March 23, 2011

The Kids Are All Right?

Don Shifrin, M.D. FAAP

Now that Amy Chua has tacked her parenting mantra to the church door, are we surprised the autobiographical view of raising her two daughters has culminated in her becoming more of a controversial cultural lightning rod than Sarah Palin?

I cannot imagine she would be blind to this, as any description of extremism sets its author up as a target. Thus, I feel marginally forthright in adding my modest commentary of the descriptive paradigms of her tome, which some are referring to as the definitive manual on überparenting. T. Berry Brazelton this isn't.

The book reads as a how-to manual for parents who want to help -- no -- make their kids succeed. At the very least, you have to admire Chua's veracity in penning this exposé. Her "Battle Hymn" reveals in graphic terms how she tirelessly compelled her girls to never be losers. The book's descriptive passages struck me as the parenting equivalent of Vince Lombardi's, “Winning isn't everything. It's the only thing."

She has opened up the floodgates of professional and parental scorn, ridicule, and vitriol. I have always acceded to the notion that the word, parent, is more verb than a noun, connoting what we do, not who we are. But, I would be reluctant to highlight Chua as the parent-model others would want or need to emulate.

A simplistic view of parental responsibility would include physical safety, emotional security, fiscal responsibility, as well as social, cultural, community, religious, academic, political, and moral role modeling. Most would agree to throw in more than a little unconditional love as well.

All parents, myself included, have, on more than one occasion, fallen way short of the mark. Granted, our children are subject to the whim and whimsy of quirky parenting styles. (I will confess to being a stickler for politeness and manners.) As a pediatrician, I have seen many parents step right across the egregious over-parenting line, where, it appears that the "Tiger Mother" has firmly planted herself, at least, until she was forced to realign when her youngest 'rebelled'.

The descriptions of her children's subsequent successes as a result of her parenting should not activate or relieve any of our collective parenting angst. Product development takes longer than 18 years. I would caution us to continuously monitor results, while consciously readjusting our outcome parameters. And, inadvertently, that maybe the best lesson from Ms. Chua's book.
Parenting is a challenge; it is not a war. It's a marathon, not a sprint. Children are human hard drives, with back-up programming that fortunately, or unfortunately, will last a lot longer than their parents.

So, I, for one, welcome her commentary, certainly not for her definition of success, but to motivate all of us to reexamine our parenting roles. Getting past all the obvious data points, the take away message is, perhaps, to redirect in a kinder, gentler way the burning passion all parents share: to balance nature and nurture in creating a childhood -- not an apprenticeship.
So, for all you Tiger Mothers (and Tiger Fathers) out there, a final note. Even with the best of intentions, parents that are rarely satisfied with their children, raise children that are rarely satisfied with themselves.

March 10, 2011

The Injustice of Immunization Interviews

Wendy Sue Swanson, MD, MBE, FAAP
Author, Seattle Mama Doc Blog

When Dr. Wakefield interviewed on "Good Morning America" in January, an injustice occurred. It occurred inadvertently, I suspect, yet this injustice happens frequently in the world of pediatric health messaging. The stories the media covers, clearly change how we think and feel in regards to protecting and parenting our children. Their work to inform and educate, just like that of physicians and nurses, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr. Andrew Wakefield with a 2-minute introduction by Dr. Richard Besser, a pediatrician and medical editor/correspondent. Yet, when the interview was over, we are left remembering the myth.

Dr. Wakefield interviewed with George Stephanopoulos who later labeled the interview "combative." Mr. Stephanopoulos was given a terribly difficult task. He was interviewing Wakefield on one of the most complex, emotional and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefield's purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research refuting his work, Mr. Stephanopoulos had to defend science. Alone. Although Stephanopoulos isn't gaining popularity (read the comments) with the anti-vaccine crowd, the 7-minute interview simply stirs the pot. I trust it had huge viewership. I worry that this is why it was done.

We need to discuss immunizations in the context in which decisions for vaccinating are made. In 2011, interviewing Wakefield alone on national TV doesn’t help. Wakefield’s myth and legacy regain power with each second he's on the news. We need to acknowledge the fear that has arrived on parents' doorsteps because of Wakefield's work. We needed a general pediatrician, a parent of immunized children, and a vaccine expert in the interview too. We need voices of reason. We need to frame issues surrounding immunizations truthfully. Although Wakefield's original study only applied to the MMR he has fueled millions of parents to distrust all vaccines. Dr. Wakefield claims that he doesn’t want others to stop immunizing against pertussis, but this point is easily lost. Stephanopoulos needed to make that point clear. In the office, when parents who are hesitant about immunizations talk about their worry, they point to Wakefield's claim.

Dr. Besser's introduction included micro-interviews (sound-bites) from Dr. Paul Offit and Seth Mnookin (book author of The Panic Virus). Neither was given the time and exposure Wakefield received. What we learned from Offit and Mnookin about immunizations could easily be forgotten by the time the interview with Wakefield was over.

Interviews, such as this one, leave parents increasingly more confused, not more informed. Although some bloggers are declaring vaccine-hesitancy dead with BMJ’s expose on Wakefield's work, we're far from seeing its end. Distrust in our physicians and nurses only increases when stories and interviews occur in this fashion. I suspect I will be helping families concerned about immunizations for the rest of my clinical career.

It can take only seconds to create a myth. It can take decades to rebuild the truth.

The editorials in The BMJ uncomfortably put Wakefield back into the spotlight. His message, although rebuked, regains momentum. Regardless of the scientific findings that vaccines have not been found to cause autism, Wakefield "won" the January interview.

Seven minutes alone in front of millions is power.

Viewership is the economy of television. If you want to get people to watch, putting Dr. Wakefield in the hot seat is a great way to start. And that’s where the injustice occurs.