THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Monday, March 18, 1996 TAG: 9603180038
SECTION: LOCAL PAGE: B1 EDITION: FINAL
TYPE: Interview
DATELINE: NORFOLK LENGTH: Long : 200 lines
Larry K. Pickering was in fifth or sixth grade when his mother's battle with breast cancer began. It was the type of childhood experience that ages a boy, saturating his days with thoughts of illness and death.
Maybe that is why Pickering became a doctor. Or maybe it was because his mother's physician was so kind and helpful.
Or maybe it was because medicine saved her life.
These days, as director of Norfolk's Center for Pediatric Research, Pickering looks for ways to fight infectious diseases that attack children. The infectious disease specialist was named to fill a new chair, an endowed position, at the center.
The center is a joint project of Children's Hospital of The King's Daughters and Eastern Virginia Medical School.
Pickering divides his time between the lab and the examining room. The dual roles give him a chance, he says, to see how the fruits of scientific studies work in real life.
Soon, said Pickering, babies will have a new vaccine for rotavirus diarrhea, a common illness that leads to 250,000 hospitalizations a year in the United States, along with millions of visits to the doctor. The problem is even worse in developing countries. The Center for Pediatric Research was a test site for what proved to be a successful vaccine against this disease.
Pickering talked recently with medical reporter Marie Joyce about what researchers are doing to prevent childhood illnesses, and how parents and the community can help.
Do people in the United States tend to ignore the spread of some public health problems because we havesuch good medical treatment?
Not only good treatment, but good sanitation. We take a lot for granted. We go into our kitchen, turn on the spigot and get clean water. We can flush the toilets and not worry about waste. Other countries - in our studies in Chile and Guatemala and Mexico and many places throughout the world - you go into people's homes, and there is no running water. They have to get it from a river or well, probably (with) contaminated water.
We've seen this in the United States. You remember a year or so ago, in Milwaukee, the water (was) contaminated with cryptosporidium. It was 400,000 people. Then in Seattle you'll see children dying from E. coli 0517, from impure hamburger. Then you'll see, somewhere else in the United States, salmonella infection from a food-borne outbreak. We have a general background of pretty safe food and water, but every once in a while the barriers break down.
Are we naive? Should we be more aware that these barriers can break down?
Oh, absolutely. In the United States, the number of diseases of all sorts is dramatically increasing. Those range from AIDS to tuberculosis to food-borne disease, flesh-eating bacteria. And that includes antibiotic-resistant organisms against which we don't have any therapy. Those of us in public health are trying to change the way things are done, to prevent disease. Treating is sort of taking care of the horse when it's out of the barn. Prevention is clearly the way we need to approach this.
I guess most of us think, ``I've never gotten salmonella from handling my food improperly. I've never had bad water out of the tap.'' Really, how much of a danger are some of these things to Americans?
We don't need to be alarmed, but we need to be very cautious. Any infectious disease can break down our barriers and get any of us. I can take you over to Children's Hospital, and I can introduce you to many parents who have never had these diseases either, and now their children are hospitalized for them.
This new vaccine for rotavirus diarrhea probably would be used on all children here. What about in foreign countries, where this obviously would have a lot of use because of poor sanitation? Is the infrastructure in place to get the vaccine to the kids?
The developing countries, they often have mass immunization programs, where they immunize 500,000 children in a week. Many of the programs in the Latin American countries have better immunization rates then we have in the United States.
Really?
Well, you remember now that several years ago, only 40 percent of children in the United States were appropriately immunized by 2 years of age. Many of our colleagues in Latin American countries can show that their rates are 80 percent. They're much better at delivering vaccines.
The United States has improved. The rates are in the 70s now. The goal by the year 2000 is to get rates into the 90s.
What's wrong with us? How come we have one of the best medical systems in the world, and we have such bad immunization rates?
Education is needed. We've become a little complacent. If we've never seen a case of polio, haven't seen a case of diphtheria, we think that it never happens to us.
We have to streamline and simplify the delivery to make it so people can afford them.
What about altering vaccines so more can be given at once and require fewer trips to the doctor?
There's a big push now by vaccine manufacturers to combine them all into one shot, with a needle about this big. (He chuckles.)
I think in two to three years that will be done.
Is it possible that some of childhood illnesses would go the way of smallpox - be eliminated?
Yes. Polio's been eliminated from the Americas. The goal is to eradicate measles from the Americas, which may or may not be possible. (We will) try to markedly reduce diarrheal disease. We hopefully will markedly reduce if not eliminate tuberculosis, but that's going to be hard.
Some diseases, I think, are just always going to be with us.
Which ones are permanent residents?
Some of the causes of ear infections, because there are so many (causes). Diarrheal disease, I think, will always be with us, because you've got 10 or 15 organisms that can cause it, and you can't prevent disease caused by 10 or 15 organisms by immunization. You've got to improve hygiene and human nature. I'm sure we won't be able to improve hygiene to the status of elimination.
For instance, look at all the sexually transmitted diseases. We shouldn't see sexually transmitted diseases. There are good ways to prevent those.
So human behavior will always stand in your way?
The human behavior factor will override whatever we do, to ensure that we always have infectious diseases. You can count on that.
Why don't we do what's best for us? I guess we just don't.
We don't. We don't. I walked by Norfolk General the other day - thanking my lucky stars I'm a pediatrician - and there outside are a group of people who are overweight, with their IV poles hanging on them, smoking cigarettes. You can tell people that it's not good for you. You can put labels on boxes. But people still do it.
What are some of the things people should be doing to ensure their children's health?
Make sure immunizations are up to date. Women should try to breast-feed. When children are in cars, they need to be in seat belts. Make sure children are taught about strangers. Don't expose them to environmental contaminants like smoke in the household. Children exposed to household smoke have a higher incidence of infectious diseases.
Most organizations doing medical research say they've been hurt by cuts in funding from the NIH (National Institutes of Health), foundations and private companies.
The competition for research dollars is fierce. It's interesting, because it's being decreased at a time when medical technology is at its pinnacle. The advances we're making in medicine are absolutely phenomenal.
Training grants are almost nonexistent. We have to maintain the pipeline of young people into medicine and medical research. If the funds for that are not available, we're all going to suffer. It may not be next year. But five years from now, we're going to suffer. MEMO: Breast milk on list of center's studies
Mother's milk, say scientists at the Center for Pediatric Research,
is a powerful weapon against disease.
``It's very complex. It's a wonderful fluid,'' says Dr. Larry K.
Pickering, the center's director.
Breast milk is just one of the subjects being studied at the center.
The center has a staff of roughly 60, including about 16 EVMS faculty
members.
The center, for instance, is participating in an international study
to develop a vaccine for rotavirus diarrhea.
Researchers there have discovered that breast milk protects children
against diarrhea caused by a type of virus called rotavirus. That
disease affects nine of 10 American children by age 3 and leads to
roughly 250,000 hospitalizations each year.
The experiments were successful, and the vaccine most likely will be
considered for approval this year by the Food and Drug Administration.
It could become part of the standard round of immunizations. The vaccine
also could be given to mothers so their babies pick up some immunity
from breast milk.
Doctors also are examining how substances in breast milk work at the
cellular level to reduce inflammation. What they discover might someday
be used in the treatment of conditions, such as burns, that cause
inflammation and scarring.
Other projects under way at the center include:
Drug-resistant bacteria. A grant from the Centers for Disease Control
and Prevention will help the center investigate why antibiotics are
losing their effectiveness in treating infections in children.
Lung development in premature infants. Scientists are looking at ways
to overcome underdeveloped lungs, one of the biggest problems for
premature babies.
Medicating children. Doctors believe that giving drugs to children
isn't simply a matter of reducing the dose based on patient weight. They
are studying the different ways medicine works in the bodies of
premature infants and 200-pound teenagers.
Genetics. Researchers are looking at chromosomal abnormalities in
children with various kinds of cancer to see why some children suffer
relapses and others do not.
Immunization. Programs at the center are looking at ways to improve
the inoculation rates.
ILLUSTRATION: LAWRENCE JACKSON
The Virginian-Pilot
Dr. Larry K. Pickering's dual roles, as researcher and medical
practitioner, allow him to see how his lab tests do in real life.
``We don't need to be alarmed, but we need to be very cautious. Any
infectious disease can break down our barriers and get any of us.''
by CNB