Teenager hears herself too loud. Crazy? No.

Posted September 29, 2014 by Dr. Roy
Categories: Medical problems

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The Pediatric Insider

© 2014 Roy Benaroch, MD

Amanda wrote in: “I know this sounds crazy, but my teenage daughter has been complaining that she hears herself talk very loudly. She’s self-conscious to begin with, so now she tries to talk very quietly, and no one can even hear her at all! She also says that she can hear her heart beating and her own breathing, and all of this is making her very anxious. We took her in for a hearing test, and it was OK, and I think the doctor thought she was making this up (she does have problems with anxiety, too.) Is this just all in her head?”

As a general sort of rule, I don’t usually answer specific medical questions about individual cases on my blog here. I can’t examine patients, and I can’t really get the kind of information I need to make a diagnosis; besides, I’m not your doctor. My advice for most people writing in for my help figuring out what’s wrong with your child is to go see your own doctor.

But Amanda’s question caught my attention. I hate that her daughter was “blown off” by her doc. I get it, she has anxiety issues, and that can lead to a lot of physical symptoms (typically headaches, belly aches, nausea, and dizziness.) But even while we’re thinking that psychological factors may be contributing to physical symptoms, doctors need to keep in mind that kids can have more than one thing going on. Yes, there’s anxiety. But guess what? I think Amanda’s daughter may also have a physical diagnosis. So I’m going to bend my own rule here, and toss out a possible diagnosis—and I hope Amanda’s mom takes her into a different doctor to get this checked out for real.

The symptoms described—hearing one’s own voice, breathing, and heartbeat excessively loudly, to the point where it’s annoying and distracting—can be caused by what’s called a “patulous eustacian tube” (another term, patulous auditory tube, is more correct, but people don’t really call it that.) To understand what’s going on, we’ll have to do a (brief) anatomy lesson.

Your middle ear is a small, air-filled space behind the eardrum. When you go up in a plane, the drop in air pressure around you allows that air in the middle ear to expand, so you feel a “pressure” in your head. A small tube connects the middle ear to the nasal cavity, which allows pressure to equalize—you hear or feel a little “pop”, and that funny sensation of fullness goes away. Something similar happens when you descend. Most of the time, that little tube (called a eustacian tube, or auditory tube) stays closed—it just pops open now and then to equalize the pressure on either side of your eardrum. Usually, it pops open for a moment when you swallow (which is why chewing gum is a good way to clear your ears after a flight).

With a patulous eustacian tube, the tube stays open all of the time. That allows sound waves from within your head to get directly to the middle and then inner ear, bypassing the dampening effect of the eardrum and middle ear structures. The bottom line: you hear the noises from your own body much louder than you ought to, and noises like your own voice, breathing, and heartbeat can even sound louder than noises from the outside world.

Ordinarily, the eustacian tube is kept closed by surrounding fat and other tissues. Being slender, or losing a lot of weight quickly, seems to be a risk factor for developing a patulous eustacian tube. It can also occur after certain kinds of ear surgery, or during pregnancy. Sometimes, there’s no apparent cause. The presence of a patulous eustacian tube can sometimes be confirmed during the physical exam, by looking at the eardrum while the patient breathes or talks. Sure enough, you can sometimes see the drum vibrate at those times if the eustacian tube is staying abnormally open all of the time.

There aren’t a lot of great treatment options for this—but I’ve found it’s very helpful to reassure the patient that while this is, in fact, all in their heads, it is not “all in their heads.” I found this news report of a new method being tried in England, sticking a bit of putty on the eardrum to dampen sounds. If that pans out as truly effective, it can bring some serious relief to a lot of people. But, as the news article says, do NOT try this at home!

More resources here

The science of not eating vegetables

Posted September 25, 2014 by Dr. Roy
Categories: Guilt Free Parenting, Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

It’s an epidemic. Many kids just won’t eat their vegetables. Eek!

Let me say up front that “not eating vegetables” really should be considered “One More Thing Parents Don’t Need to Worry About.” Yes, veggies are a good source of vitamins, and since they’re not calorie-dense they’re a great part of the diet for anyone who’s trying to maintain a healthy weight. But those vitamins are identical to the vitamins in fruit and inexpensive supplements. I have yet to meet any child who is genuinely unhealthy just because they didn’t eat their brussels sprouts. And I suspect just as many adults don’t eat veggies, either—and we don’t pick on them, and we don’t make them sit at their seats at the table watching their icky peas congeal. When faced with a child who doesn’t eat veggies, my inclination is to give the kid a break and worry about something else.

Besides, it turns out there’s some genuine science, here. Many kids who won’t eat vegetables may have a genetically-determined increased sense of taste, and they find vegetables too bitter to be enjoyable.

Researchers in Naples, Italy published a study titled “Taste perception and food choices,” looking at about 100 children, their parents, and unrelated control adults. They used genetic studies on saliva samples to look for variations in genes for the TASR38 bitter taste receptors, along with a standardized assay for bitterness taste sensitivity using 6-propyl-2-thiouracil. Kids and adults who were very sensitive to the bitter taste of that chemical were classified as “supertasters.” They also used food diaries to see what kids of foods the study subjects ordinarily consumed. There were several interesting conclusions:

  • Childrens’ taste sensitivity was very different from both unrelated adults and from their own parents. Far more children than adults were “supertasters” who could easily taste even a tiny concentration of bitter chemical.
  • Both children and adults who were supertasters tended to avoid eating vegetables, though the effect was stronger in children. Adult supertasters were more willing to eat veggies than child supertasters, perhaps because of habituation or social pressures, or just because they were willing to put up with bitterness—but they still didn’t eat as many veggies as the adults who were not supertasters.
  • Supertaster status was associated with Body Mass Index in boys—in other words, boys who were supertasters tended to be more slender. None of the obese boys in the study was a supertaster.
  • Supertasting children were less likely to be willing to try new foods, and the most taste-sensitive children tend to have the most restrictive diet with the least variety.

I like veggies—I grow a big garden every year, and I actually really like brussels sprouts (especially roasted.) I think eating veggies is a good idea for both adults and kids. But it’s certainly not a matter of life and death. If your children won’t eat veggies, it’s very possible that they are genetically built to be especially sensitive to bitter taste, and they just don’t like the flavor. In time, as they become adults, they may be more willing to try veggies—or maybe not. Either way, it’s probably not your fault, and it’s certainly nothing to worry about.

Dr Roy's veggies

Dr Roy’s veggies

Butternut squash!

Get more happiness from doing things rather than having things

Posted September 22, 2014 by Dr. Roy
Categories: Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

The Journal Psychological Science just published a complicated, long, and fascinating study about happiness. The full text is tucked behind a paywall, but it’s great reading if you can get your hands on it.

The authors arranged four separate experiments, looking at the effects of getting things versus experiencing things, and how the anticipation of waiting might affect happiness. Some of the studies involved just imagining a future purchase or vacation; another one had study subjects answer brief texts about how they felt throughout the day. Some of the authors’ findings were really quite consistent across study modes, and though the study subjects were all adults I think a lot of this would apply just as well to kids. Some of their conclusions:

You get more happiness out of doing things than out of having things. A vacation where you go somewhere, or a trip to the park or having ice cream—these are experiences, things you do, and you don’t get to keep anything afterwards but your memories. These experiences are contrasted in the study with material things you might get, like a new toy or a new car. (It occurs to me that many “things” are actually both materials and experiences, like a book—but let’s leave that grey zone out for now.) Several aspects of this study, and a lot of other research, has shown that people get more happiness and more long-lasting happiness from experiences than things. Why? The strongest reason seems to be that we quickly habituate to the things we have. New sneakers? Great. In a day or so you don’t even notice you’re wearing them. The “Happiness Effect” of things seems fleeting, whatever the things are. In other words: Stuff will not make you happy.

The authors also looked at anticipation—what it means to have to wait for something. What they found might be surprising at first: people, overall, enjoyed waiting for things and experiences, and in fact got greater happiness from their things and experiences the longer they waited. Anticipation and waiting increased enjoyment. This increased happiness applied both to things and experiences, but was much stronger for experiences. People who planned vacations well in advance enjoyed their vacations way more than people who didn’t have to wait. People who waited to purchase a new jacket ended up enjoying their jackets a little more than people who bought them right away.

So: having stuff doesn’t make you as happy as doing stuff; and having to wait to do something makes you even happier than getting to do it right away.

Does this sound true for children as well as adults? You bet. Young and old, we concentrate too much on what we want to have. Once we have what we wanted, meh, we just want something else. The quicker we get it, the more meh we become.

My advice: go take your kids outside. Plant some flowers or brussels sprouts, eat some ice cream, and catch fireflies. Then let them go.

When a child refuses to poop

Posted September 18, 2014 by Dr. Roy
Categories: Medical problems, Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

Michelle wrote in: “We trained my 3 year old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there are days when he holds it in all day, and misbehaves all day because he’s in pain. All of my friends tell me to give him laxatives to make him go, but my pediatrician recommended against it because he said he doesn’t want to mess with his muscles, and he’ll get over it eventually. I trust my pediatrician completely, but I wanted to hear your thoughts.”

Here are three parenting truisms: you can’t make kids eat, you can’t make kids sleep, and you can’t make kids poop. So issues around eating, sleeping, and the potty are often the biggest parenting challenges, a least for younger children. Parents wish they had a way to “fix” these issues, or “make” their child do what they know their child needs to do. It can be frustrating, but raising children doesn’t always work like that. Children really do have ultimate control over their own eating, sleeping, and pooping. Why do children sometimes hold their stool? Sigmund Freud felt that stool holding was part of the anal psychosexual stage, and that a children who rebelled against potty training would develop anal-retentive personalities. He also thought that boys in particular had a fear of castration, and that stool looked like a little penis, so boys didn’t want to even symbolically lose their little penises into a toilet. Fascinating stuff, Freud—though it’s worth remembering that his specific analytic theories were just about 100% wrong, even though he deserves credit for figuring out that experiences and subconscious thought affected our outward behavior. In other words, I doubt Michelle’s son is holding his stool because he’s afraid his penis is falling off, but I do believe that his fear could be related to other experiences he’s having a difficult time articulating.

Freud’s theories aside, I think the most common reasons for kids to hold their stool are more ordinary: (1) they like being in control; and (2) stools sometimes hurt. Whatever the initial cause, stool holding inevitably leads to larger, more-painful stools, which makes the child try even harder to hold the stool. I’ve called this the “constipation death spiral.” Fixing stool holding means interrupting the cycle of holding leading to pain leading to more holding.

One thing you can try that will not work: talking. I’m not saying you shouldn’t talk about this with your child, but honestly, once your child learns it hurts to poop, you’re not going to be able to talk him out of it. Sure, you’d love to crawl into his little brain and say “Relax, honey. If you let the poop out it will feel better and you’ll be OK.” Good luck with that. Instead, try all of these methods, all at the same time:

Don’t make passing stool any more uncomfortable than it already is. Don’t try to force it, and don’t punish any behavior that’s involved with stool. Don’t belittle the child or insult him. Avoid saying things like “don’t act like a baby” or “you’re making me mad.” Don’t show even with body language that you’re disappointed or upset, even after a stool accident—all of that just feels negative to the child, and will reinforce a holding habit.

Please, please don’t rely on enemas or suppositories. Maybe once every ten years I’ve suggested one of these, and I’ve usually regretted it afterwards. Almost all constipation and holding, no matter how bad, can be managed without sticking things into your child’s bottom. Believe me, once you start wresting with things down there, it will only get worse.

Make stools more comfortable by using an oral, daily stool softener. You can get exact doses and instructions from your pediatrician. The key here is to use a consistent daily dose to keep stools soft and painless, and to not stop using the stool softener until all memories of the painful stools have disappeared. This usually requires months of therapy. That may sound discouraging, but it’s much better than going on and off medications for years. The main medication you’ll use will be a softening agent only, though sometimes we have to add a laxative to get the bowel squeezing. Again, rely on your own child’s pediatrician for specific advice here.

Michelle mentioned a concern that medications might change the muscles of the bowel. While it’s true that with long term use some laxatives (including Exlax and Senokot) can cause changes in muscle functioning, the stool softeners (like Miralax) are not addictive in any way, and don’t permanently change anything. They just make stool softer. In fact, by relieving the pressure of a big retained mass of stool, softeners allow the muscle wall of the colon to return to normal. No one should be afraid of using these sorts of agents to help their child.

Encourage healthy eating, though don’t harp on it or make it a big deal. More fruits and vegetables, and drinking more water, can help. More dairy can make things worse. But, again, don’t harp on diet or punish your child because of food issues. That will lead to even bigger problems. You will not solve a holding habit by changing diet alone.

Set aside a “potty time” every day for Junior to go sit on the pot, to wait to see what happens. A good time for this is right after dinner. Don’t let Junior just sit there a few seconds and have a little tiny BM—encourage him to sit a long time, read a story, or play with your phone (I think some Samsung phones are water resistant!) Do whatever keeps him happy. This should not come across as a punishment. The idea here is to stop relying on whether Junior says he does or doesn’t have to “go”—just tell him it’s time to go, once a day. And don’t rush.

One final idea: add some fun with something called “The Poopy Party”. (Works best for boys over age 3)

By the way, as with many of my posts, all of this applies to ordinary, healthy, neurologically typical children. If your child has GI problems or developmental challenges, other approaches might be more appropriate. Please talk with the doctors who know your child best.

With time and patience, stool holding will stop. The approach needs to be gentle, non-judgmental, and consistent—and even with that, it takes time to develop new habits. Good luck, Michelle, and let us know how it goes!

Homemade infant formula is not a good idea

Posted September 15, 2014 by Dr. Roy
Categories: Guilt Free Parenting, Nutrition, Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

Miranda wrote in with a topic suggestion—she wanted to know about homemade infant formula. She had noticed a lot of people suggesting it. What’s the deal?

Speaking about nutrition and human babies, it makes sense to start with this: human breast milk, from mom, is the best food for babies. But even that is an over-simplification. It turns out that in the modern world, human breast milk is often deficient in vitamin D, and maybe iron, too. I know I’m going to get some heat over this, but it’s true: even human breast milk isn’t “perfect.” It’s close, but if we’re going to be honest, even straight-up mom’s milk isn’t “ideal” for babies.

So what’s the best alternative? The contestants: human breast milk, which we’ll just call “human milk.” Commercial infant formula, which we’ll call “science milk.” This is the stuff that’s been studied for years, and is lab-designed to give babies the exact nutrition they need to thrive. Then there’s home-mixed infant formula, which we’ll call “homemade milk”, usually prepared based on an internet recipe.  What kind of “grade” should we give our three competitors, based on an objective assessment of their composition?

The number one “ingredient”, so to speak, is water. Clean, pure, safe water. Human milk, fresh from the breast, is free of harmful contaminants and infectious germs. Science milk is made under sterile conditions, and the liquid versions are pasteurized—as long as they’re stored correctly, there’s essentially no risk of infections spreading. Homemade milk? Who knows. I doubt anyone at home is sterilizing all of their surfaces to the extent done in a commercial lab. And some of the homemade milk recipes call for unpasteurized, “raw” milk—which can be loaded with animal colon bacteria as has been linked to all sorts of colorful infections. Winners: human milk and science milk (tie); loser: homemade milk.

Then there’s protein. There’s too much protein of the wrong kind in most mammal milks (including cow and goat), so science milk relies on modified mammal milk or soy to get the right amounts of the right kind of proteins. The wrong proteins can cause intestinal and kidney damage. One homemade milk recipe I found used blenderized livers as a protein source, which is even more dangerous. Human milk, protein-wise, is perfect. Winner: human milk, with science milk a close second. Loser: homemade milk.

The carbohydrate in all mammal’s milks is mostly lactose. Goats, humans, cows—our milk is all lactose-based. Science formulas sometimes substitute other carbs, largely to take advantage of the fear of lactose intolerance (which doesn’t occur in human newborns.) There’s no known downside to this, though it’s kind of silly. Winner: tie! Lipids (fats) are pretty much the same across the board, or near-enough so.

Sodium: ordinary milk from other mammals (goats and cows and presumably kangaroos, though I honestly don’t know about them) has far, far too much sodium. To properly reduce this, homemade formulas have to dilute that out somehow. Winners: human and science formulas.

Other micronutrients: there are a lot of these, of course—iodine and vitamin C and vitamin D and iron. And these really are important. Iron deficiency in infancy can contribute to permanent cognitive problems. You really do want to make sure that Junior is getting all of these vitamins and minerals in the exact proportions needed. The micronutrient content of human milk has been extensively studied, and science formula does a great job in either copying that, or even improving on that (re: iron and vitamin D.) Winner, science formula, by a nose; human milk is a very close second. Homemade formula are based on dozens or maybe hundreds of recipes, and no one has systematically figured out which if any actually deliver the micronutrients that are needed.

 Here’s a funny, true story from my residency: an 8 month old baby was admitted to the pediatric intensive care unit, near death. (Wait, it gets funnier.) He was very, very anemic—I remember noticing when drawing blood from his nearly lifeless body that the blood itself was kind of watery and runny. He also had neurologic problems and his vital organs had shut down. It turns out that his father was traveling hours a day, back and forth, to a farm to pick up fresh goat’s milk to feed him (because his parents had heard that goat’s milk was healthy!) Since goat’s milk is entirely deficient in one of the B vitamins (folate), the child’s blood marrow pretty much shut down. And there were a whole bunch of other health consequences related to other nutrient deficiencies and protein overload. After a few weeks in the ICU the baby survived. Isn’t that a funny story? No, of course it isn’t. It isn’t funny at all.

Ease of use and preparation: human milk wins, here, of course—though it has to be said, not always. Some women really do have a hard time nursing. It’s not always the easiest choice. Fortunately, we have another reasonably easy alternative: science milk. Mix the powder with water in the right proportion, and you’ve got pretty much exactly what your baby needs. The worst choice, here, would be homemade milk: it’s complicated and fiddly, has a lot of ingredients to get wrong, and it still may not even provide the nutrition your baby needs.

Homemade infant formula is a terrible idea. There is no way for parents to make something as pure and complete as either human milk or commercial infant formula (science milk.) There’s no evidence whatsoever that it even might be safer or better in any tangible way. This is one case where homemade is not the way to go. If you’re not breastfeeding, you should use commercial infant formula. Do not trust your baby’s health on your chemistry skills and recipes from the internet.

Protect your kids from the “new” respiratory virus

Posted September 10, 2014 by Dr. Roy
Categories: In the news, Medical problems

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The Pediatric Insider

© 2014 Roy Benaroch, MD

Facebook and other social media sites are all a-twitter (ha!) about a “new” respiratory virus, sweeping the country and sickening thousands of kids. There is something new, or new-ish, out there, and it looks like the infection can get pretty bad. But now is not the time for panic. We’ll get through this, like we get through other spikes in viral infections. With some common-sense steps, your kids will be OK.

As reported officially by the CDC this week, in the last month hospitals in Illinois and Missouri reported an increase in emergency department visits and hospitalizations for respiratory symptoms. Since then, reports of similar illness are coming in from many other states, scattered across the country. Most (but not all) of the cases with more severe illness had pre-existing lung disease (like asthma).

The illness seems to be mostly affecting children. Most cases begin with ordinary, cold-like symptoms—and it’s likely that most cases actually never develop into anything more than that. The reported cases, so far, may well be a “tip of the iceberg” effect, where only the sickest children get tested and identified. These are the kids who develop trouble breathing and low oxygen levels, and often need intensive care. It’s quite likely that most children with this infection quickly recover after a cough, sniffles, and runny nose. Of the cases reported so far, only about 1 in 4 or 5 runs a fever. Probably, most children and adults who have this infection don’t seek medical care, and very few of them (so far) are even being tested for the likely viral cause.

Most of the reported cases are testing positive for a specific virus, called enterovirus D68. That virus was first identified in California and 1962, and until now had rarely been a reported cause of illness. The enterovirus group, as a whole, contains a lot of other viruses that cause a whole bunch of different symptoms—fevers, respiratory illnesses, GI problems, heart disease, rashes, and neurologic problems. Pediatricians and others who take care of kids are used to seeing tons of enterovirus, which usually strikes in the summer, most typically as hand-foot-and-mouth disease, or as a fever. So we’re used to these kinds of viruses, even though this specific one is a newly-recognized member of the family. We’re not 100% sure, yet, exactly how D68 is transmitted, but other enteroviruses spread though respiratory drops and in stool, and can remain infectious for a long time on contaminated surfaces.

As with many viral infections, prevention is the best strategy. Common sense things can really help: keep your kids home when they’re sick, and don’t send your kids off to play with sick children. Encourage your kids to wash their hands and use hand sanitizer frequently. Get a good night’s sleep and moderate exercise. Keep your child up-to-date on vaccines—though there is no specific vaccine for this enterovirus*, bacterial and viral coinfections with influenza and pneumonia can be prevented. If your child has asthma (or any other respiratory problems), make sure that you’re keeping up with all prescribed treatments, so things are less likely to spiral out of control when an infection strikes.

If your child does get sick with cough, look out for these symptoms:

  • Having trouble breathing. You may see individual ribs poking out with each breath, or the depression at the bottom of the neck sinking in, or bobbing up and down. Children with trouble breathing usually breathe fast, and sometimes breathe noisily.
  • Having trouble speaking. If you can’t get good breaths in, you can’t typically complete sentences and talk normally.
  • Seeming listless, with low energy. Children with serious respiratory compromise may not be getting enough oxygen to their brains. They can seem “foggy” or “out of it.”
  • Drinking poorly. Younger children and babies may have a hard time eating and (especially) drinking when they’re really ill.
  • Looking blue or pale.

If you’re seeing those kinds of symptoms, take your child to the doctor right away, or head to the emergency department. Even if things don’t seem quite that bad, if you’re worried, don’t hesitate to call for help.

Most children who are getting enterovirus D68 infection will do just fine. Some of you have probably already had children with this, and didn’t even know it. Every year, we see spikes of infections like this, caused by a variety of viruses like RSV, metapneumovirus, or influenza. Though there is no specific therapy for most of these, we’re pretty good at recognizing who needs extra help, and we can provide good supportive care when it’s needed. It sounds scary when you see news of a new, bad infection—but in truth, this isn’t very different from other infections we’re used to dealing with. We need to stay vigilant and keep our eyes on whatever’s out there making our children sick, but there’s no reason to get too worked up over this latest challenge.

*Fun trivia challenge: we routinely vaccinate against one other enterovirus, one that historically caused infections in the summertime. Guess!

This was adapted from a post I wrote for my practice website.

Dr. Bob Sears says skipping vaccines is not good for public health

Posted September 9, 2014 by Dr. Roy
Categories: In the news, Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

This weekend, The Los Angeles Times reported on California pediatrician Dr. Bob Sears’ role as a favorite among vaccine-fearing parents. What he tells them is absolute nonsense that he has freely admitted he made up in a Reddit interview. Now he’s let a little more honesty shine through. He told the reporter:

“I do think the disease danger is low enough where I think you can safely raise an unvaccinated child in today’s society,” he said. “It may not be good for the public health. But … for your individual child, I think it is a safe enough choice.”

I had wondered: is it possible that a board-certified pediatrician, one from a family of influential and well-known children’s health experts including Dr. William “Attachment Parenting” Sears and Dr. Jim “The Doctors” Sears, could really believe the idiocy in his own book? Now we know. Dr. Bob Sears says screw public health, screw everyone else’s children, screw your neighbors and their families. It’s fine if you skip your child’s vaccines, because for your child the risk isn’t great. That may not be good for the public, Bob says, for all of those other idiots out there—we know if people start skipping vaccines the disease will surge back. But for your snowflake, well, it’s OK. You can even picture him winking when he says it.

This is just despicable. Mendacious, vile… I’m running out of adjectives, here. Dr. Bob thinks his own special pals, his patients, the suckers who buy his books, they don’t need their vaccines—they can just hide in the herd, as long as the rest of us get our kids vaccinated. His white, affluent, Orange County kids can’t be bothered with needles. Sure, it’s no good for public health, but public health isn’t something his parents need to think about.

Dr. Bob freely regurgitates long-disproved anti-vaccine canards throughout his laughably mis-named The Vaccine Book: Making the Right Decision for Your Child. The book has sold well. He’s telling people exactly what they think they want to hear, blaming all sorts of ills on vaccines, fueling fear and anxiety and a mistrust of every legitimate health authority on the planet. They’re all wrong, he says, the CDC and the IOM and every county health officer and every single country’s health ministries and all of the pediatricians, family medicine docs, infectious disease specialists, and everyone else who’s invested their careers in protecting the public health. We don’t need no stinkin’ evidence.

He’s making oodles of money off of your fear, while freely admitting that what he’s doing is no good for the public health. Don’t forget: the public is you, your children, your family. We’re all in this together, sharing our planet and sharing these infections. You can help keep your children and communities safe by making sure your kids are vaccinated. Or you can join the “me first, screw you” brigade led by Dr. Bob.


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