April 27, 2010

The Empathic Family Meal

In the last post, I’ve pointed out that a family meal is a good idea.  At least by current research, there seems to be solid evidence that family meals are good things for your kids.  When read critically, the research leaves many questions unanswered.  Research shows that kids who eat regular family meals have lower rates of obesity.  And lower rates of other problems.  It could be that kids are less likely to have eating issues if they come from these cartoonishly-structured families. You know, the families where mom is in an apron most of the day at home and dad comes home from work about 5:30.  It could also be that families that make an effort to get together and keep in touch with the lives of each family member are more supportive, and this is a key factor in prevention of obesity.  Maybe just the fact of having a dependable dinner every night prevents that fast-food or pizza stop on the way home from school. 

Since I’m writing this to encourage you to make a family meal part of your daily routine, or part of your weekly routine if you can’t do it daily, you should have an idea what an Empathic Family Meal might look like.

Those that follow my general take on parenting see that I encourage an empathic approach.  The authoritarian, Top-Down Management model of parenting—as would be practiced by the family I described above with mom at home wearing an apron and so looking forward to the time her husband will give her permission to leave the bunker and freshen up their survivalist hoard—is not going to get a lot of support here.  But because these families don’t move much (it’s just so inconvenient to pack up all the firearms), have stable family structures and menus that are easy to keep track of, they are heavily followed by researchers.  That alone might skew some of the conclusions.

It’s both funny and foolish to look back on those family meals from our own childhoods or those we have witnessed.  Sometimes they were opportunities for bitter parents to enforce conformity, where having an elbow on the table was an offense deserving of discipline.  Children were there to be interrogated about their school or personal lives, and their attempts to keep certain parts of their lives private were never respected.  Occasionally, parents who were either sadistic or indifferent would bring up the most humiliating issues at the dinner table.  You know this is possible.  It has happened to you or your friends.  (These parents are the ones who in 30 years will have adult children that don’t talk to them.)  So there’s a danger in the power structure of the family meal that I think has been ignored.  Absolute power, corrupting as it does, has a nasty tendency to make the people sitting at the head of the table really believe that they are in charge.  Like a president-for-life in a small ex-colonial country, they really believe that if they are happy, the family is happy.

Family meals do more than somehow help reduce the chances of obesity and eating disorders.  They are a great way of reducing picky eating in younger kids, and getting children to try new--occasionally even green--things.  This can be accomplished with an empathic family meal. 

Here is the best way I know to get a preschooler to eat vegetables.  Give them some guidelines, take them to the market, and leave them in charge.  Start with a plan.  Maybe your plan is that on Wednesday night, Eric is making dinner.  Why would he?  Is this just another unrewarded chore that Eric, 5, is supposed to do while you catch up on your emails?  Of course not.  Eric’s true reward is the one-on-one time he will spend with you.  First, you and he will plan a menu.  Make the menu suitable for a weeknight family dinner.  There are many fine cookbooks with short recipes, if you don’t know some off the top of your head.  This dinner, however, does not consist of a phone number and stained paper menu of the ethnic restaurant that delivers.  From the menu, make a shopping list.  From the shopping list, make a trip to the market.  With Eric.  This last part is crucial for success.  When you call your partner to pick up some broccoli on the way home, you have rescinded Eric’s ownership of the event.  He needs to pick it out.  However ridiculous it may appear, he makes an important step when he’s at the market with you and picks out one bunch of broccoli over another.  In his mind, he has been given authority over what his family will eat.  You have trusted him with your sustenance and he has taken up that challenge. 

I often encourage new parents to put aside one bottle a day for dad to feed the baby.  A baby bottle, I mean.  Whatever bottle dad was hoping for is his own business.  However sleep-deprived he might be, that intimate time with the baby, giving her what she needs, is profoundly meaningful to new dads.  Even though newborns may not smile or laugh, the dads have no problem sensing their baby’s gratitude.  It’s a moving and wonderful thing that every mother knows.

I think this wonderful generosity of supporting another’s life through food stars with feeding a baby.  It continues through life.  There’s a reason humans of all cultures socialize over food.

So picture the parent I saw today with an 18-month old.  She complained that he’s “starting to get picky about eating.”  She said that she fed him in the kitchen before she and his dad sat down to eat.  I asked why they didn’t have him at the table with them.  She said that it was just too much trouble because he would keep grabbing their food if they held him, and if he was in his high chair, he would complain about not getting stuff off their plates.  Do you see the empathic parenting lesson here?  When they give him baby food he’s not interested in, he won’t eat it unless he’s very hungry or it’s one of his favorite foods.  We’ve all had this experience.  We look in the full refrigerator, the bursting pantry and complain that there’s nothing to eat.  That’s us.  We’re picky, too. 

But we usually will eat if the company is good, and even if the food isn’t just to our taste, we’ll be polite about it because we see how happy it makes others.  Babies know this and they feel it.  This 18-month-old was telling his mother this in the clearest way he could.  Isolating the child isn’t what he wants.  If he had a place at the table, it would indeed be a lot messier.  But he would love to taste the broccoli off mom’s plate and maybe some of the clam chowder dad was eating.  They don’t want to try healthy foods, and they don’t want to try new foods.  They want to try your foods.  Let them.

April 23, 2010

The Family Meal

family dinner meal food
One of the things that research consistently supports is the value of a family meal. The more often your children sit at the table with you and have a meal together, the better off they are.

When I read some of the early research on this topic, it seemed obvious and biased. When we examine households in which there are two parents, one full-time breadwinner who shows up every night by 6 PM, one full-time homemaker who shops and does child-care and prepares meals, we find certain unsurprising and uninformative things. Relatively low rates of juvenile delinquency, teenage drug use, legal entanglements, and similar social problems. The kids seem to eat healthier, snack less and have a lower rate of obesity.
I was and remain dismissive of this as medically relevant. In so many ways, it’s like surveying people who identify themselves as happy and then announcing that these people have a lower rate of depression than the population in general and a much lower rate of depression than those who have been hospitalized for depression. These mythical households, in which parents live unrealistic lives in unrealistic places with unrealistic children, provide little in the way of helpful insight for those who don’t fit into the constraints of these fantasy family structures. In most places, financial realities have made two incomes essential. Even when it’s not, and perhaps especially when it’s not, the idea that one partner is at home cooking dinner for several hours a day is obsolete. equally unstudied are school and work schedules. Our children, even from the happy and intact families, are busy with their own schedules that include after school sports, tutoring, or jobs. Perhaps because of where I practice, here in Berkeley (but I think this is true most places) it’s tough to make a living from a job you never take home. It’s been hard not to notice, making as many house calls as I do, how often one of the parents isn’t at home. Mostly it’s dad who is still working at 7 or 8 o’clock. But I have often seen kids who are fed and watched and put to bed by dad or grandma since mom won’t get home from work until after the child is asleep.

So I admit that this might seem like a distant dream for many families. But there are a lot of lessons in The Family Meal that go beyond nutrition. Those families from the television-reality of the 1950’s may not have much in common with yours. And it’s no surprise that in these families, teenagers are expected to be home from school before dinner and don’t go out at night. With this level of tight supervision, it is understandably difficult to imagine them getting into trouble. There’s also little opportunity for stopping for a cheeseburger on the way home instead of dinner with the family. No chance for snacking, drinking, or other unhealthy activities.
I have intentionally painted this lifestyle as repressive and restrictive. That’s the way your teenager is likely to see it. After all, their friends get to do these things. And that feeling of imprisonment is a universal one at this developmental stage. They know what they are able to do, and this doesn’t match what their parents are able to allow them to do. But I wouldn’t be doing my job if I advised ignoring some of this research.
I don’t think the research adequately explains why kids with more family meals are less likely to be obese. Maybe the reduced time outside of the house, eating fast food less often is an explanation. Maybe the increased parental supervision contributes something. Maybe it’s something deeper.

Think about the last binge you had—whatever constitutes a binge for you. Did you do it sitting down at a table of people? Maybe kids who would eat particularly badly feel this same social restraint. So if they get a family dinner every night, even if it’s hot dogs and mashed potatoes, and even if they have two helpings, they won’t be having 7 or 8 portions. Even if they could sneak out, the sense of fullness probably will short-circuit the impulse to binge, which happens more often when we miss meals.

Think about the last good dinner you had with someone else, or a group of people. What made it good? The most fabulous chef can’t make food good enough to provide satisfaction and enjoyment from time spent with bickering unfriendly people. Normal family and sibling interactions are not, realistically, going to lead to peaceful supportive conversations at every meal. But the dependability of the meal, day after day—or even week after week—will provide its own important support. Think of it this way. You are on a team. Sometimes it’s competitive, and sometimes you need to work together. Sometimes you will win and sometimes you’ll lose—and some of those times, you feel that you’ve lost very unfairly. But you keep showing up for practice, keep showing up for games. And your coach is always available, whether encouraging you or pointing out your mistakes. I think the family dinner is like this. Sometimes a child will be sulking and quiet, or quick to anger. And nobody should be forced, somehow, to do this. But the dependability of that dinner is crucial. They can invite a friend to join. That may seem easy, but it’s an impossible social step if everyone in the family eats at different times, in different places. So it’s easy for a child to ask a classmate to come over for dinner if your child knows in advance when and where that dinner will take place. If they don’t do this, when will you meet and get to know your child’s friends? This is an easy, natural way to do this important task.

Most important of all, the family meal is the place to show your children that you’re interested in them and their lives, their schoolwork, friends, and news. Please, no interrogations. Don’t go around the table as I have sometimes seen and make each child complete some checklist you have created for them. Tell me one thing that happened in school today or something like that. If the child is always saying that nothing happened and that they have no homework and nothing is new, you need to reach out in a better way. Maybe over the dinner table isn’t the ideal venue for many types of conversation. But when parents repeatedly express interest in their children and the lives of their children, it’s probably a good thing. Maybe it will convince some of those kids that their parents really care about them. Maybe it will help them care about themselves. Maybe it will help a few of them eat healthier.

April 20, 2010

Satiety and Problems with Obesity Research

There's plenty of research on obesity. When push comes to shove, however, we already know the answer. When we consume fewer calories than we use, we gain weight and vice versa.

There's much less research on what drives obesity: satiety. This is the feeling of being satisfied that you've had enough. So all the useless research on portion control, what a 4 ounce piece of steak looks like, on how to measure 100 grams of pasta, is of little applicable value. A patient put it perfectly, "I'm just not satisfied with a yogurt for lunch." We don't have a problem with metabolism, with not getting enough exercise, with fast food chains. If we could go to McDonald's and order one single hamburger and leave, we might be happy with the quality, taste, and value of the food. We don't do that for the same reasons we can't push away from the table after our 4 ounces of chicken breast.

For decades, stomach ulcers were thought to be caused by 'Type A' personalities, emotional instability, and so on. A whole medical-industrial industry had been created to get these high-strung, quick-tempered, hotheads to relax. It wasn't true. The ulcers are caused by a bacterial infection that is treatable. What everybody talks about as 'willpower' is a code word for blaming the patient in the same way that people with ulcers were blamed for their own ulcers. I have met people whose iron discipline is helpful in some circumstances; a surprising number of these folks, in my professional opinion, probably could be comfortable placed somewhere on the autistic spectrum. (You've met these people. Their diets aren't generally the only things they are completely rigid about. They often have difficulty imagining or accepting alternative ways of getting even simple tasks accomplished. Does this sound like people with easy-going personalities and excellent social skills?) For most of us, however, I think what we dismissively think of as a lack of willpower is, in fact, representative of deficiencies in our scientific knowledge about satiety. Many of us insist that our metabolisms run differently, and that others we see eating the same meals don't seem to have our difficulty with weight. I strongly suspect that what is unstudied is not differences of metabolic rate (sorry, most studies suggest that it's all about eating more calories than we burn). It's individual differences in satiety that determines if we need that extra piece of pizza.

When I lived in New York, I was taken to a screening of movies recently completed by film-school students, one of whom was the roommate of my girlfriend at the time. It seemed oddly curious to me that all the films had same maudlin themes of dark introspection. No humor, no irony, no twists, no surprises, no action, no sex. The roommate asked me what I thought. After saying that I thought it was really deep (she smiled proudly), I asked what kinds of movies she liked. She bragged, 'I've seen every European film produced in the last year that I could get my hands on.' I named a couple of blockbuster American hit movies and asked if she had seen any of these. 'Why would I?' she scoffed, and went back to a group of her classmates and professors in black turtlenecks.

It's not that the popular movies were better. But the fact that they were popular strongly suggests that there was some universal, shared appeal about them. So while I would never argue that one should eat more Big Macs, we miss something really important by ignoring how popular they are and why so many people really like them. This is the research that hasn't been done yet.

Back to the lousy student films. I would never argue that popular is equivalent to good. But only in figuring out why some things are popular can we find out our universal drives. Why isn't there more research about what makes fast food so good or so popular? Why do we like it so much, why do we eat too much of it, why do we want to get the larger size for just 50 cents more? Maybe there are great lessons to be learned there about the issues that the majority of us face every day in our eating decisions. This, I believe, is an important reason so many struggle with overweight.

This is also a reason why people on stimulant drugs lose weight. It's not that they no longer like cheeseburgers, or that the stimulant speeds up their metabolism. These medications reduce hunger and increase satiety.

Our bodies have no trouble losing weight. It's our brains that can't do it so easily.

So it has saddened me over the years to read so much research concentrating on the body, which was never the problem. Here are titles of 3 research studies in the April 2010 issue of Obesity, a leading medical research journal in this field:
  • Long-term Successful Weight Loss Improves Vascular Endothelial Function in Severely Obese Individuals
  • In Central Obesity, Weight Loss Restores Platelet Sensitivity to Nitric Oxide and Prostacyclin
  • Exercise Training Prevents Regain of Visceral Fat for 1 Year Following Weight Loss

So, based on these studies, weight loss is a good thing for the obese, especially if they start exercising. Imagine being sent a colorful postcard from a paradise-like exotic resort. It says that your friends are having a wonderful time, will probably never leave, and wish you were there. There's no mention about how to get there, how to afford it, or where, exactly, the place is.

With all of the above contributing to a comfortable amount of cynicism about this, I went to a lecture on childhood obesity. The content was an unexpected surprise. They didn't say that we're winning the war, not even winning the battle. But I think they've come up with some reasonable rudimentary tools. That's the next post.

April 16, 2010

The Committee: Problems with Obesity Researchers

A couple of years ago, I was on a committee of the American Academy of Pediatrics that focused on child nutrition and problems of overweight. We all agreed there was a problem. Maybe most adults, even those who don't work with children, have seen a generational change.

When I was a child, there was often one kid--if that--who was thought of as fat. I wasn't that child, and that child, at school at least, must have had a tough time. Honestly, I don't remember if there was such a child in the elementary schools I went to. There was a single classmate in grades 7-12, but at the school we shared, it would have been considered rude to make fun of anyone. (Though some were more competitive than others, I don't think anyone would have wanted to appear mean. I never got the impression he was anything but as happy as any of us were as teenagers.)

Things are clearly different now. Not just every school but every class has several overweight children, in every grade. Among these, some are dramatically overweight. Research confirms that though many kids get leaner when they grow into adolescents, many don't really recover from this early obesity. 

Given the lack of easy fixes for this problem, and the obviousness of the extent of the problem, it is a hot topic for research. I've been frustrated, however, by the work that's been done and the people who do it.

In general, I think people should go into fields they're interested in. This is not only important for their own happiness and job satisfaction, but also for their motivation and creativity. I was shocked, for example, to have met in my pediatric career more than a handful of people who don't particularly like children. That's OK, I suppose, but it implies a suboptimal career choice for both doctor and patient.

So, in this statistically-unsupported argumentum ad hominem, let me tell you about the people I've met in the obesity-science world. First, who do you think chooses to go into the field? The professor in medical school who lectured on the topic, and has published quite a bit on this topic since, had nothing in common with me. Rail thin, his lectures were, to my sensitive ears, fire-and-brimstone evangelical sermons on people being their own worst enemies, fast or prepared food of any kind being a narcotic-like poison that eats like a parasite at the very fiber of civilized society. He taught, at least this is what I recall, that eating is like smoking, and should be heavily regulated if not banned altogether. He could be seen in the cafeteria eating a salad without any dressing. I didn't sit at his cafeteria table. He actually said, and I remember this vividly, that doctors need to be models for their patients. I interpreted this to mean that doctors who struggle with their weight or smoking or personality flaws are pretty much equivalent to permitting an alcoholic counsel other alcoholics.

Uh, that actually works. In study after study, though by no means always successful, the Alcoholics Anonymous model--in which recovering addicts share their experience and hard-earned wisdom--has been about the most consistently worthwhile intervention. It has been copied for addictive behaviors of many kinds.

But the obesity research establishment hasn't gotten this message. They haven't even opened the mailbox to see that there might be a message waiting. It's because their aren't looking for this or some other message. They think, like that anorexic professor at Yale whose personal diet is uneconomic and unsustainable for even patients with the most driven eating disorders and who thinks that his obsessive neurosis is the only appropriate prescription for the millions of people with whom he has neither anything in common nor empathy, that they really know how to fix the problem.

So the research they do doesn't, ultimately, tell us much that's actually helpful. Studies that show that if you watch TV 6 hours a day you tend to be fatter than those whose varsity sports team practices 3 hours a day after school. The title is usually something like, 'Varsity sports participation is a protective factor for excessive body-mass-index in adolescents.' Or, 'Proportion of daily calories from fruit predicts lean body mass.'

Knowing the abysmal failure rate when doctors tell their patients they need to lose weight, and the worthless nature of this kind of research for any practical purpose except the resumé-building of the authors, I had assumed that the grind of inevitable progress would, by now, have brought us out of this dark cave. So I looked forward to joining this committee, in which I presumed to be kept at the very cutting edge of child obesity research. I wanted to find out what actually works, what has been tried, and what can I tell my patients and their families that will genuinely help them.

The committee met at a lovely upscale restaurant in San Francisco. I was one of 3 men. There were about 40 women on the committee, but not every member came to every meeting. Though their ages spanned from mid 20's to mid 40's, I feel comfortable, since this whole post is about judging books by covers, saying that they all could have been sisters. A pair of waiters came around to take our orders. You know the rest already, I suppose. Salad with no dressing--not even on the side. Fish grilled without butter or oil, no potatoes, no bread, no dessert. Even so, most didn't eat at the table, and just pushed the food around the plate. At the time, I felt humiliated and ashamed, as if they were all staring at me conspiratorially and silently agreeing that He's the reason we're here.

I thought the committee might address pediatric patients who have a nascent weight problem that needs to be addressed for their health. This group, as a subset of the obesity-research elite seeing to affirm their own dysfunctional relationship with food, was really just an excuse for these doctors to get together and affirm each other's neurosis. The consensus was that

More than one of the members of this committee proudly boasted that she had never, not once, eaten or even been inside a McDonald's.

I'm no apologist for McDonald's. But I think there's deep truth about patient care that these starvation-junkies have missed.

On a personal note, by the third meeting or so, I looked forward to the dinners. I would ask for extra butter on my mashed potatoes, ranch on the salad. At one point, about 25 people indicated that they didn't want dessert. I asked for an extra crème brûlée. It wasn't passive aggressive, it was just aggressive. The committee disbanded when the American Academy of Pediatrics realized, I suppose, that it would be cheaper to pay for these doctors to stand around outside of the restaurant rather than go inside and order food they didn't eat. And that it would not be possible for even less to get accomplished.

Next: what's missing from obesity research.
After that: some hope, or at least some reality, from recent research

April 13, 2010

Stem Cells for Autism

Danny is an 8-year old on the very functional part of the autism spectrum. He’s happy, has friends, and is in a mainstream class where his work is on grade level. He’s a success in nearly every important way a parent could want. Still, at his most recent visit, his mom gave me a flyer for a company offering fetal stem-cell transplant as a cure for autism. She asked me to take a look at it (she insisted it was dad’s idea) and let them know what I thought. Having, as I do, such a large number of patients on the autism spectrum has helped me learn a lot about treatments that are available. I hadn’t heard of this one, so I was particularly interested in learning about it.

First, here’s a dependable stock tip. People who really know how to make money in the financial markets never, ever, consider selling or sharing that knowledge. If they knew a sure way of making money through a technical analysis system, computer program, or any other way, why would they have an infomercial?

I took a careful look at the brochure. I looked at the website, looked up the people involved.

Have you heard of stem-cell transplants? Sure you have. I’m no expert in this, but here’s the general idea. A person has a specific disease caused by some cells that aren’t working right. We give them new cells, that have the sense to replace the ones that aren’t working right. In this way, a cure becomes possible. Most cells have a certain function. But stem cells are cells that can take on different functions, depending on what’s needed. It’s a promising idea, but hasn’t really resulting in major cures yet.

So is autism caused by a problem with the way that specific types of cells are working? There’s no evidence for this. No one knows what causes autism. A working treatment for autism would be a shortcut to financial and Nobel prizes.

Have you heard of a cure for autism? No? We all know that autism is a mystery. Among ways to achieve fame and fortune, finding a cure for it isn’t something that would be unnoticed. If you had a for-profit business that had such a cure, would you keep it quiet?

You’d be right again, even if you don’t follow the details of ongoing stem-cell research news, to think that you haven’t heard much about using stem cells for autism. Maybe you’ve heard about researchers trying it with some forms of cancer, and some awful neurological and brain diseases for which there aren’t other good treatments. Though there aren’t other good treatments for autism, nobody knows what causes autism. For this very reason, there’s no reason to think that stem cells will help. I can’t swear that they won’t help, but I also don’t know if seawater will help, or radio waves, or marshmallows.

Oh, did I mention they propose to use stem cells from rabbits? Have you been hearing a lot about transplanting rabbit cells into humans? Me neither.rabbit1
It might occur to you that this must be an exotic, cutting-edge research facility that is pushing the envelope in xenotransplantation to give hope to the hopeless. Some place like UCSF or Yale. The rabbit cells are ‘manufactured’ in Europe. The transplantation into humans and claim that it will cure autism would result, even there, with lost licenses, criminal charges, and likely jail time. So the company has a courier carry the processed bunny cells to an undisclosed--seriously--site in Asia somewhere. There, an unnamed practitioner of some sort does the actual transplantation. On your child.

I guess by now you must have guessed that this is very expensive, they require payment in cash up front, and that there are no refunds if it doesn’t work. If your previously healthy, though autistic, child gets some sort of side effect, adverse effect or worse from the treatment, there’s nobody to sue, and I couldn’t find an address on the website. The only person you actually meet is the person in Asia. Will they still be there, with that name, when you contact the embassy?

I’m not done. I looked at the brochure I had been given, and read it carefully. There were lots of grammatical errors. This is an ominous sign for me. If I give them the benefit of the doubt, and assume that they just don’t have anyone really fluent in English, that would still make me concerned that if you have a question, if something goes wrong, who in the company can you talk to?

I looked at every page in their website, which was entirely in English, riddled with language errors. There was a photograph of Fetal Cell Technologies--gloves a worker in their manufacturing facility, wearing protective equipment. But no gloves. This tells me that the protective outfit was to protect him or her, not prevent contamination of the product.

Another page in the document bragged about the medical advisors of the company. In most biotech companies, these are very impressive people who have little to do with the company, but lend their names in return for stock or money or both. The company touts their involvement as a way to add scientific credibility to their presentations when trying to raise venture capital. This particular group was different than others I had seen or been involved with. None, zero, were scientists or researchers or physicians in this or related fields. Nobody even claimed that their degree in naturopathic medicine gave them any expertise in stem cells, xenotransplantation, or autism or any of the other diseases their company claimed to treat by this method. One of their board members, with MD and PhD degrees, was quite clear in noting that these degrees were awarded “by thesis.” Think about that. MD degree: pay a fee, write a paper. No anatomy course, no patient contact, no classes of any kind. This is a guy that wants a lot of your money to put rabbit cells inside your child someplace in Asia by somebody you will never see again.

At the center of this company isn’t stem cells, autism, or science. It’s money. So I will finish this post with this note, and I’m embarrassed to mention it. How much do I get paid for spending 5 or 6 hours researching a treatment for your child? I do it because I have to. Would your other practitioner do the same? For the same payment?

This is part of the email I wrote back.
With so many 'alternative' treatments, I usually say that it's OK to try it if it's safe and won't hurt the kid.  With this, I am very scared that a courier delivers some product--who knows what, rabbit cells?  contamination?--to a practitioner in Asia somewhere who somehow gets it into your unconsenting child, and then everybody walks away after they get paid.  You couldn't even sue them if something bad happened, and certainly couldn't get your money back.  What about the child?  How will he feel--assuming that he did OK with the rabbit cells--if he 'fails' this treatment?  Won't he feel like he let you down?  Won't he feel like there's something wrong with him in your eyes?  Will rabbit cells make that better?  So, in this case, I'm going out on a limb.  Please don't do this. 
This is their procedure:
1) Patients consult with their respective medical doctors.
2) Doctor writes a brief medical summary or fills up the medical standardised questionnaire. Doctors can also make 1 attachment in "pdf" file or "jpeg" file comprising all relevant medical report if they think are of significant importance.
3) Doctor sent email to:- 
4)      ’s professional team analyzes the medical summary and/or medical questionnaire. A prescription of individualised preparation of different type of cells
is made if the patient is found to be an ideal candidate for Fetal Precursor Stem Cell Implantation. Doctor will also be informed of otherwise.
5) Doctor consults with the patient. A decision is made to take or not to take up the fetal stem cell Implantation by patient.  Doctor will then email to                  .com upon conformation of consent.
6) Full Payment made to                         (or Minimum: 50%) at least 17 days before carrying out the procedure on the pre-schedule.
7)  Proprietary Primary Cell Tissue Culture harvesting commence (time frame of 14 to 17 days preparation)
8) European Human Couriers transport down the cells from  Lab/Plant fromVienna airport to different parts of ASIA in special packaging while maintaining the                cells at room temperature
9) Individualised prepared cultured Fetal Precursor Stem Cells should be implanted on patient within 24 hours generally and not exceeding 72 hours from time of completion of culturing in our European Plant
10) Post Fetal Precursor Stem Cell Implantation progress report in 3.5 months to 4 months from Doctor to   coordinating team for evaluations as well as database updating.
This is a list of disease they can cure with this technique:
Ageing Disease
• Menopause
• Depression
• Impotence and loss of libido
• Memory loss
• Arteriosclerosis
• Impaired liver function
• Osteoarthrosis
• Immune deficiency
Autoimmune disease
• Scleroderma
• Rheumatoid arthritis
• Dermatomyositis
• Systemic lupus erythematosus
• Polymyositis
• Sjogren syndrome
• Hashimoto’s thyroiditis
• Addison’s disease
• Chronic active hepatitis
• Primary biliary cirrhosis
• Glomerulonephritis
• Good pasture syndrome
• Myasthenia gravis
• Bronchial asthma
• Pemphigus
• Bullous pemphigoid
• Vitiligo
• Atopic dermatitis
• Autoimmune hemolytic anemia
• Autoimmune thrombocytopenic purpura
• Pernicious anemia
• Muscular dystrophy
• Neurofibromatosis
• Tuberous sclerosis
• Cornelia-de-Lange syndrome
• Gaucher disease
• Metachromatic leukodystrophy
• Fabry's disease
• Gangliosidoses
• Refsum disease
• Mitochondrial genetic disease
Genetic and Chromosomal Disorders
• Down Syndrome
• Noonan syndrome
• Turner syndrome
• Wolf syndrome
Hematological Diseases
• Thalassemias
• Sickle cell anemia
• Aplastic anemias
• Hereditary hemolytic anemias
• Thrombocytopenia
• Erythropoiesis disorder
• Primary hemachromatosis
• Werlhof disease
Immune System Disorders
• Chronic fatigue syndrome
• Disorder of non-specific immunity(e.g. defects of natural
killer (N.K) cells)
Kidney Diseases
• Genetic diseases of renal tubules
Cancer Treatment
• Enhanced weakened immune system
Cardiovascular Diseases
• Intractable arrhythmia
• Myocardial infarction
• Congestive heart failure
• Peripheral arterial disease
• Chronic cardiac disorder
• Arteriosclerotic vascular disease
• Migraine
Central Nervous System Diseases
• Neurodegenerative disease
• Parkinson’s disease
• Demyelinisation diseases
• Old/new spinal cord injuries
• Apallic syndrome
• Encephalitis
• Locked-in-syndrome
• Amyotrophic lateral sclerosis
• Friedreich’s ataxia
• Werdnig-Hoffman disease
• Duchenne & Becker muscular dystrophies
• Dementia
Chromosomal Diseases
• Down syndrome
• Noonan syndrome
• Turner syndrome
• Wolf syndrome
Digestive System Diseases
• Atrophic gastritis
• Chronic pancreatitis
• Malabsorption syndrome
• Crohn’s disease
• Ulcerative colitis
• Peptic ulcer
Endocrine Diseases
• Diabetes mellitus
• Vasculopathy
• Adrenocortical hormonal insufficiency
• Premature menopause
• Retarded puberty
• Female infertility
• Imbalance state of autonomous nervous system
• Endometriosis
• Female infertility
• Uterine myomas
• Habitual abortion of adrenal atiology
• Parathyroid insufficiency
• Hypothyroidism
Genetic Diseases
• Wilson's disease
• Nephrotic syndrome
• Glomerular disease
Liver Disease
• Liver cirrhosis
• Chronic hepatitis
• Crigler-Najjar syndrome
• PrimaryBiliary cirrhosis
• Primary Sclerosing Cholangitis
• Hepatorenal syndrome
Locomotor System Disease
• Non-healing fractures
• Osteoarthrosis
• Aseptic necroses
• Chronic osteomyelitis
• Osteogenesis imperfecta
• Achondroplasia
• Marfan syndrome
• Arthrogryposis multiplex
• Chronic osteomyelitis
• Chronic arthritis
• Rheumatoid arthritis
• Osteoporosis
Lung Diseases
• Bronchial asthma
• Pulmonary fibrosis
• Emphysema
Metabolic Diseases
• Atherosclerosis
• Lipoprotein metabolism
• A-β-lipoproteinemia
Neonatal & Perinatal Diseases
• Cerebral palsy
• Inborn errors of metabolism
Skin Diseases
• Psoriasis
• Chronic eczemas
• Deep burns
• Acne vulgaris
• Ulcus cruris
• Various eczemas
• Sarcoid Darier-Roussy
• Hereditary keratosis
• Palmaris et plantaris
• Chronic lichen
• Scleroderma
• Vitiligo
• Frostbite of big toes
• Alopecia areata
Radiation Injuries
e.g Post radiation ulcers

Addendum, April 20, 2010.  Just a few days after posting this, and completely by coincidence (as if 60 Minutes coordinates their schedule with mine), a substantial portion of 60 Minutes was devoted to just such a stem-cell scam.  The one they investigated had recently treated a child for autism.  This is a link to part 1 of the segment.  This is a link to part 2 of the segment.

April 9, 2010

Grandparenting: Basic Guide

1.  When the baby is born, don’t come to stay. It is curious to me that by some mechanism the emergence of an infant from the body of a daughter or daughter-in-law is taken as an open-ended invitation for a sleep-over visit. I won’t be a burden. You won’t Grandma_tie_one_on even know I’m there. You won’t have to do a thing. I can help with watching the baby, doing laundry, going shopping. You’ll need the help. These are some of their honest well-meaning intentions. The reality is that your body is slowly recovering, you’re in pain just to walk around, you’re incredibly sleep-deprived, you want to focus on the baby so everything else in your life and home have been put on hold. What do you get? Critical, judgmental houseguests.

It’s great, perhaps essential, to have supportive parents or relatives nearby when a baby is born. It can be crucial to have someone trusted to watch the baby while you sleep for a couple of hours. And it is indeed helpful if somebody is willing to do the laundry or some basic shopping. But the stories I hear are often about grandparents who bring their usual daily routine with them, play with the baby when the baby is happy but give you the crying baby. I hear about grandparents who, though they might not say it, still think of you as their child so they expect to be able to direct the baby’s care. After all, they’ve already been there and done that.

So when the baby is new, stay in a hotel. Or at least find a different relative nearby you can stay with.
2.  Pay for college. Obviously, if you’re not well-off enough to pay for the kid’s college, you can’t do this. And I’m happy to say that love and support is way more important than money. If you have no money, than it’s even more important to be supportive of your adult children. Now that I got that out of the way, however, money is sometimes where the rubber meets the road. Your children are adults now, with children of their own. They will be concerned about providing for the children and will be worried about this. It’s OK to believe in self-sufficiency and living within one’s means. But complaining about the cost of your yacht maintenance while your kids are struggling is not going to get you whatever sympathy you’re looking for. It’s not an empathic thing to do, and it’s potentially lethal to the relationship you have with those grandkids. So if you can, put money away for college. If you can’t, share with an open hand. Take the grandchildren to Disneyland. If that’s too much, take them to the movies. If you don’t like the way your kids handle money (who’s fault is that?), then do your giving directly to the grandchildren. But sharing what you have in this way takes a serious burden off of your children, and it might materially improve their lives. They will be grateful for it.

3.  Watch the children. What do you have that no one else has? Trust. The disturbing stories we hear on the news have made parents more cautious than ever to leave their kids in the care of a stranger. A grandparent is in the unique and privileged position of knowing the parent for his or her whole life. The parents know where you live, know who your friends are, and know how to get hold of you. They may not want you to let their children watch cartoons all afternoon. They may not want you to feed the child chocolate cake and 2 glasses of milk every schoolday afternoon. But they will love that their child loves you. And they will love you for being there to babysit. Generosity with your time will give you the opportunity to bond directly with your grandchildren without their parents filtering your intentions. Hopefully, your children will see this as the valuable gift that it is.

4.  Bite your tongue. I have said this several times, but I’ll say it again here. You had your opportunity. You raised your children in the best way you knew at the time, and now they are raising their own. It might look to you that they are needlessly flailing about and trying to re-invent the wheel. You might feel that you could save them a lot of trouble by just telling or showing them the way certain things should be done. If you get asked, then go ahead and be the teacher. But if you aren’t asked, volunteering an opinion could leave you vulnerable. This isn’t picking out a color for the drapes! For better or worse, your adult children have chosen a path to follow with their own children. If your suggestions contradict this, you won’t change anything. But you might give the impression that you think you know better, or that you’re interested in continuing to treat your child as a child. How will this help? Your experience and knowledge are important resources if they are wanted. If not, you are playing with fire.

April 6, 2010

Empathic Grandparenting

grandmother As I publish more and more about parenting, I’ve been getting a lot more questions about the role of grandparents. Parents, whether biological or foster or adoptive or step or any other kind, have certain reasonably uniform tasks they usually need to accomplish with their children. Survival basics, such as food and shelter, schooling, love and support, and promotion of the child’s general sense of growth and accomplishment as they grow and develop. If there are some hurdles on the way, people ask me about it, and I do my best to give them some ideas on how to manage.

When grandparents are the primary caregivers for the children, and there are many, many families like this, then they are really acting as parents. In this context, parenting advice applies no matter what your title is. I have known fine adults raised by relatives both close and distant, and sometimes by parents who weren’t related to them at all. In all of these situations, I recommend openness about the reasons behind the situation. This openness should be limited to what is developmentally-appropriate for the child, and which protects the child’s sense of self worth. If parents are gone, then they’re gone and there’s no point in giving the child further opportunity for emotional scars by learning that what you say can’t be trusted. It’s hard to imagine a sadder image than a child waiting at the window for the parent who won’t return. So be as honest as you can with them.

An important part of the bargain when we take on the responsibility of being parents is that there are no warranty periods or lease expirations, during which we can trade up to a new model as long as the one we’re returning has only normal wear-and-tear. More needs to be said about what is and is not appropriate, and I’ll try to do that another time.

For most grandparents, however, the primary responsibilities of care for the grandkids falls squarely on the shoulders of your children and their spouses. This is a blissful arrangement in which you get most of the benefits of child indulgence with little of the consequences. Sure, it’s not as good to buy love as it is to get it spontaneously. But--just between us--it’s still love and it feels mighty good when bartered for some new toy or ice-cream before dinner that mommy would throw a fit about but we’ll just keep it as our little secret.

For those who’ve been reading my advice about getting kids to eat right and behave nicely, it might come as a surprise to know that I don’t disapprove of any of the above. Every child deserves to have somebody in this grandparent role, where some of the rules are a little more flexible than at home. I think there’s an important place in every child’s life for a trusted non-parental adult who isn’t spending every waking hour managing the relationship. But that’s not the same as having carte blanche.

With that said, however, we all know that childhood obesity is a big problem. There are many causes, of course, and I have no special cure or treatment. But I have had one insight that I have not seen written about in all the studies I’ve read: grandparents.

There are many reasons that both parents have to work outside the home. Mine did. With most elementary schools still dismissing their students at 3:00 in the afternoon, most working parents have to find some arrangement for the 2-3 hours or more before they get home from work. In my community, this is often a job gladly taken by grandparents. They treasure the opportunity to be with their grandchildren and have such an important role in their lives. They also are happy to help their children by being there when needed.

But when I talk to children who are overweight, I ask them about their diets. It becomes clear that their parents aren’t usually taking them out for fast food, and aren’t letting them eat potato chips instead of dinner. Most parents are reasonably careful about what they feed the kids, so the extra calories aren’t coming on their watch. Again and again, the calories just don’t add up. While it’s true that school lunch is often not nutritionally optimal, it’s usually not a major problem. They usually don’t have the money or transportation to get fast food. But again and again, I hear about the time in the afternoon with grandparents. There’s a lot of school-day afternoons filled with television and very fattening snacks. It’s one thing to be the indulgent grandparent who gets the kids stuff their parents wouldn’t or couldn’t get them. It’s quite another to be contributing to serious and long-lasting health problems for the child. Though I don’t want to be confrontational, I really wonder if these grandparents, who melt at the first hint of a whine, really feel all right with the consequences of that big piece of cake as an after-school snack.

I have often wondered about the mysterious mechanism by which brain functioning seems to change as soon as one’s offspring has offspring of their own. There is a clear difference between being a grandparent and being a parent, and I’m fine with that. But why, besides failing vision, can’t grandparents see that their grandchildren don’t need that extra cookie?

We get our parenting knowledge from several sources. Our own experience as a child is a major source, whether this was good or not. Our perspective on the parenting techniques used by our parents is a very biased one. In general, we love our parents. Perhaps as a result, I have heard people describe as useful some incredibly counterproductive experiences they had as children. Did washing your mouth out with soap stop you from using bad language? Sometime, parents are aware of the mistakes made by their own families, and make a conscious decision to go in another direction. This leaves the parent trying to find a path when they have no landmarks. And, of course, there are all kinds of parenting experts willing to suggest things, perhaps in a book or blog, that the parent hadn’t thought of.

Grandparents, however, have the certainty of their own experience. This can be a pain in the neck for parents who have decided to do some things differently. Just because you raised your kids a certain way, doesn’t mean that’s the only right way to raise them. This is often a major source of friction between adult children and their parents. If you, as a grandparent, value contact with your children and grandchildren, you must respect their point of view.

I guess it should go without saying that there are always exceptions. But it’s a mistake to assume that you are one of these exceptions.

In the next post, I’ll offer some specific guidelines for grandparents.

April 2, 2010

Quality Time with Launderteam Delta

In an online forum recently, I was asked by a grandmother why her grandchildren are so poorly behaved with their mother, but are so well behaved with her. She babysits most days while the mother works two jobs.

In my office, another working mother confided in me that her son, 7, was upset about her recent divorce. But her daughter, 5, was simply ‘sour.’ She said the girl was just never nice to her, and she was sadly misguided if she thought that was a way to get her mother’s affection. She was angry at her daughter.

I don’t always get these behavioral issues right. They are always complex, with factors of family and environment, health and finances always complicating the emotional and behavioral problems. This time, I did get it just right, so I thought it might be helpful to see these cases unfold.

Here’s an empathic interpretation. In the first case, I had some important information just from the short statement that the grandmother provided. The fact that the kids were generally well-behaved with the grandmother meant that they didn’t carry their bad behavior with them everywhere they went. That was essential to know so I could be really confident that there wasn’t something about the children that was causing the problem. I had no contact with the mother, so there was no way to know if she was really messing up the relationship with her kids, but I took an educated guess. With her heavy work schedule, she didn’t get to spend time with her kids. They didn’t see this, of course, as her sacrificing for their welfare. They see it as their own sacrifice for no apparent purpose at all. So since they feel the cost but none of the benefit, they aren’t happy about it. Then when mother comes home, they are demanding of her time. She’s exhausted, of course, and maybe protective of what little time she has for herself. The children interpret this as rejection, and get even more unhappy, and actively experiment with their own actions to do what they need to do in order to get the attention from mom that they need to get. With the escalation in difficult behavior, the mother has to escalate her attempts to control the behavior, which ends up in a spiral from skirmish to battle. Everybody gets hurt.

In the second case, the older child has tried to fill some of the role of his absent father. He helps mom around the house, gets his homework done without asking her for anything, watches his sister when asked. The elevation in his status and the affectionate rewards he gets from mom are not missed by the 5-year-old, however. What can she do? It seems that every time she tries to help, either her brother steals the chance from her or her mother complains that now she’ll have to do it over again because it was done wrong. Besides missing her dad, she can’t find a role for herself in this new family unit. So to get the attention of her mother, she needs a burning flare to get her mother’s attention and dynamite to separate her mom from her brother. Flares and dynamite are a combustible combination, and she, too, is left to her own creative devices to find activities so egregiously naughty that they demand the attention of her mother. The mom complained to me, explicitly, that she didn’t even like to spend time with this unpleasant girl.

In both cases, the parent needs to spend more time with the child.

There used to be a myth called ‘quality time.’ Though I haven’t been able to find a clear definition, sometimes it meant time uninterrupted by phone calls or distractions, sometimes it meant time with the kids during which everybody was having a good time, sometimes it meant a massive mutual crying session during which the whole family bared their innermost feelings in a catharsis that typically ended with a lot of awkward embracing.

I think there is such a thing as quality time. Again taking an empathic approach, I think it’s the children who determine if the time is ‘quality’ or not. What are their criteria? Even if they say they want more time to watch TV or play on the computer, time with a parent is what’s really valuable to them. If there’s a mistake that many parents make, it’s making this time arbitrary and unpredictable. Children cannot understand this. They don’t see the complexities of your life and can’t understand the flexible priorities you assign to your own daily tasks. So maybe you don’t take business calls at home…unless it’s your boss and it’s really important. Maybe you go to the gym every evening…unless your friend is visiting from out of town. There’s nothing bad in this kind of flexibility. It’s an essential skill of successful adulthood. Those who don’t have the ability to realign priorities with changing situations are not going to fit in to our every-changing lives. (This rigidity in the face of an obvious change in circumstances can be a sign of autistic-spectrum , or perhaps obsessive-compulsive disorder.)

But that’s not your children. To them, quality is not just time with you, but time they can count on. So here’s how to do it if you’re working all the time and have little time with them.

I had a close friend who used to work in the financial markets here in California. The problem was that he usually left for work around 5:00 am, and he hated missing his preschool-aged kids in the morning. So the family decided to skip the pre-bedtime bath. Instead, the kids would get up with daddy, everybody would take a shower together and then go back to bed when dad left for work. While I presume this did take a little more time than a quick morning shower alone would otherwise have taken, dad could leave for work feeling energized for the day. At first, one of the kids preferred to stay in bed. But when one sibling knew that the other was spending time with dad, even if it seemed like the middle of the night, there was no problem getting up.

So when I was asked about how the mom with two jobs can find ‘quality’ time with her kids, I responded by noting that the time was available, and the ‘quality’ was up to her. The key rule--it’s not a guideline, it’s a rule--is that this is an appointment you must always keep. Your children depend upon it as a sign of their importance to you. It really doesn’t matter what you do together, as long as it’s together. If you’re working long hours, what are the tasks that you have to do anyway? Even if the kids weren’t there? The ones I usually come up with are laundry, shopping for food, housework of specified kinds, maybe some others like walking the dog or even emptying all the wastebaskets and then taking out the trash. These are not chores to be assigned to your child while you catch up on your email or return important phone calls! (It could be a chore under certain circumstances. But if your child is acting up, there’s a 100% chance they need more time with you. So if you’re going to use a task for this time, it has to be something you do together.) Make it a team job.

So for a preschooler, maybe they can sort the light items from the dark ones. They can fold things as you take them from the dryer. They can help you put things away. Tip: don’t assign them tasks to do by themselves. You’re a team. So don’t tell the child to put her brother’s clothes in his closet. That’s a chore, no matter how you try to tell her how much she’s helping you (then it’s a favor). Have her help you carry her brother’s things into his room and then hand you the items as you put them in the closet. Why am I so particular about this? It’s the conversation, of course.

Yes, you’re going to have to put down the bluetooth headset. If a call comes during this important time, say ‘I’m doing some work with my son right now, let me call you back later.’ Once you’ve said it, watch the magic it makes with your son. See how much more enthusiastically he helps you. But you’ve also sent another person an important message--you. Once you have embraced that laundry with your son isn’t a chore for you, it’s quality time with your son, it might not be something you do because if you don’t, no one else will. When you do it with your son, you are doing it because no one else can. You and he are now

Launderteam Delta
Special headgear or weapons--developed at skunkworks to be indistinguishable by an untrained observer from household terrycloth--might be required.

Every busy parent’s life is filled with these tasks. Many depend on where you live and what your preferences are. Do you wash your car? Do you tend a garden? I acknowledge that often adult tasks we do alone can be fulfilling and relaxing when done alone. And there are some jobs that are downright dangerous when done with a child (mowing the lawn, blowing glass, welding the steel roll bars on your monster truck, etc.) But if you are doing these tasks instead of spending time with your children, can you blame them for acting in ways that are more demanding of your attention?

The next step in this plan is scheduling. When you have made this magical transformation from chore to team activity, you have to stop treating it as a chore to be done reluctantly and squeezed in whenever you can. That may have worked for laundry, but it doesn’t work for time with your kid. They don’t respond to being a low priority on your to-do list. So go shopping with your child for a monthly calendar. (Another team activity!) They can choose puppies or fighter jets or whatever else they like. Then every Thursday night or Saturday morning or how often you think is necessary, write laundry on those days. It doesn’t matter if he can’t read. He will see that word and recognize it for what it is, a contract with mommy or daddy for his personal time. IT’S A CONTRACT. Break it, and there will be consequences.