Joan E. Hodgman, MD, FAAP

Transcription

SENIOR BULLETIN
AAP Section for Senior Members
Editor:
Associate Editor:
Advocacy for Children Editors:
Travel & Leisure Editor:
Financial Planning Editor:
Health Maintenance Editor:
Computers Editor:
General Senior Issues Editors:
Outdoors Editor:
Joan Hodgman, MD, FAAP
Arthur Maron, MD, MPA, FAAP
Lucy Crain, MD, MPH, FAAP
Burris Duncan, MD, FAAP
Donald Schiff, MD, FAAP
Herbert Winograd, MD, FAAP
James Reynolds, MD FAAP
Avrum Katcher, MD, FAAP
Jerold Aronson, MD, FAAP
Avrum Katcher, MD, FAAP
Eugene Wynsen, MD, FAAP
John Bolton, MD, FAAP
Vo l u m e 1 7 N o . 2 – S p r i n g 2 0 0 8
Opinions expressed are those of the authors and not necessarily those of the American Academy
of Pediatrics. The recommendations in this publication do not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking into account individual
circumstances, may be appropriate.
Message from the
Chairperson
Avrum L. Katcher, MD, FAAP
Chairperson, Section for Senior Members
Delighted to converse with you again. If you are reading this message, we are conversing. A conversation
occurs in two directions, in contrast to a speech. I do
not give speeches, but I am delighted to hold a conversation. That means, that the more you respond to
these messages, the happier I am. And the more likely
you are to make a different point, the better it is,
because I am more likely to learn something from
you. That makes a conversation, and since it will often
appear in the next issue of the Bulletin, the better off
we all shall be.
What’s Inside?
Message from the Chairperson . . . . . . . . . . . 1-2
Executive Committee/Subcommittee Chairs . . . 2
2008 National Conference & Exhibition . . . . . . 3
Section for Seniors Members Program
Crucial Considerations for Grandparenting . . . . 3
Joan E. Hodgman, MD, FAAP . . . . . . . . . . . . 4-5
Lost e-mailer letter member sought!. . . . . . . . . 5
2008 Senior Bulletin Schedule . . . . . . . . . . . . . 6
Pediatric History Center . . . . . . . . . . . . . . . . 7-9
Promoting the Values of Pediatrics . . . . . . . . . . 9
The Oral Heal Risk Assessment Training
for Pediatricians and Other Child Health
Providers Training Kit . . . . . . . . . . . . . . . . . . . 10
PROGRESS. . . . . . . . . . . . . . . . . . . . . . . . . . . 10
A Happy Spring Time to you all. And I hope that if you
are in a Daylight Savings area you have completed
your adjustment without difficulty. What do you think
of Daylight Saving time? Should it be continued?
Some scientists are saying that it does not add to conservation of energy or decreasing the number of
greenhouse gases. What are your thoughts? What evidence do you have to support them?
SCHIP: Good policy for children became
ensnared in a larger debate on how to reform
health care . . . . . . . . . . . . . . . . . . . . . . . . 11-12
Medical Home Program Expands to all Domestic
Shriners Hospitals for Children . . . . . . . . . . . . 12
Over-the-counter cough and cold medicines for
infants and children - Speaking Points . . . . . . 13
COOL AID . . . . . . . . . . . . . . . . . . . . . . . . 14-15
Have you looked at the AAP Home page on the web
site recently? There is a spread to entice you to consider the National Sleep Awareness Campaign, a feature of the AAP and the National Sleep Foundation
(NSF), for the millions of Americans who are not getting the sleep they need. Now don’t laugh. I went
through this also, working for seven years as a solo
Changing Times for Neonatologist in the
Regionalization System . . . . . . . . . . . . . . . 16-17
The Contortionist . . . . . . . . . . . . . . . . . . . 17-21
Bond Basics. . . . . . . . . . . . . . . . . . . . . . . . 21-22
LINCOLN AND DOUGLAS . . . . . . . . . . . . 22-23
Update your Personal Profile . . . . . . . . . . . . . 24
Continued on Page 2
Copyright© 2008 American Academy of Pediatrics Section for Senior Members
Executive Committee
Chair
Flemington, NJ
David Annunziato, MD, FAAP
Immediate Past Chair
East Meadow, NY
Michael O’Halloran, MD, FAAP
Eau Claire, WI
George Cohen, MD, FAAP
Rockville, MD
Lucy Crain, MD, MPH, FAAP
San Francisco, CA
John Bolton, MD, FAAP
Mill Valley, CA
Arthur Maron,
MD, MPA, FAAP
Boca Raton, FL
Subcommittee Chairs
Program
Lucy Crain, MD, FAAP
Financial Planning
James Reynolds, MD, FAAP
Membership
George Cohen, MD, FAAP
History Center/Archives
David Annunziato, MD, FAAP
Newsletter Editor
Joan Hodgman, MD, FAAP
626/445-0178
[email protected]
Associate Editor
Arthur Maron, MD, FAAP
561/394-6114
[email protected]
Staff
Jackie Burke,
Sections Manager
800/433-9016, ext. 4759
[email protected]
Tracey Coletta,
Sections Coordinator
800/433-9016, ext. 4926
[email protected]
Mark A. Krajecki,
Pre-Press Production Specialist
847/434-7866
[email protected]
2
Message from the Chairperson Continued from Page 1
practitioner, on call every night and every weekend, before my first partner, Glenn Lambert came to work with me. By retirement, we had 8
members in our group practice, and more on the way. But I still do not
sleep as well as I should. The NSF has absolutely fascinating material on
factors that promote healthy sleep and those that interfere with it. What
you can do to enhance your sleep and other members of your home family are included. Well worth looking into if you feel there may be a sleep
problem. Failure to sleep well may be associated with quite a number of
behavioral and somatic difficulties, and often is readily improved. Go
from the AAP home page, click on Sections, click on Section home pages
then Senior Members to our refurbished web site, crafted by member
Jerold Aronson and staff member Amy Beschta-Newborn. Here you will
find a number of important sources of information. First, the Section for
Senior Members education program for the NCE in Boston to be held on
Monday, October 13, 2008 CRUCIAL CONSIDERATIONS FOR GRANDPARENTING Tax Exempt Investment Options to Assure College
Educations for Your Grandchildren: Lorna Meyer, Senior Vice President,
President of Private Banking & Investment Group, Merrill Lynch Foster
Parenting & Grandparenting 101: Another Way to Stay Young? Dr. Errol
and Mrs. Judy Alden, Executive Director, American Academy of Pediatrics
Impact of Adult Diet, Health, and Lifestyle on Future Generations: Lisa
Hark, Ph.D., R.D., Director, Nutrition Education Program, University of
Pennsylvania School of Medicine. In addition to a series of important articles and references noted on that page in the center column, you’ll find
on the right-hand Site Menu the Living Well Section including information on health, legal, financial, Medicare and many other topics of importance to all of us as we age. A similar compendium of useful facts is
found under the block on Health and Fitness, together with many other
thought-provoking ideas.
Finally, we want you to be aware that your Executive Committee has
been working hard on goals and objectives, structuring the areas of most
importance to our members upon which we should be concentrating our
efforts. We will be meeting in May to consider where we are. But, meanwhile, your input and thoughts are crucial to this process. Send along your
ideas, to any member of our Executive Committee, myself,
or our Section manager, Jackie Burke. Also don’t forget to consider that
growing older, in the same fashion as growing up from childhood, is a
developmental process involving progressive change leading to (we
hope) enhanced ability to navigate the inevitable changes of aging, cruise
the variations in personal and professional lives which ensue, and finally
prepare, if we are given time, for the closing of life.
With best wishes
Chairperson, Section for Senior Members
American Academy of Pediatrics
Senior Bulletin - AAP Section for Senior Members - Spring 2008
Save the Date for the 08 AAP National Conference &
Exhibition (NCE) in Boston, Oct 11-14 at the Hynes
Convention Center with free pre-conference CME and
social events happening Friday, Oct 10. There are many
new and exciting changes for 08: session times were
shortened to help you focus, and to give you MORE
traveling and networking time between sessions; Plenary times have moved from early to mid
morning; our exhibit floor will be packed again with state-of-the-art technology, products, and resources;
and the annual pre-conference symposia series, Peds21, will focus on oral health. The AAP is honored to
also announce the recent confirmation of Saturday’s Keynote speaker, Timothy P. Shriver, PhD, Chairman
of the Special Olympics.
Learn MORE at www.AAPexperieNCE.org and click on attendee. Get a first glance at 08 NCE sessions; click
on attendee > education and view sessions sorted by topic or format (dates, times, and faculty will be assigned
shortly). If you missed the 07 NCE, there is an 07NCERecap page under attendee, which has faculty podcasts on asthma control, treatment of epilepsy, effects of health information technology on therapeutic relationship, cerebral function monitoring, and HIV exposure. Also on this page are links to the daily conference
newspaper, the photo album, Fund Run race results, and a link to purchase the 07 NCE sessions on tape in
a variety of formats (MP3, CD-ROM, or CD player for PC).
Each year, universities, medical colleges, and hospitals around the country choose to
sponsor an “Alumni Event” any evening during the conference. These special receptions give you MORE
opportunities to reconnect with old friends and mentors. Interested in booking an alumni event? Contact
Jake Stein at [email protected] to reserve space today!
Section for Seniors Members Program
Crucial Considerations for Grandparenting
Sponsored by the Section for Senior Members
Monday, October 13, 2008
1:30 PM – 5:30 PM
This special session will focus on tax-exempt investment options to ensure college educations for your
grandchildren; foster parenting and grandparenting 101: another way to stay young; and the impact of an adult’s
diet, health, and lifestyle on future generations.
Faculty: Errol Alden, MD, FAAP; Judy Alden;
Lisa Hark, PhD, RD; Lorna Meyer
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Joan E. Hodgman, MD, FAAP
AAP Section for Senior Members • Executive Committee Member
I am a true westerner. I was born
in Portland, Oregon on Labor Day
in 1923. My mother, perinatal
before her time, had gone from
Medford where my parents were
living, to friends in Portland to get
a real obstetrician to deliver her. I
even had a pediatrician. We
moved to Reno, Nevada and to
Oakland, California following my
father’s construction business. When I was four, we
moved to Southern California and I have been here
ever since.
I went to South Pasadena High School, where I met
my husband, Amos Schwartz. He sat behind me in
Miss Foote’s Public Speaking Class and took me to
the Junior Prom. He had just been elected as our senior class president so he was a “catch”. He waited for
me while I messed around and we married after we
had been out of high school ten years. I was an art
major in high school; but in my senior year I switched
to pre med. I have given my determination to go into
medicine a great deal of thought and I still don’t know
where it came from. I am the only physician in my
family going back several generations. When I was a
girl, women were supposed to be nurses not doctors.
I knew if I wanted to be accepted to medical school I
would need good grades so I studied for them and
managed an A average in college at Stanford. I was still
not admitted to Stanford medical school. Stanford at
the time had no quota for women, but never took
more than two in a class. I’ve never been unhappy
with Stanford because they did me a big favor. I went
up the peninsula and applied to UCSF which at the
time was a much better medical school. I was admitted promptly and enjoyed my schooling there. Since
being admitted to medical school, I have never been
personally very aware of prejudice against women.
I stayed at UCSF Hospital for a year of post graduate
training before coming home to Los Angeles. World
War II was over by then and the veterans were coming home, I was fortunate to get a resident position in
Pediatrics at Los Angeles County University of
Southern California Medical Center. When I was in
medical school, newborns were not given medical
care. They were given nursing care and if they survived
they were discharged to a doctor. The only normal
newborn I saw during all of medical school was the
infant I delivered when I was anOB. Infants weighing
less than one kilo were expected to die. When I was a
resident, Lou Diamond of Harvard developed the
exchange transfusion for rh disease, which accounted
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for one third of the deaths in newborns at the time,
and published the procedure in one of the journals in
1978. Dr. Robert Clelland, who was the Head
Physician for Pediatrics and I as Chief Resident read
the article and tried it out. Fortunately, the newborn
infant did very well. That was my initiation into newborn care.
When I finished my residency, I opened my own
office, which was entirely possible at the time. Amos
and I had been married while I was a resident and he
was in USC Medical School. He was actually my student on Pediatrics which was considered an acid test.
House calls were common at the time, and usually
came in the evening. What did the new Pediatrician
have to offer but availability, so when the phone rang,
I went. My husband was doing his surgical residency
and needed to be at the hospital for early surgery. I
was spending my evenings making house calls and I
knew what my husband sounded like on the telephone but I was having trouble recognizing him. After
two years I decided that I didn’t need to work less
hard but I needed more control of my time. The job as
Head Physician in Pediatrics was open and I applied
for it and was chosen over seven other applicants. I
was the only full time member of the Pediatric faculty
at LACUSC Medical Center. The remainder were practicing Pediatricians who donated time for rounds with
the residents. They were excellent physicians and
devoted to teaching, but there was no academic
aspect to the program. Two years after I had started it
was decided to add another Head Physician. The service was to be divided into the wards and the clinics
and nursery. I had first choice and was going to choose
the wards as the most important part of the service,
but shortly before I had to decide I realized I would
miss the babies in the nursery. So I chose the clinics
and nursery. Among the first things I did was get rid
of the clinics and then I could concentrate on the
nursery. The gods were riding on my shoulders and I
have never looked back.
Our hospital was delivering between 15,000 and
18,000 babies per year at the time. We did not yet have
an NICU but we did have a premature ward. We were
the only hospital in town that admitted outside babies
to its nurseries. The Health Department had evaluated
all hospitals with delivery services and had established whether they could keep small babies or send
them to us. We had microchemistries, Gordon
Armstrong incubators and x-ray machines that could
give a clear picture of the lungs even if the baby was
breathing 80-100 times a minute. We did not have
Continued on Page 5
Joan E. Hodgman, MD, FAAP Continued from Page 4
ventilators as yet. In the 60’s we tried to establish an
NICU. We would clean out a nursery for the purpose
and come back the next morning to find it full of
babies. Not surprising when you consider that 18,000
births equates to 50 deliveries per day. In 1968 we
moved to another hospital on the same grounds and
finally had room to start our NICU. It was the first one
in Los Angeles. We had Fellows in training although
there was as yet no national Fellowship program. Paul
Werhle joined our faculty as Chairman of Pediatrics in
the late 1960’s and brought an academic background.
I sat at his feet and learned a bunch about presenting
abstracts, clinical research and running a division.
Neonatal care blossomed into a Division of Pediatrics
with ever smaller infants being cared for. Feizal
Waffarn, one of our junior faculty at the time and I
started our Bioethics committee in the1970’s during
the Baby Doe controversy. Our administration could
not tell us not to hold meetings but they did ask us to
keep the committee under wraps. I believe their reluctance stemmed from their worry about headlines in
the LA Times about minority babies being done in at
the County Hospital. Interestingly, in 2005 when
JACOH evaluated our hospital, they were very interested in patient advocacy. Our administration was
able to claim that we had had a bioethics committee
since 1975.
My husband and I had two daughters. I just made it
under being an elderly primipara of 30 at the time. The
second was born a year and a half later. I have four
grandchildren, three boys aged 24, 20 and 20, cousins
not twins, and finally an eleven year old granddaughter. My husband developed a lymphosarcoma and
died at the age of 47 in 1970. They say only the good
die young and he was very good. I have now been a
widow almost twice as long as we were married.
Technology in newborn care advanced rapidly. We
added ventilator care, efficient incubators, blood gas
determinations and routine monitoring of the infants.
We also became proficient at clinical research. I now
have a 36 page CV with 130 peer reviewed articles and
almost twice as many abstracts presented at research
meetings. Also, there are a number of other articles
and book chapters including one book entitled SIDS
with coauthor Toke Hoppenbrouwers. I have had the
opportunity to travel to other units world wide and in
at least two, Cali, Columbia and Poland I have been a
factor in the improvement of their newborn care. I
went through the levels of academic status, starting
with instructor as a resident and ending with
Professor of Pediatrics in 1969.When I retired recently
I became Emerita Professor. I have had a number of
awards of which I am proud but will only list two here.
I was selected in1976 as the Los Angeles TimesWoman
of the Year in Science. Then, my most prestigious
award was the Apgar Award given by the Perinatal
Section in 1999 at the NCE in Washington, DC. I
stepped down from Chairman of the Division of
Neonatology a number of years ago, but continued to
take my scheduled rotation on rounds and teaching.
A few years ago I gave up rounds in the NICU because
it was too demanding. I miss not being responsible for
the NICU as that is where I worked with the residents
and fellows and got to know them. Recently I have
spent most of my time with medical students, teaching and sponsoring them in clinical research projects. At the present time, I am involved in writing four
papers for eventual publication in peer reviewed journals and I had two abstracts in the lastWestern Society
for Pediatric Research. Not too bad for an old lady.
I have been active in the AAP as President of Chapter
2 and Alternate Chair of District IX. I have belonged
to national committees, especially Committees on
Women’s affairs when that was necessary some years
ago. Now, I am Editor of the Senior Bulletin of the
Section for Senior Members. I have been president of
all the local organizations to which I belong including
the Los Angeles Pediatric Society, Salerni Collegium,
a support group for the medical students at USC and
the Southwestern Pediatric Society. I am a founding
member of the California Association of Neonatologists and a member of the board.
On January 1, 2008, I retired from LACUSC and
received a nice parting gift. It was a very attractive
chair with the medical school logo on the back, my
name, “In Recognition for Dedicated Service”, and
the years 1948-2008. Wow!
Lost e-mailer letter member sought!
I received a letter from one of our members with his parenting program outlined in answer to the article
about parenting by Susan DiPietro in the Winter Bulletin. I wish to answer it but I can not find it in my email
and nobody in the office has a copy. I would very much like the member to send it to me again. My email is
[email protected].
Joan Hodgman, editor
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2008 Senior Bulletin Schedule
Articles for consideration should be sent to the Editor at [email protected] with copies to the Associate
Editor [email protected] and the Academy headquarters [email protected]
Summer Bulletin
June 2 articles due to Joan Hodgman MD, FAAP
July 1 mailboxes
Fall Bulletin
July 15 articles due to Joan Hodgman MD, FAAP
(this deadline is early because the editor spends August at her mountain cabin away from computers and
email and must have the Bulletin prepared before she leaves)
September 22 mailboxes
Winter Bulletin
December 1 articles due to Joan Hodgman MD, FAAP
January 1 mailboxes
Spring Bulletin 2009
March 17 articles due to Joan Hodgman MD, FAAP
April 18 mailboxes
AAP resolutions and the Annual Leadership Forum
by Michael O’Halloran, MD, FAAP
The more I learn about the Academy the more I’m
impressed not only by what it accomplishes but also
by the enormous amount of work that goes into getting it done.
This spring I attended the four day Annual Leadership
Forum (ALF) as Vice Chair of the AAP Section for
Senior Members because our chair, Av Katcher was
unable to attend. It was a fascinating and enlightening experience. The ALF is the climax of the whole AAP
resolution process of getting our ideas to the leadership.
seminars, interactive group discussions, leadership
education and presentations from the AAP President,
AAP Executive Director, and AAP President-Elect
Candidates. Even with this full schedule, ample time
is also made available for networking.
This year there were 73 resolutions. Most were
thoughtful and well reasoned. Here are some examples: The AAP should look into whether telephone
care is cost effective; The AAP should support mandated Phy-Ed in grade schools; The Legislative
Committee should generate a legislators’ report card
on their record on children’s health issues.
The Leadership Forum was conceived as a means for
the AAP to understand the priorities of, and to draw
on the expertise of, its grass roots. Originally, two voting members of each chapter met yearly for discussions. A few years ago this was changed to include the
chairs of the Sections, Councils and Committees. The
main task of the meeting is reviewing, debating, and
voting on the resolutions submitted by Chapters,
Committees, Sections, Councils and general membership of the AAP. Resolutions passed by the Forum
attendees are advisory to the AAP Board of Directors.
In addition to the resolution process, time is devoted
at the ALF to offering a variety of learning opportunities. These include chapter business management
So, here, in abbreviated form, is how a Fellow of the
AAP might get an idea to the Board of Directors or
onto the agenda of an appropriate Committee,
Council, or Section. First one would write up the idea
using the format and guidance found in the
“Guidelines for Submitting Resolutions” page in the
Membership Center of the AAP website. When the
resolution is ready the author might submit an
unsponsored resolution but it’s better to seek the
sponsorship of a Chapter, or of an AAP Section,
Committee or Council. Once that is done, the resolution goes to the Chapter Forum Management
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2008 Computer Safety Update Continued from Page 6
Committee (CFMC) to make sure it meets formatting
requirements. If the CFMC has any questions regarding a particular resolution, they must call the author
for clarification or changes. By the time the resolutions reach this stage, they have also been looked at
by any relevant department of the AAP staff for background information which might include, among
other things, comments on fiscal impact. This information is then included with the resolution.
The Chapter Forum Management Committee
(CFMC) will then assign all resolutions to a Reference
Committee based on whether it involves such things
as education, advocacy, pediatric practice, etc. These
reference committees preside at ALF sessions where
the resolutions get a hearing prior to the voting. Then,
on the last day of the ALF the resolutions are debated
and voted upon at the general voting sessions.
Authors of the resolutions who are not part of the
invited leadership may attend the ALF to take part in
the debate of their own resolution.
Assuming the resolution passes, it then is reviewed by
the Advisory Committee to the Board on Community,
Chapter and State Affairs which refers them to the
appropriate committee, council, section, or department, for a response. Their response is added to the
resolution and a “disposition document” (which
includes the status of all resolutions) is posted on the
Member Center of the AAP Website. All responses are
tracked by the District Vice Chairpersons and he/she
reports on them in the fall at the district breakfasts at
the National Conference and Exhibition (NCE).
So that’s it. The process may seem cumbersome and
messy at times but all of the steps seem necessary so
that the actual debating and voting can be efficiently
done; and, at the same time, be as scrupulously fair
as possible.
Co-Editor’s Note:
If you have an issue which merits consideration, go for
it!
Historical Archives Advisory Committee
by Howard Allen Pearson, MD, FAAP
During the next year or so, the Historical Archives Advisory Committee of
the AAP will present brief historical reviews of several important pediatric
organizations in the United States.
“Knowing where we have come from may give us insights
into where we are going.”
The History of The American Medical Association
Section on Diseases of Children (Pediatrics)
The AMA Section on Diseases of Children was organized at the thirty-first annual meeting of the AMA held in
Richmond, Virginia in 1880. It was the first national American pediatric organization. In a historical review by
Dr. Frederic W. Schlutz, chairman of the Section on its 50th anniversary in 1930, Dr Abraham Jacobi was
described as giving an eloquent address before the House of Delegates of the AMA outlining the need for an
independent Section and his rationale for considering pediatrics as a discipline separate from obstetrics and
internal medicine. Dr. Samuel Busey of Washington, D.C. then offered a resolution to create a Section on
Diseases of Children as the sixth section of the AMA, and the recommendation was adopted by the AMA House
of Delegates. Dr. Schlutz quoted an early Section chairman:
“Dr. Busey was the accoucheur on this happy occasion and Dr. Jacobi stood Godfather.”
When asked later in his life about the history of the founding of the Section, Dr. Jacobi said:
“There is no history, we just did it. It was a clear case of spontaneous generation.
The Section was in the air and we were present when it condensed – that is all.”
The first regular meeting of the Section was held in Richmond, VA in 1881 and 40 members and guests were
present. The only requirement for Section membership was membership in the AMA. Dr. Jacobi was elected
as the first chairman and delivered an address entitled, “The Progress and Knowledge of Acute Contagious
Diseases and Infections.” Dr. Thomas Morgan Rotch of Boston was the first secretary.
Continued on Page 8
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Pediatric History Center Continued from Page 7
From its beginning, the Section meetings coincided in time and place with the annual meetings of the AMA.
Dr. Schlutz meeting described the struggles of the Section during its early years due to the:
“lack of cohesion and cooperation of a diffuse and unstable membership.
It was not unusual for the chairman or secretary, or both, not to show up for the meeting.
The program would often not be followed because the essayist likely as not would not show up.”
There were no minutes of the Section published in the 1886 and 1887 Journal of the American Medical
Association (JAMA). In 1889, a resolution was presented to the House of Delegates to dissolve the Section, but
this did not carry. Despite these early problems, the Section grew in numbers so that attendance at the beginning of the 20th century averaged fifty to seventy-five.
Section meetings, which were held concurrently with annual national meetings of the AMA consisted of three,
half-day scientific sessions in which clinical papers were presented, followed by discussions. The titles of the
presentations in the first years of the Section reflected the major pediatric concerns of the day: dentition and
its effect on other diseases, croup, alimentary diseases including typhoid, and somewhat later diphtheria and
diphtheria anti-toxin. The preoccupation of early pediatricians with nutrition, and infant feeding is reflected
in the large number of presentations concerning these subjects during the Section’s first fifty years.
The Section programs list participation of many of the great names in American pediatrics of the time, including Drs. A. Jacobi, L. Emmett Holt, K. Blackfan,Thomas Morgan Rotch, T.Cooley, J. Howland, I. Abt, J. Rurah, J.
Brennenann, and many others. Many of the members of the Section were also members of the American
Pediatric Society, as well as other international and regional pediatric organizations.
Business meetings were usually brief, but resolutions were occasionally made which were then referred to the
AMA House of Delegates for consideration and possible action. Because of the by- laws of the AMA, Sections
could not function independently. The Section’s major function was to hold an annual scientific meeting, so
there was little action to influence medical or social issues. However social and educational issues were frequently discussed, often in the annual addresses of the chairmen.
Pediatric education was a repeated topic of discussion and debate. In 1909 the Section considered a resolution concerning pediatric education in medical schools. This topic had been addressed by Dr John Lovett Morse
in his chairman’s address before the Section in 1905. Morse declared that only full time pediatric specialists
were sufficiently knowledgeable to teach pediatrics.
“Pediatrics can never be taught unless it is a separate department.
If it is made a part of the departments of obstetrics or of gynecology, as in some schools,
it is certain to be neglected and to be improperly taught.
It is too important a subject to form a part of the department of internal medicine.”
In 1910 the Section recommended to the trustees of the AMA the establishment of a new pediatric journal. The
first edition of the American Journal of Diseases of Children was published in 1911 with Dr. Frank S. Churchill
as its editor. In 1930, the Section passed a resolution to change its name to “Section on Pediatrics” The change
was accepted by the AMA House of Delegates and was implemented in 1932.
The Section had a continuing interest in legislation that affected the welfare of children. At its meeting in St.
Louis in the spring of 1922, the Section debated The Sheppard-Towner Act (“Act for the Promotion of the
Welfare of Maternity and Infancy”). This was ultimately approved by the U.S. Congress ( probably as a defensive response to the passage of the 19th Amendment of the Constitution which established women’s suffrage!
). This was one of the first health initiatives by the federal government to benefit women and children. By today’s
standards, it was a small, rather modest proposal to provide grants-in-aid to states to develop health services
for mothers and children. After extensive discussion the Section endorsed the Act by unanimous resolution.
On the same day, the AMA House of Delegates, meeting across town, passed a resolution condemning the
Sheppard-Towner Act as an:
“imported scheme drawn chiefly from the radical,
socialistic, bolshevistic philosophy of Germany and Russia.”
Continued on Page 9
8
Pediatric History Center Continued from Page 8
The next morning the St. Louis newspapers featured front page stories that reported the Section’s resolution
supporting the Act. What then ensued was colorfully described by Dr. M. Carleton Pease:
“The fat was in the fire. A Committee of Wrath was sent by the House of Delegates
to reprimand the Pediatric Section but they were met with unrepentance and jeers.”
The House of Delegates then promptly enacted rulings that no section of the AMA could independently adopt
a resolution or in any other way indicate approval or disapproval of matters having to do with AMA policies:
further, all sections of the AMA must confine their activities strictly to social functions and the presentation
of a scientific program.
For the next seven years, pediatricians chafed under this rebuke and put-down as indicated by Dr. Pease:
“The status of being an unwanted child in the family of medicine was not a happy one for the average
clinical pediatrician…Legislation on matters of public health often began with the mother and child,
but pediatricians were not only not consulted, but worse were often ignored…The only ‘out’ seemed to be
to form a new, unified national pediatric society.”
This was set in motion at a dinner held in conjunction with the 1930 meeting of the Section in Portland, Oregon.
The founding of the American Academy of Pediatrics (AAP) followed shortly.
In 1975, a decision was made to discontinue scientific programs at Section meetings because the responsibility for continuing medical education (CME) was increasingly being assumed by individual specialty societies.
A new role for the Council of the Section on Pediatrics evolved that markedly increased interactions between
the AAP and the AMA. The Section Council was expanded to about 14 members who were also Delegates or
Alternate Delegates of the AMA House of Delegates. Most members of the Council are appointed by the AAP.
The Council now solicits and reviews resolutions from AAP Committees, Sections and Chapters. Resolutions
that are approved by the Section Council are forwarded to the AAP Executive Board and if they also approve
may be submitted for consideration by the AMA House of Delegates at its meeting in December. Over the years
many of the policies deemed to be important by the AAP have been supported by the AMA through their acceptance by the AMA House of Delegates. Other current activities of the Council of the AMA Section on Pediatrics
include nomination of recipients for the AAP/AMA jointly sponsored annual Abraham Jacobi Memorial Award,
and sending nominations to the AMA Committee on Education for membership on the Pediatric Residency
Review Committee.
References:
Schlutz FW. The first half century of the Section on Pediatrics. JAMA 1933; 101: 417. Pease MC. A History
of the American Academy of Pediatrics. Published by the American Academy of Pediatrics, 1952
The Historical Archives Advisory Committee oversees the activities of the AAP Pediatric History Center (PHC),
whose mission is to preserve and exemplify the value and core values of the professional of pediatrics.
For additional information about the PHC and its programs,
please contact John Zwicky, PhD, Archivist, at [email protected].
Promoting the Values of Pediatrics
The AAP Department of Communications, with help from the AAP Private Payer Advocacy Advisory
Committee, has created a new public awareness campaign, “Promoting the Value of Pediatrics,” designed
to increase appreciation of one of the greatest values in health care today: pediatric care. Resources are
provided for AAP members to help them implement the campaign at the local level. For materials and more
information, go to the Promoting Pediatrics Web Site within the AAP Member Center.
9
Now Available!
The Oral Health Risk Assessment Training for Pediatricians
and Other Child Health Providers Training Kit
FREE to AAP Members
The Oral Health Initiative of the American Academy
of Pediatrics is pleased to announce the availability of
the 2006 edition of the Oral Health Risk Assessment
Training for Pediatricians and Other Child Health
Providers training kit. Because pediatricians and
other child health professionals are far more likely to
encounter new mothers and infants than are dentists, the training was developed to support them in
making timely and effective decisions regarding early
childhood dental issues.
The kit provides materials that give an overview of the
elements of oral health risk assessment and triage for
infants and young children. Included in the kit is a 59
slide PowerPoint Presentation with extensive
speaker’s notes (on CD-ROM), and various AAP oral
health materials.
The 1-hour presentation, expands on the AAP oral
health policy statement and teaches participants
about the pathogenesis of caries, the pediatrician’s
role in assessing a child’s oral health, the correct way
to conduct an oral health screening examination, the
development of a management plan, providing anticipatory guidance and education to families, and the
referral to a dental home for children from birth to 3
years of age.
If you are interested in having a copy of the training
sent to you, or would like more information about the
Oral Health Initiative, please contactWendy Nelson by
phone at 800/433-9016 ext 7789 or by e-mail at [email protected].
PROGRESS
by David Annunziato, MD, FAAP
As we all know, one of the major goals of the Senior Section has been and continues to be to have a senior committee or group in every chapter. While we have not been fully successful in achieving this goal,
we have made notable gains.
A recent review, comparing the progress from 2006, indicates that there was a significant increase in senior activity in a number of chapters. In 2006, we note a marked increase in the number of chapters with
senior committees. When we began our efforts with this goal, there were only two or three chapters with
senior committees. In 2005 there were nine and in 2006 we note 14 chapters with functioning senior committees, a 65% increase in one year. Meanwhile three chapters are attempting to develop such a group
and many more chapters have seniors active in their activities especially in the area of advocacy.
Six chapters have published or are in the process of publishing a chapter history.
It appears that most Chapter Presidents have attempted to develop senior committees in response to our
frequent reminders, and almost every chapter notes discussion of this effort.
Over the years, we have noted that changes in AAP activities at all levels takes time. Recently we have
updated our senior section guide to developing chapter senior committees. We hope, using this and other
reminders will be incentives for chapters to succeed in this endeavor. We will continue with our efforts
to stimulate chapters to achieve this goal.
To obtain a copy of this free guide visit www.aap.org/sections/senior members/chapters/chapters.htm.
Click on Manual (2007) on “How to start a Chapter Committee for Senior Members”.
10
This article from the Office of Speaker Nancy Pelosi on SCHIP: AN UPDATE by Nancy Hardt, MD. Dr. Hardt is an
obstetrician-gynecologist from Florida, who is immediate past RWJ Fellow in Health Policy and served in that
capacity as advisor to the Speaker of the House of Representatives. I’ve long been impressed with Speaker Pelosi’s
commitment to the health of children and families. When I first met her several years ago, she stated: “I always
consider a piece of legislation with the health and well being of children in mind.” I think her record attests to
that and consider her an admirable advocate for children’s health.
Lucy Crain
SCHIP: Good policy for children became ensnared
in a larger debate on how to reform health care
by Nancy Hardt, MD
Former Robert Wood Johnson Health Policy Fellow
for Speaker Pelosi
State Children’s Health Insurance Program (SCHIP) is
known to most pediatricians as the block grant (not
an entitlement, as is Medicaid) that states can use to
provide free or subsidized health insurance to children whose parental income disqualifies them for
Medicaid.
Pediatricians and hospitals love SCHIP because it
helps them avoid gut wrenching conversations with
families whose children need hospitalization but do
not have employer based insurance or Medicaid to
pay for it. Each one of us knows families whose financial wellbeing suffered a permanent reversal when a
child became ill.
on the open market. Both chambers rejected this proposal and made no effort to enact it. In frustration, the
administration used one of its available tools: during
August recess, the administration instructed states
to cease extending SCHIP to children with family
incomes above 250% of poverty unless virtually all
children at or below 200% of poverty were already
covered. Furthermore, to discourage parents from
selecting SCHIP over employer based insurance,
states were required to make uninsured children wait
for one year before becoming eligible.
States love SCHIP because it allows for a federal government match in spending up to the limits of the
block grant. Waivers granted by the administration
allow states to creatively meet the needs of their
unique population. States, for the most part, purchase private insurance plans to administer required
services.
Before the recess, house Democrats worked out an
ambitious package to include not only expansion of
SCHIP, but a change in the SGR formula with a semipermanent fix to the Medicare cuts planned for physicians. To pay for these, a combination of tobacco tax
and “right sizing” of payments to managed Medicare
(Medicare Advantage) were proposed. Language neutralizing the administration’s instructions to states
was included. The House reasoned that their more
comprehensive package would not be vetoed by the
White House.
A popular program with both Democrats and
Republicans, SCHIP was 10 years old last year and, by
statute, needs to be reauthorized every five. The stars
appeared well aligned, with new Democratic majorities in the House and Senate and a President who
campaigned for re-election saying that the program
reauthorization would meet the needs of more children. No one thought that SCHIP would become a
political football, but it did.
Both bills passed their respective chambers, but at the
Senate Republicans insistence, the reconciled bill
trimmed out the House’s Medicare related changes
before it was sent to the President. During the negotiations, the White House signaled yet again that a
veto would come, citing many issues which, overall,
would “take the country in the wrong direction”
towards government interference in the health care
market.
What happened?
Issues included the sheer size of the expenditure, the
magnitude of the new tobacco tax, the current definition of income which excludes child support and
housing subsidies, the proof of citizenship requirement, the current coverage of some adults, etc. But the
chambers persevered, hoping that the overwhelming support by governors, child advocates, and pub-
First, the Senate worked out a bipartisan deal to
expand SCHIP to more children and pay for the
expansion with tobacco tax. During the negotiations,
the President’s 2008 budget proposal included a
reduction in SCHIP spending, to be replaced by tax
deductions for families purchasing health insurance
Continued on Page 12
11
SCHIP: Good policy for children became ensnared . . . Continued from Page 11
lic opinion polls would encourage Republicans to
change the President’s mind.
It didn’t work. The veto came and was sustained in the
House, where only 45 Republicans broke ranks with
their President. Although the senate had enough votes
to override, it was moot.
Within weeks, a renegotiated version of the bill was
passed by the House and Senate, addressing the
issues included in the President’s veto message. A
second veto arrived, and again, only 44 House
Republicans voted to override. Congress came to realize that the details of the legislation were not the issue.
The issue was public insurance versus market driven
insurance, a core issue in health care reform.
But Congress did not have time to indulge in debate
over health reform. An urgent need to provide ongoing funds for state programs remained. In order to be
sure that children were not disenrolled, a continuation of SCHIP through March 2009 was included in a
defense spending bill that the President would not
veto. This funding temporarily allays state insecurity,
but does not allow for program expansions, and also,
it does not undo the regulatory changes to SCHIP
advanced by the Administration. States such as
California planning to move towards universal coverage with SCHIP as an underpinning were disappointed.
What lies ahead? Congressional efforts to undo the
regulatory changes by the administration (which
undercut the safety net at multiple levels) consume
considerable time and effort. The desired expansion
of SCHIP will have to wait until another administration, unless the President has a change of heart on the
run-up to the 2008 elections.
Those that believe that government should support
universal coverage of children will eventually have
their way. House Democrats, led by Speaker Pelosi
have long memories for this sort of policy disagreement, and fortunately will remain in Congress after
the new administration is installed. The unwavering
support of advocates for children, including pediatricians, will insure that this vital issue remains “top of
mind” as substantive discussions of healthcare reform
take place.
Medical Home Program Expands to all
Domestic Shriners Hospitals for Children
Shriners Hospitals for Children, in collaboration with the American Academy of Pediatrics, has undertaken a
nationwide plan to enhance their current communication practices to improve collaboration between primary
and specialty care. The aim of this project is to improve the process of communication so that patients receive
efficient, coordinated healthcare within the context of a medical home. Over the past year, the project was
piloted in 7 Shriners Hospitals for Children to improve the adaptability of the intervention in various care settings that address orthopedic problems, burns, and spinal cord injuries. Elements of the project include identification of and communication with referring physicians from the time a child’s first appointment is made,
system changes to make communication automatic when children are treated, improvement of telephone systems to facilitate communication from PCPs, and educational outreach programs.
The remaining domestic Shriners Hospitals for Children were invited to join the roll out of the program starting in 2008. Eight hospitals started in January, with the remaining 5 starting in July. Currently, every Shriners
hospital is at a different level of communication with referring primary care providers: some already have systems in place, while others will be just starting the project. The goals of the program are to implement consistent communication systems that work for staff, patients, and primary care providers, while also making
these processes smoother and more efficient. The leadership team that is overseeing the implementation will
be teaching hospital staff to use advanced quality improvement techniques, such as Six Sigma and Lean
methodologies. This will ensure that all processes are streamlined and beneficial to patient care. This is one
of the first initiatives to focus on co-management between primary and tertiary care providers at the level of
an entire hospital system, as well as one of the first to implement advanced quality improvement techniques
focused on the Medical Home concept.
For more information in regards to this project, please contact, Jennifer Marks, MPH, Manager, Medical Home
Quality Improvement Programs, [email protected] or 800/ 433-9016 ext. 4924 in the Division of Children with
Special Needs.
12
Over-the-counter cough and cold medicines
for infants and children - Speaking Points
Latest action: The Food and Drug Administration [FDA] on Thursday, Jan. 17, 2008, issued a public health
advisory saying that over-the-counter cough and cold medications should not be given to children under
age 2 because of the possibility of serious and life-threatening side effects. The FDA is studying what
should be done in regards to these medications and 2- to 11-year-olds.
AAP position:
• Over-the-counter cough and cold medicines do not work for children under age 6 and, in some cases,
may pose a health risk.
• The efficacy and risk of such medications needs to be studied in children. As the AAP has testified:
“If a medicine will be used in children, it should be studied in children. Cough and cold medications
should not be exceptions to this rule.”
• The labeling needs to reflect what we know: the medications are not effective for children under age
6 and their use, and misuse, could cause serious, adverse side effects.
Speaking points:
• The FDA’s action is a start.
• More needs to be done; the medications’ efficacy and risks need to be studied in older children.
• Dosage information for these cough and cold medicines is based on adult experience. But children
are NOT little adults and studies show their bodies handle the medications differently.
• That simple fact raises the risk of mis-dosing and overdosing.
• Cold symptoms, while annoying and at times uncomfortable, are not dangerous and will go away
in time.
Questions reporters might ask:
• Why are these medications dangerous?
• What should parents do with the medications they already have at home?
• What can parents do to treat their children’s cold symptoms?
• When should they take their children to see a doctor?
• Since the makers of over-the-counter cough and cold medications already announced in October
that they would withdraw cough and cold medicines aimed at infants and toddlers under age 2 from
store shelves, what difference does the FDA’s announcement make? [It underscores the fact that,
under no circumstances, should these medications be given to very young children.]
13
COOL AID
by Eugene Wynsen, MD, FAAP
Every day we read about global warming. It is a daunting subject and is replete with a lot of articles pro and
con. The UN commission IPCC has pronounced it as
an imminent threat of disaster to the planet, and is the
result of anthropogenic causes, mostly by the use of
fossil fuels resulting in elevated CO2 levels. For the lay
person not skilled in climate matters it can be a very
confusing issue to sort out. And, in fact, it is not
entirely agreed upon by a group of skeptics who dispute that it is man-made, and that it is really just a
continuation of the cyclic nature of climate change.
There is general agreement upon the fact that there
has been gradual warming since about 1860, after the
little ice age was coming to an end. The global
warmists point out that there has been a marked
increase in temperature of the earth in recent years,
and one study showed a graph indicating a “hockey
stick” formation with the recent increase in the warming trend and they relate this to the elevated greenhouse gas, CO2, with the resulting “forcing” of the
earth to warm. There is general agreement that the
CO2 level has increased. They point out that the Arctic
polar cap is melting, and glaciers are generally shrinking. A favorite is to show the glacier of Kilimanjaro,
which is shrinking. But the temperature has not
decreased on Kilimanjaro and is stable at about 7
degrees below freezing. It is dryer there now, not
warmer, therefore there is less snow and ice.
The global warmists insist that this trend will lead to
disastrous results with warming (and cooling) which
will lead to famine, flood, increased hurricanes, crop
failure, droughts, rapidly rising sea levels with inundation of many islands and seashores, increased diseases like malaria, more deaths due to the warning,
and melting glaciers with the resultant water loss in
many areas. In order to combat this, they have proposed measures to reduce CO2 levels.
This is no little task and is variously estimated to have
costs in the range of several trillion dollars. It would
basically amount to drastic reduction in the use of fossil fuels and finding and funding alternate energy
sources. These would include wind, tides, solar energy
sources, bio-fuels, and nuclear power. It would
include using the resources that are there to best
advantage, and be “Green” oriented. But it is widely
thought that nuclear sources of energy are dangerous,
and not popular. The warmists say that there it is
unanimously agreed that the warming is threatening
and is due to anthropogenic causes, and that anyone
disagreeing with this is like ones who believe the earth
is flat. They say that there is scientific consensus that
this is true. They insist that more people will die as a
14
result of effects of warming.
There are a lot of skeptics to the global warming. In
spite of the pronouncements of the global warmists
that anyone who disagrees is like the flat-earth people, there were at least 400 scientists who testified at
the Government committee last spring, and gave their
point of view as to why they did not agree. They are
recognized experts in climate and other science areas,
and have their objections based on their own evaluation of the issue. It was pointed out that to have a different point of view was a bit hazardous, as they had
difficulty getting grants, and even in keeping their
positions in science or institutions. But they pointed
out that contrary to what the warmists were saying, it
was not a settled question and that there should be
open debate and inquiry. They indicated that there
were a lot more scientists who did not agree, but had
difficulty being heard, or were scoffed at and ignored.
They also point out that consensus does not make a
scientific truth. One does not vote on a scientific issue
to determine if it is true.
The skeptics point out that there have been cycles of
warming and cold periods for thousands of years.
There is a clear cycle of about 1,500 years of warming
and cooling. We are in a warming period now, having
come out of the “little ice age” after about 1860. There
were also major cold times with massive glaciers, followed by warming. It is interesting to try to visualize
the Chicago area with 9000 feet of ice about 15,000
years ago. There were no SUV’s and no power plants
then. Where did the ice go? What caused it to melt?
What caused it to be there to begin with? Also, there
have been warm periods in the past, warmer than at
present. They point out the medieval warming and the
“little ice age” that followed. These are not apparent
in the “hockey stick graph”, and therefore skeptics
find the “hockey stick” graph unacceptable. There is
a great deal of evidence for these periods, both in
physical findings of ice cores, sea cores, etc, and in
writings. Greenland was first settled by the Vikings
about 965 AD and this was during the warm period.
They were “iced” out about 500 years later by the little ice age. Glaciers destroyed whole villages in
Europe, and there was famine due to crop failure. The
ice age has been documented in Patagonia glaciers
also, so it was not just local. During the halocene
period it was warmer than today.
The skeptics point out that the warming began before
the industrial age of fossil fuels, and the more recent
years do not show the expected warming that should
be there if it was due to CO2. It has been shown that
COOL AID Continued from Page 14
warming leads to elevated CO2, and this occurs many
years later. It is true also, that the inland area of
Greenland is getting cooler, and the Antarctic is also
getting cooler, with the exception of a small western
area. The ice pack has increased, not decreased. There
is some decrease on the periphery of Greenland.
A big issue is the use of climate modeling. Some think
that modeling is a “child’s game”, and has not been
able to accurately predict climate. It takes 48 hours on
a very big computer to process about 25 years of
climate data, and would take over 200 years to model
the last 100,000 years. It is usual to have the model
data “tweaked” or “corrected” to make it come out
right, as has been done recently. The instruments that
measure the temps are not that accurate, and need to
be adjusted in various ways. Most of us cannot evaluate these changes, as we do not have the expertise to
do so.
In determining the effects and costs of reducing the
CO2 levels, it is estimated that one would have to
essentially eliminate fossil fuels, and this would be a
colossal feat. Some economic experts have calculated
that for the immense cost and effort there would be
a miniscule effect. It would likely make the third world
poorer, as they could not develop without the energy
resources. They would have to go back to burning
wood. And the fertilizers that are made from fossil
fuels would not be available, and thereby reducing the
already low production of food. Fertilizers increase the
yield up to four times. One should note that CO2 is a
fertilizer for plants. There would need to be much
more land farmed, with less production. Wind power
would take up huge areas of land. Wind and solar are
quite variable, and would need backup plants in any
case.
Malaria would not increase, as it is controlled by controlling the mosquito, and not the temperature. There
was malaria in Russia, England, and in cities like
Philadelphia in the past, and had little to with the
temperature. The poor children in malaria prone
areas are the main victims as they are weakened by
poor nutrition and do not have access to good medical care. Millions of people get malaria every year, and
a high percentage of them are children. And it is the
children who are more likely to die from the disease.
More people die as a result of cold weather than die
from warm weather effects.
The sea levels have not risen any more than the trend
for the past 150 years. During the glacier ages, the sea
level dropped as much as several hundred feet. It was
a meter or two lower during the Roman times than it
is today. The Romans are thought to have prospered
because there was warmth enough to grow grains
well. There were probably lakes in the Sahara desert
then, as well. Grapes and grains grew well even in
northern parts of Germany and England until the little ice age.
There is considerable evidence that solar variations
are likely to account for the cyclic nature of the earth.
Sun spot activity increases the heat by various mechanisms. In addition, small deviations in the orbit of
the earth, the tilt, and the changes in the shape of the
orbit have been postulated as mechanisms for these
solar cycles. It is not certain how these interact since
the cycle’s interactions are very complex. Recent evidence shows that Mars and Jupiter are about 0.5
degrees warmer now, about the same as the earth.
There are no SUV’s or power plants there either.
Unfortunately, the issue has become a political one,
not a scientific one. There has been much exaggeration, and some outright misleading statements. The
warmists accuse the fossil fuel companies with putting out propaganda in their favor. But there is a lot of
money to be made by some who push the warming
point of view. One is hard pressed to say which is
worse. Some skeptics say that it would be better to
spend some money to relieve famine, water problems, and diseases like malaria and TB, than spend
huge sums on ideas and methods that probably will
not produce significant effects or at best minor ones.
Benjamin Franklin wrote his own
epitaph, which is very much like him,
and summarizes the man.
“The Body of B. Franklin, Printer,
Like the Cover of an old Book,
Its Contents torn out,
Lies here, Food for Worms,
But the Work shall not be wholly lost,
For it will, as he believ’d,
appear once more,
In a new and more perfect Edition,
Corrected and amended,
By the author.”
Av Katcher
15
Editor’s Note:
Dr. Sami Elhassani was one of our very early Fellows at LAC USC Medical Center in the 1960’s, almost 50 years
ago. Following his Fellowship he began practice in Spartanburg, South Carolina where he still practices although
recently in a level II center rather than the level III where he spent most of his career. He has been there during the
growth of Neonatology.
Changing Times for Neonatologist
in the Regionalization System
by Sami B. Elhassani, MD, FAAP
Mary Black Memorial Hospital - Spartanburg, SC
For health care professionals, medicine and medical
care is an art and a science and to most physicians,
nurses and allied health personnel – a joy. Nowhere
does this apply more aptly than in perinatal-neonatal medicine. After all, this specialty deals with the
wellbeing of both mother and newborn infant and
with all the complexities and challenges that stride
towards good to excellent outcome.
The most striking aspect of caring for sick neonates
before the emergence of neonatology as a subspecialty of pediatrics is how much primary care pediatricians with special interest in the welfare of newborn
infants were able to accomplish with simple technology. Dating back to late 19th century, Pierre-Constat
Budin (1846-1907), the French gynecologist is credited as one of the fathers of neonatology and the
author of the first book “The Nursing” devoted to diseases of the newborn. The introduction of Budin’s
book dealing in neonatal medicine opened the door
to important contributions to the field by many medical pioneers in the first half of the 20th century including J.W. Ballantyne, Arvo Yippo, Julius Hess, Sir Joseph
Barcroft, and Mary Crosse, and the list of physicians
is too long to be included in this article.
Care of sick neonates remained as a matter of interest to few pediatricians until 1959 discovery by Drs
Mary Ellen Avery and Jere Mead of surfactant deficiency in the lung of infants dying of respiratory distress syndrome (RDS), the most common cause of
deaths in preterm infants, as one of the great success
stories in neonatal care and possible the turning point
in the intense interest by many physicians in improving early diagnosis and management of the many prenatal and neonatal diseases. Twenty one years later,
Fujiwara suggested the use of surfactant as treatment
of neonatal respiratory distress and ten years later
after many controlled studies, FDA approved the drug
as a standard treatment of RDS.
The age of “neonatology” as a subspecialty of pediatrics dawned upon us in the early 1960s stemming
from the real concern by many health care as well as
non health care professionals of the high rate of infant
16
mortality (25/1000 live-births in the first year of life).
Recognizing that the majority of those infant deaths
occur in the immediate neonatal period, prompted
the establishment of a discipline called “neonatology”, and in 1975, the first examination offered by the
American Board of Pediatrics coined NeonatalPerinatal sub-board.
In the early 1970s, the increase in the number of intensive care nurseries and thereby the number of neonatologists prompted the introduction of a new concept
designating hospitals with facilities that have obstetrical units each according to the level of complexities
in neonatal diseases. Moreover, the notion of regionalized Perinatal care was spearheaded by the 1976
March of Dimes report “Toward Improving the
Outcome of Pregnancy” (TIOP) as a means expanding the services offered to high-risk patients in addition to the existing university affiliated hospitals and
academic centers.
Thus, different hospitals that care for newborn infants
were included in the “regionalized neonatal care” and
labeled Level I (basic), Level II (specialty), and Level
III (subspecialty), and Level IV (regional) graded from
providing care to healthy infants to the comprehensive care of the extremely high-risk newborn infants
and those with complex and critical illnesses.
This classification was modified in 2004 by the
Committee on Fetus and Newborn of the American
Academy of Pediatrics to Level I, Level IIA, Level IIB,
Level IIIA, Level IIIB, and Level IIIC depending on the
availability of experienced personnel and updated
technology for intensive respiratory care, readiness of
surgical services, quality of ancillary services, and
accessibility of different pediatrics subspecialties.
Many controlled studies concluded better chances
of survival of very low birth weight infants delivered
in a subspecialty facility rather than a basic or specialty center.
Regionalized neonatal care is good for infants and
mothers as long as the concept is not interpreted as
Changing Times for Neonatologist . . . Continued from Page 16
centralized care with inadequate and inaccessible
transport and back-transfer system. In addition, in
many areas of the country, having an infant far away
from where the parents live have created a needless
trouble, especially when necessary care can be offered
in nearby center. For Perinatal regionalization to be
effective, a disciplinary collaboration is required
among obstetricians, perinatologists, and neonatologists working in the three levels of care. Of great help
to achieve this goal is an up to date Outreach
Education Program in all perinatal regions with
emphasis on close collaboration among all physicians involved.
Depending on population concentration, geographic
distances, the size of the state, and the number of
retrieval center for sick neonates, different states have
different laws to implement the criteria for regionalization. Thus, some states have legislative binding
laws with monetary citations for any deviations by any
hospital within the regional area from the regionalization laws. Other states however, require proof for services available and on long-term outcome of
in-hospital admissions by thorough and systematic
collections of data. These steps are essential to evaluate changes in perinatal care delivery systems as
well as new technologies and therapies.
Most neonatologists work at subspecialty (level III) or
Regional (level IV ) centers. Although the data are
unavailable, there is an emerging trend of second and
third generation neonatologists changing jobs form
taking care of high risk and very low birth weight
infants to low risk and medium sized neonates (1500g
and 32 week gestation)-thus cutting down but not
out. Although one loss out on the extended management of high risk infants, the basic knowledge of
neonatal care stays the same. In addition, working at
level II nursery with fewer low risk infants renders
more opportunities to interact with families of sick
infants. Furthermore, those neonatologists will have
extra time to be active in the local as well as national
neonatal care politics.
Medical care rests on a system of basic scientific
knowledge, recognition of diseases, the ability to combine technology and clinical acumen, the strife for
continuous improvement in health care delivery, and
the firm belief in medicine as one of the most humane
professions. From antiquity to the present time, medicine knowledge, technology, and the patient care has
been achieved with physicians, including the fairly
new subspecialty of neonatology, being in the forefront of the process.
In conclusion, there is a rewarding life both professional as well as personal, working at specialty neonatal center.
Reference:
Stark AR. Level of neonatal care. American Academy of
Pediatrics Committee on Fetus and Newborn. Pediatrics
2004;114:1341-7
Editor’s Note: Joan Hodgman
Toke Hoppenbrouwers is a respected retired member of the Neonatal Division of LACUSC Medical Center. She and
I have done a good deal of research on SIDS together since she joined our faculty from graduate school at UCLA.
Our latest project is writing the papers from her trip to Indonesia looking for SIDS in that tropical
country.
The Contortionist
by Toke Hoppenbrouwers, PhD
During a night of insomnia early this week, I was reminded of a legendary weekend in the late Sixties when a
group of about nine of us, friends during our UCLA graduate student days, took off for Ensenada in Mexico.
This was the time of marches in San Francisco against the Vietnam War, where at night after the demonstrations we took in, en passant, the gay men’s clubs in San Francisco. My straight women friends were blown away
by how handsome these men were.
With this Mexico trip we were in the company of both men and women, gay and straight. Some of us were working together at the Neuropsychiatric Institute at UCLA in a program called the Drug Abuse Training Center—
a rather dubious title. The US Army had contracted that program, and by inference us, to help eliminate drug
abuse in their GI’s stationed in Germany. The irony.
17
The Contortionist Continued from Page 17
As far as I recall, we arrived late afternoon at a fairly seedy motel by the name of El Presidente that at the time
was upscale for that town. We partied until 2:00 AM mostly with marijuana, our drug of choice. Then we caught
a few hours of sleep. At 5:00 AM that same day, we set out on a deep-sea fishing trip on an undersized, hired
motor craft.
A grainy, overexposed film clip from that weekend shows me of all things, in a bright red DRESS, nodding off
in cadence with the boat motor’s crashing onto the waves. The sun is bright. My co-travelers are busy throwing out their fishing lines; they have enjoyed a sizable amount of Tequila and their success in catching fish is
only marginal. Nonetheless, the film shows the elderly captain cleaning the fish on the way back as is customary, and throwing the entrails and carcasses into the water. A huge flock of diving and screaming seagulls follows us.
Upon returning to the harbor around 1:00 PM, my lover Ingrid cried out, “I see elephants!” Aware of her prior
alcohol intake, none of us paid much attention. The next stop was the famous blowhole that, compared to earlier visits, had been made tourist-friendly, but that had lost none of its force and spraying power.
We were all in our early and mid-twenties, loose couples or singles—and only one of these alliances has lasted.
Ingrid and I separated in the late seventies. After the blowhole, we still found time to visit a beach where some
of us were tempted to mount a couple of bony, skinny horses.
Indefatigable, we segued into a stop at the famous Hussong’s Cantina, where an overflow crowd hardly permitted any movement, but just enough to sample Margaritas, the drink that originated in that place. In the same
street we found a restaurant for a sit down dinner with tamales, pollo picado, empanadas and sopapilia. This
scrumptious meal rejuvenated us and, fools that we were, not ready to go to bed, we sauntered down the street
in the opposite direction, where we came upon an old fashioned circus tent with the performance about to
start. Just the kind of entertainment that we, giddy with laughter and excitement needed. The mystery of the
elephants was now solved. For decades Ingrid has chided us for our disbelief.
I don’t remember much of the performance except the rickety wooden benches, our choice of seating, of course,
high up in the tent, and the entry of the contortionist.
He managed to take his arms out of their sockets and outstretched, reached around his ankles to join his hands
in the front. I was reminded of my celluloid childhood doll whose arms and legs dangled because the elasticity had gone out of the strings that connected the limbs with her torso.
The contortionist’s freaky looseness captured the tenor of that weekend. We weren’t really out of control. His
super-worldly stretches seemed a metaphor for the range of activities pressed into that day, our drifting from
one event to another and the unbounded laughter that still echoes in my body.
How did I come to think of him during that sleepless night, now at least forty years later? The mysteries of language and memory . . . I have never been a frequent user of the English dictionary, even in my early days in the
United States after my immigration from the Netherlands. I simply never had one. I learned to speak, by trying. Now, however, I have two pocket books, one in each direction from Dutch into English and from English
into Dutch. It’s not rare that I recall a word only in Dutch and have to look up the English translation. Apparently,
with increasing age, I can expect to revert to Dutch on a more regular basis.
Being stoned, in those days, forced me back into Dutch to great hilarity of everybody around who suddenly
ceased to understand my utterances. I recall once having to take a red eye to Boston for a conference after getting loaded with my friends. Ariella had to help check me in, because I had lost all of my English. “She is on the
way to a brain research conference,” Ariella explained apologetically to the airline personnel behind the
counter. They must have assumed I was a patient about to demonstrate some strange neurological defect, witness my muteness and our giggling.
18
The 1960’s and early Seventies were followed by decades of seriousness, responsible behavior, purchases of
houses, for some of us, having children; the building of careers and the like. That time was also marked by a
turn toward serious writing as a calling. These days, I rarely touch any mind-altering drugs and my alcohol intake
is restricted to an occasional glass of wine with dinner. Yet, at 69, I suddenly feel the contortionist in me again.
Living alone, I have traveled solo to a host of foreign places, including some remote islands of Indonesia. There
I feel unusually safe, despite US State Department warnings about terrorist threats, earthquakes and volcanic
eruptions. Without hesitation I climb on the back of a motorcycle. I’m still involved in research and have
branched out to investigate the presence of Sudden Infant Death Syndrome (SIDS) in Toraja, a rural area of the
island Sulawesi, in that developing Asian Country.
A fifteen-seater plane typically flies to Toraja a few times per week from Makassar, the capital of Sulawesi. I have
preferred this mode of transportation to the ten-hour road trip. About a decade ago, however, I remember that
just as I was reassuring myself that the pilots knew this trajectory as well as the inside of their pockets, the plane
I was in, landed on one wheel and began to gyrate wildly on the runway. (I thought it was my end.) The crew
managed to straighten it out before it came to a halt. Armed with a cane, this time, I resolved to rely on motorcycles, cars, horse-drawn buggies, rickshaws and my two legs to get around. As if that were any safer.
At the end of my last trip to Sulawesi, in November of 2007, Stanis and I set out for the trip down to Makassar
under gorgeous weather conditions. I am fortunate to have found Stanis Sandarupa through a faculty at the
department of Anthropology, at UCLA. Stanis hails from Toraja and received his Ph.D. from the prestigious
University of Chicago. He and I have been collaborating on a number of studies during 2006 and 2007. He drives
a beat-up jeep that requires frequent visits to the mechanic, but that has managed to take us over hours of potholed back roads to remote hamlets in the mountains where electricity has not penetrated, nor television and
other modern appliances. Stanis is an excellent driver, and in even the most hairy traffic situations, I feel remarkably calm.
I was truly looking forward to the trip that began auspiciously, along bougainvillea covered mountain roads
with vistas of carefully manicured, staggered rice fields along the slopes where an occasional buffalo was tethered to a pole, wading in his private mud pool.
Then, a third of the way to Makassar, we suddenly hit a downpour. “Rainy season has arrived,” Stanis muttered.
It was still light—although sunset was approaching —and the car roof wasn’t leaking so I did not feel too concerned. The downpour, however, continued under a uniform grey sky in which no break was discernable. “How
far are we from the nearest town?” I queried. “Oh, about an hour,” he answered, “and about five hours from
home.”
The upside was that traffic was minimal; an occasional rickshaw driver, totally covered in plastic, braved this
deluge, but otherwise we were making great time.
When darkness arrived, I was relieved to see that our headlights turned on; they were weak but working. My
relief was of short duration, however, because almost simultaneously, with one sharp beep, the windshield
wipers conked out. We went from seeing little to seeing nothing.
The first thing that happened was that Stanis slowed us down from 70 to 65 miles per hour. “Any place to stop?”
I tried faintly. But I didn’t get an answer. He was glued to the windshield, trying to make out where he was going.
There was just enough light outside that I could discern what seemed like lakes, on both sides of the road. We
were very nearly hydroplaning.
The closer we came to the promised town, the heavier the traffic became. Rickshaws, motorcycles, horse and
buggies, ordinary bicycles mingled freely with cars, busses and trucks. To my consternation I noticed that every
other oncoming heavy truck, van or sedan had no functioning headlights. In order to make any progress, Stanis
had to overtake hundreds of vehicles on that two-way thoroughfare.
19
I can’t say I was praying, but I was pretty uptight. Every time I felt the temptation to grab the dashboard or the
door handle, I forced myself back into the seat and relied on some innocuous small talk to calm myself down.
The combination of torrential rains, a two-way highway, heavy traffic, unlighted vehicles, all lights amplified
and dispersed in a million directions because of the rain, and the knowledge that we had still five hours to go,
shattered my confidence in a safe trip home, to put it mildly.
Finally, at the edge of Makassar, where it was still raining, Stanis stopped the car on the side of the road, and,
for the first time, moved the window wipers manually to clean off the mud and water. I felt my heart rate and
blood pressure drop precipitously. Actually, seeing the road for the first time clearly was tantamount to seeing
my way home.
The field of neuroscience, my area of study, has advanced with incredible speed in parallel with fancy technological discoveries. Genetics, molecular biology and studies of metabolism are particularly challenging. I
bravely tackle the literature and try to teach myself the new jargon and concepts with more or less success. The
only comfort stems from knowing that I am not alone in this predicament.
This February, I presented some results of my Indonesian research at the Western Pediatric Society Meeting in
Carmel, California. It was difficult to obtain accurate data of births and infant deaths in Toraja, but after multiple visits I’m inclined to believe the Indonesian physicians and midwives who proclaim that they have never
heard of infants dying suddenly and unexpectedly in their sleep. After all, risk factors for SIDS, discovered in
the West, are very favorable for infants in Indonesia.
The meeting in Carmel tends to be low-key. That’s why young doctors and fellows are encouraged to present
their findings there. It is a safe training ground for future presentations at the more demanding national pediatric meetings. Apart from the fact that Carmel itself is a very relaxed and friendly town, the low-key nature of
this meeting derives also from the high “grey and shaking quotient” among participants such as myself. This
meeting draws a large number of emeritus, retired professors and faculty who probably see an opportunity to
meet their contemporaries, have a tax deduction and be wined and dined by pharmaceutical companies or the
meeting organizers.
A number of these elderly participants dutifully attend the presentations and feign a listening attitude, but in
the dimmed light, when the slides are presented, they unapologetically nod off. By doing so, they do not miss
a thing; I’m convinced that, just like me, they would have only understood the “but’s,” the “and’s and the “therefore’s” of the hotshot young faculty’s presentations.
A few of my contemporaries went so far as to express their delight that they could understand my talk. I was
among the youngest of the oldest and I carefully selected the few sessions to attend. Rather than sitting uncomprehendingly in the dim lights, I made sure that my dogs, Intan and Rajata, Balinese names for Silver and
Diamond, got to enjoy the most permissive beach in California, a beautiful piece of real estate in the heart of
Carmel, free for running off-leash among a hundred canine revelers.
I enjoy writing in various places, especially in nature. I don’t hesitate to take my dogs and jump in my van at
any moment to drive to places where I can find inspiration.
The campground at the North Rim of the Grand Canyon has been one of my yearly destinations. There, Alma,
the chief of housekeeping has generously offered me an outside plug for my computer next to the linen cabin,
where her electric trolleys ordinarily charge. It’s a good thing, because the only other plug I discovered during
a scouting trip was under the flagpole, a rather ostentatious place, where Park rangers would have chased me
away, fast.
Last year, I woke up to snow. Fortunately, I didn’t immediately pull up stakes because after the snow melted
the turquoise, pink and orange of the rocks were deeper than ever. In the meantime, I had found myself an oldfashioned rattan desk in the lodge to use for writing.
20
This sixth decade of my life has been unusually unstructured. It’s a loose patchwork of events, not squeezed
in a day, as that trip in the Sixties, but packed nonetheless; not executed in a group, but solo. It feels almost
scary, except that I have this reference of the past. The contortionist’s flexibility, applied to life has served me
well. I look at myself, amused, thrilled, even, with my daring, the fearlessness that I am graced with, and the
knowledge that this may be the prelude to another long or short period of stability— this time not because of
responsibility and career building, but because of the inevitable grounding at home that lies ahead, or, if not
there, in assisted living.
My overflowing present is a last hurrah that I welcome, despite the advent of frailties, such as the replacement
of a hip and the loss of a host of English words. The contortionist made his statement by doing, not by talking.
Bond Basics
by Joel M. Blau, CFP™ and Ronald J. Paprocki, JD, CFP™
MEDIQUS Asset Advisors, Inc.
“Results. One client at a time.”(sm)
Municipal bonds are debt instruments issued by
states, counties, and local government authorities.
The proceeds of municipal bond issues are used for
a wide range of public purposes, including buildings,
highways, airports, schools, or simply to fund general
government operations. In general, interest income
from municipal bonds is exempt from federal income
tax.
There are primarily two different types of municipal
bonds. General obligation bonds, also known as G.O.
bonds, are secured by the full faith and credit of the
issuer. Revenue bonds, on the other hand, are issued
by agencies such as a port authority, highway commission or water and sewer district, to build specific
public works projects. Revenue bonds are backed by
the revenues, or expected revenues, generated by
these projects for payment of principal as well as
interest. Due to the inherent risk associated with
uncertain potential revenues, insured municipal
bonds have gained in popularity. The issuer actually
purchases insurance to protect against the risk of
default. The insurer in this situation would be responsible for the payment of interest as well as principal
in the event of a default. The insurance, however, does
not protect against market or price fluctuation within
the bond market.
If a municipal bond is held until maturity, the issuer
is then obligated and required to repay the full face
amount of the bond. If the bond is insured, and is in
default, the insurer would then be responsible for the
repayment of the face amount. If the bond is sold
prior to maturity, the investor would receive the current market value of the bond which may be more or
less than the original investment. Bond prices tend to
move inversely with interest rates. If interest rates
continue to rise, this would cause pressure on bond
prices, moving them downward. Conversely, if interest rates decline, the market values of existing bonds
tend to increase in value.
The best candidates for municipal bond investments
are high tax bracket taxpayers seeking a source of taxadvantaged income, often times to generate income
during their retirement years. Municipal bond income
can serve as a nice supplement to taxable individual
retirement account (IRA) distributions, or pension
payouts which are generally taxed at ordinary income
tax rates.
Municipal bonds can be purchased directly through
a securities brokerage account, either through a
stock/bond broker or on your own via a brokerage’s
website. They can also be purchased as a mutual fund.
The main advantage of a mutual fund is the added
level of diversification, as well as management expertise. Unfortunately, since most municipal bond funds
are open ended, there is never any point in the future
where the entire portfolio matures, and then pays
back principal. As with all open end mutual funds,
shares can be bought or sold at any time, but at the
then current value, which may be more or less than
your original investment.
If this is a concern, but you still want to take advantage of a diversified portfolio of municipal bonds
selected by a professional, then a unit investment
trust (UIT) may be the answer. With this vehicle, once
the bonds are professionally researched and selected,
the portfolio remains fixed throughout the life of the
bonds. Unlike a mutual fund which replaces bonds on
an ongoing basis, the principal of each matured bond
21
Bond Basics Continued from Page 21
is paid out to the unit trust investors. The UIT can provide some peace of mind to those who prefer a finite
life to their municipal bond portfolio, as well as the
ability to essentially lock in an interest rate for the
entire period.
Keep in mind that while the interest generated is fed-
erally tax free, higher after-tax yields may actually be
available in taxable bond investments. In addition,
municipal bond income may make you subject to the
alternative minimum tax (AMT). In light of these
potential disadvantages, be sure to consult with your
tax advisor to determine if municipal bonds are
appropriate for your specific situation.
Mr. Blau and Mr. Paprocki welcome readers’ questions.
They can be reached at 800-883-8555 or at [email protected].
Securities offered through Joel M. Blau, CFP® and Ronald J. Paprocki, JD, CFP®,
registered representatives of Waterstone Financial Group, Member FINRA/SIPC.
Waterstone Financial Group and MEDIQUS Asset Advisors, Inc.
are independently owned and operated.
Please consult your tax advisor regarding any questions
you may have with respect to your personal tax liability
The opinions expressed in this report are those of the author(s) and are not necessarily those of Waterstone Financial Group.
The material has been prepared or distributed solely for information purposes and is not a solicitation or an offer to buy
any security. Investors in mutual funds should carefully consider the investment objectives, risks, charges and expenses.
This and other important information is contained in the prospectus, which can be obtained from your investment professional and should be read carefully before investing. Investments are not FDIC-insured, nor are they deposits of or guaranteed by a bank or any other entity.
LINCOLN AND DOUGLAS
The Debates That Defined America
by Allen C. Guelzo and Henry R. Luce
Professors of the Civil War Era, Gettysburg College.
Simon & Schuster, New York, 2008
Reviewed by Avrum L. Katcher, MD, FAAP
Why do we wish to read a book about the events of over 150 years ago? Primarily, because of the remarkable
skill, without overtly mentioning a specific modern event, with which Professor Guelzo utilizes these history
book circumstances to teach us about the significance of the politics of today. He shows us how the interlocking of overt and covert attitudes about race, gender and social class lines, about the institution of slavery, and
about the population growth and expansion of the United States came together to mold the politics of those
times, and to throw a bright light on how the politics of today are still influenced in the same fashion, if not by
the same routes.
As a merchant in a small town in Illinois said, “It did not take long before this crowd [realized] that the question that was before them was one that demanded sober, solemn decision, if they were to vote rightly…I tell
you that debate (Lincoln v. Douglas) set folks to thinking on these important questions in way[s] they hadn’t
dreamed of.” And that quote might be applied to the affairs that arouse us today. Then, we had a short, stocky,
fiery debater, described as “a steam engine,” already a United States Senator, running for re-election against a
very tall, skinny, inexperienced, well, it is not out of line to say, “hick” from farm country. The lawyer/Senator
won that election, but two years later was defeated for President of the United States by the hick.
Of the various issues that characterized this rivalry, that of slavery was perhaps the most prominent. Slavery
22
Lincoln and Douglas . . . Continued from Page 22
was a legal, even though repulsive system, in fourteen states. The remainder banned slavery. The issue, and
the fight, at first was whether as new territories and states were formed to join the union, would slavery be
allowed in them. As for Douglas, “there is no record that Douglas felt any deep pangs of conflict over the toleration of slavery in a republic of liberty.” Meanwhile, Lincoln was farm-raised, with an axe in his hands as early
as he could hold one, until in his twenty-third year he became a store clerk. What he also showed, from a very
early age, was a devotion to reading, as his father put it, “uncommon natural talents….a constant…and stubborn reader.” And the farm boy entered politics, quickly rose to a good position in the Illinois state legislature,
where he was embarrassed because he criticized the war with Mexico instigated by President James Knox Polk,
leading to ambush and defeats by the Mexicans.
Guelzo deftly and in detail follows both men. Lincoln pursued Douglas’ seat in the United States Senate but
lost out following his “House Divided” speech. He was to be nominated to run for the Senate; but when he spoke,
he said, relative to slavery: “If we could first know where we are, and whither we are tending, we could then
better judge what to do, and how to do it.” Lincoln went on, “A house divided against itself cannot stand. I believe
this government cannot endure, permanently half slave and half free.” This came from Mark, II, 27, “If a House
be divided against itself, that House cannot stand.”
From here, Lincoln went on through the following weeks and months, in order to make plain that the essential issue was the words of the Declaration of Independence, “All men are created equal,” a moral statement,
versus the question of the civic rights to which all men were entitled. Lincoln felt that equality had more than
one meaning. As mentioned above, there were natural rights, such as “Life, Liberty and the Pursuit of
Happiness.” Slavery was an unnatural violation, everywhere and at all times a “moral evil.”
Later, during their debates, Lincoln “plunged into a disgraceful catalogue of all, the civic rights, he, fully
as much as Douglas, believed blacks could be routinely deprived of.” The list included these sentences: “I am
not nor ever have been in favor of making voters or jurors of negroes, nor of qualifying them to hold office, nor
to intermarry with white people; and I will say in addition to this that there is a physical difference between
the white and black races which I believe will for ever forbid the two races living together on terms of social
and political equality.”
Guelzo provides us with clear understanding of how it is that a political figure may occupy a belief, a place, which
would seem to contradict other positions, and yet feel that his views are consistent. Lincoln taught us the difference between moral standards and civic standards. All men are created equal. All men should have comparable rights under the law. But it is our voice as citizens which makes that moral equality spread to the civic
rights which, for many of us, may be of greater importance. Where are we going today, with the questions of
the rights of all under the law for health care? Or the right to carry weapons? Or the right to terminate a pregnancy? The right to live in a conjugal way with a person of the same gender? The right to be paid many millions of dollars a year while others do not have enough to eat in healthy fashion? The importance of this volume
is the exploration of these seemingly contradictory issues and many others, which we must debate in order to
seek out a solution which is fair to all, while expressing a collective sense of what is it that is “fitting and proper.”
Guelzo presents no perfect solutions. What he does, that is good for each citizen, is to explore how men of reason, and without reason, attempted to combine personal ambition and the push for what is right in a moral,
fitting and proper fashion.
23
Update your Personal Profile
An important service is available on the AAP Member Center. A Personal Profile has been added to provide you with an opportunity to view and update your contact information, demographic, and subspecialty information. Simply enter the changes into the form and our database will be updated the following
day.
The online Member Directory should be your primary resource to locate colleagues. Physician Referral
Service (PRS) should be used for patient referrals. These resources have the most accurate, up-to-theminute contact information available.
With these new changes and enhancements, we believe we can further improve service to members and
the public. However, it is also an important time for our members to check their address and demographic
information for accuracy. Please take the time to visit the Member Center and click on “Update Contact
Information”. If you prefer to contact us by phone or e-mail, you can call 866/THE-AAP1, or send an email to [email protected].

Joan E. Hodgman, MD, FAAP

Transcription

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