EPtalk by Dr. Jayne 2/1/24

Physicians who care for children — including pediatricians, family medicine physicians, and psychiatrists — have been sounding the alarm for years with regard to the negative impacts of social media on the health of the world’s youth. I’ve been following the recent hearings in the US Senate Judiciary Committee this week on the topic of child sexual abuse. Executives from TikTok, X, Snap, Discord, and Meta were grilled by senators about the platforms’ role in child exploitation.

For those of you who might not be following the issue closely, abuse and exploitation of kids via social media platforms is more than cyberbullying and child pornography. The list of problems continues to expand, and includes not only the sharing of images and videos, but also predators grooming children for abuse and potential trafficking.

Drug use is also a serious concern. I’m sure a lot of parents don’t know that you can use Snapchat to buy fentanyl. As an urgent care physician, I’ve seen the faces of parents who can’t believe that the pricey TikTok-promoted cosmetic products they gave their pre-teen daughters for Christmas have caused the horrible rashes that resulted in a $100 co-pay and prescription medications.

I continue to encounter parents who are willing to help their children lie to gain access to social media even though they’re not old enough to meet the age restrictions, because they are terrified that their children will be ostracized if they’re not keeping up with their peers. I also see children who have zero parental limits on social media use, which can manifest with sleep disturbances, poor academic performance, and serious behavioral health issues.

One hot topic during the hearing was the Kids Online Safety Act, which only two of the five platform leaders were willing to support. Others claimed that the Act contains provisions which are too broad and may clash with free speech issues. The act includes language not only addressing abuse but also predatory marketing and would potentially reduce the power of notifications and auto-played videos that trigger users’ dopamine pathways and contribute to compulsive and addictive behaviors.

YouTube was notably absent from the hearing, despite the platform’s popularity among teen media consumers. Unfortunately, the hearing ended without consensus or clear solutions and those of us who have seen countless children harmed will have to continue to wait for yet another bill on Capitol Hill to finally get passed.

I received a message from the CDC’s V-safe program this week, inviting me to participate in health check-ins for the updated COVID vaccine. Unfortunately, one has to register within six weeks of receiving the vaccine. For those of us who are frontline physicians of a certain age who received the updated vaccine shortly after it became available, I guess we’re out of luck as far as participating in vaccine surveillance. Seems like that should have been something they coded and released to time appropriately with the vaccine’s arrival in retail locations.

Unfortunately, this is just the kind of food for thought that conspiracy theorists latch onto, since it can be used to try to support the assertion that that “government really doesn’t want us to know about how many people are harmed by these vaccines.” I serve on the health advisory board for our local school district, and most of us are still seeing COVID-deniers in practice. Many don’t want to seek medical care because they’re afraid they’ll be tested for COVID. Maybe someday health literacy in our country will improve to a place where clinicians can spend more time rendering care and less time refuting medical misinformation.

As a telemedicine physician, I’m concerned about the conflicting priorities that our industry faces, including balancing patient satisfaction and perceived convenience with elements such as clinical quality and antibiotic stewardship. One of the challenges is the lack of telemedicine-specific metrics, which leads organizations to try to mold in-person clinical quality measures to virtual care. The Agency for Healthcare Research and Quality has created the AHRQ Safety Program for Telemedicine, which will help prescribers look at antibiotic usage over an 18-month period starting in June 2024. The program will provide educational sessions to providers, including scripts for navigating patient concerns about not having their wishes met when they request “a Z-Pack to nip things in the bud since we’re going into a weekend,” which universally makes physicians cringe. Providers are expected to perform better on antibiotic-related quality measures after participating in the program, and continuing education credits are available. There is no charge to providers to be part of the program, which is a welcome element for those of us already spending too much to maintain board certification and other recognitions.

Mr. H recently mentioned concerns by developers such as Microsoft and Google with regard to the cost of the computing power needed for AI projects. I’m a bona fide space nerd, having once wanted to be the first physician living permanently in space. Instead, I’m content to watch from the sidelines as scientists execute cool projects that I could only dream of. I’ve followed NASA’s Ingenuity helicopter, which nearly every journalist describes as “plucky,” especially since it was planned for less than a half dozen missions and eventually flew 72. Ingenuity weighs less than 4 pounds, but provided an amazing amount of data about the ability to achieve powered autonomous flight on another planet.

A headline about the craft caught my eye this week, noting that the craft “packed more computing power than all other NASA deep space missions combined.” This was a challenge given its small size, with engineers having to forego heavy components whose design would mitigate radiation damage and the extreme temperatures on Mars. Instead, designers specified off-the-shelf components, including the brain of the helicopter: the Qualcomm Snapdragon 801 processor, which was used in smartphones nearly a decade ago. Here’s to those IPhone 6, Blackberry Passport, and Google Nexus 6 users whose daily calls shared NASA-worth technology and they didn’t even know it. Photo credit: NASA/JPL.

What was your childhood dream? Are you working in a related field or would you give up your meeting-filled days for a ride into outer space? Leave a comment or email me.

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