Dr. Maller’s Blog

It’s been six weeks since my last day at the Vanowen office and I’m way overdue to check in. I am in the beautiful central coast area of California, covering a practice very much like my old one while its owner enjoys a well-deserved European vacation.
The pace is so relaxed, the scenery and weather so lovely that it’s almost like a vacation for me too, especially while Cynthia and Gucci were here the past two weeks. I’ve seen interesting patients too.
A 7-year-old boy who while normal in every other respect has never eaten anything but liquid (he nursed for three years) or pureed foods..I had the luxury of an extra half hour to talk to him and his 43-year-old engineer mother. Q: what do you eat for school lunch? A: yogurt and pudding. Q: what about birthday parties? Do you eat cake? A: no- too much sugar. He has been referred to a therapist in San Luis Obispo. My guess: obsessive-compulsive disorder (his uncle has it). Prognosis? I wish I knew.
Three kids have had pre-op exams for dental surgery for nursing-bottle mouth. The worst was a 3-year-old going for his second surgery. Usually I can barely contain my anger when I see such severe and preventable disease; it’s the main reason I’m so strict about weaning from the bottle. But this mom seemed so sweet that for once I resisted being judgmental. Turns out this youngster never had a bottle! Mom breast-fed him day and night for two years. No one told her she could damage his teeth just as badly that way as with night bottles.
A 20-year-old college girl came in worried about hypoglycemic symptoms and I realized she was the first patient I’d ever seen after a gastric bypass. She had lost 90 pounds. That’s the good news. The trouble is she’s still 90 pounds overweight with medical problems more typical of a Medicare patient. Obesity is the great scourge not only of our overindulged society, but of us doctors. We can treat and often cure almost everything – except the morbidly obese. The long-term cure rate is less than 10% and the future cost burden is incalculable.
After 44 years running a mostly solo practice, the changes have been remarkable in medicine. The science has jumped ahead enormously but the art remains a big challenge. Will the patients of tomorrow have personal physicians to talk with? I fear not, especially under Obamacare.
Earlier I was reading a book review about a gentleman who is now a PhD and directs a major ink tank. As a college student he dropped out to pursue his passion of playing classical music in a small touring group. After six years he took what he thought was a dream job playing in a state orchestra in Spain for better money. He hated it. I can relate at this time in my life to what he discovered. The joy was gone; he had to obey the conductor. “The more control you have over your life, the more responsible you feel for your own success (or failure). And as we’ve seen, the more you feel you’ve earned your success, the happier your life will be.”

There are over 200 wineries around here. So far I’ve only tasted two. Sounds like it may be time to try another. Be well, friends.

That’s baby talk for “See you later.” At least it was in my house when my first-born began imitating adult speech. You’ve probably also found yourselves so delighted at your first child’s early attempts at conversation that you’ve added several new expressions to your lexicon. Now he’s 50 and I’m still imitating him imitating me. My surviving lovebird, Clyde, now a widower since his mate Bonnie died recently, is at home where I call him “Boorp” because that’s the way Steve said “bird.” When I find my glasses, phone, keys, or remote I often yell “Ee-dee-dee” for “Here it is.” But I digress.

By now you’ve received my letter announcing my departure from private practice after 44 years. At 75 (which they tell me is the new 74) I might be expected to retire. However I wouldn’t if I could. I love what I do too much, and I’m blessed with good health. Except for a 4-week cancer break in 2001 I’ve never taken a sick day, making me the Cal Ripken of pediatricians. The opportunity to sell the practice arose last year and it was a one-time chance to stop the tailspin that I (and most of my colleagues) had been experiencing since the failure of managed care and the recession. There was uncertainty as to where that would lead, but now we know.

I am too independent-minded to work full-time for someone else. The incessant bureaucratization of medicine, the erosion of authority, the replacement of bedside skills with high-technology razzle-dazzle, and now electronic record-keeping have all come between the doctor and his patient. Seventy years ago we headed down a path which joined health insurance with employment, and federal and state government now account for half of all coverage, with all the political fallout that entails. Predictably, the “marketplace” for health care is a mess, partly because no one has any idea what a fair charge is, especially the consumers. In the future virtually all primary care will be group-centered. Perhaps that will be a good thing for both of us.

What I’ve chosen to do is “take my act on the road”, so to speak. I have already been working some nights and weekends at Urgent Care centers around the city, as well as covering practices in both private and community settings. It’s a bit of a gamble because the work is rarely made available more than a few weeks ahead of time. However I’m assured that there will be plenty. Much of my family lives in the Silicon Valley, which I hope to visit more often. Cynthia is excited about all the farmers’ markets and antique shops, and Gucci will get even more attention than usual.

Thank you all for the unforgettable experiences, for the honor of being part of your families, for the trust you’ve placed in me. As the letter mentions, my cell phone is 818-414-6777 and my e-mail, as you obviously know, is harry@doctormaller.com. I’ve also taken a box for my snail mail: P.O. Box 7725, Van Nuys 91409. For the foreseeable future we’ll keep our home here and would love to hear from you.

I’m not referring to pizza but to politics.

In the last 24 hours the equivalent of a tsunami has hit health care in the form of a sweeping “reform” passed by one party in Congress, despite growing opposition from the public. I’m disappointed and like most of you, frightened of the long-term implications of this enormous change that will, if it stands, affect every person out there, most of all the young.

I cast my first vote on the south side of Chicago. It was not an experience likely to elevate my opinion of the process. I learned first-hand what a “community organizer” does and why. Back in those pre-ACORN days they were called “ward heelers”. At 8 a.m. a drunk, badly-dressed goon stood in the doorway of the local polling place, a barber shop, handing out lists of candidates to be voted for, right under the American flag. When I tried to get past him and told him what he could do with his list he said, “Well could you at least vote for MY judge?” Ironically I had spent a day in court as part of my psychiatry training, observing that very judge and I did vote for him because he seemed caring and professional. He later became governor of Illinois (Otto Kerner) and went to jail for corruption, which is a common career path in the state of Illinois.

The current crop of White House operators come straight out of the moral vacuum that is Chicago politics. Every vote is bought, every transaction tainted by cronyism, and few even try to hide it. Like the Mafia and the drug cartels, the power brokers build parks, schools, gyms, housing, etc. to give themselves a veneer of respectability while creating more and more dependency and perpetuating the cycle of corruption.

While our economy staggers, while Iran and the Islamofascist world menace us, our single-minded president and his minions have chosen to focus on a “crisis” in health care that happens to represent a naked power grab of one-sixth of our economy. Nancy Pelosi said “We have to pass this bill so we can find out what’s in it.” Alcee Hastings, an impeached federal judge who now sits in Congress as Chairman of the Rules Committee, is caught on C-SPAN camera saying “We ain’t got no rules – we makes them up as we goes along.” The president wants us to believe that this multi-trillion-dollar legislation will lower costs while insuring over 30 million more people and that pharmaceutical research and medical care will be available no matter how many punitive taxes and onerous regulations they pile on.

As fourteen months of pseudo-crisis have unfolded, millions of Americans have realized what they voted into office. This is socialism on steroids. In the face of a 3-2 level of opposition, these Chicago thugs have installed an unconstitutional and fatally flawed program that is not about health care but about controlling votes. We are at the tipping point where the producers of wealth are becoming outnumbered and outvoted by those who live off them, and where the debt incurred by our children and grandchildren can never be repaid. As Margaret Thatcher famously said, “The trouble with socialism is that sooner or later you run out of other people’s money.” But this program does create “jobs”; i.e. 16,000 IRS agents to enforce its provisions. I wonder if they’ll all be be named Guido.

Hope is not lost – it never is in America because we’re not Europeans. The “benefits” don’t start until 2014, which gives us time to put a new Congress in place which can undo some of the damage. The requirement to buy health insurance is so blatantly unconstitutional that even the 9th Circuit must be embarrassed. Not to sound like the happy kid in the manure pile saying “There must be a pony in here,” but the health care system we’ve evolved in the last 45 years is so messed up that this may be an opportunity to wind up with real reform. In earlier blogs I’ve outlined the keys: a competitive national health insurance market; insurance for major expenses only; malpractice reform (“What do you call five trial lawyers at the bottom of a lake? A good start.”) Either we put patients and doctors in charge or we go down the path to destruction of what is, for all its faults, the best health care in the world. Government can’t run the 50% of medicine it already controls. States are lining up to sue the Feds over Medic-Aid because they’re broke. Social security is a Ponzi scheme like the one Bernie Madoff is serving 150 years for. The CEO of United Health Care made about $785 million last year, but if your child had an ear infection in 1998, he might not be covered for future ear problems for the rest of his life.

My wife wants us to go see “Alice in Wonderland” tomorrow night. Aren’t we already there?

What? The title is spelled wrong? And you noticed! You must have gone to an expensive private school.

The state of education is like the weather. Everyone talks about it but no one has any idea how to fix it. But it is too important to ignore.

I’ve been more than a spectator but less than an expert. I’ve been taught by unforgettable teachers in grade and high schools; I’ve graduated from an Ivy League college and an even better medical school. My children have ranged from college dropout to law school, all of them doing well with no correlation to their academic status. My oldest grandson is a freshman in college, I hope for education and not indoctrination.

I read recently that a school superintendent somewhere (?North Carolina?) decided that American History should be taught henceforth starting after the Civil War. In that spirit, let’s drop the first two years of medical school and law school. Wanna learn to fly? Skip ground school – just take the keys and try it out. Is this the dumbest idea you’ve heard in a while? Or do you agree with the lady that nothing important happened in America before 1865? Or is it just that our children would be too stressed out having to learn what happened before then, or why America is exceptional, or what the Constitution and Declaration say or mean?

An impertinent reporter recently toured the campus of Berkeley asking random students who their favorite president was and why. Lincoln was first (but no one could say why) followed by
Obama and Benjamin Franklin (who was never president); the actual winner was “I can’t think of anyone.” Half of the freshmen entering elite schools like Berkeley require remedial English and math. Spelling is no longer considered important; to correct one’s spelling might damage his or her self-esteem, you see.

My practice has been impacted directly by the sad state of our education system in the San Fernando Valley, which is part of the sprawling and underperforming LA Unified School District. Those families with the means choose private or parochial schools, which generally turn out a far better “product” at less cost. For most families those options are out of reach. Over the years I’ve seen hundreds of families move to the outer valleys with better schools, or even go back home to places with frigid winters and muggy summers, just to get their kids out of LA. But more and more have opted for home-schooling, including some of my largest and highest-achieving families. It’s a wonderful choice for those parents who can handle it. But it is not without its critics, who as far as I can see care more about teachers’ unions and bureaucratic jobs than about our kids.

We usually describe special interest groups such as unions and government employees as “liberal” because that’s usually how they vote, but they are the true reactionaries in our society, standing in the way of innovation and free choice and leaving our kids short-changed and less able to compete in the global economy. Indeed the only “choice” these folks usually support is abortion; everything else is to be decided by “experts”. The most outrageous example I can think of is the betrayal of a popular school voucher program for the poor, almost 100% black kids in D.C. by the Obama administration.

There are many reasons why some kids fail. In our minority cultures, education is often derided as “turning white” or some such rubbish. I’m very proud of a young Latino friend who has become an engineer despite his family’s efforts to dissuade him. A protegé of mine, a young black pediatrician whom I’ve known since she was 11, thrived at Stanford and UCLA because she is super-bright and committed – but she also had the wind at her back because everyone in her family expected great things from her. And she had more than that – an intact, devout family that would have been typical of American blacks through most of their history until the sixties.

In the last two generations we have seen chaotic changes in our society, largely attributable to government’s clumsy attempts to address social problems that are not part of their constitutional mandate. One of the greatest of these failures has been the teaching of our children. Liberal programs generally sound good on paper but rarely work out that way, nor are they even looked at critically. Head Start, which seems to exist largely to employ thousands of busybodies to make nonsensical rules like “every 3-year-old needs a TB test”, has been evaluated recently and found to be an abject failure; by second or third grade there is no difference between their graduates and other children who didn’t participate. We have been inhaling diesel exhaust by the ton for 40 years so kids can be bussed all over town to achieve absolutely nothing. Basic skill classes, tough subjects that make stronger minds, classic works of literature are too often set aside so that the ever-present “self-esteem” merchants can peddle their psychobabble and our munchkins can learn about all the “-isms” and go on to major in pseudo-sciences like Diversity, Ethnic Studies, Gay-Lesbian-Transgender-Whatever Studies, or pursue the phantom of man-made global warming.

Over a hundred years ago my grandparents, teenagers without means, bravely came to America to escape persecution and to enjoy the blessings of freedom. My generation of Jewish kids excelled in school because we were expected to! The Asian immigrants of today are so like us. So are many of the Latino and African children, but their climb is harder.

Last week a proud father brought in his 12-year-old son, just arrived from Ecuador, for his first visit. His father had come here a couple of years ago and worked to make it happen. He said without irony, “My son is here to live the American dream.” And he teared up.

That dream didn’t start in 1865, and I hope it never ends. Do our parents of today know what their children are not learning? I don’t know who first said it but I love this quotation: “To know nothing of what happened before you were born is to remain ever a child.” Indeed.

This time of year it’s hard on us Southern Californians to bear the slings and arrows of our friends and family living almost anywhere else, watching not one but two Rose Bowl games played in glorious warm weather while they shiver and sulk, shovel and skid through an unusually harsh winter.

I’m feeling pretty smug about the weather, but not because of where I live. The Climategate scandal was our Christmas present du jour and wasn’t it a beaut?

Just before the Al-Gore crowd was to assemble in Copenhagen it came out that major weather “experts” on both sides of the pond had been systematically excluding data that questioned their so-called “settled science” that the earth was warming alarmingly and that human activity was to blame. Editors had been fired and careers destroyed. The intent of the Denmark conclave, which required 1200 limousines and innumerable private jets to populate, was to transfer billions of dollars in wealth from rich nations (us) to needy nations (the other 190) in the name of controlling CO2 emissions. (Of course India and China are too busy becoming prosperous to be bothered). Didn’t we learn in school that CO2 was what plants breathed in? I guess that went the way of school prayer and dress codes. Anyway, Al Gore won some awards for a movie ironically called “An Inconvenient Truth” that our schoolchildren have to suffer through, and CO2 got a bum rap, especially since everything we enjoy doing (driving, eating, farting, breathing for example) added more CO2 to our atmosphere. And if Mr. Gore’s mansion in Tennessee produced 20 times as much as your house, well HE is saving the planet and you’re not.

Age has its benefits, one of which is remembering when the script was different. Back in the 70s the earth was cooling dangerously. Time’s cover blared “The Coming Ice Age.” Some clown with a PhD predicted that we’d run out of food by the 80s. He’s still around, getting fat fees for lectures and books paid for by the hardy few who survived. The intellectuals instinctively blame all our ills on ourselves – there are just too many people, we’re running out of everything, blah blah blah. Unfortunately the western world seems bent on demographic self-destruction; most countries have barely half the necessary birth rate to maintain themselves.

My interest in so-called global warming started in earnest several years ago when I read “The Skeptical Environmentalist” by Danish statistician and Greenpeace member Bjørn Lomborg, who showed with meticulous research that money spent on reducing carbon emissions would have no measurable effect on climate change and would better be spent on meaningful reforms like sanitation. It is still his mission through the Copenhagen Project to influence the rich countries to spend wisely, and his impact is growing. Since then I have pursued the subject with growing concern because of the clear political poisoning of the debate. Should you choose to do so you can read or watch such works as “Unstoppable Global Warming – Every 15,000 Years”, which show that the earth is always warming or cooling, that industrial activity was nonexistent when the greatest warm periods occurred, that the Little Ice Age did far more damage than could conceivably occur with a degree or two of warming, and all sorts of other good news. An Arctic melting is happening but the polar bears will survive; meanwhile the opening of the Northwest Passage will save the environment enormous amounts of pollution by shortening shipping routes in the summertime. More food can grow; less fuel will be needed to heat homes. Did you know that Greenland was once green? Vikings farmed there for a few hundred years! There are fossils of palm trees in Siberia. Antarctica was almost surely once free of ice. The planet, like our own bodies, has an amazing capacity to regulate itself, When oceans warm, clouds increase and more sunlight is reflected away from earth. Water vapor, not CO2, is the primary greenhouse gas (excluding what emanates from the mouths of politicians).

In my first blog I cautioned not to confuse science, the pursuit of truth, with truth. Too many scientists have swallowed the Kool-aid and allowed their principles to be compromised. The nineteenth-century philsopher G. K. Chesterton famously warned, “When men cease to believe in God, they do not believe in nothing; they believe in anything. This failure of faith often leads men to overestimate their own power. “Man-made global warming” is such a conceit.

The course I most enjoyed in college was Greek Drama. It was a rare treat to choose an elective, pre-med being the challenge it is. It was also the one class I shared with my wife-to-be.

The word I refer to is hubris, the hero’s fatal flaw, the arrogance, the lustful pride that would be his undoing. Nemesis was the instrument of his destruction. There are some forty surviving Greek plays by Aeschylus, Sophocles and Euripides. A few were funny (e.g. Lysistrata) wherein the wives band together to withhold matrimonial pleasures from their husbands until they stop fighting wars, but most were tragic. Some of the names are familiar: Oedipus, Electra, Medea. The “Greek chorus” acted as a sort of narrator. Special effects were primitive but powerful; the climax often involved a deus ex machina, quite literally a god (the Greeks had many) who arrived via a sort of trapeze to inflict the hero’s punishment or salvation.

The past year we have witnessed hubris all around us with truly tragic effects. Tiger Woods was surely the most admired and blessed athlete in the world; his beautiful wife and children rounded out a picture that shattered months ago with the disclosure of his sordid sexual behavior. The corporate world has taken an estimated $12 billion hit, but that’s not what makes it a tragedy. Bill Clinton got away with it (except for that impeachment thing) but no one ever confused him with an Olympian figure. No, this was the self-destruction of a man of mythic stature.

I do believe that history will show a similar downfall for another man of mixed heritage who had it all, who was worshipped, who transcended all barriers to arrive at the figurative Olympus of our world, the White House, but whose fatal flaw was the greatest aphrodisiac of all, power. Mr. Obama has mistaken his 53% win as an invitation to undo 232 years of unparalleled democracy and prosperity and put in place a Chicago-style thugocracy with his hand-picked cronies in power, spending recklessly and helping to destroy our children’s future. His aim seems to be to create so many government-controlled ventures and voters that his power cannot be challenged. Meanwhile his #1 job, keeping our nation safe from its enemies, is apparently “above his pay grade”.

There have been so many other examples of hubris: Mark Sanford, Republican governor of South Carolina, who has make “hiking the Appalachian trail” the latest euphemism for having sex with one’s mistress; the former vice-presidential candidate and presidential wannabe, John Edwards, he of the trial lawyer billions and $1250 haircuts who fathered a child with his mistress while his wife was recovering from breast cancer therapy, then tried to blame it on one of his aides (who had had a vasectomy).

The inevitable question is Why? The answer seems to be “Because they can.” Shame on them. But shame on us too, for elevating celebrity beyond all reason, for allowing ourselves to be seduced by ordinary mortals who promise us gratification without cost.

That’s “wring” with a “w”, not a typo. 2009 was a sloppy mess of a year and I say “good riddance.”

It’s been two years since I started blogging and I’ve been looking back at my off-and-on efforts with a mixture of pride and embarrassment. Forty posts plus some instructional entries aren’t as much as I’d hoped. But my readers tell me to keep at it. Tomorrow is two years since Gucci, then a one-pound fuzzball, appeared unexpectedly at my front door tucked into my wife’s cleavage, which is still her favorite hangout. Now she’s a seven-pound wonder dog whom most of you know. Getting through 2009 might have been impossible without her.

On a personal level this has been the toughest transition I’ve made in many a year and many of you have suffered through it as well. Going from a proudly independent solo doctor to part of a group, trading my beloved Mac computers for the Brand X variety and having to march to a different drummer haven’t come easily. The old charts are gone and the computer rules the roost. Claudia had her baby boy Daniel on October 17 and will be working elsewhere soon. Brenda has been with me for 15 months now and I hope she continues, but I’m not the boss any more (don’t tell her that!)

Faces are long and tempers short in the doctors’ lounge these days. We had a terrible blow in April when our CEO Al Greene, who had arrived in 2006 and turned Valley Pres around dramatically, died of pancreatic cancer at age 58. Practices built up ethically and deservedly over the years are under siege. The center of the Valley has been hammered economically, not just lately but for decades by the loss of its tax base and the disappearance of thousands of jobs as GM, Hughes, Lockheed and so many others have moved on.

When I began this effort at communication, I hoped to keep politics to a minimum. No chance! What we are witnessing in our beloved USA is an unprecedented assault on our very way of life – not just by zealots of the “religion of peace” but by our own duly elected (with help from the ACORN thugs) government. We have at its head a narcissistic graduate student who has never run a lemonade stand, surrounded by sycophants who answer to no one but him. Our grandchildren are being saddled with trillions of dollars in debt; the dollar is becoming a joke; prostitution is apparently legal as long as it is between consenting congresspersons – and of course the global warming hysterics march on despite the disgrace heaped upon them.

But the big enchilada is health care, one-sixth of our economy and to millions a most personal and painful part of their lives. At this moment Congress is home, I hope hearing the American public loud and clear about the toxic brew they’re trying to make us swallow. I am still hopeful that this overreaching, lying, unread and unreadable 2000+ page monstrosity will die. Hillarycare was less unpopular at this point in 1993 than Obamacare is now, and yet 1994 happened and a lot of the bums were sent packing. I believe that will happen again. There is a lot that needs fixing in health care, as I’ve alluded to earlier. Three real reforms aren’t being dealt with because of political back-scratching – separating health insurance from employment, creating a competitive national health insurance marketplace, and getting rid of the lottery of a runaway malpractice system as California did in 1976.

2009 saw its share of medical advances, mainly in technology. New drugs are few and far-between however. One of the aftereffects of Obamacare would be a worldwide dearth of meaningful research. It costs a billion dollars to develop a new drug or vaccine and the risks of doing so are huge – but that’s the essence of capitalism. In the world of the socialists in D.C. profit is evil – unless it comes in the form of a bribe or a speaker’s fee or whatever else passes for “business as usual” in the seamy back rooms of our nation’s capitol (or Sacramento, etc.)

Every generation seems to have to re-learn Milton Friedman’s famous warning: “There’s no free lunch.” Government never creates wealth, it redistributes it from the earners and creators to those who do neither, keeping a hefty piece for itself. But I see Americans pouring out all over the country, in town hall meetings and “tea parties” and I feel renewed hope that ordinary folks will take back our country and preserve our freedoms.

Our Founding Fathers were courageous and brilliant, but they probably could not have imagined a permanent political class. Service to the public was like PTA meetings – you did it for your children and your community, not to replace work or to enrich yourself. Now we have an administration whose members have had, in 92% of cases, NO private sector experience! We have a tax cheat as Secretary of Treasury, an Attorney General who will, if he gets away with it, commit treason by giving aid and comfort to the enemy, namely KSM, who admitted masterminding 9-11 and asked to be executed. We have 32 unelected czars of dubious allegiance and ability running roughshod over our Constitution. We treat our allies with contempt and bow to dictators and rogues.

We need a slogan for the year ahead. I propose:
LIBERTY AGAIN
IN TWO THOUSAND TEN

Are you still with me? Need a pick-me-up? Read Sarah Palin’s book!

The influenza strain formerly known as swine flu has now been with us for about five months and the first vaccines are arriving, so it’s time for an update.

We are experiencing several unusual events. The last pandemic was in 1968. Influenza rarely occurs during the summer, but this pandemic has continued throughout the hot months. Will it replace the seasonal flu which generally appears about now, or will they occur side by side? We continue to vaccinate high-risk patients with the ordinary flu vaccine but it offers no protection against H1N1. Folks over 60 are immune. Deaths have been uncommon, perhaps 1000 in the U.S. compared to 36,000 in an average influenza year, but the highest rates have been in young adults and infants. So whom to vaccinate?

CDC suggests focus on priority groups, the first being pregnant women, then those caring for infants under 6 months, followed by kids 6 months to 4 years. Vaccine clinics have sprung up with long waiting lines; so far they are the only option. Safety should not be an issue with the killed injectable vaccine, given the better technology we have compared to the 1976 fiasco. I would not consider the live intranasal vaccine safe. The wild card is that by the time we could even vaccinate all those groups, almost all patients will have been exposed to the actual disease. H1N1 is also odd in that it causes more vomiting and diarrhea than other strains and therefore may not be recognized. Moreover, at least 40% of infected people have no symptoms at all. Computer models show that the best we could hope for with a mass vaccination program is a 6% reduction in cases.

Treatment with drugs such as Tamiflu is available but overrated in that it shortens the illness by just a day, and I believe the toxicity in children makes its use unacceptable.

I don’t expect the above information to change much over the next few months. The decision to vaccinate or not is one we need to make together. Clearly the threat of this new virus is more economic than medical. Government mandates to vaccinate have been tried and will backfire, given the mood in the country. We should have some vaccine within the next two weeks (that’s not a promise). In the meantime stay out of crowds, wash hands and store up some herbal tea, chicken soup and your favorite headache remedy.

As many of you already know, important changes are occurring in my office these days. The good news is that I’m not retiring. The bad news is that I’m not retiring. Just kidding – really.

Kids & Teens Medical Group Inc. in the person of Dr. Janesri DeSilva is absorbing my practice, which will be one of three locations. I will continue at Suite 102 (that’s Practice 5.0) as I have been since 2004. Her office is at 10550 Sepulveda in Mission Hills, and the other is nearby at 14608 Victory Blvd. This will allow growth and modernization that would not be feasible on my own. The group has two other physicians and a nurse practitioner and plans continuing expansion under Dr. DeSilva’s husband Sunil, who has an extensive business background. Claudia and Brenda will continue to greet and care for your children (except for some maternity time off for Claudia who refuses to have her baby on her lunch hour).

The benefits of this change include conversion to electronic medical records, about which I have mixed feelings (loathing and hatred). Mostly it’s difficult to give up my beloved Mac computers, plus I need to learn to type with the other eight fingers. But I take heart in that I practiced before there were computers, faxes, cell phones, MRI’s and CT scans, or for that matter HMO’s, PPO’s, Facebook or Twitter. On to the future!

By the way Practice 1.0 was the first 12 years in a rapidly growing solo practice with over 200 new babies every year, sometimes 200 visits a week, teaching rounds at Childrens plus the children’s games, recitals, Back-to-School nights, etc. The second phase was a 6-year stab at group practice with taking on two young pediatricians and opening a second office in Valencia. Good idea, wrong people. Then followed 15 years back at solo practice from 1984-99 during which managed care whittled away at doctors’ livelihoods and sanity. That was 3.0; the next five years sharing space with Dr. Menzer upstairs was 4.0 followed by the phase that’s phasing into the new phase, to coin a phase – I mean phrase.

Thank you all for your loyalty. I hope to sneak a day off now and then but try not to notice, OK?

At the suggestion of a new mom who has sent me a list of some 11 “old wives’ tales”, I shall try to shed some light in these dusty corners.

1. Doubling your toddler’s height at age 2 will give you their adult height.
That’s the rule for boys; for girls it’s eighteen months. I’ve had hundreds of patients grow up to adulthood, and it’s a pretty good estimate. But everything in biology falls on a bell curve. The eventual height can be influenced by early or late puberty; “late-bloomers” may keep growing through their teens. One caveat: measuring a toddler accurately can be like nailing Jello to a wall. It is also sadly true that our maximum height is achieved around 19 and thereafter we shrink as our vertebral cushions deteriorate. I’ve lost an inch and a half since 19.

2. My newborn had a high Apgar score; should I start saving up for Harvard?
The Apgar score, especially at 5 minutes, is a great help to the medical team in that a high score (8-10) means little intervention is needed, whereas a low score calls for drastic measures. However, the eventual outcome for the baby correlates very poorly with the score and is more influenced by heredity, nutrition and other factors. Besides why would you want your kid to go to Harvard?
I actually met Dr. Apgar once when I arrived at Columbia-Presbyterian for my training; she was retiring as chief of anesthesiology. How simple the most elegant contributions to science can be!

3. Bundle up your child or they will get a cold.
This is not only nonsense but worse. If your baby actually gets sick, layers of blankets will trap heat and make fever harder to manage.

4. Shaving a baby bald will cause the hair to grow back thicker.
Nope – and it won’t work for Dad either!

5. Girls develop faster than boys.
Yes, although because of the bell curve you see large variations. Baby boys are larger on average than girls but puberty usually happens at a younger age in girls, as any junior high boy can tell you. If by development you mean social and intellectual skills, girls are faster. Did you know that 58% of today’s college kids are women?

6. If your baby skips crawling and goes right into walking they will be clumsy.
Crawling was thought until recently to be crucial to proper development, not only in physical skills but learning as well. Since the “back to sleep” push to prevent SIDS we have seen a generation of babies resist learning to crawl, but with no discernible impact on later outcomes. “Tummy time” is important for muscle development, so get down and dirty with your baby.

7. Children grow more quickly in the spring (hence the term “growth spurts”).
There’s no reliable evidence that it’s true, but in places with long winters the arrival of more sun may work with vitamin D to hasten bone development. Some say babies grow more during sleep. Imagine trying to prove that!

8. A baby who drools will experience a delay in talking.
This one is new to me, which in itself is quite remarkable. I can’t remember many babies who didn’t drool at times. Delayed speech is on everyone’s mind these days. Clipping a tied tongue has come back into fashion, but for breastfeeding problems rather than speech.

9. Putting breast milk in a baby’s eye will cure conjunctivitis.
I love this one because I recommend it all the time. Most goopy eyes in the early months are caused by blocked tear ducts, and massage with mother’s milk on a regular basis will often clean up the discharge and prevent future surgery. A full-blown conjunctivitis may call for topical antibiotics, however.

10. Mixing rice cereal into a bottle of milk or formula will help your baby sleep through the night.
NOT! Cereal will slow the absorption of the milk somewhat but sleep is controlled by the brain, not the stomach. Eighty percent of new babies sleep “through” the night (really six hours or so) by three months; the others are factory rejects who should be returned – as if! Actually the term “sleeping through the night” is inaccurate. Like adults, babies have a sleep cycle of 45-55 minutes. If you’re lucky they self-soothe and go back to sleep, as we do. If not, it must be Dad’s fault. Why? Isn’t the man always to blame? But I digress…

11. Vaccines are related to autism.
This was the subject of my first blog, Since then the evidence has piled up totally putting this silly idea to rest. Almost all the authors of the original report have renounced it and admitted they were duped; the “study” was financed by trial lawyers and never had the slightest validity in the first place.

12. A wide space between the upper incisors is a sign of superior intelligence.
I added this one because I’ve heard it often. It must be true – check my smile some time!

This all reminds me of a time when I saw an old wives’ tale develop before my eyes. My internship was served at the ancient general hospital in Philadelphia. The nursery had those enormous factory-style windows. The head nurse was an elegant and wise lady named Priscilla Parke (her family was the Parke of Parke-Davis; it used to be common for rich ladies to become nurses). Her insight was that at certain seasons babies were jaundiced more or less than at other times, and she thought it might be the amount of sunshine coming via those windows. It wasn’t but a few years later that phototherapy was discovered as effective for treating jaundice.

With over 40 countries represented in my practice lifetime, I’d probably be able to collect much more folk wisdom from around the globe. Feel free to send me your favorites.