Archive for Editorial – Page 2

Who are the best Doctors?

As a physician, many of my friends ask me to comment on the doctoring skills of my medical colleagues. Admittedly, a positive testimonial from a physician about your private physician is reassuring, but is it reliable? Outside of my specialty of urology, I found it very challenging to assess the competency of my colleagues other than by the three A’s of medical practice, first Availability, second Affability and finally Ability in that order. Yet, each year both Cincinnati and Cincy magazines glibly put forth a list of the Top or Best doctors in the Greater Cincinnati area.

Currently, statistical measures do not differentiate the best from the average also. Web site such as Healthgrades.com may crunch the numbers of millions of medical claims from federal and private sources to rate and rank doctors but their parameters that allegedly factor in experience, complication rates and patient satisfaction are grossly incomplete and subject to arbitrary standards of care.

You might think that primary care physicians and pediatricians (PCPs) would be knowledgably about the quality of medical care rendered by the specialists to whom they refer. But today’s PCPs are generally hospital employees and do not follow their patients in the hospital if they are admitted and thus rarely interact professionally or socially with the specialists. Moreover, the hospital systems (Christ, TreHealth, Mercy Healthcare, UC Health and St. Elizabeth Healthcare) have incentives for their ‘owned’ physicians to refer exclusively to other doctors in the network. The advent of the ‘Hospitalist’ and ‘Intensivist’, new breeds of physician that manages hospital care, has added an additional layer of isolation between the PCP and other physicians.

Moreover, insurance plans often change their panel of physicians and enrollees often change health plans. And when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the physicians covering the practice.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practitioners. Many patients have already received the 3 or 4 page satisfaction surveys after a routine office visit, outpatient surgery or a hospital admission.  The soft data of patient satisfaction does correlate with quality of care, but the response rates to these surveys are much higher in the outliers of either the very satisfied or very dissatisfied. From a physician’s perspective, they do not paint an accurate picture.

So how does one latch onto the best doctors. Probably word of mouth from satisfied patients remains the best method upon which to judge a doctor. In the hospital setting, possibly, the floor nurses and operating room technicians with whom the doctor works day-over-day give the most reliable testimonials about the behaviors and capabilities of individual physicians.  But there is no surefire way to select the very best. In most instances, it is a leap of faith that ends in a good match based upon trust, bedside manner, accessibility and previous treatment outcomes.

And yet the magazine lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, and medical testing facilities goes on and must certainly sell magazines. However, if your doctor or medical facility does not make the cut, don’t get concerned; the lists are very arbitrary and have little correlation with quality of care.

 

— Richard G. Wendel MD, MBA

Passive Aggressive Poison

How passive/aggressive individuals can poison a work environment even more than overtly antagonistic employees

The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes passive-aggressive personality disorder as a “pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational situations.” In my experience, it most frequently occurs in the workplace as indirect behaviors that subtly undermine efficiency, authority and interpersonal relationships.

The lazy hostile employee with an attitude is usually not the most disruptive to a functional work environment. You might ask why? It is because those types of individuals are easily identified and, at least, you know where they are coming from. Moreover, management usually terminates these folks before they disrupt organizational culture. On the other hand, more problems are created in the office culture by employees who appear to be doing a reasonable job… but in fact are slowly eroding the performance, attitude, and morale of the people around them through passive/aggressive behaviors.

What do they do?

  1. They frequently use the expression, “That’s not my job.”

To get the work done, it is important to have employees that do whatever it takes to get things done regardless of their title, position or seniority and not procrastinate. “It’s not my job,” really says, not only do I not care about you but I am passively indifferent to the needs both of the company and fellow workers.

  1. By virtue of their position, they think they’ve already paid their dues.

They wish to rest on their laurels and assume that they no longer need to work very hard. This type of passive/aggressive behavior can be especially malignant since it is infectious to other workers that may feel that they have a right to coast also.

  1. They feel that experience is enough.

Experience is certainly important but it is not an excuse to sit in the office waiting for someone to drop by to be mentored and intimidated by showing them your superior knowledge. Holding back and not proactively sharing your knowledge is characteristic of the passive/aggressive type personality.

  1. They lead the meeting after the meeting.

After the group holds a meeting that garners a degree of consensus,

the passive/aggressive tends to hold the “meeting after the meeting” about issues that had seemingly been resolved. They create passive resistance by raising issues that undermine the decisions so that no agreed upon actions can be implemented.

  1. They love to gossip by innuendo and a form of a negative grapevine effect.

Casual back biting and rumor are common tools of the passive/aggressive individual. Even under the guise of harmless banter and being a ‘fun guy’, nothing can more quickly destroy employee morale than negative sarcasm. This can also cause key employees to leave or act as a barrier for promotion based upon merit.

  1. Passive aggressive personalities excel at fence sitting.

This trait is, in my opinion, the most disturbing of this personality complex. They tend to hide and flip-flop on issues at will. Because they avoid making any waves, they are often promoted into managerial positions where the negative impact of their passive/aggressive behaviors is amplified. This is supportive of the Peter’s Principal that proposes that employees have a tendency to be promoted to their level of incompetence.

Transparency, teamwork and congeniality punctuate an ideal work environment and passive/aggressive behaviors do the opposite. Do any readers have experiences to share where these types of negative resistance have created a hostile work environment?  

  

 

 

The role of sugar in cardiovascular health

Research on the potential benefits of sodium reduction for treatment of hypertension has yielded conflicting results, with some evidence suggesting that reducing sodium intake could actually increase cardiovascular and all-cause mortality in patients with diabetes. A review in the journal Open Heart examines the role of sugar, not salt, in cardio-metabolic health, as up to 80% of individuals with “essential” hypertension also exhibit insulin resistance and about 50% of hypertensive patients also have hyperinsulinemia. Numerous studies have linked sugar intake with blood pressure, especially with sugar-sweetened beverages and hypertension. However, naturally occurring sugars appear to not have this same association. One study found that a diet with increased servings of whole fruit significantly lowered systolic blood pressure, even with a fructose intake of about 200g.

The American Heart Association currently recommends no more than six teaspoons of sugar per day for women and no more than nine for men, but does not make specific recommendations regarding added sugars and hypertension. Because added sugars may increase cardiovascular risk by inciting metabolic dysfunction and increasing blood pressure variability, myocardial oxygen demand, heart rate, and inflammation, the authors recommend a greater emphasis on added sugar reduction in hypertension and cardiovascular disease guidelines.

Wounded Warrior Project, why is it necessary?

For decades America has had an all volunteer military force. Without conscripts and with a massive pentagon budget, it would seem reasonable that the Federal Government take care of its employees both in regard to retirement benefits and long term medical care.

Why do we need organizations such as the Wounded Warrior Project to supplement government benefits? In 2012, the Wounded Warrior Project, a 501 (c) 3 charity, raised over $230 million dollars. In 2012, the IRS Form 990 reveals that the total compensation for their two highest paid employees exceeded $400,000 and the net assets of the organization were $166,000,000.  Because we are overdosed with highly emotional appeals for donations to the Project, we can only conjecture how much they spend on TV and prime time media advertizing.

As a veteran of the Vietnam War where I was a combat surgeon, I am very sympathetic to the needs of our wounded soldiers. However, I question the need for private sector funding for medical care for our disabled veterans. Unfortunately, this need may be an indictment of our entire Governmental military system. Or it may represent an opportunistic approach to raising money through empathy so as to create jobs and pads the pockets of the founders of charities such as the Wounded Warrior Project.

– Richard G. Wendel MD, MBA

Medication Expiration dates… What do they mean?

A medical school friend of mine recently threw out some Nembutal capsules he was given on a tour of Ely Lilly tour while in Medical School in 1959. He now wonders if this was necessary.

If a bottle of Tylenol, for example, says something like “Do not use after June 1998,” and it is August 2002, should you take the Tylenol? Should you discard it? Can you get hurt if you take it? Will it simply have lost its potency and do you no good?

In other words, are drug manufacturers being honest with us when they put an expiration date on their medications, or is the practice of dating just another drug industry scam, to get us to buy new medications when the old ones that purportedly have “expired” are still perfectly good?

These are the pressing questions I investigated after my mother-in-law recently said to me, “It doesn’t mean anything,” when I pointed out that the Tylenol she was about to take had “expired” 4 years and a few months ago. I was a bit mocking in my pronouncement — feeling superior that I had noticed the chemical corpse in her cabinet — but she was equally adamant in her reply, and is generally very sage about medical issues.

So I gave her a glass of water with the purportedly “dead” drug, of which she took 2 capsules for a pain in the upper back.

About a half hour later she reported the pain seemed to have eased up a bit.

I said, “You could be having a placebo effect,” not wanting to simply concede she was right about the drug, and also not actually knowing what I was talking about.

I was just happy to hear that her pain had eased, even before we had our evening cocktails and hot tub dip (we were in “Leisure World,” near Laguna Beach, California , where the hot tub is bigger than most Manhattan apartments, and “Heaven,” as generally portrayed, would be raucous by comparison.

Upon my return to NYC and high-speed connection, I immediately scoured the medical databases and general literature for the answer to my question about drug expiration labeling. And voila, no sooner than I could say “Screwed again by the pharmaceutical industry,” I had my answer.

Here are the simple facts:

First, the expiration date, required by law in the United States, beginning in 1979, specifies only the date the manufacturer guarantees the full potency and safety of the drug — it does not mean how long the drug is actually “good” or safe to use.

Second, medical authorities uniformly say it is safe to take drugs past their expiration date — no matter how “expired” the drugs purportedly are. Except for possibly the rarest of exceptions, you won’t get hurt and you certainly won’t get killed.

Studies show that expired drugs may lose some of their potency over time, from as little as 5% or less to 50% or more (though usually much less than the latter). Even 10 years after the “expiration date,” most drugs have a good deal of their original potency.

One of the largest studies ever conducted that supports the above points about “expired drug” labeling was done by the US military15 years ago, according to a feature story in the Wall Street Journal (March 29, 2000), reported by Laurie P. Cohen.

The military was sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every 2 to 3 years, so it began a testing program to see if it could extend the life of its inventory.

The testing, conducted by the US Food and Drug Administration (FDA), ultimately covered more than 100 drugs, prescription and over-the-counter.

The results showed, about 90% of them were safe and effective as far as 15 years past their expiration date.

In light of these results, a former director of the testing program, Francis Flaherty, said he concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer.

Mr. Flaherty noted that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn’t mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

“Manufacturers put expiration dates on for marketing, rather than scientific, reasons ” said Mr. Flaherty, a pharmacist at the FDA until his retirement in 1999. ” It’s not profitable for them to have products on a shelf for 10 years. They want turnover.”

The FDA cautioned there isn’t enough evidence from the program, which is weighted toward drugs used during combat, to conclude most drugs in consumers’ medicine cabinets are potent beyond the expiration date.

Joel Davis, however, a former FDA expiration-date compliance chief, said that with a handful of exceptions — notably nitroglycerin, insulin, and some liquid antibiotics — most drugs are probably as durable as those the agency has tested for the military. “Most drugs degrade very slowly,” he said. “In all likelihood, you can take a product you have at home and keep it for many years.” Consider aspirin. Bayer AG puts 2-year or 3-year dates on aspirin and says that it should be discarded after that.

However, Chris Allen, a vice president at the Bayer unit that makes aspirin, said the dating is “pretty conservative”; when Bayer has tested 4-year-old aspirin, it remained 100% effective, he said. So why doesn’t Bayer set a 4-year expiration date? Because the company often changes packaging, and it undertakes “continuous improvement programs,”

Mr. Allen said that each change triggers a need for more expiration-date testing, and testing each time for a 4-year life would be impractical. Bayer has never tested aspirin beyond 4 years, Mr. Allen said.

Dr. Carstensen, professor emeritus at the University of Wisconsin’s pharmacy school, who wrote what is considered the main text on drug stability, said,

“I did a study of different aspirins, and after 5 years, Bayer was still excellent. Aspirin, if made correctly, is very stable.

Okay, I concede. My mother-in-law was right, once again. And I was wrong, once again, and with a wiseacre attitude to boot. Sorry mom.

Now I think I’ll take a swig of the 10-year dead package of Alka Seltzer in my medicine chest to ease the nausea I’m feeling from calculating how many billions of dollars the pharmaceutical industry bilks out of unknowing consumers every year who discard perfectly good drugs and buy new ones because they trust the industry’s “expiration date labeling.”

By Richard Altschuler

Choosing the Best Doctor

 What is the Best Way to choose your Doctor?

As a physician, many of my friends and acquaintances ask me to comment on the doctoring skills of some of my medical colleagues. Some take it a step farther and ask who the very best doctors are in a given field of medicine. Admittedly, a positive testimonial about the skills, knowledge and abilities from a physician about your private physician or specialist is reassuring.

But even as a physician, it is difficult to judge the competencies of other doctors and how their practices treat patients. Only in my specialty of urology was I confident that I knew with certainty who were the better practitioners. For instance, I knew the number and types of procedures they were performing at the hospital and often took care of some of their complications or patients that were dissatisfied with their care. In addition, I knew them socially and attended the same scientific and medical conferences. As they were competitors, it was unusual for me to refer patients to other urologists.

Judging medical practitioners outside of your medical specialty is very challenging and most often based on subjective and second hand information. Certainly the doctor’s reputation amongst his colleagues is important, but not always accurate because it may relate more to friendship and social skills than ability. However, the opinions voiced by the floor and operating room nurses and staff with whom the doctor works, however, are usually right on target. Other considerations that may or may not influence your decision include malpractice actions and catastrophic medical complications plus any disciplinary actions against the doctor by the State Medical Board or curtailment of privileges by a Hospital.

You might think that primary care physicians and pediatricians (PCPs) would be accurate in their assessments of the quality of medical care rendered by the specialists to whom they refer. But the typical PCP refers only a few patients to any one specialist and rarely has the time to discuss the patient’s experience with that doctor’s practice when he or she returns. Additionally, PCPs today rarely follow their patients when they are admitted to the hospital and in large groups specialty practices the new patients are often assigned a doctor that has openings rather than the doctor the PCP referred the patient to in the first place. Moreover, physicians no longer congregate in the morning in the hospital medical staff lounges to socialize, provide curb stone consults and get to know one another.

Adding to the difficulty in assessing the quality of an individual physician is the very structure of today’s medical marketplace. For starters, insurance plans often change their panel of physicians and enrollees often change health plans. Most physicians are now in large medical groups and when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the numerous partners that happens to be on call. Moreover, the hospital systems are buying medical practices to form large vertically ‘integrated’ healthcare systems and this disrupts traditional referral patterns by the hospital’s insistence that their physicians refer only to other doctors in their system.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practices. In fact, within Obamacare, up to 2 percent of reimbursements will be linked to patient satisfaction in the near future. Many patients have already received the 3 or 4 page satisfaction questionnaire after a medical visit, outpatient surgery or a hospital admission.  Response rates to these extensive surveys are generally low and the majority of patients that complete the survey are either the very satisfied or the very dissatisfied. Thus, from a physician’s point of view, these surveys have limited ability to quantify quality.

New Statistical Ways to Choose a Doctor

In a recent USA TODAY article they talk of a revamped Healthgrades.com website as a new tool to research doctors. This site uses about 500 million claims from federal and private sources to rate and rank doctors. It claims to factor in experience, complication rates and patient satisfaction. Problems arise with selecting a physician in this way because:

  1. Some physicians treat sicker patients than other doctors and accordingly might have higher complication rates. No severity of disease adjustment of patient populations is possible.
  2. Medical treatment still lacks broad standardized parameters of medical care for all but a few common clinical conditions such coronary artery bypass surgery, diabetes, asthma and pneumonia.
  3. The collection of electronic data covering large populations of patients is still in its infancy and the current statistical data is insufficient to evaluate individual physician performance.
  4. The geographic, insurance and technical barriers to properly match patient and physician are many.
  5. Patient satisfaction statistics may be the only valid indicator because patient satisfaction does correlate with quality and outcomes.

Both Cincinnati and Cincy Magazines rate the ‘best doctors’ in Cincinnati based upon surveys sent to all or some of the 5000 physicians practicing in Hamilton County. The surveys are quite simple, “who would you send your relatives to for care?” With large group practices dotting the medical landscape and hospitals owning a large swath of medical practices, this type survey causes business interests to surface rather than objectivity in physician evaluation. There are few independent physicians in solo practice who ever make the list of best doctors. Moreover, the survey response rates tend to be less than 20 percent and, at best, this exercise becomes a ‘popularity contest.’ In my review spanning many years of these ratings, I have been unable to see any correlation between the survey results and the quality of care administered by those selected.

Lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, medical testing facilities and so on must sell magazines and attract viewers because the numbers of lists in all media just proliferate. In Cincinnati, virtually all major heart, orthopedic and neurosurgical clinics claim to have high national ranking. You must ask how and by whom or just chalk it off to the hospital’s or practice’s aggressive marketing efforts.

In the medical field, physicians and physician specialists all read the same scientific journals, attend the same medical society meetings and, as a consequence, no one has ‘special’ knowledge or revolutionary techniques. Some efficient hospital systems such as the Mayo and Cleveland Clinics have perfected their processes to expedite medical care and achieve a reputation through exemplary patient satisfaction. Additionally, if a surgeon or hospital does 500 open hearts a year, they usually are more proficient than if they do 50-100 per year.

So how does one latch onto the best doctors. Probably word of mouth from satisfied patients remains the best method upon which to judge a doctor. But there is no surefire way to select the very best. In most instances, it is a leap of faith that ends in a good match.. At the end of the day, you, the patient, are the best custodian of your health. A healthy lifestyle has greater survival benefit than selecting the best of the best doctors.

 

– Dick Wendel MD, MBA

Sore Knees and Ringing Ears

A recent editorial in the Cincinnati Enquirer strongly resonated with me. It was titled ‘standup guy’ a growing force with the standup guy being the Bengals fans that stand up continuously throughout the game even when nothing is happening on the field. This blocks the line of sight for the fans behind them and this standing stance cascades or ascends through the spectators much like an ‘upward wave’ and leaves everyone standing. This phenomenon is seen even in those stands close to the playing field.  It is useless to complain and there seems to be no way to reverse this ‘wave’, because to do so might result in physical and verbal altercations, especially with inebriated fans that are hyper excitable due to alcohol.

If being forced to stand were not enough, the sound levels at Bengal’s games are deafening. There always seems to be a few fans with loud shrill voices (usually sitting immediately behind us) that elevate the noise to decibel levels that assault the ear drums. This is especially true if you have seats located in the end zones. As a physician, I would suggest that all fans bring ear plugs with them to the games.

These two elements of the experience when you go to see a professional football game is the primary reason I gave up my Bengal’s season tickets years ago. I have no solutions to the standing and noise problem, except to have friends that have enclosed boxes and invite you to the games.

I enjoy watching football in the comfort of my home and am pleased that home games no longer need to be sold out to avoid a TV blackout.

-Dick Wendel MD, MBA

OLLI: A Bargain for the Fifty and Older Set

OLLI-program-full               OLLI, the Osher Lifelong Learning Institute, is an affiliate of the University of Cincinnati that offers three eight-week quarters of classes (fall, winter, spring) plus summer classes for Seniors who love lifelong learning. Classes are held on the main campus at the Tangeman University Center as well as at UC Blue Ash, Adath Israel, the Sycamore Senior Center and elsewhere. The cost per quarter is $85 that opens the door to over 120 course selections that will stimulate your curiosity and thirst for knowledge.

The curriculum includes a broad range of classes including history, science, computers, music, the arts, writing, current events, hobbies, estate planning, medicine and many more. Each week during each quarter, an exciting three hour seminar (WOW) on a special topic is offered at the Sycamore Senior Center. Most days, a one-and-a-half hour ‘Brown Bag’ lunch from 12:30 to 2PM is held at UC Blue Ash.

In 2013, over 1800 students experienced the joy of learning at OLLI. The average age of students that attend OLLI classes is 68 years with 60 percent being women and 95 percent college graduates.

You can get more information and register for classes by visiting the website at www.uc.edu/ce/olli

 

The Mayor’s Bulletin… Misinformation?

Chicken Little? “The sky is falling!”

Chicken Little is an endearing and amusing folk tale all of us have heard or told. It has a moral to it, warning us against hysterical beliefs that disaster is imminent or against being unreasonably afraid. The story of Chicken Little came to mind when I read the latest Mayor’s Bulletin (April 2014).

Despite the innocuous title, the Bulletin article “MARIEMONT.ORG IS THE ONLY OFFICIAL WEBSITE OF THE VILLAGE”  had little to do with websites. This was another  use of an “official” Mariemont publication, paid for by Mariemont taxpayers, that digresses from the topic of the Village of Mariemont website into a personal attack, an atttempt to intimidate and bully, and projection of unreasonable conclusions  on other issues. Let’s dissect this article from the Bulletin,hopefully making more rational comments and sense than it contained:

“MARIEMONT.ORG IS THE ONLY OFFICIAL WEBSITE OF THE VILLAGE”

“At Town Meeting, a few citizens were still confused about the Village’s website, so once again, I want to point out to everyone that the Village’s official website is www.mariemont.ORG.  The website with the domain name of www.mariemont.COM is NOT a Village-authorized site.”

  • The Village of Mariemont does not have statutory authority to authorize sites or domain names.
  • Mariemont.com has voluntarily and repeatedly expressed publicly and on its website that it is not connected to the Village government and is an independent site, presenting independent viewpoints and information on Mariemont and surrounding communities. These recurring attempts in the Mayor’s Bulletins to discredit it and diminish it border on libel.
  • Mariemont.com existed long before Mariemont.org!

“The publisher of this unofficial website wrote a letter to ODOT in support of running the Eastern Corridor through our South 80 Park – something we have vehemently opposed!”

  • Why continue to claim this is an “unofficial” site when it clearly is not Village sponsored nor paid for by the Village?
  • What relevance does this comment have to either web site?
  • What is the point of these repeated attempts to deride a differing viewpoint?  While some may not agree on the direction or objectives of the Eastern Corridor, it does not prevent one’s freedom of expression. Differences of opinion and the ability to express them are basic rights and recognized as a sign of a healthy democracy! Where is the respect for others’ opinions?

“Our experience with ODOT leads us to believe that they will use this letter against us, saying that it indicates support from Village residents to build the Eastern Corridor which would destroy our historic parkland and possibly cause us to lose our status as a National Historic Landmark by paving over an important historic Native America village site.”

  • What experiences with ODOT are being referenced here and why would these lead you to believe ODOT would use the letter against the Village? If you’re going to make these claims, provide FACTS, not opinions, assumptions or innuendos.
  • Does anyone seriously believe ONE letter will carry more weight or sway ODOT to act against Village wishes compared to the many opposing letters and opposition groups involved in this project? This is hyperbole at its finest.
  • What evidence exists Mariemont could lose its National Historic Landmark designation if the Eastern Corridor is built? Is there a letter from the Interior Department or cite from a federal act verifying this? My review of the National Historic Preservation Act and 36CFP Part 800 – Protection of Historic Properties did not indicate any reasons for losing an historic landmark designation. What’s the basis for this fear-mongering comment?

“What’s more, we have heard rumors that ODOT is using the four-lane Eastern Corridor like a ‘Trojan Horse’ to lay the groundwork for extending I-74 through our community and into Clermont County.”

  • Who told you these “rumors?” What evidence or facts were presented to give any substantiation to them? Was any investigation or fact finding conducted to verify or dismiss them?
  • Promoting unsubstantiated rumors in a Village sponsored publication would be unsavory and unctuous.

“Can you imagine an expressway running through the South 80 Park?  It would fill our quiet neighborhood with a constant roar of traffic and fill our air with pollution from the large volume of cars passing through.”

  • It already exists. What about the traffic, noise and pollution created every day from the 30,000 cars passing through the heart of Mariemont, and next to schools and parks? This is nothing more than pandering to the emotions of opponents to the Eastern Corridor.

“No longer would the South 80 Park and/or the Concourse be places for relaxing and enjoying nature as they were intended.  Because it is prone to flooding, the area could never be used for playfields or a shelter house. “

  • Because it’s prone to flooding, does that mean we can’t have the South 80 trails or camp site we’re using today? Schmidt baseball fields, Riverbend music center, and other facilities are located in the flood plain of the Ohio River and are used year after year, flood after flood. Why would the South 80 be any different?

“Obviously the publisher of this letter did not have all the facts or understand the significant ramifications of ODOT’s plans before sending that letter to ODOT.  Now that everyone is aware of how harmful this would be to the Village of Mariemont, we respectfully ask that this letter be rescinded and let ODOT know that, in the best interest of this community, the publisher no longer supports the construction of the Eastern Corridor.  Certainly anyone who cherishes the peace and tranquility that is the Village of Mariemont would not want it replaced with a major expressway! Please let it be known that you do not agree with the statement in the letter to ODOT! “

  • What is this obsession with a letter that was written two years ago expressing a differing viewpoint?
  • This is nothing more than a BULLYING tactic and attempt to discredit someone who has a difference of opinion.  Surely the Village has not become a community where people cannot disagree or have a difference of opinion?
  • Why isn’t the” publisher” mentioned several times in this article ever identified? Fear of libel?

While I initially applauded the purpose of the Mayor’s Bulletin to communicate regularly with residents of the community about issues, events and activities in the community, I cannot condone it for what it has become. It’s time for Mariemont Council and its Solicitor to stop allowing the use of taxpayer money to promote unfounded rumors, unsubstantiated claims, personal vendettas and personal agendas in a Village sponsored and paid publication.

The sky is not falling Chicken Little. it’s just a little thunder!

Mike Lemon

Early childhood development and education

Is it time to place a greater emphasis on early childhood development and education?

Richard Wendel MD, MBA

The American educational system is a favorite media target for criticism because of low test scores, subpar graduation rates, lack of teacher accountability, contracts that entrench underperforming teachers, underfunding, out-of-date technology, parental indifference and poorly motivated children. The data comparing our system with that of other developed nations is damming and we seem to be producing school dropouts and graduates with skill sets that do not match the needs of the marketplace. There are too few engineering, science and technology graduates and too many graduates with bachelor degrees in the soft liberal arts that frequently are the entry point to low paying jobs that cause graduates to bump along the poverty line with unpaid educational debt. This debt burden often delays getting married, raising a family and purchasing a home.

I believe our school systems get a bum rap and are not the primary reason our students underperform and here is why. It is widely estimated that over 80 percent of brain development in the human occurs before the age of five. Now if 80 percent of brain development occurs before age 5 with a decelerating rate of development after that, then we can assume that more than 50 percent of brain development takes place in the time interval starting in intrauterine life and ending at age two. To support this supposition, the circumference of the head of the average male at birth is 13.7 inches and at 2 years of age 19.4 inches; whereas in the male adult it is just 21-22 inches, an increases of a mere two to two and a half inches.  Intuitively, this frontal occipital circumference of the cranium correlates with the size and function of the brain.

In recent times, mandatory preschool and all day kindergarten have been given a higher priority to address and correct learning deficiencies and level the educational playing field for disadvantaged kids. In preschool, the Kindergarten Readiness Test is a good reproducible metric for evaluating intellectual skills. Most studies show improved long term academic performance with quality preschool for underprivileged children. In our inner cities, full day Kindergarten offers defined benefits as well.

The intellectual nurturing of the infant before preschool is more problematical, but probably more imperative and productive on a time weighted basis. Public dollars might produce better educational benefits if a larger share were directed toward prenatal care and the environment surrounding a child’s first two years of life.

No amount of remedial training can completely reverse the ravages of neglect during infancy. For instance, recent studies of prisoners placed in solitary confinement show that the lack of stimulation produces brain atrophy and deranged thinking. This is analogous to the effects that might be anticipated from the neglected infant.

Results from more intrusive intervention in the toddler age group are difficult to measure. How do you evaluate the toddler with rudimentary verbal skills and a limited ability to emote? How do you measure neglect in environments where there is a void in stimulation with little touching, cuddling, verbal exchange, reading, love, play and nurturing?

All the solutions to this problem that infects a sizeable segment of our society impinge upon our fundamental human rights to privacy and independence in a free society. The solutions are also stymied by religious and moral considerations as well as politics, entitlements, social justice and ignorance. Neglected infants are innocent victims and the society needs to adopt a more aggressive approach to the realization that bearing a child is a privilege that carries with it an enormous responsibility.

Our teachers and school administrators do a great job with limited resources. Most short comings in our educational system can be explained by adverse selection due to impoverished environments. To get better outputs you need to improve the quality of children entered into the system. Better child care coupled with preschool is a recipe to improve test scores and graduation rates to serve the job market. Moreover, teachers will be grateful to teach highly motivated students.

“Success by Six’ sponsored by the United Ways is an exciting program that supports a ‘whole child’ approach. It has been introduced in more than 350 cities. It monitors the home environment, access to medical care, security and adequate nutrition. Without addressing these root causes for ‘slow learning’, the cycle of underachievement and ignorance will continue to erode the American dream for millions of our children.