As a pediatric subspecialist in practice for twenty years (pediatric pulmonology), I have been a long time member of the American Academy of Pediatrics. I have been proud of their advocacy for children, including their being a reputable source of information and a strong voice for pandemic preparedness from a pediatric perspective (special thanks to the Committee on Infectious Diseases for that work), as well as keeping an eye on teen smoking risks, well before it was fashionable to do so.
Professional organizations like the AAP are very important to practicing docs, and there are as many professional organizations as there are specialties. Many practicing docs belong to one or more professional organizations; some are more politically active than others. Recently, I wrote about why I have not been a member of the American Medical Association. Few, if any, of the professional societies are more patient-focused than the AAP, which helps to establish practice standards for pediatricians all over the country, and advocates for issues as diverse as lead screening, autism recognition, health reform and nutrition in schools.
I had the opportunity to discuss some of these issues with the President Elect of the AAP, Dr. Judith Palfrey, FAAP (Fellow, American Academy of Pediatrics.) Dr. Palfrey has a distinguished record from Radcliffe, Columbia and Children's Hospital, Boston, where she is based, and is all too familiar with the issues and barriers that pediatricians, specialists and primary care docs face in practicing modern medicine today, issues that are at the heart of health reform.
Daily Kos: Thanks for making yourself available. Let’s talk some about health reform, and how it relates to children.
Does the AAP have specific concerns about how the health reform debate is playing out in regard to the needs of children and adolescents? What are we not talking enough about?
The AAP supports the current effort to reform our health care system, particularly as it relates to improved access, benefits, quality, efficiency and appropriate payment for services. We do have concerns that policy-makers and the general public think that the reauthorization of the Children’s Health Insurance Program (CHIP) earlier this year accomplished all the goals of health reform for children. It was an important step forward, but CHIP was not health reform for children. There are still millions of uninsured children. With the recession and its effects on states, even with Medicaid and CHIP, there are woefully inadequate funds to provide high quality health services to children. Also, privately insured children are not assured the age-appropriate pediatric benefits. Our state immunization programs are not well funded and we lack registry functions to track and monitor vaccines.
We are also very concerned that policymakers and the general public do not understand that pediatric services are undervalued. In many states, children cannot get access to health care because Medicaid rates are at 60-70 percent of Medicare (which, by the way, is often considerably lower than private insurance).
Finally, we do have effective, proven methods of prevention and care delivery that are not fully deployed because of mal-alignment of incentives in our current system. We are eager to see explicit recognition of the importance of maternity benefits, the Medical Home, Bright Futures and support for pediatric subspecialists and pediatric emergency and hospital services.
Daily Kos: The AMA recently made news with opposition to a public option. Other specialty groups like the American Academy of Family Physicians appear more open to a public plan ( http://www.aafp.org/... ) Does the AAP have a position?
Our position is that we want to remove all barriers to full access to age-appropriate benefits with appropriate payment. We will accept any program that delivers on those goals.
Daily Kos: There appears to be a shortage of primary care doctors looming. Are there enough pediatricians and pediatric specialists to meet future needs, including after universal care is achieved? Is it the right mix? If not, what do we need to do to fix the problem?
You are right. Because of all the hassles and difficulties in our current system, many young people have opted not to go into primary care. They see a life that is filled with administrative forms, telephone trees to authorize medications, inadequate payment for services provided and too little time to practice the kind of high quality medicine they have been taught. Reforming the system will do a great deal to bring people back into primary care.
We also have a real problem with the mal-distribution of pediatric subspecialists. Rural areas and some poor urban areas find it hard to attract and retain pediatric subspecialists. In some ways, this is a much harder nut to crack because it has to do with the low volume of cases in the lower population areas as well as the desire of subspecialists to be affiliated with research universities where they can be involved in working on the latest science. The advent of electronic medical records and telemedicine should provide some relief for this problem, but we will probably not solve it entirely without serious attention to regionalization of services and more attention to epidemiology, demographics and placing doctors where they can reach out most effectively to the greatest number of patients through techniques such as circuit riding and co-management.
Finally, young people who are interested in medicine in general are being turned off and are turning away from potential careers in pediatrics (both primary care and subspecialty) because of the enormous debt burden they face...now in the many hundreds of thousands of dollars. The Obama administration’s recognition of this problem and attention to it is most welcome and should help the situation if there is adequate funding for loan repayment.
Daily Kos: We have a new head of the FDA (Margaret Hamburg). What message would you give her regarding the availability and approval of medications for children, particularly new medications that come on board that may or may not have been tested in children, or come in child-friendly forms?
The FDA serves the very important function of assuring the safety and efficacy of drugs and medical devices. Children's bodies are different from those of adults and they handle medications differently. If children are not involved in drug trials, many life saving and health promoting medicines and medical devices remain unavailable to children. For more than a decade AAP has been on the forefront of legislative initiatives to improve children's access to medicines and devices that are labeled for their use. We have made progress legislatively in getting more access to needed testing and FDA has been a good partner in implementing appropriate policies regarding children. We welcome Dr. Hamburg and encourage FDA to continue to involve children and adolescents in the FDA's priorities.
Daily Kos: Does the AAP have a position on the new law regarding tobacco products being regulated by the FDA? How about funding SCHIP through tobacco taxes?
Yes. The AAP has been a strong advocate for regarding tobacco as a product needing regulation. Tobacco manufacturers market tobacco aggressively to teen-agers by adding flavors and using teen-attracting slogans and other techniques. We know that people who start smoking in their adolescent years have a high likelihood of becoming addicted to cigarettes. Having the FDA regulate tobacco will have the benefit of governmental oversight on how the products are promoted.
Tobacco taxes have provided a double benefit. The tax has been a good source of revenue. And raising taxes deters smoking. We are actually supportive of this pro-health approach related to products such as sugar-sweetened beverages, which are associated with the obesity epidemic.
Daily Kos: In a pandemic or other natural disaster, special needs children are among the most vulnerable populations. Are we doing enough to prepare for the needs of this population and their parents?
The American Academy of Pediatrics is very concerned that children are often not considered when disaster plans are being made. Disasters may happen during the day when children are in school and daycare and can become separated from their families. Systems for reunification are critically important. Stockpiles of medications in pediatric formulations should be a routine part of the disaster plan as well as high priority responses to address the needs of children who have special health care needs and may depend on technologies that require generator or other back-ups.
Thank you, Dr. Palfrey.
The American Academy of Pediatrics health reform links and web site can be found at www.aap.org
Previous Daily Kos interviews with health care and policy experts, including Erika Sward (American Lung Association), Jeff Levi (Trust For America's Health), Georges Benjamin (American Public Health Association) and Scott Layne (UCLA School of Public Health) can be found by clicking the links.