies in the early years of the anti-smoking public health movement.

According to PRWatch.org, the tobacco industry created what eventually became known as the Council for Tobacco Research(CTR) in 1953, claiming that the organization’s mission was to ”find out whether smoking was dangerous…’” During the 1980s, internal CTR memos revealed that “ the CTR actually worked at “promoting cigarettes and protecting them from these and other attacks,” by “creating doubt about the health charge without actually denying it, and advocating the public’s right to smoke, without actually urging them to take up the practice.” Just as the infant formula industry currently pays for much of the research into breastfeeding in the U.S, for many years the CTR funded most research into tobacco health issues and attempted to insert itself as a “concerned” corporate citizen into the government’s earliest anti-smoking campaigns.

While Dr. Johnston’s letter to DHHS referred only to a “negative tone” in the ads, infant formula industry lobbyists had been contacting DHHS and Ad Council officials since Spring, 2003 and insisting that the specific scientific research upon which some of the language of the ads were based was faulty. OWH spokesperson Christina Pearson confirms that the infant formula industry raised these concerns with DHHS officials, and concedes that the ads have now been modified to remove references to specific statistics that quantify the higher risks for certain diseases. However, she says that this change was in no way the result of pressure from the infant formula industry.

Several sources within the Ad Council, which relies heavily on funding by pharmaceutical companies that also produce infant formula – such as Mead Johnson – claim otherwise. They say that Mead Johnson threatened to pull its millions from The Ad Council’s budget if the references to specific risk numbers were not removed from the ads. The Ad Council declined to comment on this report, instead referring all inquiries to Christina Pearson at OWH, who says her agency can neither confirm or deny this alleged incident.

According to Dr. Gartner, the industry’s complaints about a “negative” tone in the ads, as well as its questioning of the science behind the campaign are just red herrings designed to delay and water down the campaign for as long as possible.

“As far as a negative tone goes, most successful public health campaigns rely heavily on making the public aware of negative consequences of certain behaviors. While it may be a new way to approach breastfeeding promotion, it’s a common advertising device.” says Dr. Gartner. “We don’t tell parents about the ‘benefits’ of carseats. We tell them that studies indicate that if they do not use a carseat, their baby has a greater risk for being injured or killed in an accident. And telling them this has worked. Thousands of lives are saved every year because this message works.”

Dr. Johnston admits that he now regrets not having discussed the letter he sent to Secretary Thompson with his own “breastfeeding experts” within the AAP, including Dr. Gartner. But notification is as far as it should have gone, says Johnson. He stands by his concerns about the ad campaign.

“I rely on the breastfeeding experts to help me learn more about breastfeeding issues, but some of the science behind these breastfeeding claims is shaky. It’s just not solid yet, and you know how some of these breastfeeding enthusiasts can lack objectivity,” noted Dr. Johnston.

When asked whether this lack of scientific objectivity he has observed extends to members of the AAP breastfeeding section, he replied “some, not all.”

Dr. Gartner says that he finds Dr. Johnston’s statement about objectivity among the physicians in the AAP’s Breastfeeding Section “outrageous.”

“I’ve read thousands of scientific papers on breastfeeding and formula feeding in just the past few years and so have my colleagues in the Breastfeeding Section within the AAP,” notes Dr. Gartner. “I challenge Dr. Johnston to discuss the hard science behind this issue with me any time. I would welcome the opportunity. Frankly, I do not believe he is qualified to comment on the research because I doubt he’s read much of it except –it appears – possibly what the infant formula companies have shown him.”

According to many lactation consultants and physicians who have played a consulting role in crafting the DHHS ad campaign, an earlier release date offered by DHHS officials was to be in October, 2003, to correspond with World Breastfeeding Week. That date came and went and participants were next told that the date for the campaign’s official roll-out would December 3rd, to correspond with a meeting of breastfeeding and infant health experts that was scheduled to take place in Washington. In its December 4th edition, the New York Times cited an Ad Council newsletter that named a December, 2003 release date for the campaign.

Christina Pearson of OWH disputes the claim that there has ever been a true release date set for the ads and emphatically denies that any changes have been made to the campaign’s message as a result of pressure from the AAP or infant formula industry representatives.

“The campaign is still on the drawing board and as far as we are concerned it has never come off the drawing board,” explains Pearson. “Anyone who thought we were about to release the ads was simply mistaken. We will continue our review of the message and the content until everyone feels comfortable that we have it right.”

Katie Allison Granju is the author of “Attachment Parenting: Instinctive Care for Your Baby and Young Child” and her essays can be viewed on her website at Loco Parentis.

The allergen in poison ivy is a substance called urushiol. What urushiol does, to people who are allergic to it, is bind with the skin cells and produce a rash. In order to treat a reaction to the poison ivy what you essentially need to do is “neutralize” the urushiol.

There are several herbs, when applied topically, that can do this. Jewelweed is one of the best. You can also combine this with any herb that contains a significant amount of saponins such as Soapwort, Horse Chestnut, Licorice, or Rose Leaves. Please remember that these are for topical use only as saponins shouldn’t be taken internally while pregnant or nursing, but are perfectly safe when used externally. Some things to help control the itching are aloe vera or plantain. Also, cool baths with powdered colloidal oatmeal can be extremely soothing.

It’s no wonder that the pharmaceutical industry has made a huge effort to market drugs for ADHD and that a large and intelligent backlash has developed against the widespread use of these powerful chemicals.

I have been a pediatrician for twenty years and for fifteen of those years I completely disdained the use of Ritalin and the other psychopharmaceuticals for ADHD kids. I was probably wrong to “throw out the baby with the bath water.” Denying that a small percentage of children receiving Ritalin actually benefited from the drug was not fair to them. We don’t know enough about brain chemistry to completely understand ADHD, but we do know the impact of untreated ADHD on children: a much more difficult childhood and adolescence with school and social problems which can be nonstop.

I now try “everything else” before resorting to prescription medication, but I no longer rule out that possibility.

Deficiency in central nervous system dopamine probably causes many, if not most, of the problems associated with ADHD. Nutritional problems can cause or exacerbate this deficiency: supplemental tyrosine, B vitamins, vitamin C and copper have all shown a positive influence on improving the school performance of children with ADHD. These can all be combined with conventional therapy with no adverse interactions. Ritalin and similar drugs act by directly increasing brain dopamine levels.

Before I consider anything else, I try to persuade the family to put their child and themselves on an excellent diet. The standard American diet filled with sugar, artificial sweeteners, colors, preservatives, saturated fats, low levels of vitamins and minerals, and too much protein is not good for brain health or health in general. Mainstream medical journals have debated this topic for decades and most medical practitioners don’t like to consider nutritional alternatives in the treatment of any disease because it takes too long to discuss it with their patients.

I recommend whole foods as the backbone of the nutritional regimen. As obvious as this sounds, most children get the bulk of their food in an over-processed form. Whole grain cereals and breads and lots of fresh fruit and vegetables and beans and pasta make for meals which interest children and adults. Counsel your patients to avoid sugar!! Reading labels closely will show parents just how many artificial additives have worked their way into kids’ daily diets. Many chemicals mimic brain neurotransmitters and even conventionally published research admits that sugar has a negative impact on the behavior of ADHD children. Processed cereals and high-fructose corn syrup sweetened drinks add huge amounts of sugar to a child’s day. Even regular unsweetened apple juice in the quantities some children like can be a large source of extra sugar.

There are many alternative remedies which can be used to treat children with ADHD and learning disorders. We must help the families in our practices find these and guide them in their usage.

Ginkgo Biloba dilates blood vessels and improves circulation to the brain. Researchers have shown it’s utility in Alzheimer’s Disease.

Variations are to be expected, and are in no way to be considered a defect.

– Hang tag from Madras shirt

Statistics reflect this confusion. Depending on who you read, some experts say we have about eight hundred-thousand learning disabled children in the country. Others put the figure as high as eight million.

In 1963, when “learning disabilities” were first described, we found very few students with the problem and thought the problem was rare.

Some take a very conservative view and say that 30 – 50% of us will outgrow it, but a growing body of experts think we just learn to cope with it. There’s a certain brain development that takes place at puberty that sometimes makes ADD much easier to live with. I think the jury’s still out but my guess that most of learn to live with it, not outgrow it.

For anxiety, a mix of Kava and Siberian Ginseng is good.

For depression, Gingko Biloba or Borage. There has been a good amount of success with a combination of the two as well.

Keep in mind when combining herbs to treat one symptom or illness to use a proportional dosage. (i.e., two herbs would be half dosage of each, three herbs would be one-third dosage, etc.)

Here is a link that goes into homeopathic remedies for depression. The info given is on postpartum depression simply because all of these are safe while nursing. They are all used to treat general depression as well, so they’re not specific for use for PPD.

Homeopathic Remedies for Postpartum Depression – MotherNature.com Health Encyclopedia

The usual speech applies here. When looking into using herbal or homeopathic remedies, make sure you’re getting them from a good health food store. Avoid commercial places like GNC. Get out the yellow pages and look under health food stores, then call around until you find one with a certified herbalist on staff. This is the store you want to go to.

Exercise should not be forgotten when dealing with depression. It has been shown that regular exercise is the best remedy for depression. There have been patients who’ve suffered repeated bouts of depression who have been able to go off meds completely after starting and maintaining a regular exercise program.

The dosage for regenerating cartilage is 1500 mg of glucosamine a day and 1200 mg of chondroitin a day. Take this dosage until you start feeling a relief from the pain. Then drop down to 1000mg of glucosamine and 800 mg of chondroitin until pain disappears. From that point on, take a daily dose of 500 mg glucosamine and 400 mg chondroitin daily to prevent future degeneration.

Patients using glucosamine for osteoarthritis should take 1500 mg per day. It can take up to 4 – 8 weeks to relieve pain. Therefore, continuing on a NSAID during this time period may be necessary.

Patients with type II diabetes should monitor their blood sugar carefully due to concerns that glucosamine might increase insulin resistance.

In considering which supplements will assist you best with joint pain, it may be helpful to know that the absorption rate for chondroitin is 0 to 8% while the glucosamine sulfate is 98%. Glucosamine sulfate is the best source. It is possible to get the relief you are looking are with glucosamine alone.

Here are some natural treatments for colds that can be used in children and are also safe while nursing. When using herbs with children you can usually find a product made specifically for infants and children. If you can’t here’s how to determine the dosage. You take the child’s weight and divide it by 150. The resulting fraction is the portion of the adult dose to administer.

The first thing you’ll want to do is boost your body’s immune system. Echinacea, 2 capsules 3 times per day, and Colloidal Silver are great immune system boosters. You may also want to boost your intake of vitamin C, up to 500mg 4 times per day, and eat foods with plenty of fresh garlic.

Anise and Mullein, in tea form and taken as needed, are both natural expectorants. Elderberry, 10ml 2 times per day, is the best antiviral product on the market, natural or otherwise. It is most effective in fighting the flu virus, but is also very effective against cold viruses.

Aromatherapy can be a great tool as well. Lavender and Clary Sage in your bath are what you’ll want to use. Lavender works to relax muscles and can help soothe coughs and Clary Sage helps alleviate the grumpiness that tends to accompany colds. What you’ll need to look for is an essential oil. It is the oils of these plants that work, so something that merely contains a fragrance is going to be useless. Then what you do is take some unscented liquid soap and add five drops Clary Sage oil and ten drops Lavender oil and use your finger to mix the oil with the soap. This emulsifies the oils so that they mix with your bath water.

Nettle, 2ml 2-5 times per day, is a natural antihistamine. Nettle is also wonderful for treating seasonal allergies. It’s a great alternative to artificial antihistamines that can affect milk supply.

Some recipes:

Vapor Rub
1/2 teaspoon eucalyptus essential oil
1/8 teaspoon peppermint essential oil
1/8 teaspoon rosemary essential oil
1/8 teaspoon clary sage essential oil
1/4 cup olive oil

Mix ingredients together in a glass bottle (not plastic as the essential oils will bleed into it making the rub less effective) and shake well. Massage onto chest as often as needed.

Cough Syrup
1 tablespoon anise
1 tablespoon mullein leaves
1 tablespoon thyme leaves
1 tablespoon rose hips
1 tablespoon slippery elm bark
1 tablespoon lemongrass leaves
1 quart water
½ cup rice syrup

Place herbs and water in a large saucepan. Bring to a boil, uncovered. Remove from heat, cover and let herbs steep for 45 minutes. Strain out the herbs. Return liquid, uncovered, to low heat and simmer for 15 minutes. Turn off heat and slowly stir in syrup. Let cool completely. Store in a glass container in the refrigerator for up to 12 months.

Dosage: Up to 20 lbs.=1/4 teaspoon, 21-40lbs.=1/2 teaspoon, 41-60lbs.=1 teaspoon, 61 lbs. and over= 2 teaspoons, taken every 4 hours.

I think that many infections, including otitis media (middle ear infections) respond faster or better to antibiotic treatment but I also think that the negative impact of those medicines is underestimated by doctors and patients alike. Everything from yeast overgrowth in the intestines, oral thrush, vaginal or diaper area yeast infections to diarrhea result from antibiotics. Additionally, some people have allergic reactions to these medicines. Perhaps the most underestimated problem is the breeding of bacteria which are resistant to the very drugs we count on to kill them.

For all of these reasons, it’s a great idea to save antibiotics for the times when infections threaten health and safety and/or when other therapy modalities have been exhausted.

I treat ear infections with prevention (anti-allergy measures such as dairy avoidance, dust reduction and getting rid of feather pillows and quilts) and with herbal and homeopathic remedies. I have some formal training in these methods but nowhere near enough to call myself an authority. I have been trained by my patients’ actions and by years of experience watching the way children respond to gentler methods of healing otitis media and other infections.

I like to put mullein/garlic oil in the ears hourly for a day or two and give pulsatilla 6X or 12C (homeopathic strength–the range I have given indicates homeopathic ignorance… but it works) or lachesis homeopathically hourly for two days.

Elderberry is an herbal preparation which interferes with viral growth and I use the extract for younger children and the lozenges (hourly again… tough day for moms) for the toddlers and older kids. The doses can be calculated from the bottle you buy.

I also give extra vitamin C (500 mg/year of age/day to a maximum of 5000 for ten year olds to adults) and 5-15 mg of zinc/day to help immune function.

Echinacea is another good herb for stimulating immune function and I use it for any child without bad allergies or other autoimmune problems.

Dairy avoidance is crucial to treat or prevent ear infections and many people like to replace the lost calcium either with fortified drinks (soy, rice, orange juice) or with supplemental calcium.

Pain control can be done either herbally or with Tylenol-type meds. Hot compresses on the ear will increase blood flow and speed up healing.