Matt Masiello, M.D., MPH

Blog

  • Support Florida Students – Pediatric Action Plan 1

    March 4, 2018

    Dear Colleague,

    Yesterday, the Florida Senate rejected a ban on assault weapons as well as an amendment to allow police to seize weapons from someone under domestic violence injunction. Two weeks ago, as the Parkland students were marching to their state legislature to plead for safer gun control measures, their politicians were in session voting to disallow any conversation or debate on the ban of assault weapons. The Governor of Florida had created incentives for gun manufacturers to move to Florida. Senator Rubio and the majority of his Republican colleagues in the Florida legislature have voted against any meaningful firearm safety legislation.

    In November 2018, the AAP is scheduled to hold its annual conference in Orlando. This is occurring as Florida students, themselves, are asking for people and businesses to boycott events and activities in Florida. Major corporations, businesses and investment firms have changed or are considering a change to their policies on supporting the NRA and/or banning the sale of assault weapons.

    I ASK YOU NOW TO DO SOMETHING THAT   WILL TAKE ONLY A MOMENT OF YOUR TIME. CALL, EMAIL, OR TWEET THE NATIONAL AAP OFFICE AND THE MASSACHUSETTS CHAPTER OF THE AAP EXPRESSING THE CRITICAL IMPORTANCE OF MOVING THE 2018 NATIONAL AAP CONFERENCE OUT OF FLORIDA TO A CITY THAT IS LEGITIMATELY AND DELIBERATELY ADDRESSING THE ISSUES RELATED TO THE USE OF FIREARMS.

    We must be more than an advocate for these students. We must now be an ally, walking and protesting beside these courageous teens and their families. It will take only a moment of your time to offer the clear message to politicians that pediatricians and our pediatric provider colleagues will be direct, firm and active in this effort. Letters and lobbying efforts certainly need to continue but we can do more. Saying “MOVE THE AAP CONFERENCE” will deliver that message. Thank you. PLEASE SEND THAT “MOVE THE AAP CONFERENCE” MESSAGE NOW. THE TIMING IS CRITICAL.

    For our Children,

    Matt Masiello, M.D., MPH, FAAP

    “MOVE THE AAP CONFERENCE” message to:

    The Massachusetts Chapter of the American Academy of Pediatrics

    781-895-9852

    chaggerty@mcaap.org

    @MassChapAAP

     

    American Academy of Pediatrics

    202-347-8600

    dmiller@aap.org

    @AmerAcadPeds

  • The Sexual Predator and Childhood Adverse Experiences: The Moore situation is worse than what is being reported. “Time, shame, secrecy and social taboo.”

    “The victimization of children is nowhere forbidden; what is forbidden is to write about it.”

    ― Alice Miller, Thou Shalt Not Be Aware: Society’s Betrayal of the Child

    In 1998, a large study commented on the health and social effects of adverse childhood experiences (ACE) over the course of a lifetime. It is an extremely significant report in that for the first-time researchers demonstrated the relationship between adverse conditions and experiences of childhood and how they would later affect the health and wellbeing of these children as adults. Three categories of adverse experiences were identified: childhood abuse, neglect and household challenges. Specific to the events taking place in Alabama, the abuse categories identified those adults studied later in life, who as children, were abused emotionally, physically and sexually.

    The population was mostly white, college prepared, and approximately 50 years of age. The interviews indicated that these predatory incidents are well concealed by “time, shame, secrecy and social taboo.” The adverse experiences were predictors of how these victims went on to experience more disease, more alcoholism, more drug use, higher incidence of suicide attempts and early death.

    As ACE increases so does the number of marriages, and unwanted pregnancies leading to abortion. Domestic violence increases by over 500 % and the likelihood of being raped by 900%. Adverse childhood experiences are responsible for half of all depression leading to suicide attempts, two thirds of rape cases, and 50% of domestic violence

    With an ACE score going from 0 to 5, alcoholism increases 5-fold, intravenous drug use 9-fold and suicide attempts 17-fold. A rising ACE score is responsible for 2/3 of alcoholism, and half of all drug use. These risk factors associated with ACE underlie the 10 most common cause of death in the U.S.

    It is no surprise then that these women are coming out now to reveal their terrible experiences. Physicians and public health professionals need to step up and give testimony to this fact of why women are revealing these negative experiences of their youth and doing so later in life. The reason for the timing of these revelations is based on multiple scientific studies since 1998. As the initial researchers at Kaiser Permanente and the CDC stated, individuals hide these feelings and this anger because of ‘time, secrecy, and social taboos.” These prominent figures that now have their political bully pulpit strike a nerve of courage in these women. The resiliency these women have developed to overcome these adverse conditions now allows them to speak up and be heard. We need to support them not only because of the credibility and corroboration of their stories but support them based on the science of what we now know about these experiences and how it affects their lives.  We cannot assume for one moment that the sexual abuse inflicted upon a 14 year old by one political figure has been the only negative and harmful childhood experience. We are living in America, the land where not all benefit from a safe home, adequate education and housing ,  optimal health care and an adequate wage. Adverse Childhood Experiences are the most basic causes of health risk behaviors, morbidity, mortality, disability and health care costs in America. Yes, these experiences are very different from those experienced by an adult. The sooner we realize this the sooner we can make appropriate decisions about the Moore’s of the world, and hopefully someday, about health care in America.

    Matt Masiello, M.D., MPH, FAAP

     

    “The truth about our childhood is stored up in our body and lives in the depths of our souls, and although we can repress it, we can never alter it. Our intellect can be deceived, our feelings manipulated, and conceptions confused, and our body tricked with medication. But someday our body will present its bill, for it is as incorruptible as a child, who, still whole in spirit, will accept no compromises or excuses, and it will not stop tormenting us until we stop

    evading the truth.”

    ― Alice Miller

     

    Reference:         Vincent J. Felitti, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death: The Adverse Childhood Experiences (ACE) Study. Amer J Prev Med 1998; 14(4).

  • War – No Longer an Option

    “In the counsels of Government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the Military Industrial Complex. The potential for the disastrous rise of misplaced power exists, and will persist. We must never let the weight of this combination endanger our liberties or democratic processes.” – Dwight D. Eisenhower, 1961

     “It’s a growth industry and we will get what we want.” – General David Petrius.

    (When recently asked about the need for the deployment of more troops to Afghanistan.)

     “The question in my mind is how many additional American casualties is Saddam worth? And the answer is not very damned many.” ~Dick Cheney (Speaking to the Discovery Institute after the first Gulf War, on 8/14/1992, when Secretary of Defense.)

     

    As we came to the end of our walking-wheel chair trek from the Jefferson Memorial, Korean and Vietnam War Memorials and finally to the World War II site my 82 year old mother offered a most surprising comment. And this was from the wife of a WWII veteran who was awarded the Silver Star and a Purple Heart for his heroism. “We Americans sure like our wars”, she sadly stated from her wheel chair. It was that simple comment that made me pause and reflect on where we were as a society, a country. I am also the sibling of a two tour Vietnam War veteran. Thousands of our young died depriving us of a social force that may have brought us to a more peaceful, a more academically enlightened and possibly a more environmentally friendly time decades later. Dwight Eisenhower said it best when he commented on the need for war to “prevent” communism, terrorism, or world domination. “When people speak to you about a preventive war, you tell them to go and fight it. After my experience, I have come to hate war.”

    As thousands of our young soldiers have died in this war many more thousands have returned with a multitude of war related illnesses. And as we were under prepared to properly equip and protect our soldiers on the battlefield so are we now so ill prepared to care for these young Americans, their children and their wives upon their return to our communities. And, again, another generation lost and a country missing out on what could have been,  if these thousands of young men and women were here today, healthy and alive. The compromised physical and mental health of these thousands of young soldiers will have an immeasurable toll on their families, our health care system and our country for years to come. “The time not to become a father is eighteen years before a war”, so says E.B. White.

     A conservative number of 100,000 thousand innocent Iraq and Afghan men, women and children have died in this war. An apology and a few thousand dollars is offered as a payment of loss of home and life.  For generations, the families of these innocent victims will hold us accountable for their sadness, misery and loss – A breeding ground for sustainable acts of terrorism.

     “And one of the things we should learn is you can’t fight and win a civil war with outside troops, and particularly not when the political structure in a country is dissolved. So it wasn’t the press that was the problem. The problem was that we were in the wrong place with the wrong tactics.” –

    Robert S. McNamara, (Former Secretary of Defense for two presidents who acknowledged that he and his colleagues were “wrong, terribly wrong” in the prosecution of the war in Vietnam)

    One in eight Americans and one in four children now rely on food stamps and the number is growing. Sixteen million people are out of work and this number is also is growing. We have more families and children living in poverty now then we did during the Lyndon Johnson war on poverty era. In the U.S., a child is born into poverty every 33 seconds (Children’s Defense Fund, CDF). As we continue to experience the numbing greed of Wall Street, we have more children going to bed hungry than ever before. The economist Jeffrey Sachs, tells us that “Wall Street takes more bonuses each year then the U.S. gives in all official development assistance.” In this United States many of our community food pantries were finding it difficult to keep their shelves well stocked for this past Thanksgiving Day and quite possibly for the upcoming holidays and holydays. “Food-stamp beneficiaries aren’t them; they’re us,” states James Weill, President of the Food research and Action Center, on an analysis of 30 years of data that found nearly half of U.S. children and 90% of black youths will have to depend on food stamps at some point in their childhoods (Time magazine, Nov, 16, 2009). Since 2001 more then $950 billion has been spent on the war. According to Marian Wright Edelman, President of the CDF, it will take $105 billion over ten years to provide maximum health care reform for children. What is the child worth? Who are we?”

                 As our health system is fragmented and failing, our educational system is also suffering. The U.S. high school dropout rate is unacceptable by anyone’s standards. Our science and math scores are noncompetitive at the international level and the ability of our students to obtain a degree once they enter college is surprisingly and sadly low. Our children still do not have the right to an education and health as is the case in other modern, industrialized countries where health outcomes are significantly better than that of the U.S. Our young adults leave their educational environment thousands of dollars in debt before they have their first job offer. This is not the case in the great majority of other modern societies. We still abuse children by the hundreds of thousands, with one in ten suffering some form of maltreatment.  More than 10,000 children died from abuse and neglect in the U.S. from 2001 through 2007. “It is an alarming statistic, and the real number could be twice as large because many deaths from abuse or neglect are attributed to other causes,” states David Finkelhor, University of New Hampshire. Thousands of children go to school every day in this country and feel unsafe and feel that they have not one friend. On our city streets, playgrounds, and in our schools, children are victims of what the world sees as our strange approach to firearm ownership. According to U.S. Attorney General Eric Holder, sixty percent of our children are exposed to violence in their lifetime. “It is a ‘toxic’ stress to them. Children are exposed to a level of violence that we would not ‘tolerate’ as adults.”

    This month nations are staging special events to mark the 20th anniversary of the Convention on the Rights of the Child, which came to be on November 20, 1989. It is the most widely ratified international human rights treaty. Every country in the world, with the exception of the United States and Somalia, has ratified it.

    Poverty breeds social unrest and violence. Though we need to be intelligently and morally responsive, militarily, to terrorism, the real war to win is that on poverty. Our military experts are now negotiating with the Taliban, realizing that they fight for food and money, regardless of who pays. According to Sachs’, it will take one tenth of one percent of the world’s gross national product to provide basic financial support to the worlds’ poor; and $35 billion, total, as compared to the hundreds of billions being spent on the war effort, to significantly and positively alter the course of world poverty.

    This has been a war where some of our most esteemed politicians, like Colin Powell, stated that misleading and false statements were used to encourage entrance into this conflict. Even those endorsing on-going support for the war admit that it may take five or more years of military involvement. In other words, another generation of youth subject to the decisions we will make today. When General David Petrius, the overall commander of U.S military forces in Iraq and Afghanistan, was recently asked about the need for more troops his response was the following: “It’s a growth industry and we will get what we want.”

    Many Americans are now approaching that Viet Nam mindset of war weariness, and at a time when we are in a deep economic depression. There is discussion of a ‘war tax” just as we are realizing the cost to overhauling of our health care system; upgrading our educational system and moving to cleaner, more efficient energy sources. It is also the poverty, the hunger and the declining spirit of the masses. “The most successful war seldom pays for its losses,” so states one of our Founding Fathers, Thomas Jefferson.

    “Peace is not absence of conflict; it is the ability to handle conflict by peaceful means”. -Ronald Reagan

     This country has a “machine” as strong and powerful as our military machine of generals and war strategists. “Give peace a chance” should no longer be a cliché of the past. Today, we are much better prepared to call upon and muster nations, experts in international economists and community planning; sociologists, educators, medical and public health professionals, and known political peace makers who can strategically infiltrate a society in conflict, or a country experiencing massive poverty and reap significant gains, with significantly less loss to life. And, yes, there is actually a United States Institute of Peace, located in Washington D.C. The challenge is being proactive in inserting new and different voices into the national conversations of conflict and war. It is time for a new world order.

    Whether it be with the advice of  John Kennedy, “Mankind must put an end to war, or war will put an end to mankind,” or  General Douglas MacArthur when he courageously stated: “I believe that the entire effort of modern society should be concentrated on the endeavor to outlaw war as a method of the solution of problems between nations,” it is now that moment in the history of our country, at this place in time, to speak out, peacefully protest, write and stir the spirit of this country.

     May we never confuse honest dissent with disloyal subversion. ~Dwight D. Eisenhower

     

    War will exist until that distant day when the conscientious objector enjoys the same reputation and prestige that the warrior does today. – John F. Kennedy
     
    War should be the politics of last resort. And when we go to war, we should have a purpose that our people understand and support.  – Colin Powell

     

  • Health is Everywhere

    BY MATT MASIELLO, MD, MPH
    Often times the feeling is the opposite; it is illness that is everywhere, not health. With the U.S. population experiencing a continuing surge of chronic illness, costing this country, we Americans, 80% of the money we spend on health, why should we think that illness is not here to stay. Sadly, the U.S. is not leading the international charge in maintaining and sustaining maximum health for all citizens. The present generation of U.S. children could be the first to have a lower life expectancy than their parents’. Forty-six-plus million individuals in this country live without health insurance and that number will only grow as the economy suffers.

    “Sick Around the World,” a Public Broadcasting Station (PBS) documentary, reviewed the stark comparisons between the health care systems of several countries to that of the U.S. The one interesting question asked of the health care leaders of the five countries was: “Would a citizen of your country ever go bankrupt over a hospital bill?” The response was “not possible” or “never,” along with a facial expression of surprise and wonder that the question was even asked. When the small country of Taiwan had the opportunity to re-invent their health care system in the 80s they identified the advice of those countries considered to have the best health systems. When asked, and again with a polite pause in the conversation, the Taiwan spokesperson responded that the U.S. was not one of those countries.

    These countries certainly have issues and obstacles in providing the very best health care. However, “health” is considered a human right and thus they are committed, through political will and leadership, in making it work.
    Ilona Kickbusch, a well-known health care author and academician, who has worked and lectured on both sides of the Atlantic, speaks of the roles of hospitals in the “health society of the 21st century.” At the 2007 World Health Organization-Health Promoting Hospital Network (WHO-HPH) meeting in Vienna, Austria, she eloquently and simply stated that “health is everywhere.” And in that environment she describes the important role of hospitals in identifying and utilizing “health.” Health care professionals from around the world gathered at the annual event to discuss how hospitals can identify themselves as public health advocates for their patients, hospital staff, community and environment. David Ollier of Hospitals and Health Networks wrote of the minimal participation by the U.S. in the international organization in his 2007 article, entitled “American Exceptionalism,” where he comments on “where one is a lonely number.” Nicely, so that “one” (hospital) is in Pennsylvania.
    The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” In the U.S. we do a good job in curing diseases and treat illnesses for some, not all. We are less proficient in the area of hospital based disease prevention, health promotion or public health or public health advocacy.

    So, what can U.S. hospitals and health care systems do to realize and benefit from the fact that health care can also be everywhere? First, there is the issue of leadership. We need a different type of health care leader. Hospital CEO’s, Presidents, Trustees should have training, experience, background and appreciation of the broad social and health issues of our day, as well as manage the day to day operations of the health care system. These new health care leaders must find that common ground of how hospitals can obtain the optimal profit margin as well as strategically serve as public health advocates for the communities they serve. Second, the international arena is the “health” classroom where we can learn. If we have the desire, fortitude and leadership to redesign our U.S. health care system our hospitals, managed care organizations and political leaders must make the effort to identify this new health care leadership as well as reach out internationally for this level of expertise. The WHO-HPH network would serve as a viable resource.

    According to Ilona Kickbush, hospitals must begin to live in the four domains of health – medical health, personal health, public health and the health market. In the health market alone, she describes 18 categories of potential activity. To participate and excel in these activities a new kind of political and health leadership must rise up and be able to speak beyond the important but limited topics of “access to care”, “health insurance for all”, or “reimbursement for clinical services.” For the U.S., we need to strategically create the balance between the attention and funding we provide for treatment of chronic illness and technology and the more encompassing “health society” of health promotion, wellness and disease prevention. As steam was an economic driver in the 1800s, steel in the 1850s, electricity in the early 1900s, the automobile in the 30s and information technology in 2000, health must become the driver in the decades to come. Kickbush and others have commented on these comparisons, with wellness, health promotion and medical technology as being the economic driver for 2050.

    And lastly, we must also be willing to retrain our health care professionals. Though we may need more nurses at the bedside of our hospitalized citizens we also need nurses, as well as physicians, who are trained to “clinically” promote the health of the patient beyond that of the hospital bed and back to their homes and work places. Europe, Asia and many other countries are forging ahead on these health care practices. We must work to change how we do health in America.
    It is time we counter the impression and opinions of others by reflecting upon a quote from Winston Churchill: “Americans are a wonderful people in that they always find the right answer…after they have tried every wrong answer first.” We can do better, we must do better, and we must find the right answer to better health.

    Dr. Matt Masiello, Director, The Center for Health Promotion and Disease Prevention, Windber Research Institute & Windber Medical Center, and Project Coordinator (U.S.-based), International HPH Network, World Health Organization-Collaborative Center (WHO-CC), Copenhagen Denmark, can be reached at m.masiello@wriwindber.org or (814) 619-6168

    4 December 2008 http://www.wpahospitalnews.com HospitalNews

  • Preventing Bullying Through Science, Policy, and Practice

    Publication

    Released: May 10, 2016

    Bullying has long been tolerated as a rite of passage among children and adolescents. There is an implication that individuals who are bullied must have “asked for” this type of treatment, or deserved it. Sometimes, even the child who is bullied begins to internalize this idea. For many years, there has been a general acceptance and collective shrug when it comes to a child or adolescent with greater social capital or power pushing around a child perceived as subordinate. But bullying is not developmentally appropriate; it should not be considered a normal part of the typical social grouping that occurs throughout a child’s life.

    Although bullying behavior endures through generations, the milieu is changing. Historically, bullying has occurred at school, the physical setting in which most of childhood is centered and the primary source for peer group formation. In recent years, however, the physical setting is not the only place bullying is occurring. Technology allows for an entirely new type of digital electronic aggression, cyberbullying, which takes place through chat rooms, instant messaging, social media, and other forms of digital electronic communication.

    Composition of peer groups, shifting demographics, changing societal norms, and modern technology are contextual factors that must be considered to understand and effectively react to bullying in the United States. Youth are embedded in multiple contexts and each of these contexts interacts with individual characteristics of youth in ways that either exacerbate or attenuate the association between these individual characteristics and bullying perpetration or victimization. Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, this report evaluates the state of the science on biological and psychosocial consequences of peer victimization and the risk and protective factors that either increase or decrease peer victimization behavior and consequences.
    Learn more about the report: nas.edu/ScienceOnBullying

    For more information, or to purchase this ebook: http://www.nationalacademies.org/hmd/Reports/2016/Preventing-Bullying-Through-Science-Policy-and-Practice.aspx

    #MattMasielloMD

  • A Public Health Approach to Bullying Prevention

    A Public Health Approach to Bullying Prevention will serve as a practical, sustainable, cost-efficient strategy to tackle bullying. More importantly, it may be the best approach to providing legitimate and sustainable hope to our children at a time when bullying is becoming increasingly more difficult to tackle.

    This book presents a public health approach to bullying prevention in a comprehensive and deliberate manner. Formal public health strategies have been used to combat infectious disease epidemics, tobacco use, and motor vehicle injuries. When applied to bullying, public health strategies provide a scientific approach to community planning, the use of evidence-based programs, coalition development, and the ability to change the culture in a school and community to one that is positive and strong. This text will serve as invaluable resource to parents and professionals looking for advice on specific facets of school-based bullying.

    Available on Amazon: https://www.amazon.com/Public-Health-Approach-Bullying-Prevention/dp/0875530419

    A Public Health Approach to Bullying Prevention is a valuable resource on how to assess, apply, and evaluate public health interventions to reduce bullying and violence in schools. Anyone intending to launch a bullying prevention program should begin by reading this book. —Donald S. Burke, MD, Dean, Graduate School of Public Health, University of Pittsburgh


    #MattMasielloMD