ASHLEY MALTZ, MD
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Is SpongeBob trouble for kids' brains??

9/12/2011

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Wow, I just read an interesting research article in my email box accusing high-speed cartoons, in this case, SpongeBob SquarePants, of decreasing the attention span and cognition (speed of processing of information) of children.

The scientists involved in the study measured the accuracy of kids' responses to questions measuring their attention and cognition after 9 minutes of watching a fast-paced cartoon (SpongeBob, whose screen changes every 5 seconds) or after 9 minutes of drawing. They concluded that the kids' responses varied between the 2 groups (were what we call 'statistically significant') with the former group showing giving fewer correct responses than the latter.  

This significant result actually does not surprise me as actively stimulating the brain by drawing would, to me, logically, recruit more brain cells to work to imagine the drawing and use motor and hand-eye coordination skills to create it. TV, while it does stimulate the auditory and visual parts of the brain, does not recruit the same degree of neurons (brain cells) and therefore would not significantly improve a child's cognition or attention. In addition, the fast-paced changing of scenes in any fast-paced TV show decreases attention span and cognition in general. I learned while taking my medical school entarnce exams (MCAT) as we were all instructed to watch a movie and NOT TV the night before our exams. We were also instructed to listen to classical music on the day of the exam during breaks...who knows if any of it made any difference in my scores, but I made it through medical school following this advice. ??

Anyways, enough about me...back to SpongeBob! The study does have some major flaws (as do ALL studies!). For one, the number of children studied was small (only 60 children participated). Secondly, the statistics were analyzed "post-hoc", meaning ran a second analysis of the data with some presumed changes and not the originally planned data. This is considered a major flaw. Thirdly, the children were investigated after only 9 minutes of watching cartoons or drawing. This obviously doesn't represent their true TV wwatching habits as most children watch a LOT more TV (and cartoons) than that. And, they may end up drawing afterwards. Therefore, the confounders are varied.

Despite all of these flaws, I find this research to present a valid argument. Fast-paced TV likely does less for the neural circuits in our head and too too much TV is bad for EVERYONE'S health! That being said, if I were SpongeBob, I would definitely have my lawyers pursue a lawsuit for slander!

Have a great day and stay safe,
Dr. M

Source reference: Lillard AS, Peterson J. "The immediate impact of different types of television on young children's executive function" Pediatrics 2011; DOI: 10.1542/peds.2010-1919.

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In response to Gabe's comments/questions

6/18/2011

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Hi Gabe,

I'm trying to respond to your comments as you highlight some great points, however, my website won't let me respond for some reason (quirk!). As you have already discovered (evidenced by your second comment), we are in WAY over our heads in terms of carcinogens in our environment. Here's one great reference to start to answer your "environmental causes of cancer" question:

http://www.environmentalhealthnews.org/ehs/news/presidents-cancer-panel


You can find the full report at: http://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp08-09rpt/PCP_Report_08-09_508.pdf.
I have also blogged on that report a few times - See "Repost: Because It's So Important" from November 2010.

Other resources on the toxins implicated in causing cancer in children can be found on the Mount Sinai Children's Environmental Health Center website at http://www.mountsinai.org/patient-care/service-areas/children/areas-of-care/childrens-environmental-health-center

Their research can be found at:
http://www.mssm.edu/research/programs/childrens-environmental-health-and-disease-prevention-research-center

http://www.mountsinai.org/vgn_lnk/Regular%20Content/File/Advertorials/MS_OpEd%20Ad_080309_Revised.pdf

As for your first question, it is possible that unfunded patients may die without a diagnosis, but that is generally not the case.  They usually die because they do not get adequate screening and preventive care as they tend to present too late in the disease process for treatment. I can tell you from firsthand experience, that I have diagnosed multiple patients in the hospital with cancer for which they cannot receive treatment either due to lack of funding or to late progression of the disease process. That being said, American citizens can apply for emergency Medicaid/Medicare status with the hopes that they recieve approval. Also, there are great non-profits working their butts off to obtain funds for some of them.

And yes, New Yorkers have been noted to live longer than other Americans (likely secondary to walking so much). I do agree this goes against my argument today, however, there are SOO many factors involved, ranging from socioeconomic status and education level to the droves of young people flocking to the live in Manhattan every year. Let's be honest, NYC is no place to grow old!

I hope this has been helpful in answering some of your questions. Let me know if you have any more. Happy Father's Day to all the Dads out there! : D

Dr. M
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The shocking cost of environmental toxins on children

6/13/2011

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From the Mount Sinai Children's Environmental Health Center website:

"New data show that, despite previous efforts to curb their use, toxic chemicals have a major impact on health care costs and childhood morbidity.

NEW YORK, NY  – May 4, 2011 /Press Release/  –– In three new studies published in the May issue of the journal Health Affairs, Mount Sinai School of Medicine researchers reveal the staggering economic impact of toxic chemicals and air pollutants in the environment, and propose new legislation to mandate testing of new chemicals and also those already on the market.

Leonardo Trasande, MD, Associate Professor of Preventive Medicine and Pediatrics at Mount Sinai School of Medicine, analyzed the costs of conditions – including lead poisoning, childhood cancer, asthma, autism, and attention deficit hyperactivity disorder (ADHD) – associated with exposure to toxic chemicals. Dr. Trasande and his team calculated the annual cost for direct medical care and the indirect costs, such as parents’ lost work days, and lost economic productivity caring for their children, of these diseases in children.

The researchers found the annual cost in the United States to be an estimated $76.6 billion, representing 3.5 percent of all U.S. health care costs in 2008. The breakdown includes: lead poisoning ($50.9 billion), autism ($7.9 billion), intellectual disability ($5.4 billion), exposure to mercury pollution ($5.1 billion), ADHD ($5 billion), asthma ($2.2 billion), and childhood cancer ($95 million).

"Our findings show that, despite previous efforts to curb their use, toxic chemicals have a major impact on health care costs and childhood morbidity," said Dr. Trasande. "New policy mandates are necessary to reduce the burden of disease associated with environmental toxins. The prevalence of chronic childhood conditions and costs associated with them may continue to rise if this issue is not addressed."

Dr. Trasande also reviewed an earlier study of 1997 data, which was conducted by Philip J. Landrigan, MD, and documented $54.9 billion in annual costs forchildhood diseases associated with environmental toxins in the United States. Reviewing this prior analysis, Dr. Trasande found that while exposure to lead and costs associated with asthma had diminished, new chemicals and new environmentally-induced diseases, like ADHD, have increased the overall burden of disease. Dr. Landrigan is currently Dean for Global Health, and Professor and Chair of Preventive Medicine, and Professor of Pediatrics, at Mount Sinai School of Medicine.

In a related article also in the current issue of Health Affairs, Dr. Landrigan and Lynn R. Goldman, MD, Dean of the School of Public Health at George Washington University, propose a three-pronged approach to reduce the burden of disease and rein in the effects of toxic chemicals in the environment:

  • Conduct a requisite examination of chemicals already on the market for potential toxicity, starting with the chemicals in widest use, using new, more efficient toxicity testing technologies.
  • Assess all new chemicals for toxicity before they are allowed to enter the marketplace, and maintain strictly-enforced regulation on these chemicals.
  • Bolster ongoing research and epidemiologic monitoring to better understand, and subsequently prevent, the health impact of chemicals on children.
"Implementing these proposals would have a significant impact in preventing childhood disease and reducing health costs," said Dr. Landrigan. "Scant legislation has been passed to reduce the risks associated with childhood exposure to toxic chemicals in the environment. Even though only six chemicals have been banned, we have seen dramatic benefits from that action alone. The removal of lead from gasoline and paint is an example of the importance of this type of regulation."

In a separate article in Health Affairs, Perry Sheffield, MD, Assistant Professor of Preventive Medicine at Mount Sinai School of Medicine, evaluated the little-studied correlation between air pollution and infectious respiratory illness in children, and the resultant health care costs.

Dr. Sheffield and her team analyzed hospitalization data between 1999 and 2007 for children aged one month to one year who had bronchiolitis – a type of viral lung infection with symptoms similar to asthma – and monitored the air quality surrounding in the hospitals where the patients were treated. They found a statistically significant association between levels of fine particulate matter pollutant surrounding the hospitals, and total charges and costs for infant bronchiolitis hospitalizations.

Her team revealed that as the amount of air pollutants increased, infant bronchiolitis hospitalization costs increased by an average of $127 per patient. As a result, they concluded that reducing the average level of fine particulate pollutant by just seven percent below the current annual standard could save $15 million annually in U.S. health care costs.

"While more research is required to understand the full effect of air pollutants on infectious disease severity and health care costs, our findings are indicative of the tremendous impact new legislation on air quality control standards could have on the health of our children," said Dr. Sheffield.

To access these three articles in Health Affairs, please visit http://www.healthaffairs.org."

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    Dr. Maltz earned a Medical Degree and Master in Public Health from the University of Texas Medical Branch (UTMB) in Galveston, TX. She completed a combined Internal and Preventive Medicine Residency at UTMB in June, 2011. She then completed a 2-year Integrative Medicine Fellowship at Stamford Hospital in Stamford, CT, during which she simultaneously underwent an intensive 1000-hour curriculum created by The University of Arizona Integrative Medicine Program founded by Dr. Andrew Weil.  

    Dr. Maltz's specific interests include helping her patients and populations improve their health through lifestyle interventions including, but not limited to, natural pain relief, nutrition, mind-body techniques and decreasing environmental exposures. She spent the last year of her four-year medical residency participating in health policy, cancer prevention and environmental health rotations and enjoys guiding people through the overwhelming amount of health information available on the web.

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