Dr. Maller’s Blog

The topic du jour this week has been the emergence of a new influenza strain in Mexico. Initially it was reported to be “part pig, part bird, part human” and as it seemed to coincide with the visit of our Boy President and his 500-person entourage to Mexico City, my paranoia meter went bonkers. Such a chimera virus sounded like the product of an evil lab somewhere, perhaps a trial terrorist run.

Now the hysteria has abated and we have a more rational basis for assessing the threat. This is a new H1N1 strain, an Influenza A virus primarily associated with swine contact (not eating pork). The outbreak in Mexico has caused some deaths, and cases have been identified in several states here as well as countries around the world. Overall though, the severity of this strain seems ordinary. It seemed odd that the source was Mexico as flu strains usually come out of Asia, but there is evidence that this outbreak began with a visit to Mexico of a citizen of Bangladesh who was quite ill on arrival.

This is not a harbinger of a 1918-like scourge that killed tens of millions of people in the wake of World War I. It seems more like the 1976 strain that struck Fort Dix NJ and led to the emergency production of a new vaccine which forty million Americans received. It was apparent by the fall that the “epidemic” had not materialized but the program went ahead as government programs usually do. The fallout was about a thousand cases of the paralytic condition Guillain-Barré syndrome, and a widespread antagonism toward vaccine mandates that carries over to this day.

Influenza is a true menace; it kills 36,000 of us in an average year, and the present choice of vaccines will not protect against the new strain. So far we can be hopeful that by fall an effective vaccine will be available and that the Virus Formerly Known as Swine Flu will prove to be manageable. Antiviral drugs are of some help (TamiFlu or Relenza) but their use in kids is problematic because of side effects, and the best they do is shorten the illness, not cure it.

Since influenza is seasonal, we won’t hear much for a few months about this. Schools and public venues should stay open and I hope folks won’t flock to emergency rooms with minor symptoms. But there is some precedent for new flu strains to appear mild at first, then return after summer with a vengeance. (One of the great mysteries of influenza is where it hides for six months, only to reappear, often in the same communities.)

Stay tuned, but enjoy the nice weather.

An old favorite smidgen of poetry went lost during one of my office moves, but most parents know it:
Children’s faces looking up
Holding wonder like a cup…”
Last week I had a cute little patient show up in an Alice Blue gown. I asked what the occasion was and her Mom said she always dresses like that (she’s 3 and a half). I grabbed my Polaroid (yes they still make them) and took two quick shots, one for her and one for me. The wonder in her eyes was priceless as she saw her Princess image slowly appear.

Why bring that up? Because I’m afraid for my profession, afraid for tomorrow’s children and the health care they’ll receive. That may be a stretch but these are worrisome times for all of us at both ends of medicine. Will the doctor who starts her practice in 2016 have the time and opportunity to catch those moments as I have since 1966? It seems unlikely.

This last election seemed so foreordained that I wonder how many folks listened to the choices regarding health care as well as so many other issues. In 1993 we were clearly threatened by Hillarycare and responded effectively. This time all of us are sick of insurance companies, $500 prescriptions, and the drumbeat of “47 million uninsured” that we’re permitting a select group of technocrats (mainly unelected) to take over and redesign our most personal health care decisions. The solo practitioner is targeted for extinction – you can look it up in Mr. Daschle’s little book on the government’s plans for your family’s care. If you have elderly folks in your family, they’d better stay healthy!

One of the key strategies in this conversion to socialized medicine is electronic medical records, which will allegedly eliminate mistakes and inefficiencies. Now many doctors and hospitals are going in that direction and for those who can afford it, there may be some benefits. But don’t buy that “efficiency” BS. It’s all about control of the patients and doctors, endangering both our and your privacy so the wise people in Washington and Sacramento can decide who gets what care and whether it’s worth paying for (after the fact of course). Fact is many hospitals and medical groups report a whole new set of problems in this brave new world. Even the Joint Commission, the body that accredits hospitals, has warned that reliance on computers is leading to less focus on patients and more opportunities for errors that keep repeating themselves. The VA system (which is pretty much what medicine will look like if the government takes it over) recently found out after months of errors that their computerized bar-code reading medication system was set up wrong and that thousands of patients got incorrect doses!

Do you really want a computerized robot taking your history and examining you? (I know they can do surgery but humans still have to tell them what to do.)

Yep, our health care “system” isn’t a system so much as a conglomeration of arrangements so typical of America. Foreign visitors are always amazed at all the choices we have, from cars to cereals. Our medical care is a mess but it’s the best in the world, statistics be damned. Winston Churchill famously said that democracy is the worst of all possible political arrangements except
for all the others that have been tried. So it is with our health care.

Chatting with a young pediatrician recently I remarked on seeing about 350 cases of spinal meningitis in my one year as an infectious disease fellow at LA County/USC. She was amazed; she had never seen ONE!

Such is the march of progress over one’s career in medicine. Most cases of bacterial meningitis are caused by Hemophilus influenzae Type b, commonly called “H flu” or “Hib.” One of my attending physicians at Columbia-Presbyterian in New York during my residency was Dr. Hattie Alexander, who pretty much owned “H flu”, having done much of the early work on it. Since its name is a misnomer, she deserves to have it renamed after her (Hemophilus hattiae has a nice ring to it).
In the aftermath of the pandemic of influenza that swept the globe after World War I and killed many millions, a newly recognized species of bacterium was isolated from many cases and was thought to be the causative agent; ergo, H. influenzae. But it was a virus, something long imagined (“little man”) but never seen. H. flu has made its mark despite that inauspicious beginning. It was responsible for about 25,000 deaths in American children every year until the mid-80’s when a vaccine came out. Before sulfa drugs and antibiotics it was always fatal, and it remained deadly even in the modern era. Not only did it kill through nervous system infection but it caused a respiratory disease called epiglottitis, often fatal without an emergency tracheotomy. Pediatricians in my training days were taught the art of low-tech tracheotomy using a key. Did it work? I never found out.

In this era of vaccine controversies it is all too easy to forget what life was like for children growing up. I remember the terror every summer when polio lurked behind each headache. In the two years I spent at Columbia, 30,000 cases of congenital rubella occurred in New York City alone. My oldest child had measles at two during a vacation trip through redwood country, probably 300 miles from the nearest children’s hospital. In my early practice years, before my community hospital had a pediatric unit or even a proper emergency department, I treated about ten cases of H. flu meningitis myself. All recovered but one was permanently left deaf, a common result.

Now H. flu deaths are so rare that each calls for a conference when it occurs. The vaccine is safe and very effective, often combined with others and given in 3 or 4 doses by 18 months. Since 1985 over half a million of our babies have not died of this classic killer. Rubella no longer threatens pregnant women. Polio is gone from our part of the world. Measles should be but imported cases and resistance to vaccination continue to cause localized outbreaks.

The accomplishments of vaccine research are so staggering as to defy comparison to any other field of medicine. New vaccines will strike cancer (we already use one now) and other chronic diseases. A flu vaccine that doesn’t need to be reinvented every year is on the way.

Why have we so soon forgotten where we’ve been?

Tomorrow is the 200th birthday of two of the most famous men who ever lived – Abraham Lincoln and Charles Darwin. And no one can be that famous for so long without being controversial.

President Lincoln is revered for saving the Union, at least outside Dixie. But he suspended habeas corpus, swept away states’ rights, and went through a bunch of mediocre generals before finding a winner. Slavery, that abomination which still goes on today in many parts of the world, would eventually have disappeared as it had in England, but eradicating it was a noble cause.

I believe Darwin is much more of a provocative figure, especially in our country. His theory is just that, and in this 150th year of its presence, it is perhaps less accepted than ever as truth. In an earlier blog I spoke of “science vs. truth”. Science is a path to the truth, a set of tools, but in our secularized world it has too often been used as a cudgel to threaten and punish those who have faith, who believe in divine revelation and intelligent design. No one can question that evolution occurs within a species or that millions of species have disappeared because they could not compete. If Darwin’s insight is correct, where are the missing links? How do we explain “irreducible complexity”, the staggering number of proteins and structures needed to make just one cell, much less an eye or a brain? If the Darwin ideas (many lifted from his friend Alfred Wallace) are so unassailable in the eyes of most science and education authorities, why are they so hysterical about their suppositions being challenged? If evolution explains all the wonders around us, why can’t scientists make it happen in a lab? If it matters that chimpanzees have 98% of human DNA, where are the books they’ve written, their art and music, their bridges and hospitals, their agriculture, their cemeteries – well, you get my drift.

In 1859 “The Origin of the Species” was a ground-breaking sensation. In 2009 it stands as a landmark in mankind’s search for the truth, but the ground beneath it is more sand than rock.

A favorite motto of mine is “Illegitimi Non Carborundum”. It appears on my cell phone when I activate it. It also adorns an archway at New York University, probably put there in the 19th century. I was an ace in Latin in high school, and that translates to “Don’t Let the Bastards Wear You Down” despite some folks denying it really means that.

The climate in the country is decidedly worrisome in general, and downright apocalyptic in the world of medicine. Congress is passing a near-trillion-dollar “stimulus” bill that will put our nation further in debt as far as the imagination can stretch. (A spider bite is also a “stimulus”.) Tucked into the 837 pages which few have actually read is the beginning of the end of our health care system as we know it. A government agency is to be set up to determine whether the care you need is allowable. If you’re over 65 in most developed countries, you can’t get dialysis, you’ll probably die waiting for your angiogram, and so on. Need an expensive drug? You’re so not worth it! (Unless you’re a congressperson or a large donor to one). Since the bill will effectively put a damper on biomedical research, we and the rest of the world will have to learn to do without the latest medicines. All this control is to be obtained by digitizing your medical records. Lots of luck with privacy issues. Good people, I take it as a serious responsibility to protect those records from snoops. Insurance companies have already gained far too much access in my opinion. Of course the cost of going fully electronic is beyond the reach of most small practices, but that is OK with our pals in Washington – in fact the playbook for this takeover, written by former Sen. Daschle in anticipation of his becoming the health “czar” (before he pulled out in disgrace for his $140,000 income tax slip-up) specifically calls for eliminating solo practices as too inefficient.

Two days ago I saw a case of mumps, my first in several years. It was an “augenblicht” (the blink of a light), a diagnosis I could make from five feet away. This seven-year-old boy had a swelling over the angle of his jaw. His Mom suspected it despite his having been vaccinated twice. Mumps vaccine is only about 90% effective. No treatment, no worries. Yesterday I got a call from the county health department, to which I had already initiated a report as required by law. After many questions, the young lady asked me what lab work I had done. I held my temper and asked what tests she expected. “Well, we can’t confirm this as a case without a viral culture and two blood tests.” I resisted the urge to impress her with my resumé and said, “That’s your problem – goodbye!” Besides the hundreds of dollars wasted, those tests would be of NO value to the patient, which is my criterion. A small example of where medicine is going.

Some days the only salvation is humor. As Art Linkletter, my college roommate’s father-in-law famously wrote half a century ago, “Children Say the Darndest Things.” (He’s still going strong at 96). Two new patients came in recently for physicals. I asked the 3-year-old, as I always do, to copy a circle. Then I asked her to draw Mommy, which she declined. Dad spoke up and said to draw him; she wrinkled up her face and said “You’re too ugly!”

Some years ago my oldest grandkids were in the office because the younger, age 6, had a fever. I first checked his throat, ears and chest, then looked up his nose, whereupon his 9-year-old brother said, “What a way to make a living!” Indeed it is.

So your baby’s a year old or so and doesn’t need formula any more. What are your options?

First of all, let’s talk delivery systems. Since my patients often breast-feed for a long time, they may be unfamiliar with the bottle or even with formula. Taking Baby off the bottle may be a challenge, but the sooner you do it the better, for several reasons. Using a bottle after a 12-15 months is unnecessary, and may cause major problems such as tooth decay and ear infections. “Nursing bottle mouth” is more than a cosmetic issue; it can ruin the permanent teeth and even lead to life-threatening infection. There’s another reason I push for no bottles, despite resistance from grandmothers, babysitters and parents; it’s an opportunity to establish who’s boss. Learning to parent effectively involves a series of confrontations. It’s my job to help you anticipate and deal with them.

A new device just came on the market called a “Tilty Cup” which enables the baby to drink from a training cup without getting into the “chug-a-lug” position. I make a point of introducing a cup early in infancy so as to make the baby’s transition easier.

The nutrition aspect deserves detailed attention. Despite uniform insistence on whole milk for babies one to two by the government and its assorted experts, I have always recommended 2% milk, and here’s why. True, fat is important for a toddler’s brain growth. However, a baby fed whole milk is more likely to reject other foods and to become iron-deficient. It’s time to focus on the “4 basic food groups”, only one of which is dairy. Moreover, there are healthier sources of fat such as olives, nuts, avocado and even eggs. Parents rarely object to this reasoning if it’s explained. We have obesity rampant all over our country, government wringing its hands, lawyers preparing to sue fast-food companies, and yet we know that prevention is the only useful approach. Fat babies may be “cute” (I was one) but I prefer “lean machines”.

Now you may be thinking, “Does this doctor really think he’s smarter than the U.S. government?” I have a 1940 book published by the Childrens Bureau (I’m not making up that name) instructing parents on nutrition, toilet training and other issues. Almost everything in it is wrong! Committees of experts (and they are smart folks) get together regularly to tell doctors what to tell their patients and parents about vaccinations, nutrition, sex, guns, drugs and so on. Trouble is these decisions seem to be made (like most government stuff) in a vacuum devoid of common sense. I’ve worked in such bureaucracies. There is a dangerous combination of arrogance and elitism afoot. Ordinary people are assumed to be irresponsible, ignorant, and worst of all, independent and therefore needing to be told what to do.

I’ve stayed in solo practice almost all my career largely because I love being my own boss. Would I get away with recommending 2% milk if I were in government service or at a clinic? Would I defer certain vaccinations as long as possible so they’d be more effective (as I learned at CDC) and get away with it? No, and thereby hangs a tale. When the chickenpox vaccine came out in 1995, I chose to give it at age two because the research had been done on that age group, and the 12-month recommendation was based on those factors described above and not on sound medical science (let’s nail those babies as early as possible because they won’t show up later). After a dozen years it was found that kids vaccinated at age 12 months had significantly poorer immunity than those immunized when older. Meanwhile I’ve had to lower my age for varicella shots to 18 months because I was getting dinged by the insurance companies and government health plans because my patients were “out of compliance”.

Yep, those brilliant government types who’ve been so successful with Fannie Mae and Freddie Mac, the Dept. of Education, the Post Office and the DMV are slowly but surely taking over the practice of medicine. Don’t you feel better already?

Perhaps it’s unfair to blame Gucci for my seven-month absence from my blog, but you see every time I’d try to write she’d sit on my lap or the keyboard and I just couldn’t do a thing. Pretty lame, eh?

Truthfully it’s been a rough year, probably for many of you as well. But it took a reprimand from one of my moms and a few quiet hours on an airplane a few weeks ago to get my writing itch going again.

My 42d anniversary in my Van Nuys practice just passed. A cynic might say I’ve not had 42 years’ experience, but one year’s worth 42 times. Not so. Practice is so much more than runny noses and tummy aches. Lately I’ve had a remarkable run of interesting challenges.

Yesterday started with a 2-year-old girl who celebrated Christmas by putting blueberries up her nose (mom had removed one and the other mercifully found its own way out). Before the day was over, I’d welcomed a new baby girl, seen a 3-week-old baby boy who’d already survived open-heart surgery for a severe congenital defect called transposition of the great vessels (a diagnosis made by ultrasound a month before birth!), done a checkup on a teenaged boy suspected of Marfan’s syndrome (Abe Lincoln had it – he does not).

The last patient of the day deserves his own paragraph. He’s 7, raised by a single mom. From infancy he had been markedly obese with behavioral problems that progressed to the extent that I expected him to have to be institutionalized. At school entry he weight 107 and was too unmanageable to attend regular school, but he had started seeing a child psychiatrist and the tide started to turn. Ordinary ADHD drugs did not work, but an old drug (Klonopin) and a new drug (Abilify) have been quite effective. Yesterday he had grown 5 inches in two years while remaining 107 pounds, still too much but a 17% drop in his BMI (body-mass index). More important, he could read at third-grade level and was delightful to talk with. His mom is married and expecting. She never gave up on him, which would have been easy to do. He may have Asperger’s Syndrome as the psychiatrist says, but his physical and social awkwardness keep improving. Whoda thunk?

Yesterday also featured a little boy with a serious elbow fracture, a little girl hospitalized with another urinary tract infection, probably her sixth, and a history of convulsions with high fever who probably has a defective bladder because of a hidden spinal anomaly, a delightful 3-year-old boy being checked for bronchitis whom I might not have mentioned except that four days after he was born, his father was diagnosed with leukemia which eventually took his life a year ago. It’s the context that makes every patient in a private practice so special; he’s not just a kid with a cough, he’s part of a family I know, with a lovely older sister, a heroic mother, extended families in Italy and the USA whom I met at Dad’s funeral.

The other day a new mom called about her second baby, who I knew had a heart murmur with a tiny hole between the major chambers. He was “very irritable and struggling to breathe” – no further questions were needed. The baby was at the office minutes later, inconsolable, ashen grey with a heart rate of about 280 (really uncountable). Fortunately the Emergency Dept. is a hundred yards away. His abnormal rhythm was corrected with a drug and after a nervous night in the hospital, he is home on digitalis and doing well.

Do you still think practice is dull? It is if you don’t look for challenges. To me every checkup is a chance to find something that can make a difference in a child’s life. I’m known as a good diagnostician, the outcome of wonderful teaching and my years at CDC and LA County/USC. The other night we were watching “Mystery Diagnosis” on TV and a teenaged boy was brought to an ED in Texas with a 105 temperature and a relentless pneumonia that threatened his life. He had been rock-climbing in Colorado with a pal. I like to impress my wife so I flippantly said, “Sounds like hantavirus.” What the heck is THAT, says she. I explained that it’s a mouse-borne virus recently discovered in that part of the country. Turns out he and his buddy found a mouse in their truck while eating lunch, and he indeed caught hantavirus, which is rare (34 cases in the country last year) but fatal 50% of the time.

I really should have gone on Jeopardy.

The change in drug store shelves has come about rather suddenly, leaving folks asking why and what now.

Lots of people depended on Sudafed (pseudoephedrine) for congestion and were puzzled when it went behind the counter. We can thank our entrepreneurial drug makers for that, since it is the base from which crystal meth is made.

With uncharacteristic haste and certitude, the FDA then banned decongestants and cough preparations for children less than two. Now all compounds intended for children 2-4 years are to be re-labeled and restricted. There is talk of the ban being raised to six or even twelve.

My practice hasn’t been much impacted by these changes because I was never much of a fan. However, the popular medications such as the Triaminic line, Dimetapp, Robitussin, Formula 44 and others were generally harmless and because they were readily available in samples, we dispensed them partly so that parents wouldn’t go home empty-handed. Most practitioners knew that illnesses were not shortened by these nostrums but symptoms might abate a bit. More sophisticated patients increasingly rejected these medications, an attitude I encouraged as I learned more about natural remedies. Symptoms are annoying but do represent the body’s defenses against intrusion, and if possible should be tolerated.

Several trends occurred in recent years that led to the recalls. My Dad was a grocer and taught me a lot of lessons, including some lines I use on a regular basis. (When it’s too noisy in the office I’ll yell “Quiet – you’ll wake up the help!”) He pointed out to me when I was a teenager working in what was one of the first “supermarkets” in our area that marketing products was all about shelf space. If Kellogg made each of its cereals in three sizes, with and without sugar/cinnamon/berries/all the above, they could crowd out their competition. Drug makers went on a space binge in recent years in much the same way, and I believe they brought down the wrath of government and consumer groups for that reason. Combining several ingredients, varying colors and flavors, sizes and delivery systems made sense to corporate types but confused parents and doctors alike, the latter because we no longer got samples and couldn’t keep up with the blitz. I’d often find when patients called after hours that they were using several preparations with similar or even identical ingredients, often counteracting each other (e.g. antihistamines to dry up secretions and expectorants to encourage them).

Truth to tell, almost all over-the-counter stand-bys have never been shown to work, especially in children under 12 who are rarely subject to research. If aspirin were discovered now, it might not be licensed. Ibuprofen is a wonder drug to many in pain, but thousands die every year of GI bleeding, most of it NOT preceded by warning signs. The only expectorant ever proved to work was iodide, too dangerous to be used on a regular basis.

As I tell people every day, a cold lasts a week if you treat it and 7 days if you don’t (or is it the other way around?)

There wasn’t supposed to be a dog in my life. Then I unexpectedly found out what I’d been missing when Gucci arrived five months ago, a one-pound black hairball stuffed in my wife’s neckline. All the years of resistance and rationale melted when she saw that starburst white face, the little nose and round eyes of a cartoon dog, and the ears of an Ewok. Now she’s fully grown but less than five pounds and will forever look like a puppy.

She is a “designer breed”, a purposely mixed mating between a teacup Maltese and a Pomeranian. My stepdaughter acquired a Yorki-poo at the same time and they often play together. How wonderful to have a puppy who is gentle, quiet yet full of spirit, and hypoallergenic! She is in my office most days and many of you know her personally.

She was born three days after my latest grandchild, my seventh, but unlike them she isn’t hours away by car or plane but here in my life, my space, my heart. I’ve had to re-learn what new parents all experience: the unconditional love and hard work, the reading of subtle sounds and body language, the moments of pure joy and the anxiety of vaccinations, injuries (one trip to the emergency room already), the challenge of toilet-training, vet’s bills, and above all the responsibility of caring for a little package of life so totally dependent on you. A friend said recently after meeting her that a dog is the only animal that prefers the company of another species to its own.

Parents often ask about dogs and children. Generally it’s best to wait until all the kids are 6 or more. That’s because younger children may abuse the dog, won’t help care for it, and you have enough to do already! However, these days people often have pets before kids and that’s manageable too. Cats are more of a problem because they cause more allergies and infections and tend to get jealous of babies whereas dogs usually are protective. It is true that a dog’s mouth is cleaner than a human’s; I’m glad because Gucci would have licked me to death by now.

Somewhere in his adolescence my oldest started referring to his sister and brothers as Sibling Units. Perhaps he preferred to think of them as having been created in a high-tech factory rather than in the regular way. Anyway over the course of a long career as a pediatrician, father and grandfather I’ve developed certain generalizations about the birth order of children. I believe it was Mark Twain who said “All generalizations are false including this one”, so this is far from a scientific tract.

Sibling Unit #1 tends to be the most successful, most pleasing to adults, most neurotic, and most cautious. I am an oldest child. If I ever get around to writing my long-planned book its title will be “Children Are Like Pancakes – You Should Be Able to Throw the First One Away.” New parents get their on-the-job training with Numero Uno, hovering over him or her, taking pictures all day and boring their friends with minute-by-minute play-by-play of every hiccup and poop. The first child’s universe is dominated by insecure, overprotective parents whose efforts at discipline are often inconsistent if not downright silly. When I’m on call at night I can usually guess within the first 30 seconds if the parent on the phone is new or not.

Sibling Unit #2’s very existence may be determined by #1. The first child who turns his or her parents into a puddle of tears may wind up an only child, a subspecies of human not always thought of as admirable. But for sake of this exposition let’s assume there is a second. Typically this bundle of joy will arrive when #1 is about two-and-a-half, the worst possible interval in terms of sibling rivalry. Just when Mom and Dad figure they’ve got this parent job down they learn that #2 is from another planet. This child’s universe is much different, being less controlled by parents but more by this irksome larger humanoid who has all the toys, all the privileges, and way too much attention and therefore must be challenged. Sibling Unit #2 tends to be independent, fearless, impulsive and rather indifferent to grownups. #1’s weapon of choice is passive-aggressiveness; #2 is far less subtle. Everything is “Mine!”. This child will spend much more time in the Emergency Room and much less posing for pictures.

Sibling Unit #3 is less often seen these days, what with $40,000 tuition bills (and that’s just for private kindergarten) and older parents, but the old saw tends to be true; #3 is a charm, and why not? This child’s universe is full of excitement and love from a family that’s survived the learning curve. On the other hand, #3 has turned #2’s world upside down, creating the dreaded middle child and sometimes causing regression to infantile behavior. It does have its advantages though, and they do get over it. Parents need to be aware that each child’s growing-up experience has its ups and downs, and giving up the treasured baby position in the family can be a major trauma.

After #3 subsequent children tend to be like #3 although each is unique. My S.U. #4 is probably my sweetest and least complicated even though he was just 13 when his parents divorced and by all odds should have become a drug-addicted criminal. Now he’s a father of two and a great one. I’ve cared for two families of ten each, plus a few fives and sixes, and it seems such children are exceptionally well-behaved and responsible. Perhaps you’ve seen the Duggers on cable TV with their 17 or 18 kids and marveled as I have at how happy and youthful they all are, including Mom and Dad.

Children often get a bad rap in our modern world. In earlier agricultural societies they were an economic asset, and a vulnerable one. People had many children because some died. Now we’ve come all the way to becoming the first culture in human history to have an entire class of young people whose major economic impact is to spend money buying gadgets and hanging out at the mall, or to spend years soaking up higher education (and lots of alcohol) at universities which are charging a lot and teaching less of relevance.

From the time of Malthus in the 18th century, experts have warned that the world’s population is too large. As recently as the 1970’s Ehrlich predicted that we’d run out of food and natural resources by the 80’s. He continues to ply his message of fear and doom despite the progress being made in agriculture and medicine. In truth the USA is one of the few developed countries having enough children. The “sustainability factor” is 2.1 children per woman, which is just where we are in our country. Other modern nations are far below that; even largely Catholic Italy’s rate is 1.1 and as people live longer there will be too few young people to work and sustain programs like social security. In China, years of forced abortions have created labor shortages in parts of that enormous country, and there are far more young men than women, a sure formula for more crime and social unrest.

So let’s hear it for our children, our future. And Steve, I was just kidding about the pancake thing.