Pediatrics leader talks about biggest issues facing kids
Last month, Dr. James M. Perrin, a professor of pediatrics at Harvard Medical School and the Massachusetts General Hospital for Children, became the president-elect of the American Academy of Pediatrics, a professional group of 60,000 doctors. A primary care physician, Perrin is particularly interested in addressing chronic childhood illness during his three years of leadership at the academy, first as president-elect, then president, then president emeritus.
What do you think are the biggest health issues facing today’s kids?
Childhood obesity and other chronic health conditions: the continuing growth in childhood asthma, and the tremendous growth in mental health conditions and developmental conditions like autism. We’ve got three or four major epidemics really growing among children and adolescents in America.
As head of the pediatrics academy, how much power do you really have? Is it primarily a bully pulpit or can you shape policy and direct research?
I think we can shape research only to a degree. I think what we really want to be working on is recognizing that all of these conditions have grown tremendously in their prevalence over the last decade or so — things like obesity, asthma, mental health conditions like depression and ADHD, and things like autism and other neurodevelopment disorders. We want to make sure we’re much better able to provide the kind of care that these children and their families need. I see that as a major role for the academy right now.
Do you think that the Affordable Care Act is good for pediatricians?
I think that this notion of building teams of providers to work together is really critical. There’s a lot of interest in making this happen. A major role of the president [of the American Academy of Pediatrics] is to advocate to make these changes.
What do you think isn’t working about the current payment system?
We’ve been trying to improve the diagnostic and treatment side of things like Attention Deficit Hyperactivity Disorder [ADHD]. To do that right, it takes time. You can’t make that diagnosis in a 10- to 15-minute office visit. So, we want to make sure people are appropriately paid to do it right. I think that’s absolutely critical at this point.
Do you have any suggestions for improving the quality of care?
[In Massachusetts,] the state provides backup for primary care physicians who are treating children and adolescents with mental health conditions. We now have it across the state and 20 other states are trying to do similar programs. It’s that kind of backup that makes me feel comfortable making a change in a child’s medications, and knowing that I’m doing it intelligently. This has really enhanced our ability to do mental health care in primary care. I think we can do that more broadly for other chronic conditions.
What is your view of complementary and alternative medicine for children with conditions like autism and ADHD?
We know that among kids with chronic conditions, about 60 to 70 percent of their moms and dads use some form of complementary or alternative medicine. For many of them, they seem to work, they seem to change how they and their child feel and I want to support that. If I were in their shoes I would do exactly the same thing. How can you not try whatever you think is right to get their child feeling better? My concern is when parents use things that are potentially dangerous, or when parents use complementary and alternative medicine instead of things we know will be helpful to their child. But they may be very complementary to the other things we’re doing to help their child.
Do you think we need more research in this area?
We certainly do. In ADHD, where a moderate amount of complementary and alternative medicine is used, we’ve almost no studies at all about whether they work. In autism, many parents use specialized diets for their children. They may work and they may not, we just don’t have the information, frankly.
How much power does a pediatrician have to improve a child’s health?
The things that make kids grow up well or grow up less well, some of them are in the hands of what we can do in our offices. Many of them aren’t. Pediatricians are pretty passionate about trying to help families raise their kids to be really effective, exciting, involved adults. We recognize that pediatricians aren’t going to change poverty. But it’s part of our job to work with other agencies and people and groups who are working to change the environment in which children live in ways that will help them grow up better and have less illness.