Dolphin-Assisted Therapy, Antibiotics, Drug Reps – PediaCast 098

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  • Dolphin-Assisted Therapy
  • Hib Booster Deferment
  • Are The Antibiotics Working?
  • Coffee For Kids
  • Drug Rep Rant



Announcer: Bandwidth for PediaCast is provided by Nationwide Children's Hospital, for every  
child, for every reason.


Announcer: Welcome to PediaCast, a pediatric podcast for parents.  And now direct from  
Birdhouse Studios, here's your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone and welcome to PediaCast, a pediatric podcast for moms, and dads.   
This is Dr. Mike coming to you from Birdhouse studio, and I'd like to welcome everyone to the  


Also welcome to 2008!  It's our first show of the New Year, and I want to put a special welcome  
out there for all of our new listeners, you know who you are, you're the ones who got iPods for  
Christmas and you discovered the iTunes store.  The podcast directory and you're wondering  
what podcast were all about, and then you came across PediaCast, so welcome all of you, and a  
special welcome back to our regular listeners as well.  

Now since it is a New Year, it's time for a fresh start, so you'll notice we have some new intro  
music, we also have some intro interlude music as well, and I'm tweaking the format a little bit, I'm  
not going to talk too much.  Exactly what I'm doing with that, because you kind of listen, and then  
you kind of figure it out.  In a nut shell, the news and the listener's segment have been the most  
popular segments of the program.  

Rather than doing a separate new show, the listener segment and the news segments have been  
the most popular.  


Our standard show is going to be here for a little while anyway till I decide to change it again.  A  
couple new stories, instead of a whole show, full of new stories, and then a listeners segment  
where we'll try to answer about three listener questions, and we'll try to do all that in a half an hour,  
so I know we're going to have to really boogie to do that to get it all in.  But we're going to try, and  
then we'll still throw on a research show here and there and an interview show here and there too,  
but the standard one is going to be a little bit of news in the beginning, and then our listener's  

Ok I do want to also thank everyone who did reviews in iTunes; I really, really appreciate that.  I  
guess where this started is around Thanks Giving time; I had mentioned that I wanted to try to  
break the 200 mark in the number of iTunes reviews before the New Year.  And I think at that time  
we had around 160, 165, something like that.  


And honestly, after I mentioned it, I thought, "Oh I shouldn't have done that", because I really did  
not think it was possible to get 40 new reviews in iTunes in the course of a month.  I mean,  we're  
talking ten a week, and to get people motivated to do it, you know I thought, "Oh great, I'm not  
going to make it, we're going to fall flat," and then pretend that never happened and don't mention  
it, is that what you do?  But you guys surprised me.  

People came out of the wood work and more of them broke the 200 mark with the review.  So,  
really, all of you who took the time to do a review on iTunes, seriously, from the bottom of my  
heart, I really appreciate it.  It means a lot to me, and I really thank you for taking the time to do  
that.  And in return, I will honor my pledge to not mention iTunes reviews again for a very, very  
long time.  OK, I'm going to zip my lips on the iTunes reviews and I got at least a month without  
mentioning them, OK because you know enough is enough.


All right, before we get started, one other thing I have to mention, you probably noticed from my  
voice, now the new listeners out there, you won't really notice, but my regulars, you're going to  
know, my voice sounds a little scratchy, and I had actually wanted to get this show out the day  
after New Year's.  And I had that script all done, everything was ready, I had the new music set,  
but then I had laryngitis, and my throat is still scratchy.  In order to not cough, I've had to suck  
down honey; it works great, by the way.  

This is about my third take of the introduction, I was just coughing through it and Karen, it was her  
ideas, because we've talked about this before in past episodes about the benefits of honey in  
helping cough, and I have to tell you, it really does work.  So I had a teaspoon of honey right  
before I started this introduction.


And I haven't coughed at all; it's going well, during the interludes I've got the honey and the spoon  
down here.  So if you hear some funny noises in the background, it's just me sucking down some  
honey to try to coat my throat, so I don't cough through all the different segments.  All right, usually  
the introductions not quite this long, but when we've been away from each other for couple of  
weeks, there's a lot to say.  

Tonight, the Buckeyes play LSU in the national championship game of college football, and of  
course those of you who know me well know that I'm rooting for the Ohio State Buckeyes, so go  
Bucks.  Last year, they didn't show up to the national championship game, so it's an honor to be  
able to be there again.  This time we need to show the nation our stuff, so let's go Bucks!  And  
you'll know if you don't watch the game you'll know from my tone of voice on Wednesday whether  
we won or not.


All right, so what are we going to talk about today?  In the news segment, dolphin assisted  
therapy, is it good?  Is it bad?  We're going to talk about that.  Also, Hib boosters, doctors are  
asked to defer those, and then in our listener segment this week, are the antibiotics working in  
coffee for kids?  And then we have a rant from a listener, we'll let it speak for itself when we get to  
that in the listener segment little bit later on.  

Don't forget if there's a topic that you would like us to discuss or if you have a question or a rant,  
you can go to and click on the contact link. is another way  
to get a hold of us, make sure you'll let us know who you are and where you're from when you do  
that, or you can call the voice line, 347-404-KIDS.  And of course the information presented in  
PediaCast is for general educational purposes only; we do not diagnose medical conditions or  
formulate treatment plans for specific individuals.


If you have a concern about your child's health, call your doctor and arrange a face to face  
interview, and hands on physical examination, also your use of this audio program is subject to  
the PediaCast terms of use agreement, which you can find at  And with that in  
mind, we'll be back with news parents can use, right after this short break.




Dr. Mike Patrick: Our News Parents Can Use edition is brought to you in conjunction with news partner,  
Medical News Today, the largest independent health and medical news website.  You can visit  
them online at  And I do want to take a moment here just to say a  
special thank you to the folks at Medical News Today.  They do a wonderful job, bringing  
excellent news story to the PediaCast audience week after week.  

With the New Year, I just wanted to say special thank you and kudos to them.  If you're interested,  
we just cover couple stories here and there, and if you are interested in more medical news,  
whether it be pediatric, adult medicine, anything with a medical bend to it, make sure that you do  
check them out, again that's at


All right, people suffering from chronic mental or physical disabilities should not resort to a  
dolphin healing experience, warn to researchers from Emory University, Lori Marino, senior  
lecturer in the neuroscience and behavioral biology program has teamed up with Scott  
Lilienfeld, professor in the Department of Psychology, to launch an educational campaign  
countering claims made by purveyors of what is known as dolphin assisted therapy.  

Dolphin assisted therapy is not a valid treatment for any disorder, says Marino, a leading dolphin  
and whale researcher.  We want to get the word out, that it's a lose-lose situation for people and  
for dolphins.  Swimming with dolphins maybe a fun, novel experience, no scientific evidence exist  
for any long term benefit from dolphin assisted therapy.  Marino says that, "People who spend  
thousands of dollars for the experience don't just lose out financially, they put themselves and the  
dolphin at risk of injury or infection, and they're supporting an industry, at least outside of the  
United States.  Takes dolphins form the wild in a brutal process that often leaves several  
dolphins dead for every surviving captive."  


Marino and Lilienfeld reviewed five studies published during the past eight years, and found the  
claims for efficacy of dolphin assisted therapy were invalid.  Their conclusions were recently  
published in Anthrozoos, the journal of the International Society for Anthrozoology.  The paper  
entitled "Dolphin Assisted Therapy, More Flawed Data and More Flawed Conclusions….  

We found all five studies were methodologically flawed and plagued by several threats to both  
internal and construct validity, wrote Marino and Lilienfeld who conducted similar review in 1998.   
We conclude that nearly a decade following our initial review, there remains no compelling  
evidence that dolphin assisted therapy is a legitimate therapy, or that it affords any more than  
fleeting improvements in mood.


An upcoming issue of the newsletter of the American Psychological Associations Divisions of  
Intellectual and Developmental Disabilities will feature another article by Marino and Lilienfeld,  
entitled "Dolphin Assisted Therapy for Autism and Other Developmental Disorder's a Dangerous  
Fad'.  We want to reach psychologists with this message; because dolphin assisted therapy is  
increasingly being applied to children with developmental disabilities.  

Although there is no good evidence that it works, said Lilienfeld, who's also a clinical  
psychologist.  It's hard to imagine the rationale for a technique that at best, makes a child feel  
good in the short run but could put the child at risk of harm.  The Emory scientists have timed their  
campaign to coincide with the recent call by two UK based none profits, The Whale and Dolphin  
Conservation Society, and Research Autism, to ban the practice of this therapy.


Well, Marino is against taking dolphins from the wild and holding them a captive for any purpose,  
she finds dolphin assisted therapy specially egregious, because the people who are being  
exploited are the most vulnerable, including desperate parents who're willing to try anything to  
help a child with a disability.  Many people are under the impression that dolphins would never  
harm a human.  In reality, injury is a very real possibility when you place a child in a tank with a  
400 pound wild animal that may be traumatized from being captured, Marino says.  

Dolphins are breed in captivity in US Marine parks, but in other countries, they're often taken  
from the wild.  If people knew how these animals were captured, I don't think they would want to  
swim in it, with them in a tank, or participate in this, Marino says, referring to the annual dolphin  
drive in Japan.  During the dolphin drive, hundreds of animals are killed in water that's red with  
their blood, while trainers from facilities around the world picked out young animals for their  
marine parks.  They hoist them out of the water, sometimes by their tail flukes, and take them  


Each live dolphin can bring a fisherman $50,000 or more, she says.  The marine park makes  
millions off dolphins, so that's a drop in the bucket.  Marino goes on to say it's ironic that dolphins  
are among the most beloved and the most exploited animals in the world.  All right, for those of  
you, new to the program, I'll admit that some of this information is kind of gross, about the dolphin  
dives, and I did not check the validity of those facts.  

It seems like there could be some animal activist propaganda at work here, but my point with this  
article is not the animal right aspect to the story, not that I don't care about that, but it's a pediatric  
podcast.  So my point is if you contemplated spending thousands of dollars for dolphin assisted  
therapy for your developmentally disabled child or you know someone else who has  
contemplated that, maybe you should think again.


All right, the CDC which is the US Centers for Disease Control and Prevention in Atlanta,  
Georgia has asked doctors to defer the final booster dose of the childhood haemophilus  
influenza type B, known simply as HIB, because of a possible problem with supplies, however,  
children at high risk of HIB, which cause serious bacterial infections including meningitis and  
pneumonia should continue to receive the booster shot which is given at age 12 to 15 months.  

High risk children include those with cancer, sickle cell disease, or HIV as well as American  
Indian, and native Alaskan children.  There is likely to be a short term shortage of HIB vaccine in  
the US this year.  The drug company Merck announced it was recalling over 1 million doses of  
HIB vaccine, following a potential bridge of sterilization procedures at its Pennsylvania factory.


The recall is simply a precaution, its company officials found no contaminated vaccines during  
quality sampling of factory shipment.  Merck filled about half of the annual US demand for HIB  
vaccine, the other half being filled by Sanofi Aventis.  However, according to the CDC, Sanofi  
Aventis cannot immediately fill the gap left by the Merck recall; hence the need to prioritize this  
year's vaccination program until the full demand can be met again.  

According to CDC, when supplies are restored doctors should go ahead and give the booster  
shot to the children who were deferred.  The CDC recommends all American children under five  
receive the vaccine; the first dose is given at two months, the second at four months, the third at  
six months, and the final one, the booster at 12-15 months.  According to the CDC, HIB is the  
leading cause type B of bacterial meningitis in children under five years old, and it's still a leading  
cause of bacterial pneumonia that's in children as well.


During the 1980's the incidence of this disease was between 40 and 100 for 100,00 children  
under age five in the US, but since routine administration of the vaccine, that incident has  
dropped under 2 per 100,000 children.  In developing countries where the vaccine is not routinely  
given, haemophilus remains a major cause of lower respiratory tract infection in babies and  
young children.  

The CDC advice doctors to defer the booster dose for those children not at a high risk for taking,  
when they made this decision, it was taken in consultation with the American Academy of  
Pediatrics, and the American Academy of Family Physicians, and the Advisory Committee on  
Immunization Practices.  That way they can spread the blame if a child who it was deferred to get  
HIB disease in my opinion, but you got to do that.  These days with all the litigation that's out  


So what does this mean for you as a parent, this story may sound familiar, we did cover it before  
the New Year, and I'm covering it again because the situation has changed when we covered it  
before, we were just saying that there have been a recall, but now we do have official  
recommendation to defer the booster dose except for high risk individuals, and we already  
mentioned who those are.  

Your kids should get the HIB vaccines at two months, four months, and six months, but the 12 -15  
month dose were asked to defer those to make the supply more readily available for the two,  
four, and six month old.  If your doctor says that your 12-15 month old is not getting their HIB  
vaccine now but the six month old across the street who sees the same doctor did get his, well  
now, you can understand why.  

Check out the show notes, we do have a link to the CDC website with some more information  
about haemophilus influenza type B disease and the vaccine that prevents it.


All right, we're going to take a quick break and we will be back with the listener segment of the  
program right after this.



Dr. Mike Patrick: All right folk, my throat is loving the honey, although at the end of that last segment, I did  
have to do a little coughs, so I apologize for that.  My pancreas on the other hand is not liking the  
honey so much; it's having an insulin spasm of the pancreas with all the honey that I've been  
sucking down.  The honey works it just didn't last very long, that's the problem.  Let's move on to  
our listener segment.  

First up we have Jennifer from Garden City, Michigan, and Jennifer says, "Hi Dr. Mike, my son is  
20 months old and has his first ear infection, his pediatrician prescribed antibiotics.  We are on  
day three and his behavior is off, he wouldn't play like he normally does at day care.  He's very  
inactive; the day care provider suggested his antibiotics aren't working.  

My question, how do you tell if antibiotic is working?  I will of course follow up with my  
pediatrician, but I thought it was a great question for you and the show.  Thank you for the  
informative podcast."


Well thank you for your question, Jennifer.  The answer to this question is not as easy as it might  
first appear.  First, some points to consider.  The pain that's associated with ear infections is not  
caused directly by the bacteria that you're killing when you treat with antibiotic.  The pain is  
caused by the body's response to the infection, so the body recognizes that the middle ear  
space is overrun with bacteria, you got increased blood flow to the area which equals to  
inflammation, that equals ear drums swelling and pain, and then plasma leaks in, and white blood  
cells invade to mop up the bacteria until you get puss, you get fluid, you get pressure, you get  

It's not the bacteria itself causing the pain; it's your body creating the inflammation and the puss  
that results from your body killing the bacteria, and that pressure that causes the pain that's  
associated with ear infections.


So, pain is really not a good indicator of how well the antibiotic is working, the antibiotic may be  
killing the bacteria fine, but if inflammation, and puss, and fluid, and pressure, those things are  
going to persist and pain goes along with them for a while.  What do you do?  Well, you want to  
do pain control along with the antibiotic, and you can use acetaminophen, which is Tylenol versus  
ibuprofen, which is the Motrin and Advil products.  

For the kids who are older than six months, I prefer ibuprofen myself, because it's a non-steroidal  
anti-inflammatory drug, where Tylenol is not.  Technically you're going to get some reduction in  
inflammation, since inflammation is one of the things causing the pain with the ear infection that  
helps a little bit more.  Now on the other hand you could argue that the inflammation is important  
for getting rid of the infection because it's just doing its job and pain is a by-product of that  


So if you suppress the inflammation with your non-steroidal anti-inflammatory drug, then it does  
again take longer for the body to take care of the infection.  Pain control's important and  
ibuprofen products, I think, are going to help with pain a little bit more that the Tylenol products.  
The other thing you can use, a topical analgesic, there's one called Auralgan for instance, it's a  
drops that topically numb the ear drum.  They have a substance kind of like you get what before  
you have stitches, you put the medicine and it numbs the skin.  

These are just ear numbing drops that help with pain, and I'll be honest, your mileage may vary on  
those, you find some kids who they really make a big difference, and then others are just so  
irritated that you'd put something in their ear, they seem to be worst that better,  it's one of those  
things where you just have to tell if your kid tolerate it or not and use the kind of sparingly or if it  
really seems to work, use them as often as every two to four hours.  


But these things can only do so much, in terms of helping the pain it's just a good old fashion  
comfort kind of things, let them cuddle up on the couch, the kind of stuff your mom did for you  
when you were sick that just made you feel better.  What if fever persist a couple of days after the  
antibiotic is started?  This is a better indicator than pain.  Fever is a by-product of the immune  
systems recruiting process.  

Cells release chemicals to make this increase blood flow and inflammation, and the white blood  
cell migration to the area of infection and along with the release of those chemicals, you get  
fever.  So if the antibiotic is working, the battle should be shifting over in favor of the body, so  
you get less chemical release, less fever production, and if the antibiotic is not working, then the  
immune system recruitment and fever are going to persist.  


However, often an upper respiratory virus accompanies a bacterial ear infection, and ear  
infections themselves may be caused by a virus rather than bacteria, which case the antibiotics  
aren't going to do anything anyway.  And these viral infections also results in fever production, but  
of course the antibiotic's not killing the virus, they're design to kill bacteria, not viruses.  So in  
these cases the fever may not represent an antibiotic failure, it may just represent the viral upper  
respiratory infection or cold virus, or the ear infection itself, if it's a viral ear infection and really  
treating the symptoms is all you can do.  

And the fever, it may not be that it's the problem with the antibiotic even with the fever persisting.   
Here's another however, the fever may represent a new infection, possible complications of  
bacterial ear infections include mastoiditis, which is a bone infection behind the ear, meningitis,  
sinusitis, periorbital cellulitis, tonsillitis, peritonsillar abscess, pneumonia.  


So you know, you can get complications from ear infections and so the fever persisting could be  
one of this complications starting to set in, and addition to the fever you may see decreased  
activity, behavioral changes, grumpiness, lethargy.  We sort of come full circle here, decreased  
activity and increase pain from inflammation fluid and pressure may be there even if the  
antibiotics are working, or they could be a sign of a developing complications, so what is a  
parent to do?  

Well there's no easy answer, you got to just stay in touch with your doctor, schedule a recheck  
appointment if the fever persist beyond the couple of days of starting the antibiotic.  Schedule a  
recheck appointment if the pain is not responding to pain medication, and schedule a recheck  
appointment if decreased activity, irritability or fuzziness is worsening.


There'll be a tendency for some doctors to want to just call in a different antibiotic over the phone,  
if this occurs.  I've been tempted and guilty of this myself from time to time, especially when the  
office is already over booked and parents are inconvenience, but every time we do this, both us  
doctors and you as parents, we and you risk missing a potentially life threatening complication,  
it's unlikely but it's not impossible, so, something to keep in mind for doctors and parents alike.  

The bottom line Jennifer, I'd say, follow up with your doctor, which was what Jennifer said she  
was going to do and of course I agree with that plan whole heartedly.  All right, moving on,  
Brenda in North Central, Indiana, first she says, "My husband wonders if you feel bad because  
the Ohio State win preceded the resignation of Michigan's football coach?"  


No, I don't feel bad at all.  I hate to see Lloyd Carr go though, because new coaches mean new  
beginnings and I'd rather not mess with the direction that series between Ohio State of Michigan  
is gone in recent years.  All right, so Brenda goes on to say, "McDonalds has iced coffee, and  
Burger King has a mocha Joe, I have on occasion let my 10 year old daughter have an iced  
coffee type drink, but I'm wondering, partially because my daughter asked, is coffee an  
acceptable occasional beverage.  

I know milk, juice, and water are the preferred, but let's be real, children do drink pop in  
moderation, so what about coffee?"  All right Brenda, well thank you for your question.


You're asking the wrong person about coffee because I live on coffee and for me coffee is my  
stimulant of choice to control my ADHD symptoms.  And I have a 13 year old daughter who  
adores Frappuccino from Starbucks.  Now that said, the party line answer would be that kids  
shouldn't drink coffee or soda pop, and juice, well fine in small quantities should not be  
consumed in excess.  Milk is an important source of calcium and vitamin D, and the majority of  
adults, and children both do not get adequate amounts of daily water intake.  

Kids in a habit of drinking soda, and coffee, and juices are not drinking enough milk and water,  
and milk, and water will greatly benefit their future health.  But then let me take off my pediatrician  
hat and put on my dad cap and my human cap too.  Indulgences do come with living, and life  
would be pretty boring without them, and really, I'd rather see a kid indulging in the occasional  
iced coffee than dope.


Caffeine is not all that bad.  In some, it can contribute to high blood pressure in a small number of  
individuals.  It can also alter appetite and sleep cycles, but it also improves attention and  
concentration, that's why people get addicted to it.  I don't really call that an addiction because it's  
not a physical addiction.  But caffeine is related to the stimulants that we use to treat ADHD, so  
Ritalin, Concerta, Adderall, Focalin
, Metadate, all of these are related to caffeine.  

OK, so why don't we send kids to school a thermos of coffee instead of taking a daily pill?  It's a  
good question.  Unfortunately my answer's not as good as the question.  Well first, coffee has a  
short life span, so you need to drink it all day long, and unless you drink your coffee black, then  
you're getting extra calories all day, that's not necessarily good if you're putting cream and sugar  
in your coffee.  


And then you could also argue with other beverages or the kid's going to sneak into their  
thermos, I'll leave that to your imagination.  The Janitorial staff may have issues with the coffee  
policy at school.  And it's also difficult to adjust dose based on a measured response, difficult  
standardized the dose of coffee, and of course, different coffees have different t caffeine content.  
Also there's no studies that I know of giving us guidelines on how much coffee to use and  
probably never will be, because you think the drug companies are going to give up the ADHD  
market to Juan Valdez?  No, of course not, I'll keep treating the kids I see their ADHD with the  
approved medications, but for my own ADHD, I'll continue to use coffee, and I'll continue to allow  
my daughter to indulge in the occasional Frappuccino, but again that's my choice.  


Now, what about your kids?  Well, as a parent that's going to be your choice.  I think it gives you  
the right guidelines, keep it occasional, keep it in moderation and I'll add a few more guidelines.   
Insist on a balanced diet with a reasonable number of daily calories, insist your kids get daily  
physical activity that results at least 30 minutes of them sweating, and insist on safe indulgencies,  
like occasional Frappuccino, that's part of living.  

Again, it's better to have your teen to an iced coffee in front of your face than sneaking dope  
behind your back.  Understand folks, that's not the party line, but I'm not really a party line kind of  
guy, you probably figured that out by now.  All right, we have one more, you guys are going to love  
this one.  This comes from Elaine in Rocky Mount, North Carolina.  Elaine says, "Dr. Mike, I'm  
writing in regard to your gripe about the pharmaceutical view finder you received via mail."  Let  
me stop here, those of you who don't remember this.  


I got a box in the mail at home, opened it up and there's a view master inside with a drug  
wrapped presentation on the slides that you click around, and on the show I griped about it and  
said that, "It's inappropriate, it's just a waste of money to send me a view finder presentation."   
OK, so what does Elaine say?  Elaine says, "First I respected that it's your show, and you can  
discuss any topic you like, but I usually really like and appreciate all the medical knowledge you  
impart, even on topics I don't have immediate application for….  

"However the recent pharmaceutical gripe was inappropriate, I'm a pharmaceutical Rep.  I work  
all day, five days a week waiting patiently, bringing in modest meal, to meet the crazy  
requirements many offices have just to allow me a signature for samples, and often not allowing  
the medical discussion for which I was hired.  When I started this job ten years ago, I could see  
many physicians between patients for quick reminder or update on new information."  


"Now I have to be Rep. Number one on Wednesday from 12:30 to 1:30 for a signature only.   
Doctors have made it almost impossible for us to do our jobs, so our headquarters are trying to  
be creative and find ways of getting the basic information to you.  I'm sorry you are offended, I  
agree it's not the best use of resources, but you and your peers have driven us to these tactics,  
inventing about our marketing on air, just allows misplaced anger from your patients that I already  
deflect daily.  

I pay the same cost of medication you do, and pharmaceutical companies are not the evil witch,  
many make us out to be, please don't help perpetuate this image with your listeners."  OK,  
Elaine, I don't think I'm perpetuating any sort of image about pharmaceutical companies.   
Obviously, they're important, I rely on them every day, you rely on them, I personally rely on them  
because I have glaucoma, and pharmaceutical companies allow me to keep my eyesight.


Now at the same time, I think it is all together appropriate to make mom and dad's aware of the  
tactics drug companies used to reach doctors.  I mean, the actions speak for themselves and if  
you're worried about the reaction parents and patients will have with the marketing tactics, then  
that reinforce my claim that they are flawed.  With regard to signing for samples and finding time  
to talk to us, you must realize, doctors are under increasing pressure to see more and more  
patients than ever before because of decrease reimbursements and increased over head, and  
you couple that with an ever increasing number of drug Reps to request our time, and something  
has to give.  

There's just isn't enough time during the day, but as doctors we do have a responsibility to stay  
current with the latest information on the drugs we use, there's no question about that.  But, let's  
face it; the best source of information is not always the person trying to sell you the product.   
There's a fine line between drug Reps and used car sales man, now, yes, I just said that.


That's not to say that all drug Reps are shysters, and that's not to say that all used car salesman  
are shysters for that matter, because they aren't.  But many in both groups are.  It's the rare drug  
Rep that will tell you the entire story, their product is always the best one, the data they show  
supports their position every time, never mind that their company designed and conducted the  
clinical trial, or that their competition we use the different study that conveniently proves their  
product is in fact better.  

So, do we take their claims with a grain of salt?  Yes!  Do we look at their studies with the critical  
eye?  Yes!  Do we trust everything they tell us is absolute truth about the drug? No!  Are we  
frustrated by the number of Reps and the time they demand?  Yes!  And do I enjoy opening the  
tenth brochure of the afternoon, or the box with the view master presentation in it? No!  So let me  
give you just a bit of advice Elaine, and not just you but any other pharmaceutical Rep that's out  


The best way to get to me, and I'm sure many of my colleagues will agree with this, is to schedule  
a meeting, perhaps over lunch, so as not to encroach on patient time, or my personal family time,  
which is also important, with a pediatric medical expert who can talk about their experience with  
your drug, and pick one who'd be candid, who will tell us about alternative therapies they have  
tried, and will give us an honest assessment of the pro's and con's all around.  

For example, if you represented ADHD medicine, bring in a pediatric psychiatrist who can talk to  
us about their experience with your drug and other drugs.  If you represent an asthma medicine,  
bring in a pediatric pulmonologist, if you represent an antibiotic; bring in an infectious disease  
expert.  Sure it's going to take more planning and time, it cost money, the expert may say that  
they don't always use your product, but that's life, let's be honest about it, and I'm going to be a lot  
more receptive and will learn a lot more from this kind of a presentation.  

And it's going to beat the flashy brochures and the view master presentations that go into the  
trash can five minutes after it crosses my desk.


You speak about the good old days Elaine, when you have open access to your doctors.  Well I'm  
proud to deny open access to drug reps.  My patients come first, and I don't have time to listen to  
the rosy can spill, while kids are waiting for me in the exam room, that's what's not appropriate.   
But on the other hand, if you'll take the time to educate me at the time that's convenient to me,  
with a respected source, that isn't objective third party, then I will listen and I will learn.  

And if we can't have this sort of debate in full view of the moms and dads and young patients that  
we're supposed to be serving, and then we should probably find different lines of work.  We were  
running over and we need to wrap things up, so let's take it to one last break and we'll wrap up  
the show right after this.




Dr. Mike Patrick: All right, we're back one last time here.  I want to thank Nationwide Children's Hospital  
for providing the bandwidth for this program today, also Medical News Today which you can find  
at for contributing the news stories, Vlad at for providing  
the artwork for both the website and also the feed.  


And of course, thank you to all of you, the listeners, for joining us and for participating in the  
program with your questions, and your comments, and your rants, and Elaine, no offence  
personally, just on your position, I appreciate you, being a listener, really I do, and it's not  
personal attacks, it's just a difference of opinion, which is always healthy.  And we're fortunate to  
live in a country where we can do that, and broadcast it in the world.  

OK, Pediascribe, for those of you who are new listeners, my wife handles the blogging arm of  
PediaCast, we call it Pediascribe.  And it's not really a medical blog as much as it is a parenting  
and mom type blog.  So what we try to feature a post with each of our episodes, and the featured  
post this week, or today I should say our Christmas recaps.  So since we haven't really talked  
since Christmas, Karen gives a nice recap of our family's holiday and you can find a link to that in  
the show notes at  

All right, more pediatric news and might take on your questions are coming up on Wednesday  
and we'll do another show on Friday, and until then, this is Dr. Mike saying, "Stay safe, stay  
healthy, and stay involved with your kids," so long everybody.


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