September 03 Senior Bulle#D2901 - The American … well the new Medicare Part D is working....

Message from theChairpersonAvrum L. Katcher,MD, FAAPChairperson, Section for Senior Members

How manyof youhave checkedout our newwebsite?There youwill findmanynewpageswith informationof value. For example, there is a short article abouthow well the new Medicare Part D is working.Mentioning both pros and cons. Links to informativearticles recently appearing inNewEngland Journal ofMedicine are provided. If you are age 65 or older, thisis worth reviewing.

Another example is the summary of Chapter SeniorCommittee activities, as described in the Chapterannual reports. See what is happening in yourChapter.Have youaSeniorCommittee?Are youactivein it, or working to form one. The real action is at thelocal level.The Section for Senior Members has manypossible objectives, but theymaybe summarized intotwo groups, identified as two constituencies—our-selves and children and young people. On the onehand, we are here to help our members navigate thechanges and challenges that occur as we age, to shareexperiences and opinions, to learn from each otherand from many expert sources outside of Pediatrics.We have much to offer the children of the world—many tools we may bring to bear for them—but ourmost important tool is ourselves. On the other hand,as pediatricians we are to help children, and theSection for Senior Members offers, at Chapter andNational level, an opportunity to join with others forthe benefit of children, to be involved, to be active,both while still in practice, and as we are phasing out.

What’s Inside?Message from the Chairperson . . . . . . . . . . . 1-2

Executive Committee/Subcommittee Chairs . . . 2

2006 Section For Senior Members EducationalProgram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Senior Friendly Places to Eatand Things to do in Atlanta. . . . . . . . . . . . . . 3-4

David Annunziato, MD, FAAP. . . . . . . . . . . . 4-5

Letter to the Editor from Constant Reader . . . . 6

Senior Section Survey . . . . . . . . . . . . . . . . . . . . 6

A String Theory . . . . . . . . . . . . . . . . . . . . . . . . 7

Advocacy Activities . . . . . . . . . . . . . . . . . . . . 8-9

Erythroblastosis Exchange Transfusion witha subtitle of An Unusual Occurrence . . . . . . . 10

WARNING . . . New Credit Card Scam . . . 10-11

Anti-Vaccine Attitudes . . . . . . . . . . . . . . . 11-12

Financial Commentary:Secular Bear Markets . . . . . . . . . . . . . . . . 13-14

Digital Photography – Primer andResource Guide. . . . . . . . . . . . . . . . . . . . . 15-18

Why We Write . . . . . . . . . . . . . . . . . . . . . 18-19

My Life As A Writer . . . . . . . . . . . . . . . . . 20-21

Still I Learn . . . . . . . . . . . . . . . . . . . . . . . . 21-23

What the Heck is a Fender Skirt? . . . . . . . 23-24

Take It Or Leave It (For Now)? . . . . . . . . . 24-25

“On Medical Stories and Myths” Today:“The Stethoscope” . . . . . . . . . . . . . . . . . . 26-27

Aging Well . . . . . . . . . . . . . . . . . . . . . . . . 28-29

Copyright© 2006 American Academy of Pediatrics Section for Senior Members

Continued on Page 2

A A P S e c t i o n f o r S e n i o r M e m b e r sVolume 15 No. 4 – Fa l l 2006

Opinions expressed are those of the authors and not necessarily those of the American Academyof Pediatrics. The recommendations in this publication do not indicate an exclusive course oftreatment or serve as a standard of medical care. Variations, taking into account individualcircumstances, may be appropriate.

SENIOR BULLETINEditor: Joan Hodgman, MD, FAAPAssociate Editor: Arthur Maron, MD, MPA, AAPAdvocacy for Children Editors: Lucy Crain, MD, MPH, FAAP

Burris Duncan, MD, FAAPDonald Schiff, MD, FAAP

Travel & Leisure Editor: Herbert Winograd, MD, FAAPGeneral History Editor: Maurice Liebesman, MD, FAAPFinancial Planning Editor: James Reynolds, MD FAAPHealth Maintenance Editor: Avrum Katcher, MD, FAAPComputers Editor: Jerold Aronson, MD, FAAPGeneral Senior Issues Editors: Avrum Katcher, MD, FAAP

Eugene Wynsen, MD, FAAPOutdoors Editor: John Bolton, MD, FAAP

So, look on the web site to see what your chapter is doing, and becomeinvolved to help.Your Chapter officers have copies of a Chapter Guide toprovide advice for Chapter Senior Committees.

For yourselves, come to the annual National Conference and Exhibitionof the Academy, this year in Atlanta, George, from October 6 to 9. At theNCE, the Section for Senior Members will have an outstanding program,pulled together by Lucy Crain and George Cohen, on Monday afternoonOctober 9. This program is open to all AAP members and guests, butparticularly for our Section for SeniorMembers. Itwill bewellworth yourwhile to attend.

Recent studies have shown that fewer than 30% of physicians haveliving wills or advanced directives. Similarly, judicious planning for longtermcare of familymembers or ourselves is all too often neglected, aswecare for our patients. Our program offers 3.5 hours of CME credit.Afterwards, there will be an informal reception to meet faculty andfriends. In addition, all Chapter officers have been invited.The programand location for the meeting are listed in this Bulletin.

At the NCE, there will be a reception for first time attendees to be heldon Friday, October 6 in the early evening. Members of the Senior Sectionare invited, to help introduce newattendees to the NCE, offer advice andinformation about the Academy, and provide links to Academy activitiesand objectives, and also to the many sources of useful information,personal advice, and opportunities to work for children within theAcademy framework.

If you plan to be in Atlanta, Michael Levine has prepared an excellentguide to restaurants and points of interest, also on ourWeb Site for yourbenefit. Take a look. There is so much in Atlanta one might go there justfor enjoyment and education!

I hope to see you all there in October. Look for me.

Avrum L. Katcher,MD, FAAPChairperson, Section for Senior Members

2 Senior Bulletin - AAP Section for Senior Members - Fall 2006

Executive Committee

Avrum L. Katcher, MD, FAAPChairFlemington, NJ

David Annunziato, MD, FAAPImmediate Past ChairEast Meadow, NY

Jacqueline Noonan, MD, FAAPLexington, KY

George Cohen, MD, FAAPRockville, MD

Lucy Crain, MD, MPH, FAAPSan Francisco, CA

John Bolton, MD, FAAPMill Valley, CA

Arthur Maron,MD, MPA, FAAPBoca Raton, FL

Subcommittee Chairs

ProgramLucy Crain, MD, FAAP

Financial PlanningJames Reynolds, MD, FAAP

MembershipGeorge Cohen, MD, FAAP

History Center/ArchivesDavid Annunziato, MD, FAAP

Newsletter EditorJoan Hodgman, MD, FAAP323/[email protected]

Associate EditorArthur Maron, MD, FAAP561/[email protected]

StaffJackie Burke,Sections Manager800/433-9016, ext. [email protected]

Message from the Chairperson Continued from Page 1 _________

How Do You Decide Whom To Marry?(Written by kids)

Yougot to find somebodywho likes the same stuff. Like, if you like sports,she should like it that you like sports, and she should keep the chips anddip coming.

Alan, age 10

No person really decides before they grow up who they’re going to marry.Goddecides it allwaybefore, andyouget to findout laterwhoyou’re stuckwith.

Kristen, age 10

Senior Bulletin - AAP Section for Senior Members - Fall 2006 3

2006 Section For Senior Members Educational Programby Lucy Crain,MD,MPH, FAAP

Monday, October 9, 2006, 1:30-4:30 pm (Reception follows)Room A405, GeorgiaWorld Congress Center Atlanta, GA

Title: THE ELEPHANTS IN THE ROOMNCE course number H349

Target audience: Both general pediatricians and section members, as well as guests. Numerous studiesdocument that fewer than 30% of physicians have living wills or advance directives. Many have not madedefinitive plans for their end of life care. Others address these concerns with their patients and may not applylessons learned to their personal considerations.

Attendees will learn necessary terminology, indications, and legal requirements & state variations for theabove topics, in order to apply them appropriately and judiciously to themselves, and their family members/loved ones, and, when indicated, to patients with chronic illnesses, disabilities, or fatal diseases. Approved for3.5 hours CME credit.

PROGRAM TITLE: THE ELEPHANTS IN THE ROOM

ABCs of ASSISTED LIVING, LONG TERM CARE, & LONG TERM CARE INSURANCE- Robyn Stone, Ph.D:American Association of Homes & Services for the Aging,Washington, DC

ALLYOUSHOULDKNOWABOUTLIVINGWILLS, ADVANCEDIRECTIVES, POWERSOFATTORNEY,&HEALTHCARE SURROGATES: Thomas Finucane, MD: Johns Hopkins University School of Medicine, Baltimore, MD

PALLIATIVE CARE, TREATMENT OF PAIN, & END OF LIFE CARE: Sandra Wishon, RN, MS, PNP: Hospice ofMarin and Hospice by the Bay, Larkspur, CA

Wemoved toAtlanta in 1965 when I entered theprac-tice of Pediatrics following my training in Boston andtwo years in the Air Force at Shaw Air Force Base inSouth Carolina. At that time Atlanta had 1,200,000people. Today the population is close to 5 million soyou can see it has been a fertile field for Pediatricians.

Along with the population there has been tremen-dous growth in cultural venues and restaurants and Iwill highlight some,which I think visitorsmight enjoy.

First, you have to eat and based on the location of themeeting, which is in the central downtown area, youwill have many excellent choices:

City Grill – great food, architecturally beautiful spaceNan Thai – Thai fusion, regal dining roomTable 1280 – at thenewHighMuseumofArt, contem-porary cuisineTaurus – great steaks, chopsBacchanalia – a special occasion restaurant with aprix fixe menuOceanaire Seafood Room – fresh seafood in a sleekrestaurant

111MLKDeli –NYstyle great steamedpastramion ryeRathbun’s – wonderful American foodZocalo Taqueria – fresh MexicanBobby and June’s Country Kitchen – 6:00 a.m. – 3:00p.m. real Southern

Further away if you have a car or by cab:

CanoeBagel Palace DeliSouth of FranceLaGrottaHorseradish Grill – creative SouthernBuckhead DinerPano and Paul’sAtlanta Fish MarketNava – southwesternSeeger’s – very expensiveFlying Biscuit Café – turkey meatloafCHOPSFago de Chao – BrazilianImperial FezJoel – continental, expensive

Continued on Page 4

Senior Friendly Places to Eat and Things to do in AtlantabyMichael K. Levine,MD, FAAP


David Annun-ziatowasbornonStaten Is land,N e w Yo r k i nSeptember 1921.He attended thepublic schools

and then earned his B. S. fromWagner College there. He grad-uated from the Long IslandCollegeofMedicine (nowSUNY-Downstate at Brooklyn, NY) inMarch 1946. After a rotatinginternship, and three years ofpediatric residency at the LongIsland College Hospital, he

served in the U. S. Navy doingPediatrics at the Brooklyn andSt. Albans Naval Hospitals.

Dr. Annunziato believes thatone of his greatest honorsoccurred early when, uponcompletinghis training, eight ofhis professors asked him to jointhem inpractice inBrooklyn.Hechose not to stay there.

In 1947,Dr. AnnunziatomarriedRuthTeichmann.Theyhave twowonderful children, Philip, age57 and Diane, age 55 and one

grandchild, Grace, 12 years old.

In 1952, he enteredprivateprac-tice in Massapequa Park, NewYork where he enjoyed proba-bly the largest pediatric practiceon Long Island. In those days,one could not be appointed to ahospital staff unless they hadbeen in practice for at least twoyears. The exception was theCounty hospital where anypractitioner had privileges. Hejoined that staff immediately atthe then-called Meadowbrook

Continued on Page 5

David Annunziato, MD, FAAP

Kyma – Greek seafoodAu Pied de Cochon – Intercontinental Hotel

Things to do:

In the general downtown area there are many attrac-tions within walking distance:

Piedmont Park and the Atlanta Botanical GardensGeorgiaAquarium–world’s largest (advance reserva-tions recommended)Underground Atlanta and Coca Cola MuseumMartin Luther King, Jr. Historic DistrictCNN CenterMuseum of Decorative Arts

Short cab ride or rapid transit (MARTA):

Cyclorama and Atlanta Zoo (pandas)High Museum of Art – Renzo Piano designMuseum of Contemporary ArtSymphony Hall and the Alliance Theater (check forperformances)Atlanta History CenterMargaret Mitchell HouseSpelman College MuseumCarlos Museum at Emory UniversityJimmy Carter Presidential CenterFernbank Museum of Natural HistoryShopping: Lenox Square and Phipps Plaza

Theaters nearby:Alliance Theater – next door to the High Museum14th St. PlayhouseActor’s Express at King Plow Arts CenterSchwartz Center for the Performing Arts at EmoryUniversityHorizon TheaterSeven StagesShakespeare TavernAgatha’s Dinner TheaterLibby’s Cabaret

Funky neighborhoods:The Highlands and Little Five Points

Art Galleries:Fay Gold GallerySignature ShopTimothy TewLowe GalleryBarbara ArcherMarciaWoodMason MurerSandler HudsonSwan Coach HouseTrinity GalleryVesperman – glassJackson Fine Art - photography

Senior Friendly Places to Eat and Things to do in Atlanta Continued from Page 3 ____________

Note: As of April 29, 2006, there is an Atlanta Tourist Loop Shuttle bus linking the major hotels to many of thesites I mentioned in the article.


Hospital, and very shortly wasasked to supervise the poliodivision there. In 1956, he wasappointeddirector of pediatricsa t a pr i va te hosp i ta l , theBrunswick Hospital Center andin 1959, he was also appointeddirector at the Good SamaritanHospital (G.S.H.) in West Islip,New York. While at G. S. H. heestablished a pediatric resi-dency program there, the firstresidency program of any kindin all of New York’s SuffolkCounty.

In 1964, Dr. Annunziato wasappointed Chairman of theFetus and Newborn Committeeof New York Chapter 2 of theAmerican Academy of Pedia-trics (AAP). That began a stair-way of committee work, whichled to his election to ChapterChairman. Following that, hewas elected toAlternateDistrictChairmanofDistrict II and thenDistrict II Chairman serving onthe Board of Directors of theAAP. He is proud of his workat all levels of the Academy’shierarchy.

Dr. A , as he is ca l led , wasP re s i d en t o f t h e Na s s auPediatric Society in 1966. Hehas participated and chairedinnumerable committeeslocally and nationally.

In the early 70’s he was ap-pointed Assistant Professor ofPediatrics at theHealthSciencesCenter, School of Medicine atStony Brook, New York andcurrently is Professor of ClinicalPediatrics there.

In 1973, when the new medicalschool was two years old andclinical teachers were needed,he left private practice to

assume a full time teachingposition at the Nassau CountyMedical Center as Director ofAmbulatory Pediatrics, wheremedical students received theirclinical training. He becameDirector of the res idencytraining program there, thenAssociate Chairman and thenActing Chairman. He retired in2001but continues toworkdailythere as Director of PediatricEducation.

He continues his work with theAAP sitting on the ExecutiveCommit tee of the SeniorSection (as immediate pastChairman) and is a member oftheHistorical ArchivesAdvisoryCommittee since its inception.

Over the years Dr. A. has beenhonoredwithnumerous awardsand citations. He has receivedfive citations from the NassauChapter of the March of Dimesas their chairman and alsoreceived their first “Silver StorkAward”. He has also receivedvarious hospital and local pedi-atric society, civic and teachingawards, including the RichardL. Day master teacher awardfrom his alma mater. He washonored by the New York StatePerinatal Association for a life-time of service to children.

In 1993, he was invited to theWhite House to help developthe Clinton health plan for chil-dren. He is most proud of therecognition awards he hasreceived over the years from hisresidents, students and fellowfaculty. In 1995, Dr. A was pre-sented with the AAP’s mostprestigious Clifford G. Gruleeaward for his “outstandingcommitment to children and tothe American Academy of

Pediatr ics”. In June 2006,the Department of Pediatricsnamed their post graduatelecture Series in his honor inappreciation of “his dedicationto the educational mission ofthe department”.

Currently, Dr. ‘A’, in addition tohis educational efforts, is activewith the Nassau Academyof Medicine chairing theirPreventive Health Committeeand as a member of severalother committees.

Dr. ‘A’ enjoys gardening andfishing and is attempting tobecome computer literate.

He continues to contributedaily, a little less and a littlemore slowly. He has achieveda most rewarding life, noneof which could have beenaccomplished without hisloving wife, Ruth.

David Annunziato, MD, FAAP Continued from Page 4 ________________________________________

What IsThe Right AgeTo Get Married?

(Written by kids)

Twenty-three is the best agebecause you know the personFOREVER by then.

Camille, age 10

No age is good to get marriedat. You got to be a fool to getmarried.

Freddie, age 6(very wise for his age)

This second installment of obser-vations andpotential implicationsof the Senior Section Surveyfollows the summary of the sur-vey and results by Dr. GeorgeCohen in the Summer 2006 issueof the BULLETIN.

Attempting to better determinethe interests and educationalneeds of our members to assist inplanning future section educa-tional programs was a major rea-son for the survey. Of the 65% ofsectionmemberswho responded,64%hadnot attendedanAAPNCEin the past 5 years. Of those res-pondents who had attended theAAP NCE in the past 5 years, oneout of 5 did not attend the seniorsection educational program.Based on the survey alone, wemight question whether our sec-tion program is justified, so it’simportant to compare the surveyresults with the program and fac-ulty evaluation summaries frompast section programs, as submit-ted by those 50-60 section mem-bers who have consistentlyattended the section programs.We see greater reason for opti-mism. Of the three outstandingpresentations orchestrated by Dr.Jacqueline Noonan on behalf ofthe section, evaluations from the2005 NCE Section program on

senior lifestyle issues,mean scoreswere 4.60 to 4.73, on a possible“perfect” score of 5.0. (A scoreof 4.0 or above is consideredexcellent to outstanding.) Seeannouncement in this issue ofthe Bulletin for this year’s NCEsection program on October 9 inAtlanta and plan to attend!

Better defining the membershipof the section was another motivefor the survey, updating a similareffort a decade ago. As Dr. Cohennoted, the sect ion remainspredominant ly males , whoremain clinically active full orpart-time. Compared with theincreasing percentage of femalemembership of AAP, increasingnumbers of pediatricians whopractice part-time or practiceshare, and the arrival of “babyboomers” at the age of eligibilityfor section membership, oursectionand theAAPcananticipatemany changes in the next fewyears. Today’s average member oftheAAP is 45 years old and female,a dramatic change in profile fromwhen most section membersentered practice, or even asrecently aswhen they retired (49%of section members have beenretired for more than 5 years.)

Addressing the finding that only

2% (3 respondents) in the surveyare age 55-59 years of age, andonly 14% (22 respondents) are age60-64, clearly defines a recruit-ment challenge for youngermem-bers if our section is to continue.

The full survey report canbe found on the Section forSenior Members home page atwww.aap.org/moc.


Letter to the Editor from Constant ReaderThe thoughtful ideas described by Dr. Wynsen in his article on abuse have applications beyond what he hasmentioned. For one example, in organizations, whether for profit or not-for-profit, successful involvement ofthe staff includes taking active steps of a positive nature, in addition to seeking how to undo noxious elements.Or, in instances of medical error, or possible malpractice, active steps should be taken to look at the systemitself,what is doneornot done, and consider how to alter the system, the environment, theway things aredone.This can only be accomplished if full transparency of whatever the events were can be achieved. And finally,in well childcare (as compared to disease detection and treatment) the point is again, how to counsel parentson taking, or how oneself to take active steps favorably to alter the odds of health in the future. Life has noguarantees, but one hopes to shift the odds by active steps whatever one is trying to do.

Senior Section Surveyby Lucy Crain, MD, MPH, FAAP

Is It Betterto Be

Single or Married?(Written by kids)

It’s better for girls to be single butnot for boys. Boys need someoneto clean up after them.

Anita, age 9

What DoYou Think YourMom and Dad

Have in Common?(Written by kids)

Both don’t want any more kids.Lori, age 8


A few weeks ago while vacationing in Aspen, I was fortunate enough to hear a lecture on String Theory givenby one of its most active investigators, Brian Greene. This approach to understanding the fundamentalstructure of the physical universe struck me as being a clear vision and potential answer to a question, whichwas not previously solved by even Einstein.

Not withstanding the enormous differences between health care and theoretical physics, we in health carepolicy are not close yet to having a clear vision of how to reach our goal of quality health care for all. Perhapsthere is no comparable all-encompassing answer to providing health care for all of our citizens, but thissummer our nation appears to be going in opposite directions.

Although it is apparent that the general public aswell as the congresshave a very limitedunderstandingofhealthand how insurance plays a major role in protecting and maintaining both our national and individual health,a series of legislative and administrative actions currently being acted out require our study and focus.Whilethe Medicaid and SCHIP federal and state health insurance programs for the poor and near poor have overthe past five years reduced the number of uninsured children from 11 million to 8 million, July 1 marked theimplementation of a new identification and verification of citizenship program that extends from birth to theelderly covered by Medicaid. This effort to prevent fraud will raise extraordinary barriers for current and newenrollees. The evidence, which this program will accept as proof of identity and citizenship, is limited and inmany cases will be impossible to find or produce.

Another powerful deterrent to the families of millions of Medicaid eligible children is the drive to eliminatethe incentives for illegal immigrants to come to the USA. The economic opportunities, which have broughtmillions of work-seeking families to our country will not protect their children, as the fear of discovery anddeportation keeps them from signing up their eligible legal children in the Medicaid plan.

In the face of these negative developments for children’s health, two states, Massachusetts and Vermont, inan amazing display of bipartisanship (both states have Democratic-controlled legislatures and Republicangovernors), passed bills designed to bring near universal health insurance to their states.

TheMassachusetts planutilizes a mandated purchase of health insurancewith employer contributions. A holein this safety net allows an exemption if affordable (not defined) insurance cannot be found.

Vermont provides a voluntary, standardized plan, which will be offered by private insurers with benefits andcharges similar to the Vermont Blue Cross and Blue Shield plan. People with incomes below 300% of thepoverty level will be eligible for premium subsidies.

AsMassachusetts andVermont set aside ideologies to forge a compromise, thismaywell spur a renewed,much-needed debate on national health coverage in the 2008 election.

I would welcome your thoughts and comments. Please e-mail me at [email protected].

A String Theoryby Donald Schiff, MD, FAAP

How Would the World Be DifferentIf People Didn’t Get Married?

(Written by kids)

There sure would be a lot of kids to explain, wouldn’t there?Kelvin, age 8


Editor’s Note:I’ve known Peter Michael Miller for more years than either of us would like to admit, so I can honestly state thathe is a tireless advocate for children’s health issues! His articulate, thoughtful testimony in the CaliforniaLegislature and elsewhere,his comprehensive knowledge of resources for childrenwith special health care needs,and his ongoing enthusiastic commitment to improving quality and systems of care for children and theirfamilies is inspiring!You’ll find his article about some of his insights into his favorite past-time enlightening.

Lucy CrainMD,MPH, FAAP

Advocacy Activitiesby Peter Michael Miller,MD,MPH, FAAP

1. Public Health and Clinical Pediatrics

It’s important for a community to have good public health activities and good direct pediatric clinical care. Forfull well child care’, public health and clinical pediatrics must be meshed.

For example:

• Apediatricianmustprovide goodcare to youngchildren. This should includediscussionwith the family aboutchildcare options. Referral should be made to the appropriate childcare (or no childcare) option for thefamily – with appropriate support from the doctor.

• The pediatrician must communicate effectively with the child care provider to ensure medical, develop-mental, safety andother issues are addressed as they apply to the home and the child care settings. Childcareproviders should feel comfortable in calling on the pediatrician for support, guidance and clinical care asnecessary.

• Pediatricians should take an active role in the community, county and state to helpdevelopquality child careoptions through many types of advocacy and personal involvement.

I was involved in this as the county Assistant Health Officer, as Chairperson of the county MCH Directors inCA, and as chairperson of the national AAP COECADC. I continue as a member of the AAP SIG for child carewhich originated during my term with the COECADC. I also continue on the advisory board for the Preventionand Public Health SIG. (more details available as requested)

2. Primary Prevention

The essence of public health – and pediatrics – should be the primary prevention of medical and develop-mental problems.This includes family planning, prenatal care, perinatal care, and services to infants andyoungchildren. I have been involved in multiple examples during my career:

• county clinic family planning services advocacy for comprehensive perinatal services for MediCal families(early 90s)

• advocacy for regionalization of perinatal services

• support for newborn services: genetic testing; hearing screening; screening for substance abuse andfollow up; high risk infant determination and follow up arrangements; HIV and Hep B screening andimmunization

• nutrition services (e.g.,WIC) and primary prevention of obesity

• Back to Sleep campaigns (via COECADC)

• SIDS program in Marin for parents

• Identification of families at risk for child abuse and early referrals and counseling

3.Early Brain and Child Development (EBCD)

The key to long-term production of young adults ready to participate positively in society rests with attentionContinued on Page 9


to EBCD. Starting in the pre-prenatal period and continuing past 5 years, there needs to be attention to howthe nation, communities and pediatricians help families raise their young children. AsCOECADC chairperson,and through various lectures to child care staffs, school program staffs, parent groups and pediatricians, I haveemphasized educationof parents andchild careproviders as to thebest developmental practices to enable theiryoung children to grow into caring, empathetic, open-minded, cooperative and respectful children and youngadults.

4. ProgramCoordination and Consolidation

Federal, state and local governments have created a myriad of programs over the years to help children andfamilies for a variety of medical and developmental needs. Unfortunately, there is little planning as programsare developed, and this has led to much duplication, conflict, confusion, and wasted time among parents andprogram staffs as they try to maneuver for appropriate services for children.

I have dedicated my career to trying to coordinate or consolidate these programs, or help pediatricians andparents bridge the gaps when necessary. I served as a consultant to California’s attempt in 1991-3 to combinethe multiple MCH programs. I was an advocate as part of the California Children’s Lobby for 25 years to ensurelegislative integrity in children’s programs. As a long time member of the Chapter COCWD, ongoing efforts aremade to improve the spectrum of services to children with severe medical problems and disabilities.

5. Program and Service Planning

This relates to the above issue, but goes deeper. Child advocacy, including many chapter, district and nationalAAP efforts, are often devoted to provide a missing service, as often evidenced via the CATCH grants. I haveworked in a program in California devoted to program need and planning to advise local communities onhow to best utilize their limited resources. We focused on looking at data to identify needs, working withcommunity experts and advocates regarding concerns for care, and planning the implementation of thelimited resources to achieve the greatest outcomes. This activity continued as representative of the AAP tovarious groups, include thePanAmericanHealthOrganization (nationally) andvarious state groups (oral health;perinatal care; child care for children with disabilities, etc.)

6. Health System

The current health system includes private care and insurance, Medicaid and SCHIP – much of which hasbeen organized into various formats of health plans. Ancillary and related services for children are rarelyincorporated successfully into comprehensive care (nutrition, child abuse prevention, oral health, physicalexercise, etc.). There are also few standards for care, little data that is inefficiently collected, analyzed andreported, and a system that is still more geared to the bottom line than it is to making sure each child’s andfamilies medical and developmental needs are fully met.

I have been involved in media and legislative contacts, advocacy within the child health programs, andconnections with governmental groups (e.g., CA County Health Officers) to advocate for a more logical andeffective system.

7. ChildWell Being

There is often talk of children’s health, and much attention to the more dramatic challenges to child health –including injuries, infections, chronic illnesses and conditions, dangers of terrorism, child abuse, etc.However,overall there is a lack of recognition of the significant roles that so many community based issues have on theoverall well being of children. These issues include: poverty, poor air, water or soil environments, culture andethnicity, exposure to violence in their environments, effects of social issues on child development (e.g., TV,videogames, parent child-rearing skills, etc.), community development (e.g., relationship of homes, shops,schools and parent work) in a neighborhood. I continue to try to help my colleagues and community leaderssee the overall child well-being issues and how to look beyond just medical care to the child’s and family’soverall needs and how to best address the myriad of issues that need to be considered and addressed.

Advocacy Activities Continued from Page 8 _____________________________________________________________


Erythroblastosis Exchange Transfusion with asubtitle of An Unusual Occurrence

by David Annunziato,MD, FAAP

While I was a chief resident in1951, not many people weredoing exchange transfusions forErythroblastosis Fetalis. Since Ihad done many, the medicalschool had become a center forthis procedure; I was approachedin the corridor one day by acolleague who was a radiologyresident. She was obviouslypregnant and toldme that shehadhigh Rh antibody titres. She askedif I would do the exchangetransfusion on her baby when itwas born. Of course, I agreed.

This was her first pregnancy andwe were at a loss to explain howshe had become sensitized. Longdiscussions with her, her fatherwho was the chairman of Medi-cine, our pediatric hematologist,and my chairman, who had beenher pediatrician, failed to define acause. All were honest, knowl-edgeable and caring people.

The baby was born at term, wasanemic and became jaundicedin a few hours. An exchangetransfusion was done when thebaby, a boy, was only five hoursold. All went well and the infantdid very well.

We still did not know how theyoungdoctor hadbeen sensitized.I must admit that some unkindspeculations were discussed.About two weeks after the motherand baby were discharged, mychairman called me one morningtohappily announce that he knewthe answer.While at breakfast thatmorning, he mentioned ourdilemma tohiswife,who immedi-ately said she knew the answer.When the mother was an infant,she had been exposed to measles.My chairman, her pediatrician,gave her an injection of five cc ofblood inherbuttock to try tomakethe measles a milder case. I hadnever heard of this before. In

speaking to some of the olderpediatricians at that time, Ilearned that this was a commonprocedure in the 1920’s and 30’s.After exposure to measles, someof themwould takeblood fromthechild’s mother or father and injectit into the child’s buttock. Thisprocedure, they thought, madethe disease less severe.

Three years later, Iwas inpractice;I received a call from the radio-logist, now in practice, who wasthen pregnant again. She asked ifI would “exchange” this secondbaby’s blood. She worked in anddelivered the baby at a hospitalsome distance away, I receivedadministrative hospital approvalto do the procedure. That babyalso did very well.

As a great philosopher once said,“Forgive us for our mistakes of thepast, it was the best we knew atthe time”.

Editor’s Note:There has been considerable discussion of late about data based versus opinion basedmedicine, some of it in theSenior’s Bulletin. Here is another example of theunexpecteddangers thatmay lurk in opinionsnot based ondata.

Note, the callers do not ask foryour card number; they alreadyhave it. This information is worthreading. By understanding howtheVISA & MasterCardTelephoneCredit Card Scam works, you’llbe better prepared to protectyourself.

The scam works like this: Personcalling says, “This is (name), and

I’m calling from the Security andFraud Department at VISA. MyBadge number is 12460.Your cardhas been flagged for an unusualpurchase pattern, and I’m callingto verify. This would be on yourVISA card which was issued by(name of bank).Did you purchasean Anti-Telemarketing Device for$497.99 from a Marketing com-pany based in Arizona?”

Whenyou say“No”, the caller con-tinues with,“Then we will be issu-ing a credit to your account.This isa company we have been watch-ing and the charges range from$297 to $497, just under the $500purchase pattern that flags mostcards. Before yournext statement,the creditwill be sent to (gives youyour address), is that correct?”

WARNING . . . New Credit Card Scamby George Cohen,MD, FAAP

Continued on Page 11

The process of vaccination hasbeen around for a long time. Anti-vaccine attitudes have beenaround for a long time as well.

In the 16th century, it was com-mon for people to be vaccinatedwith the live smallpox virus fromaskin bleb of a patient with activesmallpox acquired in the commu-nity, and even knowing that therewas considerable risk in the dis-ease that developed, many werewilling to under go this processbecause they were aware it wasless risky than acquiring the com-munity smallpox. Later, Jennefound that the cow-pox viruswould confer immunity, and thisbecame a better way to vaccinate,avoiding the more serious prob-

lems with the wild smallpox virus,even though it was not withoutrisk. But, even at that time, therewas dissent about the procedure,and people resisted it. That wassome time ago. So, this idea thatvaccination is bad and is to beavoided, is not new. With persist-ence, smallpox has been elimi-nated, due to the uniqueproperties of the smallpox virus.But nay-sayers, down play thisremarkable feat.

At the present time, there is stillwidespread distrust and avoid-ance of vaccines. There has beenimmense progress made in vac-cines, and their use has resultedin the elimination of countlessamounts of suffering and disease.

It is the mantra of many of theanti-vaccine persons to demandthat the vaccines be perfected, sothat there is complete safety andefficacywithno short or long termcomplications or developments.There is constant demand that thevaccines be studied for long peri-ods of time,withdouble blind andeven cross-over studies beingdone to assure that no possibleproblems develop. Unfortunately,it is not possible to do a cross-overstudy with vaccines, so it is a use-less demand, since in cross-overstudies the patients act as theirown control. The patient can notbe vaccinated and also not vacci-nated. It is claimed that the com-paniesmakinganddeveloping the


You say“yes”.The caller continues- “I will be starting a Fraud inves-tigation. If you have any ques-tions, you should call the 1- 800number listed on the back of yourcard (1- 800-VISA) and ask forSecurity.

You will need to refer to thisControl Number. The caller thengives you a 6 digit number. “Doyou need me to read it again?”

Here’s the IMPORTANT part onhow the scam works. The callerthen says, “I need to verify you arein possession of your card”. He’llask you to“turnyour cardover andlook for somenumbers”.There are7 numbers; the first 4 are part ofyour card number, the next 3 arethe security numbers that verifyyou are the possessor of the card.These are the numbers you some-times use to make Internet pur-chases toprove youhave the card.

The caller will ask you to read the3 numbers to him After you tellthe caller the 3 numbers, he’ll say,“That is correct, I just needed toverify that the card has not beenlost or stolen, and that you stillhave your card. Do you have anyother questions?” After you sayNo, the caller then thanks you andstates, “Don’t hesitate to call backif you do”, and hangs up.

You actually say very little, andthey never ask for or tell you theCard number. But after we werecalled on Wednesday, we calledback within 20 minutes to ask aquestion. Are we glad we did! TheREAL VISA Security Departmenttold us it was a scam and in thelast 15 minutes a new purchase of$497.99 was charged to our card.

Long story made short - we madea real fraud report and closed theVISA account.VISA is reissuing us

a new number.

What the scammers want is the3-digit PIN number on the back ofthe card. Don’t give it to them.Instead, tell them you’ll call VISAorMaster carddirectly for verifica-tion of their conversation.

The real VISA toldus that theywillnever ask for anything on the cardas they already know the informa-tion since they issued the card! Ifyou give the scammers your 3Digit PIN Number, you thinkyou’re receiving a credit.However,by the timeyouget your statementyou’ll see charges for purchasesyou didn’t make, and by then it’salmost too late and/or more diffi-cult to actually file a fraud report.

Please pass this on to all yourfamily and friends. By informingeach other, we protect each other.

WARNING . . . New Credit Card Scam Continued from Page 10 _____________________________________

Anti-Vaccine Attitudesby Eugene R.Wynsen,MD, FAAP


vaccines are just in it for themoney, and would do most any-thing to make a profit.Worse, it isalleged that physicians naively goalong with this, and are duped bythe companies that make the vac-cine. Pediatricians are in the fore-front of the vaccine efforts andbear the brunt of the criticism.

In medical procedures, there hasalwaysbeen the elementof unpre-dictability, and theuse of vaccinesis no exception. So the claim thatthey cause some problems is true,although in small numbers, andgenerally minor in nature. It is notlikely that it is possible to developa perfect vaccine with zero sideeffects or complications, eventhough we would very much liketo be able to do that. It is a matterofweighing the relative risks of thevaccine with the risk of the dis-ease.There is alsonoquestion thatefforts continue to study andimprove vaccines as much as ispossible to eliminate as muchuncertainty as can be done. Butthere remains the small statisticalgroup that will develop complica-tions no matter what precautionswe take, due to the biological vari-ability inherent in the immunesystem and in fact, in any biolog-ical system. Since the number ofthese is going to be very small rel-ative to the number of vaccinesgiven, it is a significant problemtrying to separate out the real cau-sations from those that onlyappear to be caused by the vac-cines by temporal association.This is a real problem. At present,there is considerable pressure topostulate that the vaccines causeneurological disorders, includingautistic spectrum disorders, andother developmental syndromes.Many anti-vaccine groups areabsolutely convinced that this isso. But, so far, there is no convinc-

ing evidence for this. Statisticsfrom the VAERS data have beencited to support this, but VAERSdata cannot be used for testingcausation as there is no denomi-nator in the data. VAERS datais greatly influenced by manyfactors, especially litigation.Thimerosal has been blamed, butagain, no convincing evidence forthis is apparent. There has beenno thimerosal in vaccines inDenmark and Sweden since theearly 90’s, and there has been nochange in the incidence of thereported syndromes. One wouldhave to conclude that thimerosalcauses these syndromes in ourcountry, but not in the Scandi-navian countries. This is prettyhard to swallow. So, it wouldappear that this is an unsubstan-tiated allegation. Regardless,thimerosal has been taken out ofthe vaccines here, except for somevaccines like influenza, and onecould not really argue that it is nota good thing. So, we are in theposition of trying to decide whatcriteriawe shoulduse to concludethat a vaccine is safe, effective andreasonable to use. How manycomplications or reactions shouldwe accept as being within reason-able bounds? What risk/benefitratio is acceptable? How longshould a vaccinebe studiedbeforeit is declared reasonably safe andeffective in the short and longterm? Is it ethical to use long termdouble-blind studies that wouldleave a large group vulnerable tothe disease, just to study the pos-sible long termeffects?Howsevereshould adiseasebebefore consid-ering using a vaccine? How muchdisability and suffering from adisease shouldbe toleratedbeforewe say a vaccine should be used?Is it even ethical to use case-con-trol studies, since the subjects in-volved would not know if they

received the vaccine andwouldbevulnerable to the disease?

It is interesting to note that stud-ies have indicated that there isanti-vaccine sentiment evenamong physicians, includingpediatricians. Some would avoidthemas they feel the largenumberof vaccines that are now routinein pediatrics would possibly over-load the immune system, or havepotential side effects and compli-cations. I am afraid that some ofthesemaybephysicianswhohavenever seen the terrible effects ofdiseases like polio, measles,rubella and smallpox, diphtheria,yellow fever and tetanus. Also, itis apparent that someolder physi-cians have not kept up theirinfluenza vaccines, either by neg-lect, or subtle resistance to vacci-nation. And a small number ofvery vocal anti-vaccine advocatesare themselves physicians or invarious healing professions.

There is no question that wewouldall like vaccines tobeessen-tially perfectwithno reactions andno complications at all. But, this islikely anunattainable goal, andweare left with trying to make thebest use of vaccines with theknowledge at hand, and with con-tinued effort to improve themboth in safety and efficacy. Thereare still a numberof infectiousdis-eases that remain scourges tohumanity: AIDS, malaria, tuber-culosis, dysentery, hepatitis B andC, papilloma virus, and rotavirus,tomention a few. Hopefully, thesemaybeable tobe approachedandameliorated with the use of newvaccines. Development and test-ing of these possible vaccines willchallenge themedical communityfor some time, but I don’t think itis likely that we will get rid of theanti-vaccine attitudes.


Anti-Vaccine Attitudes Continued from Page 11 ________________________________________________________


As of today, June1, 2006, the stockmarket is downsince its recent topby about 4%, as measured by theDow, and 7% based on the S & P500 and the NASDAQ.This down-turn was to be expected: Not onlybecause the recent equity marketwas long in the tooth, but mainlybecause we currently are in a sec-ular bear market, i.e., a long-term,10-20 year, period during whichthe market, as judged by the S&P500 Index, is either negative, orresults in a wash. During secularbear markets one expects moreshort-term market downturns.Oneusually thinksof stockmarketmovements in terms of relativelyshort cyclic movements, usuallyof several months, up and down,but one needs to be aware just asmuch, actually more, of the mar-ket’s long-term cycles in decidingwhether to be in or out of it. Thecurrent secular bearmarket beganin March of 2000 and continues;we are perhaps almost a third to ahalf of the way through it, asjudged by the duration of priorsecular bearmarkets. Losses in thethree-year 2000-2002 short-termbear market were horrendous—about 30% for the S & P 500 andabout 70% for the NASDAQ.Whether the current marketdownturn (a 0%-10% loss) willeventuate in a short-term correc-tion (a 10%-15% loss), or a short-term bear market (a loss or 20% ormore) is problematic.

To me, the main consideration forSeniors, is not the current down-turn, but the current secular bearmarket. That we are in this long-termbearphasemeans that abuy-and-hold investment strategy ofthe S&P 500, which accounts for85% of stock market capitaliza-

tion, will eventuate either in anaccount’s failure to gain, or in aloss. Seniors are particularly vul-nerable to secular bear markets.In the first place, they, in contrastto young adults, do not have timeon their side to recoup seriouslosses. The current equities mar-ket peaked, asmeasuredbyoneofthe threemajor indices, during thefirst three months of 2000. Now,more than six years later, the stockmarket has still not returned to thehigh of any one of the three majorindices by which it is measured:the Dow Industrials, the S & P 500,or the NASDAQ. Not only has the2000-2002 lossnotbeen recouped,but over six years worth of invest-ment opportunity since 2000 hasbeen lost. Greater than six yearsand still counting is a very longtime in a senior’s financial or life-time horizon. Even absent living-expense deduction, a senior’suntouched equity portfolio todaywould be worth a bit less than itwas almost seven years ago. Thisgives one pause.

In the second place, those seniorswho, unfortunately, needannuallyto deplete their investmentaccount for living expenses, runtheDamoclean risk of runningoutof money using a buy-and-holdscenario during a secular bearmarket—especially likely if theyannually deplete their account bymore than 4%. (If life were fair, therecent medical boon of increasedlongevitywouldnot be attenuatedby a contingent protracted needfor income.) Buy-and-hold worksduring secular bullmarkets; itwasparticularly effective during theextraordinarily long secular bullmarket that preceded the 2000debacle, but the current secular

bear market demands an alter-native strategy.

Two strategies are worthy ofconsideration:

1. Diversification

2. Market timing

Diversification has become astrategic mantra at any time, andin all market cycles, whether onebuys-and-holds or not. A simpleand effective diversificationmethod for seniors is to have nearequal parts of stocks and bonds,with bonds divided between gov-ernment and corporate issues,with perhaps some inflation-pro-tected types, and stocks equallydivided between large and small,value and growth, and U.S. andforeign issues—foreign marketstoday equal 50% or more of inter-national worth; they are impor-tant in themselves and for theirsometimes negative correlationwith the direction of the U.S. mar-ket. In the secular bear market of1966-1981, real return, i.e., returnminus that period’s inflation indexof 7% (!), was + 4.0% for large-value stocks and + 7.8% for small-value stocks, while that of the S&P500was -1.0% (!).The real returnoflong-term government and cor-porate bonds was negative, - 4.5%and - 4.1%, respectively.

By contrast, in the secular bearmarket of 1929-1941, neither theS&P500nor any categoryof stockshad a positive return.Value stocksdid much worse than growthstocks (7.8 times worse for thesmall vs. large value category).Inflationwas - 0.8% for theperiod,and government bonds had a real

Financial Commentary: Secular Bear Marketsby James L. Reynolds,MD, FAAP

Chairman, Senior Section Financial Planning Committee



return of + 5.3% and for corpo-rates, a return of + 6.9%.The starkcontrast in the typeof security thatbest weathered the two secularbear markets of the last centuryemphasizes the need for diversifi-cation, particularly during secu-lar bear markets.

Market timing is the other defen-sive strategy used to achieve pos-itive investment returns in equitymarkets during secular bear mar-kets. (Real estate, commodities,art, philately, etc., are, of course,alternatives to stocks.) We arewarned about market timing: It’ssaid nor to be of proven successand some timingmodels fall short,but it can work and is safer in asecular bear market than a buy-and-hold approach. Althoughmany mutual fund managers,repudiate market timing, andwarn their shareholders against it,U.S. mutual fund managers, onaverage, have an annual portfo-lios turnover rate of 100% in theirmanaged funds. One notes thatthe public was similarly warnedabout the jeopardy of buying andholding at the end of the last sec-ular bear market in 1981.

The primary purpose of markettiming is to be out of the marketduring its downturns; a second-ary purpose is to be investedduring market upturns. Duringsecular bull markets, market tim-ing may result in somewhat lowerreturns than buying and holding.The idea of timing is to use amechanical—as contrasted withan emotional—system in order toget out of the market when it isheading down, and to get back inwhen it is headed upward. Oftenone makes graduated, not all-or-none moves in or out. Markettiming methods abound. Onereference on the subject is “All

AboutMarketTiming”byLeslieN.Masonson, published by McGrawHill, 2004. A most elementarymethod is to invest only duringthe six months of the year—Nov.to April—when the market is,statistically, much more likely toyield positive results. Anotherabecedarian method is to use the100-day moving S&P 500 averageto time in-and-out moves.

A somewhat more involved aca-demically-based, market-timingmethod is theReichenstein&Richmethod (reported in the summer1993 issue of The Journal ofPortfolio Management). It’s basedon three factors, the stock mar-ket’s dividend yield, the interestrate on 90-day Treasury bills, andthe median projection of howmuch the 1,700 stocks followedbyValue Line (a well-known invest-ment firm)will appreciate over thenext three to five years—thesethree items are easily come by. It’sbeen a reasonably reliable indica-tor of market performance over asubsequent 18-month period. Itscurrent projection for the S&P 500is, incidentally, a bearish 1% lessthan riskless 90-dayTreasury bills.Some timing systems work wellduring some secular marketcycles, but are deficient in others.That recommended in theTelephoneSwitchNewsletter, e.g.,worked well through the 80’s, butnot so well since then.

A simple, but rather gross, mar-ket-timing system is readily foundon the first page of the InvestorsBusiness Daily newspaper in its“Big Picture” and “Market Pulse”columns. IBDpredicts an impend-ing market downturn—whether acorrection or a bear market iscompletely unpredictable—basedon greater than 3-5 daily lossesduring a previous month’s period

in one or more of the majorindices with simultaneous dailylosses in trading volume on thosedays. A similar system is used topredict when one should re-enterthe market (secondary indicatorsare also used by IBD).

I don’t necessarily advocate theIBD method, or any other, andhave no vested interest in anymentioned, but refer to themsim-ply to indicate that market-timingmethods are available. One has topersonally investigate to find theright one. Many are “black box”methods that are not made publicbecause they are proprietary. Oneshould investigate a method’strack record in actual extendedpractice, not on an a posteriorimined-data basis, i.e., how itwould have done had it been inplace. Do-it-yourself market tim-ing is, of course, possible, but ifthemethod selectedhas any com-plexity, daily attention to marketmovement is mandatory; this canbe quite burdensome. The pointis that in the midst of a secularbear market, market timing bysome tested method is helpful,alongwithdiversification, inorderto minimize loss. One takesadvantage of the inevitableperiodic short-termupwardcyclesoccurring during secular bearmarkets to be in the marketaccumulating funds.

Beware the secular bear!

Financial Commentary: Secular Bear Markets Continued from Page 13 __________________________

Kids’ Letter to GodDear God,Please put another holidaybetween Christmas and Easter.There is nothing good in there now.

Amanda


Holiday seasonwill soonbeuponus.Manyof uswill bemaking“holidaywish lists”.Here’s one - consider enter-ing, or improving your skills in digital photography. This article will introduce you to the joys, wonders, andchallenges of digital photography and combining your computer with a digital camera.These articles containmany referenceweb sites.Thus, a brief disclaimer is in order.The sites are commercial sites; however, they con-tain good reviews of specific topics and product information and serve a good first resource for general andspecific information that may lead you to the information that you seek. Neither the AAP nor the Section forSenior Members endorses either the specific web sites, or the specific products found on the web sites. Theweb site addresses are provided for information only!

The bottom line in digital photography is that for optimum results one needs the 8 Rights. In this series of 3articles we will cover:• Article 1

• Right Plan• Right Camera• Right Technique

• Article 2• Right PC• Right Software to: i) organize your photos, and ii) edit them• Right on-line photo-editing and storage

• Article 3• Right photo printing and on-line photo-sharing strategies• Right Place to Buy

Let’s go!

Right Plan: The investment that you will be making in digital photography is significant in terms of time anddollars. Creating the right plan before you begin to purchase and/or use your equipment is a good idea. Askyourself; what are the advantages and disadvantages of digital photography? Am I a snapshooter?

“Iwant to takephotos that I cane-mail to friends and family, post on theWeb, or print in sizes smallerthan 8x10 inches. I’d like a digital camera that is easy enough for the whole family to use and smallenough to take anywhere. I’ll be printing on an inexpensive, all-purpose inkjet printer, thoughI’ll consider buying a photo printer if I like the pictures enough. I plan to spend $150-$500 for mysystem.”

Or am I a seriousAmateur?

“I want to shoot stills and video clips for theWeb, use creative effects when shooting and manipu-lating images, haveprofessional-level control, output prints that are 8x10 inches or larger on ahigh-quality photo printer, and use accessories and different lenses. I’ll probably spend >$500 in total.”

Or am IUndecided?“I want a camera that’s easy to use but that I can grow into if I get hooked on digital photography. Iwant to be able to print good-looking photos at sizes smaller than 8x10 inches on my inexpensiveinkjet printer, but I’d like prints that will look OK if I decide to print larger or get a better printer. Iwant to spend less than $600.”

At c/Net Reviews – “What kind of digital camera is best for me?” one can find examples of system configura-tions exist based on your characterization of your photography desires.

In the long run, digital photography provides the opportunity to save money (fewer pictures to be commer-cially developed), infinite storage time (somewhat controversial), pictures that are easier to catalog, retrieve,

Digital Photography – Primer and Resource Guideby Jerold M. Aronson,MD, FAAP

(SectionWebmaster)



personally customize and create“keepsake” albums to share with relatives and friends,. Each choice, leads oneto another topic to explore. Short Courses.com (http://www.shortcourses.com ) is a popular on-line resourcefor general information about such topics as: Choosing a Digital Camera, Using Your Digital Camera, DigitalPhotography Equipment, Displaying and Sharing Digital Images. Each of these short courses provides aTableof Contents, and good, illustrated, introductory information on the topic.

Another “must-see” web site is “Digital Picture Imaging Guides” (http://www.myceknowhow.com/digitalImaging.cfm).Themenuof interactive guide selections is shownbelow.Views animatedPowerPoint slidepresentations on your screen, or download an Adobe PDF file for later review. To view the interactive guides,oneneeds tohaveMacromediaFlashPlayer installed. If not present, the siteprovides adownloadof FlashPlayer- A cool tool!

In this article, I will attempt to cover the “big picture”. Researching these sites, and others (Google ‘digitalphotography review’), will enable you to prepare the Right Plan. Finally, SitesYou Must See is a unique elementof the ShortCourse.com web site that links you to many other sites with information on specific topics.

Right Camera (find out more - Google “digital camera review”)

You have the Right Plan! Now, what do you need/want in a camera? For example, do you want a “Point andShoot” automatic in contrast to a manual SLR digital camera with interchangeable lens? How much weight areyou willing to carry? Do you want a mini-camera to fit in your pocket, compact to wear on your waist in a case,or a digital SLR“luggable” in a camera bag?What camera resolution/megapixel rating do you need? Plan for aminimum 2MB to print wallet size and/or 4X6 photos, 3MB to print 5X7 photos and 8X10 photos, 4MB or moreto print quality 8X10 and 11X17 photos or greater? How about memory size and type? (key to the # andquality/resolution of the pictures that you take) How many pictures at what resolution can your memory hold?

• What are the costs/benefits of different types of memory?What memory card is easiest to transfer picturesto my PC? More questions remain:

• What will be my power source (disposable/rechargeable batteries vs. proprietary lithium ion long lastingbattery)?

• How easy is it to use the camera?

• How fast, and in what settings will you be taking pictures?Will you need flash? How about capturing indoorfamily gatherings? Grandchildren in sports activities move quickly. What is the shutter lag time and flashrecharge time?.

• How close do you want to be to your subject? Point and Shoot cameras with flash are most effective at adistance of 8 ft. or less. How much optical zoom capability do you need and want to carry? The higher theoptical zoom, the heavier and more costly is the camera!

Digital Photography – Primer and Resource Guide Continued from Page 15 ____________________


Interactive Guides

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Finally, always look for web sites that contain consumer reviews! They can be very helpful. The Digital PhotoReview (http://www.dpreview.com/ ) web site enables one to search for cameras by brand name, read reviews,and to obtain competitive pricing. The “Buying Guide Features Search” at this site is unique. Learn about different camera feature options, select and place those features that are important to you into an online form,and view a list of cameras that meet your specifications.

C/Net digital camera reviews (www.cnet.com ) provides camera reviews, and enables you to search for differ-ent cameras by price, resolution, manufacturer or other criteria. This site provides “Editors Choice” informa-tion and a list of “No-brainer” digital cameras with relatively low prices and pocket-friendly designs. In a similarfashion, surf to PC Magazine (www.pcmag.com) and select Digital Camera from the PC Magazine Product GuideMenu for product information by camera type, price, company, megapixels including their product reviewsand “Editor’s Choice” information. One also will find buying guide information and resources at the site. PCMagazine is a popular magazine for computer users. Their reviewers address the challenges of integrating thedifferent pieces of camera and computer hardware and software equipment.

Right Technique

You’ve heard this before: “Digital cameras do all the work. You just push the button and great pictures magi-cally appear.” “The better the camera, the better the photos.” Isn’t that right? Not quite! It’s not the camera thatmakes beautiful images; it’s the photographer. Here are some tips that will enable you to take better pictureswithout maxing out your credit card on a lot of expensive equipment.

1. Read your camera manual and experiment with its different features before you take important pictures!Remember, the beauty of digital photography is that the picture is instantaneously available to you with-out the cost and time of developing. If you don’t like it, delete it!! Many cameras have “Scene” features built-in. For example, select “Fireworks” to take July 4th night photos outside; select “Backlight” if the sun is behindyour subject; select “Beach/Snow” for bright outdoor shots; or “Sunset” for the romantic picture at dusk, andso forth. The preset selections may not work for you; but then again, they just might work fine. For more infor-mation about making specific settings to manage focus, aperture, etc. for your digital SLR, see Using YourNew Camera: Technical skills .

2. Experiment with and use the “fill flash” or “flash on” mode in lieu of the automatic camera setting especiallywith outdoor portraits. In flash on mode, the camera exposes for the background first, and then adds justenough flash to illuminate your portrait subject. The result is a professional looking picture where every-thing in the composition looks good. Wedding photographers have been using this technique for years. Oruse “fill flash” to illuminate the subject in a bright background situation out of doors. Use the pre-focus but-ton (depress the shutter part-way) to focus on the subject, and then re-frame your picture and place yoursubject anywhere you choose. Your subject will be properly illuminated

3. Keep the camera level – many of the newer digital cameras lack a viewfinder. Photographers often have a hard time holding the camera level when using the LCD monitor. The result can be cockeyed sunsets, lopsided landscapes, leaning and drunk-looking people, and tilted towers. Outside, look for nature’s horizontal lines and use them as guides. Sometimes you can use the line where the sky meets the ocean,other times you can use a strip of land as your level. Look for vertical structures (walls, lamps) or horizon-tal structures (floor, top of couch) and use them to line up the picture indoors. If you practice level framingof your shots, over time the process will become easier.

4. Figure out the memory you need, and then buy the next size up! If you have a 3 Megapixel camera, get atleast a 256MB card, 512MBs for 4 Megapixel models, and 1GB for 6 Megapixels and up. That way you’ll nevermiss another shot because your memory card is full. I like to carry a spare memory card just in case my memory card fails while I am out in the field. Digital memory card prices are falling. Look for sales and special promotions!



5. Use the High Resolution camera setting all of the time! Now that you have purchased a large memory card,provide yourself the flexibility to print larger size prints or to optimally crop your picture later. For exam-ple, if you take a beautiful picture at the low 640 x 480 resolution, that means you can only make a print aboutthe size of a credit card, not exactly the right dimensions for hanging in the museum. On the other hand, ifyou record the image at “Hi Rez” (4 Megapixel) or larger, then you can crop the image to your liking and stillmake a lovely 8- x 10-inch photo-quality print suitable for framing. Remember that lower cost/lower weightcameras are equipped with only a 3-4X optical zoom lens. Thus, having extra pixels enables you to crop yourimage to highlight and maximize the size of your subject, and still have enough resolution to make a decentsized print. Digital images can always be scaled down and compressed for other purposes, e.g. email, later.

6. Don’t use, or be cautious with using your digital zoom. Digital zoom is different from optical zoom. Digitalzoom does not capture any more detail than the maximum optical zoom of your camera. Instead digital zoomuses interpolation to make a portion of the image larger by adding extra pixels. Whether you are using opti-cal or digital zoom, the closer you zoom in on a subject, the harder it is to get correct focus and exposure.Any problems created by camera shake are intensified. So an image that is captured with digital zoom is morelikely to turn out worse than one captured at maximum optical zoom, then cropped and resampled in yourphoto editing software.

7. Minimize the JPEG compression setting on your camera. JPEG compression makes your file sizes small, soyou can fit more pictures on your digital storage card. Using reasonable levels of compression can signifi-cantly reduce file size without noticeably reducing the image quality. JPEG is a compressed file format thatpermanently, irreversibly loses quality each time the image is saved. There are various levels of JPEG com-pression. High compression produces lower quality and smaller files. Remember, lower JPEG compressionequals higher quality and higher file sizes. The quality lost from compression can not be restored—ever—so if you later decide to edit your already over-compressed photos (even just to crop them), the quality isfurther reduced. For most, the middle setting usually offers a good compromise between quality and size.If you plan to do a lot of post processing in a photo editor, use the highest quality setting. You can alwayscompress the image more later after the originals have been safely archived.

8. Finally, back up you digital photos regularly, using more than one medium (e.g. computer, CD/DVD, external hard drive)

See you next time for more on digital photography. For more information on the web, login to the AAP Sectionfor Senior Members website at www.aap.org/seniors and view Technology for Seniors in the Living Well section.



I write because I get a big chargeout of stringing words together injust the right way to express myintended thoughts. I also like totry to create new metaphorsbecause I really appreciate themwhen I come across them in myown reading. Even when you areconvinced that what you want tosay is just right, one of the basiccaveats in writing is to expect to dorevisions; they are the rule ratherthan the exception. I never feel as

happy as I do when I am writingfor pleasure. No other hobby canreplace it, including reading,which I consider my number twofavorite. Thus I would say that myprimary reason for writing is forits demand for creativity and thefun of it. At the same time, I freelyadmit that I am from the oldschool of writers, those who reallybelieve truth is stranger than fic-tion – which probably explainswhy much of my writing is autobi-

ographical except that the namesof the characters and places havebeen changed. Finally, I know of atleast two friends who felt that thesimple desire to write was suffi-cient to write the great Americannovel. To them and all would-bewriters, my biggest piece of adviceis to take a minimum of two years’creative writing and poetry.

Learning my second reason for

Why We Writeby Sol Browdy, MD, FAAP



writing came as a shock to me.Early in my pediatric career I contributed many articles toMedical Economics, a magazineexclusively for physicians, for eachof which I received a modeststipend. In my day the journal wel-comed personal experiences frompracticing physicians; today theemphasis is on managing the eco-nomics of their individual prac-tices and specialties. I rememberthe personal experience, whichprompted me to write my firstmanuscript forM.E.My wife and Ihad purchased one of the fewremaining lots in Bucks County,Pennsylvania, and at about thesame time we hired an architect.Despite the fact that we had dis-cussed our budget at the outset,the bids were coming in way overthis figure. When we decided tocut our losses and told him thatno way could we build such anexpensive home, he insisted thatwe pay him his originally submit-ted fee. At that point we settled ona lower figure, but from thatmoment on I could not rest until Ihad obtained satisfaction inexposing the perils of hiring anarchitect. I suppose the incidentis another case of the pen beingmightier than the sword. And sowhen I saw my first by-line in thejournal, I liked it as well as thereimbursement I received; I thinkit was about $350. I usually dealtwith one of the journal’s staff edi-tors, who would call me when oneof my manuscripts had beenaccepted for publication. She wasa smart cookie, and when onanother occasion I felt that I wasbeing underpaid, her responsewas an eye-opening “Like all writ-ers, you like to see your name inprint as a by-line.” It was a ratherrude awakening to hear the matterexpressed in such crude terms,and at first I was not willing to

accept it. But slowly I camearound to her way of thinking.

Most successful writers who arecapable of producing a salablemanuscript every one to threeyears seek and receive a monetaryreturn, are writing for a living. Tosum up, of the three reasons forwriting I have stated above, in theorder of decreasing importance, I would rate (1) a challenge to creativity; (2) fame and seeingone’s name in the by-line; and (3)monetary return.

While writing may be easy forsome, finding a publisher can bequite difficult. For every manu-script which is published, theremust, literally, be reams of paperad nauseam which never see thelight of a printing press. True, onecan self-publish one’s work. I did it when I wrote my memoir Lifethe Second Time Around. I do notconsider the charges of the localprinting house I employed exces-sive. My opportunity materializedwhen I happened to be a patient ina local rehab hospital for a crush-ing chest injury sustained when I totaled my second Subaru withina period of three weeks. One of my attending staff doctors and Ihappened to be discussing ourfavorite hobby, writing, when heidly mentioned that he had beenpublished. When I tried to contacthis writing agents, I accidentallylearned the name of his publisher,PublishAmerica. When I wrotethem a query letter about mynovella, A Strange Tale of an Age-Mismatched Twosome, I wasasked to submit the entire manu-script. It was published by themin April of 2005. Currently, myshort story, Single Mom Breaks outof Mold, is in the process of beingpublished. Fresh start-up publish-ing houses appear to be the wave

of the future for hitherto unpub-lished writers. Remember, it takesjust one acquisition editor to likewhat you’ve written to start theball rolling.

Don’t be discouraged by the raftof form rejection letters youreceive. Be sure to try some of thefresh start-up publishing housesand include a SASE (self-ad -dressed stamped envelope). Thesenewer publishing entities appearto be the wave of the future forhitherto unpublished writers.Remember, it takes only oneacquisition editor to like whatyou’ve written to start the ballrolling. And when you hit pay dirt,don’t be shocked by their originalwelcoming letters, being ad -dressed as “Author”, and theirgoing out of their way to say thatthey really are happy to be pub-lishing your manuscript!

Why We Write Continued from Page 18 __________________________________________________________________

What DoMost PeopleDo On a Date?

(Written by kids)

Dates are for having fun, and peo-ple should use them to get to knoweach other. Even boys have some-thing to say if you listen longenough.

Lynnette, age 8(isn’t she a treasure!)

* * *

On the first date, they just tell eachother lies and that usually getsthem interested enough to go for asecond date.

Martin, age 10


Editor’s Note:Dr. Al Usin recently retired from the position as Director of Development at the Los Angeles County+Universityof Southern California Medical Center, Department of Pediatrics. Although he remains busily involved in a num-ber of undertakings including as immediate past president of the Southwestern Pediatric Society, his retirementgives him more time for one of his long term enthusiasms. He describes this involvement in the following article.

I have always been fascinated byWWII, perhaps because I was aboy during the years when it tookplace, and I did have relatives whofought in it, some of whom werekilled. When I was in college I wasrequired to complete one year ofEnglish literature in order to grad-uate. The second half of that yearwas dedicated to English poetry.One poet I read during that semes-ter was William Blake. WilliamBlake, as you know, was a poetwho wrote using symbols. Hisworks consisted of three series ofpoems, which examined humannature. The first was called Songsof Innocence, which consisted ofpoems relating to the more posi-tive aspects of human nature thatincluded love and compassionleading to peaceful and coopera-tive interactions between humanbeings. The symbol he used to rep-resent that aspect was the lamb.The second was called Songs ofExperience, which representedthe negative aspects of humannature that included anger andhatred leading to violent andaggressive acts between humanbeings. The symbol he chose torepresent that aspect was the tiger.The third was called The Marriageof Heaven and Hell, and describedhow the interaction between thesetwo aspects influences humanbehavior.

The tiger is described in a wellknown poem of that name withwhich most people are familiar. Its

first two lines are:

Tiger, tiger burning brightIn the forests of the night

These lines utilize Blake’s symbol-ism and can be interpreted asmeaning that violent and aggres-sive acts born of hatred and anger[the tiger] are vibrant componentsof humankind’s darker side[forests of the night].

At the time, I thought that Forestsof the Night would make a won-derful title for a novel. And for atime I became an author with atitle in search of a novel. Aftersome consideration, I came to theconclusion that a novel about theSecond World War, which hadalways interested me, would bethe perfect subject of the novel Iwould write. Could there be anysubject better than war with itshorrendous consequences todemonstrate the darker side ofhuman nature? I think not.

I began researching the SecondWorld War in my off quarterbetween my second and thirdyears of medical school at theUniversity of Chicago. I began towrite my novel at that time andcontinued to write it over the nextforty years in bits and pieces dueto time limitations. I led a “physi-cian’s life”, and was always busywith work relating to my profes-sion. Whatever free time I had wasspent with my wife and three sons,

which left little room for writingsomething as frivolous as a novel.

When I retired at age sixty-eight, Ifinally had the time to “put it alltogether”. That took about oneyear at which the book was finallycompleted. I sent it to several publishers, and one did agree to publish it. Their name isPublishAmerica, and they arelocated in Maryland.

I had copyrighted the book beforesending it off to PublishAmerica,and when they agreed to publishit, I decided to find it at the copy-right office computer page. WhenI typed in the title: Forests of theNight, at least one hundred workswith the same name came up. Ittook me twenty minutes to findmine. The publisher had listed itwith Amazon.com, and when Ilooked it up there I found at leasttwo hundred works with the sametitle. I wrote to the publisher ask-ing them to change the name toThe Creatures of Prometheus,[there were no other titles withthat name], but it was too late.Since the book has sold only tencopies, they were reluctant toinvest any more money in it.

Lesson #1 learned: As much asyou may adore a title, alwayscheck the copyright and booksearch engines to see if and howmany titles with the same namehave already been published.

My Life As A Writerby Alvin S. Usin, MD, FAAP

Somewhat retired


In his old age, the Spanish painter,Goya, noted for his socio-politicalworks, left us a small line drawingof a very old man, bearded,stooped, weary and supported bytwo canes, entitled “Aun Aprendo.Still I Learn.” I introduce this as amessage to those of us who areretired from the every day activi-ties of our professional lives, and,like Goya’s old man, we are nevertoo old to continue learning.

I have recently become ac -quainted with a resource for ouradventures in learning, TheTeaching Company. Located nearVienna Virginia, this enterprisehas been producing educationalcourses on VCR tapes and nowDVDs on a multitude of subjects,ranging from art to music to sci-ence and many other disciplines.The courses, made up of twelve toforty eight 30-minute lectures, arepresented by professors frommany universities, and are in -tended for home non-commercialviewing. A retired internist friendand I have established a “School AtHome “ where we regularly havestudied such courses as EarlyGreek History, The Art of theRenaissance, The Great Com -posers, and most recently, the

History of Scientific MedicineRevealed Through Biography.

To illustrate, let me briefly reviewthe last mentioned, presented byProfessor Sherwin. B. Nuland,Clinical Professor of Surgery, YaleSchool of Medicine. The lecturessketch the lives and contributionsof ten physicians starting withHippocrates and continuing toDrs. Blalock and Taussig. Hippo -crates writings were not only hisown but the compilation of 200years of medical thinking. We lookto Hippocrates as the father ofmedicine teaching that illnessarises from the environment orthe patient, not from supernaturalcauses. Therefore, sickness shouldbe treated using natural methodsnot by appealing to deities, astaught by Aesculapius. One of thefamous aphorisms of Hippocratesreads as, “Life is short. The Art islong. Opportunity is fleeting.Experience is delusive. Judgmentis difficult.” The Hippocratic groupformed a code of ethics, whichsurvives to this day.

After Hippocrates, the most wellknown name was Galen who livedin the first century CE. He mademany observations on the ana -

tomy and function of the bodythrough animal dissection. Hisonly experience with humananatomy and function was bybeing the doctor to gladiators inwhom he observed many seriouswounds. In contrast to Hippo -crates who thought that healingwas an art, Galen believed thathealing was a science. He wroteprofusely and his teachings dom-inated medical thought until thediscoveries of the 15th and 16th

centuries. His concept of prede-terminism and demiurge (a divinemaster plan) ultimately were con-tradicted by physicians whosecareers follow later in this course.

Dr. Nuland continues with a dis-cussion of Andreas Vesalius, thefamous Flemish physician, who,when studying medicine in Paduain the late Renaissance, began thestudy of the human body throughcadaver dissection. He foundmany errors in Galen’s observa-tions and theories which had beentaken as gospel since Galen’s time.He published a brilliant atlas ofanatomy at the age of 28, butmade many enemies of those whowere reluctant to disregard Galen’steaching. Because Vesalius made

I should add that my royalty on each copy sold is ninety – fivecents.

Lesson #2 learned: Do not give upyour pension expecting to live offyour royalties.

At this time I am moving in a back-ward direction as I am writing asecond novel, this one about theCivil War. I have completed 500

pages in eight months and it is stillnot done.

Lesson #3 learned: Do not giveyourself too much free time oryour writing takes over your totalexistence.

I have returned to part timeemployment.

So much for my life as a writer!

If you want to buy Forests of theNight, and add ninety – five centsto my total annual income, pleasefeel free to do so. I do suggest thatyou use my name rather than thebook’s title should you want tolocate it on Amazon.com, other-wise you may lose many hours try-ing to get through all the manynovels with that same name thatexist on that website.


My Life As A Writer Continued from Page 20 ___________________________________________________________

Still I Learnby Robert Grayson, MD, FAAP



the earliest text of humananatomy with the collaboration ofan expert artist, this is consideredto be the renaissance of medicine.

The course takes us consecu-tively through the lives and con-tributions of William Harvey,Giovanni Morgagni and JohnHunter. Harvey is known for hisdescription in 1626 of the circu-lation of blood, traveling in a cir-cle of arteries and veins with theheart as a pump. Morgagni sug-gested that is due to the malfunc-tion of various organs andanatomical structure. He wasasked by the great anatomistValsalva to work with him, andby following the course of an ill-ness by symptoms and signs, fol-lowed up by autopsy, the art ofphysical diagnosis was born. Hecorrelated 700 cases of diseasewith their symptoms, signs andautopsy findings, and later pub-lished these in a text, which wascross-indexed by symptoms,signs and post mortem findings.Physicians then could search forcauses of an illness in severalways. He is quoted as saying,“symptoms that people come todoctors with are the cries of suf-fering organs”. He was the fatherof physical diagnosis.

John Hunter was a student ofnature from childhood. It is saidthat his early education was a con-tinual field trip, out in the naturalworld and not in school. Hebecame an anatomist in his olderbrother’s anatomy school, andwith great technical skill, contin-ued studies in surgery. Practicingin the mid 1700s, Hunter corre-lated his surgical observationswith the natural world andchanged surgery from the work ofan artisan to that of a scientist. Themuseum of surgical specimens

and nature in his home becameworld famous.

Dr. Nuland continues by taking usthrough the story of Laennec andthe stethoscope, Morton andanesthesia, Virchow and the cel-lular origins of disease and Lister’sgerm theory, Length requirementsprevent us from summarizingdetails of each of these famousdoctor’s contributions.

Of particular interest is the careerof William Halsted, who was thefirst professor of surgery at theyoung Johns Hopkins MedicalSchool that opened in 1893.Halsted had been a brilliant youngsurgeon in New York City whosecareer was changed by his addic-tion to cocaine, which he had usedfor local anesthesia on patientsand himself. After treatment forthe problem and invited to thenew Hopkins Medical School byWilliam Welch, the first Professorof Pathology, he was appointedprofessor and chief of surgery atHopkins. Because of the lifelongeffects of his habit, he developed,at Hopkins, the concept of“surgery of safety” with slowmeticulous technique, whichserved as a model in many newdeveloping medical schools. Thiswas in contrast to the then currenttechnique of speed for which hehad been known in his New Yorkcareer.

The story of Halsted also includedthe history of the Hopkins MedicalSchool, whose finances were res-cued by a group of Baltimorewomen with the stipulation thatall individuals admitted to themedical school must be collegegraduates with an educations inbasic sciences, and that womenwould be admitted on the samebasis as men. The first full time

system for professors was also ini-t iated, enabling Hopkins tobecome the finest medical train-ing institute of its time, a statusthat it has maintained to this day.Halsted also involved himself inclinical research, in devising newsurgical methods (e.g. repair ofinguinal hernia). He trained 17chief residents, 11 of whom created new departments of surgery and in turn trained 136residents in the Halstedian tech-nique. He literally was the father ofmodern surgical teaching in thiscountry, and became the modelfor European surgeons as well.Truly, a remarkable career!

Nuland concludes this lectureseries with the story of Drs. Taussigand Blalock, also of Hopkins fame.Taussig was the pediatric cardiacc l i n i c i an and B l a l o ck t h eVanderbilt trained surgeon whoassiduously pursued new surgicaltechniques with his extraordinarylaboratory assistant, VivianThomas. Dr. Taussig a graduate ofHopkins, trained in pediatrics,became especially interested inthe blue baby syndrome, theTetralogy of Fallot where venousblood was bypassing pulmonaryoxygenation, and was recycledthrough the arterial system.Profiting by the anatomicaldescriptions of Maude Abbott, theauthor of an “Atlas of CongenitalCardiac Disease”, Dr. Taussig pos-tulated a surgical approach toimprove oxygenation. Blalock andThomas developed the techniqueon dogs, and with his residentsDrs. Wil l iam Longmire andDenton Cooley, it was first triedon a blue baby in November 1944.This successful innovation was thestart of intracardiac surgery in thiscountry, and has led to the amaz-ing surgical accomplishments

Still I Learn Continued from Page 21 ______________________________________________________________________



since then.

And thus I learn about the historyof my profession. I urge my col-leagues to look to The TeachingCompany, (www.TEACH12.com)and other sources of self-enhancement as they find moretime away from practice. I might

mention just a few of suchresources. Many local colleges anduniversities have provisions forauditing or actually taking non-credit courses on numerous sub-jects, some especially tuned to theretired professional. The Internetis loaded with similar opportuni-ties. I mention only one, given by

MIT as an example. (http://web.m i t . e d u / o c w / i n d e x .htm). This site includes completelectures, illustrations and bibli-ographies as offered at MIT. Iinvite other members of theSection to submit their favoritesources like these for publicationin the Bulletin for the rest of us.

Still I Learn Continued from Page 22 ______________________________________________________________________

I came across this phrase in a bookyesterday, “FENDER SKIRTS”. Aterm I haven’t heard in a long timeand thinking about “fender skirts”started me thinking about otherwords that quietly disappear fromour language with hardly a notice.

Like “curb feelers” and “steeringknobs.” Since I’d been thinking ofcars, my mind naturally went thatdirection first. Any kid wouldprobably have to find some eld-erly person over 50 to explainsome of these terms.

Remember “Continental kits?”They were rear bumper extendersand spare tire covers that weresupposed to make any car as coolas a Lincoln Continental.

When did we quit calling them“emergency brakes?” At somepoint “parking brake” became theproper term. But I miss the hint ofdrama that went with “emergencybrake.”

I’m sad, too, that almost all the oldfolks are gone who would call theaccelerator the “foot feed”.

Didn’t you ever wait at the streetfor your daddy to come home, soyou could ride the “runningboard” up to the house?

Here’s a phrase I heard all the timein my youth but never anymore -“store-bought.” Of course, justabout everything is store-boughtthese days. But once it was bragging material to have a store-bought dress or a store-boughtbag of candy

“Coast to coast” is a phrase thatonce held all sorts of excitementand now means almost nothing.Now we take the term “worldwide” for granted. This floors me.

On a smaller scale, “wall-to-wall”was once a magical term in ourhomes. In the ‘50s, everyone cov-ered his or her hardwood floorswith, wow, wall-to-wall carpeting!Today, everyone replaces theirwall-to-wall carpeting with hard-wood floors. Go figure.

When’s the last time you heard thequaint phrase “in a family way?”It’s hard to imagine that the word“pregnant” was once considered

a little too graphic, a little too clinical for use in polite company.So we had all that talk about stork visits and “being in a family way”or simply “expecting”.

Apparently “brassiere” is a wordno longer in usage. I said it theother day and my daughtercracked up. I guess it’s just “bra”now “Unmentionables” probablywouldn’t be understood at all.

I always loved going to the “picture show,” but I considered“movie” an affectation.

Most of these words go back tothe ‘50s, but here’s a pure-‘60sword I came across the other day - “rat fink.” Ooh, what a nastyput-down!


Editor’s Note:We received a question from Ben Silverman about the definition of a fender skirt. They are the panels that covered the upper part of the rear wheel well.

What the Heck is a Fender Skirt?by John Bolton, MD, FAAP


Here’s a word I miss - “percolator.”That was just a fun word to say.And what was it replaced with?“Coffee maker.” How dull. Mr.Coffee, I blame you for this.

I miss those made-up marketingwords that were meant to soundso modern and now sound soretro. Words like “DynaFlow” and

“Electrolux.” Introducing the 1963 Admiral TV, now with“SpectraVision!”

Food for thought - Was there atelethon that wiped out lumbago?Nobody complains of that any-more. Maybe that’s what castor oil cured, because I never hearmothers threatening kids with

castor oil anymore!

Some words aren’t gone, but aredefinitely on the endangered list.The one that grieves me most“supper.” Now everybody says“dinner.” Save a great word. Invitesomeone to supper. Discussfender skirts.

What the Heck is a Fender Skirt? Continued from Page 23 __________________________________________

Take It Or Leave It (For Now)?by Joel M. Blau, CFP™

Ronald J. Paprocki, JD, CFP™MEDIQUS Asset Advisors, Inc.

“Results. One client at a time.”(sm)

The decision of when to begin taking your social security benefits should not be made lightly. While themajority of Americans, both men and women, elect to receive their benefits beginning at age 62, for manyretirees it may make sense to defer distributions and receive a higher benefit amount when they are older. Thekey factor, of course, is whether the retiree will live long enough to make up for the lower benefits they wouldhave received for a longer period of time by starting early. In the absence of a crystal ball, becoming familiarwith the resources available is your best option.

Full retirement benefits are available only upon reaching normal retirement age, which for 2006 is age 65 and8 months. Reduced early benefits are available at any time after age 62. If you do wait until after full retirementage, your benefits will increase each year you delay retirement up until age 70. The amount of the increase variesfrom 4.5% to 8%, depending on the year you were born. For those born after 1938, the age to receive a full benefit has been increased, and the percentage of benefit reduction at age 62 has been lowered even further.The full retirement age will increase gradually until the year 2022, when it becomes age 67.

For those trying to determine the “break even” point of how long you would have to live to justify a deferredhigher payment or conversely taking the lower payment earlier should visit the Social Security Administrationswebsite at ssa.gov. There you will find a tool called the “Break Even Age Calculator”. You can then fill in the amountof your anticipated benefits at different ages and the calculator will provide with you various break evenpoints.

Also keep in mind that there are issues associated with taking social security benefits, even if you are entitledto them, while you are still working. The maximum amount that persons who have not reached full retirementmay earn in any single year and still receive Social Security benefits is limited. If you are under the full retirement age when you begin receiving benefits, $1 of benefits will be deducted for each $2 you earn abovethe annual limit of $12,480. Wait until “normal” retirement age, and you will lose $1 of benefits for each $3 earnedabove $33,240, for just that year. After normal retirement age, there is no reduction of benefits, regardless ofthe amount of earned income.

There may, however, be taxes due on benefits if your earned income during retirement, as well as investmentincome, exceeds certain levels. Married couples filing jointly with provisional income (defined as adjusted grossincome, plus non taxable interest, plus ½ of your social security benefits) may have to pay tax on up to 50% of their social security benefits. Provisional income in excess of $44,000 increases the potential tax on socialsecurity benefits up to 85%.



There also seems to be confusion relative to spousal benefits. At retirement, married individuals are entitledto three types of benefits; a benefit based solely on their own earnings, a reduced amount based on a workingspouse’s benefit, or a survivor’s benefit. The reduction amount is dependent on when the older person reachesnormal retirement age. For example, for those born between 1943 and 1954, the normal retirement age is 66years old. A 62-year-old spouse can receive 35% of the other spouse’s unreduced benefit. Keep in mind that nospousal benefit is payable until the retiree begins to receive their benefits. In the case of two income-earningspouses, each spouse will be eligible to collect benefits based on their own earnings record, in addition to beingeligible for a spousal benefit. While Social Security will not pay both benefits in full, it will pay whichever benefit is greater. With regard to survivor’s benefits, at the time of death, a spouse is entitled to a benefit equalto 100% of the deceased spouse’s actual benefit, assuming that this amount would be greater than their ownearned benefit.

Mr. Blau and Mr. Paprocki welcome readers’ questions. They can be reached at 800-883-8555 or [email protected].

Securities offered through Joel Blau, a registered representative of Waterstone Financial Group, Member NASD/SIPC.

Waterstone Financial Group and MEDIQUS Asset Advisors, Inc. are independently owned and operated.

Take It Or Leave It (For Now)? Continued from Page 24 _____________________________________________

Dear God,Thank you for the baby brother butwhat I asked for was a puppy. Inever asked for anything before.You can look it up.

Joyce

Dear Mr. God,I wish you would not make it soeasy for people to come apart I hadto have 3 stitches and a shot.

Janet

God,I read the bible. What does begetmean? Nobody will tell me.

Love Alison

Dear God,How did you know you were God? Who told you?

Charlene

Dear God,Is it true my father won’t get inHeaven if he uses his golf words inthe house?

Anita

Dear God,I bet it’s very hard for you to love allof everybody in the whole world.There are only 4 people in our fam-ily and I can never do it.

Nancy

Dear God,I like the story about Noah the bestof all of them. You really made upsome good ones. I like walking onwater, too.

Glenn

Dear God,My Grandpa says you were aroundwhen he was a little boy. How farback do you go?

Love, Dennis

Dear God,Do you draw the lines around thecountries? If you don’t, who does?

Nathan

Dear God,Did you mean for giraffes to looklike that or was it an accident?

Norma

Dear God,In bible times, did they really talkthat fancy?

Jennifer

Dear God,How come you did all those miracles in the old days and don’tdo any now?

Billy

Dear God,Please send Dennis Clark to a different summer camp this year.

PeterDear God,Maybe Cain and Abel would notkill each other so much if they eachhad their own rooms. It works outOK with me and my brother.

Larry

Dear God,I keep waiting for spring, but itnever did come yet. What’s up?Don’t forget.

Mark

Kids’ Letters to God


As soon as I submitted my first essay for the Sept.2004 issue of this Bulletin (“The First Medical Journalprinted in English”) I received a message from AvrumKatcher, the then Editor-in Chief who, amazed by thereport said: -“Maurice, do you realize that althoughLaennec is credited with the invention of the stetho-scope, the instrument described in 1684 by Monsieurde Hautenfille could have been the precursor of thestethoscope?” (“A little horn made conically whichhas a tube at its top which divides it self into two othertubes whereof the ends are placed in each ear”). Indoing my research for this essay, I could find no evidence that Laennec was aware of that older instrument.

Rene-Theophile Hyacinthe Laennec was born atQuimpers, in Brittany, France on Feb.17, 1781. Hisfather was a Lieutenant at the Admiralty and wholoved literature and is known to have written manypoems. His mother died in her thirties, probably oftuberculosis, when Rene was only six years old. Hisfather, overwhelmed by the domestic disarray,decided to send his three children to live with rela-tives. Rene was sent to Nantes to live with his pater-nal grand-uncle, Dr. Gauillame-Francois who was theRector and prominent member of the Faculty ofMedicine at the local University. During the FrenchRevolution many casualties filled the wards of all thecity hospitals, a situation that gave Rene an opportu-nity to acquire his surgical skills. In 1795, he was com-missioned as Third Surgeon at the Hospital de la Paixand shortly afterward at the Hospice of La Fraternite.

Although he was young, his health was not good as hesuffered from exhaustion, difficult breathing and pro-longed periods of fever. He needed weeks to recoverand although his illness left him physically weakenedhe was determined to pursue his career. During hisrecovery he found consolation in music and poetry. InJune of 1799 he returned to his medical studies andwas appointed surgeon at the Hotel-Dieu, in Nantes.

In 1800, he went to Paris where, within a year, heearned first prizes in Medicine and Surgery. Heentered the Ecole Pratique in Paris and studied dissec-tion with Guillame Dupuytren. In 1802, he publishedhis first paper in the Journal de Medecine:“Observations sur une maladie de couer”. A fewmonths later, he published “Histoire de inflamma-tions du peritoine”. He was then taken under the wingof Jean-Nicolas Corvisart, a former disciple ofGiovanni Morgagni and who, at that time, wasFrance’s foremost medical teacher at the Court, andthe personal physician of Napoleon.

Although Rene was suffering with a chronic cough,wheezing and fever, he did not diminish his work-load. Because of his interest in tuberculosis (probablecause of his mother’s death) he concentrated hisenergy in its study. He was the first one to report thatthe tubercular lesion was not limited to the lungs butcould be present in all organs of the body. His thesis“Propositions sur la doctrine d’ Hippocrate relative-

“On Medical Stories and Myths”Today: “The Stethoscope”by Maurice Liebesman, MD, FAAP


“When it comes to observations,nature only favors the mind that isprepared”

— Louis Pasteur

ment a la Medicine Pratique” was presented andaccepted in July of 1804; thus he became an associateof the Societe de l’Ecole de Medecine.

In 1816, frustrated with his career and disappointedat not being elected to the Chair of HippocraticMedicine and Rare Cases as he hoped, he accepted apost at the Necker Hospital, in Paris. It was here thathe continued in his studies of tuberculosis, emphy-sema and physical signs of the chest. He was aware of the contents in the “Corpus Hippocraticum” (supposed to have been written around 400 B.C.)where it says: “You shall know that the chest containswater and pus and if, in applying your ear on a certainplace, you will perceive a noise like boiling vinegar”.It also includes: “the creaking noise like new leatherthat is heard when an injured lung rubs against theinside of the chest wall”.

Intrigued by a forgotten fifty-year old report on thesounds of the chest written by Dr. Auenbrugger, aViennese physician (1722- 1809), he reflected on theidea that there should be an instrument that wouldfacilitate the listening to the sounds in the chest. Hecreated it and described it in 1819 when he publisheda book on the subject: “De L’ Auscultation Mediate ouTraite du Diagnostic Des Maladies Des Poumons et duCouer, fonde principalement sur ce noveau moye d’exploration”. In its preface, he wrote, “The mostimportant part of an art is to be able to observe properly”.

There are different stories about how Laennec cameto think about the stethoscope. One says that he gotthe idea when he was walking in the Bois de Boulogneand he saw two boys at opposite ends of a long log;they were aware that by tapping or scratching at oneend it was easy to hear the sound at the other. A second story suggests that since bathing was not popular in those days and people’s body odor disgusted physicians, they resented getting their facesin direct contact with the patient’s skin. Probably, amore accurate story was reported in “Source book ofmedical history” compiled by Logan Clendening,where he quotes Laennec as saying: “In 1816, I wasconsulted by a young woman presenting symptomsof disease of the heart. Owing to her stoutness, littleinformation could be gathered by application of thehand and percussion. The patient’s age and sex didnot permit me to resort to applying my ear directly toher chest. Taking a sheaf of paper, I rolled it into a verytight roll which I applied to her precordial area, whilst

I put my ear to the other.” Having had experiencewith carpentry, he next made an instrument of awooden cylinder 30 cm. long. Placing this instrumenton a patient’s chest, he could hear the various soundsof the lungs and heart. He named it “stethoscope”which in Greek means examination of the chest

In January of 1823, he became a full member of theAcademie de Medecine and Professor at the MedicalClinic at the Hospital de la Charite. In August of thefollowing year, he was made a Chevalier of the Legionof Honor. Absorbed by his medical career, he hired a Mme. Argon as a housekeeper and whom he eventuallye married in December of 1824.

He is considered the most prominent clinician of histime; his books on diseases of the lungs and heartwere considered masterpieces and his studies oftuberculosis were monumental.

He introduced many terms that we still use: rales,egophony, pectoriloquy, bruit, bronchophony,bronchial and vesicular breathing. He said: “I riskedmy life but the book I am going to publish will be, Ihope, useful enough, sooner or later, to be worth thelife of a man.” Indeed, it was.

His health deteriorated rapidly and in May of 1826 heleft Paris and returned to Brittany where he eventuallydied of tuberculosis on August 13 of the same year. Hewas only 45 years old.

Maurice Liebesman, MD, FAAP

Bibliography:1. “Source Book of Medical History” Compiled by Logan

Clendening – Dover Publications Inc. NY 1960

2. “The Romance of Medicine” by Benjamin L. Gordon,MD F.A. Davis Company, Publishers, Philadelphia. 1945

3. “History of Medicine” by Fielding H. Garrison, MD W. B.Saunders Company, Philadelphia, 1917

4. “Doctors, the biography of Medicine” by Sherwin B.Nuland. – Alfred A. Knopf. New York, 1988


“On Medical Stories and Myths” Continued from Page 26 ___________________________________________

How Would You Makea Marriage Work?

(Written by kids)And the #1 Favorite is.......

Tell your wife that she looks pretty, even if she lookslike a truck.

Ricky, age 10


Aging Wellby Avrum L. Katcher, MD, FAAP

For centuries, aging has been viewed, and portrayed, as the period of progressive downhill function, increas-ing disability, loss of control, senescence and finally more or less complete dependency terminated by death.Indeed, with the exception of that group (often overtly or in thoughts regarded as fortunate) who stop suddenlywith abrupt loss of a vital function or massive trauma the process of aging has often adhered to that map.

There are other viewpoints from which to examine and study the process of aging. Some are quite pediatric.Suppose we say that aging is a process of development, a task requiring the navigation of change in and by theself. While the end may be unavoidable, and the same for everyone, the path to that place may be quite vari-able, easier for some than others, but not necessarily uncontrollable. Just as with our patients we recognize thata mix of inherent genetic, prenatal, familial, cultural, social, behavioral and along the way incidental factorsall contribute to outcomes. Degrees of influence of each of these factors vary. But there is much that may beaccomplished by the individual along with her or his family and friends. And as stated in a quote from Scott-Maxwell,

“We who are old know that age is more than disability. It is an intense and varied experience,almost beyond our capacity at times, but something to be carried high. If it is a long defeat, itis also a victory.”

Now Dr. George E. Vaillant, a psychiatrist at Harvard, has written a useful, thoughtful and informative book aboutsome of the influences on the development of the older person, laid to rest some of the beliefs about develop-mental aging, and attempted to lay out some of the important events and attitudes that may influence thatprocess. He has studied and interviewed members of three long-term studies of aging, a group from Harvard,predominantly from upper social-economic backgrounds, another cohort of inner city youths from disadvan-taged backgrounds, and a third of women who had been in the Terman-Stanford study of gifted children. A fourthstudy, the precursors study of medical school graduates of Johns Hopkins, commencing with the class of 1948(full disclosure: I am a member of that class) was not included, with no explanation. It might have beenbecause the Baltimore study concentrated more on the health qualities that were associated with impairmentin later life and timing of death, rather than taking a developmental perspective.

Vaillant follows the lead of Erik Erikson in conceptualizing six sequential life tasks (note, not stages, but tasks,activities, processes, goals). These are:

• Achieving a sense of Identity, a sense of one’s own self, in sustained separation from one’s fam-ily of origin.

• Achieving Intimacy, mastering the task of living with another person in a reciprocal, com-mitted and contented fashion over time.

• Mastering the work of Career Consolidation to assume a social identity within the world ofwork.

• Generativity involves the demonstration of clear capacity to guide the next generation inunselfish fashion. We in pediatrics might say, mentoring.

• The role of Keeper of the Meaning is about conservation and preservation, with due defer-ence to changing environments and circumstances, of the culture and institutions in whichone lives.

• And, finally, Integrity or Wisdom is the ability to express detached concern with life in the faceof death, to convey integrity of experience in spite of decline of bodily and mental functions.



Much of this so thoughtful volume expands upon the significance of these tasks, and how individuals in thethree groups studied achieved—or were unable to achieve—them. Vaillant reviewed, and took advantage of datacompiled over decades, but relied heavily on interviews, and the opinions of interviewers—predominantly him-self. He sees generativity as key to successful aging—meaning to age with happiness and satisfaction in one-self and those around one. He says that those who have descendants and juniors to whom they may impartboth direct help and the fruits of wisdom are most likely to say they have aged well. As with every point of viewexpressed, the concepts of always, or never, are not utilized.

Another six concepts were used to define healthy aging. The text provides detailed definitions of the measuresof each of these:

• Absence of objective physical disability.

• Degree of subjective physical health.

• Length of prior undisabled life.

• Objective mental health.

• Objective social supports.

• Subjective life satisfaction.

As one might expect, stable marriage, exercise, lack of overweight, heavy smoking, alcohol abuse and maturedefenses correlate with scores of successful aging. To these would be added for the inner city sample at least ahigh school education. But Vaillant retains an optimistic point of view. If all one has is lemons, make lemon-ade. He provides too little information about temperament and the role of innate behavioral style as an influ-ence upon one’s response to events and people. As my mother said when she told me about the 50th reunionof her dental school class. She had sat next to a man she remembered, “He was a jerk 50 years ago and he wasa jerk last night.”

This book attempts to teach us to predict the future. “[Vaillant] would suggest, rather than count up the riskfactors in a person’s life—the ones that researchers believe condemn disadvantaged children to a substandardfuture—count up the positive and the protective factors.”

I would encourage all of you to read, no, study this volume, and consider what you can do with your life, nomatter how much more you might think is left, to make it useful for others as well as yourself, within whateverlimits you may have, and whatever level you may have attained. It is a process of development, not an end point.As a human animal, we have but two resources in which to garden, the earth with its life, and our children.Voltaire wrote, and Sondheim took as his lyric for Candide, “I’ll make my garden grow.”

Aging Well Continued from Page 28 _______________________________________________________________________

When Is It Okay To Kiss Someone?(Written by kids)

When they’re rich. Pam, age 7

The law says you have to be eighteen, so I wouldn’t want to mess with that. Curt, age 7

The rule goes like this: If you kiss someone, then you should marry them and have kids with them It’s the right thing to do. Howard, age 8

A A P S e c t i o n f o r S e n i o r M e m b e r sVolume 15 No. 4 – Fa l l 2006

Opinions expressed are those of the authors and not necessarily those of the American Academyof 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.

SENIOR BULLETINEditor: Joan Hodgman, MD, FAAPAssociate Editor: Arthur Maron, MD, MPA, AAPAdvocacy for Children Editors: Lucy Crain, MD, MPH, FAAP

Burris Duncan, MD, FAAPDonald Schiff, MD, FAAP

Travel & Leisure Editor: Herbert Winograd, MD, FAAPCareer Changes Editor: Jacqueline Noonan, MD, FAAPGeneral History Editor: Maurice Liebesman, MD, FAAPFinancial Planning Editor: James Reynolds, MD FAAPHealth Maintenance Editor: Avrum Katcher, MD, FAAPComputers Editor: Jerold Aronson, MD, FAAPGeneral Senior Issues Editors: Avrum Katcher, MD, FAAP

Eugene Wynsen, MD, FAAPOutdoors Editor: John Bolton, MD, FAAP

September 03 Senior Bulle#D2901 - The American … well the new Medicare Part D is working....

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