September 03 Senior Bulle#D2901 - aap.org ·...

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

Today’s newspaper carries a rather exciting story forthose who feel that children are in need of betterhealth insurance coverage, andmany are quite with-out it. On page A14 of the New York Times, a storyappearsunder theheadlineHealth Insurance IndustryUrges Expansion of Coverage. Under this somewhatself-serving headline, we see reiterated a sorry fact,that the latest government figures show that 46.6mil-lion Americans lacked health insurance in 2005. Butwe also learn that the chairman of America’s HealthInsurance Plans, the main lobbying organization forthe industry, has offered proposals to expand theChildren’s Health Insurance Program to cover at aminimum all children in families with incomes lessthan twice the poverty level. In addition a tax credit iscalled for to benefit families with children who buyhealth insurance for those children.

One wonders whether the spirit of Christmas hasunexpectedly invaded, like a rogue virus of some sort.Muchmore likely that these beneficent health insur-ance reps have concluded that expansion of healthinsurance coverage, as long as it is not a government-run single payer system,will benefit them. Interestingto see how this will play out.

Weenjoyedanother splendidprogramput togetherbyProgram Chairperson Lucy Crain, at the NCE inAtlanta early in October. The topic was preparing forthe inevitable end of life.We had wonderful talks onlegal documents, palliative care, andmanaging pain.At the same program, Katherine Lobach received theSection for Senior Members Advocacy award for her

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

Executive Committee/Subcommittee Chairs . . . 2

2007 Senior Newsletter Schedule . . . . . . . . . . . 3

Member Spotlight - George Cohen . . . . . . . . 3-4

In Memoriam - Maurice Liebesman . . . . . . . . . 4

To The Editor . . . . . . . . . . . . . . . . . . . . . . . . . . 4

“ON PERCUSSION”“Signs and symptoms are the cry of thesuffering organs” . . . . . . . . . . . . . . . . . . . . . 5-6

Section for Senior Members Website. . . . . . . 6-7

A Change of Direction . . . . . . . . . . . . . . . . . 7-8

AHRQ Press Release . . . . . . . . . . . . . . . . . . . 8-9

To Our Readers . . . . . . . . . . . . . . . . . . . . . . . 10

It’s All Connected! . . . . . . . . . . . . . . . . . . . . . 10

Senior Child Advocacy Award, October 9, 2006recipent Katherine S. Lobach. . . . . . . . . . . 11-14

Digital Photography . . . . . . . . . . . . . . . . . 14-17

Imperium . . . . . . . . . . . . . . . . . . . . . . . . . 17-19

National Institutes of Health launches . . . 19-20

Noval Program Enhances Dementia Caregivers’Quality of Life. . . . . . . . . . . . . . . . . . . . . . 21-22

Racing Father Time —The Benefits of Exercise . . . . . . . . . . . . . . 22-23

Accidental Flight Surgeon . . . . . . . . . . . . . 23-24

What Budding Writers Need to Remember. . . 24

Dividends Regain Investors’ Favor . . . . . . . . . 25

Copyright© 2007 American Academy of Pediatrics Section for Senior Members

Continued on Page 2

A A P S e c t i o n f o r S e n i o r M e m b e r sVolume 16 No. 1 – Winte r 2007

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

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

Burris Duncan, MD, FAAPDonald Schiff, MD, FAAP

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

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

many activities, such as encouraging breast-feeding, and tireless work-ing for universal health insurance.

Another event I would like to mention for your interest is our new andexpandedweb site. Do check in, at www.aap.org/seniors where youwillfindmanynew items about your ownwelfare, health, activities, navigat-ing changes that occur with aging, and interesting projects for thebenefit of children. You will also find reports about our annual meetingat the NCE in Atlanta Georgia. And how to contact members of theExecutive Committee and staff if you have questions, ideas about newthings to do, criticism, or anything else.

Just to let you know that the New Jersey Chapter is preparing to embarkon anovel project for seniors. It is hoped,with the aid of state legislators,to train semi-retired or retired seniors to be available on relatively shortnotice to meet with legislators, government officials, or representativesof other groups, in order to help them understand health and welfareissues which are of significance for children. Stay aware, and we willkeep you posted.

David Annunziato is at workwith our SectionManager, Jackie Burke, onan addendum to our Chapter Guide for creating a Chapter SeniorCommittee.Whencompleted, copieswill be sent to yourChapterOfficersand administrators. Be on the lookout.

With best wishes, good health and good luck.

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

2 Senior Bulletin - AAP Section for Senior Members -Winter 2007

Executive Committee

Avrum L. Katcher, MD, FAAPChairFlemington, NJ

David Annunziato, MD, FAAPImmediate Past ChairEast Meadow, NY

Michael O’Halloran, MD, FAAPEau Claire, WI

George Cohen, MD, FAAPRockville, MD

Lucy Crain, MD, MPH, FAAPSan Francisco, CA

John Bolton, MD, FAAPMill Valley, CA

Arthur Maron,MD, MPA, FAAPBoca Raton, FL

Subcommittee Chairs

ProgramLucy Crain, MD, FAAP

Financial PlanningJames Reynolds, MD, FAAP

MembershipGeorge Cohen, MD, FAAP

History Center/ArchivesDavid Annunziato, MD, FAAP

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

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

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

Message from the Chairperson Continued from Page 1 _________

Senior Bulletin - AAP Section for Senior Members -Winter 2007 3

2007 Senior Newsletter ScheduleArticles for consideration should be sent to the Editor at [email protected] with copies to the AssociateEditor [email protected] and the Academy headquarters [email protected]

Spring NewsletterMarch 16 articles due to Joan Hodgman, MD, FAAPApril 16 mailboxes

Summer NewsletterJune 1 articles due to Joan Hodgman, MD, FAAPJuly 2 mailboxes

Fall NewsletterJuly 15 articles due to Joan Hodgman, MD, FAAP(this deadline is early because the editor spendsAugust at hermountain cabin away fromcomputers and emailand must have the bulletin prepared before she leaves)October 1 mailboxes

Winter NewsletterDecember 1 articles due to Joan Hodgman, MD, FAAPJanuary 1 mailboxes

George Cohen was born and raised inWashington, DC and attended publicschool there. He attended bothUniversity of Chicago (on scholarship)and Union College (Navy V-12); withno undergraduate degree he enteredGeorgeWashingtonSchool ofMedicine

and graduated in 1950.

After a Navy rotating internship, he began residencyat Children’s Hospital of DC, but after one year hewas called back to active duty in the Navy. With hisnew bride, Lenore, Georgewent to Philadelphia for afour month training program in psychiatry at theNaval Hospital there. Next assignment was NavalHospital atCampLejeuneNCwherehismain respon-sibility was evaluating Marines with mental andadjustment problems.Thosewith pre-existing disor-ders were triaged for discharge from the Marineswhile those with more serious mental illness werereferred for therapy. There he had the opportunity toworkwith a fewchildrenwithbehavior problemswithsupervision by the chief of psychiatry, and occasion-ally was called on to help in the pediatric/nurserydepartment.

Upon returning to DC, George completed his resi-dency and then opened a solo private practice inSilver Spring, MD. As a member of the Children’sHospital active staff, he served as ward medical offi-cer for one or two months each year. He was also thepediatrician for the hospital’s lead poisoning/picaclinic for 17 years until it was absorbed into the gen-eral pediatric clinic because of the sharp decrease inthe number of affected children. At that time hebecame the leader of one of the resident continuityclinics.

After 20 emotionally rewarding years of solo practiceGeorge was recruited to the full time faculty of thehospital and became medical director of the generalpediatric clinic, and ultimately was promoted toProfessor of Pediatrics at the School of Medicine atGeorge Washington University. In 1995, he retiredfrom the hospital, but as a Clinical Professor he stillattends in the clinic oneor twomornings eachmonthas a volunteer.

Throughout his career(s)Georgehas enjoyednumer-ous other activities. In the 1960’s he tutored childrenmoving into the county’s recentlydesegregated school

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Member Spotlight - George Cohen, MD, FAAPEditor’s Note:The Bulletin is publishing biographies of the Executive Committee of the Section so that the members maybecome more familiar with them. In the preceding two issues we have included Avrum Katcher as Chair of theSection and David Annunziato as past chair. George Cohen is an active member of the six member council.

ToThe Editor

Congratulations to Maurice Liebesman on his well-written note on the “invention” of the stethoscope!But, where is our evidence-basedmedicine? The possibilities raised are, as is so often the casewith his-torical data, basedonhand-me-downstories soof course I have another. Myversiongoes that thepatientwas the Queen of France, and the physician Laennec could not dream of putting his lowly ear to thequeenly bosom. He therefore excusedhimself, paced in the courtyard to think, and cameupon theboysplaying with a length of bamboo log. The rest is history, as the saying goes- and it all sounds good.

Maurice needs to do another piece on Augenbrugger, who designed percussion after watching his tav-ern-owner father tap on his beer barrels to determine the level of the beer. And Augenbrugger wasn’teven a rocket scientist!!

Some of the stories we’ve heard in the past are just great.

Herbert H. Pomerance MD

Editor’sNote: We thank Dr.Pomerance for his letter and suggest he turn to this article by Liebesman titledOn Percussion. Great minds!

In Memoriam

Maurice Liebesman, MD, FAAPWeare saddened to report that the following article onpage 5,“OnPercussion”,willbe one of the final articles from Maurice Liebesman, whose death occurred inDecember, 2006. Mauricewas adedicatedpediatrician, a consummate gentleman,and a legendary author of articles in our Bulletin for years. He is gone, but will notbe forgotten.


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system.With other tutors he helped develop a volun-teer program of primary health care for the county’slow income/no income population. In its 36 years ofservice “Mobile Medical Care” has grown from oneclinic evening per week in a local church to five daysandeveningsweekly in almost 20 sites including threeoutfitted vans andGeorge continues to serve as a vol-unteer clinician one morning each week.

Academy activities have also been stimulating andrewarding for George who has been a chapter chair-man, district alternate chairman, national nominat-ing committee member, COPACFH member, expertpanel member for Bright Futures and Academy rep-resentative on theNationalConsortium forChild andAdolescent Mental Health Services.

In 1974, George joined a small group of Americanphysicians, hired to help“westernize” a newhospitalin Jakarta Indonesia.While working there, he treated

TB meningitis, tetanus and typhoid fever, as well asmoremundane illnesses. In 1980, he volunteered fora month in a 24 bed hospital on the Navajo reserva-tionwhere he delivered babies, set fractures, suturedlacerations, treated infants with sepsis and adultswithdiabetes andUTI. Amonth in 1981 as a volunteerattending in the hospital of BenGurionUniversity inthe Negev was another stimulating and educationalexperience.

Outside ofmedicine, George and Lenore derive greatpleasure from time spent with their 4 children, 8grandchildren and 3 great grandchildren.They enjoywalking, bridge, concerts, adult educationprograms,travel and synagogue activities. In addition, Georgeplays chamber music (flute) and tennis, sings in achoir and volunteers with local Head Start, HealthyFamilies and Mental Health Association, and gener-ally enjoys being retired.

Member Spotlight - George Cohen, MD, FAAP Continued from Page 3 __________________________

“ON PERCUSSION”“Signs and symptoms are the cry of the suffering organs”

Giovanni Morgagniby Maurice Liebesman, MD, FAAP

I will never forget how impressed I was when, as a young medical student I was trailing along with allthe attending physicians, making rounds with the Chief of Service and him stopping at the bedside ofa child that was short of breath. He tapped at the boy’s chest and solemnly said: “The needle, please”.While one of the doctors was preparing the area marked by the Chief with iodine, he, very calmlyinserted the needle into the child’s chest and, like magic, purulent fluid poured out of the needle.Suddenly the patient was breathing much easier.

As a medical student, my instructor made me practice the technique of percussion on everything andeverybody who was willing to serve for the benefit of my future as a doctor.

-“ You apply the middle finger of your left hand firmly on the surface and you tap on its distal phalanxwith themiddle of your right hand, gently, very gently with a flick of the wrist. Remember, it is all in thewrist.”- I practiced tapping containers, furniture, walls and anything that would notmove, until I got itright. I was so proud of myself!

Not too long ago,while Iwasmentoringmedical students onphysical examination, Iwas teaching clin-ical percussionon thebackof oneofmypatientswhen Iwas told: -“Wedonot do that anymore”- Itmademe sad because I realized that this generation of doctors will rely more in technology (nothing wrongwith that) but theywill lose someof the finesse of physical examination that I think every clinician shouldmaster regardless of how often it is going to be used.

Then, I got curious,whowas the first“modern”physician todescribe the techniqueofpercussion? I foundout it was Leopold Auenbrugger, born in Graz, Austria on November 19, 1722.

His father was an innkeeper and young Leopold observed that when his father would go to the cellar tocheck the amount of beer left in the barrels, he would tap at the end of the barrel, starting from the top,working hisway down to the bottom;whenhe heard the change of sound, he knewhowmuchbeerwasleft inside.

Leopold was also a skilled musician and knew of resonance, pitch and tonalities which helped him tomake senseof this discovery.Hewasoneof the favorite people of EmpressMariaTherese, anothermusiclover and for whom he wrote the libretto of an opera: “Der Rauchfangkehrer” (The chimney sweeper)to which the famous Antonio Salieri, a colleague of Mozart, composed the music.

Hewent tomedical school andgraduatedat age22whenhewasadmitted to theSpanishMilitaryHospitalof Vienna.There, he spent ten years tapping on the chest of patients. He confirmed his observations bycomparisonwithpost-mortemspecimens.Hewould also inject fluid into thepleural cavity and showedthat it was perfectly possible to tell, by percussion, the level of fluid present. He also did some studieson tuberculosis and taught how to detect cavities in the lungs.

Hewas considered an innovator in the art of physical examination anddescribedhis procedure in abookpublished in Vienna in 1761: “Inventum Novum ex Percussion Thoracis Humani ut Signo AbstrusosInterni PectorisMorbosDetegendi”whichwas eventually translated intoEnglish in1936by J. Forbes, JohnsHopkins Press, Baltimore.Thewhole book is only twenty-four pages of ordinarymodernprint but it rev-olutionized the world of medicine.


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Give yourself a gift and visit the revised and updatedAAPSection for SeniorMembers (SFSM)newwebsiteat www.aap.org/seniors. Remember, the web site isdesigned to provide information andnews of uniqueinterest to those members of the AAP that are olderthan 55 years of age in a very user-friendlymanner. Isit hard for you to view text on your monitor? Atwww.aap.org/seniors, set the print text size to small,medium or large - one that is comfortable for youreyes (at upper left of “Home”). Learn about ourSection, our members, and their interests and activ-ities. View Opportunities for staying involved withchildren, the AAP, and your community. And ofcourse, please renewyourmembership inour Sectionby following the links in “About Us“.

Recent changes to thewebpages: If you’venot visitedwww.aap.org/seniors in awhile, notice the changes tothe web pages that improve your ability to partici-pate in our Section, to communicatewith our leader-ship, and navigate the web site. On the Home Page,e-mail questions, concerns, and suggestions directly

to eithermembers of the ExecutiveCommittee or theEditorial Staff of the Senior Bulletin – the SFSMQuarterly Newsletter. The “What’s New” section ontheHomePage spotlights and links you to importantnew features of our web site. For example, one clickon Fitness for Seniors takes you to a SpecialSupplement to our Health & Fitness Section that willprovide you with up-to-date strategies designed tomaintain and improve yourphysical fitness.Were youunable to attend the recent AAP NCE in Atlanta? Noproblem! Click on “Recap the NCE 2006 Meeting”.This feature may be useful even to those thatattended, as well. Notice the new web site section,Newsroom, on the Site Menu at the right side of thepage. Many of our SFSM members have recom-mended that we post general news items of interesttoolder adults.Youcanexpect to find themhere, if notin our other Sections of unique content. All pediatri-cians may find the recent report from theCommonwealthFund (October 2006) entitled “AHighPerforming System forWell Child Care – AVision for

Section for Senior Members Websiteby Jerold M. Aronson, MD, MPH, FAAP (SFSMWebmaster)

On the natural sounds of the chest he wrote:” The thorax of a healthy person sounds, when struck. Thesound thus elicited resembles the stifled sound of a drum covered with a thick woolen cloth or otherenvelope. This sound is perceptible on different parts of the chest in the following manner: the left side,over the space occupied by the heart, the sound loses part of its clearness and becomes dull”. On themethod of percussion, he wrote: “The thorax ought to be struck slowly and gently, with the points of thefingers brought close together and, at the same time, extended. Robust and fat subjects require a strongerpercussion.”

On the disease of the chest, he wrote: “The duller the sound, the more severe is the disease”. “The diseaseis more dangerous on the left side”. “The existence of the morbid sound on the superior and anterior partof the chest indicates less danger that on the inferior parts of the chest”. “The entire absence of the natu-ral sound over a large space in the region of the heart is a fatal sign.”

As it is frequently the case, Auenbrugger’s new method of examination was met with skepticism by hiscolleagues andwasquickly forgotten. Itwas JeanNicolasCorvisartwho, in 1808, almost forty years later,rediscovered Auenbrugger’s book and translated the German text into French and popularized it butrefused to take credit for it. He said: “It is he and the beautiful invention which rightly belongs to himthat I wish to recall for life”.

Auenbrugger was a genial, inflexibly honest, unassuming, charitable, very modest man and a good-natured person; he lived to a happy old age and was remembered for his kindness to the poor and tothe patients with tuberculosis. He died in Vienna in 1809, one year after he witnessed Corvisart makepercussion part of the curriculum for his students, including Laennec, who made good use of it.

“-We do not do that anymore…-“Who knows,maybe in forty years fromnow somebodywill rediscoverclinical percussion again…

“On Percussion” Continued from Page 5 _________________________________________________________

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The 2006mid-termelections are over, andwith a strong sense of relief, we are now free from the offensive can-didate advertising campaigns, which cost over $2 billion. Both the President and the Democratic party lead-ers in the House and the Senate have agreed to approach the next two years with a sense of cooperation andbipartisanship and an end to the bitter battles that have marked the past six years ofWashington infighting.

During the recent campaign, health care issues took a lower place on the list of first tier controversies, clearlybehind the war in Iraq, congressional corruption, gender issues and immigration. The question of Medicaidcosts and Medicare Part D revisions surfaced from time to time in some states. A more comprehensive con-sideration of medical needs, including a plan to significantly lower the number of Americans without healthinsurance, almost fell off of the radar screen.

A 2006 survey in Colorado revealed that 73% of those surveyed thought that every child in Colorado shouldhave health insurance (15% do not). This question, however, did not become an important issue during therecent election campaign.

For the foreseeable future, seeking a solution to the Iraq war will demand somuch attention and energy fromthe administration and congress that until some agreement is reached on how to exit, it is unlikely that anyother important legislation can pass.

It appears possible, however, that if the Republican andDemocratic parties canwork together and avoid grid-

the Future” must reading!! The web site links you tothe Executive Summary and/or the full report.

Useour easyweb sitenavigationbuttons foundeitherat the Site Menu on the right side of the Home Pageor located at the top of individual Section pages toquicklymove around to different sections. For exam-ple, browsenot only the newly published Fall Editionof the Senior Bulletin at “Home” but archived articlesin past issues of the Senior Bulletin, our quarterlyprint newsletter. Click on Senior Bulletin in eitherthe Menu Bar at the top of “Home” or in the rightpanel and view the Table of Contents from all SeniorBulletin issues published - a very rich treasure ofcontent.

Finally, if you are a health news “junky”, the “BeInformed” subsection of “Health and Fitness” pro-vides direct links to either the Reuters HealthInformation new service giving you current mediaarticles on Senior Health and other various topics ortheNIH/National Library ofMedicine “MedlinePlus”collection of medical media.

Have younoticed the ever-changingpictures of SFSMmembers on the Home Page and various Sectionpages? We encourage our members to share theirexperiences, (includingpictures if available) or activ-ities as small articles for the website that we post in“Opportunities”, under “Community Service as a

Volunteer” subsection or other. Colleagues in theSection are very interested in learning about theworkof other members. Indeed, you may find Sectionmembers involved in similar activities or stimulateothers to get started.

The leadership of the Section for Senior Members ofthe American Academy of Pediatrics (AAP) appreci-ates yourmembership and encourages you topartic-ipate in ourwealth of activities. Be active in a Sectionwhosemembers have the knowledge andexpertise toinfluence issues at the state and national level, whilesharing the commonbondof dedication to thehealthof all children.

Remember, eligibility in the AAP Section for SeniorMembers is determined by age: 55 and up. Tell aFriend!For thosewhoare active inpediatric practice,teaching or research, and for those who have retired,membershipoffers a route toparticipate inAAPaffairsespecially at the Chapter level.Members offer adviceto residents and youngpractitioners, contribute arti-cles to our popular quarterly Senior Bulletin, workonprojects of their own interest, advocate for impor-tant matters pertaining to children and family, andexchange ideas and solutions to common practiceand retirement issues. Find out more about us andSFSM benefits in About Us. Put your years of experi-ence to use in the Section that strives to make a dif-ference for kids AND senior pediatricians.


Section for Senior Members Website Continued from Page 8 _____________________________________

A Change of Directionby DonaldW. Schiff, MD, FAAP

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lock in 2007, we may see successful legislation to increase the hourly minimum wage and an additional stepor two in the direction of ameliorating the immigration legislative impasse.

The only health-oriented bill thatmay see the light of daywould likely be a bipartisan effort to reduce or elim-inate the doughnut hole in theMedicare Part D plan that has become the problem formany, as was predicted.

The funds to accomplish this improvement inPartD could come fromachange in the original bill whichwouldremove the prohibition of negotiation byMedicare with drug companies. The savings derived by negotiationscould bring costs down and thereby help close or eliminate the doughnut hole altogether.

None of the above comments describe the level of effort and the attainment of the “political will” that isrequired to reduce the egregious number of uninsured (47 million), particularly children (9 million) in ournation.

In spite of an economy which is reputed to be doing exceptionally well, studies indicate that the cost of med-ical care andprivate health insurance is outdistancing the small rise, if any, in the incomeof the averageworker.This data helps explain the decline in health insurance coverage, and suggests that this trend away from pro-tection for American families will continue.

Our A.A.P., in coalition with dozens of other child advocacy groups, will continue to push for universal cover-age for children by a public/private approach. As the business community strives to maintain a competitiveedge by reducing all costs, including health care, it is very likely that private insurance cannot continue to bethe major source of health insurance coverage that it has been in the past.

Although the question of how to achieve universal health care insurance protection remains an unsolved rid-dle, and although a few states (Vermont and Illinois) are pioneering the move to reach this goal for children,we have been far too slow in undertaking a comprehensive review of the alternative approach to reaching ourgoal, namely health insurance coverage for all children through a type ofMedicare Part F. The Fwould remindus of our nation’s future - our children.

Please contact me at [email protected] with your thoughts and suggestions.

A Change of Direction Continued from Page 8 _________________________________________________________

Advancing Excellence in Health Care

FOR IMMEDIATE RELEASE Contact: AHRQ Public AffairsFriday, October 27, 2006 (301) 427-1863

(301) 427-1865Marjorie Tharp, AAP(2002) 347-8600

NEWDISASTER-PREPAREDNESS RESOURCE PROVIDESVALUABLE INFORMATIONFORPEDIATRICIANS ANDEMERGENCYRESPONSE PLANNERS

HHS’ Agency for Healthcare Research and Quality (AHRQ), in partnership with the American Academy ofPediatrics (AAP), today releasedPediatric Terrorism and Disaster Preparedness:A Resource for Pediatricians.The

Continued on Page 9


resource is intended to increase awareness about the unique needs of children and encourage collaborationamong pediatricians, state and local emergency response planners, health care systems, and others involvedin planning and response efforts for natural disaster and terrorism incidents.

“This resource provides critical information about howpediatricians and other physicians caring for childrencanworkwith other entities involved in public health planning,” said AHRQDirector CarolynM.Clancy,M.D.“Based on their well-established role in the community, pediatricians are in an ideal position to assist in thedevelopment and implementation of plans that address the needs of our most vulnerable citizens.”

With thepublicationof this new resource, ournation’s planning and response efforts are strengthenedbybring-ing needed focus on children in disasters, “ said HHS Assistant Secretary for Public Health EmergencyPreparednessRear AdmiralW.CraigVanderwagen,M.D.“NotOnly pediatricianswill benefit, but also state andcommunity response planners, who will be better able to address our children’s special needs in all types ofdisasters.”

Children have increased vulnerability to injury from catastrophic events because of their unique anatomic,physiologic, immunologic, and developmental characteristics. Local, state, regional, and federal emergencyresponse plans that recognize and address these differences can reduce harm and even save lives, accordingto the resource.

The publication provides an overview of the role of national, regional, and local emergency response systemsbefore, during, and after disaster and terrorism events. The pediatrician’s role in collaborating with thisinfrastructure and local emergency departments, schools, and day care facilities is highlighted. Individualchapters provide detailed information on the triage, supportive care, and referral of children affected bynatural, biological, chemical, radiological, nuclear, and blast events.

Children’s emotional and mental health needs are also described, including the treatment of post-traumaticstress disorder, depression, andbehavioral problems that often result from these incidents. In addition to adviceon integrating the information into emergency response plans, the resource also contains an extensive list ofsuggested references and a discussion of lessons learned room Hurricane Katrina.

“Pediatricians already have the knowledge to identify and manage the physical and psychological symptomschildren experience as a result of illness and trauma, “ said AAP President EileenM. Ouellette,M.D., J.D. “Thisresource gives them thenecessary tools to extend that expertise tomanagement ofwidespreador catastrophicevents.”

Development of the resource, which is available online at: http://www.ahrq.gov/research/pedprep/resource.htm, was funded by AHRQ, the Office of Public Health Emergency Preparedness, and theHealth Resources and Services Administration. AHRQ has several related resources to help clinicians, policymakers, and the public address the special needs of children in emergency situations, including the reportPediatric Anthrax: Implications for Bioterrorism Preparedness (go to: http://www.ahrq.gov/clinic/tp/pedanthtp.htm) and the videoDecontaminationofChildren:PreparednessandResponseforHospital EmergencyDepartments (for information about the video and to see a clip, go to: http://www.ahrq.gov/research/decontam.htm).

To learnmore about all AHRQ-supported research, tools, andactivities related tobioterrorismandpublic healthemergency preparedness, visit the AHRQ Web site at: http://www.ahrq.gov/browse/bioterbr.htm. For moreinformation about the American Academy of Pediatrics’ terrorism resources, visit their website at:http://www.aap.org/terrorism.

Agency for Healthcare Research andQualityU.S. Department of Health and Human Services

540 Gaither Road, Rockville, MD 20850 301-427-1364 www.ahrq.gov

New Disaster-Preparedness Resource Provides . . . Continued from Page 8 ____________________


To Our Readers:Webring to your attention an article recently published in the New England Journal ofMedicine, which dealswith Drug Safety in the United States. The article deals with the existing approval process for new pharma-ceutical products and the monitoring, evaluation and verification of safety of these products. The article is,at best, thoughtful, and at worst, frightening and alarming.

If you are concernedabout the safety ofmedications takenby youandyour lovedones, this article canbe foundon http://content.nejm.org/cgi/content/full/355/17/1753?query=TOC

Editor’s Note:The followingarticle, submittedby one of our Advocacy forChildren editors, chronicles her involvementwith otherorganizations besides the AAP. We strongly recommend that Pediatricians become involved with their local andstate medical associations. Their input is valued and needed. We would be pleased to receive the experience ofother members.

It’s All Connected!by Lucy Crain, MD, MPH, FAAP

Now that I’m a “has been” with the AAP (except for remaining active in the Senior Executive Committee andin chapter committees), I’m re-discovering how important it is for pediatricians, perhaps more than ever, tohave a “place at the table” in the broader venues of organized medicine. Although I’ve been a member of theSan Francisco Medical Society, the California Medical Association, and the American Medical Associationfor decades, I’ve always admired my colleagues who have been equally active in leadership roles in thoseorganizations, as well as in the AAP. I’m discovering since semi-retirement from practice more time for CMAand the SFMS.

I was privileged to chair the reference committee on Science and Public Health at last month’s House ofDelegates of theCaliforniaMedical Association thisOctober. Itwasnot unlike the old“AnnualChapter Forum”of theAAP, inwhichmanyof usparticipated. But, resolutions assigned toour reference committee ranged froma majority on maternal and child health to those on green chemistry and nuclear weapon bans. Of the manyresolutions considered by our committee and advised by informed testimony, we were able to achievecompromisemodificationsofmany resolutions,which should result inmore child friendlyCMApolicyon selectissues. For example: After deliberation, a slightlymodified versionof theAAPpolicy statement onCircumcisionwas accepted, quite different than that of the original resolution which proposed CMA policy be that “Thereis nomedical justification for circumcision.”Other resolutionswere also directed by informedperspectives ofother specialists, for example the information provided by sports medicine specialists regarding proposedpolicy resolutions on all terrain vehicles, so popular with our children and youth.

Of the CMA’s 40,000 physician members, only a small number are pediatricians. The CMA does much of the“heavy lifting” for the legislative agenda of the CA district of the AAP, working in close concert with our StateGovernment Affairs committee, executive director, and part-time lobbyist in the state capital. It’s not unlikethe advocacy roles played by statemedical societies across the country and certainly akin to prominent partsof theAMAagenda. In fact, one of themost effective gun safety advocacy initiatives in recentmemorywas thatof the AMA, in concert with the surgeon general, and the AAP, producing a comprehensive public awarenessandmedia campaignwhich helped to informphysicians and the public and to promote the success of federallegislation to restrict sales of assaultweapons.Withdevolutionof responsibility for gun sales and firearmsafetyas well as a host of other issues from the federal to state political arena, it may be the most important time inour professional experience to become increasingly involved in political child health advocacy. The opportu-nities are there, the need is vast, and the informed voices of senior pediatricians within the broader realm oforganized medicine is essential.

Thank you to the section forchoosingme, NewYork Chapter 3for nominating me and all thosewho have collaborated with meover the years in so many pro-grams and projects. There aremany I could mention but thereis onepersonmore thananyotherwho ledand supportedmyefforts-Dr. Lewis Fraad, late professor ofpediatrics at Albert EinsteinCollege of Medicine and JacobiMedical Center.

I’ve been asked to say a fewwordsabout some of my work as anadvocate, how I got started andwhat I’ve learned along the way.

To begin with, I’d like to say Ibelieve that every pediatrician inonewayor another is a child advo-cate, just by virtue of being apedi-atrician. Of course, what youchoose to advocate for, and howyougoabout itwill usually dependon a combination of circum-stances, alongwith your ownper-sonal qualities and experience. Italso helps to have a few heroesand role models and at this pointI’d like to mention three of mine:Eleanor Roosevelt, the icon of mychildhood and youth; LeonaBaumgartner, the pediatricianwho became the NYC Com-missioner of Health; andJosephine Baker, the physicianwho was the first to establishmaternal andchildhealth servicesin NYC almost 100 years ago.These became a model for theUnited States.

For most of us, advocacy begins,as it did for me, when youencounter a situation that con-cerns and disturbs you. In mycase, as a medical student andhouse officer, I was troubled toobserve that our medical centeroperatedwith twoclasses of care –one for poor and uninsured fami-lies in the clinics and one for the

insured middleclass in privateoffices. It was notunusual to hearthe clinic childrenand families re-ferred to as“teach-ingmaterial” or forattendings to tellus how we couldexpect to practicein the “real world”after residency – asif the people wewere taking care ofthen were some-how less real. Weall know the story: they were toldto arrive at the beginning of theclinic session, first come firstserved, waiting on the hardbenches, sometimes for hours,until their name was called, sel-domseeing the samedoctor twice,noone to call after hours, oftennoaccess to specialists, needing torely on drug company samplesbecause they couldn’t afford theprescriptions and so on and on.

Now that was in the nineteen-fifties, and it was just the waythings were. Change would even-tually come, although it wouldtake years to arrive. But finally theday did come in the 1960’s whenthe old systemstarted to giveway.The so-called “war on poverty”began–Medicaid,Medicare,HeadStart, WIC, Title V Children andYouth Projects and the OEONeighborhood Health Centers allappeared in the land.

Iwas fortunate enough tohave thechance to help design and thendirect one of those children andyouthprojects.You canbe surewebuilt in all the amenities andresources that might have beenfound in a private group practice,as well as an orientation to thecommunity in which we werelocated.Wedidn’t call the projects

“medical homes” at the time, butin all but name that’s what theywere.

It goes without saying that webelieved deeply in what we weredoing and that brings me to theadvocacy part of the story. For thefirst few years, our project fundswere adequate and all went well.Bet as Vietnam dragged on, thechoice in Washington becamegunsorbutter, and tonoone’s sur-prise, guns came first, and thebudget cuts for health andpovertyprograms began.

The fight topreserveourprogramstook us to legislators’ offices athome and in Albany andWashington. At first we learnedour advocacy on the job, so tospeak, but as timewentonand theproblemsdidn’t goaway,we foundallies, learned from those withmore experience and becamemore effective. Here I’d especiallylike to acknowledge the tremen-dous value of the Washingtonoffice of the Academy and also ofthe National Association ofCommunity Health Center. Thestaff of these organizations aretrue professionals and they didthenand still doawonderful joboftraining us foot soldiers out in the


Senior Child Advocacy Award, October 9, 2006Remarks by Katherine S. Lobach, MD, FAAP

Continued on Page 12

grass roots. We in turn could gohome and mobilize our healthcenter families to support theprograms and we used that tacticmore than once. The receptionareas had sample letters andpetitions to sign. Local electedofficials were invited to tour thecenters and thanked them fortheir support and of course theadvocacydidn’t stop there.Wehadto generate support within oursponsoring institutions and inall the external agencies wedepended on. Sometimes wewould appeal to their conscienceand sometimes to their self-interest.

Although much of the time wewere successful, as the yearswent by the C&Y projects eventu-ally changed focus and narrowedtheir scope. The communityhealth centers, however, havegrown and thrived. Today theyare stronger than ever, and haveeven found favor in the currentadministration.

Through all this period, and evenlong before that, our advancedAmerican Society, that can givesome kind of education to all itschildren andprovide for all its eld-erly, had never found a way toguarantee health insurance for itsentire population. When I was inthe eighth grade (back in the darkages) I wrote one of my first essayassignments on Senator RobertWagner’s original 1939 proposalfor universal health insurance.This also became my first advo-cacy failure, for aswe knowall toowell, that legislationnever passed.In those days I didn’t even know Iwanted tobe adoctorwhen I grewup,but somethingmusthavebeenimprinted in theprefrontal cortexbecause as the decades rolled by,my belief in the necessity for uni-versal coverage has neverwavered. In fact one of my majorcommitments in retirement hasbeen to intensify my long-term

advocacy for single-payernationalhealth insurance or if you prefer“Medicare for all”.

There aremanyways to advocate,and as I said at the outset,we eachchoose the ones that suit us best.My preference has been to workin and through existing organiza-tions, both general and profes-sional. For instance as a memberof the Women’s City Club of NewYork, I offered a position paper onsinglepayernational health insur-ance and was able to persuadetheir health committee andboardof directors to endorse it and pro-mote it through their conferenceseries and government contacts.

For a pediatrician advocate how-ever, thepreeminent organizationto be associated with is our ownAcademy of Pediatrics. As we allknow, the academy has been inthe forefront in advocating forchildren’s coverage. The passageof SCHIP was a victory, but onethatwas incomplete, and it is grat-ifying thatAAPhasmaintained theposition it will not be satisfieduntil every last child in the U.S. isadequately insured. Up to a pointI have been pleased to supportthis positionand toaccept that theAcademymustprioritize its effortsand use its resources for issuesdirectly affecting children. Butwehave begun to see that the incre-mental approach touniversal cov-erage is falling short. It even tendsto add to the expense and compli-cations of our health care system.

Now I believe the time has comefor the Academy to reconsider aposture that promotes the insur-anceneedsof childrenbut ignoresthe situation of the families andcommunities where they live. Iwas helped to reach the conclu-sion after a review of two publica-tions from the institute ofmedicine. The first, with the titleHealth Insurance is a FamilyMatter describes the many ways

that the poor health of uninsuredparents can directly affect thehealth of children – difficulty tak-ing them to the doctor, gettingthem immunized, caring for ill-nesses, ect. The second publica-tion entitled A Shared Destiny:Community Effects of Uninsureddescribes how communities thathave large numbers of uninsuredpeople lose local providers, terti-ary care services such as NICU’sand traumaunits, ect. to the greatdisadvantage of communitymembers, regardless of their age.

As a grass roots advocate, I haveintroduced a resolution throughmy chapter (NY3) and district (II)that calls for theAcademy tobeginto promote universal coverage forall Americans. The resolution willbepresented at the annual leader-ship forum next spring. I’d like toread you the “resolved”:

TheAcademy recast andenlargeupon its child health insuranceadvocacy to call for universalcoverage for all Americans by

• revising its policy statementsin regard to children’s healthinsurance

• supporting relevant federaland state legislation for uni-versal coverage

• developing appropriateinformational materials forthe membership, press andpublic

• including this component inall other aspects of its advo-cacy for expanded healthinsurance coverage.

I hope this sectionmight considerendorsing it.

Of course the organization withthe most direct commitment touniversal coverage is “Physiciansfor a National Health Program”where there are numerous oppor-tunities for advocacy. I have a few


Senior Child Advocacy Award - October 9, 2006 Continued from Page 11 ______________________



brochures here today for anyonewho’s interested.

It will soon be three quarters of acentury that we’ve been waitingfor our health insurance situationto catch up with the rest of thedeveloped world. Should we bediscouraged?Not if you accept, asI do, that an advocate’s work isnever done. Or, to put it anotherway, it’s not thedestination, it’s thejourney.We’ll never reach utopia,which is only a state of mind any-way, but along thewaywe stillmay

be able to make some things bet-ter in our imperfect world.

Letme leave youwith one closingthought. The section criteria forthis award emphasizes that it isimportant for the candidates’advocacy activities to be outsidethe scopeof their regular position.In the years when I was gainfullyemployed, itwasmygood fortunethat my regular responsibilitiesallowed considerable latitude foradvocacy and I took full advantage

of it. One resultwas that Iwas abletomake a seamless transition intoretirementwhere I could domoreof the same.Needless to say,whenretirement is your “regular posi-tion”, nothing is outside its scope.I’m sure there are many in thisroomwhowill joinme in that sen-timent. I’m proud to have beensingled out today, but I know I’monly one among the many, in mygeneration andbeyond,whoeachin their ownway, are continuing topromote the cause of children.


2006 Annual Leadership Forum

TITLE: Health Insurance for All Americans

SUBMITTED BY: District II

DATE: March 5, 2006

DISPOSITION:

Whereas, The American Academy of Pediatrics is committed to promoting the health and wellbeing of children, and recognizes that children need to live in healthy families andhealthy communities and

Whereas, At least 20% of families with children have one or more uninsured member and thehealth of one family member, especially a parent, affects the health of the others,including the well-being of children, and

Whereas, Parentswith health insurance aremore likely to enroll their children in insurancepro-grams, andwhenparents usehealth care, their children aremore likely touse it aswell,and

Whereas, Over 45,000,000 Americans lack health insurance, and health care services and theeconomy of an entire community are adversely affectedwhen it has large numbers ofuninsured people, and

Whereas, The Academyhas long advocated for health insurance coverage for all American chil-dren, therefore be it

RESOLVED: the Academy recast and enlarge upon its child health insurance advocacy to call foruniversal coverage for all Americans by

• revising its policy statements in regard to children’s health insurance• supporting relevant federal and state legislation for universal coverage

• developing appropriate informational materials for the membership, press andpublic

• including this component in all other aspects of its advocacy for expanded healthinsurance coverage.


AUTHOR/CONTACT PERSON: Katherine S. Lobach, MD

Telephone: 718-920-6497FAX: 718-920-5289

Email: [email protected]

BACKGROUND INFORMATION:

In its publication Health Insurance is a Family Matter (The National Academies Press, 2002) the Committeeon the Consequences of Uninsurance of the Institute of Medicine of the National Academy of Science hasdescribed themanyways inwhich thepresence or absence of health insurance can affect a family and its indi-vidual members, for instance uninsured parents have poorer health and parents in poor health may be lesslikely to take their children to the doctor, to get them immunized on schedule, or be able to care for their ill-nesses. Stressed or depressed parents are less likely to read to their children, maintain their daily routines orprovide social and emotional support. (pp. 97-98)

In the companionpublicationASharedDestiny:CommunityEffects ofUninsurance, the IOMCommittee foundthat communities with large numbers of uninsured people were more likely to have higher use of emergencyrooms with resultant reduced access for all; fewer hospital specialty services such as burn and trauma units,PICUs, NICUs, and psychiatric ERs; loss of local providers; higher local taxes to subsidize care; and diversionof health department resources from population health to personal health services. (p. 5).

The Academy now supports S.1303 Medikids, which amends the Social Security Act to add a new title XXII toprovide for health insurance coverage for all childrenbornafterDecember 31, 2006, in aprogrammodeled afterMedicare that also includes prescription drugs and reduced cost –sharing for low-income children.



In our series on Digital Photography, we are covering the following:

For optimum results one needs the 8 Rights:

• Article 1 (Last issue of the Senior Bulletin and at www.aap.org/seniors )

• Right Plan

• Right camera (Note – see Consumer Reports, November 2006 for a recent review and ratings of digitalcameras.)

• Right technique

• In this Article, we will cover:

• Right PC

• Right Software to: i) organize your photos, and ii) edit them

• Right on-line photo-editing and storage

• Finally, in Article 3 we will cover:

• Right photo printing and on-line photo-sharing strategies

• Right Place to Buy

Let’s go!

Right PCHardwareSelecting PC equipment to use with your digital camera is straight-forward and you probably own adequate

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

(SectionWebmaster)


PCequipmentnow. Formoredetails, I refer you to aprevious SeniorBulletin article on this topic (seeComputerSavvy for Seniors, June 2005 in Senior Bulletin Archive at www.aap.org/seniors). Here is a list of basic require-ments:PC

• Fast CPU, especially if you plan to do a lot of photo-editing.

• Large hard drive – 80 GB or larger to store photos.

• CD/DVD writer – to enable one to easily archive photos; consider double density DVD writer for morecapacity. ACD-R can typically store 650MB (insert approx #photos)worth of photos andaDVD-Rcan store4GB of photos.

• External hard drive – option to assure safe storage of archived photos “off-site” in case your PC crashes.

• Premium video card to get best screen colors.

• Large monitor – 17” or larger with low dpi (dots per inch) providing high resolution and easy viewing.

• Built-in multi-card memory reader: to transfer pictures, these devices enable you to insert your memorycard directly into the PC for automatic transfer of pictures in lieu of connecting your camera to your PC.

• Comfortable, ergonomic chair – you will be spending a good deal of time at the PC

• Ergonomic arm rests – it is not too late to get repetitive stress disorder

Right PC Software for photo-editing and organizing your digital photosThe fun part of digital photography comes after you transfer the images to your PC, and use software that canorganize, store, find, edit and share these images.

The basic elements that you are looking for in photo-editing software are:

• Red-eye removal

• Photo retouch

• Auto-fix functions (a one-touch bundle of “quick-fixes” for the novice)

• Rotate and Crop - to remove cluttered surroundings that draw attention away from your subject.

• Color balance – be able to play and experiment with colors.With image editing you can make the leavespurple, change the entire photo to black and white, and add a sepia effect - almost anything you want. Agood photo editing programwill have automatic color balance options to adjust color defects in your pic-tures.

• Special effects, e.g. blurring, or sepia tones

• Resizing - If you’re emailing a picture to a friend, you’ll want to resize and compress the picture down to amuch smaller size to ease the challenge of emailing the picture. If you’re printing the photo on a greetingcard, you can scale down the image to the size of a 4x6 print.

Many photo-editing programs and books for the novice and expert are reviewed at About.com. This articlefocuses on the following popular software that is widely recommended for beginners.LLeett’’ss ssttaarrtt wwiitthh PPiiccaassaa aatt hhttttpp::////ppiiccaassaa..ggooooggllee..ccoomm// .. PPiiccaassaa iiss aa ffrreeee ssooffttwwaarree ddoowwnnllooaadd ffrroomm GGooooggllee..

Picasa automatically locates all your pictures (even ones you forgot you had) and sorts them into visual albumsorganized by date with folder names you will recognize each time you open the program. You can drag and droppictures to arrange your albums and make labels to create new groups. Picasa makes sure your pictures arealways organized. Picasa also makes advanced editing simple by putting one-click fixes and powerful effectsat your fingertips. And Picasa makes it a snap to share your pictures – you can email, print photos home, makegift CDs, instantly share via Hello™, and even post pictures on your own blog. Picasa will probably be fine forcasual digital shooters who just want to find all their pictures, sort them into albums, do quick edits, and sharewith friends and family. Pros and more serious photographers should look elsewhere.

Other low cost and popular software exists. Some samples are below:

Adobe Photoshop Elements 5.0 –– my personal favorite. Part of the famous Photoshop family of products,Elements 5.0 has all the tools novices need to organize, edit and share digital photos. Besides standard image-

Senior Bulletin - AAP Section for Senior Members - Winter 2007 15


Digital Photography – Primer and Resource Guide Continued from Page 14 ____________________

16 Senior Bulletin - AAP Section for Senior Members - Winter 2007

editing options, there are also photo enhancement tools like red-eye removal and color cast adjustment. It hasmore power than most novices will use. Photoshop Elements can also be purchased as a bundle with AdobePremiere Elements 3.0 that enables the user to create customized DVD’s from Photoshop 5.0 slide shows thatcan be viewed on the TV.

Microsoft Digital Image Suite –– contains all the features you need to edit and organize, and quickly touch upyour photos with a wide range of Auto fix tools. You can also turn your photos into video and burn them intoa DVD for playback on the TV. On the whole, this is a great photo editor with a wide range of user-friendly features.

Ulead Photo Impact -- One of the best-selling photo editors out there is Ulead PhotoImpact. Ulead Systemsmakes great software, and this program is no exception. With its easy-to-use wizards, you can easily create graphics, edit photos and add special effects. I highly recommended it for the beginner digital photographyenthusiast.

Roxio PhotoSuite 8 -- The final tool in this list of top beginner photo editors is Roxio PhotoSuite. This softwareis very affordable and comes with great extras like templates, fun effects and project ideas. It’s wonderful forthe beginner who wants a simple-to-use and fuss-free photo editor.

Many sites exist to review photo-editing software of varying types e.g. (hhttttpp::////ggrraapphhiiccssssoofftt..aabboouutt..ccoomm//oodd//ffiinnddssooffttwwaarree//). Also view (hhttttpp::////ggrraapphhiiccssssoofftt..aabboouutt..ccoomm//ccss//iimmaaggeeeeddiittiinngg//ttpp//). Here, one can link to the following reviews:

• Top 5 Beginner Photo Editors for Windows -

• Top 8 Free Photo Editors for Windows

• Top 5 Advanced Photo Editors for Windows

• Top 4 Beginner Photo Editors for Macintosh – Apple is generally lauded for its built-in image editing software that is excellent for all users.

Right Way to Store and Share Your PhotosEffective storage of your digital photos involves memory cards for your camera, hard disk storage on your PC,disposable archive media e.g. CD or DVD, and on-line secure storage. Let’s briefly look at all options:

Using Memory Cards

Digital photography can lead to lower costs with use over time since one can choose to selectively print certain photos rather than printing an entire roll. In lieu of printing, one can take and store all photos electron-ically and display them with a variety of devices. One way to ‘store’ your images is to leave them all in your camera’s memory card. Unfortunately, this is not a very good idea. Most cameras come with 0 – 16 MB of built-in memory with the option to add “memory cards”. Although the cost of memory cards continues to drop andmemory cards are now as large as 1 GB, you will periodically need to clear out space in your camera’s memorycard to take more photos. Buy a minimum of 256MB memory card if your camera is 3-4 MB pixel resolutionor below: if >4 mega pixels, purchase at least a 512MB card. Consider carrying a spare if you travel often.

Using Hard Drives

After you import your images from your camera to your computer (usually via a USB cable), you will store thosepictures stored in your hard drive. Hard drives are also pretty cheap these days. For $100, you can get a branded160 GB hard disk (that’s enough to store about 32,000 pictures at 5 mega pixel resolution each!). However, evenwith “reliable” hard drives there is the uncertainty of the data safety due to hard disk crashes and virus infections. To avoid the loss of a lifetime of family memories, use CDs, DVDs, external hard drives or even web-servers as your back-up option in lieu of printing each picture.

Using CDs and DVDs

To use CDs or DVDs, you need a CD burner or a DVD burner, along with CD or DVD burning software to burnthose photos. DVD’s can save about 4 GB of pictures in contrast to 700 MB for a CD, almost 6X as much data.

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



If one sets each DVD to be a multi-session DVD, one can use it for multiple sessions before the space isexhausted. Today’s PC usually has CD-ROM/DVD readers and writers built-in. If not, they can be obtained atvery reasonable cost.

Storing Your Photos Online

Another good option is to store your photos online. Some techies claim that CD-Rs can become unreadablein as little as 2 years, even if stored properly. The inexpensive CD-Rs are especially subject to becoming unread-able. CD-R’s are also sensitive to heat, moisture, and light. Another common issue is that most people keep theirbackup CD-Rs in their home – usually in or on the same desk as their PC. In the event of theft, fire, flood, orother unpredicted disaster, the backup media is likely to be destroyed as well – and you will have lost every-thing. The safest way to preserve your precious photos is to back up your pictures to media that can be storedat a separate location.

How about combining storage and sharing of digital photos? Emailing digital pictures as attachments can bogdown email systems. It often is not practical. Consider using either use online photo sharing sites (e.g. Snugmug– PC Magazine’s Editor’s Choice for online photo sharing, - a flat fee pay site ) or upload them to your own web-site often provided by your ISP (Internet Service Provider). This is a great way to share your photos with friendsand family without the hassles of emailing photos. Some of the photo sharing sites (most have free trials) allowyou to specify logon passwords for specific users to come online and view private photos, and they often con-tain a choice of templates for displaying your pictures and photo-editing capabilities. Additionally, there maybe a selection of presentation styles including thumbnail, thumbnails plus images, slide shows, and journalswhere you can include text. Google “photo storage sites” for more information to find what’s right for you.

In our next and last article for this series, we will discuss Photo Printing and Digital Camera Purchasing strate-gies. For more information, visit our new “Technology for Seniors” subsection in “Living Well” atwww.aap.org/seniors and click on Digital Photography.

This review is written by Avrum L. Katcher, MD, FAAP

Marcus Tullius Cicero, the first of two sons of awealthy family, was born in 106 BCE. After educationin philosophy and other academic subjects, he fol-lowed a career as an attorney, rising to great distinc-tion in Rome in the late days of the Republic. Cicerowas immersed in political affairs throughout hiscareer; he made many enemies and also many friendsof distinction. He rose to high rank, married well, andwas regarded as the most distinguished orator of thecountry. His profile in the Oxford Classical Dictionaryoccupies four and a half two-column densely writtenpages.

Imperium, by Robert Harris, is a fascinating novel, abiography, and also a political encyclopedia, full ofexcellent first rate aphorisms, and highly relevant tothe politics of today in our country and abroad. It iswritten first person singular, as by Tiro, a slave and theconfidential secretary of Cicero. As seems to be trueof many of the characters in the book, Tiro was a realperson, also in the Oxford, who has come down in his-tory as the inventor of shorthand, because he was

required to serve as a court stenographer, to takedown Cicero’s speeches as they were given, and thenreproduce them accurately.

But the fun in this story, as told by Tiro, is in the manyquotes from Cicero. As Tiro says, “If [Cicero] does notalways emerge as a paragon of virtue, well, so be it.Power brings a man many luxuries, but a clean pair ofhands is seldom among them.” Or, on pages 117-119,the description of how Romans held an election, bysetting up tents on the Field of Mars; voters went tothe tent of their choice to cast a vote. As a result, Tironotes, “There are few forces in politics harder to resistthan a feeling that something is inevitable, forhumans move as a flock, and will always rush likesheep toward the safety of a winner.” Or, as Cicerosaid, of someone he regarded as an innocent, “Thetrouble with Lucius is that he thinks politics is a fightfor justice. Politics is a profession.” And similarly,later, “The journey to the top in politics often confinesa man with some uncongenial fellow passengers.” Or,relative to the relationship between Cicero andPompey, his mentor and protector, “He had discov-

Imperiumby Robert Harris

Simon & Schuster, New York, 2006


Digital Photography – Primer and Resource Guide Continued from Page 16____________________


ered that there are few blessings in life more onerousthan the friendship of a great man.”

The narrator takes us through a series of legal casesand political conflicts, which often reveal that for allhis reputation as a defender of the right, Cicero wasnot beyond taking on an odorous client, or politicalcause. Tiro points out, that “[Cicero] was not merelytrying, as a cynical and second-rate advocate mighthave done, to devise some clever tactic in order to out-wit the prosecution. He was trying to find somethingto believe in. That was the core of his genius, both asan advocate and as a statesman. ‘What convinces isconviction,’ he used to say, ‘You must believe the argu-ment you are advancing, otherwise you are lost’” Hereis one comment that may not apply to the politics oftoday, where cynicism is the hallmark both of theadvocate and the pol.

At that time, Rome was being chastised by a series ofpirate attacks on her shipping. City fathers met toconsider how to handle it. A variety of methods hadbeen ineffective. The then leader, Pompey (the sameman who later lost the civil war to Julius Caesar),commented in a way that today resonates in consid-ering our plague of terrorists, “I do not believe weshould negotiate with such people, as it will onlyencourage them in their criminal acts.” Perhaps wemight learn, as Cicero wrote once, “To be ignorant ofwhat occurred before you were born is to remainalways a child.”

The reader of Imperium could go on and on, identi-fying these familiar comments. It is probably moreuseful for this review to point out four types of speechwhich seem to have characterized the politicos ofRome, and which are often heard from those of ourday. Specifically, I refer to humbug, bullshit, lies andsincerity. The best reference for the structure of theseconcepts is a very small book—67 pages, each about20% of the verbiage of a typical text page—titled OnBullshit, by Harry G. Frankfurt, Professor ofPhilosophy Emeritus at Princeton University, pub-lished by the Princeton Press. Frankfurt makes plainthat humbug is an utterance or action by which thespeaker endeavors to create a fake or false impressionof himself. Humbug falls short of lying, in that a per-son who lies knows the truth—it is not possible to tella lie if one does not know the truth—and deliberatelyfalsifies; a person who utters humbug is describingsomething without regard for the truth but none theless intended to induce an opinion in the mind of thelistener. A person who utters bullshit may not deceivethe listener, nor even intend to do so. Rather in a cer-tain way he misrepresents what he is up to. In contrastto a liar, this person may not know the truth nor careabout it.

Finally Frankfurt holds strongly to the belief that ourpersonal beliefs and natures are elusively insubstan-tial and less stable and less inherent than the naturesof other things. Therefore, he feels that the very con-cept of sincerity (and, one would judge in particularthe political use of the term) is bullshit.

Av, Here with a comment

I enjoyed your evocative review of “Imperium”,and was intrigued by the space you devoted tothe four kinds of the “bad” rhetoric, i.e., the typeadvancing falsehood, or aimed at an ulteriormotive, that seems so prevalent on both sides ofthe political aisle today.

Historically, rhetoric’s reputation, as a disci-pline—it was part of the original trivium alongwith grammar and dialectic—has vacillatedbetween good and bad, i.e., between truth andfalsehood; we seem currently to be in a badperiod in the U.S.; witness the connotation ofthe phrase, “That’s just rhetoric!”

Your review of ‘Imperium” suggests to me a con-trast between what the Roman politician,Cicero, believed philosophically and rhetori-cally vs. the beliefs of America’s politicianstoday. Although Cicero had to contend in theRoman senate of the time with a great deal of“bad” rhetoric.

Cicero championed republicanism, especially incontrast to the rule of an aristocratic class, or ofa dictator. The word republican is derived froma lost work of his, De Republica (On PublicAffairs). Cicero’s republican ideals—anti-democratic in the Athenian sense, as well asanti-authoritarian—are still current today.Rhetorically, he was interested in the power ofdeeply held conviction as a rhetorical tool andimbued with the idea of duties, officia, “whatwe owe to others based on our specific relation-ship to them.” Cicero’s aim was to acquaintRoman public officials with the rhetoric andmoral philosophy of the 5th c. Greek philoso-phers and orators, such as Socrates, Plato, andAristotle, and to advance their theories in thesedisciplines. His ideas were essential, long-lived,and of overwhelming importance in the educa-tion of 18th c. Americans—witness the rever-ence in which they were held by the foundingfathers and their widespread incorporation intoour Declaration of Independence andConstitution.

Imperium Continued from Page 17 __________________________________________________________________________


After a doctor sees a patient, he or she often pre-scribes medications. But what if such a doctor alsowants to direct a patient to up-to-date, reliable, con-sumer-friendly information about a genetic condi-tion, or an explanation of the basics of geneticscience? Under a new program launched today, prac-titioners are being encouraged to refer their patients

to Genetics Home Reference, a free, patient-friendlyWeb site of the National Institutes of Health (NIH), at.

Under this program, doctors can request free“Information Rx” pads, which will enable them to


Currently, Cicero’s precepts seem to be on thewane, and those of the earlier 5th c. GreeksSophists to be advancing. Your detailing of fourtypes of speech—humbug, bullshit, lies and sin-cerity— characteristic of Roman politicians,against which Cicero railed, and which giverhetoric a bad name seem ubiquitous today.The Sophists, starting with Gorgias (483-316),from Leontine, Sicily, “the father of all Sophists”,had themselves corrupted the rhetoric of Corax,who, early in the 5th c. BC, devised the very firstart of rhetoric. It was, nobly, for use by the peo-ple of Syracuse to facilitate their regaining inthe courts there their land and possessions thathad been confiscated by Thrasyulus, the tyrantwho had seized them.

The Sophists believed that there were no absolutes,not in morality or anything else, but that all was rel-ative and dependent on the culture of a time andplace—a matter of convention. Morality orimmorality should be judged in cultural context:“Man is the measure of all things.” They taught thatevery argument has a counter-argument, and thatargument, rhetoric, is judged successful not by itseffectiveness in promoting the truth, but by how

persuasive it is to others. The Sophists were so unat-tached to any absolute truths that they taught theirstudents to be resourceful enough to successfullytake either side of any argument on request, and toargue strongly, but without, of course, conviction.Are their ideas so off the mark for some of us today?

But, what goes around comes around, so shouldyou be discouraged, just hold tight and wait...

Yours,Jim

I ended my email comments, actually, withHeraclitus's concept, that things change, and since hesaid everything changes, philosophical concepts areincluded: "Everything flows (changes) and nothing isleft (unchanged)." The hodiernal global economy weare experiencing exemplifies the centrality of change,and, banausically, the need and importance of ourwork force changing in order to cope with increasinginternational competition. That Heraclitus realizedchange was overarching as long ago as the 6th c. BCis rather humbling. In spite of the obvious currentneed for work force change, for individuals, imple-menting change is most difficult.

Imperium Continued from Page 18 __________________________________________________________________________

Editor’s Note:I could not define two words in Dr. Reynolds’ comment nor find them in my dictionary. The answer was providedby Dr. Reynolds as follows:

hodiernal - an adjective pertaining to today.

banausic - an adjective pertaining to a mechanic or mechanic’s workshop meaning commonplace, unadorned,pedestrian.

From Mrs. Byrne’s Dictionary of Unusual, Obscure and Preposterous Words, Josepha Heifetz Byrne, Citadel Pressand Unusual books 1974, republished under the title Word Lover’s Dictionary, MJF, New York 1994. Mrs. Byrnesis Jascha Heifetz daughter.

National Institutes of Health launches“Health Information RX Program”

on Newborn Screening and Related Genetic DisordersU.S. Department of Health and Human Services

National Institutes of Health

Physicians Can Direct Patients to Consumer-Friendly Online Information with the NIH Seal of Approval


write “prescriptions,” pointing patients to theGenetics Home Reference site and to the wealth ofinformation it contains. Obstetricians can direct theirpatients to the site’s explanation of newborn screen-ing, so expectant mothers will better understand whythis testing will be important for their baby.

Pediatricians and family physicians who see newmoms and dads often provide good advice on new-born or child care concerns. If there happens to be aproblem detected in a screening, where should thisdoctor direct the concerned parents for reliable, easy-to-read information at a stressful time? NIH’s GeneticsHome Reference can be an invaluable resource.

All states screen newborns for certain genetic disor-ders. These conditions are usually not apparent inthe newborn, but can cause physical problems, men-tal retardation and, in some cases, death.

Micki Gartzke, a patient advocate from Shorewood,Wisconsin, lost her 13-month-old daughter, LeAMarie to a rare genetic disorder, Krabbe disease, in1987. “As a parent, of course you want every possiblepiece of information when you find out your child issick. The Internet back then was in its infancy —resources were scattered and I did a lot of hunting andpecking to find things that would help us. It’s so grat-ifying to see a resource like Genetics Home Reference,which has collected and organized a wealth of help-ful materials into a one-stop shopping experience. Iknow that it is of great relief to parents I work withthrough Hunter’s Hope, the foundation to help fam-ilies coping with Krabbe disease, and parents aroundthe country.”

Fortunately, most babies receive a clean bill of healthwhen tested. When test results show that a baby hasa health defect, however, early diagnosis and treat-ment can make the difference between lifelong dis-abilities and optimal development.

Four of the nation’s most respected medical associa-tions, with a combined membership of over 200,000,have teamed with two NIH institutes on this ground-breaking initiative. The National Library of Medicine(NLM), the world’s largest medical library, and theNational Institute of Child Health and HumanDevelopment (NICHD), the research arm of NIH ded-icated to ensuring that every child in the U.S. is bornhealthy and grows up free from disease and disabil-ity, have entered into partnerships with the AmericanAcademy of Pediatrics (AAP), the American Academyof Family Physicians (AAFP), the American College ofObstetricians and Gynecologists (ACOG) and theAmerican College of Medical Genetics (ACMG) to

encourage physicians to point patients to first-rateonline health information in NLM’s Genetics HomeReference database.

“Part of a physician’s job is to explain illnesses, diag-noses and treatments to their patients,” says DonaldA.B. Lindberg, MD, Director of the National Library ofMedicine. “NLM’s Genetics Home Reference providesauthoritative, user-friendly, and commercial-freeinformation that doctors can use to supplementinformation provided in the office or clinic. We thinkit saves time and improves doctors’ communicationswith patients, in addition to its obvious value in help-ing keep babies healthy.”

“Physicians have always known that an informedpatient who takes an active role is a ‘better’ patient,”notes Duane Alexander, MD, Director of the NationalInstitute of Child Health and Hunan Development.“We believe that both patients and their doctors willwelcome this additional tool — good medical infor-mation — in their continuing efforts to provide goodhealth care, for newborns and for people of all ages.”

Genetics Home Reference includes over 500 topics ongenetic conditions and related genes. The site fea-tures a richly illustrated tutorial that explains thebasics of genetics, from the cellular level on up, anda glossary of genetics terms. The site is regularlyupdated by scientific staff and reviewed by externalexperts.

A similar Information Rx Project, pointing patients toNLM’s Medline Plus database , was launched in 2003. That program has beenwell received by doctors and their patients nation-wide, helping doctors direct patients to NLM’sMedline Plus database, with information on over 700health topics and many other resources.

The National Library of Medicine, the world’s largestmedical library, is a component of the NationalInstitutes of Health, an agency of the U.S. Departmentof Health and Human Services.

The National Institutes of Health (NIH) — TheNation’s Medical Research Agency — includes 27Institutes and Centers and is a component of the U.S.Department of Health and Human Services. It is theprimary federal agency for conducting and support-ing basic, clinical and translational medical research,and it investigates the causes, treatments, and curesfor both common and rare diseases. For more infor-mation about NIH and its programs, visit.


National Institutes of Health Continued from Page 20 ________________________________________________

A multifaceted, personalized intervention can signif-icantly improve the quality of life for caregivers ofpeople with dementia, new research published Nov.21, 2006, in “Annals of Internal Medicine” has found.The study, Resources for Enhancing Alzheimer’sCaregiver Health II (REACH II), is the first random-ized, controlled trial to look systematically at theeffectiveness of a multi-component caregiver inter-vention provided to ethnically diverse populations.Follow-up studies, the researchers suggest, shouldexamine how the intervention might be used in com-munities through the nation’s existing network ofhealth and aging services.

REACH II was funded by the National Institute onAging (NIA) and the National Institute of NursingResearch (NINR), both components of the NationalInstitutes of Health (NIH). The research was con-ducted at five sites nationwide — the University ofAlabama (Birmingham and Tuscaloosa), ThomasJefferson University (Philadelphia), the University ofTennessee (Memphis), the University of Miami (Fla.)and Stanford University (Palo Alto, Calif.). TheUniversity of Pittsburgh served as the coordinatingcenter, and Pittsburgh’s Richard Schulz, Ph.D., wascorresponding author for the study.

“Family members and friends provide most of thecare for millions of people with dementia who live athome, often facing challenges that can seriously com-promise their own quality of life,” notes NIA DirectorRichard J. Hodes, M.D. “REACH II tells us that a well-designed, tailored intervention can make a positive,meaningful difference in caregivers’ lives.”

“This important research demonstrates that the inter-vention can readily benefit the diverse communitiesof caretakers who provide care to individuals withAlzheimer’s disease,” adds NINR Director Dr. PatriciaA. Grady. “It also underscores the substantial cost thatcaregivers face — financially, physically, spirituallyand emotionally — and helps to illustrate why caregiving research is a priority for NINR and NIA.”

The REACH II study included 642 individuals, morethan 200 each of Hispanic, white and AfricanAmerican caregivers of persons with dementia. Thecaregivers within each ethnic/racial group were ran-domly assigned to either an intervention or a controlgroup.

Trained project staff visited the caregivers in the inter-

vention group at home nine times, talked with themduring three half-hour telephone calls, and offeredfive structured telephone support sessions. Thestrategies included information sharing, instruction,role playing, problem solving, skills training, stress-management techniques and telephone supportgroups. Those in the control group received a packetof dementia education materials and two brief“check-in” telephone calls. Spanish-language serv-ices and materials were offered to the Spanish-speak-ing caregivers in Miami, Palo Alto and Philadelphia.

Before the services began and six months later,researchers assessed caregivers’ quality of life overalland in five specific quality of life areas: depressivesymptoms, the burden of care giving (such as thelevel of stress), engagement in self-care activities(such as getting rest or seeing a doctor when needed),level of social support, and problem behaviors exhib-ited by the person with dementia. The investigatorsalso measured the prevalence of clinical depressionamong the caregivers and collected data on whetherthe care recipients had been placed in institutionsduring the six-month study period.

After six months, improvements in the caregivers’overall quality of life were significant among theHispanic and white caregivers who took part in theintervention and, while significant among AfricanAmerican spouse caregivers, were less so among non-spouse African American caregivers. Large and clin-ically important quality of life improvements werefound for 45 percent of Hispanic caregivers, 40 per-cent of white caregivers and 28 percent of AfricanAmerican caregivers in the intervention group, com-pared with 7 percent, 13 percent and 11 percentamong Hispanics, whites and African Americans,respectively, in the control group.

For Hispanics, the intervention was found to be mosteffective in reducing depressive symptoms and prob-lem behaviors of the care recipient. Among whites,the greatest impact was in the area of social support,and among African Americans, there were positiveeffects specifically in reducing the caregiver burdenand improving self-care among spouse caregivers.

The research also showed that following the program,the rate of clinical depression was significantly loweramong caregivers in the intervention group thanthose in the control group (12.6 percent and 22.7 per-



Noval Program Enhances Dementia Caregivers’ Quality of Life

by Richard Schulz, PhD

Sometimes when I’m at my health club, I wonderwhether I am doing myself any good or whether I’mjust abusing my body.

Then I came upon this headline over a feature articlein the local paper: “GERONTOLOGIST TOUTS DAILYEXERCISE AS A MAJOR DEFENSE AGAINST AGING”.This stimulated me to do some research and I foundthat there is good evidence that regular exercise pro-longs life and retards disease and disability in seniors.

When older people lose their ability to function inde-pendently it frequently doesn’t happen because ofaging. It’s more likely because of lack of activity.

Research shows that many changes attributed toaging are actually caused by disuse. Studies now sug-gest that not exercising is risky behavior.

Exercise experts often cite the Dallas Bed Rest andTraining Study. In this research project, five youngmen in their twenties were asked to spend threeweeks of their summer vacation resting in bed. At theend of the study when they got out of bed, theresearchers found significant changes including:faster heart rate, higher systolic blood pressure,reduced cardiac output, increase of body fat, andreduced muscle strength. With just three weeks of


cent, respectively). The rate of institutionalization forcare recipients was lower in the intervention groupwhen compared with the control group (4.3 percentvs. 7.2 percent), but this difference was not statisticallysignificant.

The researchers also collected data on how study par-ticipants viewed the intervention. Caregivers in theintervention group reported that taking part in theprogram helped them feel more confident in workingwith the care recipient, made life easier for them,improved their ability to care for the person withdementia, improved the care recipient’s life, andhelped them keep the patient at home. Many mem-bers of the control group also said they benefited“some” or “a great deal” from participating in thestudy, suggesting that even minimal support andattention can help caregivers.

“REACH II was a carefully constructed, controlledstudy involving a diverse group of caregivers at fivesites across the country. We are excited to demon-strate that the intervention really helps family mem-bers caring for people with Alzheimer’s,” says SidneyM. Stahl, Ph.D., chief of the Individual BehavioralProcesses Branch within the NIA’s Behavioral andSocial Research Program. Based on the current study,the REACH program looks promising for widespreadcommunity use, especially if the outcomes are repli-cated by other organizations and the program isfound to be cost-effective when compared with alter-natives, Stahl adds.

The study was developed based on the findings ofthe earlier REACH I study, which tested multiple inter-ventions at six sites in the United States to identify the

most promising approaches to decrease caregiverburden and depression.

To reach the corresponding author, Richard Schulz,Ph.D., professor of psychiatry, School of Medicine,University of Pittsburgh, contact Jocelyn Uhl Duffy at412-647-3555 or .

The NIA leads the federal effort supporting and con-ducting research on aging and the medical, socialand behavioral issues of older people, includingAlzheimer’s disease and age-related cognitive decline.For information on dementia and aging, please visitthe NIA’s Alzheimer’s Disease Education and Referral(ADEAR) Center at , or call 1-800-438-4380. For more generalinformation on research and aging, go to.

The primary mission of the NINR is to support clini-cal and basic research to establish a scientific basis forthe care of individuals across the life span. For addi-tional information, visit the NINR Web site at.

The National Institutes of Health (NIH)

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